Self-reported bone fracture among Malaysian adults: Baseline findings of PURE Malaysia cohort study.

INTRODUCTION: In Malaysia, studies on self-reported bone fractures are scarce. Due to the fact that bone fractures may serve as an indicator of osteoporosis in the community, this study aimed to identify the factors associated with their occurrence among adults in Malaysia. MATERIALS AND METHODS: Epidemiological data for selfreported bone fractures were obtained through direct interviews using a validated questionnaire from the Prospective Urban and Rural Epidemiology (PURE) study. RESULTS: Of 15,378 respondents, 6.63% (n=1019) reported bone fractures, with a higher proportion of men (65.8%, n=671) than women (34.2%, n=348). Higher odds of selfreporting bone fractures were seen in males (aOR, 2.12; 95%CI: 1.69, 2.65), those with a history of injury (aOR 5.01; 95%CI: 3.10, 6.32) and those who were obese (aOR: 1.46; 95% CI: 1.13, 1.89), highly active (aOR 1.25; 95%CI: 1.02, 1.53), smokers (aOR 1.35; 95%CI: 1.11, 1.65) and alcohol consumers (aOR 1.67; 95%CI: 1.20,2.32). CONCLUSION: Adopting a healthier lifestyle that includes a balanced diet and moderate physical activity is critical for weight loss, increased muscle and bone mass and better stability, which reduces the likelihood of fractures following a fall.

Firefighter satisfaction and happiness at work: how big is the effect?

INTRODUCTION: Firefighter satisfaction plays a crucial role in overall workplace happiness. We seek to quantify the effect size of firefighters' satisfaction with happiness at work after adjusting for socio-demographic attributes. MATERIALS AND METHODS: This study used data from an online cross-sectional survey that was conducted from 24 June to 24 July 2021 in the Fire and Rescue Department of Malaysia. Firefighters were approached using the saturation sampling technique. They received online surveys via email through the Director of State and follow-up reminders through the Assistant Director of State Operations. A total of two filter questionnaires were employed i.e. type and duration of service. Firefighters stating that they were volunteer/auxiliary firefighters or had been in service for 2 years or less were excluded. In this study, data from 6041 out of 8581 firefighters were included for further analysis. The survey utilised the validated staff satisfaction index (SSI) and the happy career (HC) scale for in-service firefighters. SSI was a dual-dimension index consisting of welfare and protection against hazards at work, with 16 subdimensions. The HC is a five multi-dimensional items scale. Then, we used multiple linear regression to obtain the coefficient of determination while adjusting for age groups, gender, marital status, job grade, years of service and region of service. RESULTS: A total of 6041 eligible data points were analysed in the study. The mean (±SD) age was 38.70 (8.97) years, of which 95.9% were male. The firefighters were in service for a median of 14 years (Q1, Q3: 8, 21). The firefighter reported higher life satisfaction (mean [SD] = 78.30 [9.15]) than happiness at work (mean [SD] = 77.22 [0.20]). The mean happiness scores differed significantly between years of service groups (p<0.001), region of service (p<0.001), marital status (p=0.029) and grade (p<0.001). Firefighters' satisfaction contributed 42.7% of workplace happiness (ßadj=1.096 [95% CI: 1.064, 1.128]; p<0.001) after adjusting for frontline, married, the central region of service and male gender as control variables. CONCLUSION: Firefighter satisfaction had a large effect size on happiness at work (42.7%). However, the interpretation of this effect size should be done with caution because happiness at work is inseparable from other life dimensions such as stability in matrimonial relationships and finances, involvement in leisure and religious activities and being mentally healthy.

Occupational exposure and challenges in tackling M. bovis at human-animal interface: a narrative review.

