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The intricate dynamics of gender roles significantly shape emotion regulation (ER) among adolescents, underscoring the importance of understanding these assigned roles in comprehending adolescents' emotional experiences. This study aimed to investigate and analyze in detail the central aspects of disparities between genders in the utilization of ER strategies. The formulation of the hypotheses aimed to predict significant distinctions between boys and girls, particularly in cognitive reappraisal (CR) and expressive suppression (ES) strategies. A cross-sectional design was employed and implemented in 27 public secondary schools across 12 states in Malaysia. A total of 1,718 adolescents, both boys and girls who did not have any current or prior clinical issues became participants in this study. Using the Malay version of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), the study's findings contradicted the proposed hypotheses. The findings showed no gender disparities in CR and ES. These findings provide valuable insights for parents, caregivers, teachers, and adolescents, offering a nuanced understanding of ER during the critical stages of adolescence. The implications of ER across genders may guide the development of targeted interventions to address potential gender disparities and mitigate the risk of psychopathological issues. [ABSTRACT FROM AUTHOR]

Parents are important figures in shaping an adolescent's emotion regulation. However, there have been fewer studies investigating the effects of parental care and parental autonomy on adolescents' emotion regulation, and the findings from the existing research have been inconsistent. Therefore, the aim of this study is to examine the effects of parental care and autonomy (from both the father and mother) on adolescents' emotion dysregulation. The Malay versions of Parental Bonding Instrument (PBI) and Difficulties in Emotion Regulation Scale-18 (DERS-18) were administered to 491 students between the ages of 13 and 14 years old. The students were recruited from public schools in Peninsular Malaysia by using a non-proportionate random stratified sampling technique. This study employed the Structural Equation Modelling (SEM) with regression analysis. The results showed a significant negative effect of paternal and maternal care on adolescent's emotion dysregulation. There is no significant effect of paternal and maternal autonomy on the adolescent's emotion dysregulation. This study concludes that both fathers and mothers who care for and provide warmth to their children would promote better emotion regulation. The current findings highlight intervention and prevention efforts in promoting parental care and warmth in our children upbringing particularly involving adolescents. These will foster positive impact in the adolescents' abilities to regulate their emotion. [ABSTRACT FROM AUTHOR]

Introduction: Digital device helps children enhance academic, cognitive and psychomotor skills. However, prolonged use causes physical inactivity, poor interpersonal skills and communication problems. Information on digital device use among young children in Malaysia is currently limited. Hence, this study aimed to determine the prevalence of digital device utilisation among preschool children in Kota Setar District, Kedah. Methods: A cross-sectional study at government preschools in Kota Setar District was conducted from February to April 2020. Selection of preschools and students was done using multistage simple randomisation. A self-administered questionnaire containing demographic and digital device use details was filled by parents. Results: The prevalence of digital device use among preschool children was 95.9% and mostly used smartphones (94.2%). Most children (95%) did not own the device, and usage was under supervision (95.7%). The reason for supervision was to prevent exposure to inappropriate content (70.5%). The common reasons for allowing digital device use were for educational (37.4%) and entertainment purposes (36%) through videos (30.9%) and games (30.2%). Approximately 21.5% and 50.3% of the children spent more than 1 and 2 hours on digital devices during weekdays and weekends, respectively. Conclusion: The prevalence of digital device use among the preschool children in Kota Setar District was very high. Most of them used digital devices for educational and entertainment purposes under parental supervision. However, some exceeded the recommended screen time on weekends. These findings could promote awareness of digital device use among young children and help design public health awareness programmes and future policies. [ABSTRACT FROM AUTHOR]

Unplanned and unwanted pregnancy is a challenging life event, especially to young unmarried women in Malaysia as they often left unsupported. Using theory of resilience, this study aimed to explore challenges faced by noninstitutionalised young unmarried women who decided to keep their pregnancy. By understanding their challenges, we could recognise their main needs for planning of effective strategies and policies that can help them to cope better with their pregnancy and prepare for their future. This was a qualitative exploration study using a multiple-case study design. Five pregnant women recruited from two primary care clinics, aged 18 years and above, with different life experiences and at different trimester underwent in-depth interviews. Data was examined using thematic analysis and compared across the five cases. The main challenges during pregnancy faced by the unmarried women were: (1) avoiding social stigma, (2) having poor psychosocial support from family, and (3) preparing for future. They were worried about financial security, childcare, illegitimate status of their child, housing arrangement and stable employment. Thus, they need to be supported in these areas. Although these young women in the community appeared to be self-reliant, independent and strong minded, they need to be supported especially from their own family members, parents, peers, health care providers and organisation for a better future for them and their children. [ABSTRACT FROM AUTHOR]

