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@#Introduction: The Healthier Choice Logo (HCL) was introduced in 2017 by the Ministry of Health Malaysia. This paper analysed acceptance of HCL, effectiveness of HCL in encouraging healthier product reformulation, and factors affecting reformulation among food industries. Methods: An online self-administered questionnaire consisting of four sections utilising multiple choice and 5-point Likert scale questions was distributed to food industries in Malaysia. Sample size calculation yielded 100 respondents. Results: Food industries had a higher acceptance of the processes and requirements involved in HCL implementation. HCL was highly effective in encouraging product reformulation among food industries in Malaysia. Meeting consumer demand, improving brand image, public health, more awareness around nutrition labelling, logo and national nutrition target, more technical knowledge and budget were found to motivate healthier product reformulation. However, product suitability, consumer acceptability, difficulties maintaining taste and shelf life, and limited budget were the challenges faced in product reformulation. There was no correlation between HCL acceptance and factors encouraging or inhibiting reformulation. Conclusion: These findings are expected to help relevant authorities or stakeholders make changes, if necessary, towards processes and requirements involved in HCL application to ensure wider HCL implementation. Future research should identify the relationship between HCL implementation and public health improvement among the Malaysian population.
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@#Alar ligament is one of the most important craniocervical junction (CCJ) ligaments; acting as stabilizer of CCJ and limiting axial rotation. It may be involved in various pathological processes including trauma. Magnetic resonance imaging (MRI) is increasingly being used in cervical spine trauma as a supplement to conventional radiography and computed tomography (CT) to detect a wide range of severe cervical spine injuries. MR depiction of alar ligament requires special sequences despite no known established MR sequence is available. However, the role of MRI in minor or moderate trauma, including whiplash injuries, has long been debated, particularly when neurological dysfunction is absent, because no anatomical disruption other than degenerative disc disease have been reported. In this review, we provide detailed account on the current knowledge of MR visualization of normal alar ligament; outlining the variations in its signal intensity, dimension, shape and orientation.
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@#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.
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@#Aim and design: This systematic review aimed to estimate the prevalence of online natural health products (NHPs) purchases among consumers. Data Sources: Four databases (PubMed, Science Direct, Scopus and Web of Sciences) were searched for articles published up to July 1, 2021. Review Method: Studies included were those reporting the prevalence of online NHPs purchases, those excluded were case reports, commentaries, letters, editorials, review articles, theses and non-English studies. The risk of bias of selected studies was assessed using the Joanna Briggs Institute’s checklist, and the pooled prevalence of online NHPs purchases was generated using the random-effect model. Results: A total of 30 studies were included in the meta-analysis, representing a total of 40,535 respondents. The pooled prevalence of online NHPs purchases was estimated at 7.60% (95% CI: 5.49, 10.01). Prevalence was higher in studies conducted in recent years, among physically active populations and when sports nutrition was included within the scope of NHPs. More than half of the selected studies have a moderate risk of bias, and considerable heterogeneity was observed across the selected studies. Conclusion and Impact: Online purchases of NHPs are not common among consumers, but they have become more common in recent years. A wide range of NHPs were investigated across studies, which may have contributed to the considerable heterogeneity reported in this review. It is suggested that future studies investigating online NHPs purchases consider reporting individual prevalence statistics specific to each NHP type, to facilitate meaningful comparisons between studies.
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@#Introduction: Alar ligament is a paired craniocervical junction ligaments which stabilizes the atlantooccipital and atlantoaxial joints. The main purpose of the study was to compare the normal anatomy of alar ligament on MRI between male and female. The prevalence of alar ligament visualized on MRI and its characteristics were also studied apart from determining the association between the heights of respondents with alar ligament signal intensity and dimensions. Methods: Fifty healthy volunteers were studied using 3.0T MR scanner (Siemens Magnetom Spectra) by 2-mm proton density, T2 and fat-suppression sequences. Alar ligament visualization, dimensions and variability of the ligament courses, shapes and signal intensity characteristics were determined. Results: The orientation of the ligament was laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. Females are 70% less likely to exhibit alar ligament signal inhomogeneity than males. There were positive correlation between height and the craniocaudal diameter of the alar ligament as well as the anteroposterior diameter, which were statistically significant (r = 0.25, n = 100, p = 0.01 and r = 0.201, n = 100, p = 0.045 respectively). Conclusion: Tremendous variability of alar ligament shows that clinical and multimodality correlation needs to be exercised, especially in evaluating alar ligament MR signal in male. Taller individuals otherwise tend to have longer and thicker ligaments. Future studies with larger samples of alar ligaments including trauma cases are also recommended to supplant a new classification system of alar ligament injury.
