COVID-19 is a highly contagious disease that caused a worldwide pandemic in 2020. Medical students are public advocates for COVID-19 vaccination to achieve herd immunity. Our objective is to ascertain the level of knowledge, attitude, and practice toward COVID-19 immunisation among medical students in Malaysia. The online study included four public universities in Peninsular Malaysia: Universiti Putra Malaysia, International Islamic University Malaysia, Universiti Sains Malaysia and Universiti Sains Islam Malaysia. Data collected include sociodemographic characteristics, history of COVID-19 infection, knowledge, attitude and practice towards COVID-19 immunisation. Analytical statistics were analysed with IBM Statistical Package Statistical Package for the Social Science (SPSS) v27.0 using Pearson chi-square or Fisher’s exact test (significant if p < 0.05). From the total of 427 respondents, 60.2% had good knowledge whereby clinical students 67.0% had a higher proportion of good knowledge as compared to preclinical students 53.5% (p = 0.004). Respondents in the age group of 21 to 24 years old (p < 0.001) and 25 to 29 years old (p = 0.016), and Indian ethnicity (p = 0.006) were more likely to have good knowledge. Respondents registered in Malaysia’s National COVID-19 vaccination program were considered as having a positive attitude (n = 264, 61.8%). A vaccination rate of 100% was observed. In conclusion, 60.2% of medical students had good knowledge, 61.8% had a positive attitude and 100% were vaccinated in these four public medical schools in Malaysia. Sociodemographic factors (age group and Indian ethnicity) have an association with only good knowledge but none with the level of attitude and practice towards COVID-19 immunisation.
COVID-19

Introduction: Metal artifacts can degrade the image quality of computed tomography (CT) images which lead to errors in diagnosis. This study aims to evaluate the performance of Laplace interpolation (LI) method for metal artifacts reduction (MAR) in CT images in comparison with cubic spline (CS) interpolation. Methods: In this study, the proposed MAR algorithm was developed using MATLAB platform. Firstly, the virtual sinogram was acquired from CT image using Radon transform function. Then, dual-adaptive thresholding detected and segmented the metal part within the CT sinogram. Performance of the two interpolation methods to replace the missing part of segmented sinogram were evaluated. The interpolated sinogram was reconstructed, prior to image fusion to obtain the final corrected image. The qualitative and quantitative evaluations were performed on the corrected CT images (both phantom and clinical images) to evaluate the effectiveness of the proposed MAR technique. Results: From the findings, LI method had successfully replaced the missing data on both simple and complex thresholded sinogram as compared to CS method (p-value = 0.17). The artifact index was significantly reduced by LI method (p-value = 0.02). For qualitative analysis, the mean scores by radiologists for LI-corrected images were higher than original image and CS-corrected images. Conclusion: In conclusion, LI method for MAR produced better results as compared to CS interpolation method, as it worked more effective by successfully interpolated all the missing data within sinogram in most of the CT images.

Introduction: Prevalence of malnourished children in Putrajaya was unexpectedly high in 2016. This paper describes the study protocol for a case-control study conducted to identify the associated factors of malnutrition among children under 5 years old in Putrajaya. Methods: This study involved two phases. Phase I was ‘screening’ where all children aged 6-59 months in 118 preschools and four government health clinics were measured for their weight and height. The World Health Organization Anthro software was used to determine the nutritional status of these children. Phase II was the ‘interview’ where children from screening were sampled into four pairs of case and control. The optimum sample size for the case of stunted, wasted, underweight, and overweight were 380, 335, 318, and 308, respectively. The same number of controls were recruited. Parents/caregivers of selected children were approached to obtain data on parental factors, children factors, food intake factors, and environmental factors that contributed to malnutrition. Data analysis was performed by multiple logistic regression in SPSS version 26. Results: Screening phase successfully measured 8,261 (50.1%) children from an estimated 16,500 children under 5 years old in Putrajaya. The number of children who were stunted, wasted, underweight, and overweight were 2,105 (25.5%), 512 (6.2%), 1,516 (18.4%), and 248 (3.0%), respectively. As overweight was undersampled, the number of controls for overweight was doubled to increase the power of the study. Parents/caregivers of selected cases and controls were interviewed in their household or any other venues at their convenience. Conclusion: This protocol promises beneficial outputs to stakeholders and policy makers that can be used for combating malnutrition in children.

