Introduction: The health effects of inhaling rice dust contaminated with endotoxin include respiratory problems, asthma, chronic bronchitis and chronic obstructive pulmonary disease.Thus, this comparative cross-sectional study aims to associate the concentration of endotoxin levels in inhalable rice dust and the lung function decline among rice millers.
Materials and Methods: The endotoxin level in inhalable dust for both area and personal samplings were collected using 25 mm Glass Fiber (A) filter loaded in IOM samplers connected to a pump by tygon tubing. The pump was operated at 2.0 litres/min and clipped around the breathing zone of the rice millers for eight hours. The endotoxin concentrations were analysed using Limulus Amoebocyte Lysate Chromogenic Endpoint assay at 405 nm. Lung function tests were carried out using Spirometer (Pony FX), for both the rice millers and the non-exposed groups.
Results: Findings for the mean concentration of endotoxin for areas was 0.26(standard deviation (SD) = 0.12) EU/m3 whereas the mean personal inhalable endotoxin level among the rice millers was 0.29(SD = 0.15) EU/m3. Post-shift lung function tests for FEV1/FVC measured appeared lower among rice millers (54%) compared to non-exposed workers (62%), but not statistically significant (p = 0.313). However, there were significant correlations between endotoxin concentration and post-shift LFT parameters of measured FVC, FEV1 and PEFR (p < 0.05).
Conclusion: Despite the low level of endotoxin exposure, proper protective measures should be applied for rice millers for long term protection.
Introduction: Optimal humidity, temperature, improper handling and storage of rice will increase the likeliness of aflatoxin growth in the air. The most common and carcinogenic aflatoxin is Aflatoxin B1 (AFB1) that may cause lung cancer if inhaled. This study aims to associate the exposure of AFB1 in inhalable dust and its respiratory effects among rice millers.
Materials and Methods: This cross-sectional study utilised the purposive sampling method and recruited 76 rice millers as exposed subjects and 48 office workers as the control group. The total inhalable dust was collected using the filter-loaded air samplers for an eight working hours’ exposure. The subjects’ hands were swabbed with cotton pads wetted with 0.5 ml Phosphate buffered Saline Tween-20 solution post shift. The collected samples were analysed for AFB1 by using the ELISA kits. The questionnaire gathering information on sociodemographic, work data and respiratory symptoms were completed. The lung function test was performed for the pre- and post-shifts.
Results: The mean airborne AFB1 at the rice mill area and personal exposure were 2.22 ng/m3 ± 0.07 and 0.25 ng/m3 ± 0.24, respectively. The mean contamination level of AFB1 on hands was 0.25 ng/ml detected on two rice millers (2.3%) while non-detectable in non-exposed workers. The most complained symptoms among rice millers were wheezing and breathlessness (n = 6, 9.2%). There was a significant difference in the mean forced expiration volume (FEV1) for pre- and post-shifts between rice millers and the non-exposed workers, but no significant correlation between the mean AFB1 concentration and lung function. Age and work factors were confounders in lung function.
Conclusion: Despite no association being established in this study, the promotion of wearing suitable personal protective equipment (PPE) is highly recommended to prevent cumulative exposure among the rice millers.
Background: TheJob Demand – Resource Model (JD-R) is a job-stress model that focuses on assessing the effect of the employees’ health-related outcomes, and their performances due to stress induced by their job demands, and job resources. Different occupations possess different combinations of specific job-related demands, and job resources. The Copenhagen Psychosocial Questionnaire (COPSOQ) is an established self-reported tool that has been widely used to measure general job demands through the JD-R model. In contrast, the BDJD-24 is a model that was developed to assess the specific job demands of the bus drivers’ job demands.
Objective: This study aims to measure the validity and reliability of the job demand questionnaire by applying it on the taxi drivers of Malaysia so as to assess their safety performance (safety motivation and safety compliance).
Method: A sample of 33 (N = 333) taxi drivers from the Klang Valley, Malaysia was recruited. Participants completed the questionnaire in the native language (Malay). To examine the psychometric properties of the COPSOQ and BDJD-24, we used the Exploratory Factor Analysis (EFA) derived from SPSS, and then confirmed it with the Confirmatory Factor Analysis (CFA) derived from AMOS.
