Introduction: This study looks at the patient’s perspective to determine the Catastrophic Health Expenditure (CHE) level and the possible factors which can be associated with CHE in cancer patients. Methods: This cross sectional study was done in National Cancer Institute, Malaysia with 206 patients sampled using the multilevel sampling method and data collected from interview with patients using a validated questionnaire. The CHE definition used in this study is when the monthly health expenditure exceeds more than 10% of the monthly household income. Results: This study showed a CHE level of 26.2%. CHE was higher in Indian ethnicity (P = 0.017), single marital status (P = 0.019), poverty income (P < 0.001), small household size (P = 0.006) and without Guarantee Letter (GL) (P = 0.002) groups. The significant predicting factors were poverty income aOR 5.60 (95% CI: 2.34 – 13.39), home distance near to hospital aOR 4.12 (95% CI: 1.74 – 9.76), small household size aOR 4.59 (95% CI: 1.07 – 19.72) and lack of Guarantee Letter aOR 3.21 (95% CI: 1.24 – 8.30). Conclusion: The information from this paper can be used by policy makers to formulate better strategies in terms of health financing so that high risk for CHE cancer patients groups can be protected under a better health financing system.

Introduction: Risk factors for Parkinson’s disease (PD) fall into three broad categories, namely environmental, genetic, and lifestyle factors. Identifying environmental factors that increase the risk of PD would allow these exposure to be reduced and the disease prevented while facilitating experimental investigation of mechanisms and intervention options. Thus, the aim of this review is to summarise the current evidence on the role of environmental factors in the development of PD. Methods: All original articles published between 2018 and 2022 and written in English were searched from three databases, i.e., PubMed, Scopus Web of Science (WoS), using combination of primary keyword (PD and its MeSH and synonyms), and two secondary keywords; (“environment*”) and risk (factor*). Result: After a thorough screening process, nineteen articles were included in this scoping review. The environmental risk factors examined in the included studies fell into five categories: a) pesticide exposure, b) heavy metals and organic solvent exposure, c) drug abuse and d) air pollution and e) source of water. Conclusions In summary, PD is a complex neurological disorder for which there are several environmental risk factors involved. Identifying and reducing exposure to these environmental factors could have a significant impact on the future occurrence of the disease.

Pengenalan: Aduan dalam sistem rawatan kesihatan adalah aduan yang dibuat oleh pesakit atau saudara-mara pesakit kerana pelbagai alasan seperti kualiti perkhidmatan yang buruk atau harapan yang tidak dipenuhi. Terdapat beberapa kajian yang dilakukan untuk mengukur berlakunya aduan hospital tetapi tidak ada yang dilakukan di Hospital Sultan Ismail Johor Bahru dan kajian yang sangat terhad melihat faktor-faktor yang berkaitan dengannya dan dengan tuntutan pampasan. Kajian ini bertujuan untuk mengenal pasti aduan di Hospital Sultan Ismail Johor Bahru dan faktor-faktor yang berkaitan dengannya dan dengan tuntutan pampasan. Metodologi: Kajian ini menggunakan kaedah keratan lintang (cross sectional study). Data diambil dari jumlah aduan terkumpul oleh Jawatankuasa Pengurusan Aduan Hospital Sultan Ismail Johor Bahru bermula dari 1 Januari 2009 sehingga 31 Disember 2016. Hasil Kajian: Hasil kajian mendapati terdapat 304 data aduan dengan prevalens 0.13 per 1000 kedatangan pesakit. Seramai 16.7% pengadu telah membuat tuntutan pampasan. Kebanyakan pengadu adalah terdiri daripada lelaki (51.5%) dengan (67.4%) adalah berbangsa Melayu. Sejumlah (46.2%) aduan adalah berkaitan pengurusan klinikal, (61.4 %) aduan dibuat terhadap perkhidmatan doktor manakala (12.1%) aduan adalah berkaitan mortaliti dan (11.4%) berkaitan morbiditi. Kajian ini juga mendapati terdapat hubungan di antara bangsa, jenis aduan dan faktor penyakit dengan tuntutan pampasan. Kesimpulan Aduan berkaitan pengurusan klinikal dan faktor penyakit mempunyai hubungan signifikan dengan pengadu yang menuntut pampasan. Oleh itu, aduan ini harus disiasat secara menyeluruh untuk mengetahui apa yang perlu dilakukan atau diperbaiki supaya kejadian tidak berulang pada masa akan dating.

