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Abstract The transition of ICD has never been a straightforward initiative. As nations transition to ICD-11, ensuring its acceptance among the users is essential. To our knowledge, there are limited studies about the instrument and ICD-11 adoption. Therefore, the purpose of this study was to design an instrument and investigate the factors influencing the intention to use the ICD-11 among medical record officers (MROs) and assistant medical record officers (AMROs) at Ministry of Health (MOH) Malaysia facilities. Based on the current literature, a model based on the decomposed theory of planned behaviour (DTPB) was proposed. The model consisted of 13 dimensions and 12 hypotheses identified from previous studies. Using PLS-SEM, 185 survey data points were analysed. The study findings showed that ten factors have a significant impact on the suggested model. Users' subjective norm was the most influential factor in their intention to use ICD-11. Unexpectedly, perceived usefulness and was found to have no significant influence. This study is important for policymakers in strategising ICD-11 implementation efforts. This study's novelty lies in applying a DTPB theory model in the context of the intention to use ICD-11.

As health systems transition to ICD-11, it is essential to gauge the readiness and improve existing transition efforts. Assessing the intention to use ICD-11 and factors influencing it is imperative to encourage the use of ICD-11 among the medical record officers (MROs) and assistant medical record officers (AMROs). This study aims to develop and validate a questionnaire on the factors influencing the intention to use ICD-11 among MROs and AMROs in the Ministry of Health, Malaysia. This study comprised a questionnaire development and validation involving 292 participants nationwide from Ministry of Health Malaysia facilities. The questionnaire was developed based on items adapted from the literature. Forward and backward English-Malay translation was done. Then, the questionnaire was examined for content validity, internal consistency reliability, construct validity, face validity, convergent validity, discriminant validity and confirmatory factor analyses. The final version of the questionnaire consists of eleven domains represented by 50 items. The content validity index and modified kappa were excellent for all domains. The Kaiser-Meyer-Olkin sampling adequacy value was appropriate, with a value of 0.790. The questionnaire also demonstrated good internal consistency reliability with Cronbach's alpha values between 0.850 and 0.992. Confirmatory factor analysis showed a reasonable fit for this eleven-factor model. In conclusion, this questionnaire provides a reliable tool for investigating the intention to use ICD-11 among MROs and AMROs. Positive findings from the psychometric properties support the validity of the questionnaire. This instrument can potentially support personnel in charge of ICD codification, guide the ICD-11 transition at various levels and facilitate research on support dynamics among the MROs and AMROs.

Introduction Electronic cigarettes (e-cigarettes) are new smoking devices that have gained popularity recently. However, there is limited evidence on e-cigarette consumption in Malaysia. This study aims to determine the prevalence, risk factors and perception associated with e-cigarette use among those attending government hospitals and health clinics in Malaysia. Methods A cross-sectional hospital-based study was conducted in seven public hospitals and health clinics in Malaysia, which were selected through a twostage cluster sampling. A validated questionnaire was used to obtain data from the selected participants. Multivariable logistic regression was employed to determine the association between sociodemographics and perceptions of e-cigarette use. Results Almost three-quarters (73.6%; n=923/1254) of participants were aware of e-cigarettes and 13.2% (n=122/923) reported having ever used e-cigarettes. The prevalence was significantly higher among males (18.1%), smokers (21.4%), and younger age group 18–34 years (30.2%). Ever users showed favourable perceptions towards e-cigarettes compared to non-users (23.3% vs 30.14%, p

Background Worldwide, success rates for quitting smoking have been stagnant for decades despite advancement in pharmacotherapy. This study aims to test the effectiveness of a current smoking cessation treatment programme which implemented the modified UK Standard Treatment Plan based on the NHS Centre for Smoking Cessation and Training (NCSCT). Methods We conducted a double-arm, cluster-randomised controlled trial with 1-month, 3-months and 6-months follow-ups among newly registered smokers seeking quit smoking services from 19 public hospitals in Malaysia. Smokers were assigned to either NCSCT behaviour modification (treatment group; n = 330) or usual care (control group; n = 172). The intervention was administered by dedicated health staff trained in the NCSCT. Data was collected through self-administered questionnaires, with validation conducted using expired air carbon monoxide measurement. Intention-to-treat analysis was adopted, with smokers who did not return for follow-ups considered smoking. Multiple logistic regression was conducted using a backward elimination model to assess the repeated measures treatment effect of quitting for each point of follow-up. Results No significant difference was discernible between the intervention and control group other than: first cigarette of the day (p=0.05), urge to smoke (p=0.020), method of quitting (p=0.018) and COppm level (p=0.0234) at baseline. Compared to the control group, individuals from the intervention group were more likely to quit successfully at 1-month, 3-months and 6-months follow-up (OR=1.698, OR=3.395, and OR=3.506 respectively). Older individuals were also more likely to abstain at 1-month, 3-months and 6-months follow-up (OR= 1.015, OR=1.022 and OR=1.032 respectively). Individuals who smoked at home were less likely to abstain at 1-month, 3-months and 6-months follow-up (OR= 0.637, OR=0.592 and OR=0.385 respectively). Conclusions The modified Standard Treatment Programme appears superior to routine care practice in maintaining follow up sessions among smokers due to its structured and organized sessions.