Results: The internal consistency was found to be acceptable, between 0.71 to 0.84. The CFA revealed that the taxi drivers’ job demands, as proposed, had a 5-dimensional influence. The five demands (i.e. emotional, hiding emotion, sensory, time, and safety) were clearly distinguished in the factor analysis. The KMO was adequate, at 0.78, and the variance for the 5-factor structure was 51.97%. The CFA also confirmed the correlation among these demands.
Discussion: It is found that the COPSOQ and the BDJD-24 measurement were both reliable and valid for measuring the taxi drivers’ job demands. However, the general vs. specific job demands hypothesis, as proposed by the JD-R model, was not supported. The general job demands (emotional demands) were found to be more strongly associated with safety motivation, and safety compliance. The practical implications and limitations of the present study are further discussed in the paper.
Background: WHO has recommended that all countries apply the concept of Universal Health Coverage (UHC) in their commitment to ensure the health of their people. Although most ASEAN countries have implemented UHC, only 30% of them are considered successful. UHC considers three pillars for its implementation; all groups of people should be covered, at least the basic healthcare services are delivered, and that people could afford to access healthcare when in need. National health insurance had been set up by many countries as the approach to ensure that all citizens could obtain healthcare. However, in Indonesia, after several years of implementation, 33% of the population has yet to register while the 100% target was overdue in 2019.
Objective: To describe the progress towards UHC in Indonesia and determine the strategies used by other countries in ASEAN in achieving UHC.
Methods: Articles on UHC in ASEAN countries between the years 2014-2019 were searched according to PRISMA and reviewed. The articles were compiled using a series keyword in ResearchGate, ScientDirect, ProQuest, SAGE, and EmeraldInsight database. The studies included qualitative studies and written in English.
Results: There are various healthcare financial mechanisms that a country can implement. In 2014, Indonesia had developed a national health insurance known as JKM as its mechanism of financing healthcare towards achieving UHC. However, till date only 54% of her population had registered for JKM. There is no automatic registration via the national identity card and registration for NHIS is only done when there is a need to use the healthcare services.
Conclusion: The review demonstrates that policy implementation still needs to be monitored and evaluated. Recommendations are made for the medical professional association and the government.
The beginning of this year, 2020, has been a very challenging one as all over the world, we were caught right in the midst of the Coronavirus (COVID-19) pandemic. This pandemic is a serious global health threat, and its devastating effects are felt in all aspects of life. The World Health Organization (WHO) reported that as of 17th May 2020, we have 4,534,731 confirmed cases of COVID-19, and 307,537 deaths in total, throughout the world. In the WHO Western Pacific region, there were 167,546 confirmed cases, and 6,730 deaths while in the WHO Southeast Region, the COVID-19 accounted for a total of 136,314 confirmed cases, and 4,425 deaths (1). In Malaysia, the figure stood, thus far, at 6,872 confirmed cases, and 114 deaths while in Indonesia, there were 17,514 confirmed cases, and 1,148 deaths (2). Different countries are at different phases of this pandemic. While the curve may have flattened in some countries, there might still be spikes here and there. The COVID-19 pandemic has not disappeared; it is here to stay!
Background: There are rising concerns for the deterioration of outdoor thermal comfort (OTC) level as it influences the health and well-being of sensitive and vulnerable urban communities such as school children. However, the understanding of OTC among school children in an urban setting has been poorly highlighted in existing literature.
Methods: A cross-sectional quantitative study was conducted among secondary school students in a selected area within Greater Kuala Lumpur (GKL) so as to understand their thermal perception towards the urban outdoor environment. A clustered random sampling was used to gather a total of 236 students for this study. Meteorological data were collected concurrently with the questionnaire survey which was conducted during the peak urban heating hours (0800 – 2000) from July 2018 to January 2019.
Results: The secondary school students in the selected study area felt hot (n=120, 51%) and experienced little discomfort (n=144, 61%). If given a choice, 76% (n=179) of the students preferred a cooler environment although 56% (n=132) accepted the current thermal environment. Findings based on the on-site meteorological observations revealed that the students were constantly exposed to a mean of 32.7°C Physiological Equivalent Temperature (PET) while the expected neutral temperature was found to be 25.1°C PET.
