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  1. How, Vivien, Zailina Hashim, Dzolkhifli Omar
    Int J Public Health Res, 2015;5(2):592-596.
    MyJurnal
    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
    the study.

    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.
  2. How, Vivien, Raihanah Chokeli, Nurul Syazani Binti Yuswir
    MyJurnal
    In Malaysia, chemical pesticides are widely used not only for agricultural development, but also to public health, household to control diseases, pests or weeds. In order to ensure that the information of the pesticides’ hazard prop- erties conveyed to all pesticide users, the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) has initiated to promote standard criteria for classifying chemicals according to human health, physical and environmental hazards. Even though statuses of GHS implementation on pesticides are remained unstandardized across different countries, Malaysia has taken proactive measures to implement the GHS at the workplace through the promulgation of the Occupational Safety and Health (Classification, Labelling and Safety Data Sheet of Hazard- ous Chemicals) Regulations 2013 (CLASS Regulations). This paper attempted to summarize the health hazards of pesticide chemicals registered in Malaysia by summarizing the nature of the registered pesticides’ hazards classifica- tion based on GHS in order to understand the current situation of GHS adoption in pesticides sector in the country. Overall, registered pesticides in Malaysia are known to cause either acute or chronic health effects. Out of 3,610 pesticides registered under the Pesticide Board, a total of 2,241 pesticides are listed as highly hazardous pesticides (HHP). Even though GHS includes appropriate labelling tools to convey information about each of the hazard classes and categories, several limitations have found when classifying appropriate hazard class and categories to individual pesticides.
  3. Norhafizah Yaacob, Shamsul B.M. Tamrin, Ng, Yee Guan, How, Vivien, Rozanah A. Rahman, Zerguine, Haroun, et al.
    MyJurnal
    Background: Occupational Safety and Health Master Plan for Malaysia 2015 was intended to increase awareness, knowledge and commitment to Occupational Safety and Health in all undertaking to reduce the number of injuries, diseases and fatalities. Objectives: The purpose of this study is to determine the effectiveness of Occupational Safety Health Master Plan for Malaysia 2015 (OSH-MP 15) in enhancing government leadership and preventive workplace culture. Methods: This cross sectional study covered all the states in Malaysia, constituting of 309 employers, 350 Occupational Safety Health practitioners and 360 employees as respondents. There were three questionnaires for three different groups which were employers, Occupational Safety Health practitioners and general employees. The respondents were selected through random sampling. Results: For strategy 1, there was a significant difference in mean of effectiveness of OSH-MP15 between sectors for general workers [F (11, 348) =12.06, p= =
  4. Azmi ES, How V, Abdul Rahman H
    Jamba, 2021;13(1):1102.
    PMID: 34394849 DOI: 10.4102/jamba.v13i1.1102
    Worsening climatic conditions can subsequently lead to the frequent occurrence of unpredictable natural disasters. The early-life educational approach is one of the non-structural mitigations in disaster management, which are the most effective efforts to promote early-life disaster awareness and enhance the knowledge transfer in disaster risk education. By using the health belief model (HBM), this study aims to examine the effectiveness of HBM on the flood-risk reduction (FRR) educational intervention by looking into the perceived susceptibility, severity, benefit and self-efficacy among elementary school children in Malaysia. This study utilised the one-group pre-test-post-test design by recruiting 224 elementary school children in the pre-FRR educational intervention programme, and 205 who undertook a post-intervention programme a month later. This study showed that the FRR educational intervention significantly improved (p < 0.001) the overall HBM components during the post-intervention, particularly in: (1) FRR knowledge, (2) perceived susceptibility, (3) perceived severity and (4) perceived benefits. The