Background: From the Theory of Planned Behaviour perspective, sexual intention is determined by a permissive attitude, perception of social norms and perceived self-efficacy in performing sexual activity. The aim of this study was to develop and validate the Youth Sexual Intention Questionnaire (YSI-Q), which was designed to measure sexual intention among youths in Malaysia.Methods: A total of 25 items were developed based on literature reviews encompassing four main constructs: sexual intention, attitude, social norms and self-efficacy. The YSI-Q then underwent a validation process that included content and face validity, exploratory factor analysis (EFA), reliability analysis, and confirmatory factor analysis (CFA). This study was conducted on unmarried youths aged 18 to 22 years who were studying in colleges around Klang Valley, Malaysia.Results: EFA supported the four factor structure, but five items were removed due to incorrect placement or low factor loading (<0.60). Internal reliability using Cronbach's alpha ranged between 0.89 and 0.94. The CFA further confirmed the construct, convergent and discriminant validity of the YSI-Q with χ 2 = 392.43, df = 164, p < 0.001, χ 2/df = 2.40, CFI = 0.93 and TLI = 0.92 and RMSEA = 0.08.Conclusion: The final set of YSI-Q consisted of 20 items measuring sexual intention (five items), attitude (five items), social norms (six items) and self-efficacy (four items) of practicing sexual activity. YSI-Q was shown to be a reliable and valid tool to be used among Malaysian youths. [ABSTRACT FROM AUTHOR]

Background: Parenting behaviour is culturally sensitive. The aims of this study were (1) to translate the Parental Bonding Instrument into Malay (PBI-M) and (2) to determine its factorial structure and validity among the Malaysian population. Methods: The PBI-M was generated from a standard translation process and comprehension testing. The validation study of the PBI-M was administered to 248 college students aged 18 to 22 years. Results: Participants in the comprehension testing had difficulty understanding negative items. Five translated double negative items were replaced with five positive items with similar meanings. Exploratory factor analysis showed a three-factor model for the PBI-M with acceptable reliability. Four negative items (items 3, 4, 8, and 16) and item 19 were omitted from the final PBI-M list because of incorrect placement or low factor loading (< 0.32). Out of the final 20 items of the PBI-M, there were 10 items for the care factor, five items for the autonomy factor and five items for the overprotection factor. All the items loaded positively on their respective factors. Conclusion: The Malaysian population favoured positive items in answering questions. The PBI-M confirmed the three-factor model that consisted of care, autonomy and overprotection. The PBI-M is a valid and reliable instrument to assess the Malaysian parenting style. Confirmatory factor analysis may further support this finding. [ABSTRACT FROM AUTHOR]

Objective: To assess the outcomes and risk factors of adolescent pregnancies in 2 major hospitals in Malaysia.Methods: We conducted a case-control study of pregnant girls aged 10 through 19 years. The controls were women aged 20 through 35 years who did not become pregnant in their adolescence. Cases and controls were matched for parity and place of delivery. Data were collected from questionnaires and the hospitals' medical records.Results: The study included 102 cases and 102 controls. There were significant associations between adolescent pregnancy and low education level, low socioeconomic status, being raised by a single parent, not engaging in extracurricular school activities, engaging in unsupervised activities with peers after school, and substance abuse (P<0.05 for all); being anemic, being unsure of the expected delivery date, and having few antenatal visits and a late delivery booking; and low Apgar scores and perinatal complications.Conclusion: Adolescent pregnancies are high-risk pregnancies. Better sexual health strategies are required to address the associated complications. [ABSTRACT FROM AUTHOR]

Background: Worldwide the prevalence of overweight and obesity in children is escalating. Parents' recognition of overweight or obesity in their own children is very important for a successful intervention in these children. This study examined parental perception of their children's weight status, and its association with their knowledge on nutrition and obesity. Materials and Methods: This was a cross sectional study of parents with children aged 9 to 12 years, in a primary school of Kuala Lumpur. Parents responded to a self-administered questionnaire which contains parental perception of their child weight status as well as knowledge on nutrition and obesity. The parents' perception of the children's weight status was then compared with the actual measured weight status. Results: There were 204 parents who participated in the study. Parents were found to underestimate their child weight status and 38.2% were inaccurate in their perception. The mean score of knowledge on nutrition and obesity was 78.5±14.4; and this did not associate with the accuracy of their perception on the child weight status. Parents showed inadequate knowledge in food pyramid and preparation of low fat meals. Conclusion: The Malaysian Health Campaigns had resulted in overall good knowledge on nutrition and obesity in the parents except in few domains. However, this was insufficient to make the parents recognize the growing overweight and obesity problem in their children. [ABSTRACT FROM AUTHOR]

