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Context: Handling of electronic and electrical waste (E-waste) has adverse effects on the environment and human well-being. To address the environmental and health risks arising from improper e-waste disposal, it is crucial to foster responsible practices and enhance understanding of e-waste management. Aims: This study aimed to assess the knowledge, awareness, and practice of e-waste management and association of these factors with demographic variables among undergraduate medical students. Settings and Design: A cross-sectional study was conducted at a private medical university among medical students in Malaysia. Subjects and Methods: The selection of participants was done using purposeful sampling, and the questionnaire was distributed in the form of an online survey using Google Forms. Statistical Analysis Used: Chi-square test and multivariable logistic regression were calculated. Results: Out of the 135 medical students surveyed, 39.3% demonstrated a good knowledge and 27.4% displayed a good awareness. In terms of practice, 67.4% of respondents appropriately disposed of electronic gadgets, whereas 41.5% properly disposed of electrical appliances. Notably, no statistically significant associations were found between demographic characteristics and the knowledge, awareness, and practice in e-waste management among the participants. Conclusions: Our research emphasizes the insufficient knowledge, awareness, and inadequate implementation of proper practices concerning e-waste management among medical students. Fostering a supportive environment and emphasizing collaborative efforts are crucial steps that empower medical students to actively participate in and contribute to responsible electronic waste practices. This approach enables students to be proactive agents in promoting a greener and more environmentally conscious approach to electronic waste.

Introduction: The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence. Methods: This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28). Results: A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P

Background: Neglected tropical diseases (NTDs) usually affect the population living in poverty, especially in low- and middle-income countries located in tropical and subtropical regions. This study aimed to assess the awareness of NTDs and willingness to participate in prevention and control measures and their associated factors among healthcare students in Asian countries. Methods: This cross-sectional study was conducted by recruiting healthcare students from Asia mainly Bangladesh, India, Indonesia, Malaysia, and Syria. Data was collected via online Google form and analyzed in both descriptive and general linear model by using Statistical Package for the Social Sciences (SPSS). Results: A total of 1115 respondents participated; among them, 66.1% were medical and the majority (>70%) of the respondents revealed their willingness to participate in the prevention and control programmes. Being a medical student (B = 2.00, P

Context: Good health and well-being for all constitute the third sustainable development goal established by the United Nations which aims to ensure healthy lives and promote well-being for everyone at all ages. However, health disparities are a rampant yet often neglected issue in many nations across the world. Aims: We aimed to determine medical students’ self-perceived knowledge and attitude toward health disparities as well as the association among gender, ethnicity, family income, and self-perceived health disparities. Settings and Design: A cross-sectional study was conducted among medical students of private medical university in Malaysia. Materials and Methods: Online questionnaire was distributed. A total of 123 students participated. Statistical analysis used: Chi-Squared test and Fisher exact test were calculated. Results: 60.97% of the medical students agreed that they would be able to demonstrate empathy toward multiple difficulties faced by patients from underserved populations. There were significant associations between students’ family income and medical students’ comfort of addressing health issues in six underserved populations such as immigrants and refugees (P = 0.005), lesbian, gay, bisexual, transgender, and queer community (P = 0.001), homeless (P = 0.018), incarcerated individuals (P = 0.003), those who are mentally ill or those with substance abuse (P < 0.001), and veterans (P = 0.029). Conclusions: Most of the students had adequate knowledge, positive attitudes, and a good holistic self-perception toward health disparities. We recommended medical institutes to provide learning environments for student to be exposed to underserved populations which will help to strengthen students’ attitudes and commitment to underserved communities.

