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The medical course is known to be demanding and critical. However, the relationship between resilience and medical students' psychological distress is barely known. This study investigated resilience and psychological distress among third-year UiTM medical students. A cross-sectional survey was conducted among 166 medical students in Universiti Teknologi MARA (UiTM) in 2019, assessing resilience and psychological distress. The mean score of resilience was 26.6. The study found that 38.0% had depressive symptoms, 31.9% reported anxiety, and 70.5% showed stress symptoms. A higher level of resilience was significantly associated with lower psychological distress. Keywords: resilience, psychological distress, medical students. eISSN: 2398-4287 © 2022. The Authors. Published for AMER ABRA cE-Bs by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians/Africans/Arabians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning & Surveying, Universiti Teknologi MARA, Malaysia DOI: https://doi.org/10.21834/ebpj.v7i21.3706

Background Globally, the Coronavirus Disease-2019 (COVID-19) pandemic results in major psychological sequalae across age groups including adolescents. Mental illness rates are high, yet mental help seeking attitude (MHSA) among adolescents is evidently low in developed countries during the pandemic. However, data is scarce in developing countries, hence the aim of this study was to determine the MHSA and its predictors including psychological wellbeing of Malaysian college foundation students during the COVID-19 pandemic. Methods A cross sectional study was conducted among college foundation students, aged 18 to 19 years old, from a private college in Klang Valley from 1st December 2021 until 30th March 2022. All college foundation students were invited, and eligible students completed self-administered online questionnaires. Data on MHSA, sociodemographic, clinical factors, availability, accessibility and affordability of mental health service, mental health literacy, self-stigma of seeking help and psychological wellbeing were collected. An independent T-test analysis was performed to compare mean of MHSA between psychological distressed and non-psychological distressed. Multiple linear regression analysis was done to identify predictors of MHSA. Results 345 participants completed the questionnaires and the response rate was 62.9%. The mean age was 18.7 (± 0.75) years old. More than half were female (64.3%, n=222) and a majority had no past history of mental health illness (95.1%, n=328). Almost half had personal history of COVID-19 infection (49.3%, n=170). The mean of MHSA was 50.98 ±10.39. The predictors associated with MHSA were; self-stigma of help seeking (β=-0.59 (95% CI: -0.76, -0.42) p The prevalence of psychologically distressed was 23.2%, (95%CI: 20.4, 26.1), in which psychological distressed had a higher mean of MHSA than that of non-psychological distressed (53.29 ±10.48 vs. 50.29 ±10.29, p=0.02) Conclusion Mental help seeking attitude among Malaysian college foundation students was low during the COVID-19 pandemic. This may result in lost opportunities for early diagnosis and treatment. Strategies to reduce self-stigma of seeking help for mental illness is vital, while efforts to educate young adults about mental health and make mental health services affordable are warranted.

Background: Geriatric Depression Scale (GDS) has been widely used in assessing depression in elderly population. Using the Ministry of Health Malaysia definition for elderly, this study aimed to examine the construct validity and reliability of the GDS (Malay version) in elderly with cognitive impairment in Malaysia. Methods: A cross-sectional validation study involving 219 elderlies with cognitive impairment was conducted using universal sampling method. Participants aged 60 years old and above, scored less than 11 for the short mini mental state examination (SMMSE), have sufficient command of the Malay or English language, residing in the government nursing homes and attending memory clinics in government hospitals in Klang Valley were sampled. The GDS-15 English version underwent adaptation, translation, face validation and field testing to produce the Malay version. Psychometric analysis was performed using the exploratory factor analysis and its internal consistency was examined. Results: Mean age of participants were 72.61 ± 7.79. Majority were male (50.7%), Malay (50.2%), studied at least until primary school (71.7%) and stayed at nursing homes (50.2%). Construct validity showed significant Bartlett’s test of sphericity (Chi-square = 1,340.058, P < 0.001) and Kaiser-Meyer-Olkin (KMO) test of 0.90. Factor loadings for each item in the depression domain were satisfactory ranging from 0.42 to 0.83. Factor loadings for each item in the psychosocial activities’ domain were satisfactory ranging from 0.53 to 0.76. For the questionnaire reliability analysis, the total Cronbach’s alpha for the final model was satisfactory, with and overall Cronbach’s alpha of 0.89. Cronbach’s alpha value for the depression and psychosocial activities domain was 0.861 and 0.80, respectively. Conclusion: The GDS (Malay version) is a valid and reliable tool to screen for depression in elderly with cognitive impairment.

