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Asthma exacerbations are among the commonest reasons for hospitalizations in Malaysian pilgrims during the Hajj. We interviewed 21 stakeholders involved in the pre-Hajj health examination at 14 primary care clinics, to explore their perceptions on barriers to and facilitators of asthma care for Hajj pilgrims. The disadvantages of the short time frame and centralized organization of the pre-Hajj health examinations were viewed as compromising clinicians’ level of competencies in asthma care, which could potentially be enhanced through more training, audit, and supervision by specialists. Longer time frame to permit sufficient disease control, provision of care by a dedicated asthma team, asthma registry to support continuous care, more resources of long-acting β-agonist/inhaled corticosteroid, and provision of influenza and pneumococcal vaccines at no cost were the perceived facilitators. Delivery of asthma education, especially the asthma action plan, should be tailored to the level of the pilgrim’s health literacy and facilitated by educational resources, family engagement, and regular health briefing.

Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia.We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data.Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues.This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study.Patients were involved in the study design, recruitment and analysis.

Shared decision making (SDM) activities in Malaysia began around 2010. The rise in the numbers of patients with chronic disease in Malaysia underscores a growing need for doctors to practice patient-centred care and SDM as more Malaysians come into regular contact with health decision-making scenarios. Recent guidelines for medical professionalism have emphasized that options and risks be discussed in consultations, especially for procedures with risk of adverse outcomes. Although SDM is not legally required, principles of SDM are applied in legal judgements on informed consent. Research on SDM has grown to include the adoption of patient and public involvement in research, an increased emphasis on incorporating local cultural values in SDM, and implementation of SDM in Malaysia's health system and organizational culture. While COVID-19 hindered the progress of SDM research, one positive development was that vaccination choices heightened public consciousness about personal decisional autonomy and the need to discuss pros and cons with doctors before making a medical decision.

Purpose: The goal of this study was to see how flipped learning affected nursing students in South Korea who were enrolled in a quit smoking intervention education program. The flipped learning-based quit smoking intervention education program was developed to help nursing students implement the intervention. Methods: This quasi-experimental study was conducted using a pretest-posttest design. A total of 52 nursing students, divided into experimental and control groups of 26 each, participated between November and December 2021. The experimental group was instructed in the flipped learning-based quit smoking intervention education program over six sessions. In accordance with flipped learning, each session was composed of pre-class, in-class, and post-class sections. Results: Compared to the control group, the experimental group showed improved beliefs about the health benefits of quitting smoking, as well as positive attitudes and self-efficacy from the quit smoking intervention. The experimental group experienced the greatest increase in student-centered activities and student participation through flipped learning. Conclusion: These results indicate that the flipped learning method was effective in quit smoking intervention education for nursing students. Therefore, it is worthwhile to consider that a quit smoking intervention education program based on flipped learning be included in the regular nursing curriculum.

Background This study aimed to evaluate the implementation of an insulin-choice PDA specifically measuring implementation outcomes.Methods A mixed-methods sequential explanatory design was used. The RE-AIM domains namely “Reach”, “Adoption”, “Implementation”, and “Maintenance” were used to guide evaluation.Results For ‘Reach’, 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors’ ‘Adoption’ of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of ‘Implementation’ of the PDA varied for different tasks (ranged from 19.2%-84.9%) and was challenged by patient and system barriers. For ‘Maintenance’, 80% of the doctors were willing to continue using the PDA due to its benefits.Conclusion This study highlighted that PDA implementation is promising. Addressing the issues of social hierarchy, and HCPs’ roles and responsibilities can further improve implementation outcomes.