one-way analysis of covariance test showed that knowledge transfer intervention is effective to improve all the HBM components that include (1) FRR knowledge, F(38,127) = 2.517; (2) perceived susceptibility, F(6,191) = 6.957; (3) perceived severity, F(20,163) = 2.944; (4) perceived benefits, F(25,153) = 2.342 and (5) self-efficacy, F(7,189) = 12.526. The impact of integrating HBM into knowledge transfer intervention was seen to be effective and provide a positive knowledge enhancement among learners. Therefore, it is crucial to implement a consistent and sustainable educational intervention to harness formal education for community resilience at an early age.
  5. How V, Singh S, Dang T, Fang Lee L, Guo HR
    Int J Environ Health Res, 2023 Apr;33(4):413-429.
    PMID: 35157533 DOI: 10.1080/09603123.2022.2033706
    Farmers in tropical countries have been impacted by slow-onset heat stress. By comparing the nature of farming activities performed by conventional farmworkers and agroecological farmers, this study examined the changes in physiological health in responses to heat exposure through a six-month longitudinal study. Throughout the six-month follow-up period, the heat stress index (HSI), physiological strain indices (PSI), and physiological health parameters (BMI, blood glucose level, blood cholesterol level, uric acid level) were measured and repeated every two-month. Physiological parameters were recorded twice daily, before and during their first lunch break. This study found that slow-onset heat stress affects farmers differently. The health of agroecological farmers is more resistant to slow-onset extreme temperatures. Pre-existing metabolic health effects from pesticide exposure make conventional farmers more susceptible to extreme temperatures, delaying their bodies' adaptation to rising temperatures.
  6. How V, Hashim Z, Ismail P, Omar D, Said SM, Tamrin SB
    Arch Environ Occup Health, 2015;70(2):102-9.
    PMID: 24965330 DOI: 10.1080/19338244.2013.823905
    This is a cross-sectional study conducted among paddy farmers to characterize potential risk factors that influence levels of DNA damage from exposure to mixtures of organophosphates. Comet assay was used to determine the level of DNA damage by measuring the comet tail length from the exfoliated buccal mucosa. The result suggests that farmers who chronically exposure to a mixture of organophosphates has at least 2-fold significant increase of DNA damage as compared with control group. Factor analysis and linear regression both suggest that DNA damage reported by farmers may influence individual, occupational, and residential factors and are reported as significant predictor factors, whereas this effect is mainly caused by individual factors among the control group. The findings of the present study suggest that either farmer or control group bear certain extent of genotoxic burden contributed by different risk factors.
  7. How V, Hashim Z, Ismail P, Md Said S, Omar D, Bahri Mohd Tamrin S
    J Agromedicine, 2014;19(1):35-43.
    PMID: 24417530 DOI: 10.1080/1059924X.2013.866917
    Children are the vulnerable group in the agricultural community due to their early exposure to pesticides through the dynamic interplay between genetic predisposition, environment, and host-related factors. This study aims to identify the possible association between the depression in blood cholinesterase level and genotoxic effect among farm children. The results of micronuclei assay and comet assay showed that the reduced blood cholinesterase level from organophosphate pesticide exposure is significantly associated with an increase in chromosome breakage and DNA strand breaks. These genotoxicity end points suggest that farm children's cells experience early DNA damage that may lead to uncontrolled cell proliferation during their adulthood. Thus, farm children who grow up near pesticide-treated farmland have a higher probability of developing cancer than children with minimal or zero exposure to pesticides.
  8. Shawal FNS, Guan NY, Mohd Suadi Nata DH, How V, Tamrin SBM
    Work, 2018;60(1):153-162.
    PMID: 29733040 DOI: 10.3233/WOR-182725
    BACKGROUND: People who work with the steam boilers in palm oil mills are vulnerable to accidents, notably to explosions, whenever failures of any kind occur during their operation.

