Over the past decade, increased awareness about leptospirosis disease in developing and industrialized countries has resulted in increased numbers of leptospirosis cases being reported worldwide. About 5% to 15% of leptospirosis patients end up with severe forms of the disease. Complication due to leptospirosis requires monitoring, specific treatments, and intensive care admission, thus increasing the cost of treating severe leptospirosis cases. Currently, we have data on incident and mortality rates, but we do not have data on the number of patients with severe form of leptospirosis or how many patients have complications, and whether or not these complications were resolved. Therefore, we carried out this study to determine the predictive factors for severe leptospirosis cases in Kedah. We conducted a cross-sectional study. The data of patients diagnosed with leptospirosis were obtained from the surveillance unit, Kedah Health Department, through the e-notification system. These data were then sorted according to the hospitals where the patients were admitted. The patients’ medical records were collected, and their information was obtained using a checklist. A total of 456 confirmed leptospirosis cases were included in the study, with 199 patients classified as severe cases and 257 patients as mild cases, based on the Malaysian leptospirosis guidelines. Most patients were male (71.5%) with a mean SD age of 36.62 ± 20.75 years. The predictive factors for severe leptospirosis include abnormal lung sounds (OR: 3.07 [CI 1.58–6.00]), hepatomegaly (OR: 7.14 [1.10–45.98]), hypotension (OR: 2.16 [1.08–4.34]), leukocytosis (OR: 2.12 [1.37–3.29]), low hematocrit (OR: 2.33 [1.43–3.81]), and increased alanine aminotransferase (SGPT ALT) (OR: 2.12 [1.36–3.30]). In conclusion, knowing these predictive factors will help clinicians identify severe leptospirosis cases earlier and develop their treatment plans accordingly, to reduce the complications and death from severe leptospirosis.

Adolescents involved in bullying can be at risk of developing behavioural problems, physical health problems and suicidal ideation. In view of this, a quantitative research design using a cross-sectional study was conducted to determine the prevalence of bullying and associated individual, peer, family and school factors. The study involved 4469 Malaysian public-school students who made up the response rate of 89.4%. The students were selected using a randomized multilevel sampling method. The study found that 79.1% of student respondents were involved in bullying as perpetrators (14.4%), victims (16.3%), or bully–victims (48.4%). In a multivariate analysis, the individual domain showed a significant association between students’ bullying involvement and age (OR = 1.38; 95% CI 1.12–1.70), gender (OR = 1.73; 95% CI 1.47–0.91), ethnicity (OR = 0.66; 95% CI 0.47–0.91), duration of time spent on social media during the weekends (OR = 1.43; 95% CI 1.09–1.87) and psychological distress level (OR = 2.55; 95% CI 1.94–3.34). In the peer domain, the significantly associated factors were the number of peers (OR = 0.69; 95% CI 0.56–0.86) and frequency of quarrels or fights with peers (OR = 2.12; 95% CI 1.24–3.26). Among the items in the school domain, the significantly associated factors were students being mischievous in classrooms (OR = 1.52; 95% CI 1.06–2.06), student’s affection towards their teachers (OR = 1.53; 95% CI 1.06–2.20), frequency of appraisal from teachers (OR = 1.49; 95% CI 1.16–1.94), frequency of friends being helpful in classrooms (OR = 1.92; 95% CI 1.09–3.38) and frequency of deliberately skipping class (OR = 2.91; 95% CI 2.90–1.72). As a conclusion, the study revealed high levels and widespread bullying involvement among students in Malaysia. As such, timely bullying preventions and interventions are essential, especially in terms of enhancing their mental health capacity, which substantially influences the reduction in the prevalence rates of bullying involvement among students in Malaysia.

IntroductionAlthough immunisation prevents the death of millions of infants and children each year, the vaccination coverage of routine childhood vaccination does not reach its target. The reasons for low vaccination uptake can be related to both demand and supply side determinants. The prevalence of vaccine hesitancy is increasing globally. However, data on vaccine hesitancy in low-income Arabic countries are scarce. To investigate this issue in Yemen, an Arabic low-income country, we aim to examine the link between vaccine hesitancy and the immunisation status of children living in Costal Hadhramout, Yemen, from the perspective of their parents and healthcare providers.Methods and analysisWe will use a mixed-method research design. The study will be conducted in Costal Hadhramout in three phases. Phase 1 will involve a situational analysis using secondary data from records of the national expanded immunisation programme in Costal Hadhramout to examine the trend for previous years. Phase 2 will be a quantitative study aimed at assessing the prevalence of vaccination status of children aged <2 years and the determinants of parental vaccine hesitancy perception through a validated questionnaire. Lastly, phase 3 will be a qualitative study that explores vaccine hesitancy in Yemen using in-depth interviews and focus group discussions with parents and healthcare providers, respectively.Ethics and disseminationThe study has been approved by the Research Committee of the Faculty of Medicine, University Kebangsaan Malaysia. The findings will be disseminated via publication in peer-reviewed academic journals, academic conferences and public presentations.

