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  1. Fulltext Profiling medical school learning environments in Malaysia: a validation study of the Johns Hopkins Learning Environment Scale
    Tackett S, Bakar HA, Shilkofski NA, Coady N, Rampal K, Wright S
    J Educ Eval Health Prof, 2015;12:39.
    PMID: 26165949 DOI: 10.3352/jeehp.2015.12.39
    PURPOSE: While a strong learning environment is critical to medical student education, the assessment of medical school learning environments has confounded researchers. Our goal was to assess the validity and utility of the Johns Hopkins Learning Environment Scale (JHLES) for preclinical students at three Malaysian medical schools with distinct educational and institutional models. Two schools were new international partnerships, and the third was school leaver program established without international partnership.
    METHODS: First- and second-year students responded anonymously to surveys at the end of the academic year. The surveys included the JHLES, a 28-item survey using five-point Likert scale response options, the Dundee Ready Educational Environment Measure (DREEM), the most widely used method to assess learning environments internationally, a personal growth scale, and single-item global learning environment assessment variables.
    RESULTS: The overall response rate was 369/429 (86%). After adjusting for the medical school year, gender, and ethnicity of the respondents, the JHLES detected differences across institutions in four out of seven domains (57%), with each school having a unique domain profile. The DREEM detected differences in one out of five categories (20%). The JHLES was more strongly correlated than the DREEM to two thirds of the single-item variables and the personal growth scale. The JHLES showed high internal reliability for the total score (α=0.92) and the seven domains (α, 0.56-0.85).
    CONCLUSION: The JHLES detected variation between learning environment domains across three educational settings, thereby creating unique learning environment profiles. Interpretation of these profiles may allow schools to understand how they are currently supporting trainees and identify areas needing attention.
    KEYWORDS: Educational assessment; Learning; Malaysia; Medical students; Validation studies
  2. Fulltext Learning environment assessments of a single curriculum being taught at two medical schools 10,000 miles apart
    Tackett S, Shochet R, Shilkofski NA, Colbert-Getz J, Rampal K, Abu Bakar H, et al.
    BMC Med Educ, 2015;15:105.
    PMID: 26081751 DOI: 10.1186/s12909-015-0388-0
    Perdana University Graduate School of Medicine (PUGSOM), the first graduate-entry medical school in Malaysia, was established in 2011 in collaboration with Johns Hopkins University School of Medicine (JHUSOM), an American medical school. This study compared learning environments (LE) at these two schools, which shared the same overarching curriculum, along with a comparator Malaysian medical school, Cyberjaya University College of Medical Sciences (CUCMS). As a secondary aim, we compared 2 LE assessment tools - the widely-used Dundee Ready Educational Environment Measure (DREEM) and the newer Johns Hopkins Learning Environment Scale (JHLES).
  3. Fulltext Asbestosis in Malaysia: report on first two cases
    Lim HH, Rampal KG, Joginder S, Abu Bakar CM, Chan KH, Vivek TN
    Med J Malaysia, 1999 Sep;54(3):364-7.
    PMID: 11045065
    The first two cases of asbestosis in Malaysia are reported. Both had considerable occupational exposure to asbestos dust in the past, with a long latency period exceeding 30 years. One case presented with distinctive clinical and radiological features, while the other case was only confirmed by histological diagnosis. The usefulness of modern investigation techniques such as CT scan in the diagnosis of asbestosis is also illustrated.
  4. Fulltext Respiratory conditions in Malaysian asbestos cement workers
    Lim HH, Rampal KG, Joginder S, Abu Bakar CM, Chan KH, Vivek TN
    Med J Malaysia, 2002 Sep;57(3):340-7.
