Introduction: Cardiovascular disease (CVD) is a major cause of global mortality, including Brunei Darussalam. Health literacy plays an important role in the management of CVD. It is not clear how much patients could understand, judge and apply CVD knowledge in the management of their condition after completion of a cardiac rehabilitation programme at the Raja Isteri Pengiran Anak Saleha Hospital, a tertiary referral centre in Brunei Darussalam. Materials and Methods: This was a cross - sectional study of cardiac rehabilitation patients who completed Phase II of the programme over a four-month period . Patients were recruited through convenience sampling methods. A validated questionnaire was used to assess participants ’ knowledge, attitude and practice (KAP) on CVD. The data were computed using R v.3.4.4. and analysed using descriptive and inferential statistics. A p<0.05 was considered to be statistically significant. Results: Of the total (n=120) participants recruited, 89.2% were males. 90.0% were below 70 years of age and 82.5% were Malay. 54.2% achieved the highest level of education at secondary school. Hypercholesterolemia and hypertension were prevalent; accounting for 71.7% and 70.0% respectively, while obesity and diabetes mellitus accounted for 47.5% and 39.7% respectively. The mean (standard deviation) scores for knowledge, attitude and practice were 66.86 (3.71) out of 75, 57.83 (4.47) out of 65, and 33.11 (3.65) out of 44, respectively. There was a significant difference in the CVD knowledge scores between different levels of education (p=0.024). Conclusions: There is a good level of CVD knowledge, attitude and practice in cardiac rehabilitation patients post -Phase II of the programme. Delivery of education sessions in Phase II of the programme in consideration of the varied educational backgrounds of the participants may help ensure everyone can benefit equally

Introduction: The COVID -19 pandemic significantly impacted the mental health and wellbeing of healthcare workers worldwide. This study examined the prevalence and predictors of self -reported mental health problems, specifically depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam during the second and subsequent waves of the pandemic. Materials and Methods : A cross -sectional online survey was distributed to all government healthcare workers employed by the Ministry of Health in Brunei Darussalam. The survey collected sociodemographic information and applied two validated tools: the Depression Anxiety Stress Scale 21 -item version (DASS -21) to assess the depression, anxiety, and stress, and the Oldenburg Burnout Inventory (OLBI) to measure burnout. Results : Of 1,759 invited healthcare workers, 704 responded (response rate 40.0%). The prevalence of common mental health problems and burnout were 32.4% and 71.7%, respectively. Older age was protective against common mental health problems. Performing clinical duties outside one's training scope, and direct involvement in managing COVID -19 patients were significant predictors of common mental health problems. Expatriate staff had significantly lower odds of burnout compared to Bruneian nationals. Shift work and additional administrative duties independently predicted burnout. A history of mental health problems and difficulty accessing mental health support were strongly associated with both outcomes. Conclusions : This study identified a substantial burden of depression, anxiety, stress, and burnout among government healthcare professionals in Brunei Darussalam, with distinct vulnerable subgroups. These findings highlight the need for targeted mental health interventions, improved access to support services, and systemic workplace strategies to safeguard the wellbeing of the healthcare workforce. The Brunei International Medical Journal (BIMJ) is a peer -reviewed official publication of the Ministry of Health and Universiti Brunei Darussalam, under the auspices of the Clinical Research Unit, Ministry of Health, Brunei Darussalam. The BIMJ publishes articles ranging from original research papers, review articl es, medical practice papers, special reports, audits, case reports, images of interest, education and technical/innovation papers, editorials, commentaries, and letters to the Editor. Topics of interest include all subjects related to clinical practice and research in all branches of medicine, both basic and clinical, including topics related to allied health care fields. The BIMJ welcome s manuscripts from contributors but usually solicits review articles and special reports. Proposals for review papers can be sent directly to the Managing Editor. Please refer to the contact inf ormation of the Editorial Office. DISCLAIMER: All articles published, including editorials and letters, represent the opinions of the contributors and do not reflect the o fficial views or policies of the Clinical Research Unit, the Ministry of Health, or the institutions with which the contributors are affiliated, unless clearly stated. The appearance of advertisements does not constitute an endorsement by the Clinical Research Unit or the Ministry of Health, Brunei Darussalam. Furthermore, the publisher cannot accept responsibility for the c orrectness or accuracy of the advertisers' text, claims, or any bimjonline@gmail.com www.bimjonline.com Author Details: 1 Psychiatry Services, Ministry of Health, Brunei Darussalam 2 Dorset Healthcare University NHS Foundation Trust, United Kingdom 3 Community Psychology Division, Ministry of Health, Brunei Darussalam 4 PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam 5 Department of Forensic Psychiatry, NHS Forth Valley, United Kingdom 6 Primary Health Care, Ministry of Health, Brunei Darussalam 25 Mikhail SOLIMAN1,2*, Fauziyyah MANAP3, Nur Syahirah CHUA3, Rina RAHMAD3, Hjh Rozailah RAHMAN3, Hanif ABDUL RAHMAN4, Najib NAIBI6, Kartini TUDIN1, Hilda HO1,5