Objective To investigate how gait parameters in children with traumatic brain injury (TBI) versus typically developing (TD) children are influenced by secondary concurrent tasks and examine the correlations between gait parameters and attention and balance in children with TBI.Methods Sixteen children with TBI (mean age, 11.63±1.89 years) and 22 TD controls (mean age, 11.41±2.24 years) participated in this case-control study. Attention and functional balance were measured using the Children’s Color Trail Test (CCTT) and Pediatric Balance Scale (PBS). All participants first walked without concurrent tasks and then with concurrent motor and cognitive tasks. The APDM Mobility Lab was used to measure gait parameters, including gait velocity, stride length, stride duration, cadence, and double support time. Repeatedmeasures analysis of variance and Spearman correlation coefficient were used for the analysis.Results Children with TBI showed significantly more deterioration in gait performance than TD children (p

Introduction: The COVID-19 pandemic is affecting our day-to-day life and brings a serious impact on public mental health. Due to the practice of physical distancing, the Internet technology is being used to accommodate our daily interactions. In view of the increasing dependency towards this technology, its impact on our mental health well-being is indeterminate. This study aimed to examine the association between problematic Internet use, psychological distress, and the type of coping strategies used among Universiti Teknologi MARA students during this pandemic. Materials and Methods: A cross-sectional online survey was conducted using Internet Addiction Test, Kessler Psychological Distress Scale, and Brief Coping Orientation to Problems Experienced (COPE) Inventory. Data was analysed using SPSS version 26. Results: Of the 444 respondents, 32.2% were noted to have problematic Internet use with 61.3% reported psychological distress. Problematic Internet use was associated with higher level of psychological distress (OR = 1.04, 95% CI: 1.01 – 1.08), and the coping strategies of self-distraction (OR = 1.24, 95% CI: 1.04 – 1.47) and behavioural disengagement (OR = 1.29, 95% CI: 1.07 – 1.55). Conclusion: A high prevalence of psychological distress and its association with problematic Internet use and maladaptive coping among students during this pandemic was evident in this study. Hence, the findings from this study could help to provide insight on the state of the psychological well-being of students in higher education institutions as well as to assist the stakeholders in taking measures to help the students dealing with the pandemic.

Background Epidemiological studies conducted in various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in Western societies but also in Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour of patients with MetS components (i.e., diabetes or hypertension). However, evidence is lacking in terms of their effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving activation and self-management behaviours among patients with MetS. This paper presents the study protocol. Methods A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients aged 18–60 years with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months, and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model and persuasive technology theory. It consists of training primary care physicians, nurses and patients to use the EMPOWER-SUSTAIN web-based self-management mobile app, strengthening the patient–physician relationship and reinforcing the use of relevant clinical practice guidelines to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the changes in waist circumference, body mass index, blood pressure, patient physical activity level, eating behaviour, perception of chronic illness care, satisfaction with patient–physician interaction, and perceived absolute 10-year cardiovascular disease risk. Feasibility of implementing the intervention will be evaluated. This includes acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and the intervention’s potential effectiveness. Conclusion To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial. Trial registration ClinicalTrials.gov, NCT04120779. Registered on 9 October 2019, protocol version 1.

High demands of academic life and social changes caused relatively high prevalence of psychological distress among university students compared to the general population. The aim of this study was to determine the prevalence of psychological distress among university students and to examine the factors associated with them. This was cross sectional study involving 467 Bachelor degree students from various faculties in Universiti Teknologi MARA. Participants were assessed using the Brief Religious Coping Scale (Brief RCOPE), the Hatta Islamic Religiosity Index 1996 (HIRS96) and the Depression, Anxiety and Stress Scale (DASS 21). This study highlighted relatively high prevalence of depression, anxiety, and stress among the students of UiTM Shah Alam. We also found consistent significant association between negative religious coping with both anxiety and depressive symptoms. Consistent with the earlier studies done among Muslim samples, the positive religious coping is not significantly associated with better psychological outcomes although only small effect was observed towards the depressive symptoms.

Additional file 3. The EMPOWER-SUSTAIN patient consent form.

Additional file 1. The EMPOWER-SUSTAIN SPIRIT checklist.

Additional file 4. The EMPOWER-SUSTAIN physician consent form.

Additional file 2. The EMPOWER-SUSTAIN mobile app mock prototype.

