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Purpose: The paper aims to identify the emerging themes on the challenges faced by the Malaysian private higher learning institutions (HLIs) in the provision of providing quality education. Design/methodology/approach: Semi-structured interviews were purposively conducted with 29 of the Malaysian private HLI internal and external stakeholders ranging from the relevant personnel of the institutions (the quality director, administrators and senior academics), regulatory agencies, prospective employer, students and parents. Thematic analysis was then applied to analyze the participants' responses in determining and clarifying the challenges faced by the Malaysian private HLIs in the issue of providing quality education. Findings: Eight overarching themes were identified, namely, Academics, Facilities, Students, Programs and curriculum, Competition, Accreditation, Finance and Research. Academics represent the most frequent challenge raised by the participants, whereas Research emerged as the least mentioned challenge during the interview sessions. Research limitations/implications: The present paper focused solely on Malaysian private HLIs, and thus, the findings may not be applicable to the foreign private HLIs that are operating in Malaysia as well as to the public HLIs. Originality/value: The findings are expected to provide valuable guidelines to the Malaysian Private HLIs in areas where resources need to be critically disbursed. To the regulatory agencies and policy-makers, the findings could enlighten them on the difficulties faced by these privately funded institutions so that further policies can be designed and implemented to assist these institutions in their operations and long-term survival.

Like all organisations, good governance is a fundamental requirement for the responsible and accountable management of universities in general and open universities in particular. This is to ensure that these (open) universities remain relevant to their mission of facilitating unfettered access to higher education for citizens and at the same time continue being reliable contributors to personal and institutional developments, the vital ingredients to maintaining sustained national development. While several studies have, in the past, been conducted on governance of universities, almost all of them have centred around conventional, face-to-face institutions. Not much published literature is in evidence on the governance of Open Universities. This paper, drawing from a study on the governance of a few open universities in Asia, tries to discuss the nature of their challenges, and the lessons that can be drawn from their practices and experience. The study focused on aspects relating to institutional autonomies such as curriculum, budgeting and financial management, admission standards, conferment of qualifications, academic staff appointments, development and promotions and research policies. Our findings indicate that, similar to conventional systems, the state plays a crucial role in many aspects of governance both in publicly funded and privately supported institutions. Recent attempts at governance transformation towards greater institutional autonomies is beginning to show limited changes in some but not all jurisdictions studied.

International students undertaking higher education in foreign countries bring with them some perceived beliefs about academic conduct. These beliefs are often in contrast with the host countries' academic practices, which may generate confusion and frustration among international students, affecting their learning behaviours. As a consequence of intercultural interactions in a foreign country, international students' beliefs and behaviours may change. Since Malaysia has emerged to be a hub of educational excellence in the region by transforming its higher education, thereby attracting increasing number of international students, this paper aims to investigate whether international students' acculturation-oriented attitudes impact their ethical academic conduct pertaining to research, exams and assignments in a public university in Malaysia. The results reveal that students adjusting to the local academic norms demonstrate significant positive commitments to host country's academic norms concerning research, exam and assignments. However, students upholding the norms of their home countries tend to show non-significant attitudes towards host country's academic norms. These findings have strategic policy implications for the host educational institutions that are highlighted in the paper. The paper also identifies its limitations and explores future research potential.

Purpose: The purpose of this paper is to investigate learning space for research workspaces in Higher Education Institutions (HEIs) in Malaysia based on the evaluations by experts and university research workers on a practical model for creating an effective research learning space. It examines expert analyses of the notion of a suitable research learning workspace and explores worker viewpoints on this issue. Method: Experts from business (n = 2), education (n = 2) and architectural (n = 2) backgrounds were interviewed and a survey was conducted on research workers from selected universities in Malaysia (n = 222). Findings: A research learning workspace model is proposed based on evaluations by workers and experts on what was needed in a research-based working space to make it more work-friendly and intellectually stimulating for researchers. Significance: This research attempts to understand research learning space problems in institutions of higher learning and proposes one possible model for future research learning workspace planning. It also contributes to the literature on research learning workspace and its management in developing countries, especially when Asia is positioning itself today as a competitive global educational hub.

BACKGROUND: Fear of losing psychological resources can lead to stress, impacting psychological health and behavioral outcomes like burnout, absenteeism, service sabotage, and turnover. OBJECTIVE: The study examined the impact of job stressors (time pressure, role ambiguity, role conflict) on employee well-being and turnover intentions. The study also investigated the mediating role of employee well-being between job stressors and turnover intention based on the conservation of resources (COR) theory. METHODS: Data from 396 IT executives in Malaysian IT firms were analyzed using the Partial Least Squares - Structural Equation Modeling (PLS-SEM) technique. RESULTS: Results confirmed a significant negative correlation between time pressure (–0.296), role ambiguity (–0.423), role conflict (–0.104), and employee well-being. Similarly, employee well-being showed a significant negative relationship with turnover intentions (–0.410). The mediation analysis revealed that employee well-being mediates the relationship between time pressure (0.121), role ambiguity (0.173), role conflict (0.043), and turnover intentions. CONCLUSION: This paper aims to manifest the importance of designing employee well-being policies by firms to retain employees. Findings reflect the role of the managerial approach towards ensuring employee well-being for employee retention, thereby reducing recruitment and re-training costs. [ABSTRACT FROM AUTHOR]

Management of newborns with disorders of sex development (DSD), especially in deciding the need for a sex assignment surgery, is a complex matter. It is associated with many bioethical issues, such as concerns about the rights and welfare of the newborns and the reliability of parents' consent to the paternalistic disposition of physicians in making the best decisions. This paper, containing interviews with six medical experts and three religious' experts, aims to raise awareness of the multidisciplinary approach, which uses a combination of medicine, religion, and ethics in managing children with DSD, particularly in Malaysia, to avoid unnecessary psychological, biological, emotional, and societal ramifications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to provide an overview of breast cancer researches in Malaysia. Besides, this study aimed to identify the trends of breast cancer research in Malaysia. This study retrieved 343 related publications from the Scopus database. After removing one duplicated publication and another two publications that did not meet the study criteria, the remaining 340 publications were analysed using a bibliometric analysis and trending keywords analysis. This study found that the annual growth rate of publications was 7.4%. The majority of the publications were research articles and multi-author. The most productive author was Yip CH with 69 publications, and the University of Malaya was the top institution in Malaysia related to this research area. For the last five years, there were no dominant themes in this research area. However, this study found two emerging clusters of breast cancer research in Malaysia, which related to medical data analytics and precision medicine in genomic breast cancer. Overall, breast cancer research in Malaysia is progressing towards a positive side, though a few improvements are needed. As the funding in this research area is scarce, proper allocation of the resources is needed. [ABSTRACT FROM AUTHOR]

Background: Stress, which can be attributed to household and workplace stressors, is prevalent among nurses. However, these stressors' attribution may differ between hospital and non-hospital nurses. It is currently unknown whether there are significant differences in the sociodemographic and occupational characteristics between hospital and non-hospital nurses which may potentially influence the type and magnitude of stressors, and subsequently the stress status. Therefore, this study aims to estimate the prevalence of stress and compare the roles of sociodemograhic characteristics, occupational profiles, workplace stressors and household stressors in determining the stress status between hospital and non-hospital female nurses in Malaysia. Methods: This cross-sectional study was conducted among randomly-selected 715 female nurses in Malaysia using pencil-and-paper self-reported questionnaires. Results: The majority of participants were ever married (87.0%), having children (76.2%), and work in hospital setting (64.8%). The level of household stressors was generally similar between hospital and non-hospital nurses. However, hospital nurses significantly perceived higher level of workplace stressors. Shift work is significantly associated with higher level of household and workplace stressors among nurses in both groups. The level of stress was significantly higher among hospital nurses. Both household and workplace stressors explained about 40% of stress status in both hospital and non-hospital nurses. Conclusion: Hospital nurses are at higher risk of having stressors and stress as compared to non-hospital nurses, probably due to higher proportion of them involved in shift work. Hospital nurses should be given high priority in mitigating stress among nurses. [ABSTRACT FROM AUTHOR]