Zoonotic tuberculosis caused by Mycobacterium bovis (M. bovis), a member of Mycobacterium tuberculosis complex (MTBC) has increasingly gathered attention as a public health risk, particularly in developing countries with higher disease prevalence. M. bovis is capable of infecting multiple hosts encompassing a number of domestic animals, in particular cattle as well as a broad range of wildlife reservoirs. Humans are the incidental hosts of M. bovis whereby its transmission to humans is primarily through the consumption of cattle products such as unpasteurized milk or raw meat products that have been contaminated with M. bovis or the transmission could be due to close contact with infected cattle. Also, the transmission could occur through aerosol inhalation of infective droplets or infected body fluids or tissues in the presence of wound from infected animals. The zoonotic risk of M. bovis in humans exemplified by miscellaneous studies across different countries suggested the risk of occupational exposure towards M. bovis infection, especially those animal handlers that have close and unreserved contact with cattle and wildlife populations These animal handlers comprising of livestock farmers, abattoir workers, veterinarians and their assistants, hunters, wildlife workers as well as other animal handlers are at different risk of contracting M. bovis infection, depending on the nature of their jobs and how close is their interaction with infected animals. It is crucial to identify the underlying transmission risk factors and probable transmission pathways involved in the zoonotic transmission of M. bovis from animals to humans for better designation and development of specific preventive measures and guidelines that could reduce the risk of transmission and to protect these different occupational-related/populations at risk. Effective control and disease management of zoonotic tuberculosis caused by M. bovis in humans are also hindered by various challenges and factors involved at animal-human interface. A closer look into factors affecting proper disease control and management of M. bovis are therefore warranted. Hence, in this narrative review, we have gathered a number of different studies to highlight the risk of occupational exposure to M. bovis infection and addressed the limitations and challenges underlying this context. This review also shed lights on various components and approaches in tackling M. bovis infection at animal-human interface.

The household economic burden of non-communicable diseases in 18 countries

BACKGROUND: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. METHODS: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. RESULTS: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. CONCLUSIONS: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs. (AU)

Effects of hydration practices on the severity of heat-related illness among municipal workers during a heat wave phenomenon.

INTRODUCTION: The continue rise in temperatures due to climate change increases the risk of heat-related illness (HRI) among outdoor workers. This study aims to evaluate the effects of hydration practices on the severity of HRI during a heat wave episode among municipal workers in Negeri Sembilan. METHOD: A cross-sectional study was performed in March and April 2016. The outdoor temperatures were measured using the wet-bulb globe temperature (WBGT) tool. The participants completed a self-administered questionnaire containing sociodemographic factors prior to work shift; while working profile, hydration practices, and HRI symptoms at the end of work shift. The hydration status of the respondents was assessed by direct observation of their urine colour. Multiple logistic regression was performed to ascertain the effects of age, working profile, hydration practice, history of previous HRI, and hydration status on the likelihood that outdoor workers having moderate to severe HRI. RESULTS: A total of 320 respondents completed the questionnaire. The mean (standard deviation) outdoor workplace temperature was 30.5°C (SD 0.53°C). The percentage of respondents who experienced moderate to severe HRI was 44.1%. The likelihood that outdoor workers experienced moderate to severe HRI symptoms was associated with irregular fluid intake [odds ratio (OR): 16.11, 95% confidence interval (95%CI): 4.11; 63.20]; consumption of non-plain water (OR: 5.92, 95%CI: 2.79; 12.56); dehydration (OR: 3.32, 95%CI: 1.92; 5.74); and increasing outdoor workplace temperature (OR: 1.85, 95%CI: 1.09; 3.11). CONCLUSION: Irregular drinking pattern and non-plain fluid intake was found to have a large effect on HRI severity among outdoor workers exposed high temperatures during a heat wave phenomenon.

Psychosocial stressors at work and well-being of male employees.

