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This study aims to determine the association and risk of daily fluctuations of air pollution parameters in Klang Valley, Malaysia, with cardiovascular and respiratory admissions. The data on admissions and air pollution concentrations were obtained from various government agencies in Malaysia. The associations were estimated using a time series analysis of Poisson regression. The effects for every 10μ/m3 increase in pollutants were reported as Relative Risk (RR). SO2 showed the highest association with immediate effects at lag 0 for all cardiovascular admissions followed by NO2. Gaseous pollutants of SO2 and NO2 showed a higher risk among elderly more than 60 years old. Immediate effects were found in both genders, with higher risks observed in males. NO2 continues to be suggestively associated with all respiratory admissions. Children less than 9 years old presented a higher risk of NO2 at various lag times with the highest value at lag0, followed by PM10. Stratified analysis showed an incremental risk of respiratory admissions for males exposed to NO2 compared to females. We found noteworthy associations for overall and age-specific admissions of cardiovascular and respiratory with the pollutants. Compared to particulates pollutant, gaseous pollutants showed a higher risk in both admissions.

Intestinal parasitic infections (IPIs) are largely overlooked in Malaysia’s rapidly urbanising areas, while thriving in conditions of poor sanitation, environmental decline, and high population density. Studies in Malaysia are largely skewed towards indigenous communities, with few focusing on other vulnerable sectors, including the inhabitants of public housing programs (PHP)—often plagued with poor facilities and indiscriminate waste management. We assessed the prevalence of IPIs and their associated risk factors amongst occupants of PHPs in Klang Valley, Malaysia, recruiting 394 residents from 19 PHPs and screening stool samples via six microscopy techniques. Overall prevalence was moderate (19.3%), with 76 participants infected with at least one intestinal parasite. Ascaris lumbricoides was the most prominent species (13.5%), followed by Trichuris trichiura (6.1%), and Cryptosporidium spp. (0.51%). Significant associations between helminthic infections and individual risk factors included locality, presence of pest breeding grounds, pet keeping, failure to use soap during handwashing, and overflowing waste collection facilities. No significant factors were associated with the protozoan infections. These results highlight the presence of IPIs in the urban poor communities, potentially attributed to poor maintenance of housing facilities and lack of civic consciousness amongst the occupants, calling for better, integrated interventions to improve the livelihoods of these communities.

Benzene, toluene, ethylbenzene, m , p -xylene, and o -xylene (collectively referred to as BTEX ), which are prevalent in the ambient air of urban environments, potentially cause chronic health effects, particularly among outdoor workers. Aim of this study was to evaluate BTEX concentrations in the Klang Valley of Malaysia and assess the health risks to urban traffic police officers, whose duties include controlling the traffic flow and enforcing traffic laws. Air samples were collected with low-flow personal samplers during the officers’ work shifts outdoors, and the BTEX content was then analyzed via gas chromatography-mass spectrometry (GC-MS) coupled with thermal desorption (TD). A probabilistic method based on Monte Carlo simulation was applied to determine the cancer risk (CR) and hazard quotient (HQ), and a sensitivity analysis was performed to identify the greatest contributors to the estimated risks. The total BTEX concentration in the samples averaged 211.83 µg m –3 , with the largest component being toluene (averaging 89.08 µg m –3 in concentration), followed by m , p -xylene (37.25 µg m –3 ), o -xylene (35.80 µg m –3 ), benzene (25.82 µg m –3 ), and ethylbenzene (23.89 µg m –3 ). The average CR value for benzene (5.31 × 10 –6 ) as well as the 95 th percentiles of the CR values for benzene and ethylbenzene (1.70 × 10 –5 and 2.12 × 10 –6 , respectively) exceeded the acceptable level of exposure (1.0 × 10 –6 ). The HQ values for all of the BTEX species were less than one. The sensitivity analysis revealed that the most influential parameter in increasing the estimated CR and HQ was the exposure duration, followed by the BTEX concentration. The estimated CR indicates that the prolonged exposure to benzene and ethylbenzene experienced by traffic police officers exacerbates the risk of adverse health effects. These results, which provide baseline data for determining the occupational risk to individuals who are exposed to BTEX while working on or near a road, emphasize the need for additional regulations, including the use of appropriate respiratory protective equipment.