Many forms of gambling are legal and popular in Malaysia. Despite this, in Malaysia, research into gambling is limited and there is no coherent strategy to tackle gambling-related harms. This paper summarises the gambling landscape of Malaysia, law governing gambling and research done so far and gives some recommendations on the way forward. [ABSTRACT FROM AUTHOR]

Learning environment has always been traditionally associated with the physical presence of classrooms, textbooks, pen-and-paper examinations and teachers. However, today's evolving technology has rapidly changed the face of education. Online learning, teleconferencing, internet, Computer Assisted Learning (CAL), Web-Based Distance Learning (WBDL) and other technologies are integrated in education. This blended learning environment has become the major role in training and education scene. This paper focuses on a set of quantitative data pertaining to the perception of blended learning, attitude towards technology, effectiveness and efficiency of blended learning by using path analysis. Data were drawn from a group of business students who were engaged in blended learning environment. This study intends to find out the effectiveness and efficiency of blended learning in Malaysia tertiary institutions. The empirical results confirm that blended learning does enhance student's learning experience and learning outcomes. [ABSTRACT FROM AUTHOR]

Objective: Special Study Module (SSM) is a mandatory research module implemented in Universiti Kebangsaan Malaysia (UKM). The objective of this paper is to provide a brief overview on the student research activities and to find out the outcome measures in terms of publication. Methods: It was a retrospective study done on SSM research projects at UKM. The SSM research is conducted from beginning of year-4 until 1st seven weeks of year-5. In year-4, students are assigned to a faculty-supervisor in small groups and spend every Thursday afternoon to plan and carry the research. Whole first seven weeks of year-5, students are placed with their supervisor continuously to collect data, do analysis, write report and present in the scientific conference. Outcomes of 5-years SSM research-projects starting from 2008/2009 to 2012/2013 academic session were analyzed. Results: Total 257 projects were completed and presented in annual scientific meetings from which 57 (22.2%) articles were published in peer reviewed journals. Conclusion: Mandatory undergraduate student research project brings an opportunity to develop students' capacity building from conception to final report writing and thereby narrowing the gap between education and practice. Medical schools should implement research module to bring changes in research and publication culture of undergraduate medical education. [ABSTRACT FROM AUTHOR]

Background: The use of finished herbal products (FHPs) among Malaysians today is expanding rapidly leading to a huge market of FHPs in the country. However, the mass production of FHPs in today's market is alarming due to safety-use issues that could lead to serious adverse effects. Nevertheless, demands are still high for FHPs as most consumers perceived it as safe to consume as it is made from natural substances as the active ingredients. This study aims to explore the safe use elements of FHPs identified by two stakeholders: consumers and practitioners in Malaysia and further compare these elements with the current regulations. Methods: As an exploratory study, its approach is to investigate at an in-depth level of understanding of safe use elements from the involved stakeholders: consumers and practitioners. We had a total of 4 focus group discussion sessions (1 FGD session with consumer and 3 FGD sessions with practitioners) as a method of collecting data from the participants. The FGDs were conducted in local native Malaysian and then being translated by researchers without changing their meanings. Thematic analysis was done which involves methodically reading through the verbatim transcripts and consequently segmenting and coding the text into categories that highlight what the participants have discussed. Results: From the result, we found that both practitioners and consumers agreed a safe FHP must be in compliance with the guidelines from the Ministry of Health Malaysia (MOH). There are other safe use elements highlighted including halal certification, trusted over-the-counter outlets, and published reports on the safety, efficacy, and quality. Conclusions: In conclusion, both practitioners and consumers agreed that the most important safe-use element is compliance with MOH guidelines, but the depth of discussion regarding the safety elements among these stakeholders holds a very huge gap. Thus, initiatives must be planned to increase the knowledge and understanding about the MOH guidelines towards achieving a sustainable ecosystem in the safe use of FHPs. [ABSTRACT FROM AUTHOR]

Background: This paper describes the cross-cultural adaptation of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Malay version (Malay PIDAQ), an oral health-related quality of life (OHRQoL) instrument specific for orthodontics for Malaysian adolescents between 12 and 17 years old.Methods: The PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validations. After initial investigation of the conceptual suitability of the measure for the Malaysian population, the PIDAQ was translated into Malay, pilot tested and back translated into English. Psychometric properties were examined across two age groups (319 subjects aged 12-14 and 217 subjects aged 15-17 years old) for factor structure, internal consistency, reproducibility, discriminant and construct validity, criterion validity, and assessment of floor and ceiling effects.Results: Fit indices by confirmatory factor analysis showed good fit statistics (comparative fit index = 0.936, root-mean-square error of approximation = 0.064) and invariance across age groups. Internal consistency and reproducibility tests were satisfactory (Cronbach's α = 0.71-0.91; intra-class correlations = 0.72-0.89). Significant differences in Malay PIDAQ mean scores were observed between subjects with severe malocclusion and those with slight malocclusion based on a self-rated and an investigator-rated malocclusion index, for all subscales and all age groups (p < 0.05). Construct validity of the Malay PIDAQ subscales with those who rated themselves with excellent to poor dental appearance and those who felt they needed or did not need braces, showed significant associations for all age groups (p < 0.05). Criterion validity also showed significant association between the Malay PIDAQ scores with those with and without impact on daily activities attributed to malocclusion. There were no ceiling effects detected but floor effects were detected for the Aesthetic Concern subscale.Conclusion: The study has provided initial evidence for the validity and reliability of the Malay PIDAQ to assess the impact of malocclusion on the OHRQoL of 12-17 year old Malaysian adolescents. [ABSTRACT FROM AUTHOR]

Purpose The principles of mindfulness have been increasingly applied in medical education for stress reduction. One of the most often used measures for mindfulness research is the Mindful Attention Awareness Scale (MAAS). The purpose of this paper is to determine the factor structure, and investigate its reliability and validity in a sample of multi-ethnic medical students in Malaysia.Design/methodology/approach In total, 590 medical students were involved in the study. After minor modification of the MAAS, a test battery including sociodemographic information, the MAAS, Subjective Happiness Scale (SHS), Satisfaction with Life Scale (SWLS), Five-facet Mindfulness Questionnaire (FFMQ), Depression, Anxiety and Stress Scale (DASS), and Perceived Stress Scale (PSS) was administered to the participants.Findings Exploratory and confirmatory factor analyses supported a one-dimensional factor structure of the MAAS. Cronbach’s α coefficient of the scale was 0.92 and in a sub-sample (n=118), it showed satisfactory temporal stability in two weeks period. There were significant positive correlations with SHS, SWLS, and four subscales of FFMQ scores (convergent validity); and negative correlations (discriminant validity) with the DASS and PSS scores (p<0.05). In another sub-sample (n=52) who participated in a four-week mindfulness-based intervention, the scale showed significant change in scores (p=0.002).Originality/value The study provided preliminary results supporting the use of the MAAS as a valid, reliable and stable factor structure of mindfulness measure among medical students in Malaysia. [ABSTRACT FROM AUTHOR]