Objective: To determine the frequency and severity of the breakthrough infections and the associated factors in Malaysia. Methods: This cross-sectional study was conducted among the adult general population in Malaysia who completed at least one dose of vaccination. The validated online questionnaires were used for data collection between December 2022 to February 2023. The participants were recruited by a convenient sampling method. The data were analysed by descriptive statistics, and logistic regression by using SPSS (Version 27). Qualitative data from open-ended questions were analysed as thematic analysis by using RQDA software. Results: A total of 524 participants' data were analyzed and 77.5% of them completed three doses of COVID-19 vaccination. Breakthrough infections after vaccination were reported in 57.3% of the participants. Age group of 18 and 30 years (aOR 2.32, 95% CI 1.01-5.32) and other ethnicities (aOR 2.00, 95% CI 1.02-3.93) significantly associated with the occurrence of breakthrough infections. A total of 35.5% of the participants were not willing to take another booster dose in the future because of their attitudes towards fear of long-term side effects, lack of trust to the vaccine, less susceptibility to severe infection, belief in natural immunity, and myths. Conclusions: Future public health policies and interventions should be focused on disseminating the information about safety of booster doses of vaccine, management and re-assurance of side effects, and targeted vaccination to the working (younger age group) and ethnic minorities.

Background: The coronavirus pandemic (COVID-19) has a social and psychological impact among healthcare workers worldwide and appropriate coping strategies are essential to avoid the negative mental health effects. This study aimed to investigate the coping strategies among the healthcare workers from different countries and their attitude towards teamwork during the COVID-19 pandemic. Methods: A cross-sectional study was conducted by using an online, web-based questionnaire, which was distributed to healthcare workers from 32 countries during April and May 2020. The respondents were recruited by the non-random convenience sampling method. Results: A total of 2166 respondents responded to the survey and the majority were working in low- and middle-income countries. Among them, 36% were doctors, 24% were nurses and 40% worked in other healthcare sectors. More than 70% of the respondents answered that “getting family support” and “positive thinking” were coping methods for them during the COVID-19 pandemic. Approximately half of the respondents worshiped according to their belief and conducted prayers (58.4%) and had adequate sleep and food intake (48.2%). The significant associations were observed between attitude score towards interprofessional teamwork and gender (p = 0.009), age (31–45 years) (p

BackgroundHepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar.MethodsA mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research.Results46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization.ConclusionA community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.

Background: Disease surveillance is one of the major components to combat against infectious diseases. As health-care professionals are indispensable to mandatory notifiable disease surveillance, their knowledge and attitudes toward infectious disease notification played an important role for timely and effective reporting to the surveillance system. Therefore, we aimed to determine the knowledge of mandatory notifiable infectious diseases in Malaysia and attitude towards infectious disease reporting among final year medical students. Methods: A cross-sectional study was conducted from May to June 2017 in the private medical college in Malaysia. Materials and Methods: We purposively selected the final year (semester 10) medical students and a total of 124 students participated in this study. We collected data using a self-administered, structured questionnaire. Data were analyzed using descriptive statistics, independent t-test, and one-way analysis of variance. Results: Among the final year medical students, 47.5% had moderate knowledge but 4.2% had good knowledge of mandatory infectious disease notification. Only 3.2% of the students correctly answered all the notifiable diseases listed in the questionnaire. Most of the students had positive attitude toward communicable diseases reporting, rewards, and penalty for notification. There was no significant relationship between sociodemographic characteristics and knowledge and attitude of infectious disease notification. Conclusions: The majority of the final year medical students had moderate level of knowledge and positive attitude of infectious disease notification; however, there were some deficiencies. Better instruction and training on infectious disease notification procedures of Malaysia should be provided to the final year medical students which could not only reduce underreporting but also improve timely and effective reporting in future.

Abstract Humans and dogs are the two major hosts of Strongyloides stercoralis, an intestinal parasitic nematode. To better understand the phylogenetic relationships among S. stercoralis isolates infecting humans and dogs and to assess the zoonotic potential of this parasite, we analyzed mitochondrial Cox1, nuclear 18S rDNA, 28S rDNA, and a major sperm protein domain-containing protein genes. Overall, our analyses indicated the presence of two distinct lineages of S. stercoralis (referred to as type A and type B). While type A parasites were isolated both from humans and dogs in different countries, type B parasites were found exclusively in dogs, indicating that the type B has not adapted to infect humans. These epidemiological data, together with the close phylogenetic relationship of S. stercoralis with S. procyonis, a Strongyloides parasite of raccoons, possibly indicates that S. stercoralis originally evolved as a canid parasite, and later spread into humans. The inability to infect humans might be an ancestral character of this species and the type B might be surmised to be an origin population from which human-infecting strains are derived.