Conclusion: Based on these outcomes, it can be deduced that the students in this study showed traits of thermal acclimatization. Future studies should be conducted to identify the influence of other confounding factors, such as gender, ethnicity, and clothing variations among the secondary school students so as to ensure that the students are able to better adapt to the deteriorating OTC levels in urban outdoor spaces.
Background:Past research evidenced that the individuals from low socio economic status (SES) families were having a higher prevalence of mental health problems when compared to higher income families. Therefore, this study aimed to examine the prevalence of the depressive symptoms among parents by socio-demographics profile: age, number of children living in a household, marital age, and household income.
Objective:The purpose of this study also aims to examine other variables that correlate to the symptoms.
Methods:A total of 205 participants consisting of fathers and mothers from four People’s Housing Projects (PHP) around Kuala Lumpur completed a self-report questionnaire which included a demographic profile form, Beck’s Depression Inventory (BDI), Parenting Daily Hassle Scale (PDHS) and Social Support Scale were used in order to measure all the variables that possibly added to the depressive symptoms among the parents. Correlation analyses were used to assess the relative significance of all the variables tested in this study.
Results:40.4% of the respondents reported a mild depression whilst another 4.4% reported a moderate level of depressive symptoms and 2.4% of them reported a severe level. The majority of the respondents reported a moderate to a high level of daily hassles and reported that their spouses were their supporters in any difficult situation. From the correlation analysis, only three variables;the household income, parenting daily hassles score and social support found the significance correlation to the depressive symptoms among the low SES parents in Kuala Lumpur.
Conclusion:The prevalence of the depressive symptoms among the low SES and the correlated variables were determined. Further research on intervention to educate parents is needed to react to the present findings and to reduce the transmission risk to the children as well as to develop a healthy nation.
Introduction: Metabolic Syndrome (MetS), refers to the clusters of metabolic abnormalities which increase the individual’s risk in developing cardiovascular diseases, and various types of cancers. Studies show that genetic, environmental, and social factors may also have a role in the pathogenesis of MetS, but the association between life course social determinants of health (SDH), and MetS, has yet to be established. The current systematic review aims to summarize the outcomes derived from previous studies which have links between life course SDH and MetS, and in that regard, this review also explores the common indicators of the SDH.
Methods: Three electronic databases were used: Medline, CINAHL, and Scopus. Articles published from 1st January 1990 until 10th January 2017 were utilised. These studies contained at least one single indicator of childhood structural determinants of health as the independent variable, and adulthood metabolic syndrome as the outcome variable. Only English articles were included.
Results: There were twelve articles were retrieved for analysis: three were from Asia, five were from Europe, and three were from the US. The commonest measurement of childhood SDH was noted to be parental socioeconomic status (SES), with some even reporting car, house, and sewing machine ownership as household SES. It is possible that women with SDH adversity throughout their life course may be associated with higher risks of MetS while the findings among men were inconclusive.
Conclusion: The association between MetS and SDH depends on gender, indicators of SDH, time of adversity, and geographic location. In order to achieve the UN’s Sustainable Development Goal on tackling NCD, policies to prevent MetS must include action for taking the SDH at all stages of life.
Objective: This study aimed to assess self-perceived aesthetics and orthodontic need, information-seeking behaviours and knowledge on orthodontic treatment among young adults in Malaysia.
Methods: A cross-sectional study was conducted among 933 polytechnic students in Malaysia using a selfadministered questionnaire. The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was used to assess self-perceived orthodontic need. Respondents were also asked about their intention to seek orthodontic treatment. Those showing intention were further asked about their reason(s) for seeking treatment, their information-seeking behaviours, and knowledge on orthodontic treatment. Data was analysed using SPSS.
