Introduction: Sleep quality has become a public health concern due to serious impacts on individual’s health outcomes. Thus, this cross-sectional study aimed to determine the sleep quality and its associated factors among adults living in the province of Terengganu, Malaysia. Materials and Methods: Socio-demographic information was self-reported whilst anthropometric measurements were measured by trained researchers. Sleep quality was assessed using the validated Pittsburgh Sleep Quality Index (PSQI) whilst eating behavior was measured using the Dutch Eating Behavior Questionnaire (DEBQ). Descriptive statistics and multivariable linear regression models were employed using IBM SPSS version 25.0. Results: A total of 580 participants were enrolled (mean age = 29.1 ± 10.0 years; 51.2% female), of which 74.7% (n = 433) had poor sleep quality (PSQI global score > 5) with a total sleep duration per night of 6.2 ± 1.6 hours. Gender (p-value=0.044), educational level (p-value=0.001), emotional level (p-value=0.005) and external eating (p-value=0.026) were significantly associated with poorer sleep quality. Conclusion: This study underscored the high prevalence of poor sleep quality among adults living in Terengganu, Malaysia. The findings could serve as a basis for developing sleep education strategies that are tailored to improve sleep quality among adults.

FIVE-YEAR TREND IN SECONDARY PREVENTION MEDICATION PRESCRIPTION AND RISK FACTOR CONTROL AMONG PATIENTS WITH DIABETES MELLITUS AND CARDIOVASCULAR DISEASES IN PERAK HEALTH CLINICS Introduction: Prescription of secondary prevention medications (SPMs) and effective control of cardiovascular risk factors (RFs) are crucial to reduce the risk of recurrent cardiovascular events,particularly in high-risk individuals including those with diabetes mellitus (DM). This study aimed to analyse the trends in SPM prescription and identify the factors associated with RF control among patients with DM and cardiovascular diseases in Perak health clinics. Methods: Data of patients with ischaemic heart disease (IHD) and cerebrovascular diseases (CeVDs) audited from 2018 to 2022, excluding those lost to follow-up, were extracted from the National Diabetes Registry. Descriptive and trend analyses were conducted. Multivariable logistic regression was utilised to identify the factors associated with RF control. Results: Most patients (76.7%) were aged ≥60 years and were Malays (62.3%). The majority had IHD (60.8%) and CeVDs (54.7%) for ≥5 years. SPM prescription increased significantly over the past 5 years. However, blood pressure (BP) and lipid control remained static. Good BP control was associated with a DM duration of ≥10 years and poor control with Malay ethnicity and prescription of two or three antihypertensives. Good DM control was associated with an age of ≥60 years and age at DM diagnosis of ≥60 years and poor control with Malay and Indian ethnicities, DM duration of≥10 years and prescription of two or three and more glucose-lowering drugs. Poor lipid control was associated only with Malay and Indian ethnicities. Conclusion: SPM prescription has increased over time, but the achievement of treatment targets,particularly for lipid control, has remained poor and unchanged. Statin use is not associated with lipid control. The accessibility and availability of alternative lipid-lowering drugs must be improved to enhance overall RF control, especially lipid control, in patients with DM and cardiovascular diseases.

Introduction: Many countries struggle to supply enough blood while maintaining their quality and safety. Increasing the number of regular donors is expected to increase the donor pool and blood safety. Thus, this study describes lapsed and regular blood donors’ characteristics, knowledge, motivation, and barriers concerning blood donation. Methods: This observational cross-sectional study has adopted an assisted self-administered questionnaire, which was distributed to blood donors at the Department of Transfusion Medicine, Hospital Sultanah Bahiyah, Kedah. A total of 328 participants consisting of 164 lapsed and 164 regular donors were selected. Logistic regression tests were used to determine the factors that predict lapsed donors. Results: Out of the selected 328 respondents, 54.3% were in the 25–39 age group, 66.2% were males, and 85.1% were Malays. Most of the respondents (88.4%) showed adequate blood donation knowledge, and 99.7% cited altruism as a motivator for blood donation. About 47.0% of the respondents claimed they lack enough time as their donation barrier. Donors who were younger in age, had a moderate blood donation knowledge (adjusted OR, 3.60; 95% CI, 1.34-9.64), didn’t know where to donate (adjusted OR, 2.79; 95% CI, 1.47-5.29), lack enough time (adjusted OR, 1.83; 95% CI, 1.04-3.24), and insufficient information about blood donation campaigns (adjusted OR, 2.19; 95% CI, 1.23-3.91) were more likely to lapse. Conclusion: Donor education, convenient time and location, and sufficient information about blood donation campaigns targeted at young donors are critical for preventing lapsed donors, which could subsequently increase the regular donor pool.