Background: Recognising that excessive dietary salt intake is associated with high blood pressure and adverse cardiovascular health, the Ministry of Health Malaysia conducted the Malaysian Community Salt Survey (MyCoSS) among Malaysian adults. This paper introduced MyCoSS projects and presented findings on the salt intake of the Malaysian adult population.Methods: MyCoSS was a nationally representative survey, designed to provide valuable data on dietary salt intake, sources of salt in the diet, and knowledge, perception, and practice about salt among Malaysian adults. It was a cross-sectional household survey, covering Malaysian citizens of 18 years old and above. Multi-stage-stratified sampling was used to warrant national representativeness. Sample size was calculated on all objectives studied, and the biggest sample size was derived from the knowledge on the effect of high salt on health (1300 participants). Salt intake was estimated using a single 24-h urine collection and its sources from a food frequency questionnaire. Knowledge, attitude, and practice were determined from a pre-tested questionnaire. All questionnaires were fully administered by trained interviewers using mobile devices. Anthropometric indices (weight, height, and waist circumference) and blood pressure were measured using a standardised protocol. Ethical approvals were obtained from the Medical Research Ethics Committee, Ministry of Health Malaysia, and Queen Mary University of London prior to conducting the survey.Results: Findings showed that the average sodium intake of Malaysian adults (3167 mg/day) was higher than the WHO recommendation of 2000 mg/day. Daily intake was significantly higher among males and individuals with higher BMI and higher waist circumference.Conclusion: Salt intake in the Malaysian population was higher than the WHO recommendation. MyCoSS's findings will be used for the development and implementation of national salt reduction policy. A successful implementation of a national salt reduction programme in Malaysia will benefit the whole population. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The study aimed to identify factors associated with participation in Phase II cardiac rehabilitation and to assess patient perceptions towards the usage of technologies in cardiac rehabilitation. Background: Despite efforts to promote utilisation of cardiac rehabilitation (CR), participation among patients remains unsatisfactory. Little is known of patient decision to participate Phase II CR in a multi‐ethnic country. Design: A cross‐sectional study design. Methods: A consecutive sampling of 240 patients with coronary heart disease completed Coronary Artery Disease Education Questionnaire (CADE‐Q) II, Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS) and Cardiac Rehabilitation Barriers Scale (CRBS). Results: Seventy per cent of patients (mean age 60.5 [SD = 10.6] years, 80.8% male) participated in phase II cardiac rehabilitation. Self‐driving to cardiac rehabilitation centres, higher barriers in perceived need/health care and logistical factors were significantly associated with decreased odds of participation. Patients with more barriers from comorbidities/functional status, higher perceived social support from friends, and anxiety were more likely to participate. Chinese and Indians were less likely to participate when compared with Malays. More than 80% of patients used both home and mobile broadband internet, and 72.9% of them would accept the usage of technologies, especially educational videos, instant messenger, and video calls to partially replace the face‐to‐face, centre‐based cardiac rehabilitation approach. Conclusion: Several barriers were associated with non‐participation in phase II cardiac rehabilitation. With the high perceived acceptance of technology usage in cardiac rehabilitation, home‐based and hybrid cardiac rehabilitation may represent potential solutions to improve participation. Relevance to clinical practice: By addressing the barriers to cardiac rehabilitation, patients are more likely to be ready to adopt health behaviour changes and adhere to the cardiac rehabilitation programme. The high perceived acceptance of using technologies in cardiac rehabilitation may provide insights into new delivery models that can improve and overcome barriers to participation. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to conduct an investigation into the relationship between a firm’s corporate governance mechanisms (audit committee (AC) composition and operation, block shareholder, chief executive officer duality, financial state, ownership dominance, political connection, share price, and family control) and auditor quality selection in Malaysia, for periods before and after the introduction of Malaysian Code of Corporate Governance (MCCG) in 2007. Design/methodology/approach – In total, 300 companies listed on the Malaysian Stock Exchange from 2006 to 2008 were selected. A binary regression method was used to analyze the data collected from both annual reports and financial databases. Findings – The study has found that in general, MCCG 2007 influenced auditor selection through restructuring of corporate governance tools, such as ACs and internal audit functions. Research limitations/implications – Results have provided evidence that the restructuring of corporate governance may contribute and drive company to enhance the quality of the audit performed by selecting better quality auditor and/or improvising the audit-related functions within the company such as formalizing internal audit function. This study, however, employed an archival method of study and only used three years (2006, 2007, and 2008) of data analysis. Future research should analyze data from a longer period and utilize a field survey to understand reasons for auditor selection from the company perspective. Originality/value – Building on previous studies, this study contributes to the current body of knowledge as it also considers the objective from the perspective of the revised MCCG 2007. It examines whether the introduction of new or revised corporate governance guidelines may immediately impact company auditor selection. Therefore, it compares the auditor quality of the company from pre-MCCG 2007 (2006) and post-MCCG 2007 (2008). [ABSTRACT FROM AUTHOR]

This paper offers an in-depth analysis of efficiency and productivity changes using the Hicks–Moorsteen total factor productivity index, in the context of higher education institutions. Unlike the Malmquist method, this approach makes no assumptions about firms' returns to scale conditions. We assume that the production technology exhibits variable returns to scale, which is more plausible than the constant returns to scale assumption, because universities usually operate at suboptimal scales. Three major groupings of Malaysian public universities are used in our case study: research, comprehensive, and focused universities. The results show that technical efficiency has improved after the 2007 National Higher Education Strategic Plan within all the three university groupings. [ABSTRACT FROM PUBLISHER]

Purpose – The purpose of this paper is to ascertain whether different types of institutional investor in Malaysia are involved in the corporate governance of their investee companies, and, if yes, to what extent is the level of the involvement. Design/methodology/approach – A qualitative approach, consisting of a series of interviews with 18 senior investment managers of different types of institutional investor, was chosen. Findings – The findings suggest that lessons learnt from the fallout of the Asian crisis has made Malaysian institutional investors not only to be more prudent in managing their total funds and in making equities investment decisions, but has resulted in a more active participation in their “core” investee companies apart from merely discharging their voting rights. Interview analysis revealed that government-linked investment companies are championing the cause and could possibly affect the overall level of institutional investors’ involvement, which bode well for the future of the corporate governance system of the country. Research limitations/implications – Generalisations may be an issue when interviews are used as the method of inquiry. Also, the sample is not random, as access to many managers depended on recommendations. In addition, respondents were consciously selected to obtain different types of institutional investors that included government and non-government linked. Originality/value – There is a lack of work on studying the involvement of institutional investors in developing countries, whereby previous work and literature review were predominantly based upon the experience of Western economies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to examine the relationship between Bumiputra (in reference to Malay indigenous race) directors, a proxy for culture and analysts forecast. In addition, the study investigates whether corporate governance affects that relationship. Design/methodology/approach – The sample of this study is based on 664 firm-year observations from 193 firms during the 1999-2009 periods. The authors employ a panel least square regression with both period and industry fixed effects. The authors retrieved of analyst data from the Institutional Broker Estimate System (I/B/E/S) database while the authors hand collected the corporate governance variables. The remaining data were collected from Compustat Global. Findings – The authors find a positive relationship between the proxy of culture, Bumiputra directors and analysts forecast error suggesting that cultural values influences the level of information in the Malaysian capital market. Research limitations/implications – The research is dependent on the data availability from I/B/E/S database. Originality/value – The authors extend the work of Haniffa and Cooke (2002) in investigating how cultural values influence the capital market. In addition, this is the first study that investigates culture values and the analysts forecast. [ABSTRACT FROM AUTHOR]

INTRODUCTION The use of e-cigarettes (EC) has reached alarming proportions among Malaysians. On a national level, little is known about the profile and perceptions of Malaysian EC users. This study aimed to explore the prevalence of long-term EC usage and its associated factors among EC users in Malaysia. METHODS This nationwide online questionnaire survey was administered among 694 EC users across 13 states and 1 Federal Territory in Malaysia, between January and April 2018. A survey link was e-mailed to EC users that were recruited from an official national vape entity through their Facebook association page. We obtained information on respondents' sociodemographic characteristics, smoking habits, long-term e-cigarette usage and perceptions of EC use. We estimated long-term EC user prevalence and fitted multivariate regression models to predict factors associated with long-term EC usage. Statistical significance was set at p<0.05. RESULTS Respondents were predominantly Malays (87.6%), aged >30 years (68.1%) and tertiary educated (71%). The majority were employed (93.1%) with a monthly household income of MYR 4000 or less (56.6%). About 84% were former smokers, while 10% were current smokers. The prevalence of long-term EC usage in this study was 82.3%. Most users believed that EC had helped them to cut down tobacco smoking (94.8%), reduced the urge to smoke (88.3%) and ultimately helped them to quit smoking (87.2%). Respondents aged >30 years and those who perceived that EC has helped them stop smoking were significantly more likely to be long-term EC users. CONCLUSIONS Most respondents engaged in EC use to quit smoking. They were more likely to be long-term EC users if they were older and perceived that EC has helped them to quit smoking. This information is valuable for targeted prevention, health promotion and policy regulations. [ABSTRACT FROM AUTHOR]

