Proactive Personality and Caring Behavior of Clinical Nurses: A Moderated Mediation Model of Emotional Intelligence and Disgust Sensitivity.

The aims of the research were to investigate the mediating effect of emotional intelligence and the moderating effect of disgust sensitivity on the relationship between proactive personality and caring behavior among clinical nurses. A cross-sectional design while adhering to STROBE guidelines was used for this study. Three hundred ninety-three purposely selected nurses from three tertiary general hospitals completed an online survey. Measures included proactive personality, emotional intelligence, disgust sensitivity, and caring behavior. The findings showed that proactive personality positively predicted nurses' caring behavior, and that emotional intelligence played a mediating role in the relationship between proactive personality and caring behavior. Disgust sensitivity indirectly and negatively moderated the impact of proactive personality on nurses' caring behavior mainly in the second half of this moderated relationship. The findings underscore that the nursing managers may consider incorporating emotional intelligence topic in practical nursing skills training and improving nurses' ability to control their disgust sensitivity can improve their professional behavior, thus to provide patients with high-quality nursing services.

Working mothers' breastfeeding experience: a phenomenology qualitative approach.

BACKGROUND: Breastfeeding practice is influenced by the mother's attitude toward and knowledge of breastfeeding. Working mothers face many challenges and need support to maintain breastfeeding. This study aimed to explore working mothers' breastfeeding experiences and challenges that can influenced their practices. METHODS: The qualitative phenomenological approach involving working mothers in Kota Bharu who fulfilled the inclusion criteria and consented to participate in the study were recruited using purposive sampling. Sixteen participants aged 24 to 46 years were interviewed using semi-structured in-depth interviews in the study. All interviews were recorded in digital audio, transcribed verbatim and analyzed using thematic analysis. FINDINGS: Three main themes emerged from the data analysis: perception of breastfeeding, challenges in breastfeeding, and support for breastfeeding. Two subthemes for perceptions were perception towards breastfeeding and towards infant formula. Challenges had two subthemes too which were related to perceived insufficient milk and breastfeeding difficulty. Where else, two subthemes for support were internal support (spouse and family) and external support (friends, employer, and healthcare staff). CONCLUSIONS: Maintaining breastfeeding after return to work is challenging for working mothers and majority of them need support to continue breastfeeding practice. Support from their spouses and families' influences working mothers' decision to breastfeed. Employers play a role in providing a support system and facilities in the workplace for mothers to express and store breast milk. Both internal and external support are essential for mothers to overcome challenges in order to achieve success in breastfeeding.

Maternal Factors Associated with the Initiation of Exclusive Breastfeeding among Mothers at One Week after Delivery in Two Selected Hospitals in Kelantan, Malaysia.

BACKGROUND: The first week following delivery usually coincides with the initiation of exclusive breastfeeding. This study aimed to determine the prevalence of and the associated factors regarding the initiation of exclusive breastfeeding among mothers at one week after delivery in two selected hospitals in the state of Kelantan, Malaysia. METHODS: A cross-sectional study was conducted from March to August 2015 among post-partum mothers, who were selected through systematic sampling. A newly developed and validated questionnaire on the participants' data, knowledge and attitude items and a breastfeeding practice checklist were used. The mothers were interviewed in the post-natal ward, and their breastfeeding practices were determined through a phone call at one week following delivery. Descriptive statistics and simple and multiple logistic regressions were used for the data analysis. RESULTS: A total of 335 participants were included. The prevalence of exclusive breastfeeding at one week post-partum was 77.9% (95% CI: 73.0%, 82.2%), with significant associated factors being previous exclusive breastfeeding experience [adjusted odds ratio (AOR) 2.48; 95% CI: 1.37, 4.49; P-value = 0.003] and the mean total score of knowledge [AOR 1.06; 95% CI: 1.01, 1.11; P-value = 0.011]. CONCLUSION: Every mother should receive breastfeeding education, with special emphasis on those with no previous experience. The weak areas of knowledge identified herein should be strengthened during health education.

The experiences of women with maternal near miss and their perception of quality of care in Kelantan, Malaysia: a qualitative study.

