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Background: Accurate and reliable anthropometric measurements in children with neurological impairments who are not able or not suitable for conventional anthropometric measuring techniques can be challenging and potentially leading to misinterpretation of their nutritional status. Nutrition-Focused Physical Exam (NFPE) is proven useful in providing supportive evidence to malnutrition. This study investigated the use of NFPE to identify malnutrition among children with Down syndrome (DS) and cerebral palsy (CP), in comparison to AND/ASPEN Pediatric Malnutrition Identification Criteria as the reference method. Methods: A cross-sectional study was conducted to recruit 31 children with DS and 20 children with CP aged between 4 and 15 years old. Nutrition-focused physical findings (fat loss, muscle wasting, abnormality observations on hair, eyes, oral cavity, skin, and nails), weight, height, mid upper arm circumference, and dietary intake were collected. The malnutrition status of children was determined using NFPE and AND/ASPEN criteria, respectively. Weighted Kappa agreement and diagnostic values were analyzed between these two criteria. Chi-square test examined the association between oral cavity abnormalities and the nutritional status identified by the AND/ASPEN criteria and NFPE. A p-value of

BackgroundThe high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. ObjectiveWe sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. MethodsA 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. ResultsOf 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P

Abstract Background Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes. Methods We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively. Results We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members. Conclusions An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.

Background and objectivePregnant mothers are at risk of many adverse pregnancy outcomes, including infants with low birth weight (LBW). The World Health Organization aimed to achieve a 30% reduction in the number of LBW infants by the year 2025. In this study, we aimed to determine the incidence and determinants of LBW infants among pregnant mothers attending government health clinics in Peninsular Malaysia.Material and methodsA prospective cohort study "Relative Risk of Determinants of Adverse Pregnancy Outcomes Among Pregnant Mothers Attending Government Health Clinics, Peninsular Malaysia, PEN-MUM" was conducted from March 2022 until March 2023 at 20 government health clinics in Peninsular Malaysia that were randomly selected through a multistage sampling method. Malaysian pregnant mothers between 18 and 49 years old were recruited at 12-18 weeks of gestation and followed up at three time points: 1 (24-28 weeks of gestation), 2 (36-40 weeks of gestation), and 3 (post-delivery). Eight exposure factors of LBW were studied: gestational weight gain, dengue infection, urinary tract infection, COVID-19 infection, gestational hypertension, preeclampsia, maternal anemia, and gestational diabetes mellitus (GDM).ResultsAmong 507 participants enrolled in the cohort, 40 were lost to follow-up. A total of 467 were included in the final analysis, giving an attrition rate of 7.9%. The incidence of LBW infants in Peninsular Malaysia was 14.3%. After adjusting for three covariates (ethnicity, employment status, and gestational age at birth), three determinants of LBW were identified. The risk of giving birth to LBW infants was higher among those with inadequate gestational weight gain (aRR = 2.86, 95% CI: 1.12, 7.37, p = 0.03), gestational hypertension (aRR = 4.12; 95% CI: 1.66, 10.43; p = 0.002), and GDM (aRR = 2.21; 95% CI: 1.18, 4.14; p = 0.013) during the second and third trimesters.ConclusionsThe incidence of LBW infants in Peninsular Malaysia can be considered high. Having inadequate gestational weight gain, gestational hypertension, and GDM in the second and third trimesters increased the risk of LBW infants by threefold, fivefold, and twofold respectively. Thus, intervention strategies should target prevention, early detection, and treatment of gestational hypertension and GDM, as well as promoting adequate weight gain during antenatal care.

