Objective Structured Clinical Examination (OSCE) is an essential clinical skills evaluation method used in the preclinical stage. OSCE increases students' average readiness to practice the role of medical personnel. Good knowledge is expected to be directly proportional to clinical practice skills. The cumulative grade point average (GPA) is the parameter used to measure knowledge. Students are said to be ready to practice if they balance clinical skills, basic knowledge, and critical thinking which can be seen through comprehensive OSCE scores and student GPA. This study aims to examine the relationship between comprehensive OSCE scores and GPA on the readiness of undergraduate medical students to undergo clinical rotations at the Faculty of Medicine, Universitas Udayana. This study was conducted at the Faculty of Medicine, Universitas Udayana, from May to October 2024. Its subject was research on medical students who will undergo clinical rotations. The research instrument used was the Preparedness for Hospital Practice Questionnaire (PHPQ). Data analysis was carried out using SPSS for Windows version 25.0 software. The mean age of respondents was 22.02 ± 0.835 years. Most respondents were female (61.1%) and international students (51.9%). The mean rating scale of the research respondents from the eight domains was 4-5, indicating that students' readiness to undergo clinical rotations was adequate to adequate. Comprehensive OSCE scores and GPA have a significant relationship with the readiness of undergraduate medical students for clinical rotations, respectively, in the domains of collaboration, holistic care, and interpersonal skills. Conclusion: The results of this study can serve as a reference for evaluating the readiness of undergraduate medical students to undergo clinical rotations and for preparing appropriate learning strategies at the Faculty of Medicine, Universitas Udayana, particularly during the transition to clinical rotations.
Voltage-gated sodium channels (VGSCs) play a critical role in generating and propagating electrical signals in excitable cells. To date, the technology has gained much attention for its therapeutic potential in treating various diseases, including cancer. This study provides a comprehensive bibliometric analysis of VGSC research trends over 40 years (1984-2023) using the Scopus database. A total of 3,170 articles were analysed to explore publication productivity, authorship, key research topics, and collaboration patterns. The analysis identified the leading countries according to the number of articles contributed and determined that the USA, China, and Germany were the most productive. In fact, the USA alone accounts for 41.6% of global VGSC research on therapeutics. Additionally, based on the number of published articles, institutions such as Harvard Medical School and the University of Cambridge were found to be at the forefront of this field. Overall, the performed research focused on the therapeutic applications of VGSCs in conditions like atrial fibrillation, chronic pain, cancer, and genetic diseases. The study also highlights a growing interest in VGSC-related research in the past decade as a result of the advancements in molecular techniques such as next-generation sequencing (NGS) and small interfering RNA (siRNA). These findings suggest that VGSCs will remain a central point in therapeutic research for years to come, with a greater interest in international collaboration to drive further progress.
The Timed Up and Go (TUG) test effectively identifies risk of fall, especially in institutional care settings with limited resources. This is the first Malaysian study assessing the validity of the TUG test against the Downton Fall Risk Index (DFRI) and establishing an optimal TUG cut-off for institutional settings. This cross-sectional study included residents aged > 60 years who could ambulate independently with or without aid from Rumah Seri Kenangan Cheras. Demographic data, TUG test scores, and DFRI scores were collected for fall risk assessment. Receiver operating characteristic (ROC) analysis was used to assess the validity of TUG, with the area under the curve (AUC) measuring sensitivity and specificity, and the Youden Index identifying the optimal cut-off. Of the 192 residents, 92 (47.9%) fulfilled the inclusion and exclusion criteria. The mean age was 72.24 years (standard deviation, SD = 8.42), and 33.7% were classified as having a high risk of falling (DFRI ≥ 3). The TUG test showed an AUC of 0.65 (95% Confidence Interval [CI]: 0.54-0.77, P = 0.018), indicating moderate validity. A cut-off of 12.5 s achieved high sensitivity (93.5%) and low specificity (34.4%). The TUG test cut-off point identified was 12.5 s, which is lower than the standard 13.5 s reported for community-dwelling older adults. This difference reflects the unique characteristics of institutionalised older adults, who often experience greater physical and cognitive impairments. Environmental factors and methodological variations may contribute to this discrepancy, emphasising the need to set specific cut-off points to assess risk of fall in this population accurately.
