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Abstract Oral health problems prove to be a significant public health issue due to their high prevalence and their impacts on people’s self-confidence and basic physical functions such as talking, chewing and smiling, all of which affect an individual’s social role. For that, this study aims to determine oral health-related quality of life (OHRQoL) and its association with a sense of coherence (SOC) and perceived social support among Yemeni adults residing in Malaysia. Data was collected from 223 Yemeni adults residing in Malaysia for over a year. The data collection instruments used were: a short version of the sense of coherence Scale (SOC-13), a new short version of the oral health impact profile (OHIP-5) questionnaire, the multidimensional scale of perceived social support (MSPSS), and a questionnaire containing socio-demographic and oral health behaviours information. Simple and adjusted binary logistic regression analyses with the level of significance p

Abstract Cutaneous leishmaniasis (CL), a neglected tropical disease (NTD), is a major public health problem in Yemen with widespread distribution in rural areas. Evaluating the knowledge and understanding of people’s beliefs towards the disease is essential to the implementation of effective control measures. This study aims to assess the knowledge, attitudes, practices (KAP) and treatment-seeking behaviour concerning CL among rural populations in the western highlands of Yemen. A community-based cross-sectional study was conducted among 289 household heads in four rural areas of the Utmah District. Data were collected using a pre-tested questionnaire. All the participants had heard about the disease; however, only 9.3% attributed it to sandflies. Nearly half (48.1%) of the participants could not mention any preventive measures for CL, and nearly two-thirds (65.4%) could not do so for sandflies. The overall ‘good’ knowledge about CL was found to be 51.2%, and it was 33.9% for sandflies. The participants’ attitude and prevention practices towards CL were not satisfactory, as only 38.1% and 16.3% had a positive attitude and good CL-related prevention practices, respectively. Moreover, 45.7% believed CL to be a stigmatising disease, and 50% had used traditional remedies to treat suspected CL lesions. Multivariate analyses showed that age, sex, presence of CL-confirmed cases in the same household, residency, occupation and monthly household income were the significant predictors associated with KAP concerning CL among the participants. The findings support an urgent need for integrated health education and community mobilisation interventions to improve awareness of these vulnerable populations about this devastating disease.

Background Occupational diseases are one of the most important health problems related to employment However, in Malaysia, there are few epidemiological studies discussing these issues, especially among workers in the industry. For that, this study aimed to screen workers from high-risk industrial sectors, identify hazards in the workplace and recommend improvement measures in the workplace to prevent occupational diseases.Methods and analysis This is a 3-year project in which a survey of 100 000 workers from all 13 states in Malaysia will be conducted using a web-based screening tool that is comprised of two parts: occupational disease screening tool and hazard identification, risk assessment and risk control method. Data will be collected using a multistage stratified sampling method from 500 companies, including seven critical industrial sectors. The independent variables will be sociodemographic characteristics, comorbidities, previous medical history, high-risk behaviour and workplace profile. The dependent variable will be the types of occupational diseases (noise-induced hearing loss, respiratory, musculoskeletal, neurotoxic, skin and mental disorders). Subsequently, suggestions of referral for medium and high-risk workers to occupational health clinics will be attained. The approved occupational health service clinics/providers will make a confirmatory diagnosis of each case as deemed necessary. Subsequently, a walk-through survey to identify workplace hazards and recommend workplace improvement measures to prevent these occupational diseases will be achieved. Both descriptive and inferential statistics will be used in this study. Simple and adjusted binary regression will be used to find the determinants of occupational diseases.Ethics and dissemination This study has been approved by the MARA University of Technology Research Ethics Board. Informed, written consent will be obtained from all study participants. Findings will be disseminated to the Department of Occupational Health and Safety, involved industries, and through peer-reviewed publications.