    PMID: 12440274 MyJurnal
    A cross-sectional study was conducted to determine the prevalence and type of respiratory conditions including asbestos-related diseases among Malaysian asbestos cement workers. The study population consisted of 1164 workers who had undergone medical surveillance from 1995 to 1997, including full history, physical examination, chest radiography and spirometry. More than half the male workers were smokers or ex-smokers, with smokers having more respiratory symptoms and signs, and reduced FEV1 compared with non smokers. The five most common respiratory conditions diagnosed were bronchial asthma, chronic bronchitis, pulmonary tuberculosis, upper respiratory tract infections and allergic rhinitis. On follow-up, there were also two cases of asbestosis and one case of bronchial carcinoma. The asbestosis cases were probably related to heavy occupational exposure to asbestos fibres in the past, before governmental regulations were gazetted in 1986. Further follow-up is essential for continued monitoring of the health status of asbestos workers.
  5. Fulltext The prevalence of musculoskeletal problems and risk factors among women assembly workers in the semiconductor industry
    Chandrasakaran A, Chee HL, Rampal KG, Tan GLE
    Med J Malaysia, 2003 Dec;58(5):657-66.
    PMID: 15190650
    A cross-sectional study to determine work-related musculoskeletal problems and ergonomic risk factors was conducted among 529 women semiconductor workers. Overall, 83.4% had musculoskeletal symptoms in the last one year. Pain in the back (57.8%), lower leg (48.4%) and shoulder (44.8%) were the three most common musculoskeletal problems. Significant associations were found between prolonged standing and upper and lower leg pain, between prolonged sitting and neck and shoulder pain and between prolonged bending and shoulder arm, back and upper leg pain. The study therefore showed a clear association between work-related musculoskeletal pain and prolonged hours spent in particular postures and movements.
  6. Fulltext Low back pain and association with whole body vibration among military armoured vehicle drivers in Malaysia
    Rozali A, Rampal KG, Shamsul Bahri MT, Mohd Sidik S, Shamsul Azhar S, Khairuddin H, et al.
    Med J Malaysia, 2009 Sep;64(3):197-204.
    PMID: 20527267 MyJurnal
    A cross sectional study was conducted among military armoured vehicle drivers in the two largest mechanized battalions with the objective to determine the prevalence of low back pain (LBP), and its association with whole body vibration (WBV) and other associated factors. A self-administered questionnaire and Human Vibration Meter were used in this study. A total of 159 respondents participated in this study and 102 (64.2%) of them were subjected to WBV measurement. One-hundred-and-seventeen respondents complained of LBP for the past 12 months giving a prevalence of 73.6%. The prevalence of LBP among tracked armoured vehicle drivers was higher (81.7%) as compared to wheeled armoured vehicle drivers (67.0%). The mean acceleration at Z-axis in tracked armoured vehicles (1.09 +/- 0.26 ms(-2)) and wheeled armoured vehicles (0.33 +/- 0.07 ms) were the dominant vibration directions. The mean estimated vibration dose value (eVDV) for eight-hour daily exposure at Z-axis (19.86 +/- 4.72 ms(-1.75)) in tracked armoured vehicles showed the highest estimation. Based on the European Vibration Directive (2002), the mean eVDV at Z-axis in tracked armoured vehicles exceeded exposure action value (EAV) (> 9.1 ms(-1.75), but did not exceed exposure limit value (ELV) (<21.0 ms(-1.75)). Logistic regression analysis revealed that only driving in forward bending sitting posture (OR = 3.63, 95% CI 1.06-12.42) and WBV exposure at X-axis (OR = 1.94, 95% CI 1.02-3.69) were significant risk factors to LBP. Preventive measures should be implemented to minimize risk of WBV and to improve ergonomic postures among drivers.
  7. Fulltext Development of underwater and hyperbaric medicine in Malaysia
    Rozali A, Rampal KG, Zin BM, Mohd Sidik S, Khairuddin H, Abd Halim M, et al.
    Med J Malaysia, 2006 Dec;61(5):647-50.
