Displaying publications 61 - 80 of 86 in total

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  1. Kamaralzaman S, Budin SB, Mohamed J, Sidi H, Yau M, Sani A
    Sains Malaysiana, 2011;40(8):945–951.
    Neuropathy is a problem often suffered by patients with diabetes mellitus. Types of neuropathy that occur are peripheral neuropathy and autonomic neuropathy. This cross sectional study was conducted to determine the association between duration of diabetes and loss of protective sensation and the association between imbalance and loss of protective sensation among Malay women with diabetes mellitus. Eighty one Malay women with diabetes mellitus, aged 20 to 60 years from three clinics in Hulu Langat District participated in this study. Socio-demographic information were obtained from respondent using a questionnaire. Foot sensory evaluation was conducted using Semmes-Weinstein Monofilament
    grade 5.07. Assessment of balance was done using Timed One-leg Stance. Chi-squared test was used to determine the association between the two variables. Result showed that 56.8% of respondent had loss of protective sensation on at least one foot. While, 17.3% had imbalance while eyes were open and 60.5% experienced imbalance while eyes were closed. However, there was no significant correlation (p<0.05) between imbalance while eyes opened [χ2=3.27, p=0.07] and while eyes close [χ2=0.29, p=0.59]) with loss of protective sensation in at least one foot. Similar result were obtained between duration of diabetes and the loss of protective sensation. (χ2=3.27, p=0.20). Although there was no association between these factors, a screening program should start early to ensure early problems are identified before more severe complications occur.
    Keywords: Diabetes mellitus; imbalance; loss of protective sensation; Malay women
    Study site: Klinik Kesihatan, Hulu Langat, Selangor, Malaysia
  2. Irfan M, Hussain NHN, Noor NM, Mohamed M, Sidi H, Ismail SB
    Am J Mens Health, 2020 7 7;14(4):1557988320937200.
    PMID: 32623948 DOI: 10.1177/1557988320937200
    Male sexual dysfunctions (MSDs) often remain undiagnosed and untreated in Asia compared to Europe due to conservative cultural and religious beliefs, socioeconomic conditions, and lack of awareness. There is a tendency for the use of traditional medicines and noncompliance with and reduced access to modern healthcare. The present systematic review compared the incidence and factors of MSD in European and Asian populations. English language population/community-based original articles on MSDs published in MEDLINE from 2008 to 2018 were retrieved. A total of 5392 studies were retrieved, of which 50 (25 Asian and 25 European) were finally included in this review. The prevalence of erectile dysfunction (ED) (0%-95.0% vs. 0.9%-88.8%), low satisfaction (3.2%-37.6% vs. 4.1%-28.3%), and hypoactive sexual desire disorder (HSDD) (0.7%-81.4 vs. 0%-65.5%) was higher in Asian than in European men, whereas the prevalence of anorgasmia (0.4% vs. 3%-65%) was lower in Asian than in European men. Age was an independent positive factor of MSD. In European men over 60 years old, the prevalence of premature ejaculation (PE) decreased. The prevalence of MSD was higher in questionnaires than in interviews. The significant factors were age, single status, low socioeconomic status, poor general health, less physical activity, cardiovascular diseases, diabetes, obesity, lower urinary tract symptoms, prostatitis, anxiety, depression and alcohol, tobacco, and drug use. The prevalence of MSD differed slightly in Asian and European men. There is a need to conduct large studies on the various Asian populations for the effective management of MSD.
  3. Woon LS, Sidi H, Nik Jaafar NR, Leong Bin Abdullah MFI
    PMID: 33302410 DOI: 10.3390/ijerph17249155
    This study investigated the prevalence and severity of depression, anxiety, and stress and determined the association between various factors, social support, and depression, anxiety, and stress among university healthcare workers in Malaysia after the government lifted the movement control order (MCO) put in place to curb the coronavirus disease 2019 (COVID-19) pandemic. This online, cross-sectional survey recruited 399 participants from two university hospitals, and they were administered a self-reported questionnaire on demographic, personal, and clinical characteristics, as well as COVID-19-related stressors and coping. In addition, they completed the Multidimensional Scale of Perceived Social Support (MSPSS) to measure perceived social support, as well as the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess depression, anxiety, and stress. We found that the prevalence rates of depression, anxiety, and stress were 21.8%, 31.6%, and 29.1%, respectively. Participants with moderate to extremely severe depression, anxiety, and stress made up 13.3%, 25.8%, and 8.1% of the sample, respectively. Being single or divorced, fear of frequent exposure to COVID-19 patients, agreeing that the area of living had a high prevalence of COVID-19 cases, uncertainty regarding the prevalence of COVID-19 cases in the area of living, and a history of pre-existing psychiatric illnesses were associated with higher odds of depression, anxiety, and stress. Conversely, having more than three children and greater perceived friend support were associated with lower odds of depression, anxiety, and stress. The prevalence of depression, anxiety, and stress remained elevated even after the MCO was lifted.
    Study site: Hospital Universiti Sains Malaysia (HUSM); Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
  4. Sha'ari N, Woon LS, Sidi H, Das S, Bousman CA, Mohamed Saini S
    Phytomedicine, 2021 Dec;93:153760.
    PMID: 34638031 DOI: 10.1016/j.phymed.2021.153760
    BACKGROUND: Female sexual dysfunction (FSD) includes female orgasmic disorder, female sexual interest or arousal disorder, and genito-pelvic pain or penetration disorder. FSD affects 40% of women worldwide, but it is understudied and likely undertreated. Natural products are frequently used by women to treat FSD, but scientific evidence of their efficacy is lacking.

