Introduction: The Theory of Planned Behavior (TPB) construct is recommended by the World Health Organization to assess intention for vaccination; however, there is yet a validated instrument in the context of booster dose Covid-19 vaccination in Malaysia. The purpose of the present study is to translate and investigate the factorial validity and internal reliability of the TPB construct for booster dose Covid-19 vaccination (TPB-BDV) questionnaire in Malaysia. Materials and methods: In the pre-testing of the study, five experts and 40 Malaysian adults respectively rated the content and validity index of all 11 items of the translated questionnaire in Malay version. Next, 160 Malaysian adults completed the Malay version of Theory of Planned Behavior- Booster Dose Vaccination (TPB-BDV) questionnaire via online. Results: In the pre-testing phase, Content Validity and Face Validity Index for 10 items in Malay version of TPB-BDV achieved cutoff mean score >3.0 for relevancy, clarity, ambiguity, and simplicity. Meanwhile, Item 8 scored low on relevancy. In the main study, exploratory factor analysis suggested three factors consisting of a final 10 items (without Item 8) which accounted for 74.0% of the total variance. The three factors were Attitude (5 items), Subjective Norms (3 items), and Perceived Behavioral Control (2 items). The internal reliability ranged from a = 0.83 to a = 0.93, with an overall value of a = 0.90. Conclusion: The findings suggest that the 10-items Malay version of TPB-BDV is valid and reliable to measure the individual decision in taking the Covid-19 booster-dose vaccine among Malaysian adult population.

Pengenalan: Soal selidik sebagai alat untuk mengukur faktor sosiobudaya berkaitan COVID-19 masih belum digunakan secara meluas oleh kebanyakan penyelidik. Di Malaysia, tiada soal selidik yang dibina dan disahkan untuk tujuan tersebut. Oleh itu, tujuan kajian ini adalah untuk membina dan mengesahkan soal selidik sebagai alat ujian yang baru bagi mengukur faktor sosiobudaya berkaitan COVID-19 dalam kalangan Orang Asli di Malaysia. Metodologi: Kajian rintis ini melibatkan 30 orang penduduk Orang Asli di Pos Lenjang, Kuala Lipis, Pahang. Indeks Kesahan Kandungan (CVI) digunakan untuk menguji kesahan kandungan soal selidik, manakala kesahan konstruk dan kebolehpercayaan konsistensi dalaman soal selidik ditentukan menggunakan Exploratory factor analysis (EFA) dan Cronbach’s Alpha. Hasil Kajian: Satu set soal selidik terdiri daripada empat konstruk telah dibina iaitu kepercayaan, amalan perubatan tradisional, adat dan budaya tradisional, dan sokongan sosial. Sebanyak 16 item telah dikekalkan di dalam EFA dengan nilai Cronbach’s Alpha setiap konstruk adalah 0.617, 0.778, 0.773 dan 0.779. Rumusan Soal selidik yang telah dibina ini berjaya divalidasi dan boleh digunakan untuk mengukur faktor sosiobudaya berkaitan COVID-19 dalam kalangan Orang Asli. Walau bagaimanapun, penambahbaikan masih perlu dilakukan dari masa ke semasa untuk memastikan soal selidik ini relevan terutamanya jika ia digunakan ke atas populasi atau dari negara yang berbeza dari Malaysia, dengan mengambil kira juga penyakit yang berbeza.

The options for prenatal genetic testing have evolved rapidly in the past decade, and advances in sequencing technology now allow genetic diagnoses to be made down to the single-base-pair level, even before the birth of the child. This offers women the opportunity to obtain information regarding the foetus, thereby empowering them to make informed decisions about their pregnancy. As genetic testing becomes increasingly available to women, clinician knowledge and awareness of the options available to women is of great importance. Additionally, comprehensive pretest and posttest genetic counselling about the advantages, pitfalls and limitations of genetic testing should be provided to all women. This review article aims to cover the range of genetic tests currently available in prenatal screening and diagnosis, their current applications and limitations in clinical practice as well as what the future holds for prenatal genetics.
Child ; Pregnancy ; Female ; Humans ; Prenatal Diagnosis ; Knowledge ; Parturition

Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.

Introduction: Laboratory tests account for 66% of clinical decision making and reducing inappropriate test utilisation is a step towards optimising patients’ care and hospital cost savings. This study aims to identify the rate and cost of redundant test requests in our centre. Methods: A cross-sectional study comprising laboratory results of 14 analytes in renal function test (RFT) and liver function test (LFT) were made. Data involved blood results from adult patients admitted to Hospital Universiti Sains Malaysia from January to December 2018. The redundant test is defined as test results consecutively normal twice and requested within 26 hours for analytes in RFT and 50 hours for analytes in LFT. Cost contributions were estimated by multiplying cost-per-test with total redundant requests. The test redundancy in different wards and disease groups were also evaluated. Results: Equal distribution of RFT and LFT requests were observed in both genders (50% respectively), with the most requests seen in the 60 – 79 years age group. More than 20% redundancy rate was observed for seven analytes (ALT, total bilirubin, sodium, urea, potassium, AST, Chloride), and overall redundancy was 19.7%, equals to Malaysian Ringgit (MYR) 669,105.00. Oncology wards and genitourinary diseases contribute to the highest redundancy rate. Conclusion: This study estimated MYR 600 thousands of saving if test redundancy were to be eliminated. The finding is hoped to serve as a platform for future intervention and policymaking. Future planning to optimise the current laboratory request system and collaboration among physicians and laboratory professionals can minimise test inappropriateness.

