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INTRODUCTION: The Risk Perception Survey on Developing Diabetes questionnaire identifies how women with gestational diabetes mellitus (GDM) perceived the risk of developing diabetes after their pregnancy has ended. The objective of this study was to translate and validate an English questionnaire into Malay. MATERIALS AND METHODS: A cross-sectional study was conducted from February 2019 to July 2019 among 200 women with GDM who attended public health clinics in Johor Bahru, Malaysia. The original author of the questionnaire granted us permission to use for this study. The translation of the questionnaire, content, and face validation was performed. It was followed by confirmatory factor analysis using R version 3.5.3 and item analysis for the knowledge domain. The composite reliability and internal consistency reliability using Cronbach alpha were also computed. RESULTS: The Malay version consists of 20 items in five domains; personal control (2 items), optimistic bias (2 items), knowledge of diabetes risk factors (11 items), benefits and barriers of preventive behaviour (3 items), and risk perception (2 items). Confirmatory factor analysis confirmed the structure of the model. The goodness-of-fit values were adequate [comparative fit index=0.994, Tucker-Lewis Index=0.990, standardized root mean square residual=0.038, root mean square of approximation=0.021 (90% CI: 0.000,0.064)]. The four domains had composite reliability values between 0.60 and 0.88. The Cronbach alpha value for knowledge of diabetes risk factors domain was 0.843. CONCLUSION: The translated Malay questionnaire is valid and reliable to assess the perception of women with GDM towards their future risk of getting diabetes. [ABSTRACT FROM AUTHOR]

Background Stroke is a significant public health concern characterized by increasing mortality and morbidity. Accurate long-term outcome prediction for acute stroke patients, particularly stroke mortality, is vital for clinical decision-making and prognostic management. This study aimed to develop and compare various prognostic models for stroke mortality prediction. Methods In a retrospective cohort study from January 2016 to December 2021, we collected data from patients diagnosed with acute stroke from five selected hospitals. Data contained variables on demographics, comorbidities, and interventions retrieved from medical records. The cohort comprised 950 patients with 20 features. Outcomes (censored vs. death) were determined by linking data with the Malaysian National Mortality Registry. We employed three common survival modeling approaches, the Cox proportional hazard regression (Cox), support vector machine (SVM), and random survival forest (RSF), while enhancing the Cox model with Elastic Net (Cox-EN) for feature selection. Models were compared using the concordance index (C-index), time-dependent area under the curve (AUC), and discrimination index (D-index), with calibration assessed by the Brier score. Results The support vector machine (SVM) model excelled among the four, with three-month, one-year, and three-year time-dependent AUC values of 0.842, 0.846, and 0.791; a D-index of 5.31 (95% CI: 3.86, 7.30); and a C-index of 0.803 (95% CI: 0.758, 0.847). All models exhibited robust calibration, with three-month, one-year, and three-year Brier scores ranging from 0.103 to 0.220, all below 0.25. Conclusion The support vector machine (SVM) model demonstrated superior discriminative performance, suggesting its efficacy in developing prognostic models for stroke mortality. This study enhances stroke mortality prediction and supports clinical decision-making, emphasizing the utility of the support vector machine method., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Che Nawi et al.)