Background: Nonsyndromic cleft lip and/or without cleft palate (NSCL/P) with or without hypodontia is a common developmental aberration in humans and animals. This study aimed to identify the loss of heterozygosity (LOH) involved in hypodontia and NSCL/P pathogenesis. Methods: This is a cross-sectional study that conducted genome-wide copy number analysis using CytoScan 750K array on salivary samples from Malay subjects with NSCL/P with or without hypodontia aged 7–13 years. To confirm the significant results, simple logistic regression was employed to conduct statistical data analysis using SPSS software. Results: The results indicated the most common recurrent copy neutral LOH (cnLOH) observed at 1p33-1p32.3, 1q32.2-1q42.13 and 6p12.1-6p11.1 loci in 8 (13%), 4 (7%), and 3 (5%) of the NSCL/P subjects, respectively. The cnLOHs at 1p33-1p32.3 (D1S197), 1q32.2-1q42.13 (D1S160), and 6p12.1-6p11.1 (D1S1661) were identified observed in NSCL/P and noncleft children using microsatellite analysis markers as a validation analysis. The regions affected by the cnLOHs at 1p33-1p32.3, 1q32.2-1q42.13, and 6p12.1-6p11.1 loci contained selected genes, namely FAF1, WNT3A and BMP5, respectively. There was a significant association between the D1S197 (1p33-32.3) markers containing the FAF1 gene among NSCL/P subjects with or without hypodontia compared with the noncleft subjects (p-value = 0.023). Conclusion: The results supported the finding that the genetic aberration on 1p33-32.3 significantly contributed to the development of NSCL/P with or without hypodontia. These results have an exciting prospect in the promising field of individualized preventive oral health care. [ABSTRACT FROM AUTHOR]

Background The interpretive paradigm and hermeneutic phenomenological design are the most popular methods used in international cross-cultural research in healthcare, nurse education and nursing practice. Their inherent appeal is that they help researchers to explore experiences. The ethnographic principle of cultural interpretation can also be used to provide meaning, clarity and insight. Aim To examine the use of hermeneutic phenomenology and the ethnographic principle of cultural interpretation in a research study conducted with Malaysian nurses on part-time, transnational, post-registration, top-up nursing degree programmes provided by one Australian and two UK universities. Discussion To enable the researcher to undertake international cross-cultural research and illuminate Malaysian nurses' views for the reader, cultural aspects need to be considered, as they will influence the information participants provide. Useful strategies that western researchers can adopt to co-create research texts with interviewees are outlined. The paradigm and research designs used in the study revealed the views and experiences of Malaysian nurses. Conclusion Hermeneutic phenomenology enabled the exploration of participants' experiences, and the ethnographic principle of cultural interpretation enabled the researcher's reflexivity to provide emic and etic views for the reader. Implications for practice This paper adds to the discussion of the paradigms and research designs used for international, cross-cultural research in Asia. It identifies the influence participants' cultural values have on their confidence and level of disclosure with western researchers. [ABSTRACT FROM AUTHOR]

Background: Sleep disturbance in children with atopic dermatitis (AD) frequently goes unnoticed and can be associated with behavioral challenges. The aims of this study were to determine (a) the prevalence and factors associated with sleep disturbance and behavioral problems and (b) the correlation between sleep disturbance and behavioral problems in children with AD. Methods: This cross‐sectional study involved children aged 4–12 years old with moderate to severe AD. Age and sex‐matched healthy children were recruited as the comparison group. The Children's Sleep Habits Questionnaire (CSHQ) and the Strengths and Difficulties Questionnaire (SDQ) were used to assess sleep disturbance and behavioral problems, respectively. Higher scores in both questionnaires signify more disturbance. Results: Seventy patients and 141 controls were recruited. Median (interquartile range) age of patients was 5 (4,8) years. Patients had later sleep time (p < 0.001), longer night awakening (p < 0.001), and shorter sleep duration (p < 0.001) compared to controls. CSHQ total scores and all its domains, except for sleep‐disordered breathing were significantly higher in patients compared to controls. Patients also had significantly higher SDQ total difficulties scores in all domains, except for peer problems. Severity of AD was significantly associated with high CSHQ and SDQ scores. There was a moderate positive correlation between the total CSHQ score and total SDQ score in patients (r = 0.532). Conclusions: Children with moderate‐to‐severe AD had significantly more sleep disturbance and more behavioral problems than their healthy peers. Sleep disturbance had a positive correlation with behavioral problems. Severity of AD was associated with sleep disturbance and behavioral problems. [ABSTRACT FROM AUTHOR]

Study abroad has a long-standing tradition in higher education. Apart from the pursuit of knowledge that cannot be confined by the boundaries of nation-state, sending local talents to study abroad has also been a strategy to build capacity in a developing/emerging nation like Malaysia. This article focuses on the stories and experiences of Malaysian in adjusting and adapting to the local situation as academic staff when they returned to Malaysian universities after their doctoral study abroad. Through thematic analysis and guided by Structuration Theory, this article illustrates structural constraints in the form of research governance, practices and cultures, as well as agency manifestations of these returnees to overcome and address these constraints and challenges. These stories and experiences are important to understand and to make recommendations to improve the governance, practices and culture of universities especially in developing/emerging systems globally. [ABSTRACT FROM AUTHOR]

Introduction: Descriptions and definitions for occupation-based intervention vary in the literature. Occupation-based intervention is assumed to be based on occupation and is seen as both a means and an end. Occupation-based intervention also includes all levels of interventions in occupational therapy as long as the goal is occupational performance. Occupation-based intervention can also be described as a therapeutic process that emerges during the therapy session. The purpose of this study was to achieve a consensus definition of occupation-based intervention among Malaysian occupational therapists. Method: A three-round Delphi technique using a sequential questionnaire was conducted. Fifteen occupational therapists and occupational therapy educators completed all rounds. The Delphi process began with open-ended questions, asking the participants some questions about occupation-based intervention. The second and third rounds asked participants to rank their agreement with statements about occupation-based intervention. Results: Occupation-based intervention is seen by therapists to be both a means and an end, with occupational performance as the main outcome. It is believed that using occupation alone is not enough; preparatory and purposeful methods may have to be incorporated to achieve the outcomes. Conclusion: It is important to adopt a common definition of occupation-based intervention in practice and education to signify occupation at the centre of occupational therapy. [ABSTRACT FROM AUTHOR]

This study focuses on students from vulnerable communities who are at the bottom 40% of the population income distribution in a developing country. These students are more likely to face challenges in accessing quality education, with many having a high propensity to drop out of school. Computer-aided education is one way to increase academic enthusiasm and creativity amongst these students to enable them to complete their studies and acquire skills for an information-driven society. Drawing upon the Unified Theory of Acceptance and Use of Technology (UTAUT) model, this study examines the key factors influencing computer use for learning amongst students and if a computer-aided learning experience can lead to improved academic enthusiasm and creativity. Primary data collected from 414 primary school students from the targeted segment of the population was analysed using the partial least squares structural equation modelling technique (PLS-SEM). The findings revealed that performance expectancy, social influence, and facilitating conditions determined students' computer use for learning. Additionally, computer use for learning influenced the academic enthusiasm and creativity of students. The findings offer insights on the potential implications in the formulation of computer-based education initiatives for students from a vulnerable group in a developing country context. [ABSTRACT FROM AUTHOR]

Burnout syndrome is a condition marked by emotional exhaustion, deterioration in motivation and lack of commitment, resulting from long-lasting workplace stress, characterized by exhaustion, negative feelings towards one's work and reduced professional efficacy. Healthcare workers are at particularly high risk for burnout due to high levels of stress. Our objectives were to determine the prevalence of burnout syndrome among doctors in Sabah and factors associated with it. This multi-centre cross-sectional study was carried out among doctors working in five Sabah main hospitals. Data were collected by using self-administered questionnaires consisting of basic socio-demographic information and Copenhagen Burnout Inventory (CBI). Overall, a total of 523 doctors consented to participate in this study. The prevalence of personal burnout, work-related burnout, and patient-related burnout among doctors were 57.1%, 48.8%, and 30.4% respectively. Chi-square analysis showed factors that were associated to personal burnout and work-related burnout, were marital status, duration of service and position in the service. Duration of service was the only factor associated with patient-related burnout. The prevalence of burnout syndrome in Sabah should not to be overlooked and more researches are indicated to look into prevention of burnout syndrome in Malaysian setting. [ABSTRACT FROM AUTHOR]

