Stress and Coping Strategies in Malay Parents of Children with Cleft Lip and/or Palate.

OBJECTIVE: This study was aimed at describing the level of stress and types of coping strategies used among Malay parents of children with cleft lip and/or palate (CL/P). DESIGN: Cross-sectional study. SETTING: A dental clinic and a general hospital. PARTICIPANTS: Parents (N = 84) whose children were less than 12 years old with CL/P. METHODS: Socio-demographic data and clinical characteristics of CL/P were collected. Self-administered validated Malay versions of the stress scale from the Depressive, Anxiety and Stress Scale-42 (DASS-42) and COPE Inventory questionnaires were used. Descriptive statistics and Multivariate Analysis of Covariance were used for data analysis. RESULTS: The prevalence of stress among parents of children with CL/P was 21.4% [95% confidence interval (12.4, 30.4)]. The most common coping strategies were problem-focused (mean 58.15, standard deviation (SD) 7.75), followed by emotion-focused (mean 54.05, SD 4.78). The adjusted mean score for overall coping strategies was significantly different between stressed and non-stressed parents after adjustment for education, number of children, sex of child with CL/P, and cleft type [F (df) = 4.174 (3,74), P = .009]. There was a significant mean difference between stressed and non-stressed parents for avoidant coping strategies [P = .003]. Problem-focused and emotion-focused coping strategies did not differ after Bonferroni correction. CONCLUSIONS: Around a fifth of parents caring for children with CL/P experienced stress and avoidant coping strategies were more common among stressed parents. Multi-disciplinary team care should provide social support to parents of children with CL/P.

Attitude Towards Anti-smoking Measures and Its Associated Factors Among Adults in Sub-urban Area, in Kuala Terengganu, Terengganu, Malaysia

@#Introduction: General population across different countries have shown an overall support for anti-smoking measures that vary significantly by certain population parameters. However, characteristics of the public attitude in a community who has been exposed to prolonged awareness campaigns and smoke-free area legislation is unclear. Consequently, we investigate residents who reside next to Batu Buruk beach in Kuala Terengganu city which has been gazetted as a smoke-free area since 2017. Methods: The cross-sectional study involves self-administered validated questionnaires. Multiple linear regression with forward method was applied to identify significant factors associated with the attitude towards anti-smoking measures. Results: A total of 295 residents participated. Most of them were Malays (96.6%), married (64.4%), attained up to the secondary school level (45.4%) and employed (59.7%). The mean value of the total attitude scores was 181.86 (range: 70-200). Multivariate analyses revealed those having higher monthly income had a higher total attitude scores (adjusted b: 6.91, 95% CI: 2.15, 11.66), while current daily smokers had a lower total attitude scores towards anti-smoking measures than non-smokers (adjusted b: -23.30, 95% CI: -29.55, -17.05). These findings highlight comparatively stronger and more consistent support for anti-smoking measures that may vindicate high-stake investment and legislation against smoking. Conclusion: The novel evidence may also better-inform the strategy to expand the initiatives further through profiling the target population with heightened emphasis on the economic standing and prevalence of current daily smokers. Future research may adopt experimental design to establish causality relationship between predictors and outcomes revealed in this community.

Do Our Diabetic Patients Ready for Safe Pregnancy? Attitude Towards Preconception Care and Its Associated Factors Among Women With Diabetes Attending Government Health Clinics in Terengganu

@#Introduction: Women with uncontrolled diabetes may conceive but will result in poor pregnancy outcomes. This study aimed to assess the level of knowledge and attitude and determine factors associated with attitude towards preconception care. Method: A cross-sectional study was conducted in various government health clinics from all districts in Terengganu by using multistage random sampling. A self-administered questionnaire was applied to assess the level of knowledge and attitude towards preconception care. Multiple logistic regressions were applied to determine factors associated with attitude towards preconception care. Results: A total of 422 respondents were involved. The prevalence of respondents with unsatisfactory knowledge and attitude were 41.7% and 84.1%, respectively. Knowledge was not significantly associated with attitude. Respondents who used contraception had a better attitude (Adj. OR: 0.44, 95% CI:0.23,0.84). Low household income was associated (Adj. OR: 2.40, 95% CI:1.10,5.26) with an unsatisfactory attitude towards preconception care. Conclusion: Attitude towards preconception care amongst diabetic women who were attending primary care clinics was unsatisfactory. A structured and focused preconception educational programme care is necessary, especially amongst low-income women.

