METHODS: Unmatched case control and comparative studies were carried out among fertilizer factory workers in Sarawak with the aim of determining contributing factors for hearing impairment. Respondents consisted of 49 cases that were diagnosed from 2005 to 2008 with 98 controls from the same work places. Chi-square test and Mann-Whitney test were used in a univariate analysis to determine the association between hearing impairment and the contributing risks being studied.

RESULTS: The results of the univariate analysis showed that hearing impairment was significantly (p<0.05) associated with older age, lower education level, high smoking dose, high occupational daily noise dose, longer duration of service, infrequent used of hearing protection device (HPD), and low perception of sound on HPD usage. Multivariate logistic regression of hearing impairment after controlling for age found the following five variables: occupational daily noise dose ≥50% (OR 3.48, 95% CI 1.36-8.89), ≥15 years of services (OR 2.92, 95% CI 1.16-7.33), infrequent use of HPD (OR 2.79, 95% CI 1.15-6.77), low perception of sound on HPD (POR 2.77, 95% CI 1.09-6.97), and smoking more than 20 packs per year (OR 4.71, 95% CI 1.13-19.68).

METHOD: This study used secondary data retrieved from a cross-sectional study involving 492 male employees' completed data. Eligible participants completed validated questionnaires of the Psychosocial Safety Climate (PSC-12) scale, short version Demand Induced Strain Compensation (DISQ 2.1), Oldenburg Burnout Inventory - Emotional Exhaustion domain and the Three Eating Factor Questionnaire (TEFQ) -Uncontrolled Eating domain; assessing psychosocial safety climate, job demands and job resources, emotional exhaustion, and uncontrolled eating behaviour, respectively. Body mass index (BMI) was calculated based on weight and height. The research statistical model was tested by two-steps of assessment replicating partial least squares structural equation modelling (PLS-SEM).

RESULT: The results show that psychosocial stressors (psychosocial safety climate, job demands and job resources) had significant effects on emotional exhaustion (β= -0.149, p=0.004; β= 0.223, p<0.001; β= -0.127, p=0.013). Emotional exhaustion predicted by work stressors may act as a chain reaction which could result in uncontrolled eating (β=0.138, p=0.005) and high BMI (β=0.185, p<0.001). Emotional exhaustion does mediate the relationship between PSC and uncontrolled eating behaviour (β= -0.021 [95% boot CI bias corrected: -0.048, -0.002]).

CASE PRESENTATION: A 36-year old fifth gravida patient who had a missed abortion was diagnosed as having a molar pregnancy with beta human chorionic gonadotrophin (βhCG) level of 509,921 IU/L. Her lung field was clear and she underwent suction and curettage (S & C) procedure. However, after six weeks, AA presented to the emergency department with a massive bleeding, although her βhCG level had decreased to 65,770 IU/L. A trans-abdominal ultrasound indicated the presence of an intra-uterine mass (3.0 × 4.4 cm). Nevertheless, her βhCG continued to show a declining trend (8,426 IU/L). AA was advised to undergo a chemotherapy but she refused, citing preference for alternative medicine like herbs instead. She opted for an "at own risk" (AOR) discharge with scheduled follow up. Subsequently, her condition improved with her βhCG showing a downward trend. Surprisingly, at six months post S & C, her βhCG ameliorated to 0 IU/L with no mass detected by ultrasound.