Two hundred and seventy one original published materials related to tobacco use were found in a search through a database dedicated to indexing all original data relevant to Medicine and Health in Malaysia from 1996 - 2015. A total of 147 papers were selected and reviewed on the basis of their relevance and implications for future research. Findings were summarised, categorised and presented according to epidemiology, behaviour, clinical features and management of smoking. Most studies are cross-sectional with small sample sizes. Studies on smoking initiation and prevalence showed mixed findings with many small scale studies within the sub-groups. The majority of the studies were related to factors that contribute to initiation in adolescents. Nonetheless, there are limited studies on intervention strategies to curb smoking among this group. There is a lack of clinical studies to analyse tobacco use and major health problems in Malaysia. In addition, studies on the best treatment modalities on the use of pharmacotherapy and behavioural counselling have also remained unexplored. Reasons why smokers do not seek clinic help to quit smoking need further exploration. A finding on the extent of effort carried out by healthcare providers in assisting smokers to make quit attempts is not known. Studies on economic and government initiatives on policies and tobacco use focus mainly on the effects of cigarette bans, increased cigarettes taxes and the influence of the tobacco industry. Recommendations are given for the government to increase efforts in implementing smoke-free legislation, early and tailored interventions. Clinical studies in this area are lacking, as are opportunities to research on ways to reduce smoking initiation age and the most effective quit smoking strategies.
Smoking ; Tobacco Use

Burnout and psychological distress were reported at higher rates among hospital healthcare workers. Despite this, there is a paucity of research examining the associated risk factors among workers across specialties and occupations in Asia. This paper aimed to examine the risk factors associated with burnout and psychological distress among Malaysian hospital healthcare workers from diverse medical specialties and occupations. A total of 368 doctors, nurses, assistant medical officers and hospital attendants were recruited from major medical and surgery departments in an urban general hospital. The participants were self-administered a questionnaire consisting of demographic information, Maslach Burnout Inventory-Human Services Survey and Depression Anxiety and Stress Scale. In the fully adjusted multivariate analyses, doctors were about four to five times more likely to be emotionally exhausted (aOR [adjusted Odds Ratio], 4.826; 95% CI [Confidence Interval]: 1.492-15.604, p<0.01), depressed (aOR, 5.221; 95% CI: 1.995-13.661, p<0.01) and stressed (aOR, 3.990; 95% CI: 1.473-10.809, p<0.01). Paediatric workers demonstrated three to five times higher risks of depression (aOR, 3.105, 95% CI: 1.043-9.243, p<0.05), anxiety (aOR, 3.517, 95% CI: 1.194- 10.356, p<0.05) and stress (aOR, 5.404, 95% CI: .1.628-17.942, p<0.01). Emotional exhaustion (aOR, 1.046, 95% CI: .1.013-1.079, p<0.01) and depersonalization (aOR, 1.078, 95% CI: .1.015-1.145, p<0.05) led to higher risks of psychological distress, while stress predicted higher risks of burnout (aOR, 1.153, 95% CI: 1.062-1.251, p<0.01). There were occupational and departmental differences in susceptibility to burnout and psychological distress, requiring further investigation into the unique working environments and roles of hospital healthcare workers.
Burnout ; psychological distress ; healthcare worker ; healthcare personnel ; hospital ; Malaysia

The importance of nontechnical skills among healthcare professionals is gaining widespread recognition as criticalelements complementing technical skills that are used to improve patients’ safety. These skills are typically acquiredthrough simulation training which has emerged as an effective way to complement clinical training. Effective simulationrequires structure and effective debriefing methods to enhance its learning outcome. In previous literature, evidence of theeffectiveness of healthcare simulation was available but studies evaluating debriefing method(s) remain sparse. In thispaper, the effectiveness of debriefing methods in eight studies on the acquisition of nontechnical skills among healthcareprofessionals is reviewed. Articles published from 1st January 2016 across three different databases were referred to. Theresults of the review show a statistically significant improvement in the performance of nontechnical and technical skillsacross different professionals through various methods of debriefing. Nontechnical skills such as teamwork, effectivecommunication, decision-making, and situational awareness have improved significantly. In addition, integration ofrealism in simulation learning has begun to emerge as an effective technique of providing a real world experience.However, there was lack of detailed information on the length and type of debriefing conducted in the studies. Thesemethods clearly require further research since the key to successful simulation learning is through debriefing which isthe heart of simulation.

