ObjectiveThe current study aimed to identify the barriers to participation among high-risk individuals in the UK Lung Cancer Screening (UKLS) pilot trial.SettingThe UKLS pilot trial is a randomised controlled trial of low-dose CT (LDCT) screening that has recruited high-risk people using a population approach in the Cambridge and Liverpool areas.ParticipantsHigh-risk individuals aged 50–75 years were invited to participate in UKLS. Individuals were excluded if a LDCT scan was performed within the last year, if they were unable to provide consent, or if LDCT screening was unable to be carried out due to coexisting comorbidities.Outcome measuresStatistical associations between individual characteristics and UKLS uptake were examined using multivariable regression modelling. In those who completed a non-participation questionnaire (NPQ), thematic analysis of free-text data was undertaken to identify reasons for not taking part, with subsequent exploratory linkage of key themes to risk factors for non-uptake.ResultsComparative data were available from 4061 high-risk individuals who consented to participate in the trial and 2756 who declined participation. Of those declining participation, 748 (27.1%) completed a NPQ. Factors associated with non-uptake included: female gender (OR=0.64, p<0.001), older age (OR=0.73, p<0.001), current smoking (OR=0.70, p<0.001), lower socioeconomic group (OR=0.56, p<0.001) and higher affective risk perception (OR=0.52, p<0.001). Among non-participants who provided a reason, two main themes emerged reflecting practical and emotional barriers. Smokers were more likely to report emotional barriers to participation.ConclusionsA profile of risk factors for non-participation in lung screening has emerged, with underlying reasons largely relating to practical and emotional barriers. Strategies for engaging high-risk, hard-to-reach groups are critical for the equitable uptake of a potential future lung cancer screening programme.Trial registration numberThe UKLS trial was registered with the International Standard Randomised Controlled Trial Register under the reference 78513845.

Introduction: Smoking is a major public health significant and a leading preventable cause of premature mortality. Assisting smoking cessation is important due to potential positive health impacts. The establishment of "Quit Smoking Clinics" reflect a great commitment by the health authority to reduce the national burden of smoking prevalence. Aim: The objective is to measure the prevalence of smoking cessation and factors associate with successful quit smoking in all public healthcare "Quit Smoking Clinic" in Seremban district, Malaysia. Method: This retrospective cross-sectional study uses registry data and clinical notes from public healthcare clinics in Seremban district from January 2019 to June 2019. The outcome of interest was the proportion of smokers that enrolled in "Quit Smoking Clinic" who remained abstinent at six months of follow-up. Multivariate analysis was done to determine the predictors for successful smoking cessation in the study. Result: Out of the 285 smokers included in this study, 86 smokers (30.2%) quit smoking in this programme. Significant predictors of quitting smoking were use of nicotine replacement therapy (NRT), frequency of attending the appointments, presence of diabetes comorbidity, and Malay ethnicity. The Hosmer test showed a good model fit (p-value 0.998) and area under the curve (AUC) was 0.96% (95% CI 0.94-0.98) in the receiver operating characteristic (ROC) curve. Conclusion:The "Quit Smoking Clinic" programme showed good outcome and the service should be expanded to the private sector. Predictors for smoking cessation identified can be used by policy makers to design more targeted approaches, ensuring more smokers quit smoking.

Introduction. Dengue remains a public health threat. Clarifying the characteristics of future threats and prioritising intervention towards the highest risk potential can help to control and prevent dengue outbreaks. However, obtaining a consensus from panels of experts is certainly challenging due to the relative subjectivity of experience. Therefore, this article incorporates the fuzzy Delphi method (FDM) within a nominal group technique (NGT) as a multicriteria decision-making tool for (1) describing the characteristics of socioecological attributes (SEAs) with a high risk of causing dengue outbreak and (2) ranking those SEAs as priorities for intervention. Material and Methods. Experts were recruited using a purposive sampling technique. Informed consent was obtained before the start of the study. The NGT process began with an introductory presentation of dengue SEA by the moderator, followed by “silent generation.” Next, each participant provided information in a round-robin fashion. Ideas were collected by the moderator and displayed publicly. All experts were given ample time and space to contribute and justify their ideas without interruption during the discussion step to yield agreeable SEA characteristics. Ultimately, FDM was incorporated in the voting step to ensure rigorous analysis. The study was approved by an ethical committee before its commencement. Results. A total of 10 field experts participated in the study, with a median experience of 7.5 years working on a dengue team. The common characteristics of SEA prone to cause dengue outbreaks were the presence of human-made containers, in high quantities, left unattended, and covered from direct sunlight. Apart from that, all eight SEAs passed the triangulation of fuzzy numbers and defuzzification processes. The average fuzzy numbers ranged between 0.500 and 0.780, and the threshold value ( d ) ranged from 0.055 to 0.196. Of the potential risk factors identified, experts ranked illegal dumping sites as the most important, followed by old and unused items and construction sites. Conclusion. The NGT process successfully helped to obtain a consensus among the expert panels in describing SEA characteristics. Nevertheless, the integration of FDM offered a robust analysis that validated their ranking in dengue risk prioritisation. Therefore, we strongly recommend the application of FDM to be incorporated in any public health decision-making process.

