A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy.

OBJECTIVE: Chemotherapy-related cognitive impairment (CRCI) is a well-known phenomenon among breast cancer survivors. Cognitive impairment among breast cancer survivors can significantly affect their quality of life and ability to function independently. However, there is a lack of specific and focused cognitive intervention to improve their cognitive performances. This study aimed to develop a tailored cognitive intervention framework module by adapting the attention and memory interventions from the Cognitive Rehabilitation Manual of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) and incorporating them with the relevant exercises for cognitive rehabilitation for Malaysian breast cancer survivors with CRCI based on the consensus agreement of the expert panel. METHODS AND ANALYSIS: The Delphi consensus technique was conducted online to review and evaluate the framework module. A panel of experts, including rehabilitation medicine physicians, occupational therapists, and clinical psychologists in Malaysia, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items. RESULTS: A total of 33 practitioners completed the three Delphi rounds. 72.7% of the expert panel have been practising in their relevant clinical fields for more than six years (M = 10.67, SD = 5.68). In Round 1, 23% of the experts suggested that the framework module for attention training required further improvements, specifically in the language (M = 1.97, SD = 0.75) and instructions (M = 2.03, SD = 0.71) provided. In Round 2, 15% of the experts recommended additional changes in the instruction (M = 2.15, SD = 0.67) for attention training. Amendments made to the framework module in line with the recommendations provided by the experts resulted in a higher level of consensus, as 94% to 100% of the experts in Round 3 concluded the framework module was suitable and comprehensive for our breast cancer survivors. Following the key results, the objectives were practical, and the proposed approaches, strategies, and techniques for attention and memory training were feasible. The clarity of the instructions, procedures, verbatim transcripts, and timeframe further enhanced the efficacy and utility of the framework module. CONCLUSIONS: This study found out that the cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfully developed and feasible to be implemented using Delphi technique.

The effect of dietary patterns on mild cognitive impairment and dementia incidence among community-dwelling older adults.

Multiple studies have shown that dietary patterns have beneficial health effects on cognitive function. However, information on this relationship is presently limited, particularly among older adults. Thus, this study aimed to determine the effects of dietary patterns on mild cognitive impairment (MCI) and dementia incidence among Malaysian community-dwelling older adults. In this prospective cohort study, a total of 280 participants aged 60 years and above were included in the 5-year follow-up analysis. Participants' sociodemographic, medical history, anthropometry, blood pressure, body composition, biochemical indices, cognitive assessments, psychosocial functions, functional status, and dietary intake were obtained. MCI was classified based on Petersen criteria, whereas dementia status was assessed using clinical dementia rating (CDR). Univariate analysis was performed for all variables, followed by multinomial regression analysis to identify the ability of dietary patterns in predicting the incidence of MCI and dementia. After controlling for confounding factors, the findings indicated that "local snacks-fish and seafood-high salt foods" dietary pattern was associated with an increased risk of MCI incidence, where the T3 [adjusted OR = 3.943 (95% CI: 1.212-12.832), p = 0.032] had the highest OR compared to T2 [adjusted OR = 3.252 (95% CI: 1.108-9.546), p = 0.023]. Meanwhile, a negative association across the tertiles of tropical fruits-oats dietary pattern and dementia incidence was observed [T2: adjusted OR = 0.152 (95% CI: 0.026-0.871), p = 0.034; T3: Adjusted OR = 0.101 (95% CI: 0.011-0.967), p = 0.047]. In conclusion, specific dietary patterns, particularly "local snacks-fish and seafoods-high salt foods," were shown to increase the risk of MCI, while increasing intakes of "tropical fruits-oats" dietary patterns would protect against the dementia incidence among Malaysian older adults.

Development and Validation of Huffaz ProHealth 1.0©: A Module to Improve the Well-Being of Tahfiz Students in Selangor, Malaysia.