INTRODUCTION: Psychosocial stressors appear to alter the state of mind and adoption of overeating behaviour, resulting in high body mass index. This study was conducted to determine the magnitude of psychosocial stressors on male employees' well-being. METHOD: This study used secondary data retrieved from a cross-sectional study involving 492 male employees' completed data. Eligible participants completed validated questionnaires of the Psychosocial Safety Climate (PSC-12) scale, short version Demand Induced Strain Compensation (DISQ 2.1), Oldenburg Burnout Inventory - Emotional Exhaustion domain and the Three Eating Factor Questionnaire (TEFQ) -Uncontrolled Eating domain; assessing psychosocial safety climate, job demands and job resources, emotional exhaustion, and uncontrolled eating behaviour, respectively. Body mass index (BMI) was calculated based on weight and height. The research statistical model was tested by two-steps of assessment replicating partial least squares structural equation modelling (PLS-SEM). RESULT: The results show that psychosocial stressors (psychosocial safety climate, job demands and job resources) had significant effects on emotional exhaustion (ß= -0.149, p=0.004; ß= 0.223, p<0.001; ß= -0.127, p=0.013). Emotional exhaustion predicted by work stressors may act as a chain reaction which could result in uncontrolled eating (ß=0.138, p=0.005) and high BMI (ß=0.185, p<0.001). Emotional exhaustion does mediate the relationship between PSC and uncontrolled eating behaviour (ß= -0.021 [95% boot CI bias corrected: -0.048, -0.002]). CONCLUSION: The psychosocial stressors at work are significant factors for emotional exhaustion, which further signifies the positive effect on uncontrolled eating behaviour and BMI among Malaysian male employees.

Thirst as the threshold symptom to prevent worsening heat-related illness.

INTRODUCTION: The heat-related illness (HRI) is a continuum illness ranging from minor health effects to life-threatening medical emergencies when the pathological effects of heat load are not prevented. The aim of this study was to demonstrate the threshold HRI symptom for deciding to take simple preventative actions both by the individual workers and employers. METHOD: A total of 328 municipal workers were enrolled in April to March 2016 were asked to recall if they experienced eleven HRI symptoms during the previous work day. Rasch Measurement Model was used to examine the unidimensional parameters and bias for gender before identifying the threshold of HRI symptoms. We determined the threshold symptom based on the person-item map distribution on a logit ruler value. RESULTS: A total of 320 respondents were analysed. The psychometric features HRI symptoms suggested evidence of unidimensionality and free of bias for gender (DIF size =0.57; DIF t value =1.03). Based on the person-item map distribution, the thirst item was determined as the threshold item (Cut-off point = -2.17 logit) for the preventative action purposes to group the person as mild and moderate/severe HRI groups. CONCLUSION: Thirst item is viewed as threshold symptoms between mild and moderate or severe HRI symptoms. It is a reliable symptom to initiate behavioural response to quench the thirst by adequate fluids. Failure to recognise the thirst symptom may lead to devastating unwanted health complications.

Pesticide applicators questionnaire content validation: A fuzzy delphi method.

BACKGROUND: The most crucial step in forming a set of survey questionnaire is deciding the appropriate items in a construct. Retaining irrelevant items and removing important items will certainly mislead the direction of a particular study. This article demonstrates Fuzzy Delphi method as one of the scientific analysis technique to consolidate consensus agreement within a panel of experts pertaining to each item's appropriateness. This method reduces the ambiguity, diversity, and discrepancy of the opinions among the experts hence enhances the quality of the selected items. The main purpose of this study was to obtain experts' consensus on the suitability of the preselected items on the questionnaire. METHODS: The panel consists of sixteen experts from the Occupational and Environmental Health Unit of Ministry of Health, Vector-borne Disease Control Unit of Ministry of Health and Occupational and Safety Health Unit of both public and private universities. A set of questionnaires related to noise and chemical exposure were compiled based on the literature search. There was a total of six constructs with 60 items in which three constructs for knowledge, attitude, and practice of noise exposure and three constructs for knowledge, attitude, and practice of chemical exposure. The validation process replicated recent Fuzzy Delphi method that using a concept of Triangular Fuzzy Numbers and Defuzzification process. RESULTS: A 100% response rate was obtained from all the sixteen experts with an average Likert scoring of four to five. Post FDM analysis, the first prerequisite was fulfilled with a threshold value (d) ≤ 0.2, hence all the six constructs were accepted. For the second prerequisite, three items (21%) from noise-attitude construct and four items (40%) from chemical-practice construct had expert consensus lesser than 75%, which giving rise to about 12% from the total items in the questionnaire. The third prerequisite was used to rank the items within the constructs by calculating the average fuzzy numbers. The seven items which did not fulfill the second prerequisite similarly had lower ranks during the analysis, therefore those items were discarded from the final draft. CONCLUSION: Post FDM analysis, the experts' consensus on the suitability of the pre-selected items on the questionnaire set were obtained, hence it is now ready for further construct validation process.