Introduction/background Dengue fever remains a public health threat despite being preventable. A solution to the constant problem of dengue infection will require active intervention and a paradigm shift. Assessing perceived risk and correlating it with the attitude and practice of the community will help in designing appropriate measures. However, possible instruments for these assessments come with limitations. Objective The aim is to develop and validate a new scoring-based questionnaire, using dual statistical approaches to measure risk perception, attitude, and practices (RPAP) related to dengue in the community. Methods The RPAP questionnaire was developed bilingually using the International Society for Pharmacoeconomics and Outcome Research (ISPOR) guidelines. Content analysis was reviewed scrupulously by four expert panels. The initial 35-item scale was tested among 253 Malaysian respondents recruited non-probabilistically via multiple online platforms. Two statistical methods were employed to measure the construct validity: Exploratory Factor Analysis (EFA) as part of the Classical Test Theory (CTT) measurement, while Rasch Measurement Analysis (Rasch) was performed for the Item Response Theory (IRT) measurement. All results were cross-validated with their counterpart to ensure stability. Confirmatory Factor Analysis (CFA) was used to obtain a model fit index. Results 29 questions were retained after the final analysis. Both EFA and Rasch analysis detect multidimensionality. Nine latent factors were extracted from EFA, while only eight factors remained in the final model following CFA: 1) perceived susceptibility; 2) perceived severity; 3) perceived barrier; 4) perceived benefit; 5) cues to action; 6) self-efficacy; 7) attitude; and 8) practice. All items had adequate factor loadings and showed good internal consistency. The final model after CFA achieved a good fit with an RMSEA value of 0.061, SRMR of 0.068, PNFI of 0.649, and GFI of 0.996. Conclusion The RPAP questionnaire contains 29 items and is a reliable and accurate psychometric instrument for measuring the risk perception of dengue fever, attitude, and practice of the community in dengue prevention. The Rasch measurement provides additional rigour to complement the CTT analysis. This RPAP questionnaire is suitable for use in studies related to dengue prevention in the community.

BACKGROUND: Coronavirus disease (COVID)-19 has become a global pandemic with an increasing burden on healthcare. Early recognition of the trend and pattern of the chain of transmission is necessary to slow down the spread. AIM: Therefore, the study aimed to describe the epidemiology of COVID-19 at a local setting. METHODS: A retrospective cross-sectional study was done to all COVID-19 cases registered in Seremban Health District. Statistical analysis, using Chi-square test, was employed to compare the sociodemographic characteristic of COVID-19 patients between the red zone area and the non-red zone area in Seremban. RESULTS: As of April, a total of 214 number of COVID-19 cases reported in Seremban district alone. The trend of cases registered has changed as more asymptomatic infection outnumbered patients with clinical symptoms from the aggressive active case detection (ACD) activity. Majority of the cases affecting Malay ethnicity were due to a large religious gathering event held 1 month earlier than subsequently spread the infection within the community. CONCLUSION: The first wave of COVID-19 cases in Seremban was sudden and unexpected, with a skewed distribution affecting a particular race group regardless red zone area and non-red zone area. Therefore, identifying the pattern of infection in the local community is important for a focused intervention strategy. ACD strategy, isolation of patients, quarantine the exposed, tracking down the close contact, and continuous health promotion and education will ultimately break the chain of transmission.

(1) Background: electronic medical record (EMR) systems remain a significant priority for the improvement of healthcare services. However, their implementation may have resulted in a burden on healthcare workers (HCWs). This study aimed to determine the prevalence of burnout symptoms among HCWs who use EMRs at their workplace, as well as burnout-associated factors. (2) Methods: an analytical cross-sectional study was conducted at six public health clinics equipped with an electronic medical record system. The respondents were from a heterogeneity of job descriptions. Consent was obtained before enrolment into the study. A questionnaire was distributed through an online platform. Ethical approval was secured. (3) Results: a total of 161 respondents were included in the final analysis, accounting for a 90.0% response rate. The prevalence of burnout symptoms was 10.7% (n = 17). Three significant predictors were obtained in the final model: experiencing ineffective screen layouts and navigation systems, experiencing physical or verbal abuse by patients, and having a poor relationship with colleagues. (4) Conclusions: the prevalence of burnout symptoms among healthcare workers working with electronic medical record systems was low. Despite several limitations and barriers to implementation, a paradigm shift is needed to equip all health sectors with electronic medical record systems to improve healthcare service delivery. Continuous technical support and financial resources are important to ensure a smooth transition and integration.