The increase in the number of Tahfiz schools in Malaysia indicates a high demand from the community for Tahfiz education. Tahfiz schools provide a Quran memorization syllabus as the main part of the curriculum at the primary and secondary levels. There is no holistic module that combines learning and health for Tahfiz students in Malaysia. Huffaz ProHealth 1.0© Module is a health intervention module developed explicitly for Tahfiz students by a group of researchers from Universiti Kebangsaan Malaysia Kuala Lumpur (UKMKL). The module encompasses educational and motivational components for the Tahfiz students, and acts as a guide for their teachers and staff to improve the students' health and quality of life. The module consists of three components: physical health, nutritional and psychological well-being. Each component is divided into several units with specific activities. The Sidek Module Development Model (SDMM) was used as a reference model. The study involved two phases: the development (Phase I) and evaluation (Phase II). In Phase I, a needs assessment was conducted among students and teachers from Tahfiz schools to evaluate their knowledge, attitude, and practice on the related topics. Meanwhile, the module's validity and feasibility were assessed by healthcare experts and Tahfiz teachers in Phase II. The item-content validity index (I-CVI), content validity value, Tool to Evaluate Materials used in Patient Education (TEMPtEd) score, and expert feedback were evaluated. In conclusion, the Huffaz ProHealth 1.0© module was successfully developed and evaluated. Strong validity values were observed in all components, indicating high suitability to be employed at Tahfiz schools.

Psychometric Properties and the Cut-Off Point of the English Version of the Yatt Suicide Attitude Scale.

Background: The Malay version of the Yatt Suicide Attitude Scale (YSAS) was found to be reliable and valid for use in the Malaysian context. This study aims to validate and determine the cut-off points of the English version of the YSAS for a wider application by English-speaking researchers and practitioners. Methods: The English version of the YSAS, the Suicidal Behaviors Questionnaire-Revised (SBQ-R), and Kessler's K10 Psychological Distress Scale were distributed to 527 university students. Factor analysis was employed in the evaluation of its construct validity. The determination of the convergent and concurrent validity was determined by way of a bivariate correlation with the SBQ-R and Kessler's K10 scales. Cronbach's alpha and Receiver Operating Characteristic-analysis were also used to measure the internal consistency reliability as well as evaluate the screening properties of the scale. Results: The English YSAS and its ideation and attempt subdomains exhibited a high internal consistency value (>.8). The scale also had a cumulative variance of 76.39% and acceptable convergent and concurrent validity when compared to the SBQ-R and K10. The instrument demonstrated a better specificity in terms of the total score and suicide attempt and a better sensitivity trait on the suicidal ideation score. Conclusion: The English YSAS is a valid and reliable scale to assess suicidality, suicidal ideation, and suicide attempt among Malaysian university students.

Mapping the evidence of multidimensional health approaches in treating individuals with Prader-Willi Syndrome: A scoping review protocol.

INTRODUCTION: Prader-Willi Syndrome (PWS) is one of the rare diseases involving genetics and affects various body systems. The disease is known due to the absence of paternal genes on chromosome 15q11-q13. Multisystem complex conditions require interdisciplinary healthcare treatment. However, to the best of our knowledge, there is little evidence of an established successful model of an interdisciplinary approach in managing rare diseases like PWS. METHODS AND ANALYSIS: The scoping review process follows the five-staged Arksey and O'Malley (2005) methodology framework excluding the optional consultation stage (stage 6): the definition of the research questions (step 1); the eligibility criteria and search strategy are defined (stage 2); the study selection process based on the eligibility criteria identified will follow (stage 3); a framework developed for this review will then inform the extraction and charting of data from the included studies (step 4) and results will be aggregated and summarised with criteria relevant for health professionals and policymakers (stage 5). We will search for electronic databases (MEDLINE/PubMed, Scopus, Web of Science), grey literature sources and critical studies' reference lists to determine the appropriate inclusion criteria. Three researchers will review all abstracts and full-text studies for inclusion. ETHICS AND DISSEMINATION: This scoping review methodology does not require ethical approval since it aims to synthesise information from available publications. A scoping review article will be submitted for publication to a scientific journal following this protocol.

The effects of polyphenols-rich tropical fruit juice on cognitive function and metabolomics profile - a randomized controlled trial in middle-aged women.