Psychosocial Burden Among Women With Abnormal Pap Smear And Post Colposcopy In Malaysia

@#Objective: The purpose of this study was to determine the level of psychosocial burden and its associated risk factors among women with abnormal Pap smear and post colposcopy. Methods: A cross-sectional study was conducted employing universal sampling of 218 respondents with abnormal Pap smear and post colposcopy. They fulfilled the specific inclusion and exclusion criteria. Three tertiary hospitals in the East Coast of Malaysia were participated. Self-administration of validated Malay-version Psychosocial Effect of Abnormal Pap smear Questionnaire was used to assess the psychosocial burden. The General Health Questionnaire-12 (GHQ-12) was applied to assess the general health factor. Data was analyzed using IBM-SPSS of version 22. Results: The results showed that respondents with an abnormal Pap smear and post-colposcopy women (43.1%) demonstrated a high level of psychosocial burden. The significant risk factor of psychosocial burden was living in an urban and semi-urban area of residence (p = <0.001) and distress condition (p = <0.001) respectively. Conclusions: A substantial number of women with abnormal Pap smear results were experiencing psychosocial burden. Women with an abnormal Pap-smear who were living in the urban and semi-urban and distressed were more likely to experience a higher psychosocial burden.

General Health And Psychosocial Burden Among Women With Abnormal Pap Smear After Post Colposcopy

@# The identification of psychosocial burden and general health among women with abnormal Pap smear results was fundamentally important because women play the significant role in the family and community. The purpose of this study was to determine the level of psychosocial burden, level of general health and relationship between psychosocial burden with general health among women with abnormal Pap smear after colposcopy. This crosssectional study was done towards 218 women with abnormal Pap smear after colposcopy. Universal sampling at gynecology clinic from three tertiary hospitals in the East Coast of Malaysia was conducted. Respondents selfanswered the validated Malay version of Psychosocial Effect of Abnormal Pap smear Questionnaire and General Health Questionnaire-12 in Malay version. Data were analyzed by using statistical software IBM-SPSS version 22, descriptive statistical method, Pearson and Spearman Correlation coefficient analysis were used. The results revealed that 43.1% and 16.5% of women with psychosocial burden were having distress due to abnormal Pap smear after colposcopy. The correlation coefficient showed a significant moderate correlation between psychosocial burden and general health (r = 0.41 and p=0.000). The women are facing psychosocial burden and distress in life after being diagnosed with abnormal Pap smear, because it is related to physical and psychological aspects. This shown that psychological aspect is important in health, therefore health care needs to perform the assessment of the psychosocial burden and general health among women with abnormal Pap smear in Malaysia.

Reporting Statistical Results in Medical Journals.

Statistical editors of the Malaysian Journal of Medical Sciences (MJMS) must go through many submitted manuscripts, focusing on the statistical aspect of the manuscripts. However, the editors notice myriad styles of reporting the statistical results, which are not standardised among the authors. This could be due to the lack of clear written instructions on reporting statistics in the guidelines for authors. The aim of this editorial is to briefly outline reporting methods for several important and common statistical results. It will also address a number of common mistakes made by the authors. The editorial will serve as a guideline for authors aiming to publish in the MJMS as well as in other medical journals.

Immediate and long-term relationship between severe maternal morbidity and health-related quality of life: a prospective double cohort comparison study.

