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The polymorphisms of the 5HTR1A and 5HTR2A receptor genes (rs6295C/G and rs6311G/A) have been evaluated for association with SSRI treatment outcome in various populations with different results. The present study was carried out to determine the association between genotypes of HTR1A-rs6295 and HTR2A-rs6311 with SSRI treatment outcome among the ethnic Malay patients diagnosed with first-episode major depressive disorder (MDD). The patients were recruited from four tertiary hospitals in the Klang Valley region of Malaysia. Predefined efficacy phenotypes based on 25% (partial early response) and 50% (clinical efficacy response) reduction in Montgomery Asberg Depression Rating Scale-self Rated score (MADRS-S) were adopted for assessment of treatment efficacy in this study. Self-reporting for adverse effects (AE) was documented using the Patient Rated Inventory of Side Effect (PRISE) after treatment with SSRI for up to 6 weeks. Adjusted binary logistic regression between genotypes of the polymorphism obtained using sequencing technique with the treatment outcome phenotypes was performed. The 142 patients recruited were made up of 96 females (67.6%) and 46 males (32.4%). Clinical efficacy and Partial early response phenotypes were not significantly associated with genotypes of HTR1A and HTR2A polymorphism. The GG genotype of HTR2A polymorphism has decreased odds for dizziness (CNS) and increased odds for poor concentration. The GA genotype increases the odd for excessive sweating, diarrhoea, constipation and blurred vision. The CC genotype of HTR1A-rs6295 decreases the odd for nausea/vomiting and increases the odd for anxiety. Thus, some genotypes of HTR1A and HTR2A polymorphism were associated with SSRI treatment outcomes in ethnic Malay MDD patients.

Heritability of major depressive disorder (MDD) is between 36 and 44%, suggesting that up to nearly half of the phenotypic variability is attributable to genes. A number of genetic polymorphisms have been shown to predispose certain individuals to depression. Of particular interest are the polymorphisms of the vitamin D receptor (VDR) gene. Although the VDR gene has been well characterized and a vast number of polymorphisms have been identified, the association between BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236) single-nucleotide polymorphisms (SNPs), together with their haplotypes, and MDD risk have yet to be established. We conducted a matched case–control study with a total of 600 participants comprising 300 major depressive disorder (MDD) cases and 300 controls matched by age, gender and ethnicity in a 1:1 ratio, in four public hospitals in Kuala Lumpur and Selangor. Three adjacent SNPs of the VDR gene—BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236)—were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Odds ratios and 95% confidence intervals (CIs) were obtained from conditional logistic regression using Stata 16. Linkage disequilibrium and haplotype association with MDD were analyzed using the online SNPStats program. None of the genotypes of the three SNPs was significantly associated with risk of developing MDD after adjusting for confounding factors. However, the TAC (BAt) haplotype was associated with increased odds of MDD (adjusted OR = 2.17, 95% CI = 1.30–3.61, p = 0.003) using CCT (baT) as reference haplotype. The findings suggest that the BsmI-ApaI-TaqI TAC (BAt) haplotype of the VDR gene increases susceptibility to MDD.

Objectives: This study aimed to determine the prevalence of different types of intimate partner violence (IPV) experienced by married Iranian women and their impact on the growth and development of their children. Methods: For this descriptive-analytical study, we recruited the mothers of one-year-old children attending primary health centers in Gonbad-e-Kavoos city, Iran. The data was collected using a questionnaire comprising the World Health Organization Domestic Violence, Ages and Stages Questionnaire-12; and queries related to the participants’ socio-economic, obstetrics, demographic, and anthropometric characteristics. The body mass index z (BMI z) scores of the children were divided into five categories based on the World Health Organization’s classification: severely underweight (z < -3), underweight (-3 ≤ z < -2), normal (-2 ≤ z < 1), overweight (1 ≤ z ≤ 2), and obese (z > 2). The data were subjected to descriptive analysis, chi-square test, and regression. Results: A total of 596 of mother-child dyads were included in this study. The prevalence of psychological, physical, and sexual IPV was 29.5%, 7.4%, and 2.4%, respectively. Most children (91.7%) had normal weight while the rest were overweight or obese. Developmental problems were reported in 1.7% of children. The education level of the father was significantly related to IPV (p =0.001) while the type of his occupation was related to delay in child growth (p =0.020). There was no significant difference between BMI z-score and developmental disabilities in the children of women exposed and not exposed to any type of IPV. Conclusions: The prevalence of psychological IPV was high while those of physical and sexual IPV were low. The rates of poor child growth and development were also low. The father’s educational and socio-economic status influenced IPV and the children’s growth deficits.