Feed additives are essential in improving the growth and immunity of eels, which are often affected by nutritional and disease challenges. This study evaluated the effects of two dietary synbiotics in Japanese eel, Anguilla japonica: Bacillus subtilis with mannooligosaccharide (MOS) and Enterococcus faecium with fructooligosaccharide (FOS). Six diets, including a basal diet (CON), a 4 g kg− 1 oxytetracycline (OTC), and four synbiotic diets - B.subtilis at 1 × 106 and 107 CFU g− 1 plus 5 g kg− 1 MOS (BS6MO and BS7MO) and E. faecium at 1 × 106 and 107 CFU g− 1 plus 5 g kg− 1 FOS (EF6FO and EF7FO) - were prepared and fed to triplicate groups of 20 fish averaging 6.00 ± 0.07g (mean ± SD) for eight weeks. Weight gain (WG) and specific growth rate (SGR), and feed efficiency (FE) of fish fed B. subtilis plus MOS (BSMOS) diets were significantly higher than those of fish fed CON and OTC diets (p E. faecium plus FOS (EFFOS) diets. Best protein efficiency was achieved in fish fed the synbiotics diets (p Vibrio anguillarum. Since synbiotics are dose dependent, the synergetic efficiency of EFFOS is better at 107 CFU g− 1. These results suggest that BS7MO may be more effective as a synbiotic in Japanese eel diet than EFFOS diets. Our results showed that synbiotic diets could improve growth and immunity and be a sustainable alternative to antibiotics.

Asthma, a common chronic respiratory illness is mostly managed in primary care. We aimed to determine healthcare resources, organisational support, and doctors’ practice in managing asthma in a Malaysian primary care setting. A total of six public health clinics participated. We found four clinics had dedicated asthma services. There was only one clinic which had a tracing defaulter system. Long-term controller medications were available in all clinics, but not adequately provided. Resources, educational materials, and equipment for asthma management were present, though restricted in number and not placed in main locations of the clinic. To diagnose asthma, most doctors used clinical judgement and peak flow metre measurements with reversibility test. Although spirometry is recommended to diagnose asthma, it was less practiced, being inaccessible and unskilled in using as the main reasons. Most doctors reported providing asthma self-management; asthma action plan, but for only half of the patients that they encountered. In conclusion, there is still room for improvement in the provision of clinic resources and support for asthma care. Utilising peak flow metre measurement and reversibility test suggest practical alternative in low resource for spirometry. Reinforcing education on asthma action plan is vital to ensure optimal asthma care.

Introduction: This study aimed to determine the prevalence of suspected depression and its associated factors among patients with hypertension in a Malaysian primary care clinic. Methods: This cross-sectional study was conducted in a primary care clinic from 1 June to 31 August 2019 using the Patient Health Questionnaire-9. Results: The prevalence of suspected depression was 9.0%. The significant predictors of depression were Indian ethnicity (adjusted odd ratio [AOR]: 2.373; confidence interval [CI]: 1.147–4.907), divorce (AOR: 3.5; CI: 1.243–9.860), singleness (AOR: 2.241; CI: 1.182–4.251), heavy episodic drinking (AOR: 7.343; CI: 2.494–21.624), low physical activity level (AOR: 1.921; CI: 1.093–2.274), low fibre intake (AOR: 1.836; CI: 1.061–3.178), uncontrolled blood pressure (AOR: 1.800; CI: 1.134–2.858) and presence of hypertension complications (AOR: 3.263; CI: 2.053–5.185). Conclusion: Primary health care providers must screen for depression among patients with hypertension, particularly those within high-risk groups, and implement interventions that address modifiable risk factors.

Crassostrea gigas is a frequently studied species in understanding physiological processes in bivalves. Similar to other animals, oysters store glucose in the body as glycogen. Glycogen is known to supply energy for germ cell development and maintenance. Glycogen is synthesized by glycogen synthase. GSK3β regulates glycogen synthase activity and plays an important role in glycogen synthesis. Therefore, this study aims to examine the effect of GSK3β on the annual cycle of oysters and the glycogen synthesis pathway and to investigate the energy pathway in comparison with seasonal variation. Oysters were sampled monthly for one year and were subjected to glycogen content, RT-PCR, FISH, and western blot analysis. The year-round glycogen content significantly differs only in the mantle edge during spring and summer of both sexes but not in labial palp, digestive gland, gonad, and adductor muscle. The expression of GSK3β mRNA level was highest in October for females and April for males. Both sexes had the lowest expression in July. In the adductor muscle, females and males showed the highest expression in April and the lowest in July and October. The pattern of GSK3β expression in gonads and adductor muscle was similarly confirmed through FISH. As a result of examining the signaling system, p-GSK3β (serine 9) increased. At the same time, glycogen synthase decreased in May when the condition index was the highest, p-GSK3β decreased in October and July when spawning occurred, and glycogen synthase increased. Overall, it is thought that p-GSK3β expression is high in C. gigas at ripe, which inhibits glycogen synthesis and is used as energy for growth and maturation. Glycogen synthesis occurs for energy storage during degeneration.