Evidence shows that immigrants face several challenges post migration, impacting their social inclusion. Yet, limited scholarly knowledge exists on older immigrants including Tamils from Sri Lanka. Thus, an exploratory concept mapping (CM) study was conducted in 2017 with 27 Tamil immigrant women and men aged ≥55 years and settled in Toronto, Canada. The aim was to gather their perspectives on factors that help them to feel socially included (focal question). The CM methodology first engaged participants in brainstorming sessions to generate ideas in response to the focal question. Participants then joined sorting and rating sessions and sorted 72 generated items and rated them on a scale of 1–5 for importance and feasibility to initiate a change. Finally, in the interpretation session, participants provided feedback on the visual cluster maps generated through quantitative analysis of the collected data. Participants labelled the seven identified clusters: (a) Services for Employment and Settlement; (b) Financial Independence; (c) Medical System and Senior Care; (d) Adaptation and Integration; (e) Family Harmony; (f) Cultural Interaction and Feeling of Security; and (g) Social Interaction. The clusters one to three were at the top for importance (mean 4.33, 4.22, 4.17) and participants interpreted these as needing policy‐level attention (e.g. credential evaluation, hiring practices) and identified the roles of advocacy and community‐engagement for community‐based programmes (CBPs). The Family Harmony was interpreted as needing 'work within families', while CBPs' culturally sensitive outreach was viewed as valuable. Participant interpretation of other clusters highlighted the role of social networking, trust, belonging, civic engagement and social cohesion through joint working of the community members and CBPs. The findings call for an inter‐sectoral and community‐engaged approach to strengthen the social inclusion of the community. Future research with a larger sample is needed, especially on early settlement experiences and social inclusion of older immigrants. [ABSTRACT FROM AUTHOR]

Background: Poor waste disposal practices hamper the progress towards an integrated solid waste management in households. Knowledge of current practices and perception of household solid waste management is necessary for accurate decision making in the move towards a more sustainable approach. This study investigates the household waste practices and perceptions about waste management in Panji, one of the sub-districts in Kota Bharu, Kelantan, Malaysia.Methods: A stratified random sampling technique using a cross-sectional survey questionnaire was used to collect data. A total of 338 households were interviewed in the survey and data were analyzed using SPSS. Chi-square goodness of fit test was used to determine the relationships between categorical variables, whereas Chi-square bivariate correlation test was performed to observe the correlation between the perceptions of waste segregation with socio-demographic background of the respondents. The correlation between perception of respondents with the locality, house type and waste type were also conducted. Principal component analysis was used to identify grouping of variables and to establish which factors were interrelated in any given construct.Results: The results of the study revealed that 74.3 % of households disposed of food debris as waste and 18.3% disposed of plastic materials as waste. The study also showed that 50.3% of the households segregate their waste while 49.7% did not. About 95.9% of the respondents were aware that improper waste management leads to disease; such as diarrhea and malaria. There were associations between locality, age and house type with waste segregation practices among respondents (Chi-square test, p<0.05). Associations were also found between locality with the perception of improper waste management which lead to disease (Chi-square test, p<0.05). Principal Component Analysis showed that 17.94% of the variance has high positive loading (positive relationship) with age, marital status and, type of house.Conclusion: This study highlights the importance to design waste separation programs that suit the needs of targeted population as a boost towards sustainable solid waste management practices. [ABSTRACT FROM AUTHOR]

Background: in recent years, many Asian countries have witnessed an intensification in populist discourses identifying the death penalty as a central tool of drug control, with public opinion surveys referred to as invaluable evidence of public support for the death penalty. This paper will address the claim that the public supports capital punishment, and the role of surveys in shaping this discourse.Methods: review of thirty-nine public opinion surveys on the death penalty carried out in five Asian countries which retain the death penalty for drugs or are considering re-introducing it. The review was conducted by analysing and comparing design, methodology, findings, and the relationship between these elements.Results: all but two surveys recorded a majoritarian support for the death penalty, driven by beliefs in (a) deterrent effect of the death penalty, and (b) perfect justice - both disproven. Complex surveys found a low intensity of support, and a limited interest and knowledge by the public in capital punishment. Support for capital punishment is lower for drug offences specifically, and it decreases significantly when expressed with reference to real-life cases. Limited data suggest that the public in the focus countries has reservations on the effectiveness of the death penalty to reduce drug offences, and prefers a discretionary system of punishment. The analysis also revealed correlations between the framing of survey questions and their findings.Conclusion: Public opinion surveys conducted in China, Malaysia, the Philippines, Singapore, and Thailand suggest that the public knows little and has little interest in the death penalty. Although majoritarian, its support is based on a faulty understanding of key facts related to capital punishment, and an increase in knowledge is correlated to a decrease in support. More rigorous polling exercises demonstrate that public support for capital punishment - both in general and for drug offences specifically - is instinctive, abstract, elastic, and contextual. [ABSTRACT FROM AUTHOR]

Aim: Anxiety is prevalent among women with Hyperemesis Gravidarum (HG), which is associated with coping strategies and bio-psychosocial risk factors. This study aims to predict socioeconomic status (SES) and obstetric factors towards anxiety and stress-coping strategy, and to explore the significant differences in levels of anxiety on each coping strategy. Design: It was a cross-sectional survey in the Malaysian context. Methods: Forty women medically diagnosed with HG were recruited and completed Generalized Anxiety Disorder-7 (GAD-7) to assess generalized anxiety disorder and coping scale inventory using the Brief COPE questionnaire. Results: The employment status of pregnant women diagnosed with HG significantly predicted their anxiety. Household income and education level predicted emotion-focused coping strategies. None of the obstetric factors predicted the coping strategy. A significant difference was found across anxiety levels in problem-focused and dysfunctional coping strategies. The post-hoc test reveals that dysfunctional coping has the highest mean score in the severe anxiety category. Conclusion: It is essential to promote awareness about effective coping strategies for pregnant women who are diagnosed with HG. Greater efforts are needed to increase the duty of care among healthcare providers to propagate holistic and resourceful coping management with the HG that could help potential patients in the future. [ABSTRACT FROM AUTHOR]

Objective: To conduct formative research using qualitative methods among stakeholders of secondary schools to explore their perceptions, barriers and facilitators related to healthy eating and physical activity (PA) among Malaysian adolescents.Design: A qualitative study involving eight focus groups and twelve in-depth interviews. Focus groups and interviews were recorded and transcribed verbatim. An inductive thematic analysis approach was used to analyse the data.Setting: Four secondary schools in Perak and Selangor states (two urban and two rural schools) in Malaysia.Participants: Focus groups were conducted with seventy-six adolescents aged 13-14 years, and in-depth interviews were conducted with four headmasters, four PA education teachers and four food canteen operators.Results: Stakeholders thought that adolescents' misperceptions, limited availability of healthy options, unhealthy food preferences and affordability were important challenges preventing healthy eating at school. Low-quality physical education (PE) classes, limited adolescent participation and teachers' commitment during lessons were perceived as barriers to adolescents being active at school. Affordability was the main challenge for adolescents from rural schools. Stakeholders perceived that a future school-based intervention should improve the availability and subsidies for healthy foods, provide health education/training for both adolescents and PE teachers, enhance active adolescent participation in PE and develop social support mechanisms to facilitate engagement with PA.Conclusions: These findings provide important insights into developing school-based lifestyle interventions to improve healthy eating and strengthening PA of Malaysian adolescents. [ABSTRACT FROM AUTHOR]

Background: Anxiety disorder is one of the most common mental health problems worldwide, including Malaysia, and this issue has gained concern and attention from many, including experts and authorities globally. While average levels of stress and worry may help to motivate students to perform well in their studies, excessive feelings will increase their level of anxiety.Methods: A cross-sectional study was conducted at selected government and private universities throughout Malaysia. A total of 1851 students participated in this study. The students were asked to complete self-administered questionnaires, including socio-demographic, academic, and psychosocial characteristics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the prevalence risk of anxiety among the students. Chi-square analysis was conducted to find the relationship between the variables and anxiety, and multivariate logistic regression analysis was used to identify the predictors.Results: The response rate was 97.90%, where 1821 out of 1860 students participated in the study. The prevalence risk of anxiety in this study was recorded at 29%. The data revealed that academic year, financial support for the study, alcohol consumption, poor sleep quality, body mass index (BMI), having a good friend in the university, having doubt regarding the future, actively involved in the society, and having problems with other students and lecturer(s) were significantly associated with risk of anxiety; with the academic year as the primary predictor.Conclusions: The findings highlight the current prevalence risk of anxiety among university students in Malaysia. The outcome of this study can serve as the evident baseline data and help with the development of specific interventions in addressing and managing the issue appropriately. [ABSTRACT FROM AUTHOR]