    OBJECTIVE: This cross-sectional study was conducted in palm oil mills to determine the knowledge, attitude, and perception (KAP) concerning the risk management of steam boilers among workers in palm oil mills.

    METHODS: A total of 50 workers who were working with steam boilers and/or involved in managing the operation of steam boilers with at least three years of working experience in the palm oil industry were purposively sampled. A self-administrated questionnaire consisting of four main parts - socio-demographic and occupational information, knowledge, attitude, and perception of the risk management of steam boilers was distributed. The knowledge, attitude, and perception were calculated based on a Likert-type scale.

    RESULTS: This study found that 56% of boiler workers had a good level of knowledge (mean score = 77.22±19.6), 72% had a good attitude toward risk (mean score = 83.17±5.85), and 64% had a good perception of risk (mean score = 79.50±11.22). The prevalence of accidents was 16%, and, for near misses, it was 24%. The cause of the reported accidents was largely attributed to carelessness, specifically at 80%. Apart from that, there was a positive association (χ2 = 6.56; p = 0.010) between attitude and accidents.

    CONCLUSION: This study found that the workers had good KAP levels of risk management of steam boilers in palm oil mills. However, there is a need for the employers to revise the training of workers and ensure its effectiveness in heightening the awareness of risks and accidents despite the high level of KAP.

