Psychometric properties of the newly developed self-report environmental determinants of health questionnaire (EDH-Q): development and validation.

BACKGROUND: The environmental determinants of health (EDH) have a significant impact on people's physical, mental, and social wellbeing. Everyone needs access to environmental resources of all types, including food, materials, and energy, to survive. Currently, no valid and reliable instrument exists for evaluating individuals' perceived levels of EDH. Hence, the purpose of this study was to develop and validate the environmental determinants of health questionnaire (EDH-Q) among undergraduate students in Nigeria. METHOD: We conducted a cross-sectional survey among undergraduate students in Nigeria to assess the psychometric properties of the newly developed Environmental Determinants of Health Questionnaire (EDH-Q). Respondents were selected using a convenience sampling approach to evaluate their perceptions of environmental determinants of health. The Content Validity Index (CVI) and Face Validity Index (FVI) were calculated to ascertain the scale's content validity and response process validity, respectively. Additionally, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), composite reliability (CR), average variance extracted (AVE), Cronbach's alpha, and intraclass correlation coefficient (ICC) were computed to assess the scale's construct validity. RESULTS: The study involved 300 respondents in the EFA (males 55.7%, females 44.3%) and 430 respondents in the CFA (males 54.0%, females 46.0%). In the EFA, two constructs were identified (the natural environment and the built environment). The EFA model was able to explain 63.57% of the total cumulative variance, and the factor correlation was 0.671. The whole scale Cronbach's alpha value was 0.947, while the two constructs' Cronbach's alpha values were 0.918 (natural environment) and 0.935 (built environment). In the CFA, six pairs of error covariances were included between items within the same construct to improve the fit indices of the initial proposed measurement model. The final re-specified measurement model showed that the EDH-Q, which has two constructs and 18 items, has adequate construct validity (CFI = 0.948, TLI = 0.938, SRMR = 0.046, RMSEA = 0.052, and RMSEA p-value = 0.344). The CRs were 0.845 (natural environment) and 0.854 (built environment). The ICCs were 0.976 (natural environment) and 0.970 (built environment). CONCLUSION: The results show that the newly created EDH-Q has sufficient construct validity and may be utilized to assess participants' perceptions of their level of EDH. Researchers should examine this instrument in populations with different age ranges and other demographic characteristics, as the present study only applied it to undergraduate students who may share similar characteristics.

Psychometric properties of the environmental factors' questionnaire for undergraduate medical students taking online learning during COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Environmental factors are important for students' learning during online classes, especially during a pandemic, such as COVID-19. This study aimed to validate the environmental factors' questionnaire during online learning. METHODS: A total of 218 undergraduate medical students at the Health Campus, Universiti Sains Malaysia, participated in a cross-sectional study that involved an online survey. Environmental factor scales were assessed with the nine-item lighting, noise, and temperature (LNT) scale and the six-item technology scale. Analysis was performed using confirmatory factor analysis (CFA). RESULTS: The English version of the LNT scale with nine items and three factors showed a good fit to the data, with no item deleted. For LNT, the composite reliability (CR) was 0.81, 0.81, and 0.84, respectively, while the average variance extracted (AVE) was 0.61, 0.59, and 0.6, respectively. The English version of the technology scale, with six items and one factor, also showed a good fit to the data, with no item deleted. The CR was 0.84, and the AVE was 0.51. CONCLUSIONS: The results provide psychometric evidence for environmental questionnaire scales in evaluating the factors associated with online learning among Malaysian university medical students. All items were retained and confirmed to fit the sample data.

Structural Relationships between Environmental Factors, Psychological Health, and Academic Performance in Medical Students Engaged in Online Learning during the COVID-19 Pandemic.

As a result of the COVID-19 outbreak and the enforced quarantine, universities in Malaysia were required to switch to an online class format. The resulting changes in the environmental factors of students may have had an impact on their psychological health and academic performance. This study aimed to determine the effects of environmental factors and the psychological health of students and examine their structural relationship with academic performance. A cross-sectional design with an online self-reported questionnaire was adopted, and the study was conducted among 207 undergraduate medical students at the Health Campus of Universiti Sains Malaysia. The environmental factors were measured using the lighting-noise-temperature scale and technology scale, while psychological health was assessed using the short version of the General Health Questionnaire and academic performance was determined based on Grade Point Average. Descriptive statistics and structural equation modeling were used for analysis of the data. No significant relationship was found between environmental factors and academic performance, or between environmental factors and psychological health. Nonetheless, the hypothesized structural model provided scientific evidence of an inverse relationship between psychological health and academic performance. These findings could be helpful for academics, health policymakers, and health educators in terms of understanding and promoting psychological wellbeing among university students, as well as improving their academic performance.

Community Health Survey of Residents Living Near a Solid Waste Open Dumpsite in Sabak, Kelantan, Malaysia.

