Ageing is associated with changes in body balance mechanism. The gold standard assessment for body balance is posturography. However, because of the high cost constraints, not many health centers are equipped with the equipment. Nintendo Wii balance board (WBB) has been reported as a potential tool to be used to assess body balance and sway. Also, because WBB is more economical and portable, it has greater potential to be used in primary health centers and community settings. The objective of this study was to compare balance measures using BRU™ and WBB among young and older healthy adults during quiet standing. Thirty three young (26.9±5.6 years) and 33 older adults (65.6±4.4 years) were randomly tested on both equipments. Subjects performed 30sec trial for each of the four testing conditions: quiet standing on a firm or compliant surface (foam) with eyes-open and closed. The results showed significant differences in balance measurements between all four testing conditions and age groups using both equipments.This study also found significant positive correlations between the COPand sway velocity, SV (of the BRU™) and COB (of the WBB) in all test conditions. These results indicated that WBB coupled with its commercially available software could potentially be used as a screening tool for balance assessment in primary health centres.

Negative attitudes towards ageing are reported to be associated with greater functional impairment in older adults. There is limited information regarding attitudes towards ageing and physical performance in regard to adults aged 55 to 64 years. The objective of our study was to examine the association of attitude towards ageing on physical performance which includes mobility, agility and falls risk. This cross sectional study was conducted at five senior citizen clubs around Klang Valley in Malaysia. A total of 154 community dwelling adults aged 55 and above (mean:65.8+6.82) participated in this study. Attitude towards ageing was measured using Kogan’s Attitude towards Older People Questionnaire (KAOP). Mobility and agility were measured using gait speed test and ten step test respectively. Risk of falls was assessed using physiological profile aproach (PPA). Approximately 75% of the participants had positive attitude towards ageing with high to very high risk of falls. A significant (p<0.05) correlation was demonstrated between attitude towards ageing, falls risk and gait speed.Regression analysis showed that attitudes toward ageing had a relationship with falls risk, explaining 6% of the variance, F (1, 152) =10.26, p<0.01.The results of this study suggest that there is some relationship between attitude towards ageing and falls risk measured using a combination of physical performance test. Positive attitude towards ageing should be promoted among adults in an earlier age for overall physical health among older adults.

The purpose of this study is to determine the prevalence and causes of visually impairment among children below 4 years old in two public tertiary referral hospitals in Selangor, Malaysia. In this cross-sectional retrospective study, the case files of all children aged below 4 years from the ophthalmology clinics in two separate public hospitals in Selangor, Malaysia were analysed over a 5-year period. The definition of visual impairment was based on the World Health Organization (WHO) classification, i.e. moderate visual impairment: visual acuity <6/18 to 6/60 in the better eye; severe visual impairment: <6/60 to 3/60 in the better eye; and blindness: visual acuity <3/60 in the better eye. Prevalence of visual impairment was based on the presenting visual acuity and then differentiated according to the cause of visual impairment diagnosed. A total of 243 (17.38%) children from a total of 1,398 children were classified as visually impaired. Most of these children (n=119, 49.0%) exhibited moderate visual impairment, 26 (10.7%) had severe visual impairment, while 98 (40.3%) were blind. Refractive errors (n=60, 24.7%) were the most common cause of vision impairment, mostly myopes (n=28, 46.7 %). This was followed by strabismus (n=31, 12.8%) and retinopathy of prematurity (n=29, 11.9%). In conclusion, vision impairment was prevalent in children aged below 4 years old presenting to two ophthalmology clinics in a highly urbanised region in Malaysia. High refractive errors were the major cause of vision impairment seen. Our study highlights the need and utmost importance of an early intervention programme to be implemented for these children since the main cause of vision impairment found in this study is an easily treated problem.

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

Male infertility is a relatively common condition affecting approximately 1 in 20 of the male population. DNA fragmentation is an important factor in the etiology of male infertility. Men with high DNA fragmentation levels have significantly lower odds of conceiving, naturally or through procedures such as intrauterine insemination and IVF. The most common contributing factor of male infertility is smoking. Studies have shown that smoking intensity is positively associated with job demands and stress. Therefore, we believe that work stress increases the nicotine-dependent thus causing lower male fertility rate. As proper protamine to histone ratio is essential to produce viable sperm, smoking is strongly suspected to reduce sperm viability through histone-to-protamine transition abnormalities. These abnormalities, results in sperm with high DNA damage when exposed to excessive free radical. This present study was undertaken to evaluate the relationship of work stress, smoking and sperm quality. A total of 210 infertile patients attending Medical Assisted Contraceptive Clinic (MAC), UKMMC were selected for the study. Smoking status and stress level of patients were collected after obtaining relevant consent. Histone-to-protamine ratio was acquired using Aniline Blue staining and Chromomycin A3 staining respectively. Sperm DNA fragmentation was estimated using Comet Assay. Result revealed that smokers tend to be more stressful (r = .446, p <. 001). The result showed a significantly increased level of histone (r = .385, p <. 001) and incomplete protamination (r = .492, p <. 001) in smokers. The imbalance of histone-to-protamine ratio lead to increase of DNA damage. All the data were analyzed using SPSS version 20.0. Result revealed that patients who smoke are more stressful at work. Higher proportion of abnormal sperm histone to protamine ratio were found among smokers suggesting that cigarette smoking may inversely affect male fertility.