Implementing asthma guideline recommendations is challenging in low- and middle-income countries. We aimed to explore healthcare provider (HCP) perspectives on the provision of recommended care. Twenty-six HCPs from six public primary care clinics in a semi-urban district of Malaysia were purposively sampled based on roles and experience. Focus group discussions were guided by a semi-structured interview guide and analysed thematically. HCPs had access to guidelines and training but highlighted multiple infrastructure-related challenges to implementing recommended care. Diagnosis and review of asthma control were hampered by limited access to spirometry and limited asthma control test (ACT) use, respectively. Treatment decisions were limited by poor availability of inhaled combination therapy (ICS/LABA) and free spacer devices. Imposed Ministry of Health programmes involving other non-communicable diseases were prioritised over asthma. Ministerial policies need practical resources and organisational support if quality improvement programmes are to facilitate better management of asthma in public primary care clinics.

We construct a consistent truncation of six-dimensional matter coupled $F(4)$ gauged supergravity on a cornucopia of two-dimensional surfaces including a spindle, disc, domain wall and other novel backgrounds to four-dimensional minimal gauged supergravity. Using our consistent truncation we uplift known AdS$_2\times {\Sigma}_1$ solutions giving rise to four-dimensional orbifold solutions, AdS$_2\times{\Sigma}_1\ltimes{\Sigma}_2$. We further uplift our solutions to massive type IIA supergravity by constructing the full uplift formulae for six-dimensional U$(1)^2$-gauged supergravity including all fields and arbitrary Romans mass and gauge coupling. The solutions we construct are naturally interpreted as the near-horizon geometries of asymptotically AdS$_6$ black holes with a four-dimensional orbifold horizon. Alternatively, one may view them as the holographic duals of superconformal quantum mechanical theories constructed by compactifying five-dimensional USp$(2N)$ theory living on a stack of D4-D8 branes on the four-dimensional orbifolds. As a first step to identifying these quantum mechanical theories we compute the Bekenstein--Hawking entropy holographically., Comment: v2: 49 pages, 3 figures, minor changes, published version

Background Primary healthcare workers (PHCWs) are at the frontline of dealing with viral pandemics. They may experience significant psychological stresses, which have hitherto not been examined in depth. We aimed to explore the impact of the COVID-19 pandemic on the psychological health and wellbeing of frontline PHCWs in Malaysia. Method We purposively recruited PHCWs with diverse backgrounds in Klang Valley, Malaysia. Using longitudinal qualitative methods, we conducted two sequential semi-structured telephone interviews, 3 to 4 weeks apart, to capture different stages of the pandemic. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Result Twenty-one PHCWs participated yielding a total of forty-two interviews. Themes clustered around stressors associated with work, home, and leisure activities, emotional changes, and modifying factors. In the first interviews, COVID-19 had just started in Malaysia. Participants expressed fear about the actual and perceived personal risk of COVID-19 infection. Most were worried about transmitting COVID-19 to their family members. Some felt stigmatized because of this perceived risk of infection. By the second interviews, participants felt safer, but instead focused on the need to keep other people safe. Participants’ emotions were influenced by their perceived risk of contracting COVID-19 infection. Internal factors such as religion enabled them to manage their concerns and develop personal coping strategies. Support from family members, colleagues, and employers promoted wellbeing during the pandemic. Training sessions, daily roll calls, and psychological support services were important in maintaining their psychological health and wellbeing. Many participants were hopeful and believed normalcy would return by the end of 2020. Conclusion PHCW’s psychological health and wellbeing evolved throughout the early stages of the pandemic and were influenced by their perceived risk of contracting the disease and personal belief structures. Clear updates on the disease and strategies for keeping safe at work and socially are essential to maintaining PHCWs’ psychological health and wellbeing.