Parkinson's disease (PD) is a neurodegenerative disorder with a complex aetiology involving several genetic and environmental factors. Although no clear evidence of a direct link between the electronic features of DNA and PD has been found, elucidating the role of DNA in cellular function and dysfunction could provide valuable insights into the mechanisms of the disease (e.g. mutations occurring in the phosphatase and tensin homolog [PTEN]-induced kinase 1 [PINK1] DNA of PD). This study aimed to analyse topographic images and measure the electronic conductivity of synthetic normal and mutant PINK1 DNA molecules. Two 15-mer synthetic oligonucleotides of Oligo1 normal PINK1 (5'-CAG CTG CTG GAA GGC-3') and Oligo2 mutant PINK1 (5'-CAG CTG CCG GAA GGC-3') were measured using scanning tunnelling microscopy and spectroscopy. The study's findings revealed that the mean values of the voltage gap (Vg) between Oligo1 normal and Oligo2 mutant PINK1 DNA molecules at the mutation region A2-C2 are 1.204 ± 0.198 V and 0.676 ± 0.495 V, respectively, indicating differences in the electronic properties between the Oligo1 normal and Oligo2 mutant PINK1 DNA molecules. However, the mean Vg values of Oligo1 normal and Oligo2 mutant PINK1 DNA molecules were found to not significantly differ from each other (P = 0.162 > α = 0.05). The study found that the voltage gap between normal and mutant PINK1 DNA molecules is not significantly different, suggesting that DNA sequence differences may not directly alter electrical properties. However, PINK1 mutations play a role in early-onset PD due to mitochondrial dysfunction, and future therapies should focus on restoring PINK1-Parkin signalling and mitochondrial health.
The supervised practice of newly credentialed medical practitioners within the public sector following completion of specialist training, referred to previously in Malaysia as specialist gazettement or post-qualification working experience (PQWE), is a unique regulatory mechanism aimed at safeguarding the quality and safety of specialist care. This probationary phase enables senior consultants or specialists to assess the competence and readiness of the practitioners for independent clinical practice. In response to evolving demands on healthcare delivery and workforce governance, the Ministry of Health has introduced a series of strategic reforms to strengthen its framework, especially within the public healthcare setting. These include legislative amendments to formalise and regularise the implementation of the probationary phase through supervised work experience or SWE (legal transformation), fiscal measures to support financing incentives (financial transformation), and digital innovations that enhance experience and administrative efficiency (digital transformation). This paper describes these transformative interventions, positioning the Ministry of Health's approach within broader policy discourses on clinical governance and health system sustainability.
Down syndrome (DS) is the most common chromosomal disorder worldwide. This study aimed to analyse the incidence of newborns with DS in a tertiary centre in the East Coast of Peninsular Malaysia and determine the factors associated with the length of hospital stay among them. This is a retrospective study from 2017 to 2021 that recruited 41 newborns with DS. We analysed patients' clinical characteristics, comorbidities and length of hospital stay. Kaplan-Meier survival and Cox regression analyses were used to determine the median length of hospital stay and factors affecting the length of hospital stay. The incidences of newborns with DS for five consecutive years were between 0.52 and 1.39 in 1,000 live births. The gender was equally distributed and the majority were delivered from advanced maternal age with multiple antenatal histories. The majority had non-disjunction trisomy 21 and were born with multiple comorbidities. Median length of hospital stay (IQR) among newborns with DS is 24 days (17.7-30.3). Every newborn with pulmonary hypertension (adjusted hazard ratio [aHR]: 0.24; 95% CI 0.10, 0.58), feeding intolerance (aHR: 0.16, [95% CI 0.06, 0.54]) and who had been invasively ventilated (aHR: 0.13, [95% CI 0.03, 0.48]) is expected to have a prolonged hospital stay. The incidence of newborns with DS in Hospital Pakar Universiti Sains Malaysia is lower than other countries worldwide. We found that pulmonary hypertension, history of invasive ventilation and feeding intolerance are the main factors that affect the length of hospital stay for newborns with DS in our hospital.
