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Concept: Kuala Lumpur

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Rivers play a significant role in providing water resources for human and ecosystem survival and health. Hence, river water quality is an important parameter that must be preserved and monitored. As the state of Selangor and the city of Kuala Lumpur, Malaysia, are undergoing tremendous development, the river is subjected to pollution from point and non-point sources. The water quality of the Klang River basin, one of the most densely populated areas within the region, is significantly degraded due to human activities as well as urbanization. Evaluation of the overall river water quality status is normally represented by a water quality index (WQI), which consists of six parameters, namely dissolved oxygen, biochemical oxygen demand, chemical oxygen demand, suspended solids, ammoniacal nitrogen and pH. The objectives of this study are to assess the water quality status for this tropical, urban river and to establish the WQI trend. Using monthly WQI data from 1997 to 2007, time series were plotted and trend analysis was performed by employing the first-order autocorrelated trend model on the moving average values for every station. The initial and final values of either the moving average or the trend model were used as the estimates of the initial and final WQI at the stations. It was found that Klang River water quality has shown some improvement between 1997 and 2007. Water quality remains good in the upper stream area, which provides vital water sources for water treatment plants in the Klang valley. Meanwhile, the water quality has also improved in other stations. Results of the current study suggest that the present policy on managing river quality in the Klang River has produced encouraging results; the policy should, however, be further improved alongside more vigorous monitoring of pollution discharge from various point sources such as industrial wastewater, municipal sewers, wet markets, sand mining and landfills, as well as non-point sources such as agricultural or urban runoff and commercial activity.

Concepts: Oxygen, Water, Water pollution, Hydrology, Chemical oxygen demand, Surface runoff, Kuala Lumpur, Klang

4

There is a lack of mobile app which aims to improve health screening uptake developed for men. As part of the study to develop an effective mobile app to increase health screening uptake in men, we conducted a needs assessment to find out what do men want from a health screening mobile app. In-depth interviews and focus group discussions were conducted with 31 men from a banking institution in Kuala Lumpur. The participants were purposely sampled according to their job position, age, ethnicity and screening status. The recruitment was stopped once data saturation was achieved. The audio-recorded interviews were transcribed verbatim and analyzed using thematic approach. Three themes emerged from the analysis and they were: content, feature and dissemination. In terms of the content, men wanted the app to provide information regarding health screening and functions that can assess their health; which must be personalized to them and are trustable. The app must have user-friendly features in terms of information delivery, ease of use, attention allocation and social connectivity. For dissemination, men proposed that advertisements, recommendations by health professionals, providing incentive and integrating the app as into existing systems may help to increase the dissemination of the app. This study identified important factors that need to be considered when developing a mobile app to improve health screening uptake. Future studies on mobile app development should elicit users' preference and need in terms of its content, features and dissemination strategies to improve the acceptability and the chance of successful implementation.

Concepts: Focus group, Educational psychology, Qualitative research, Need, Kuala Lumpur, Usability, Want, Mobile computing

3

Plasmodium knowlesi is extensively used as an important malaria model and is now recognized as an important cause of human malaria in Malaysia. The strains of P. knowlesi currently used for research were isolated many decades ago, raising concerns that they might no longer be representative of contemporary parasite populations. We derived a new P. knowlesi line (University Malaya line, UM01), from a patient admitted in Kuala Lumpur, Malaysia, and compared it with a human-adapted laboratory line (A1-H.1) derived from the P. knowlesi H strain. The UM01 and A1-H.1 lines readily invade human and macaque (Macaca fascicularis) normocytes with a preference for reticulocytes. Whereas invasion of human red blood cells was dependent on the presence of the Duffy antigen/receptor for chemokines (DARC) for both parasite lines, this was not the case for macaque red blood cells. Nonetheless, differences in invasion efficiency, gametocyte production and the length of the asexual cycle were noted between the two lines. It would be judicious to isolate and characterise numerous P. knowlesi lines for use in future experimental investigations of this zoonotic species.

Concepts: Immune system, Cell nucleus, Malaria, Plasmodium, Red blood cell, Kuala Lumpur, Malaysia, Plasmodium knowlesi

3

Transboundary haze episodes caused by seasonal forest fires have become a recurrent phenomenon in Southeast Asia, with serious environmental, economic, and public health implications. Here we present a cross-sectional survey conducted among people in Kuala Lumpur and surrounds to assess the links between knowledge, attitudes, and practices in relation to the transboundary haze episodes. Of 305 respondents, 125 were amateur athletes participating in a duathlon event and the remainder were surveyed in an inner-city shopping mall. Across the whole sample, people who possessed more factual information about the haze phenomenon showed significantly higher levels of concern. Duathletes were more knowledgeable than non-duathletes and also more concerned about the negative effects of haze, especially on health. For all people who regularly practice outdoor sports (including people interviewed at the shopping mall), higher levels of knowledge and concerned attitudes translated into a greater likelihood of engaging in protective practices, such as cancelling their outdoor training sessions, while those with greater knowledge were more likely to check the relevant air pollution index on a daily basis. Our results indicate that the provision of accurate and timely information about air quality to residents will translate into beneficial practices, at least among particularly exposed individuals, such as amateur athletes who regularly practice outdoor sports.

