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.

A priority list of environmental health issues for Malaysia.

OBJECTIVES: Environmental risk factors contribute to 24% of the global burden of disease from all causes in disability-adjusted life years (DALYs), and to 23% of all global deaths. Malaysia being an advanced developing country, there is a need to prioritise environmental health issues to enable environmental health practitioners to focus on the most significant and urgent environmental health concerns. CONTENT: This project was undertaken by a Thematic Working Group on Environmental Health Experts (TWG 10) under the Malaysian National Environmental Health Action Plan. Sixteen pre-selected environmental health issues were presented to a two focus group discussions among 20 environmental health and related professionals who then scored each issue on its magnitude and severity scale. SUMMARY: The total of these scores generated a list of priority environmental health issues for Malaysia. Children environmental health came out as the environmental health issue of the highest priority. OUTLOOK: We hope that this list of priority environmental health issues will be used for prioritising academic and professional manpower training, research funding allocation and planning for intervention programmes by various stakeholders.

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.

Evaluation of the Relationship between Fractional Exhaled Nitric Oxide (FeNO) with Indoor PM10, PM2.5 and NO2 in Suburban and Urban Schools.

Numerous epidemiological studies have evaluated the association of fractional exhaled nitric oxide (FeNO) and indoor air pollutants, but limited information available of the risks between schools located in suburban and urban areas. We therefore investigated the association of FeNO levels with indoor particulate matter (PM10 and PM2.5), and nitrogen dioxide (NO2) exposure in suburban and urban school areas. A comparative cross-sectional study was undertaken among secondary school students in eight schools located in the suburban and urban areas in the district of Hulu Langat, Selangor, Malaysia. A total of 470 school children (aged 14 years old) were randomly selected, their FeNO levels were measured, and allergic skin prick tests were conducted. The PM2.5, PM10, NO2, and carbon dioxide (CO2), temperature, and relative humidity were measured inside the classrooms. We found that the median of FeNO in the school children from urban areas (22.0 ppb, IQR = 32.0) were slightly higher as compared to the suburban group (19.5 ppb, IQR = 24.0). After adjustment of potential confounders, the two-level hierarchical multiple logistic regression models showed that the concentrations of PM2.5 were significantly associated with elevated of FeNO (>20 ppb) in school children from suburban (OR = 1.42, 95% CI = 1.17−1.72) and urban (OR = 1.30, 95% CI = 1.10−1.91) areas. Despite the concentrations of NO2 being below the local and international recommendation guidelines, NO2 was found to be significantly associated with the elevated FeNO levels among school children from suburban areas (OR = 1.11, 95% CI = 1.06−1.17). The findings of this study support the evidence of indoor pollutants in the school micro-environment associated with FeNO levels among school children from suburban and urban areas.

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.

Cost analysis of facial injury treatment in two university hospitals in Malaysia: a prospective study.

OBJECTIVE: Facial injury (FI) may occur in isolation or in association with injuries to other parts of the body (facial and other injury [FOI]). The objective of this study was to determine the direct treatment costs incurred during the management of facial trauma. MATERIALS AND METHODS: A prospective cohort study on treatment cost for FIs and FOIs due to road-traffic crashes in two university hospitals in Malaysia was conducted from July 2010 to June 2011. The patients were recruited from emergency departments and reviewed after 6 months from the date of initial treatment. Direct cost analysis, comparison of cost and length of hospital stay, and Injury Severity Score (ISS) were performed. RESULTS: A total of 190 patients were enrolled in the study, of whom 83 (43.7%) had FI only, and 107 (56.3%) had FOI. The mean ISS was 5.4. The mean length of stay and costs for patients with FI only were 5.8 days with a total cost of US$1,261.96, whereas patients with FOI were admitted for 7.8 days with a total cost of US$1,716.47. Costs doubled if the treatment was performed under general anesthesia compared to local anesthesia. CONCLUSION: Treatment of FI and FOI imposes a financial burden on the health care system in Malaysia.

Potential Health Impacts of Bauxite Mining in Kuantan.

Bauxite mining is not known to most Malaysian except recently due to environmental pollution issues in Kuantan, Pahang. Potential impacts are expected to go beyond physical environment and physical illness if the situation is not controlled. Loss of economic potentials, and the presence of unpleasant red dust causing mental distress, anger and community outrage. More studies are needed to associate it with chronic physical illness. While evidences are vital for action, merely waiting for a disease to occur is a sign of failure in prevention. All responsible agencies should focus on a wider aspect of health determinants rather than merely on the occurrence of diseases to act and the need to emphasize on sustainable mining to ensure health of people is not compromised.