Abstract Background Colorectal cancer (CRC) is the third most common cancer type worldwide. Colorectal cancer treatment costs vary between countries as it depends on policy factors such as treatment algorithms, availability of treatments and whether the treatment is government-funded. Hence, the objective of this systematic review is to determine the prevalence and measurements of financial toxicity (FT), including the cost of treatment, among colorectal cancer patients. Methods Medline via PubMed platform, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined CRC FT. There was no limit on the design or setting of the study. Results Out of 819 papers identified through an online search, only 15 papers were included in this review. The majority (n = 12, 80%) were from high-income countries, and none from low-income countries. Few studies (n = 2) reported objective FT denoted by the prevalence of catastrophic health expenditure (CHE), 60% (9 out of 15) reported prevalence of subjective FT, which ranges from 7 to 80%, 40% (6 out of 15) included studies reported cost of CRC management– annual direct medical cost ranges from USD 2045 to 10,772 and indirect medical cost ranges from USD 551 to 795. Conclusions There is a lack of consensus in defining and quantifying financial toxicity hindered the comparability of the results to yield the mean cost of managing CRC. Over and beyond that, information from some low-income countries is missing, limiting global representativeness.

Abstract Background In the competitive health care environment, patient satisfaction and quality of life (QoL) have become the subject of interest to evaluate the efficacy of therapeutic interventions as we experience improved breast cancer survival in modern times. The knowledge of the long-term effects of surgery on the QoL in breast cancer patients is currently limited in the Asian setting. The purpose of this longitudinal study is to evaluate the QoL of early-stage breast cancer patients undergoing mastectomy and breast-conserving surgery (BCS). Methods In this prospective cohort study, the QoL of 208 patients who underwent mastectomy and the BCS treatment were assessed, using the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The questionnaire was administered at the baseline, 6 and 12 months following diagnosis. One-way ANCOVA was used for statistical analysis. Results A total of 208 female survivors of Stage 0–II breast cancer were included, among them 47.1% underwent BCS and 52.9% underwent mastectomy. Older (63.3%), Chinese women (63.6%), and patients with primary education (71.7%) were more likely to undergo mastectomy. At baseline, no significant differences were observed for QoL in both treatment groups. At 6 months, patients who underwent BCS had better social functioning scales( P = 0.006) and worse symptom scales for dyspnoea (P = 0.031), compared to mastectomy patients. One year after diagnosis, the role functioning score of the mastectomy group was significantly higher than the BCS group, specifically among patients who had undergone chemotherapy (P = 0.034). Conclusion Patients who underwent BCS had better social functioning and worse dyspnoea symptoms compared to patients undergoing mastectomy at six months. During one year, there were only significant improvements in the role functioning among the mastectomy groups compared to the BCS groups. After further stratification, only mastectomy patients who received chemotherapy exhibited improved role functioning compared to patients those who did not undergo chemotherapy. Providing social and physical support postoperatively and monitoring patients for cancer worry, or other symptoms in the long-term survivorship period would be important to ensure optimal QoL.

Background Cardiovascular disease (CVD) is the major cause of mortality worldwide. Recent studies showed that there is increasing CVD incidence at younger ages. Therefore, this study aimed to estimate the risk of CVD and its associated factors among young adults.Methods A cross-sectional study was conducted among university students in Selangor, Malaysia, using a self-administered questionnaire along with anthropometric measurements. The sample size was calculated using a single proportion formula. The CVD risk was calculated using the non-laboratory-based Inter-Heart Modifiable Risk Score (IHMRS). Participants aged 18 years and above, with no CVD history, were recruited using a convenience sampling method between February and May 2022. CVD risk was classified as low (scores between 0 and 9 points), moderate (scores between 10 and 15 points) and high (scores between 16 and 48 points). The factors associated with the CVD risk were identified using χ2 analysis.Results A total of 241 participants were included in this study. The median age was 28 years and the majority were females (75.1%). The IHMRS revealed that 46.5%, 44.4% and 9% of the respondents have low, moderate and high CVD risk, respectively. The CVD risk associated factors were education, the history of heart attacks among parents, feeling sad or depressed for 2 weeks or more in a row, having several episodes/permanent stress, expose to secondhand smoke and consuming meat and poultry more than two times daily.Conclusions This study found that more than 50% of study participants had moderate to high risk of CVD. Family history and lifestyle factors are the most likely determinants of CVD risk among the young age group. These findings support the development and implementation of targeted prevention programmes as well as provide useful information for action planning and policymaking to curb the disease in the future.

