Introduction: University students’ perspectives on mental health issues remain scarce despite the growing prevalence of mental illness among this population. Therefore, this study aimed to explore university students’ perceptions and beliefs about mental health and mental illness. Methods: Virtual in-depth interviews were conducted from December 2021 to March 2022. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Sixteen informants from a Malaysian university were interviewed. Four major themes emerged: (1) understanding of mental health and mental illness; (2) perceived causes of mental illness; (3) attitudes towards mental illness; (4) strategies to maintain good mental health. Most informants related mental health to an individual’s thoughts, emotions and behaviours, while a minority equated ‘mental health’ with ‘mental illness’. The majority of informants cited socio-environmental factors as the primary cause of mental illness. Unexpectedly, informants did not view religious factors as a cause of mental illness, although it was thought to be deeply rooted in the older generation. Nearly all informants expressed positive attitudes and willingness to help people with mental illness. However, some informants decided to cover up their mental health problems to avoid the likelihood of experiencing negative emotions. Most informants believed that living a fulfilling and balanced life, staying optimistic and being religious could help them to maintain good mental health. Conclusion: To mitigate the deterioration of students’ mental health, it is necessary to understand their perceptions and beliefs about mental health and mental illness as these may influence their help-seeking behaviours. The study findings showed that university students have a basic understanding of mental health and mental illness and most of them are supportive in handling people with mental illness.

INTRODUCTION: Three doses of SARS-CoV-2 mRNA vaccines have been recommended for cancer patients to reduce the risk of severe disease. Anti-neoplastic treatment, such as chemotherapy, may affect long-term vaccine immunogenicity. METHOD: Patients with solid or haematological cancer were recruited from 2 hospitals between July 2021 and March 2022. Humoral response was evaluated using GenScript cPASS surrogate virus neutralisation assays. Clinical outcomes were obtained from medical records and national mandatory-reporting databases. RESULTS: A total of 273 patients were recruited, with 40 having haematological malignancies and the rest solid tumours. Among the participants, 204 (74.7%) were receiving active cancer therapy, including 98 (35.9%) undergoing systemic chemotherapy and the rest targeted therapy or immunotherapy. All patients were seronegative at baseline. Seroconversion rates after receiving 1, 2 and 3 doses of SARS-CoV-2 mRNA vaccination were 35.2%, 79.4% and 92.4%, respectively. After 3 doses, patients on active treatment for haematological malignancies had lower antibodies (57.3%±46.2) when compared to patients on immunotherapy (94.1%±9.56, P<0.05) and chemotherapy (92.8%±18.1, P<0.05). SARS-CoV-2 infection was reported in 77 (28.2%) patients, of which 18 were severe. No patient receiving a third dose within 90 days of the second dose experienced severe infection. CONCLUSION This study demonstrates the benefit of early administration of the third dose among cancer patients.
Humans ; SARS-CoV-2 ; COVID-19/prevention & control* ; Treatment Outcome ; Neoplasms/drug therapy* ; Hematologic Neoplasms ; Vaccination ; RNA, Messenger ; Antibodies, Viral ; Immunogenicity, Vaccine

Introduction: In understanding of the general public’s knowledge, attitude and practice (KAP) on the returning and disposal of unused medications is imperative towards the designing of better educational materials and policy development. The objectives of this study was to validate the Malay version of the Return and Disposal of Unused Medications (ReDiUM) questionnaire for use among Malaysian as well as to gain an understanding on these patterns of behaviour among Malaysians. Methods: The English version of the ReDiUM was translated into Malay language according to international guidelines. Content and face validity of the questionnaire was examined by experts. Subsequently, the questionnaire was pilot tested in 10 native speakers. Reliability was assessed using Cronbach’s alpha coefficients. The test-retest reliability was measured with Spearman’s Correlation Coefficient and Cohen’s κ coefficient. Public were recruited through convenient sampling for the study. Results: The study recruited 319 respondents. For test-retest reliability, all the correlation coefficient values were >0.5 indicating strong reliability (26 respondents). Except few items, most of the kappa coefficients were >0.61 indicating substantial to almost perfect agreement. Cronbach’s alpha of the KAP domains were 0.585, 0.770 and 0.759, respectively. The median knowledge score was only 50% with some negative attitudes and practices found. Conclusions: The translated questionnaire was valid and reliable for use in Malaysia with acceptable to strong internal consistency and most items with substantial to almost perfect agreement. The findings from the study provide supporting evidence for policy makers to develop interventions to help with reducing wastage and optimize healthcare expenditure.

