Influence of gender and oral health knowledge on DMFT index: a cross sectional study among school children in Kaski District, Nepal.

BACKGROUND: Oral health problems are highly prevalent among school children in Nepal. Poor oral health condition may be influenced by various factors. However, little is known about the sociodemographic and awareness related factors on oral health problems among school children in Nepal. Therefore, this study aimed to assess the association of gender and knowledge on DMFT index among school children. METHODS: A cross-sectional study was conducted among school children of Grade Seven in 12 schools of Kaski district in Nepal. Schools were randomly selected from the urban and semi-urban areas in the district. Data were collected covering oral health knowledge, socio-demographic characteristics, oral health condition and practices. The factors of poor oral health condition and practices were examined using t-test, one-way ANOVA, and multiple linear regression. RESULTS: Of the total participants (n = 669), 54.9% were females and their mean DMFT score was 1.82 (SD = 1.07). Total decayed score was higher among those who did not have knowledge that fluoride prevents decay compared to those who had knowledge about it (Being aware of fluoride prevents decay: Mean = 1.21 (SD = 1.54) versus not being aware of that: mean = 2.13 (SD = 2.13); p = 0.029). Females were more likely to have higher DMFT scores compared to males (ß-coefficient = 0.43, 95% CI 0.13, 0.73, p = 0.005). In addition, higher knowledge score was negatively associated with higher DMFT score (ß-coefficient = - 0.09, 95% CI - 0.20, -0.01, p = 0.047). CONCLUSION: Being female students and those having lower level of knowledge on oral health attributed to higher DMFT index. Periodic dental check-up coupled with oral health education on regular brushing, use of fluoridated paste, tongue cleaning and care of gum diseases are recommended in schools.

Time Taken for Symptom Recognition, First Consultation, Diagnosis and First Definitive Treatment and Its Associated Factors among Women with Breast Cancer.

BACKGROUND: Breast cancer patients in Malaysia often present late, delaying diagnosis and treatment. Decisions on health-seeking behaviour are influenced by a complex interplay of several factors. Early detection and subsequent successful treatment are the main goal in order to reduce breast cancer mortality. The aims of this study were to identify the time taken by women with breast cancer for consultation, diagnosis and first definitive treatment and the factors associated with the initiation of definitive treatment. METHODS: In this cohort study, we interviewed 328 women with histologically confirmed breast cancer at five medical centres in Malaysia. Times were measured from recognition of symptoms to first consultation to diagnosis and to the first definitive treatment. The event was initiation of definitive treatment. Data was analysed using multivariable Cox proportional hazards regression. RESULTS: The mean age was 47.9 (standard deviation 9.4) years and 79.9% were ethnic Malays. The median follow-up time was 6.9 months. The median times for first doctor consultation, diagnosis and initiation of treatment were 2 months, 5.5 months and 2.4 weeks, respectively. The percentage of consultation delay more than a month was 66.8%, diagnosis delay more than three months was 73.2% and treatment delay more than one month was 11.6%. Factors associated with not initiating the definitive treatment were pregnancy (adjusted hazard ratio (AHR) 1.75; 95% Confidence Interval (CI): 1.07, 2.88), taking complementary alternative medicine (AHR 1.45; 95% CI: 1.15, 1.83), initial refusal of mastectomy (AHR 3.49; 95% CI: 2.38, 5.13) and undergoing lumpectomy prior to definitive treatment (AHR 1.62; 95% CI: 1.16, 2.28). CONCLUSIONS: Delays in diagnosis and consultation were more serious than treatment delays. Most respondents would accept treatment immediately after diagnosis. Respondents themselves were responsible for a large proportion of the delays. This study was successful in understanding the process of breast cancer patients' experience, from symptoms recognition to consultation, diagnosis and treatment.

Lower back pain and its association with whole-body vibration and manual materials handling among commercial drivers in Sabah.