Background & Aims: Accumulating evidence showed that inflammation contributes markedly to cancer progression, with C-reactive protein (CRP) being one of the lengthily studied inflammation marker. For breast cancer (BCa), pre-treatment elevated CRP upon diagnosis was linked with increased mortality. This study aimed to identify factors predictive of elevated CRP in pre-treatment BCa population that can serve as potential therapeutic targets to reduce inflammation. Methods: This is a cross-sectional study using multiple logistic regression to identify predictors of elevated CRP among pre-treatment, newly diagnosed BCa patients. Studied variables were socio-demographic and medical characteristics, anthropometric measurements [body weight, Body Mass Index, body fat percentage, fat mass/fat free mass ratio, muscle mass, visceral fat], biochemical parameters [albumin, hemoglobin, white blood cell (WBC), neutrophil, lymphocyte], energy-adjusted Dietary Inflammatory Index, handgrip strength (HGS), scored Patient Generated-Subjective Global Assessment, physical activity level and perceived stress scale (PSS). Results: A total of 105 participants took part in this study. Significant predictors of elevated CRP were body fat percentage (OR 1.222; 95 % CI 1.099–1.358; p < 0.001), PSS (OR 1.120; 95 % CI 1.026–1.223; p = 0.011), low vs normal HGS (OR 41.928; 95 % CI 2.155–815.728; p = 0.014), albumin (OR 0.779; 95 % CI 0.632–0.960; p = 0.019), and WBC (OR 1.418; 95% CI 1.024–1.963; p = 0.036). Conclusion: Overall, predictors of elevated CRP in pre-treatment, newly diagnosed BCa population were body fat percentage, PSS, HGS category, albumin and WBC.

AbstractBackground Obesity, particularly excessive body fat, is an established risk factor and substantial prognostic determinant in breast cancer. Recent studies suggested that diet-related inflammation plays a key role in obesity. This study aimed to determine the association between energy-adjusted dietary inflammatory index (E-DII) and body composition, particularly body fat percentage, among patients with newly diagnosed breast cancer.Materials and methods This cross-sectional study was conducted on 124 breast cancer outpatients within the first year of diagnosis and yet to commence oncological treatment. Body composition parameters [body weight, body mass index (BMI), body fat percentage, fat mass over fat-free mass ratio (FM/FFM), muscle mass, and visceral fat] were obtained using a bioelectrical impedance analyzer. Body fat percentage was categorized into two groups which were normal (

BackgroundHigh prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention. ObjectiveThis study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia. MethodsA single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child’s screen time, whereas secondary outcomes included mother’s screen time knowledge, perception about the influence of screen time on the child’s well-being, self-efficacy to reduce the child’s screen time and increase physical activity, mother’s screen time, and presence of screen device in the child’s bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention’s effectiveness was evaluated using generalized linear mixed models. ResultsA total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child’s screen time compared with the control group (β=−202.29, 95% CI −224.48 to −180.10; P

BackgroundAdaptable cardiopulmonary resuscitation/basic life support (CPR/BLS) training are required to reduce cardiac arrest mortality globally, especially among nurses. Thus, this study aims to compared CPR knowledge and skills retention level between instructor-led (control group) and video self-instruction training (intervention group) among nurses in northwestern Nigeria.MethodsA two-arm randomized controlled trial study using double blinding method was conducted with 150 nurses from two referral hospitals. Stratified simple random method was used to choose eligible nurses. For video self-instruction training (intervention group), participants learnt the CPR training via computer in a simulation lab for 7 days, in their own available time whereas for instructor-led training (control group), a 1-day program was conducted by AHA certified instructors. A generalized estimated equation model was used for statistical analysis.ResultsGeneralized Estimated Equation showed that there were no significant differences between the intervention group (p = 0.055) and control group (p = 0.121) for both CPR knowledge and skills levels respectively, whereas higher probability of having good knowledge and skills in a post-test, one month and three-month follow-up compared to baseline respectively, adjusted with covariates (p < 0.05). Participants had a lower probability of having good skills at 6-month follow-up compared to baseline, adjusted with covariates (p = 0.003).ConclusionThis study showed no significant differences between the two training methods, hence video self-instruction training is suggested can train more nurses in a less cost-effective manner to maximize resource utilization and quality nursing care. It is suggested to be used to improve knowledge and skills among nurses to ensure cardiac arrest patients receive excellent resuscitation care.

Abstract TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.