BACKGROUND: Dyspepsia and headache frequently co-exist, but the clinical implication of this association is uncertain. We planned to examine the prevalence and impact of dyspepsia in adults with headache. METHODS: A cross-sectional study was conducted in a secondary care setting. Clinical, psychological and health-related quality of life (HRQOL) data were compared between subjects with headache and controls (non-headache subjects). The impact of dyspepsia was analysed further in subjects with headache alone. RESULTS: 280 subjects (93 cases with headache and 187 matched controls) were recruited. The following baseline characteristics of subjects were as follows: mean age 45.0 ± 17.3 years, 57.0% females and ethnic distribution-Malaysian = 45 (48.4%), Chinese n = 24 (25.8%) and Indians n = 24 (25.8%). Headache sub-types among cases with headache were as follows: tension-type headache (TTH) n = 53 (57.0%) and migraine n = 40 (43.0%). Dyspepsia was more prevalent in cases with headache compared to controls (25.8% vs 12.8%, p = 0.011), and headache was independently associated with dyspepsia (OR 2.75, 95% CI 1.39-5.43). Among cases with headache, there was a trend towards a higher prevalence of dyspepsia in those with migraine (27.5%) compared to TTH (24.5%). Subjects with headache and dyspepsia, compared to those with headache alone, had a greater severity of headache symptoms (63.67 ± 22.85 mm vs 51.20 ± 24.0 mm VAS, p = 0.029). Overall HRQOL scores were lower in headache subjects with dyspepsia (EQ-5D summary score 0.82 ± 0.18 vs 0.90 ± 0.16, p = 0.037 and EQ-5D VAS 62.08 ± 17.50 mm vs 72.62 ± 18.85 mm, p = 0.018), compared to those without dyspepsia. CONCLUSION: Dyspepsia is associated with more severe headache symptoms and results in a lower HRQOL in patients with headache.

The COVID-19 pandemic has affected the way of teaching and learning in medicine. Conventional medical education has been fully transformed to open distance learning that includes the full utilization of various digital platforms. Thus, this study explored the impact of digital learning usage on learning motivation among medical students of Universiti Kebangsaan Malaysia (UKM) before and during the COVID-19 pandemic period. A validated Students Motivation towards Science Learning (SMTSL) tool was used to assess the learning motivation of UKM undergraduate medical students throughout years 1 to 5. Digital learning during the COVID-19 pandemic was significantly higher compared to before the pandemic (p < 0.05) but there was no significant difference (p = 0.872) in learning motivation. The use of digital learning among clinical students was significantly higher during the COVID-19 pandemic as compared to preclinical students (p < 0.05). There was a moderately strong correlation (r = 0.512) between digital learning and learning motivation. Hence, digital learning should be utilized as an additional driving factor to increase learning motivation, especially during this current pandemic.

Abstract Background Gene therapy could provide an effective treatment of diabetes. Previous studies have investigated the potential for several cell and tissue types to produce mature and active insulin. Gut K and L-cells could be potential candidate hosts for gene therapy because of their special features. Results In this study, we isolated gut K and L-cells to compare the potential of both cell types to produce insulin when exposed to similar conditions. The isolated pure K and L-cells were transfected with recombinant plasmids encoding insulin and with specific promoters for K or L-cells. Insulin expression was studied in response to glucose or meat hydrolysate. We found that glucose and meat hydrolysate efficiently induced insulin secretion from K and L-cells. However, the effects of meat hydrolysate on insulin secretion were more potent in both cells compared with glucose. Results of enzyme-linked immunosorbent assays showed that L-cells secreted more insulin compared with K-cells regardless of the stimulator, although this difference was not statistically significant. Conclusion The responses of K and L-cells to stimulation with glucose or meat hydrolysate were generally comparable. Therefore, both K and L-cells show similar potential to be used as surrogate cells for insulin gene expression in vitro. The potential use of these cells for diabetic gene therapy warrants further investigation.

