Improving outcomes for Colorado's IRT-IRT-DNA cystic fibrosis newborn screening algorithm by implementing floating cutoffs.

The Colorado Newborn Screening Program (CO-NBS) screens for cystic fibrosis (CF) by measuring immunoreactive trypsinogen (IRT) from two screens coupled with DNA analysis (IRT/IRT/DNA). The Colorado CF Care Center identified 8 missed CF cases among 358,187 infants screened by the CO-NSP since 2016. Retrospective analysis of CO-NSP IRT data shows that a 96th percentile floating IRT cutoff with a 50 ng/mL fixed cutoff on the first screen, and second screen 50 ng/mL fixed cutoff would have identified 7 of the 8 missed cases. These efforts demonstrate the importance of continuous quality improvement in order to increase sensitivity and reduce missed cases.

Contextualized School-Based Cognitive Behavioral Therapy (CBT) Intervention for Malaysian Secondary School Students.

This study investigates the effectiveness of the school-based Shine Through Any Roadblocks (STAR) CBT intervention, by a screening conducted on 634 students from eight secondary schools in Malaysia. Participants (n = 85) who fulfilled the eligibility criteria were assigned randomly to either the intervention group (n = 42) or the assessment-only waitlist control group (n = 43). The intervention consisted of eight group-based sessions over a period of 2 months. Sessions were 60-min each and conducted according to the STAR module. Outcome measures (depressive symptoms and automatic negative thoughts) were administered at five intervals: baseline/pre-intervention, mid-intervention, post-intervention, 1-month after intervention, and 3-months after intervention. Results showed significant and lasting lower levels of depressive symptoms and automatic negative thoughts in the intervention group, indicating that the STAR intervention could be an effective means of reducing depressive symptomatology among adolescents. Clinical implications for the Malaysian secondary school context are further discussed.

Student, Teacher, and School Counselor Perceptions of National School Uniforms in Malaysia.

The national school uniform remained a requirement for all primary and secondary school students in Malaysia since its first introduction by the British missionaries in the nineteenth century. Although it is commonly thought that wearing uniforms improve cohesion among students, little research has been done to investigate the perception of national school uniforms and perceived cohesion among Malaysian students. The aim of the current study is to explore the experiences of former students, teachers and school counselors in relation to Malaysia's national school uniform policy, their influence on student life, and their relationship to school and national cohesion. Three studies were conducted. In Study 1, Malaysian secondary school graduates (N = 192) completed a self-report questionnaire with close and open-ended questions. In Study 2 and study 3, secondary school teachers (N = 10) and school counselors (N = 6) participated in semi-structured interviews, respectively. Although students felt the uniforms were unattractive, they had neutral to somewhat positive feelings about them overall. They did not report greater school cohesion or national identity related to uniforms but did report that uniforms lessened the importance of socioeconomic and other differences. Teachers and counselors reported similar views; they did not perceive much influence on national or school identity but did see advantages in terms of discipline and the lessening of student inequality. Generally, teachers and counselors were in favor of school uniforms but some suggested that uniform designs could be more culturally inclusive, particularly in regard to Muslim and non-Muslim students. Limitations of using non-representative sampling and future direction for Malaysian school uniforms were discussed. This study highlights the important characteristics that should be taken into consideration by educators and policymakers for future improvement of the national school uniform policy in Malaysia.

Malaysians' Preferences and Concerns Regarding Seeking Information About Illegal Drugs.

A brief survey asked Malaysians if they had searched for information about illegal drugs and their thoughts about the information available. Two hundred and eighty participants from four states: Selangor, Penang, Malacca, and Johor filled out a paper-and-pencil survey including both multiple choice and open-ended written questions. Quantitative analyses of closed-ended, and thematic analyses of open-ended data indicated the following: Half of participants had, at some point, actively searched for information about drug use; 28% reported searching at least once per month. Participants generally (79%) preferred to obtain information online, but 62% also reported sharing and obtaining information about drugs in face-to-face interactions with friends and others. Concerns regarding the reliability of information, such as the presence of conflicting or contradictory messages from multiple sources, was a common theme in open ended responses. Of those who searched for information, about 70% reported desiring more detailed information about different drugs, in particular about their various side effects and risks. It is suggested that drug information campaigns, particularly those aimed at university students, might better focus on providing accurate, detailed information about the risks and other issues involved in various types of drug use, rather than one-size-fits-all messages. Given the varied and confusing nature of information already available, overly simplistic anti-drug messages may be ineffective, if not counterproductive.