Introduction: Malaysia is one of the hardest-hit countries by COVID-19 in Asia. The rapidly rising number of cases had sparked fear among healthcare providers. This study aimed to assess the determinants of fear towards COVID-19 among healthcare providers in primary care settings. Methods: This online-based cross-sectional study was conducted among 1280 healthcare providers aged ≥18 years from 30 primary care clinics in the state of Selangor, Malaysia. The Fear of COVID-19 Scale was used to assess the level of fear, and the results were analysed using multiple linear regression. Results: The mean age of the respondents was 36 years, and the mean working experience was 11 years. The majority of the respondents were women (82.4%) and Malays (82.3%). The factors that were significantly correlated with higher levels of fear were underlying chronic disease (ß=1.12, P=0.002, 95% confidence interval [CI]=0.08, 3.15), concern about mortality from COVID-19 (ß=3.3, P

Coronavirus disease 2019 (COVID-19) deaths can occur in hospitals or otherwise. In Malaysia, COVID-19 deaths occurring outside of the hospital and subsequently brought to the hospital are known as brought-in-dead (BID) cases. To date, the characteristics of BID COVID-19 cases in Malaysia are not clear. The objectives of this study are 2-fold: to explore the characteristics of 29,155 mortality cases in Malaysia and determine the factors associated with the high probability of BID, using the multilevel logistic regression model. Data on COVID-19 mortality cases from the entire country between March 17, 2020 and November 3, 2021 were retrieved from a national open data source. Of the 29,155 COVID-19 mortality cases, 5,903 (20.2%) were BID. A higher probability of BID (p < 0.05) was seen among individuals aged between 18 and 59 years, non-Malaysians, had no comorbidities, did not receive COVID-19 vaccination, and the interval between the date of death and diagnosis. A high prevalence of BID is an alarming public health issue, as this may signal health system failure at one or several levels and, hence, need urgent attention from relevant stakeholders. Based on the findings of this study, increasing the intensity of the vaccination campaign, addressing any issues faced by noncitizens about to COVID-19 management in- and out-of-hospital, increasing the awareness of signs and symptoms of worsening COVID-19 and, hence, the significance of self-monitoring, and determining the potential gaps in the health system may contribute to their increased risk of deaths.

Parenting programs often train parents in improving their parenting practices and parent-child relationship to reduce behavioral problems in children. However, the children’s prosocial behaviors are less examined as an intervention outcome in these programs. This study aimed to evaluate the effectiveness of the Incredible Years parenting program (IYPP) for Malaysian parents of school-going children and its sustainability in improving the children’s prosocial behaviors. This randomized controlled study involved pre- and post-intervention assessments at 2 and 14 weeks. Mothers of children aged 6-12 years (n = 70) recruited through the pediatrics and the child and adolescent psychiatric clinics were randomly assigned to the parenting program or a waitlist control condition. The mothers rated their children’s prosocial behaviors using a self-administered questionnaire. The program ran two to three hours weekly for 14 weeks. Several modifications were made to the program to accommodate public health control during the pandemic. Children in the intervention group showed a notable but non-significant increase in prosocial skills. However, subsequent score decline at follow-up may suggest a lack of evidence that the program is potentially effective in improving prosocial behaviors among school children who are at risk of or already having behavioral problems.

Abstract Background Dental caries in primary teeth is a serious oral health concern among children. It can lead to detrimental impacts on a child’s growth, development, and quality of life. Therefore, this cross-sectional study aimed to examine the prevalence of dental caries and its associations with nutritional status, sugar and second-hand smoke exposure among pre-schoolers. Methods A total of 26 pre-schools in Seremban, Malaysia were randomly selected using the probability proportional to size sampling. Dental examination was performed by a dentist to record the number of decayed teeth (dt). Weight and height of the pre-schoolers were measured. The mother-administered questionnaire was used to gather information pertaining to the sociodemographic characteristics and second-hand smoke exposure. Total sugar exposure was calculated from a 3-day food record. Results Among the 396 participating pre-schoolers, 63.4% of them had at least one untreated caries, with a mean ± SD dt score of 3.56 ± 4.57. Negative binomial regression analysis revealed that being a boy (adjusted mean ratio = 1.42, 95% CI = 0.005–0.698, p = 0.047), exposed to second-hand smoke (adjusted mean ratio = 1.67, 95% CI = 0.168–0.857, p = 0.004) and those who had more than 6 times of daily total sugar exposure (adjusted mean ratio = 1.93, 95% CI = 0.138–0.857, p = 0.013) were significantly associated with dental caries among pre-schoolers. Conclusion A high prevalence of dental caries was reported in this study. This study highlights the need to reduce exposure to second-hand smoke and practice healthy eating behaviours in reducing the risk of dental caries among pre-schoolers.