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.
After-Hours Care ; Asian Continental Ancestry Group ; Education, Medical ; Humans ; Internal Medicine ; Medical Errors ; Patient Safety ; Patient Satisfaction

Long duty hours have been associated with significant medical errors, adverse events, and physician “burn-out”. An innovative night float (NF) system has been implemented in our internal medicine program to reduce the negative effects of long duty hours associated with conventional full-call systems. However, concerns remain if this would result in inadequate training for interns. We developed a structured questionnaire to assess junior doctors’ perceptions of the NF system compared to full calls, in areas of patient safety, medical training, and well-being. Ninety-seven (71%) of the 137 doctors polled responded. Ninety-one (94%) felt the NF system was superior to the full call system. A strong majority felt NF was beneficial for patient safety compared to full call (94% vs. 2%, p<0.001). The NF system was also perceived to reduce medical errors (94% vs. 2%, p<0.001) and reduce physician “burn-out” (95% vs. 5%, p<0.001). Beyond being a practical solution to duty-hour limitations, there was a significant perceived benefit of the NF system compared to the full call in terms of overall satisfaction, patient safety, reducing medical errors and physician “burn-out”.

Background: Many smokers have undiagnosed chronic obstructive pulmonary disease(COPD), and yet screening for COPD is not recommended. Smokers who know that they haveairflow limitation are more likely to quit smoking. This study aims to identify the prevalence andpredictors of airflow limitation among smokers in primary care.Methods: Current smokers ≥ 40 years old who were asymptomatic clinic attendees in aprimary care setting were recruited consecutively for two months. We used a two-step strategy.Step 1: participants filled in a questionnaire. Step 2: Assessment of airflow limitation using apocket spirometer. Multiple logistic regression was utilised to determine the best risk predictorsfor airflow limitation.Results: Three hundred participants were recruited. Mean age was 58.35 (SD 10.30) yearsold and mean smoking history was 34.56 pack-years (SD 25.23). One in two smokers were found tohave airflow limitation; the predictors were Indian ethnicity, prolonged smoking pack-year historyand Lung Function Questionnaire score ≤ 18. Readiness to quit smoking and the awareness ofCOPD were low.Conclusions: The high prevalence of airflow limitation and low readiness to quit smokingimply urgency with helping smokers to quit smoking. Identifying airflow limitation as an additionalmotivator for smoking cessation intervention may be considered. A two-step case-finding methodis potentially feasible.

Introduction: Steven-Johnson syndrome and Toxic Epidermal Necrolysis are rare but life threatening severe cutaneous adverse reactions to drugs. To determine the epidemiology of SJS, TEN and SJS/TEN overlap in University Malaya Medical Centre (UMMC). Methods: All patients admitted to UMMC from year 2013-2015 for SJS, SJS/TEN, TEN were recruited. The classification of SJS, SJS/TEN overlap and TEN was made based on the criteria laid down by Bastuji et al.2 Results: A total of 32 patients were recorded to have SJS, SJS/TEN overlap and TEN from 2013 to 2015. Drugs (n=32, 86.49%) remained the most common aetiology of SJS and TEN. The top three commonest drugs are allopurinol (n=6), followed by carbamazepine (n=5) and bactrim (n=3). Conclusion: This study demonstrates that drugs were the most common cause of SJS/TEN. Antibiotics were the most common drug group that caused SJS/TEN. Awareness of the common etiology such as drug is important and high index of suspicion of SJS and TEN is needed if patients were on the above medications.

Adult-onset metachromatic leukodystrophy is often a diagnostic challenge to many clinicians. It may be presented with psychiatry symptom before other evidences of leukodystrophy are uncovered. We report a 53-year-old patient who presented with 7-year history of manic-like presentation in addition to progressive neurocognitive deterioration. Diagnosis was made eventually with neuroimaging. Mutational analysis showed compound heterozygous of ARSA gene. This case demonstrated the challenge in diagnosing this condition due to its complex neuropsychiatric presentation.
Leukodystrophy, Metachromatic