Introduction: Prolonged COVID-19 pandemic with high morbidity and mortality may cause traumatic events to Healthcare Workers (HCW), resulting in Post-Traumatic Stress Disorder (PTSD) symptoms. Hence, this study aims to determine the prevalence of PTSD symptoms and its association with coping strategies among HCW in managing COVID-19 pandemic at Klang Valley Public Hospitals in Malaysia. Methods: A cross-sectional study with total of 424 eligible respondents were recruited through stratified random sampling. Data was collected from 6th May until 6th June 2021 using a self-administered online questionnaire adopted from MPCL-5 and Brief COPE instruments. IBM Statistical Package for Social Sciences Version 26 was used to analyse data. Result: 25% of the respondents demonstrated PTSD symptoms. Respondents who are single (aOR=3.319, 95% CI: 1.912, 5.762, p-value <0.001) and had history of positive COVID-19 (aOR= 2.563, 95% CI:1.058, 6.209, p-value=0.037) were more likely to experience PTSD symptoms. Frequently coping with self-blaming (aOR= 7.804, 95% CI: 3.467, 17.568, p-value < 0.001), behavioural disengagement (aOR= 7.262, 95% CI: 1.973, 26.723, p-value =0.003), humour (aOR= 5.303, 95% CI: 1.754, 16.039, p-value =0.003), venting emotion (aOR= 3.287, 95% CI: 1.521, 7.105, p-value =0.002) and less planning (aOR= 2.006, 95% CI:1.154, 3.487 p-value =0.014) are significant predictors for PTSD symptoms. Conclusion: One in four HCW managing COVID-19 in Klang Valley public hospitals experienced PTSD symptoms. Therefore, urgent interventional program targeting HCW who are single with history of positive COVID-19 is beneficial to prevent PTSD. Maladaptive coping strategies like self-blaming, venting emotion, humour and behavioural disengagement should be replaced with more adaptive coping strategies like planning, self-compassion, self-care and self-reflection.

Introduction: Over the last decade, tuberculosis (TB) has remained the main cause of death from communicable diseases in Malaysia. This study was aimed to determine the risk factors of unfavourable treatment outcomes (UTO) among new TB cases in Hulu Langat. Methods: A cohort study was prospectively conducted among the new TB cases registered in the government health clinics of Hulu Langat district. The event was defined as any one of the UTO (default, transferred out, treatment failure and death) whichever came first. This data was analysed using SPSS version 25.0. Survival pattern was assessed by Kaplan-Meier plots and Log rank test. Hazard ratios of unfavourable TB treatment outcomes among the new TB cases at 95% confidence interval and level of significance set at 0.05 were calculated using Cox proportional hazard model. Results: Of the 321 patients analysed, 80.4% (n=258) had favourable treatment outcomes and 19.6% (n=63) had UTO with 10.9% (n=35) transferred out, 6.9% (n=22) defaulted and 1.9% (n=6) died. There was no treatment failure. The mean survival time was 5.2 (SD=0.09) months. The risk factors of hazard probability of UTO were male, ethnicity type Others, positive human immunodeficiency virus (HIV) status and not done sputum at 2 months of treatment. Conclusion: Transferred out and default formed the bulk of the UTO in Hulu Langat. New interventions to improve the existing TB prevention and control program should be planned in the first three months of treatment.