BACKGROUND: Adjusting to life with a chronic condition is challenging, especially for people with limited health literacy, which is associated with low compliance with self-management activities and poor clinical outcomes.OBJECTIVE: We explored how people with limited health literacy understand asthma and undertake self-management practices.DESIGN: We adapted the arts-based qualitative methodology Photovoice.SETTING AND PARTICIPANTS: We sampled ethnically diverse adults with asthma and limited health literacy from four primary healthcare clinics in Malaysia. After a semistructured in-depth interview, a subset of participants took part in the Photovoice component in which participants undertook a 2-week photo-taking activity and subsequent photo-interview. Interviews, conducted in participants' preferred language, were audio-recorded, transcribed verbatim, translated and analysed thematically. We used the Sorensen's framework (Domains: access, understand, appraise, apply) to describe participants' experience of living with asthma, what they understood about asthma and how they decided on self-management practices.RESULTS: Twenty-six participants provided interviews; eight completed the Photovoice activities. Participants with limited health literacy used various sources to access information about asthma and self-management. Doctor-patient communication had a pivotal role in helping patients understand asthma. The lack of appraisal skills was significant and experiential knowledge influenced how they applied information. Self-management decisions were influenced by sociocultural norms/practices, stigmatizing experiences, and available social support.CONCLUSION: Locally tailored multilevel interventions (interpersonal, health system, community and policy) will be needed to support people with limited health literacy to live optimally with their asthma in an ethnically diverse population.PATIENT/PUBLIC CONTRIBUTION: Patients were involved in the study design, recruitment, analysis and dissemination.

Surgical plugging to treat superior semicircular canal dehiscence (SCD) has been proven to impede the effect of the third mobile window, abating cochleovestibular symptoms. Knowledge of superior semicircular canal (SC)-plugging status has been proposed to serve as a guide for adjuvant treatment. Here, we investigated disturbances in the inner ear fluid space following SC plugging using a novel three-dimensional (3D) reconstruction-based method. This approach used a semi-automatic segmentation algorithm and a direct volume rendering method derived from conventional magnetic resonance images. The variable extents of filling defects at the sites of SC plugging and the positional relation of the defect to the ampulla and common crus were identified. The success group exhibited markedly reduced volumes following surgery, whereas the failure group displayed no changes in volume. These results indicate that the success or failure of SC plugging was related to 3D volume changes in the labyrinth fluid signal. Collectively, this study presents individualized SC-plugging statuses using a novel 3D reconstruction-based method and it facilitates future work regarding easy-to-measure 3D volume changes. This current technology also aids in the exploration of pathologic changes in various targets of interest.

Thermal comfort of occupants in conventional vehicles driven by an internal combustion engine is controlled by heating, ventilation, and air conditioning (HVAC) system. However, the operation of a conventional HVAC system decreases the mileage of electric vehicle (EV) in the heating mode by nearly 50 %. Thus, local radiant heating was proposed as a heating strategy to reduce electric energy consumption while providing reasonable thermal comfort. In this work, we developed a personalized overall thermal sensation (OS) model using machine learning to evaluate the thermopsychological effect of local radiant heating and simulate the OS of occupants in EVs. Data were obtained from a real EV that went through a cold environmental chamber and were evaluated using random forest algorithm. By considering individual thermal preferences of occupants, we predicted the OS for each subject with higher accuracy by a factor of 2.6 compared with the prediction performed using the weighted average method. Total energy consumption was reduced by approximately 10 % in the EV equipped with local infrared radiant warmers while providing OS that was comparable with that of the HVAC system.

