Introduction Hepatitis C Virus (HCV) recently was identified as a major cause of post transfusion hepatitis world wide. To evaluate the role of blood transfusion on the prevalence of HCV infection, by testing antibody and RNA as well as the genotypes of HCV .Also to detect if Blood transfusion acts as unconfounding risk factor for HCV infection.
Methods Sera from 3491 pregnant women were investigated for the presence of HCV antibodies (anti-HCV) by using third generation enzyme immunoassay (EIA-3) as screening test, followed by immunoblot assay (Lia Tek-III). In addition 94 sera of studied women were subjected to molecular analysis (at laboratories of Sorin BioMedica - Italy) for the detection of viral RNA and genotypes of HCV. Using RT-PCR & DNA Enzyme immunoassay (DEIA) method.
Results Our study revealed, that seroprevalence rate of HCV specific Ab & RNA were significantly higher (16.32 %, 80% respectively) among women with a history of blood transfusion, compared to those (2.53%, 56.5%) with no such history P=0.0001, P=0.01. And there is a significant direct linear correlation between number of blood transfused and the seropositive rate of anti-HCV (r=0.7, p=0.046). Based on multivariate analysis, interestingly, this study confirmed that, blood transfusion significantly acting as unconfounding risk factor for acquiring HCV infection (Adjusted OR=1.938,95% C.I=1.646-2.28). And the risk of exposure is increases with increased number of blood transfused. Although, we found no significant association between, HCV genotypic distribution and history of blood transfusion. However, high proportion of women with a history of blood transfusion were harboring HCV genotype -4 or 1b, 50%,40%, resepctively.
Conclusions Our study shows, evidence that, blood transfusion acts as unconfounding risk factor for acquiring and in a mode of transmission of HCV infection. Therefore strict screening of blood donor for HCV-Abs and / or RNA is highly recommended.
A prospective study done In al Zaafaranya General Hospital in Baghdad/Iraq In the period between April 2003 and February 2007. Ninety two patients admitted to the surgical wards diagnosed as Intestinal obstruction. The aim is to find out the possible common conditions resulting in causing this common surgical emergency. Also to compare the provisional clinical diagnosis about ischemic obstruction and the definitive post operative diagnosis. To encourage post graduate students to use their clinical abilities with the few laboratory and radiological facilities available needed to decide about the management of those patients.
Introduction Breast cancer is ranked number one from the ten most frequent cancers in
female, Peninsular Malaysia. Various studies provide negative evidence on
malignancies and one of the end results is impaired quality of life (QOL).
Studies show lifestyle approaches are key factors in enhancing the QOL
among cancer survivors. The purpose of this study is to describe the lifestyle
practices (LP) among breast cancer survivors (BCS) which consist of dietary
intake, exercise habits, and stress management and to determine whether
these practices have influence on the QOL among Malaysian BCS.
Methods This study adopts a cross-sectional study design using a self-administered
questionnaire. A total of 280 BCS from public and private hospitals
throughout Peninsular Malaysia had participated. The questionnaire covers
QOL and LP items which consist of dietary intake (consumption of high-fat
food, high-fibre food, fruits and vegetables), exercise habits, and stress
management. Descriptive statistics and one-way ANOVA were used to
determine the relationship between LP and QOL.
Results Mean age of the study sample was at 41 (SD=7.37). Majority of them were
Malay (74%), 53% were diagnosed with breast cancer between 1 to 2 years
whereas 54% were presented with stage 2 at diagnosis. There was a
statistically significant difference (p
Introduction The aim of this study was to examine the aspect of information disclosure by
doctor-investigator during the process of obtaining informed consent in
Methods This research employed a mixed-method data collection that is library
research and interview. A qualitative methodology and analysis were used in
an open-ended, face-to-face interviews with 17 patient-subjects. The
interview questions were based on information that needed to be disclosed to
patient-subjects during the process of obtaining informed consent. Each
interview took place in Kajang Hospital and National Heart Institute and
lasted 25-30 minutes. Interviews were conducted in Bahasa Melayu and
English. The interviews were tape-recorded, and the main points from the
interviews were jotted down to ensure that all information was adequately
gathered. Interviewed occurred in Kajang Hospital and National Heart
Institute. The participants were patients who had been referred to the Kajang
Hospital and National Heart Institute. They were recruited (8 from Kajang
Hospital and 9 from National Heart Institute) by their own doctors to
participate in a study to evaluate the safety and effectivenes of the
investigational stent after been diagnosed with coronary artery disease and
also in a study to investigate drug for antidepressant. respectively.
