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Major depressive disorder (MDD) compromises the individual’s capacity for self-care and productivity. Single nucleotide polymorphisms (SNP) of a number of genes have been associated with MDD. The zinc transporter-3 protein, encoded by the ZnT3 (SLC30A3) gene, maintains zinc-glutamate homeostasis at the glutamatergic synapse, a disruption of which increases risk of MDD. We hypothesise that variation in SLC30A3 (rs11126936) SNP increases risk of MDD. We recruited 300 MDD cases and 300 controls, matched in the ratio of 1:1 by age, gender and ethnicity. PCR-restriction fragment length polymorphism analysis was used in DNA genotyping, validated by sequencing 10% of samples. Deviation from the Hardy-Weinberg equilibrium was tested using the chi-square test. Conditional logistic regression was used to estimate adjusted odds ratios, controlling for age, gender, ethnicity, occupation and family monthly income. Genotypes G/G and G/T showed two times greater odds of developing MDD compared to variant genotype T/T (OR=1.983, 95% CI=1.031-3.815; p=0.040 and OR=2.232, 95% CI=1.100-4.533; p=0.026 respectively). Carriers of genotypes G/G and G/T of the SNP rs11126936 in SLC30A3 are associated with increased risk of MDD.

Background: Social media may be an effective medium by which parents could be trained to promote healthy eating behaviour and physical activity for their children. This trial evaluates the effectiveness of a family-based intervention using social media in combination with face-to-face sessions - the REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme - on adiposity of Malay children. Methods: Five primary schools in an urban area in Selangor, Malaysia participated in this two-arm randomized controlled field trial. Participants were parents (n = 134) and their primary school-going children 8-11 years of age who were either overweight or obese. These parent-child dyads were randomly allocated to intervention and wait-list control groups and were blinded to group assignment. The intervention was a four-week training programme using two face-to-face sessions and two Facebook sessions followed by weekly booster sessions over a three-month period using WhatsApp. The primary outcome was body mass index (BMI) z-score. Height, body weight, waist circumference and percentage of body fat were measured by blinded assessors. Data were collected at baseline (T1), immediately post-training (T2) and at three- (T3) and six-month post training (T4) and were analysed using generalized linear mixed modelling adjusted for covariates to estimate the intervention effects. Subgroup analysis was conducted for overweight and obese children. Results: Ninety-one percent of parents completed the study, 64 in intervention group and 58 in wait-list group. At the sixth month post-training, BMI z-scores were significantly reduced in the intervention group compared to the wait-list group, for the all children (overweight and obese children) and within the obese subgroup ((F(6, 517) = 2.817, p = 0.010) and (F(6, 297) = 6.072, p < 0.001) respectively. For waist circumference percentile and body fat percentage, the intervention group experienced a significant reduction compared to

Background: Pediculosis capitis is a common infestation among the school-aged group. Necessary intervention must be taken to prevent and manage the problem. A full study using cluster randomized control trial is proposed to assess the effectiveness of a health education module on the knowledge, attitude and practices on Pediculosis capitis among government primary school students. If the intervention is effective, it can be generalized to the whole primary schools across the country. Therefore, this paper will discuss on the development of a school-based health education intervention to improve the knowledge, attitude and practices on Pediculosis capitis among the government primary school students. Materials and Methods: Literature review was done to examine the prevalence of Pediculosis capitis and its determinants. Based on the findings, a health education intervention module based on KAP Model was developed for the implementation at a school level. Contribution by the panel of experts was attained for the development of the module. Validation of the module was carried out to ensure it is suitable to be implemented and will be effective in preventing and managing Pediculosis capitis. Expected Result: The health education intervention is effective to improve the knowledge, attitude and practices on Pediculosis capitis of the respondents as compared to baseline. Conclusion:Preventing Pediculosis capitis and controlling its risk factors by a well-developed health education module will help to obtain the desired outcome which is the reduction of Pediculosis capitis and improvement of knowledge, attitude and practice on Pediculosis capitis among the respondents.

