Respiratory fit test panel representing population of Malaysia.

BACKGROUND: The existing respiratory fit test panels (RFTPs) are based on Bivariate and Principal Component Analysis (PCA) which utilise American and Chinese head and facial dimensions. As RFTPs based on local facial anthropometric data for Malaysia are not available, this study was conducted with the aim to develop new RFTPs using Malaysian data. METHODOLOGY: A cross-sectional study was conducted across Malaysia among 3,324 participants of the study of National Health and Morbidity Survey 2020 aged 18 and above. Ten head and facial dimensions were measured. Face length and face width were used to construct bivariate facial panel, whereas the scores from the first two PCA were used to develop the PCA panel. RESULTS: This study showed that Malaysians have the widest upper limit for facial width. It also found that three factors could be reduced from the PCA analysis. However only 2 factors were selected with PCA 1 representing head and facial size and PCA 2 representing facial shape. Our bivariate panel could accommodate 95.0% of population, while our PCA panel accommodated 95.6%. CONCLUSION: This was the first study to use Malaysian head and facial anthropometry data to create bivariate and PCA panels. Respirators constructed using these panels are likely to fit ≥ 95.0% of Malaysia's population.

Environmental and Occupational Factors Associated with Leptospirosis: A Systematic Review.

Background: Leptospirosis is a neglected emerging zoonotic disease with a profound public health impact worldwide with higher burden of disease in resource-poor countries. The environmental and occupational exposures contribute to human and animal transmission, but the interaction was less explored. A deeper understanding of the critical environmental and occupational drivers in different contexts will provide useful information for disease control and prevention measures. Objective: This review aimed to summarize the potential environmental and occupational risk factors associated with leptospirosis infection. Methods: Four databases (Scopus, Web of Science, Ovid MEDLINE, EBSCOhost) were searched for articles published from 2012 to 2021. Eligible articles were assessed using a checklist for assessing the quality of the studies. The quality of the articles was assessed based on the laboratory diagnosis approach and statistical analysis method. Results: A total of 32 studies were included in this systematic review. Water-related risk factors such as natural water as the primary water source (AOR 1.8-18.28), water-related recreational activities (AOR 2.36-10.45), flood exposure (AOR 1.54-6.04), contact with mud (AOR 1.57-4.58) and stagnant water (AOR 2.79-6.42) were associated with increased risk of leptospirosis. Infrastructural deficiencies such as un-plastered house walls and thatched houses presented a higher risk (AOR 2.71-5.17). Living in low-lying areas (AOR 1.58-3.74), on clay loam soil (OR 2.72), agricultural land (OR 2.09), and near rubber tree plantations (AOR 11.65) is associated with higher risk of leptospirosis. Contact with rats (AOR 1.4-3.5), livestock (AOR 1.3-10.4), and pigs (AOR 1.54-7.9) is associated with an increased risk of leptospirosis. Outdoor workers (AOR 1.95-3.95) and slaughterhouse workers (AOR 5.1-7.5) have higher risk of leptospirosis. Conclusion: The environmental and occupational components related to water, infrastructure, landscape, agriculture, and exposed animals play an essential role in leptospirosis transmission. The magnitude of those risk factors differs with geographical region, climate factor, urbanization and population growth, and the country's socioeconomic status.

The effect of N95 designs on respirator fit and its associations with gender and facial dimensions.

This study examined the association of various brands of NIOSH-certified N95 filtering face-piece respirators (FFR) fit with facial dimensions and gender. One hundred and thirty-five participants (77 females and 58 males) were recruited from the previous facial anthropometry study among Malaysians in 2020. Quantitative respirator fit testing of six FFR were performed using the TSI Portacount Pro+ 8038 which comprised of four exercises (bending over, talking, up-down head movement, and side to side head movement). An overall fit factor (FF) of ≥ 100 was considered a pass for each FFR. Analysis was done using T-test, Pearson's correlations, and generalised linear regression. The passing rates for the six FFR were 36.3% (Cup B), 50.4% (Trifold A), 54.1% (Duckbill A), 57.0% (Cup A), 74.1% (Trifold B), and 83.7% (Duckbill B). Both Duckbill B and Trifold B had the highest passing rates for both genders. However, certain FFR models (Cup B, Trifold A, Trifold B, and Duckbill A) fit better for participants with large facial size who were mostly males, while others (Cup A and Duckbill B) specifically fit better for those with small facial size, who were mostly females. This study showed significant positive effect of nose protrusion, nasal root and subnasale-sellion and the negative effect of menton-sellion, bigonial breadth and nose breadth on fit factors of various FFR. The results of this study emphasized the importance of choosing and designing FFR based on local anthropometry data, with careful consideration on the dimensions that affect the respirator fit. Since N95 are commonly used in the healthcare settings to prevent airborne transmission, the practice of respirator fit testing and selecting N95 with high passing rates for healthcare workers need to be emphasized.