    OBJECTIVE: This systematic review and meta-analysis focused on the study of the efficacy of natural products on FSD.

    STUDY DESIGN: Systematic review and meta-analysis of existing studies on natural products in the treatment of FSD.

    METHODS: The literature search included MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trial databases for studies published from January 2000 to February 2020. The quality and the level of evidence of the studies were assessed. The association between natural products and FSD was summarized using standardized mean differences (SMD) with a 95% confidence interval (CI).

    RESULTS: A total of 536 studies were identified, with 20 of them meeting the criteria. According to this meta-analysis, Tribulus terrestris showed a significant positive effect in improving overall female sexual function (SMD = 1.12, 95% CI = 0.46 - 1.79, p = 0.001) and individual sexual arousal (SMD = 1.03, 95% CI = 0.22 - 1.84, p = 0.013), sexual desire (SMD = 1.08, 95% CI = 0.52 - 1.63, p ≤ 0.001) and sexual orgasm (SMD = 0.51, 95% CI = 0.02 - 1.00, p = 0.040) domains compared to placebo. Panax ginseng was found to be effective in treating sexual arousal (SMD = 0.54, 95% CI = 0.11 - 0.97, p = 0.014) and sexual desire (SMD = 0.59, 95% CI = 0.27 - 0.90, p < 0.001) compared to placebo. Meanwhile, other natural products reviewed in this study, such as Trifolium pretense, did not differ significantly from placebo in terms of improving FSD.

    CONCLUSION: Preliminary evidence suggests that Tribulus terrestris and Panax ginseng may be effective as alternative treatments for FSD in a clinical setting.