  9. Muhamad SN, How V, Lim FL, Md Akim A, Karuppiah K, Mohd Shabri NSA
    Sci Rep, 2024 Jul 15;14(1):16265.
    PMID: 39009671 DOI: 10.1038/s41598-024-67110-w
    Rising global temperatures can lead to heat waves, which in turn can pose health risks to the community. However, a notable gap remains in highlighting the primary contributing factors that amplify heat-health risk among vulnerable populations. This study aims to evaluate the precedence of heat stress contributing factors in urban and rural vulnerable populations living in hot and humid tropical regions. A comparative cross-sectional study was conducted, involving 108 respondents from urban and rural areas in Klang Valley, Malaysia, using a face-to-face interview and a validated questionnaire. Data was analyzed using the principal component analysis, categorizing factors into exposure, sensitivity, and adaptive capacity indicators. In urban areas, five principal components (PCs) explained 64.3% of variability, with primary factors being sensitivity (health morbidity, medicine intake, increased age), adaptive capacity (outdoor occupation type, lack of ceiling, longer residency duration), and exposure (lower ceiling height, increased building age). In rural, five PCs explained 71.5% of variability, with primary factors being exposure (lack of ceiling, high thermal conductivity roof material, increased building age, shorter residency duration), sensitivity (health morbidity, medicine intake, increased age), and adaptive capacity (female, non-smoking, higher BMI). The order of heat-health vulnerability indicators was sensitivity > adaptive capacity > exposure for urban areas, and exposure > sensitivity > adaptive capacity for rural areas. This study demonstrated a different pattern of leading contributors to heat stress between urban and rural vulnerable populations.
  10. Muhamad SN, Lim FL, Md Akim A, Karuppiah K, Mohd Shabri NSA, How V
    PMID: 38616509 DOI: 10.1080/09603123.2024.2340125
    Continued heat exposure can cause physiological and cellular responses. This study investigated the association between physiological responses and heat shock protein 70 (HSP70) expressions in Kuala Lumpur's urban vulnerable population. We conducted a cross-sectional study involving 54 participants from four areas classified as experiencing moderate to strong heat stress. Physiological measurements included core body temperature, heart rate, and diastolic and systolic blood pressure. RT-qPCR and ELISA were also performed on blood samples to assess HSP70 gene and protein expressions. Despite indoor heat stress, participants maintained normal physiological parameters while there were significant indications of HSP70 expression at both the gene and protein levels. However, our study found no significant correlation (p > 0.05) between physiological responses and HSP70 expressions. This study shows no interaction between physiological responses and HSP70 expressions in the study population, revealing the complex mechanisms of indoor heat stress in vulnerable individuals.
  11. Al-Battawi S, Latif MT, How V, Thilakavathy K, Abd Hamid HH, Hameed S, et al.
    Environ Res, 2024 Nov 15;261:119744.
    PMID: 39098713 DOI: 10.1016/j.envres.2024.119744
    Ambient polycyclic aromatic hydrocarbons (PAHs) originate predominantly from fuel combustion of motor vehicles and have the potential to affect human health. However, there is insufficient knowledge regarding serum PAHs health risks among the Malaysian population. This study aims to compare PAH concentrations, distributions, correlations, and health risks in 202 blood serum samples drawn from residents living in high-traffic volume areas (Kuala Lumpur) and low-traffic volume areas (Hulu Langat) in Malaysia. Solid phase extraction and gas chromatography-mass spectrometry (GC-MS) were employed to extract and analyze blood serum samples. Questionnaires were distributed to obtain sociodemographic and contributing factors of serum PAHs. The mean total PAHs concentration in serum of the Kuala Lumpur group was 54.44 ng g-1 lipids, double the Hulu Langat group's concentration (25.7 ng g-1 lipids). Indeno(1,2,3-cd)pyrene (IcP) and acenaphthene (ACP) feature the most and least abundant compounds in both study groups. The mean concentrations of IcP and ACP in the Kuala Lumpur and Hulu Langat groups were 26.8 vs 12.68 and 0.27 vs 0.14 ng g-1 lipids, respectively. High-molecular-weight PAHs (HMW-PAHs) composed 85% of serum total PAHs in both groups. Significant correlations were found (i) between the individual serum PAH congeners (p 
  12. Ng YG, Mohd Tamrin SB, Mohd Yusoff IS, Hashim Z, Deros BM, Abu Bakar S, et al.
    Ann Agric Environ Med, 2015;22(2):286-92.
    PMID: 26094525 DOI: 10.5604/12321966.1152101
    This cross-sectional study intends to investigate the associations of musculoskeletal disorders (MSDs) among foreign labourers on a socio-economic background, occupational exposure, social lifestyle, and postures adopted during harvesting tasks. A total of 446 male respondents (263 FFB cutters; 183 FFB collectors) were studied using an interview-assisted questionnaire. OWAS was used to determine the severity of awkward posture based on videos of harvesting tasks recorded for each respondent. Analysis found that increasingly educated respondents had higher risk of developing MSDs. Shorter daily work duration and longer resting duration appear to increase the risk of neck and shoulder disorders among harvesters, which may be attributable to organizational work design. Awkward posture was a particularly significant risk factor of MSDs among FFB collectors. Among the results of the study, occupational exposure, postures and certain socio-demographic backgrounds explained some, but not all, the risk factor of MSDs among harvesters. An in-depth investigation, preferably a longitudinal study investigating the dynamic of work activities and other risk factors, such as psychosocial risk factors, are recommended.
  13. Ibrahim TNBT, Feisal NAS, Kamaludin NH, Cheah WY, How V, Bhatnagar A, et al.
    Bioresour Technol, 2023 Jan 21;372:128661.
    PMID: 36690215 DOI: 10.1016/j.biortech.2023.128661
    Microalgae are photoautotrophic microorganisms which comprise of species from several phyla. Microalgae are promising in producing a varieties of products, including food, feed supplements, chemicals, and biofuels. Medicinal supplements derived from microalgae are of a significant market in which compounds such as -carotene, astaxanthin, polyunsaturated fatty acids (PUFA) such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and polysaccharides such as -glucan, are prominent. Microalgae species which are commonly applied for commercial productions include Isochrysis sp., Chaetoceros (Chlorella sp.), Arthrospira sp. (Spirulina Bioactive) and many more. In this present review, microalgae species which are feasible in metabolites production are being summarized. Metabolites produced by microalgae as well as their prospective applications in the healthcare and pharmaceutical industries, are comprehensively discussed. This evaluation is greatly assisting industrial stakeholders, investors, and researchers in making business decisions, investing in ventures, and moving the production of microalgae-based metabolites forward.
  14. Muhamad SN, Mohd Shabri NSA, Cotter JD, Bolton A, How V, Lim FL, et al.
    Rev Environ Health, 2024 Nov 21.
    PMID: 39562285 DOI: 10.1515/reveh-2024-0101
    INTRODUCTION: Climate change is raising global temperatures, leading to more extreme heat events, even in temperate climates like Aotearoa|New Zealand (A|NZ). The impact of rising temperatures and the adequacy of planning measures remain underexplored. This paper highlights A|NZ's anticipated heat-health challenges by analyzing vulnerable populations and assessing current response systems, thereby reinforcing the need for system-level redress, mitigation and adaptation.