Introduction Job stress is recognized as a significant concern across various occupational settings which have profound implications for both individuals and organizations. During the COVID-19 pandemic, job stress among the public health workforce (PHW) has been a significant concern, as they face a significantly increased risk of infection and mortality due to excessive COVID-19 exposure. This study presents a descriptive exploration of key job stress-related factors among PHW in Terengganu, Malaysia. Methodology This is a cross-sectional study conducted from May 2022 to April 2023, encompassing all eight District Health Offices (DHO) and government health clinics in Terengganu. Data collection involved a Malay version of the Job Content Questionnaire (M-JCQ), which assesses job characteristics based on Karasek's demand-control-support model and consists of four main domains: decision latitude, psychological job demands, physical job demands, and social support. Data was collected from 1044 participants, and statistical analysis was performed using SPSS version 27 (IBM Corp., Armonk, NY, USA). Findings Of the 1044 participants, 18.9% experienced job stress. The highest percentage of job stress was observed among nurses (24.3%), followed by medical assistants (18.3%) and physicians (16.0%). In contrast, the public health assistant (PKA) group had the lowest rate of job stress. Job types based on Karasek's model also showed variations, with doctors having the highest percentage of active jobs (46.4%), while medical assistants had the highest percentage of low job strain (17.9%), and PKAs had the highest percentage of passive job types (44.7%). Conclusion This study offers significant insights into the work-related challenges faced by the public health workforce in Terengganu, Malaysia, especially during the COVID-19 pandemic. Job stress is a substantial concern, and understanding its underlying factors is essential for improving the well-being of PHWs. Decision latitude, job demands, and social support play critical roles in shaping job stress among PHWs. Strategies and interventions are needed to mitigate job stress, improve working conditions, and enhance the effectiveness of PHWs in public health initiatives. This study highlights the importance of addressing job stress in this sector, with potential benefits for both the mental and physical health of PHW., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Abd Wahab et al.)

The quick advancement of digital technology through artificial intelligence has made it possible to deploy machine learning to predict stroke outcomes. Our aim is to examine the trend of machine learning applications in stroke-related research over the past 50 years. We used search terms stroke and machine learning to search for English versions of original and review articles and conference proceedings published over the past 50 years in Scopus and Web of Science databases. The Biblioshiny web application was utilized for the analysis. The trend of publication and prominent authors and journals were analyzed and identified. The collaborative network between countries was mapped, and a thematic map was used to monitor the authors' trending keywords. In total, 10,535 publications authored by 44,990 authors from 2,212 sources were retrieved. Two distinct clusters of collaborative network nodes were observed, with the United States serving as a connecting node. Three terms - deep learning, algorithms, and neural networks - are observed in the early stages of the emerging theme. Overall, international research collaborations, the establishment of global research initiatives, the development of computational science, and the availability of big data have facilitated the pervasive use of machine learning techniques in stroke research., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Che Nawi et al.)

Data on the prevalence and risk factors of low back pain (LBP) in Malaysia remain unclear as they are currently limited to specific settings and occupational groups. Therefore, this study aims to determine the prevalence and risk factors of low back pain in Malaysia. In this scoping review, we had systematically searched PubMed, Scopus, ScienceDirect and Google Scholar from January 2016 to April 2020. In addition, we had included cross-sectional studies on LBP in Malaysia. Studies without data on the prevalence and risk factors were excluded. The settings, population, design, sample size, evaluation methods, prevalence and risk factors of the studies were summarised. The literature search identified 435 potentially eligible studies; of these, 21 had met the inclusion criteria. The prevalence of LBP in Malaysia among various types of the population had ranged from 12.4% to 84.6%. Among the various types of occupation, the prevalence of LBP was the highest among nurses (67.9%), followed by drivers (65.7%). In addition, age, gender, body mass index (BMI), lifting heavy objects, working posture, lifestyle, working hours and mental health were identified as the risk factors of LBP in Malaysia. The current evidence suggests that LBP is a serious health problem among several occupational groups in Malaysia. Therefore, it is crucial to implement the correct interventions for the prevention of LBP among these groups., Competing Interests: Conflict of Interest None., (© Penerbit Universiti Sains Malaysia, 2023.)

The PREDICT breast cancer is a well-known online calculator to estimate survival probability. We developed a new prognostic model, myBeST, due to the PREDICT tool's limitations when applied to our patients. This study aims to compare the performance of the two models for women with breast cancer in Malaysia. A total of 532 stage I to III patient records who underwent surgical treatment were analysed. They were diagnosed between 2012 and 2016 in seven centres. We obtained baseline predictors and survival outcomes by reviewing patients' medical records. We compare PREDICT and myBeST tools' discriminant performance using receiver-operating characteristic (ROC) analysis. The five-year observed survival was 80.3% (95% CI: 77.0, 83.7). For this cohort, the median five-year survival probabilities estimated by PREDICT and myBeST were 85.8% and 82.6%, respectively. The area under the ROC curve for five-year survival by myBeST was 0.78 (95% CI: 0.73, 0.82) and for PREDICT was 0.75 (95% CI: 0.70, 0.80). Both tools show good performance, with myBeST marginally outperforms PREDICT discriminant performance. Thus, the new prognostic model is perhaps more suitable for women with breast cancer in Malaysia.