Results: The overall response rate was 93.2% with the mean age of 20.43 (SD±1.07). Although most of the respondents rated themselves under the no treatment need category of the AC-IOTN scale, 61.9% reported intention to seek orthodontic treatment. The main reason for seeking treatment was to improve dental function (45.3%) and aesthetics (40.1%). Most claimed to look for information prior to orthodontic treatment, either using online or offline platforms. Many relied on friends (83.3%) as a source of information and more than half used online sources including social media and websites. A minority demonstrated lack of knowledge in terms of appropriate places to receive treatment (2.2%) and qualification of orthodontic practitioners (37.7%).
Conclusions: The majority of young Malaysian adults have high intention to seek orthodontic treatment regardless of their perceived need. A minority had lack of knowledge about qualified orthodontic providers and places to receive treatment. Majority reported positive attitudes towards information-seeking behaviour prior to seeking orthodontic treatment.
Introduction: Cyberbullying is a growing public health menace although research into the topic is very much lacking in Malaysia. This study aimed to determine the prevalence of cyberbullying among Malaysian adolescents and its association to gender, internet use pattern and offline bullying.
Methods: This study adopts a cross-sectional methodology among Malaysian adolescents’ (N=882, 13 to 14 years old) through both the dimensions of victimization and perpetration using the European Cyberbullying Intervention Project Questionnaire (ECIPQ).
Results: The result shows that if the period of the cyberbullying experience is confined to the past one month, the prevalence cyber-victimization and cyber-perpetration are 31.6% and 20.9% respectively. The prevalence however increased by more than 2-fold when it was extended to the past 3-months experience (73.7% and 64.2% respectively). Online harassment seems to dominate the prevalence of various types of cyberbullying in both cyber-victimization and cyber-perpetration dimensions (60.4% and 55.4% respectively). Both offline victims (AOR 2.40, p
Cubital tunnel syndrome (CuTS) is the second most common nerve compression neuropathy in the upper extremity. Intraneural ganglion cyst (IGC) within the ulnar nerve around the elbow, might present as CuTS. A 51-year-old Chinese man presented with paresthesia at the ulnar two digits of the left hand for one year. He was clinically diagnosed as severe CuTS. Nerve conduction study revealed marked axonal damage of the left ulnar nerve and ultrasonography showed a mass along the ulnar nerve, three centimetres proximal to the medial epicondyle, which was highly suggestive of Schwannoma. The mass was explored by a longitudinal incision. Intraoperatively, multiple cystic lesions were found within the epineurium of the ulnar nerve. Communication was seen between the elbow joint and the cyst. Swellings were partially excised under microscope. Decompression or partial excision of the cyst along with ligation of the articular branch should be the treatment of choice to prevent recurrence in case of IGC.
The Takotsubo syndrome is an acquired, non-ischemic stress-induced cardiomyopathy popularly known as the ‘broken heart syndrome’. It is an acute left ventricular dysfunction presenting mostly in older women after an intensely stressful event. The exact pathophysiology remains elusive. The term came into existence in the early 1990s in Japan, where the distinctive change in the shape of the left ventricle with apical ballooning during systole, resembled the Takotsubo, an octopus pot used bythe Japanese fisherman. From a rare underrecognized syndrome, it has been increasingly recognised as a form of acute cardiac failure. Clinical diagnosis of the syndrome may be unidentified due to its similarity with the acute coronary syndrome, but without the narrowing of coronary vessels in angiographic imaging. There is a substantial elevation of the cardiac biomarkers, troponin and the natriuretic peptides which helps in differentiating the Takotsubo syndrome from myocardial infarction. A case report of a 59-year old Malaysian lady with typical, recurrent episodes of the Takotsubo syndrome is presented.
Background: Cataract is the second priority eye disease in the world and this case in Indonesia occupies the third-highest position in Southeast Asia. There are two methods for cataract treatment that can be expensive, small incision method (SICS) and Phacoemulsification method, and it is important to know the cost-effective comparison of those two methods.
Objective: This study aims to conduct Cost-Effectiveness Analysis (CEA) between cataract surgery; Small Incision Cataract Surgery (SICS) and Phacoemulsification, at Undaan Eye Hospital Surabaya.