BACKGROUND: Maternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. Our study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia. METHODS: A qualitative phenomenological approach with in-depth interview method was conducted in two tertiary hospitals in Kelantan, Malaysia. All women admitted to labour room, obstetrics and gynaecology wards and intensive care units in 2014 were screened for the presence of any vital organ dysfunction or failure based on the World Health Organization criteria for maternal near miss. Pregnancy irrespective of the gestational age was included. Women younger than 18 years old, with psychiatric disorder and beyond 42 days of childbirth were excluded. RESULTS: Thirty women who had experienced maternal near miss events were included in the analysis. All were Malays between the ages of 22 and 45. Almost all women (93.3%) had secondary and tertiary education and 63.3% were employed. The women's perceptions of the quality of their care were influenced by the competency and promptness in the provision of care, interpersonal communication, information-sharing and the quality of physical resources. The predisposition to seek healthcare was influenced by costs, self-attitude and beliefs. CONCLUSIONS: Self-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women's perceptions of quality of care should be of concern to those seeking to improve services at healthcare facilities. The addition of a maternal near miss case review programme, allows for understanding on the factors related to providing care or to the predisposition to seek care; if addressed, may improve future healthcare and patient outcomes.

Role of Religion in Preventing Youth Sexual Activity in Malaysia: A Mixed Methods Study.

One of the popular approaches of preventing youth sexual activity in Malaysia is using religion to promote premarital sexual abstinence. Despite this intervention, youth continue to practise premarital sex. Thus, the purpose of this exploratory mixed methods study was to understand the role of religion on sexual activity among college students in Klang Valley, Malaysia. A self-administered questionnaire survey to determine the relationship between religiosity and youth sexual activity was carried out on 1026 students recruited from 12 randomly selected colleges. Concurrently, face-to-face interviews were conducted on 15 students to explore how religiosity had influenced their decision on sexual activity. The survey data were analysed using logistic regression, while the qualitative data from the interviews were examined using thematic analysis with separate analysis for each gender. Both quantitative and qualitative results were then compared and integrated. Religious activity significantly reduced the risk of continuing sexual activity among female students (AOR = 0.67, CI = 0.47, 0.95, p = 0.02) but not male students. There was no significant relationship of religious affiliation and intrinsic religiosity (inner faith) to sexual activity by gender. Having faith in religion and strong sexual desire were the main themes that explained participants' sexual behaviour. Engaging in religious activity might be effective at preventing female students from being sexually active. However, when sexual urges and desires are beyond control, religiosity might not be effective.

The Availability of Information on Induced Lactation in Malaysia.

Induced lactation is a method of stimulating the production of breast milk in women who have not gone through the process of pregnancy. Recent advances in technology have given such women the opportunity to breastfeed adopted children. Previous studies conducted in Western countries have explored the breastfeeding of adopted children, as well as the experiences, successes and challenges of this process. However, research on procedures for breastfeeding adopted children is lacking in Malaysia. The authors have therefore reviewed literature related to induced lactation in Malaysia to fill this gap. Of the 30 related articles identified, 19 described the breastfeeding practices and experiences of adoptive mothers in Malaysia. Out of 19 articles, there were four journal articles, five circulars and regulations, two books, two post-graduate theses, four blogs posts and forum discussions, and two online newspaper articles. Medical information relating to induced lactation procedures was also reviewed, showing that there was a lack of scientific studies focusing on induced lactation practices among adoptive mothers. Information on religious, specifically Islamic, perspectives on breastfeeding and child adoption laws was gathered from websites, social networks, blogs, magazines and online news sources. In consideration of recent advancements in medical technology and the dire need among Malaysians, it is crucial that evidence-based, accurate and reliable information on induced lactation is made available to professionals and other individuals in this country.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study.

BACKGROUND: Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia. METHODS: A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0. RESULTS: A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity. CONCLUSIONS: Our study suggests the enhanced screening and monitoring of women of advanced maternal age, women with past pregnancy complications, those who underwent caesarean section deliveries, those who delivered preterm and the mothers referred to tertiary centres as they are at increased risk of severe maternal morbidity. Identifying these factors may contribute to specific and targeted strategies aimed at tackling the issues related to maternal morbidity.