Major depressive disorder (MDD) is a serious mental illness with a multifactorial aetiology that was shown to influence behaviour and affect cognition. Previous research has favoured the involvement of dopamine in the aetiology of the disorder, and since one of the critical regulators of the dopamine levels and activity in the brain is DAT1, the present study investigated the association of a single nucleotide polymorphism in the DAT1 gene (rs40184) and MDD in the Malaysian population. A total of 300 cases and 300 matched controls were recruited from four Klang valley hospitals and were screened for DAT1 rs40184 using high resolution melting assays. The allele and genotype frequencies were analysed by using Chi-square. Hardy Weinberg equilibrium for the distribution of alleles and genotypes was tested by using Chi-square. Determination of the association between rs40184 and MDD was achieved by conditional logistic regression using SPSS. In the present study, no significant association was obtained between DAT1 and MDD in the Malaysian population.

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.

Highlights • Discovery of new viruses have created a renewed interest in the epidemiology of respiratory viruses. • Respiratory viruses are the major cause of acute lower respiratory tract infections (ALRTIs) in children. • Assessment of the morbidity of specific etiological agents of ALRTIs is important to determine agent-specific interventions. • Sensitive and rapid diagnosis of respiratory infections in hospitalized children is cost-effective., Background The role of respiratory viruses as the major cause of acute lower respiratory tract infections (ALRTIs) in children is becoming increasingly evident due to the use of sensitive molecular detection methods. The aim of this study was to use conventional and molecular detection methods to assess the epidemiology of respiratory viral infections in children less than five years of age that were hospitalized with ALRTIs. Methods The cross-sectional study was designed to investigate the occurrence of respiratory viruses including respiratory syncytisl virus (RSV), human metapneumovirus (HMPV), influenza virus A and B (IFV-A and B), parainfluenzavirus 1, 2, 3 and 4 (PIV 1, 2, 3 and 4), human rhinoviruses (HRV), human enterovirus (HEV), human coronaviruses (HCoV) 229E and OC43, human bocavirus (HBoV) and human adenovirus (HAdV) in hospitalized children with ALRTIs, at Hospital Serdang, Malaysia, from June 16 to December 21, 2009. The study was also designed in part to assess the performance of the conventional methods against molecular methods. Results Viral pathogens were detected in 158 (95.8%) of the patients. Single virus infections were detected in 114 (67.9%) patients; 46 (27.9%) were co-infected with different viruses including double-virus infections in 37 (22.4%) and triple-virus infections in 9 (5.5%) cases. Approximately 70% of samples were found to be positive using conventional methods compared with 96% using molecular methods. A wide range of respiratory viruses were detected in the study. There was a high prevalence of RSV (50.3%) infections, particularly group B viruses. Other etiological agents including HAdV, HMPV, IFV-A, PIV 1–3, HBoV, HCoV-OC43 and HEV were detected in 14.5, 9.6, 9.1, 4.8, 3.6, 2.4 and 1.8 percent of the samples, respectively. Conclusion Our results demonstrated the increased sensitivity of molecular detection methods compared with conventional methods for the diagnosis of ARTIs in hospitalized children. This is the first report of HMPV infections in Malaysia.