Droplet digital PCR application for the detection of SARS-CoV-2 in air sample.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may transmit through airborne route particularly when the aerosol particles remain in enclosed spaces with inadequate ventilation. There has been no standard recommended method of determining the virus in air due to limitations in pre-analytical and technical aspects. Furthermore, the presence of low virus loads in air samples could result in false negatives. Our study aims to explore the feasibility of detecting SARS-CoV-2 ribonucleic acid (RNA) in air samples using droplet digital polymerase chain reaction (ddPCR). Active and passive air sampling was conducted between December 2021 and February 2022 with the presence of COVID-19 confirmed cases in two hospitals and a quarantine center in Klang Valley, Malaysia. SARS-CoV-2 RNA in air was detected and quantified using ddPCR and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The comparability of two different digital PCR platforms (QX200 and QIAcuity) to RT-PCR were also investigated. Additionally negative staining transmission electron microscopy was performed to visualize virus ultrastructure. Detection rates of SARS-CoV-2 in air samples using ddPCR were higher compared to RT-PCR, which were 15.2% (22/145) and 3.4% (5/145), respectively. The sensitivity and specificity of ddPCR was 100 and 87%, respectively. After excluding 17 negative samples (50%) by both QX200 and QIAcuity, 15% samples (5/34) were found to be positive both ddPCR and dPCR. There were 23.5% (8/34) samples that were detected positive by ddPCR but negative by dPCR. In contrast, there were 11.7% (4/34) samples that were detected positive by dPCR but negative by ddPCR. The SARS-CoV-2 detection method by ddPCR is precise and has a high sensitivity for viral RNA detection. It could provide advances in determining low viral titter in air samples to reduce false negative reports, which could complement detection by RT-PCR.

The Impact of Heat Waves on Health Care Services in Low- or Middle-Income Countries: Protocol for a Systematic Review.

BACKGROUND: Heat waves significantly impact ecosystems and human health, especially that of vulnerable populations, and are associated with increased morbidity and mortality. Besides being directly related to climate-sensitive health outcomes, heat waves have indirectly increased the burden on our health care systems. Although the existing literature examines the impact of heat waves and morbidity, past research has mostly been conducted in high-income countries (HICs), and studies on the impact of heat waves on morbidity in low- or middle-income countries (LMICs) are still scarce. OBJECTIVE: This paper presents the protocol for a systematic review that aims to provide evidence of the impact of heat waves on health care services in LMICs. METHODS: We will identify peer-reviewed studies from 3 online databases, including the Web of Science, PubMed, and SCOPUS, published from January 2002 to April 2023, using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Quality assessment will be conducted using the Navigation Guide checklist. Key search terms include heatwaves, extreme heat, hospitalization, outpatient visit, burden, health services, and morbidity. RESULTS: This systematic review will provide insight into the impact of heat waves on health care services in LMICs, especially on emergency department visits, ambulance call-outs, hospital admissions, outpatient department visits, in-hospital mortality, and health care operational costs. CONCLUSIONS: The results of this review are anticipated to help policymakers and key stakeholders obtain a better understanding of the impact of heat waves on health care services and prioritize investments to mitigate the effects of heat waves in LMICs. This entails creating a comprehensive heat wave plan and ensuring that adequate infrastructure, capacity, and human resources are allocated in the health care sector. These measures will undoubtedly contribute to the development of resilience in health care systems and hence protect the health and well-being of individuals and communities. TRIAL REGISTRATION: PROSPERO CRD42022365471; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=365471. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44702.

Assessing Mental Health Outcomes in Quarantine Centres: A Cross-Sectional Study during COVID-19 in Malaysia.

During the COVID-19 pandemic, persons under surveillance (PUS) were isolated in quarantine centres instead of at home. However, there is limited knowledge regarding the mental health issues experienced by these persons. This study aimed to assess mental health outcomes and associated factors among PUS and frontline workers at quarantine centres. This study conducted an analysis of secondary data from a cross-sectional survey carried out by the Mental Health and Psychosocial Support Services (MHPSS). The MHPSS employed the Depression, Anxiety, and Stress Scale (DASS-21) to evaluate mental health outcomes across 49 quarantine centres in Malaysia. The study included a total of 4577 respondents. The prevalence of stress, anxiety, and depression was found to be 0.9%, 11.4%, and 10.2%, respectively. Frontline workers and being part of the younger age group were found to be associated with depression, anxiety, and stress. Other factors associated with mental health issues were being female, staying at an institution-type centre, and a longer duration of the stay or work at the centre. In conclusion, assessing the mental health status and its associated factors among quarantine centre occupants is crucial for developing future strategies to safeguard their mental well-being.