Supported self-management reduces asthma-related morbidity and mortality. This paper is on a feasibility study, and observing the change in clinical and cost outcomes of pictorial action plan use is part of assessing feasibility as it will help us decide on outcome measures for a fully powered RCT. We conducted a pre–post feasibility study among adults with physician-diagnosed asthma on inhaled corticosteroids at a public primary-care clinic in Malaysia. We adapted an existing pictorial asthma action plan. The primary outcome was asthma control, assessed at 1, 3 and 6 months. Secondary outcomes included reliever use, controller medication adherence, asthma exacerbations, emergency visits, hospitalisations, days lost from work/daily activities and action plan use. We estimated potential cost savings on asthma-related care following plan use. About 84% (n = 59/70) completed the 6-months follow-up. The proportion achieving good asthma control increased from 18 (30.4%) at baseline to 38 (64.4%) at 6-month follow-up. The proportion of at least one acute exacerbation (3 months: % difference −19.7; 95% CI −34.7 to −3.1; 6 months: % difference −20.3; 95% CI −5.8 to −3.2), one or more emergency visit (1 month: % difference −28.6; 95% CI −41.2 to −15.5; 3 months: % difference −18.0; 95% CI −32.2 to −3.0; 6 months: % difference −20.3; 95% CI −34.9 to −4.6), and one or more asthma admission (1 month: % difference −14.3; 95% CI −25.2 to −5.3; 6 months: % difference −11.9; 95% CI −23.2 to −1.8) improved over time. Estimated savings for the 59 patients at 6-months follow-up and for each patient over the 6 months were RM 15,866.22 (USD3755.36) and RM268.92 (USD63.65), respectively. Supported self-management with a pictorial asthma action plan was associated with an improvement in asthma control and potential cost savings in Malaysian primary-care patients.Trial registration number: ISRCTN87128530; prospectively registered: September 5, 2019, http://www.isrctn.com/ISRCTN87128530.

Introduction: It is common, and many international and local studies confirm this, that women of reproductive age misperceive their body-weight status. This phenomenon can lead to their being less likely to adopt a healthy lifestyle which later exposes them to increased health problems and risks including those of a gynecological and obstetric nature. Generally, there have been inconsistent findings concerning the association between the self-perceived weight status and sociodemographic factors, physical activities, and previous weight loss attempts of women of reproductive age in an Asian population like Malaysia. Objective: This study aimed to determine the factors associated with body weight status misperception among reproductive-aged women at a primary care setting in Malaysia. Methods: This is a cross-sectional study conducted at Klinik Kesihatan Durian Tunggal in 2016-2017. The questionnaire included questions on the perception of weight status, sociodemographic factors, smoking status, level of physical activity, and weight loss attempts. Logistic regressions were used for statistical analysis to examine the association between body weight status misperception and related factors. Results: The study recruited 630 reproductive-aged women. The mean age and SD of the respondents was 32.7 + 8.9 years, and 84% of the respondents were Malays. More than three-quarters of the respondents (75.5%, n = 476) had received up to a secondary level of education. The majority of the respondents were in the overweight/obese group (59.4%, n = 374). The mean BMI of the respondents was 27.1 kg/m2 + 6.61. Approximately 65.4% (n = 412) of the respondents had an inactive lifestyle. However, 60% (n = 378) of the respondents reported that they had attempted to reduce their weight in the last year. A total of 141 respondents (22.4%) misperceived their weight status with 113 (80.1% ) of them underestimating their weight status. Women with primary-level education (OR: 3.545, 95% CI: 1.530-8.215, p = 0.003) and secondary-level education (OR: 1.933, 95% CI: 1.065-3.510, p = 0.030) had a greater likelihood of misperceiving their body weight status as compared to those who have a tertiary level of education. Women with no weight loss attempts were also at risk of body weight status misperception (OR: 1.850, 95% CI: 1.195, 2.865, p = 0.006). Conclusion: Bodyweight status misperception among reproductive-aged women was associated with a low level of education and with those who had made no weight loss attempts. Identifying women who are at risk of misperceiving their weight status would enable early counseling on weight management.