    PMID: 17623973 MyJurnal
    Underwater and Hyperbaric Medicine is a treatment modality gaining recognition in Malaysia. It uses the hyperbaric oxygen therapy (HBOT) approach where patients are placed in recompression chambers and subjected to oxygen therapy under pressure. In Malaysia it was introduced as early as the 1960's by the Royal Malaysian Navy to treat their divers for decompression illness (DCI), arterial gas embolism (AGE) and barotraumas. Other sectors in the armed forces, universities and private health centres began developing this approach too in the late 1990's, for similar purposes. In 1996, Underwater and Hyperbaric Medicine began gaining its popularity when the Institute of Underwater and Hyperbaric Medicine at the Armed Forces Hospital in Lumut started treating specific clinical diseases such as diabetic foot ulcers, osteomyelitis, and carbon monoxide poisoning and other diseases using HBOT. This paper discusses the development of this interesting treatment modality, giving a brief historical overview to its current development, as well as provides some thought for its future development in Malaysia.
  8. The lead content of currently available new residential paint in several Asian countries
    Clark CS, Rampal KG, Thuppil V, Chen CK, Clark R, Roda S
    Environ Res, 2006 Sep;102(1):9-12.
    PMID: 16782088
    Worldwide prohibitions on lead gasoline additives were a major international public health accomplishment, the results of which are still being documented in parts of the world. Although the need to remove lead from paints has been recognized for over a century, evidence reported in this article indicates that lead-based paints for household use, some containing more than 10% lead, are readily available for purchase in some of the largest countries in the world. Sixty-six percent of new paint samples from China, India, and Malaysia were found to contain 5000 ppm (0.5%) or more of lead, the US definition of lead-based paint in existing housing, and 78% contained 600 ppm (0.06%) or more, the limit for new paints. In contrast, the comparable levels in a nearby developed country, Singapore, were 0% and 9%. In examining lead levels in paints of the same brands purchased in different countries, it was found that some brands had lead-based paints in one of the countries and paints meeting US limits in another; another had lead-free paint available in all countries where samples were obtained. Lead-based paints have already poisoned millions of children and likely will cause similar damage in the future as paint use increases as countries in Asia and elsewhere continue their rapid development. The ready availability of lead-based paints documented in this article provides stark evidence of the urgent need for efforts to accomplish an effective worldwide ban on the use of lead in paint.
  9. Fulltext Prevalence of Sexual Harassment and its Associated Factors among Registered Nurses Working in Government Hospitals in Melaka State, Malaysia
    Suhaila O, Rampal KG
    Med J Malaysia, 2012 Oct;67(5):506-17.
    PMID: 23770869 MyJurnal
    INTRODUCTION: This study focuses on sexual harassment, a form of psycological hazard that female registered nurses face throughout their day to day routine. The objective of this study is to find the prevalence of sexual harassment among female registered nurses working in government hospitals in Melaka, Malaysia and factors affecting them.

    METHODS: This is a cross sectional study conducted on 455 female registered nurses who have worked more than one year in the present 3 government hospitals in Melaka, Malaysia. A validated and pre tested questionnaires were given for the respondents to answer. Before respondents answer the questionaires, they are required to read the definition and the forms of sexual harassment provided. This is to help them to understand the correct definition and forms of sexual harassment that they could have experienced. The researcher is available during the distribution of the questionnaires and the respondents are free to ask the researcher anything that they do not understand about it.

    RESULTS: The results of this study show that the prevalence of sexual harassment among these nurses was 51.2% with the past one year incidence recorded at 22.8%. The most common forms of sexual harassment were verbal (46.6% ), visual (24.8% ), psycological (20.9%), physical (20.7%) and non -verbal (16.7% ). The study showed that 74.7% of the victims suffered from psychological effects brought upon by their encounter with various types of sexual harrasement at work. The study also found that the victims' self-perception of their physicality was a contributing factor to the prevalance of this situation. Those who were pretty, with attractive body figure, a friendly character and easy going had a higher prevalence of sexual harassment in the workplace. Meanwhile, those who were strict, and those who had a fierce character were not prone to sexual harassment.

