Introduction:A cross sectional study was conducted to estimate risk of exposure to lead via tap water ingestion pathway for the population of Seri Kembangan (SK).Methodology:By using purposive sampling method, 100 respondents who fulfilled the inclusive criteria were selected from different housing areas of SK based on geographical population distribution. Residents with filtration systems installed were excluded from the study. Questionnaires were administered to determine water consumption-related information and demographics. Two water samples (first-flushed and fully-flushed samples) were collected from kitchen tap of each household using HDPE bottles. A total of 200 water samples were collected and lead concentrations were determined using a Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS).Results:Mean lead concentration in first-flushed samples was 3.041± SD 6.967µg/L and 1.064± SD 1.103µg/L for fully-flushed samples. Of the first-flushed samples, four (4) had exceeded the National Drinking Water Quality Standard (NDWQS) lead limit value of 10µg/L while none of the fully-flushed samples had lead concentration exceeded the limit. There was a significant difference between first-flushed samples and fully-flushed samples and flushing had elicited a significant change in lead concentration in the water (Z = -5.880, p<0.05). It was also found that lead concentration in both first-flushed and fully flushed samples was not significantly different across nine (9) areas of Seri Kembangan (p>0.05). Serdang Jaya was found to have the highest lead concentration in first-flushed water (mean= 10.44± SD 17.83µg/L) while Taman Universiti Indah had the highest lead concentration in fully-flushed water (mean=1.45± SD 1.83µg/L). Exposure assessment found that the mean chronic daily intake (CDI) was 0.028± SD 0.034µgday-1kg-1. None of the hazard quotient (HQ) value was found to be greater than 1.Conclusion:The overall quality of water supply in SK was satisfactory because most of the parameters tested in this study were within the range of permissible limit and only a few samples had exceeded the standard values for lead and pH. Non-carcinogenic risk attributed to ingestion of lead in SK tap water was found to be negligible.
Factories and Machinery (Noise Exposure)
Protein-energy wasting (PEW) is a devastating metabolic derangement that leads to increased morbidity and mortality in hemodialysis (HD) patients. This study aimed to determine the diagnostic test accuracy of bioelectrical impedance analysis derived-phase angle (PhA) in detecting PEW among HD patients. This was a multi-centre, cross-sectional study conducted amongst 152 multi-ethnic HD patients in Klang Valley, Malaysia. PEW was assessed using the International Society of Renal Nutrition and Metabolism criteria as the reference method. PhA was measured using a multi-frequency bioelectrical impedance spectroscopy at 50 kHz. Multiple and logistic regressions were used to determine factors associated with PhA and PEW diagnosis, respectively. A receiver operating characteristics curve analysis was used to establish the gender-specific PhA cut-offs to detect PEW. PEW existed in 21.1% of the HD patients. PhA was found as an independent predictor of PEW (adjOR = 0.308, p = 0.001), with acceptable to excellent discriminative performance (adjAUCmale = 0.809; adjAUCfemale = 0.719). Male patients had higher PhA cut-off compared to female patients (4.26° vs. 3.30°). We concluded that PhA is a valid and pragmatic biomarker to detect PEW in multi-ethnic Malaysian HD patients and a gender-specific cut-off is necessary, attributed to the gender differences in body composition.
BACKGROUND With the unprecedented growth of mobile technology, a plethora of dialysis diet apps have been developed to promote patient dietary self-management. Nevertheless, the utility of such apps remains questionable. OBJECTIVE This study aimed to evaluate the content, features, and quality of commercial dialysis diet apps for adult dialysis patients. METHODS This study consisted of a quantitative content analysis of commercial dialysis diet apps downloaded from Google Play and the Apple App Store available in the Asian marketplace, searched for using the following keywords in English: <i>dialysis diet</i> and <i>diet for kidney disease</i>. Free and paid apps available in English that provide nutrition information for adult dialysis patients were included. Apps that were not relevant to the dialysis diet, not meant for patient self-management, or redundant were excluded. Apps were evaluated for language medium (subscore=1), credibility (subscore=1), food database (subscore=1), valuable features (subscore=12), health-behavior theory constructs (subscore=60), and technical quality (subscore=25). The relationships among the variables of interest were determined by Pearson correlation. Stepwise multiple linear regression analysis was performed to identify the features that contribute to greater technical quality of dialysis diet apps. Statistical significance was defined as <i>P</i><.05. RESULTS A total of 22 out of 253 apps (8.7%) were eligible for evaluation. Based on a 100-point scale, the mean overall score of the apps was 31.30 (SD 14.28). Only 5% (1/22) of the apps offered relevant language options, and 46% (10/22) contained food databases. In addition, 54% (12/22) of the apps were not credible. The mean score for valuable features was 3.45 (SD 1.63) out of 12, in which general education (16/22, 73%), free download (15/22, 68%), and usability (13/22, 59%) were the three most popular features. However, the apps scored a mean of 13.41 (SD 11.56) out of 60 for health-behavior theory constructs. The overall app technical quality was considered poor, with a mean score of 2.70 (SD 0.41) out of 5. The scores of valuable features (<i>r</i>=.65, <i>P</i>=.001) and health-behavior theory constructs (<i>r</i>=.55, <i>P</i>=.009) were positively correlated with the overall technical quality of the commercial dialysis diet apps. Features such as free download (β=.43, <i>P</i>=.03) and usability (β=.41, <i>P</i>=.03) could significantly determine the functional quality of the apps. Health-behavior theory constructs such as self-monitoring could significantly predict both the subjective quality (β=.55, <i>P</i>=.008) and the engagement quality (β=.66, <i>P</i>=.001) of the apps, whereas the information quality domain could be determined by plan or orders (β=.48, <i>P</i>=.007) and knowledge (β=.45, <i>P</i>=.01). CONCLUSIONS Although most of the available commercial dialysis diet apps are free and easy to use, they are subject to theory deficiency, limited language options, and a lack of food databases, credibility, tailored education, and overall technical quality.
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