Background: Since the last decade, postpartum depression (PPD) has been recognized as a significant public health problem, and several factors have been linked to PPD. Mothers at risk are rarely undetected and underdiagnosed. Our study aims to determine the factors leading to symptoms of depression using Structural Equation Modeling (SEM) analysis. In this research, we introduced a new framework for postpartum depression modeling for women.Methods: We structured the model of this research to take into consideration the Malaysian culture in particular. A total of 387 postpartum women have completed the questionnaire. The symptoms of postpartum depression were examined using the Edinburgh Postnatal Depression Scale (EPDS), and they act as a dependent variable in this research model.Results: Four hundred fifty mothers were invited to participate in this research. 86% of the total distributed questionnaire received feedback. The majority of 79.6% of respondents were having depression symptoms. The highest coefficients of factor loading analysis obtained in every latent variable indicator were income (β = 0.77), screen time (β = 0.83), chips (β = 0.85), and anxiety (β = 0.88). Lifestyle, unhealthy food, and BMI variables were directly affected by the dependent variable. Based on the output, respondents with a high level of depression symptoms tended to consume more unhealthy food and had a high level of body mass indexes (BMI). The highest significant impact on depression level among postpartum women was unhealthy food consumption. Based on our model, the findings indicated that 76% of the variances stemmed from a variety of factors: socio-demographics, lifestyle, healthy food, unhealthy food, and BMI. The strength of the exogenous and endogenous variables in this research framework is strong.Conclusion: The prevalence of postpartum women with depression symptoms in this study is considerably high. It is, therefore, imperative that postpartum women seek medical help to prevent postpartum depressive symptoms from worsening. [ABSTRACT FROM AUTHOR]

Despite the importance of carers supporting the lives of people with mental illness, there are limited studies investigating the well‐being and needs of Malay carers in multicultural Singapore. The Malays consist of 13.4% of Singapore's population. A mixed methods qualitative dominant research approach was used to explore the well‐being and needs of Malay carers in a voluntary welfare organisation. The Kessler‐10, Friendship Scale and Carers' and Users' Expectations of Services—Carer version were used to assess the needs and well‐being of 17 Malay carers. Findings show that Malay carers experienced poor well‐being and had numerous unmet needs. Four main themes were found: (a) Concerns related to relatives with mental illness, (b) Mental health practices related to carers, (c) Holistic support for carers and (d) Preference for greater spiritual support in mental health. Recovery‐oriented mental health practice implications are discussed. Spirituality of Malay carers needs to be given greater consideration in recovery‐oriented mental health services. [ABSTRACT FROM AUTHOR]

The Malaysian Mangrove Research Alliance and Network (MyMangrove) was established in recognition of the needs for a collaborative effort to significantly influence the management and conservation of mangrove forests through research and education. MyMangrove brings scientists and researchers together, to join forces in exploration and enhancement of scientific knowledge on mangroves and their connecting habitats and ecosystems. The goal of the establishment of MyMangrove is chiefly to close the gap and create a functional and efficient scientific networking among scientists and researchers. It also anticipates at improving public communications on mangrove-related issues and to influence the landscape of policies and regulations pertaining to mangrove management and conservation, particularly in the context of Malaysia. Ultimately, MyMangrove aims at being a strategic platform for the local communities, NGOs, students, corporate sectors and government agencies to collaborate with the multi- and inter-disciplinary group of scientists and researchers from universities and agencies on all matters concerning mangroves and their interconnectedness with other coastal and marine habitats. [ABSTRACT FROM AUTHOR]

The participation of dentists in dental sciences research within Asian countries is still substantially below the target. Exposure to research may improve the quality of dental education, and potentially increase the participation of dental graduates' in academic dentistry. This study aims to evaluate the attitude of students towards scientific research during their study in the School of Dental Sciences, Universiti Sains Malaysia as well as to identify the barrier that might affect their learning process in research. A cross-sectional, self-administered online questionnaire was distributed to 155 undergraduates among whom a total of 122 response were collected, between June to September 2016. In general, students demonstrated favourable attitudes about research integration in the undergraduate curriculum. The respondents also agreed that research is relevant to dental education (81.9%) and that participation in research activities may facilitate admission to postgraduate programs (77.7%). The effective presence of supervisors is a crucial element that affects student engagement in research, including the ability to provide proper training and guidance (61.7%) and flexibility for academic discussions (57.44%). Current data serve as an important evidence to evaluate the existing practice of delivering the research component to undergraduate dental students in Malaysia, which includes a proper project title, objectives, sampling population, literature review, analytical instrument, methodology and data analysis. In depth knowledge and improved research skills will allow for better participation of undergraduates in various dental sciences research, ranging from laboratory-based experiments to clinical and community-based research projects. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the superficial surgical site infection (SSI) rate to 28 days and patient satisfaction with wound coverage management when their transverse suprapubic caesarean wound is left exposed compared with dressed after skin closure.Design: Randomised trial.Setting: University Hospital, Malaysia: April 2016-October 2016.Population: 331 women delivered by caesarean section.Method: Participants were randomised to leaving their wound entirely exposed (n = 165) or dressed (n = 166) with a low adhesive dressing (next day removal).Main Outcome Measures: Primary outcomes were superficial SSI rate (assessed by provider inspection up to hospital discharge and telephone questionnaires on days 14 and 28) and patient satisfaction with wound coverage management before hospital discharge.Results: The superficial SSI rates were 2/153 (1.3%) versus 5/157 (3.2%) (relative risk [RR] 0.4, 95% CI 0.1-2.1; P = 0.45) and patient satisfaction with wound management was 7 [5-8] versus 7 [5-8] (P = 0.81) in exposed compared with dressed study groups, respectively. In the wound-exposed patients, stated preference for wound exposure significantly increased from 35.5 to 57.5%, whereas in the wound-dressed patients, the stated preference for a dressed wound fell from 48.5 to 34.4% when assessed at recruitment (pre-randomisation) to day 28. There were no significant differences in inpatient additional dressing or gauze use for wound care, post-hospital discharge self-reported wound issues of infection, antibiotics, redness and inflammation, swollen, painful, and fluid leakage to day 28 across trial groups.Conclusion: The trial is underpowered as SSI rates were lower than expected. Nevertheless, leaving caesarean wounds exposed does not appear to have detrimental effects, provided patient counselling to manage expectations is undertaken.Tweetable Abstract: An exposed compared with a dressed caesarean wound has a similar superficial surgical site infection rate, patient satisfaction and appearance. [ABSTRACT FROM AUTHOR]

Population genetic analysis revealed that Plasmodium knowlesi infections in Malaysian Borneo are caused by 2 divergent parasites associated with long-tailed (cluster 1) and pig-tailed (cluster 2) macaques. Because the transmission ecology is likely to differ for each macaque species, we developed a simple genotyping PCR to efficiently distinguish between and survey the 2 parasite subpopulations. This assay confirmed differences in the relative proportions in areas of Kapit division of Sarawak state, consistent with multilocus microsatellite analyses. Analyses of 1,204 human infections at Kapit Hospital showed that cluster 1 caused approximately two thirds of cases with no significant temporal changes from 2000 to 2018. We observed an apparent increase in overall numbers in the most recent 2 years studied, driven mainly by increased cluster 1 parasite infections. Continued monitoring of the frequency of different parasite subpopulations and correlation with environmental alterations are necessary to determine whether the epidemiology will change substantially. [ABSTRACT FROM AUTHOR]

