Translation and validation of menopause quick 6 (MQ6) into the Malay language.

BACKGROUND: Inquiring conservative Asian women about their menopausal symptoms is often challenging in crowded primary healthcare clinics. Furthermore, the subject matter is culturally sensitive to most Malaysian women. Hence, the translation of MQ6 into Malay is crucial to enable self-administration, eliminating the necessity for interviewers and mitigating potential respondent shyness. METHODS: The Menopause Quick 6 (MQ6) questionnaire was translated into the Malay language with an addition of an item, henceforth termed MQ6 (M). Forward and backward translation was performed. Face and content validity were conducted. MQ6 (M) was self-administered to 400 women aged between 40 and 60 attending six primary healthcare clinics in Malaysia. To ascertain the reliability for MQ6 (M), corrected Item-Total Correlation, Squared Multiple Correlation, Cronbach's Alpha if the Item is Deleted, and Kuder-Richardson Reliability Coefficients (KR20). Exploratory factor analysis was done to determine its' construct validity. RESULTS: The outcome of the validation was satisfactory. By the Lawshe method, the content validity ratios ranged from 0.6 to 1.0 and the content validity index was 0.914. The Internal consistency for MQ6(M) Cronbach's alpha was 0.711 while Kuder-Richardson Reliability Coefficients KR20 was 0.676. Factor loading of all four items is above 0.70, indicating a well-defined structure. Whereas factor loading for three items fell within the range of 0.50-0.69 indicating a practically significant threshold for a new questionnaire. CONCLUSION: MQ6 (M) has acceptable reliability and construct validity to be considered as a self-administered screening tool in primary care clinics in Malaysia.

Marketing claims, promotional strategies, and product information on Malaysian e-cigarette retailer websites-a content analysis.

BACKGROUND: Marketing and sales of e-cigarettes are unregulated in Malaysia. We analyzed content displayed on e-cigarette retailer websites to identify marketing claims, promotional strategies, and product details in the year 2022. METHODS: We analyzed 30 Malaysia-based retailer websites using a mixed methods approach. Data were extracted as the frequency of occurrences of marketing claims, presence of regulatory information, product types, and flavors of e-juice as per a predefined codebook based on published literature. We also extracted textual details published on the websites about marketing claims, and slogans. RESULTS: Most retailer websites provided contact information and physical store addresses (83%) but only half had 'click through' age verification (57%) that seldom needed any identification proof for age (3%). Marketing claims were related to health (47%), smoking cessation (37%), and modernity/trend (37%) and none had health warnings. Promotional strategies were discounts (80%). starter kits (57%) and email subscriptions (53%). Product types displayed were rechargeable (97%) and disposable (87%) devices and e-liquids (90%) of an array of flavors (> 100). Nicotine presence, its concentration, and "nicotine is an addictive chemical" were displayed in 93%, 53%, and 23% of websites respectively. CONCLUSION: Surveillance of content displayed online on e-cigarette retailer websites and regulation of online marketing and sales should be implemented by the Ministry of Health, Malaysia. Such measures are needed to prevent access to, and initiation of e-cigarette use among the youth and adults who do not smoke.

Changes in E-cigarette Use, Cigarette Smoking, and Dual-Use Among the Youth (13-15 Years) in 10 Countries (2013-2019)-Analyses of Global Youth Tobacco Surveys.