    CONCLUSION: The prevalence of sexual harassment among registered nurses in the workplace found in this study was high and self-perception profile of the victims of sexual harassment was the main contributing factor to the problem. Sexual harassment in the workplace should not be taken lightly because the resulting effects was not only felt by the victims, but also by their family members, colleagues and patients under their care. Hence, steps should be taken by the hospital managements to manage and prevent this problem from occuring again in the future.
  10. Fulltext Hearing loss and contributing factors among airport workers in Malaysia
    Nasir MH, Rampal KG
    Med J Malaysia, 2012 Feb;67(1):81-6.
    PMID: 22582554 MyJurnal
    Sensorineural hearing loss is a common and important source of disability among the workers and often caused by occupational noise exposure. Aims of the study were to determine the prevalence and contributing factors of hearing loss among airport workers. A cross-sectional study was carried out at an airport in Malaysia. This study used stratified sampling method that involved 358 workers who were working in 3 different units between November 2008 and March 2009. Data for this study were collected by using questionnaires eliciting sociodemographic, occupational exposure history (previous and present), life-style including smoking habits and health-related data. Otoscopic and pure-tone audiometric tests were conducted for hearing assessment. Noise exposure status was categorize by using a noise logging dosimeter to obtain 8-hour Time-Weighted Average (TWA). Data was analyzed by using SPSS version 12.0.1 and EpiInfo 6.04. The prevalence of hearing loss was 33.5%. Age >40 years old (aOR 4.3, 95%CI 2.2-8.3) is the main risk factors for hearing loss followed by duration of noise exposure >5 years (aOR 2.5, 95%CI 1.4-4.7), smoking (aOR 2.1, 95%CI 1.2-3.4), duration of service >5 years (aOR 2.1, 95%CI 1.1-3.9), exposure to explosion (aOR 6.1, 95%CI 1.3-29.8), exposure to vibration (aOR 2.2, 95%CI 1.1-4.3) and working in engineering unit (aOR 5.9, 95%CI 1.1-30.9). The prevalence rate ratio of hearing loss for nonsmokers aged 40 years old and younger, smokers aged 40 years old and younger, non-smokers older than 40 years old and smokers older than 40 years old was 1.0, 1.7, 2.8 and 4.6 respectively. This result contributes towards better understanding of risk factors for hearing loss, which is relatively common among Malaysian workers.
  11. Serial testing of Malaysian health care workers with QuantiFERON®-TB Gold In-Tube
    Rafiza S, Rampal KG
    Int J Tuberc Lung Dis, 2012 Feb;16(2):163-8.
    PMID: 22236915 DOI: 10.5588/ijtld.11.0364
    BACKGROUND: Serial testing for tuberculosis (TB) exposure has been advocated among health care workers (HCWs) at risk of nosocomial infection.
    OBJECTIVE: To determine the incidence and factors associated with TB infection among selected HCWs in Malaysia and to determine interferon-gamma response in serial testing.
    DESIGN: A cohort of 769 HCWs were retested after 1 year using QuantiFERON®-TB Gold In-Tube. Incidence of TB infection was determined among HCWs who previously tested negative. Conversion and reversion rates using several definitions were explored.
    RESULTS: Incidence of TB infection was 9.9 per 100 workers per year (95%CI 7.9-12.3). Working in the Emergency Department (ED; RR 2.18, 95%CI 1.07-4.43) was significantly associated with risk of TB infection. Reversion and conversion occurred frequently, with 46.7% reversion among HCWs with baseline interferon-gamma (IFN-γ) levels of 0.35-0.70 international units (IU)/ml, and 23.8% conversion among HCWs with baseline IFN-γ levels of 0.20-0.34 IU/ml.
