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Background: Immunoglobulin A (IgA) accounts for 15% of total protein production per day and plays a crucial role in the first-line immune defence. Recently, IgA has been established as a vital clinical biomarker for nephropathy, allergic asthma, celiac disease (CD), pneumonia, and asthma as well as some neurological disorders. In this work, we have studied several carbon nanomaterials (CNMs) having different dimensions (D): carbon nano-onions (CNOs) - 0D, single-walled carbon nanotubes (SWCNTs) - 1D, and graphene nanoplatelets (GNPs) - 2D, on glassy carbon electrode (GCE) to identify which CNMs (CNOs/SWCNTs/GNPs) work best to fabricate IgA based electrochemical immunosensor. Methods: Different CNMs (CNOs, SWCNTs, GNPs) were tested for high electric current on GCE using square wave voltammetry (SWV), and among them, GNPs modified GCE platform (GNPs/GCE) showcased the highest electric current. Therefore, GNPs/GCE was utilized for the development of highly sensitive label-free electrochemical immunosensor for the detection of Immunoglobulin A using SWV. Results: Despite the simple fabrication strategies employed, the fabricated sensor demonstrated a low limit of detection of 50 fg mL-1 with an extensive linear range of detection from 50 fg mL-1 to 0.1 μg mL-1. Conclusion: Fabricated immunosensor represented high stability, repeatability, specificity and resistance to most common interferences as well as great potential to analyse the real sample.

Medical schools must ensure that their curricula evolve in response to changes in clinical practice and the needs of future doctors. Undergraduate medical programs should be better equipped to anticipate and plan for changes in future clinical practice and learning needs of the students. The COVID-19 outbreak and the recent epidemics of new and emerging infections have brought into sharp focus the importance of subjects, such as infectious diseases, infection control, public health, occupational health and virology in medical school curricula. A review of the medical curriculum at PAPRSB Institute of Health Sciences revealed that the time allotted for teaching these subjects is much less than that allotted for teaching non-communicable diseases and other subjects. The changing health paradigm requires medical teaching to be continuously redefined and updated. Given the reduced amount of teaching time allotted for subjects, such as infectious diseases, infection control, public health, occupational health and virology, it might be timely to review and recalibrate the teaching hours of these subjects in all the medical curricula, to better prepare our doctors facing the challenges of future epidemics and pandemics.

Introduction: Postpartum warming is widely practiced among women in Asian countries despite unsubstantiated health claims. This study aimed to identify sources of knowledge and explore the practices of postpartum warming among mothers in Brunei. Methods: A cross-sectional study using a self-administered questionnaire was conducted on 124 mothers who had experience in postpartum warming. Results: Coal was commonly used for heat. Main source of knowledge came from family members. Older women had significantly lower intention to perform the practice in future pregnancies. Women who lived in nuclear families practiced it to a significantly higher frequency compared with those living in extended families. Discussion: Women still practice warming to adhere with family expectations and traditions although noticeable changes have been observed as society modernizes. It still poses a risk of carbon monoxide poisoning and fire hazard from burning coal. Future studies should focus on health and safety aspects to provide evidence on the actual health benefits and ameliorate risk factors.

While counting cases of disease appears straightforward, there are issues to consider when enumerating disease counts during an epidemic. For example, for Coronavirus Disease-2019 (COVID-19), how is a case defined? Hubei province in China changed its case definition twice in a fortnight—from laboratory-confirmed cases to clinically confirmed cases without laboratory tests, and back to laboratory-confirmed cases. This caused confusion in the reported number of cases. If a confirmed case requires laboratory testing, what is the population who are laboratory-tested? Due to limited laboratory testing capacity in the early phase of an emerging epidemic, only “suspected cases” are laboratory-tested in most countries. This will result in underdiagnosis of confirmed cases and also raises the question: how is a “suspect case” defined? With the passage of time and increased capability to perform laboratory tests, more people can be screened and the number of confirmed cases will increase. What are the technical considerations of laboratory testing? This includes specimen collection (variable collection methods), samples collected (upper or lower respiratory tract biospecimens), time of collection in relation to course of disease, different laboratory test methods and kits (not all of which may be standardised or approved by authorities such as the Food and Drug Administration). Are approved laboratory facilities and trained manpower available, and how are test results interpreted and false-negatives excluded? These issues will affect the accuracy of disease counts, which in turn will have implications on how we mount an appropriate response to the outbreak. Key words: Diagnosis, Laboratory testing, Outbreak, Pandemic, Screening