INTRODUCTION: The increasing use of e-cigarettes among the youth is a public health problem that needs surveillance. We report changes in e-cigarette use, cigarette smoking, and "dual use" among youth in 10 countries. AIMS AND METHODS: Global Youth Tobacco Survey (GYTS)s from Georgia, Iraq, Italy, Latvia, Montenegro, Paraguay, Peru, Qatar, Romania, and San Marino were analyzed. Changes in prevalence of "awareness of e-cigarettes," "ever use" (even tried a few puffs) and "current use" (during last 30 days) of e-cigarettes and cigarette smoking, and "dual use" (both e-cigarette and cigarette smoking) between baseline (2013 and 2014) and most recent (2017-2019) surveys were estimated. RESULTS: "Awareness of e-cigarettes" and "ever e-cigarette use" significantly increased (p < .001). "Ever e-cigarette use" was highest in Italy, 93% (95% CI 90.9, 94.4). "Current e-cigarette use" significantly (p < .05) increased by > 50% in most countries. During the most recent surveys, "current e-cigarette" use was > 10% in five countries Italy (18.3%) and Latvia (18.5%) being the highest. Cigarette smoking significantly declined in Italy, Latvia, Peru, and San Marino (p < .05) but remains unchanged in other countries. "Dual use" (both electronic and conventional cigarettes) significantly increased in all countries (p < .001). During the most recent surveys "dual use" was highest in Italy (10%, 95% CI 8.1, 12.2) and Latvia (8.6%, 95% CI 7.2, 10.2). Youth aged 14 and ≥15 years the smokers, were more likely to be e-cigarette users. CONCLUSIONS: Awareness and use of e-cigarettes and "dual use" among youth have increased. Closer monitoring of tobacco use among youths and comprehensive tobacco control policies inclusive of e-cigarettes are needed. IMPLICATIONS: Secondary data analyses of serial GYTSs in 10 countries showed that both awareness of e-cigarette and e-cigarette use has increased among school-going youth aged 13-15 years. A concurrent increase in "dual use" of e-cigarettes and cigarette smoking during the last 30 days in all 10 countries indicates continued cigarette smoking in the absence of e-cigarettes because of the common risk construct of tobacco product use. Results call for continued surveillance of both e-cigarettes and cigarette smoking among school-going youth. Comprehensive tobacco control measures inclusive of e-cigarettes should be implemented to reduce tobacco use among the youth.

Tobacco Imagery in the 50 Most Popular Malaysian Movies Released During 2015-2019.

INTRODUCTION: Exposure to tobacco imagery creates a positive impression about smoking and is associated with youth smoking uptake. METHODS: From the list of movies released during 2015-2019, we selected the top 10 movies per year rated by the Malaysian Film Development Corporation. Two researchers coded tobacco imagery in each movie considering 5-minute time intervals as a unit. The 5-minute interval coding was adopted from previous research for comparability. Frequencies and the average occurrence of tobacco imagery were compared by movie language, genre, and age categorization. RESULTS: In 50 movies analyzed, there were a total of 1037 five-minute intervals of which 26 (52%) movies and 277 (26.7%) of intervals tobacco imagery were present. Brand appearances were absent and health warnings about tobacco use were present in just one movie. The proportions of intervals containing actual use, paraphernalia, and implied use were 63.5%, 22.0%, and 14.5%. Tobacco imagery of actual use, paraphernalia, and implied use was present in 25, 20, and 10 movies, respectively. In those movies with tobacco imagery, the average number of occurrences of actual use, paraphernalia, and implied use was 3 (interquartile range [IQR] 2-11.5), 2.5 (IQR 1.3-4.0), and 1 (IQR 1-4), respectively. Movies classified as "p13" (median 6, IQR 6-13) and "18" (median 5, IQR 0-15) had higher average occurrences of tobacco imagery than "U" movies (median 0, IQR 0-2; p = .028). CONCLUSIONS: The lack of health warnings despite the presence of tobacco imagery in Malaysian movies calls for measures to regulate tobacco-related content and reclassify such movies as "for adults-only." IMPLICATIONS: Tobacco imagery was prevalent in Malaysian movies that are allowed viewing by individuals aged 13 years and above. A review of the age categorization of Malaysian movies and the placement of health warnings in movies is needed. A comprehensive implementation of the ban on tobacco advertisements, promotion, and sponsorship should also include a ban on tobacco imagery in movies.

Nicotine dependence and associated factors among persons who use electronic e-cigarettes in Malaysia - an online survey.

BACKGROUND: Nicotine dependence, factors associated with dependence, and self-reported side effects among people who use e-cigarettes are scarce in developing countries. METHODS: A sample of 302 persons who currently use e-cigarettes was recruited from discussion forums on Reddit, Facebook, and the forum 'lowyat'. The online Google form survey collected data on demographics, e-cigarette use, and the reasons, for cigarette smoking, Fagerstorm Test for Nicotine Dependence adapted for e-cigarettes (eFTND), and side effects experienced. RESULTS: The mean age was 25.5 years (6.5), 60.6% were males and 86% had higher education. About 47% were using e-cigarettes only, 27.8% were currently using dual products (both electronic and conventional cigarettes), and 25.2% had also smoked cigarettes in the past. 'Less harmful than cigarettes' (56.3%), 'because I enjoy it' (46.7%), and 'it has a variety of flavors (40.4%) were the common reasons for e-cigarette use. The mean eFTND score was 3.9 (SD = 2.2), with a median of four side effects (IQR 3-6), sore or dry mouth/throat (41.4%), cough 33.4%, headache (20.5%), dizziness (16.2%) were commonly reported side effects. eFTND score and side effects were higher among persons using dual products. By multiple linear regression analysis, males (ß = 0.56 95% CI 0.45, 1.05, p = 0.033), dual-use (ß = 0.95 95% CI 0.34, 1.56, p < 0.003), and use of nicotine-containing e-cigarettes (ß = 0.66 95% CI 0.07, 1.25 p = 0.024) had higher eFTND score. CONCLUSION: Our findings of the study call for the placement of disclaimers about possible nicotine addiction and side effects of e-cigarette products.