Severe maternal morbidity and near misses in tertiary hospitals, Kelantan, Malaysia: a cross-sectional study.

BACKGROUND: Severe maternal conditions have increasingly been used as alternative measurements of the quality of maternal care and as alternative strategies to reduce maternal mortality. We aimed to study severe maternal morbidity and maternal near miss among women in two tertiary hospitals in Kota Bharu, Kelantan, Malaysia. METHODS: A cross-sectional study with record review was conducted in 2014. Severe maternal morbidity and maternal near miss were classified using the new World Health Organization criteria. Health indicators for obstetric care were calculated and descriptive analyses were performed using SPSS version 22.0. RESULTS: In total, 21,579 live births, 395 women with severe maternal morbidity, 47 women with maternal near miss and two maternal deaths were analysed. The severe maternal morbidity incidence ratio was 18.3 per 1000 live births and the maternal near miss incidence ratio was 2.2 per 1000 live births. The maternal near miss mortality ratio was 23.5 and the mortality index was 4.1 %. The process indicators for essential interventions were almost 100.0 %. Haemorrhagic disorders were the most common event for severe maternal morbidity (68.6 %) and maternal near miss (80.9 %) and management-based criteria accounted for 85.1 %. CONCLUSIONS: Comprehensive emergency care and intensive care as well as overall improvements in the quality of maternal health care need to be achieved to substantial reduce maternal death.

The enablers and barriers to continue breast milk feeding in women returning to work.

AIM: To describe the enablers and barriers working women experience in continuing breast milk feeding after they return to work postpartum in urban Malaysia. BACKGROUND: In Malaysia, urban working women have low rates of breastfeeding and struggle to achieve the recommended 6 months exclusive breastfeeding. DESIGN: A qualitative enquiry based on a phenomenological framework and multiple methods were used to explore women's experiences in depth. METHODS: Multiple qualitative methods using face-to-face interview and participant diary were used. Data collection took place in urban suburbs around Penang and Klang Valley, Malaysia from March-September 2011. Participants were 40 employed women with infants less than 24 months. FINDINGS: Only 11 of the participants worked from home. Based on the women's experiences, we categorized them into three groups: 'Passionate' women with a strong determination and exclusively breastfed for 6 months, 'Ambivalent' women who initiated breastfeeding, but were unable to sustain exclusive breastfeeding after returning to work and 'Equivalent' women who introduced infant formula prior to returning to work. CONCLUSION: Passion and to a lesser extent intention, influenced women's choice. Women's characteristics played a greater role in their infant feeding outcomes than their work environment.

Decision-Making on Contraceptive Use among Women Living with Human Immunodeficiency Virus in Malaysia: A Qualitative Inquiry.

BACKGROUND: Malaysia is the first country in the Western Pacific Region to receive the validation certificate for the elimination of mother-to-child transmission of human immunodeficiency virus (HIV). The validation report recommends making sexual and reproductive health and rights of women living with HIV a priority. This article explores and assesses the sexual and reproductive health, rights, and access to healthcare services of Malaysia's women living with HIV (WLHIV). METHODS: A qualitative secondary analysis conducted on 73 WLHIV from all over Malaysia comprised 11 in-depth interviews and 16 focus group discussions. Data were extracted from the original interview transcripts that emerged from the following questions: (1) "What are your experiences as a woman living with HIV in relation to your sexual and reproductive health and rights?" (2) "What are your experiences in accessing contraception?" (3) "What are your day-to-day experiences as a woman living with HIV?" Data were analyzed using thematic analysis. RESULTS: Four themes emerged from the study findings: "lack of negotiation," "idealism in pregnancy," "coping with restrictions," and "past and future fears." The four themes are grounded in religion, a patriarchal culture, meaning and expectations of motherhood, taking risks and going against medical advice to pursue fertility desires, fear of HIV transmission, and the side effects of contraceptive use. CONCLUSION: The complexities involved in decision-making regarding contraceptive use revealed how WLHIV may have unresolved reproductive health needs inconsistent with healthcare providers' focus on HIV management and prevention. Suggestions are made for improving the sexual and reproductive health and rights of WLHIV in Malaysia, which include establishing a reproductive health counseling program.