Introduction: Dog bite is a global public health concern because it is the main risk factor for human rabies and it particularly affects children. In Nigeria, most dog bites are from stray dogs and their vaccination status remains unknown. Thus, this study aimed to investigate the prevalence and associated factors of dog bite among public primary school children in Madawaki district Gusau, Nigeria. Methods: A cross-sectional study was conducted using an unequal stratified sampling technique among 999 children aged 11 to 13-year-old at seven public primary schools from September 2017 to January 2020. A self-reported history of dog bites, socio-demographic characteristics, knowledge on interaction with dogs, knowledge on the implication of dog bites, risk behaviours of children and dog ownership were collected using a validated questionnaire. Results: The prevalence of dog bites was 54.5%. The predictors of dog bite among the children were being a male (Adjusted Odds Ratio; AOR = 2.252; Confidence Interval; CI = 1.719, 2.949), dog ownership by respondent’s family (AOR = 1.456; Cl = 1.089, 1.946), dog ownership by neighbours of the respondents (AOR = 1.752; Cl =1.334, 2.303), total score for knowledge on interaction with dogs (AOR = 0.884; Cl = 0.858, 0.911), and total score for risk behaviours of children (AOR = 1.020; Cl =1.004, 1.035). Conclusion: Poor knowledge on interaction with dogs, children’s risk behaviours around dogs, dog ownership and being male were the factors associated with a high prevalence of dog bite among primary school children from this study. These factors should be considered in order to develop an effective awareness campaign in schools to reduce the prevalence of dog bites among children.

health problem throughout the world. The effects of theexisting intervention in ensuring compliance to thesubscribed regimen and the impact of nutrition education inenhancing dietary modification during pregnancy inMalaysia have been minimal. This study aims to develop,implement and evaluate the effects of the Health BeliefModel educational intervention on haemoglobin level amonganaemic pregnant women.Methods: This is a quasi-experimental research with pre-post test design with control group involving 81 participantsper group from two health clinics in Sepang. The primaryoutcome was a change in the haemoglobin levels followingeducational intervention. Secondary outcomes includeknowledge on anaemia, Health Belief Model (HBM)constructs, dietary iron intake and compliance towards ironsupplementation. The intervention group received a HBM-based education intervention programme. Results: The response rate in the intervention and controlgroup were 83.9% and 82.7% respectively. Generalisedestimating equations analysis showed that the interventionwas effective in improving the mean haemoglobin level(β=0.75, 95%CI=0.52, 0.99, p<0.001), the knowledge score(β=1.42, 95%CI=0.36, 2.49, p=0.009), perceived severityscore (β=2.2, 95%CI= 1.02, 3.39, p<0.001) and increasedproportion of high compliance level (AOR=4.59, 95%CI=1.58,13.35, p=0.005).Conclusion: HBM-based health education programme hasproven to be effective in improving the haemoglobin levels,knowledge scores, perceived severity scores andcompliance level of participants. The study resultsemphasized on the effectiveness of such an approach,therefore it is recommended that future educationalinterventions which aim at increasing preventive healthybehaviours in pregnant women may benefit from theapplication of this model in primary health care settings.

Introduction: Prevention of osteoporotic fracture requires identification of individuals at high risk. Bone mineral density(BMD) is commonly used to estimate fracture probability despite inadequate predictive discrimination ability. Sphingosine-1-phosphate(S1P), a new marker of bone metabolism and bone turnover markers(BTM) such as procollagen-type-1 amino-terminal propeptide(P1NP) and C-terminal telopeptide of type I collagen(CTX) may complement current assessment. The study determined P1NP, CTX and S1P levels and their correlation with BMD, 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone(PTH) in selected subjects. Method: A cross-sectional study involving Malaysian Chinese men and women aged 50-90 years old from Puchong and Kajang, Selangor. Each subject had BMD determined by dual-energy x-ray absorptiometry and blood samples taken for 25(OH)D, PTH, P1NP, CTX and S1P. Results: A total of 131 subjects [45(34.4%) males and 86(65.6%) post-menopausal women] with median age of 65(IQR=17) were recruited. P1NP and CTX were significantly higher in post-menopausal women (P1NP=61.71 ng/ml, CTX=0.489 ng/ml) compared to men (P1NP=46.94 ng/ml, CTX=0.381 ng/ml). P1NP and CTX differed significantly according to BMD categories with values highest in osteoporosis. S1P between men (2.12±0.75 µmol/L) and post-menopausal women (1.96±0.68 µmol/L) did not differ significantly and did not differ according to BMD categories. S1P did not correlate with BMD, P1NP, CTX and 25(OH)D. P1NP and CTX negatively correlated with BMD at all measured sites but not 25(OH)D. Conclusion: CTX and P1NP, but not S1P negatively correlated with BMD. CTX and P1NP were highest in those with osteoporosis. In this group of Malaysian Chinese subjects, CTX and P1NP rather than S1P reflects bone health.