Hardening determinants among adult daily smokers in nine African countries: Data from the Global Adult Tobacco Survey.

Little has been reported about hardening nor softening indicators in Africa where smoking prevalence is low. We aimed to examine the determinants of hardening in nine African countries. We conducted two separate analyses using data from the most recent Global Adult Tobacco Survey in Botswana, Cameroon, Egypt, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda (total sample of 72,813 respondents): 1) multilevel logistic regression analysis to assess individual and country-level factors associated with hardcore, high dependence, and light smoking.; 2) a Spearman-rank correlation analysis to describe the association between daily smoking and hardcore, high dependence, and light smoking at an ecological level. Age-standardized daily smoking prevalence varied from 37.3% (95 %CI: 34.4, 40.3) (Egypt) to 6.1% (95 %CI: 3.5, 6.3) (Nigeria) among men; and 2.3% (95 %CI: 0.7, 3.9) (Botswana) to 0.3% (95 %CI: 0.2, 0.7) (Senegal) among women. The proportion of hardcore and high-dependence smokers was higher among men whereas for light smokers the proportion was higher among women. At the individual level, higher age and lower education groups had higher odds of being hardcore smokers and having high dependence. Smoke-free home policies showed decreased odds of both being hardcore and highly dependent smokers daily smoking correlated weakly and negatively with hardcore smoking (r = -0.243, 95 %CI: -0.781, 0.502) among men and negatively with high dependence (r = -0.546, 95 %CI: -0.888, 0.185) and positively with light smokers (r = 0.252, 95 %CI: -0.495, 0.785) among women. Hardening determinants varied between the countries in the African region. Wide sex differentials and social inequalities in heavy smoking do exist and should be tackled.

Topical corticosteroid counselling among Malaysian community pharmacists: a qualitative interview study.

BACKGROUND: Topical corticosteroids (TCS) are commonly available in community pharmacies and are used in skin conditions like atopic dermatitis and psoriasis among others. Problems such as overuse, use of potent steroids and steroid phobia have been identified in the use of TCS in the literature. The aim of the study was to obtain community pharmacists (CPs) views regarding factors influencing their counselling of patients about TCS; challenges associated, important problems, the counselling process, shared care with other healthcare professionals, and explore further the findings from the questionnaire-based study. METHODS: Seven licensed practicing community pharmacists (from the Klang Valley, Malaysia) were interviewed between 23rd September to 14th November 2021. These were CPs participating in the questionnaire study who agreed to be interviewed. NVIVO 11 software was used for data analysis. Codes and themes were generated and agreed on by the researchers. RESULTS: The major themes identified related to the process mentioned of providing information to patients, the issues addressed by CPs during the counselling (including steroid phobia, overuse of TCS, patients asking for a specific preparation by name), less counselling support material, language barriers, lesser knowledge about certain conditions, information sources used by CPs (material provided by Ministry of Health and Malaysian Pharmacists Association, MIMS) and suggestions to strengthen the quality of counselling (specialization in skin diseases, webinars, shared care models). For patients requesting a particular preparation by name, the pharmacist will decide whether the preparation requested is suitable or suggest an alternative. Steroid phobia was seen more commonly among parents of young children and young patients. MIMS was available as a smartphone application making it easier to use. Advanced training for CPs in the management of skin conditions like that provided for diabetes mellitus can be considered. CONCLUSIONS: Counselling was conducted while dispensing TCS in the open area of the pharmacy. Challenges to counselling were lack of time, limited counselling materials, and language barriers. Steroid phobia requires attention. Initiatives to strengthen counselling were mentioned by respondents and appear feasible. Further research covering the entire country is required.