Objectives: Polyphenols, particularly anthocyanins, have received attention in improving health issues during old age, including decline in cognitive function and other health parameters. We aimed to determine the effects of polyphenols-rich tropical fruit TP 3-in-1™ juice towards improving cognitive function, oxidative stress and metabolomics profiles among middle-aged women.Methods: This clinical trial involved 31 subjects with signs of poor cognitive function, as assessed using the Rey Auditory Verbal Learning Test (RAVLT). They were randomized to receive either TP 3-in-1™ juice (n = 16) or placebo (n = 15). Study subjects consumed 500 ml of beverages for three times per day, three days per week, for a period of ten weeks. Juice supplementation provided 9135 mg GAE of total phenolic content and 194.1 mg cyanidin-3-glucoside of total anthocyanin monomer.Results: There was a significant interaction effects on RAVLT immediate recall (p < 0.05) and Comprehensive Trail Making Test (CTMT) Trail 4 (p < 0.05). Metabolomics analysis showed the presence of metabolites related to polyphenols intake and cognitive functions with the intervention group showed increased urinary excretion of thyroxine and 3-methyladenine. Thyroxine and 3-methyladenine give stability to human transthyretin (TTR) and activate autophagy, respectively, which are associated with the pathogenesis of Alzheimer's disease.Conclusion: The result shows the potential of TP 3-in-1™ juice which is rich in anthocyanins in improving cognitive function, particularly learning, memory, processing speed, sequencing, mental flexibility and visual-motor skills domains, among middle-aged women.

Predictors of health-related quality of life after completion of chemotherapy among Malaysian early-stage breast cancer survivors.

PURPOSE: Health-related quality of life (QoL) is an important outcome measure in breast cancer management. Evidence of QoL of breast cancer patients in lower and middle-income countries remains scarce. We examined the level of QoL, cognitive impairment, psychological distresses, and the predictors of QoL among multiethnic Malaysian early-stage breast cancer survivors 1 to 3 years following chemotherapy. METHODS: A total of 160 breast cancer survivors from the University of Malaya Medical Centre (UMMC) participated in this cross-sectional study. Their QoL was evaluated with the Malay version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) version 3.0. Cognitive functioning and psychological distress were evaluated using the Malay version of the Montreal Cognitive Assessment (MoCA-BM) and Hospital Anxiety and Depression Scale (HADS), respectively. Data analysis was performed with Pearson's correlation and multiple regression analyses. RESULTS: At 1- to 3-year post-chemotherapy, the mean EORTC QLQ-C30 global health status of the breast cancer survivors was relatively low (60.5 over 100, SD = 10.88). One-third (31.9%) of them demonstrated cognitive impairment, and another 3.2% showed moderate to severe anxiety levels. The significant predictors for global health status and functioning included age, psychological distresses, cognitive performance, fatigue, appetite loss, insomnia, pain, and constipation. CONCLUSION: Our breast cancer survivors demonstrated poor global health status. Health care providers and policymakers must strive to provide holistic intervention strategies to improve the multiple dimensions of QoL and the cognitive and psychological functioning of this vulnerable population.

Chemotherapy-related cognitive impairment (CRCI) among early-stage breast cancer survivors in Malaysia.

Introduction: Breast cancer survivors frequently develop cognitive impairment following chemotherapy which can significantly hamper their well-being, ability to function independently, and overall quality of life. Evidence of cognitive functioning in breast cancer survivors from lower and middle-income countries remains scarce. We examined the prevalence of cognitive impairment among Malaysian multiethnic early-stage breast cancer survivors one to three years post-chemotherapy.Methods: This cross-sectional study included 160 breast cancer survivors from the University Malaya Medical Center (UMMC). The cognitive assessments used included the Montreal Cognitive Assessment (MoCA-BM), the Rey Auditory and Verbal Learning Test (RAVLT-BM), and the digit span and arithmetic of the Working Memory Index (WMI) of Wechsler Adult Intelligence Scale-IV (WAIS-IV). Data were analyzed using independent sample t-tests and Pearson's correlation.Results: Our breast cancer survivors demonstrated poor performances in MoCA-BM (31.9%) RAVLT-BM, recall (53.8%), and WMI of WAIS-IV (51.3%) with 30.6% of them performed poorly in all three cognitive tests administered. There were no significant mean group differences in cognitive performances between <24 months after chemotherapy and ≥24 months after chemotherapy.Conclusions: A high proportion of breast cancer survivors exhibited poor performances in the cognitive assessments. Cognitive rehabilitation programmes tailored to the needs of these survivors should be incorporated into cancer care management.

