BackgroundThe frequency and magnitude of dengue epidemics continue to increase exponentially in Malaysia, with a shift in the age range predominance toward adults and an expansion to rural areas. Despite this, information pertaining to the extent of transmission of dengue virus (DENV) in the rural community is lacking. This community-based pilot study was conducted to establish DENV seroprevalence amongst healthy adults in a rural district in Southern Malaysia, and to identify influencing factors.MethodsIn this study undertaken between April and May 2015, a total of 277 adult participants were recruited from households across three localities in the Sungai Segamat subdistrict in Segamat district. Sera were tested for immunoglobulin G (IgG) (Panbio® Dengue Indirect IgG ELISA/high-titer capture) and immunoglobulin M (IgM) (Panbio®) antibodies. The plaque reduction neutralization test (PRNT) was conducted on random samples of IgG-positive sera for further confirmation. Medical history and a recall of previous history of dengue were collected through interviews, whereas sociodemographic information was obtained from an existing database.ResultsThe overall seroprevalence for DENV infection was 86.6% (240/277) (95% CI: 83–91%). Serological evidence of recent infection (IgM/high-titer capture IgG) was noted in 11.2% (31/277) of participants, whereas there was evidence of past infection in 75.5% (209/277) of participants (indirect IgG minus recent infections). The PRNT assay showed that the detected antibodies were indeed specific to DENV. The multivariate analysis showed that the older age group was significantly associated with past DENV infections. Seropositivity increased with age; 48.5% in the age group of <25 years to more than 85% in age group of >45 years (P < 0.001). No associations with occupation, study site, housing type, comorbidity, educational level, and marital status were observed, although the latter two were statistically significant in the univariate analysis. None of the studied factors were significantly associated with recent DENV infections in the multivariate analysis, although there was a pattern suggestive of recent outbreak in two study sites populated predominately by Chinese people. The majority of infections did not give rise to recognizable disease (either asymptomatic or nonspecific symptoms) as only 12.9% of participants (31/240) recalled having dengue in the past.ConclusionsThe predominantly rural community under study had a very high previous exposure to dengue. The finding of a high proportion of unreported cases possibly due to subclinical infections underscores the need for enhanced surveillance and control methods. This finding also has implications for measuring disease burden, understanding transmission dynamics, and hypothesizing effects on DENV vaccine efficacy and uptake.Electronic supplementary materialThe online version of this article (10.1186/s40249-017-0384-1) contains supplementary material, which is available to authorized users.

BackgroundGlobally, dengue infections constitute a significant public health burden. In recent decades, Malaysia has become a dengue hyper-endemic country with the co-circulation of the four dengue virus serotypes. The cyclical dominance of sub-types contributes to a pattern of major outbreaks. The consequences can be observed in the rising incidence of reported dengue cases and dengue related deaths. Understanding the complex interaction of the dengue virus, its human hosts and the mosquito vectors at the community level may help develop strategies for addressing the problem.MethodsA prospective cohort study will be conducted in Segamat district of Johor State in Peninsular Malaysia. Researchers received approval from the Malaysian Medical Research Ethics Committee and Monash University Human Research Ethics Committee. The study will be conducted at a Malaysian based health and demographic surveillance site over a 1 year period in three different settings (urban, semi-urban and rural). The study will recruit healthy adults (male and female) aged 18 years and over, from three ethnic groups (Malay, Chinese and Indian). The sample size calculated using the Fleiss method with continuity correction is 333. Sero-surveillance of participants will be undertaken to identify asymptomatic, otherwise healthy cases; cases with dengue fever who are managed as out-patients; and cases with dengue fever admitted to a hospital. A genetic analysis of the participants will be undertaken to determine whether there is a relationship between genetic predisposition and disease severity. A detailed medical history, past history of dengue infection, vaccination history against other flaviviruses such as Japanese encephalitis and Yellow fever, and the family history of dengue infection will also be collected. In addition, a mosquito surveillance will be carried out simultaneously in recruitment areas to determine the molecular taxonomy of circulating vectors.DiscussionThe research findings will estimate the burden of asymptomatic and symptomatic dengue at the community level. It will also examine the relationship between virus serotypes and host genotypes, and the association of the clinical manifestation of the early phase with the entire course of illness.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0172-3) contains supplementary material, which is available to authorized users.

Does customer satisfaction and behavioural intention directly influence by customer orientation, service orientation, service quality, service encounter quality, perceived value towards? In order to address this question, a survey was conducted in different grocery stores across the city. At the same time, this research also tends to examine whether the western oriented service evaluation model is applicable in non-western country. This study also proposed to examine the direct relationship without the existence of customer satisfaction and service quality as mediator. The outcomes of the analyses were used to determine the acceptance or rejection of the proposed hypotheses. With the positive relationship between the independent variables and dependent variables, all the generated hypotheses proposed in this research were accepted and approved.

Well-being is a complex concept with objective and subjective elements that contribute to life satisfaction. Medical students experience inevitable transition from pre-clinical to clinical training with increasingly more independence and responsibility. This study aimed to identify well-being issues in undergraduate clinical students. The emotional, physical, social, spiritual, occupational and intellectual aspects of well-being were focused on. A thorough literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting issues from the six aspects of well-being in undergraduate clinical students, and published in peer-reviewed journals in English language from the year 2000 to 2020 with full-text available online were included. The initial search from PubMed, OVID Medline, Psych INFO and CINAHL Plus retrieved 623 articles with 51 studies included in this review. Evidence from the previous studies demonstrated poor well-being among undergraduate clinical students. Stress, lack of exercise, low peer and family support, and mistreatment by clinicians and patients were common well-being issues encountered. Based on this literature review, the five aspects of well-being except the emotional aspect were less explored. Thus, it will be of interest to investigate well-being issues among Malaysian undergraduate clinical students from the physical and occupational aspects, which are further impacted by the COVID-19 pandemic, and to identify possible contributing factors. Undergraduate clinical students are faced with several well-being issues. Thus, early detection of these issues is important to avoid devastating consequences to students and patients.