Rahman et al Brunei International Medical Journal 2025;21:125-132 Brunei International Medical Journal Knowledge, Attitudes, and Practices Toward Physical Activity Among Public Sector Librarians in Brunei: A Cross-Sectional Study Amirul Rahman1*, Nik A. Tuah1,2, and Hanif A Rahman 1

Introduction:: Halitosis, or bad breath, is a prevalent health concern with social and psychological implications. This study investigated the knowledge of halitosis among undergraduate students at Universiti Brunei Darussalam (UBD), focusing on health-science (HS) and non-health-science (non-HS) students. The research aimed to contribute to the understanding of halitosis within the context of undergraduate student populations and the impact of health science-based programmes. Methods:: The study was conducted among 4108 undergraduate UBD students using a self-administered, closed-ended online questionnaire. Results:: 279 students from five UBD undergraduate faculties participated in the study giving a response rate of 6.79%. HS students exhibited significantly higher awareness of factors contributing to halitosis, including smoking, tooth cavities, incorrect teeth cleaning, gastrointestinal tract disease, tonsillitis and certain medications. Furthermore, HS students reported receiving more educational material on halitosis (24.1% vs. 2.3%). Both HS and non-HS students primarily relied on dentists (62.0% vs. 56.1%) for halitosis consultations. In terms of self-perception, no significant difference was found between the two groups. The vast majority of students agreed that halitosis could negatively impact a person's life (92.8%). 49.1% of the respondents have been told that they have bad breath and felt embarrassed. Conclusion: The greater level of halitosis-related knowledge in HS students indicates the positive impact of HS programs and the potential need for educational initiatives among non-HS students. Halitosis presents a potentially significant issue in the sample, reflecting the relevance of its physical and psychological impact. Broader research with larger and more diverse samples is necessary to improve generalisability.

Background: The spread of COVID-19 was inevitable and has not spared small and isolated communities, including the community of Perhentian Island in Besut District, Terengganu. Managing clusters in small islands can be difficult, given the limited resources. This study explores the characteristics of COVID-19 cases and the experience of outbreak containment at Perhentian Island. Methodology: A retrospective study involving record review of COVID-19 cases and at-risk individuals registered under Perhentian Cluster were retrieved from the Besut District Health Office COVID-19 online registry from the 16thAugust2021 until 6thOctober 2021. All notified cases and close contacts who fulfilled the inclusion criteria were extracted and analysed using descriptive statistics. Results: A total of 1,093 community members of Perhentian Island were screened of which 170 (15.5%) tested positive for COVID-19, while 923 (84.5%) tested negative. Among individuals who tested positive, the majority were adults (52.4%), male (51.8%), Malays (98.8%), and villagers (96.5%). Clinical characteristics were categorized into: asymptomatic (55.9%), had no known medical comorbidities (90.6%), low-risk groups (87.1%), vaccinated (57.6%), and admitted to PKRC (97.1%) for treatment. Multiple agencies were involved in the outbreak containment of the Perhentian Cluster, working collectively and in good coordination. Conclusion The outbreak was attributed to community gatherings and close interactions among villagers. Prompt actions, targeted planning, and inter-agency collaboration were the key factors in successful containment of further spread of COVID-19 in Perhentian Island.
COVID-19

Objectives: To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. Methods: Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. Results: The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. Conclusion The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.

Objectives: To assess the prevalence of noncommunicable disease (NCD) risk factors and the factors associated with the coexistence of multiple risk factors (≥ 2 risk factors) among adolescent boys and girls in Bangladesh. Methods: Data on selected NCD risk factors collected from face to face interviews of 4,907 boys and 4,865 girls in the national Nutrition Surveillance round 2018-2019, was used. Descriptive analysis and multivariable logistic regression were performed. Results: The prevalence of insufficient fruit and vegetable intake, inadequate physical activity, tobacco use, and being overweight/obese was 90.72%, 29.03%, 4.57%, and 6.04%, respectively among boys; and 94.32%, 50.33%, 0.43%, and 8.03%, respectively among girls. Multiple risk factors were present among 34.87% of boys and 51.74% of girls. Younger age (p < 0.001), non-slum urban (p < 0.001) and slum residence (p < 0.001), higher paternal education (p = 0.001), and depression (p < 0.001) were associated with the coexistence of multiple risk factors in both boys and girls. Additionally, higher maternal education (p < 0.001) and richest wealth quintile (p = 0.023) were associated with the coexistence of multiple risk factors in girls. Conclusion The government should integrate specific services into the existing health and non-health programs which are aimed at reducing the burden of NCD risk factors.

