Introduction: This methodological research study aimed to measure content validity and reliability of a newly developed questionnaire of knowledge, attitudes, and self-reported practices towards pureed diet preparation (KAP DYS Puree) among hospital food handlers for dysphagia management. Methods: The study was conducted through face validation, content validation, content reliability and construct validation. A cross-sectional design with convenience sampling was carried out involving 4 panels for face validation, 10 raters for content validity and 161 food handlers participated for Exploratory Factor Analysis (EFA), while 30 food handlers were involved for test-retest reliability. The questionnaire which consisted of 40 items distributed into 3 domains and was assessed and analyzed using modified kappa (k*) for reliability. Results: Content Validity Index revealed the following I-CVI values: knowledge = 0.915, attitudes = 0.922 and self-reported practices = 0.900 and modified kappa values (k*) knowledge = 0.983, attitudes = 0.9214 and self-reported practices = 0.899. The EFA was employed for two dimensions which were self-reported practices and attitudes based on principal axis of factoring with varimax rotation. The factor analysis yielded two factors with a total of 10 items in the attitudes domain and two factors with a total of 9 items in the self-reported practices domain that had satisfactory factor loading (> 0.3). The Kaiser-Meyer-Olkin (KMO) values for attitudes = 0.816 and self-reported practices = 0.776. Bartlett’s test of sphericity was significant at p < 0.0001 for attitudes and self-reported practices indicating the suitability of this data for factor analysis. Interclass Correlation Index (ICC) values for attitudes = 0.739 and self-reported practices = 0.789. Conclusion: This instrument can be used as a need assessment tool in the development of a comprehensive training module for pureed diet preparations in dysphagia management.

Introduction: Diabetic foot infection, a complication that is associated with lower-limb amputation, incurs a huge economic burden to the hospital and health care system of Malaysia. The bacteriological profile of pathogens in diabetic foot infections in Malaysia has been sparsely studied. We investigated the microbiology of diabetic foot infections in patients admitted to the district hospitals on the east coast of Malaysia. Methods: A retrospective analysis was conducted in three district hospitals (Hospital Kuala Lipis, Hospital Bentong and Hospital Raub) in Malaysia from 1st of January 2016 to 31st December 2016. The clinical specimens were cultured using Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic sensitivity testing to different antibiotics was carried out using the disc diffusion method. Result: A total of 188 pathogens were isolated from 173 patients, with an average of 1.09 pathogens per lesion. Majority of the pathogens isolated were gram negative pathogens (73.4%). The most commonly isolated pathogens were Staphylococcus aureus (17.5%). This was followed by Klebsiella spp. (17%), Pseudomonas spp. (15.4%) and Proteus spp. (13.8%). Gram positive pathogens were sensitive to most of the antibiotics tested except penicillin and fusidic acid. Gram negative pathogens were sensitive to all antibiotics tested except ampicillin and amoxicillin/clavulanic acid. Amikacin provide coverage for all gram negative pathogens in DFI. Conclusion: For the management of patient with infection in diabetic foot, the choice of antibiotic therapy depends on the sensitivity of the pathogens, the severity of the infection, the patient’s allergies history, toxicity and excretion of the antibiotics.

Introduction: Diabetic foot infection, a complication which can lead to lower limb amputation, is a major source of morbidity and mortality in Malaysia. The objective of this study was to determine the predictive factors of major lower limb amputation among patients with diabetes mellitus in a cluster of three district hospitals in Pahang, Malaysia. Materials and Methods: This cross-sectional study involved 170 patients who had undergone surgical interventions for diabetic foot infections at three district hospitals from 1st of September 2014 to 31st December 2015. The predictors for major amputation of lower limb were determined using simple logistic regression (LR) and forward LR multiple logistic regression. Results: A total of 21 patients had undergone major amputations of lower limb (15 transtibial and 6 transfemoral). The following factors were associated with major amputation of lower limb; longer duration of disease, age ≥ 60 years, patients from Bentong Hospital, presence of hypertension, presence of fever, history of multiple limbsalvaging surgeries, monomicrobial culture, necrotising fasciitis, anemia and leukocytosis. Upon forward LR multiple logistic regression, only duration of disease, history of more than three previous limb-salvaging surgeries and total white blood cell count ≥15X109/L were found to be significant as predictive factors of major amputation of lower limb. Conclusion: Among the factors analysed in this study, a longer duration of disease, raised total white blood cell count and history of more than three limb-salvaging surgeries were identified as predictors for major amputation of lower limb in diabetic foot infections using stepwise logistic regression analysis.

