Adinegara Lutfi Abas

Secondhand smoke exposures in indoor public places in seven Asian countries.

Exposure to secondhand smoke (SHS) is a major threat to public health. Asian countries having the highest smoking prevalence are seriously affected by SHS. The objective of the study was to measure SHS levels in hospitality venues in seven Asian countries and to compare the SHS exposure to the levels in Western countries. The study was carried out in four types of related hospitality venues (restaurant, café, bar/club and entertainment) in China, India, Japan, Korea, Malaysia, Pakistan and Sri Lanka. Real-time measurement of particulate matter of <2.5microm aerodynamic diameter (PM(2.5)) was made during business hour using a handheld laser operated monitor. A total of 168 venues were measured in seven countries. The average indoor PM(2.5) level was 137microg/m(3), ranging from 46microg/m(3) in Malaysia to 207microg/m(3) in India. Bar/club had the highest PM(2.5) level of 191microg/m(3) and restaurants had the lowest PM(2.5) level of 92microg/m(3). The average indoor PM(2.5) level in smoking venues was 156micro/m(3), which was 3.6 times higher than non-smoking venues (43microg/m(3)). Indoor PM(2.5) levels were significantly associated with country, type of venue, smoking density and air exchange rate (p<0.05). In the seven Asian countries, PM(2.5) levels were high due to SHS in public places. The current levels are comparable to the levels in Western countries before the adoption of smoke-free policy. Since Asian country has high prevalence of SHS in public places, there is an urgent need for comprehensive smoke-free regulation in Asian countries.

Fatal occupational injuries among non‐governmental employees in Malaysia

BACKGROUND In Malaysia, surveillance of fatal occupational injuries is fragmented. We therefore analyzed an alternative data source from Malaysias Social Security organization, the Pertubuhan Keselamatan Sosial (PERKESO). METHODS We conducted a secondary data analysis of the PERKESO database comprised of 7 million employees from 2002 to 2006. RESULTS Overall, the average annual incidence was 9.2 fatal occupational injuries per 100,000 workers. During the 5-year period, there was a decrease in the absolute number of fatal injuries by 16% and the incidence by 34%. The transportation sector reported the highest incidence of fatal injuries (35.1/100,000), followed by agriculture (30.5/100,000) and construction (19.3/100,000) sectors. Persons of Indian ethnicity were more likely to sustain fatal injuries compared to other ethnic groups. CONCLUSIONS Government and industry should develop rigorous strategies to detect hazards in the workplace, especially in sectors that continuously record high injury rates. Targeted interventions emphasizing worker empowerment coupled with systematic monitoring and evaluation is critical to ensure success in prevention and control measures.

Non-fatal occupational injuries among non-governmental employees in Malaysia.

Abstract We analyzed data on non-fatal occupational injuries reported to Malaysias social security organization from 2002 to 2006. There was a decrease in both the absolute number and the incidence rates of these injuries over time. About 40% of cases occurred in the manufacturing sector followed by the service (17%) and trading (17%) sectors. The agriculture sector reported the highest incidence rate (24.1/1,000), followed by the manufacturing sector subcategories of wood-product manufacturing (22.1/1,000) and non-metallic industries (20.8/1,000). Men age 40 to 59 and persons of Indian ethnicity had a greater tendency to sustain injuries. Government and non-governmental organizations should strive to develop strategies to reduce the occupational injuries targeting vulnerable groups. Enforcement of safety measures will further play an important role to ensure that both employees and employers take special precautions to address workplace hazards.

Learning Preferences of Clinical Students: A Study in a Malaysian Medical College

Introduction: Awareness of learning preferences can have useful learning and teaching implications. However, there is paucity of literature on the learning preferences of clinical students in a medical school. This study uses the VARK questionnaire to explore the learning preferences of the clinical students of Melaka-Manipal Medical College, Malaysia. VARK is an acronym that stands for visual [V], aural [A], reading [R] and kinesthetic [K] sensory modality of learning. Materials and Methods: The study was approved by the College ethical committee. After taking an informed consent, the clinical students participated in the study in April/May 2012 [ n = 176]. Instrument: VARK questionnaire Version 7.1 was used and it consisted of 16 multiple choice questions. It was distributed among students in the form of hard copy and they submitted their responses to the VARK questionnaire in a classroom setting. Statistical Analysis: Strong preference was calculated on Microsoft Excel using the VARK guidelines. Likert scale [1 to 5] was used to know their perceptions of their VARK score. Feedback written legibly by the participating students was included in the study [ n = 127]. Results: The majority of students [ n = 99] were multimodal. Kinesthetic modality was the strongest single preference [ n = 35]. Out of 127 feedbacks included in the study, the majority of students [82.7%] agreed with the validity of their VARK score. Conclusion: The majority of clinical students is multimodal in their learning preference and kinesthetic modality is their strongest single preference. Educational Implications: Students can develop learning strategies based on their preferences of learning. Teaching should involve all sensory modality so that all types of students can actively participate in learning session. Students pursuing clinical science can benefit more with the kinesthetic modality of learning.