Neuroimaging Functional Magnetic Resonance Imaging Task-Based Dorsolateral Prefrontal Cortex Activation Following 12 Weeks of Cosmos caudatus Supplementation Among Older Adults With Mild Cognitive Impairment.

BACKGROUND: Cosmos caudatus (CC) is traditional Asian vegetable, commonly consumed among the Southeast Asian population. It has been reported to be high in flavonoids and might potentially improve brain activity among older adults with mild cognitive impairment (MCI). The effect of CC in brain activation improvement using neuroimaging is yet to be discovered. PURPOSE: To investigate the effects of CC supplement on brain activity using functional magnetic resonance imaging (fMRI) among older adults with MCI. STUDY TYPE: Prospective, randomized, double-blind, placebo-controlled trial. POPULATION/SUBJECTS: Twenty older adults with mild cognitive impairment (60-75 years old), 14 of them (70%) were female subjects. FIELD STRENGTH/SEQUENCE: A 3.0-T, T1-weighted anatomical images, T2*-weighted imaging data, A single shot, gradient echo-echo planar imaging (EPI) sequence. ASSESSMENT: All subjects were asked to consume two 500 mg capsules of either CC supplement or placebo (maltodextrin) daily for 12 weeks. Cognitive function was measured using validated neuropsychological tests (i.e. Mini-mental State Examination and Digit Span) and task-based fMRI (N-back and Stroop Color Word Test) at baseline and 12th week. Brodmann's area 9, 46 and anterior cingulate cortex were selected as the regions of interest to define dorsolateral prefrontal cortex (DLPFC) in fMRI analysis. STATISTICAL TESTS: Normality test was performed with the Shapiro-Wilk test. Two-way repeated ANOVA determined the intervention effects of the CC supplementation on brain activity after adjustments for covariates. Significance level at P < 0.05 for independent-t test and Chi square test; adjusted P < 0.0042 for two-way repeated ANOVA after Bonferroni correction. RESULTS: Findings showed significant improvements in digit span (partial η2  = 0.559), increment in right DLPFC activation while performing 1-back task (partial η2  = 0.586) and left DLPFC activation while performing Stroop Color Word Test (SCWT) (congruent) task (partial η2  = 0.432) at 12th week of CC supplementation. CONCLUSION: CC supplementation might have the ability to improve DLPFC activation, potentially leading to improved working memory among older adults with MCI after 12 weeks of administration. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 4.

Quality of Life Among Caregivers of Children with Special Needs in Kelantan, Malaysia: The Importance of Psychosocial Mediators.

BACKGROUND: Quality of life (QoL) is an important aspect of well-being for the caregivers of children with disability, making it a noteworthy outcome. Little is known about the challenges faced by the caregivers in Asian countries and its association to their QoL. The purpose of this study was to examine a model describing the relationship between sociodemographic and disability-related factors on caregivers' QoL, mediated by the caregivers' psychosocial factors such as perceived stress, coping skills, and social support. METHODS: A cross-sectional study was conducted involving caregivers of children with special needs in Kelantan, a state of Peninsular Malaysia. A total of 383 caregivers completed questionnaires measuring sociodemographics, disability-related factors, psychosocial factors and QoL outcome. Structural equation modelling was performed to examine the relations of the variables in the conceptual model. RESULTS: In the final model, childcare dependency, caregiver's age, financial support, negative perception of stress and maladaptive coping skills were significant predictors of QoL (R 2 = 0.65). Caregiver's age had a direct effect on QoL, while financial support had an indirect effect on QoL via negative perception of stress. Childcare dependency had direct and indirect effects on QoL via negative perception of stress. Higher perceived stress was associated with lower QoL directly and indirectly via maladaptive coping skills. The final model fitted the data well (root mean square error of approximation [RMSEA] = 0.046; CFI = 0.923; χ2/df = 1.798). CONCLUSION: Intervention strategies to improve the QoL of caregivers should target the family unit and take into account the factors of child's disability, demographic and caregiver's psychosocial status.

