Green Procurement in Construction: Analysis of the Readiness Level and Key Catalyst among Construction Enablers

In the concern of sustainability and increasing awareness of environmental degradation, the Malaysian government has promoted numerous initiatives on green growth and green procurement (GP) to maintain and minimize the ecological effects in construction. However, this initiative is still in the infancy stage as to date, there is no specific guideline delineated to the construction industry, and it has yet to be enforced by the government to the construction practitioners. In construction, green procurement is a new area, and immediate actions are needed upon the principles, guidelines, and policy and implementation framework. Hence, this research aims to analyse the readiness level, barriers, and key catalysts among construction enablers towards adopting green procurement in the construction industry. Questionnaires were distributed to 102 construction enablers, focusing on quantity surveying firms in the Klang Valley area (Kuala Lumpur and Selangor), and 87 returned the responses. The analysis uses descriptive statistics via mean score, and the standard deviation was used to measure the variables and the mean's dispersion. It is revealed that the consultants are ready to adopt green procurement. However, GP's implementation's top challenges are lack of internal expertise, low awareness about green procurement, and lack of established best practices, standardized procedures and guidelines. It can be summarized that promoting GP and its implementation requires government support in policies, initiatives, and incentives. As the current practice is fragmented, ideally, GP's adoption in construction projects needs to conform to the acceptable standards that enable specific provisions to acquire eco-friendly sustainable construction

Depression among children at shelter care institutions in Terengganu Malaysia

Background: Depression is a state of psychological disease that occurs to someone divers in age due to certain reasons. Among the factors include lack of self-confidence, problematic family, stress, low self-esteem and social environment. It could lead to a mental disorder that endangers the mental health. Aim: To investigate the status of children's depression using the Children Depression Inventory (CDI) at 21 shelter care institutions in Terengganu Malaysia. Methodology: A quantitative research design was used. The sample consists of 404 respondents from 21 Islamic shelter cares such as Tahfiz, Madrasah and Orphanage in Terengganu Malaysia from the age of 10 to 18 years. Data was analyzed using Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA) and Discriminant Analysis (DA) which were then computed to identify the most dominant factors whereas reducing the initial five parameters with recommended >0.50 of factor loading. Results: Forward stepwise of DA shows the total of groups validation percentage by 92.08% (17 independent). The result showed that the highest frequency of respondent index was at a moderate level (62.87% of respondents). This showed that children still can be controlled and cared to reduce depression. Keywords: Children, depression, Shelter Car

Associated factors and coping mechanism for stress among primary healthcare doctors, assistant medical officers and nurses in government health clinics in Kelantan 2010

(tress is experienced by everybody in daily life. Healthcare providers also experience job stress while giving treatment to the clients. Numerous studies have shown high levels of psychological stress in doctors, assistant medical officers and nurses and other healthcare professionals working in various medical fields. However there are limited studies about job stress among primary healthcare staff in the country. Therefore, this study aims to explore associated factors for stress and coping mechanism practised by primary healthcare doctors, assistant medical officers and staff nurses at government health clinics in Kelant This was a cross sectional study conducted from 1 S` June until 31 S` August 2010. A total of 248 respondents (responds rate 84.9%) which consist of 34 doctors, 76 assistant medical officers and 138 nurses were selected through stratified random sampling. The Malay version of the validated Depression, Anxiety and Stress Scale, Karasek's Job Content Questionnaire and The Malay version of Brief cope Questionnaire were used as research instruments in this study. Informed consent was obtained from all participants. The prevalence of stress among primary healthcare doctors, assistant medical officers and nurses in government health clinics in Kelantan was 7.3% (95% Cl 4.06,10.54). According to job categories, the prevalence of stress among doctors was 8.8%, assistant medical officers 10.5% and nurses 5.1 %. Multiple Linear Regression analysis of stress score among doctors showed that supervisor support (adj b= -0.74,95% Cl -0.98, -0.50, P <0.001) and hazardous condition (adj b = 0.86,95% Cl 0.58,1.15, P <0.001) were significant associated factors for stress. For assistant medical officers, MLR analysis revealed that co-worker support (adj b= -1.45,95% CI -1.77, - 1.12 P= 0.002), job insecurity (adj b= 0.89,95% Cl 0.61,1.16, P <0.001) and supervisor support (adj b= 0.44,95% Cl 0.17,0.71, P=0.002) were the significant associated factors for stress. MLR analysis of stress score among nurses showed that duration of employment (adj b=0.30, 95% CI 0.24,0.36, P <0.001), number of children (adj b= -0.95,95% Cl -1.25, -0.65 P<0.001), decision authority (adj b= -0.19,95% Cl -0.33, -0.06, P =0.005), psychological job demand (adj b= -0.33,95% Cl -0.44, -0.22, P <0.001), physical exertion (adj b= 2.81,95% CI 1.78,3.84, P <0.001) and job insecurity (adj b= 0.45,95% Cl 0.04,0.87, P =0.033) were th: ' significant associated factors for stress. Majority of the respondents in this study had practised positive coping mechanism. The commonest coping practised by doctors and AMOs were religion, planning and acceptance and for nurses were religion, positive reframing and planning. This study also found that the stressed respondents had used more negative coping mechanism like; self distraction and self blame among the stressed doctors; denial coping among stressed AMOs ; and denial, instrument support, self distraction, behavioural disengagement, humour and self blame among the stressed nurses. Finding of this study may be useful for intervention strategies of preventing stress among primary healthcare providers in the country