Introduction: One of the commonly used techniques for mutation screening is High Resolution Melting (HRM) analysis. HRM is a post PCR method that relies on the detection of the fluorescent signals acquired due to the release of DNA intercalated dyes upon the melting of dsDNA to ssDNA. The method is simple, inexpensive and does not require post PCR-handling, making it suitable for high throughput screening. Methods: This study aimed to develop and validate HRM technique for the screening of two disease-associated single nucleotide polymorphisms (SNPs) namely BDNF rs6265 and DAT1 rs40184 using a total of 30 gDNA samples. The obtained results were confirmed and validated by sequencing. Results: HRM analysis showed that the predicted genotypes of BDNF rs6265 and DAT1 rs40184 among all the gDNA samples were in 100% concordance with the sequencing results, making it an accurate and sensitive method for the detection of SNPs. Conclusions: The application of HRM can accurately determine the genotype of BDNF rs6265 and DAT1 rs40184 SNPs, making it a promising tool for rapid and high-throughput screening of targeted SNPs in a large population study.

Introduction: Tuberculosis is the commonest cause of death among HIV patients in Nigeria. Though tuberculosis is common among HIV patients, their knowledge about transmission and prevention is poor. Objective: To determine knowledge, attitude and preventive practices regarding tuberculosis and its predictors among HIV patients receiving treatment. Methods: A cross sectional study was carried out involving 226 randomly selected HIV patients receiving care at General Hospital, Minna. Study duration was from June 2015 to July 2017. Data on socio-demographic characteristics, psychosocial factors, knowledge, attitude and preventive practices regarding tuberculosis was collected using a self-administered, WHO modified, pretested and validated questionnaires. Data collected was analysed using SPSS version 22. Results: Out of 226 respondents, 60(26.5%) had poor knowledge, 123(54.4%) had negative attitude and 48(21.2%) had poor preventive practices regarding tuberculosis. The predictors of knowledge were age (B=0.087, 95%CI=0.031, 0.143, p=0.002), depression (B=-0.444, 95%CI=-0.673,-0.214, p<0.001) monthly income (B=-0.058, 95%CI=-0.095, -0.021, p=0.002) and marital status (B=-1.276, 95%CI=-2.525,-0.025, P=0.046). The predictors of attitude were anxiety (B=-0.395, 95%CI=-0.584, -0.206, p<0.001), cigarette smoking (B=4.473, 95%CI=0.992, 7.954, p=0.012) and duration of HIV infection (B=0.371, 95%CI=0.110, 0.631, p=0.005). The predictors of practice were depression (B=-0.176, 95%CI=-0.276, -0.076, p=0.001), cigarette smoking (B=2.200, 95%CI=0.926, 3.474, p=0.001) and duration of HIV infection (B=0.098, 95%CI=0.003, 0.194, p=0.043). Conclusion: Overall, knowledge and practices regarding tuberculosis prevention were good, but attitude was poor. The predictors of knowledge, attitude and preventive practices were age, depression, anxiety, cigarette smoking, monthly income, marital status and duration of HIV infection.

Workplace architectural lighting conditions that are biologically dim during the day are causing healthy individuals to experience light-induced health and performance-related problems. Dynamic lighting was reported beneficial in supporting individuals’ psychological behavior and physiological responses during work period in Europe. It has yet to be investigated in workplaces with minimal/no natural daylight contribution in tropical Malaysia. Hence, an exploratory experimental study was initiated in an experimental windowless open-plan workplace in Universiti Putra Malaysia, Serdang. The aim was to identify dynamic lighting configurations that were more supportive of a morning boosting effect than the control constant lighting, to support dayshift individuals’ psychophysiological wellbeing indicators during the peak morning work period. The immediate impact of a 2-hour morning exposure to overhead white LED (6500 K) with different horizontal illuminance levels and oscillations (lighting patterns) were investigated on physiological indicator limited to urinary 6-sulfatoxymelatonin, and psychological indicators for alertness, mood, visual comfort, cognitive and visual task performance. Not all of the investigated dynamic lighting configurations were supportive of a morning boost. Only configurations 500increased to750 and 500increased to1000 lx therapeutically supported most of the indicators. Both these configurations suppressed urinary 6-sulfatoxymelatonin, and improved alertness, cognitive performance, positive affect, and visual comfort better than ‘visit 1: 500constant500’ lx (control). The increasing oscillation was observed more beneficial for the morning boost in tropical Malaysia, which is in reverse to that specified in the human rhythmic dynamic lighting protocol developed by researchers from the Netherlands for application during winter. The findings from this study present the feasibility of dynamic architectural lighting acting as an environmental therap