Concerns, perceived impact, practices, preventive measures, and stress among healthcare workers during COVID-19 pandemic in Malaysia.

Introduction: Healthcare workers (HCWs) have been continually exposed to patients with COVID-19 and are at higher risk of contracting the disease. Their psychological health is important for overall wellbeing and productivity, which could lead to a reduction in human errors during the pandemic crisis. This study aimed to measure the level of concerns, work practices, adequacy of preventive measures among HCWs, and the impacts on their life and work, including mental health status during the second wave of the COVID-19 pandemic in Malaysia. Methods: An online questionnaire was distributed randomly to 1,050 HCWs from the Ministry of Health facilities in the Klang Valley who were involved directly in managing or screening COVID-19 cases from May to August 2020. The questionnaire was divided into five domains, which were concerns, impact on life and work, practice, perceived adequacy of preventive measures, and Revised Impact of Event Scale (IES-R). Logistic regression was used to identify sociodemographic predictors of the five domains. Results: A total of 907 respondents (86.4%) participated in this survey. Approximately half of the respondents had a low concern (50.5%), most of them had a good practice (85.1%), with 67.5% perceiving there were adequate preventive measures, and they perceived the outbreak had a low impact (92%) on their life and work. From the IES-R domain, 18.6% of respondents potentially suffered from post-traumatic stress disorder (PTSD). Conclusion: During the second wave of the COVID-19 outbreak in Malaysia, HCWs practiced high levels of precautions and preventive measures because they were aware of the risk of infection as an occupational hazard. With the adequate implementation of policy and control measures, the psychological wellbeing of the majority HCWs remained well and adequately supported.

The Impact of Heatwaves on Mortality and Morbidity and the Associated Vulnerability Factors: A Systematic Review.

BACKGROUND: This study aims to investigate the current impacts of extreme temperature and heatwaves on human health in terms of both mortality and morbidity. This systematic review analyzed the impact of heatwaves on mortality, morbidity, and the associated vulnerability factors, focusing on the sensitivity component. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. Four databases (Scopus, Web of Science, EBSCOhost, PubMed) were searched for articles published from 2012 to 2022. Those eligible were evaluated using the Navigation Guide Systematic Review framework. RESULTS: A total of 32 articles were included in the systematic review. Heatwave events increased mortality and morbidity incidence. Sociodemographic (elderly, children, male, female, low socioeconomic, low education), medical conditions (cardiopulmonary diseases, renal disease, diabetes, mental disease), and rural areas were crucial vulnerability factors. CONCLUSIONS: While mortality and morbidity are critical aspects for measuring the impact of heatwaves on human health, the sensitivity in the context of sociodemographic, medical conditions, and locality posed a higher vulnerability to certain groups. Therefore, further research on climate change and health impacts on vulnerability may help stakeholders strategize effective plans to reduce the effect of heatwaves.

Head and face anthropometric study for respirators in the multi-ethnic Asian population of Malaysia.

Background: Existing anthropometric studies for respirator designs are based on the head and facial dimensions of Americans and Chinese nationals, with no studies for multi-ethnic countries like Malaysia. This study aimed to create head and facial morphological database for Malaysia, specifically to identify morphological differences between genders, ethnicities, and birthplaces, as well as predictors of the dimensions. Design: A cross-sectional study. Setting: Malaysia. Participants: A nation-wide cross-sectional study using a complex survey design with two stage-stratified random sampling was conducted among 3,324 participants, aged 18 years and above who were also participants of the National Health and Morbidity Survey 2020. Primary and secondary outcomes: The study collected data on sociodemographic, measurement of Body Mass Index (BMI) and 10 head and facial dimensions (3 dimensions were measured using direct measurement, and 7 others using Digimizer software for 2-dimension images). Linear regression was performed to determine the association between gender, ethnicity, birthplace, age and BMI and the dimensions. Results: There were significant differences in all the dimensions between sex, birthplace and ethnicity (p < 0.005). Further analysis using linear regression showed sex, ethnicity, birthplace, age and BMI were significant predictors of the dimensions. In comparison to studies from the United States and China, our study population had a wider interpupillary distance and nose breadth for both male and female participants, but smaller bigonial breadth and smaller minimal frontal breadth. Conclusion: These findings could assist in the design and sizing of respirators that will fit Malaysians and possibly other Southeast Asian population.

Compliance to Infection Prevention and Control Practices Among Healthcare Workers During COVID-19 Pandemic in Malaysia.

Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as "always, as recommended" during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07-9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36-168.44), health attendant (AOR = 4.42; 95% CI = 1.74-11.24), and others (AOR = 3.63; 95% CI = 1.1-12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28-17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08-3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.

An ecological study of the relationship between urban built environment and cardiovascular hospital admissions (2004-2016) in an Asian developing country.

This study aims to evaluate the relationship between urban built environment and hospital admissions from cardiovascular diseases in Kuala Lumpur, Malaysia. Hospital admission data from 2004 to 2016 for cardiovascular diseases were used with patient residential postcodes as the unit of analysis. Data was split into 2004-2009 (12,551 cases) and 2010-2016 (17,154 cases) periods corresponding to land use data. We used generalized linear mixed model to analyse population density, property value, entropy index, and the kernel density (800 m) of specific land use, bus and rail stations, and road junctions, with time period and postcodes as the random effects to generate incidence rate ratios (IRRs). Results indicated that entropy index and recreational area density were associated with fewer hypertensive disease and ischemic heart disease hospital admissions (IRR range: 0.49-0.68, 95%CI: 0.27, 0.97). Population density and property value were associated with fewer cerebrovascular disease hospital admissions (IRR range: 0.29-0.34, 95%CI: 0.11, 0.75). Contrarily, density of road junctions was associated with 2.5-6.3 times more hospital admissions for cardiovascular disease hospital admissions (IRR range: 2.53-6.34, 95%CI: 1.07,17.91). There were no significant association between hospital admission and density of residential area, undeveloped land, rail and bus stations. The shapes of relationships for all attributes were non-linear, and changed markedly at the third quartile except for recreational area density. The findings suggest that land use attributes have some protective effects on the cardiovascular disease admission cases as compared to the transport attributes. These findings have important merits for integrating health into urban planning.

Leptospirosis Outbreak After the 2014 Major Flooding Event in Kelantan, Malaysia: A Spatial-Temporal Analysis.

Severe floods increase the risk of leptospirosis outbreaks in endemic areas. This study determines the spatial-temporal distribution of leptospirosis in relation to environmental factors after a major flooding event in Kelantan, Malaysia. We conducted an observational ecological study involving incident leptospirosis cases, from the 3 months before, during, and three months after flood, in reference to the severe 2014 Kelantan flooding event. Geographical information system was used to determine the spatial distribution while climatic factors that influenced the cases were also analyzed. A total of 1,229 leptospirosis cases were notified within the three study periods where incidence doubled in the postflood period. Twelve of 66 subdistricts recorded incidence rates of over 100 per 100,000 population in the postflood period, in comparison with only four subdistricts in the preflooding period. Average nearest neighborhood analysis indicated that the cases were more clustered in the postflood period as compared with the preflood period, with observed mean distance of 1,139 meters and 1,666 meters, respectively (both at P < 0.01). Global Moran's I was higher in the postflood period (0.19; P < 0.01) as compared with the preflood period (0.06; P < 0.01). Geographic weighted regression showed that living close to water bodies increased the risk of contracting the disease. Postflooding hotspots were concentrated in areas where garbage cleanup occurred and the incidence was significantly associated with temperature, humidity, rainfall, and river levels. Postflooding leptospirosis outbreak was associated with several factors. Understanding the spatial distribution and associated factors of leptospirosis can help improve future disease outbreak management after the floods.

Understanding Dieting and Previous Weight Loss Attempts among Overweight and Obese Participants: Insights into My Body Is Fit and Fabulous at Work Program.

BACKGROUND: A qualitative study providing an in-depth exploration of people's view and the increasing burden of overweight and obesity is required. This study aimed to explore the understanding of dieting and previous experiences on weight loss attempts among overweight and obese government employees in Kelantan, Malaysia, prior to recruitment into the intervention program. METHODS: Thirteen focus group discussions involving 129 participants from a weight-loss intervention program were conducted within the first 1 month of recruitment. These discussions were moderated by two trained researchers in the Malay language and assisted by an interview guide. They were audio-recorded and transcribed verbatim. A thematic analysis was performed, and codes and themes from each discussion were constructed. RESULTS: The participants understood dieting with various meanings, including skipping meals and removing rice from daily diets. They applied numerous methods to lose weight and achieved various outcomes. Health and appearance, social support, and compliance with current trends were the factors motivating these participants to lose weight. Their determination to lose weight was limited by lack of self-control and motivation, experiences of unpleasant effects, influence on weight, and environmental and health factors. CONCLUSION: Real-life weight loss experiences and perceptions provided relevant insights into current weight loss management strategies. Some of these issues and misunderstandings should be emphasized in weight loss strategies during health promotion.