A 10-year-old well and asymptomatic female was referred for screening of acute right ventricular dilatation (ARVD) as she had an elder brother diagnosed with ARVD whom died of sudden cardiac death. Electrocardiography (ECG), transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR) were performed. Results of these investigations were suggestive of ARVD. Despite being a rare cardiac disease and largely unrecognised in children and young adult population, ARVD is an important cause of ventricular arrhythmias in this group of patients and is one of the causes of sudden cardiac death (SCD) in this population.

Introduction: Flood is a natural disaster cause by heavy rainfall and high tide phenomenon. In the event of flood, substantial amount of wastes tend to be moved away and washed with mud that cause the task of waste recovering extremely challenging. The objective of the study was to assess flood victims participation, duration and major problem arise during post flood waste clean-up activity together with respondent’s knowledge and psychological importance in the recovery process. Methods: A cross sectional survey using interview and self-administered questionnaire was conducted involving 150 flood victims in Kuala Krai, Kelantan, who were heavily affected by the recent flood. Results: Respondents participation in the clean-up process was high (N = 126, 84%). Average 1 to 3 months were taken for the clean-up activity. Majority of the respondents had low and moderate satisfaction on the cleaning service provided by the authority (N = 84, 56%). Major problem arises from the past flood waste clean up activity was the biased waste removal process (N = 124, 83%), victims have to find alternative ways for disposal (N = 108, 72%) and the temporary disposal site were located near to the housing area that creates discomfort (N = 105, 70%). The correlation test obtained significant relationship between knowledge and education level (X2 = 0.203, p=0.013). But no significant relationship was obtained between knowledge with gender, age, monthly income, duration of clean-up process, respondents participation and satisfaction. Conclusion: Disaster debris management and disposal is critically important to support the victims in their recovery process.
Natural disaster

Abstract Introduction: Noise was evident to reduce job satisfaction among workers which will negative impacts to workers including increase job turnover, decrease motivation and increased number of accidents. This study aims to explore job satisfaction and its risk factors among workers working in a noisy workplace. Method: The study design was cross-sectional study which involved 167 workers in a cable manufacturing factory selected by simple random sampling. MSQ was used to assess employee’s satisfaction with their job on seven facets and sound level meter was used to measure workplace noise level. Results: All respondents were exposed to noise above permissible exposure limit. Most workers (49%) were moderately satisfied with their work. Factors that were rated as lowest level of satisfaction were work itself (the ability to work alone) (40%) and the way company system policies are implemented (40%). Factors with the highest level of satisfaction were their freedom to implement their judgement (responsibility) (51%) and the supervision quality of their superiors (51%). The most dominant facet predicting total satisfaction level was recognition followed by advancement and company policy and administration. All variables in socio-demographical and job characteristics were not significantly associated with their level of job satisfaction except noise. Noise was significant in predicting one facet of job satisfaction which was physical work condition. Conclusion: Overall, the average level of job satisfaction among respondents were moderate and they were exposed to occupational noise which was the only significant study variable correlated with their job satisfaction.

Introduction: This study determined nitrate concentration and identify the classifying sources of nitrate pollution in the alluvial deposit aquifer system in Bachok, Kelantan. Materials and Methods: A total of 300 groundwater samples were collected in two different areas; agricultural area (150 samples) and non-agricultural area (150 samples). The samples were analyzed for nitrate and other parameters such as pH, EC, NH4+, TDS, turbidity and salinity. The multivariate analyses were used to identify factors that govern the groundwater quality and potential nitrate sources in the study area. Results: Samples in the agricultural area were slightly acidic (5.89 ± 0.67), contained high nitrate (15.10 ± 15.90 mg/L NO3-N), NH4+ (0.82 ± 1.24 mg/L) and turbidity (3.25 ± 2.78 NTU). The principal component analysis (PCA) have identified the groundwater quality in the study area was influenced by the natural processes and anthropogenic activities. Based on the hierarchal cluster analysis (HCA), Cluster II in the agricultural area was identified to be most heavily nitrate contamination, while Cluster III in the non-agricultural area was identified to be strongly affected by seawater intrusion. Conclusion: The findings of this study are useful for developing protection alternatives of private well waters to prevent further deterioration of groundwater quality by nitrate such as control of nitrogen fertilizer use, manure applications and other agricultural practices in the agricultural area. In order to reduce the health risk of nitrate, private well water users in this area should be advised to treat their water or find alternative sources for drink