Materials and Method: A prospective study following up patients from before surgery up to 21 days’ post surgery. A total of 155 cataract patients had undergone surgery; 25 patients and 130 patients had SICS and Phacoemulsification, respectively. Quality-Adjusted Life Years (QALYs) was used as the outcome measure. The assessment of utility using ‘Visual Function 25’ (VF-25) was the quality of life regarding visual function before surgery, 7 days, and 21 days post-surgery.
Result: The average cost of Phacoemulsification technique was Rp 10,821,038 and the average cost of SICS technique was Rp 10,443,544. QALYs at day7 post-surgery of Phacoemulsification and SICS was 9.49 and 8.95, respectively. While QALYs at day21 post- surgery of Phacoemulsification and SICS was 10.37 and 10.15, respectively. ICER values for Phacoemulsification versus SICS at day7 post-surgery was Rp 696,360 (USD 49,74) while at day 21 was Rp 1,723,559 (USD 123,11).
Conclusion: Phacoemulsification and SICS are effective ways to improve the quality of life related to visual function. The incremental cost per QALYs obtained via Phacoemulsification from SICS at D7 and day21 post- surgery were less than Indonesia’s GDP per capita income of USD 3,347, means that Phacoemulsification is more cost effective than SICS technique for cataract surgery.
Background: South Sulawesi is one of the most successful provinces in Indonesia to develop Healthy Cities. This can be characterized by awards Swasti Saba, an award given by the central government to the districts/cities that successfully held Healthy Cities.
Aims: The purpose of this paper is to understand the meaning of Healthy Cities Awards and to identify the expectations and challenges towards Healthy Cities Awards in South Sulawesi, Indonesia.
Method: This study used a qualitative approach. The research method was in-depth interviews. The informants were 22 people consisting of healthy district/city advisors including the head of the districts/cities planning agency, health office, transportation agency, food and nutrition security agency, public works office and head of the healthy citiy/district and province forum.
Results:This paper found that the award of Healthy Cites isimportant. Seven expectations and several challenges have been identified. This paper suggests that the implementation of Healthy Cities emphasizes the essence of achieving Healthy City goals.
Conclusion: Many healthy district/city managers are oriented towards the awards rather than the essence of healthy districts/cities goals.
Background: Strength of leg musculature is crucial to generate propulsive force during rowing. The purpose of this study was to determine the relationship of isokinetic dominant leg strength and 2 km time trial on stationary rowing ergometer among male national rowers.
Methods: Seventeen male national rowers were recruited for the study. Their hip and knee isokinetic strength were determined in the sagittal plane at 60°/s angular velocity. The relationship between the hip and knee strength, and 2 km time trial performance were evaluated using Pearson correlation.
Results: The national rowers completed the 2 km time trial duration in 7.20±0.39 minutes. The hamstring to quadriceps ratio (H:Q) was significantly correlated to 2 km time trial performance (r=-0.491, p=0.045). No other significant relationships between hip and knee isokinetic strength and 2 km time trial performance were observed.
Conclusion: Increased isokinetic knee strength ratio (H:Q) may enhance 2 km time trial performance among male national rowers. Other isokinetic variables of hip and knee isokinetic strength were not significantly related to 2 km time trial.
According to tradition, plants and herbs are potential cures for numerous illnesses. In recent decades, they have gained worldwide recognition as critical sources of new drugs, especially for cancer, and the focus on medicinal plant research has increased tremendously. Currently, research scientists attribute the occurrence of post-chemotherapy tumour exacerbation to the presence of cancer stem cells hidden in the bulk of the malignant tumour, forming a rare subpopulation that plays a major role in tumour re-initiation, progression and recurrence. There is increasing evidence of cancer stem cells in a wide array of tumours, and these cells could be the crucial target for future chemotherapy approaches. This review of the major plant-basedphy to chemicals with documented antagonistic activities against cancer stem cells, their molecular targets and the mechanisms involved, may serve as a guide for developing from the existing natural agents, more effective, and broader spectrum anti-cancer stem cell compounds with the potential for clinical application.