Results The study revealed that doctor-investigators fail to disclose full information
to patient-subjects. Instead, doctor-investigators only disclosed information
which they thought were necessary for the patient-subjects to know. The
study also showed that there were doctor-investigators who did not disclose
information at all to the patient-subjects.
Conclusions This study implies that the aspect of information disclosure in the process of
obtaining informed consent in clinical trials is rather poor and did not fulfill
the criterion of good medical practice. A random monitoring task to be
conducted by the research ethics commitees during the informed consent
process is suggested.
Introduction Low bone mineral density is a significant problem in children with
Thalassemia which may lead to increased risk for fragility fractures and
suboptimal peak bone mass. This cross-sectional study was conducted to
determine the bone health status of Thalassemia children Universiti
Kebangsaan Malaysia Medical Centre and Paediatrics Insititute Kuala
Methods A total of 81 respondents diagnosed with transfusion dependant beta
Thalassemia (41 boys and 40 girls) aged between 7 to 19 years old completed
the study. The data collected were demographic information, anthropometric
measurements, dairy frequency questionnaires, dietary habits of the
respondents and their parents, dietary intakes and bone densitometry using
Ultrasound Bone Densitometer.
Results For Quantitative Ultrasound (QUS) parameters, T-score of 9.8% participants
were lower than -1.0 and 30.9% of the participants had lower Speed of Sound
(SOS) than healthy SOS. This study showed there was no difference in bone
density by sex (p>0.05). The median bone density of boys was 1616.00 m/
sec (IQR= 39.00) and girls’ was 1579.00 m/ sec (IQR= 116.00). SOS was not
increased with age, height and weight; but girls’ Body Mass Index (BMI).
Malay children had significantly higher SOS than non-Malay children.
Conclusions This study highlights a need of proper intervention for the high risk group to
achieve optimal bone health.
Introduction It is well known that low back pain among working population is a global
problem throughout the world. However, the current situation of occupational
low back pain in Malaysia is still vague due to limited number of studies
Objective A cross sectional study was conducted among three automotive industry
workers in Selangor, Malaysia from October 2010 to April 2011.
Methods This study aims to determine the prevalence and risk factors of low back pain
among automotive industry workers performing manual material handling
tasks using self-administered questionnaire survey.
Results A modified Standardised Nordic Questionnaire was used to assess low back
pain problem, to obtain personal and psychosocial risk factors information.
The prevalence of low back pain showed increment in the point prevalence of
57.9%, 49.5%, and 35.1 % for 12 months, one month, and of 7 days
respectively. Working hour, frequency of overtime, stress at work, work
pace, and faster movement were found to be significantly associated with the
12 months prevalence for low back pain.
Conclusions This finding indicates that psychosocial risk factors are associated to the
occurrence of low back pain.
Introduction In light of the important role of health-promoting expenditure in health, the
objective of this study was to investigate the socio-demographic determinants
of health-promoting expenditure such as purchase of medical equipment and
services, food supplements and health education services and products among
Methods Third National Health and Morbidity Survey (NHMS III) consisting of 28771
observations was used for analysis. It was the latest nationally representative
cross-sectional population-based survey conducted by the Ministry of Health
Malaysia from April 2006 to January 2007. A censored regression model
(Tobit) was applied to examine the factors affecting health-promoting
Results The results showed that age, income, gender, ethnicity, education, marital
status, employment status and location of residence were able to affect healthpromoting
expenditure. In particular, individuals who were younger, poor,
males, Indian/others, less educated, unmarried, unemployed and residing in
rural areas tended to spend less money on health promotion compared to
Conclusions This study reached a conclusion that socio-demographic factors were
significantly associated with individual’s preferences for health promotion.
Therefore, the government should devote its attention to these factors when
formulating nationwide health policies.
