Nursing students are reported to have moderate to high test anxiety, leading to reduced academic performance, poor self-esteem, and failure to complete the program and practice nursing. This review aims to examine the interventions for test anxiety reduction in nursing students. Following the PRISMA guidelines, peer-reviewed experimental studies published in English between 2016 and 2021 from four databases, EBSCOhost, PubMed, Science Direct, and Scopus, were systematically searched. The findings were presented in tabular and narrative form. Among the 722 studies retrieved, 14 selected studies were critically appraised, guided by the Joanna Briggs checklist for Randomized Controlled Trials and the checklist for Quasi-Experimental Studies, resulting in 11 studies for inclusion in the systematic review. Test anxiety was assessed by different scales. Aromatherapy hand massage, aromatherapy using a diffuser in combination with music therapy, confidence training for test relaxation, coping program, music therapy, emotional freedom technique, animal-assisted intervention, and guided imagery were all found to be effective in reducing test anxiety. In conclusion, while numerous interventions to reduce test anxiety in nursing students were found to be effective, the quality of the studies investigating these interventions was varied with generally small sample sizes and limited follow-up. Future research should be conducted, and the same interventions should be carried out using a larger sample size to strengthen the body of evidence.

The Dietary Inflammatory Index (DII) was extensively used to examine the inflammatory potential of diet related to colorectal cancer (CRC). This meta-analysis aimed to update the evidence of the association between the DII and CRC across various culture-specific dietary patterns. Literature search was performed through online databases (Scopus, Web of Science, PubMed, and EBSCOHost). Observational studies exploring the association between the DII and CRC, published between 2017 and 2021, were included. The risk ratio (RR) and 95% confidence interval (CI) were separately computed for 12 studies comparing the highest and lowest DII scores and for 3 studies that presented continuous DII scores. A high DII score was associated with a higher risk of CRC (RR:1.16; 95% CI, 1.05–1.27). In the subgroup analysis, significant associations were seen in cohort design (RR: 1.24; 95% CI, 1.06–1.44), those lasting for 10 years or longer (RR: 2.95; 95% CI, 2.47–3.52), and in adjustment factor for physical activity (RR: 1.13; 95% CI, 1.07–1.20). An increase of one point in the DII score elevates the risk of CRC by 1.34 (95% CI: 1.15–1.55) times. The findings call for standardized measurement of the inflammatory potential of diet in future studies to enable the establishment of global guidelines for CRC prevention.

Orang Asli, the indigenous people of Peninsular Malaysia, is a minority population and placed behind in terms of socioeconomy, education and health. The Malaysian government has supported Orang Asli since the second Malaysia Plan in the 1970s, resulting in changes in their living standard, access to health, education and occupation. Hence, this review aims to assess the recent prevalence of diseases among Orang Asli in Peninsular Malaysia. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) review protocol guided this systematic review. The research question was formulated based on Population, Interest, Comparison and Outcome (PICO). The selected databases include Web of Science, Scopus, Ovid and EBSCOhost. The process of identification, screening and inclusion identified 33 articles. The mixed methods appraisal tool (MMAT) was then used to rank the quality of the articles. Selangor is the most frequent state involved in this review (12 studies), followed by Perak (10 studies), Pahang (10 studies) and Kedah (one study). We categorised into four categories of diseases, namely neglected tropical disease (n = 20), non-communicable disease (n = 6), nutritional status (n = 5), and hepatic disease (n = 2). The prevalence of diseases among Orang Asli is higher than in the general population, especially for soil-transmitted helminth (STH) and malnutrition. There is increasing research on non-communicable diseases due to an increasing trend in the socioeconomic status and lifestyle of the Orang Asli. Government agencies and private organisations must work together to empower Orang Asli with a healthy lifestyle, improve their socioeconomic status, and enhance food security, all of which will improve Orang Asli's health and reduce the prevalence of diseases.

Pregnant women form one of the high risk groups facing hypovitaminosis D. Low level of vitamin D will affect directly or indirectly both mother and fetus. Screening vitamin D in the first trimester of pregnancy is important to determine the necessary preventive action. Therefore, this study was aimed to determine the prevalence of hypovitaminosis D and its risk factors among pregnant women in the first trimester. A cross sectional study was carried out among first trimester pregnant women during their first antenatal visit. Samples were taken from different ethnicities in an urban district in Malaysia. A total of 396 respondents (99 % response rate) aged 18–40 years completed self–administered and guided questionnaire (characteristics and risk factors), validated semi-quantitative food frequency questionnaire for vitamin D in Malaysia (FFQ vitamin D/My), anthropometric measures (weight and height), blood test for serum 25(OH)D, skin measurement using Mexameter (MX 18) and Fitzpatrick Skin Type Chart Measurement (FSTCM). Data were analyzed to determine the association between risk factors and hypovitaminosis D. The prevalence of hypovitaminosis D (serum 25(OH)D < 50 nmol/L) was 90.4 % (358). The mean age of respondents was 28.06 ± 4.09 years old. The independent predictors of hypovitaminosis D were Malay ethnicity (OR 33.68; 95 % CI: 12.81, 88.56), Indian ethnicity (OR 16.86; 95 % CI: 3.78,75.20), secondary education (OR 12.12; 95 % CI: 2.71, 54.16) and tertiary education (OR 14.38; 95 % Cl: 3.31, 62.45). Awareness should be raised among Malay and Indian pregnant women with secondary and tertiary education who consumed vitamin D (especially milk) poorly in order to prevent adverse health outcomes. Further studies need to be conducted among health care workers to determine their level of knowledge related to vitamin D, as they are front liner in detecting the hypovitaminosis D.

Vitamin D deficiency and insufficiency are public health concerns that have contributed to multiple negative health outcomes. Recent studies have revealed that vitamin D deficiency and insufficiency influence glycaemic control and the development of diabetes complications. The goal of this systematic review is to summarise the latest evidence on the impact of vitamin D deficiency and insufficiency on the outcome of Type 2 Diabetes Mellitus (T2DM) patients. In this PRISMA-guided systematic review, articles were sourced from three databases, namely, PubMed, Scopus, and Web of Science. The review only included literature published from 2012 until 2022, and 33 eligible studies met the inclusion criteria for this review. The included articles were critically appraised using the Mixed Method Appraisal Tool (MMAT). According to our findings, vitamin D deficiency or insufficiency is associated with mental health status, macrovascular and microvascular complications of T2DM, metabolic syndrome, increased risk of obesity, increased blood pressure, dyslipidaemia, glycaemic control, nerve-related disease, musculoskeletal-related complications, and reduced quality of life. Due to the diverse implications of vitamin D deficiency and insufficiency, screening for vitamin D levels in T2DM patients may be beneficial.

Lead (Pb) is a heavy metal which is abundant in the environment and known to cause neurotoxicity in children even at minute concentration. However, the trace elements calcium (Ca), magnesium (Mg), zinc (Zn) and iron (Fe) are essential to children due to its protective effect on neurodevelopment. The primary objective of this study was to assess the role of Pb and trace elements in the development of autism spectrum disorder (ASD) among preschool children. A total of 81 ASD children and 74 typically developed (TD) children aged between 3 and 6 years participated in the study. Self-administered online questionnaires were completed by the parents. A first-morning urine sample was collected in a sterile polyethene urine container and assayed for Pb, Ca, Mg, Zn and Fe using an inductively coupled plasma mass spectrometry (ICP-MS). Comparisons between groups revealed that the urinary Pb, Mg, Zn and Fe levels in ASD children were significantly lower than TD children. The odds of ASD reduced significantly by 5.0% and 23.0% with an increment of every 1.0 μg/dL urinary Zn and Fe, respectively. Post interaction analysis showed that the odds of ASD reduced significantly by 11.0% and 0.1% with an increment of every 1.0 μg/dL urinary Zn and Pb, respectively. A significantly lower urinary Pb level in ASD children than TD children may be due to their poor detoxifying mechanism. Also, the significantly lower urinary Zn and Fe levels in ASD children may augment the neurotoxic effect of Pb.