Fatigue-related crashes have long been the topic of discussion and study worldwide. The relationship between fatigue-related crashes and time of day is well documented. In Malaysia, the possibility of banning express buses from operating during the early-hours of the morning has emerged as an important consideration for passenger safety. This paper highlights the findings of an impact assessment study. The study was conducted to determine all possible impacts prior to the government making any decision on the proposed banning. This study is an example of a simple and inexpensive approach that may influence future policy-making process. The impact assessment comprised two major steps. The first step involved profiling existing operation scenarios, gathering information on crashes involving public express buses and stakeholders' views. The second step involved a qualitative impact assessment analysis using all information gathered during the profiling stage to describe the possible impacts. Based on the assessment, the move to ban early-hour operations could possibly result in further negative impacts on the overall road safety agenda. These negative impacts may occur if the fundamental issues, such as driving and working hours, and the need for rest and sleep facilities for drivers, are not addressed. In addition, a safer and more accessible public transportation system as an alternative for those who choose to travel at night would be required. The proposed banning of early-hour operations is also not a feasible solution for sustainability of express bus operations in Malaysia, especially for those operating long journeys. The paper concludes by highlighting the need to design a more holistic approach for preventing fatigue-related crashes involving express buses in Malaysia.
This paper discusses national programs implemented in India, Pakistan, Malaysia, and Philippines to generate and apply evidence in making informed policy decisions on the approval, pricing, reimbursement and financing of medicines, diagnostics, and medical devices.
In the last decade factory owners, in response to brand-name Corporate Social Responsibility (CSR) parameters, have joined associations that verify (through a monitoring and audit system) that management does not exploit labour. There have been no reports of violations of codes of conduct concerning Malaysian workers but for foreign workers on contract there are certain areas that have been reported. These areas, including trade union membership, the withholding of workers' passports and unsuitable accommodation, generally escape notice because auditors who monitor factory compliance do not question the terms of contracts as long as they comply with national labour standards. This paper is based on research with foreign workers in Malaysia and argues that despite the success of the anti-sweatshop movement in a global context, the neo-liberal state in Malaysia continues to place certain restrictions on transnational labour migrants which breach garment industry codes of conduct. Available evidence does not support the assumption that CSR practices provide sufficient protection for both citizen and foreign workers on contract in the garment industry.
Matched MeSH terms: Public Health/legislation & jurisprudence; Public Policy/legislation & jurisprudence; Emigrants and Immigrants/legislation & jurisprudence
Three authors describe problematic scenarios of health policy in their respective countries. These examples illustrate the role of government influences in determining resource allocation, legislation, health provision and health outcomes in very different situations. These outcomes are affected not only by attitudes to public health, but also by the legal systems in the countries which are the subjects of this study. The authors draw conclusions about the use and abuse of public health regulation.
Matched MeSH terms: Consumer Participation/legislation & jurisprudence; Delivery of Health Care/legislation & jurisprudence; Public Health/legislation & jurisprudence*
One of the most important ironies of modern health care is that public expectations are rising faster than the ability of health services to meet them. Patients nowadays no longer want to be treated as passive recipients of medical care but as co-producers or partners able to manage their illnesses. Thus, it is not surprising that poor communication and failure to take into account the patient's perspective are at the heart of most formal complaints and legal actions in Malaysia. The difficulties of existing complaint procedures in Malaysia have become manifest over the years and this has been accentuated by patients becoming more willing to challenge the decisions of medical practitioners and health service management in court. To reduce the number of complaints and risks of litigation, a more patient-centred approach should be adopted. When patients voice their concern by making a complaint or inquiry, this should be seen as a unique source of information for health care services on why adverse events occur and how to prevent them. As well as reducing future harm to patients, better management of complaints should restore trust and reduce the risk of litigation, through open communication and a commitment to learn from the problem. The existing procedures for patients to be heard in Malaysia should be reviewed and incorporate features such as responsiveness, accessibility, impartiality, simplicity, speed and accountability.