Introduction The risk factors associated with mental health among adolescents are usually
described by researchers at an individual level. Neighbourhood factors and
health have opened a new insight into the field of epidemiology. The aim of
this study was to assess the reliability and validity of a newly developed
Neighbourhood Factors on Mental Health Questionnaire among Malaysian
Methods A cross-sectional study was conducted in four secondary schools in Kuala
Lumpur, Malaysia using a newly developed questionnaire which comprised
of two main domains and seven items. Exploratory factor analysis and
Cronbach‟s alpha were used to measure the instrument‟s construct validity
Results A total of 106 adolescents participated in this research. The majority of
adolescents were 13 years old (40.6%), female (55.7%), Malays (68.9%),
have parents who only studied until secondary school (66.0%) and lived in
flats (32.1%). Bartlett‟s Test of Sphericity was significant (Chi-square =
Introduction During haze, at what level should Air Pollutant Index (API) showed, public
or private school be closed is not without controversy and is very much
debated. Therefore, the aim of this paper is to objectively quantify the
potential inhaled dose of PM10 associated with exposure at school and home
microenvironments during haze. The result of the health risk assessment will
be used to propose the API level for closing the school during haze episode.
Methods A hypothetical haze exposure scenario was created using the breakpoints of
PM10 concentration for calculation of API and respective inhaled dose during
haze. To determine the potential inhaled dose, we have considered many
factors that include time spent for specific physical intensity at school and
home microenvironments, age-specific and physical intensity-specific
inhalation rate (m3/min), and the indoor/outdoor ratio of PM10. To calculate
risk quotient (RQ), the inhaled dose was compared with the health reference
dose computed based on the concentration of PM10 in the Malaysian
Ambient Air Quality Standard.
Results When considering the specific exposure at each microenvironment (school
and home), the potential inhaled dose of PM10 was substantially lower when
school is closed for both primary and secondary school. The calculated risk
quotient (RQ) indicates that primary school children are likely to be affected
at slightly lower PM10 concentration (equivalent to API of 197) as compared
to secondary school children. Short duration of high physical activity
intensity during school breaks has contributed to a large proportion of inhaled
dose among school children indicating the important to avoid physical
activities during haze.
Conclusion Based on the assessment, taking into account the uncertainty of risk
assessment methodology, we proposed school to be closed when API reach
190 for both primary and secondary schools. These findings and
recommendations are only valid for naturally ventilated school and applicable
in the context of the current API calculation system and the existing
Recommended Air Quality Guideline values in Malaysia.
Introduction Prolonged mechanical ventilation among cardiac surgery patient has been
found to be correlated with negative clinical outcome and increased
healthcare resources utilization. Prolonged mechanical ventilation (PMV)
was defined as the accumulative duration of 24 hours or more of
postoperative endotracheal intubation starting from transfer of the patient to
cardiac ICU. This study is aimed to identify the risk factors preoperative,
intra operative and postoperative for prolonged ventilation among cardiac
patients in AL-Thawra Modern General Hospital (TMGH).
Methods Observational study design was conducted during a two-month period (from
1 August 2014 to 30 September 2014). It was among 70 patients who were
admitted to cardiac surgery intensive care unit in Al-Thawra Modern General
Hospital and selected by convenient sampling. The soci-demographic
characteristic and clinical patient data were collected using short
questionnaire developed by researcher. All patients had the same anesthetic
and postoperative management. Statistical analysis was performed with SPSS
version 20 and using bivariate analysis and multivariate logistic regression.
The p-value of < 0.05 was found to be statistically significant.
Results Incidence of prolonged mechanical ventilator post cardiac surgery was 37.1%
(26/70) through bivariate analysis, multivariate logistic regression. Low
Ejection fraction of Left Ventricle was inversely related to mechanical
ventilation time (AOR= 0.872) with 95% confidence interval [0.790 - 0.963],
hemodynamic instability were associated with prolonged mechanical
ventilation time (AOR=16.35) with 95% confidence interval [2.558 -
Conclusion Low ejection fraction of Left Ventricle and Hemodynamic Instability post
operation were identified risk factors for prolonged mechanical ventilation
post cardiac surgery.
Introduction Overweight and obesity is a major public health problem in Malaysia. This
study aims to determine the prevalence of overweight and obesity among the
Malaysian adult population and their association with socio-demographic
characteristics (gender, ethnic, and age groups).