To explore sociodemographic factors, anthropometric measurements, and non-communicable disease risk factors as predictors of screening behaviours in Brunei Darussalam. Data from the National Non-communicable Diseases survey (STEPS) involving 3808 participants were extracted. Multivariable regression analyses were applied to explore factors associated with screening behaviours. Highest prevalence of cardiovascular disease screening was blood pressure (81.0%, 95% CI: 79.7, 82.2), followed by glucose measurement (64.9%, 95% CI: 63.3, 66.4) and cholesterol monitoring (63.4%, 95% CI: 61.9, 65.0). For prevalence of cancer screenings, pap smear was the highest (56.5%, 95% CI: 54.3, 58.6), followed by mammography (11.3%, 95% CI: 10.0, 12.7), colonoscopy (7.9%, 95% CI: 7.1, 8.8) and prostate (6.5%, 95% CI: 5.4, 7.8). Marital status, age, tobacco use, co-morbidity and family history were significant predictors of cardiovascular screening behaviours. Whereas family history, age, lifestyle factors, glucose levels, fruit and vegetable intake, work status, and knowledge on cancer were significant predictors of cancer screening behaviours. Identifying specific predictors of screening behaviours could help policymakers introduce tailored guidelines and effective approaches for screening and early detection programmes. Causal relationships and barriers to screening, including healthcare provider’s role and health service utilisation, are highly recommended in future studies.

Purpose: Variability in accelerometry-data processing decisions limited data comparability across studies. We aimed to examine different accelerometry-data processing rules: varying bout lengths an...

Background There is a global commitment to eliminating tuberculosis (TB). It is critical to detect and treat cases of latent TB infection (LTBI), the reservoir of new TB cases. Our study assesses trends in publication of LTBI-related research. Methods We used the keywords (“latent tuberculosis” OR “LTBI” OR “latent TB”) to search the Web of Science for LTBI-related articles published 1995–2018, then classified the results into three research areas: laboratory sciences, clinical research, and public health. We calculated the proportions of LTBI-related articles in each area to three areas combined, the average rates of LTBI-related to all scientific and TB-related articles, and the average annual percent changes (AAPC) in rates for all countries and for the top 13 countries individually and combined publishing LTBI research. Results The proportion of LTBI-related articles increased over time in all research areas, with the highest AAPC in laboratory (38.2%/yr), followed by public health (22.9%/yr) and clinical (15.1%/yr). South Africa (rate ratio [RR] = 8.28, 95% CI 5.68 to 12.08) and India (RR = 2.53, 95% CI 1.74 to 3.69) had higher RRs of overall TB-related articles to all articles, but did not outperform the average of the top 13 countries in the RRs of LTBI-related articles to TB-related articles. Italy (RR = 1.95, 95% CI 1.45 to 2.63), Canada (RR = 1.73, 95% CI 1.28 to 2.34), and Spain (RR = 1.53, 95% CI 1.13 to 2.07) had higher RRs of LTBI-related articles to TB-related articles. Conclusions High TB burden countries (TB incidence > 100 per 100,000 population) published more overall TB-related research, whereas low TB burden countries showed greater focus on LTBI. Given the potential benefits, high TB burden countries should consider increasing their emphasis on LTBI-related research.