A cross-sectional study was undertaken to determine the prevalence of lower back pain (LBP) and its association with whole-body vibration (WBV) and manual materials handling (MMH). We studied 110 commercial vehicle drivers using a self-administered questionnaire and the VI-400Pro human vibration monitor. Prevalence of LBP was 66.4%. The percentage of drivers who had frequent manual handling of heavy loads was 45.5% and those who handled heavy loads in awkward postures accounted for 86.4%. Daily vibration A(8) averaged on the z axis was 0.25 (0.06) m·s-2 and at vector sum was 0.29 (0.07) m·s-2. Daily vibration exposures on the z axis, frequent manual handling of heavy loads and awkward posture during MMH were significantly associated with LBP. Drivers who are exposed to WBV and frequently handle heavy loads manually and with awkward postures probably have more LBP than drivers who are exposed to only one of these risk factors.

Pesticides Exposure and Cardiovascular Hemodynamic Parameters Among Male Workers Involved in Mosquito Control in East Coast of Malaysia.

BACKGROUND: Research findings have linked exposure to pesticides to an increased risk of cardiovascular (CVS) diseases. Therefore, this study aimed to assess the impact of chronic mix-pesticides exposure on CVS hemodynamic parameters. METHODS: A total of 198 male Malay pesticide-exposed and 195 male Malay nonexposed workers were examined. Data were collected through exposure-matrix assessment, questionnaire, blood analyses, and CVS assessment. Explanatory variables comprised of lipid profiles, paraoxonase 1 (PON1), and oxidized low-density lipoprotein (ox-LDL). Outcome measures comprised of brachial and aortic diastolic blood pressure (DBP) and systolic BP (SBP), heart rate, and pulse wave velocity (PWV). Linear regressions identified the B coefficient showing how many units of CVS parameters are associated with each unit of covariates. RESULTS: Diazoxonase was significantly lower and ox-LDL was higher among pesticide-exposed workers than the comparison group. The final multivariate linear regression model revealed that age, body mass index (BMI), smoking, and pesticide exposure were independent predictors of brachial and aortic DBP and SBP. Pesticide exposure was also associated with heart rate, but not with PWV. Lipid profiles, PON1 enzymes, and ox-LDL showed no association with any of the CVS parameters. CONCLUSIONS: Chronic mix-pesticide exposure among workers involved in mosquito control has possible association with depression of diazoxonase and the increase in ox-LDL, brachial and aortic DBP and SBP, and heart rate. This study raises concerns that those using pesticides may be exposed to hitherto unrecognized CVS risks among others. If this is confirmed by further studies, greater efforts will be needed to protect these workers.

The Malay Version of the Perceived Stress Scale (PSS)-10 is a Reliable and Valid Measure for Stress among Nurses in Malaysia.

BACKGROUND: The Perceived Stress Scale-10 (PSS-10) is widely used to assess stress perception. The aim of this study was to translate the original PSS-10 into Malay and assess the reliability and validity of the Malay version among nurses. METHODS: The Malay version of the PSS-10 was distributed among 229 nurses from four government hospitals in Selangor State. Test-retest reliability and concurrent validity was conducted with 25 nurses with the Malay version of the Depression Anxiety Stress Scales (DASS) 21. Cronbach's alpha, confirmatory factor analysis (CFA), intraclass correlation coefficient and Pearson's r correlation coefficient were used to determine the psychometric properties of the Malay PSS-10. RESULTS: Two factor components were yielded through exploratory factor analysis with eigenvalues of 3.37 and 2.10, respectively. Both of the factors accounted for 54.6% of the variance. CFA yielded a two-factor structure with satisfactory goodness-of-fit indices [x2/df = 2.43; comparative fit index (CFI) = 0.92, goodness-of-fit Index (GFI) = 0.94; standardised root mean square residual (SRMR) = 0.07 and root mean square error of approximation (RMSEA) = 0.08 (90% CI = 0.07-0.09)]. The Cronbach's alpha coefficient for the total items was 0.63 (0.82 for factor 1 and 0.72 for factor 2). The intraclass correlation coefficient (ICC) was 0.81 (95% CI: 0.62-0.91) for test-retest reliability testing after seven days. The total score and the negative component of the PSS-10 correlated significantly with the stress component of the DASS-21: (r = 0.61, P < 0.001) and (r = 0.56, P < 0.004), respectively. CONCLUSION: The Malay version of the PSS-10 demonstrated a satisfactory level of validity and reliability to assess stress perception. Therefore, this questionnaire is valid in assessing stress perception among nurses in Malaysia.

