Postoperative cognitive dysfunction (POCD) is the undesirable complication following surgery that significantly impacts patients’ quality of life. The outcome of POCD is characterized by mental disorders, anxiety, personality changes and impaired memory. This study aimed to identify the differentially expressed genes (DEGs) in high-risk CABG patients with POCD and the level of the protein biomarker that correlates with the expressed gene. Forty-six patients scheduled for high-risk CABG procedures were selected based on inclusion and exclusion criteria. Cognitive assessments were done one day before and seven days after surgery to classify POCD. For DEGs analysis using microarray, ribonucleic acid (RNA) samples were collected from patients’ blood one day preoperative and 3 days postoperatively. A total of 16 samples from the 46 patients were selected for microarray analysis. Further, an enzyme-linked immunosorbent assay (ELISA) was conducted to determine the level of protein biomarkers related to the DEGs. Independent T-test and paired T-test were performed to compare the differences between groups. Based on pre and postoperative analysis of POCD patients, the findings revealed 5 differentially expressed genes. The downregulated genes were KIR3DL2, KIR2DS3, and KIR2DS2, which are involved in immunoregulatory responses, and LIM2, a gene involved in cataractogenesis. Whilst the upregulated gene was ERFE, that is involved in iron metabolisms. For postoperative analysis of POCD and non-POCD patients, one gene was downregulated, which is BTNL3, that involved is in immunoregulation. A significantly higher concentration of erythroferrone protein, ERFE, was found in POCD patients’ plasma than in non-POCD patients (p<0.05). Receiver Operating Characteristic (ROC) curve was generated and revealed that ERFE has a moderate performance in predicting POCD with the threshold set at 0.761 with specificity and sensitivity at 80% and 50% (AUC:0.685, 95% CI: 0.564 to 0.802, p<0.05). In conclusion, immunoregulatory and iron metabolism genes are potential genes involved in POCD development. ERFE concentration in plasma may potentially be used as a biomarker for clinicians to predict POCD. This study serves as a pioneer in understanding POCD at the molecular level.

Introduction: Twenty-four-hour services have become vital in the majority of industries and business establishments, including healthcare, which requires the workers to be employed in shifts system. The worrying fact is that working in shifts contributes to circadian rhythm misalignment, and subsequently leads to the development of various disorders psychologically and physically. The study aims to determine the shift workers’ psychosocial well-being and its association with the physical activity and eating habits of hospital shift workers in Klang Valley. Methodology: Phase I was a cross-sectional study involving 413 respondents, with the utilisation of self-administered questionnaires comprise of the International Physical Activity Questionnaire-Short Form Malay (IPAQ-M), Dutch Eating Behaviour Questionnaire (DEBQ), Malay Depression, Anxiety, Stress Scale-21 (Malay-DASS-21), Malay 36-Item Short Form Survey (Malay-SF-36), WHO-5 Well-Being Index Malay (WHO-5-Malay), Utrecht Work Engagement Scale Malay (UWES-M) and Pittsburgh Sleep Quality Index Malay (PSQI-M). Phase II was the development of the SHiFT module for psychosocial well-being maintenance, including the processes of content and face validity. Results: Overall, Phase I demonstrated that the majority of the hospital shift workers in this study were classified as physically inactive (31.7%) and minimally active (43.6%). Most of them also had good emotional eating habit, but poor external and restrained eating habits. Zooming on the psychosocial well-being of the hospital shift workers, the prevalence of depression, anxiety and stress were 27.4%, 34.6% and 11.6%, respectively for the mental health. Good quality of life, average work engagement but poor sleep quality (58.1%) were observed among the hospital shift workers. There were significant associations between factors of age, gender, ethnicity, religion, marital status, healthcare position, workplace, body mass index (BMI), physical activity, eating habits and sleep quality with mental health. Quality of life was found to be strongly associated with the presence of comorbidity, healthcare position, workplace, eating habits and sleep quality. Multiple factors were significantly associated with work engagement, including physical activity, eating habits and sleep quality. Gender, healthcare position, workplace and smoking status were the strong predictors of sleep quality. The findings of Phase I contributed to the development of SHiFT module in Phase II which primarily focuses on improving the sleep quality of hospital shift workers by modification of a few associated factors that are modifiable, with the intention to give a beneficial impact on their psychosocial well-being. The analysis of content validity showed that the module achieved a satisfactory level with the content validity index (CVI) of I-CVI (0.89 – 1.00), S-CVI/Ave (0.978), and S-CVI/UA (0.80). The percentages for all items in the analysis of face validity was also more than 80%. This indicated the acceptability of the SHiFT module among the hospital shift workers. Conclusions: In a nutshell, the psychosocial well-being of hospital shift workers is proven to be significantly associated with their sleep quality, physical activity and eating habits. The SHiFT module is an initiative to attain recommended psychosocial well-being. Future research must focus on the validation of the module proposed and determining its impact in maintaining the healthy lives and well-being of shift workers.