Elevated levels of low-density lipoprotein cholesterol (LDL-C) result in dyslipidaemia, increasing the risk of atherosclerotic cardiovascular disease (ASCVD). As of 2022, Malaysian population (56.7%) demonstrated high LDL-C, necessitating an analysis of cardiovascular risk factors (CVRFs), comorbidities and treatment using lipid-lowering therapies (LLTs) to achieve target LDL-C < 1.4 mmol/L, as per Malaysian guidelines. This retrospective cohort study of 431 hospitalised patients (≥ 18 years) with elevated LDL-C levels from the National Heart Institute, Malaysia, assessed CVRFs, comorbidities, treatment patterns, and the proportion of patients achieving LDL-C goals (< 1.8 mmol/L, < 1.4 mmol/L, and < 1.0 mmol/L) after LLT. The association pattern of CVRFs was studied in patients achieving the target goal of < 1.4 mmol/L. The mean age of the patients was 60.53 (9.86) years, with the majority being male (79.35%), non-smokers (84.78%), and Malay (61.48%). Most patients (88.40%) had acute coronary syndrome, and the most prevalent risk factors were systemic hypertension (76.33%), diabetes mellitus (DM) (51.97%), and chronic kidney disease (CKD) (28.54%). Monotherapy with high-intensity statins was the most common LLT. At 1 year, 48.26%, 24.83% and 7.66% of patients had achieved target goals of < 1.8 mmol/L, < 1.4 mmol/L, and < 1.0 mmol/L, respectively. Poor LDL-C achievement was observed among patients with DM and recurrent events (P = 0.0097), left ventricular ejection fraction < 35% (P = 0.0325), and age > 75 years (P = 0.0087). Hypertension, diabetes and CKD are prevalent risk factors, and despite high-intensity statins, only 24.83% of patients achieved the LDL-C target goal. Thus, the use of combination therapy and innovative therapies is necessary to improve ASCVD management in Malaysia.
Understanding the perspectives and experiences of hospital food service personnel in managing food waste may aid in determining the factors that influence food waste. However, such research is still scarce globally. This study aimed to determine the factors influencing food wastage in Malaysian public hospitals. This qualitative research was performed in four Malaysian public hospitals and used purposive sampling to select participants for one-to-one interviews because of their role as key informants. Themes such as patient culture and background, the quality and variety of food choices, the complexity of the ordering system, staff competency and attitude, environmental factors, treatment procedures, and patient clinical condition were identified using thematic analysis. Rather than focusing solely on patient experiences, this study explores other factors influencing food wastage in Malaysian public hospitals based on the experiences of hospital food services staff in managing food wastage.
The growing incorporation of artificial intelligence (AI) within academic settings has prompted increased scholarly attention to understanding how academicians perceive its impact. Although the General Attitudes Towards Artificial Intelligence Scale (GAAIS) is a widely recognised instrument for evaluating perceptions of AI, a formally validated version in Bahasa Malaysia has not yet been developed. This study, therefore, sought to adapt and validate the GAAIS in Bahasa Malaysia to assess attitudes toward AI among Malaysian academicians accurately. A cross-sectional study was conducted among academicians at the Universiti Sains Malaysia Health Campus in Malaysia. A Confirmatory Factor Analysis (CFA) was performed to evaluate the factor structure of the translated scale. Composite reliability (CR) was utilised to assess reliability, whereas convergent validity was determined by calculating the average variance extracted (AVE). The final CFA model confirmed a two-factor structure, retaining 14 out of 20 original items. Factor 1 (Optimism and Benefits) comprised eight items, while Factor 2 (Risks and Ethical Concerns) consisted of six items. The model demonstrated strong fit indices (χ 2/df = 1.616, TLI = 0.947, CFI = 0.936, RMSEA = 0.073) and high internal consistency (CR values: Factor 1 = 0.899, Factor 2 = 0.888). An AVE of 0.530 for Factor 1 and 0.573 for Factor 2 indicates the convergent validity of the scales. The translated Bahasa Malaysia version of GAAIS is a valid and reliable tool for assessing AI attitudes in general among Malaysian academicians. Its relevance spans multiple academic fields and professional industries, contributing valuable support to ongoing research involving multilingual and multicultural populations.