Fatigue-related crashes involving express buses in Malaysia: will the proposed policy of banning the early-hour operation reduce fatigue-related crashes and benefit overall road safety?

Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia.

Analysis of factors associated with seatbelt wearing among rear passengers in Malaysia.

A cross-sectional survey using a self-administered questionnaire was conducted among 793 rear passengers in Malaysia. Logistic regression was performed to analyse the association of rear seatbelt wearing with 12 independent variables. Seven factors were significantly associated with rear seatbelt wearing. Experience of being stopped by an enforcement officer for not wearing rear seatbelt yielded the highest odds ratio 2.3 (p = 0.002) followed by self-consciousness (odds ratio 1.7; p = 0.004), attitude (odds ratio 1.5, p = 0.001), and knowledge (odds ratio 1.4, p = 0.004). Age of participants and their perception of being caught by an enforcement officer were also significantly associated with rear seatbelt wearing, odds ratios were 1.03 (p = 0.004) and 1.1 (p = 0.004), respectively. In contrast, level of education was negatively associated with rear seatbelt wearing (odds ratio 0.59, p = 0.003). It was concluded that enforcement activities, knowledge and attitude on seatbelt wearing play a very important role in improving the rate of rear seatbelt wearing. Thus, efforts to increase these factors should be the special focus in designing education and social marketing activities to advocate rear seatbelt wearing.

Obstructive sleep apnea among express bus drivers in Malaysia: important indicators for screening.

OBJECTIVES: Obstructive sleep apnea (OSA) has been identified as one of the significant risk factors for motor vehicle crashes (MVCs). In the interest of public safety, this study was conducted to determine the prevalence of OSA and its associated factors among express bus drivers in Malaysia. Identifying factors or conditions related with OSA is very important because they can be used as indicators to subject a person to a confirmatory diagnosis using polysomnography testing. METHODS: Two hundred eighty-nine randomly selected express bus drivers from 5 express bus companies participated in the study. Information on demography, medical history, clinical symptoms, and signs of OSA were collected by a designated medical officer and the diagnosis of OSA was done based on the Apnea Hypopnoea Index (AHI) from polysomnography testing. RESULTS: Based on AHI, 128 (44.3%) subjects were diagnosed as having OSA with 83 (28.7%), 26 (9.0%), and 26 (6.6%) classified as mild, moderate, and severe OSA, respectively. Multiple logistic regression analysis results showed that age (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.01-1.09), snoring (OR = 3.54, 95% CI 1.91-6.57), body mass index (BMI; OR = 1.17, 95% CI 1.09-1.25), hypertension (OR = 1.87, 95% CI 1.02-3.40), and neck circumference (OR = 1.31, 95% CI 1.18-1.46) were significantly associated with OSA status. CONCLUSIONS: The results supported the need for identifying the risk group for OSA among express bus drivers and the need to diagnose them early for an early intervention.

Effects of very low blood lead levels on neurobehavioral performances of male policemen in kota bharu, kelantan.

Many published studies that examined the effect of lead exposure on neurobehavioral performances were conducted in confined manufacturing environment with low to moderate blood lead levels as a marker of exposure. This study was conducted in a general environmental setting with very low exposure intensity and blood lead levels. The objective of the study was to determine the effect of very low blood lead levels (below 10 µg/dl) on the neurobehavioral performances of policemen in Kota Bharu, Kelantan. The study, conducted between August 25(th) and October 20(th) 2001, was cross-sectional in design and comprised of 89 policemen working in Kota Bharu district. The lead concentration of venous blood was determined using graphite furnace absorption spectrometer. We assessed neurobehavioral performances using the WHO Neurobehavioral Core Test Battery (NCTB). The mean blood lead concentration was 2.5 + 1.0 mg/dl. Among the seven tests performed, the positive effect of blood lead on Benton visual retention was not significant after controlling for the confounding effect of smoke-dose. This study suggested that very low blood lead levels have no significant effects on the neurobehavioral performances. Therefore, more studies with blood lead levels below the recommended environmental limit of 10 mg/dl, as recommended by Centers for Disease Control (CDC), be conducted in order to justify that limit.