This study is aimed at seat design optimization for high-speed train based on the Malaysians sitting anthropometrydata focusing on seat fit parameters. An analysis of anthropometry data composed of 15 dimensions that arerequired in seat design was done with 50 male subjects. These data were collected through direct measuringmethods with standard equipment. According to the Malaysian automotive seat fit parameters, the backrest width,backrest height, cushion width, and cushion length were established based on these anthropometric dimensions:interscye breadth (5th percentile female and 95th percentile male), hip breadth (95th percentile female), sittingshoulder height (5th percentile female), and buttock-popliteal length (5th percentile female), respectively. Thisstudy uses the CATIA software to design and analyse the proposed seat design. The fit parameters proposed for thenew design are seat height, 380mm; cushion width, 450mm; backrest width, 450mm and backrest height, 850mm.The CATIA human activity analysis (based on Rapid Upper Limb Analysis, RULA) was also executed. From the study,the new conceptual seat design gives the most optimized fit when compared to the current seat.

Poor oral conditions among older adults can cause significant impacts to their overall quality of life. Older adults with reduced number of functional teeth and dental diseases may experience difficulty in daily activities like chewing and eating. The aim of this study is to assess the association between oral health and oral health-related quality of life (OHRQoL) among a group of community-dwelling older adults in Negeri Sembilan, Malaysia. A cross-sectional study was carried out on 436 older adults aged 50 years and above from 20 randomly selected villages in the state. Respondents were interviewed using a structured questionnaire to collect information on their demographic characteristics. Clinical oral examination was carried out to determine the oral health conditions of older people. The validated Malay version of Geriatric Oral Health Assessment Index (GOHAI) was used to measure OHRQoL. Total GOHAI score ranged from 12 to 60 with higher scores indicate better OHRQoL. Majority (77.1%) of the older adults had less than 20 teeth and about 18.3% were edentulous (total tooth loss). All dentate respondents had experienced dental caries. The median GOHAI score was 54.5 (IQR 50-57). About 25.5% of the older adults perceived their oral health as good, while 74.5% had poor perception on oral health. Bivariate analysis showed that less than 20 teeth and high dental caries experience were significantly associated with poor OHRQoL. A significantly higher proportion of older adults with less than 20 teeth limit the kinds of food intake, had trouble biting or chewing, and experienced tooth sensitivity. The physical functioning and well-being of the older people may be disrupted due to oral diseases. Measures of OHRQoL are important as to complement the clinical oral findings in identifying treatment needs of the geriatric patients.

The response and transport intervals of an ambulance dispatch are affected by various factors. The present ambulance system relies on the driver’s experience, knowledge of local road map and estimations of directions. These may contribute to delays, misdirection and inefficient utilization of resources. The objectives of this study were to assess the effects of GPS navigation device on the response and transport time intervals of an ambulance service operating in urban setting. This was a three-month experimental study involving simulated ambulance dispatch based in a hospital. A total of 50 simulated cycles were constructed. Travel time, arrival time and distance were documented from each cycle. The median actual response time using map and GPS navigation device was 11.82 min and 10.47 min respectively. The median actual transport time using map and GPS navigation device was 11.00 min and 10.74 min respectively. The differences in response time and transport time between map and GPS navigation were not statistically significant (p= 0.215 and p=0.710). The application of GPS reduced the error value between estimated and actual response time by 8.73%. It also reduced the mean error value between estimated and actual transport time by 1.42%. The result shows that the GPS navigation device allowed for more accurate travel time estimation and its application in an urban setting such as Kuala Lumpur has the potential to reduce ambulance response time.

The aim of this study is to determine the effective factors that influence the development of medical tourism in Georgia. Qualitative and quantitative methods were used for research. Within the qualitative research the experts of medical tourism were interviewed. Within the qualitative research this study investigates medical tourists’ expectations and perceptions regarding healthcare services. Study tools were prepared on the basis of specially developed “Medical Outcomes Study, Patient Satisfaction Questionnaire” (MOS PSQ-III). The results reveal that policies and regulations, government support, costs, capacity problems, and the healthcare needs of the local community are the main barriers to the development of such tourism. Several strategies for lifting these barriers are suggested, such as new promotional activity policies, government action to encourage investment in the medical tourism market, and cooperative efforts by the hospitality sector and medical institutions to develop medical tourism products. This paper sheds light on a poorly researched field in the Georgian context. It provides directions for hospital managers to develop strategies which will meet patients’ expectations of service quality and increase their competitiveness in the health tourism market.

The lack of awareness about comprehensive eye examination amongst athletes could impact their eye health, hence it needs to be addressed. The authors hypothesize that a majority of athletes in Malaysia have never undergone a thorough eye examination. The present study aims to determine Malaysian athletes’ awareness of the importance of eye assessment. One hundred and twenty-one junior athletes, aged 13 to 16 years participated in the visual screening programme. A questionnaire consisting of fourteen dichotomous questions was developed in two languages, each being English and Malay language and administered prior to eye examination. The questionnaire was designed to measure self-reported visual function, ocular symptoms, and perceptions towards eye health. Questionnaire analysis showed 67.8% of participants never underwent any eye examination. A majority of participants, 66.9% and 75.2%, complained of visual and ocular symptoms respectively. The critical finding of this study showed that 57.9% of participants had reduced vision which could be visually corrected. Overall 90.9% of the participants agreed that eye examination was important. Almost none of the athletes owned any sports safety eyewear nor had undergone any visual training. The importance of wearing protective eyewear during sports needs to be given emphasis. This study implies that athletes' awareness of eye health, as well as visually related issues, is still at a very low level. Hence, the need for comprehensive eye examination and regular review among athletes’ needs to be emphasized. Athletes should also be educated on the importance of regular eye examinations from a young age.