Self-system and mental health status among Malaysian youth attending higher educational institutions: A nationwide cross-sectional study.

Introduction: Mental health disorders (MHDs) are a global health burden with an increasing prevalence. During the COVID-19 pandemic, depression was the commonest MHD, followed by anxiety and stress. This nationwide study aimed to determine the prevalence and associated factors of depression, anxiety and stress among Malaysian students attending higher educational institutions. Methods: A cross-sectional study was conducted from June to December 2021. Institutions were selected via stratified random sampling and students via convenience sampling. A self-administered questionnaire comprising questions on socio-demographic characteristics, academic background, substance abuse, childhood abuse, religiosity and the Depression Anxiety Stress Scale-21 was used. Data were analysed using SPSS version 27; descriptive, point-biserial correlation, chi-square and multiple binary logistic regression analyses were conducted. Results: Sex and adverse childhood experiences significantly predicted all three MHDs (P<0.05). The students from public institutions (odds ratio [OR]=0.71, 95% confidence interval [CI]=0.56-0.90, P=0.004) had a lower risk of depression than those from private institutions. The smokers/vapers (OR=1.43, 95% CI=1.02-2.02, P=0.041) a higher risk of depression than the non-smokers/non-vapers. The social science students (OR=1.29, 95% CI= 1.01-1.65, P=0.039) had a higher risk of anxiety than the science students. The students who highly engaged in organisational religious activity (OR=0.91, 95% CI=0.84-0.98, P=0.015) had a lower risk of anxiety than their counterparts. Conclusion: Anxiety is the commonest MHD among Malaysian youth, followed by depression and stress. Childhood abuse is a crucial related factor requiring further attention. Screening, surveillance, preventive measures and comprehensive interventions for MHDs should be initiated among youth.

Level of fear towards COVID-19 and its determinants among healthcare providers in Malaysia: A cross-sectional study.

Introduction: Malaysia is one of the hardest-hit countries by COVID-19 in Asia. The rapidly rising number of cases had sparked fear among healthcare providers. This study aimed to assess the determinants of fear towards COVID-19 among healthcare providers in primary care settings. Method: This online-based cross-sectional study was conducted among 1280 healthcare providers aged ≥18 years from 30 primary care clinics in the state of Selangor, Malaysia. The Fear of COVID-19 Scale was used to assess the level of fear, and the results were analysed using multiple linear regression. Results: The mean age of the respondents was 36 years, and the mean working experience was 11 years. The majority of the respondents were women (82.4%) and Malays (82.3%). The factors that were significantly correlated with higher levels of fear were underlying chronic disease (ß=1.12, P=0.002, 95% confidence interval [CI]=0.08, 3.15), concern about mortality from COVID-19 (ß=3.3, P<0.001, 95% CI=0.19, 7.22), higher risk of exposure (ß=0.8, P<0.001, 95% CI=0.14, 5.91), concern for self at work (ß=2.8, P=0.002, 95% CI=0.08, 3.10) and work as a nurse (ß=3.6, P<0.001, 95% CI=0.30, 7.52), medical laboratory worker (ß=3.0, P<0.001, 95% CI=0.12, 4.27) and healthcare assistant (ß=3.9, P<0.001, 95% CI=0.17, 5.73). The level of fear was inversely correlated with a higher work-related stress management score (ß=-0.9, P<0.001, 95% CI=-0.14, -5.07) and a higher sleep quality score (ß=-1.8, P<0.001, 95% CI=-0.28, -10.41). Conclusion: Family physicians should be vigilant and identify healthcare providers at risk of developing COVID-19-related fear to initiate early mental health intervention.

A Mobile Phone App for the Prevention of Type 2 Diabetes in Malaysian Women With Gestational Diabetes Mellitus: Protocol for a Feasibility Randomized Controlled Trial.

BACKGROUND: Over 50% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM. OBJECTIVE: The protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation. METHODS: This is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health's Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212). RESULTS: Recruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022. CONCLUSIONS: To our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future. TRIAL REGISTRATION: ClinicalTrials.gov NCT05204706; https://clinicaltrials.gov/ct2/show/NCT05204706. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37288.

Impacts of a nutrition education intervention in individuals with cardiometabolic risk: Protocol of a randomized controlled trial.