Emotional burnout, perceived sources of job stress, professional fulfillment, and engagement among medical residents in Malaysia.

This study was the first to explore factors associated with emotional burnout (EB) among medical residents in Malaysia. A cross-sectional study was conducted in a universal sample of 205 medical residents in a Malaysian general hospital. The self-administered questionnaire used consisted of questions on sociodemographics and work characteristics, sources of job stress, professional fulfillment, engagement, and EB. EB was measured using the emotional exhaustion subscale, the Maslach Burnout Inventory (MBI). Mean (±SD) age of the respondents was 26.5 (±1.6). The most common source of job stress was "fear of making mistakes." Most of the participants were dissatisfied with the increase of residentship period from one year to two years. A high level of EB was reported by 36.6% of the respondents. In multivariate analysis, the most important correlates of EB were sources of job stress, professional fulfillment, and engagement. A high prevalence of EB was found among medical residents. Sociodemographic characteristics, performance pressure, and satisfaction with policies were significantly associated with EB. Although this study was limited by its cross-sectional design, its findings posit a sufficient foundation to relevant authorities to construct, amend, and amalgamate existing and future policies. Nothing will sustain you more potently than the power to recognize in your humdrum routine, as perhaps it may be thought, the true poetry of life-the poetry of the common place, of the common man, of the plain, toil-worn woman, with their loves and their joys, their sorrows and their grief.SirWilliam Osler, Aphorisms from the Student Life (Aequanimitas, 1952).

Understanding barriers to Malaysian women with breast cancer seeking help.

Delay in help-seeking behaviour which is potentially preventable has a major effect on the prognosis and survival of patients with breast cancer. The objective of this study was to explore reasons for delay in seeking help among patients with breast cancer from the East Coast of peninsular Malaysia. A qualitative study using face- to-face in-depth interview was carried out involving 12 breast cancer patients who had been histo-pathologically confirmed and were symptomatic on presentation. Respondents were selected purposely based on their history of delayed consultation, diagnosis or treatment. All were of Malay ethnicity and the age range was 26-67 years. Three were in stage ll, seven in stage lll and two in stage lV. At the time of interview, all except one respondent had accepted treatment. The range of consultation time was 0.2-72.2 months with a median of 1.7 months, diagnosis time was 1.4-95.8 months( median 5.4 months )and treatment time was 0-33.3 months (median 1.2 months). The themes derived from the study were poor knowledge or awareness of breast cancer, fear of cancer consequences, beliefs in complementary alternative medicine, sanction by others, other priorities, denial of disease, attitude of wait and see and health care system weakness. Help-seeking behaviour was influenced by a complex interaction of cognitive, environmental, beliefs, culture and psycho-social factors. Breast cancer awareness and psychological counselling are recommended for all patients with breast symptoms to prevent delay in seeking clinical help.

Factor Structure and Reliability of the Malay Version of the Perceived Stress Scale among Malaysian Medical Students.

BACKGROUND: The Perceived Stress Scale 10 (PSS-10) is a validated and reliable instrument to measure global levels of perceived stress. This study aims to assess the internal consistency, reliability, and factor structure of the Malay version of the PSS-10 for use among medical students. METHODS: The original English version of the PSS-10 was translated and back-translated into Malay language. The Malay version was distributed to 242 Bachelor of Medical Science students in a private university in Malaysia. Test-retest reliability was assessed in 70 students. An exploratory principal component factor analysis with varimax rotation was performed. Reliability was tested using the intraclass correlation coefficient (ICC). RESULTS: All 242 students participated in the initial questionnaire study (validity and factor structure), and 70 students participated in the test-retest reliability of the study. Exploratory factor analysis yielded 2 factors that accounted for 57.8% of the variance. Cronbach's alpha coefficients for the 2 factors were 0.85 and 0.70, respectively. The reliability test showed an ICC of 0.82 (95% CI: 0.70, 0.89). CONCLUSION: The Malay version of the PSS-10 showed adequate psychometric properties. It is a useful instrument for measuring stress among medical students in Malaysia.