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@#Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.
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@#Introduction: Malnutrition, specifically undernutrition, in community-dwelling older adults reduces their well-being and predisposes to diseases. Therefore, timely malnutrition identification through nutrition screening is needed to identify at risk and malnourished patients. This study aimed to develop the content of nutrition screening guideline to facilitate healthcare staffs in health clinics to administer a validated nutrition screening tool specifically for older adults. Methods: A scoping review was conducted electronically using SCOPUS, PubMed, ProQuest Health & Medical Complete, and Cochrane databases. The systematic search was performed up to 31st December 2021. Search terms were created for identification of eligible and related articles. Inclusion and exclusion criteria were determined for the systematic search. The search was limited to English and Malay languages, and full text articles with no limitation of years. All data were extracted and analysed, guided by the PRISMA extension for scoping reviews (PRISMA-ScR). Results: From 728 identified articles, 18 articles were included in the analysis. Identified information for the guideline content were: introduction, aims and objectives, definition of malnutrition, prevalence of malnutrition, implementation of nutrition screening, guidance on administering items in validated tools, and guidance on anthropometric measurements. Meanwhile, format and flow charts from established guidelines served as references for the guideline development process. Conclusion: Appropriate content to develop a nutrition screening guideline has been identified based on this review. Development of a guideline based on this content can facilitate healthcare staffs to perform timely nutrition screening in older adults.
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Purpose@#Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. @*Methods@#A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. @*Results@#Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P<0.001). Histopathology of the appendix was the predictor of conversion from LA to OA (adjusted odds ratio, 8.82; 95% confidence interval, 3.13–24.91; P<0.001). @*Conclusion@#The result from our study shows that the overall conversion rate for the study period was high. Patients with perforated appendicitis had a higher risk of conversion to OA. Therefore, preoperative diagnosis of perforated appendicitis may be paramount in predicting conversion to OA.
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@#Introduction: Food insecurity is currently a problem faced by both developing and developed nations. Issues of food insecurity reflect both social and economic challenges, posing a significant policy dilemma. Although there has been various research on food insecurity, very little has been done to better understand what are the sociodemographic factors that can predict food insecurity within a Malaysian context, especially amongst the unique community of Malay university students, which makes up the largest group of students in tertiary education. Therefore, this study examined the prevalence of food insecurity and its associated factors among Malay university students. Methods: Conducted in Universiti Teknologi MARA, Selangor Campus, conveniently sampled participants (n = 181) completed a pre-tested English version of the US Adult Food Security Survey Module (AFSSM) questions in 2015, which measures their level of food security status. Binary logistic regression analysis was carried out to determine the sociodemographic predictors of food insecurity among the sampled population. Results: More than one-third of participants (42.5%) reported food insecurity within the past year with 22.1% experiencing very low food insecurity. Additionally, of those who experienced food security, 5.4% reported a low food security status. However, no significant predictors were observed positively related to food insecurity. Conclusion: Data indicates that food insecurity is a significant problem among university students and additional research is needed to better understand and address food insecurity in higher education.
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@#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.