Concepts: Southeast Asia, Atmosphere, Smog, National Ambient Air Quality Standards, Air pollution, Kuala Lumpur, Malaysia, Air Quality Index

3

In response to a near absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (≥18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral loads. The primary outcome was unsuppressed viral load (≥40 copies/mL). A sample of 153 refugees and 148 host clients were recruited. Refugees were younger (median age 35 [interquartile range, IQR 31, 39] vs 40 years [IQR 35, 48], p < 0.001), more likely to be female (36 vs 21 %, p = 0.004), and to have been on HAART for less time (61 [IQR 35, 108] vs 153 weeks [IQR 63, 298]; p < 0.001). Similar proportions of those on treatment for ≥25 weeks from both groups were not virologically suppressed (19 vs 16 %, p = 0.54). The proportions in each group with <95 % adherence to pharmacy refills were 26 versus 34 %, p = 0.15. Refugee status was not independently associated with the outcome (adjusted odds ratio, aOR = 1.28, 95 % CI 0.52, 3.14). The proportions of refugee and host community clients with unsuppressed virological outcomes and sub-optimal adherence were similar, supporting the idea that refugees in protracted asylum situations are able to sustain good treatment outcomes, and should explicitly be included in the HIV strategic plans of host countries with a view to expanding access in accordance with national guidelines for HAART. Respondiendo a una ausencia casi total de estudios entre refugiados y las comunidades de acogida y acceso a terapia antirretroviral de gran actividad (TARGA) en zonas urbanas, nuestro objetivo fue comparar la adherencia y resultados virológicos entre los clientes que asisten a una clínica pública en Kuala Lumpur, Malasia. Un estudio transversal se llevó a cabo entre los clientes adultos (≥18 años). Las fuentes de datos incluyen un cuestionario estructurado que midió adherencia auto-reportada, una medida farmacéutica basada en el relleno de medicamentos recetados de TARGA durante 24 meses, y la carga viral del VIH. El resultado principal fue carga viral no suprimida (≥40 copias/mL). Una muestra de 153 refugiados y 148 clientes de la comunidad de acogida fueron reclutados. Los refugiados eran más jóvenes (media de 35 años [rango intercuartil, IQR 31, 39] frente a 40 años [IQR 35, 48], p < 0.001), más probabilidades de ser mujer (36 vs 21 %, p = 0.004), y haber estado en TARGA durante menos tiempo (61 [IQR 35, 108] vs 153 semanas [IQR 63, 298], p < 0.001). Una proporción similar de las personas en tratamiento durante ≥25 semanas de ambos grupos no tuvieron supresión virológica (19 vs 16 %, p = 0.54). Las proporciones de cada grupo con <95 % de adherencia a rellenos de recetas de farmacias eran 26 frente a 34 %, p = 0.15. La condición de refugiado no se asoció de forma independiente con el resultado (razón de momios ajustado, aOR = 1.28, IC del 95 %: 0.52, 3.14). Las proporciones de refugiados y de clientes de la comunidad de acogida con resultados virológicos no suprimidos y adherencia subóptimas fueron similares, apoyando la idea que los refugiados en situaciones de asilo prolongados son capaces de mantener buenos resultados del tratamiento, y deberían explícitamente incluirse en los planes estratégicos de VIH de los países de acogida con el fin de ampliar el acceso de acuerdo con las directrices nacionales de TARGA.

Concepts: Antiretroviral drug, HIV, AIDS, Viral load, Refugee, Kuala Lumpur, Displaced person, Categoría Preferente de Aficionados de la Comunidad de Madrid

1

Despite the worldwide circulation of human coronavirus OC43 (HCoV-OC43) and HKU1 (HCoV-HKU1), data on their molecular epidemiology and evolutionary dynamics in the tropical Southeast Asia region is lacking.