Objectives: To determine the prevalence of osteopenia (OPe) and osteoporosis (OP) in an urban adult population in Malaysia, and to compare the change in the prevalence when using a Caucasian compared to an Asian reference range. Methods: A cross-sectional random sample of the population aged between 45 and 90 years from the state of Selangor, Malaysia, was invited to attend a bone health check-up. Participants with diseases known to affect bone metabolism or who were on treatment for OP were excluded. Bone mineral density was measured using dual energy X-ray absorptiometry. Based on the World Health Organization definitions, the prevalence of OPe and OP was calculated using the Asian and Caucasian T-scores. Results: A total of 342 subjects (222 females, 120 males), with a mean age of 59.68 (standard deviation: 8.89) years, who fulfilled the study criteria were assessed. Based on the Asian reference range, there were 140 (40.9%) subjects with OPe and 48 (14.0%) with OP. On applying the Caucasian reference range, there were 152 (44.4%) subjects with OPe and 79 (23.1%) with OP, with significant increases in males, females, and Chinese ethnic groups. Overall, 75 (21.9%) of subjects had a change in their diagnostic status. T-scores were consistently lower when the Caucasian reference range was used. Conclusions In a healthy urban Malaysian population, the prevalence of OP is 14.0% and OPe is 40.9%. Application of a Caucasian reference range significantly increased the number of subjects with OP and may potentially lead to over-treatment.

Objectives: To determine the prevalence of osteopenia (OPe) and osteoporosis (OP) in an urban adult population in Malaysia, and to compare the change in the prevalence when using a Caucasian compared to an Asian reference range. Methods: A cross-sectional random sample of the population aged between 45 and 90 years from the state of Selangor, Malaysia, was invited to attend a bone health check-up. Participants with diseases known to affect bone metabolism or who were on treatment for OP were excluded. Bone mineral density was measured using dual energy X-ray absorptiometry. Based on the World Health Organization definitions, the prevalence of OPe and OP was calculated using the Asian and Caucasian T-scores. Results: A total of 342 subjects (222 females, 120 males), with a mean age of 59.68 (standard deviation: 8.89) years, who fulfilled the study criteria were assessed. Based on the Asian reference range, there were 140 (40.9%) subjects with OPe and 48 (14.0%) with OP. On applying the Caucasian reference range, there were 152 (44.4%) subjects with OPe and 79 (23.1%) with OP, with significant increases in males, females, and Chinese ethnic groups. Overall, 75 (21.9%) of subjects had a change in their diagnostic status. T-scores were consistently lower when the Caucasian reference range was used. Conclusions In a healthy urban Malaysian population, the prevalence of OP is 14.0% and OPe is 40.9%. Application of a Caucasian reference range significantly increased the number of subjects with OP and may potentially lead to over-treatment.