Kratom (Mitragyna speciosa), an indigenous medicinal plant of Southeast Asia, is believed to be harmful. We compared the perceptions toward kratom use among kratom users and non-users in Malaysia. 356 respondents (137 kratom users and 219 non-users) were recruited for this cross-sectional study. The majority of respondents were male (60%, n = 212/356), Malays (88%), and 51% were ≥37 years old. Non-users showed higher unadjusted odds of reporting a perception that kratom use can cause addiction (OR = 6.72, CI: 3.91-11.54, p < .0001), withdrawal symptoms (OR = 7.58, CI: 4.62-12.42, p < .0001), illicit drug use problems (OR = 10.12, CI: 6.14-16.68, p < .0001), impaired social-functioning (OR = 12.05, CI: 7.24-20.05, p < .0001), and health problems (OR = 10.44, CI: 6.32-17.24, p < .0001). Similarly, non-users viewed kratom policies differently from kratom users, displaying increased odds of reporting the belief that kratom use and sales must be regulated with stringent laws (OR = 5.75, CI: 3.61-9.18, p < .0001), and kratom should be regulated instead under the Dangerous Drugs Act 1952 to overcome kratom use problems (OR = 8.26, CI: 4.94-13.82, p < .0001). Because of the disconnect in kratom use perceptions and personal experiences between kratom users and non-users, hastily criminalizing kratom without investigating carefully its scientific merits can significantly impede future kratom research. [ABSTRACT FROM AUTHOR]

Malaysia is a developing country in the South-East Asian region with a significant burden of disability from musculoskeletal disease. Rheumatology in Malaysia is a relatively young speciality. Currently, there is approximately 1 rheumatologist per 390,000 population, mostly concentrated in the urban areas. This article aims to give a brief overview of the research in rheumatology, the healthcare system, and rheumatology training and education in Malaysia. From 1950 until mid-2019, there were 547 publications about rheumatological conditions from Malaysia, with a 27-fold increase in the numbers from the period before 1980 compared to 2010–2019. Although there is universal access to healthcare through the public (government funded) hospitals and clinics, as well as a system of private healthcare, funding for expensive biological therapies remain patchy and scarce, leading to significant under-utilization of such treatments in rheumatology patients. Training in rheumatology in Malaysia is well established with a formalised training curriculum introduced in 2004, followed by the introduction of training in musculoskeletal ultrasound in 2006. To improve care for patients with musculoskeletal conditions, there has been regular continuing educational meetings and courses, not just for rheumatologists, but also for other medical professionals, as not all areas in Malaysia have easy access to rheumatology services. Thus overall, despite the small number of rheumatologists, rheumatology in Malaysia has made encouraging progress over the past 2 decades, but improvements in patient care, training, education and research need to continue in the future. [ABSTRACT FROM AUTHOR]

Aim: The optimal placement of the endotracheal tube (ETT) in ventilated infants is essential, but birthweight may be not the best parameter to predict it. The aim of this study was a direct comparison of shoulder-umbilical length (experimental group) versus birthweight (control group) as predictor of optimal ETT placement in Malaysian ventilated infants.Methods: All infants requiring ventilation in the neonatal intensive care unit of a tertiary hospital in Malaysia during the 4-month study period were eligible to enter this randomised controlled trial. All participants were randomised into two groups: experimental and control group. The main outcome measure was malposition of the ETT (requiring adjustment), as seen on the chest X-ray performed within 1 h after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation.Results: One hundred and ten infants were randomised, 55 in each group. The ETT was malpositioned in 13 of 55 infants (23%) for the experimental group and 22 of 55 infants (40%) in the control group (P = 0.06).Conclusion: In the experimental group, fewer infants showed a need for tube adjustment than in the control group. While a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance. [ABSTRACT FROM AUTHOR]

In Malaysia, the HIV epidemic is concentrated in a highly stigmatized population, men who have sex with men (MSM). The relationship of multiple psychosocial health conditions and HIV risks have not been investigated. This study aims to assess the association of multiple psychosocial factors with risky sexual behaviour and HIV infection among MSM. Data on demographic characteristics, psychosocial health conditions, condomless anal intercourse (CAI), HIV testing and HIV status were collected via an anonymous online survey. Multivariable logistic regression model was used to determine whether psychosocial health conditions among MSM have a syndemic association with HIV status. Between July 2017 and February 2018, 622 MSM completed the online survey. Overall, 54.3% of participants reported engaging in CAI in the past three months and 46.0% were found to have two or more psychosocial health conditions. Increasing numbers of psychosocial health conditions (1, 2, 3, 4 or more) were significantly associated with HIV infection compared to those without psychosocial health condition (odds ratio [OR] 3.39, 95% confidence interval [CI]: 1.41–8.14; OR 3.51, 95% CI: 1.43–8.61; OR 4.22, 95% CI: 1.68–10.96, and OR 7.58, 95% CI: 2.44–23.55, respectively). Comprehensive HIV prevention programs addressing mental health and substance use are needed for MSM in Malaysia. [ABSTRACT FROM AUTHOR]

Background: This randomised controlled trial (RCT) aims to compare 6-week posttreatment outcomes of an Integrative Adapt Therapy (IAT) to a Cognitive Behavioural Therapy (CBT) on common mental health symptoms and adaptive capacity amongst refugees from Myanmar. IAT is grounded on psychotherapeutic elements specific to the refugee experience.Methods and Findings: We conducted a single-blind RCT (October 2017 -May 2019) with Chin (39.3%), Kachin (15.7%), and Rohingya (45%) refugees living in Kuala Lumpur, Malaysia. The trial included 170 participants receiving six 45-minute weekly sessions of IAT (97.6% retention, 4 lost to follow-up) and 161 receiving a multicomponent CBT also involving six 45-minute weekly sessions (96.8% retention, 5 lost to follow-up). Participants (mean age: 30.8 years, SD = 9.6) had experienced and/or witnessed an average 10.1 types (SD = 5.9, range = 1-27) of traumatic events. We applied a single-blind design in which independent assessors of pre- and posttreatment indices were masked in relation to participants' treatment allocation status. Primary outcomes were symptom scores of Post Traumatic Stress Disorder (PTSD), Complex PTSD (CPTSD), Major Depressive Disorder (MDD), the 5 scales of the Adaptive Stress Index (ASI), and a measure of resilience (the Connor-Davidson Resilience Scale [CDRS]). Compared to CBT, an intention-to-treat analysis (n = 331) at 6-week posttreatment follow-up demonstrated greater reductions in the IAT arm for all common mental disorder (CMD) symptoms and ASI domains except for ASI-3 (injustice), as well as increases in the resilience scores. Adjusted average treatment effects assessing the differences in posttreatment scores between IAT and CBT (with baseline scores as covariates) were -0.08 (95% CI: -0.14 to -0.02, p = 0.012) for PTSD, -0.07 (95% CI: -0.14 to -0.01) for CPTSD, -0.07 for MDD (95% CI: -0.13 to -0.01, p = 0.025), 0.16 for CDRS (95% CI: 0.06-0.026, p ≤ 0.001), -0.12 (95% CI: -0.20 to -0.03, p ≤ 0.001) for ASI-1 (safety/security), -0.10 for ASI-2 (traumatic losses; 95% CI: -0.18 to -0.02, p = 0.02), -0.03 for ASI-3 (injustice; (95% CI: -0.11 to 0.06, p = 0.513), -0.12 for ASI-4 (role/identity disruptions; 95% CI: -0.21 to -0.04, p ≤ 0.001), and -0.18 for ASI-5 (existential meaning; 95% CI: -0.19 to -0.05, p ≤ 0.001). Compared to CBT, the IAT group had larger effect sizes for all indices (except for resilience) including PTSD (IAT, d = 0.93 versus CBT, d = 0.87), CPTSD (d = 1.27 versus d = 1.02), MDD (d = 1.4 versus d = 1.11), ASI-1 (d = 1.1 versus d = 0.85), ASI-2 (d = 0.81 versus d = 0.66), ASI-3 (d = 0.49 versus d = 0.42), ASI-4 (d = 0.86 versus d = 0.67), and ASI-5 (d = 0.72 versus d = 0.53). No adverse events were recorded for either therapy. Limitations include a possible allegiance effect (the authors inadvertently conveying disproportionate enthusiasm for IAT in training and supervision), cross-over effects (counsellors applying elements of one therapy in delivering the other), and the brief period of follow-up.Conclusions: Compared to CBT, IAT showed superiority in improving mental health symptoms and adaptative stress from baseline to 6-week posttreatment. The differences in scores between IAT and CBT were modest and future studies conducted by independent research teams need to confirm the findings.Trial Registration: The study is registered under Australian New Zealand Clinical Trials Registry (ANZCTR) (http://www.anzctr.org.au/). The trial registration number is: ACTRN12617001452381. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between maternal lipaemia and neonatal anthropometrics in Malaysian mother-offspring pairs.Design: Prospective observational cohort study.Setting: Single tertiary multidisciplinary antenatal clinic in Malaysia.Population: A total of 507 mothers: 145 with gestational diabetes mellitus (GDM); 94 who were obese with normal glucose tolerance (NGT) (pre-gravid body mass index, BMI ≥ 27.5 kg/m2 ), and 268 who were not obese with NGT.Methods: Maternal demographic, anthropometric, and clinical data were collected during an interview/examination using a structured questionnaire. Blood was drawn for insulin, C-peptide, triglyceride (Tg), and non-esterified fatty acid (NEFA) during the 75-g 2-hour oral glucose tolerance test (OGTT) screening, and again at 36 weeks of gestation. At birth, neonatal anthropometrics were assessed and data such as gestational weight gain (GWG) were extracted from the records.Main Outcome Measures: Macrosomia, large-for-gestational-age (LGA) status, cohort-specific birthweight (BW), neonatal fat mass (NFM), and sum of skinfold thickness (SSFT) > 90th centile.Results: Fasting Tg > 95th centile (3.6 mmol/L) at screening for OGTT was independently associated with LGA (adjusted odds ratio, aOR 10.82, 95% CI 1.26-93.37) after adjustment for maternal glucose, pre-gravid BMI, and insulin sensitivity. Fasting glucose was independently associated with a birthweight ratio (BWR) of >90th centile (aOR 2.06, 95% CI 1.17-3.64), but not with LGA status, in this well-treated GDM cohort with pre-delivery HbA1c of 5.27%. In all, 45% of mothers had a pre-gravid BMI of <23 kg/m2 and 61% had a pre-gravid BMI of ≤ 25 kg/m2 , yet a GWG of >10 kg was associated with a 4.25-fold risk (95% CI 1.71-10.53) of BWR > 90th centile.Conclusion: Maternal lipaemia and GWG at a low threshold (>10 kg) adversely impact neonatal adiposity in Asian offspring, independent of glucose, insulin resistance and pre-gravid BMI. These may therefore be important modifiable metabolic targets in pregnancy.Tweetable Abstract: Maternal lipids are associated with adiposity in Asian babies independently of pre-gravid BMI, GDM status, and insulin resistance. [ABSTRACT FROM AUTHOR]