PURPOSE: To identify factors responsible for hospital health care workers' intention to leave their job during the COVID-19 pandemic. DESIGN: A cross-sectional study was performed. METHODS: A self-administered questionnaire was delivered to solicit hospital health care workers' demographics, intention to leave, workplace environment, and changes related to COVID-19 from July to November 2020 in Taiwan. Principal component analysis was performed to compare group-related factors. Multiple logistic regression was used to determine the risk factors for the intention of health care workers to leave their job. FINDINGS: Among the 1209 health care workers (mean age, 36.3 years) who participated in the study, intention to leave the job was found to be related to factors relating to COVID-19, including perceived risk, affected social relationships, and increased workload and job stress, after adjustment for demographic and work factors. Supportive administration/management were protective factors against leaving the job. These results were supported by sensitivity analyses. CONCLUSIONS: Our findings suggest that the intention of health care workers to leave their job during a pandemic is related to potentially modifiable factors relating to the infection itself and work environment. CLINICAL RELEVANCE: High perceived risk of COVID-19, affected social relationaops, and increased workload and job stress were positively associated with the intention of health care workers to leave their job, whereas supportive administration and management were protective factors against leaving the job. Development of workplace strategies is important to help mitigate these above factors, improve psychological wellbeing, and promote workforce stability.

INTRODUCTION: Many tinnitus service providers advocate counselling as an initial and important approach for the management of tinnitus. Our tinnitus counselling clinic (TCC) developed a counselling protocol to deliver information and educate patients on self-help strategies. We aimed to obtain feedback on the components of the initial session and the self-help choices made by patients who returned for follow-up. METHODS: All patients who were attending the TCC completed a Tinnitus Handicap Inventory (THI) questionnaire during their first and follow-up sessions. At follow-up, patients were asked to rate how helpful each counselling component was and their choice of self-help strategy for tinnitus. RESULTS: 203 patients attended the follow-up session, representing 60.1% of patients initially counselled. THI scores improved, with 45.8% more patients categorised as having no handicap at follow-up compared to the initial 26.1%. Two most helpful counselling components (rated on a 5-point scale) were explanation of self-help strategies (mean score 4.40 ± 0.68) and illustration of healthy and damaged hair cells (mean score 4.30 ± 0.74). The most popular choice for self-help was using a sound strategy plus change in thinking (41.9%, n = 85). A few (32.5%, n = 66) patients were able to change their perception of tinnitus without any sound enrichment, while 17 (8.4%) patients relied solely on sound strategy. Most (97.5%) patients found the initial counselling session helpful. However, 92 (45.3%) patients were still seeking a cure for their tinnitus. CONCLUSION: Most patients found the counselling helpful at follow-up. Counselling offered them the opportunity to actively manage their tinnitus.

Occupational health is the ‘promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations’. Work-related ill-health and injuries cause considerable mortality and morbidity to workers worldwide, and are a major cause of disability, lost productivity, and sickness absence. In the occupational setting, workers may suffer from occupational diseases (those directly caused by workplace hazards); ‘work-related diseases’ (those that are multifactorial in origin with occupational exposures contributing to part of the aetiology); and non-occupational diseases that affect the general population. Primary, secondary, and tertiary preventive measures can be used to reduce the burden of disease at the workplace. Prevention of occupational ill-health requires an understanding of the work processes, the range and extent of exposures to hazards, and the steps that may be available to reduce exposure. It also requires recognition of vulnerable occupational groups such as workers in developing nations, migrant workers, child labour, women workers, and impaired workers. The standard hierarchy of control strategies for reducing exposure to workplace hazards includes elimination, substitution, isolation, engineering measures, administrative procedures, and personal protective equipment. The workplace can be a suitable venue for health promotion activities although this should not be at the expense of elimination and control of exposure to occupational hazards. As occupational health practice has evolved to consideration of health issues beyond the ‘factory gate’, the discipline now has much in common with environmental health and encompasses the philosophy and principles of good public health practice.

Risk-based decision-making increasingly has global dimensions, extending from the international management of chemical risks to the sustainable development of our planet. Environmental risk analysis is firmly based on toxicological sciences with input from other public health disciplines. Increasing understanding of how the human genotype and phenotype affects absorption, distribution, metabolism, and excretion of xenobiotics (compounds foreign to a living organism), is providing insight into answers to the oldest human question about disease: ‘Why me?’ The risk paradigm components of hazard assessment, dose–analysis, exposure assessment, risk characterization, risk management, and risk communication, and the toxicological concepts on which they are based, have proven durable in approaching increasingly complex environmental hazards. Newer approaches to managing risk, such as the precautionary principle, and newer challenges, such as nanotechnology and genetically modified organisms, necessitate further systematic thinking on how best to protect human health and the environment.