  5. Razali NA, Sidi H, Choy CL, Roos NAC, Baharudin A, Das S
    Curr Neuropharmacol, 2022;20(10):1941-1955.
    PMID: 35193485 DOI: 10.2174/1570159X20666220222145735
    Although few clinical trials examined the efficacy of bupropion to treat sexual dysfunction among female patients, a comprehensive and objective synthesis of the best available evidence is still lacking. To date, to the best of our knowledge, there are no published systematic reviews or meta-analyses specifically focusing on the role of bupropion in the treatment of female sexual dysfunction. The main objective of the present study was to evaluate the efficacy of bupropion in the treatment of female sexual dysfunction, and we hypothesized that bupropion is efficient in treating female patients with sexual dysfunction. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search for published literature was performed using Ovid, Medline, Scopus, Cochrane Library, Science Direct, and PubMed databases. In our study, we found that bupropion was almost three-fold more favorable in improving problems with sexual desire (pool estimate 2.845, 95% CI: 0.215 to 5.475, I2= 95.6%, p=0.034). A meta-regression was performed to explore heterogeneity and we found that only the dosage of bupropion was statistically significant in explaining the variance, i.e., the lower the dosage (150 mg vs. 300 mg), the better the improvement in the sexual desire of women with hypoactive sexual desire disorder (HSDD). Based on the results of this systematic review and metaanalysis, there is a potential role of bupropion as an effective treatment for women with HSDD.
  6. Zaini MA, Mohd Zain A, Din NM, Mustapha M, Sidi H
    PLoS One, 2023;18(8):e0290260.
    PMID: 37624864 DOI: 10.1371/journal.pone.0290260
    BACKGROUND: Since the enforcement of the Movement Control Order (MCO) to contain the spread of COVID -19 infection in Malaysia, most clinic appointments have been rescheduled and procedures and surgeries postponed to a later date. Clinic appointments including intravitreal endothelial growth factor (anti-VEGF) treatment for patients with diabetic macular edema (DME) were also no exception to the postponement. This measure takes a psychological toll on patients because of the overwhelming concern for their eye condition. This study was conducted to assess the psychological status of DME patients with delayed anti-VEGF treatment during the pandemic.

    METHODS: A cross-sectional study was conducted from September 2020 to March 2021 in Ophthalmology Clinic Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia (HCTM UKM). Subjects diagnosed with center-involved DME aged between 20 to 80 years who experienced delayed anti-VEGF injection were recruited. Level of depression, anxiety and stress were assessed using DASS-21 questionnaire. Statistical analysis using non-parametric tests were performed to determine the relationship between the DASS-21 score and duration of last injection, in those whose vision was affected by delayed injection and the relationship to the impact of COVID-19 pandemic. Statistical significance was denoted as p < 0.05.

    RESULTS: A total of 86 respondents with median age of 69 years old participated in this study. Most respondents were Malays (n = 47,54.7%) males (n = 51, 59.3%), had education up to secondary level (n = 37, 43%), unemployed (n = 78, 90.7%), married (n = 72, 83.7%) and living with their family (n = 82, 95.3%). The number of intravitreal injections received was at least three times among the respondents (n = 81, 94.2%). More than half of the respondents (n = 46, 53.5%) had been postponed for more than 12 weeks and felt that their vision was affected after delayed intravitreal injection (n = 47, 54.7%). Most of the subjects did not experience depression, anxiety, or stress. However, there was a significant level of stress scores among those with delayed injection of 9 to 12 weeks (p = 0.004), and significant anxiety (p = 0.029) and stress (p = 0.014) scores found in subjects with vision affected due to delayed treatment.

    CONCLUSION: The level of anxiety and stress can be significant in DME patients who experienced delay in intravitreal anti-VEGF treatment. Assessment of psychosocial impacts is important to identify early mental health issues potentially leading to the onset of psychiatry illness, thus early intervention is indispensable.