The utility and cultural specificity of cognitive-based interventions in preventing cognitive decline among healthy older adults in Asia: A systematic review.

BACKGROUND: The effects of aging and its associated cognitive decline is particularly acute in Asia given the exponential growth of older adults as a proportion of the population as a whole. Many structured cognitive interventions have been proposed to prevent the cognitive decline typically seen in older age, but their utility as a viable means of achieving these goals is questionable. OBJECTIVES: To summarize and synthesize evidence on the utility and methodological quality of cognitive-based interventions on cognitive performance and associated secondary outcomes among healthy older adults in Asia, as well as novel, culture-specific components of cognitive interventions across the region. DATA SOURCES: The PubMed/Medline, Web of Science, Scopus, and ScienceDirect databases were searched through May 2020. ELIGIBILITY: Studies including individuals aged 60 years and above, who had no previous history of physical and/or mental illness. Few restrictions placed on intervention design, duration and mode of delivery, provided that participants were randomized to study conditions, and intervention included components addressing at least one cognitive domain. RESULTS: A total of 17 studies from six countries met the eligibility criteria and were included in the final review. Evidence from those studies indicated that cognitive interventions may be most effective when the design and aims were directed towards improvement in specific cognitive domains, but evidence regarding long-term effectiveness in preventing progression to clinical-level cognitive deficits is still unclear. Several studies highlighted culture-specific activities as components of their interventions, though these will need to be further outlined and standardized clearly in future research.

Dietary Supplement Intake and Its Association with Cognitive Function, Physical Fitness, Depressive Symptoms, Nutritional Status and Biochemical Indices in a 3-Year Follow-Up Among Community Dwelling Older Adults: A Longitudinal Study.

PURPOSE: Use of dietary supplements by older adults has been increasing for improving micronutrient deficiencies, cognitive function, and overall health status. Thus, the objective of this secondary investigation is to explore the longitudinal association of baseline supplement intake in improving cognitive function, biochemical parameters, anthropometric variables and physical fitness among older adults. METHODS: Towards Useful Aging (TUA) is a three-year longitudinal study conducted at baseline (2013-2014) and at follow-up (2015-2017) surveys. The number of participants dropped from 2322 during baseline study to 1787 and 1560 during the 18th and 36th month follow-up, respectively. Data on socio-demography, use of dietary supplement, biochemical indices, anthropometry, cognitive function, physical fitness and depressive symptoms were obtained. Longitudinal associations were done using the linear mixed model analysis among 1285 subjects with complete data. RESULTS: The most common vitamin and mineral supplementations consumed were multivitamin, B-complex, and calcium. Meanwhile, the herbal supplements consumed by participants were Eurycoma longifolia, Morinda citrifolia and Orthosiphon aristatus. Longitudinal analysis adjusted for multiple covariates showed improvement in both supplement users and non-users for global cognitive function, working memory, visual memory, 2-minute step test, chair stand test, chair sit and reach and time up and go test, waist circumference and hip circumference in both the supplement users and non-users. CONCLUSION: Our findings indicated that dietary supplement intake is not associated with cognitive function, physical fitness, nutritional status, depressive symptoms or biochemical indices since improvement in the parameters was observed among both supplement users and non-users.

Is There Any Relationship Between Biochemical Indices and Anthropometric Measurements With Dorsolateral Prefrontal Cortex Activation Among Older Adults With Mild Cognitive Impairment?

Working memory is developed in one region of the brain called the dorsolateral prefrontal cortex (DLPFC). The dysfunction of this region leads to synaptic neuroplasticity impairment. It has been reported that several biochemical parameters and anthropometric measurements play a vital role in cognition and brain health. This study aimed to investigate the relationships between cognitive function, serum biochemical profile, and anthropometric measurements using DLPFC activation. A cross-sectional study was conducted among 35 older adults (≥60 years) who experienced mild cognitive impairment (MCI). For this purpose, we distributed a comprehensive interview-based questionnaire for collecting sociodemographic information from the participants and conducting cognitive tests. Anthropometric values were measured, and fasting blood specimens were collected. We investigated their brain activation using the task-based functional MRI (fMRI; N-back), specifically in the DLPFC region. Positive relationships were observed between brain-derived neurotrophic factor (BDNF) (ß = 0.494, p < 0.01) and Mini-Mental State Examination (MMSE) (ß = 0.698, p < 0.01); however, negative relationships were observed between serum triglyceride (ß = -0.402, p < 0.05) and serum malondialdehyde (MDA) (ß = -0.326, p < 0.05) with right DLPFC activation (R 2 = 0.512) while the participants performed 1-back task after adjustments for age, gender, and years of education. In conclusion, higher serum triglycerides, higher oxidative stress, and lower neurotrophic factor were associated with lower right DLPFC activation among older adults with MCI. A further investigation needs to be carried out to understand the causal-effect mechanisms of the significant parameters and the DLPFC activation so that better intervention strategies can be developed for reducing the risk of irreversible neurodegenerative diseases among older adults with MCI.