Challenges experienced by induced lactation women in Malaysia: An exploratory qualitative study.

BACKGROUND: Induction of lactation occurs when breast milk is produced in a human (woman), without going through the process of pregnancy and delivery. Efforts to produce milk by women who had never been pregnant and give birth are not easy. According to the many who have attempted it, it is far more arduous a task than initiating postpartum lactation, but it is possible and worth the effort. RESEARCH AIM: This study aimed to explore and understand the challenges for women during induced lactation in Malaysia. METHODS: This qualitative study was done in 2017 and utilized in-depth interview among women who induced lactation in five states based on five regions in Malaysia [Central Region (Selangor), Northern Region (Penang), Southern Region (Johor), East Coast Region (Kelantan), Malaysia Borneo (Sabah)]. All interviews were consented, audio-recorded then transcribed verbatim, followed by identification of main themes. RESULTS: Data saturation was achieved after interviewing a total of 23 induced lactation women. Data synthesized using thematic analysis revealed six themes describing the main challenges during the induction process were (1) health condition, (2) work commitment, (3) overexertion, (4) not eligible to take leave, (5) inability to follow the treatment plan, and (6) difficulty attaching the adopted baby to initiate breastfeeding during induced lactation process. CONCLUSIONS: The challenges faced by women during the process of induced lactation were complex and the induced lactation process requires considerable dedication and determination. The findings of this research will help other women and their spouses/partners comprehend the challenges, obstacles, and support that are needed along the induced lactation process. The Government and other stakeholders have roles in more efforts and programs to help these mothers breastfeed their adoptive child and make them feel more accomplished as women and mothers.

ABM Position Statement: Paid Maternity Leave-Importance to Society, Breastfeeding, and Sustainable Development.

Background: Paid maternity leave benefits all of society, reducing infant mortality and providing economic gains. It is endorsed by international treaties. Paid maternity leave is important for breastfeeding, bonding, and recovery from childbirth. Not all mothers have access to adequate paid maternity leave. Key Information: Paid leave helps meet several of the 17 United Nations' Sustainable Development Goals (2, 3, 4, 5, 8, and 10), including fostering economic growth. A family's expenses will rise with the arrival of an infant. Paid leave is often granted with partial pay. Many low-wage workers earn barely enough to meet their needs and are unable to take advantage of paid leave. Undocumented immigrants and self-employed persons, including those engaging in informal work, are often omitted from maternity leave programs. Recommendations: Six months of paid leave at 100% pay, or cash equivalent, should be available to mothers regardless of income, employment, or immigration status. At the very minimum, 18 weeks of fully paid leave should be granted. Partial pay for low-wage workers is insufficient. Leave and work arrangements should be flexible whenever possible. Longer flexible leave for parents of sick and preterm infants is essential. Providing adequate paid leave for partners has multiple benefits. Increasing minimum wages can help more families utilize paid leave. Cash benefits per birth can help informal workers and undocumented mothers afford to take leave. Equitable paid maternity leave must be primarily provided by governments and cannot be accomplished by employers alone.

Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies.

Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies. Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.

Factors Associated with Attitudes towards Rejecting Intimate Partner Violence among Young Adults in Malaysia.

Intimate partner violence (IPV) is a serious public health issue, which is health threatening across all age groups, including young adults, and makes them and vulnerable. The rejection of IPV and willingness to disclose IPV as part of the solution are important as they correlate to this concealed violent behavior. This study aimed to investigate determinants of attitudes towards rejecting IPV among young adults. A cross-sectional study was carried out on 405 young adults attending premarital courses who were selected using purposive sampling. A validated questionnaire (MYPAIPVQ) was used as the study instrument. Logistic regression analyses were performed to test for associations between sociodemographic characteristics and relationship status with attitudes towards IPV. Attitudes towards rejecting IPV included not accepting IPV and have the willing to disclose it. About half of the premarital young adults (50.4%) had attitudes towards rejecting IPV. In the regression analysis, age (AdjOR 1.12), female (AdjOR 2.49), self-employed (AdjOR 0.20), and drama as sources of information (AdjOR 3.66) were significantly associated with attitudes towards rejecting IPV. The findings have potentially important implications for interventions aimed at preventing violence among the young adult population as they are vulnerable to being involved in IPV in the future.