Background Typhoid fever causes global morbidity and mortality and is a significant health burden, particularly in low- and middle-income countries. The direct fecal-oral route is the main transmission mode, but indirect environmental transmission could occur, particularly in urban settings. This study aimed to investigate the burden and trend of typhoid fever, reporting the coverage system between government and private practice and pattern of multidrug-resistant (MDR) typhoid cases in the urban Klang Valley area from 2011 to 2015. Methods The data from a cross-sectional study retrieved from the e-Notifikasi System, a national reporting system for communicable diseases provided by the Disease Control Division, Ministry of Health Malaysia and secondary data of all the typhoid cases were obtained from the public and private hospitals and laboratories in Klang Valley. Descriptive analysis was performed to examine the sociodemographic characteristics, spatial mapping was conducted to examine trends, and the crude incidence rates of confirmed typhoid cases and percentage of reporting coverage were calculated. Significant differences between MDR and non-MDR Salmonella typhi were determined in the patient’s sociodemographic characteristics, which were analyzed using χ 2 test. P values < 0.05 were considered statistically significant. Results In total, 507 typhoid fever cases were reported in Klang Valley; however, only 265 cases were confirmed by culture tests. The crude incidence rates of confirmed cases were between 0.5 to 0.7 but peaked at 1.42 per 100,000 population in 2015. Most typhoid fever cases were observed among men (55.6%), individuals aged 21 to 30 years (27.6%), Malaysians (86.3%) and individuals of Malay ethnicity (52.1%). The reporting coverage of confirmed cases was 78.9% and non-reporting coverage of unconfirmed typhoid cases was 79.5%. The predictive value positive (PVP) was 89.3, and 7.5% were detected as MDR Salmonella typhi . Statistical significance was found in gender, citizenship and ethnicity regarding MDR Salmonella typhi ( p  = 0.004, p  = 0.008 and p  = 0.034, respectively). Conclusions The local transmission of typhoid is still prevalent in the Klang Valley despite rapid urbanization and development in recent years. These findings are essential for policy makers to plan and implement focused and effective preventative activities to curb typhoid infection in urban areas.

Background The demand in biobanking for the collection and maintenance of biological specimens and personal data from civilians to improve the prevention, diagnosis and treatment of diseases has increased notably. Despite the advancement, certain issues, specifically those related to privacy and data protection, have been critically discussed. The purposes of this study are to assess the willingness of stakeholders to participate in biobanking and to determine its predictors. Methods A survey of 469 respondents from various stakeholder groups in the Klang Valley region of Malaysia was carried out. Based on previous research, a multi-dimensional instrument measuring willingness to participate in biobanking, and its predictors, was constructed and validated. A single step Structural Equation Modelling was performed to analyse the measurements and structural model using the International Business Machines Corporation Software Package for Social Sciences, Analysis of Moment Structures (IBM SPSS Amos) version 20 with a maximum likelihood function. Results Malaysian stakeholders in the Klang Valley were found to be cautious of biobanks. Although they perceived the biobanks as moderately beneficial (mean score of 4.65) and were moderately willing to participate in biobanking (mean score of 4.10), they professed moderate concern about data and specimen protection issues (mean score of 4.33). Willingness to participate in biobanking was predominantly determined by four direct predictors: specific application-linked perceptions of their benefits (β = 0.35, p  < 0.001), issues of data and specimen protection (β = − 0.31, p  < 0.001) and religious acceptance (β = 0.15, p  < 0.05) and trust in key players (β = 0.20, p  < 0.001). The stakeholders’ willingness to participate in biobanking also involves the intricate relationships between the above-mentioned factors and other predictors, such as attitudes regarding technology, religiosity and engagement. Conclusions The findings of this study reaffirmed that stakeholders’ willingness to participate in biobanking is a complex phenomenon that should be viewed from a multidimensional perspective. Stakeholder willingness to participate in biobanking is warranted when direct predictors (benefits, issues of data and specimen protection, religious acceptance, and trust in key players) as well as indirect factors are well accounted for.

The emerging population has increased travel demand and improved public transport mode in cities to connect the people. (1) Background: This study used the Theory of Planned Behavior (TPB) to assess the usage behavior for city rail transport with the factors attitude, subjective norm, and perceived behavioral control and its impact on pro-behavioral intentions to increase the actual usage of rail transports, i.e., LRT, MRT, and KTM commuter. (2) Method/Approach: To understand the antecedents of pro-environment behavioral intention, this study performed pilot testing, for which we collected the data through closed-ended questionnaires to test the instrument’s reliability, specifically from the Klang Valley in Malaysia. (3) Findings/Results: This study revealed that the public attitude due to environmental concern and subjective norms and perceived behavioral control are the strongest predictors for public transport usage through behavioral intention. The study estimated that most respondents would have agreed to choose public transport mode if quality of services increased. (4) Conclusion: In future research, the goal of this study could be extended as a strategic indicator for sustainable development through efficient mobility choice in Malaysia. The TPB model helps to present the factors involved in growing and retaining clients for rail transport. In terms of implications for policy, this study also provides policymakers with valuable information to maintain the current public transport passengers and attract new users through the perceived service quality and customer satisfaction of public transport.