Stress and coping strategies of students in a medical faculty in malaysia.

BACKGROUND: Stress may affect students' health and their academic performance. Coping strategies are specific efforts that individuals employ to manage stress. This study aimed to assess the perception of stress among medical students and their coping strategies. METHODS: A cross-sectional study was conducted among 376 medical and medical sciences undergraduates in Management and Science University in Malaysia. Stress was assessed by a global rating of stress. Sources of stress were assessed using a 17-item questionnaire. The validated Brief COPE inventory was used to assess coping strategies. RESULTS: The majority of respondents were females (64.4%), aged 21 years or older (63.0%), and were Malays (68.9%). Forty-six percent felt stress. The most common stressor was worries of the future (71.0%), followed by financial difficulties (68.6%). Significant predictors of stress were smoking (OR = 2.9, 95% CI 1.3-6.8, P = 0.009), worries of the future (OR = 2.1, 95% CI 1.3-3.4, P = 0.005), self-blame (OR = 1.3, 95% CI 1.1-1.5, P = 0.001), lack of emotional support (OR = 0.8, 95% CI 0.7-0.9, P = 0.017), and lack of acceptance (OR = 0.8, 95% CI 0.6-0.9, P = 0.010). Students used active coping, religious coping reframing, planning, and acceptance to cope with stress. CONCLUSION: Stressors reported by the students were mainly financial and academic issues. Students adopted active coping strategies rather than avoidance. Students should receive consultation on how to manage and cope with stress.

Prevalence and risk factors of latent tuberculosis infection among health care workers in Malaysia.

BACKGROUND: Health care workers are exposed to patients with tuberculosis and are at risk of nosocomial infection. The aim of this study was to determine the prevalence and factors associated with latent tuberculosis infection among health care workers in Malaysia and also to evaluate the agreement between Quantiferon TB Gold in tube test with Tuberculin Skin Test. METHODS: A cross sectional study was conducted at four randomly selected hospitals in the Klang Valley from December 2008 to May 2009. Self administered questionnaire was used to obtain information on health care workers and possible risk factors. The response rate for this study was 90.8% with 954 respondents completed the questionnaire and were tested with Quantiferon TB Gold in tube for latent tuberculosis infection. Agreement between Quantiferon TB Gold in tube and Tuberculin Skin Test was assessed among 95 health care workers who consented to undergo both tests. RESULTS: The overall prevalence of latent tuberculosis infection among health care workers was 10.6% (CI: 8.6%; 12.6%). Factors significantly associated with latent tuberculosis infection were aged 35 years and older [9.49 (CI: 2.22; 40.50)], history of living in the same house with close family members or friends who had active tuberculosis [8.69 (CI: 3.00; 25.18)], worked as a nurse [4.65 (CI: 1.10; 19.65)] and being male [3.70 (CI: 1.36; 10.02)]. Agreement between Quantiferon TB Gold in tube test and tuberculin skin test at cut-off points of 10 mm and 15 mm was 50.5% and 82.1% respectively. However, Kappa-agreement was poor for both cut-off points. CONCLUSION: The prevalence of latent tuberculosis infection in Malaysia was relatively low for an intermediate TB burden country. We could not comment on the occupational risk of latent tuberculosis infection among health care worker compared to the general population as there were no prevalence data available for latent tuberculosis infection in the general population. Kappa agreement between Quantiferon TB gold in-tube and tuberculin skin test was poor.

Prevalence and associated factors of burnout among doctors in Yemen.