Background: Metalworking fluids are the most common coolants and lubricants used in metal machining industry in order to protect the machine and the products. The most common form of MWF is water based MWF. During the machining process the MWF can be splashed into workers’ environment and suspended as aerosols that can be inhaled by the workers into their respiratory system. Exposure to MWF can lead to serious respiratory diseases as cough, phlegm, asthma, chronic obstructive lung disease, or hypersensitivity pneumonitis. Objective: To review and summarize the principle of respiratory exposure to MWF among metal machining workers and the adverse health effects on respiratory system. Method: A survey of the literatures concern on MWF respiratory exposure, respiratory health effects of MWF, microbial contamination of water based MWF, effectiveness of permissible exposure limits of MWF and assessment of respiratory health of workers exposed to MWF were reviewed and summarized in this review paper. Result: Review shows, the workers in metal machining industries and handling MWF in their daily activities are at high risk of respiratory diseases due to respiratory exposure to MWF. Conclusion: There is a shortage in number of related studies on exposure to metalworking fluids in Malaysia.

Inter-racial variations in genotype frequency have been implicated as a probable cause of the inconsistencies in pharmacogenetic studies of major depressive disorder (MDD). The aim of this study was to determine whether the polymorphisms of the serotonin 1A (5HT1A) 1019C>G and serotonin 2A (5HT2A) 1438A>G are associated with response to SSRI treatment among Malaysian MDD patients. These polymorphic changes are shown to modulate the transcription of these genes and are associated with attenuation of the density of the encoded receptors. Modulation of these receptors is central to the activity of antidepressant medication. The study involved six weeks follow up of incidence and prevalence (diagnosed within 2 years to recruitment) MDD patients from a case-control hospital based study in Malaysia. Only Malaysians aged 18–65 years and diagnosed with MDD (other Axis 1 psychiatric diagnosis were excluded) on treatment with SSRIs were recruited. One hundred and ninety two patients (females - 71.4% and males – 28.6%) were recruited. A total of 77.7% of the patient showed response to treatment and the rest did not. The response rate was also highest among the females (81%) compared to males (67%). The frequencies of the genotypes 5HT1A1019C>G were GC (34.2%), CC (55.2%), GG (10%) and those of the 5HT2A 1438A>G were GA (45.3%), AA (33%), GG (21.9%). Association testing for response to SSRIs with the 5HT1A 1019C>G polymorphism and not the 5HT2A1438A>G polymorphism revealed a chi-square score of 3.911 with P≤0.05 (P=0.048) in a dominant model of inheritance. This study revealed that the dominant effect of the G-allele in both the GG and GC genotypes of the 5HT1A receptor gene was associated with treatment response in Malaysian MDD patients.

Introduction: Osteoarthritis (OA) is the main cause of knee pain. It also affects individual’s physical functioning. Anti- inflammatory drugs and knee replacement are the mainstay methods in the management of knee OA in Malaysia. However, patients with knee OA often suffer pain. The general objective of the study is to evaluate the effectiveness of a cognitive behavioural intervention module on knee pain, functional disability and psychological outcomes among knee OA patients attending Orthopedics Clinics in Hospital Putrajaya and Hospital Serdang, Malaysia. This study aims to determine the baseline level of knee pain and functional disability among knee OA patients. Methods: Baseline results on the knee pain and functional disability were obtained from a two arm parallel- group randomized controlled study. Three hundred patients aged 35 to 75 years diagnosed with knee OA were recruited. A set of pre tested and validated Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used in this study. Results: Mean baseline of KOOS pain was 56.09 (SD=21.75) and 52.26 (SD=22.08) for the intervention and control groups respectively. Participants in the intervention and control groups had a mean KOOS function in daily living of 61.11 (SD=21.20) and 56.72 (SD=22.13) respectively. Overall mean baseline of KOOS function in sport and recreation was 35.30 (SD=27.38). Conclusions: Majority of participants had moderate level of knee pain and functional disability in daily living. However, participants had more extreme symptoms of functional disability in sport and recreation. Therefore, interventions to reduce knee pain and functional disability symptoms in knee OA are needed.