Teeth are the most durable structures in the human body. The timing and sequence of their development, as contained in dental development charts, have been used as valid criteria for age determination. The third molars however are the last teeth to erupt and are regarded as the most variable in the dentition. Age estimation in a legal context, using developing third molars must be carefully applied otherwise justice may miscarry. A case of wrongful use of the technique is presented here.
Matched MeSH terms: Drug and Narcotic Control/legislation & jurisprudence; Expert Testimony/legislation & jurisprudence*; Forensic Dentistry/legislation & jurisprudence
Malaysia has strict laws requiring seat belt use by all vehicle occupants. However, neither passive devices nor inertial reel belts are mandated. Seat belt usage was investigated among 60 taxicab drivers in Kuala Lumpur, Malaysia, in 1993. Although all drivers appeared to be restrained during an initial curb-side inspection, 60% did not fasten the latch. There was no statistical difference between ethnic groups. Curb-side estimates of restraint use may overestimate actual usage, resulting in falsely low estimates of effectiveness. Requiring inertial reel belts, which would retract if not latched, could greatly increase actual restraint use. This may be cost effective for developing nations.
The illegal ivory trade continues to drive elephant poaching. Large ivory seizures in Africa and Asia are still commonplace. Wildlife forensics is recognised as a key enforcement tool to combat this trade. However, the time and resources required to effectively test large ivory seizures is often prohibitive. This limits or delays testing, which may impede investigations and/or prosecutions. Typically, DNA analysis of an ivory seizure involves pairing and sorting the tusks, sampling the tusks, powdering the sample, decalcification, then DNA extraction. Here, we optimize the most time-consuming components of this process: sampling and decalcification. Firstly, using simulations, we demonstrate that tusks do not need to be paired to ensure an adequate number of unique elephants are sampled in a large seizure. Secondly, we determined that directly powdering the ivory using a Dremel drill with a high-speed cutter bit, instead of cutting the ivory with a circular saw and subsequently powdering the sample in liquid nitrogen with a freezer mill, produces comparable results. Finally, we optimized a rapid 2 -h decalcification protocol that produces comparable results to a standard 3-day protocol. We tested/optimised the protocols on 33 raw and worked ivory samples, and demonstrated their utility on a case study, successfully identifying 94% of samples taken from 123 tusks. Using these new rapid protocols, the entire sampling and DNA extraction process takes less than one day and requires less-expensive equipment. We expect that the implementation of these rapid protocols will promote more consistent and timely testing of ivory seizures suitable for enforcement action.
Over the last three decades in response to a rise in substance use in the region, many countries in East and Southeast Asia responded by establishing laws and policies that allowed for compulsory detention in the name of treatment for people who use drugs. These centers have recently come under international scrutiny with a call for their closure in a Joint Statement from United Nations entities in March 2012. The UN's response was a result of concern for human rights violations, including the lack of consent for treatment and due process protections for compulsory detention, the lack of general healthcare and evidence based drug dependency treatment and in some centers, of forced labor and physical and sexual abuse (United Nations, 2012). A few countries have responded to this call with evidence of an evolving response for community-based voluntary treatment; however progress is likely going to be hampered by existing laws and policies, the lack of skilled human resource and infrastructure to rapidly establish evidence based community treatment centers in place of these detention centers, pervasive stigmatization of people who use drugs and the ongoing tensions between the abstinence-based model of treatment as compared to harm reduction approaches in many of these affected countries.
Environmental noise remains a complex and fragmented interplay between industrialization, population growth, technological developments, and the living environment. Next to the circulatory diseases and cancer, noise pollution has been cited as the third epidemic cause of psychological and physiological disorders internationally. A reliable and firm relationship between the cumulative health implications with the traffic annoyance and occupational noise has been established. This agenda has called for an integrated, coordinated, and participatory approach to the reliable protection of noise interference. Despite several fragmented policies, legislation and global efforts have been addressed; the noise pollution complaints have been traditionally neglected in developing countries, especially in Malaysia. This paper was undertaken to postulate an initial platform to address the dynamic pressures, gigantic challenges, and tremendous impacts of noise pollution scenario in Malaysia. The emphasis is speculated on the traffic interference and assessment of industrial and occupational noise. The fundamental importance of noise monitoring and modeling is proposed. Additionally, the confronting conservation program and control measure for noise pollution control are laconically elucidated.
Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.
Matched MeSH terms: Health Services Needs and Demand/legislation & jurisprudence*; Quality of Health Care/legislation & jurisprudence; Clinical Laboratory Services/legislation & jurisprudence
Religion and spirituality have always played a major and intervening role in a person's life and health matters. With the influential development of patient autonomy and the right to self-determination, a patient's religious affiliation constitutes a key component in medical decision making. This is particularly pertinent in issues involving end-of-life decisions such as withdrawing and withholding treatment, medical futility, nutritional feeding and do-not-resuscitate orders. These issues affect not only the patient's values and beliefs, but also the family unit and members of the medical profession. The law also plays an intervening role in resolving conflicts between the sanctity of life and quality of life that are very much pronounced in this aspect of healthcare. Thus, the medical profession in dealing with the inherent ethical and legal dilemmas needs to be sensitive not only to patients' varying religious beliefs and cultural values, but also to the developing legal and ethical standards as well. There is a need for the medical profession to be guided on the ethical obligations, legal demands and religious expectations prior to handling difficult end-of-life decisions. The development of comprehensive ethical codes in congruence with developing legal standards may offer clear guidance to the medical profession in making sound medical decisions.
Modern medicine, specifically assisted reproductive technology (ART), has overtaken the law in many jurisdictions around the world. New technologies and practices open a Pandora's Box of ethical, religious, social and legal questions, and may present a variety of significant legal problems to the courts and legislators. Surrogate motherhood and pregnancy through ART have both attracted controversy. Some groups condemn ART and want it banned while its supporters acknowledge there is a need for legislative guidelines and regulations. A proposed statute, the Assisted Reproductive Technique Services Act, aimed at regulating reproductive technologies, including surrogacy arrangements, will be introduced in the Malaysian parliament, probably in 2012, and the Assisted Reproductive Technology (Regulation) Bill 2010 is already before the Indian parliament. This paper will discuss several of the potential socio-legal issues surrounding ART in the light of the complex situation, with a comparative analysis of the Malaysian, USA, UK and Indian positions.
This paper seeks to examine the provisions for extended producer responsibility (EPR) within the Malaysian environmental and waste management policies and to determine its existing practice and future prospects in Malaysia. Malaysian waste generation has been increasing drastically where solid waste generation was estimated to increase from about 9.0 million tonnes in 2000 to about 10.9 million tonnes in 2010, to about 12.8 million tonnes in 2015 and finally to about 15.6 million tonnes in 2020. Malaysian e-waste was estimated to be about 652 909 tonnes in 2006 and was estimated to increase to about 706 000 tonnes in 2010 and finally to about 1.2 million tonnes in 2020. The projected increasing generation of both solid waste and scheduled wastes is expected to burden the country's resources and environment in managing these wastes in a sustainable manner. The concept of EPR is provided for in the Malaysia waste management system via the Environmental Quality Act 1974 and the Solid Waste and Public Cleansing Management Act 2007. However, these provisions in the policy are generic in nature without relevant regulations to enable its enforcement and as such the concept of EPR still remains on paper whereas the existing practice of EPR in Malaysia is limited through voluntary participation. In conclusion, policy trends of EPR in Malaysia seem to indicate that Malaysia may be embarking on the path towards EPR through the enactment of an EPR regulation.
The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.
Drivers of sustainable waste management are defined as groups of related factors that influence the development (or lack thereof) of industry. There has been no attempt to reasonably list the drivers that influence sustainable waste management in Asia. In this review, four groups of drivers of sustainable waste management, specifically of Asia, are explained. The four groups of drivers consist of three human elements (human, economic and institutional) and the environment as a single driving group. Typically, the first three groups have been very influential, with the environment driver, noticeably, only considered when preceded by other groups of drivers. The interconnectedness of the drivers and neglect of the environment driver is discussed. It is concluded that while the essence of the four groups of drivers can be found all over Asia, each driving group must be investigated in a local context and all information combined to devise sustainable waste management policies or strategies.