OBJECTIVES: This study aimed to determine the level and factors contributing to burnout among doctors in Sana'a City, Yemen and to determine the relationship between burnout and psychological morbidity. METHODS: This was a cross-sectional study of 563 working doctors in the four main hospitals in Sana'a City, Yemen. The 12-item version of the General Health Questionnaire (GHQ12) was used as a measure of psychological morbidity and the 22-item Maslach Burnout Inventory (MBI) was used to measure emotional exhaustion, depersonalization, and personal accomplishment. Sources of job stress were determined using a 37-item scale questionnaire. The questionnaire elicited information about socio-demographic and work characteristics. RESULTS: On the MBI, 356 doctors showed high emotional exhaustion (63.2%), 109 showed high depersonalization (19.4%) and 186 showed low personal accomplishment (33.0%). Sixty six doctors (11.7%) were identified as experiencing a high degree of burnout (high emotional exhaustion and depersonalization and low personal accomplishment). The prevalence of high degree of burnout was significantly higher in those with duration of work or=40 h/wk (OR=2.1, 95% CI 1.25-3.62) and in those who had psychological morbidity (OR=5.3, 95% CI 2.22-12.39). Thirteen out of 37 sources of stress were significantly associated with high degree of burnout. In multivariate analysis, the significant predictors of high burnout were: dealing with patient's psychosocial problems, feeling of isolation, disturbance of home/family life by work, not chewing khat, long working hours and psychological morbidity. CONCLUSION: The prevalence of high degree of burnout as well as emotional exhaustion in Yemeni doctors was higher than those reported internationally and was associated with psychological morbidity and many important sources of job stress.

Developing regulations for occupational exposures to health hazards in Malaysia.

In Malaysia exposures in the workplace are regulated under the Factories and Machinery Act (FMA), 1967 and also under the more comprehensive Occupational Safety and Health Act (OSHA) enacted in 1994. With OSHA 1994 the philosophy of legislating safety and health in the workplace changed from one that was very prescriptive and containing detailed technical provisions under FMA, 1967 to one that is more flexible and encourages self-regulation under OSHA 1994. OSHA 1994 is supported by regulations, codes of practices and guidelines to further clarify the provisions in the Act. Under the FMA 1967 emphasis was on safety while with OSHA 1994 there has been equal emphasis on addressing health hazards in the workplace. Regulations for occupational exposures are developed by the Department of Occupational Safety and Health with tripartite and stakeholder consultation. When developing these regulations International Labor Organization Conventions, laws of other countries and occupational exposure standards adopted internationally are reviewed. The government also conducts surveys to collect information on both exposures and health effects in workplaces to have better understanding on specific occupational health problems. Effective law enforcement is crucial in ensuring compliance to safety and health law. The challenge at the moment is to ensure all employers and employees, particularly those in the small and medium enterprises, understand and comply with the provisions stipulated in the legislation.

Ergonomic risk factors of work processes in the semiconductor industry in Peninsular Malaysia.

A cross-sectional survey of semiconductor factories was conducted to identify the ergonomic risk factors in the work processes, the prevalence of body pain among workers, and the relationship between body pain and work processes. A total of 906 women semiconductor workers took part in the study. In wafer preparation and polishing, a combination of lifting weights and prolonged standing might have led to high pain prevalences in the low back (35.0% wafer preparation, 41.7% wafer polishing) and lower limbs (90.0% wafer preparation, 66.7% wafer polishing). Semiconductor front of line workers, who mostly walked around to operate machines in clean rooms, had the lowest prevalences of body pain. Semiconductor assembly middle of line workers, especially the molding workers, who did frequent lifting, had high pain prevalences in the neck/shoulders (54.8%) and upper back (43.5 %). In the semiconductor assembly end of line work section, chip inspection workers who were exposed to prolonged sitting without back support had high prevalences of neck/shoulder (62.2%) and upper back pain (50.0%), while chip testing workers who had to climb steps to load units had a high prevalence of lower limb pain (68.0%). Workers in the assembly of electronic components, carrying out repetitive tasks with hands and fingers, and standing in awkward postures had high pain prevalences in the neck/shoulders (61.5%), arms (38.5%), and hands/wrists (30.8%).

Occupational health in Malaysia.

This article provides a detailed examination of Malaysian occupational health agencies and their roles in formulating and enforcing standards, promoting occupational health and safety (OSH), and providing advisory services. Available OSH training is described, and the need for policies and personnel in various industries is outlined. Further, the authors discuss how international models and collaboration have influenced Malaysian OSH, and how some successes can be repeated and failures remedied.