Major depressive disorder (MDD) is primarily hinged on the presence of either low mood and/or anhedonia to previously pleasurable events for a minimum of 2 weeks. Other clinical features that characterize MDD include disturbances in sleep, appetite, concentration and thoughts. The combination of any/both of the primary MDD symptoms as well as any four of the other clinical features has been referred to as MDD. The challenge for replicating gene association findings with phenotypes of MDD as well as its treatment outcome is putatively due to stratification of MDD patients. Likelihood for replication of gene association findings is hypothesized with specificity in symptoms profile (homogenous clusters of symptom/individual symptoms) evaluated. The current review elucidates the genetic factors that have been associated with insomnia symptom of MDD phenotype, insomnia symptom as a constellation of neuro-vegetative cluster of MDD symptom, insomnia symptom of MDD as an individual entity and insomnia feature of treatment outcome. Homozygous CC genotype of 3111T/C, GSK3B-AT/TT genotype of rs33458 and haplotype of TPH1 218A/C were associated with insomnia symptom of MDD. Insomnia symptom of MDD was not resolved in patients with the A/A genotype of HTR2A-rs6311 when treated with SSRI. Homozygous short (SS) genotype-HTTLPR, GG genotype of HTR2A-rs6311 and CC genotype of HTR2A-rs6313 were associated with AD treatment-induced insomnia, while val/met genotype of BDNF-rs6265 and the TT genotype of GSK-3beta-rs5443 reduced it. Dearth of association studies may remain the bane for the identification of robust genetic endophenotypes in line with findings for genotypes of HTR2A-rs6311.

This study aimed to determine the prevalence of depression, anxiety, and the associated factors among 632 adolescents (age range: 13-17 years, Mage = 14.47, SD = 1.32) staying in sheltered homes in Malaysia. The Malay versions of the Beck Depression Inventory, Beck Anxiety Inventory, Automatic Thoughts Questionnaire, and Rosenberg Self-Esteem Scale were applied. The overall prevalence of mild to severe depression and anxiety in this study was 70.9% and 82.3% respectively, with 64.1% for comorbidity of both symptoms. Specifically, the prevalence rates of minimal, mild, moderate, and severe depressive symptoms were 29.1%, 38.4%, 22.4%, and 10.1% respectively whereas the prevalence rates of minimal, mild, moderate, and severe anxiety symptoms were 17.7%, 27.7%, 33.2%, and 21.4% respectively. The severity of negative automatic thoughts increased with the severity of depression and anxiety. Age, anxiety, negative automatic thoughts, and self-esteem were significantly associated with depression while depression, negative automatic thought, and anger were significantly associated with anxiety. The high rates of depression and anxiety among adolescents residing in the sheltered homes indicate the need to identify these at-risk populations and provide trained personnel who can deliver psychiatric and psychological services at sheltered homes.

The purpose of this study was to evaluate the psychometric properties of the Malay version of the Beck Youth Inventories-Second Edition (BYI-2 Malay) in a sample of adolescents living in the nongovernment-run sheltered homes. In this study, 300 adolescents completed the BYI-2 Malay, the Beck Depression Inventory-Malay (BDI-Malay), the Beck Anxiety Inventory-Malay (BAI-Malay), the Automatic Thoughts Questionnaire-Malay (ATQ-Malay), and the Rosenberg Self-Esteem Scale-Malay (RSES-Malay). The internal consistency estimates for the BYI-2 Malay scales, as measured by Cronbach’s alpha, were excellent: .86 for self-concept, .89 for anxiety, .92 for depression, .92 for anger, and .92 for disruptive behaviours. The five-factor model of the BYI-2 Malay (i.e., Self-Concept, Anxiety, Depression, Anger, and Disruptive Behaviour) showed a good fit to the data. Evidence for concurrent validity was established between the BYI-2 Malay Self-Concept scale and the RSES-Malay (r = .41), between the BYI-2 Malay Anxiety scale and the BAI-Malay (r = .60), and between the BYI-2 Malay Depression scale and the BDI-Malay (r = .69). The evidence for convergent validity was established between the BYI-2 Malay Anger scale and the ATQ-Malay (r = .71), and between BYI- 2 Malay Disruptive Behaviour scale and the ATQ Malay (r =.52). The present findings shed light on the utility of the BYI-2 Malay in aiding clinicians as well as therapists for identifying multiple symptoms of social and emotional problems in adolescents.

