Valuation of Fatal and Non-Fatal Injuries Due to Motorcycle Accidents in Malaysia

Policy makers often struggle with the question of what is the appropriate monetary value to be associated with reduced fatalities. As a result, a disproportionate number of road safety projects were abandoned in favor of other types of projects as they all conlpetc for a limited amount of public funds. This is the motivation for carrying out this research the main objective of which is to evaluate of the value of statistical life (VOSL) of fatal and non-fatal injuries among motorcyclists in Malaysia in an attempt to overcome the lack of reliable estimates of accident. The study utilizes extensively two surveys namely the valuation survey amongst motorcyclists covering 6 constituents within the Seremban Municipality in the state of Negeri Sembilan and the epidemiology survey of hospitalized non-fatal injuries amongst injured motorcyclists at Seremban Hospital to develop the Injury Scale Descriptor. Apart from using descriptive statistics, the inferential statistics have been utilised to test the reliability and stability on the estimated values. Results from the valuation survey passed all the criteria of the construct validity especially the critical scope test. Multiple regression analyses showed statistically significant relationships between WTP and vital variables of income, age, accident experience and riding purpose. A unique variable of race was also found to be significantly related to WTP. Upon control for the effect of inter-country variation in income, the mean values of statistical life (VOSL) have been found to be approximately RM1.1 million and RM77,000 per non-fatal injury. After considering GDP growth, the suggested estimate to reflect the benefits 'of road safety in public policy analysis for year 2004 is RM1.3 million and RM92,400 for fatal and non-fatal injury respectively This study recommends the need for further research on other cost elements to complement the human cost in the effort to establish the comprehensive road accident costs. Other valuation methods should also be conducted in similar valuation studies to fortify the present human cost estimates. Finally, after the successful estimate of intangible benefits (human cost) of road safety, it is strongly recommended that research on other infrastructure investment benefits be undertaken. Only then, can proper Cost Benefit Analysis method become the instrument in evaluating Suture investments of transport infrastructures

Experimental Evaluation of A Cylinder Actuator Control Using McKibben Muscle

There has been an increased interest in applying pneumatic muscle actuator (PMA) in robotic systems because of its low weight and high compliant characteristics. On the other hand, pneumatic muscle actuator (PMA) is gaining attention in robotic applications because of its low weight and high compliant characteristics. It is known that the McKibben muscle is different from the fluidic cylinder actuator in that the cylinder was unstable in its position and in its velocity in an open-loop system unlike the McKibben that is stable in its position. The modeling and control of McKibben muscle as the actuator for the cylinder are crucial because it is known to have non-linear response, hysteresis and small stroke. In this project, a single acting cylinder model which would have uncontrolled extension to push direction by compressed air, is actuated and controlled using a PMA. The system is designed with two 1.3mm-diameter McKibben muscles attached to the cylinder. Open loop control was used and the result shows that the PMA is able to control the cylinder with good performance

The assessment of risk factors for the Central/East African Genotype of chikungunya virus infections in the state of Kelantan: a case control study in Malaysia

BACKGROUND: The aims of the study were to assess the risk factors in relation to cross border activities, exposure to mosquito bite and preventive measures taken. An outbreak of chikungunya virus (CHIKV) infection in Malaysia has been reported in Klang, Selangor (1998) and Bagan Panchor, Perak (2006). In 2009, CHIKV infection re-emerged in some states in Malaysia. It raises the possibilities that re-emergence is part of the epidemics in neighbouring countries or the disease is endemic in Malaysia. For this reason, A community-based case control study was carried out in the state of Kelantan. METHODS: Prospective case finding was performed from June to December 2009. Those who presented with signs and symptoms of CHIKV infection were investigated. We designed a case control study to assess the risk factors. Assessment consisted of answering questions, undergoing a medical examination, and being tested for the presence of IgM antibodies to CHIKV. Descriptive epidemiological studies were conducted by reviewing both the national surveillance and laboratory data. Multivariable logistic regression analysis was performed to determine risk factors contributing to the illness. Cases were determined by positive to RT-PCR or serological for antibodies by IgM. CHIKV specificity was confirmed by DNA sequencing. RESULTS: There were 129 suspected cases and 176 controls. Among suspected cases, 54.4% were diagnosed to have CHIKV infection. Among the controls, 30.1% were found to be positive to serology for antibodies [IgM, 14.2% and IgG, 15.9%]. For analytic study and based on laboratory case definition, 95 were considered as cases and 123 as controls. Those who were positive to IgG were excluded. CHIKV infection affected all ages and mostly between 50–59 years old. Staying together in the same house with infected patients and working as rubber tappers were at a higher risk of infection. The usage of Mosquito coil insecticide had shown to be a significant protective factor. Most cases were treated as outpatient, only 7.5% needed hospitalization. The CHIKV infection was attributable to central/east African genotype CHIKV. CONCLUSIONS: In this study, cross border activity was not a significant risk factor although Thailand and Malaysia shared the same CHIKV genotype during the episode of infections