    CONCLUSIONS: TB infection control measures need to be strengthened, particularly in the ED, as the incidence of TB was high. Conversion and reversion rates in serial testing were high, and further studies are needed to facilitate its interpretation.
  12. Job strain and its associated factors among lecturers in the School of Medical Sciences, Universiti Sains Malaysia and Faculty of Medicine, Universiti Kebangsaan Malaysia
    Huda BZ, Rusli BN, Naing L, Winn T, Tengku MA, Rampal KG
    Asia Pac J Public Health, 2004;16(1):32-40.
    PMID: 18839865
    A cross-sectional study to assess job strain and its associated factors among lecturers of the School of Medical Sciences, Universiti Sains Malaysia (USM) and Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (JCQ) version 1.7 (revised 1997) by Robert Karasek based on the Job Strain Model was self-administered to 73 (response rate 58.4%) and 80 (response rate 41.7%) lecturers in the medical faculties of USM and UKM respectively. The prevalence of job strain (defined by low decision latitude and high psychological demand) in USM and UKM was 23.3% and 17.5%, respectively; the difference was not significant (p 2 0.05). Analysis showed that the associated factors of job strain in USM lecturers were psychological stressors (adjusted OR 1.2, 95% CI: 1.0, 1.4), created skill (adjusted OR 0.4, 95% CI: 0.2, 0.8), working in clinical-based departments (adjusted OR 18.9, 95% CI: 1.6, 22.7). The risk factors of job strain in UKM lecturers were created skill (adjusted OR 0.3, 95% CI: 0.1, 0.9), psychological stressors (adjusted OR 1.2, 95% CI: 1.0, 1.5) and co-worker support (adjusted OR 0.3, 95% CI: 0.1, 0.9). We conclude psychological stressors and created skill were nonprotective and protective, respectively, against job strain in both USM and UKM lecturers.
  13. Fulltext Job dissatisfaction in lecturers in School of Medical Sciences Universiti Sains Malaysia and Faculty of Medicine Universiti Kebangsaan Malaysia
    Huda BZ, Rusli BN, Naing L, Tengku MA, Winn T, Rampal KG
    Med J Malaysia, 2004 Jun;59(2):242-51.
    PMID: 15559176 MyJurnal
    Job dissatisfaction in doctors and teachers is known to have direct consequences on the quality of service and teaching for patients and students respectively. A cross-sectional study to assess dissatisfaction in lecturers of School of Medical Sciences, Universiti Sains Malaysia (USM) and Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) was undertaken between August 2001 and May 2002. The original English version of the Job Content Questionnaire (CQ) version 1.7 (revised 1997) by Robert Karasek was self-administered to 73 (response rate 58.4%) and 80 (response rate 41.7%) lecturers in the medical faculties of USM and UKM, respectively. The prevalence of job dissatisfaction in USM and UKM lecturers were 42.6% and 42.9%, respectively; the difference was not significant (p>0.05). Risk factors of job dissatisfaction in USM lecturers were decision authority (p<0.001) and psychological job demand (p<0.001). Significant risk factors of job dissatisfaction in UKM lecturers were skill discretion (p<0.01) and psychological job demand (p<0.001). We conclude that psychological job demand was a risk factor of job dissatisfaction in both USM and UKM lecturers; in USM, decision authority was protective, while in UKM, skill discretion was protective against job dissatisfaction.
  14. Relation between sick leave and selected exposure variables among women semiconductor workers in Malaysia
    Chee HL, Rampal KG
    Occup Environ Med, 2003 Apr;60(4):262-70.
    PMID: 12660374
    To determine the relation between sick leave and selected exposure variables among women semiconductor workers.
  15. Fulltext Current developments and future directions of occupational health in Malaysia
    Rampal KG
    Med J Malaysia, 2000 Sep;55(3):295-8.