Background: Existing research indicated a high prevalence of mental health issues among adolescents. Gender and parenting styles are two factors that may influence adolescents' mental health. Nonetheless, most published studies focused on either secondary school or university students. In contrast, there is a dearth of similar research involving pre-university students. This study aimed to determine the prevalence of mental disorders among pre-university students and their association with parenting styles. Methods: A cross-sectional study via online questionnaire survey was conducted among students from a pre-university college on the East Coast of Malaysia. Convenience sampling was used to recruit the participants. The questionnaire consisted of three parts: i) sociodemographic data, ii) the Parental Authority Questionnaire and Depression, and iii) the Anxiety and Stress Scale (DASS-21). An online invitation to answer the questionnaire was done via the Student Representative Council (SRC). Data were analysed using descriptive statistics and Pearson's chi- square test. Results: A total of 431 participants responded to the online survey. The prevalence of depression, anxiety and stress was 49.0% (n = 210), 68.0% (n = 293) and 37.6% (n = 162), respectively. In addition, father's educational level (x² = 10.332, P = 0.001) and the authoritarian parenting style (x² = 10.099, P = 0.006) were significantly associated with mental health disorders among adolescents. Conclusion: The prevalence of mental disorders among pre-university students is relatively high. Pre-university admission mental health screening is vital for early detection and intervention of mental disorders among this vulnerable group. Further research is imperative to establish a comprehensive plan of action that targets parental involvement in managing adolescent mental health disorders. [ABSTRACT FROM AUTHOR]

Introduction: Local profiles on the use of weight loss products are scarce. The study aims to address this together with concerns on the users' misperception of the safety of these products, and the absence of high-quality evidence to support such use. Methods: This was a cross-sectional study conducted in overweight and obese patients attending a public primary care clinic in Penang. Selected patients were given a set of self-administered questionnaire that assessed types of weight loss products used, factors that influenced the usage and the users' perception of their own body weight and the diet products they are taking. Results: From 332 participants of this study, 18.7% were users. Mean age of users were 44.6 (SD 11.9) years. The majority (66.1%) only used dietary supplements, 11.3% used weight loss medications and the rest (22.6%) used both products. Reasons for its use were for health, a faster result to lose weight and failing dieting and exercise regimes. The average amount spent on this was RM100 per month. Commonest source of weight loss products were friends. Majority (80.6%) did not discuss the use of the products with doctors. Factors associated with the use of weight loss products were being female (AOR=5.59), had tertiary level education (AOR=2.27), being employed (AOR=3.42), self-perceived of overweight (AOR=3.61) and perception that weight loss products as safe (AOR 2.48). Conclusion: Users of weight loss products are among highly educated working females who perceived themselves as being overweight and assume the products are safe. [ABSTRACT FROM AUTHOR]

Background: The prevalence of teenage smoking has decreased over the past decade following the implementation of the national tobacco control programme. However, the effect of the programme on smoking cessation in teenagers has not been determined. Methods: Twenty-eight participants (12 teenagers, 8 teachers, and 8 doctors) were interviewed using 5 in-depth interviews and 3 group discussions. Social cognitive theory (SCT) was applied as the theoretical framework. Semi-structured interview protocols were used, and thematic analysis and analytic generalisation utilising SCT were performed. Results: The current national tobacco control programme was found to be ineffective in promoting smoking cessation among teenagers. The participants attributed the ineffective campaign to the followings: inadequacy of message content, lack of exposure to the programme, and poor presentation and execution. In addition, the participants perceived the developed tobacco control policies to be a failure based on poor law enforcement, failure of retailers to comply with the law, social availability of cigarettes to teenagers, and easy availability of cheap, smuggled cigarettes. This study highlighted that the programme-related problems (environmental factors) were not the only factors contributing to its perceived ineffectiveness. The cunning behaviour of the teenagers (personal factor) and poor self-efficacy to overcome nicotine addiction (behavioural factor) were also found to hinder cessation. Conclusion: Tobacco control programmes should include strategies beyond educating teenagers about smoking and restricting their access to cigarettes. Strategies to manage the cunning behaviour of teenagers and strategies to improve their self-efficacy should also be implemented. These comprehensive programmes should have a foundation in SCT, as this theory demonstrates the complex interactions among the environmental, personal, and behavioural factors that influence teenage smoking. [ABSTRACT FROM AUTHOR]