he increased use of health care services by elderly has placed greater pressure to an already strained health care resources. Thus, an accurate economic cost estimation for specific age-related diseases like dementia is essential. The objectives of this project are to estimate costs of treating patient dementia among Malaysian elderly in the hospital settings. Two types of data were collected: Hospital costing data (using costing template) and patient clinical data (using questionaire). The cost analysis for hospital setting was carried out using a step-down costing methodology. The costing template was used to organize costing data into three levels of cost centers in hospitals: overhead cost centers (e.g. administration, consumables, maintenance), intermediate cost centers (e.g. pharmacy, radiology), and final cost centers (all wards and clinics). In estimating the cost for each cost center, both capital cost (building, equipment and furniture cost) and recurrent cost (staff salary and recurrent cost except salary) were combined. Information on activities which reflects the workload such as discharges, inpatient days, number of visit, floor space etc., are gathered to determine an appropriate allocation factor. In addition, for each final cost center, the fully allocated costs are then divided by the total unit of in-patient days to obtain the cost of providing services on a per-patient per-day of stay basis, referred as unit cost. The unit cost is finally multiplied with the individual patient’s length of stay to obtain the cost of care per patient per admission. All these steps were simplified by using the Clinical Cost Modeling Software Version 3.0 (CCM Ver. 3.0). The mean cost of dementia cases per episode of care was RM 12,806 (SD=10,389) with the length of stay of 14.3 (SD=9.9) days per admission. The top three components of cost for the treatment of dementia were the ward services 8,040 (SD=7,512), 62.78% of the total cost, followed by the pharmacy 1,312(SD=1,098), 10.25% of the total cost and Intensive Care Unit 979 (SD=961), 7.64% of the total cost. A multivariable analysis using multiple linear regressions showed that factors which significantly influence (p<0.05) the treatment costs of dementia cases were the length of stay (p<0.001), followed by age (p=0.001), case type severe (p=0.005) and study location (p=0.032). However, the factor length of stay is the tremendous parameter. In conclusion, data collection from selected hospitals as well as patient level data from medical record unit were successfully used to estimate the provider costs of hospital for the elderly with dementia disease. Results from the project will enable an assessment on the economic impact and consequences of cognitive impairment in an aged population. A cost quantification and distributive mapping of the burden of care can assist in policy implementation through targeted intervention for at-risk groups, which will translate into savings by means of delayed onset or progression of dementia.
dementia ; Provider Cost ; CCM ; Step-down costing

As the Malaysian population ages, the burden of age-related cognitive disorders such as dementia and Alzheimer’s disease will increase concomitantly. This is one of the sub-study under a research project titled by quantify the cost of age-related cognitive impairment in Malaysia, which was undertaken to develop a clinical pathway for Mild Cognitive Impairment (MCI) and Dementia. The clinical pathway (CP) will be used to support the costing studies of MCI and Dementia. An expert group discussion (EGD) was conducted among selected experts from six (6) government hospitals from different states of Malaysia, Ministry of Health, and United Nations University, International Institute for Global Health, UKM and UPM. The expert group includes psychiatrist specialists and public health medicine specialists. A total of 15 participants took part in the EGD. The group was presented with the different approach in managing MCI and Dementia. Finally, the group came to the consensus agreement on the most appropriate and efficient ways of managing the two conditions. In the EGD, an operational definition for MCI and Dementia was agreed upon and a pathway was developed for the usual practice in the Malaysian health system. A typical case used, as a reference is a 60-year-old patient referred to a memory clinic with complaint of “forgetfulness”. After three outpatient visits in the clinic, the diagnosis of MCI and Dementia could be clinically established. The clinical pathways covered all active clinical and non-clinical management of the patient over a period of one year. The experts identified the additional resources required to manage these patients for the whole spectrum of lifetime based on the expected life expectancy. The Clinical pathway (CP) for MCI and Dementia was successfully developed in EGD with strong support from practitioners in the health system. The findings will help the researchers to identify all-important clinical activities and interventions that will be included in the costing study.

Introduction: The escalated demand for protective rubber glove in the healthcare industries has resulted in increased prevalence of glove related skin problem, irritant and allergic contact dermatitis and latex sensitivity. The industry has recently introduced a new nitrile glove product using a novel patented non-sulphur system to effect co-valent bond crosslinking to provide the desired elasticity of the gloves. This glove also has ionic crosslinking provided by the zinc oxide used in the formulation and the carboxylic group of the nitrile latex. The main objective of this study is to prove that residual chemical additives at a level that may induce Type IV allergy in the unsensitized general user population are not present in this rubber glove and to compare it with a powder free latex examination glove. Methods: In collaboration with the Islamic University of Gaza, we conduct modified test on a specially formulated and powder free, accelerator free LOW DERMA™ enhanced nitrile rubber glove that has physical properties and barrier integrity similar to that of NRL gloves. This glove does not contain sulphur or sulphur related compound. Two sets of Powder free, accelerator free LOW DERMA™ Nitrile Patient Examination Gloves*, white and blue colour were tested using the modified draize-95’ test. Filter paper soaked in normal saline and powder free latex examination glove were used as control. Results: A total of 209 subjects, 149 subjects, Caucasian (71.29%), 30 subjects, Afro Caribbean (14.35%) and 30 subjects, Asiatic (14.35%) were recruited. All 209 subjects had a final patch testing scoring of not more than 1.5 during both the induction phase and the challenge phase for both types of Powder Free Nitrile Patient Examination Gloves (white and blue) and to the negative control, normal filter paper and the powder free NRL control glove. Conclusion: The skin sensitization test (‘Modified Draize-95’ Test) of Powder Free Nitrile Patient Examination Gloves (white and blue) and the powder free NRL examination glove were negative. There was no clinical evidence on the presence of residual chemical additives at the level that may induce Type IV allergy in unsensitized general user population for both Powder Free Nitrile Patient Examination Gloves, blue and white colored, non-sterile. Both gloves qualify for “Low dermatitis Claim”.