  7. Masiran R, Sidi H, Mohamed Z, Mohd Nazree NE, Nik Jaafar NR, Midin M, et al.
    J Sex Med, 2014 Apr;11(4):1047-1055.
    PMID: 24533444 DOI: 10.1111/jsm.12452
    INTRODUCTION: Selective serotonin reuptake inhibitors (SSRIs) are known for their sexual side effects. Different SSRIs may affect different areas of sexual function at different rates.
    AIMS: The study aimed to determine the prevalence of female sexual dysfunction (FSD), its clinical correlates, and association with 5HT2A (rs6311) single nucleotide polymorphisms (SNPs) in patients with major depressive disorder (MDD) who were on SSRI therapy.
    METHODS: This was a cross-sectional study on 95 female outpatients with MDD treated with SSRI. The patients were in remission as determined by Montgomery-Asberg Depression Rating Scale. Genomic DNA was isolated from buccal swabs and samples were processed using a real time polymerase chain reaction.
    MAIN OUTCOME MEASURES: The presence or absence of FSD as measured by the Malay Version of Female Sexual Function Index and 5HT2A-1438 G/A (rs6311) SNP.
    RESULTS: The overall prevalence of FSD was 32.6%. After controlling for age, number of children, education level, total monthly income, SSRI types, and SSRI dosing, being employed significantly enhanced FSD by 4.5 times (odds ratio [OR] = 4.51; 95% confidence interval [CI] 1.00, 20.30; P = 0.05). Those having marital problems were 6.7 times more likely to have FSD (OR = 6.67; 95% CI 1.57, 28.34). 5HT2A-1438 G/A (rs6311) SNP was not significantly associated with FSD.
    CONCLUSION: There was no significant association between FSD and the 5HT2A (rs6311) SNP in patients with MDD on SSRI therapy. Employment status and marital state were significantly associated with FSD among these patients.
    Study site: Psychiatry clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
  8. Nik Jaafar NR, Midin M, Mahadevan R, Sinniah A, Rahman AH, Ming W, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S60-4.
    PMID: 24139853 DOI: 10.1016/j.comppsych.2013.09.002
    OBJECTIVE: Most weight interventions among patients with severe mental illness (SMI) used body mass index (BMI) as outcome measure but excluded waist circumference (WC) although the latter is a stronger predictor of obesity complications. This study aimed to assess a weight-management program consisting of education, exercise and behavioural techniques for patients with SMI using weight parameters including WC as the outcome measures.
    METHODS: A group intervention was carried out as part of psychiatric outpatient community service. It used structured modules on diet, exercise and related topics comprising of education and exercises sessions with a total of 12-week duration. The participants were outpatients with SMI recruited through referrals to the program by the treating doctor. The participants' body weight, BMI and WC were measured at the baseline, fortnightly and at the end of the program.
    RESULTS: A total of 27 patients participated in the program which was carried out in 6 cycles. The pre- and post-intervention comparisons analysis of the weight parameters found a significant reduction in the WC (mean=3.878 cm+5.165, p=0.001) while no significant changes were recorded in body weight and BMI.
    CONCLUSION: Small but significant loss in WC and possibly weight maintenance were achieved using this non-pharmacological intervention. Modest loss in WC may have an impact on reducing the risk of obesity-related health risks.
    Study site: Psychiatric clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
  9. Fadzil A, Balakrishnan K, Razali R, Sidi H, Malapan T, Japaraj RP, et al.
    Asia Pac Psychiatry, 2013 Apr;5 Suppl 1:7-13.
    PMID: 23857831 DOI: 10.1111/appy.12036
    Anxiety and depression are prevalent during pregnancy. Estimates of the prevalence of anxiety and depression during pregnancy vary according to the criteria used, variable methodologies and population characteristics.
  10. Nik Jaafar NR, Selamat Din SH, Mohamed Saini S, Ahmad SN, Midin M, Sidi H, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S52-9.
    PMID: 23706655 DOI: 10.1016/j.comppsych.2013.03.003
    The period of the cancer patients undergoing treatment is also the most stressful time for their family caregivers. This study aimed to determine the rates of major depressive disorder and dysthymia; and their associated factors in the caregivers during this time.

    Study site: Oncology centre, Pusat Perubatan Universiti Kebangsaan Malaysia
  11. Dahlan R, Midin M, Shah SA, Nik Jaafar NR, Abdul Rahman FN, Baharudin A, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S46-51.
    PMID: 23679983 DOI: 10.1016/j.comppsych.2013.03.007
    The study aimed to determine the rates of functional remission and employment as well as the factors associated with functional remission among patients with Schizophrenia, receiving community psychiatric service in an urban setting in Malaysia.
  12. Ismail AH, Baw R, Sidi H, Guan NC, Midin M, Nik Jaafar NR, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S29-33.
    PMID: 23623640 DOI: 10.1016/j.comppsych.2013.03.009
    The present study aimed to determine the prevalence and associated factors of orgasmic dysfunction among Malay women with type 2 diabetes mellitus in Malaysia.
  13. Latif RA, Muhamad R, Ann AY, Sidi H, Nik Jaafar NR, Midin M, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S7-12.
    PMID: 23206495 DOI: 10.1016/j.comppsych.2012.10.008
    This cross-sectional study aimed to determine the construct of the phases of the female sexual response cycle (SRC) in women with hypertension and their association with the duration of hypertension and types of antihypertensive agents.
  14. Fadzil MA, Sidi H, Ismail Z, Hassan MR, Thuzar K, Midin M, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S23-8.
    PMID: 23453753 DOI: 10.1016/j.comppsych.2012.12.024
    OBJECTIVE:
    The main aim of the study was to estimate the prevalence of ED and the associated socio-demographic and psychological correlates among hypertensive patients from a rural multiethnic community in Malaysia.