Studies have found the association between hypercholesterolemia with oxidative stress and atherogenesis. Atherosclerosis has become one of the leading causes of mortality among industrial countries due to abnormal cholesterol metabolism, inflammation of arterial wall and build-up of atherosclerotic plaque. This disease has been recently linked with alpha lipoic acid (ALA), a mitochondrial compound with antioxidative effects in water- and fat-soluble mediums, in both oxidized and reduced forms: lipoic acid (LA) and dihydrolipoic acid (DHLA), respectively. This article provides a comprehensive review of the development and progression of atherosclerosis and the roles and regulations of ALA as a potent antioxidant against atherosclerosis.
Information regarding water fluoridation (WF) in Malaysia has been substantially documented, but is scattered in various government publications and may be lost to the stakeholders. This paper is a review of water fluoridation in Malaysia and its effect on oral health: a history of WF in Malaysia, the current policy, the evidence of its effectiveness, the challenges and the future directions. A search for relevant physical and electronic documents of WF in Malaysia resulted in the identification of 70 documents for review. WF was gazetted as national policy with an optimal fluoride level of 0.7 parts-per-million (ppm) in 1972, with a reduction of the level to 0.5 ppm in 2005. Evidence showed that WF effectively reduced population dental caries while fluorosis was not a prevalent public health concern. Strong collaboration between stakeholders and the extensive network of piped water supplies resulted in 80% of the population receiving WF in 2013. However, the coverage was reduced to 74.1% in 2018, largely due to the cessation of WF in Pahang. The key challenges in WF included a lack of funding, weak legislation, use of reverse osmosis water filtration system, difficulty to maintaining an optimal level of fluoride in the water, and lack of local data on the impact of WF cessation on oral health, and its cost-effectiveness. This review will provide dental health professionals with scientific evidence on WF and oral health in Malaysia and assist them in answering relevant questions about WF raised by the public.
Wound management is important as it helps to promote healing without microbial infection. Euphorbia hirta, a species of Euphorbiaceae family, also known as Ara tanah among Malaysians, is traditionally used to promote wound healing where its poultice is applied to the sores on the legs, bruises and wounds. Several reported pharmacological properties including antioxidant, antimicrobial, antidiabetic, anti-anaphylactic activities have been reported on this plant. The aim of this review was to evaluate the wound healing effects of E. hirta. Information involving only in vivo studies on wound healing effect of E. hirta was searched using electronic databases. The electronic databases include PubMed, Google Scholar, Ovid, CENTRAL, LILACS, and ClinicalTrials.gov from year 1962 to 2020. A total of five out of 70 studies were included and assessment was made. All included articles studied different wound models in rats. All showed significant wound healing activity with different mechanism of action for incision, excision and dead space wound. Quality assessment of the included studies suggested that experimental animal study design can be improved. It can be concluded that E. hirta displayed potential as a wound healing agent in vivo studies although further research on structure-activity relationship of compounds responsible for the wound healing effect and toxicological studies before it can proceed to clinical studies.
The undergraduate dental degree in Malaysia is regulated by the Malaysian Dental Council (MDC) (Standard of Undergraduate Competencies), Code of Professional Conduct of the Malaysian Dental Council, the Malaysian Qualification Framework 2.0 and the Malaysian Quality Agency (MQA) quality assurance documents. These primary documents emphasize the importance of professional ethics and law in dentistry as will be further detailed and discussed later. This study reflects on the need to integrate ethics, professionalism and law with sufficient coverage in terms of content and emphasis in the dental undergraduate curriculum. Literature and benchmarking practices are reviewed for a deeper reflection of the current needs in a professional dental ethics and law education course. The present study is primarily focused on regulatory requirements, legal cases and comparative literature to serve as a reference on how professional ethics and law courses may be conducted. As an incidental measure, a reflection as to how the course of study of professional ethics is delivered in a local university is considered in a selected local university’s undergraduate dental curriculum. The findings indicate that ethics professionalism and dental law is not given sufficient emphasis as it is included as one of the minor components within another overcrowded subject and the coverage of what is taught is limited in context. This paper is an invitation to all dental schools to review and reflect whether, given the emphasis on professional ethics, legal and regulatory compliance in the regulatory documents, it is adequately reflected in their dental curriculum. In this regard, some benchmarking references are done to suggest what such a course should cover, for consideration of the dental schools.