COVID-19 is a global health emergency. People living with human immunodeficiency virus (PLHIV) have concerns about whether they have a higher risk of getting the infection and suffer worse COVID-19 outcomes. Findings from studies on these questions have largely been inconsistent. We aimed to determine the epidemiological characteristics, clinical signs and symptoms, blood parameters, and clinical outcomes among PLHIV who contracted COVID-19. Relevant studies were identified through Medline, Cinahl, and PubMed databases. A random-effects model was used in meta-analyses with a 95% confidence interval. Eighty-two studies were included in the systematic review and sixty-seven studies for the meta-analysis. The pooled incidence proportion of COVID-19 among PLHIV was 0.9% (95% CI 0.6%, 1.1%) based on the data from seven cohort studies. Overall, 28.4% were hospitalised, of whom, 2.5% was severe-critical cases and 3.5% needed intensive care. The overall mortality rate was 5.3%. Hypertension was the most commonly reported comorbidity (24.0%). Fever (71.1%) was the most common symptom. Chest imaging demonstrated a wide range of abnormal findings encompassing common changes such as ground glass opacities and consolidation as well as a spectrum of less common abnormalities. Laboratory testing of inflammation markers showed that C-reactive protein, ferritin, and interleukin-6 were frequently elevated, albeit to different extents. Clinical features as well as the results of chest imaging and laboratory testing were similar in highly active antiretroviral therapy (HAART)-treated and non-treated patients. PLHIV were not found to be at higher risk for adverse outcomes of COVID-19. Hence, in COVID-19 management, it appears that they can be treated the same way as HIV negative individuals. Nevertheless, as the pandemic situation is rapidly evolving, more evidence may be needed to arrive at definitive recommendations.

Although depression after pregnancy may resemble other forms of depression, it has its own uniqueness, happening at a time in which pregnancy and parturition play an inherently vital role in influencing its occurrence and sequelae. High-income countries tend to have lower prevalence of PPD compared to low- to middle-income countries. Strong predictors of postpartum depression (PPD) include depression during pregnancy, various stressors, lack of social support, and a previous history of depression. Several hypotheses on the etiology of PPD have been proposed and tested, including neurobiological pathogenesis involving hormonal changes and inflammatory processes as well as genetic susceptibility. The approach to managing PPD should be comprehensive and multidisciplinary as suffering mothers, infants, and their families are affected. Apart from ensuring that depressive symptoms are treated using pharmacological or psychotherapeutic approaches, safety and well being of mothers and infants need to be considered. Preventive interventions to alleviate the major risk factors that make women vulnerable to developing PPD could be instituted at any stage of a woman’s reproductive life.

The objective of this study was to evaluate the effect of a family-based intervention program (REDUCE) on children&rsquo, s eating behaviors and dietary intake. A two-arm randomized controlled field trial was conducted among parents and children of 7 to 10 years old who were either overweight or obese. The intervention was conducted via face-to-face sessions and social media. The child eating behaviors were assessed using the child eating behaviors questionnaire (CEBQ), while their dietary consumption of vegetables and unhealthy snacks was assessed using a parental report of three days unweighted food. The generalized linear mixed modelling adjusted for covariates was used to estimate the intervention effects with alpha of 0.05. A total of 122 parents (91% response rate) completed this study. At the six-month post-training, there were statistically significant mean differences in the enjoyment of food (F(6481) = 4.653, p &lt, 0.001), fruit and vegetable intake (F(6480) = 4.165, p &lt, 0.001) and unhealthy snack intake (F(6480) = 5.062, p &lt, 0.001) between the intervention and wait-list groups, however, it was not clinically meaningful. This study added to the body of knowledge of family-based intervention that utilized social media and assessed the effect in children&rsquo, s eating behavior using the CEBQ and children&rsquo, s dietary intake.

