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.

Cost-Effectiveness of Mobile Application Use in Managing Type 2 Diabetes Mellitus: A Systematic Review Introduction Type 2 diabetes mellitus (T2DM) is a debilitating condition that imposes a significant economic burden on its management. This study aims to systematically review the published evidence on the cost-effectiveness of mobile health (mHealth) application interventions for T2DM. Methods A search strategy was conducted using electronic bibliographic databases, including PubMed, Web of Science and Scopus for published studies. The inclusion criteria included original articles that reporting cost-effectiveness evaluation studies on mHealth application interventions directed at patients diagnosed or at risk of T2DM, English-language articles and published in the year 2016 to 2020. Results A total of 6 eligible studies were selected. The cost savings per person for treating T2DM ranged from USD 1,346 to USD 3,781 per year. The major contributor to cost savings was reduced complication management resulting from good glycaemic control. The direct impacts of the intervention include reduced hospitalisation and fewer unplanned clinic visits, while diabetes- related mortality was indirectly reduced usingmHealth. Conclusions The mHealth intervention was cost-effective in managing patients with T2DM. Implementation can be extended to other disease management areas to not only reduce total healthcare expenditure but also improve patients’ quality of life.

Introduction: The 2021 IDF-DAR risk calculator had been previously evaluated in multiple studies and subsequently widely accepted and applied in clinical practice as a practical standardized tool for patient risk stratification. Recently updated, the 2026 IDF-DAR Risk calculator enables a more individualized, evidence-related evaluation of patientrelated and disease-related risk factors, incorporating modern diabetes technologies, including continuous glucose monitoring (CGM), automated insulin delivery (AID) systems, and advanced insulin formulations to enhance risk stratification. This tool allows medical professionals to tailor Ramadan practices based on overall factors toward promoting safe fasting. Methodology: This prospective multicentre observational study recruited adults with Type 1 and Type 2 diabetes attending public hospitals nationwide. People with diabetes (PwD) intending to perform Ramadan fasting were invited to participate and assessed using the 2026 IDF-DAR Risk Calculator in the 6-week pre-Ramadan period between 30th January and 19th March 2026. Results: A total of 458 PwD were evaluated and stratified into low (15.7%), moderate (41%), and high risk (43.3%) categories. Most participants had Type 2 diabetes (83.6%), with 60.3% having a disease duration exceeding 10 years and 43% exhibiting poor glycemic control (hemoglobin A1c >9%). Insulin therapy was used by 76.4% of participants, including two individuals with Type 1 diabetes using AID systems. Most participants reported no recent hypoglycemia (76.4%), 81.0% performed glucose monitoring, and 3.3% used CGM. Severe comorbidities were uncommon, with 1.1% having unstable macrovascular disease and 4.4% advanced chronic kidney disease (estimated glomerular filtration rate <30). Notably, 72.2% received structured Ramadan education. Conclusion Majority of PwD attending tertiary diabetes clinics were in the moderate- to high-risk category and intended to fast despite medical advice against fasting in some cases. Although most participants were on insulin therapy, hypoglycemia was low in the pre-Ramadan period. Integration of modern technologies, advanced insulin therapies, and structured education may support safer fasting practices.
Risk Assessment ; Diabetes Mellitus ; Hospitals ; Fasting

Introduction: Arginine vasopressin deficiency (AVP-D) is characterized by impaired antidiuretic hormone secretion, leading to polyuria and a significant dehydration risk. The British Islamic Medical Association classifies AVP-D as a “very high risk” condition, advising against Ramadan fasting. However, many patients fast due to religious convictions, creating a gap between clinical guidelines and patient practice. This study evaluates the clinical outcomes and safety of fasting in this population. Methodology: A single-centre retrospective cohort study was conducted at Hospital Putrajaya. We included adults with permanent AVP-D on desmopressin therapy for more than 1 year who fasted during Ramadan 2025. Data were extracted from electronic medical records and patient consultations. Primary outcomes included hospitalization rates, dehydration symptoms, and desmopressin dose adjustments. Results: Of the 43 patients (mean age 42.4 ± 15.28 years; 53.5% female), 27 successfully fasted for a mean of 27.6 ± 6.56 days. Pre-Ramadan counseling was documented in only 55.8% of cases. While 25.9% of participants experienced dehydration symptoms (thirst, dizziness), and 22.2% broke their fast for safety reasons, there were no hospitalizations. None of the patients required additional desmopressin dose adjustments. Most patients (66.7%) maintained twicedaily desmopressin dosing (Sahur and Iftar). Anterior pituitary deficiencies were present in 70.3% of the cohort. Conclusion Despite being classified as very high risk, many AVP-D patients safely complete Ramadan fasting without severe adverse events. However, the high rate of dehydration symptoms and the significant gap in pre-Ramadan counseling (44.2% un-counseled) highlight the need for structured clinical reviews 4–6 weeks prior to Ramadan to optimize hydration and dosing
Humans ; Diabetes Insipidus, Neurogenic ; Retrospective Studies ; Arginine ; Fasting