Conventional farming is labor-consuming and the need to continuously monitor crops can be a burden for farmers. By realizing the concept of smart farming based on Internet of Things (IoT) technology, farmers can use a mobile application to observe and monitor air humidity, air temperature, and soil moisture-factors that can affect plant growth. Furthermore, the use of timers to control the pumps in conventional watering systems is not always practical in real-life cases. This paper proposes a framework that enables advanced fuzzy logic to control a pump's switching time according to user-defined variables, whereby sensors are the main aspect of and contributor to the system. Our proposed idea offers great potential for excellent performance as an interface between the sensors as the input and the IoT as the output medium. A comparison is made between the proposed system and manual handling. The results prove that the water consumption and watering time has been reduced significantly.

This paper presents a simulation and characterization of piezoelectric macromachined ultrasonic transducer (PMUT) based on planar electrodes. This small scale device with low power consumption is important as an underwater sensor. However, PMUT has a low sensitivity problem. Thus, PMUT based on planar electrodes are designed to improve the sensitivity of the PMUT. The designs are simulated using Finite Element Analysis (FEA) COMSOL Multiphysics 5.0. It is based on planar electrodes, cavity and multilayer membranes which can improve the transmitting and receiving sensitivity of ultrasonic transducer. The targeting application is for an underwater sensor with the range frequency in between 300 kHz to 800 kHz. Two characterizations are studied which are transmitting voltage response (TVR) and open circuit receiving response (OCRR). Three parameters are investigated namely the piezoelectric material, the thickness of PZT5H and electrode area. In simulation results, aluminium nitrate (AlN) has the highest in both TVR and OCRR. For the different PZT5H thicknesses, the highest transmitting sensitivity is obtained at the thickness of 300 μm meanwhile for highest receiving sensitivity is obtained at the thickness of 500 μm. It is found that the electrode area at 0.3 mm x 0.3 mm has the highest in both transmitting sensitivity and receiving sensitivity. Based on the targeted frequency design, PZT5H with a thickness of 200 μm and the electrode area of 0.5 mm x 0.5 mm is the most appropriate one.

Background: Migrant children and adolescents face a significantly increased risk of mental health issues. Focusing on this population's mental health issues is fundamental and requires more attention to detect and reduce these burdens in adulthood. Nevertheless, life skills intervention can improve mental health. Its effects on Arab migrant adolescents have not been tested. Here, an evaluation protocol of the effect of an online life skills-based intervention for improving depression, anxiety, stress, self-efficacy, and coping skills among Arab adolescents in Malaysia will be examined. Material and methods: This cluster randomised controlled trial (RCT) will involve 207 Arab students (14–18 years old) from 12 Arabic schools in the Klang Valley. The schools will be assigned randomly to an intervention (online life skills programme) or control group at a 1:1 ratio. The researcher will deliver eight one-hour sessions to the intervention group weekly. The control group will receive the intervention at the evaluation end. Both groups will complete assessments at baseline, and immediately and three months after the intervention. The primary outcome is anxiety, depression, and stress [Depression Anxiety and Stress Scale-21 (DASS-21)]. The secondary outcomes are self-efficacy (General Self-Efficacy Scale) and coping skills (Brief COPE Inventory). Data analysis will involve the Generalised Estimation Equation with a 95% confidence interval. P <.05 will indicate significant inter- and intra-group differences. Discussion: This will be the first cluster RCT of an online life skills education programme involving Arab adolescent migrants in Malaysia. The results could support programme effectiveness for improving the participants' mental health problems (depression, anxiety, stress), increasing their self-efficacy, and enhancing their coping skills. The evidence could transform approaches for ameliorating migrant children and adolescents' mental well-being. Trial registration: The study is registered with the Clinical Trial Registry (Identifier: NCT05370443). [ABSTRACT FROM AUTHOR]

In acoustic receiver design, the receiving sensitivity and bandwidth are two primary parameters that determine the performance of a device. The trade-off between sensitivity and bandwidth makes the design very challenging, meaning it needs to be fine-tuned to suit specific applications. The ability to design a PMUT with high receiving sensitivity and a wide bandwidth is crucial to allow a wide spectrum of transmitted frequencies to be efficiently received. This paper presents a novel structure involving a double flexural membrane with a fluidic backing layer based on an in-plane polarization mode to optimize both the receiving sensitivity and frequency bandwidth for medium-range underwater acoustic applications. In this structure, the membrane material and electrode configuration are optimized to produce good receiving sensitivity. Simultaneously, a fluidic backing layer is introduced into the double flexural membrane to increase the bandwidth. Several piezoelectric membrane materials and various electrode dimensions were simulated using finite element analysis (FEA) techniques to study the receiving performance of the proposed structure. The final structure was then fabricated based on the findings from the simulation work. The pulse–echo experimental method was used to characterize and verify the performance of the proposed device. The proposed structure was found to have an improved bandwidth of 56.6% with a receiving sensitivity of −1.8864 dB rel 1 V µPa. For the proposed device, the resonance frequency and center frequency were 600 and 662.5 kHz, respectively, indicating its suitability for the targeted frequency range.