INTRODUCTION: Family planning and contraception is the effective strategy to reduce maternal mortality, child mortality, abortion, and unwanted pregnancies. Since the medical students are the future doctors, it is important to have proper knowledge and training on family planning services. This study aimed to explore the effect of teaching-learning process at maternal and child health (MCH) clinics on the students' knowledge, perceptions toward contraception methods, and family planning counselling. METHODS: This quasi-experimental study was conducted in the private medical institution in Malaysia. The same questionnaire was used to administer twice, before and after the posting. Moreover, a qualitative question on the issues related to family planning and contraception utilizations in Malaysia was added to the after posting survey. The quantitative data were analyzed using IBM SPSS (version 20) and qualitative data by RQDA software. RESULTS: A total of 146 participants were recruited in this study. Knowledge on contraception method before posting was 5.11 (standard deviation [SD] ±1.36) and after posting was 6.35 (SD ± 1.38) (P < 0.001). Thematic analysis of the students' answer revealed four salient themes, which were as follows: (1) cultural barrier, (2) misconception, (3) inadequate knowledge, and (4) improvement for the health-care services. CONCLUSIONS: The teaching-learning process at the MCH posting has an influence on their perception and upgraded their knowledge. It also reflects the role of primary health-care clinics on medical students' clinical exposure and training on family planning services during their postings.

Context: Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community. Aims: The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia. Settings and Design: This was qualitative study. Subjects and Methods: This qualitative study used the data of the students' reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software. Statistical Analysis Used: Thematic analysis. Results: Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning. Conclusions: To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.

Objectives: To explore the client perspectives of “individualfinancing” at private hospital and government hospital undercommunity cost-sharing scheme.Materials and Methods: A cross sectional study was done in agovernment hospital, namely Yangon General Hospital andBosi private hospital in Yangon, Myanmar. All the new patientsundergoing surgical operations/ procedures were approachedfor their potential participation in the study. A consent wastaken from those willing to participate in this study. A total of83 surgical cases, (35 from private and 48 from governmenthospital) were interviewed using a structured Data collectionform. Quantitative analyses were done for the structuredquestions and qualitative analysis was made for the openended questions. Chi square test was applied to see thestatistical differences in socio demographic characteristics ofYangon General Hospital and Bosi Hospital. P value of 0.05 wasset at 95% confident level.Results: findings of the current study demonstrated that thepatients with High family income (P=>0.001) were more likelyto use the private hospital compare to low family incomegroup. The main reasons behind choosing the private hospitalwere better accommodation, shorter waiting time, andminimum restriction of visiting hours and perceived lackof free services at government hospital. However, thoseattending the public hospital have justified it by statingthat they are familiar with the government hospital andthe services in private hospitals are expensive. For thepatient from the low income group the hospitalexpenditure were managed with family’s monthlyincome, support from non-family members and somesecured the payment with borrowed money or by sellingthe personal assets.Conclusion: It is seen that the socioeconomic status ofthe patients was the main factors responsible for theselection of the hospitals. Those with low income statusprefer public hospitals because of low cost on the medicalservices.