    CONTENT: A scoping review examined the impact of heat and existing mitigation and adaptation responses for vulnerable populations in temperate regions, with a focus on A|NZ. Additionally, temperature trend analysis was conducted for current and projected trends using Climate CHIP for six major heat-affected cities in A|NZ to assess the recognition of heat as a societal concern.

    SUMMARY AND OUTLOOK: The review identified mitigation and adaptation strategies for existing vulnerable groups and discovered other potential vulnerable groups in A|NZ, including Indigenous people (Māori), Pacific communities, low-income groups, migrants, and visitors. Temperature trends show an increasing pattern, suggesting heightened future heat-related impacts on these populations. This review reveals A|NZ's growing vulnerability to rising temperatures, particularly among high-risk groups, and calls for stronger mitigation and adaptation strategies to address future heat-health risks.

  15. Jamil PASM, Karuppiah K, Rasdi I, How V, Tamrin SBM, Mani KKC, et al.
    Ann Glob Health, 2020 07 28;86(1):84.
    PMID: 32775216 DOI: 10.5334/aogh.2895
    Background: Apart from being exposed to various hazards, there are several other factors that contribute to the deterioration of traffic police health.

    Objectives: A cross-sectional study was carried out to explore the association of occupational, socio-demographic, and lifestyle factors with lung functions in traffic policemen in Kuala Lumpur (KL) and Johor Bahru (JB).

    Methods: A spirometer was used to measure lung function of subjects, whereas a self-administered questionnaire was used to obtain their information on background data, lifestyle, and occupational factors. The statistical test used was Spearman rho's test and chi-square test; then, the factors were further tested using Logistic regressions.

    Findings: 134 male subjects were selected as respondents in this study with 83% response rate. Among all the factors tested, age (FVC: χ = 8.42(3), p = 0.04), (FEV: χ = 8.26(3), p = 0.04), rank (FVC: χ = 8.52(3), p = 0.04), (FEV: χ = 8.05(3), p = 0.04), duration of services (FVC: χ = 11.0(1), p = 0.04), (FEV: χ = 6.53(1), p = 0.01), and average working hours (with the Measured FVC (litre), r = -3.97, p < 0.001; Measured FEV1 (litre), r = -3.70, p < 0.001; Predicted FVC, r = -0.49, p < 0.001; Predicted FEV1, r = -0.47, p < 0.001; and %Ratio FEV1/FV, r = -0.47, p < 0.001) were significantly related to lung function among traffic police.

    Conclusions: Occupational factors play a crucial role, and hence, the authorities should take action in generating flexible working hours and the duration of services accordingly. The data from this study can help by serving as a reference to the top management of traffic police officers to develop occupational safety and health guideline for police officers to comply with the Occupational Safety and Health Act (OSHA, Act 514 1994).