Objective Depression is the second leading cause of morbidity worldwide. This study aimed to assess the prevalence and associated risk factors of paternal postpartum depressive symptoms (PPD). Methods In a cross-sectional study, via a stratified random and convenience sampling method 591 couples who were referred to Mazandaran primary health centers between 2 and 8 weeks postpartum were recruited from March to October 2017. Couples were screened for depressive symptoms using Edinburgh Postnatal Depression Scale (EPDS). Fathers provided information on socio-demographic characteristics, life events, neonatal stressor, perceived stress (Perceived Stress Scale), social support (Multidimensional Scale of Perceived Social Support), and general health status using General Health Questionnaire (GHQ-12) as well. Data was analyzed using multiple logistic regression. Results Overall, 93 fathers (15.7%) and 188 mothers (31.8%) reported depressive symptoms above the cut-off EPDS score of 12. In the multiple logistic regression model, older age, maternal depressive symptoms, higher GHQ-12 scores and increased recent life events were related to paternal PPD. A significant inverse association was found between number of children and paternal PPD. Conclusion Depressive symptoms especially in first-time fathers following the birth of a child are not uncommon. Creating opportunities for men to access special health care services, parental education to help adapting to parenthood, screening programs, and psychiatric/psychosocial interventions to decrease suffering of depression for both depressed parents are recommended.

Background: Psychosocial interventions for patients with osteoarthritis (OA) of the knee to reduce pain and improve physical and psychological functioning are still lacking in Malaysia. Methods: A parallel-group unblinded randomized controlled trial involving 300 patients was conducted in two hospital orthopedics clinics in Malaysia. Patients were randomly assigned to receive cognitive behavioral-based group therapy (n = 150) or no further intervention (n = 150). The primary outcome was the change from baseline in knee pain as determined by the Knee injury and Osteoarthritis Outcome Score (KOOS) at 6 months. The data collected were analyzed by covariate-adjusted mixed design repeated measures analysis of variance. All analyses were performed under the terms of intention-to-treat. Results: At 6 months, mean change from baseline in the KOOS knee pain score was 0.6 points (95% CI &minus, 1.73 to 2.94) in the control group and 8.9 points (95% CI 6.62 to 11.23) (denoting less knee pain intensity) in the intervention group (significant treatment effect p &lt, 0.0001). Patients treated with such an approach also experienced significant improvement in functional ability when performing activities of daily living and had improved ability to cope with depression, anxiety and pain catastrophizing. Conclusion: The intervention module delivered by healthcare professionals had a sustained effect on knee OA pain and functionality over 6 months, thereby leading to an overall improvement in psychological well-being, thus benefitting most of the Malaysian knee OA patients.

Heritability of major depressive disorder (MDD) is between 36 and 44%, suggesting that up to nearly half of the phenotypic variability is attributable to genes. A number of genetic polymorphisms have been shown to predispose certain individuals to depression. Of particular interest are the polymorphisms of the vitamin D receptor (VDR) gene. Although the VDR gene has been well characterized and a vast number of polymorphisms have been identified, the association between BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236) single-nucleotide polymorphisms (SNPs), together with their haplotypes, and MDD risk have yet to be established. We conducted a matched case-control study with a total of 600 participants comprising 300 major depressive disorder (MDD) cases and 300 controls matched by age, gender and ethnicity in a 1:1 ratio, in four public hospitals in Kuala Lumpur and Selangor. Three adjacent SNPs of the VDR gene-BsmI (rs1544410), ApaI (rs7975232) and TaqI (rs731236)-were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Odds ratios and 95% confidence intervals (CIs) were obtained from conditional logistic regression using Stata 16. Linkage disequilibrium and haplotype association with MDD were analyzed using the online SNPStats program. None of the genotypes of the three SNPs was significantly associated with risk of developing MDD after adjusting for confounding factors. However, the TAC (BAt) haplotype was associated with increased odds of MDD (adjusted OR = 2.17, 95% CI = 1.30-3.61, p = 0.003) using CCT (baT) as reference haplotype. The findings suggest that the BsmI-ApaI-TaqI TAC (BAt) haplotype of the VDR gene increases susceptibility to MDD.