Introduction: ABO blood group can be associated with chronic diseases, for example, cancer and coronary heart disease, however it is not proven in Type 2 Diabetes Mellitus (T2DM). The aim of this study was to identify the association between the ABO blood group and disease control among T2DM patients at Kepala Batas, Penang. Methods: Approximately two mL vials of fresh blood were collected and typed using the tube method from 129 T2DM and 132 non-diabetic (control) patients, who visited the specialist clinic. The sociodemographic characteristics of the T2DM patients was analysed using descriptive analysis. The proportions of A, B, AB, and O blood groups among the diabetic and control patients were compared using the chi-square test. Any association between the ABO blood group and disease control was identified using the bivariate correlation test. Results: No significant association was found between the ABO group and T2DM patients (p = 0.152) when compared with the control group. However, blood group B was the most frequent among T2DM patients (33.3%) compared to blood group O within the control group (36.4%). Negative associations were observed between the ABO blood group and BMI (r = 0.098, p = 0.268), as well as the HbA1C value (r = -0.065, p = 0.464). Conclusion: No association was found between the ABO blood group and the associated risk factors (BMI and HbA1C). However, individuals with blood group B and risk factors, such as older age group, obesity, and high HbA1C value (more than 7.0%), should be monitored.

This study aimsto determine the reliability and validity and optimal cut-off scores of the Malay version of Montreal Cognitive Assessment for visually impaired (MoCA-BM-blind) among older adults with cognitive decline. Participants for this study were recruited from the population-based longitudinal study on neuroprotective model for healthy longevity (LRGS TUA) among Malaysian older adults. A total of 220 participants, aged 60 years and above, from Selangor were included in this study. Cognitive functions were assessed using MoCA-BM-blind and Malay version of Mini-Mental State Examination for visually impaired (M-MMSE-blind). Habitual distance VA was measured monocularly using the Early Treatment Diabetic Retinopathy Study chart. Cronbach’s alpha and Pearson correlation coefficient were used to determine reliability and validity of MoCA-BM-blind, respectively. Receiver operating characteristic (ROC) analysis was conducted to determine the optimal cut-off score for MoCA-BM-blind. Reliability (Cronbach’s alpha: 0.76) and validity (Pearson correlation: r = 0.77) of MoCA-BM-blind were high. The optimal cutoff for MoCA-BM-blind in detecting cognitive decline was 9 with 86.8% sensitivity and 72.7% specificity. With this cut-off, 35.0% visually impaired participants were classified as having cognitive decline. MoCA-BM-blind is a valid and reliable screening tool to assess cognitive function among visually impaired older adults.
Aging

Perioperative Patient Blood Management is part of the patient blood management (PBM) program specifically focused on surgical patients. Even though this concept had been introduced in 2010 by World Blood Organization (WHO), earlier studies in Europe had shown poor knowledge and practice among clinicians in this area. In Malaysia, PBM approach is still not comprehensive, and there was no published data to relate this problem with clinicians’ lack of knowledge and practice. Therefore, our main objective was to study the knowledge and practice of PBM among clinicians mainly involved in the perioperative field at Hospital Universiti Sains Malaysia (Hospital USM), Kelantan. A cross-sectional study was done from 1st December 2019 to 31st October 2020 using a structured and validated questionnaire containing 41 items. Logistic regression was used to evaluate the association between socio-demographic variables with knowledge level. A total of 252 participants were involved in this study. About 61.5% of the clinicians had a poor knowledge level. Poor knowledge level among clinicians was significantly associated with clinicians' age, primary field, previous knowledge about PBM, and PBM course attendance (p<0.05). The practice was at a moderate level. Overall, there were significant knowledge gaps and inadequate practice of PBM in perioperative patients among clinicians in Hospital USM. These results might guide the local clinical division to formulate more constructive and effective training strategies to strengthen the clinicians’ knowledge and practice of PBM in perioperative patients.
Knowledge

Introduction: Acute transfusion reactions (ATR) are commonly reported in clinical transfusion practice, which may result in significant morbidity and mortality. This study aims to explore the impact of transfusion practice on the prevalence, characteristics, and associated factors of ATR at Hospital Sultanah Bahiyah, Kedah, Malaysia. Methods: This was a retrospective study using records from haemovigilance forms of reported transfusion reactions, E-Delphyn (blood bank system), and E-His (hospital information system). A total of 118 cases of ATR from January 1, 2015 until December 31, 2017 were selected and analysed. For each case, a control was selected from a patient who did not develop ATR. Results: A total of 122,215 units of whole blood and blood component transfusions have been performed and 415 ATR were reported. The prevalence of ATR was 0.34% or one in 294 units transfused. There was a significant association between ATR and red cell concentrate (RCC) stored for more than 14 days (adj OR = 65.29, 95% CI 9.29-458.85). The most common ATR were allergic reactions with 63 cases (53.4%), followed by febrile non-haemolytic transfusion reactions (FNHTR) with 45 cases (38.1%). Allergic reactions were significantly associated with female patients (p = 0.038) and the paediatrics age group (p = 0.038). Multivariate analysis revealed a significant association between FNHTR and RCC stored more than 14 days (p = 0.002). Conclusion: The prevalence of ATR in this hospital was low and associated with RCC stored for more than 14 days. Implementation of pre-storage leucoreduction is recommended.