The Third National Health and Morbidity Survey (NHMS III) 2006: nutritional status of adults aged 18 years and above

1Department of Nutrition Research, Institute for Public Health, Ministry of Health, Kuala Lumpur; 2Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor; 3Department of Nutrition and Dietetics, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur; 4Epidemiology and Biostatistics Unit, Institute for Medical Research,Kuala Lumpur; 5Clinical Epidemiology Unit, Clinical Research Centre, Ministry of Health, Kuala Lumpur; 6Department of Paediatrics, Universiti Kebangsaan Malaysia, Kuala Lumpur; 7Department of Community Health and Family Medicine, Faculty of Medicine, International Islamic University, Kuantan The Third National Health and Morbidity Survey (NHMS III) was conducted in 2006 to determine the nutritional status of a nationally representative sample of Malaysian adults aged 18 years and above. Body weight, height and waist circumference measurements were taken by trained health nurses according to a standard procedure (WHO, 1998). Body Mass Index (BMI) was determined among 33,055 eligible adults, while risk of abdominal obesity based on waist circumference (WC) was obtained from 32,900 individuals. In addition, peripheral muscle wasting was determined using calf circumference (CC) among 4,282 older individuals aged 60 years and above. The national prevalence of normal BMI (BMI 18.5-24.9 kg/m2) was 48.4% (47.7–49.0)*. The prevalence of underweight (BMI <18.5 kg/m2) was 8.5% (8.2–8.9), being higher in rural areas {9.8% (9.2–10.4)} than in urban areas {7.8% (7.4–8.3)}. Meanwhile, 29.1% (28.6–29.7) of the adults were overweight (BMI 25.0-29.9 kg/m2). Among the ethnic groups, Indians had the highest prevalence of overweight followed by Malays and Chinese. In addition, 14.0% (13.6–14.5) of the adults were obese (BMI >30.0 kg/m2). Women had higher obesity prevalence at 17.4% (16.7–18.0) than men at 10.0% (9.5–10.5). In terms of ethnic groups, Indians and Malays had higher obesity prevalence than other groups. By occupation category, housewives showed the highest prevalence of obesity at 20.3% (19.4–21.3). The prevalence of abdominal obesity (WC for women >88 cm and men >102 cm) was 17.4% (16.9-17.9), with women showing higher prevalence {26.0% (25.2-26.8)} than men {7.3% (6.7-7.6}. The prevalence of older persons with peripheral muscle wasting (calf circumference for women < 27.3 cm and men < 30.1 cm) was 19.9% (18.5–21.6), with a higher prevalence of men {23.7% (21.6-25.9)} than women {16.8% (15.1-18.5)} at risk of malnutrition according to this indicator. In comparison, the present national prevalence of underweight of 8.5% was three times lower than that (25.2%) reported in the NHMS II in 1996. In contrast, the prevalence of overweight hasof 14.0% in this study and 12.7% in the MANS were approximately three times the level of 4.4% found in 1996 (NHMS III). This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults. increased from 16.6% in the NMHS II to 29.1% in the present study. The latter is comparable with the finding of 27.4% reported in another nationally representative sample involving over 5,000 adults namely, the Malaysian Adults Nutrition Survey (MANS) conducted in 2003. It is noted that obesity prevalence of 14.0% in this study and 12.7% in the MANS were approximately three times the level of 4.4% found in 1996 (NHMS III). This alarming trend calls for serious re-examination of public health programmes for more effective reduction of obesity among Malaysian adults

Reliability and Technical Error of Calf Circumference and Mid-half Arm Span Measurements for Nutritional Status Assessment of Elderly Persons in Malaysia

