Knowledge, Awareness, and Practice of Safety and Emergency Response Among Scuba Divers in Malaysia: Questionnaire Development and Validation

Introduction: Safety has become paramount to ensure that scuba diving continues to expand into new markets, with minimal risks, and that scuba diving translates into a safe and relaxed adventure in response to growing market demands. Research focusing on assessing the knowledge, awareness, and practices (KAP) regarding safety and emergency response among scuba divers has been limited, and there is a need for validated assessment tools in this area. Methods: This study involved 555 scuba divers in Malaysia, and the questionnaire underwent a thorough development and validation process, including content and face validity assessments, as well as exploratory factor analysis. The validation of the knowledge domain was conducted using Item Response Theory (IRT) analysis, while awareness and practice were validated through exploratory and confirmatory factor analyses (EFA and CFA). Results: The content validity of the instrument was confirmed, with all items scoring over 80% for Item Content Validity Index (I-CVI), Scale Content Validity Index (S-CVI), and Scale Content Validity Index/Average (S-CVI/AVE). The initial draft comprises three domains: knowledge, awareness, and practice. Knowledge items were analyzed using IRT and demonstrated acceptable difficulty and discrimination levels. For the awareness and practice domains, EFA showed a Kaiser-Meyer-Olkin measure (KMO) of 0.83 and 0.79, respectively, with a significant Bartlett's test of Sphericity (P < 0.001). EFA yielded three factors for both awareness and practice domains with a total of 12 items for awareness and 13 items for practice, with satisfactory factor loadings (≥0.3). The final model of CFA showed good fits for both awareness and practice domains in terms of absolute, parsimonious, and comparative measures. The composite reliability of awareness was acceptable with Raykov's rho of 0.71, whereas the practice domain fell slightly below the acceptable threshold at 0.55. This was attributed to low factor loading and a limited number of items within each factor. The final questionnaire now consists of 20 items for knowledge, 10 items for awareness, and 12 items for the practice domain. Conclusion: The results of this validation and reliability study indicate that the newly developed questionnaire possesses favorable psychometric properties for assessing KAP related to safety and emergency response in the scuba diving context. This research is essential for harmonizing the perspectives of crucial stakeholders within the recreational scuba diving industry

Survival analysis and prognostic factor of non-Hodgkin lymphoma treated in Hospital Universiti Sains Malaysia (HUSM)

INTRODUCTION: Non-Hodgkin’s lymphoma (NHL) is included in the ten leading cancers worldwide, accounting for an estimated more than 63 thousand new cases and over 19 thousands deaths per year. The study on survival rate and prognostic factors may be useful in building a better intervention program as well as improving survival rate. OBJECTIVES: The aims of this study were to determine the survival and to identify the prognostic factors that influence the risk of death of non-Hodgkin’s lymphoma (NHL) in Hospital Universiti Sains Malaysia (HUSM). METHODOLOGY: A retrospective record review was conducted involving 154 patients diagnosed as NHL from 1st January 1997 till 31st December 2006. Additional three years follow-up after the recruitment of the subjects was done to verify patients’ status. All patients who fulfilled the inclusion criteria were included in the study. The required information at time of diagnosis as well as patients’ survival status until 31st December 2009 was retrieved from medical records. For some patients who were still alive upon discharge from hospital but defaulted appointment or were loss to follow-up were traced by telephone calls and home visit to obtain information on patients’ survival status. Data entry and analysis was done using SPSS version 12 and STATA version 9. Kaplan-Meier procedure was used to calculate survival estimates while Cox Proportional Hazards Model was used to determine prognostic factors. RESULTS: The overall 5 and 10-years survival rates for NHL in HUSM was 33.2% (95%CI: 25.2, 41.4) and 26.9% (95%CI: 18.7, 35.8) respectively. Adjusted for other variables, the significant prognostic factors identified by Cox Proportional Hazards Model are age at diagnosis (HR=1.02; 95%CI: 1.0, 1.2; p=0.009), number of extranodal involvement (HR= 3.2; 95%CI: 1.4, 7.0; p=0.005), thrombocytopenia (HR= 2.0; 95%CI: 1.2, 3.6; p= 0.001) and lymphocytopenia (HR= 2.3; 95%CI: 1.3, 4.2; p= 0.006). CONCLUSION: The 5 and 10-year survival of NHL patients treated in HUSM was lower compared to other studies. The significant prognostic factors identified in this study were age at diagnosis, number of extranodal involvement, thrombocytopenia and lymphocytopenia. However, other important significant prognostic factors such as stage, treatment modalities and grade were not identified as prognostic factors in this study after adjusting other variables. Key word: Non-Hodgkin’s lymphoma, survival, prognostic factors

Burden and Risk Factors of Melioidosis in Southeast Asia: A Scoping Review

This scoping review aims to provide a comprehensive overview of human melioidosis in Southeast Asia as well as to highlight knowledge gaps in the prevalence and risk factors of this life-threatening disease using available evidence-based data for better diagnosis and treatment. Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was used as the guideline for this review. The literature search was conducted on 23 March 2022 through two electronic databases (PubMed and Scopus) using lists of keywords referring to the Medical Subject Headings (MeSH) thesaurus. A total of 38 articles related to human melioidosis were included from 645 screened articles. These studies were carried out between 1986 and 2019 in six Southeast Asian countries: Thailand, Cambodia, Malaysia, Myanmar, Singapore, and Vietnam. Melioidosis has been reported with a high disease prevalence among high-risk populations. Studies in Thailand (48.0%) and Cambodia (74.4%) revealed disease prevalence in patients with septic arthritis and children with suppurative parotitis, respectively. Other studies in Thailand (63.5%) and Malaysia (54.4% and 65.7%) showed a high seroprevalence of melioidosis among Tsunami survivors and military personnel, respectively. Additionally, this review documented soil and water exposure, diabetes mellitus, chronic renal failure, thalassemia, and children under the age of 15 as the main risk factors for melioidosis. Human melioidosis is currently under-reported in Southeast Asia and its true prevalence is unknown