PURPOSE: Little evidence estimated the exposure of psychosocial work stressors, work-related fatigue, and musculoskeletal disorders for nurses working in South-East Asian region, and research on this subject is almost nonexistent in Brunei. The main aim of our study was to provide a comprehensive exploration and estimate exposure of the study variables amongst emergency (ER) and critical care (CC) nurses in Brunei. The study also aims to compare whether experiences of ER nurses differ from those of CC nurses. METHODS: This cross-sectional study was implemented in the ER and CC departments across Brunei public hospitals from February to April 2016 by using Copenhagen Psychosocial Questionnaire II, Occupational Fatigue Exhaustion Recovery scale, and Cornell Musculoskeletal Discomfort Questionnaire. RESULTS: In total, 201 ER and CC nurses (82.0% response rate) participated in the study. Quantitative demands of CC nurses were significantly higher than ER nurses. Even so, ER nurses were 4.0 times more likely [95% confidence interval (2.21, 7.35)] to experience threats of violence, and 2.8 times more likely [95% confidence interval: (1.50, 5.29)] to experience chronic fatigue. The results revealed that nurses experienced high quantitative demands, work pace, stress, and burnout. High prevalence of chronic and persistent fatigue, threats of violence and bullying, and musculoskeletal pain at the neck, shoulder, upper and lower back, and foot region, was also reported. CONCLUSION: This study has provided good estimates for the exposure rate of psychosocial work stressors, work-related fatigue, and musculoskeletal disorders among nurses in Brunei. It provided important initial insight for nursing management and policymakers to make informed decisions on current and future planning to provide nurses with a conducive work environment.
Asian Continental Ancestry Group ; Brunei* ; Bullying ; Critical Care Nursing ; Critical Care* ; Cross-Sectional Studies ; Emergencies* ; Emergency Nursing ; Fatigue* ; Foot ; Hospitals, Public* ; Humans ; Musculoskeletal Pain ; Neck ; Nursing ; Occupational Health ; Prevalence ; Shoulder ; Social Support ; Violence

Our recent studies have shown that co-activation of Gq and Gi proteins by 5-hydroxytryptamine (5-HT) and adrenaline show synergism in human platelet aggregation. This study was conducted to examine the mechanism(s) of synergistic interaction of 5-HT and platelet activating factor (PAF) in human platelets. We show that PAF, but not 5-HT, increased platelet aggregation in a concentration-dependent manner. However, low concentrations of 5-HT (2 microM) potentiated platelet aggregation induced by subthreshold concentration of PAF (40 nM) indicating a synergistic interaction between the two agonists and this synergism was blocked by receptor antagonists to either 5-HT or PAF. 5-HT also potentiated the effect of PAF on thromboxane A2 (TXA2) formation and phosphorylation of extracellularly regulated mitogen-activated protein kinases (ERK1/2). The synergism of 5-HT and PAF in platelet aggregation was inhibited by calcium (Ca2+) channel blockers, verapamil and diltiazem, phospholipase C (PLC) inhibitor, U73122, cyclooxygenase (COX) inhibitor, indomethacin, and MEK inhibitor, PD98059. These data suggest that synergistic effect of 5-HT and PAF on human platelet aggregation involves activation of PLC/Ca2+, COX and MAP kinase pathways.
Diltiazem/pharmacology ; Dose-Response Relationship, Drug ; Drug Synergism ; Estrenes/pharmacology ; Flavones/pharmacology ; Human ; In Vitro ; Indomethacin/pharmacology ; Kinetics ; Mitogen-Activated Protein Kinases/metabolism ; Phosphorylation/drug effects ; Platelet Activating Factor/*pharmacology ; Platelet Activation/drug effects ; Platelet Aggregation/*drug effects/physiology ; Pyrrolidinones/pharmacology ; Serotonin/*pharmacology ; Thromboxane A2/biosynthesis ; Verapamil/pharmacology