Background: Epidemiological studies from various parts of the world have clearly demonstrated that metabolic syndrome (MetS) is an increasing global health problem, not only in the western societies but also in the Asian populations. Web-based and mobile phone-based self-management applications have been proven to be effective in improving self-management behaviour in patients with MetS components i.e. diabetes or hypertension. However, evidence is lacking in terms of its effectiveness specifically for patients with MetS. The aim of this pilot study is to evaluate the feasibility and potential effectiveness of the EMPOWER-SUSTAIN Self-Management e-Health Intervention in improving patient activation and self-management behaviours among patients with MetS. This paper presents the study protocol. Methods: A pilot randomised controlled trial will be conducted in a university primary care clinic. A total of 232 patients with MetS will be recruited; 116 will be randomised to receive the EMPOWER-SUSTAIN intervention for 6 months and another 116 patients will continue with usual care. The EMPOWER-SUSTAIN intervention is a multifaceted chronic disease management strategy based on the Chronic Care Model (CCM) and persuasive technology (PT) theory. It consists of training physicians and patients to use the EMPOWER-SUSTAIN web-based self-management intervention mobile apps, strengthening patient-physician relationship and reinforcing the use of relevant clinical practice guidelines (CPG) to guide management and prescribing. The primary outcome is the mean change in patient activation score using the Patient Activation Measure short form Malay version (PAM-13-M) questionnaire. The secondary outcomes include the change in patients’ physical activity level, eating behavior, patients’ perception on chronic illness care, satisfaction in patient-physician interaction and perceived absolute 10-year cardiovascular disease (CVD) risk. Feasibility of implementing the intervention will be evaluated. These include acceptability of the intervention, estimating the likely rate of participant recruitment and retention, appropriateness of the outcome measures, calculation of sample size, and its potential effectiveness. Conclusion: To our knowledge, this is the first study in Malaysia that aims to determine the feasibility of a multifaceted e-health intervention, as well as to indicate more useful aspects of this intervention for further exploration in a larger trial.

Objectives: To investigate the effects of concurrent tasks (motor and cognitive) on postural control performance in children with traumatic brain injury (TBI) compared to typically developing (TD) control subjects. Methods: Sixteen children with TBI (aged 11.63±1.89 years) and 22 TD controls (aged 11.41±2.24 years) participated in this case-control study. This study was conducted between May 2016 and March 2017. Each child performed static standing under 3 different conditions: single, concurrent motor, and concurrent cognitive task. Postural control performance measure includes sway area, anterior-posterior (AP) sway velocity, medio-lateral (ML) sway velocity, AP sway distance and ML sway distance as measured using the APDM® Mobility Lab (Oregon, Portland). A repeated-measure analysis of variance was used to analyse the data. Results: We found that children with TBI showed significantly more deterioration in postural control performance than TD children (p

Background. Tasks requiring simultaneous mobility and cognition (dual tasks) have been associated with incidence of falls. Although these deficits have been documented in individuals with neurologic disorder, the effect of dual task in children with traumatic brain injury has not been fully explored. Objective. To investigate the effect of dual-task (dual-motor and dual-cognitive task) conditions on spatiotemporal gait parameters during timed up and go test in children with traumatic brain injury. Methods and Material. A total of 14 children with traumatic brain injury and 21 typically developing children participated in this case-control study. Functional balance was assessed before the actual testing to predict the risk of falls. Timed up and go test was performed under single-task and dual-task (dual-motor and dual-cognitive task) conditions. Spatiotemporal gait parameters were determined using the APDM Mobility Lab system. The descriptive statistics and t-test were used to analyze demographic characteristics and repeated measure ANOVA test was used to analyze the gait parameters. Results. Under dual-task (dual-motor and dual-cognitive task) conditions during the timed up and go test, gait performance significantly deteriorated. Furthermore, the total time to complete the timed up and go test, stride velocity, cadence, and step time during turning were significantly different between children with traumatic brain injury and typically developing children. Conclusions. These findings suggest that gait parameters were compromised under dual-task conditions in children with traumatic brain injury. Dual-task conditions may become a component of gait training to ensure a complete and comprehensive rehabilitation program.

Depression, alienation and decreased functional competence can influence the QoL of patients with dementia. The aims of this study are to investigate the prevalence of depression in institutionalized dementia patients and its influence on the QoL. A cross-sectional survey involving 111 dementia patients aged 60 and above was carried out using the Short Mini Mental State Examination, EUROPE Health Interview Survey-Quality of Life and Cornell Scale for Depression in Dementia. There was no evidence to suggest that depression is a key predictor for better QoLin dementia patients. Interactions of various factors need to be acknowledged and considered in improving the QoL of dementia patientsin Malaysia.