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@#Proficient hand dexterity (HD) may help students with learning disabilities (LDs) perform various hand tasks efficiently. Video modelling (VM) is a strategy that uses a model to improve desired skills. However, the limited study focuses on VM to improve HD among students with LDs. Therefore, this study explores VM implementation in the learning and teaching process to improve the HD of students with LDs. Five Special Education (SE) teachers who taught the Hand Manipulative Component lessons in two different states were purposefully selected and invited to participate in this study. A one-toone interview was conducted with individual SE teachers. The interview sessions were audio-recorded and transcribed verbatim, and the data was analysed through thematic analysis. Rigorous approaches were performed to ensure the findings' trustworthiness, such as triangulation, member checking, and an audit trail. Four key themes emerged: conventional learning and teaching methods, challenges faced by students with LDs in improving HD, and the advantages of implementing VM in learning and teaching to improve HD and develop a video module. This study suggests SE teachers can implement VM in their learning and teaching processes to improve the HD performance of students with LDs. This current study concludes that VM can be a supportive strategy in the teaching process to improve HD performance among students with LDs.
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@#Superior mesenteric artery (SMA) syndrome is rare with the common presentation of megaduodenum from entrapment of the third part of the duodenum (D3) by the SMA. We present a case report of a thin, fit 16-year-old boy, active smoker complaining of generalized colicky abdominal pain associated with persistent postprandial vomiting. Small bowel study demonstrated partial duodenal obstruction from compression of the third part of the duodenum by the SMA. Computed tomography of the abdomen shows an aorto-mesenteric angle of 13 degrees with aorto-mesenteric distance of 0.32 cm, indicating SMA syndrome. His symptoms resolved spontaneously with watchful waiting and nutritional care plan. The success was contributed to restoring the fat cushion around the SMA, hence, widening the aorto-mesenteric angle. In conclusion, watchful waiting with a nutritional care plan is a feasible initial strategy in the approach to SMA syndrome. However, should this strategy be unsuccessful, the choice of surgical treatment is duodenojejunostomy.
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@#Introduction: The elderly population is highly vulnerable to malnutrition, including those in the community. The use of nutrition education as part of nutrition intervention is able to improve their nutritional status. Hence, provision of a nutrition resource kit addressing the needs of at-risk and malnourished elderly would be advantageous. This research aimed to develop, validate and evaluate the acceptance of a newly developed nutrition resource kit, which served as an educational material among at-risk and malnourished elderly in Malaysian health clinics. Methods: This study was conducted in three phases: Phase I comprised of qualitative needs assessment to identify the types of nutrition resource kit needed; Phase II was the development and validation of the nutrition resource kit; while Phase III was acceptance evaluation, which involved individual in-depth interview and triangulation. Results: An A5-sized booklet with incorporation of an educational video in a QR code was developed. Both printed material and educational video had excellent content and face validity. Suggestions by experts and elderly from validation were considered and revision was done accordingly. Acceptance evaluation revealed four themes: 1) positive acceptance, 2) elderly-friendly, 3) valuable, and 4) individual preference. Triangulation data revealed that all elderly positively evaluated both resources. Additional suggestions given by elderly were considered for improvement. Conclusion: This newly developed nutrition resource kit, both in the printed and electronic format, was well-accepted among the at-risk and malnourished elderly. It could be used as an important reference for the elderly, especially those attending health clinics, in treating and preventing malnutrition.
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Aims@#The utilisation of lignocellulosic biomass for bioethanol production reduces the dependency on fossil fuels as a source of energy and emission of greenhouse gas (GHG). However, studies in this emerging field are hampered by the cost of ethanol quantification methods. Due to the volatile nature of ethanol, the method for the quantification of bioethanol production should be reproducible and rapid to avoid any evaporation loss to the surroundings. Therefore, this study aimed to develop a simple, rapid and precise bioethanol quantification method using a gas chromatographyflame ionisation detector (GC-FID) without having to go through distillation process for ethanol purification.@*Methodology and results@#The bioethanol was produced via consolidated bioprocessing (CBP) using Trichoderma asperellum B1581 and paddy straw. The peak corresponding to ethanol was obtained at 2.347 min with a peak area of 189.66, equating to 0.159% (v/v) or 1.25 g/L ethanol. A comparison between the quantity of ethanol detected by GC-FID and spectrophotometric analysis (340 nm) showed no significant difference (p>0.05) in the amount of ethanol detected by GC analysis, thus validating the accuracy of the GC method.@*Conclusion, significance and impact of study@#This work presents a simple, precise and reliable method to determine the amount of bioethanol in the sample using a GC-FID. Currently, there are many GC-FID methods available for the determination of ethanol/alcohol in a human blood samples or in beverages but not in bioethanol samples. Thus, this method was developed to facilitate the determination of bioethanol in the samples produced from lignocellulosic materials.