Determinants of non-exclusive breastfeeding practice during the first 6 months after an elective caesarean birth: a prospective cohort study.

BACKGROUND: Caesarean birth is associated with higher rate of non-exclusive breastfeeding (non-EBF) than vaginal birth. Non-EBF refers to providing food or fluid besides breast milk, excluding drugs and vitamins, to infants before six months of age. This study determined the prevalence and factors associated with non-EBF during the first six months after an elective Caesarean birth. METHODS: This prospective cohort study recruited 171 mothers who underwent an elective caesarean birth at two tertiary hospitals in Kelantan, Malaysia. Face-to-face interviews were conducted two days after the birth to obtain information on the variables of interest. Follow-up phone calls were made at one, three and six months after birth to determine the prevalence of non-EBF. Simple and multiple logistic regressions were used for data analysis. RESULTS: The prevalence of non-EBF was 19.9%, 40.4% and 57.9% at one, three and six months, respectively. Women who perceived that they had no breast milk, or their breast milk was inadequate were more likely to practise non-EBF at one month [Adjusted Odds Ratio (AOR) 4.83; 95% CI 1.06, 21.96], three months (AOR 4.97; 95% CI 1.67, 14.85) and six months (very often / often AOR 10.06; 95% CI 2.41, 41.99; sometimes / seldom AOR 3.27; 95% CI 1.46, 7.32). Women with at least one child were less likely to practise non-EBF at one month (age of last child ≤ 2 years old AOR 0.10; 95% CI 0.02, 0.66; 3-5 years old AOR 0.10; 95% CI 0.02, 0.53; and > 5 years AOR 0.15; 95% CI 0.02, 0.92). CONCLUSION: Perceived breast milk insufficiency was the only factor associated with non-EBF at all time points. The issue of perceived breast milk insufficiency therefore needs to be explored further and addressed by lactation consultants and other maternal and child health professionals. Strategies may include breastfeeding education prior to the surgery and provision of a helpline to provide information and emotional support to the mothers following delivery. The important roles of lactation support groups in early detection and intervention of the problem cannot be emphasised enough.

Maternal Vitamin D Supplementation for the Prevention of Respiratory Tract Infections in Offspring: A Meta-Analysis.

BACKGROUND: Vitamin D may enhance immune system function and provide a protective effect against infections. Feto-maternal circulation plays an important role in supplying the developing fetus with nutrients and antibodies for its development and health during pregnancy and for its early years of life after birth. This meta-analysis aimed to determine the effectiveness of maternal vitamin D supplementation in preventing respiratory tract infections (RTIs) in children. METHODS: We searched the Central and MEDLINE databases and went through all the reference lists in the related articles. We also searched for ongoing trials at http://www.who.int/ictrp/en/ and www.clinicaltrials.gov. Randomized controlled trials comparing vitamin D supplementation with a placebo or no treatment in pregnant women published in the English language up to March 2019 were included. Two reviewers extracted data independently using a predefined protocol and assessed the risk of bias using the Cochrane risk of bias tool, with differences agreed upon by consensus. The predefined primary outcome was the number of offspring who had RTIs. The secondary outcome was the presence of measurable serum immunoglobulin E levels. RESULTS: Three trials involving 3,224 participants (mother-child pairs) met the inclusion criteria and were included in this review. The present analysis reported that maternal supplementation with vitamin D had no effect on RTIs among children (n=1,486 offspring; risk ratio, 0.95; 95% confidence interval, 0.82-1.11; random effects; I2 statistics, 0%). CONCLUSION: Maternal vitamin D supplementation had no effect on RTIs in children. Therefore, consideration of other prevention methods in this regard is recommended.

Experiences of women who underwent induced lactation: A literature review.