BACKGROUND: Unhealthy dietary pattern including high dietary sugar intake is responsible for the cardiometabolic-related deaths. Nonetheless, adherence to the recommendation is low, and appropriate nutrition education to reduce sugar consumption is scarce. OBJECTIVE: This proposed project aims to evaluate the effectiveness of a nutrition education module in modifying sugar consumption and other cardiometabolic risk (CMR)-related outcomes in individuals with CMR. METHODS: This is an open-label, 3-group parallel-randomized controlled trial that will be conducted in Universiti Putra Malaysia, Serdang, Malaysia. Participants will be equally randomized into three groups. Participants in the Control Group (n = 35) would receive no intervention and undergo usual follow-up. In comparison, those participants in the Intervention Groups (n = 70) would receive nutrition education to modify sugars consumption. They will also be given either refined white sugar (n = 35), or Minimally Refined Brown Sugar (n = 35) for daily consumption throughout a six-month study period. Measurements include socio-demographic status, medical characteristics, nutritional status, lifestyle practices, Health Belief Model constructs, and knowledge of healthy diet will be measured at baseline, first- (V1), third- (V3) and sixth-month (V6) intervals. CONCLUSION: Participants of both Intervention Group aiming for sugar intake modification, would have lower sugar consumption and better CMR-related outcomes than the Control Group. Since Minimally Refined Brown Sugar contains fair amount of antioxidants, participants of Intervention Group (Minimally Refined Brown Sugar) will have better CMR-related outcomes than participants of Intervention Group (white sugar) at the end of the study.

Barriers to reporting postpartum hemorrhage at different levels of healthcare facilities in Nigeria: A qualitative study.

Background: Maternal mortality reduction remains a world health priority. One of the causes of maternal death is bleeding after childbirth. However, little is known regarding barriers to reporting for postpartum hemorrhage care among postnatal women in Nigeria. Objective: This research aimed to understand the perceived barriers to reporting postpartum hemorrhage care experienced by women and healthcare workers in Birnin Kebbi, North west-Nigeria. Methods: Qualitative case research was employed in this study with face-to-face interviews among ten postnatal women who experienced bleeding and six healthcare workers. Data were collected from September to November 2021. The interviews were all audio-taped, transcribed verbatim, and analyzed using thematic analysis. NVivo Pro Version 12 was applied to organize further and manage the data. Results: Six themes were developed: (1) knowledge deficit, (2) poor attitudes, behaviors, and performances, (3) low socioeconomic status, (4) lack of healthcare personnel, (5) cultural norms, and (6) lack of access to healthcare facilities. Conclusion: The study findings might serve as input for healthcare policymakers and healthcare workers to improve health and reduce maternal mortality. Enhancing knowledge and awareness about reporting process is necessary to improve reporting for postpartum hemorrhage care among women. Training and continuous professional development of health care workers are also highly suggested to enhance the quality of care.

Short-Term Intake of Yellowstripe Scad versus Salmon Did Not Induce Similar Effects on Lipid Profile and Inflammatory Markers among Healthy Overweight Adults despite Their Comparable EPA+DHA Content.

Yellowstripe scad (YSS) have comparable eicosapentaenoic acid and docosahexaenoic acid (EPA+DHA) content to salmon. We aimed to compare the effects of YSS and salmon on lipid profile and inflammatory markers. A randomized crossover trial with two diet periods was conducted among healthy overweight (with BMI 23.0-27.4 kg/m2) Malaysian adults aged 21-55 years. Steamed whole YSS fish (≈385 g whole fish/day) or salmon fillets (≈246 g fillet/day) were given for eight weeks (3 days per week), retaining approximately 1000 mg EPA+DHA per day. Diets were switched after an 8-week washout period. Fasting blood samples were collected before and after each diet period. A total of 49 subjects participated in the intervention (35% male and 65% female; mean age 29 (7) years). YSS did not induce any significant changes in outcome measures. However, the consumption of salmon as compared with YSS was associated with reduction in triglycerides (between-group difference: -0.09 mmol/1, p = 0.01), VLDL-cholesterol (between-group difference: -0.04 mmol/1, p = 0.01), atherogenic index of plasma (between-group difference: -0.05 mmol/1, p = 0.006), and IL-6 (between-group difference: -0.01 pg/mL, p = 0.03). Despite their comparable EPA+DHA content, short-term consumption of salmon but not YSS induced significant changes in lipid profile and inflammatory markers. Larger clinical trials are needed to confirm the findings.