  16. Mohamad Jamil PAS, Karuppiah K, Rasdi I, How V, Mohd Tamrin SB, Mani KKC, et al.
    Rev Environ Health, 2021 Jun 25;36(2):167-176.
    PMID: 33594842 DOI: 10.1515/reveh-2020-0107
    This paper provides a specific deliberation on occupational hazards confronted daily by Malaysian Traffic Police. Traffic police is a high-risk occupation that involves a wide range of tasks and, indirectly, faced with an equally wide variety of hazards at work namely, physical, biological, psychosocial, chemical, and ergonomic hazards. Thereupon, occupational injuries, diseases, and even death are common in the field. The objective of this paper is to collate and explain the major hazards of working as Malaysian traffic police especially in Point Duty Unit, their health effects, and control measures. There are many ways in which these hazards can be minimised by ensuring that sufficient safety measures are taken such as a wireless outdoor individual exposure indicator system for the traffic police. By having this system, air monitoring among traffic police may potentially be easier and accurate. Other methods of mitigating these unfortunate events are incorporated and addressed in this paper according to the duty and needs of traffic police.
  17. Mohamad Jamil PAS, Karuppiah K, Mohammad Yusof NAD, Mohd Suadi Nata DH, Abdul Aziz N, How V, et al.
    Digit Health, 2022;8:20552076221103336.
    PMID: 35656285 DOI: 10.1177/20552076221103336
    OBJECTIVES: Designs for low-cost air monitors and associated performance data appear in many peer-reviewed articles; however, few manuscripts provide feedback from end user's experiences or comprehensive evaluation. The present study addresses the usability of the wireless outdoor individual exposure indicator system from the viewpoint of the Malaysian Traffic Police (end users). This study is one of the first to chronicle end user experiences for low-cost pollution sensing.

    METHOD: The evaluation involved 12 target end users to assess the usability of a prototype for Malaysian Traffic Police to manage their exposure to outdoor air pollution. The test evaluation includes a pre-test, post-task and post-test questionnaire (Post-Study System Usability Questionnaire). The main components in this Post-Study System Usability Questionnaire are Overall satisfaction, System Usefulness, Information Quality and Interface Quality.

    FINDINGS: The results of the Post-Study System Usability Questionnaire indicated the mean score of the Overall satisfaction item (2.33), System Usefulness (2.25), Information Quality (2.36) and Interface Quality (2.17) on a scale of 1-10. Prototype users were satisfied with the system because the score is close to 1 on the Post-Study System Usability Questionnaire.

    CONCLUSIONS: A user-friendly wireless outdoor individual exposure indicator system is now available for Malaysian Traffic Police. Users have stated that they are happy to use the system at work. However, in addition to more technological advances, practical implementation requires evidence supporting its efficacy, viability and effectiveness.

  18. Mohammad Yusof NAD, Karupiah K, Mohd Tamrin SB, Rasdi I, How V, Sambasivam S, et al.
    PLoS One, 2021;16(10):e0258796.
    PMID: 34665845 DOI: 10.1371/journal.pone.0258796
    Traffic police riders are exposed to prolonged static postures causing significant angular deviation of the musculoskeletal, including the lumbar angle (L1-L5). This postural alteration contributes to awkward posture, musculoskeletal disorders and spinal injury, especially in the lower back area, as it is one of the most severe modern diseases nowadays. Thus, the study aimed to evaluate the effect of lumbar support with a built-in massager system on spinal angle profiles among traffic police riders. A randomised controlled trial (pre-testpost-test control design) was used to assess spinal angle pattern while riding the high-powered motorcycle for 20 minutes. Twenty-four traffic police riders were randomly selected to participate and 12 riders were assigned to the control group and 12 riders to the experimental group. The pre-test and post-test were conducted at a one-week interval. Each participant was required to wear a TruPosture Smart Shirt (to monitor spinal posture). The TruPosture Apps recorded the spinal angle pattern. The data indicated that the police riders using motorcycle seat with lumbar support and built-in massager system showed a huge improvement in maintaining posture which only involves slight spinal angle deviation changes from the spinal reference angle throughout the 20 minutes ride. The data collected then were analysed using the Mann-Whitney test and Wilcoxon signed-ranked test to verify a statistically significant difference between and within the control and experimental groups. There were significant differences in all sensors between the control group and experimental groups (p<0.05) and within the experimental group. According to the findings, it can be said that the ergonomic intervention prototype (lumbar support with built-in massager system) successfully helps to maintain and improve the natural curve of the spinal posture. This indirectly would reduce the risk of developing musculoskeletal disorders and spinal injury among traffic police riders.
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