AIMS: Classical guitarists may experience unique occupational health problems due to a constellation of biopsychosocial demands associated with the physical characteristics of the classical guitar, performance techniques, repertoire, and performance practices consistent with the classical music genre. Unfortunately, epidemiologic studies of classical guitarists are limited. The purpose of this study was to examine musculoskeletal and non-musculoskeletal problems in classical guitarists. METHODS: A sample of 190 classical guitarists completed a web-based survey. The survey assessed demographics, music-related variables, musician identity, non-musculoskeletal problems, and site-specific pain. Novel interactive body and hand maps were deployed to assess site-specific frequency, intensity, influence on playing, and quality of pain. RESULTS: A total of 168 subjects (88.9%) reported experiencing classical guitar-related pain in the past year at one or more musculoskeletal sites. The left thenar (25%) was the most prevalent pain site. Pain at the right upper back was reported to influence performance the most. Classical guitarists reported problems with non-musculoskeletal problems at rates similar or higher to other instrument-specific groups. CONCLUSION: Classical guitarists are an understudied group of musicians who experience occupational health problems. The novel assessment protocols developed for this study produced outcomes that may be helpful to both clinicians and pedagogues.

ObjectiveWe aimed to explore the views of Malaysian children with asthma and their parents to enhance understanding of early influences on development of self-management skills.DesignThis is a qualitative study conducted among children with asthma and their parents. We used purposive sampling and conducted focus groups and interviews using a semi-structured topic guide in the participants’ preferred language. All interviews were audio-recorded, transcribed verbatim, entered into NVivo and analysed using a grounded theory approach.SettingsWe identified children aged 7–12 years with parent-reported, physician-diagnosed asthma from seven suburban primary schools in Malaysia. Focus groups and interviews were conducted either at schools or a health centre.ResultsNinety-nine participants (46 caregivers, 53 children) contributed to 24 focus groups and 6 individual interviews. Children mirrored their parents’ management of asthma but, in parallel, learnt and gained confidence to independently self-manage asthma from their own experiences and self-experimentation. Increasing independence was more apparent in children aged 10 years and above. Cultural norms and beliefs influenced children’s independence to self-manage asthma either directly or indirectly through their social network. External influences, for example, support from school and healthcare, also played a role in the transition.ConclusionChildren learnt the skills to self-manage asthma as early as 7 years old with growing independence from the age of 10 years. Healthcare professionals should use child-centred approach and involve schools to facilitate asthma self-management and support a smooth transition to independent self-management.Trial registration numberMalaysian National Medical Research Register (NMRR-15-1242-26898).

There are several treatment options for localized prostate cancer with very similar outcome but vary in terms of technique and side effect profiles and risks. Considering the potential difficulty in choosing the best treatment, a patient decision aid (PDA) is used to help patients in their decision-making process. However, the use and applicability of PDA in a country in Asia Pacific region like Malaysia is still unknown. This study aims to evaluate the effectiveness of a PDA modified to the local context in improving patients’ knowledge, decisional conflict, and preparation for decision making among men with localized prostate cancer. Sixty patients with localized prostate cancer were randomly assigned to control and intervention groups. A self-administered questionnaire, which evaluate the knowledge on prostate cancer (23 items), decisional conflict (10 items) and preparation for decision-making (10 items), was given to all participants at pre- and post-intervention. Data were analyzed using independent T test and paired T test. The intervention group showed significant improvement in knowledge (p = 0.02) and decisional conflict (p = 0.01) from baseline. However, when compared between the control and intervention groups, there were no significant differences at baseline and post-intervention on knowledge, decisional conflict and preparation for decision-making. A PDA on treatment options of localized prostate cancer modified to the local context in an Asia Pacific country improved patients’ knowledge and decisional conflict but did not have significant impact on the preparation for decision-making. The study was also registered under the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12614000668606 registered on 25/06/2014.