T-BACCO SCORE: A predictive scoring tool for tuberculosis (TB) loss to follow-up among TB smokers.

IntroductionLoss to follow-up (LTFU) and smoking during TB treatment are major challenges for TB control programs. Smoking increases the severity and prolongs TB treatment duration, which lead to a higher rate of LTFU. We aim to develop a prognostic scoring tool to predict LTFU among TB patients who smoke to improve successful TB treatment outcomes.Materials and methodsThe development of the prognostic model utilized prospectively collected longitudinal data of adult TB patients who smoked in the state of Selangor between 2013 until 2017, which were obtained from the Malaysian Tuberculosis Information System (MyTB) database. Data were randomly split into development and internal validation cohorts. A simple prognostic score (T-BACCO SCORE) was constructed based on the regression coefficients of predictors in the final logistic model of the development cohort. Estimated missing data was 2.8% from the development cohort and was completely at random. Model discrimination was determined using c-statistics (AUCs), and calibration was based on the Hosmer and Lemeshow goodness of fit test and calibration plot.ResultsThe model highlights several variables with different T-BACCO SCORE values as predictors for LTFU among TB patients who smoke (e.g., age group, ethnicity, locality, nationality, educational level, monthly income level, employment status, TB case category, TB detection methods, X-ray categories, HIV status, and sputum status). The prognostic scores were categorized into three groups that predict the risk for LTFU: low-risk ( 25 points). The model exhibited fair discrimination with a c-statistic of 0.681 (95% CI 0.627-0.710) and good calibration with a nonsignificant chi-square Hosmer‒Lemeshow's goodness of fit test χ2 = 4.893 and accompanying p value of 0.769.ConclusionPredicting LTFU among TB patients who smoke in the early phase of TB treatment is achievable using this simple T-BACCO SCORE. The applicability of the tool in clinical settings helps health care professionals manage TB smokers based on their risk scores. Further external validation should be carried out prior to use

Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study.

IntroductionThe monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality.Materials and methodsUsing registry-based secondary data, a retrospective cohort study was conducted. TB patients' sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality.ResultsA total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality.ConclusionsThis study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future

Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study

Abstract Background Finding innovative methods to enhance Tuberculosis treatment adherence in Malaysia is imperative, given the rising trend of non-adhere TB patients. Direct Observed Therapy (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy is developed that connects three users the patient, supervisor, and administrator, allowing drug monitoring and patient loss to follow up with the patient tracking system. Thus, the objective of this study is to determine the impact of Gamified Real-time Video Observed Therapy (GRVOTS) mobile apps on patient medication adherence rates and motivation. Methods 71 patients from 18 facilities participated in the 8-week single-arm intervention study. GRVOTS mobile apps were installed in their mobile apps, and patients were expected to fulfill tasks such as providing Video Direct Observe Therapy (VDOTS) daily as well as side effect reporting. At 3-time intervals of baseline,1-month, and 2-month intervals, the number of VDOT taken, the Malaysian Medication Adherence Assessment Tool (MyMAAT), and the Intrinsic Motivation Inventory (IMI) questionnaire were collected. One-sample t-test was conducted comparing the VDOT video adherence to the standard rate of 80%. RM ANOVA was used to analyze any significant differences in MyMAAT and IMI scores across three-time intervals. Results This study involved 71 numbers of patients from 18 healthcare facilities who showed a significantly higher treatment adherence score of 90.87% than a standard score of 80% with a mean difference of 10.87(95% CI: 7.29,14.46; p < 0.001). The participants’ MyMAAT and IMI scores significantly increased over 3-time intervals with the IMI Interest domain showing the highest mean difference 19.76 (95% CI: 16.37, 21.152: p < 0.001). Conclusions By utilizing GRVOTS, a mobile application based on gamification and real-time features, we can enhance motivation and medication adherence among TB patients, while also addressing the limitations of physical DOTS. Trial registration IRCT20230308057657N1, Registered on (15/03/23)

A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia.

BackgroundLoss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care.MethodIn-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method.ResultsWe identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence.ConclusionStudy findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia