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Stress, Anxiety, Depression and Sleep Disturbance among Jordanian Mothers and Fathers of Infants Admitted to Neonatal Intensive Care Unit: A Preliminary Study

Al Maghaireh DF, Abdullah KL, Chong MC, Chua YP, Al Kawafha MM

J Pediatr Nurs, 2017 06 19;36:132-140.
PMID: 28888494 DOI: 10.1016/j.pedn.2017.06.007

PURPOSE: To investigate the stressors and stress levels among Jordanian parents of infants in the NICU and their relationship to three factors: anxiety, depression and sleep disturbance.
DESIGN AND METHODS: A cross-sectional survey was conducted in two hospitals in Jordan among 310 parents of infants in the NICU by using PSS: NICU and PROMIS.
RESULTS: Both parents experienced high levels of stress, anxiety, depression and sleep disturbance. There was a significant difference in stress level between mothers and fathers [t (308)=3.471, p=0.001], with the mothers experiencing higher stress than the fathers [mean: mothers=108.58; fathers=101.68]. The highest and lowest sources of stress were infant behavior and appearance (M=4.09) and sights and sounds in the NICU (M=3.54), respectively. The correlation between stress levels with anxiety (r=0.79) and depression (r=0.75) was strong and positive while sleep disturbance was significant and moderate (r=0.43).
CONCLUSIONS: The mothers experienced higher levels of stress compared to fathers, with positive correlations between stress and anxiety, depression and sleep disturbance.
PRACTICAL IMPLICATIONS: The findings of this study create nursing awareness of parent stress and its impact, which will help them to improve nursing care for parents.

Matched MeSH terms: Parents/psychology*
Stress experienced by mothers of Malaysian children with mental retardation

Ong LC, Chandran V, Peng R

J Paediatr Child Health, 1999 Aug;35(4):358-362.
PMID: 28871653 DOI: 10.1046/j.1440-1754.1999.00383.x

OBJECTIVE: To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress.
METHODOLOGY: Seventy-five mothers of children with mental retardation aged 4-12 years and 75 controls (those without disabilities who attended the walk-in paediatric clinic) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with sociodemographic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion.
RESULTS: Mothers of children with mental retardation scored significantly higher than control subjects in both the child-related domain (difference between means 26.1, 95% confidence interval 19.6-32.5) and parent-related domain (difference between means 15.0, 95% confidence interval 7.9-22.1) of the PSI. The total child behaviour scores from the CBCL (P < 0.01), IQ scores (P < 0.01) and sibship size (P < 0.01) were associated with child-related domain scores. For the parent-related domain, CBCL (P < 0.01) and IQ scores (P = 0.01) remained important factors but Chinese ethnicity (P < 0.01) and maternal unemployment (P < 0.01) were also significant predictors of stress.
CONCLUSION: A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.
Study site: Outpatient clinic, Paediatric Institute, Hospital Kuala Lumpur, Malaysia

Matched MeSH terms: Parents
Fulltext Stress and psychological wellbeing among parents of children with autism spectrum disorder

Nikmat AW, Ahmad M, Ng LO, Razali S

ASEAN Journal of Psychiatry, 2008;9(2):65-72.
MyJurnal

Objective: To investigate the prevalence of parental stress and psychological wellbeing among parents with autistic children and their associations with dimensions of support system.
Methods: This is a preliminary cross sectional study which randomly selected parents with clinically diagnosed autistic children. Those parents who attended psycho-education session on management of autistic children at Health Psychology Unit were randomly selected to enroll in the study. Psychological wellbeing, parental stress and dimensions of support system were assessed by using the General Health Questionnaire (GHQ-28), the Parenting Stress Index (PSI) and the Provision Social Relation (PSR), respectively.
Results: Of 52 parents with autistic children (34 female and 18 male), about 90.4% of parents had significant parenting stress, and 53.8% of parents showed clinical disturbance in psychological wellbeing. Gender (t=1.67, p=0.02) and occupation (F=4.78, p=0.01) showed statistically significant association with psychological wellbeing. No association found between other socio-demographic factors, parental stress and psychological wellbeing with dimensions of support system among parents with autistic children.
Conclusion: Parents with autistic children have high prevalence of stress and psychological disturbances. Interactions of various factors need to be acknowledged and considered in order to reduce the burden of parents with autistic children.

Matched MeSH terms: Parents
Fulltext Stress and coping strategies among medical students in National University of Malaysia, Malaysia University of Sabah and Universiti Kuala Lumpur Royal College of Medicine Perak

Johari, A.B., Noor Hassim

Malaysian Journal of Community Health, 2009;15(2):106-115.
MyJurnal

Introduction : Stress is part of our life. It can happen anywhere including in medical school. Medical school is perceived as being stressful because their difficulties in education, longest period of study and dealing with the patients. Stress can be perceive as negative or positive. Coping strategies are the method that we can use to prevent stress when it comes to us. The aim of this study was to determine the prevalence of stress and coping strategies among of medical students in National University of Malaysia, Malaysia University of Sabah and Universiti Kuala Lumpur Royal College of Medicine Perak.
Methods : This study involved 450 medical students through stratified sampling in which 150 medical students from each of the three universities. This study was conducted through self administered questionnaires. The questionnaires included were socio demographic factor, Personal Stress Inventory (using Stress Symptoms Scale with 52 items), BRIEF COPE (Coping Orientation for Problems Experienced with 28 items). The determination of cut off point for stress symptoms score was using Receiver Operating Characteristic (ROC) curve.
Results : Response rate was 90.8%. The prevalence of stress among medical students were 44.1%. The contributory factors to the stress were financial problems, stress of up coming examination period, relationship problems with parents, peers, siblings and lecturers. Coping mechanisms which had significant association with stress includes self distraction, venting of emotion, denial, behavioral disengagement, humor and self blaming. Multiple linear regression analysis revealed a significant association (p

Matched MeSH terms: Parents
Fulltext Stress among parents with acutely ill children

Nizam M, Norzila MZ

Med J Malaysia, 2001 Dec;56(4):428-34.
PMID: 12014761

Objectives: A child's admission into intensive care is a major cause of stress for parents. However among Malaysian parents, data concerning the perception of stress are virtually absent. Therefore we conducted a study to measure the reliability of the Malay version of Parental Stressor Scale: Pediatric Intensive Care Unit (PSS: PICU) in identifying sources of stress and to study factors that might influence their stress response.
Methods: Over a six-month period, one hundred and twelve parents were requested to answer the questionnaires twice either in Malay or English, a week apart. Spearman's correlation and Cronbach's alpha coefficient was used to assess the repeatability and internal consistency of the questionnaires.
Results: Ninety-four (83.9%) and seventy-one (75.3%) parents responded to the first and second administration of questionnaire respectively. All answered in the Malay language except for three. The correlation ranged from 0.50 to 0.71 with a total score of 0.76. The Cronbach's alpha coefficient ranged from 0.75 to 0.93, with total a score of 0.95.
Alteration in parental roles was the most stressful source of stress. Fathers, parents of children with higher PRISM score and parents with no previous admission into intensive care unit scored significantly higher in staff’s communication.
Conclusion: The Malay version of PSS: PICU is reliable in identifying sources of stress. Alteration in parental roles was the most stressful source of stress. Parents' gender, previous experience and severity of the child illness may influence their stress responses.

Matched MeSH terms: Parents/psychology*
Stress among parents of children with attention deficit hyperactivity disorder, a Malaysian experience

Narkunam N, Hashim AH, Sachdev MK, Pillai SK, Ng CG

Asia Pac Psychiatry, 2014 Jun;6(2):207-16.
PMID: 23857633 DOI: 10.1111/j.1758-5872.2012.00216.x

Attention deficit hyperactivity disorder (ADHD) is a chronic debilitating illness with onset in early childhood. The objective of this study was to look at the impact of children with ADHD on their parents.

Matched MeSH terms: Parents/psychology*
Fulltext Strength and difficulties questionnaire: A tool as prerequisite to measure child's mental health problems attending dental clinics

Pandiyan NJ, Hedge A

J Indian Soc Pedod Prev Dent, 2016 Oct-Dec;34(4):354-8.
PMID: 27681399 DOI: 10.4103/0970-4388.191417

INTRODUCTION: Child's behavior on dental visit depends on variables such as age, parental behavior, parental anxiety, medical/dental history, and dental procedures. Behavioral-screening questionnaire, such as the Strengths and Difficulties Questionnaire (SDQ), can be used to preassess the child's mental health status which further predicts child behavioral pattern in dental clinics.
AIM: To measure emotional status among children of 3-14 years age group attending dental clinics.
METHODOLOGY: A total of 176 parents of children aged 3-14 years were involved in this study. The child's emotional and behavioral statuses were assessed using SDQ.
RESULTS: On analyzing the SDQ data, it was found that 80% of children came under the abnormal category whereas only 8% of children were found to be in normal category. Twelve percent of children came under borderline category. On the individual behavioral subsets scores, 13% were rated as abnormal on emotional subset, 40% on conduct problems, 12% on hyperactivity, and 29% on peer problems subset.
CONCLUSION: Findings of this study suggest that incorporating tools to identify the current emotional state would give a clue and allow the dentist to develop a behavior guidance plan to accomplish the necessary oral health care. However, the results are preliminary; studies with larger sample should be done to validate the results among diverse populations.

Matched MeSH terms: Parents
Fulltext Stop and Play Digital Health Education Intervention for Reducing Excessive Screen Time Among Preschoolers From Low Socioeconomic Families: Cluster Randomized Controlled Trial

Raj D, Ahmad N, Mohd Zulkefli NA, Lim PY

J Med Internet Res, 2023 May 04;25:e40955.
PMID: 37140970 DOI: 10.2196/40955

BACKGROUND: High prevalence of excessive screen time among preschool children is attributable to certain parental factors such as lack of knowledge, false perception about screen time, and inadequate skills. Lack of strategies to implement screen time guidelines, in addition to multiple commitments that may hinder parents from face-to-face interventions, demands the need to develop a technology-based parent-friendly screen time reduction intervention.
OBJECTIVE: This study aims to develop, implement, and evaluate the effectiveness of Stop and Play, a digital parental health education intervention to reduce excessive screen time among preschoolers from low socioeconomic families in Malaysia.
METHODS: A single-blind, 2-arm cluster randomized controlled trial was conducted among 360 mother-child dyads attending government preschools in the Petaling district, who were randomly allocated into the intervention and waitlist control groups between March 2021 and December 2021. This 4-week intervention, developed using whiteboard animation videos, infographics, and a problem-solving session, was delivered via WhatsApp (WhatsApp Inc). Primary outcome was the child's screen time, whereas secondary outcomes included mother's screen time knowledge, perception about the influence of screen time on the child's well-being, self-efficacy to reduce the child's screen time and increase physical activity, mother's screen time, and presence of screen device in the child's bedroom. Validated self-administered questionnaires were administered at baseline, immediately after the intervention, and 3 months after the intervention. The intervention's effectiveness was evaluated using generalized linear mixed models.
RESULTS: A total of 352 dyads completed the study, giving an attrition rate of 2.2% (8/360). At 3 months after the intervention, the intervention group showed significantly reduced child's screen time compared with the control group (β=-202.29, 95% CI -224.48 to -180.10; P

Matched MeSH terms: Parents/education
Fulltext Sociodemographic, nutritional, and environmental factors are associated with cognitive performance among Orang Asli children in Malaysia

Murtaza SF, Gan WY, Sulaiman N, Mohd Shariff Z, Ismail SIF

PLoS One, 2019;14(7):e0219841.
PMID: 31306442 DOI: 10.1371/journal.pone.0219841

Children aged 2 to 6 years are in a crucial period of growth development, during which it is important for them to attain specific cognition related to concentration and attention so that they can perform well in school later in life. Various factors influence children's cognition during this crucial period. However, to date, only a limited number of studies have examined the cognitive performance of underprivileged children living in poverty, particularly indigenous children (also known as Orang Asli children in Malaysia). Therefore, this cross-sectional study aimed to determine the associations between sociodemographic factors, nutritional factors (body composition and hemoglobin), and environmental factors (home environment and parasitic infections) with cognitive performance among Orang Asli children in Negeri Sembilan, Malaysia. The participants were 269 children (51% boys, 49% girls) aged 2 to 6 years (M = 4.0, SD = 1.2 years) and their mothers, from 14 Orang Asli villages. Face-to-face interviews were conducted with the mothers, and the children's cognitive performance, operationalized as working memory index (WMI), processing speed index (PSI), and cognitive proficiency index (CPI), was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). The children's weight and height were measured, and their blood and stool samples were collected to assess hemoglobin level and parasitic infections, respectively. Multiple linear regression analysis showed that the father's years of education (β = 0.262-0.342, p < 0.05), availability of learning materials at home (β = 0.263-0.425, p < 0.05), and responsiveness of the parent to the child (β = 0.192-0.331, p < 0.05) were consistently associated with all three cognitive indices (WMI, PSI, and CPI). A holistic approach involving parents, communities, and government agencies should be established to improve the cognitive performance of these underprivileged children.