Introduction: Diabetic Peripheral Neuropathy (DPN), the most common complication of Diabetes Mellitus (DM), is often under-diagnosed and inadequately treated. This study identified the proportion of undiagnosed DPN and its associated risk factors among patients with established type 2 DM (T2DM) in community health clinics in the Gombak district. Methods: A cross-sectional study was conducted in 2 community health clinics within the Gombak district between September and December 2017. Adults with T2DM were selected via systematic random sampling and screened using the Neuropathy Symptoms Score (NSS). Clinical records of participants’ foot examinations were reviewed to identify positive findings of DPN and compared with the NSS. Results: The study’s sample comprised 425 patients. Most had co-morbidities, including hypertension, dyslipidaemia and pre-existing DM-related complications. About two-thirds of them performed no daily foot inspection and had no proper footwear. The proportion of patients with positive NSS was 49.4%. However, only 0.2% were diagnosed with positive DPN in their clinical foot examination record. Conclusion: Although a positive NSS was identified in 1 out of 2 patients with established DM, only 0.2% of patients had DPN on their examination records. Most patients had never done daily foot inspections and lacked proper footwear. A positive NSS was associated with uncontrolled diabetes and lower BMI. Proper screening and examination for patients, especially those with uncontrolled diabetes and low BMI, is crucial in identifying DPN to ensure that these diabetic patients receive better preventative care, especially proper foot care and strict diabetic control, to prevent DPN-related complications.

Background: Asthma was one of the top causes of hospitalization and unscheduled medical attendances due to acute exacerbations and its complications. In Malaysia, all pilgrims must undergo a mandatory health examination and certified fit to perform pilgrimage. We studied the current organisational and clinical routines of Hajj health examination in Malaysia with a focus on the delivery of care for pilgrims with asthma.Methods: We conducted non-participant observation to obtain ethnographic understanding of Hajj health examination activities for 2019. Observations were guided by a checklist and recorded as notes that were analysed thematically. The study was conducted at 11 public (from each region in Malaysia, namely, North, South, East, West of Peninsular Malaysia, and Sabah and Sarawak of East Malaysia) and two private primary care clinics.Results: We observed considerable variation in the implementation and practice of Hajj health examinations among the 11 public clinics but no marked variation among the private clinics. The short time span of between three to four months was inadequate for disease control measures and had put pressure on health care providers. They mostly viewed the Hajj health examination as merely a certification of fitness to perform the pilgrimage, though respiratory health assessment was often inadequate. The opportunity to optimise the health of pilgrims with asthma by providing the appropriate medications, asthma action plan and asthma education including the preventive measures was disregarded. The preliminary health screening, which aimed to optimise pilgrims' health before the actual Hajj health examination was not appreciated by either pilgrims or health care providers.Conclusions: There is great potential to reform the current system of Hajj health certification in order to optimise its potential benefits for pilgrims with asthma. A systematic approach to restructuring the delivery of Hajj health examination could address the time constraints, clinical competency of primary health care providers and resources limitations.

Despite the advancements made in the knowledge and treatment of the human immunodeficiency virus (HIV) since it was first discovered, people living with HIV (PLWH) continue to be stigmatized. This paper presents the case of an HIV-infected patient who delayed the necessary treatment due to stigma and ultimately presented with AIDS. Through social support, however, he was able to overcome his internalized stigma; he was finally willing to start on antiretroviral treatment (ART). This case report addresses the effect of stigma on and the role of social support in the management of an individual with HIV.

Background This study was initiated to examine the psychometric components of the Diabetes Empowerment Scale (DES) by translating and validating the scale into the Malay language (DES-M) which is the main language spoken in Malaysia. This study can determine the level of empowerment among diabetic patients towards diabetes management. In addition, the reliability and validity of the DES-M was also demonstrated. Methods A total of 151 patients with type 2 diabetes mellitus were recruited (between June 2016 and October 2016) to complete sets of questionnaires, which were DES-M, the Malay versions of the Diabetes Quality of Life (DQOL) for Adults and Summary of Diabetes Self Care Activities Questionnaire (SDSCA). Confirmatory and Exploratory factor analysis (CFA and EFA) were carried out to determine the factor structures of the DES-M. Results There were 100 males and 51 females with ages ranging from 19 to 81 years old (55 ± 13) included in this study. The instrument displayed good internal consistency (Cronbach’s α =0.920) and the respective coefficients ranged from 0.65–0.84. Discriminant validity showed adequate correlations ranged from 0.257–0.744. Concurrent validity with SDSCA (Pearson’s correlation = 0.313, p = 0.012). Predictive validity with DQOL (B = 0.27, p = 0.016). CFA indicated that four factor model of the DES-M has good fit to the data. Conclusion This study indicates that the DES-M has a good internal consistency and validity. Therefore, it is a valid and reliable instrument for assessing empowerment score among patients with diabetes in Malaysia. Trial registration NMRR-16-805-30503 (IIR).