Preferences for Online and/or Face-to-Face Counseling among University Students in Malaysia.

Increasingly, online counseling is considered to be a cost-effective and highly accessible method of providing basic counseling and mental health services. To examine the potential of online delivery as a way of increasing overall usage of services, this study looked at students' attitudes toward and likelihood of using both online and/or face-to-face counseling. A survey was conducted with 409 students from six universities in Malaysia participating. Approximately 35% of participants reported that they would be likely to utilize online counseling services but would be unlikely to participate in face-to-face counseling. Based on these results, it is suggested that offering online counseling, in addition to face-to-face services, could be an effective way for many university counseling centers to increase the utilization of their services and thus better serve their communities.

Examining Depressive Symptoms and Their Predictors in Malaysia: Stress, Locus of Control, and Occupation.

The 2015 National Health and Morbidity Survey estimated that over 29% of the adult population of Malaysia suffers from mental distress, a nearly 3-fold increase from the 10.7% estimated by the NHMS in 1996 pointing to the potential beginnings of a public health crisis. This study aimed to better understand this trend by assessing depressive symptoms and their correlates in a cross-section of Malaysians. Specifically, it assesses stress, perceived locus of control, and various socio-demographic variables as possible predictors of depressive symptoms in the Malaysian context. A total of 728 adults from three Malaysian states (Selangor, Penang, Terengganu) completed Beck's depression inventory as well as several other measures: 10% of respondents reported experiencing severe levels of depressive symptoms, 11% reported moderate and 15% reported mild depressive symptoms indicating that Malaysians are experiencing high levels of emotional distress. When controlling for the influence of other variables, depressive symptoms were predictably related to higher levels of stress and lower levels of internal locus of control. Ethnic Chinese Malaysians, housewives and those engaged in professional-type occupations reported less depressive symptoms. Business owners reported more depressive symptoms. Further research should look more into Malaysians' subjective experience of stress and depression as well as explore environmental factors that may be contributing to mental health issues. It is argued that future policies can be designed to better balance individual mental health needs with economic growth.

Physical Activity and Its Correlates among Adults in Malaysia: A Cross-Sectional Descriptive Study.

Obesity and rates of non-communicable diseases linked to physical inactivity have increased dramatically in Malaysia over the past 20 years. Malaysia has also been identified as one of the least physically active countries in the world with over 60% of adults being essentially sedentary. This study examines the relationship of socio-demographic factors to physical activity among 770 adults from 3 Malaysian states. Physical activity levels were significantly related to ethnicity, gender, age, occupation and educational level. Controlling for inter-relationships among these variables; age, gender, Chinese ethnicity and education level were found to have unique effects on total physical activity, as well as moderate and vigorous exercise. As would be expected, younger people were more physically active, engaging more in both moderate and vigorous types of exercise and males were generally more active than females. Contrary to findings from many developed countries, however, more educated Malaysians were less likely to engage in all types of physical activity. Ethnic Chinese participants, and to a lesser degree Indians also consistently reported lower levels of activity. Possible intervention strategies are discussed that specifically target ethnic and cultural norms related to physical activity. Future research programs exploring barriers to participation and perceptions of physical activity, as well as programs to encourage active life styles among youths are also suggested.

Substance Abuse, Relapse, and Treatment Program Evaluation in Malaysia: Perspective of Rehab Patients and Staff Using the Mixed Method Approach.

This study examined reasons for substance abuse and evaluated the effectiveness of substance treatment programs in Malaysia through interviews with rehab patients and staff. Substance rehab patients (aged 18-69 years; n = 30) and staff (ages 30-72 years; n = 10) participated in semi-structured interviews covering a range of topics, including family and peer relationships, substance use and treatment history, factors for substance use and relapse, motivation for entering treatment, work experience, job satisfaction, treatment evaluation, and patient satisfaction. Most patients did not demonstrate the substance progression trend and had normal family relationships. Most patients reported having peers from normal family backgrounds as well. Various environmental and personal factors was cited as contributing to substance abuse and relapse. There was no significant difference between patient and staff program evaluation scores although the mean score for patients was lower. A holistic treatment approach with a combination of cognitive-behavioral, medical, social, and spiritual components was favored by patients. Suggestions for improving existing programs include better tailoring treatment to individual needs, and providing more post-treatment group support.