Despite several guidelines published by the World Health Organization (WHO) and national authorities, there is a general increase in the number of healthcare workers (HCWs) contracting tuberculosis. This review sought to evaluate the compliance of the HCWs toward tuberculosis preventive measures (TPMs) in their workplace. Both electronic databases and manual searches were conducted to retrieve articles regarding the compliance of HCWs in the workplace published from 2010 onwards. Independent reviewers extracted, reviewed, and analyzed the data using the mixed methods appraisal tool (MMAT) 2018, comprising 15 studies, 1572 HCWs, and 249 health facilities. The results showed there was low compliance toward TPMs in the workplace among HCWs and health facilities from mostly high-burden tuberculosis countries. The failure to comply with control measures against tuberculosis was mainly reported at administrative levels, followed by engineering and personnel protective control measures. In addition, low managerial support and negative attitudes of the HCWs influenced the compliance. Further studies are needed to elucidate how to improve the compliance of HCWs toward the preventive measures against tuberculosis in order to reduce the disease burden among HCWs worldwide.

PurposeThis study is to establish the validity and reliability of Malay version of Post-traumatic Check List-5 (MPCL-5) among the fire and rescue officers in the state of Selangor, Malaysia.Design/methodology/approachA cross-sectional study was conducted, which involved 100 firefighters from the state of Selangor, Malaysia. Construct validity, internal consistency, and concurrent validity were performed and analyzed using Statistical Package for Social Sciences (SPSS) version 20. Concurrent validity was tested with validated Malay version of Trauma Screen Questionnaire (TSQ-M).FindingsOverall internal consistency reliability was a 0.960 and individual construct Cronbach's alpha ranged from 0.827 to 0.926. The model, which consists of four constructs with 20 items, demonstrated the presence of acceptable loading factors. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) are 0.81, 0.65, 0.31 and 0.95 respectively at an optimum cut-off score of 35.Research limitations/implicationsThe Post Traumatic Check List 5 (PCL-5) is the latest tool based on DSM-5 developed recently and still having limited studies on the psychometric properties of the tool in local population and the findings produced are comparable with the results from validation from previous studies. The study limitations are population samples used are considering the minimum numbers of sample for each item for factor analysis and the concurrent validation was tested with the TSQ-M instead of the Clinician Administered PTSD Scale for DSM-5 (CAPS-5).Practical implicationsThe study suggested that MPCL-5 is acceptable to be used to measure post-traumatic stress disorder in local populations.Originality/valueThere are limited known validation studies for PCL-5 in local populations and this is the first study done among fire and rescue officers in Malaysia. The results are comparable with findings from previous studies and therefore MPCL-5 are valid and reliable for PTSD screening.

A balanced interaction between osteoblast and osteoclast plays a major role in maintaining bone strength and structural integrity. Tocotrienol, a palm derivative with potent antioxidant properties showed an anti-osteoporotic effect but little is known about its mechanism of action. Hence, this research was conducted to determine the effects of palm tocotrienol on the surface osteoblast and osteoclast of the the glucocorticoid-induced osteoporotic bones. The study involved 40 male Sprague-Dawley rats weighing 250-300 g which were randomly divided into an equal number of Baseline, Sham, Adrx+Dexa (adrenalectomized with dexamethasone), Adrx+Dexa+ATF (adrenalectomized with dexamethasone supplemented with α-tocopherol) and Adrx+Dexa+PTT (adrenalectomized with dexamethasone supplemented with palm tocotrienol). Bloods were taken prior to sacrifice for serum biomarkers and either tibia or femur was harvested for bone biomarkers, gene expressions analysis and histological studies. A double-blinded experiment was performed to calculate the number of total cells (osteoblasts and osteoclast) with intact nuclei within five fields of view. While serum osteocalcin and gene expression did not show any changes, CTX level was increased in the Adrx+Dexa group but reduced after the supplementation of palm tocotrienol. Supplementation of palm tocotrienol also significantly decrease the osteoclast population (p<0.05) compared to Adrx+Dexa group. In contrast, osteoblast population showed no significant difference across the groups. The result showed that palm tocotrienol acts by modulating the osteoclasts but not osteoblast, which revert the dynamics of bone cells population in the osteoporotic bone to its pre-osteoporotic levels. Supplements of tocotrienol in daily diet may be beneficial in preventing osteoporosis.

Introduction: Adherence to anti-retroviral therapy (ART) regimens remains a difficult issue. Thus, it was hoped that the use of phone reminders would improve adherence. Methodology: The Cochrane database was searched using selected keywords for this meta-analysis. We included randomised, controlled trials (RCTs) that utilised interventions with phone reminder and reported adherence outcomes, as the proportion of prescribed pills taken, the scores on an adherence questionnaire, or the follow-up rate. Two independent authors screened titles of article for inclusion, extracted the relevant data, and assessed articles for risk of bias. Results: Seven RCTs published between 2010 and 2017 were selected for inclusion in this review. The sample size ranged from 76 to 631 participants. Most RCTs used short message service (SMS) and phone call reminders as interventions. The rate of adherence was 1.17-fold greater among those who received phone reminders than those who did not, which was statistically significant (Z = 2.86, p = 0.004). Those who received phone reminders showed a 17% higher likelihood for adherence compared with those who did not receive any phone reminder interventions. Conclusion: Phone reminders remain significantly effective means for improving adherence.

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