Background: Care management providing a high quality of life (QoL) is a crucial issue in dealing with increasing numbers of dementia patients. Although the transition from informal (home-based) care to formal (institutional) care is often a function of dementia stage, for those with early dementia there is currently no definitive evidence showing that informal or formal care provides a higher QoL, particularly where informal care is favored for local cultural reasons. This paper outlines the research protocol for a study comparing formal and informal care in Malaysia. It seeks to provide evidence regarding which is more appropriate and results in higher QoL in early dementia.Methods: This is a quasi-experimental study design involving 224 early dementia patients from both nursing home and community settings. Participants will be assessed for cognitive severity, QoL, needs, activities of daily living, depression and social isolation/connectedness by using the Mini-Mental State Examination (MMSE), Cognitive Impairment Scale – 4 items (CIS-4), EUROPE Health Interview Survey-Quality of Life (WHO8), Assessment of Quality of Life (AQoL8), Camberwell Assessment of Need for the Elderly – Short Version (CANE-S), Barthel Index (BI), Cornell Scale for Depression (CSDD), Geriatric Depression Scale – 15 items (GDS-15), and Friendship Scale (FS) respectively.Conclusion: This study aims to provide a better understanding of care needs in early dementia. Given population aging, the study findings will provide evidence assisting decision-making for policies aimed at reducing the burden of caregiving and preserving the QoL of dementia patients.

Autism is a neuro developmental disorder that is recently well known among Malaysian. Many researches on autism detection have been conducted worldwide. However, there is lack of research conducted in detecting autism severity level. Therefore, this paper focuses on autism severity level detection using fuzzy expert system. Two main autistic behavioral criteria are selected which are social communication impairment and restricted repetitive behavior. Data acquisition was based on interview sessions with clinical psychologist and distribution of 36 questionnaires to teachers and parents that have autistic children. It was then analyzed and the cut off points for each severity level; level 1 (mild), level 2 (moderate), and level 3 (severe) is determined. The fuzzy expert system processes are employed to detect the severity levels. The processes involve Fuzzy system architecture, fuzzification, rules evaluation, rules evaluation and defuzzification. The finding demonstrates that the system is able to detect autism severity level with a good accuracy. This system also accommodates with suitable recommendation based on the generated result whether the suggestion is to go for speech therapy or behavior therapy.

Introduction: Little is known about anxiety symptoms among diabetic patients, especially among those who are living in rural areas in Malaysia. Thus, the aim of this paper is to investigate the prevalence of anxiety among diabetic patients and factors associated with anxiety in rural communities in Malaysia. Methods: A cross-sectional study involving 464 diabetes mellitus patients in rural health districts and outpatient clinics in Malaysia was conducted. Each participant was interviewed using the Hospital Anxiety and Depression Scale. Results: Respondents consisted of 193 (41.6%) males and 271 (58.4%) females. The mean age of participants was 59.65 ± 10.16 years and the mean duration of diabetes mellitus was 6.9 ± 6.3 years. Results indicate that 15% of the participants have anxiety symptoms. Multiple logistic regression analysis revealed that patients with history of ischemic heart disease and depression and those who were underweight have higher anxiety scores with adjusted OR 5.06 (95% CI 1.79 to 14.27), 27.71 (95% CI 14.23 to 53.98) and 14.6 (95% CI 2.49 to 84.82), respectively. Conclusions: This study suggests that although the prevalence of anxiety among diabetics is low, primary care physician should be trained to identify high risk patients and to manage their condition in order to improve the clinical outcome.

Background Living arrangements play an important role in determining the quality of life (QoL) of people with dementia. Although informal care (home-based) is favored, the transition to formal (institutional) care often becomes necessary, especially in the later stages of dementia. Nevertheless, there is currently no definitive evidence showing that informal or formal care provides a higher QoL for those with dementia. Objective To compare the QoL of people with dementia in the nursing home and home care, and identify factors that differentiate their QoL. Design and methods This was a cross-sectional survey. A total of 49 people with dementia ≥60 years old were recruited from government nursing homes and hospitals (home care). Consenting participants were assessed on cognitive severity, QoL, activities of daily living (ADLs), depression, and social isolation/connectedness by the Short Mini Mental State Examination (SMMSE), the WHO-8 (the EUROHIS-QOL), Short Assessment of Quality of Life (AQoL-8), Barthel Index (BI), Cornell Scale for Depression (CSDD), and Friendship Scale (FS). Results There were significant differences in QoL, HRQoLs, ADLs, and social connectedness among people with dementia in home care ( n = 19) and those in nursing homes ( n = 30) ( p Conclusions Older adults with dementia who were living at home experienced higher QoL, ADLs, and social connectedness compared with those living in institutional care. Support should be provided enabling home care and empowering caregivers to provide better care for people with dementia.