Despite extensive research on air pollution estimation/prediction, inter-country models for estimating air pollutant concentrations in Southeast Asia have not yet been fully developed and validated owing to the lack of air quality (AQ), emission inventory and meteorological data from different countries in the region. The purpose of this study is to develop and evaluate two machine learning (ML)-based models (i.e., analysis of covariance (ANCOVA) and random forest regression (RFR)) for estimating daily PM

The World Health Organisation Western Pacific Region countries were declared free of polio in 2000 until a polio outbreak involving 305 cases occurred in Indonesia in 2006. It was not until 2014 that the World Health Organisation South East Asia region was officially declared polio-free again. However, in February 2019, the Global Polio Eradication Initiative announced a new circulating vaccine-derived poliovirus outbreak in the Papua province of Indonesia. To make matter worse, the outbreak responses were tardy and led to transmission among migrating communities to other cities. The pressing regional issues of polio outbreak caused by circulating vaccine-derived poliovirus and use of oral polio vaccine have not been well presented. Our letter highlighted the suboptimal outbreak responses as well as the necessity of cross-border vaccination to curb continued poliovirus transmission.

Summary This study explored how cultural values affected Health Belief Model (HBM) components and the influenza vaccine uptake among nurses across three Asian populations using a survey conducted in 2017 (N = 3971). The vaccination coverages were 33.5% (Brunei), 35.6% (Hong Kong) and 69.5% (Singapore). Three HBM components (perceived susceptibility, perceived benefits and cues to action) were positively associated with vaccination. A direct negative link and an indirect positive link via HBM were observed between collectivism and vaccination, whereas a negative indirect link via HBM between power distance and vaccination was observed. Cultural values, notably collectivism, advanced HBM to study nurses' vaccination.

In the classification of non-stationary time series data such as sounds, it is often tedious and expensive to get a training set that is representative of the target concept. To alleviate this problem, the proposed method treats the outputs of a number of deep learning sub-models as the views of the same target concept that can be linearly combined according to their complementarity. It is proposed that the view's complementarity be the contribution of the view to the global view, chosen in this paper to be the Laplacian eigenmap of the combined data. Complementarity is computed by alternate optimization, a process that involves the cost function of the Laplacian eigenmap and the weights of the linear combination. By blending the views in this way, a more complete view of the underlying phenomenon can be made available to the final classifier. Better generalization is obtained, as the consensus between the views reduces the variance while the increase in the discriminatory information reduces the bias. The data experiment with artificial views of environment sounds formed by deep learning structures of different configurations shows that the proposed method can improve the classification performance.

Globally, self-medication has increased, where 25% of adults use OTC medicines. This research is intended to assess the knowledge, attitude and practice regarding OTC medicines among adults in Brunei Darussalam. An online cross-sectional survey was performed using a questionnaire adapted from similar research conducted among students in Brunei Darussalam. A total of 364 responses were collected, where the median age of the study participants was 23 years. The mean knowledge score was 7.3 out of 9, with most respondents (77.7%) having good knowledge of OTC medicines. Almost all (92.9%) showed a positive attitude towards OTC use. A statistically significant difference (p ≤ 0.05) was observed in attitude scores between age groups and education levels. Most of the study participants (88.2%) have practiced self-medication with OTC medicines, mainly due to their easy accessibility (79.4%). A small number practiced improper habits, such as consuming more than the recommended dose (6.0%) and not checking the expiry date (0.5%). The practice of self-medicating with OTC medicines can be advantageous when patients fully know the medications and nature of their disease. Knowledge of proper OTC medicine use among adults in Brunei Darussalam is essential to avoid improper user practices and potential health hazards associated with the misuse of medications.

Despite extensive research on air pollution estimation/prediction, inter-country models for estimating air pollutant concentrations in Southeast Asia have not yet been fully developed and validated owing to the lack of air quality (AQ), emission inventory and meteorological data from different countries in the region. The purpose of this study is to develop and evaluate two machine learning (ML)-based models (i.e., analysis of covariance (ANCOVA) and random forest regression (RFR)) for estimating daily PM2.5 and PM10 concentrations in Brunei Darussalam. These models were first derived from past AQ and meteorological measurements in Singapore and then tested with AQ and meteorological data from Brunei Darussalam. The results show that the ANCOVA model (R2 = 0.94 and RMSE = 0.05 µg/m3 for PM2.5, and R2 = 0.72 and RMSE = 0.09 µg/m3 for PM10) could describe daily PM concentrations over 18 µg/m3 in Brunei Darussalam much better than the RFR model (R2 = 0.92 and RMSE = 0.04 µg/m3 for PM2.5, and R2 = 0.86 and RMSE = 0.08 µg/m3 for PM10). In conclusion, the derived models provide a satisfactory estimation of PM concentrations for both countries despite some limitations. This study shows the potential of the models for inter-country PM estimations in Southeast Asia.

A neural network that matches with a complex data function is likely to boost the classification performance as it is able to learn the useful aspect of the highly varying data. In this work, the temporal context of the time series data is chosen as the useful aspect of the data that is passed through the network for learning. By exploiting the compositional locality of the time series data at each level of the network, shift-invariant features can be extracted layer by layer at different time scales. The temporal context is made available to the deeper layers of the network by a set of data processing operations based on the concatenation operation. A matching learning algorithm for the revised network is described in this paper. It uses gradient routing in the backpropagation path. The framework as proposed in this work attains better generalization without overfitting the network to the data, as the weights can be pretrained appropriately. It can be used end-to-end with multivariate time series data in their raw form, without the need for manual feature crafting or data transformation. Data experiments with electroencephalogram signals and human activity signals show that with the right amount of concatenation in the deeper layers of the proposed network, it can improve the performance in signal classification.

Air quality forecasting is important as it provides early warning of air pollutants, which could be harmful to human health and the environment. This study presents a statistical analysis and prediction of various air pollutants (such as PM 10 , CO, SO 2 , NO 2 and O 3 ) and the air pollution index (API) in Labuan, Malaysia using advanced machine learning approaches. The exponential triple smoothing (ETS) and seasonal autoregressive integrated moving average (SARIMA) forecasting methods were used in the study. Air pollutants and API data from 2000 to 2018 were analyzed and tested with these forecasting models. The ETS model with 68% confidence interval (CI) fitted well for all air pollutants except SO 2 , which was best fitted by the 95% CI model. The SARIMA (1, 1, 1)(0, 1, 1)12 model was found to be the most appropriate for forecasting different air pollutants and API in Labuan. The ETS model was more suitable for forecasting CO and SO 2 and the SARIMA (1, 1, 1)(0, 1, 1)12 model was more suitable for forecasting PMio, NO 2 , O 3 and API. The ETS model predicts that the annual concentrations of CO and SO 2 in 2030 would be about 0 ± 0.81 ppm and 0 ± 0.002 ppm, respectively, at 68% CI. The SARIMA (1, 1, 1)(0, 1, 1)i 2 model predicts that the annual concentrations of PMio, NO 2 and O 3 in 2030 would be about 38.7 ± 14.8 pg/m3, 0 ± 0.006 ppm and 0.01 ± 0.008 ppm, respectively, and API value of about 44 ± 15 in Labuan.

Guidance from many health authorities recommend that social distancing measures should be implemented in an epidemic when community transmission has already occurred. The clinical and epidemiological characteristics of COVID-19 suggest this is too late. Based on international comparisons of the timing and scale of the implementation of social distancing measures, we find that countries that imposed early stringent measures recorded far fewer cases than those that did not. Yet, such measures need not be extreme. We highlight the examples of Hong Kong and Brunei to demonstrate the early use of moderate social distancing measures as a practical containment strategy. We propose that such measures be a key part of responding to potential future waves of the epidemic.

On 31 December 2019, the World Health Organization (WHO) received reports of pneumonia cases of unknown etiology in the city of Wuhan in Hubei Province, China. The agent responsible was subsequently identified as a coronavirus—SARS‐CoV‐2. The WHO declared this disease as a Public Health Emergency of International Concern at the end of January 2020. This event evoked a sense of déjà vu, as it has many similarities to the outbreak of severe acute respiratory syndrome (SARS) of 2002‐2003. Both illnesses were caused by a zoonotic novel coronavirus, both originated during winter in China and both spread rapidly all over the world. However, the case‐fatality rate of SARS (9.6%) is higher than that of COVID‐19 (

Noise can affect hearing in the occupational setting but can have other effects where exposures are non-occupational. For clinical purposes, noise is measured in decibels weighted according to the sensitivity of the human ear (dB(A)). Regardless of source, the effects of overexposure to noise are similar. Initially there is a temporary threshold shift, where reversibility of hearing loss is possible with removal away from further noise. Noise-induced hearing loss occurs following prolonged or intense exposure, with poor prospects for improvement of hearing. The classical audiogram for noise-induced hearing loss shows a 4 kHz dip. Non-auditory effects of prolonged noise exposure include annoyance, sleep disturbance, hypertension, and cardiovascular disease, stress, and impaired cognitive performance. Prevention of noise-induced hearing loss is by reducing exposure to noise at source minimizing exposure time, using hearing protection, and participating in surveillance.

Over-the-counter (OTC) medicine is defined as safe and effective for the general public to use, without seeking therapy from a health professional. As primary social media and internet users, university and college students are more likely to be exposed to unverified sources of health information. This study aims to assess the knowledge, attitudes, and behaviour of students at institutions of higher learning in Brunei with regard to the safe use of OTC medicines. A cross-sectional study was performed using a self-administered online questionnaire, adapted from the literature with additional information from the United States Food and Drug Administration (FDA) on the educational resources in understanding OTC medicine for consumers. The questionnaire consisted of 4 sections: demographic information, knowledge of OTC medicines, attitudes, and practice. Descriptive and inferential statistics were used for data analysis. A total of 335 students returned a completed questionnaire. The students had a mean knowledge score of 7.1 out of 9, with more than half (53.4%) having good knowledge (knowledge score > 7), and only a small percentage (5.7%) with poor knowledge. Almost all of the students (99.7%) had a positive attitude toward OTC medicine use. Few of the students practiced improper habits in terms of OTC medicine use, such as not reading the instructions or taking more than the recommended dose. Awareness of proper OTC medicine use among students in institutions of higher learning is necessary to prevent the rise of inappropriate user practices.

The Depression Anxiety and Stress Scale (DASS) is a promising tool compared with traditional measures because of its greater divergent validity. Unlike the original DASS-42, the DASS-21 version still lacks validation studies particularly in Asian populations. To validate the psychometric properties of DASS-21 among nursing and midwifery students. Data were collected at three time points, the beginning, middle and end of the semester, from students enrolling in the positive thinking module. Reliability statistics, floor and ceiling effects, and factor analysis were computed. One hundred twenty-six data points were used where participants reported mild stress levels (mean = 14.8 ± 4.18), moderate anxiety levels (mean = 13.3 ± 3.45) and mild depression levels (mean = 12.3 ± 3.40). DASS-21 showed excellent internal consistency reliability estimates except for item 2. Discriminant validity was an issue, and it was observed that 9 items, instead of 21, provided the best model fit (χ2 = 57.1, p

This study explores the relationship between competitiveness and stress. In Experiment 1, we observe a higher response of cortisol—the primary stress hormone—to the computation task coupled with tournament than to the computation task with piece rate. Moreover, more competitive subjects exhibit higher stress responses than their less competitive counterparts in the computation tasks under both tournament and piece rate. In Experiment 2, we find that exogenously induced stress does not significantly affect competitiveness. Overall, our findings reveal an important trade‐off between tournament and piece rate in terms of stress response with implications on the design of incentive contracts.

