Rosnawati Muhamad Robat

Introduction: A catastrophic landslide in Batang Kali, Hulu Selangor, Malaysia on December 16, 2022, displaced 16 million cu ft of soil, resulting in 61 rescues and 31 fatalities. Search and Rescue (SAR) team members face significant health risks and traumatic experiences during such operations. Objectives: This case study examines four key aspects of SAR operations, that is the efficacy of global health management for SAR teams, the physical and mental health implications on personnel during extended operations, the assessment of environmental health hazards in the disaster area and their mitigation measures, and the documentation of key lessons learned for future operational improvements. Methods: This is a case study on piloting innovative composite questionnaire on global assessment of health risks of SAR team members. The environmental health assessments were conducted using an adapted form from MOH Malaysia Guidelines for the Diagnosis, Management, Prevention and Control of Leptospirosis, 2011. The mental health using Whooley and GAD-2 questionnaires and the rest of the assessments including physical health using adapted MOH Malaysia Flood Preparedness Guidelines, 2008. Data was analysed using descriptive statistics. A one-stop health base was established for surveillance, coordination, and support. Results: Of 509 SAR team members, 56 (11%) participated. Physical health screening (n=18) revealed physical injuries (37.5%), hypertension (25%), mental health issues (25%), and one cardiovascular accident (12.5%). Mental health screening (n=29) identified three (10.3%) positive cases requiring counselling. Nine members attended Psychological First Aid sessions (44% psychoeducation, 33% relaxation, 23% sleep hygiene). No infectious diseases were reported during or one-month post-operation. Discussion & Conclusion: This novel model demonstrates effective comprehensive health monitoring during disaster response. The study supports pre- and post-deployment health screenings and improved interagency coordination, serving as a framework for future emergency responses.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may transmit through airborne route particularly when the aerosol particles remain in enclosed spaces with inadequate ventilation. There has been no standard recommended method of determining the virus in air due to limitations in pre-analytical and technical aspects. Furthermore, the presence of low virus loads in air samples could result in false negatives. Our study aims to explore the feasibility of detecting SARS-CoV-2 ribonucleic acid (RNA) in air samples using droplet digital polymerase chain reaction (ddPCR). Active and passive air sampling was conducted between December 2021 and February 2022 with the presence of COVID-19 confirmed cases in two hospitals and a quarantine center in Klang Valley, Malaysia. SARS-CoV-2 RNA in air was detected and quantified using ddPCR and real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The comparability of two different digital PCR platforms (QX200 and QIAcuity) to RT-PCR were also investigated. Additionally negative staining transmission electron microscopy was performed to visualize virus ultrastructure. Detection rates of SARS-CoV-2 in air samples using ddPCR were higher compared to RT-PCR, which were 15.2% (22/145) and 3.4% (5/145), respectively. The sensitivity and specificity of ddPCR was 100 and 87%, respectively. After excluding 17 negative samples (50%) by both QX200 and QIAcuity, 15% samples (5/34) were found to be positive both ddPCR and dPCR. There were 23.5% (8/34) samples that were detected positive by ddPCR but negative by dPCR. In contrast, there were 11.7% (4/34) samples that were detected positive by dPCR but negative by ddPCR. The SARS-CoV-2 detection method by ddPCR is precise and has a high sensitivity for viral RNA detection. It could provide advances in determining low viral titter in air samples to reduce false negative reports, which could complement detection by RT-PCR.

The COVID-19 pandemic potentially increases doctors’ work demands and limits their recovery opportunity; this consequently puts them at a high risk of adverse mental health impacts. This study aims to estimate the level of doctors’ fatigue, recovery, depression, anxiety, and stress, and exploring their association with work demands and recovery experiences. This was a cross-sectional study among all medical doctors working at all government health facilities in Selangor, Malaysia. Data were collected in May 2020 immediately following the COVID-19 contagion peak in Malaysia by using self-reported questionnaires through an online medium. The total participants were 1050 doctors. The majority of participants were non-resident non-specialist medical officers (55.7%) and work in the hospital setting (76.3%). The highest magnitude of work demands was mental demand (M = 7.54, SD = 1.998) while the lowest magnitude of recovery experiences was detachment (M = 9.22, SD = 5.043). Participants reported a higher acute fatigue level (M = 63.33, SD = 19.025) than chronic fatigue (M = 49.37, SD = 24.473) and intershift recovery (M = 49.97, SD = 19.480). The majority of them had no depression (69.0%), no anxiety (70.3%), and no stress (76.5%). Higher work demands and lower recovery experiences were generally associated with adverse mental health. For instance, emotional demands were positively associated with acute fatigue (adj. b = 2.73), chronic fatigue (adj. b = 3.64), depression (adj. b = 0.57), anxiety (adj. b = 0.47), and stress (adj. b = 0.64), while relaxation experiences were negatively associated with acute fatigue (adj. b = −0.53), chronic fatigue (adj. b = −0.53), depression (adj. b = −0.14), anxiety (adj. b = −0.11), and stress (adj. b = −0.15). However, higher detachment experience was associated with multiple mental health parameters in the opposite of the expected direction such as higher level of chronic fatigue (adj. b = 0.74), depression (adj. b = 0.15), anxiety (adj. b = 0.11), and stress (adj. b = 0.11), and lower level of intershift recovery (adj. b = −0.21). In conclusion, work demands generally worsen, while recovery experiences protect mental health during the COVID-19 pandemic with the caveat of the role of detachment experiences.