Methods A total of 17,257 adults aged 18 years and older (8,252 men, 9,005 women)
were assessed for BMI status, with a response rate of 97.8%, through a
household survey from the National Health and Morbidity Survey (NHMS),
conducted in all states of Malaysia in 2011.
Results All socio-demographic factors were consistently associated with higher
chance of being overweight (except gender and location) and obesity (except
location and household income). The identified risk of overweight were
Indian (aOR: 1.8, 95% CI: 1.2-2.8), aged 50-59 years (aOR: 2.8, 95% CI:
2.0-3.9), widower (aOR: 1.6, 95% CI: 1.3-2.0), subject with secondary
education (aOR: 1.2, 95% CI: 1.0-1.4), Homemaker/unpaid worker (aOR:
1.3, 95% CI: 1.1-1.4), and with high household income group (aOR: 1.3, 95%
CI: 1.2-1.6). The identified risk of obesity were women (aOR: 1.4, 95% CI:
1.2-1.6), Indian (aOR: 1.7, 95% CI: 0.9-3.2), aged 30-39 years (aOR: 3.6,
95% CI: 2.4-5.5), widower (aOR: 1.2, 95% CI: 0.9-1.6), subjects with
primary education (aOR: 1.2, 95% CI: 0.9-1.6), Homemaker/unpaid worker
(aOR: 1.3, 95% CI: 1.1-1.6), and with middle household income group (aOR:
1.3, 95% CI: 1.2-1.6).
Conclusions Our data indicate a high prevalence of overweight and obesity in the
population. Several sociodemographic characteristics are associated with
both overweight and obesity. This study highlights the serious problem of
overweight and obesity among Malaysia adults. Documentation of these
problems may lead to research and policy agendas that will contribute both to
our understanding and to the reduction of these problems.
Introduction Physical activity assessment in children is the first step in assessing the
relationship between activity and health, as well as the determinants of
childhood physical activity and changes in activity level.Physical Activity
Questionnaire for Older Children (PAQ-C) is self- administered
questionnaire to assess physical activity among older children. The objective
of this study was to determine the validity and reliability of Physical Activity
Questionnaire for Older Children in Malay language PAQ-C (M).
Methods The validation study was done among 73 students aged 10 to 17 years old.
The PAQ-C was translated into Malay language using forward and backward
translation. The evaluation of the psychometric properties included internal
consistency, test-retest reliability and criterion validity. Reliability of PAQ-C
(M) was determined using Cronbach alpha and intra-class correlation
coefficient (ICC). The PAQ-C (M) was administered twice in one week
interval to assess test-retest reliability. Criterion validity was assessed
between PAQ-C (M) and 3 Day Physical Activity Recall (3DPAR).
Results The internal consistency of PAQ-C (M) assessment calculated in this study
was α = 0.75 and α = 0.77 for assessments one and two, respectively. The
ICC between individual items of PAQ-C (M) was 0.59 to 0.91, indicating
moderate to good correlation. The Spearmen correlation coefficient between
PAQ-C (M) and 3DPARwas acceptable (r=0.60, p
Introduction The prevalence of Type 2 diabetes mellitus (T2DM) is increasing worldwide
and many of these affected individuals remain unidentified. Undiagnosed
T2DM may impose substantial public health implications because these
individuals remain untreated and at risk for complications. The objective of
this study was to determine the national prevalence of undiagnosed T2DM
and to identify the associated risk factors.
Methods A nationwide cross-sectional study was conducted involving 17,783
respondents. Two-stage stratified sampling design was used to select a
representative sample of the Malaysian adult population. Structured
validated questionnaires with face to face interviews were used to obtain
data. Respondents, who claimed that they were not having diabetes, were
then asked to perform a fasting blood glucose finger-prick test by Accutrend
Results The prevalence of undiagnosed T2DM was 8.9% (n=1587). The highest
percentage of undiagnosed T2DM was found among males (10.2%), 55-59
years old (13.4%), highest education attainers of primary school (11.1%),
Indians (10.3%), married (10.3%), working (8.9%) and living in the urban
areas (9.2%). Multivariate analyses showed that factors associated with
undiagnosed T2DM were gender, age group, ethnicity, marital status, obesity
Conclusion This study found an increasing trend of undiagnosed T2DM in Malaysia
compared to 2006. This finding is alarming as risk factors associated with
undiagnosed diabetes were related to most of the socio-demographic factors
studied. Therefore, early diabetic screening is crucial especially among adults
aged 30 and above to prevent more serious complications of this disease.