BackgroundThere is limited evidence of financial toxicity (FT) among cancer patients from countries of various income levels. Hence, this study aimed to determine the prevalence of objective and subjective FT and their measurements in relation to cancer treatment.MethodsPubMed, Science Direct, Scopus, and CINAHL databases were searched to find studies that examined FT. There was no limit on the design or setting of the study. Random-effects meta-analysis was utilized to obtain the pooled prevalence of objective FT.ResultsOut of 244 identified studies during the initial screening, only 64 studies were included in this review. The catastrophic health expenditure (CHE) method was often used in the included studies to determine the objective FT. The pooled prevalence of CHE was 47% (95% CI: 24.0–70.0) in middle- and high-income countries, and the highest percentage was noted in low-income countries (74.4%). A total of 30 studies focused on subjective FT, of which 9 used the Comprehensive Score for FT (COST) tool and reported median scores ranging between 17.0 and 31.9.ConclusionThis study shows that cancer patients from various income-group countries experienced a significant financial burden during their treatment. It is imperative to conduct further studies on interventions and policies that can lower FT caused by cancer treatment.

Background Cyberbullying is a growing public health concern with clear, negative impacts on the mental, physical and social health of targeted victims. Previous research on cyberbullying has largely focused on examining its occurrence among children and adolescents. The present study aims to examine the prevalence of cyberbullying victimisation and its association with family dysfunction, health behaviour and psychological distress among young adults in Selangor, Malaysia.Methods A cross-sectional study was conducted in a locality within Selangor, sampling a total of 1449 young adults. The Cyberbullying and Online Aggression Survey was used to measure cyberbullying victimisation. The Family APGAR scale, General Health Questionnaire, Pittsburgh Sleep Quality Index and single-item measures were used to assess family dysfunction, psychological distress and health behaviour, respectively.Results The 1-month prevalence of cyberbullying victimisation among young adults was 2.4%. The most common cyberbullying act experienced was mean or hurtful comments about participants online (51.7%), whereas the most common online environment for cyberbullying to occur was social media (45.8%). Male participants (adjusted OR (AOR)=3.60, 95% CI=1.58 to 8.23) had at least three times the odds of being cyberbullied compared with female participants. Meanwhile, participants with higher levels of psychological distress had increased probability of being cyberbullied compared with their peers (AOR=1.13, 95% CI=1.05 to 1.21).Conclusions As evident from this study, cyberbullying victimisation prevails among young adults and is significantly related to gender and psychological distress. Given its devastating effects on targeted victims, a multipronged and collaborative approach is warranted to reduce incidences of cyberbullying and safeguard the health and well-being of young adults.

Abstract Background Studies have revealed that a higher proportion of women affected by cervical cancer are from some minority groups of immigrant women. Hence, this study was conducted to assess Yemeni immigrant women’s awareness of cervical cancer and its associated socio-demographic factors. Methods A cross-sectional study was conducted among 370 Yemeni women in Selangor and Kuala Lumpur, Malaysia. Data on the awareness of symptoms/signs, risk factors, and screening programme were collected using Cervical Cancer Awareness Measurement (Cervical CAM) questionnaire. Results More than 74% of the study participants were unable to recall any warning symptoms/signs, and 73% were unable to recall any risk factors. The factors associated with the awareness of symptoms and risk factors were age (95% CI 4.22–5.22, p = 0.039), marital status (95% CI 4.05–7.87, p = 0.021), employment (95% CI 3.89–5.77, p = 0.046) and the number of children (95% CI 5.33–6.54, p = 0.041). Conclusion The findings underline the need for public awareness campaigns to improve public awareness of cancer symptoms and risk factors among underserved communities.

Blastocystis spp. is a unicellular enteric protozoan parasite in humans with a controversial role in disease etiology. It is common in developing countries among immunocompromised patients and people who have close contact with animals. In this study, we have systematically reviewed previous studies on the distribution and genotypes of human Blastocystis infection in Peninsular Malaysia. Studies examining the prevalence of Blastocystis in diverse demographics, including rural, urban, comorbid conditions, and high-risk populations, were taken into consideration. The infection has been reported in nine states; the total percentage of infection was 17.8% (1671/9397), with the most cases in Pahang (27.3%) and the least in Johor (3.4%). Molecular studies revealed the presence of six subtypes: ST1, ST2, ST3, ST4, ST5, and ST6. ST3 was reported as the predominant subtype in all the states, with a prevalence of 54.7% (338/618). The findings provide greater clarity on the epidemiology of Blastocystis in Malaysia, which will help in policy making towards planning and strategizing control measures against the parasite.

