Minor head injury in a developing country like Malaysia is managed by primary care physicians and/or medical assistants in district hospitals. These patients are seen initially in their local hospitals, which have at least an X-ray machine for the purpose of screening. This study aimed to guide these physicians to manage these patients at a primary care level. A cross-sectional study was conducted and the study revealed significant predictors of significant computed tomographic (CT) findings. The presence of a Glasgow coma scale (GCS) score of 14 or 13 was associated with the risk of developing significant CT findings compared to patients with a GCS of 15 (p<0.001). Thirty-seven out of 50 patients with GCS of 14 or 13 developed clinically significant brain injury on CT scan. Similarly, the presence of skull fracture was associated with the risk of developing CT abnormalities (p<0.001). Forty-two out of 51 patients with skull fracture developed clinically significant CT findings. Vomiting was associated with developing CT abnormalities (p=0.017). Twenty-seven out of 40 patients with vomiting showed significant CT findings. Soft tissue injury was also found to be associated with developing CT abnormalities (p=0.007). Therefore, we propose reclassifying minor head injury based on the GCS score. Patients with a GCS score of 15 were classified as having mild head injury, while patients with a GCS score of 13 or 14 were at higher risk of developing brain injury and therefore categorized as high risk mild head injury. This group requires emergency CT scan examination, especially when associated with non-motor vehicle accidents, abnormal central nervous system (CNS) examination, craniofacial injuries or skull fractures. They should be referred to a general surgical unit which can treat head injuries or a neurosurgical tertiary centre.
Today, the spread of the Coronavirus 2019 (COVID-19) pandemic continues to impact on world public health and bring about considerable human suffering partly due to government policies on reducing the spread. COVID-19 has significantly affected human health and it has impacted on the occupation of vulnerable groups such as tour guides, drivers and shop assistants. Of these, the present study aims to investigate the impact of the COVID-19 self-isolation policy on the occupation of vulnerable groups in Semarang City, Indonesia. To achieve this objective, this study uses a qualitative method with an ethnography approach considering a rational or non-rational thinking model. The binary opposition thinking pattern pioneered by Lévi-Strauss was used in the interview process with 25 informants in Semarang City, Indonesia. The data analyzed the response pattern of informants through the taxonomy analysis. Three levels of vulnerability among groups relating to occupation were identified; jobs lost, income decreased, and delayed salary. The result of the analysis found that the group who obeyed self-isolation was categorized as a rational thinking; these groups stay at home, do not go to work, and have no income. Besides that, the group who ignored self-isolation is categorized as non-rational thinking; they work, as usual, get their salary, and believe that the COVID-19 pandemic is a disaster and they pray for their safety to God. In conclusion, COVID-19 brings a significant impact on occupation in the forms of postponing, declining, and missing income besides the health effects among vulnerable groups in Semarang city, Indonesia. In avoiding COVID-19 infection, the circumstances of vulnerable groups are worse when self-isolation is required. Thus, this study suggests that the government needs to assist vulnerable groups by focusing on strategic policies, such as strategies for survival, providing access to basic needs, including health, and offering livelihood plans by providing access to medical services and other source of income.