With millions of women experiencing forced displacement, attention is needed toward migrant women's lived experiences. Religion is an understudied but central component of coping for many migrant women. Through the use of qualitative and quantitative methods, an exploratory study was conducted with 36 forced migrant Shia Muslim women residing in a predominantly Sunni Muslim country of first asylum. Using the brief Multidimensional Measure of Religiousness/Spirituality and drawing from feminist theory, intersectionality, and the ecological framework, we describe women's experience with religion and spirituality across a variety of domains. Open-ended semistructured interviews were analyzed using a thematic analysis approach. Participants were highly religious across all domains measured. Key themes emerged related to how religion helps women manage stress, including: (1) trusting God to solve problems and (2) relying on prayer and other religious practices to cope. Despite these strengths, women also described major challenges to religious practice, where the third identified theme emphasized that fear and persecution limit religious practice. This article builds understanding of forced migrant women's experiences, with implications for social work practice and immigration policy. Service organizations can recognize and support religious coping, particularly among religious minority refugee women. Additionally, practitioners and policy makers can promote religious tolerance and understanding within diverse host communities. [ABSTRACT FROM AUTHOR]

Background: Many studies on biochemical and psychological variables have aimed to elucidate the association between aging and cognitive function. Demographic differences and protein expression have been reported to play a role in determining the cognitive capability of a population.Objective: This study aimed to determine the effect of age on the protein profile of Malay individuals and its association with cognitive competency.Methods: A total of 160 individuals were recruited and grouped accordingly. Cognitive competency of each subject was assessed with several neuropsychological tests. Plasma samples were collected and analyzed with Q Exactive HF Orbitrap. Proteins were identified and quantitated with MaxQuant and further analyzed with Perseus to determine differentially expressed proteins. PANTHER, Reactome, and STRING were applied for bioinformatics output.Results: Our data showed that the Malay individuals are vulnerable to the deterioration of cognitive function with aging, and most of the proteins were differentially expressed in concordance. Several physiological components and pathways were shown to be involved, giving a hint of a promising interpretation on the induction of aging toward the state of the Malays' cognitive function. Nevertheless, some proteins have shown a considerable interaction with the generated protein network, which provides a direction of focus for further investigation.Conclusion: This study demonstrated notable changes in the expression of several proteins as age increased. These changes provide a promising platform for understanding the biochemical factors affecting cognitive function in the Malay population. The exhibited network of protein-protein interaction suggests the possibility of implementing regulatory intervention in ameliorating Malay cognitive function. [ABSTRACT FROM AUTHOR]

Background Deprescribing describes a process of medication regimen optimization with the aim to reduce adverse events and improve quality of life. There is limited research on perceptions of older adults, defined as those 60 years of age and older, about their willingness to cease a medication in developing countries. Objective To ascertain patients' attitudes, beliefs, perceptions, and experiences regarding the number of medications they were taking and their opinions regarding deprescribing. Setting A primary care health clinic and three community pharmacies in Malaysia. Method A multicenter cross-sectional study was conducted by administering the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to older adults aged 60 years and over or caregivers attending a health clinic and three community pharmacies in Malaysia. Descriptive results were reported for participants' characteristics and questionnaire responses. Analysis of correlation between participant characteristics and their responses was performed using Spearman's correlation. Main outcome measure Patients' and caregivers' attitudes and beliefs towards reducing medications and characteristics of patients such as age, gender, education level, number of medication taken and number of medical center managing the patient. Results 650 participants were approached and the response rate was 85.2%. A total of 554 participants completed the questionnaire (502 older adults and 52 caregivers). Older adults in the study were taking a median of three medications and/or supplements compared to four in caregiver recipients. 88.1% of older adults were satisfied with their current medication regimen and 67.7% would like to try stopping or reducing the dose of their medicines when their doctor recommended. 82.7% of caregivers were satisfied with their care recipient's current medications and 65.4% were willing to stop taking or reduce the number of drugs taken by their care recipient's upon doctor's recommendation. Older adults (p = 0.003) and those with lower education level (p < 0.001) were more willing to have their medications deprescribed. Other demographic characteristics such as gender, number of medication taken or number of doctors managing patient were not found to be correlated with willingness to stop a medication. Conclusion Older adults taking multiple medications for various medical conditions were largely accepting of a trial of cessation of medication. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to develop an EQ-5D-5L value set reflecting the health preferences of the Malaysian adult population.Methods: Respondents were sampled with quotas for urbanicity, gender, age, and ethnicity to ensure representativeness of the Malaysian population. The study was conducted using a standardized protocol involving the EuroQol Valuation Technology (EQ-VT) computer-assisted interview system. Respondents were administered ten composite time trade-off (C-TTO) tasks and seven discrete choice experiment (DCE) tasks. Both linear main effects and constrained non-linear regression models of C-TTO-only data and hybrid models combining C-TTO and DCE data were explored to determine an efficient and informative model for value set prediction.Results: Data from 1125 respondents representative of the Malaysian population were included in the analysis. Logical consistency was present in all models tested. Using cross-validation, eight-parameter models for C-TTO only and C-TTO + DCE hybrid data displayed greater out-of-sample predictive accuracy than their 20-parameter, main-effect counterparts. The hybrid eight-parameter model was chosen to represent the Malaysian value set, as it displayed greater out-of-sample predictive accuracy over C-TTO data than the C-TTO-only model, and produced more precise estimates. The estimated value set ranged from - 0.442 to 1.Conclusions: The constrained eight-parameter hybrid model demonstrated the best potential in representing the Malaysian value set. The presence of the Malaysian EQ-5D-5L value set will facilitate its application in research and health technology assessment activities. [ABSTRACT FROM AUTHOR]