Introduction: Pediculosis capitis infestation is endemic in both developing and developed countries leading to various physical, economical and psychological consequences. Our main objective was to determine the prevalence and predictors of pediculosis capitis among primary school children in Hulu Langat District, Malaysia. Methods: An analytic cross-sectional study using cluster random sampling method was carried out in Hulu Langat District, Malaysia. Self-administered pretested questionnaires were used to collect the data. Hair and scalp examination was also carried out. Multivariate logistic regression was used to control for potential confounding and determine the predictors. Results: The overall mean age of the 1,336 respondents was 9.3 years. Majority were males (52.8%), Malays (79.5%) and 81.3% of the fathers had secondary or tertiary education as compared to 77.3% for the mothers. The overall prevalence of pediculosis capitis was 15.3%. The prevalence of pediculosis was significantly higher among females (28.4%) than males (3.7%, p=0.001). Multivariate logistic regression analysis showed that age 10 years or more (Odds Ratio (OR) = 2.34, 95% Confidence Interval (CI) = 1.673 to 3.272), female gender (OR = 10.26, 95% CI = 6.620 to 15.903), history of contact with an infested person (OR = 2.11, 95% CI = 1.506 to 2.960), Indian compared to Chinese (OR = 3.55, 95% CI = 1.282 to 9.860), Malay to Chinese (OR = 2.59, 95% CI =.994 to 6.774) were associated with pediculosis capitis. Conclusions: Prevalence of pediculosis capitis among children aged 7 - 12 years in Hulu Langat District was high. There is a need for screening and treatment of pediculosis capitis in primary schools.

Dynamic overhead white LED ambient lighting is more conducive to an individual’s morning psycho-physiological wellbeing when compared to the constant lighting in workplaces where there is minimal natural daylight penetration or a windowless work space.

Background: Knowledge of hepatitis B and C has been reported to be low among respondents in different studies. We conducted a cross-sectional study among international students of Universiti Putra Malaysia (UPM) to ascertain their levels of knowledge, attitude and practices regarding hepatitis B and C and its associated factors. Methods: Six hundred and sixty two (662) international students participated in this study. A cluster sampling method was employed and data was generated using self-administered questionnaire, which was validated and its reliability checked. Results: Normality test was conducted followed by descriptive statistics, spearman's correlation and Chi-square tests to explore associations between variables in the study. The response rate was 71.49 %. Of these, 50.3 % of the respondents had better knowledge of hepatitis B; 52.7 % had better knowledge of hepatitis C; 54.8 % had positive attitude towards hepatitis B and C and 77.6 % had safer practices towards hepatitis B and C. Positive correlations were found between knowledge of hepatitis B and knowledge of hepatitis C; knowledge hepatitis B and attitude; knowledge hepatitis C and attitude; knowledge hepatitis B and practice; knowledge hepatitis C and practice; and attitude and practice regarding hepatitis B and C. Similarly, some socio-demographic variables and history of hepatitis were found to be associated with knowledge, attitude and practice related to hepatitis B and C. Conclusion: The levels of knowledge and attitude towards hepatitis B and C were low among respondents but majority of them exhibited safe practices. The study level, faculty, age, nationality, marital status and gender of the respondents were significantly associated with their levels of knowledge, attitude and practices towards the disease. These findings imply that there is need for hepatitis health promotion among the international students of UPM and possibly other international students across the globe. It will serve to