Background: The quality of life (QoL) describes the multidimensional self-perceived well-being of a person, which is an important diabetes outcome. This study aimed to measure the QoL scores among patients with type 2 diabetes mellitus (T2DM), as well as their clinical and sociodemographic predictors. Methods: This cross-sectional study involved 180 randomly sampled patients at a primary care clinic on the East Coast of Peninsular Malaysia. A self-administered questionnaire containing the Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) was used. Results: Most of the respondents (96.7%) were Malay, with a median (interquartile range, IQR) age of 54.0 (14.0) years old. The majority of them were females (60.0%), married (81.1%) and from low-income families (63.3%), who attained a secondary education or lower (75.6%). Only 49.4% of them were employed. The mean (standard deviation, SD) ADDQoL-18 average weighted impact score was -4.58 (2.21) and all 18 domains were negatively affected, particularly the living condition, family life and working life. The multiple linear regression analysis showed that the age (adjusted B = 0.05, P = 0.004) and insulin use (adjusted B = -0.84, P = 0.011) were QoL predictors. Conclusion: T2DM negatively impacts the patient's QoL in all aspects of their life. The QoL improvement with age suggests that the older patients had accepted and adapted to their illness. The need to improve the QoL among insulin users was also highlighted. [ABSTRACT FROM AUTHOR]

Objective: The Difficulties in Emotion Regulation Scale-18 (DERS-18) is an instrument used to measure deficits in emotion regulation. However, the instrument has not been adapted to Malaysians and has never been validated in the Malay language. This study aimed to examine the psychometric properties of the Malay version of DERS-18., Method: The DERS-18 underwent forward-backward translation and assessment of face and content validity. Both Malay version of the DERS-18 and DASS-21 were completed by 701 adolescents (44.4% boys) aged 13 and 14 years old. To assess its dependability, a floor and ceiling effect evaluation and Cronbach's analysis were both performed. A series of confirmatory factor analyses (CFA), bivariate correlation, and regression were performed to evaluate the construct and criterion validity, respectively., Results: The Malay version of DERS-18, after excluding "Awareness", indicated excellent reliability (Cronbach's α = 0.93), and acceptable internal consistency for each subscale (range of α from 0.63 to 0.82). Floor or ceiling effects were observed at item level and subscale level, but not at total level. CFA results revealed that the Malay version of the DERS-18 bifactor model (excluding "Awareness") portrayed the best construct validity (χ2/df = 2.673, RMSEA = 0.049, CFI = 0.977, TLI = 0.968) compared to a single factor, a correlated factor, and a higher-order factor model. The DERS-18 subscales (except "Awareness") and DERS-18 total scores were significantly correlated with stress, anxiety, and depression in a positive direction (r ranged from 0.62 to 0.64, p < 0.01). The general factor of the DERS-18 and its specific factors ("Clarity", "Goals", and "Non-Acceptance") significantly predicted the symptoms of stress, anxiety, and depression (R2 ranged from 0.44 to 0.46, p < 0.001)., Conclusion: The Malay version of the DERS-18, excluding "Awareness", possessed good reliability, construct validity, and criterion validity to assess emotion dysregulation among Malaysian adolescents., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rosharudin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) has been translated and adapted globally. This study aimed to examine the psychometric properties of the Malay version of the ERQ-CA. The ERQ-CA underwent forward and back translation twice and was tested in two separate studies, Study 1 and Study 2, with 296 and 359 students aged between 13 and 14 years old, respectively. Cronbach's alpha values were calculated, and confirmatory factor analysis was conducted. The results from Study 1 demonstrate good internal consistency for cognitive reappraisal and expressive suppression. The results indicate a good factor loading for most of the items, but only one value of the goodness-of-fit met the criteria for a good fit. The results from Study 2 show improvements in the values of the goodness-of-fit that are comparable to previous studies, but there was a decrease in the factor loading scores. Overall, the Malay version of the ERQ-CA possesses acceptable reliability and validity. Further studies are required in the near future to develop a Malay version of the ERQ-CA that reasonably represents Malaysian adolescents.