BACKGROUND: Given the growing interest in severe maternal morbidity (SMM), the need to assess its effects on quality of life is pressing. The objective of this study was to compare the quality of life scores between women with and without SMM at 1-month and 6-month postpartum in Kelantan, Malaysia. METHODS: A prospective double cohort study design was applied at two tertiary referral hospitals over a 6-month period. The study population included all postpartum women who delivered in 2014. Postpartum women with and without SMM were selected as the exposed and non-exposed groups, respectively. For each exposed case identified, a non-exposed case with a similar mode of delivery was selected. The main outcome measures used were scores from the Short Form-12 Health Survey (SF-12). RESULTS: The study measured 145 exposed and 187 non-exposed women. The group-time interaction of the repeated measure analysis of variance (RM ANOVA) showed no significant difference in the mean overall SF-12 physical component summary score changes (P = 0.534) between women with and without SMM. Similarly, the group-time interaction of the RM ANOVA showed no significant difference in the mean overall SF-12 mental component summary score changes (P = 0.674) between women with and without SMM. However, women with SMM scored significantly lower on a general health perceptions subscale at 1-month (P = 0.031), role limitations due to physical health subscale at 6-month (P = 0.019), vitality subscale at 1-month (P = 0.007) and 6-month (P = 0.008), and role limitations due to emotional problems subscales at 6-month (P = 0.008). CONCLUSIONS: Women with severe maternal morbidity demonstrated comparable quality of life during the 6-month postpartum period compared to women without severe maternal morbidity.

Factors associated with severe maternal morbidity in Kelantan, Malaysia: A comparative cross-sectional study.

BACKGROUND: Knowledge on the factors associated with severe maternal morbidity enables a better understanding of the problem and serves as a foundation for the development of an effective preventive strategy. However, various definitions of severe maternal morbidity have been applied, leading to inconsistencies between studies. The objective of this study was to identify the sociodemographic characteristics, medical and gynaecological history, past and present obstetric performance and the provision of health care services as associated factors for severe maternal morbidity in Kelantan, Malaysia. METHODS: A comparative cross-sectional study was conducted in two tertiary referral hospitals in 2014. Postpartum women with severe morbidity and without severe morbidity who fulfilled the inclusion and exclusion criteria were eligible as cases and controls, respectively. The study population included all postpartum women regardless of their age. Pregnancy at less than 22 weeks of gestation, more than 42 days after the termination of pregnancy and non-Malaysian citizens were excluded. Consecutive sampling was applied for the selection of cases and for each case identified, one unmatched control from the same hospital was selected using computer-based simple random sampling. Simple and multiple logistic regressions were performed using Stata Intercooled version 11.0. RESULTS: A total of 23,422 pregnant women were admitted to these hospitals in 2014 and 395 women with severe maternal morbidity were identified, of which 353 were eligible as cases. An age of 35 or more years old [Adj. OR (95 % CI): 2.6 (1.67, 4.07)], women with past pregnancy complications [Adj. OR (95 % CI): 1.7 (1.00, 2.79)], underwent caesarean section deliveries [Adj. OR (95 % CI): 6.8 (4.68, 10.01)], preterm delivery [Adj. OR (95 % CI): 3.4 (1.87, 6.32)] and referral to tertiary centres [Adj. OR (95 % CI): 2.7 (1.87, 3.97)] were significant associated factors for severe maternal morbidity. CONCLUSIONS: Our study suggests the enhanced screening and monitoring of women of advanced maternal age, women with past pregnancy complications, those who underwent caesarean section deliveries, those who delivered preterm and the mothers referred to tertiary centres as they are at increased risk of severe maternal morbidity. Identifying these factors may contribute to specific and targeted strategies aimed at tackling the issues related to maternal morbidity.

Severe Maternal Morbidity and Postpartum Depressive Symptomatology: A Prospective Double Cohort Comparison Study.

