To validate the Workplace COVID-19 Knowledge and Stigma Scale (WoCKSS) using item response theory (IRT), exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Cross-sectional psychometric validation.

Manufacturing companies registered in Malaysia.

A total of 137 factory workers participated in the exploratory phase and 300 in the confirmatory phase. Inclusion criteria were Malaysian nationality and ability to read Malay.

The knowledge domain was examined using the two-parameter logistic IRT model in two stages: an exploratory IRT analysis in phase 1 to screen items and a confirmatory IRT analysis in phase 2 to evaluate the final item set. The stigma domain was analysed using EFA followed by CFA. Reliability was assessed using Cronbach’s alpha and McDonald’s omega (). The development process and content and face validity results were previously published.

14 knowledge items were retained after exploratory IRT and formed the final knowledge scale evaluated in confirmatory IRT. For these final items, discrimination parameters ranged from 0.77 to 3.17 and difficulty values from –4.47 to 0.23, with unidimensionality supported (p=0.644). EFA supported a three-factor stigma structure (stereotype, fear, prejudice), and CFA confirmed excellent model fit (²=8.91, df=11, p=0.630; root mean square error of approximation=0.00; Comparative Fit Index=1.00; Tucker-Lewis Index=1.00; standardised root mean square residual=0.021). Composite reliability by McDonald’s omega ranged from 0.691 to 0.893.

WoCKSS is a reliable and valid instrument for assessing workplace COVID-19 knowledge and stigma in industrial sectors in Malaysia.

Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.

A cross-sectional survey was conducted using a multistage random sampling method.

Urban residential areas in Selangor, Malaysia.

A total of 2542 adults residing in urban areas of Selangor were recruited.

Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.

The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value

There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.

Leptospirosis is a significant public health concern worldwide, as it imposes a substantial economic burden on the global economy. Despite a comprehensive search of the relevant literature, few studies evaluating the economic burden experienced by leptospirosis patients were identified. In particular, very few studies thoroughly examined the cost components, including direct, indirect and intangible costs. This paucity of evidence further motivates the need to conduct a more focused search using a systematic review approach. Thus, this study aims to systematically review the global literature on the magnitude and aspects of the direct, indirect and intangible costs incurred by leptospirosis patients and the methods available for assessing these costs.

This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines. The Population, Intervention, Comparison, Outcomes, Study Design framework was used to develop the review questions. The search strategy will comprise two key term blocks: ‘Leptospirosis’ and ‘Economic cost’. A comprehensive literature search will be conducted in PubMed, Web of Science, Scopus, MEDLINE, CINAHL, the Cochrane Library, EconStor and IDEAS to collect publications from inception to July 2025. The search will be limited only to English-language and peer-reviewed publications. The Mixed Methods Appraisal Tool will be used to assess the quality of eligible studies. Extracted cost data will be categorised into direct, indirect and intangible costs. A meta-analysis will be conducted to quantify the magnitude of these costs if sufficient methodological and contextual homogeneity exists. Moreover, a narrative synthesis will be performed to analyse the qualitative data related to intangible costs.

As this study will use secondary data, ethical approval is not required. The systematic review’s findings will be published in a scientific journal and presented at relevant conferences to address the knowledge gap regarding the economic burden (including direct, indirect and intangible costs) faced by leptospirosis patients. The results of this systematic review will guide policies for prioritising prevention, improving surveillance and efficiently allocating resources to control leptospirosis.

PROSPERO CRD 42024585056.

To examine the associations between food-related behaviours and nutrient intake on nutritional status among clients undergoing Community-Based Treatment and Rehabilitation (CBTaR) in Kelantan, Malaysia.

Cross-sectional analytical study.

Seven CBTaR centres (n=7) across the state of Kelantan, Malaysia.

A total of 393 adult clients (aged 18 years and above) enrolled in CBTaR programmes between June and December 2022 were selected through stratified random sampling.

The primary outcome was nutritional status, assessed using body mass index. Secondary outcomes included nutrient intake (macronutrients and micronutrients) and food-related behaviours (emotional eating, external eating, restrained eating and food addiction), measured through Bahasa Malaysia validated questionnaires and 24-hour dietary recalls. All variables were introduced into the structural equation modelling to examine the associations among these variables and their association with nutritional status.

The results revealed that food-related behaviour was significantly associated with the nutrient intake (β=–0.524, p≤0.001). Additionally, the drug use profile significantly determined the food-related behaviour (β=–0.129, p=0.006) and nutritional status (β=–0.134, p=0.007). Nutrient intake was found to be a significant predictor of nutritional status (β=–0.213, p≤0.001). Sociodemographic and drug use profiles were significantly correlated with nutritional outcomes through behavioural and dietary associations. Importance-performance map analysis identified nutrient intake as the most impactful variable, highlighting the need for urgent intervention (R²=0.272).

This study highlights that nutrient intake is a significant predictor associated with food-related behaviours on nutritional status among individuals with substance use disorder. Integrating nutrition counselling and behavioural interventions into CBTaR services may improve recovery and long-term health outcomes.

To explore whether large language models (LLMs), Generative Pre-trained Transformer (GPT)-3, GPT-3.5 and GPT-4 can autonomously manage a virtual fracture clinic (VFC) as a marker of their efficacy in an emergency department and with simple orthopaedic trauma.

Simulated UK VFC workflow.

11 clinical scenarios were generated, and GPT-4, GPT-3.5 and GPT-3 were prompted to write clinic letters and management plans.

The Readable Tool was used to assess the clarity of letters. Six independent orthopaedic surgeons then evaluated the accuracy of letters and management plans.