Abstract Fundamento: The role of papillary muscle function in severe mitral regurgitation with preserved and reduced left ventricular ejection fraction and the method of choice to evaluate PM have still been the subjects of controversy. Objectives: To evaluate and compare papillary muscle function in and between patients with severe degenerative and functional mitral regurgitation by using the free strain method. Methods: 64 patients with severe mitral regurgitation - 39 patients with degenerative mitral regurgitation (DMR group) and 25 patients with severe functional mitral regurgitation (FMR group) - and 30 control subjects (control group) were included in the study. Papillary muscle function was evaluated through the free strain method from apical four chamber images of the anterolateral papillary muscle (APM) and from apical three chamber images of the posteromedial papillary muscle (PPM). Global left ventricular longitudinal and circumferential strains were evaluated by applying 2D speckle tracking imaging. Results: Global left ventricular longitudinal strain (DMR group, -17 [-14.2/-20]; FMR group, -9 [-7/-10.7]; control group, -20 [-18/-21] p < 0.001), global left ventricular circumferential strain (DMR group, -20 [-14.5/-22.7]; FMR group, -10 [-7/-12]; control group, -23 [-21/-27.5] p < 0.001) and papillary musle strains (PPMS; DMR group, -30.5 [-24/-46.7]; FMR group, -18 [-12/-30]; control group; -43 [-34.5/-39.5] p < 0.001; APMS; DMR group, (-35 [-23.5/-43]; FMR group, -20 [-13.5/-26]; control group, -40 [-32.5/-48] p < 0.001) were significantly different among all groups. APMS and PPMS were highly correlated with LVEF (p < 0.001, p < 0.001; respectively), GLS (p < 0.001, p < 0.001; respectively) and GCS (p < 0.001, p < 0.00; respectively) of LV among all groups. No correlation was found between papillary muscle strains and effective orifice area (EOA) in both groups of severe mitral regurgitation. Conclusions: Measuring papillary muscle longitudinal strain by the free strain method is practical and applicable. Papillary muscle dysfunction plays a small role in severe MR due to degenerative or functional causes and papillary muscle functions in general seems to follow left ventricular function. PPM is the most affected PM in severe mitral regurgitation in both groups of DMR and FMR.

Introduction: The burden of cardiovascular disease and early morbidity and mortality is exacerbated by hypertension. According to the 2019 National Health and Morbidity Survey, 30% of adults in Malaysia aged over 18 years had hypertension. Our study aimed to investigate the association between medication adherence and blood pressure control and the factors associated with antihypertensive medication adherence. Methods: This cross-sectional study was conducted among adult patients with hypertension who had been under treatment at public primary health clinics in the Melaka Tengah District. A self-administered questionnaire was used, and blood pressure was measured. Descriptive and multivariate logistic regression analyses were conducted using the Statistical Package for the Social Sciences (version 28). Results: A total of 1531 patients were recruited in this study. Among them, 74.1% had good antihypertensive medication adherence, and 51.4% had their blood pressure controlled. Medication adherence was significantly associated with blood pressure control (P<0.005). The multivariate analysis showed that the determinants for antihypertensive medication non-adherence were Malay ethnicity, secondary education, farther distance from the clinic, experience of side effects of antihypertensive medications, concern about long-term side effects and usage of alternative medicine (P<0.05). Taking multiple antihypertensive medications was the only factor associated with uncontrolled blood pressure (P<0.05). Conclusion: Addressing issues on medication adherence is important to ensure blood pressure control. The factors associated with non-adherence should be closely monitored to improve blood pressure control and prevent adverse health outcomes. Single-pill combination antihypertensive medications are encouraged to reduce pill burden and improve blood pressure control. [ABSTRACT FROM AUTHOR]

Introduction: Dengue is a globally prevalent mosquito-borne disease that has been endemic in Malaysia since the 1980s. Despite significant government efforts, dengue cases continue to rise. To combat this trend, fostering positive perceptions, attitudes, and practices is essential. This study aims to assess the perceptions and attitudes of undergraduate medical students in Malaysia regarding dengue prevention activities and their responses to early warnings. Methods: Participants were given online questionnaires constructed in English. Statistical tests (Unpaired t-test and chi square test) were done using Epi Info software (version 7.2.2.6). Results: Almost 100% of the students are aware of dengue fever, and 96.2% believe that it can cause mortality. Additionally, 79.5% reported having sufficient knowledge to prevent dengue infection. Furthermore, 99.4% think that an early warning system is a useful tool for the community to take preventive measures to avoid potential infection in a timely manner. However, only 23.7% of the participants checked the current dengue hotspot in their area. Regarding early warning about dengue, 95.6% reported that they would help convey this information to others, 81.4% reported that they would avoid outdoor activities, and 82.7% reported that chemical fogging is necessary. Conclusion: Most participants demonstrated a positive perception, attitude, and response regarding dengue infection and early warning systems. The study found a significant association between the participants' phases of study and their perceptions of dengue. Overall, medical students showed a favorable outlook toward dengue infection, a positive attitude toward the early warning system, and an appropriate response to it. [ABSTRACT FROM AUTHOR]