Deep learning (DL) has been introduced in automatic heart-abnormality classification using ECG signals, while its application in practical medical procedures is limited. A systematic review is performed from perspectives of the ECG database, preprocessing, DL methodology, evaluation paradigm, performance metric, and code availability to identify research trends, challenges, and opportunities for DL-based ECG arrhythmia classification. Specifically, 368 studies meeting the eligibility criteria are included. A total of 223 (61%) studies use MIT-BIH Arrhythmia Database to design DL models. A total of 138 (38%) studies considered removing noise or artifacts in ECG signals, and 102 (28%) studies performed data augmentation to extend the minority arrhythmia categories. Convolutional neural networks are the dominant models (58.7%, 216) used in the reviewed studies while growing studies have integrated multiple DL structures in recent years. A total of 319 (86.7%) and 38 (10.3%) studies explicitly mention their evaluation paradigms, i.e., intra- and inter-patient paradigms, respectively, where notable performance degradation is observed in the inter-patient paradigm. Compared to the overall accuracy, the average F1 score, sensitivity, and precision are significantly lower in the selected studies. To implement the DL-based ECG classification in real clinical scenarios, leveraging diverse ECG databases, designing advanced denoising and data augmentation techniques, integrating novel DL models, and deeper investigation in the inter-patient paradigm could be future research opportunities.

Ethnicity, native and/or foreign language knowledge, as well as the learned writing systems potentially influence the development of an individual's handwriting. The unique education system consisting of National schools, Chinese-medium vernacular schools, Tamil-medium vernacular schools, and Islamic religious schools in Malaysia may have established specific characteristic handwritten allographic features that deserve investigation within the intelligence context. This study was aimed to explore handwritten allographic features of handwriting samples from 120 subjects (30 writers from four different educational backgrounds mentioned above). Characteristic features which could be attributed to the study groups were statistically analyzed and identified. In this study, thirteen allographic features, including letters "A", "B", "D", "H", "p", "T", "t", "w", "X" and "x", were found to be discriminative. Such information could serve to indicate the primary education system undergone by a writer; enabling the comparison of different handwriting profiles and allowing characterization of writers to a specific group of people.

BackgroundRisk governance involves processes and mechanisms to understand how risk decisions are taken and executed. This concept has gained a reputation over time as being essential for emerging comprehensive management that defines the success of an organization. While guiding documents that explain the use of risk management related to nuclear safety and security are available worldwide, few locally conducted studies have explained risk governance practices in areas where hazard usage is known, such as in radiological emergencies. ObjectiveThis paper describes a protocol that was used to determine several factors that influence emergency responders’ perceptions toward radiological risk practices and visualize the risk radiological framework for emergency preparedness and response. MethodsA mixed methods study with a convergent design was performed. A qualitative analysis was performed using a case study approach where 6 key informants were purposely sampled for in-depth interview, and a cross-sectional study involving a self-administered questionnaire was conducted among approximately 260 emergency respondents from national regulatory, research, and services organizations. NVivo (version 12, QSR International) was used to analyze the interview transcripts and emerging themes were identified through abductive coding. Simultaneously, multiple logistic regression analysis was used to determine significant predictors that form the equation model. ResultsThe study is still underway. Qualitative findings were based on transcript-coding that informed the relevant thematic analysis, while statistical analyses including multiple logistic regression analysis measured the adjusted odds ratio of significant variables for the equation model. The study is expected to conclude in late 2021. ConclusionsImportant emerging themes and significant factors that are related to the emergency responders’ perceptions regarding radiological governance practices were determined through the convergent design. This potentially facilitated the development of a plausible radiological risk governance framework. Furthermore, our results will provide key insights that can be used in future studies. International Registered Report Identifier (IRRID)DERR1-10.2196/25877

Abstract Background Malnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children. Methods/design This quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up. Discussion It was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment. Trial registration UMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered). Protocol version 16th September 2019 & Version 4

IntroductionCOVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic.Material and methodsWe performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI.ResultsWe included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8-41.3), anxiety 39.7(95%CI: 34.3-45.1), stress 36.4% (95%CI: 23.2-49.7), fear 71.3% (95%CI: 54.6-88.0), burnout 68.3% (95%CI: 54.0-82.5), and low resilience was 16.1% (95%CI: 12.8-19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30-1.68) and nurses (OR = 1.21; 95%CI = 1.02-1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49-1.85), (Nurse: OR = 1.36; 95%CI = 1.16-1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28-1.97).ConclusionIn conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

Knowledge and attitude are essential components of food security as malnutrition remains a critical public health concern among adolescents. The study evaluates the effectiveness of a Triple Benefit Health Education Intervention on knowledge, attitude and food security towards malnutrition among adolescent girls. This was a cluster randomized controlled trial among 417 randomly selected adolescent girls aged 10 to 19 years old in Maiduguri, Borno state, Nigeria from October 2019 to March 2020. About 208 respondents were assigned to experimental while 209 to control group, respectively, using an opaque sealed envelope. A structured questionnaire using KoBo Collect Toolbox was used for the collection of data at baseline, three and six-months post intervention while the data collected were analyzed using generalized estimating equation (GEE). The outcome of the baseline shows no statistically significant difference in sociodemographic characteristics, knowledge, attitude and food security between experimental and control groups. The study reveals a statistically significant difference between experimental and control groups for knowledge (p < 0.001; p < 0.001), attitude (p < 0.001; p < 0.001) and food security (p = 0.026; p = 0.001) at three and six-months post intervention, respectively. The triple benefit health education intervention package employed in this study can serve as an intervention tool to combat malnutrition among adolescent girls in Nigeria at large.

Objective To compare the performance of different anthropometric indices including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and a body shape index to predict high blood pressure (BP) in adolescents using the 90th and 95th percentiles as two different thresholds.Design Cross-sectional study.Setting Probability proportionate to size was used to randomly select two schools in Selangor state, Malaysia.Participants A total of 513 adolescents (58.9% women and 41.1% men) aged 12–16 years were recruited.Primary and secondary outcome measures Weight, height, WC and BP of the adolescents were measured. The predictive power of anthropometric indices was analysed by sex using the receiver operating characteristic curve.Results BMI and WHtR were the indices with higher areas under the curve (AUCs), yet the optimal cut-offs to predict high BP using the 95th percentile were higher than the threshold for overweight/obesity. Most indices showed poor sensitivity under the suggested cut-offs. In contrast, the optimal BMI and WHtR cut-offs to predict high BP using the 90th percentile were lower (men: BMI-for-age=0.79, WHtR=0.46; women: BMI-for-age=0.92, WHtR=0.45). BMI showed the highest AUC in both sexes but had poor sensitivity among women. WHtR presented good sensitivity and specificity in both sexes.Conclusions These findings suggested that WHtR might be a useful indicator for screening high blood pressure risk in the routine primary-level health services for adolescents. Future studies are warranted to involve a larger sample size to confirm these findings.

Inadequate food security contributes to poor health outcome for all, including adolescent girls. The study aims at determining the level of food security and hygiene among adolescent girls. A school-based cross-sectional study was carried out among adolescent girls aged 10 to 19 years old from six schools in Maiduguri Metropolitan Council, Borno State. The instrument for data collection was a questionnaire using KoBoCollect Toolbox between June and July 2019. Multivariable logistic regression was used to identify the predictors of food security and hygiene among respondents. A majority of the respondents (73.5%) were in a very low food security level. Three factors were significantly associated with food security level, these included schools (p = 0.007), age of mother (p = 0.004), and occupation of mother (p < 0.001). School (p = 0.003), age (father p = 0.017; mother; p = 0.012), hygiene (p = 0.005), and occupation of mother (p = 0.002) were predictors of food security. About (46.6%) of respondents had poor hygiene practice, school (p = 0.016) was significantly associated with hygiene practice. School (p = 0.019; and p = 0.005) and food security (p = 0.009) were predictors of hygiene practice. This study reveals a high prevalence of low food security among adolescent girls.