Unplanned absenteeism (UA), which includes medically certified leave (MC) or emergency leave (EL), among nurses may disturb the work performance of their team and disrupt the quality of patient care. Currently, there is limited study in Malaysia that examines the role of stressors in determining absenteeism among nurses. Therefore, apart from estimating the prevalence and the reasons of UA among nurses in Malaysia, this study aims to determine its stressor-related determinants. A cross-sectional study was conducted among 697 randomly sampled nurses working in Selangor, Malaysia. Most of them were female (97.3%), married (83.4%), and working in shifts (64.4%) in hospital settings (64.3%). In the past year, the prevalence of ever taking MC and EL were 49.1% and 48.4%, respectively. The mean frequency of MC and EL were 1.80 (SD = 1.593) and 1.92 (SD = 1.272) times, respectively. Meanwhile, the mean duration of MC and EL were 4.24 (SD = 10.355) and 2.39 (SD = 1.966) days, respectively. The most common reason for MC and EL was unspecified fever (39.2%) and child sickness (51.9%), respectively. The stressor-related determinants of durations of MC were inadequate preparation at the workplace (Adj.b = −1.065) and conflict with doctors (adjusted regression coefficient (Adj.b) = 0.491). On the other hand, the stressor-related determinants of durations of EL were conflict with spouse (Adj.b = 0.536), sexual conflict (Adj.b = −0.435), no babysitter (Adj.b = 0.440), inadequate preparation at workplace (Adj.b = 0.257), lack of staff support (Adj.b = −0.190) and conflict with doctors (Adj.b = −0.112). The stressor-related determinants of the frequency of MC were conflicts over household tasks (Adj.b = −0.261), no time with family (Adj.b = 0.257), dangerous surroundings (Adj.b = 0.734), conflict with close friends (Adj.b = −0.467), and death and dying (Adj.b = 0.051). In contrast, the stressor-related determinants of frequency of EL were not enough money (Adj.b = −0.334), conflicts with spouse (Adj.b = 0.383), pressure from relatives (Adj.b = 0.207), and inadequate preparation (Adj.b = 0.090). In conclusion, apart from the considerably high prevalence of unplanned absenteeism and its varying frequency, duration and reasons, there is no clear distinction in the role between workplace and non-workplace stressors in determining MC or EL among nurses in Malaysia; thus, preventive measures that target both type of stressors are warranted. Future studies should consider longitudinal design and mixed-method approaches using a comprehensive model of absenteeism.

Introduction: Doctors are exposed to various psychosocial hazards such as high task demands and demanding work schedule which may influence fatigue, recovery, stress, job satisfaction, wellbeing, and work-family interface. This research generally aims to examine the interrelationship between work-home domain variables with outcomes of fatigue, its recovery, and others related outcomes such as work-to-family conflict, general wellbeing, and perceived stress level among doctors working at public hospital at general and day-level on-call duty. Methods: This is a multicenter analytical mix cross sectional (general) and longitudinal (day-level) research among proposed 390 randomly-sampled on-call doctors working at seven core clinical disciplines from seven public tertiary hospitals in Malaysia. Data will be collected three times: (a) any days after obtaining informed consent (cross sectional), (b) at the end of on-call duty (first wave longitudinal), and (c) at the beginning of subsequent work period (second wave longitudinal). Data will be modelled by covariance-based structural equation modelling (SEM). Conclusion: This research is well justifiable in view of limited available research on complex interrelationship of work domain, home domain and work-home boundary control with fatigue, recovery and other psychological health consequences (e.g. stress, wellbeing, work-home conflict) among doctors, particularly in Asia and developed countries, including Malaysia. This research is expected to provide strong evidence to policy makers in developing prevention and management policy related to fatigue, recovery and other psychological health consequences among doctors. Keywords: doctor, fatigue, recovery, on-call, intershift, wellbeing, stress,