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All Journal International Journal of Public Health Science (IJPHS) Universa Medicina Kesmas: Jurnal Kesehatan Masyarakat Nasional (National Public Health Journal)
Sundram, Bala Murali
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Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Determining the effectiveness of stress management program by using hair cortisol concentration Sundram, Bala Murali; Shaharudin, Rafiza; Mohamad, Nadia; Pahrol, Muhammad Alfatih; Omar, Affandi; Sevaratnam, Gogillan; Kumareswaran, Suriya; Rajendran, Kamesh
International Journal of Public Health Science (IJPHS) Vol 13, No 1: March 2024
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v13i1.23273

Abstract

Many studies have shown that healthcare workers are exposed to higher levels of stress than other occupations. However, little research has been conducted on the use of biomarker tools to assess chronic stress and assess the effectiveness of stress management programs for healthcare workers. The aim of this study was to measure the effectiveness of a Stress Management Program by measuring Depression Anxiety Stress Scale (DASS-21) scores and hair cortisol concentration (HCC) levels of healthcare workers in public healthcare facilities. This study was a three-group, quasi-experiment study with pre- and post-study assessment sessions. A total of 119 healthcare workers (28 from Group A, 21 from Group B, and 70 from Group C) were followed for 6 months. Significant favorable intervention effects on DASS-21 scores were found in Group A (Effect size =0.6) as compared to Group B (Effect size=0.2) and Group C (Effect size =02) at the end of the program. Time and group interaction effects were examined using the repeated measure ANOVA test in which there was a significant group *time interaction and effect size of 0.2 (p-value <0.01) across all the groups with a reduction in hair cortisol concentrations following the program. The study showed that stress management under healthy communities, building the nation (KOSPEN PLUS) program was successful in reducing stress levels, as seen through a decrease in both stress scores and hair cortisol levels. This is the first study in Malaysia to use hair cortisol as a biomarker for stress management, suggesting its reliability.
Work-related musculoskeletal disorders among dental staff in south Malaysia Kumareswaran, Suriya; Muhadi, Siti Umairah; Retnam, Sathiya Kumaran Vijaya; Sathasivam, Jeyanthini; Sundram, Bala Murali
International Journal of Public Health Science (IJPHS) Vol 12, No 4: December 2023
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v12i4.23406

Abstract

The dental industry poses ergonomic health concerns, leading to work-related musculoskeletal disorders (MSD) among staff. This study aims to assess MSD incidence and related sociodemographic and occupational hazard factors among dental practitioners in Johor, Malaysia. A cross-sectional investigation in December 2022 included 382 dental officers from government and commercial sectors. Participants comprised 79.2% females, 72.3% Malays, 97.4% non-smokers, and 92.4% working in dental clinics. MSD was most prevalent in the neck, shoulder, and lower back regions. Logistic regression revealed higher neck pain probability among smokers and a positive association between back pain and standing while working. Poisson regression indicated an inverse relationship between exercise frequency and MSD pain occurrence. Regular physical activity correlated with lower body mass index (BMI) and reduced MSD pain. The study underscores the importance of ergonomic interventions and promoting exercise to prevent MSD and enhance the well-being of dental staff in Johor, Malaysia. Understanding the factors contributing to MSD among dental practitioners is crucial for implementing effective preventive measures and improving overall occupational health in the dental industry.
Understanding HIV transmission and prevention among men who have sex with men in a sexual health clinic Kumareswaran, Suriya; Sundram, Bala Murali
International Journal of Public Health Science (IJPHS) Vol 14, No 2: June 2025
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v14i2.24552

Abstract

This comprehensive study investigates the knowledge, attitudes, and practices (KAP) concerning human immunodeficiency virus (HIV) transmission and prevention among men who have sex with men (MSM) in a sexually transmitted infections (STI)-friendly clinic in Johor, Malaysia. Utilizing a cross-sectional design, the study analyses data from 421 MSM patients, emphasizing the critical role of sociodemographic factors in influencing HIV-related behaviors. The majority of participants, mostly with tertiary education, displayed a sound understanding of HIV, with 71% showing good knowledge on HIV prevention and transmission. However, there remain gaps in knowledge, particularly among those with lesser education, and in practices related to condom use and pre-exposure prophylaxis (PrEP). The study highlights a stark disparity in HIV-related attitudes and practices based on education level, employment status, and income. Notably, those with higher education and income levels demonstrate more responsible practices and better knowledge, underscoring the need for tailored educational programs. The findings call for comprehensive and targeted interventions, considering the diverse backgrounds of individuals, to effectively mitigate the risk of HIV infection. This research is vital in the absence of a definitive cure for HIV and acquired immune deficiency syndrome (AIDS), emphasizing preventive measures based on accurate information and positive attitudes towards the disease.
Navigating the storm of healthcare workers burnout in the COVID-19 era: a bibliometric analysis Kumareswaran, Suriya; Sundram, Bala Murali; Naidu, Thaalitha
Universa Medicina Vol. 44 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2025.v44.219-231