    METHODS:
    A cross-sectional study was conducted among hypertensive patients attending rural primary care clinics. The socio-demographic, health characteristics, erectile function and levels of depression, anxiety and stress were recorded and analysed. The International Index of ErectileFunction-5 (IIEF-5) questionnaire and the Depression, Anxiety and Stress Scale (DASS-21) were used to assess erectile function and the levels of depression, anxiety and stress, respectively.

    RESULTS:
    A total of 253 hypertensive patients comprising 178 (70.4%) Malays, 56 (22.1%) Chinese and 18 (7.5%) Indians participated. The mean age of participants was 59.8 ± 10.62 years. Overall, the prevalence rate of ED was 62%: 90 (35%) with moderate and 69 (27%) with severe ED. The prevalence rate of ED among those aged 65 years or older (83.1%) was significantly higher than those less than 65 years (51.8%), (p<0.001). Higher prevalence rates were also noted among the Chinese (78.6%) compared to Malays (59.6%) and Indians (50%) (p=0.021); lower education level (69.1%) (p=0.026), among hypertensive patients with concomitant diabetes mellitus (70.6%) (p=0.026) and WHR ≥ 0.9 (31.3%) (p=0.021). However, no significant association was found between depression, anxiety and stress scores with IIEF-5 score.

    CONCLUSION:
    The prevalence rate of ED among Malaysian hypertensive patients is high. The rate increases significantly with age, Chinese ethnicity, concomitant diabetes mellitus, lower education level, WHR and the number of pack years of smoking. ED should be properly recognized and managed in hypertensive patients.
  15. Sulaiman AH, Said MA, Habil MH, Rashid R, Siddiq A, Guan NC, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S89-94.
    PMID: 23433219 DOI: 10.1016/j.comppsych.2013.01.003
    The objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied.
  16. Musa R, Ramli R, Yazmie AW, Khadijah MB, Hayati MY, Midin M, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S65-9.
    PMID: 23433218 DOI: 10.1016/j.comppsych.2013.01.001
    Studies from Western countries have observed that couples undergoing infertility treatment suffer various physical and psychological difficulties at a higher frequency than the comparable general population. These relate to treatment challenges and other psychosocial stressors, often influenced by coping style, personality factors and available support systems. There is paucity of studies in non-Western populations.
  17. Grewal GS, Gill JS, Sidi H, Gurpreet K, Jambunathan ST, Suffee NJ, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S17-22.
    PMID: 23452905 DOI: 10.1016/j.comppsych.2013.01.009
    OBJECTIVE: To determine the prevalence and risk factors of female sexual dysfunction (FSD) among healthcare personnel in selected healthcare facilities in Malaysia.
    METHODS: This was a cross-sectional study carried out at three large healthcare facilities that were selected by convenience sampling. Within each facility, stratified random sampling was used to select suitable candidates to participate in the study (n=201). Validated questionnaires were used to assess depression, anxiety, sexual function in women and erectile dysfunction (ED) in their partners.
    RESULTS: The prevalence of FSD was 5.5%. Women with sexual dysfunction were more likely to be married longer (OR=4.08; 95% CI; 1.15-4.50), had lower frequency of sexual intercourse (OR=5.00; 95% C; 1.05-23.76) and had a spouse with ED (OR=24.35; 95% CI; 4.55-130.37). Multivariate analysis showed that ED was the strongest predictor for FSD (AOR=27.30; 95% CI; 4.706-159.08).
    CONCLUSION: One in eighteen female healthcare personnel suffered from FSD and presence of ED in the partner strongly impacted her sexual function, negatively. The findings highlight the importance of including the male partner in clinical assessment of FSD.
  18. Ismail AH, Bau R, Sidi H, Guan NC, Naing L, Nik Jaafar NR, et al.
    Compr Psychiatry, 2014 Jan;55 Suppl 1:S34-7.
    PMID: 23375262 DOI: 10.1016/j.comppsych.2012.12.028
    This study compared the components of sexual responses between Malaysian women with Type 2 diabetes mellitus and those without the disease.
  19. Munikanan T, Midin M, Daud TIM, Rahim RA, Bakar AKA, Jaafar NRN, et al.
    Compr Psychiatry, 2017 05;75:94-102.
    PMID: 28342379 DOI: 10.1016/j.comppsych.2017.02.009
    OBJECTIVE: To understand the needs of patients with schizophrenia for recovery, this study examined the type and level of social support and its association with quality of life (QOL) among this group of patients in the city of Kuala Lumpur.