Background: The delivery of pelvic floor muscle training (PFMT) through mHealth apps has been shown to produce promising results in improving pelvic floor muscle strength and urinary incontinence (UI). However, there is limited evidence on mHealth apps designed for pregnant women who are at high risk of developing UI. This pilot study aims to evaluate the feasibility of conducting an effectiveness trial for a newly developed PFMT app among pregnant women in Malaysia., Methods: This is a prospective, single-centre, single-blind, randomised controlled pilot feasibility study: The Kegel Exercise Pregnancy Training app (KEPT-app) Trial. Sixty-four incontinent pregnant women who attended one primary care clinic for the antenatal follow-up will be recruited and randomly assigned to either intervention or waitlist control group. The intervention group will receive the intervention, the KEPT-app developed from the Capability, Opportunity, Motivation-Behaviour (COM-B) theory with Persuasive Technology and Technology Acceptance Model., Discussion: This study will provide a fine-tuning for our future randomised control study on the recruitment feasibility methods, acceptability, feasibility, and usability of the KEPT-app, and the methods to reduce the retention rates among pregnant women with UI., Trial Registration: This study was registered on ClinicalTrials.gov on 19 February 2021 (NCT04762433) and is not yet recruiting.

Introduction: Pelvic floor muscle training (PFMT) strongly recommended to incontinent pregnant women. The Kegel Exercise Pregnancy Training-app trial is a multicentre cluster-randomised study aims to assess the effectiveness and its cost-effectiveness of the mobile app guidance in PFMT among incontinent pregnant women., Methods and Analysis: 370 pregnant women (aged 18 years old and above) will be recruited with International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form. Ten clusters (primary care clinics) will be randomly assigned to either PFMT or usual care in a 1:1 ratio by an independent researcher (sealed envelope). The primary outcome will be urinary incontinence, and the secondary outcomes (quality of life; PFMT adherence, psychological status and mobile apps' usability) will be assessed at four measurement time points (t0: baseline) and postintervention (t1: 4 weeks, t2: 8 weeks and t3: 8 weeks postnatal). T-test analysis will determine any significant differences at the baseline between the control and intervention groups. The mixed-model analysis will determine the effectiveness of the intervention at the population-average level for both the primary and secondary outcomes. For the cost-effectiveness analysis, expenditures during the study and 6 months after the intervention will be compared between the groups using the multiway sensitivity analysis. The recruitment planned will be in December 2020, and the planned end of the study will be in August 2021., Ethics and Dissemination: This study protocol was approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia (JKEUPM-2019-368) and Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, NMRR-19-412-47116 (IIR) with the ANZCTR registration. This study will obtain informed written consent from all the study participants. The results which conform with the Consolidated Standards of Reporting Trials and the Recommendations for Interventional Trials will be published for dissemination in peer-reviewed journals and conference proceedings., Trial Registration Number: ACTRN12619000379112., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors., Design, Setting and Participants: This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing., Results: The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia., Conclusion: Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care., Trial Registration Number: NMRR-15-660-24324., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: University students face not only challenges related with independent living, but also academic challenges. This predisposes them to depression, anxiety and stress, which are fairly common., Objective: The aim was to assess the prevalence of depression, anxiety and stress, and identify their correlates among university students., Methods: A cross-sectional study was conducted on 506 students between the ages of 18 and 24 years from four public universities in the Klang Valley, Malaysia. Through an anonymous, self administered questionnaire, they were assessed by the Depression Anxiety Stress Scale-21 (DASS-21). Data on socio-demographic, family characteristics and living arrangement were also obtained. Student's t-test and one-way ANOVA were used to explore association between these aspects., Results: Analysis showed among all students, 27.5% had moderate, and 9.7% had severe or extremely severe depression; 34% had moderate, and 29% had severe or extremely severe anxiety; and 18.6% had moderate and 5.1% had severe or extremely severe stress scores based on the DASS-21 inventory. Both depression and anxiety scores were significantly higher among older students (20 and above) and those born in rural areas. Whereas, higher stress scores were significantly higher among older students (20 and above), females, Malays and those whose family had either low or high incomes compared to those with middle incomes., Conclusions: The prevalence of anxiety is much higher than either depression or stress, with some differences in their correlates except for age. These differences need to be further explored for development of better intervention programs and appropriate support services targeting this group., (Copyright © 2013 Elsevier B.V. All rights reserved.)