Introduction: Rabies post-exposure vaccination (Rabies PEV) remains the most fundamental prevention of human Rabies if administered in a timely and appropriate manner. The study was aimed to determine the proportion and determinants of non-compliance on Rabies PEV among dog bite patients in Perlis, Malaysia from July 2015 to June 2020., Methods: A retrospective cohort study was conducted using Perlis Rabid Potential Animal Bite Registry data. Independent variables and compliance status were obtained from the registry. Logistic regression analysis was utilized on 507 dog bite patients., Results: Most of dog bite patients were age group of 46-60 years old (23.1%), male (61.3%), Chinese (49.5%), seeking treatment less than 24 h after the exposure (78.3%), category two of exposure (76.3%) and bitten on lower extremities (57.8%) by an owned dog (58.4%). Only 19.5% were non-compliance to Rabies PEV. Siamese had significantly two-timed (AOR: 2.00; 95% CI 1.06, 3.76) odd higher to become non-compliance. Being bitten during 3rd (AOR: 0.27; 95% CI 0.12, 0.59), 4th (AOR: 0.24; 95% CI 0.11, 0.52) and 5th (AOR: 0.20; 95% CI 0.09, 0.44) year of the outbreak had significantly lower odds to non-comply with Rabies PEV., Conclusion: 19.5% of dog bite patients still did not comply with the Rabies PEV series. Siamese would likely to non-comply whereas bitten on the 3rd, 4th and 5th years of outbreak less tendency to non-comply. Continuous health promotion to the public in the various languages despite outbreak status are ongoing to improve the perception of risk and benefit toward compliance of Rabies PEV., (© 2023. The Author(s).)

Women with breast cancer are keen to know their predicted survival. We developed a new prognostic model for women with breast cancer in Malaysia. Using the model, this study aimed to design the user interface and develop the contents of a web-based prognostic tool for the care provider to convey survival estimates. We employed an iterative website development process which includes: (1) an initial development stage informed by reviewing existing tools and deliberation among breast surgeons and epidemiologists, (2) content validation and feedback by medical specialists, and (3) face validation and end-user feedback among medical officers. Several iterative prototypes were produced and improved based on the feedback. The experts (n = 8) highly agreed on the website content and predictors for survival with content validity indices ≥ 0.88. Users (n = 20) scored face validity indices of more than 0.90. They expressed favourable responses. The tool, named Malaysian Breast cancer Survival prognostic Tool (myBeST), is accessible online. The tool estimates an individualised five-year survival prediction probability. Accompanying contents were included to explain the tool's aim, target user, and development process. The tool could act as an additional tool to provide evidence-based and personalised breast cancer outcomes.

Employee performance in terms of knowledge of job scope, safe working practices, and safety-related attitude at work are used to measure an organization’s success in managing employee welfare and safety to prevent workplace injury and death. This study aims to determine the level of knowledge, attitude, and practice on safe working in confined space among water services workers. A cross-sectional study involving a randomly selected 207 water services workers working in a confined space was performed in the central region of Malaysia. The assessment was performed using a validated Malay self-administered questionnaire. Descriptive statistics, Chi-square test and Logistic regression were used for data analyses. The study’s participants were all men, with a mean (SD) age of 35.2 (8.83) years. The average working duration was 10.8 years. Overall, 67.1% of participants had good knowledge, while 65.7% had a positive attitude. The majority of the workers (60.4%) were found to follow safe working practices. Regression analysis revealed that significant predictors for knowledge were age [Adjusted odds ratio (Adj. OR) 2.793; 95% CI: 1.310, 5.955; p = 0.008] and attitude (Adj. OR 2.127; 95% CI: 1.011, 4.526; p = 0.048). Attitude was influenced by marital status (Adj. OR 4.126; 95% CI: 2.079, 8.186; p < 0.001) and knowledge level (Adj. OR 2.224; 95% CI: 1.025, 4.824; p = 0.043). A positive attitude was the sole predictor influencing the safe practice (Adj. OR; 1.878; 95% CI: 1.041, 3.388; p = 0.036). In conclusion, the workers’ levels of knowledge, attitudes, and practices were relatively satisfactory. Extensive investment in workplace safety and health programs, appropriate training, growth opportunities, and effective employee performance evaluation methodologies may assist workers in performing at their best.