    METHOD: A cross-sectional study was conducted on 160 individuals with schizophrenia receiving community psychiatric services in Hospital Kuala Lumpur (HKL). The WHOQOL-BREF, Brief Psychiatric Rating Scale (BPRS) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess QOL, severity of symptoms and social support, respectively. The study respondents were predominantly Malay, aged less than 40, males, single, unmarried, had lower education levels and unemployed.

    RESULTS: About 72% of the respondents had poor perceived social support, with support from significant others being the lowest, followed by friends and family. From multiple regression analysis, social support (total, friend and family) significantly predicted better QOL in all domains; [B=0.315 (p<0.001), B=0.670 (p<0.001), B=0.257 (p<0.031)] respectively in Physical Domain; [B=0.491 (p<0.001), B=0.735 (p<0.001), B=0.631 (p<0.001)] in Psychological Domain; [B=1.065 (p<0.001), B=0.670 (p<0.017), B=2.076 (p<0.001)] in Social Domain and; [B=0.652 (p<0.001), B=1.199 (p<0.001), B=0.678 (p<0.001)] in Environmental Domain. Being married and having shorter duration of illness, lower BPRS (total) scores, female gender and smoking, were also found to significantly predict higher QOL.

    CONCLUSION: Social support is an important missing component among people with schizophrenia who are already receiving formal psychiatric services in Malaysia.

  20. Shahidin SH, Midin M, Sidi H, Choy CL, Nik Jaafar NR, Mohd Salleh Sahimi H, et al.
    Int J Environ Res Public Health, 2022 Nov 28;19(23).
    PMID: 36497921 DOI: 10.3390/ijerph192315848
    Emotion Dysregulation (ED) and Problematic Smartphone Use (PSU) are two rising global issues requiring further understanding on how they are linked. This paper aims to summarize the evidence pertaining to this relationship. Five databases were systematically searched for published literature from inception until 29 March 2021 using appropriate search strategies. Each study was screened for eligibility based on the set criteria, assessed for its quality and its level of evidence was determined. The Comprehensive Meta-Analysis software program (CMA) was employed to run further analyses of the data. Twenty-one studies were included in the systematic review. Nine studies with extractable data for meta-analysis had high across-studies heterogeneity, hence subgroup analyses were performed that confirmed a significant moderate positive correlation between ED and PSU (pooled correlation coefficient, r = 0.416 (four studies, n = 1462) and r = 0.42 (three studies, n = 899), respectively) and a weak positive correlation between "expressive suppression" and PSU (pooled correlation coefficient, r = 0.14 (two studies, n = 608)). Meta-regression analysis showed a stronger correlation between ED and PSU (R2 = 1.0, p = 0.0006) in the younger age group. Further studies to establish and explore the mechanisms that contribute towards the positive link between ED and PSU are required to guide in the planning of targeted interventions in addressing both issues.
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