Artificial Intelligence is great when it comes to routine activities and vast amounts of data are analyzed. This can be done more quickly and efficiently than men. In the world of digital marketing, Artificial Intelligence is quickly coming into play. With Artificial Intelligence joining the digital marketing environment, predicting user behavior, search cycles, and much more will be easier. This can support websites that are highly user-friendly for organizations. Moreover, with the aid of Artificial Intelligence, content creation has become a faster and easier task for brands. Practically, a company's degree of enterprise marketing can have an effect on its overall business efficiency. Entrepreneurial marketing is driven by entrepreneurial opportunities which involves the proactive identification and exploitation of opportunities for acquiring and retaining profitable customers through Digital approaches to risk management, resource leveraging and value creation. This research was done by collecting data using semi structure questionnaire distributed to 169 start up owners in Klang Valley area. Using two-layer 6-3-1 with hyperbolic tangent-purelin configurations neural network model, it was found that proactiveness, risk taking, resource leveraging, opportunity focus, intensity and value add are the significant factors towards digital marketing respectively. It is expected that the findings would give some inputs to the Malaysian entrepreneurs on innovative digital marketing in their businesses, regardless the sizes.

Background: Zika fever is a mosquito-borne disease with global health concern. It has been underreported or misdiagnosed due to its unspecific clinical manifestations, including mild-influenza like and subclinical symptoms. However, its associated serious complications which include fetal microcephaly and Guillain-Barré syndrome remained a challenge to the public health sectors. This research aimed to evaluate the knowledge, awareness, and perception toward Zika virus infection among community pharmacists in the Klang Valley of Malaysia and to determine the association between the knowledge of Zika virus infectious disease and years of community practice experience among community pharmacists in this region. Methods: This survey research was conducted from August to December 2018 through a pre-tested, self-administration, and cross-sectional random convenient sampling at various districts in the Klang Valley. A total of 275 registered community pharmacists were involved in this study by completing a pilot-tested questionnaire. Descriptive analysis, Mann-Whitney U test, and Kruskal-Wallis H test were used to analyze the data. Results: The knowledge toward Zika virus infection of respondents was classified into “poor” (5.1%), “basic” (70.9%), and “broad” (24.0%). Most of the participants (n = 195, 70.9%) presented with basic knowledge toward Zika virus infection. A total of 268 (97.5%) participants presented with high awareness toward Zika virus infection. The mean score of respondents’ knowledge and awareness was 15.88 ± 3.61 (maximum score = 28) and 13.96 ± 1.60 (maximum score = 16), respectively. There was a statistically significant difference between the years of practice of community pharmacists and the level of knowledge toward Zika virus infection. Conclusions: In conclusion, our respondents demonstrated a basic level of knowledge and high awareness toward Zika virus infection. Also, we highlighted some possible pitfalls in the knowledge of Zika virus infection, including the virus transmission, symptoms, diagnosis, treatment, prevention, and complications of the disease.

Background: Diego blood group antigen, Di(a), is very rare among Caucasians and Blacks, but relatively common among the South American Indians and Asians of Mongolian origin. The antibody to Di(a) is clinically significant to cause hemolytic disease in a new-born or hemolytic transfusion reaction. Objectives: This study was designed to determine the prevalence of Di(a) antigen among the blood donors from the three major ethnic groups in Klang Valley of Malaysia as well as to find an incidence of an antibody of the Diego antigen, anti-Di(a), in a tertiary care hospital to ascertain the need to include Di(a+) red cells for an antibody screen cell panel. Materials and Methods: Serological tests were performed by column agglutination technique using commercial reagents and following instruction as per kit insert. Results: Di(a) antigen was found with a frequency of 2.1% among the Malaysians donors in three ethnic groups viz, Malay, Chinese and Indian. It was present among 1.25% of 401 Malay, 4.01% of Chinese and 0.88% of 114 Indian origin donors. None of the 1442 patients, including 703 antenatal outpatients, had anti-Di(a) in serum. Conclusion: The prevalence of Di(a) antigen was found among the donors of all the three ethnic background with varying frequency. Inclusion of Di(a+) red cells in routine antibody screening program would certainly help in detection of this clinically significant antibody and to provide safe blood transfusion in the Klang Valley, though the incidence of antibody appears to be very low in the region.