Background: Work-related musculoskeletal disorders (WRMSDs) remain a major cause of occupational disability and productivity loss worldwide. Traditional statistical methods have identified numerous associated factors; however, they often struggle to capture complex non-linear relationships and interactions across multiple domains of risk. Machine learning (ML) offers an alternative analytical approach for modelling such multidimensional relationships. Methods: Following the PRISMA 2020 guidelines (PROSPERO: CRD420250605234), literature searches were conducted in Web of Science, Scopus, and PubMed for studies published between 2020 and 2025. Eligible studies applied ML methods to identify factors associated with WRMSDs using cross-sectional study designs. Included studies were appraised using the Joanna Briggs Institute Critical Appraisal Checklist for analytical cross-sectional studies. Results: Ten studies met the inclusion criteria, representing workers from healthcare, transport, manufacturing, and service sectors across Asia, Africa, and Europe. Frequently applied ML algorithms included random forest, support vector machine, and artificial neural networks, demonstrating strong internal discriminative performance (area under the receiver operating characteristic curve: 0.80–0.99), although the absence of external validation in several studies suggests a potential risk of overfitting. Commonly identified factors included age, sex, awkward posture, vibration exposure, prolonged working hours, stress, and burnout. Psychosocial factors, including post-traumatic stress disorder, job stress, and depression, were ranked among the most influential predictors within ML models. Conclusions ML models demonstrate strong capability in discriminating WRMSDs risk and identifying multidimensional risk factors compared with traditional statistical approaches. These models highlight complex interrelationships between ergonomic and psychosocial exposures. Future research should incorporate external validation, objective exposure measurements, and standardized ML reporting frameworks to enhance methodological transparency and generalizability.

ASSOCIATION BETWEEN BODY MASS INDEX AND DIABETES MELLITUS CONTROL CLASSIFICATION AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS: EVIDENCE FROM THE NATIONAL DIABETES REGISTRY OF MUAR DISTRICT HEALTH OFFICE, MALAYSIA, FROM JANUARY 2021 TO JULY 2023 Introduction: Type 2 diabetes mellitus (T2DM) is one of the most prevalent non-communicable diseases globally. This study aimed to determine the association between body mass index (BMI) and diabetes mellitus (DM) control among patients with T2DM. Methods: A retrospective study was conducted from October 2023 to June 2024 using secondary data from the National Diabetes Registry (NDR) of Muar District Health Office, Johor. Patients with T2DM registered in the NDR and audited from 2021 to July 2023 were included. The association between BMI and DM control was analysed using hierarchical multinomial logistic regression. Results: A total of 1955 patients were included in the study. The prevalence of good, intermediate and poor BMI control was 38.8% (95% Confident Interval (CI)=36.7, 41.0), 22.2% (95% CI=20.3, 24.0) and 39.0% (95% CI=36.7, 41.2), respectively. Most patients were older Malay women. There was an association between BMI and DM control unadjusted (P<0.001) and adjusted for several confounding factors using seven models (P=0.003–0.034). The R2 value also improved from 0.008 to 0.293. Conclusion: Among patients with T2DM, a higher BMI, the creatinine level and medications such as glucose-lowering drugs, ticlopidine, acetylsalicylic acid and statins are associated with DM control. However, as the study design does not allow for the assessment of causality or progression over time, the findings should be interpreted as descriptive associations rather than as evidence of cause-and effect relationships. Focus on medication compliance, healthcare providers’ role during medication consultation and stakeholders’ role in maintaining drug supplementation is needed.

DEVELOPMENT AND VALIDATION OF A VIDEO-BASED INTERVENTION ON SELF-CARE PRACTICES FOR PATIENTS WITH HYPERTENSION IN MALAYSIAN PRIMARY CARE SETTINGS Introduction: Self-care practices among patients with hypertension have been shown to improve blood pressure control. Video-based interventions (VBIs) are helpful in enhancing patients’ self-care practices. However, validated VBIs in the Malay language for patients in primary care settings are scarce. This study aimed to develop and validate a VBI series in the Malay language to educate patients with hypertension on self-care practices in primary care settings. Methods: This study was conducted in three phases: (1) pre-production, (2) production and (3) post-production. The pre-production phase involved designing the storyboard and scripts, which underwent content validation by content experts and subsequently by patients with hypertension. Once the storyboards and scripts achieved acceptable consensus, the videos were recorded (production phase). The post-production phase included video editing and face validation among patients with hypertension. Statistical analysis included the calculation of the item-level content validation index (I-CVI) and item-level face validation index (I-FVI) during content and face validation, respectively. Results: The storyboards and scripts for five videos were developed. The I-CVI of all videos was 1.0 after two rounds of content validation among six content experts. The I-CVI of all videos was 1.0 among five patients with hypertension. Five videos were recorded and edited, achieving an I-FVI of 1.0 during face validation among 10 patients. Conclusion: A VBI series consisting of five videos was developed and validated for use among patients with hypertension in primary care settings to improve their knowledge of self-care practices.