Health-Seeking Behaviors and Treatments Received for Menopause Symptoms: A Questionnaire Survey among Midlife Women Attending Primary Healthcare Clinics in Malaysia.

OBJECTIVES: This study aimed to assess menopause symptoms, treatment-seeking behaviors, treatments received, and factors associated with seeking consultation from healthcare providers (HCPs). METHODS: Using a self-administered Menopause Quick-6 in the Malay language (MQ6[M]) questionnaire, we surveyed 349 women aged 40-60 years attending primary healthcare clinics in four states in Malaysia for their menopause symptoms. Health-seeking behaviors for menopause symptoms were assessed using questions regarding HCPs consulted and treatments prescribed. Binary logistic regression was employed on factors associated with seeking consultation for menopause symptoms. RESULTS: Using MQ6(M), we observed that 125 (31.3%) women reported at least one menopause symptom, with joint pains (42.8%), menstrual changes (39.5%), and hot flashes (29.3%) being the most frequent symptoms. Furthermore, 60% of the women were prescribed vitamins, and only 13% were administered Hormone Replacement Therapy (HRT). Medical comorbidities, the presence of at least one gynecological condition, menopause status, and MQ6(M) score were associated with seeking consultation with an HCP. For women with medical conditions, the odds of seeking consultation increased by a factor of 1.34 (adjusted odds ratio [AOR], 1.34; 95% confidence interval [CI], 1.11-1.76) for every additional comorbidity. The odds of seeking consultation from an HCP increased by a factor of 1.26 (AOR, 1.26; 95% CI, 1.04-1.47) with a unit increase in MQ6(M) score. CONCLUSIONS: Most women had menopause symptoms but favored the use of complementary and alternative medicine over HRT. Screening and awareness of menopause treatments need to be improved at primary healthcare clinics.

Electronic cigarettes use and 'dual use' among the youth in 75 countries: estimates from Global Youth Tobacco Surveys (2014-2019).

We report the country-level prevalence of awareness about electronic cigarette use, and 'dual use' and its association with age, sex, country income, and e-cigarette regulatory status. We analyzed the most recent Global Youth Tobacco Surveys done on nationally representative samples of school-going youth aged 13-15 years in 75 countries/territories. The weighted prevalence of 'awareness' (heard about e-cigarettes), 'ever use' (even tried a few puffs), 'current use' (during the last 30 days), and 'dual use' (e-cigarette use and cigarette smoking during the last 30 days) were estimated. Awareness was > 80% in 13 countries mostly from Europe Poland being the highest at 95.8% (95% CI 94.8- 96.6). In seven countries, 30-50% of the youth had ever used an e-cigarette, Italy was the highest at 55.1% (95%CI 51-3,58.9). In 30 countries, current e-cigarette use was > 10%, the highest of 35.1% (95%CI 32.4-38.0) in Guam. Awareness and use were highest in the European region (74.6% and 34.5%) and HIC (83.6% and 39.4%). Youth from HIC (compared to lMIC) and countries having restrictive e-cigarette regulations (compared to NRP) had 2.4 times (aOR 2.2.4, 95% CI 2.2, 2.7) and 1.8 times (aOR 1.8, 95% CI 1.6, 2.0) higher odds of being current e-cigarette users respectively. Youth in countries with the most restrictive e-cigarette regulations (compared to NRP) had 0.6 times lower odds of being current e-cigarette users (aOR 0.6, 95% CI 0.6, 0.7). Awareness and e-cigarette use varied by sex, country income level, and region. Continued global surveillance of youth e-cigarette use is needed for the formulation of e-cigarette regulatory policy. Awareness and use of e-cigarettes were higher among boys, in countries in Europe and America regions, and among those with higher income and restrictive policies, whereas it was lower in countries having the most restrictive policies. Higher awareness is strongly correlated with a trial and current use of e-cigarettes. E-cigarette marketing should be restricted, and continued surveillance of e-cigarette use is needed. Most restrictive policies such as the ban on e-cigarettes appear to reduce e-cigarette use among the youth.

House officers' specialist career choices and motivators for their choice- a sequential mixed-methods study from Malaysia.