Psychometric properties of the Malay-translated General Practice Physical Activity Questionnaire among shipyard workers.

BACKGROUND: The General Practice Physical Activity Questionnaire (GPPAQ) is a validated and reliable screening tool to measure the level of physical activity in adults. However, it has never been translated and validated in Malaysian population. This study aimed to translate the GPPAQ into Malay language and to evaluate the psychometric properties of the Malay-translated GPPAQ among shipyard workers. METHODS: The original English version of GPPAQ was translated forward and backward into Malay version by experts. The final version of the Malay-translated GPPAQ was then tested for validity and reliability. A cross-sectional study design was performed and systematic random sampling was used to select respondents. Construct validity and internal consistency of the Malay-translated version were tested using exploratory factor analysis and Cronbach's alpha respectively. RESULTS: Sixty-two male shipyard workers participated in this study. The GPPAQ showed good factor loading values for all items (0.608-0.834). The exploratory principal component factor analysis delineates all seven items into two factors with variance of 41.65%. The Cronbach's alpha value was good with 0.81, 0.84 and 0.76 for total scale, factor 1 and factor 2 respectively. CONCLUSION: The Malay-translated version of GPPAQ has high psychometric properties. Therefore, it is a valid instrument to assess physical activity among Malaysian working population, particularly in male shipyard workers.

Cardiovascular risk assessment between urban and rural population in Malaysia.

INTRODUCTION: Cardiovascular disease (CVD) caused significant burden to Malaysia as it accounted for 36% of total deaths. This study aims to evaluate the burden of cardiovascular risk factors among Malaysian adult and assess the difference between urban and rural population in the selected communities. METHODS: This study is part of the ongoing Prospective Urban Rural Epidemiology (PURE) database, whereby the baseline data were collected since June 2008. CVD risk was measured using INTERHEART risk score which comprised of eleven risk factors i.e. age and gender, family history of heart attack, smoking status, exposure to second hand smoke, diabetes mellitus, hypertension status, waist-hip ratio, self-reported stress, depression, dietary habits and physical activity status. RESULTS: Majority of the studied participants had low cardiovascular risk (57%). Participants from rural area were generally older, had lower educational status, higher prevalence of smokers, obesity, hypertension, diabetes, and more likely to be depressed. In comparison, urbanites had lower physical activities and more likely to be stressful. Mean INTERHEART score among rural participants were higher, especially for male, in comparison to urbanite (11.5±5.83 vs. 10.01±5.74, p<0.001). CONCLUSION: Contradict to common beliefs, participants in rural areas generally have higher cardiovascular risk factors compared to their urban counterparts. The rural population should be targeted for focused preventive interventions, taking account the socioeconomic and cultural context.

A tale of two construct validation analysis: Rasch model and exploratory factor analysis approach for Three-Factor Eating Questionnaire (TFEQ-R21) among Malaysian male workers.

INTRODUCTION: This study aims for construct validation using two approaches, i.e., exploratory factor analysis and Rasch Model. METHODS: A cross sectional of 313 male workers from multiple worksites had completed self-administered Malay translated version of Three-Factor Eating Questionnaire- R21. Data quality was assessed by misfit person criteria, dimensionality, summary statistic, item measure and rating (partial credit) scale followed by exploratory factor analysis and internal consistency reliability assessment. RESULTS: The dual approaches of construct validation analysis were complement to each other. Rasch analysis supported the theoretical constructs of three eating behaviour dimensions among respondents. In contrary to exploratory factor analysis, it did show presence of a newfound factor (∝=0.04) came up from the separation of the cognitive restrain and uncontrolled eating however, the correlation between the two respective sub-factors were fair (r=0.39) and weak (r= -0.08). Both analyses had detected three problematic items but those items were psychometrically fit for used for current study setting. The data had adequate psychometric properties. Cronbach's alpha for cognitive restraint, uncontrolled eating and emotional eating were 0.66, 0.79 and 0.87 respectively. Rating scale quality was conformed to standard criteria. CONCLUSION: Malay version TFEQ-R21 with promising psychometric properties and valid measures for eating behaviour dimensions among male workers aged between 20 to 60 years old is now available. Further development should focus on the items in relation to Malaysian cultural adaptation before its use for daily practice in future setting.