The adverse consequences to mothers of postpartum depression are well-documented, and risk factors are of interest. There is limited evidence on postpartum depression among women with severe maternal morbidity, defined as potentially life-threatening conditions during pregnancy, childbirth, or soon after termination of pregnancy. We compared postpartum depressive symptoms of postpartum women aged 18 and older who delivered in two tertiary referral hospitals in 2014 in Kelantan, Malaysia, and had (n = 145) or had not (n = 187) suffered severe maternal morbidity. A prospective double cohort study design was applied. Postpartum depressive symptoms were assessed at 1 and 6 months postpartum using the Malay version of the Edinburgh Postnatal Depression Scale. There was no significant difference in the mean Edinburgh Postnatal Depression Scale score changes (p = .803) between the two groups of women, after adjusting for age, social support, physical health, occupation, and education. Factors other than severe medical complications should be pursued as predictors of postpartum depressive symptomatology. © 2016 Wiley Periodicals, Inc.

Functional status of women with and without severe maternal morbidity: A prospective cohort study.

BACKGROUND: Little is known regarding the impact on maternal functional status in women who have survived severe obstetric complications. OBJECTIVE: To compare the maternal functional status score between women with and without severe morbidity at one month and six months postpartum in Kelantan, Malaysia. METHODS: A prospective cohort study design was applied at two tertiary referral hospitals over a six-month period. The study population included all postpartum women who gave birth in 2014. Postpartum women with severe maternal morbidity and without severe maternal morbidity were selected as the exposed and non-exposed group, respectively. Functional ability based on the Inventory of Functional Status after Childbirth was used as the main outcome measure. Repeated measure analysis of variance was performed. RESULTS: A total of 145 and 187 women with and without severe maternal morbidity, respectively, were measured. There were significant differences in Inventory of Functional Status after Childbirth score changes (P<0.001) between women with and without severe maternal morbidity at one month and at six months. Functional ability score of women with severe maternal morbidity was lower at one month postpartum (P=0.001). The most affected domain was infant care (P=0.002). CONCLUSIONS: Healthcare providers are recommended to assess the short-term functional ability of severe morbid mother in addition to existing routine physical examination. Provision of physical support from spouse and family of the high risk mothers particularly on infant care during their early postpartum period is crucial to optimise health and minimise the negative health outcomes.

Coping Among Flood Affected Traditional Village Residents In Kuala Nerus, Terengganu

The communities settled in this traditional flood-prone area are potentially at risk of frequent inundation. This compelled the affected population to cope or adapt some strategy to reduce the negative impacts on their lives. The objective of this study was to explore the coping approach among the residents in a flood affected traditional village in Kuala Nerus, Terengganu and determine its associated factors. A cross sectional study which involved 210 adults who lived in traditional village houses was conducted from April to May 2015. Universal sampling was applied. This community-based study was part of the curriculum requirement for undergraduate medical students of UniSZA. The participants’ background, experience during the recent flood and their coping response were assessed using self-administered validated Malay version Brief COPE inventory that consists of three domains (emotion-focused, problem-focused and less-useful), 14 subscales and 30 items. The mean (SD) age of participants were 46.7(15.54) years with almost equal sex ratio. Most of the participants were married (78.1%) and unemployed (54.8%). The most common coping approach applied by the villagers was emotion-focused followed by problem-focused and less-useful coping. There were four adjusted variables significantly associated with higher total coping score namely awareness on evacuation site (b=5.38, 95%CI:1.68,9.08, p=0.005), knowledge on health risk of flood (b=3.79, 95%CI:0.92,6.66, p=0.010), discussed on flood preparedness with family (b=2.50, 95%CI:0.84,4.16, p=0.003) and stored food before flood (b=4.506, 95%CI 1.67,7.34, p=0.002). The emotion-focused coping was the most preferred coping approach among the villagers. A significant better coping was associated with the villagers who were aware of the gazetted evacuation site and have knowledge on the flood health hazard. The villagers who planned with their family and practiced storage of adequate food as part of household preparedness also demonstrated significant higher coping level.

Psychometric properties of the revised Malay version Medical Outcome Study Social Support Survey using confirmatory factor analysis among postpartum mothers.