Introduction: Influenza outbreak causes high economic burden to Malaysia and other countries in South East Asia. Scientists have found a relatively new way to detect influenza outbreaks early thus reducing the burden of disease by early intervention. This new technology is a social network information system which uses Facebook or Twitter data to detect potential influenza cases. Such system is good to be developed by the Malaysian government as it can detect influenza outbreaks three weeks earlier than the normal pathway. However, to implement this we require good evidence that the development will be accepted by potential users. Objective: This study was looking at the acceptance towards using social network information system among public health workers. Materials and Method: This study was done on 205 Malaysian One Health University Network (MyOHUN) members through email and physical survey. Results: Results show that 62.4% public health workers accepted the use technology. The acceptance was shown to be associated with performance expectancy (p<0.05). However, unlike the very famous Unified Theory of Acceptance and Use of Technology (UTAUT) model, the acceptance of social network information system was not associated with effort expectancy, social factors, facilitating conditions and socio-demographic factors. Therefore, it is suggested that social network information system be developed by the authorities in Malaysia, and be developed in a way that the system could strongly increase performance in detection of outbreak earlier than the current normal pathways. As such the system to be accepted and used, it must be sensitive, specific and be able to detect influenza outbreak early Conclusion: The development of social network information system is feasible as it is highly accepted and it’s potential to improve early detection of influenza outbreak.

Introduction: Distal radial fracture is a commonly encountered fracture. This study aims to study the epidemiology of distal radial fracture and factors affecting the patients’ functional outcome one to two years after the injury. Materials and methods: This is a retrospective cohort study. The records of patients, fulfilling the radiographical diagnosis of distal radial fracture, and aged 18 and above, who presented to our Emergency Department from 1st January 2018 to 31st December 2018 were retrieved. According to AO classification, we grouped our patients into A (extra-articular), B (partial articular) and C (complete articular). Patients with congenital abnormalities were excluded. Epidemiological data and relevant medical history were obtained and tabulated. A Malaysian language translation of Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to assess the functional outcome. Results: Out of 168 patients’ data retrieved, only 110 patients’ data were found complete for purposes of this study. The mean DASH score was 13.7 ± 7.87 approximately one to two years post-injury regardless of treatment method. Increasing age was associated with higher DASH score with r=0.407(p<0.001). Several variables had significantly better functional outcome: male gender (p=0.01), Type A fracture configuration (p=0.007) and non-operational treatment (p=0.03). There was no significant difference between treatment modalities in Type A fracture (p=0.094), but Type B (p=0.043) and Type C (p=0.007) had better outcome without surgery. There was no significant difference between different ethnic groups, open or closed fracture and mechanism of injury. Conclusion: Better functional outcome after sustaining distal radial fracture was associated with young age, male gender, type A fracture and treated non-operatively. Interestingly, more complex fracture pattern had better functionality were observed without surgery.

Using pulmonary tuberculosis (pTB) as an example of a vaccine-preventable disease (VPD), we aimed to gather evidence on the economic impact of treating a case or managing an outbreak of a VPD. A scoping review was conducted. Online databases (MEDLINE and Google Scholar) were used to collate published studies from the year 2015 to 2019 on the management cost of one case or an outbreak of pTB. Keywords used were cost, treatment, outbreak, pulmonary tuberculosis, tuberculosis, economic, economic evaluation. A total of 29 studies were analysed. The costs of pTB treatment for individual patient were higher in high-income countries compared to middle-income and low-income countries. A case of pTB can result in household catastrophic health expenditure; while an outbreak can overwhelm the health system’s capacity, and disrupts the economy of a country. Therefore, accessibility of vaccines especially in low-income countries must be ensured. Also, vaccine-hesitant individuals must reconsider their stance on vaccination.

Objectives: Body weight perception may determine the practice of proper weight management. The objective of this study was to measure the agreement between body weight perception and actual body weight status and its associated factors among late adolescents in Kuantan, Malaysia. Methods: A cross-sectional study was conducted from April to October 2018 among 479 adolescents aged 17-19 years old from seven institutions of higher learning in Kuantan. Body weight status was described as body mass index (BMI). Weight and height were measured, and BMI was calculated. Validated, self-administered Figure Rating Scale (FRS) questionnaires were used. Agreement between BMI and body weight perception was calculated using Kappa statistics. Logistic regression was employed to examine the association between body weight perception and sociodemographic variables. Results: More than one-third (35.3%) of the respondents misjudged their own body weight. More than one third of the respondents (38.7%) who were underweight, misperceived themselves as having normal weight whilst 31.7% of obese respondents identified themselves as overweight. The agreement between body weight perception and body mass index was moderate (k0.46, p<0.01). Conclusion: Body weight perception was in moderate agreement with actual weight in late adolescents. Accurate body weight perception is an important factor in late adolescent’s weight management behaviour. Hence, health education related to body weight management should be emphasized among this age group.