Colorectal cancer (CRC) carries a significant burden in most world regions. However, its screening uptake remains low. This study aimed to explore awareness and perspectives on CRC screening program in a multiethnic population and their preference for CRC screening decision aid. In-depth interviews were conducted until data saturation was reached. All interviews were audiotaped, transcribed verbatim, translated to English and analysed thematically using hybrid inductive and deductive approaches. 17 informants from three main ethnic groups (Malay, Chinese and Indian) with various levels of risk for developing CRC were recruited. Awareness on CRC screening program was found to be low. Majority of informants never heard of CRC screening program. Among 11 eligible informants, only five experienced CRC screening uptake. Thematic analysis of the transcripts yielded six major themes; knowledge on CRC, screening process, authority’s role, curability, willingness to screening and preference for decision aid, and theywere mapped onto the Health Belief Model. Specific multiethnic perspectives found included preference for traditional medicine coming from all ethnics, and reliance in God coming from Malay informants. Majority preferred short videos as CRC screening decision aid, in the form of animation and live-action screenplay. Exploration of perspective of CRC screening helps in producing impactful decision aids. Future efforts should focus on developing short videos that incorporate population’s perspectives and can be disseminated through electronic media.

Socio-Ecological Framework on Risk of Prolonged Dengue Outbreak in Seremban District: A Qualitative Study IntroductionA prolonged duration of a dengue outbreak in a locality poses a detrimental risk to the susceptible population. There have been limited studies looking into the socio-ecological factors that can be modified to break the chain of transmission. Therefore, this study aimed to explore and identify the socio-ecological attributes experienced by the health authority in the Seremban district.MethodsA qualitative study was performed using an in-depth interview (IDI) technique based on semi-structured questionnaires. Results were thematically analysed when theoretical saturation was achieved.ResultsA total of 12 respondents participated in this study, representing various backgrounds and involved in dengue control activities. There were nine modifiable socio-ecological themes generated, namely (1) illegal dumpsite, (2) illegal gardens, (3) illegal man-made structures, (4) old unused items, (5) idle damaged vehicles, (6) construction site, (7) drainage system, (8) physical structure, and (9) lack of community engagement. A model framework was conceptualised from the analysis. The health authority identified that these issues require urgent attention and collaborative action by various stakeholders.ConclusionThe identified socio-ecological factors have been a challenge for the health authority. Nevertheless, identifying these attributes signifies the key to tackling the prolonged duration of the dengue outbreak. Ultimately, a multi-agency approach and community participation are vital to ensure a sustainable vector control program.

Background: Malaysians, known for their diverse ethnicities, exhibit unique aesthetic features influenced by cultural nuances.Research indicates that factors including ethnicity, culture, and personal experiences affect how people perceive beauty. Objective: This study aims to address the lack of data on the preferred facial aesthetics among women from different ethnic groups in Malaysia. Methods: A questionnaire was administered to 290 Malaysian women, covering multiple regions and dimensions of facial aesthetics, including facial shape, forehead height and slope, cheekbone height, chin shape, eye region features (eyebrow shape, eyelid creases, and inner eye fold), nose (nose bridge shape, nasolabial angle, and nose width-length ratio), and lip thickness. Edited images of Asian models were used as references for facial aesthetic criteria in this study. Results: The survey revealed that the majority of participants were of Malay ethnicity (71.0%) and employed in the private sector (39.3%). The average age of the participants was 31.6±9.2 years, and most of them (66.9%) have not undergone aesthetic procedures before. Furthermore, a significant association was observed between ethnicity and women’s facial aesthetic preferences for facial shape and nasal width-length ratio (p<0.05). Oval facial shape was preferred by Malay (40.3%, n=83), Chinese (41.4%, n=12), and Indian (41.3%, n=19) women, due to its long, narrow, and rounded chin. For nasal width-length ratio, Malay (44.2%, n=91) and Chinese (37.9%, n=11) women preferred a ratio <1, whereas Indians (39.1%, n=18) favored a ratio >1. However, no significant association was found between ethnicity and other facial aesthetic criteria assessed in the study. Conclusion This study identified that Malaysian women’s preferences for facial shape and nasal width-to-length ratio are associated with ethnicity. These findings can serve as a valuable reference for aesthetic practitioners, emphasizing the importance of preservation and enhancement of unique ethnic features, customized according to the suitability of each ethnicity, rather than conforming to prevailing beauty standards.