Abstract Background Genotyping of the three Plasmodium falciparum polymorphic genes, msp1, msp2 and glurp, has been adopted as a standard strategy to distinguish recrudescence from new infection in drug efficacy clinical trials. However, the suitability of a particular gene is compromised in areas where its allelic variants distribution is significantly skewed, a phenomenon that might occur in isolated parasite populations or in areas of very low transmission. Moreover, observation of amplification bias has diminished the value of glurp as a marker. Methods The suitability of the polymorphic P. falciparum histidine-rich protein 2 (pfhrp2) gene was assessed to serve as an alternative marker using a PCR-sequencing or a PCR–RFLP protocol for genotyping of samples in drug efficacy clinical trials. The value of pfhrp2 was validated by side-by-side analyses of 5 admission-recrudescence sample pairs from Yemeni malaria patients. Results The outcome of the single pfhrp2 gene discrimination analysis has been found consistent with msp1, msp2 and glurp pool genotyping analysis for the differentiation of recrudescence from new infection. Conclusion The findings suggest that under the appropriate circumstances, pfhrp2 can serve as an additional molecular marker for monitoring anti-malarials efficacy. However, its use is restricted to endemic areas where only a minority of P. falciparum parasites lack the pfhrp2 gene.

Abstract Background Several studies have reported a significant association of knowledge, attitude and preventive practice (KAP) regarding dengue infection among community’s resident in endemic areas. In this study we aimed to assess and develop a reliable and valid KAP survey on the subject of dengue that is suitable for the resident population of Sabah, Malaysia. Methods A community-based cross-sectional study was conducted from October 2019 to February 2020 involving 468 respondents. Information on the socio-demographic characteristics of the participants (six items), their KAP (44, 15 and 18 items on knowledge, attitude and practice, respectively) and treatment-seeking behaviour (five items) towards dengue was collected using a structured questionnaire. Data analysis was performed using SPSS and R software in the R Studio environment. The knowledge section was analysed by two-parameter logistic item response theory (2-PL IRT) using ltm package. The construct validity and reliability of items for sections on attitude, practice and treatment-seeking behaviour were analysed using psy package. Results For the knowledge section, only 70.5% (31/44) of items were within or close to the parameter acceptable range of −3 to + 3 of difficulty. In terms of discrimination, 65.9% (29/44) of items were within or close to the acceptable range of 0.35 to 2.5, and 24 items (54.5%) failed to fit the 2-PL IRT model (P 0.7, while based on the communalities, 11 items in the attitude section were excluded due to very low h2, factor loading values and low correlation with the total ( 0.7. The communalities of the practice section showed that seven items had low h2 values (

Background: The aim of this research is to assess the level of physical activity (PA) in relation to different socio-economic factors and to examine the effect of the recommended level of PA on the domains of quality of life (QoL) among residents of low-income housing in the metropolitan area of Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study that included 680 respondents from community housing projects. Reported PA was assessed using the Global Physical Activity Questionnaire (GPAQ) short form version 2. The SF-12v2 was administered to assess the health-related QoL (HRQoL) among the study population. Respondents were grouped into “active” and “insufficient” groups according to reported weekly PA level. One-way analysis of variance, analysis of co-variance, and multiple linear regression were used in the analysis. Results: Overall, 17.6% (95% CI, 14.3–20.9) of the respondents did not achieve the recommended levels of PA (≥600 metabolic equivalent [MET]-minutes week−1). Level of achieving recommended PA was higher among younger participants, females, members belonging to nuclear families, and in self-employed participants. The group that fulfilled recommended PA levels (active) has higher levels of QoL in all domains except physical functioning. Conclusions: Almost one out of five low-income urban residents were physically inactive. In addition, individuals who attained recommended PA levels had better scores on some domains of HRQOL than those who did not. Our findings call for tailor-made public health interventions to improve PA levels among the general population and particularly for low-income residents.