The increasing prevalence of electronic cigarette (e-cigarette) use among Malaysian youths highlights the inadequacy of current health education initiatives in addressing cessation challenges. This study aims to evaluate the content and face validity of educational infographics to support e-cigarette cessation among youth e-cigarette users in Malaysia. This study employed a cross-sectional study design and involved experts and youth e-cigarette users. Upon the development, 17 experts specialising in smoking or e-cigarette cessation, with a mean age of 39.10 years and a mean years of experience of 12.24 years, were recruited for content validation. Meanwhile, for the face validation, 10 Malaysian youth e-cigarette users, with a mean age of 24.00, were purposively selected to assess the clarity of the infographics and provide feedback. Content validity indices (CVI) and face validity indices (FVI) were calculated for each topic, with thresholds of > 0.74 and 0.83 indicating acceptable content. The infographics demonstrated strong content and face validity, with average CVI of 0.98 (range: 0.94, 1.00; 95% CI: 0.95, 1.00) and average FVI of 0.96 (range: 0.70, 1.00; 95% CI: 0.87, 1.00), respectively. The infographics can be utilised to promote e-cigarette cessation after the trial and implementation phase, to assess their real-world effectiveness.
Radiation dose generated from computed tomography (CT) has drawn more attention to diagnostic radiology. It is a known fact that the risk of radiation-induced cancer is increasing, thereby necessitating the optimisation of dose in CT protocols. This study focused on determining the radiation dose of CT scans for the abdomen and lung using a 64-slice CT scanner to evaluate their correlation with body mass index (BMI). The objective of the study was to critically evaluate the relationship between BMI and radiation dose metrics in both CT lung and CT abdomen examinations. Data from 106 patients who underwent CT lung and CT abdomen examinations at an advanced diagnostic center were retrospectively analysed. The volume CT dose index (CTDIvol), dose-length product (DLP), the scan range, and skin to skin antero-posterior (AP) and lateral (LAT) of the patients were documented for further analysis. Effective dose (E) and size-specific dose estimate (SSDE) were also computed. The mean BMI for CT lung was recorded as 24.85 (5.65). However, the correlation between BMI and the dose metrics (SSDE, E, DLP, and CTDIvol) was not significant, with correlation coefficients of 0.1278, 0.047, 0.047, and 0.1147, respectively. In contrast, the BMI for CT abdomen scans showed a moderate correlation with E (0.5898), SSDE (0.6288), DLP (0.5898), and CTDIvol (0.612). The results demonstrate that BMI can be used as a radiation dose metric in the case of CT abdomen scans, but has no influence on CT lung scans. These results further suggest that BMI could provide radiation dose analysis, which in turn leads to optimisation of CT scan parameters.