This study sought to examine the reliability of two measurements; Calf Circumference (CC) and Mid-half Arm Span (MHAS). A sample of 130 elderly persons aged 60 years and above seen consecutively in the Kuala Lumpur Hospital outpatient clinic during the period of December 2005 to January 2006, upon consent, were recruited to the study. There was a high degree of reliability for both inter- and intra-examiner (r close to 1). For inter-examiner, on average the CC measurements taken by the first examiner were 0.3 cm lower than that of the second examiner. The upper and lower limit of the differences were +0.4 to –0.9 cm respectively. Inter-examiner MHAS measurements on average by the first examiner were 0.2 cm lower than that of the second examiner. The limits were +1.7 to –2.1 cm. By comparison, the inter-examiner CC measurements were more reliable than the MHAS measurements. For intra-examiner, on average the CC measurements at Time 1 were consistent with Time 2 (mean difference=0) with limits of the difference at + 0.5 cm. MHAS measurements at Time 1 were on average 0.1 cm less than at Time 2 with limits at +1.7 and –1.8 cm. The technical error of measurement (TEM) and coefficient of variation of CC and MHAS for both interexaminer and intra-examiner measurements were within acceptable limits with the exception of MHAS TEM. This study suggests that CC and MHAS measured in elderly persons 60 years and above, using Seca Circumference Tape ® 206, Germany (0.05 cm) are reliable and can be used in a community survey

Reliability, technical error of measurements and validity of instruments for nutritional status assessment of children in the Third National Health and Morbidity Survey, Malaysia

The Third National Health & Morbidity Survey, Malaysia 2006 included nutritional status assessment of children. This study estimated the reliability, technical error of measurement (TEM) and validity of those instruments in 130 children below two from a paediatric clinic. Two nurses measured weight (WT) using Tanita digital weighing scale and Seca beam scale and length (LT) using Seca measuring mat and Stadiometer. Absolute mean difference (AMD) and intra-class correlation (ICC) for WT and LT indicated high inter and intra-examiner reliability. However, by Bland and Altman plot, LT were less reliable. Relative TEMs for WT were within acceptable limits whereas that of LT was slightly above the acceptable limits. The AMD and ICC showed that the test instruments were highly valid, but LT was less accurate. This study suggests that WT and LT in children below two using the test instruments were reliable and valid for a community survey. However, LT measurements require special attention

Sensitivity and specificity of waist circumference as a single screening tool for identification of overweight and obesity among Malaysian adults

Generalised obesity and central obesity are risk factors for Type II diabetes mellitus and cardiovascular diseases. Waist circumference (WC) has been suggested as a single screening tool for identification of overweight or obese subjects in lieu of the body mass index (BMI) for weight management in public health program. Currently, the recommended waist circumference cut-off points of ≥ 94cm for men and ≥80cm for women (waist action level 1) and ≥ 102cm for men and ≥ 88cm for women (waist action level 2) used for identification of overweight and obesity are based on studies in Caucasian populations. The objective of this study was to assess the sensitivity and specificity of the recommended waist action levels, and to determine optimal WC cut-off points for identification of overweight or obesity with central fat distribution based on BMI for Malaysian adults. Data from 32,773 subjects (14,982 men and 17,791 women) aged 18 and above who participated in the Third National Health Morbidity Survey in 2006 were analysed. Sensitivity and specificity of WC at waist action level 1 were 48.3% and 97.5% for men; and 84.2% and 80.6% for women when compared to the cut-off points based on BMI ≥25kg/m 2. At waist action level 2, sensitivity and specificity were 52.4% and 98.0% for men, and 79.2% and 85.4% for women when compared with the cut-off points based on BMI (≥30 kg/m 2). Receiver operating characteristic analyses showed that the appropriate screening cut-off points for WC to identify subjects with overweight (≥25kg/m 2) was 86.0cm (sensitivity=83.6%, specificity=82.5%) for men, and 79.1cm (sensitivity=85.0%, specificity=79.5%) for women. Waist circumference cut-off points to identify obese subjects (BMI≥30 kg/m 2) was 93.2cm (sensitivity=86.5%, specificity=85.7%) for men and 85.2cm (sensitivity=77.9%, specificity=78.0%) for women. Our findings demonstrated that the current recommended waist circumference cut-off points have low sensitivity for identification of overweight and obesity in men. We suggest that these newly identified cut-off points be considered

Abdominal obesity in Malaysian adults: National Health and Morbidity Survey III (NHMS III, 2006)