The Melaka Hospital cataract complications study analysis of 12,992 eyes

Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.

Comparative study on the measurement of learning outcomes after powerpoint presentation and problem based learning with discussion in family medicine amongst fifth year medical students

Background: Learning outcomes after traditional teaching methods were compared with problem-based learning (PBL) among fifth year medical students. Six students participated each in traditional teaching and PBL methods, respectively. Traditional teaching method involved PowerPoint (PPT) presentation and PBL included study on case scenario and discussion. Both methods were effective in improving performance of students. Postteaching, we did not find significant differences in learning outcomes between these two teaching methods. Aims: (1) Study was conducted with an intention to find out which method of learning is more effective; traditional or PBL. (2) To assess the level of knowledge and understanding in anemia/zoonotic diseases as against diabetes/hypertension. Settings and Design: All the students posted from February 3, 2014, to March 14, 2014, participated in this study. Six students were asked to prepare and present a lecture (PPT) and subsequent week other six students were asked to present PBL. Both groups presented different topics. Since it was a pre- and post-test, same students were taken as control. To maintain uniformity and to avoid bias due cultural diversity, language etc., same questions were administered. Materials and Methods: After taking verbal consent, all 34 students were given pretest on anemia and zoonotic diseases. Then lecture (PPT) by six students on the same topic was given it followed by posttest questionnaire. Subsequent week pretest was conducted on hypertension and diabetes. Then case scenario presentation and discussion (PBL) was done by different six students followed by posttest. Both the methods were compared. Statistical Analysis: Analysis was done manually and standard error of means and students t-test was used to find out statistical significance. Results: We found statistically significant improvement in performance of students after PPT presentation as well as PBL. Both methods are equally effective. However, Pretest results of students in anemia and zoonotic diseases (Group A) were poor compared to pretest results of students in hypertension and diabetes (Group B). The students who participated in presentation did not influence their performance as they were covering a small part of the topic and there were no differences in their marks compared to other students. Conclusions: We did not find significant differences in outcome after teaching between PBL and traditional methods. Performances of students were poor in anemia and zoonotic diseases which need remedial teaching. Assessment may influence retention ability and performance.

Vitreous loss-causes, associations, and outcomes: Eight-year analysis in Melaka Hospital

BACKGROUND: Cataract surgery is associated with a variety of complications, one of which is vitreous loss. Doctors and policymakers should be aware about the precipitating factors, associations, and expected outcomes of vitreous loss. This study was, therefore, undertaken to set guidelines to improve the visual outcomes of patients. MATERIALS AND METHODS: A retrospective 8-year analysis was conducted from 2007 to 2014 using the national eye database. Demographic features, ocular comorbidities, grade of surgeon, type of surgery, and the associations with the occurrence of vitreous loss, and the final visual outcomes of these patients were studied. RESULTS: Out of 12,992 eyes, only 3.2% had vitreous loss, mostly aged <40 years. Pseudoexfoliation was the only ocular comorbidity causing vitreous loss. Medical Officers and Gazetting Specialists got more vitreous loss compared to specialists. Intracapsular cataract extraction, phaco convert to extracapsular cataract extraction (ECCE), ECCE, and phaco all had a significant vitreous loss. Vitreous loss was the most significant intraoperative complication causing poor vision and resulted in impaired or poor visual outcome. CONCLUSION: Vitreous loss occurred in almost all types of cataract surgeries, especially by junior surgeons, among those aged <40 years and significantly caused poor visual outcome compared to other complications. Pseudoexfoliation had higher occurrence of vitreous loss. Vitreous loss patients had impaired/poor visual outcome due to preexisting comorbidity and astigmatism. Patients at risk and junior surgeons should be closely monitored to improve outcomes. Further studies need to be done to see why and when the vitreous loss occurred.