This study assessed the effectiveness of a developed and implemented Clinician Client Centered Counseling Module on improving condom use and increasing HIV status disclosure to spouses and or sex partners of adult patients living with HIV enrolled in care in Yola, Nigeria. The study was a three arm randomized single blind clinical trial involving 386 randomly selected and allocated adult patients living with HIV who were enrolled into ART care at any of the four comprehensive ART sites in Yola. A clinician client centered training module was developed based on the Information Behavior and Motivation (IBM) Model. Nine Clinicians involved in ART care were trained with this module to deliver a 10 to 15 minutes clinic based intervention (Clinician Client Centered counseling). Intervention group one received two counseling sessions; at baseline and at two month, intervention group two received a counseling session at baseline and the control group received routine care. An interviewer administered structured questionnaire was used for data collection. Data was collected at baseline, two months and six months. Outcome measures were condom use and HIV status disclosure. Data was analyzed using SPSS version 22. At six months a significantly higher median condom use score was seen in intervention group one compared to intervention group two (1.00 vs 0.50; p = 0.01), and in intervention group one compared to the control group (1.00 vs 0.00; p = 0.01). A significant change in median condom use scores from baseline to 6 months was seen for intervention group one (p = 0.02). At six months a significantly higher mean HIV status disclosure was seen in intervention group one compared to the control group (0.30 vs 0.25; p = 0.01) and in the intervention group two compared to the control group (0.30 vs 0.25; p = 0.01). A significant main effect for time was seen for HIV status disclosure to spouse and/or sexual partners (p = 0.01). Clinician Client Centered counseling is an effective

With the availability of ART in most parts of Nigeria, more HIV positive individuals are living healthy lives. In periods of illness, sexual activity may be the last thing on the mind of a HIV positive individual but when in good health, sexual activity is definitely expected. This study describes the baseline sexual behaviors and status behavior of a three arm single blind randomized controlled clinical trial involving 386 randomly selected and allocated adult HIV patients who were enrolled into ART at all four comprehensive ART sites in Yola. The intervention was 10 to 15 minutes clinic based Clinician Client Centered counseling. An interviewer administered validated structured questionnaire was used for data collection. One hundred and eleven (62.4%) of respondents were inconsistent condom users, 29 (7.5%) had more than one sexual partner/spouse while 33 (11.3%) were yet to disclose their status to their spouse(s) and/or sex partners. Inconsistent condom use, non-status disclosure and sex with an unsteady partner were the most common high risk behaviors. Behavioral interventions are thus needed to reduce HIV spread in these groups of people.

Introduction: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. The purpose of the present study was to determine the incidence of early PPD and possible relevant risk factors among women attending primary health centers in Mazandaran province, Iran for the first time. Material and methods: A longitudinal cohort study was conducted among 2279 eligible women during weeks 32–42 of pregnancy to determine bio-psycho-socio-cultural risk factors of depression at two weeks post-partum using the Iranian version of the Edinburgh Postnatal Depression Scale (EPDS). Univariate and hierarchical multiple logistic regression models were used for data analysis. Results: Among 1,739 mothers whose EPDS scores were ≤ 12 during weeks 32–42 of gestation and at the follow-up study, the cumulative incidence rate of depression was 6.9% (120/1,739) at 2 weeks post-partum. In the multivariate model the factor that predicted depression symptomatology at 2 weeks post-partum was having psychiatric distress in pregnancy based on the General Health Questionnaire (GHQ) (OR = 1.06, (95% CI: 1.04–1.09) p = 0.001). The risk of PPD also lower in those with sufficient parenting skills (OR = 0.78 (95% CI: 0.69–0.88) p = 0.001), increased marital satisfaction (OR = 0.94 (95% CI: 0.9–0.99) p = 0.03), increased frequency of practicing rituals (OR = 0.94 (95% CI: 0.89–0.99) p = 0.004) and in those whose husbands had better education (OR = 0.03 (95% CI: 0.88–0.99) p = 0.04). Conclusions: The findings indicated that a combination of demographic, sociological, psychological and cultural risk factors can make mothers vulnerable to PPD.

Postpartum depression is the most prevalent emotional problem during a women's lifespan. Untreated postpartum depression may lead to several consequences such as child, infant, fetal, and maternal effects. The main purpose of this article is to briefly describe different theoretical perspectives of postpartum depression. A literature search was conducted in Psych Info, PubMed, and Science Direct between 1950 and 2015. Additional articles and book chapters were referenced from these sources. Different theories were suggested for developing postpartum depression. Three theories, namely, biological, psychosocial, and evolutionary were discussed. One theory or combinations of psychosocial, biological, and evolutionary theories were considered for postpartum depression. The most important factor that makes clinicians' choice of intervention is their theoretical perspectives. Healthcare providers and physicians should help women to make informed choices regarding their treatment based on related theories.