The topcoat color of motor vehicles offers vital information while investigating vehicular accidents, especially in instance of hit-and-run, since witnesses seldom perceive and retain the plate details. Differences in color perceptions among individuals with normal vision may lead to confusion in determining the color of the car involved. In this way, witnesses of crash accidents could potentially initiate flawed leads in forensic investigation, and thus affect the administration of justice. In this study, the inter-rater reliability of vehicle color determination by different volunteers was explored. Six individuals observed the topcoat colors of 500 stationary and 500 moving vehicles from five locations, employing a common system of color gradation. The outcome was binary: the vehicle color was either a "match" or "non-match". This was followed by statistical analysis in terms of the colors' frequencies and inter-rater reliability, based on which more suitable color descriptions were determined for subsequent comparisons of stationary and moving vehicles. Higher match frequencies and greater inter-rater reliability were observed when color gradations were disregarded. The frequency of correct matches could have been closely related to their relative on-the-road distribution, regardless of the statuses of observed vehicles. It was also found that black and white were associated with a greater number of matches than were intermediate colors, which should be carefully interpreted during forensic investigation to avoid wrong leads. In conclusion, the present study demonstrated the forensic significance of vehicle topcoat color determination, particularly in cases where witness statements are crucial.

Hepatitis C infection is a global public health problem. This study was designed to identify the risk factors associated with hepatitis C infection among adult patients in Kedah state, Malaysia. A matched, hospital-based, case-control study was conducted at a tertiary hospital. Cases were adult (aged ≥ 18 years) patients with positive serology test results for hepatitis C virus antibody and detectable hepatitis C virus RNA from January 2015 to December 2018, and controls were age-, sex- and ethnicity-matched patients who were not infected with hepatitis C virus. Self-administered questionnaires were used to collect data on demographic characteristics and previous exposure to selected risk factors among the study participants. Associations between hepatitis C and demographic and risk factors were assessed using univariable and multivariable logistic regression analyses. A total of 255 case-control patient pairs were enrolled. The multivariable analysis indicated that having a history of blood or blood product transfusion before 1992 (adjusted odds ratio [AOR] = 6.99, 95% confidence interval [CI]: 3.73-13.81), injection drug use (AOR = 6.60, 95% CI: 3.66-12.43), imprisonment (AOR = 4.58, 95% CI: 1.62-16.40), tattooing (AOR = 3.73, 95% CI: 1.37-12.00), having more than one sexual partner (AOR = 2.06, 95% CI: 1.16-3.69), piercing (AOR = 1.71, 95% CI: 1.04-2.80), and having only secondary education (AOR = 1.92, 95% CI: 1.06-3.57) were independently associated with hepatitis C. No associations were found between health care occupation, needle-prick injury, surgical procedures, haemodialysis, acupuncture, cupping, or contact sports and hepatitis C infection. These findings demonstrate that hepatitis C risk is multifactorial. Having a history of blood or blood product transfusion before 1992, injection drug use, imprisonment, tattooing, having more than one sexual partner, piercing, and having only secondary education were associated with increased odds of hepatitis C.

BackgroundDespite evidence of physical (illness) and mental (stress) health problems, there appears to be a lack of studies or concern regarding occupational safety and health among educators in Malaysia.ObjectiveTo review the prevalence of illness, stress, and corresponding risk factors among educators in Malaysia.MethodScopus, ProQuest, PubMed, ScienceDirect, CAB, and other computerized databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between January 2013 and April 2019 on the prevalence and associated risk factors of illness and stress among educators (S1 Checklist). The keywords used included educator, teacher, lecturer, academic staff, teaching profession, university staff, academician, faculty, illness, injury, disease, pain, WMSD, dysphonia, hoarseness, stress, mental health, strain, health problem, disorder, and/or Malaysia. Selected studies were evaluated by quality assessment.ResultsTwenty-two articles fulfilled the eligibility criteria. The prevalence of illness and stress was determined for low back pain (33.3-72.9%); upper back pain (33.33-56.4%); neck/shoulder pain (40.4-80.1%); upper arm discomfort (91.3%); forearm pain (89.6%); wrist pain (16.7-93.2%); hip pain (13.2-40.9%); thigh discomfort (91.8%); lower leg discomfort (90.5%); knee pain (23.7-88.0%); ankle/feet pain (19.3-87.7%); elbow pain (3.5-13.0%); voice disorder (10.4-13.0%) and stress (5.5-25.9%). Sex, education level, teaching experience, quality of life, anxiety, depression, coping styles, and others were reported as associated risk factors across the studies.ConclusionsThere appears to be a cause for concern regarding musculoskeletal disorders, voice disorder, and stress reported among educators in Malaysia. While most risk factors matched those reported in studies elsewhere, others such as school characteristics (school level, government or private school, and location [rural/urban]) have not been investigated.