Background: Patient safety involves identifying, assessing, and managing patient-related risks and occurrences to improve patient care and reduce patient harm. In Nigeria, there is a lack of studies on patient safety culture, especially in the northern part of the country. This study aimed to determine the levels and factors that contribute to nurses' negative perceptions of patient safety culture in public health facilities., Methodology: A total of 460 nurses were surveyed across 21 secondary health facilities using the Hospital Survey on Patient Safety Culture, and the response rate was 93.5%. Descriptive statistics and multiple logistic regression were used to analyze the data., Results: The results showed that 59.8% of the respondents were female, and 42.6% were within the age range of 30-39 years old. Most of them (48.3%) had spent 1-5 years working in the hospital. Three out of 12 composite measures had higher negative responses (staffing-30.5%, non-punitive response to error-42.8%, and frequency of events reported-43.1%). A multiple logistic regression analysis affirmed that all three variables, in addition to organizational learning, were significant associated with overall negative perceptions of patient safety culture, with 3.15, 1.84, 2.26, and 2.39 odds ratios, respectively., Conclusion: The results revealed that four critical areas of patient safety required improvement; therefore, intervention is recommended to minimize unnecessary patient harm and medical expenses.

Confined space workers do a wide range of tasks, many of which have a significant risk of hazardous exposure. Hence, a reliable and valid questionnaire is important in assessing the knowledge, attitude, and practice (KAP) of workers in this field. The present study was conducted to develop and validate a questionnaire that could assess the KAP for safe working in a confined space. The questionnaire went through a development and validation process. The development stage consisted of a literature review, expert's opinion, and evaluation by experts in the field via cognitive debriefing. The validation stage encompassed exploratory and confirmatory parts to investigate the psychometric properties of the questionnaire. A total of 350 participants were recruited among confined space workers from two oil and gas companies in Malaysia. The two-parameter logistic item response theory (2-PL IRT) analysis was used for the knowledge section. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used in the attitude and practice sections of the validation stage. The development stage resulted in 30 items for knowledge, attitude, and practice sections. Items in the knowledge section showed an acceptable difficulty and discrimination, as noted during the 2-PL IRT analysis. The EFA resulted in a one-factor model for attitude and practice sections, and contained 18 items, with factor loading > 0.4. The Cronbach's alpha was 0.804 and 0.917 for attitude and practice sections, respectively. The CFA for attitude and practice sections indicated a good model fitness (Raykov's rho = 0.814 and 0.912, respectively). All items indicated good reliability and valid psychometrics for determining KAP on safe working in a confined space.