The past century has seen tremendous changes in the scope and practice of pathology laboratories in tandem with the development of the medical services in Malaysia. Major progress was made in the areas of training and specialization of pathologists and laboratory technical staff. Today the pathology laboratory services have entered the International arena, and are propelled along the wave of globalization. Many new challenges have emerged as have new players in the field. Landmark developments over the past decade include the establishment of national quality assurance programmes, the mushrooming of private pathology laboratories, the establishment of a National Accreditation Standard for medical testing laboratories based on ISO 15189, and the passing of the Pathology Laboratory Act in Parliament in mid-2007. The Pathology Laboratory Act 2007 seeks to ensure that the pathology laboratory is accountable to the public, meets required standards of practice, participates in Quality Assurance programmes, is run by qualified staff, complies with safety requirements and is subject to continuous audit. The Act is applicable to all private laboratories (stand alone or hospital) and laboratories in statutory bodies (Universities, foundations). It is not applicable to public laboratories (established and operated by the government) and side-room laboratories established in clinics of registered medical or dental practitioners for their own patients (tests as in the First and Second Schedules respectively). Tests of the Third Schedule (home test blood glucose, urine glucose, urine pregnancy test) are also exempted. The Act has 13 Parts and provides for control of the pathology laboratory through approval (to establish and maintain) and licensing (to operate or provide). The approval or license may only be issued to a sole proprietor, partnership or body corporate, and then only if the entity includes a registered medical practitioner. Details of personnel qualifications and laboratory practices are left to be specified by the Director-General of Health, providing for a formal recognition process and room for revision as pathology practices evolve. Encompassed in the responsibilities of the licensee is the requirement that samples are received and results issued through, and management vested in, a registered medical or dental practitioner. This effectively prohibits "walk-ins" to the laboratory and indiscriminate public screening. The requirement for a person-in-charge in accordance with class and speciality of laboratory ensures that the laboratory is under the charge of the pathology profession. Examined carefully, the requirements of the Act are similar to laboratory accreditation, but are backed by legislation. Many of these details will be spelt out in the Regulations, and these in turn are likely to fall back on National professional guidelines, as accreditation does. Although not at first obvious, enforcement of the Act is based on self-regulation by pathology laboratory professionals. Sincere professional input is thus required to embrace its philosophy, ensure rational and transparent enforcement of legislation, and develop National guidelines for good pathology practices upon which enforcement may be based.
Climate change and nuclear war are currently the most dangerous challenges to human civilisation and survival. The effects of climate change are now sufficient to persuade many governments to take effective measures to reduce greenhouse gas emissions. Today there are about 27,000 nuclear warheads, many at least ten times more powerful than the Hiroshima and Nagasaki bombs, and a meaningful medical response to a nuclear attack is impossible. Nevertheless, the threat of nuclear war does not raise public concern, and indeed the nuclear-weapon states are upgrading their capability. The only effective preventive measure is the abolition of nuclear weapons. Steps towards this include: a Fissile Material Cut-off Treaty, for the nuclear weapon states to observe their obligations under the Nuclear Non-Proliferation Treaty, and for the Comprehensive Test Ban Treaty to enter into force. The ultimate need is for a Nuclear Weapons Convention; International Physicians for the Prevention of Nuclear War have launched an International Campaign to Abolish Nuclear weapons (ICAN) to promote a NWC.
Recently, the abuse of ketum, an indigenous psychoactive plant, has received a lot of attention in Malaysia. To help national law enforcement agencies control its abuse, the laboratory of the Forensic Division has developed a procedure for its positive identification. Botanical identification may not be practical or conclusive, owing to the wide range of ketum materials available on the market, including dry macerated leaves, powdered leaves and drinks. In order to confirm that a substance is, in fact, ketum or that a preparation is derived from ketum, gas chromatography-mass spectrometry is used to definitively identify the presence of the psychoactive principle mnitragynine.
Matched MeSH terms: Drug and Narcotic Control/legislation & jurisprudence*; Substance Abuse Detection/legislation & jurisprudence*