Introduction Family satisfaction is referred to the extent in which family members feel
happy and fulfilled with each other. However, there has been lack of
evidences on the family satisfaction scale within the Malaysian context.
Therefore, the aim of this study was to assess validity of the Malay version of
the Olson’s Family Satisfaction Scale. This is to allow Malaysian researchers
to bring family satisfaction in line with the different field of studies.
Methods This study was conducted among 567 Malaysian working women. Data were
collected using self-administrated questionnaires. This study conducted
exploratory and confirmatory factor analysis, convergent validity and internal
consistency using Cronbach’s alpha.
Results The findings of this study support the uni-dimensionality of the Malay
version of the family satisfaction scale. The 10 items of the scale account for
68.1% of the total variance and the un-rotated factor loadings ranged from
0.76 to 0.87. Confirmatory factor analysis was run and supported the
structure of family satisfaction scale. The results of confirmatory factor
analysis using AMOS 21 in the current study reported the following indices:
RMSEA= 0.06, CFI= 0.94, NFI= 0.94, TLI= 0.93. The convergent validity
(average variance extracted= 0.65) and the internal consistency (Cronbach’s
alpha= 0.94) of this construct were adequately supported.
Conclusions The findings support the factor structure, convergent validity and the internal
consistency of the examined construct. Therefore, Malay version of the
family satisfaction scale is a valid and reliable instrument among Malaysian
Introduction Following the reveal of borderline iodine sufficiency among the Sarawakians
from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a
mandatory universal salt iodization (USI) was implemented in Sarawak
thereafter. This study aimed to determine the current status of USI in
Sarawak after a 3-year implementation of USI from 2008 to 2011.
Methods The IDD survey was conducted between Jun 2011 to July 2011 involving six
districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The
schools were selected via multistage proportionate-to-population size
sampling technique and the children were randomly selected via systematic
sampling. A total of 19 schools and 661 children were recruited into the
survey. Thyroid size was determined by palpation and was and graded
according to the classification of the World Health Organization (grade 0-2).
The iodine excretion level in spot morning urine was measured using inhouse
microplate method. The urinary iodine concentration (UIC) values
were compared by Kruskal-Wallis test and Chi-square tests were used to
compare categorical variables.
Results A total of 610 school children were participated in the study (92.3%). The
TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC
level was 154.2 (IQR, 92.7 - 229.8) μg/L, with the highest median UIC been
observed in Sarikei [178.0 (IQR, 117.6 - 308.9) μg/L], followed by Mukah
[174.8 (IQR, 99.0 - 224.3) μg/L)], Miri [158.6 (IQR, 92.3 - 235.4) μg/L],
Sibu [147.0 (IQR, 89.8 - 221.4) μg/L], Bintulu [142.3 (IQR, 52.8 - 245.1)
μg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) μg/L]. One in every ten child was
of iodine deficient (UIC < 50μg/L) while a third of the child (32%) were of
adequate level of UIC.
Conclusion The present findings indicate that the mandatory USI successfully improves
the iodine level of children in Sarawak. However, regular and proper
monitoring of the UIC level in the communities is needed to prevent
excessive iodine intake.
Introduction In maternal healthcare, pre-pregnancy weight is used to predict pregnancy
outcomes. Since no recorded data on pre-pregnancy weight, perceived weight
is used alternatively. This study examines the relationship between perceived
and actual weight among non-pregnant urban Malaysian women of
childbearing age and identifies differences in perceived and actual weight by
selected socio-demographic characteristics.
Methods A cross-sectional study was conducted between April and June 2013 among
urban Malaysian women attending public health clinics in the Klang Valley.
Information on height, perceived current weight and time when their weight
was last taken were obtained and actual weight was the average of two
measurements (TANITA-HD-323-digital-scale). Socio-demographic data
collected were age, ethnicity, education level, marital and employment status
and total household income.