Introduction: Venepuncture procedure is painful and anxiety associated with venepuncture is common. There are many tools for assessing anxiety levels in an outpatient setting. Hence, this study is to compare the degree of agreement between State-Trait-Anxiety-Inventory (STAI) and Beck Anxiety Inventory (BAI) for measuring anxiety levels among adult patients before venepuncture procedure. Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in the Phlebotomy Unit, UiTMMC in April 2020. The Malay-validated version of the State-Trait-Anxiety-Inventory (STAI) and Beck Anxiety Inventory (BAI) were used to assess the anxiety level. Differences between sets of data were plotted as described by Bland-Altman to determine the agreement between these two assessment tools. Results: A total of 330 patients participated in the study with a mean age of 46.34 ± 14.34 years old and gender was equally distributed. The scores of state-anxiety (STAI-S), trait-anxiety (STAI-T) and BAI score were 30.04 ± 20.74; 29.51 ± 19.11; and 40.98 ± 20.45, respectively. The score of anxiety using BAI was higher compared to STAI-S (p<0.001) and STAI-T (p<0.001). The mean difference between the STAI-S and BAI was -10.94 (95%CI: -53.01, 26.87) and between the STAI-T and BAI was -11.47 (95%CI: -42.26, 19.32). However, very few patients’ scores outside the 95% LOA for both differences. Conclusion: The STAI and BAI are concordances in measuring anxiety levels among these patients. However, the anxiety score using BAI was higher than STAI. Thus, both assessment tools can be used in clinical practice in measuring anxiety in the out-patients setting.

Introduction: Tobacco smoking causes various chronic diseases and adds costs to healthcare systems. The current smoking cessation interventions mostly target smokers who are ready to quit and are reactive in recruitment. Recently, mobile phones have become a new tool for promoting smoking cessation. The aim of this paper is to present a study protocol on a quasi-experimental study investigating the effects of a workplace mHealth intervention for smoking behaviour. Methods: A quasi-experimental study will be conducted among employees in an academic institution in Malaysia. The intervention group will receive a theory based WhaSTOP module via WhatsApp and will be compared with the control group (receive usual care). The primary outcomes are stage movement and the number of cigarettes per day. The secondary outcomes include knowledge of smoking, quit attempt, nicotine dependence, 7-day point prevalence of smoking abstinence, and the Transtheoretical Model constructs. A generalised estimating equation analysis will be performed to determine the effects of the intervention. Discussion: This protocol will provide a novel method to proactively approach smokers regardless of readiness to quit and to guide them through the stages of change so that they will be ready to take action to quit. This research will also provide insight into whether the intervention can be utilised as an additional tool for smokers at the workplace to quit smoking. Trial Registration: The trial was registered with the Iranian Registry of Clinical Trials (Registry Number IRCT20220415054539N1).

Major Depressive Disorder (MDD) is substantially higher in people seeking Methadone Maintenance Therapy (MMT) as compared to the normal population. Erectile Dysfunction (ED) is one of the side effects of Methadone Maintenance Therapy (MMT) which is rarely explored as it is regarded as a sensitive topic. This study aims to determine the prevalence of MDD and its association with ED among MMT clients. A cross-sectional study was conducted involving 160 subjects who attended the Methadone outpatient clinic. The clients were given Patient Health Questionnaire-9 to screen for depressive symptoms and MINI International Neuropsychiatric Interview to diagnose MDD. ED was diagnosed using the 5-item International Index of Erectile Function. The results showed the prevalence of depression in clients on MMT was 30.6% and the prevalence of ED was 72.5%. On multivariate analyses, there were significant associations between ED with depression (P<0.05). Smoking also was found to be contributed to depression. Sociodemographic factors, comorbid medical illnesses, and illicit substance use were found to have no associations with depression. Therefore, given the prevalence of MDD and ED in MMT clients was high, routine assessment of depressive symptoms and sexual function in clients on methadone should be done to minimize their negative impact on the clients