Detrimental effects of bisphenol A on development and functions of the male reproductive system in experimental rats.

Bisphenol A (BPA) is widely used in manufacturing industries. It is commonly detected in the environment and was reported to exert oestrogenic effects which may be harmful to the reproductive system. The present study was carried out to observe the effects of oral administration of BPA on the development of the reproductive organs and plasma sex hormone levels in prepubertal male Sprague-Dawley (SD) rats. Prepubertal male SD rats (n=8 in each group) were administered BPA in the doses of 1, 5, 10 and 100 mg/kg BW (body weight) via oral gavage for a period of 6 weeks. The control animals received the vehicle for BPA (Tween 80 in distilled water). Following 6 weeks of BPA exposure, the rats exhibited less evidence of spermatogenesis. There was seminiferous epithelial damage which included disruption of intercellular junctions and sloughing of germ cells into the seminiferous tubular lumen. Furthermore, the lumina of the seminiferous tubules and the epididymis of these animals were filled with immature germ cells and cellular debris. This damage may lead to the significant reduction in the seminiferous tubular diameter in BPA-treated animals. These findings were associated with the significant lower plasma testosterone and 17ß-oestradiol levels. There was no significant difference between the body weight gain, the absolute as well as relative testis weight or epididymal weight of BPA-treated animals when compared to the control animals. The findings provided further evidence of the detrimental effects of BPA on the male reproductive system.

A Systematic Translation and Cultural Adaptation Process for Three-Factor Eating Questionnaire (TFEQ-R21).

INTRODUCTION: The Three-Factor Eating Questionnaire was first constructed to measure eating behavior in an English population in the United States. It has been validated and translated for various populations in different languages. The aim of this article is to describe a systematic process for translating the questionnaire from English to Malay language. METHODOLOGY: The report of the International Society for Pharmacoeconomics and Outcome Research (ISPOR) Task Force was used as the basis for the systematic translation process. The process began with preparation; followed by forward translation (2 independent translators), reconciliation, back translation (2 independent translators), back translation review, harmonization, cognitive debriefing, review of cognitive debriefing results and finalization, proofreading; and ended with the final report. Four independent Malay translators who fluent in English and reside in Malaysia were involved in the process. A team of health care researchers had assisted the review of the new translated questionnaires. RESULTS: Majority of the TFEQ-R21 items were experiencing, conceptually and semantically equivalence between original English and translated English. However, certain phrase such as "feels like bottomless pit" was difficult to translate by forward translators. Cognitive debriefing was a very helpful process to ensure the TFEQ-R21 Malay version was appropriate in term of wording and culturally accepted. A total of four redundant comments in regards to response scale wording, word confusion and wording arrangement. CONCLUSION: The systematic translation process is a way to reduce the linguistic discrepancies between the English and Malay language in order to promote equivalence and culturally adapted TFEQ-R21 questionnaire.

Modifying antibiotic prescribing: the effectiveness of academic detailing plus information leaflet in a Malaysian primary care setting.

We assessed the effectiveness of an educational intervention in reducing antibiotic prescribing in public primary care clinics in Malaysia. Twenty-nine medical officers in nine clinics received an educational intervention consisting of academic detailing from the resident Family Medicine Specialist, as well as an information leaflet. The antibiotic prescribing rates were assessed for six months - three months before and three months after the intervention. A total of 28,562 prescriptions were analyzed. Among participating doctors, general antibiotic prescribing rates for pre- and post-intervention phases were 14.3% and 11.0% (post-intervention vs pre-intervention RR 0.77, 95% CI 0.72 to 0.83). The URTI-specific antibiotic prescribing rates for pre- and post-intervention phases were 27.7% and 16.6%, respectively (post-intervention vs pre-intervention RR 0.60, 95% CI 0.54 to 0.66). No significant change in antibiotic prescribing rates was observed among primary care practitioners who did not participate in the study. This low cost educational intervention using both active and passive strategies focusing on URTI produced a statistically significant (and clinically important) reduction in antibiotic prescribing.