Diagnosing severe dengue from those who do not develop complication is important to prevent death. The objective of this systematic review was to evaluate the diagnostic test accuracy of ultrasonography in differentiating severe dengue from nonsevere dengue; and to assess if ultrasonography/ultrasound can be used as a predictive (screening) and diagnostic tool in the course of dengue infection. An electronic search was conducted in different databases via OvidSP platform. The included studies were cohort studies between 1995 and 2016 wherein cases were confirmed by dengue blood test. Severity of dengue was assessed and compared using standard WHO references. The methodological quality of the paper was assessed by two independent reviewers by using QUADAS-2 tool. In total 12 studies were included in this review after suitable screening. Overall, the studies included had a low and unclear risk of bias. Seven out of nine studies that compared severe dengue and nonsevere dengue, performed an ultrasonography on gallbladder (wall thickness cutoff–3 mm) with a sensitivity of 24.2–100% and a specificity of 13.2–98.7%. Other parameters such as splenic subcapsular fluid collection, pericardial fluid and hepatic subcapsular fluid collection had a specificity of >90%, though the sensitivity was poor. There were insufficient evidence that ultrasonography is able to differentiate severe dengue from nonsevere dengue accurately. The predictive and diagnostic value of ultrasonography could not be concluded due to insufficient reporting on the temporality of the ultrasonography performed with regard to the diagnosis. However, it might serve as an adjunct investigation to support the clinical diagnosis.

With traditional family-based old-age care declining due to shrinking family structures, formal financial protection for the aging population is increasingly crucial. This is especially given the high cost of long-term care. Acknowledging the limitations of private insurance and tax-based systems, this study explores the potential of social insurance in Malaysia by examining factors influencing its public acceptance. Data collected from a total of 450 respondents were analyzed using SPSS for descriptive statistics and SmartPLS for hypothesis testing. The findings revealed that knowledge-based factors such as financial literacy and financial awareness do not exhibit a significant influence on financial attitude. In contrast, psychological factors such as precautionary motives and trust demonstrate a significant and positive influence on financial attitude. Furthermore, attitude emerges as a significant mediating variable that bridges the relationship between precautionary motives and acceptance, as well as between trust and acceptance. In a nutshell, this study contributes to the existing literature on long-term care financing from the lens of consumer behavior and offers valuable insights for policymaking in navigating the nation’s aging population.