Concepts: Southeast Asia, Respiratory system, Upper respiratory tract, Upper respiratory tract infection, Singapore, Lower respiratory tract, Kuala Lumpur, Malaysia

1

Fine scale population structure of Malays - the major population in Malaysia, has not been well studied. This may have important implications for both evolutionary and medical studies. Here, we investigated the population sub-structure of Malay involving 431 samples collected from all states from peninsular Malaysia and Singapore. We identified two major clusters of individuals corresponding to the north and south peninsular Malaysia. On an even finer scale, the genetic coordinates of the geographical Malay populations are in correlation with the latitudes (R(2) = 0.3925; P = 0.029). This finding is further supported by the pairwise FST of Malay sub-populations, of which the north and south regions showed the highest differentiation (FST [North-south] = 0.0011). The collective findings therefore suggest that population sub-structure of Malays are more heterogenous than previously expected even within a small geographical region, possibly due to factors like different genetic origins, geographical isolation, could result in spurious association as demonstrated in our analysis. We suggest that cautions should be taken during the stage of study design or interpreting the association signals in disease mapping studies which are expected to be conducted in Malay population in the near future.

Concepts: Demography, Map, Singapore, Kuala Lumpur, Malaysia, Brunei, Johor, Malay Peninsula

0

Negative schemas have been widely recognized as being linked to psychopathology and mental health, and they are central to the Schema Therapy (ST) model. This study is the first to report on the psychometric properties of the Young Positive Schema Questionnaire (YPSQ). In a combined community sample (Manila, Philippines, n = 559; Bangalore, India, n = 350; Singapore, n = 628), we identified a 56-item, 14-factor solution for the YPSQ. Multigroup confirmatory factor analysis supported the 14-factor model using data from two other independent samples: an Eastern sample from Kuala Lumpur, Malaysia (n = 229) and a Western sample from the United States (n = 214). Construct validity was demonstrated with the Young Schema Questionnaire 3 Short Form (YSQ-S3) that measures negative schemas, and divergent validity was demonstrated for 11 of the YPSQ subscales with their respective negative schema counterparts. Convergent validity of the 14 subscales of YPSQ was demonstrated with measures of personality dispositions, emotional distress, well-being, trait gratitude, and humor styles. Positive schemas also showed incremental validity over and above negative schemas for these same measures, thus demonstrating that both positive and negative schemas are separate constructs that relate in unique ways to mental health. Implications for using both the YPSQ and the YSQ-S3 scales in tandem in ST as well as cultural nuances from the use of Asian samples were discussed. (PsycINFO Database Record

Concepts: Psychology, Psychometrics, Factor analysis, Validity, Clinical psychology, Psychiatry, Confirmatory factor analysis, Kuala Lumpur

0

In December 2017, 79 delegates attended the 2nd regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders in Kuala Lumpur, Malaysia. This meeting featured 6 plenary lectures, interactive sessions dedicated for experience sharing, case presentations, and a practical session for paramedics. Clinical experts and researchers from 7 SEA countries and India shared experience and challenges in treating autoimmune neurological disorders. While the spectrum of diseases and neurology practice remained largely similar, there was great disparities in accessibility of therapeutic plasma exchange (TPE) within SEA countries and between urban or rural settings. Costs, human resources, and healthcare policies are common challenges in providing sustainable TPE services. Novel techniques and innovative ideas in performing TPE were explored. A working consortium comprising of key opinion leaders was proposed to improve standards of TPE and enhance future research.

Concepts: Central nervous system, Nervous system, Southeast Asia, Neurology, Novel, Kuala Lumpur, Malaysia, Plasmapheresis

0

Accumulating evidence shows a high prevalence ofClostridium difficilein Southeast Asia associated with a range of clinical presentations. However, severe infections are rarely reported. We investigatedC. difficileinfection (CDI) across four hospitals in Kuala Lumpur and Kota Bharu, Malaysia. Enzyme immunoassays for glutamate dehydrogenase (GDH) and toxin A/B were performed on diarrhoeal stool specimens collected from patients in 2015 and 2016. Specimens were also cultured and isolates ofC. difficilecharacterised by PCR ribotyping and detection of toxin genes. In total, 437 specimens were collected and faecal toxin was detected in 3.0%. A further 16.2% of specimens were GDH positive/toxin negative. Following culture, toxigenic strains were isolated from 10.3% and non-toxigenic strains from 12.4% of specimens. The most prevalent PCR ribotypes (RTs) were RTs 017 (20.0%) and 043 (10.0%). The high prevalence of RT 017 and non-toxigenic strains in Malaysia, and in neighbouring Thailand and Indonesia, suggests that they localise to the region of Southeast Asia, with an implication that they may mediate the burden of CDI in the region.

Concepts: Southeast Asia, Indonesia, Asia, Singapore, Thailand, Borneo, Kuala Lumpur, Malaysia