Abdominal obesity (AO) is an independent risk factor for cardiovascular disease, hypertension and diabetes mellitus in adults. There is a lack of data on the magnitude and socio-demographic profile of AO among Malaysian adults at the national level. In the Third National Health and Morbidity Survey (NHMS III) conducted in 2006, AO of adults aged 18 years and above was determined based on the waist circumference as part of the nutritional status assessment. This article reports the prevalence of AO in relation to socio-economic factors and demographic characteristics of adult subjects. Out of a total of 33,465 eligible individuals 18 years and above, waist circumference was measured in 32,900 (98.3%) individuals. The prevalence of AO was assessed using the cut-off points recommended by World Health Organization. The mean waist circumference in men and women was 84.0cm [95% confidence interval (95% CI): 83.8, 84.3] and 80.3cm (95% CI: 80.1, 80.6) respectively. The national prevalence of AO was 17.4% (95% CI: 16.9, 17.9). The identified risks of AO were women (OR: 4.2, 95% CI: 3.8, 4.6), aged 50-59 years (OR: 5.6, 95% CI: 4.0, 7.7), Indians (OR: 3.0, 95% CI: 2.4, 3.8), housewives (OR: 1.4, 95% CI: 1.1, 1.7), subjects with primary education (OR: 1.3, 95% CI: 1.1, 1.5) and ever married (OR: 1.4, 95% CI: 1.2, 1.6). Being the largest population-based study on AO among Malaysians, these findings have important public health implications. There is an urgent need to revise public health policies and programmes aimed at prevention of abdominal obesity especially in the groups at risk

Probable nipa palm wine-associated hepatitis a outbreak after attending a funeral ceremony in Sabah

Foodborne outbreaks of hepatitis A virus (HAV) are most commonly associated with fresh and frozen produce and with various types of shellfish. Alcoholic beverage-borne outbreaks of hepatitis A are extremely rare. Here, we report an outbreak of hepatitis A associated with the consumption of a traditional wine at a funeral ceremony in the Sabah state of Malaysian Borneo. Confirmed cases were determined by serum anti-HAV immunoglobulin M and/or for fecal HAV by reverse transcription polymerase chain reaction (RT-PCR). The amplicons of RT-PCR were subjected to nucleotide sequencing followed by phylogenetic analysis. We conducted a 1:2 case–control study to identify the possible exposure that led to the outbreak. Sixteen patients met the case definition, they were 18 to 58 years old and 90% of them were males. The case–control study showed that the consumption of nipa palm wine during the ceremony was significantly associated (P = 0.0017) with hepatitis A infection (odds ratio, 5.44; 95% CI, 1.80–16.43). Untreated river water was used to dilute the traditional wine, which was assumed to be the source of the infection. Phylogenetically, these viruses belonged to genotype IA and formed an independent cluster with strains from Taiwan, Japan, and the Philippines. This strain might be an emerging HAV in Asian countries. Environmental assessments were performed and environmental samples were negative for HAV. The incidence of hepatitis A in Sabah was also determined and it was 0.795/100,000 population. Strict monitoring of traditional wine production should be implemented by the local authority to prevent future outbreaks

Reliability, technical error of measurements and validity of instruments for nutritional status assessment of adults in Malaysia

The Third National Health & Morbidity Survey, Malaysia 2006 included nutritional status assessment of children. This study was to assess inter-and intra-examiner reliability, the technical error of measurement (TEM) and the validity of instruments for measuring weight, length and waist circumference. A convenience sample of 130 adults working in a selected office setting who fit the inclusion and exclusion criteria participated in the study. Two public health nurses, trained to follow a standard protocol, obtained the measurements. Weight was measured using Tanita digital weighing scale, 318, Japan (0.1 kg) and Seca Beam Scale, Germany (0.01 kg) weighing machines. Height was measured using Seca Bodymeter 206 Germany (0.1cm) and Stadiometer, Germany (0.1cm). Waist circumference was measured using Seca circumference tape, 206, Germany (0.1 cm). By comparison the inter-examiner reliability in descending order would be weight, height and lastly waist circumference. The intra-examiner reliability in descending order would be weight and height followed by waist circumference. Height measurement on average using test instrument reported that it was recording 0.4 cm higher than the reference instrument with upper limit and lower limit at 2.5 and 1.6 cm respectively. The technical error of measurement and coefficient of variation of weight and height for both inter-examiner and intra-examiner measurements are all within acceptable limit (below 5%). The findings of this study supports that weight, height and waist circumference measured in adults 30 years and above using Tanita digital weighing scale, 318, Japan (0.1 kg), Seca Bodymeter 206 Germany (0.1cm) and Seca circumference tape, 206, Germany (0.1 cm) are reliable and valid to be used in a community survey. Limiting the number of examiners especially for waist circumference measurements would yield higher degree of reliability and validity