This study describes the development of a highly sensitive electrochemical immunosensor for the detection of salivary secretory Immunoglobulin A (sIgA). Immunosensor fabrication involves a gold nanoparticle (AuNP) and polyethylene glycol (PEG) nanocomposite deposited on modified carbon nanofiber electrodes (CNF-SPE). Anti-sIgA monoclonal antibody (mAbS) is immobilized onto the nanocomposite, followed by blocking with BSA. This fabrication technique allows both label-free and enzyme-free detection of sIgA. Immunosensor response was measured by square wave voltammetry, while cyclic voltammetry was used for characterization. For further characterization FE-SEM was used to analyze layer-by-layer fabrication. Despite the simple fabrication technique employed, a large increase in sensitivity (3000-fold) was achieved, with an experimentally determined detection limit of 500 fg mL −1 . As well as, this immunosensor demonstrated excellent stability over time, reproducibility, selectivity, and resistance to common interferences. The latter two are of great importance when performing real sample analysis on biological fluids such as saliva. Indeed, detection of sIgA in saliva samples yielded excellent recovery percentages; 110%, 98% and 86% for 250, 500 and 1000 pg mL −1 respectively, thus demonstrating the potential to analyze real saliva samples and highlighting this as a highly sensitive platform to monitor sIgA.

Background Young adults are at risk of developing obesity, especially when transitioning into university life as they become responsible for their daily eating and lifestyles. This study estimates the prevalence of overweight/obesity and explores the eating patterns and lifestyle practices of university students. Methods A cross-sectional study was conducted at Universiti Brunei Darussalam (UBD). A total of 303 students participated. Data was collected from January to April 2016. Self-designed questionnaires comprised questions pertaining to current weight, self-reported height data, information on eating habits, exercise and knowledge of the food pyramid. The collected data were used to compare and contrast eating habits and lifestyle practices among overweight/obese students with those of non-overweight/obese students. Results The prevalence of overweight/obesity was 28.8% (95% CI: 24.0%, 34.0%). The majority ate regular daily meals, but more than half skipped breakfast. Frequent snacking, fried food consumption at least three times per week and low intake of daily fruits and vegetables were common. The frequency of visits to fast food restaurants was significantly higher in the overweight/obese. 25.4% of the students exercised at least three times per week. Almost all students are aware of balanced nutrition and the food pyramid. Conclusions Most university students had poor eating habits, although the majority had good nutrition knowledge. By way of recommendation, the university is encouraged to provide a multi-disciplinary team specialising in health promotion that includes nutrition and physical activity programmes to increase the awareness among the university students.

Background Healthcare workers (HCWs) are most at risk of contracting SARS-CoV-2 and COVID-19 infection. Their preparedness, as a result of provision and access to personal protective equipment (PPE), training programmes and awareness and practices on infection prevention and control measures, is integral for the prevention of infectious disease transmission. Objectives This study was conducted to assess the preparedness and practices of HCWs during COVID-19 first wave outbreak in Brunei Darussalam. Methods A cross-sectional study using a pre-designed and self-administered web-based questionnaire was conducted among HCWs from government and private health sectors ranging from primary to tertiary health facilities in Brunei Darussalam. Data were analysed using descriptive statistics, and chi-square test was used for statistical significance. Results A total of 511 HCWs participated in the study. Nurses (64%) and HCWs based at hospitals (66%) made up the majority of the study participants, with 74% having occupational exposure to COVID-19 cases. More than 99% of HCWs used respiratory PPE, and 94% used gloves. 74% had undergone respirator fit testing and 65% had received PPE awareness session within the last one year. Coverage in training programmes was found to be low among HCWs from private health facilities. Conclusions Majority of HCWs who had received updated training programmes and therefore were better prepared came from government health facilities. HCWs from private health facilities lacked preparedness training programmes and as such, there needs to be improvement to enhance preparedness measures in light of the ongoing COVID-19 pandemic and for future infectious disease outbreaks.