PURPOSE: Shortage and maldistribution of medical specialists hamper healthcare quality. The specialist career choices of house officers determines the future composition of healthcare systems. We studied house officers'' specialist career choices and motivators for their choice. PARTICIPANTS AND METHODS: We conducted online in-depth interviews among seven house officers using an interview guide developed based on a literature review. The transcripts were analyzed. Major themes were identified. A 33-item questionnaire was developed, and the main and sub-themes were identified as motivators for specialist career choice. An online survey was done among 185 house officers. Content validation of motivators for specialist choice was done using exploratory factor analysis. First, second and third choices for a specialist career were identified. Multinomial logistic regression analyses were done to determine the socio-demographic factors and motivators associated with the first choice. RESULTS: HOs perceived that specialist training opportunities provide a wide range of clinical competencies through well-structured, comprehensive training programs under existing specialist training pathways. Main challenges were limited local specialist training opportunities and hurdles for 'on-contract' HO to pursue specialist training. Motivators for first-choice specialty were related to 'work schedule', 'patient care characteristics', 'specialty characteristics', 'personal factors', 'past work experience', 'training factors', and 'career prospects.' House officers' first choices were specialties related to medicine (40.5%), surgery (31.5%), primary care (14.6%), and acute care (13.5%). On multivariate analysis, "younger age", "health professional in the family", "work schedule and personal factors", "career prospects" and "specialty characteristics" were associated with the first choice. CONCLUSIONS: Medical and surgical disciplines were the most preferred disciplines and their motivators varied by individual discipline. Overall work experiences and career prospects were the most important motivators for the first-choice specialty. The information about motivational factors is helpful to develop policies to encourage more doctors to choose specialties with a shortage of doctors and to provide career specialty guidance.

Smokeless tobacco consumption and its association with tobacco control factors in the Western Pacific Region: results from the Global Youth Tobacco Survey 2015-2019.

OBJECTIVES: We estimated the prevalence of smokeless tobacco (ST) consumption and its associations with tobacco control factors among school-going youth in 18 Western Pacific Region (WPR) countries. METHODS: We analyzed school-based Global Youth Tobacco Survey (2014-2019) microdata from 18 WPR countries and estimated weighted prevalence rates of ST consumption, cigarette smoking, and dual use. We used multilevel binary logistic regression to examine the associations of ST consumption and dual use with demographic variables, exposure to pro-tobacco and anti-tobacco factors, national income, and MPOWER indicators. RESULTS: Data from 58,263 school-going youth were analyzed. The prevalence of past 30-day ST consumption was highest in Kiribati (42.1%), the Marshall Islands (26.1%), Micronesia (21.3%), Palau (16.0%), and Papua New Guinea (15.2%). In adjusted multilevel models, ST consumption and dual use were significantly associated with sex, age, parental smoking, pro-tobacco factors, national income, and MPOWER score. For each unit increase in score for cessation programs, we observed approximately 1.4-fold increases in the odds of youth ST consumption (adjusted odds ratio [aOR], 1.38; 95% confidence interval [CI], 1.15 to 1.66) and dual use (aOR, 1.47; 95% CI, 1.16 to 1.86). Similarly, for each unit increase in score for health-related warnings, the odds of both ST consumption (aOR, 0.47; 95% CI, 0.42 to 0.53) and dual use (aOR, 0.35; 95% CI, 0.30 to 0.42) decreased by approximately 60%. CONCLUSIONS: The prevalence of youth ST consumption was substantial in the Pacific Islands, exceeding that of cigarette smoking in some countries. Implementing MPOWER measures for ST products could help reduce ST consumption.

Community pharmacists' counseling practices and patient experiences about topical corticosteroids - an online survey in the Klang Valley, Malaysia.