Objective: Estimation of the net survival of breast cancer helps in assessing breast cancer burden at a population level. Thus, this study aims to estimate the net survival of breast cancer at different cancer staging and age at diagnosis in the east coast region of West Malaysia., Setting: Kelantan, Malaysia., Participants: All breast cancer cases diagnosed in 2007 and 2011 identified from Kelantan Cancer Registry., Design: This retrospective cohort study used a relative survival approach to estimate the net survival of patients with breast cancer. Thus, two data were needed; breast cancer data from Kelantan Cancer Registry and general population mortality data for Kelantan population., Primary and Secondary Outcome Measures: Net survival according to stage and age group at diagnosis at 1, 3 and 5 years following diagnosis., Results: The highest net survival was observed among stage I and II breast cancer cases, while the lowest net survival was observed among stage IV breast cancer cases. In term of age at diagnosis, breast cancer cases aged 65 and older had the best net survival compared with the other age groups., Conclusion: The age at diagnosis had a minimal impact on the net survival compared with the stage at diagnosis. The finding of this study is applicable to other populations with similar breast cancer profile., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Bladder cancer ranked ninth of principal male cancer in Malaysia. This study aimed to evaluate the clinical characteristics and survival of bladder cancer patients in Malaysia., Methods: A retrospective cohort study was conducted by obtaining records in the Malaysian National Cancer Registry. Patients aged 15 years old and above with diagnosis date between 2007 and 2011 were included. Death was updated until 31 December 2016. Five-year observed survival and median survival time were determined by the life table method and Kaplan-Meier estimate method., Results: Among 1828 cases, the mean (SD) age of diagnosis was 64.9 (12.5) years. The patients were predominantly men (78.7%), Malay ethnicity (49.4%) and transitional cell carcinoma (78.2%). Only 14.8% of patients were at stage I. The overall five-year observed survival and median survival time was 36.9% (95% CI: 34.6, 39.1) and 27.3 months (95% CI: 23.6, 31.0). The highest five-year observed survival recorded at stage I (67.6%, 95% CI: 62.0, 73.3) and markedly worsen at stage II (34.3%, 95% CI: 27.9, 40.8), III (25.7%, 95% CI: 18.7, 32.6) and IV (12.2%, 95% CI: 8.1, 16.3)., Conclusions: Survival of bladder cancer patients in Malaysia was lower with advancing stage. The cancer control programme should be enhanced to improve survival.

The implementation of Family Doctor Concept (FDC) to restructure the primary healthcare systems in Malaysia were expected to enhance patient's satisfaction on doctor-patient interaction and subsequently improved glycaemic control among Type 2 Diabetes Mellitus (T2DM) patients. Thus, this study aims to determine the difference in doctor-patient interaction satisfaction between T2DM patients attended FDC-implemented clinic vs non-FDC clinics, and to determine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. A cross-sectional study was conducted throughout 10 districts in Kelantan from February until May 2019 using interview-guided Skala Kepuasan Interaksi Perubatan-11 (SKIP-11) and proforma checklist. Data were analyzed using SPSS ver.24. Chi-square statistic used to determine the difference in doctor-patient interaction satisfaction between both clinics type. Multiple logistic regression used to examine the association between FDC-implemented clinic and doctor-patient interaction satisfaction towards glycaemic control. Twenty primary health clinics involved, and 772 T2DM patients recruited. FDC clinics attendees has higher proportion of satisfaction (40.1%) compared to non-FDC attendees (33.7%) ( p = 0.070). Multiple logistic regression confirmed the association of FDC-implemented health clinics (Adj. OR 1.63, p = 0.021), and doctor-patients interaction satisfaction (Adj. OR 1.77, p = 0.005) towards glycaemic control. Hence, strengthening of FDC in primary healthcare and improve the doctor-patient interaction satisfaction were essential to escalate good glycaemic control.

Background : Structured education is needed to cultivate safe sharp disposal behavior among diabetic patients. Thus, this study aimed to assess the effectiveness of the Diabetes Community Sharp Disposal Education Module in improving knowledge and sharp disposal practice among Malaysian Type 2 diabetic patients. Methods : This quasi-experimental study was conducted at primary health clinics in two districts in Kelantan, a state in the North-East Region of Peninsular Malaysia. A total of 132 Type 2 diabetic patients on insulin therapy were involved, with 68 participants in each control and intervention group. The health education intervention was based on the validated Diabetes Community Sharp Disposal Education Module. The knowledge and practices were measured using a validated questionnaire at baseline, one month, and three months after the intervention. Results : There was a significant increment in the mean knowledge score for intervention group; from baseline to one month follow up and from baseline to three months follow up [Greenhouse-Geisser; F(1.5, 199.7) = 62.38, p < 0.001; effect size (η 2 ) = 0.318]. Intervention group had significantly higher mean knowledge score as compared to control group; at one month and three months follow up [F(1, 134) = 17.38, p < 0.001; effect size (η 2 ) = 0.115]. There was a statistically significant increment in the proportion of participants in the intervention group who practiced the proper community sharp disposal method over time, X 2 (2) = 52.061, p < 0.001. Conclusions : The Diabetes Community Sharp Disposal Education Module was an effective health education tool to improve knowledge and encourage Malaysian diabetic patients to engage with proper sharp disposal practices.