This article provides a cross-sectional weighted measurement of noncommunicable diseases (NCDs) and risk factors prevalence among Brunei adult population using WHO STEPS methodology. A 2-staged randomized sampling was conducted during August 2015 to April 2016. Three-step surveillance included (1) interview using standardized questionnaire, (2) blood pressure and anthropometric measurements, and (3) biochemistry tests. Data weighting was applied. A total of 3808 adults aged 18 to 69 years participated in step 1; 2082 completed steps 2 and 3 measurements. Adult smoking prevalence was 19.9%, obesity 28.2%, hypertension 28.0%, diabetes 9.7%, prediabetes 2.1%, and 51.3% had fasting cholesterol level ≥5 mmol/L. Inadequate consumption of fruits and vegetables prevalence was high at 91.7%. Among those aged 40 to 69 years, 8.9% had a 10-year cardiovascular disease (CVD) risk ≥30%, or with existing CVD. Population strategies and targeted group interventions are required to control the NCD risk factors and morbidities.

A contribution to a special issue on Hormones and Human Competition. Testosterone is theorized to increase retaliation after social provocation. However, empirical evidence in support of these theories is mixed. The present research investigated whether acute stress causally suppresses testosterone's association with retaliation. We also explored sex differences in behavioral responses to acute stress. Thirty-nine participants (51.28% male) were randomly assigned to a high- or low-stress condition. Then participants engaged in 20 one-shot rounds of the ultimatum game, which was used to assess retaliatory behavioral responses to unfair treatment. Participants provided two saliva samples to measure testosterone and cortisol concentrations - one sample before the stress manipulation, and the second after the ultimatum game (20minutes post-stressor). Results revealed a positive association between basal testosterone and retaliation in the low-stress condition, but not in the high-stress condition. Further, cortisol concentrations increased in the high- compared to the low-stress condition, and these cortisol changes moderated the association between basal testosterone and retaliation. The associations between basal testosterone and retaliation under varying levels of stress were similar in men and women. However, there was a sex difference in behavioral responses to the stress manipulation that was independent of testosterone. In women, the high-stress condition reduced retaliation compared to the low-stress condition, whereas in men the opposite pattern emerged. Collectively, this study (i) provides preliminary evidence that experimentally manipulated stress blocks basal testosterone's association with retaliation, and (ii) reveals a sex difference in retaliation under varying levels of stress. Discussion focuses on mechanisms, limitations, and the need for follow-up studies with larger sample sizes.

The immune system consists of a complex but organised myriad of cell types that continually maintain and survey their resident environment. It is this balanced homeostatic relationship between the cells of the immune system and its surrounding environment that shapes the microbial flora. In the oral cavity, the immune system not only has to harmonise with the ecology of commensal bacteria, fungi and viruses but also should be able to defend against pathogenic microbes. In fact, the oral microbiota is altered in situations when the immune system is dysregulated. There are a number of human diseases or conditions that perturb the balance of the host immune system and have an effect on the host oral microbiota. If this balance is disturbed, the symbiotic relationship will shift to allow the colonisation or overgrowth of potentially pathogenic species, inducing a pathogenic process that leads to various disease symptoms. The dynamics balance between the immune status and the oral microbial community of an individual has remained understudied till recently. Advances in metagenomics allow detailed investigations into oral microbial population and the possible diversity. This concise review summarises the current findings using metagenomic approaches for studying oral microbial flora diversity.

Simian malaria is a zoonotic disease caused by Plasmodium knowlesi infection. The common natural reservoir of the parasite is the macaque monkey and the vector is the Anopheles mosquito. Human cases of P. knowlesi infection has been reported in all South East Asian countries in the last decade, and it is currently the most common type of malaria seen in Malaysia and Brunei. Between 2007–2017, 73 cases of P. knowlesi infection were notified and confirmed to the Ministry of Health in Brunei. Of these, 15 cases (21%) were documented as work-related, and 28 other cases (38%) were classified as probably related to work (due to incomplete history). The occupations of those with probable and confirmed work related infections were border patrol officers, Armed Forces and security personnel, Department of Forestry officers, boatmen and researchers. The remaining cases classified as most likely not related to work were possibly acquired via peri-domestic transmission. The risk of this zoonotic infection extends to tourists and overseas visitors who have to travel to the jungle in the course of their work. It can be minimised with the recommended use of prophylaxis for those going on duty into the jungles, application of mosquito/insect repellants, and use of repellant impregnated uniforms and bed nets in jungle camp sites. Keywords: Brunei, Occupational infections, Plasmodium knowlesi, Zoonosis