Novel ecofriendly adsorbents, cellulose acetate/graphene oxide (CA-GO) nanocomposite, were prepared from sugarcane bagasse agro-waste for removing Ni2+ ions from wastewater. Graphene oxide (GO) was prepared by the oxidation of sugarcane bagasse using ferrocene under air atmosphere. Cellulose acetate (CA) was also prepared from sugarcane bagasse by extraction of cellulose through a successive treatments with sulfuric acid (10% v/v), sodium hydroxide (5% w/v), ethylenediaminetetraacetic acid, and hydrogen peroxide, and finally, followed by acetylation. CA-GO was prepared via mixing of GO and CA in the presence of calcium carbonate and different concentrations of GO, including 5, 10, 15, 20, 25, and 30 wt% relative to the weight of CA. The CA-GO nanocomposite showed porous microstructures with high surface area, which enhance their ability towars the adsorption of Ni2+ ions from wastewater. The morphological properties of the prepared adsorbents were explored by scanning electron microscope (SEM) and Fourier-transform infrared spectroscopy (FT-IR). The efficiency of the CA-GO towards the adsorption of Ni2+ ions from wastewater was explored against as time, temperature, and total content of Ni2+ ions. The adsorption measurements of Ni2+ ions were investigated within the concentration range of 10–40 mg/L, time range between 15 and 90 min, and temperature range between 25 °C and 55 °C. The results displayed a considerable improvement in the adsorption process of Ni2+ ions by CA-GO-2 with a removal efficiency of 96.77%. The isotherms were monitored to best fit the Langmuir model. Finally, the adsorption performance of the prepared CA-GO nanocomposite films demonstrated promising properties as green, sustainable and cheap adsorbents for water pollutants.

Introduction. Despite the efforts of the malaria control programme, malaria morbidity is still a common health problem in Yemen, with 60% of the population at risk. Plasmodium falciparum is responsible for 99% of malaria cases. The emergence in Yemen of parasite resistance to chloroquine (CQ) prompted the adoption of artemisinin combination therapy (ACT) in 2009, which involves the use of artesunate plus sulphadoxine-pyrimethamine (AS + SP). However, CQ was retained as the drug of choice for vivax malaria. To assess the impact of the change in the malaria treatment policy five years after its introduction, the present study investigated the mutations in the CQ resistance transporter (pfcrt) and multidrug resistance 1 (pfmdr1) genes. Method. A molecular investigation of 10 codons of pfcrt (72–76, 220, 271, 326, 356, and 371) and five codons of pfmdr1 (86, 184, 1034, 1042, and 1246) was conducted on P. falciparum isolates from districts with the highest malaria endemicity in the Hodeidah and Al-Mahwit governorates in Tehama region, Yemen. A total of 86 positive cases of falciparum monoinfection were investigated for the presence of mutations related to CQ and other antimalarials using a PCR-RFLP assay. Results. There was a wide prevalence of pfcrt gene mutations with the pfcrt 76T CQ resistance marker being predominant (97.7%). The prevalence of other pfcrt mutations varied from high (75E: 88%) to moderate (74I: 79.1%, 220S: 69.8%, 271E and 371I: 53.5%) or low (326S: 36%, 72S: 10.5%). Mutated pfcrt 72–76 amino acids haplotypes were highly prevalent (98.8%). Among these, the CVIET classic, old-world African/Southeast Asian haplotype was the most predominant, and was mostly found in the isolates from the Khamis Bani Saad district of Al-Mahwit (93.1%) and the AdDahi district of Hodeidah (88.9%). However, it was only found in 26.3% of the isolates from the Bajil district of Hodeidah. Surprisingly, the SVMNT new-world South American haplotype was exclusively detected in 9.3% of the isolates from the Bajil district of Hodeidah. Mutations at Y184F of pfmdr1 were found in all isolates (100%) from all districts. The mutation for codons 1034C and 86Y were found only in the isolates from the AdDahi and Khamis Bani Saad districts. Overall, the AdDahi and Khamis Bani Saad districts were similar in terms of carrying most of the mutations in the pfcrt and pfmdr1 genes, while there was a lower prevalence of mutation in the isolates from the Bajil district. Conclusion. The high prevalence of mutations in pfcrt 5 years after the official cessation of CQ use against P. falciparum suggests that there is sustained CQ pressure on P. falciparum isolates in the study area. Moreover, the low prevalence of mutations in the pfmdr1 gene could be a good indicator of the high susceptibility of P. falciparum isolates to antimalarials other than CQ. A new strategy to ensure the complete nationwide withdrawal of CQ from the private drug market is recommended.