The Exercise Habit Strength Questionnaire (EHSQ) has shown excellent psychometric properties. However, children in different weight categories exhibit distinct patterns of exercise engagement. Therefore, examining the EHSQ's psychometric properties across different weight groups across time may provide additional evidence of its discriminatory power and temporal stability. This study was conducted in two samples. Sample 1 involved 450 secondary school students (mean age: 14.72 ± 1.19 years), consisting of 52% males and 48% females across different body mass index (BMI) categories-normal (17.70%), overweight (23.44%), and obese (58.85%). Data collection involved the EHSQ, Body Appreciation Scale and the Implicit Association Test. Sample 2 consisted of 60 female students aged 16 years from all-girls schools, with 48.3% in the normal category and the remaining underweight, overweight, and obese categories. The EHSQ was administered twice, with a three-month interval between administrations. Confirmatory factor analysis provided evidence of factorial validity (χ 2 = 210.06, df = 129, P < 0.05; χ 2/df = 1.63; CFI = 0.96; GFI = 0.95; RMSEA = 0.04; AIC = 314.69). Item loadings were above 0.5, except for one item, with latent factor intercorrelations ranging from 0.2 to 0.5. The results of the Intraclass correlation coefficient analysis demonstrated excellent test-retest reliability. Additionally, internal consistency scores in Sample 2 mirrored those of Sample 1, with Cronbach's alpha values of 0.756 for patterned action, 0.757 for automaticity, 0.89 for negative consequences, and 0.84 for stimulus cue. Overall, the results provided adequate support for the hypothesised psychometric properties of the ESHQ.
Due to ongoing and unresolved disputes over the recognition of specialist training programmes and specialist registration, the Ministry of Health and the Ministry of Higher Education sought legal opinion from the Attorney General's Chambers. Following the legal opinion, both Ministries proposed a joint memorandum to the Cabinet to amend the Medical Act 1971 [Act 50]. This article outlines the need for these amendments, their content, and their impact on specialist training programmes conducted by the Ministry of Health.
The climate crisis combined with air pollution is increasingly disrupting the foundational conditions for healthy cognitive development and learning, particularly among children in vulnerable regions. In South and Southeast Asia, escalating levels of air pollution and extreme heat are synergistically threatening the neurocognitive health, educational attainment, and long-term potential of millions of children. Many schools in the region lack adequate ventilation, cooling infrastructure, and environmental monitoring, leaving children vulnerable to both acute and chronic health impacts. The review explores the effects of air pollution and extreme heat on cognitive function, behaviour, and academic performance in children. It highlights the urgent need to prioritise children's brain health in climate adaptation, education, and public health agendas. Beyond outlining the problem, the article identifies critical gaps and opportunities for action. It stresses the need for real-time, child-centred data as a missing link for informed decision-making. The lack of public awareness and a compelling narrative around the climate cognition link is also examined as a driver of inaction. Finally, the article offers a science-driven blueprint for change, outlining a path forward that integrates neuroscience, environmental monitoring, education reform, and equity-focused policy. Understanding and responding to this "climate cognition crisis" is not only a public health and developmental imperative, but also central to building resilient, future-ready societies in South and Southeast Asia.
Insomnia represents a significant risk factor for impaired daytime functioning and a range of chronic health conditions and has emerged as a growing public health concern in Malaysia. The absence of standardised local guidelines complicates treatment decision-making. This consensus aimed to develop pharmacological treatment recommendations for insomnia in Malaysia using a modified Delphi approach. An eight-member expert panel comprising specialists in sleep medicine, psychiatry, neurology, and pharmacology reviewed high-level evidence on the neurobiology, diagnosis, and treatment of insomnia. A 31-item consensus statement survey addressing the definition, diagnosis, and pharmacological management of insomnia was conducted, with agreement evaluated using a five-point Likert scale. The consensus recommendations were finalised after two Delphi rounds and a final vote, with at least 75% agreement required for each statement. Consensus statements highlighted the need for tailored treatment strategies in Malaysia that combine nonpharmacological and pharmacological interventions. Insomnia was recognised as a chronic condition diagnosed primarily using subjective criteria, with sleep diaries and questionnaires recommended as assessment tools. Benzodiazepines, Z-class drugs, and dual orexin receptor agonists (DORAs) were found to be effective; however, concerns regarding long-term safety and dependency were noted. DORAs demonstrated promise in managing both sleep onset and maintenance, with lemborexant highlighted as a promising pharmacological option. The meeting emphasised the importance of individualised treatment plans and careful risk assessment, particularly for older adults, and provided practical recommendations for the management of insomnia. The integration of Cognitive Behavioural Therapy for Insomnia with pharmacotherapy was strongly advocated. These consensus statements offer a practical foundation for the development of future national guidelines to enhance insomnia care in Malaysia's primary care settings.