Knowledge, attitudes, and barriers toward research: The perspectives of undergraduate medical and dental students

CONTEXT: Scientific research not only promotes health and combats diseases of an individual, but also it can strengthen the effectiveness of health systems. Hence, understanding of scientific methods becomes a crucial component in the medical profession. AIMS: This study was conducted to assess the knowledge, attitudes, and barriers toward research among undergraduate medical and dental students. SETTINGS AND DESIGN: This cross-sectional study was conducted among 295 undergraduate Bachelor of Medicine and Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) students from a private medical college in Malaysia. MATERIALS AND METHODS: We purposively selected 360 students attending the 3rd, 4th, and 5th year in MBBS course and BDS course in September 2015. A total of 295 students who were willing to provide written informed consent were included in this study. We collected data using a validated, self-administered, structured questionnaire which included 20 questions about knowledge toward scientific research, 21 attitude items in regard to scientific research, a list of 10 barriers toward conducting medical research, and 5 questions of confidence to conduct the medical research. STATISTICAL ANALYSIS USED: Data were analyzed using descriptive statistics, independent t-test, ANOVA, and multiple linear regression. RESULTS: Among the students, 56.9% had moderate knowledge while the majority (83.3%) had moderate attitude toward scientific research. The majorly cited barriers were the lack of time (79.9%), lack of knowledge and skills (72.1%), lack of funding (72.0%) and facilities (63.6%), and lack of rewards (55.8%). There was a significant association between age, academic year, and knowledge of research as the older age group, and 4th- and 5th-year students had higher knowledge score. The students of higher attitude score had better-perceived barriers score toward research with regression coefficient 0.095 (95% confidence interval 0.032–0.159). CONCLUSIONS: Even though the students had the positive attitudes toward scientific research, a supportive and positive environment is needed to improve skills and knowledge of research and to overcome the barriers toward the conduct of scientific research.

Medical students' reflection on the family planning services at primary health clinics in Malaysia

CONTEXT: Family planning is crucial for everyone within the reproductive age to promote the health and welfare of every member of the family. For the medical students, it is essential to have core knowledge, understanding of family planning concept, and competency in communication skills with the patients. The final-year medical students are posted in Maternal and Child Health Clinics for 3 weeks to gain the knowledge and practical experiences on the primary healthcare in the community. AIMS: The aim of this study was to explore the experiences of final-year medical students on family planning services offered at community clinics in Malaysia. SETTINGS AND DESIGN: This was qualitative study. SUBJECTS AND METHODS: This qualitative study used the data of the students’ reflection written in the case reports on family planning. Coding, identification of subthemes, and themes were done by two researchers independently using RQDA software. STATISTICAL ANALYSIS USED: Thematic analysis. RESULTS: Final-year medical students who had exposure to the clinical services at primary care clinic, regarding Malay word (Klinik Kesihatan) gained the learning opportunities during family planning session such as learning by observation, clerking, and counseling the patients, understanding the barriers to utilizing services and learning for their self-improvement. These learning opportunities lead to developing the positive attitudes on their learning experiences and the positive attitudes toward the concept and services of family planning. CONCLUSIONS: To have the better understanding of family planning services and provide the better care to the community in the future, the clinical exposure at the primary care clinics should be promoted for medical students in Malaysia.

Hybrid tool for assessment of professionalism among dental undergraduate students

Context: Of the several methods available for assessment of professionalism, there is still no consensus on an ideal tool for dental undergraduate (UG) students. Aims: The study aims to use a hybrid tool for assessment of professionalism among dental undergraduate students. Settings and Design: Cross-sectional design with purposive sampling. Subjects and Methods: All final year UG dental students participated in this study. Evaluation of knowledge about professionalism was through written test. Professional behavior of each final year student in a clinical setting was assessed with a prevalidated questionnaire of multisource feedback (MSF). The scores of written test and the MSF were calculated for each student. Data were analyzed to evaluate scores of knowledge and MSF scores as per assessor category. Correlation between knowledge scores and MSF was evaluated. Student perceptions were taken toward assessment of professionalism. Statistical Analysis Used: Statistical analysis was done using descriptive statistics. Pearsons coefficient was used to determine the correlation between average knowledge scores and the MSF scores. Results: Knowledge scores were significantly more for female students (P < 0.05, t-test). Patients rated the students highest. Correlation between knowledge and MSF scores was found to be statistically significant (Pearsons correlation, P < 0.01). Students gave feedback that assessment of professionalism should be done from the beginning of the clinical years. Conclusions: Evaluation revealed that knowledge toward professionalism correlated with the professional behavior implying association between knowledge and reasons for a particular action.