Prompt investigation of food poisoning outbreak are essential, as it usually involves a short incubation period. Utilizing the advancement in mobile technology, a mobile application named MyMAFI (My Mobile Apps for Field Investigation) was developed with the aim to be an alternative and better tool for current practices of field investigation of food poisoning outbreak. A randomized cross-over trial with two arms and two treatment periods was conducted to assess the effectiveness of the newly developed mobile application as compared to the standard paper-based format approach. Thirty-six public health inspectors from all districts in Kelantan participated in this study and they were randomized into two equal sized groups. Group A started the trial as control group using the paper-format investigation form via simulated outbreaks and group B used the mobile application. After a one-month 'washout period', the group was crossed over. The primary outcome measured was the time taken to complete the outbreak investigation. The treatment effects, the period effects and the period-by-treatment interaction were analyzed using Pkcross command in Stata software. There was a significant treatment effect with mean square 21840.5 and its corresponding F statistic 4.47 ( p -value = 0.038), which indicated that the mobile application had significantly improve the reporting timeliness. The results also showed that there was a significant period effect ( p -value = 0.025); however, the treatment by period interaction was not significant ( p -value = 0.830). The newly developed mobile application-MyMAFI-can improve the timeliness in reporting for investigation of food poisoning outbreak.

Background: Type 2 diabetic patients are major users of medical sharps in the community. Proper sharp disposal practice among them, however, was reported to be low. The current study was aimed to determine the factors contributing to sharp waste disposal at a health care facility among Type 2 diabetic patients., Methods: In this cross-sectional study, Type 2 diabetic patients who were on insulin therapy attending health clinics were randomly selected and interviewed using a validated questionnaire. Binary logistic regression analysis was applied., Results: Out of 304 respondents, only 11.5% of them brought their used sharps to be disposed at health care facilities. Previous advice on sharp disposal from health care providers, knowledge score, and duration of diabetes were significant contributing factors for sharp waste disposal at health care facilities: (Adj. OR 6.31; 95% CI: 2.63, 15.12; p < 0.001), (Adj. OR 1.05; 95% CI: 1.03, 1.08; p < 0.001), and (Adj. OR 2.51; 95% CI: 1.06, 5.93; p = 0.036), respectively., Conclusion: Continuous education and a locally adapted safe sharp disposal option must be available to increase awareness and facilitate diabetic patients adopting proper sharp disposal behavior.

Background: Breast cancer is the most common malignant disease and the leading cause of cancer death among women globally. This study aimed to determine the median survival time and prognostic factors for breast cancer patients in a North-East State of Malaysia. Methods: This retrospective cohort study was conducted from January till April 2017 using secondary data obtained from the state’s cancer registry. All 549 cases of breast cancer diagnosed from 1st January 2007 until 31st December 2011 were selected and retrospectively followed-up until 31st December 2016. Sociodemographic and clinical information was collected to determine prognostic factors. Results: The average (SD) age at diagnosis was 50.4 (11.2) years, the majority of patients having Malay ethnicity (85.8%) and a histology of ductal carcinoma (81.5%). Median survival times for those presenting at stages III and IV were 50.8 (95% CI: 25.34, 76.19) and 6.9 (95% CI: 3.21, 10.61) months, respectively. Ethnicity (Adj. HR for Malay vs non-Malay ethnicity=2.52; 95% CI: 1.54, 4.13; p<0.001), stage at presentation (Adj. HR for Stage III vs Stage I=2.31; 95% CI: 1.57, 3.39; p<0.001 and Adj. HR for Stage IV vs Stage I=6.20; 95% CI: 4.45, 8.65; p<0.001), and history of surgical treatment (Adj. HR for patients with no surgical intervention=1.95; 95% CI: 1.52, 2.52; p<0.001) were observed to be the statistically significant prognostic factors associated with death caused by breast cancer. Conclusion: The median survival time among breast cancer patients in North-East State of Malaysia was short as compared to other studies. Primary and secondary prevention aimed at early diagnosis and surgical management of breast cancer, particularly among the Malay ethnic group, could improve treatment outcome., (Creative Commons Attribution License)