Drug abuse, relapse, and prevention education in malaysia: perspective of university students through a mixed methods approach.

In recent years, there have been increasing accounts of illegal substance abuse among university students and professional groups in Malaysia. This study looks at university students' perceptions about this phenomenon. Students from Malaysian universities were asked for their impressions about drug availability and abuse, as well as factors contributing to drug abuse and relapse. The questionnaire also inquired into their knowledge and views regarding government versus private rehabilitation centers, as well as their exposure to, and views about, school-based drug-prevention education. Participants were 460 university students from five Malaysian states: Penang, Selangor, Kuala Lumpur, Sabah, and Sarawak. Results showed gender differences in perceptions of relapse prevention strategies, as well as factors leading to drug abuse and relapse. Students also believed that drug education would be more effective if initiated between the ages of 11 and 12 years, which is slightly older than the common age of first exposure, and provided suggestions for improving existing programs. Implications of student perceptions for the improvement of current interventions and educational programs are discussed.

Investigating diet and physical activity in Malaysia: education and family history of diabetes relate to lower levels of physical activity.

The National Health and Morbidity Survey (NHMS, 2011), estimates that the number of Malaysian adults suffering from type 2 diabetes has increased from 8.3 to 31.2% since 1996. This study is a preliminary investigation of possible factors contributing to this epidemic. Knowledge of diabetes, health locus of control, diet and exercise habits, as well as family history, education level and other demographic factors to better understand the correlates of risky and healthy behaviors. This was done as part of a larger initiative to improve prevention efforts. Questionnaires were completed by 770 individuals from three Malaysian states: Selangor, Penang, and Terengganu. Findings showed that people with better health knowledge and those who have a family history of type 2 diabetes were more likely to have healthy diets. Also, health knowledge related to lower alcohol consumption. Participants with diabetic family members, however, also reported higher levels of stress. Counterintuitively, higher educational levels, higher internal locus of control, better health knowledge, as well as a family history of diabetes all correlated with lower levels of physical activity. Thus, it is suggested that, while increasing health knowledge will be important in addressing the type 2 diabetes epidemic in Malaysia, especially in relation to diet, other cultural factors, specifically norms related to exercise and physical activity, also need to be addressed if the spread of type 2 diabetes is to be addressed over the long term.

Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness.

This paper examines the concept of free will, or independent action, in light of recent research in psychology and neuroscience. Reviewing findings in memory, prospection, and mental simulation, as well as the neurological mechanisms underlying behavioral control, planning, and integration, it is suggested in accord with previous arguments (e.g., Wegner, 2003; Harris, 2012) that a folk conception of free will as entirely conscious control over behavior should be rejected. However, it is argued that, when taken together, these findings can also support an alternative conception of free will. The constructive nature of memory and an integrative "default network" provide the means for novel and creative combinations of information, such as the imagining of counterfactual scenarios and alternative courses of action. Considering recent findings of extensive functional connections between these systems and those that subsume motor control and goal maintenance, it is argued that individuals have the capability of producing novel ideas and translating them into actionable goals. Although most of these processes take place beneath conscious awareness, it is argued that they are unique to the individual and thus, can be considered a form of independent control over behavior, or free will.

Nations' income inequality predicts ambivalence in stereotype content: how societies mind the gap.

Income inequality undermines societies: The more inequality, the more health problems, social tensions, and the lower social mobility, trust, life expectancy. Given people's tendency to legitimate existing social arrangements, the stereotype content model (SCM) argues that ambivalence-perceiving many groups as either warm or competent, but not both-may help maintain socio-economic disparities. The association between stereotype ambivalence and income inequality in 37 cross-national samples from Europe, the Americas, Oceania, Asia, and Africa investigates how groups' overall warmth-competence, status-competence, and competition-warmth correlations vary across societies, and whether these variations associate with income inequality (Gini index). More unequal societies report more ambivalent stereotypes, whereas more equal ones dislike competitive groups and do not necessarily respect them as competent. Unequal societies may need ambivalence for system stability: Income inequality compensates groups with partially positive social images.