The polymorphisms of the 5HTR1A and 5HTR2A receptor genes (rs6295C/G and rs6311G/A) have been evaluated for association with SSRI treatment outcome in various populations with different results. The present study was carried out to determine the association between genotypes of HTR1A-rs6295 and HTR2A-rs6311 with SSRI treatment outcome among the ethnic Malay patients diagnosed with first-episode major depressive disorder (MDD). The patients were recruited from four tertiary hospitals in the Klang Valley region of Malaysia. Predefined efficacy phenotypes based on 25% (partial early response) and 50% (clinical efficacy response) reduction in Montgomery Asberg Depression Rating Scale-self Rated score (MADRS-S) were adopted for assessment of treatment efficacy in this study. Self-reporting for adverse effects (AE) was documented using the Patient Rated Inventory of Side Effect (PRISE) after treatment with SSRI for up to 6 weeks. Adjusted binary logistic regression between genotypes of the polymorphism obtained using sequencing technique with the treatment outcome phenotypes was performed. The 142 patients recruited were made up of 96 females (67.6%) and 46 males (32.4%). Clinical efficacy and Partial early response phenotypes were not significantly associated with genotypes of HTR1A and HTR2A polymorphism. The GG genotype of HTR2A polymorphism has decreased odds for dizziness (CNS) and increased odds for poor concentration. The GA genotype increases the odd for excessive sweating, diarrhoea, constipation and blurred vision. The CC genotype of HTR1A-rs6295 decreases the odd for nausea/vomiting and increases the odd for anxiety. Thus, some genotypes of HTR1A and HTR2A polymorphism were associated with SSRI treatment outcomes in ethnic Malay MDD patients.

A total of 201 patients with major depressive disorder from four hospitals in Malaysia were followed up for 5 years to determine the prognostic factors of recurrent major depressive disorder that could potentially contribute to improving the management of MDD patients. For each individual patient, at the time of recruitment as part of a case-control study, information was collected on recent threatening life events, personality and social and occupational functioning, while blood samples were collected to genotype single nucleotide polymorphisms of vitamin D receptor (VDR), zinc transporter-3 (ZnT3), dopamine transporter-1 (DAT1), brain-derived neurotropic factor (BDNF), serotonin receptor 1A (HT1A) and 2A (HT2A) genes. Kaplan-Meier and Cox-regression were used to estimate hazard functions for recurrence of major depressive disorder. Individuals with severe MDD in previous major depressive episodes had five and a half times higher hazard of developing recurrence compared to mild and moderate MDD (HR = 5.565, 95% CI = 1.631-18.994, p = 0.006). Individuals who scored higher on social avoidance had three and a half times higher hazard of recurrence of MDD (HR = 3.525, 95% CI = 1.349-9.209; p = 0.010). There was significant interaction between ApaI +64978C>A single nucleotide polymorphism and severity. The hazard ratio increased by 6.4 times from mild and moderate to severe MDD for A/A genotype while that for C/A genotype increased by 11.3 times. Social avoidance and severity of depression at first episode were prognostic of recurrence. Screening for personality factors at first encounter with MDD patients needs to be considered as part of the clinical practice. For those at risk of recurrence in relation to social avoidance, the psychological intervention prescribed should be customized to focus on this modifiable factor. Prompt and appropriate management of severe MDD is recommended to reduce risk of recurrence.

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

Using Complementary and Alternative Medicine (CAMs) is growing worldwide. This study determined the midwives' attitude toward CAMs in general and their view on its safety and efficacy during pregnancy. Via a random sampling method, 344 midwives working in Mazandaran primary health centers (PHC) were recruited from March to November 2017. The data were analyzed using descriptive statistics. The majority of the midwives had positive view on the usefulness of CAMs in general (74.3 %) and thought they should have more knowledge about it (76.7 %). While 50-83 % of the midwives considered some CAM-therapies safe and beneficial, a small number of them referred the patients for CAM-therapy during pregnancy (1.2-5.4 %). A minority of the midwives stated that CAM may be a threat to public health (12.7 %). The midwives' perception toward the usefulness of CAM in general was positive; although, they approved the benefit of few CAMs during pregnancy. A small minority of the midwives considered CAMs as a threat to public health, and few of them advised the patients to use CAMs during pregnancy. As most midwives are interested in learning in this field, it is recommended to run some training programs on the benefit and side effects of CAMs.