This study was to identify seizure outcome following epilepsy surgery in paediatric group using Engel classification. We also identified histological and radiological findings of the study population. This study was a retrospective cohort study over a period of eight years from 1 January 2012 until 1 July 2019. Engel Outcome Classification was used to identify seizure outcome at immediate, three to six months and one year post-operation. Age, sex, age of seizure onset, age of operation, body weight, number of antiepileptic medications pre and post-operation, duration of stay in intensive care unit (ICU) and ward, magnetic resonance imaging (MRI) and histopathological findings and complications were noted. Analytically, Fisher's exact test was used for categorical data. Wilcoxon Signed Rank test was used for continuous but not normally distributed data. In this study, Univariate logistic regression is used to understand whether Engel Classification I can be predicted from categorical variables and numerical variables. A set P-value of < 0.05 was considered of statistical significant. 29 paediatric patients met study criteria. The mean time between seizure onset and surgery was 5.6 years. Non-invasive evaluation was used in all 29 patients during preoperative assessment. With the use of the Engel Outcome Classification, Engel I outcome or seizure free was achieved in 28 patients (96.6%) at immediate follow-up, 24 patients (82.8%) at three to six months follow-up and 24 (82.8%) at one year follow-up. Hippocampal Sclerosis was present in 13 patients (44.8%). Tumours were present in 16 patients (55.2%). The complication proportion was 14.4%. Only two patients (6.9%) underwent reoperations. There are significant changes in post operative Anti Epileptic Medications (AEDs) reduction in this study (P = 0.006). Possible risk factor of seizure was suggestive for less recurrence of seizure, which may become a predictor to achieve Engel I classification in this study (P = 0.052). The surgery outcome of epilepsy surgery of the temporal lobe in paediatric group was comparable in this study. Careful patient selection by multidisciplinary evaluations is mandatory.
Out-of-pocket costs for chronic illnesses have become significant barriers to continuing treatment, given the already substantial cost of the diseases. This study aims to estimate out-of-pocket costs and determine the health-related quality of life of patients with cancer and diabetes. A purposive cross-sectional study (January 2021-January 2022) was conducted to assess health-related quality of life and out-of-pocket costs among Malaysian adults with cancer or diabetes. Using the validated EQ-5D-5L and a three-section questionnaire, 571 participants from three hospitals and online surveys provided data on five cost categories expressed in 2021 MYR and USD. Significant differences were observed across all cost categories between patients with cancer and diabetes. Diagnostic imaging had a larger effect size (P < 0.0001, r = 0.467). Annual outpatient and hospitalisation costs among patients with cancer were found to be 42 and 11 times higher than for patients with diabetes, respectively. Overall, the out-of-pocket expenditure per year for patients with cancer was MYR 88,346.12 and MYR 9,010.60 for patients with diabetes. Additionally, patients with cancer rated their health-related quality of life using the EQ-VAS score lower than patients with diabetes (EQ-VAS = 63.7, SD = 19.2 and EQ-VAS = 71.6, SD = 18.7). Cancer and diabetes impose significant financial and quality of life burdens on patients in Malaysia. This study highlights gaps in insurance coverage and public assistance, calling for more comprehensive support for medical and nonmedical expenses and psychological support for patients. The analysis, which focuses on annual costs, may underestimate the long-term financial impact, especially for patients with cancer. Future research should examine household spending and the ability to pay for treatment costs to better understand the full economic burden of these chronic diseases.
Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder among older adults, characterised by dizziness and imbalance caused by the displacement of otoconia into the semicircular canals. Although canalith repositioning manoeuvres are considered the standard treatment, their high recurrence rate and the need for frequent clinic visits highlight the demand for supplementary therapeutic approaches. This review examines the effectiveness of home-based vestibular rehabilitation and the associated challenges in managing patients with BPPV. A comprehensive search of databases including PubMed, Scopus, Science Direct, Web of Science, PEDro, Mendeley, and Google Scholar identified 251 records using keywords such as "BPPV" and "home-based exercise rehabilitation." Following the screening of 228 records and full-text review of 172 articles, 17 studies met the inclusion criteria. The total sample included 541 patients with BPPV, with intervention group sizes ranging from 10 to 154 and control group sizes from 10 to 151. Intervention durations varied between 1 and 24 weeks. The findings indicate that home-based rehabilitation can reduce dizziness, improve balance and gait, lower fall risk, and enhance quality of life. Digital tools such as telephone consultations and online platforms were frequently used to support adherence and monitor exercise performance. However, the effectiveness varied across studies, with some reporting substantial benefits and others showing limited improvements. This review highlights the potential of digital technologies in enhancing home-based vestibular rehabilitation, while also emphasising the need for further research to optimise protocols and assess long-term outcomes.
The main aim of the study was to determine the relationships between components of physical activity level with quality of life (QoL) and cancer-related fatigue (CRF) among breast cancer survivors in Malaysia. Eighty-three female breast cancer survivors with mean age 52.8 (8.7) years old participated in this study. The participants were asked to answer Short Form International Physical Activity Questionnaire (SF IPAQ) to identify physical activity level, Breast Cancer Functional Assessment of Cancer Therapy (FACT-B) questionnaire to determine the QoL, and Brief Fatigue Inventory (BFI) scale questionnaire to assess CRF. Descriptive statistic and Pearson correlation were performed for statistical analysis. There was a significant positive correlation between time spent for moderate to vigorous physical activity (mins/week MVPA) and functional well-being, a component of QoL (r = 0.217, P = 0.049). There was a significant negative correlation between the days spent for moderate physical activity (days/week MPA) and the severity of fatigue, a component of CRF (r = -0.234, P = 0.033). A negative correlation between total CRF score and total QoL score (r = -0.298, P = 0.01) was also observed. Participation in physical activity might improve QoL and reduce the severity of CRF in Malaysian breast cancer survivors.
The World Health Organization's Communication for Behavioural Impact (COMBI) strategy aims to promote healthy behaviours through integrated communication. Malaysia has adopted the COMBI approach to combat dengue; however, sustaining these efforts presents ongoing challenges. This review explored the facilitating factors and barriers associated with challenges in the sustainability of Malaysia's COMBI programme for dengue prevention. We used the SPIDER framework (Sample, Phenomenon of Interest, Design, Evaluation, Research Type) to identify relevant articles, and we searched Scopus, PubMed, ScienceDirect, BMJ, Sage, and Google Scholar. Our search followed PRISMA guidelines, using Boolean operators "AND" and "OR" to connect keywords like "dengue" and "Communication for Behavioural Impact (COMBI)." The review included five articles, which were appraised by the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Findings indicate that COMBI programmes significantly enhance knowledge, attitudes, and practices (KAP) and reduce both dengue cases and mosquito breeding sites. The reviewed articles identified nine themes as either facilitating factors or barriers to the sustainability of COMBI: community engagement, leadership, political stability, mass media, public health campaigns, funding, human resources, multi-sectoral collaboration, and migration of residents. Identifying factors and barriers is key to improving the effectiveness and sustainability of COMBI programmes. This review highlights the importance of mixed methods research and community-centric engagement in addressing community issues and refining COMBI strategies. These comprehensive approaches are crucial for sustaining community involvement and ensuring the effectiveness of dengue prevention, thereby contributing to the long-term success of public health interventions in Malaysia and globally.