Protocol for a qualitative study exploring the perception of need, importance and acceptability of a digital diabetes prevention intervention for women with gestational diabetes mellitus during and after pregnancy in Malaysia (Explore-MYGODDESS).

INTRODUCTION: Women who develop gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes, and to reduce this risk the women have to adopt healthy behaviour changes. Although previous studies have explored the challenges and facilitators to initiate behaviour change among women with GDM, there is limited data from Malaysian women. Thus, this study will explore the factors affecting the uptake of healthy behaviour changes and the use of digital technology among women and their healthcare providers (HCPs) to support healthy behaviour changes in women with GDM. METHODS AND ANALYSIS: The study will be modelled according to the Capability, Opportunity, Motivation and Behaviour and Behaviour Change Wheel techniques, and use the DoTTI framework to identify needs, solutions and testing of a preliminary mobile app, respectively. In phase 1 (design and development), a focus group discussion (FGDs) of 5-8 individuals will be conducted with an estimated 60 women with GDM and 40 HCPs (doctors, dietitians and nurses). Synthesised data from the FGDs will then be combined with content from an expert committee to inform the development of the mobile app. In phase 2 (testing of early iterations), a preview of the mobile app will undergo alpha testing among the team members and the app developers, and beta testing among 30 women with GDM or with a history of GDM, and 15 HCPs using semi-structured interviews. The outcome will enable us to optimise an intervention using the mobile app as a diabetes prevention intervention which will then be evaluated in a randomised controlled trial. ETHICS AND DISSEMINATION: The project has been approved by the Malaysia Research Ethics Committee. Informed consent will be obtained from all participants. Outcomes will be presented at both local and international conferences and submitted for publications in peer-reviewed journals.

Decision making process and factors contributing to research participation among general practitioners: A grounded theory study.

INTRODUCTION: The participation of general practitioners (GPs) in primary care research is variable and often poor. We aimed to develop a substantive and empirical theoretical framework to explain GPs' decision-making process to participate in research. METHODS: We used the grounded theory approach to construct a substantive theory to explain the decision-making process of GPs to participate in research activities. Five in-depth interviews and four focus group discussions were conducted among 21 GPs. Purposeful sampling followed by theoretical sampling were used to attempt saturation of the core category. Data were collected using semi-structured open-ended questions. Interviews were recorded, transcribed verbatim and checked prior to analysis. Open line-by-line coding followed by focus coding were used to arrive at a substantive theory. Memoing was used to help bring concepts to higher abstract levels. RESULTS: The GPs' decision to participate in research was attributed to their inner drive and appreciation for primary care research and their confidence in managing their social and research environments. The drive and appreciation for research motivated the GPs to undergo research training to enhance their research knowledge, skills and confidence. However, the critical step in the GPs' decision to participate in research was their ability to align their research agenda with priorities in their social environment, which included personal life goals, clinical practice and organisational culture. Perceived support for research, such as funding and technical expertise, facilitated the GPs' participation in research. In addition, prior experiences participating in research also influenced the GPs' confidence in taking part in future research. CONCLUSIONS: The key to GPs deciding to participate in research is whether the research agenda aligns with the priorities in their social environment. Therefore, research training is important, but should be included in further measures and should comply with GPs' social environments and research support.

Result of randomized control trial to increase breast health awareness among young females in Malaysia.

BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths in women worldwide as well as in Malaysia. Breast self-examination (BSE) has a role in raising breast cancer awareness among women and educational programs play an important role in breast cancer preventive behavior. The aim of this study is to develop, implement and evaluate the effectiveness of Breast Health Awareness program based on health belief model on knowledge of breast cancer and breast-selfexamination and BSE practice among female students in Malaysia. METHODS: A single-blind randomized controlled trial was carried out among 370 female undergraduate students from January 2011 to April 2012 in two selected public universities in Malaysia. Participants were randomized to either the intervention group or the control group. The educational program was delivered to the intervention group. The outcome measures were assessed at baseline, 6, and 12 months after implementing the health educational program. Chi-square, independent samples t-test and two-way repeated measures ANOVA (GLM) were conducted in the course of the data analyses. RESULTS: Mean scores of knowledge on breast cancer (p<0.003), knowledge on breast self examination (p<0.001), benefits of BSE (p<0.00), barrier of BSE (0.01) and confidence of BSE practice (p<0.00) in the intervention group had significant differences in comparison with those of the control group 6 and 12 months after the intervention. Also, among those who never practiced BSE at baseline, frequency of BSE practice increased 6 and 12 months after the intervention (p<0.05). CONCLUSION: The Breast Health Awareness program based on health the belief model had a positive effect on knowledge of breast cancer and breast self-examination and practice of BSE among females in Malaysia. TRIAL REGISTRATION: The ANZCTR clinical trial registry ( ACTRN12616000831482 ), retrospectively registered on Jun 23, 2016 in ANZCTR.org.au.

Barriers to breast self examination practice among Malaysian female students: a cross sectional study.

INTRODUCTION: Breast cancer is the most frequent cancer and the second reason of cancer deaths among woman worldwide, including Malaysia. The objective of this paper is to assess the practice of breast self-examination (BSE) and identify the barriers of BSE practice among undergraduate female students in Malaysia. METHODS: A cross-sectional study conducted among 810 female undergraduate students in Klang Valley, Malaysia between April-Jun 2012. Data was collected via self-administered questionnaire which was developed and pre-tested for this study. RESULTS: The majority of respondents were Malay 709 (95.6 %) and single 719 (96.9 %) with a mean age of 21.7 (1.1). Only hundred eleven (15 %) of the participants had a family history of breast cancer. 70.5 % of the respondents do not practice breast self-examination, 70.5 % do not know how to do it, 64.7 and 61.5 % reported no symptoms of breast cancer and worries to detect breast cancer, respectively. Univariate analysis showed that age, marital status and personal history of breast disease were statistically associated with the practice of breast self-examination. CONCLUSION: In this study, a high percentage of respondents were aware of breast cancer but do not perform breast self-examination. Knowledge, socio-cultural and environmental factors were identified as barriers; so it is recommended that knowledge among the public about breast cancer and promotion of public breast health awareness campaigns through the media should be carried out.

Predictors affecting breast self-examination practice among undergraduate female students in Klang Valley, Malaysia.

AIM: Breast cancer is the most common cancer among women worldwide, including Malaysia. In developing countries, predictors affecting breast self-examination (BSE) practice are different. This cross-sectional study was conducted to determine the prevalence of BSE practice and the predictors affecting BSE practice among undergraduate female students in Klang Valley, Malaysia. MATERIAL AND METHODS: A cross-sectional study was conducted among 820 female undergraduate students to assess the BSE performance and related determinants of BSE practice in Klang Valley, Malaysia. Data were collected via a self-administered structured questionnaire that was developed for this study. RESULTS: The mean age of the respondents was 21.7 ± 1.2 years old. Most of them were single (96.8%), Malay (91.9%) and 19.6% of the participants performed BSE regularly. Multivariate logistic regression modeling revealed that BSE performance was more likely among women who have checked their breast with a doctor (odds ratio = 2.04, P = 0.00), and women who have personal history of breast disease (odds ratio = 4.43, P = 0.03). CONCLUSION: The findings showed a low BSE practice rate among young Malaysian women. Hence, the community's breast health awareness is needed to improve breast cancer prevention among young Malaysian women.

Knowledge of Female Undergraduate Students on Breast Cancer and Breast Self-examination in Klang Valley, Malaysia.

BACKGROUND: In Malaysia, breast cancer is the first cancer among females regardness of race. AIM: The purpose of this study was to identify the knowledge and BSE practice among undergraduate female students at four public universities in Klang Valley, Malaysia. MATERIALS AND METHODS: This cross-sectional study was conducted among 820 undergraduate female students using a self-administered questionnaire covering socio-demographic data, knowledge of breast cancer and BSE practice. RESULTS: The mean age of the respondents was 21.7±1.2 years. The majority of them were single (96.8%), Malay (91.9%) and 16.5% of respondents had a family history of breast cancer. This study showed low level of knowledge on breast cancer and breast self-examination among participants. Only 19.6% participants were performing BSE regularly. Knowledge of breast self-examination was significantly associated with BSE practice (p=0.00). Also, there were significant associations between performing BSE with age, marital status and being trained by a doctor for doing BSE (p<0.05). CONCLUSIONS: Our findings showed that the rate of BSE practice and knowledge of breast cancer is inadequate among young Malaysian females. A public health education program is essential to improve breast cancer prevention among this group.