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Chromatography, Gas , Flame Ionization , EthanolABSTRACT
@#Background: Menopause signifies the beginning of a non-reproductive phase from the reproductive period. Although it is considered a natural life transition, recent studies have indicated that a woman’s menopausal experience may impact her quality of life. While studies have examined Malaysian women’s knowledge and awareness of menopause, they have focused on the prevalence of menopausal symptoms and sociocultural aspects. These investigations also used a quantitative design that may have limited the information regarding the nature and experience of menopause. Objectives: This study explores women’s perceptions and understanding of their menopausal experience. Methods: A total of 20 menopausal women were recruited using purposive sampling through social media in the state of Pahang, Malaysia. In-depth semi-structured interviews were used to explore how they perceived their menopausal experience. The data were then analyzed using thematic analysis. Results: Three themes that emerged from the findings included perceptions of menopause, biopsychosocial changes and help-seeking behavior. For many Muslim women, menopause was perceived as a time for them to engage in religious commitment more than they had before. Conclusion: The study findings uncovered a knowledge gap and a lack of support for women impacted by menopause. Muslim women regarded their menopause phase as a time for them to engage in religious duty fully. These results indicate the need for a psychosocial intervention and educational program to ensure women a better transition throughout their menopausal phase
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@#Introduction: Childhood obesity is a public health problem in Malaysia. Intake of sugar-sweetened beverages (SSB) is associated with obesity in children. There is a lack of studies on factors associated with SSB consumption in Malaysia. This study aimed to determine the sociodemographic factors associated with SSB consumption among Malaysian adolescents. Methods: Data of 2,021 students, aged 10-17 years on sociodemographic, SSB intake and anthropometrics were drawn from the school-based Adolescent Nutrition Survey 2017. A multistage stratified cluster sampling was used to obtain a nationally representative sample of primary and secondary school students. Body mass index (BMI)-for-age status was determined based on calculated z-score using the World Health Organization 2007 reference. SSB consumption was obtained from a food frequency questionnaire. Results: The prevalence of overweight and obesity among Malaysian adolescents were 16.6% and 14.7%, respectively. Malaysian adolescents consumed 1.4 cups of SSB per day. Rural children had a significantly higher SSB intake (1.5 cups) than urban (1.3 cups) children, while males (1.5 cups) had a significantly higher intake than females (1.3 cups). There were no significant differences in SSB consumption between thin, normal, overweight and obese adolescents. Conclusion: Almost all Malaysian adolescents consumed SSB during one month prior to the survey and the average amount consumed was 1.4 cups per day. Rural locality and male were associated with higher SSB consumption. There were differences in SSB consumption between Chinese and Malays, between Chinese and Indians, and between Chinese and Bumiputra Sarawak. There were no differences in consumption between the different BMI-for-age categories.
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@#Introduction: Elderly population is more likely to suffer from malnutrition, thereby requiring appropriate nutrition education as part of nutrition intervention to overcome this issue. This review aims to identify content suitable for developing a nutrition resource kit that provides nutritional guidance to combat malnutrition among malnourished and at-risk elderly in health clinics setting, particularly in Malaysia. Methods: A literature search was conducted up to 15th December 2019 in four databases: PubMed, Scopus, COCHRANE, and ProQuest Health & Medical Collection. Potential literature on nutrition education, suitable dietary guidelines and existing educational materials for elderly in the community, in English and Malay languages, were searched to identify suitable content for the nutrition resource kit. All relevant documents were included based on inclusion and exclusion criteria. Data were extracted and analysed according to the PRISMA-ScR guidelines. Results: A total of 27 documents consisting of articles, printed materials and guidelines were included for analysis. Suitable content included information related to malnutrition such as definition, signs and symptoms, cause-consequences, and nutrition management, which included food plate, serving size, menu suggestion, examples of recipes, tips to increase energy and protein intakes through food or drink, texture modification, a guide to using oral nutritional supplements, tips for maintaining nutrient content in food and drink, tips to encourage to eat, and oral health. Conclusion: A nutrition resource kit tailored for malnourished and at-risk elderly would be a beneficial nutrition intervention. There is a need to incorporate these information in the development of a nutrition resource kit to improve their dietary intake.