Background: Tobacco smoking is considered a risk factor for cervical cancer development due to the presence of tobacco based carcinogenic metabolites in cervical cells of female smokers. In this study, we investigated the role of the T3801C (MspI) polymorphism of CYP1A1, a gene encoding an enzyme necessary for the initiation of tobacco based carcinogen metabolism, on cervical cancer risk. The T to C substitution may alter CYP1A1 activities, potentially elevating cervical cancer risk. Since results of gene-disease association studies vary according to the study population, the multi-ethnic population of Malaysia provides an excellent representative cohort for identifying and comparing the cervical cancer risk among the 3 major ethnics in Southeast Asia in relation to CYP1A1 MspI polymorphism. Materials and Methods: A total of 195 Thin Prep Pap smear samples from HPV negative and cancer free females were randomly selected as controls while 106 formalin fixed paraffin embedded samples from females with invasive cervical cancer were randomly selected for the cases group. The polymorphisms were identified using restriction fragment length polymorphism (RFLP) PCR. Results: We found no significant associations between CYP1A1 MspI polymorphism and cervical cancer in the general Malaysian female population. However, upon ethnic stratification, the variant C/C genotype was significantly associated with a 4.66-fold increase in cervical cancer risk in Malay females (95% CI= 1.21-17.9; p=0.03). No significant association was observed in the Chinese and Indian females. Additionally, there were no significant associations in the dominant model and allele frequency model analysis in both the general and ethnically stratified female population of Malaysia. Conclusions: Our findings suggest that the C/C genotype of CYP1A1 MspI polymorphism is associated with the development of cervical carcinoma in the Malay females of Malaysia.

Students-t test is the most popular statistical test. The test compares two mean values to judge if they are different or not. For small data it is possible to conduct it using manual calculation – however that is not the case. Researchers would need to use statistical software and packages to conduct their analysis. This guide will help the junior researchers to conduct independent- and paired-t test using STATA software.

Aim: Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. Methods: From a longitudinal cohortof 2279 women who attended Mazandaran’s primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. Results: The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Conclusion: Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.

Background: Among the factors reported to determine the quality of life of breast cancer patients are socio- demographic background, clinical stage, type of treatment received, and the duration since diagnosis. Objective: The objective of this study was to determine the quality of life (QOL) scores among breast cancer patients at a Malaysian public hospital. Materials abd methods: This cross-sectional study of breast cancer patients was conducted between March to June 2013. QOL scores were determined using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer supplementary measure (QLQ-BR23). Both the QLQ-C30 and QLQ-BR23 assess items from functional and symptom scales. The QLQ-C30 in addition also measures the Global Health Status (GHS). Systematic random sampling was used to recruit patients. Results: 223 breast cancer patients were recruited with a response rate of 92.1%. The mean age of the patients was 52.4 years (95% CI = 51.0, 53.7, SD=10.3). Majority of respondents are Malays (60.5%), followed by Chinese (19.3%), Indians (18.4%), and others (1.8%). More than 50% of respondents are at stage III and stage IV of malignancy. The mean Global Health Status was 65.7 (SD = 21.4). From the QLQ-C30, the mean score in the functioning scale was highest for 'cognitive functioning' (84.1, SD=18.0), while the mean score in the symptom scale was highest for 'financial difficulties' (40.1, SD=31.6). From the QLQ-BR23, the mean score for functioning scale was highest for 'body image' (80.0, SD=24.6) while the mean score in the symptom scale was highest for 'upset by hair loss' (36.2, SD=29.4). Two significant predictors for Global Health Status were age and employment. The predictors explained 10.6% of the variation of global health status (R2=0.106). Conclusions: Age and employment were found to be significant predictors for Global Health Status (GHS). The Quality of Life among breast cancer patient

Aim Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. Methods From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. Results The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Conclusion Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health.