Background: Post-partum depression (PPD) is the most prevalent mental problem associated with childbirth. Studies are inconsistent as to whether geographical location is linked with the risk of post-partum depression. Objectives: The current study examined and compared the prevalence and risk factors for post-partum depression in urban and rural areas. Methods: A prospective cohort study was conducted on 2279 pregnant women in Mazandaran based urban and rural areas. Edinburgh postnatal depression scale (EPDS) and other validated instruments were applied to assess the similarities and differences between depression prevalence rate within 12 postpartum weeks and two women groups’ characteristics. Logistic regression model was used to distinguish PPD risk factors in urban and rural residents. Results: PPD prevalence rate was slightly higher among the urban women (20.1%) than that of the rural ones (17.8%) with no significant difference. Although the established PPD risk factors such as prenatal depression and lack of parental self-efficacy were associated with PPD in both groups of women, the rural-specific risk factors such as socio-demographic and health problems were related to PPD in rural areas and social isolation predisposed urban women to PPD. Conclusions: PPD is a significant health problem among women regardless of their place. The increased PPD risk in each residence is associated with unique risk factors requiring specific interventions.

The abstract not available.

Background Brain-derived neurotrophic factor (BDNF) is a neurotrophin found in abundance in brain regions such as the hippocampus, cortex, cerebellum and basal forebrain. It has been associated with the risk of susceptibility to major depressive disorder (MDD). This study aimed to determine the association of three BDNF variants (rs6265, rs1048218 and rs1048220) with Malaysian MDD patients. Methods The correlation of these variants to the plasma BDNF level among Malaysian MDD patients was assessed. A total of 300 cases and 300 matched controls recruited from four public hospitals within the Klang Valley of Selangor State, Malaysia and matched for age, sex and ethnicity were screened for BDNF rs6265, rs1048218 and rs1048220 using high resolution melting (HRM). Findings BDNF rs1048218 and BDNF rs1048220 were monomorphic and were excluded from further analysis. The distribution of the alleles and genotypes for BDNF rs6265 was in Hardy-Weinberg equilibrium for the controls (p = 0.13) but was in Hardy Weinberg disequilibrium for the cases (p = 0.011). Findings from this study indicated that having BDNF rs6265 in the Malaysian population increase the odds of developing MDD by 2.05 folds (95% CI = 1.48–3.65). Plasma from 206 cases and 206 controls were randomly selected to measure the BDNF level using enzyme-linked immunosorbent assay (ELISA). A significant decrease in the plasma BDNF level of the cases as compared to controls (p

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.

Objectives Cultural practices have been found to positively impact the mothering experience. This study sought to identify the relationship between sociocultural practices and postpartum depression (PPD) in a cohort of Iranian women for the first time. Materials and methods In a longitudinal cohort design, 2279 pregnant women attending primary health centers of Mazandaran province in Iran were recruited using stratified random sampling method. Data were collected using the Edinburgh Postnatal Depression Scale and researchers developed validated cultural practices questionnaire at 3 months after delivery. Data were analyzed using Chi-square test and multiple logistic regression models. Results The prevalence of PPD was 19% among 1910 women who were followed postdelivery in this study. Cultural practices were not associated with lower odds of PPD in multiple logistic regression model after adjustment for all sociodemographic factors. The results of this study do not also provide any evidence to support that sex of baby is associated with the greater risk of PPD. Conclusions Cultural practices could not be perceived as protective mechanisms that protect women from PPD in this traditional society. However, health professionals should be familiar with postpartum beliefs and practices that could support mothers in the postpartum period.

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.

Purpose: The study aims at investigating the relationship between environmental and hereditary causes of reproductive behaviour, which would otherwise be difficult to study. Materials and Methods: This cross-sectional descriptive study of the female reproductive health of twins investigated the heritability of qualitative and quantitative measured variables related to the reproductive behaviour of adult twins. Subjects included192 identical and non-identical twins, 15 years of age and above, who were living in urban areas of Malaysia. Results: Basic genetic analysis for variables related to reproductive behaviour revealed that the age of first pregnancy, number of pregnancies and age of first marriage were under genetic influence. Proband wise concordance rate analysis showed higher similarity between identical twins in adopting recommended reproductive behaviour such as undergoing pap smears and using family planning techniques. The model-fitting analysis supported these findings.