Introduction: The prevalence of diabetes mellitus among Malaysian aged ≥ 18 years increased from 11.6% (2006) to 17.5% (2015). Positive self–care behaviour leads to good glycaemic control. The objective of this study is to determine the self-care behaviour, its associated factors and predictors among type 2 diabetes mellitus (T2DM) patients in government health clinics at a district of Northern Peninsular Malaysia. Methodology: A cross-sectional study was conducted on 546 T2DM patients aged ≥ 18 years, recruited by simple random sampling method. A validated self-administered questionnaire including socio-demographic characteristics, diabetes profile, knowledge, Health Belief Model (HBM) and Summary of Diabetes Self-care Activity Scale (SDSCA) was used. Data were analysed using SPSS version 22.0. Self-care behaviour is the dependent variable. Results: The respondents practised 3.4 (SD = 1.11) days self-care behaviour past 1 week. The predictors of self-care behaviour were self-efficacy (standardized β = 0.257, p< 0.001), knowledge (standardized β = 0.112, p = 0.007), female (standardized β = 0.107, p = 0.010), combination oral hypoglycaemic agents (OHA) and insulin (standardized β = -0.182, p = 0.002), and monthly income < RM1,000 (standardized β = -0.129, p = 0.002). The entire group of variables significantly predicted self-care behaviour [F (6, 539) = 15.79, p < 0.001, adjusted R2 = 0.140] with total variance of 14.9%. Self-efficacy was the strongest predictor in self-care behaviour. Conclusion: The findings enable us to identify the specific groups with predicted lower self-care behaviour which are useful in future planning and implementation of intervention.

Introduction: During which HFMD epidemic has kept on recurring worldwide, effective vaccine and specific treatment for HFMD are still not available, calling attention to on preventive practices as the mainstay of the management. Therefore, it is timely to renew the assessment on maternal preventive practices and its predictors in Klang District, Selangor wherein the endemicity and upsurge of HFMD cases has been demonstrated. Methods: A cross-sectional study was conducted from 1st April 2017 until 15th May 2015 among mothers of Community Development Department (KEMAS) preschool children in Klang District. Respondents were selected based on probability proportional to size sampling, whereas data collection was facilitated by validated, and reliable self-administered questionnaire, that examine on the preventive practices towards HFMD. Results: A total of 353 mothers responded to questionnaire, resulting response rate of 80.2%. Most of the respondent were housewife, married and obtained educational level up to secondary school. Insufficient knowledge score (13.61 ± 4.04) was demonstrated, with health belief highlighted on low mean score for perceived severity and perceived barrier, which was 8.30(SD=1.36) and 7.80(SD=2.14) respectively. Simple linear regression revealed significant linear relationship between preventive practices with knowledge and all health belief subscales. Hierarchical multiple linear regression reported predictors of preventive practices towards HFMD, which include knowledge, (perceived susceptibility)2, perceived severity, and perceived barrier, with the group of variables was significantly predicting the (preventive practice)3 and accounted for 13.1% variance in the (preventive practices)3 (F[5,347]=11.588, p value=<0.001, adjusted R2=0.131). Conclusion: The four predictors derived from this study should be given further attention in planning for future HFMD intervention

Introduction: Obesity is a well-established risk factor for cardiovascular disease. The objective of the study was to determine the prevalence of obesity and factors associated among secondary school students aged between 13 to 17 years at Slemani City Centre, Iraq. Methodology: A cross sectional study design was used. The calculated sample size was 1656. Probability proportional to size sampling technique was used to select the sample. A validated pretested questionnaire was used to collect the data. Weight and height were also taken. Data were analyzed using SPSS version 21. Chi-square test was used to determine an association between two categorical variables. Independent t-test was used to compare two means. Multiple logistic regression was used to determine the predictors for obesity. Results: The response rate was 92.54% and the overall mean age of the 1588 respondents was 15.42 (95% CI = 15.35, 15.49) years. The prevalence of overweight and obesity was 20.6% and 11.3% respectively. Variables significantly associated with overweight and obesity (age, monthly family income, education level of parents, body part satisfaction and body size perception) were entered into the logistic regression model. Multiple logistic regression analysis showed that the predictors for overweight and obesity were age, monthly family income, body part dissatisfaction and body size perception. Conclusion: The prevalence of overweight and obesity is high (20.6% and 11.3% respectively). The predictors of obesity among secondary school students aged between 13 to 17 years old at Slemani City Centre Kurdistan Region, Iraq were age, family income and body image dissatisfaction.
Obesity