THERAPEUTIC EFFECT OF NATURAL HERBS IN DENTISTRY: A NARRATIVE REVIEW Objectives: Natural herbs have increased attention due to their therapeutic and general health-improving qualities as reported in the literature. This review paper aims to explore the therapeutic effects of natural herbs in dentistry and to describe the various herbal sources, active compounds and its dental applications. Methodology: A literature search was conducted using WoS, Pubmed, and Scopus with the search terms ‘herbal’ AND ‘dentistry’ AND ‘alternative treatment’. Articles related to natural herbs and dental applications from the past 15 years until September 2023 were gathered. The inclusion criteria for this study were in-vitro experiments and clinical studies. Result: 512 articles were extracted from the search with 128 falling under the inclusion criteria (86 in-vitro experiments and 42 clinical studies). It was observed that 15 therapeutic properties were extensively examined, with antimicrobial studies being the most prevalent (50.0%), while the least explored properties were pulp-capping and obturation material (0.8%). Diseases such as denture stomatitis, oral candidiasis, and gingivitis were highly reported to have benefited from natural herbal medicine as an alternative treatment option. Herbals such as propolis, green tea, ginger, Zataria multiflora, chitosan, garlic, Artemisia, Schinus terebinthifolius Raddi, Uncaria tomentosa, Punica granatum, and Ricinus communis were found to be useful in the treatment of denture stomatitis. Rhizoma imperatae extract has been added to oral care products and has shown an excellent effect on reducing gingivitis. Pistacia atlantica extract mouthwash was reported to be effective against dental plaque bacteria and subgingival microorganisms. Conclusion: Numerous natural herbs have been extensively documented to have therapeutic effects in certain dental diseases as supported by laboratory and clinical studies. However, comprehensive guides such as the clinical indications, therapeutic doses and application methods were with minimal evidence that can be derived from the literature. More extensive clinical trials are to be conducted on the therapeutic efficacy of natural herbs in dentistry.

Introduction: Adventure tourism has become one of Malaysia’s most attractive tourism demands, and mountain climbing is rapidly becoming a popular recreational sport. Exploring mountain adventures offers a dynamic experience, preserving this fascinating activity, yet the climbers are exposed to the risk of altitude sickness, such as Acute Mountain Sickness (AMS). This study aimed to evaluate the prevalence of AMS and investigate the effects of high-altitude sickness on the climber profile associated with climbing at Mount Kinabalu, Malaysia. Methods:. The Lake Louise acute mountain sickness LLS score questionnaire collected 95 climber’s data at four different altitudes. SPO2 and Pulse rate was (PR) measured using a finger pulse oximeter. In a cohort study, AMS was measured on day one at 1866m (1st station), 3622m (2nd station), and day two at 3810m (3rd station), and 4095m (4th station). Results: At the altitude of 1866 (Timpohon Gate), the prevalence of AMS was 0%, 30% at 3622m (Laban Rata), 34.7% at 3810m (Sayat-Sayat), and 37.9% at 4095m (Low’s Peak). The overall prevalence of AMS was 37.9% and the majority of AMS cases were moderate in severity and the LLS score is significant with Pulse Rate and peripheral capillary oxygen saturation (SPO2). Conclusion: Concisely, this finding has triggered a need for consideration from multi agencies to enhance mountaineering guidance, especially for beginners or inexperienced hikers, for a suitable package for climbing attempts to reduce the incidence of AMS among Mount Kinabalu climbers.

Introduction: During the COVID-19 pandemic, healthcare providers have been in great fear due to the high risk of contracting COVID-19 infection at any time. This study aimed to determine the mediating role of resilience on the relationship between fear of COVID-19 and burnout in primary care healthcare providers in Malaysia. Methods: This was an online cross-sectional study involving 1280 healthcare providers aged 18 years and older from 30 government primary care clinics in Malaysia. We used the COVID-19 Fear Scale, the Copenhagen Burnout Inventory Scale, and the Short Brief Resilience Scale to collect data from the respondents. Smart-PLS was used to perform mediation analysis. Results: The mean age of the respondents was 36 years old and mean duration of working experience was 11 years. The majority of the respondents were female (82.4%) and Malays (82.3%). The study population consisted of nurses (47.4%), doctors (26%), medical assistants (11.9), healthcare assistant (7.1%), medical laboratory technicians (6.4%) and drivers(1.3).The results show that fear of COVID-19 positively predicts burnout. According to the results, resilience mediates the relationship between fear of COVID-19 and all the three burnout domains, namely personal burnout (β=0.175,p<0.001), work-related burnout (β=0.175,p<0.001) and client-related burnout (β=0.172,p<0.001). Additionally, resilience reduces the impact of COVID-19 fear on the three domains of burnout. Conclusion: Our study has reported a mediating effect of resilience on the relationship between fear of COVID-19 and burnout.