Head and neck squamous cell carcinoma (HNSCC) represents a significant world health problem, with approximately 600,000 new cases being diagnosed annually. The prognosis for patients with HNSCC is poor and, therefore, the identification of biomarkers for screening, diagnosis and prognostication would be clinically beneficial. A limited number of studies have used lipidomics to profile lipid species in the plasma of cancer patients. However, the profile and levels of lysophosphatidic acid (LPA) species have not been examined in HNSCC. In this study, a targeted lipidomics approach using liquid chromatography triple quadrupole mass spectrometry (LCMS/MS) was used to analyse the concentration of LPA (16:0 LPA, 18:0 LPA, 18:1 LPA, 18:2 LPA and 20:4 LPA) in the plasma of patients with oral squamous cell carcinoma (OSCC) and nasopharyngeal carcinoma (NPC), together with healthy controls. The levels of three LPA species (18:1 LPA, 18:2 LPA and 20:4 LPA) were significantly lower in the plasma of OSCC patients, whilst the concentrations of all five LPA species tested were significantly lower in plasma from NPC patients. Furthermore, the order of abundance of LPA species in plasma was different between the control and cancer groups, with 16:0 LPA, 18:0 LPA levels being more abundant in OSCC and NPC patients. Medium to strong correlations were observed using all pairs of LPA species and a clear separation of the normal and tumour groups was observed using PCA analysis. In summary, the results of this study showed that the levels of several LPA species in the plasma of patients with OSCC and NPC were lower than those from healthy individuals. Understanding these variations may provide novel insights into the role of LPA in these cancers.

ObjectiveThe current study aimed to investigate the relationships among the perceived quality of healthcare services, satisfaction and behavioural intentions among international students in Kuala Lumpur, Malaysia.SettingA cross-sectional study on public universities in Kuala Lumpur, Malaysia.ParticipantsAll participants in this study were international students joining public universities in Kuala Lumpur, Malaysia.Primary independent variablePerceived quality of healthcare services measured on a SERVQUAL scale.Primary dependent variableParticipants’ satisfaction of healthcare services assessed using five items.Secondary dependent variableBehavioural intentions measured on six items.ResultsOf the 556 international students, 500 (90%) completed the survey. The study used structural equation modelling (SEM) through the AMOS (Analysis of Moment Structures) software to analyse the data. SEM analyses showed that the perceived quality of healthcare services significantly and directly affected satisfaction, with a value of 89% and an effect size of 0.78. It also had a significant indirect impact on the behavioural intentions (0.78) of international students. The results indicated that participants’ satisfaction had a statistically significant impact on their behavioural intentions (0.77).ConclusionPerceived quality of care is an important driver of international students’ satisfaction and their behavioural intention with healthcare services. Such relations of effects among the three investigated factors were also positive and significant.

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of bromocriptine for type 2 diabetes mellitus.

Purpose: To evaluate the association between preconception care and the risk of adverse birth outcomes. Design: A quasi-experimental study comparing 2 groups: (1) integrated maternal health care (MHC) program (with preconception care) and (2) standard MHC program (without preconception care). Setting: Maternal health-care clinics in Alvand and Qazvin cities in Qazvin Province, Iran. Participants: A total of 152 and 247 Iranian women aged 16 to 35 years were enrolled in the integrated MHC and standard MHC program, respectively. Measures: The birth outcomes measured included low birth weight, preterm birth, maternal and neonatal complications, and mode of delivery (normal vaginal delivery and cesarean delivery). Analysis: Multiple logistic regression was performed to determine the impact of preconception care and risk of adverse birth outcomes with adjusted odds ratios (ORs) as effect sizes. Results: One hundred forty-seven women in integrated MHC and 218 women in standard MHC completed this study. Preconception care was associated with reduced risk of preterm birth (OR = 0.298; 95% confidence interval [CI] = 0.120-0.743; P = .009), low birth weight (OR = 0.406; 95% CI = 0.169-0.971; P = .043), maternal complication (OR = 0.399; 95% CI = 0.241-0.663; P < .001), and neonatal complications (OR = 0.460; 95% CI = 0.275-0.771; P = .003). Conclusion: The findings of the present study revealed advantages of preconception care with reduced adverse birth outcomes.

2017 CONSORT checklist of information to include when reporting a randomized trial assessing nonpharmacologic treatments (NPTs). (DOCX 51 kb)