In the global effort to reduce CO2 emissions and mitigate climate change, there is significant interest in replacing internal combustion engine vehicles with electric vehicles. Furthermore, the use of radiant heaters rather than conventional air conditioning systems may reduce the energy consumption in electric vehicles. In this work, a thermal physiology model that includes the effect of local radiant heaters was developed to predict the temperature change in a human body in a cold or warm environment. The developed model indicated an increase in the mean skin temperature when radiant heaters were used in a cold environment. Local and overall thermal sensation and thermal comfort predicted from simulation showed an escalation in the sensation and comfort, thereby suggesting an improvement in passenger comfort with the addition of local radiant heaters. This study might contribute to effective energy saving strategies and passenger comfort in electric vehicles.

With increasing demand for wearable electronic devices, strain sensor development with a high stretchability becomes quite critical. To develop a high performance stretchable strain sensor, we used nylon textile obtained from commercial thigh-highs as substrate for coating single-walled CNT (SWNT). Using vacuum-assisted spray-layer-bylayer technique, SWNTs were uniformly coated on the surface of textile fibers. Our SWNT/nylon textile sensor exhibited high sensitivity of 72 gauge factor at 100% strain, fast response, and excellent durability. In addition, the sensors were used for human motion detection by attaching to glove and sewing with leggings. We have a great expectation that high stretchability, sensitivity, and durability of this SWNT/nylon textile strain sensor, with its simple integration to clothing, opens up new opportunities for fabrication of high performance wearable strain sensor.

Much has been claimed on the health benefits of alkaline water including metabolic syndrome (MetS) and its features with scarcity of scientific evidence. Methods: This cross-sectional comparative study was conducted to determine whether regular consumption of alkaline water confers health advantage on blood metabolites, anthropometric measures, sleep quality and muscle strength among postmenopausal women. A total of 304 community-dwelling postmenopausal women were recruited with comparable proportion of regular drinkers of alkaline water and non-drinkers. Participants were ascertained on dietary intake, lifestyle factors, anthropometric and biochemical measurements. Diagnosis of MetS was made according to Joint Interim Statement definition. A total of 47.7% of the participants met MS criteria, with a significant lower proportion of MetS among the alkaline water drinkers. The observed lower fasting plasma glucose (F(1,294) = 24.20, p = 0.025, partial η2 = 0.435), triglyceride/high-density lipoprotein concentration ratio (F(1,294) = 21.06, p = 0.023, partial η2 = 0.360), diastolic blood pressure (F(1,294) = 7.85, p = 0.046, partial η2 = 0.258) and waist circumference (F(1,294) = 9.261, p = 0.038, partial η2 = 0.263) in the alkaline water drinkers could be considered as favourable outcomes of regular consumption of alkaline water. In addition, water alkalization improved duration of sleep (F(1,294) = 32.05, p = 0.007, partial η2 = 0.451) and handgrip strength F(1,294) = 27.51, p = 0.011, partial η2 = 0.448). Low density lipoprotein cholesterol concentration (F(1,294) = 1.772, p = 0.287, partial η2 = 0.014), body weight (F(1,294) = 1.985, p = 0.145, partial η2 = 0.013) and systolic blood pressure (F(1,294) = 1.656, p = 0.301, partial η2 = 0.010) were comparable between the two different water drinking behaviours. In conclusion, drinking adequate of water is paramount for public health with access to good quality drinking water remains a critical issue. While consumption of alkaline water may be considered as a source of easy-to implement lifestyle to modulate metabolic features, sleep duration and muscle strength, further studies are warranted for unravelling the precise mechanism of alkaline water consumption on the improvement and prevention of MetS and its individual features, muscle strength and sleep duration as well as identification of full spectrum of individuals that could benefit from its consumption.