BACKGROUND: Community Pharmacists (CPs) play an important role in patient counseling regarding the use of topical corticosteroids (TCS). We assessed CP's self-reported counseling practices regarding TCS and patients' reported counseling experiences. METHODS: A previously developed questionnaire was adapted to the Malaysian context. A random sample of 364 registered CPs practicing in three states, Selangor, Kuala Lumpur, and Putrajaya were invited for an online survey. The questionnaire for CPs explored their perceived patient knowledge about topical corticosteroid (TCS) use, their counseling practices, and perceived barriers to counseling. Thirty patients were also selected from five pharmacies i.e., six consecutive patients who consulted each CP were invited to participate in the patient survey by completing a checklist about their experiences regarding the counseling received. RESULTS: A majority (> 90%) of the CPs mostly explained to the patients that the medication was TCS and the frequency and duration of application but only 10% correctly identified scenarios needing medical referral. Only about half of the CPs always explained about side effects, strength, efficacy, and storage of TCS. The two main barriers were patients' negative perception of TCS (65.4%) and pharmacists' lack of time for counseling (49.7%). Counseling practice score was associated with CPs' age (aOR 0.86, 95%CI 0.78-0.94), pharmacists' recommendation on TCS use (aOR 0.11, 95%CI 0.02-0.61), and time spent on counseling (aOR 1.42, 95%CI 1.13-1.64). Patients mentioned they were counselled on the frequency and duration of application of TCS, and potential adverse effects. Most were not counselled on action to take when an adverse event occurs and the storage and use of leftover medication. CONCLUSION: CPs counseling practices to their patient about the use of TCS requires improvement. Continuing education and hands-on training are needed for CPs regarding counseling about TCS use.

Efficacy and Safety of Immune Checkpoint Inhibitors for Advanced Malignant Melanoma: A Meta-Analysis on Monotherapy Vs Combination Therapy.

Background: Immune checkpoint inhibitors (ICIs) are approved as cancer immunotherapeutic agents for advanced malignant melanoma (MM) in recent years, and nivolumab and ipilimumab are the most widely used ICIs either alone or in combination. However, their efficacy and safety between single and combined ICIs are not clear. This meta-analysis (MA) is aimed to update the efficacy and safety of ICIs by comparing monotherapy and combination therapy in the treatment of advanced MM. Method: We searched PubMed, Embase, EbscoHost and ClinicalTrials.gov for the eligible randomized controlled trials (RCTs) which compared the efficacy and safety of ICIs between a single ICI and combined ICIs. The outcomes analyzed included overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (AEs). A fixed-effect or random-effects model was adopted depending on the study heterogeneity. Results: A total of nine RCTs were included in this MA. Regarding the efficacy, combined nivolumab and ipilimumab therapy showed statistically significant prolonged OS and PFS with HR 0.65, 95% CI [0.53, 0.79], p <0.0001 and HR 0.48, 95% CI [0.38, 0.60], p<0.0001 respectively. Combination therapy with nivolumab and ipilimumab also showed statistically significant longer ORR than monotherapy; with RR 2.15, 95% CI [1.63, 2.84], p <0.00001. In terms of safety, the incidence of all AEs which include any AEs, high-grade, haematological, gastrointestinal, dermatological, pulmonary, liver and endocrine AEs were significantly lower with monotherapy (either nivolumab or ipilimumab) of ICI compared to combination ICI therapy with a p-value <0.00001 to 0.03. Conclusion: Efficacy of the combined nivolumab and ipilimumab was better than a single ICI, especially in the treatment of advanced MM. Although combination therapy showed better efficacy than monotherapy, monotherapy (either nivolumab or ipilimumab) was safer than combination therapy as it tended to decrease the incidence of most of the treatment-related AEs.

Menopause Rating Scale (MRS) in the Malay language-translation and validation in a multiethnic population of Selangor, Malaysia.

BACKGROUND: The Menopause Rating Scale (MRS) is an internationally used tool to measure menopause-related symptoms and to date it is unavailable in the Malay language. We aimed to translate and validate the Malay language version of the MRS. METHODS: Translation of the English version of MRS into Malay was done by a bilingual expert and back translated. Translated version of MRS was reviewed by a panel to determine the face validity. A sample of 321 women aged 40-60 years residing in Klang, Selangor, Malaysia was selected by stratified random sampling method in a house-to-house survey. The Malay language version of MRS was self-administered. Reliability analyses, including test-retest reliability (on 30 women after a two-week interval) were conducted. To ascertain the construct validity, 11 items were analyzed confirmatory factor analysis was conducted to evaluate the structural model fit of the Malay language version of MRS. RESULTS: A total of 294 (91.6%) completed the survey and their mean age was 50.9 years (SD = 6.3). An overall Cronbach's alpha for MRS was 0.904. Cronbach's alpha for psychosomatic, urogenital, and somatovegetative subscales were 0.889, 0.846, and 0.776 respectively. The corrected item correlations were approximately 0.6 and inter-item correlations were between 0.3 and 0.9. On exploratory structural equation modelling, the chi-square test of goodness of fit yielded a significant value; χ2 = 78.4, df = 25, p < 0.001, (reported if N > 200). Additionally, the value of Tucker-Lewis Index (TLI) = 0.954showed a good fit to the model. CONCLUSION: The translated English version of the Menopause Rating Scale into the Malay language showed excellent reliability, test-retest reliability, and construct validity. The instrument can be used to assess menopause-related symptoms among Malaysian women.