Urologists worldwide are increasingly adopting robot-assisted partial nephrectomy (RAPN). Some studies had compared the post-operative outcomes between RAPN and laparoscopic partial nephrectomy (LPN), however, its effectiveness of RAPN towards post-operative outcomes is controversial. The study aimed to compare the differences of post-operative outcomes after two surgeries. Materials and Methods: The study, which was comparative and cross-sectional in nature, examined patients who underwent LPN or RAPN at a hospital between January 1, 2022, and August 31, 2023. The required sample size was 364 patients, divided equally into two groups of 182. To compare the dependent variables between these groups, multiple linear regression analysis was performed, with adjustments of covariates. Result: In comparing post-operative outcomes between 150 patients receiving LPN and 152 receiving RAPN, RAPN had 3.46 days length of stay more than LPN (B=3.46, 95% CI: 2.86, 4.06, P<0.001), however, RAPN had no significantly differences on eGFR, (BUN) and creatinine than LPN at post-operative day (POD) (B=-2.52, 95% CI:-5.84, 0.80, P=0.15; B=- 0.29, 95% CI:-0.65, 0.07, P=0.12; B=-0.56,95%,CI:-9.33, 8.21, P=0.90), adjusted with covariates. Conclusion: RAPN had longer length of stay than LPN, however there was no significant differences on eGFR, BUN and creatinine between two groups at POD 0. Understanding the differences between the two surgeries could help develop strategies to enhance recovery. [ABSTRACT FROM AUTHOR]

Background: The field of automatic electrocardiogram (ECG) analysis has gained significant attention due to its potential for enhancing diagnostic accuracy and efficiency. An InceptionTime model enhanced with a lead-wise prior knowledge framework (LPKF) has been specifically developed to address the intricate challenge of multi-label ECG classification using the PTB-XL dataset. This model has demonstrated high performance, yielding superior Macro-AUC and F1 scores compared to other state-of-the-art studies. The objective of this study is to further assess the quality and interpretability of the LPKFenhanced InceptionTime model. Methods: The Grad-CAM technique has been adopted for analysis. The Grad-CAM method involves generating maps that highlight the regions of the ECG waveforms the model focuses on while making its predictions. This technique operates by computing the gradients of the target class scores with respect to the feature maps in the final convolutional layer. These gradients are then used to produce a localization map that indicates the most relevant regions contributing to the decision. Result: Grad-CAM visualizations of randomly selected ECG signals reveal the model's focus areas, which align well with clinical knowledge and provide clear, actionable insights into the decision-making process. Conclusion: The integration of Grad-CAM technique has verified the transparency and reliability of the LPKF-enhanced Inception Time approach, confirming its utility and effectiveness in clinical applications [ABSTRACT FROM AUTHOR]

COVID-19 (KAP-C19) among school children can influence the final conclusions of survey efforts, leading to incorrect intervention. The aim of this study was to adapt and adopt several questionnaires on KAP of COVID-19 into a comprehensive questionnaire, called KAP-C19, and determine its validity and reliability among middle school students in China. Methods: This study involved 1,240 middle school students in Duyun City, Guizhou Province, China. The internal consistency of the questionnaire was evaluated by Cronbach's alpha. Exploratory factor analysis with principal components analysis was used to find out the number of items correlated in a single construct. The Cronbach's alpha values for each portion of the KAPC19 questionnaire were 0.829, 0.731, and 0.944, respectively, indicating the questionnaire to be reliable. Result: The principal components analysis results showed that the knowledge sub-questionnaire had two domains (basic knowledge and preventive measures of COVID-19), the attitude subquestionnaire had two domains (attitudes toward COVID-19 or COVID-19 policies), and the practice sub-questionnaire had one domain. Conclusion: This study confirmed that the self-administered KAP-C19 questionnaire is reliable and valid and appropriate to use for future studies. [ABSTRACT FROM AUTHOR]