Malaria is a life-threatening disease caused by the Plasmodium sp. parasite. Infection results in heightened pro-inflammatory response which contributes to the pathophysiology of the disease. To mitigate the overwhelming cytokine response, host-directed therapy is a plausible approach. Glycogen synthase kinase-3β (GSK3β), a serine/threonine kinase plays a pivotal role in the regulation of inflammatory response during pathogenic infections. The present study was conducted to investigate the chemo-suppressive and cytokine-modulating effects of insulin administration in malaria-infected mice and the involvement of GSK3β. Intraperitoneal administrations of 0.3 and 0.5 U/kg body weight insulin each for four consecutive days into Plasmodium berghei NK65 (PbN)-infected mice resulted in chemo-suppression exceeding 60% and improved median survival time of infected mice (20.5 days and 19 days respectively compared to 15.5 days for non-treated control). Western analysis revealed that pGSK3β (Ser9) intensity in brain samples from insulin-treated (0.3 and 0.5 U/kg body weight) infected mice each were 0.6 and 2.2 times respectively than that in control. In liver samples, pGSK3β (Ser9) intensity from insulin-treated infected mice were significantly higher (4.8 and 16.1 fold for 0.3 and 0.5 U/kg bw respectively) than that in control. Insulin administration decreased both brain and liver pNF-κB p65 (Ser536) intensities (to 0.8 and 0.6 times for 0.3 U/kg bw insulin; and to 0.2 and 0.1 times for 0.5 U/kg bw insulin respectively compared to control). Insulin treatment (0.5 U/kg bw) also significantly decreased the serum levels of pro-inflammatory cytokines (TNF-α (3.3 times) and IFN-γ (4.9 times)) whilst significantly increasing the levels of anti-inflammatory cytokines (IL-4 (4.9 fold) and IL-10 (2.1 fold)) in PbN-infected mice. Results from this study demonstrated that the cytokinemodulating effects of insulin at least in part involve inhibition of GSK3β and consequent inhibition of the activation of NF-κB p65 suggesting insulin as a potential adjunctive therapeutic for malaria.

Introduction Thalassemia disease is a serious health problem as it gives psychosocial burden not only to the patients but also to the patients’ ecosystem. Among the difficulties faced by patients are psychosocial problems, especially in the process patients’ growth and development. Therefore, this study examines what factors can influenced the psychosocial of Thalassemic patients.. Methods A cross-sectional study was carried out among 161 of Thalasemia Major children at Women and Children Hospital, Likas and Keningau District Hospital, Sabah from February to April 2013. The validated PedsQL 4.0 Generic Core Scale and Social Support questionnaire has been used. Results The results showed that the overall psychosocial score was 68.50 (SP 15.18) with the lowest average school psychosocial score of 58.38 (SP 17.82). Only gender factor showed a significant relationship with psychosocial score of emotional function. There is no significant relationship noted between other sociodemographic factors with overall psychosocial scores or with the psychosocial scores of each function. In relation to subscale social support factors, there was a significant relationship between the psychosocial scores of each function and overall with social support factors of parents, close friends, classmates and teachers. The results of linear regression multivariate analysis suggest that social support factors from classmates is a significant factor in the psychosocial impact of Thalassemia Major pediatric patients. Conclusions In conclusion, social support factors primarily from peers are very important in influencing the psychosocial of Thalassemia Major children in overcoming their life's functionality like other normal children

Health care services are not often accessible and available for all people in one country due to multiple reasons such asthe geographical barrier, affordability, etc. The aim of this study was to analyse willingness to pay (WTP) for healthcareservices user fees among Malaysian population and determine its’ influencing factors. Structured interviews wereconducted involving 774 households in 4 states represents Peninsular Malaysia. Validated questionnaires with openended, followed by bidding games were applied to elicit maximum amount of WTP. The study was analysed descriptivelyand with multivariate regression method to adjust for potential confounding factors. More than half of respondents WTPmore than current fee for the government clinic outpatient registration fee with mean MYR3.76 (SD2.71). Majority ofrespondents not WTP more than usual for private clinic simple outpatient treatment charges with the mean MYR38.76(SD5.45). Factors that were found to have significant associations with WTP for both government and private clinic wereincome and having health insurance. Community willing to pay for healthcare services user fees and charges but atcertain amount. The healthcare services user fees and charges can be increased up to community WTP level to avoidfrom catastrophic expenditure.