Health Beliefs and Breast Self-Examination among Undergraduate Female Students in Public Universities in Klang Valley, Malaysia.

BACKGROUND: Breast cancer is the most frequently occurring cancer in women and the most common cause of cancer death worldwide. MATERIALS AND METHODS: A cross-sectional study was carried out among 792 female undergraduate students in public universities in Klang Valley, Malaysia, from January to April 2011. Data were collected using a validated questionnaire developed for this study. RESULTS: The mean age of respondents was 21.7±1.2 years. Most of them were single (96.8%), Malay (91.9%) and 150 (19.6%) claimed they had practiced BSE. There was a significant differences between performers and non-performers correlated to age, marital status, check breast by doctor, and being trained about BSE. Performers had lower mean scores for perceived barriers and susceptibility and higher mean score for confidence. Stepwise logistic regression analysis yielded four significant predictor variables. CONCLUSIONS: Overall our findings indicate that the practice of BSE while perceived as being important is not frequently practiced among female in Malaysia. Targeted education should be implemented to improve early detection of breast cancer.

Beliefs and behavior of Malaysia undergraduate female students in a public university toward breast self-examination practice.

BACKGROUND: Breast cancer is the most common cancer and the second principal cause of cancer deaths among women worldwide, including Malaysia. METHODS: A cross-sectional study was carried out among 262 female undergraduate students in University Putra Malaysia using a validated questionnaire which was developed for this study. RESULTS: The mean age of respondents was 22∓2.3 years. Most of them were single (83.1%), Malay (42.3%) and 20.7% reported having a family history of breast cancer. Eighty-seven (36.7%) claimed they had practiced BSE. Motivation and self-efficacy of the respondents who performed BSE were significantly higher compared with women who did not (p<0.05).There was no association between BSE practice and demographic details (p<0.05). Logistic regression analysis indicated that women who perceived greater motivation (OR=1.089, 95%CI: 1.016-1.168) and had higher confidence of BSE (OR=1.076, 95%CI: 1.028-1.126) were more likely to perform the screening. CONCLUSIONS: The findings show that Malaysian young female's perception regarding breast cancer and the practice of BSE is low. Targeted education should be implemented to improve early detection of breast cancer.

Contraceptive use among women with chronic medical conditions and factors associated with its non-use in Malaysia.

INTRODUCTION: Women with chronic medical conditions are at higher risk of adverse pregnancy outcomes, which may be minimized through optimal preconception care and appropriate contraceptive use. This study aimed to describe contraceptive use among women with chronic medical conditions and factors associated with its non-use. METHODS: This study used cross-sectional data from a family planning survey among women with chronic medical conditions conducted in three health facilities in a southern state of Malaysia. A total of 450 married women in reproductive age (18-50 year) with intact uterus, and do not plan to conceive were analysed for contraceptive use. Both univariate and multivariate analysis was conducted to identify factors associated with contraceptive non-use among the study participants. RESULTS: A total of 312 (69.3%) of the study participants did not use contraceptive. Contraceptive non-use was highest among the diabetics (71.2%), connective tissue disease patients (68.6%) and hypertensive patients (65.3%). Only 26.3% of women with heart disease did not use contraceptive. In the multivariate analysis, contraceptive non-use was significantly more common among women who received their medical treatment in the health clinics as compared to those who received treatment in the hospital (adjusted odds ratio [OR]=1.75, 95% confidence interval [CI]: 1.09, 2.79), being in older age group of 41-50 year (adjusted OR=2.31, 95% CI: 1.19, 4.48), having children (adjusted OR=4.57, 95% CI: 1.66, 12.57) and having lower education (adjusted OR=2.87, 95% CI: 1.43, 5.77). CONCLUSION: About two-third of women with chronic medical conditions who needed contraceptive did not use them despite the higher risk of pregnancy related complications. The high unmet need warrant an effective health promotion programme to encourage the uptake of contraceptives especially targeting women of older age group, low education and those who received their medical treatment at health clinics.