The Effects of Circadian Rhythm Disruption on Mental Health and Physiological Responses among Shift Workers and General Population.

Background: The effect of circadian disruption on the bio-psychological clock system has been widely studied. However, the mechanism and the association of circadian rhythm disruption with mental health and physiological responses are still unclear. Therefore, this study was conducted to investigate the effects of circadian rhythm disruption on mental health and physiological responses among shift workers and the general population. Methods: A total of 42 subjects participated in this quasi-experimental study. Participants were divided into a group of shift workers (n = 20) and a general population group (n = 22). Polysomnography tests, blood tests (cortisol, triglycerides and glucose), and psychological tests (Abbreviated Profile of Mood States, General Health Questionnaire-28, Working Memory and Processing Speed Indexes of the Wechsler Adult Intelligent Scale (WAIS-IV) were used to examine the effects of circadian rhythm disruption. Results: The results showed a significant relationship between circadian rhythm disruption and mood (r = 0.305, p < 0.05). The findings of this study also indicated that there was a significant effect of circadian rhythm disruption on mood (F(2,40) = 8.89, p < 0.001, η2 =0.182), processing speed (F(2,40) = 9.17, p < 0.001, η2 = 0.186) and working memory (F(2,40) = 4.963, p < 0.01, η2 = 0.11) in shift workers and the general population. Conclusions: Our findings showed that circadian rhythm disruption affects mood and cognitive performance, but it does not significantly affect psychological wellbeing and physiological responses. Future studies are warranted to examine moderator and mediator variables that could influence the circadian rhythm disruption.

Relationship Between Debt and Depression, Anxiety, Stress, or Suicide Ideation in Asia: A Systematic Review.

Background: This article aims to review research manuscripts in the past 5 years that focus on the effects of debt on depression, anxiety, stress, or suicide ideation in Asian countries. Methods: A search for literature based on the PRISMA guidelines was conducted on Medline, PubMed, Web of Science, Scopus, and ScienceDirect, resulting in nine manuscripts meeting inclusion criteria. The studies were conducted in Thailand, Korea, Singapore, Pakistan, India, Cambodia, and China. Results: The findings of the studies show that there is evidence to support that being in debt is related to Asian participants experiencing depression, anxiety, stress, or suicide ideation. However, the studies are limited to quantitative studies only. The definition of debt is also unclear in most manuscripts. Few manuscripts also examined how other factors influence the relationship between debt and mental illness. Conclusion: There are limited studies on the psychological effects of debt on the Asian population. Future studies should focus on the relationship between debt and psychological well-being among this population.

Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study.

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

Prevalence and factors of verbal learning and memory dysfunction in patients with epilepsy - A single centre study.

The objective of this study is to determine prevalence and factors leading to verbal learning and memory dysfunction among patients with epilepsy. A total of 211 subjects were recruited. Their verbal memory was assessed by Rey's Auditory Verbal Learning Test (RAVLT). This test was further subdivided into four major spheres for analysis, namely the verbal learning, interference list, immediate memory and delayed memory. All data collected were analyzed using Statistical Package for Social Sciences. Among the 211 patients, 55% (n = 116) had focal seizures and the remaining 45% (n = 95) had generalized seizures. Prevalence of verbal learning and memory impairment was high at 39.97% overall, and found most commonly in patients with focal impaired awareness seizures. Verbal learning and immediate memory dysfunction were significantly lower in focal impaired awareness group compared to others. Age more than 50 years, exposure to three or more antiepileptic drugs and use of carbamazepine more than 1000 mg a day were the predictors in poor verbal memory outcome. No statistical difference was observed in the mean RAVLT scores among the gender and hand dominance groups. Between patients with and without electroencephalogram changes as well as brain magnetic resonance imaging changes, the mean RAVLT scores showed no statistically significant difference. Verbal learning and memory impairment is prevalent among the epilepsy patients. The consequences of the memory impairment can be as debilitating as the seizure control. RAVLT is a reliable and practical test in the clinical setting.