Background: Prolonged exposure of heavy metals in the respirable particulate matter (PM10) from municipal solid waste (MSW) landfills may affect children health. Objective: To investigate the association of reported respiratory symptom with heavy metals in PM10, with heavy metals in fingernails among children residing close to MSW landfills. Methods: Two groups of children age 7 to 12 years old were involved in this cross-sectional study. Those residing within 3 km radius from a landfill were the exposed group and those residing more than 3 km radius as the unexposed group. Questionnaires adapted from American Thoracic Society were applied in the survey. Fingernails were used as biomarker. Ten heavy metals elements in PM and fingernail samples were analysed using inductively coupled plasma mass spectrometry (ICP-MS). Results: The cadmium, chromium, copper, manganese, nickel and lead concentrations in PM around the MSW landfills and residential areas exceeded the Canada and USEPA standard permissible limit. Heavy metals in fingernails (p<0.001) of exposed group were significantly higher than the unexposed group. Children with no pets have less reported respiratory symptoms. Elevated level of heavy metals in PM and fingernails were associated with high risk of reported respiratory symptoms. Conclusion: Heavy metals in PM10 and fingernails were associated with potential risk factor of respiratory health in children.

Introduction: The application of M-learning or mobile application (app) as a tool to disseminate occupational safety and health (OSH) information among students and staff in the university, to replace the use of conventional noticeboard was assessed in this study. Materials and Methods: Study was conducted between February to March 2016 and involved 124 respondents from health sciences program in Universiti Putra Malaysia. OSH information was incorporated into a mobile-app using online software and respondents were requested to use the app for fourteen days. A self-administered questionnaire was used to assess the level of knowledge, attitude and practice of respondents before and after using the app. Results: The mobile app has significantly increased the knowledge score among respondents (z = -7.331, p<0.001). The mean (SD) of knowledge score has increased from 24.39 (5.84) to 30.40 (4.97). The attitude score also has significantly increased from 12.85 (2.04) to 14.02 (2.42) (z= -4.587, p<0.001). The mobile app was not significantly changed the practice (z= -0.688, p=0.491) and the perception among respondents (z= -0.337, p=0.736). Respondents stated that the app was user-friendly (49.4%, N=61), easy to access (N= 64, 51.6%), and have interesting contents (N= 63, 50.8%). They believed continuous used of the app may improve their knowledge (N= 64, 51.6%), and increase their awareness (N= 67, 54.0%) on safety and health. Conclusion: The M-learning (mobile app) has a potential to be used to promote the safety and health culture among students on the campus.

Introduction: Cadmium (Cd) in urine and inhaled dust of the municipal waste operators was assessed. Methods: Urine spot samples were collected and analysed for Cd and creatinine of 60 municipal waste operators between April to June 2013. Respirable dust was collected using personal air sampling pump GilAir-3 and GilAir-5 for 8 working hours. Cd in urine and dust were analysed using the Flame Atomic Absorption Spectrometer (Perkin Elmer A Analyst 800) while urinary creatinine was measured using Reflotron® Plus creatinine. Results: The mean and standard deviation (SD) of Cd in the respirable dust (0.59 ± 50.27 μg/m3) was within the permissible exposure limit (PEL). The level of Cd in urine (0.015 ± 0.0097 μg/g Cr) was lower than the safe limit of 5 μg/g. The creatinine level (173.59 ± 50.27 mg/dl) was within the normal range (20 to 350 mg/dl). The multiple regression model shows smoking and years of smoking were the significant predictors for the Cd in the urine (R² = 0.216 F(3,56) = 5.150, p < 0.05). Conclusion: Municipal waste operators were exposed to minimal Cd exposure while handling waste and the accumulation of this metal urine was correlated with smoking habit.