The management of waste materials is a serious problem worldwide, especially in urbanizing countries like Malaysia. This study was conducted to compare the prevalence of health symptoms and diseases diagnosed among residents exposed to the solid waste open dumpsite in the suburb of Sabak with the non-exposed community. Research related to exposure to solid waste dumping with complete health problems has never been combined in one study. A comparative cross-sectional study was conducted. The exposed group included residents within a 1 km radius and the non-exposed group included residents between a 2.5 and 4.0 km radius from the dumpsite. The selected residents were interviewed using validated, structured questionnaires. A total of 170 residents from the exposed group and 119 residents from the non-exposed group were selected. The mean (SD) duration time of residence was 22.6 (18.9) years for the exposed group and 15.0 (12.0) years for the non-exposed group. Dumpsite exposure was significantly associated with sore throat (adjusted odd ratio (AOR) 1.88; 95% confidence interval (CI): 1.05, 3.38; p = 0.031), diabetes mellitus (AOR 2.84; 95% CI: 1.10, 7.30; p = 0.021) and hypertension (AOR 2.56; 95% CI: 1.27, 5.13; p = 0.006). This study provides evidence that the unsanitary solid waste disposal in Malaysia is hazardous to the health of residents in the surrounding 1 km, and efforts are needed to minimize the hazards.

Usage of Traditional and Complementary Medicine among Dengue Fever Patients in the Northeast Region of Peninsular Malaysia

@#Background: The recent epidemic of dengue fever (DF) in Malaysia was alarming. The treatment of DF remains supportive as there is no anti-viral agent or vaccine available as yet. Traditional and complementary medicine (T&CM) provides an alternative option for the treatment of DF but there is limited evidence with regard to its usage. The aim of this study was to determine the prevalence, types and predictor factors of T&CM usage among DF patients in the northeast region of Peninsular Malaysia. Methodology: This was a cross-sectional study of DF patients in the northeast region of Peninsular Malaysia who had been admitted to a tertiary centre from January 2014 until December 2015. Serologically-confirmed DF patients aged 18 years and above were randomly selected. Phone interviews were conducted to obtain information regarding the use of T&CM during hospitalisation. Notes were made regarding the prevalence and type of T&CM used. Binary logistic regressions were used to identify the predictor factors of T&CM usage. Results: A total of 241 DF patients with a mean age of 36.62 (SD = 14.62) years were included. The estimated prevalence of T&CM usage was 84.6% (95%CI: 80.1%, 89.2%). The most common T&CM used were crab soup (85.3%), papaya leaf extract (64.2%) and isotonic drinks (61.8%). The significant predictors for T&CM usage were age [adjusted odds ratio (AOR) 0.97; 95%CI: 0.94, 0.99], tertiary education (AOR 3.86; 95%CI: 1.21, 12.32) and unemployment (AOR 2.55; 95%CI: 1.02, 6.42). Conclusion: The prevalence of T&CM usage in our population is high. Age, tertiary education and unemployment influence the use of T&CM.

High frequency of Haemophilus influenzae associated with respiratory tract infections among Malaysian Hajj pilgrims.

BACKGROUND: Overcrowding during the annual Hajj pilgrimage has been known to increase the risk of infectious diseases transmission. Despite the high prevalence of respiratory illness among Malaysian Hajj pilgrims, knowledge about the etiologic pathogens is yet very limited. Thus, this study aimed to determine the spectrum of bacterial respiratory pathogens among the Hajj pilgrims returning to Malaysia in year 2016. METHODS: Expectorated sputum specimens were collected from the Hajj pilgrims with symptomatic respiratory tract infections (RTIs). Subsequently, the bacterial pathogens were identified using the standard bacteriological culture method and Vitek II system. RESULTS: This study indicated that 255 (87.33%) out of 292 cultured sputa were positive with at least one potential pathogenic bacteria. Out of 345 total bacterial isolates, 60% (n=207) were Haemophilus influenzae, which was associated with both single bacterium infection (132/173, 76.3%) and multiple bacterial infections (75/82, 91.5%). The other bacterial isolates included; Klebsiella pneumoniae (n=37, 10.7%), Moraxella catarrhalis (n=27, 7.8%), Haemophilus parainfluenzae (n=25, 7.2%), Streptococcus group G (n=18, 5.2%), Klebsiella spesies (n=16, 4.6%), Streptococcus pneumoniae (n=11, 3.2%) and few other organisms. CONCLUSION: High frequency of H. influenzae was isolated from Malaysian Hajj pilgrims, especially those with respiratory symptoms. Further study should evaluate the actual pathogenicity of the organism and the interactions between the respiratory microbiota towards developing effective prevention strategies of RTIs among the local pilgrims.

Placebo Controlled Trials: Interests of Subjects versus Interests of Drug Regulators

The use of placebo-controlled trials in situations where established therapies are available is considered ethically problematic since the patients randomised to the placebo group are deprived of the beneficial treatment. The pharmaceutical industry and drug regulators seem to argue that placebo-controlled trials with extensive precautions and control measures in place should still be allowed since they provide necessary scientific evidence for the efficacy and safety of new drugs. On the other hand, the scientific value and usefulness for clinical decision-making may be much higher if the new drug is compared directly to existing therapies. As such, it may still be unethical to impose the burden and risk of placebo-controlled trials on patients even if extensive precautions are taken. A few exceptions do exist. The use of placebo-controlled trials in situations where an established, effective and safe therapy exists remains largely controversial.