Abstract

The COVID-19 pandemic has imposed unprecedented challenges on healthcare systems globally, significantly impacting healthcare workers (HCWs) and intensifying the incidence of occupational burnout. Characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment, burnout has been further exacerbated by pandemic-specific stressors such as resource limitations, fear of contagion, overwhelming workloads, and emotional fatigue. This bibliometric analysis systematically evaluated 2,043 peer-reviewed publications from 2019 onwards, retrieved from major databases including Web of Science, Scopus, and PubMed. Using tools such as VOS viewer, the study analysed keyword trends, author collaborations, citation metrics, and thematic clusters to map the evolving academic landscape surrounding HCWs burnout during COVID-19. The results revealed significant research diversity, with contributions from 11,156 unique authors and a collaboration index of 6.65, indicating robust interdisciplinary engagement. High research output and citation impact were observed in countries such as the United States, China, Italy, and the United Kingdom. Prominent themes included “COVID-19,” “burnout,” “mental health,” and “nurses,” highlighting the psychological toll on frontline professionals. Keyword co-occurrence and heatmap analyses demonstrated a shift in scholarly focus from the immediate crisis to long-term strategies for resilience and recovery. Despite these insights, notable disparities in research output persist, particularly in underrepresented regions such as France and several low- and middle-income countries. These imbalances may hinder the development of globally relevant, context-specific interventions. The study underscores the urgent need for inclusive, multidisciplinary collaboration to inform policy, guide mental health interventions, and enhance support systems for HCWs in current and future healthcare emergencies.
Exploring Physician Well-Being: A Bibliometric Analysis of Mental Health Kumareswaran, Suriya; Sundram, Bala Murali; Thurairasu, Vanitha
Kesmas Vol. 20, No. 1
Publisher : UI Scholars Hub

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Abstract

This bibliometric study examined the evolving research landscape on physician mental health from 2010 to 2023, analyzing key themes, publication trends, and global contributions. A total of 3,360 articles, including 3,137 original research and 223 reviews, were sourced from Web of Science and Scopus. Findings revealed a significant increase in research output, particularly during the COVID-19 pandemic, with burnout, depression, and anxiety emerging as dominant themes. The US accounted for most publications, while research from low- and middle-income countries remains limited, indicating a substantial global disparity. Thematic analysis highlighted variations in burnout assessment methodologies, underscoring the need for standardized evaluation tools. This study also identified systemic challenges, including excessive workload, hierarchical workplace structures, and inadequate institutional support, as major contributors to physician distress. Technological inefficiencies, particularly in electronic health record systems, exacerbated administrative burdens and physician dissatisfaction. Recommendations include developing standardized mental health assessment frameworks, expanding study in underrepresented regions, and implementing organizational policies to enhance physician well-being. This review provides critical insights for policymakers, healthcare institutions, and researchers, offering a foundation for targeted interventions and evidence-based reforms to improve physician mental health globally.
Exploring the Multifaceted Nature of Occupational Stress Among Nurses: A Systematic Review Sundram, Bala Murali; Vallasamy, Suriya Kumareswaran; Muhadi, Umairah
Kesmas Vol. 19, No. 2
Publisher : UI Scholars Hub

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Abstract

This systematic review examined occupational stress among nurses, its multifaceted nature, and its significant impact on healthcare delivery and nurse well-being globally. This study identified various stressors, including intrinsic job factors, organizational structure, role expectations, interpersonal relationships, and career development. Using the Cooper and Marshall stress model, a thorough literature search was conducted across databases like ISI Web of Knowledge, PubMed, Scopus, Ovid Medline, and Google Scholar, focusing on publications from 2010 to 2023. This rigorous approach included diverse research methodologies, emphasizing studies measuring outcomes related to occupational stress and mental health among nurses. A total of 10 studies met the inclusion criteria, highlighting stressors such as workload, job demand, job insecurity, and less reward, categorized into five primary sources. The review revealed that occupational stress in nursing is a global issue, leading to adverse outcomes like burnout, decreased job satisfaction, and increased turnover. The discussion emphasized the need for a holistic approach to stress management, advocating for supportive work environments, adequate staffing, and professional development opportunities. In conclusion, strategic interventions are crucial for improving mental health, job satisfaction, and healthcare quality, necessitating collaborative efforts from healthcare leaders, policymakers, and practitioners.
Developing a conceptual framework for burnout intervention program in the workplace Sundram, Bala Murali; Kumareswaran, Suriya
Universa Medicina Vol. 43 No. 1 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.88-101

Abstract

This review proposes a comprehensive conceptual framework for developing and implementing burnout intervention programs in the workplace. In recent years, job burnout has become a new and vigorous research hotspot in the field of psychology and human resources management at home and abroad. Job burnout has a serious impact on personal health and performance but also harms the work efficiency, organizational effectiveness, and even social stability of employees. With the escalating concern over employee burnout and its consequent negative impacts on both individual health and organizational productivity, there is a pressing need for effective strategies to mitigate this issue. The framework draws on extensive literature review and theoretical model analysis, integrating key theories such as the Job Strain Model, Effort-Reward Imbalance Model, Conservation of Resources Theory, and the Job Demands-Resources Theory to explore the multifaceted nature of burnout. It identifies critical components of burnout, including symptoms such as emotional exhaustion, depersonalization, and reduced personal accomplishment, and contributing factors such as high job demands, inadequate job resources, and personal traits. Intervention strategies such as exercise have been identified as beneficial in addressing burnout. A systematic review of six studies highlights that aerobic exercise effectively lowers burnout and stress levels among employees. The framework also examines mediating factors such as personality traits and external factors, evaluating outcomes such as improved mental and physical health, enhanced job performance, and better workplace environment. Moreover, this review discusses the sustainability of interventions and emphasizes the importance of tailoring approaches to fit specific organizational contexts. The proposed framework provides a structured approach to understanding and addressing workplace burnout, highlighting the necessity for ongoing research and adaptation of intervention programs to meet evolving workplace dynamics.
Co-Authors Kumareswaran, Suriya Mohamad, Nadia Muhadi, Siti Umairah Muhadi, Umairah Naidu, Thaalitha Omar, Affandi Pahrol, Muhammad Alfatih Rajendran, Kamesh Retnam, Sathiya Kumaran Vijaya Sathasivam, Jeyanthini Sevaratnam, Gogillan Shaharudin, Rafiza Thurairasu, Vanitha Vallasamy, Suriya Kumareswaran