Results Mean age of 371 women in this study was 28.81±5.65, 82.2% were Malays,
62.8% had tertiary education, over 75% were married and employed, with
more than half from middle-income households. Overall, the mean perceived
and actual weight was 59.29±11.59 and 59.20±11.90 respectively. Pearson‟s
Correlation test showed a very strong positive correlation between perceived
and actual weight (r=0.957;p
Introduction Validation of instruments is essential when assessing physical activity (PA).
The aim of this study was to validate a Malay language version of the
International Physical Activity Questionnaire (IPAQ-M) against Actical
accelerometer and to determine its reliability and validity.
Methods A total of 90 Malay adults aged 35-65 years old participating in The
Malaysian Cohort project were recruited for this study. The IPAQ-M is
comprised of 12 items, covering vigorous, moderate, walking, sitting and
sleeping activities, and was administered on two occasions (Day 1 and Day 9)
by interviewing the participants. Participants wore the Actical accelerometer
for seven consecutive days between the two interview sessions.
Results Validity tests showed that time spent in moderate-vigorous physical activity
(MVPA) (min wk-1) from IPAQ-M was significantly correlated with MVPA
from accelerometer (=0.32, p
Air pollution has been widely known to have an influence on health of the general population.
Air pollution can result from natural causes, human activities and transboundary air pollution.
Weather and climate play crucial role in determining the pattern of air quality. In recent years,
air pollution and recurrent episodes of haze has become a major concern in Malaysia.
Surveillance data on concentrations of main air pollutants such as carbon dioxide, (CO2),
Nitrogen Dioxide (NO2), Ozone (O3), sulphur dioxide (SO2) and particulate matter (PM10)
were found to be higher during the haze days and this may have an impact on health of the
community as reflected by an increase in hospital admissions particularly the respiratory and
Introduction Helminthiasis is a common parasitic condition particularly among children in
rural areas in developing countries where poor hygiene standard is practiced.
The study aimed to determine the prevalence of helminthiasis among Indian
preschoolers in urban areas in Penang and its associated factors.
Methods A total of 194 urban Indian preschoolers aged 4 to 6 years old were selected
randomly from 11 kindergartens in the state of Penang for this cross sectional
study. Data collection was carried out in 2 phases. First, microscopic stool
examinations were done to examine the presence of helminths. Second, self
administered questionnaires which inquired about human, environment and
socioeconomic factors were completed by the parents/guardians.
Results The overall prevalence of helminthiasis was 7.2% and the most frequently
encountered infective agent was Ascaris lumbricoides (57.1%) and followed
by the tapeworms (42.86%). The logistic regression indicated that habitual
thumb sucking (AOR= 5.6. 95%CI: 1.73-18.39) and families owning
domestic pets (AOR= 3.2; 95%CI: 1.03-10.14) were the significant
contributing factors to helminthiasis among the Indian pre-schoolers in urban
Penang. Although the prevalence of helminth infection among the urban
Indian preschoolers is lower than rural area, it is still a public health concern.
Children habitual thumb sucking and rearing domestic pets at home were the
significant contributing factors in helminthiasis.
Conclusion Prevention strategy should focus on health education and promotion among
adults and children, awareness on domestic animal hygiene and maintaining
good environmental sanitation. Multi agency collaboration is clearly
essential, especially between state health, education and veterinary
departments in curbing this disease.
Introduction This paper aims to investigate the potential pesticide dermal contamination
among the agricultural community by observing the microenvironmental and
macroactivity interaction between farm children and adult farmer.
Methods A 24 hours timeline activity was observed and recorded in the agricultural
farming village, Kuala Selangor. In this study, 2 homes were monitored for 2
days following a pesticide application. A total of 2 adult farmers and 5
children (7-10 year old) were recruited to participate in this study. Twentyfour
hour videotape segments and time-activity diaries were collected during
Results The microenvironment and macroactivity interaction were modelled in this
study. By considering only the potential dermal exposure pathway, the
different biological vulnerability and exposure pattern to pesticides were
observed. Finding showed a greater extent of interaction between human and
its environment, where adult farmers are the main contributor of
environmental contaminants, and children is one of the vulnerable receivers
of the contaminants’ residuals from the environment.
Conclusion The daily activities and behaviors practiced by the agricultural community
were among the contributing factors which help to highlight the pesticide
dermal contamination pathway in the farming village. This study
recommends the necessary to consider the microenvironment and
macroactivity of the target community when assess their exposure levels to
the environment contaminants.