The application of artificial intelligence (AI) is on the rise in the healthcare industry. However, the study on the physicians’ perspectives is still lacking. The study aimed to examine physicians’ attitudes, expectations, and concerns regarding the application of AI in medicine. A cross-sectional study was conducted in October 2019 among physicians in a tertiary teaching hospital in Malaysia. The survey used a validated questionnaire from the literature, which covered: (1) socio-demographic profile; (2) attitude towards the application of AI; (3) expected application in medicine; and (4) possible risks of using AI. Comparison of the mean score between the groups using a t-test or one-way analysis of variance (ANOVA). A total of 112 physicians participated in the study: 64.3% from the clinical departments; 35.7% from the non-clinical specialties. The physicians from non-clinical departments had significantly higher mean attitude score (mean = 14.94 ± 3.12) compared to the clinical (person-oriented) departments (mean = 14.13 ± 3.10) and clinical (technique-oriented) departments (mean = 13.06 ± 2.88) (p = 0.033). The tech-savvy participants had a significantly higher mean attitude score (mean = 14.72 ± 3.55) than the non–tech-savvy participants (mean = 13.21 ± 2.46) (p = 0.01). There are differences in the expectations among the respondents and some concerns exist especially on the legal aspect of AI application in medicine. Proper training and orientation should precede its implementation and must be appropriate to the physicians’ needs for its utilization and sustainability.

Introduction: Non-communicable diseases (NCDs) are evolving as the leading cause of death worldwide, including in Malaysia. Changes in a socio-economic status have increased at-risk populations with NCDs. The objective of this study is to describe the prevalence of self-reported NCDs and its contributing factors in a selected low socio-economic status community in Kedah, Malaysia. Methods: A cross-sectional study with a self-administered questionnaire was done among convenience samples of 139 adults (age more than 18 years old) living in a selected low socio-economic status community in Kedah. Results: Among 139 respondents with a mean (SD) age 48.5 (13.1), there were 40.3% of respondents reported to have chronic illnesses with a prevalence of hypertension (25.9%), diabetes mellitus (21.6%), hypercholesterolemia (7.2%), chronic respiratory diseases (5.0%), heart disease (2.9%) and stroke (1.4%). The significant contributing factors of NCDs by multiple logistic regression were age, marital and working status. A person with an increase in 1 year of age has 1.05 times the odds to have NCDs (95% CI: 1.01 to 1.09, p-value=0.007). A divorcee has 3.55 times the odds compared to a married person to have NCDs (95% CI: 1.28 to 9.80, p-value=0.015). The non-working individual has 2.27 times the odds compared to working individuals to have NCDs (95% CI: 1.03 to 5.01, p-value=0.042). Conclusion: The prevalence of NCDs is high in this selected low socio-economic status community. The contributing factors are age, marital and working status.

Carbonated soft drinks (CSD) consumption is one of the contributing factors to weight gain, dental caries and non-communicable diseases among adolescents. This study aims to determine CSD consumption among Malaysian adolescents and their associated factors. The Adolescent Health Survey 2017, was a nationally representative survey sampled school-going adolescents aged 13 to 17 years. Findings reported that 36.9% of adolescents reported CSD consumption at least once daily in the past 30 days, and the prevalence was higher than a similar study conducted in 2012. Boys, schools in rural areas, lower secondary schoolers, not physically active, consuming fast food, having food insecurity, and truancy problem reported significantly higher odds of consuming CSD compared to their counterparts. By ethnicity, Bumiputera Sarawak adolescents showed the highest odds of consuming CSD and followed by Bumiputera Sabah. Thus, interventions to limit CSD consumption among Malaysian adolescents should consider the factors highlighted in this study.

This review aimed to provide a comprehensive overview of ruminant and human fascioliasis in Malaysia and to identify research gaps in knowledge of the prevalence of fascioliasis in Malaysia and risk factors for the disease using available evidence-based data. We conducted a scoping review based on the framework of Arksey and O’Malley. The preferred reporting items for systematic reviews and meta-analyses were used to guide the review process. The citation search was performed between May and September 2018. Using specific keywords, literature published between 1998 to September 2018 was retrieved from electronic databases. Six articles related to fascioliasis in Malaysia were included in the final review from 1,932 screened articles and reports. Five studies focused on ruminants, including cattle, buffaloes, sheep and goats in the states of Terengganu and Perak. The most frequent ruminant fascioliasis outbreaks involved cattle and goats, with a prevalence of 82%–95% and these outbreaks occurred in Terengganu. Only one study examined the risk of fascioliasis in cattle. In the study, the age and sex of the cattle were important risk-related parameters. The search returned only one documented report of a suspected case of human fascioliasis with an atypical clinical presentation. At present, human fascioliasis in Malaysia remains under-reported and its prevalence remains unknown. The data summarised in this review based on existing evidence identifies research gaps on fascioliasis in ruminants and humans.