Introduction: Obesity and physical inactivity among schoolchildren are among the most challenging health problems inMalaysia. The present study aimed to evaluate the sustainedimpact of Juara Sihat programme on physical activity leveland anthropometric status at 18-month post-intervention.Method: Participants of Juara Sihat (n=55) were followed-upat 18 months after completion of the intervention. JuaraSihat intervention was implemented over 12 weeks andfocused on four key components: (i) five one-hour nutritioneducation classes, (ii) four one-hour physical activityeducation sessions, (iii) family involvement, and (iv)empowerment of Parents and Teachers Association.Anthropometric variables (body mass index, body fatpercentage and waist circumference) were measured andphysical activity level was evaluated by using PhysicalActivity Questionnaire for Children (PAQ-C) at baseline (P0),immediately upon completion of intervention (P1), atthree-month post-intervention (P2), and at 18-month postintervention(P3). Analyses of repeated measures analysisof covariance (ANCOVA) with intention-to-treat principlewere applied.Results: Sustained effects were found in BMI-for-age z-scorewhich showed a reduction (P0 2.41±0.84 vs P3 2.27±0.81)and physical activity level which showed positiveimprovements (P0 2.46±0.62 vs P3 2.87±0.76) at 18 monthsafter intervention was completed. Body fat and waistcircumference had increased over the same time period.Conclusion: Overall, this study successfully demonstratedsustained intervention effects of Juara Sihat intervention onBMI-for-age z-score and physical activity, but not on body fatpercentage and waist circumfere

Introduction: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of thisstudy was to determine the prevalence of EC use and the socio-demographic and smoking characteristicsassociated with current EC use among Malaysian current and ex-smokers. Methods: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers. Results: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030). Conclusion: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups

Introduction: Electronic cigarettes (ECs) are new devices that have been accepted widely by both smokers and non-smokers. However, the evidence on EC used in Malaysia is scarce. The objective of thisstudy was to determine the prevalence of EC use and the socio-demographic and smoking characteristicsassociated with current EC use among Malaysian current and ex-smokers. Methods: This was a sub-analysis of data from a cross-sectional, national-population- based EC study conducted from May to June in 2016 in Malaysia. A detailed description of the sampling methods can be found in the National E-cigarette Survey (NECS) 2016 report. Briefly, data were obtained from 1396 individuals who had ever been smokers, i.e., 957 (68.6%) current smokers and 439 (31.4%) ex-smokers. Results: Current EC use was found predominantly among current smokers (8.0%) as compared with ex-smokers (4.3%). Among current smokers, the main reasons given for smoking ECs were wanting to try it (44.7%), followed by intention to quit tobacco smoking (15.8%) and to reduce tobacco smoking (10.5%). Using multiple logistic regression analysis, we found that among current smokers, current EC users were more likely to be younger, i.e., 18-44 years (aOR= 4.83, 95% CI= 1.97-11.86, p=0.001), urban residents (aOR= 1.89, 95% CI= 1.15-3.11, p=0.012), single/ divorced/ widowed (aOR= 2.11, 95% CI= 1.24-3.61, p=0.006) and students (aOR= 2.25, 95% CI= 1.01-5.01, p=0.048). Among exsmokers, only younger respondents (18-44 years old) was reported as being more likely to be current EC users (aOR= 3.81, 95% CI= 1.14-12.76, p=0.030). Conclusion: This study showed that currently using and ever having used ECs were more prevalent among current smokers. The reasons given for initiating EC use among current smokers were mainly wanting to try it, followed by intention to quit and to reduce tobacco smoking. Current EC use appears to be common among current smokers who are younger, urban residents, single/divorced/widowed and students. Therefore, EC cessation intervention strategies and policies should target these high-prevalence groups

A systematic review was conducted to summarize health intervention program that aimed to increase physical activity and/or nutrition among middle income and low income countries employees from January 2008 until December 2019. The objective of this review is to identify the types of health intervention and its effects on increasing physical activities and nutrition at the workplace. A systematic search of the following databases was conducted: Scopus, PubMed and Web of Science following the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) guideline. A modified McMaster critical appraisal tool for quantitative studies was used to assess the methodological quality of the included studies. Given the heterogeneity of the included studies, a descriptive synthesis was conducted. Out of 6940 studies, 36 studies met the inclusion criteria range from health education, environmental change and behavioural change of healthy lifestyle. Based on a heterogeneous evidence base it can be surmised that workplace health interventions may have a positive impact on the health and behaviour of the employees. Current evidence however lacks clarity and uniformity in terms of intervention parameters and measurement outcomes, which limits broader application of these results. In conclusion, workplace health intervention is potential for increasing physical activity and improving the nutritional status of employees. Recommendation with regard to effectiveness however cannot be made. It is hoped that findings from this review may inform and guide future policies and practices regarding workplace health promotion.