BackgroundExisting anthropometric studies for respirator designs are based on the head and facial dimensions of Americans and Chinese nationals, with no studies for multi-ethnic countries like Malaysia. This study aimed to create head and facial morphological database for Malaysia, specifically to identify morphological differences between genders, ethnicities, and birthplaces, as well as predictors of the dimensions.DesignA cross-sectional study.SettingMalaysia.ParticipantsA nation-wide cross-sectional study using a complex survey design with two stage-stratified random sampling was conducted among 3,324 participants, aged 18 years and above who were also participants of the National Health and Morbidity Survey 2020.Primary and secondary outcomesThe study collected data on sociodemographic, measurement of Body Mass Index (BMI) and 10 head and facial dimensions (3 dimensions were measured using direct measurement, and 7 others using Digimizer software for 2-dimension images). Linear regression was performed to determine the association between gender, ethnicity, birthplace, age and BMI and the dimensions.ResultsThere were significant differences in all the dimensions between sex, birthplace and ethnicity (p < 0.005). Further analysis using linear regression showed sex, ethnicity, birthplace, age and BMI were significant predictors of the dimensions. In comparison to studies from the United States and China, our study population had a wider interpupillary distance and nose breadth for both male and female participants, but smaller bigonial breadth and smaller minimal frontal breadth.ConclusionThese findings could assist in the design and sizing of respirators that will fit Malaysians and possibly other Southeast Asian population.

Healthcare workers (HCWs) are at risk of contracting coronavirus disease-2019 (COVID-19) in their workplace. Infection prevention guidelines and standard operating procedures were introduced to reduce risk of exposure and prevent transmission. Safe practices during interaction with patients with COVID-19 are crucial for infection prevention and control (IPC). This study aimed to assess HCWs' compliance to IPC and to determine its association with sociodemographic and organizational factors. A cross-sectional study was conducted between March and April 2021 at public healthcare facilities in the east coast of Peninsular Malaysia. HCWs who were involved with COVID-19-related works were invited to participate in the online survey. The questionnaire was adapted from the World Health Organization (WHO) Interim Guidance: WHO Risk Assessment and Management of Exposure of Healthcare Workers in the Context of COVID-19. Respondents were categorized as compliant or non-compliant to IPC. A total of 600 HCWs involved in COVID-19-related works participated in the survey. Most of them (63.7%) were compliant to IPC as they responded to all items as “always, as recommended” during interaction with patients with COVID-19. The multivariate analysis showed that non-compliance was significantly associated with working in the emergency department (AOR = 3.16; 95% CI = 1.07–9.31), working as laboratory personnel (AOR = 15.13; 95% CI = 1.36–168.44), health attendant (AOR = 4.42; 95% CI = 1.74–11.24), and others (AOR = 3.63; 95% CI = 1.1–12.01), as well as work experience of more than 10 years (AOR = 4.71; 95% CI = 1.28–17.27). The odds of non-compliance among respondents without adequate new norms and personal protective equipment training were 2.02 (95% CI = 1.08–3.81) more than those with adequate training. Although most of the respondents complied to IPC protocols, compliance status differed according to department, work category, and years of service. Ensuring adequate training that will hopefully lead to behavioral change is crucial to prevent breach in IPC and thus minimize the risk of exposure to and transmission of COVID-19 in healthcare facilities.

Electronic cigarette (EC) is a device that imitates conventional cigarettes, which vaporizes a solution, with or without nicotine. This study evaluates the nicotine levels in EC refill solutions, its release in aerosols and comparison to the amount stated on the label. Seventy-two (72) different EC refill solutions were obtained from local shops in Selangor, Malaysia consisting of 40 nicotine-containing (3-12 mg) and 32 nicotine-free (0 mg) solutions. Aerosols were obtained by using an air tight syringe connected to an EC device to draw aerosol through an XAD-4 sorbent tube that trapped the nicotine. Nicotine in solution and aerosol samples are analyzed using gas chromatography-mass spectrometry equipment. Quantified nicotine in 40 nicotine-containing solutions ranged from 0.224-17.306 mg/mL. Nicotine is detected in 3 of the 32 nicotine-free solutions. Percentage of nicotine released into aerosols from refill solutions varied from 0.54%-28.2%. Out of the 40 samples, thirty-two (32) had nicotine content that violated by more than ±10% from the value on the label. In comparing the labels, 19 samples have 0.3%-77% higher nicotine level and 13 samples have 0.2%-96.3% lower nicotine content. The inconsistency between the labelled and true levels of nicotine content indicates that commercial information may be misleading. The presence of nicotine in the nicotine-free refill solutions and higher nicotine content in aerosols may be addictive and may have negative health effects on users.

In healthcare facilities, food waste and its packaging are mostly managed as non-infectious general waste. However, waste from SARS-CoV-2 positive patients, are treated as medical waste as they may be contaminated by the virus. We investigated the possibility of SARS-CoV-2 contamination from positive COVID-19 patients to their leftover food packages at a quarantine centre. Food packages surface was swabbed using prewetted cellular foam, placed into viral transport media and analysed using real time reverse transcription polymerase chain reaction. SARS-CoV-2 RNA was detected in two samples (4.5%) from asymptomatic patients who were at day-2 positive SARS-CoV-2 with cycle threshold (Ct) value (RdRp/E), 34.96/35.72 and 37.1/36.48 respectively. Detection of SARS-CoV-2 supports that there is contamination to the waste. These poses risk of exposure as SAR-COV-2 survive on the surfaces, thus, safe handling and disposal of food waste should be maintained. However, further study involving viral culture should be explored to determine the viability of the SARS-CoV-2 from leftover food packages