    PMID: 11200706
  16. Multiplicative effect of smoking and age on hearing impairment
    Noorhassim I, Rampal KG
    Am J Otolaryngol, 1998 8 6;19(4):240-3.
    PMID: 9692632
    PURPOSE: To determine the combined effect of smoking and age on hearing impairment.

    MATERIALS AND METHODS: Pure tone audiometry test was conducted on 263 residents of a rural village who were not exposed to noise. The pack-years of smoking were computed from the subjects' smoking history. The association between pack-years and hearing impairment was assessed. The combined effect of smoking and age on hearing impairment was determined based on prevalence rate ratio.

    RESULTS: There was a statistically significant trend in the number of pack-years of smoking and age as risk factors for hearing impairment. The prevalence rates of hearing impairment for nonsmokers aged 40 years and younger, smokers aged 40 years and younger, nonsmokers older than 40 years of age, and smokers older than 40 years of age were 6.9%, 11.9%, 29.7%, and 51.3%, respectively. The prevalence rate ratio for nonsmokers aged 40 years and younger, smokers aged 40 years and younger, nonsmokers older than 40 years of age, and smokers older than 40 years of age (nonsmokers aged 40 years and younger as a reference group) was 1, 1.7, 4.3, and 7.5, respectively. The prevalence rate ratios showed a multiplicative effect of smoking and age on hearing impairment.

    CONCLUSION: Age and smoking are risk factors for hearing impairment. It is clear that smoking and age have multiplicative adverse effects on hearing impairment.

  17. Fulltext Prevalence of hearing loss and hearing impairment among rural males in Selangor, 1993. [Prevalens kurang pendengaran dan gangguan pendengaran penduduk lelaki luarbandar Selangor, 1993]
    Noor Hassim I, Rampal KG
    Med J Malaysia, 1994 Mar;49(1):78-85.
    PMID: 8057996
    A cross sectional study to determine the prevalence of hearing loss and hearing impairment was conducted on 286 male subjects from a rural area. The sample was chosen by using a simple random sampling method. Prevalence of symptoms of tinnitus, ear disease, ear drum perforation and infection of external auditory meatus was 19.0 per cent, 6.7 per cent, 3.5 per cent and 0.4 per cent respectively. Air conduction audiometry tests showed the prevalences of hearing impairment of the left, right and both ears (aged 15-30 years) were 5.9%, 8.8% and 0% respectively. The prevalence of hearing loss increased with age. The higher frequencies (> 4KHz) appeared to be more affected than the lower frequencies.
  18. Fulltext Current perspectives in occupational health
    Rampal KG
    Med J Malaysia, 1993 Sep;48(3):256-8.
    PMID: 8183135
  19. Fulltext A study of locomotor disabilities in a Malay community in Kuala Selangor
    Osman A, Rampal KG
    Med J Malaysia, 1989 Mar;44(1):69-74.
    PMID: 2533959
    A study was conducted to determine the prevalence of locomotor disability in a Malay Community in Tanjung Karang, Kuala Selangor in 1984. The causes of these disabilities, the mobility and occupational handicaps they caused and the types of treatment received were determined. Fifty percent of the households in this area were selected by stratified random sampling and all persons above seven years of age were included in the sample. The prevalence of locomotor disability was 3.9%. The prevalence among males was 5.2% and among females 2.6%. The prevalence increased with age, being as low as 0.6% in the 7-14 year age group and as high as 20.5% in the above 55 year age group. The disabilities resulted mainly from trauma (49%) and musculoskeletal and neurological problems (46.9%). Ninety percent (44 cases) had difficulty only in performance of daily activity and 20 cases (40.8%) had no mobility handicap whatsoever. Forty two (85.7%) of the 49 cases had received treatment.
  20. Fulltext [The prevalence of visual impairment in Kuala Selangor]
    Ali O, Rampal KG
    Med J Malaysia, 1988 Sep;43(3):232-6.
    PMID: 3266522
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