Introduction: The association between clinical characteristics and endoscopic profile of acute non-variceal upper gastrointestinal bleeding (NVUGIB) patients with red blood cell (RBC) transfusion has not been well explored in Malaysia. Therefore, a retrospective study was performed using a five-years database to analyse the factors clinically and endoscopically for RBC transfusion. Methods: All adult NVUGIB patients who received RBC transfusion within the study period of 2012-2017 in Putrajaya Hospital were enrolled. There were 180 patients selected by systematic random sampling. Our composed clinical data include demography, risk factor, aetiology, presenting symptoms, Glasgow-Blatchford Score (GBS), endoscopic findings according to Forrest Classification and number unit of RBC transfusion. These data were analysed using Mann-Whitney U-Test, Pearson Correlation and Multiple Linear Regression (MLR). Results: Total 180 patients, the mean age was 63.9 (SD 11.6). Their presenting symptoms were melaena (62.8%), haematemesis (38.3%), and haematochezia (10.6%), with the cause of bleeding was gastric erosion (65.6%), duodenitis/duodenal ulcer (26.1%), and oesophagitis (7.8%). The mean GBS score was 10.7, and the number of RBC transfusion unit was 2.8. The Forrest Classification showed Forrest III (36.1%), Forrest IIc (22.8%), Forrest IIb and Ib (14.4%) respectively. Pearson’s Correlation showed a strong correlation between GBS and unit of RBC transfusion (r = 0.922, p-value <0.001). MLR analysis revealed haematochezia (p = 0.022) and higher GBS (p <0.001) were independent factors associated with a higher number of RBC transfusion unit. Conclusion: Haematochezia and higher GBS score were two predictive factors for a higher RBC transfusion unit in NVUGIB patients.

Introduction: Scoliosis is a deformity of the spine that presents with a ‘S’ or ‘C’ curve with the most common type called Adolescent Idiopathic Scoliosis (AIS). The deformity begins unnoticed and can rapidly progress into severe deformation during the adolescent’s growth spurt. Factors such as onset of puberty, dietary intake, physical activity and ethnicity contributes to the development of AIS. Therefore, this study aims to determine the association of these factors with the prevalence of AIS among female school children in Kuala Langat. Methods: A total of 374 students between age 10 and 12 from six different primary schools in Kuala Langat were recruited according to the inclusion criteria. Consent form and questionnaire was distributed to the student’s parents/guardian prior conducting the research. Adam’s Forward Bend Test was performed to measure the rotation of the trunk using a smartphone Scoliometer Application. Results:Out of 374 students, 21 students from schools in Kuala Langat were found positive for AIS with a prevalence rate of 5.6%. However, no association was seen between the student’s age of menarche, dairy intake, frequency in physical activity and ethnicity with the prevalence of AIS. Conclusion: The factors measured in this study showed no association with the prevalence of AIS among school children in Kuala Langat.

Objective: To determine the etiologies of tropical acute febrile illness (TAFI) in West Pahang, Malaysia and to investigate morbidity and mortality factors in relation to TAFI. Methods: A multicenter prospective cohort study was conducted between January and June 2016 in six district hospitals throughout the western part of Pahang State in Peninsular Malaysia. A total of 336 patients answered a standardized questionnaire and blood samples were collected for laboratory confirmation of infectious etiology. Descriptive analysis and logistic regression were performed to identify factors associated with TAFI. Results: A total of 336 patients were included. The patients were mainly Malays (70.2%), males (61.3%), aged (44.6±17.4) years, with more than half (58.9%) presenting with gastrointestinal symptoms. The majority were diagnosed with dengue (35.7%) while malaria (4.5%) was the least frequent. The in-hospital mortality due to TAFI was 9.2%. Patients with meliodosis had five times higher mortality [Adjusted OR: 5.002, 95% CI: (1.233, 20.286)]. Patients with comorbidities such as cardiovascular symptoms (P <0.001) and renal replacement therapy initiation (P <0.001) were significantly associated with in-hospital mortality in all TAFI. Conclusions: The etiology of TAFI in the western Pahang includes dengue, leptospirosis, malaria and melioidosis, which carry the highest risk of in-hospital mortality. The presence of cardiovascular symptoms may be used to assess the disease severity in TAFI, but more studies are needed in the future.