Context: Handling of electronic and electrical waste (E-waste) has adverse effects on the environment and human well-being. To address the environmental and health risks arising from improper e-waste disposal, it is crucial to foster responsible practices and enhance understanding of e-waste management. Aims: This study aimed to assess the knowledge, awareness, and practice of e-waste management and association of these factors with demographic variables among undergraduate medical students. Settings and Design: A cross-sectional study was conducted at a private medical university among medical students in Malaysia. Subjects and Methods: The selection of participants was done using purposeful sampling, and the questionnaire was distributed in the form of an online survey using Google Forms. Statistical Analysis Used: Chi-square test and multivariable logistic regression were calculated. Results: Out of the 135 medical students surveyed, 39.3% demonstrated a good knowledge and 27.4% displayed a good awareness. In terms of practice, 67.4% of respondents appropriately disposed of electronic gadgets, whereas 41.5% properly disposed of electrical appliances. Notably, no statistically significant associations were found between demographic characteristics and the knowledge, awareness, and practice in e-waste management among the participants. Conclusions: Our research emphasizes the insufficient knowledge, awareness, and inadequate implementation of proper practices concerning e-waste management among medical students. Fostering a supportive environment and emphasizing collaborative efforts are crucial steps that empower medical students to actively participate in and contribute to responsible electronic waste practices. This approach enables students to be proactive agents in promoting a greener and more environmentally conscious approach to electronic waste. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, regular teaching-learning activities have been replaced with online education strategies. This study aimed to explore undergraduate medical students' experiences in conducting research projects during the COVID-19 pandemic in Malaysia. In the study institution, undergraduate medical students had a rotation at the community medicine posting during their Semesters 6 and 7, and they needed to conduct health research projects. Upon completion of the posting, students were asked to reflect on their project using Gibbs' reflective cycle. The inclusion criteria were reflective writings of undergraduate medical students in the study institution, who conducted online research projects during the COVID-19 pandemic. The secondary qualitative data from the reflections of 40 students were included until the data were saturated and analysed with thematic analysis. The R-based Qualitative Data Analysis (RQDA) software was used for data analysis. Seven salient themes emerged from the qualitative reflections: (a) sudden changes due to the COVID-19 pandemic, (b) challenges, (c) feelings of students, (d) support, (e) adaptation to the online learning process, (f) perceived benefits of online research projects, and (g) self-reflection and way forward. Although there were various challenges, the students were able to overcome and develop adaptation to conduct health research projects. The educational sector should provide support to students in terms of technology and clear guidance on the project process and encourage communication and teamwork to overcome challenges. From a positive perspective, the COVID-19 pandemic situation could have a beneficial impact on implementing e-learning and conducting online surveys and research projects. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency and severity of the breakthrough infections and the associated factors in Malaysia. Methods: This cross-sectional study was conducted among the adult general population in Malaysia who completed at least one dose of vaccination. The validated online questionnaires were used for data collection between December 2022 to February 2023. The participants were recruited by a convenient sampling method. The data were analysed by descriptive statistics, and logistic regression by using SPSS (Version 27). Qualitative data from open-ended questions were analysed as thematic analysis by using RQDA software. Results: A total of 524 participants' data were analyzed and 77.5% of them completed three doses of COVID-19 vaccination. Breakthrough infections after vaccination were reported in 57.3% of the participants. Age group of 18 and 30 years (aOR 2.32, 95% CI 1.01-5.32) and other ethnicities (aOR 2.00, 95% CI 1.02-3.93) significantly associated with the occurrence of breakthrough infections. A total of 35.5% of the participants were not willing to take another booster dose in the future because of their attitudes towards fear of long-term side effects, lack of trust to the vaccine, less susceptibility to severe infection, belief in natural immunity, and myths. Conclusions: Future public health policies and interventions should be focused on disseminating the information about safety of booster doses of vaccine, management and re-assurance of side effects, and targeted vaccination to the working (younger age group) and ethnic minorities. [ABSTRACT FROM AUTHOR]