Limited health literacy is highly associated with poor health status. The concept of health literacy in public health relates to the concern that people with lower health literacy were also less likely to engage in health promoting behaviours. This is an analysis on health literacy and its associated factors among housewives and also a sub analysis of the Malaysian My Body is Fit and Fabulous at Home (MyBFF@home) study involving 328 overweight and obese housewives living in low cost flats in Klang Valley, part of a weight loss programme recruited using convenient sampling. Health literacy was measured using the Malay version of Newest Vital Sign (NVS) test with scores ranging from 0 to 6. Total score of ≤2 indicate limited health literacy and total scores of >2 indicate adequate health literacy. Descriptive analysis, chi-square test and multiple logistic regression were used to analyse the data.The mean(SD) NVS score was 1.07(1.19) with most (87.5%) housewives having limited health literacy. Factors that were significantly associated with limited health literacy were older age of 45 to 59 years old (p = 0.040), primary education and below (p = 0.001) and absence of internet connectivity (p = 0.001). In the final model, absence of internet connectivity (OR 2.61; 95%CI 1.31 to 5.22) was associated with limited health literacy. Majority of the housewives have limited health literacy and providing internet connectivity to housewives may increase their health literacy.
housewives ; health literacy ; low cost flats ; Newest Vital Sign ; obese

Road transport is the movement of passengers or goods on the road. To date, issues concerning the safety of students and school institutions have continued to attract public attention. The recent spate of incidents insideand outside the school compoundhas brought the issue of children safety into our attention. These include the escalating number of road casualties. This study was conducted to observe road hazard outside the school compound and analyse the safety risksfaced by school children by using the risk matrix. The risks are calculated to include likelihood and severity of hazard as identified in the Guideline of HIRARC 2008. The area selected was the East Coast state of Peninsular Malaysia, with over 111 schools randomly selected in Kelantan. Results werethen analysed and six highlighted hazards were discussed. The results show that the main road posed the highest risk due to speeding vehicles. These vehicles failed to slow down when approaching the school area. The school administrationmustenhance the safety of the staff, students, and public while in the school area. In conclusion, road safety awareness must be instilledamong teachers, students, parents and road users alike.
hazard ; road transport ; school ; children ; teacher ; safety ; hazard identification, risk analysis

Aims: Bacterial pathogens such as Pseudomonas aeruginosa and Burkholderia pseudomallei are intrinsically resistant to many classes of antibiotics. This is not only due to the poor permeability of their outer membrane but also because of expression of multiple efflux pumps. A promising strategy to minimize the efflux of drugs by these pumps is the use of efflux pump inhibitors (EPIs). In this study, the potential of caffeic acid derivatives as EPIs in P. aeruginosa and B. pseudomallei were evaluated. Methodology and results: The potential of caffeic acid and its derivatives, i.e. chlorogenic acid, caffeic acid phenethyl ester (CAPE) and caffeic acid phenethyl amide (CAPA) to act as EPIs in P. aeruginosa and B. pseudomallei were assessed using the ethidium bromide (EtBr) accumulation and minimum inhibitory concentration (MIC) validation assays. Among the four test compounds, CAPE was found to significantly increased intracellular accumulation of EtBr in both P. aeruginosa and B. pseudomallei. An increase of 21.4% and 16.8% in cell fluorescence, over a 5-min time frame was observed in P. aeruginosa and B. pseudomallei respectively. Combination of CAPE with kanamycin significantly reduced MICs of this aminoglycoside by a factor of 8-fold in P. aeruginosa and 2-fold in B. pseudomallei. Combination of CAPE with gentamicin also led to a reduction of 4-fold MIC value of this antibiotic in B. pseudomallei. Conclusion, significance and impact of study: The in-vitro results suggest that CAPE has the potential to act as an EPI in P. aeruginosa and B. pseudomallei, thus improving the efficacy of aminoglycosides as antimicrobial agents.