INTRODUCTION: Social support is an essential component for the physical and emotional well-being of postpartum mothers. The objective of this study is to determine the psychometric properties of the revised Malay version Medical Outcome Study (MOS) Social Support Survey using a confirmatory validity approach. METHODS: A cross-sectional study was conducted involving 144 postpartum mothers attending Obstetric and Gynecology Clinic, Universiti Sains Malaysia Hospital. Construct validity and internal consistency assessment was performed after the translation, content validity and face validity process. The data were analyzed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA) and AMOS 20.0 (SPSS Inc., Chicago, IL, USA). RESULTS: The original questionnaire consists of four domains (emotional/informational support, tangible support, affectionate support and positive social interaction) and 19 items. Affectionate support domain with three items only was treated as a separate construct and was not included in the factor analysis. The final confirmatory model with three constructs and 13 items demonstrated acceptable factor loadings, domain to domain correlation and best fit; (χ2[df]=1.665 [61]; P-value=0.001; Tucker-Lewis Index=0.944; comparative fit index=0.956; root mean square error of approximation=0.068). Composite reliability, average variance extracted and Cronbach's α of the domains ranged from 0.649 to 0.903; 0.390 to 0.699; 0.616 to 0.902, respectively. CONCLUSION: The study suggested that the four-factor model with 16 items (including one separate factor of affectionate) of the revised Malay version MOS Social Support Survey was acceptable to be used to measure social support after childbirth because it is valid, reliable and simple.

Validity And Reliability Of The Malay Version Of 12-Item Short Form Health Survey Among Postpartum Mothers

The Short Form Health Survey SF-36 is a well-known generic health-related quality of life measure that has widely been used worldwide. However, given the cultural, social and ethnic differences in some countries, it might not follow the intended structure of the instrument. Hence, this study aims to determine the psychometric properties of the Malay version of Short Form Health Survey (SF-12) among postpartum mothers. A cross-sectional study was conducted among 1-month postpartum mothers attending Obstetric and Gynecology clinic, Universiti Sains Malaysia Hospital, Kelantan, Malaysia. Reliability was estimated using internal consistency and the factor structure was extracted by performing confirmatory factor analysis using SPSS v. 20 and AMOS v. 20. A total of 108 women responded. The mean (SD) score for the Physical Component Summary (PCS) score and Mental Component Summary (MCS) score were 43.3 (7.08) and 42.4 (6.87) respectively. The Cronbach alpha for PCS-12 was 0.749 and MCS-12 was 0.701. Spearman correlations of individual items and the SF-12 component summary scores showed PF, RP, BP and GH items correlated higher with the PCS score, whereas the VT, SF, RE, and MH items correlated higher with the MCS score lending support to its good convergent validity. The confirmatory factor solution showed final model with two factors structure and six items each with acceptable factor loadings, satisfactory absolute and parsimonious fitness (RMSEA=0.1, x2/df=2.4). The psychometric tests of the Malay version of SF-12 generally showed acceptable validity and reliability among postpartum women.

A Preliminary Study on the Reliability of the Malay Version of PedsQL™ Family Impact Module among Caregivers of Children with Disabilities in Kelantan, Malaysia

Background: No previous study has assessed the impact of childhood disability on parents and family in the context of Malaysia, and no instrument to measure this impact has previously been available. The objective of this cross-sectional study was to determine the reliability of a Malay version of the PedsQL™ Family Impact Module that measures the impact of children with disabilities (CWD) on their parents and family in a Malaysian context. Methods: The study was conducted in 2009. The questionnaire was translated forward and backward before it was administered to 44 caregivers of CWD to determine the internal consistency reliability. The test for Cronbach’s alpha was performed. Results: The internal consistency reliability was good. The Cronbach’s alpha for all domains was above 0.7, ranging from 0.73 to 0.895. Conclusion: The Malay version of the PedsQL™ Family Impact Module showed evidence of good internal consistency reliability. However, future studies with a larger sample size are necessary before the module can be recommended as a tool to measure the impact of disability on Malay-speaking Malaysian families.