Introduction: Women with uncontrolled diabetes may conceive but will result in poor pregnancy outcomes. This study aimed to assess the level of knowledge and attitude and determine factors associated with attitude towards preconception care. Method: A cross-sectional study was conducted in various government health clinics from all districts in Terengganu by using multistage random sampling. A self-administered questionnaire was applied to assess the level of knowledge and attitude towards preconception care. Multiple logistic regressions were applied to determine factors associated with attitude towards preconception care. Results: A total of 422 respondents were involved. The prevalence of respondents with unsatisfactory knowledge and attitude were 41.7% and 84.1%, respectively. Knowledge was not significantly associated with attitude. Respondents who used contraception had a better attitude (Adj. OR: 0.44, 95% CI:0.23,0.84). Low household income was associated (Adj. OR: 2.40, 95% CI:1.10,5.26) with an unsatisfactory attitude towards preconception care. Conclusion: Attitude towards preconception care amongst diabetic women who were attending primary care clinics was unsatisfactory. A structured and focused preconception educational programme care is necessary, especially amongst low-income women.

Introduction: The Family Doctor Concept (FDC) programme was introduced to public primary care clinics in late 2013 as part of the reform agenda in the primary healthcare delivery system. The study aimed to develop a validated and reliable instrument to evaluate the FDC implementation fidelity in primary care clinics. Methods: The instrument, which adapted the concept of patient-centred care (PCC), resulted from a series of expert discussions, a literature search, an FDC guideline, and a review of meeting minutes. A 2-step process was conducted with experts to achieve content and face validity. Consequently, the instrument was piloted in 5 public primary care clinics in Selangor involving 8 trained raters. Inter-rater reliability was estimated using intraclass correlation (ICC), while internal consistency was measured using Kuder–Richardson Formula 20 (KR-20). Results: The final instrument comprises 3 sections (instructions, clinic’s characteristics and assessment items), with Section 3 containing 15 items divided into four components – population registration, formation of a primary care team, integrated treatment, and monitoring and evaluation. The ICC for total score was excellent, 0.981, while the ICCs of the individual component scores were good to excellent (population registration: 0.937, formation of primary care team: 0.742, integrated treatment: 0.996, and monitoring and evaluation: 0.996). The value of KR-20 was 0.615, which was considered adequate. Conclusion The instrument developed was found to be valid in terms of face and content validity and reliable in measuring the fidelity of FDC implementation with excellent inter-rater reliability.
Primary Health Care ; Primary Care Nursing

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.

Blood collection tubes containing separator gel are widely used in many clinical laboratories because of easy to use, convenience and several other advantages. However, they are not void of limitation. We describe an unusual case with a floating separator gel in the primary blood collection tube. The blood sample was collected into a BD Vacutainer SST II Advance tube, from a 51 years old man admitted for community acquired pneumonia and had history of hyperproteinaemia. Inappropriate positioning of the separator gel was observed after centrifugation, whereby the separator gel floated above the serum. Detection of abnormal separator gel floatation pattern in this patient’s sample before analysis had prevented potential technical problem and production of erroneous result caused by aspiration of separator gel. The limitation of blood collection tube with separator gel especially in patients with hyperproteinaemia should be made aware among laboratory personnel and physicians.

Introduction: The socioeconomic impact of aging population can be reduced if majority of people achieve successful aging. This study aimed to determine the prevalence of researcher's defined successful aging (RDSA) and self-rated successful aging (SRSA) among pre-retirement public servants and their predictors. Methods: The sample included 1,064 pre-retirement public servants (50 to 60 years old) from nine government agencies. Data was analyzed using Multiple Logistic Regression to test for the association between the studied factors and SA. Results: The prevalence of RDSA and SRSA was 37.5% and 98.7%, respectively. Results showed four (4) significant factors with higher odds of having RDSA were not obese, good social support, being physically active and younger age. Meanwhile, five (5) factors highly selected by respondents as predictors for SRSA were having good spiritual or religious practice, happy family, good psycho cognitive function, social support and good physical function. Conclusions The prevalence of SRSA was higher despite the presence of self-reported chronic diseases and physical limitation identified among respondents. The discrepancy in both prevalence of SA reflects the differences that exist between the criteria for SA perceived by respondents and researchers. Misperception among respondents of their aging process as 'successful' despite having diseases or disability may worsen their health status because they continue practicing unhealthy lifestyles without action to improve it. Promotional activities on SA, regular health screening since young and healthy working environment should be implemented by various agencies.