Development and validation of motivators for medical specialist career choice questionnaire (MMSCCQ) - a methodological study.

INTRODUCTION: A validated instrument to assess the motivating factors influencing junior doctors' medical specialist career choices is not available. The Motivators for Medical Specialist Career Choice Questionnaire (MMSCCQ) was developed and validated in the present study. METHODS: An exploratory sequential mixed-methods study was conducted among house officers (HO) of a tertiary care hospital. A literature review was used to construct an interview guide. Seven HOs participated in an online, one-on-one audio-recorded in-depth interview (IDI). Seven sub-themes and 33 codes identified by thematic analyses were used to develop the MMSCCQ. The importance of each motivator was rated on a five-point Likert scale. The MMSCCQ was pretested, and a random sample of 262 house officers was invited to participate in an online survey. Psychometric evaluation was done using reliability statistics, and exploratory and confirmatory factor analyses. RESULTS: The seven main themes identified by thematic analyses were labeled as factors related to 'work schedule and personal life,' 'training opportunities', 'past work experiences', 'specialty characteristics', 'career prospects', 'patient care characteristics', and 'social factors.' The highest ratings were given to "previous job experience" and "patient care traits. "The response rate was 71%, the mean age of the 185 HOs was 26.7 years (SD = 1.6). Females made up 63.8% of the population. The internal consistency for the overall questionnaire measured by Cronbach's alpha was 0.85. Each construct demonstrated an acceptable internal consistency. Twenty-six of 33 items were maintained after an exploratory factor analysis was conducted, yielding 7 constructs with a 64.9% variance. Confirmatory factor analyses established the construct validity. CONCLUSION: The MMSCCQ has acceptable reliability and construct validity. Further studies are needed to test psychometric properties in different settings.

Inequalities in demand satisfied with modern methods of family planning among women aged 15-49 years: a secondary data analysis of Demographic and Health Surveys of six South Asian countries.

OBJECTIVE: To estimate educational and wealth inequalities in demand satisfied with modern methods of family planning (mDFPS). DESIGN: A secondary data analyses of Demographic and Health Surveys. SETTING: Six South Asian countries, Afghanistan (2015), Bangladesh (2014), India (2015-2016), Maldives (2016-2017), Nepal (2016) and Pakistan (2017-2018). PARTICIPANTS: Women aged 15-49 years. Primary and secondary outcome measures mDFPS was defined as married women aged 15-49 years or their partners, who desired no child, no additional children or to postpone the next pregnancy and who are currently using any modern contraceptive method. We estimated weighted and age-standardised estimates of mDFPS. We calculated the slope index of inequality (SII) and relative index of inequality (RII) as the measures of socioeconomic inequalities. RESULTS: A total of 782 639 women were surveyed. The response rate was 84.0% and above. The prevalence of mDFPS was below 50% in Maldives (22.8%, 95% CI 20.7 to 25.0), Pakistan (42.0%, 95% CI 39.9 to 44.0) and Afghanistan (39.1%, 95% CI 36.9 to 41.3), whereas Bangladesh had achieved 76% (75.8%, 95% CI 74.2 to 77.3). Both wealth and educational inequalities varied in magnitude and direction between the countries. Except in Nepal and Bangladesh, mDFPS wealth inequalities showed a trend of increasing mDFPS as we moved towards richer, and richest wealth quintiles that is, pro-poor (RII (0.5 to 0.9); SII (-4.9 to -23.0)). In India and Nepal, higher versus no education was in favour of no education (higher mDFPS among not educated women) (RII 1.1 and 1.4; SII 4.1 and 15.3, respectively) and reverse in other countries ((RII (0.4 to 0.8); SII (-10.5 to -30.3)). Afghanistan, Maldives and Pakistan fared badly in both educational and wealth inequalities among the countries. CONCLUSIONS: South Asia region still has a long way ahead towards achieving universal access to mDFPS. Diverse patterns of socioeconomic inequalities between the countries call for national governments and international development agencies to target the population subgroups for improving the mDFPS coverage.