OBJECTIVE: This article aims to review the literature published over the past five decades related to the experiences of women who have undergone induced lactation. METHODS: A comprehensive electronic search was conducted using PubMed, the Library of Congress, Google Scholar, SAGE, and ScienceDirect. The following search keywords were used: adoptive breastfeeding, induced lactation, non-puerperal lactation, extraordinary breastfeeding, and milk kinship. The search was restricted to articles written in English and published from 1956 to 2019. All study designs were included except for practice protocols. RESULTS: A total of 50 articles about induced lactation were retrieved. Of these, 17 articles identified the experiences of women who underwent induced lactation. The articles included original papers (n=7), reviews (n=5), and case reports (n=5). Four articles were specifically related to Malaysia, and the others were international. These 17 articles concerning the experiences of women who induced lactation will be reviewed based on four themes related to inducing lactation: (a) understanding women's perception of satisfaction, (b) emotional aspects, (c) enabling factors, and (d) challenges. CONCLUSION: Identifying a total of only 17 articles on induced lactation published over the last 53 years suggests that the subject is understudied. This review provides emerging knowledge regarding the experiences of women who have induced lactation in terms of satisfaction, emotions, enabling factors and challenges related to inducing lactation.

Bloody Nipple Discharge Post Delivery: A Case of "Rusty Pipe Syndrome".

"Rusty pipe syndrome" is a condition that needs to be considered in a primiparous woman who presents with bilateral bloody nipple discharge in the early postpartum period. Its prevalence is low and can occur due to physiological condition that arises primarily in primiparous women with increased alveolar and ductal vascularization associated with the onset of lactation. Here, we report a case of a 29-year-old primigravida who presented with bilateral painless bloody nipple discharge after delivery. Her breast examination showed no signs of infection or structural changes, and breast ultrasound did not reveal any significant observations except for a bilateral simple breast cyst. Six days after the onset of lactation, the bloody nipple discharge ceased and lactation continued on demand.

Malaysia Healthcare Early Response in Combatting COVID-19 Pandemic in 2020.

The year 2020 saw the emergence of a novel coronavirus-the severe acute respiratory syndrome coronavirus 2- which has led to an unprecedented pandemic that has shaken the entire world. The pandemic has been a new experience for Malaysia, especially during the implementation of large-scale public health and social measures called the Movement Control Order (MCO). This paper seeks to describe the experiences of the Malaysian healthcare system thus far in combatting the pandemic. The Malaysian healthcare system comprises two main arms: public health and medicine. The public health arm focuses on early disease detection, contact tracing, quarantines, the MCO, and risk stratification strategies in the community. The medical arm focuses on the clinical management of coronavirus disease 2019 (COVID-19) patients; it encompasses laboratory services, the devising of clinical setting adjustments, and hospital management for COVID-19 and non-COVID-19 patients. Malaysia experienced intense emotions at the beginning of the pandemic, with great uncertainty regarding the pandemic's outcome, as the world saw a frighteningly high COVID-19 mortality. As of writing (May 30, 2020), Malaysia has passed the peak of its second wave of infections. The experience thus far has helped in preparing the country's healthcare system to be vigilant and more prepared for future COVID-19 waves. To date, the pandemic has changed many aspects of Malaysia's life, and people are still learning to adapt to new norms in their lives.

Metoclopramide for Milk Production in Lactating Women: A Systematic Review and Meta-Analysis.

BACKGROUND: Breastfeeding is recognized as the optimal form of nutrition for the physical and neurological development of infants and is considered the most significant way to prevent child mortality. This study aimed to assess the effectiveness of metoclopramide for enhancing milk production in lactating women. METHODS: We searched the Cochrane Central Register of Controlled Trials and MEDLINE for randomized controlled trials comparing metoclopramide with a placebo, no treatment, or other galactagogue drugs. We included breastfeeding women with term or preterm infants. RESULTS: We retrieved 164 records from our search of the electronic databases and 20 records from other sources. Eight trials involving 342 lactating women that used metoclopramide were included in this review after assessing the eligibility criteria. The meta-analysis of these trials revealed that metoclopramide did not increase the milk volume of the intervention groups compared to that of the control groups. There was a significant increase in the serum concentrations of prolactin when the mothers were administered metoclopramide. No significant adverse events were reported. CONCLUSION: Metoclopramide did not improve milk production in lactating women. Therefore, we do not recommend using metoclopramide to increase milk production in lactating women.