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@#Excessive salt intake has been linked to the development of hypertension and non-communicable diseases. This study aims to explore the different types of salt reduction intervention implemented among adults aged ≥18 years and to identify the suitable settings, duration and tools used for effective salt reduction interventions. This review adapted the established structured scoping review framework by Arksey and O’Malley. Related articles from the year 2008 to 2018 were retrieved based on the study objectives using keywords in electronic databases and through a bibliographic search of books, reports, conference proceedings, posters and summaries. Out of 130 potentially relevant full-text articles assessed, 14 articles were included in the review. Suitable salt reduction initiatives for the community who regularly consume home-cooked food are through cooking and usage of a tool such as a salt-restriction spoon, together with awareness on the benefits of salt reduction in their daily diet. Healthy catering initiative should be implemented in the workplace or institution-based settings. Policy development targeting the source of salts such as mandatory usage of salt-substitutes or Front-of-Pack labelling of salt content in all food products suitable for population-level intervention.
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Aims@#Knowledge of the Trichoderma taxa is important for both control efficiency and environmental conservation. Therefore, the objective of this study is to isolate and identify Trichoderma species from various rhizosphere soil samples using phenotypic and molecular characterization.@*Methodology and results@#Native Trichoderma spp. were isolated from agricultural fields in 17 sites from seven states of Malaysia. These isolates were characterized via morphological observation and molecular phylogenetic analysis based on the translation elongation factor-1α (tef1-α) gene. About 42 isolates were classified into eight Trichoderma species, which are Trichoderma asperellum, T. hamatum, T. harzianum, T. koningiopsis, T. rodmanii, T. spirale, T. viride and T. virens. Comparison of DNA sequences of tef1-α showed that the isolates were 98-100% similar to respective Trichoderma species from GenBank, thus confirming the fungal identity. Phylogenetic trees of maximum likelihood (ML) dataset of tef1-α inferred that the isolates were clustered according to species.@*Conclusion, significance and impact of study@#Findings in the present study will be beneficial for the purposes of biodiversity conservation and plant disease management using biocontrol agents.
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RhizosphereABSTRACT
@#Introduction: The elderly population are susceptible to malnutrition due to many factors. Hence, timely malnutrition identification through nutrition screening needs to be performed routinely in health clinics. However, the nutrition screening practice in health clinics need to be improvised for malnutrition identification among the elderly population. This study identifies barriers and opportunities for nutrition screening in elderly patients in health clinic settings. Method: A qualitative study was conducted among healthcare staff from urban and rural health clinics in Kuantan, Pahang, Malaysia. In-depth individual interviews were performed, audio-recorded and transcribed verbatim. Non-participant observations that act as triangulation were conducted among elderly patients (aged ≥60 years) attending the sampled health clinics. Both data from the interviews and observations were analysed thematically using NVivo software. Results: Twenty healthcare staff participated in the interviews were medical officers (n=6), medical assistants (n=8), staff nurses (n=4), and community nurses (n=2) with a mean age of 33.7±6.3 years. Twenty- one elderly patients were involved in non-participant observations. The four themes that emerged as barriers and opportunities were: time, patient factors, organisation factors and nutrition screening knowledge. Time constituted the main barrier, whilst incorporating a validated nutrition screening tool into current health screening practices was identified as the most practical approach to performing nutrition screening. Staff also highlighted the need for appropriate guidelines for implementing nutrition screening. Conclusion: This study identified appropriate approaches to implementing nutrition screening among elderly patients in health clinics. Developing a comprehensive nutrition screening guideline may facilitate healthcare staff in performing nutrition screening.