Awareness About and E-Cigarette Use Among Adults in 15 Low- and Middle-Income Countries, 2014-2018 Estimates From Global Adult Tobacco Surveys.

INTRODUCTION: E-cigarette (EC) use is seldom reported from low- and middle-income countries (LMICs). We report the prevalence of "awareness" about EC, its use, and distribution of EC use by sociodemographic factors and cigarette smoking (CS) status. AIMS AND METHODS: We analyzed Global Adult Tobacco Survey data in Bangladesh, China, Costa Rica, Ethiopia, India, Kazakhstan, Mexico, Philippines, Romania, Russia, Senegal, Ukraine, Turkey, Uruguay, and Viet Nam during 2014-2018. The weighted prevalence of "awareness" (heard about), "ever" (even once), and "current" (daily/nondaily) EC use among never, current, and former cigarette smokers and quit ratios (past smokers/ever smokers) was estimated. Association of EC use with sociodemographic, and CS, was explored by multilevel regression. RESULTS: Overall, prevalence of "awareness," "ever," and "current" ECs use was 19.3% (95% confidence interval [CI] 27.4, 31.1), 2.6% (95% CI 2.4, 2.8), and 0.7% (95% CI 0.6, 0.8), respectively. In most countries, "ever use" <10%, and "current use" was about 1% except Romania (4.4%) and Russia (3.5%). "Current use" was 0.1%, 2.9%, and 3.1% among never, current, and former smokers, respectively. "Current" and "ever" EC use was higher among current and former than never smokers (2.8% and 3.1% vs. 0.1%; 9.9% and 10.9% vs. 0.7%), respectively. Current EC use was associated with male sex, urban residence and younger age, higher education, and wealth. "Quit attempts" (aOR 1.3, 95% CI 1.2, 1.5) and cigarettes smoked per day (aOR 1.6, 95% CI 1.4, 1.9) were associated with "ever use." CONCLUSIONS: EC use was low in most countries. "Dual use" was common among current smokers and the quit ratio was higher among ECs users. IMPLICATIONS: EC use is increasing in high-income countries (HICs) where regulations on ECs are usually permissive. Evidence on the individual- or population-level impact of ECs on CS cessation is inconclusive. Little is known about the prevalence of EC use in LMICs where regulations are nonexistent or less restrictive. Studying the distribution of EC use rates by population subgroups, CS status, and quit ratios for CS among EC users will assist the formulation of EC regulatory policies. We provide comparable nationally representative prevalence estimates of "awareness" about and, use of ECs to serve as a benchmark for future monitoring. EC use was associated with the attempt to quit CS and smoking >10 cigarettes per day. However, "dual use" was common, and the quit ratio for CS was higher among EC users. EC use was very low relative to HICs. Nevertheless, comprehensive EC regulatory policies should be implemented to prevent the escalation of EC use by targeting population subgroups such as young adults, educated and wealthier individuals.

Smoking cessation behaviors and reasons for use of electronic cigarettes and heated tobacco products among Romanian adults.

We report cessation behaviors, reasons for use of electronic cigarettes (EC) and heated tobacco products (HTP) and association of their use with quit attempts and smoking intensity using Romania Global Adult Tobacco Survey 2018. Weighted estimates of EC and HTP by cigarette smoking (CS) status were assessed. Quit attempts, intention to quit, reasons for lack of intention to quit among current CS, and reasons for current use of EC and HTP were estimated. The association of 'ever use' of EC and HTP with cigarette smoking intensity and quit attempts was explored using binary logistic regression. Of the total 4571 surveyed, 1243 (27.3%) were current CS, 300 (24.4%) made quit attempts in the past 12 months. Only 38 (12.5%) and 26 (8.6%) had used EC and HTP as an aid to quit. Among current CS, 512 (41.2%) had no intention to quit. Reasons for this were, 'enjoy smoking' (86.1%), 'reduce stress' (65.9%), and 'staying alert' (46.3%). Awareness and use of EC and HTP were significantly higher among current CS. 'Dual use' of EC and HTP with CS was manifolds higher than stand-alone use. Reasons for current use of EC and HTP were 'enjoyment', and 'use in places where smoking was prohibited'.