Introduction: The Patient Activation Measure (PAM) is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation levels in self-management. This study aimed to determine the validity and reliability of the PAM-13 Malay version among patients with Metabolic Syndrome (MetS) attending a primary care clinic.Methods: This work is a cross-sectional validation study among patients with MetS attending a university primary care clinic in Selangor. The PAM-13 Malay version underwent a validation process and field testing. Psychometric properties were examined using principal component analysis (PCA) with varimax rotation, scree plot, Monte Carlo simulation, internal consistency, and test-retest reliability analyses. Results: The content of the PAM-13 Malay version and the original version were conceptually equivalent. The questionnaire was refined after face validation by 10 patients with MetS. The refined version was then field-tested among 130 participants (response rate 89.7%). The Kaiser–Meyer– Olkin test was 0.767, and Bartlett’s test of sphericity was ≤0.001, indicating sampling adequacy. Two factors were identified and labeled as (1) Passive and Building Knowledge, and (2) Taking Action and Maintaining Behavior. These labels were chosen as they were conceptually consistent with the items representing the levels of activation in PAM-13. The validated PAM-13 Malay version consisted of 13 items, framed into two domains. The overall Cronbach’s α was 0.79, and the intraclass correlation coefficient was 0.45. Conclusions: The PAM-13 Malay version is valid, reliable, and fairly stable over time. This questionnaire can be used to evaluate the levels of activation among patients with MetS in primary care in Malaysia.

As cognition declines with age, cognitive impairment rates are expected to increase ranging from 100% to 300% in this region. It could be higher among elderly who had any chronic diseases. The aim of the present work was to determine the prevalence and associated factors of cognitive impairment among elderly with hypertension. A clinic-based, cross-sectional study was conducted at several community clinics in Sabak Bernam and Hilir Perak districts from July to December 2015. A total of 480 patients were recruited. The prevalence of cognitive impairment was 13.13% (95%CI: 13.11, 13.15). Factors associated with cognitive impairment among elderly hypertensive were no formal educational level [OR: 3.95 (95%CI: 1.80, 8.67)]; history of high cholesterol [OR: 3.24 (95%CI: 1.15, 9.16)]; underweight [adj. OR: 4.88 (95%CI: 1.34, 17.67)]; and increasing age [OR: 1.03 (95%CI: 1.01, 1.06)]. Public health policy makers and geriatric practitioners should emphasise on early cognitive function assessment among elderlies who are hypertensive, unemployed, poor educational background, males, high cholesterol level and underweight to enhance the quality of geriatric services. Earlier establishment of diagnosis may prevent from greater rate of decline in cognitive functioning among this vulnerable group.

To assess knowledge, practices on cardiovascular disease (CVD) prevention and practices among an urban population in Selangor. A cross-sectional household survey was conducted involving 336 adults in 161 houses randomly selected from three towns in Selangor, Malaysia. The mean knowledge of cardiovascular risk factors was moderately high among participants. Socioeconomic characteristics (SES) significantly associated with higher mean scores were being in middle age, female, high-income group and never smokers. Although the general knowledge on preventing cardiovascular risks among the urban population was moderately high, their lifestyle practices on preventing cardiovascular disease were moderate.

Background: The Diabetes Mellitus in the OffspringQuestionnaire (DMOQ) assesses the perceptions of Type 2diabetes mellitus (T2DM) patients on the risk of theiroffspring developing T2DM and the possibility ofintervention to reduce this risk. It has 34 items framed withinseven domains. This study aimed to adapt, translate andvalidate the DMOQ from English into the Malay language.Methods: This was a cross-sectional validation study among159 T2DM patients attending a public primary care clinic inSelangor. The DMOQ English version underwent adaptation,translation, face validation and field testing to produce theMalay version. Psychometric analysis was performed usingExploratory Factor Analysis, internal consistency and testretestreliability.Results: The DMOQ domains were conceptually equivalentbetween English and Malay language. A total of 13 items andtwo domains were removed during the validation process(three items during the content validation, three items due topoor factor loadings, five items as they loaded onto twodomains which were not interpretable, one item as it did notfit conceptually into the factor it loaded onto and one openendedquestion as it did not fit into the retained domains).Therefore, the final DMOQ Malay version consisted of 21-items within five domains. The Cronbach alpha was 0.714and the intraclass-correlation coefficient was 0.868.Conclusion: The DMOQ Malay version is a valid and reliabletool which is consistent over time. It can be used to examinethe perception of T2DM patients towards the risk of theiroffspring developing diabetes and possibility of interventionin Malay-speaking patients.