Reporting Statistical Results in Medical Journals.

Statistical editors of the Malaysian Journal of Medical Sciences (MJMS) must go through many submitted manuscripts, focusing on the statistical aspect of the manuscripts. However, the editors notice myriad styles of reporting the statistical results, which are not standardised among the authors. This could be due to the lack of clear written instructions on reporting statistics in the guidelines for authors. The aim of this editorial is to briefly outline reporting methods for several important and common statistical results. It will also address a number of common mistakes made by the authors. The editorial will serve as a guideline for authors aiming to publish in the MJMS as well as in other medical journals.

Treatment Outcomes of Patients with Multidrug-Resistant Tuberculosis (MDR- TB) Compared with Non-MDR-TB Infections in Peninsular Malaysia

Background: Treating patients with multidrug-resistant tuberculosis (MDR-TB) strains is more complicated, complex, toxic, expensive, than treating patients with susceptible TB strains. This study aims to compare the treatment outcomes and potential factors associated between patients with MDR-TB and non MDR TB infections in peninsular Malaysia. Methods: This study was a retrospective cohort study. Data were collected from the medical records of all registered MDR-TB patients and Non-MDR-TB patients at five TB hospitals in peninsular Malaysia from January 2010 to January 2014. Results: A total of 314 subjects were studied, including 105 MDR-TB cases and 209 non-MDRTB. After TB treatment, 24.8% of the MDR-TB patients and 17.7% of non MDR TB relapsed; 17.1% of the MDR-TB patients and 16.3% of non MDR TB defaulted from TB treatment. A significant difference seen in treatment success rate 17.1% for MDR-TB; 63.1% for non MDR TB (P < 0.001)). Mortality rate were 8.9% for MDR-TB; 13.2% for non MDR TB. Multivariable analysis showed the potential factors associated with poor treatment outcomes were presence of HIV infection (AOR, 1.09; 95%CI: 1.05, 1.75; P = 0.001) and previous TB treatment (AOR, 4.87; 95%CI: 2.84, 8.38; P = 0.001). Conclusion: This study revealed that the treatment success rate in patients with non MDR TB infection was higher than MDR-TB. Unsuccessful treatment was seen in MDR-TB associated with potential factors such as history of TB treatment, and presence of HIV infection.

Updates on Knowledge, Attitude and Preventive Practices on Tuberculosis among Healthcare Workers

Ranking as the most communicable disease killer worldwide, tuberculosis, has accounted with a total of 9.6 million new tuberculosis cases with 1.5 million tuberculosis-related deaths reported globally in 2014. Tuberculosis has remain as an occupational hazard for healthcare workers since 1920s and due to several tuberculosis outbreaks in healthcare settings in the early 1990s, the concern about the transmission to both patients and healthcare workers has been raised. Healthcare workers have two to three folds greater the risk of active tuberculosis than the general population. Several studies on knowledge, attitude and practices on tuberculosis among healthcare workers worldwide have revealed that majority of the participated healthcare workers had good knowledge on tuberculosis. Most of the healthcare workers from South India and South Africa also reported to have positive attitude whereas a study in Thailand reported that most of the healthcare providers have negative attitude towards tuberculosis patients. Nevertheless, majority of the healthcare workers have low level of practice on tuberculosis prevention. An improved communication between healthcare workers and the patients as well as their families is the key to better therapeutic outcomes with good knowledge, attitude and preventive practice towards tuberculosis.

Visual acuity and visual skills in Malaysian children with learning disabilities.

BACKGROUND: There is limited data in the literature concerning the visual status and skills in children with learning disabilities, particularly within the Asian population. This study is aimed to determine visual acuity and visual skills in children with learning disabilities in primary schools within the suburban Kota Bharu district in Malaysia. METHODS: We examined 1010 children with learning disabilities aged between 8-12 years from 40 primary schools in the Kota Bharu district, Malaysia from January 2009 to March 2010. These children were identified based on their performance in a screening test known as the Early Intervention Class for Reading and Writing Screening Test conducted by the Ministry of Education, Malaysia. Complete ocular examinations and visual skills assessment included near point of convergence, amplitude of accommodation, accommodative facility, convergence break and recovery, divergence break and recovery, and developmental eye movement tests for all subjects. RESULTS: A total of 4.8% of students had visual acuity worse than 6/12 (20/40), 14.0% had convergence insufficiency, 28.3% displayed poor accommodative amplitude, and 26.0% showed signs of accommodative infacility. A total of 12.1% of the students had poor convergence break, 45.7% displayed poor convergence recovery, 37.4% showed poor divergence break, and 66.3% were noted to have poor divergence recovery. The mean horizontal developmental eye movement was significantly prolonged. CONCLUSION: Although their visual acuity was satisfactory, nearly 30% of the children displayed accommodation problems including convergence insufficiency, poor accommodation, and accommodative infacility. Convergence and divergence recovery are the most affected visual skills in children with learning disabilities in Malaysia.