Employment Experiences among Young Malaysian Adults with Learning Disabilities.

The aim of this study was to describe the employment experiences of persons with learning disabilities (LDs) in developing countries, such as Malaysia. Factors associated with respondents' employment were also determined. A cross-sectional survey was conducted among young adults with LD who left the special education programs in secondary schools in Kuala Lumpur and Selangor. Ninety young adults with LD, aged 18 to 25 years were interviewed face-to-face at an agreed upon convenient place on their working experiences after leaving secondary schools. A total of 13 respondents were excluded from the analysis because their intellectual quotient (IQ) score demonstrated a high possibility of intellectual disability with IQ estimation <70. Of the 77 young adults analyzed, 74.0% reported having work experience and 64.9% were working at the time of interview. Statistical analysis showed significant associations between individual, family, and community factors with respondents' employment. Two factors made a unique statistically significant contribution to the model (gender, p = 0.043 and adult service: Financial support p = 0.012). This study suggests the current school-to-work transition program at secondary and post-secondary schools should be improved to better prepare young adults with LD with necessary skills relevant for the current job market so that they could improve their employability.

Preliminary Analysis of the Factor Structure, Reliability and Validity of an Obsessive-Compulsive Disorder Screening Tool for Use with Adults in Malaysia.

This is a preliminary study to examine the factor structure, reliability, and validity of an obsessive-compulsive disorder (OCD) screening tool for use in the Malaysian setting. A total of 199 Malaysian adults were recruited for this study. After cleaning and normalizing the data, 190 samples were left to be analyzed. Principle component analysis using varimax rotation was then performed to examine various factors derived from psychometric tools commonly used to assess OCD patients. The screening tool exhibited three factors that fit the description of obsessions and compulsions from the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM 5), as well as other common symptoms that co-morbid with OCD. The labels given to the three factors were: Severity of Compulsions, Severity of Obsessions, and Symptoms of Depression and Anxiety. Reliability analysis showed high reliability with a Cronbach's alpha of 0.94, whereas convergent validity of the tool with the Yale Brown Obsessive-compulsive Scale-Self Report demonstrated good validity of r = 0.829. The three-factor model explained 68.91% of the total variance. Subsequent studies should focus on OCD factors that are culturally unique in the Malaysian context. Future research may also use online technology, which is cost-efficient and accessible, to further enhance the screening tool.

The role of social support and spiritual wellbeing in predicting suicidal ideation among marginalized adolescents in Malaysia.

BACKGROUND: The high number of adolescents and young adults harbouring suicidal ideation, as reported by the Ministry of Health Malaysia, is alarming. This cross-sectional study aims to examine the association between social support and spiritual wellbeing in predicting suicidal ideation among Malaysian adolescents. METHODS: A total of 176 adolescents in selected urban areas in the states of Wilayah Persekutuan and Selangor were selected. The Suicide Ideation Scale (SIS) was used to measure the level of severity or tendency of suicidal ideation. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure the perceived social support received by the respondent while the Spiritual Wellbeing Scale (SWBS) was used to measure the religious wellbeing (RWB), the existential wellbeing (EWB) and the overall score of spiritual wellbeing (SWB). RESULTS: The study found that both RWB and EWB showed significant negative correlation with suicidal ideation. Similarly, support from family and friends also showed a negative correlation with suicidal ideation. Further analysis using multiple regressions showed that RWB and SWB, and family support predict suicidal ideation in adolescents. CONCLUSION: Spiritual wellbeing in combination with family support plays a major role in predicting suicidal ideation. Therefore, intervention for encompassing spirituality and family support may contribute to a more positive outcome in suicidal adolescents.