Readability was compared using the Flesch-Kincaid grade level: GPT-4: 9.11 (SD 0.98); GPT-3.5: 8.77; GPT-3: 8.47, and the Flesch readability ease: GPT-4: 56.3; GPT-3.5: 58.2; GPT-3: 59.3. Surgeon-rated accuracy comparisons indicated that GPT-4 exhibited the highest accuracy for management plans (9.08/10 (95% CI 8.25 to 9.9)). This represents a statistically significant progression in the capacity of a LLM to provide accurate management plans compared with GPT-3 at 6.84 (95% CI 5.41 to 8.27) and GPT-3.5 at 7.63 (95% CI 7.23 to 8.13) (p

LLMs can produce high-quality, readable clinical letters for common VFC presentations, and GPT-4 can generate management plans to aid clinicians in their administration. With clinician oversight, appropriately trained LLMs could meaningfully reduce routine administrative work. However, while the results of this study are promising, further evaluation of LLMs is required before they can be deemed safe for managing simple orthopaedic scenarios.

The aims of this study were to investigate the factors affecting career satisfaction within the Pakistani dental community and to assess demographic characteristics as significant predictors of professional satisfaction.

Cross-sectional survey.

Data were collected from registered dentists across urban and rural areas of Pakistan via an electronic survey distributed through professional forums, social media groups and email lists to ensure nationwide representation.

A total of 600 registered dental surgeons were selected across Pakistan using single-stage cluster sampling, with inclusion based on a permanent Pakistan Medical and Dental Council licence, excluding temporary licence holders, non-consenting individuals and those practising abroad.

Career satisfaction was measured using the validated Dentist Satisfaction Survey, which assessed various factors affecting professional fulfilment.

Of 600 participants, 566 valid responses were received, with n=134 (23.67%) men and n=432 (76.33%) women, and a mean age of 33.7±7.4 years. Most were early-career (68.9%), with a mean professional satisfaction score of 3.13±1.35. Gender, provincial background and work experience significantly influenced satisfaction, while current working status did not. Participants were neutral on career domains, such as auxiliary staff quality, professional relations, professional time, management and work-life balance, but had positive views on doctor-patient relationships. Many expressed dissatisfaction with their income, and 35.69% found dentistry stressful. While 26.15% would not recommend dentistry, 30.04% would support their child’s choice to pursue it. Despite uncertainty about career fulfilment, most dentists remained strongly committed to their profession and did not plan to change careers in the near future.

This study highlights factors influencing career satisfaction among Pakistani dentists, offering insights to improve well-being and career fulfilment and inform policy reforms aimed at enhancing professional retention and mental well-being.

The objective of this study was to explore medical practitioners’ understanding of antimicrobial resistance (AMR) and its aspects, such as its causes, possible outcomes and how doctors can contribute to its prevention.

This qualitative study was conducted in Sri Lankan healthcare settings.

Using convenience sampling, the study included allopathic medical practitioners aged 18–60 years, excluding intern-medical officers, until data saturation.

One-on-one interviews were conducted online or in person, depending on each participant’s preference. A structured questionnaire was used to triangulate the information.

Data were categorised into four: (1) understanding, awareness and identifying AMR as an issue among medical practitioners, (2) knowledge and understanding of factors that contribute to AMR development among medical practitioners, (3) knowledge and understanding of the outcome of AMR and (4) knowledge and understanding of preventive measures against AMR among medical officers. Interviewees showed an awareness of AMR; however, their knowledge was not up to date. Key reasons for inappropriate antibiotic use included unavailability and poor quality of antibiotics and unawareness of updated guidelines, especially in the government sector. In the private sector, patient pressure, the need to attract patients and the high cost of investigations contributed to misuse. Additionally, low patient literacy about AMR was a significant factor.

This study revealed that although medical practitioners in Sri Lanka are aware of AMR, their knowledge remains limited in certain areas. Several challenges contributed to inappropriate antibiotic use, including the availability and quality of antibiotics, external pressures from patients and financial constraints. The findings of this study highlight the urgent need for continuous medical education and public awareness campaigns to improve both practitioner and patient understanding of AMR. Addressing these issues is essential for effectively preventing and managing AMR in healthcare settings in Sri Lanka.

To identify the factors influencing professionals’ implementation of the National Institute for Health and Care Excellence (NICE) guidelines on self-harm.

A rapid review evidence synthesis

Five electronic databases (ASSIA, CINAHL, EMBASE, MEDLINE, PsycINFO) and five indexing databases (Science Citation Index Expanded (SCIE), Social Sciences Citation Index (SSCI), Arts and Humanities Citation Index (AHCI), Emerging Sources Citation Index (ESCI) and Conference Proceedings Citation Index (CPCI)), using the Web of Science platform, were searched in December 2023 and repeated in July 2024.

We included quantitative and qualitative studies that investigated professionals’ knowledge and implementation of NICE guidelines on self-harm, that were in English language and published between 2004 and July 2024.

One reviewer used standardised methods to search, screen, select, quality assess and synthesise the included studies, to accelerate the review. Quality assessment was conducted using the Mixed Methods Appraisal Tool. Data were extracted and synthesised thematically using NICE guidance implementation priorities.

The review included 10 studies. Six were conducted in accident and emergency (A&E) settings, two in general practice, one in a burns and plastic surgery hospital department and one involved cross-sectoral health professionals. Key findings indicate that awareness and implementation of self-harm guidelines is low among health professionals. Systemic barriers include lack of staff training, negative staff attitudes towards people who self-harm and lack of resources.

There is a need to develop and implement regular training on self-harm, incorporating NICE guidance and measures, to integrate knowledge and mobilise practice changes. Further research into the implementation of NICE guidelines in children who self-harm is needed, and in a wider variety of health and social care settings. The absence of studies from the social care sector into professionals’ awareness and implementation of NICE guidelines on self-harm is a key limitation.