Dengue is a significant public health problem in Malaysia and vector surveillance is one of the important components in a vector control program. Routinely vector surveillance in Malaysia is performed through larval surveys. However, larval surveys have several limitations. Thus ovitraps are used as an alternative method for monitoring dengue vectors. The aim of this study was to determine the effectiveness of Standard Ovitrap (SO), Mosquito larvae Trapping Device (MLTD), Double Sticky Ovitrap (DST) and NPK Fertiliser Trap to monitor the abundance of Aedes mosquitoes. Each ovitrap was placed at four different sampling points and rotated to the next position every one week. Larvae and adult mosquitoes were collected and identified in the laboratory. All four trapping methods successfully collected larvae of Aedes mosquitoes. The mean number of larvae per ovitrap in DST was significantly higher (p < 0.05) compared to SO and MLTD. DST and NPK Fertiliser Trap were capable of capturing adult mosquitoes. Ovitrap Index and the mean number of adults per ovitrap in NPK Fertiliser trap were significantly higher (p < 0.05) as compared to DST. Another set of experiments were conducted to compare NPK Fertiliser traps containing fresh NPK fertiliser solution with those containing stock NPK Fertiliser solution. The fresh solution was prepared fresh while the stock solution was stored for a month before being used in the field. Result shows no significant differences (p > 0.05) between these solutions. Findings from this study conclude that DST is the most effective ovitrap to monitor Aedes larvae, while NPK Fertiliser trap is the most effective ovitrap to trap Aedes adult mosquitoes in the study area.

comprehensive overview of chronic hepatitis C (CHC)management.1 The author highlighted the concern over theexorbitant cost of direct-acting antivirals, which is the reason for their limited use in Malaysia currently. Based on the findings of the previous studies, the author also underlined that Asians receiving the conventional, interferon-based treatment generally have a higher sustained virological response (SVR) rate as compared with Caucasians and African Americans, mainly due to the interleukin-28B (IL28) single nucleotide polymorphism (SNP) across different ethnic populations. Nonetheless, to date, information on the variations in IL-28 genotypes among different ethnic groups in Malaysia is still limited.

Safety is vital in any industry, including the offshore sector, which is classified as a major hazard industry. Health, Safety and the Environment (HSE) identified that the probability of accidents is high while working on the offshore sectors where it will exposed workers to many hazardous work activities. The appropriate measures to prevent accident in this sectors must be laid out clearly. This paper is to identify the effectiveness of safety awareness campaign and the continuity of the awareness among the workers to prevent injuries at offshore. To achieve this, we have identified the level of awareness and propose a guideline on areas of improvement. Prior of embarking to offshore, staff were exposed to safety awareness program for four weeks. After the program, we started with the pretest to all staff. They were posted offshore for 6 weeks. Within the period, the performance awareness of each staff is monitored through observation and interview. During the final week, the posttest questionnaire were administered to all staff. Two instruments were used for the quantitative data collection, which are Unsafe Act Unsafe Condition (UAUC) card; and Behavior Observation Tool (BOT) card. Questionnaire data were analyzed quantitatively. Paired-sample t-test was used for analyzing pre and post result. The results show that the mean was increased. Recent studies on the safety briefing highlighted several significant changes in terms of employee understanding toward safety. Safety awareness training has been introduced in the new safety briefing prior to offshore mobilization.
Offshore Sector ; HSE ; Hazards ; Unsafe Act/Unsafe Condition ; Behaviour Observation

The purpose of the study was to determine the level of knowledge and beliefs about female breast cancer among male students. A cross-sectional study involving 460 male students of a private university selected by convenient sampling was conducted using self-administered questionnaires that consists of socio-demographic details as well as knowledge and beliefs about female breast cancer. The prevalence of good knowledge was only 45.2%, there was a significant association between level of knowledge and age, course of study (p=0.02 and < 0.001, respectively). The prevalence of poor belief was 72.6% and the main source of information was the media (84.1 %). There was no significant association between beliefs about female breast cancer and family income, mother’s education and race. However, there was a significant association between beliefs about female breast cancer and age, course of study and father’s education. As a conclusion, the knowledge and beliefs about female breast cancer among the male students was very poor. More education and awareness need to be emphasized; especially the media was the most common source of information in our study.

Chlorhexidine is a common antiseptic and disinfectant used in the medical field. Allergy to chlorhexidine has been reported in the literature but life-threatening anaphylactic shock is rare. We present a case of severe anaphylactic shock due to chlorhexidine occurring during surgery. Literatures suggest that profound anaphylactic shock to chlorhexidine is commonly preceded by milder, non-specific reactions. These mild symptoms are often dismissed by both the patient and physicians alike. Direct questioning of these symptoms is necessary as a part of the pre-operative assessment and the patient should be referred for further immunology testing if indicated.

Safety is vital in any industry, including the offshore sector, which is classified as a major hazard industry. Health, Safet y and the Environment (HSE) identified that the prob a bility of accidents is high while working on the offshore sectors where it will exposed workers to many hazardous work activities. The appropriate measures to prevent acc i dent in this sectors must be laid out clearly. This paper is to identify the effectiveness of safety awareness campaign and the conti- nuity of the awareness among the workers to prevent injuries at of fshore. To achieve this, we have identified the level of awareness and propose a guideline on areas of improvement. Prior of embarking to offshore, staff w e re exposed to safety awareness pr o gram for four weeks. A f ter the program, we started with the pretest to all staff. They were posted off- shore for 6 weeks. Within the period, the performance awareness of each staff is monitored through observation and interview. During the f inal week, the posttest questionnaire were administered to all staff. Two instruments were used for the quantitative data collection, which are Unsafe Act Unsafe Condition (UAUC) card; and Behavior Observation Tool (BOT) card. Questio n naire data were analy zed quantitatively. Paired - sample t - test was used for analyzing pre and post result. The results show that the mean was increased. Recent studies on the safety briefing highlighted several significant changes in terms of e m ployee understanding toward safe ty. Safety awareness training has been introduced in the new safety briefing prior to of f shore mobilization.

Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a loadbearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.
Obesity