Matched MeSH terms: Parents
Fulltext Sociodemographic determinants of obesity among 12 years old school adolescents in Kuala Terengganu and Besut districts, Malaysia

Nurzaime Zulaily, Aryati Ahmad, Mohd Razif Shahril, Sharifah Wajihah Wafa Syed Saadun Tarek Wafa, Nor Saidah Abd Manan, Engku Fadzli Hassan Syed Abdullah, et al.

Malaysian Journal of Public Health Medicine, 2017;17(102):0-0.
MyJurnal

Worldwide prevalence of obesity among children and adolescents increased substantially over decades. Addressing potential risk factors of obesity among adolescents is very important for a successful intervention program in this population. The present study aimed to identify the sociodemographic determinants of obesity among school adolescents in Terengganu. A cross-sectional survey involving 3,798 school adolescents age 12 years old from 136 government primary schools in Kuala Terengganu and Besut districts were carried out from November 2014 to June 2015. For the purpose of this paper, the data for 2,842 school adolescents classified as either normal BMI (< +1SD) (n= 2,305) or obese (+2SD) (n= 537) based on WHO cut-off points were taken for analysis. Sociodemographic information on subjects and their parents were obtained from self-reported questionnaire. Anthropometric measurements were conducted by Physical Education teachers and uploaded into a specific developed database. The prevalence of obesity was relatively high in both genders in this study. Binary logistic regression analysis found gender, parental BMI, household income, household size and maternal working status were independently associated with obesity among school adolescents in this population. In the final model, being male, having working mother, and having obese parents were identified to be potential risk factors for obesity whilst having large household size lower the risk of obesity among these adolescents. Prevention programs are needed to increase awareness about the risk factors of obesity in adolescent and interventions should now focus on family member as well mainly the parents.

Matched MeSH terms: Parents
Fulltext Sociodemographic determinants of obesity among 12 years old school adolescents in Kuala Terengganu and Besut districts, Malaysia

Nurzaime Zulaily, Aryati Ahmad, Mohd Razif Shahril, Sharifah Wajihah Wafa Syed Saadun Tarek Wafa, Nor Saidah Abd Manan, Engku Fadzli Hassan Syed Abdullah, et al.

Malaysian Journal of Public Health Medicine, 2017;17 Special(2):11-19.

Worldwide prevalence of obesity among children and adolescents increased substantially over decades. Addressing potential risk factors of obesity among adolescents is very important for a successful intervention program in this population. The present study aimed to identify the sociodemographic determinants of obesity among school adolescents in Terengganu. A cross-sectional survey involving 3,798 school adolescents age 12 years old from 136 government primary schools in Kuala Terengganu and Besut districts were carried out from November 2014 to June 2015. For the purpose of this paper, the data for 2,842 school adolescents classified as either normal BMI (< +1SD) (n= 2,305) or obese (+2SD) (n= 537) based on WHO cut-off points were taken for analysis. Sociodemographic information on subjects and their parents were obtained from self-reported questionnaire. Anthropometric measurements were conducted by Physical Education teachers and uploaded into a specific developed database. The prevalence of obesity was relatively high in both genders in this study. Binary logistic regression analysis found gender, parental BMI, household income, household size and maternal working status were independently associated with obesity among school adolescents in this population. In the final model, being male, having working mother, and having obese parents were identified to be potential risk factors for obesity whilst having large household size lower the risk of obesity among these adolescents. Prevention programs are needed to increase awareness about the risk factors of obesity in adolescent and interventions should now focus on family member as well mainly the parents.

Matched MeSH terms: Parents
Social factors in relation to physical abuse in Kuala Lumpur, Malaysia

Kasim MS, Shafie HM, Cheah I

Child Abuse Negl, 1994 May;18(5):401-7.
PMID: 8032970

Available evidence has shown that the type of abuse perpetrated on children depends considerably on the social and other factors inherently faced by these children. A total of 119 cases of physical abuse was detected by the Suspected Child Abuse and Neglect (SCAN) Team of General Hospital, Kuala Lumpur in 1991. Eighty-two cases were categorized as mild and 37 as severe. The average age of those mildly abused was 7.9 years, for those severely abused the average age was 4.2 years. The perpetrators of those mildly abused were often their own parents. However, among those severely abused, the child-minder was the most frequent abuser. Ninety-two of all cases were in families of social classes IV and V. In 47 cases, there was definite evidence of family disharmony or disruption. Among the 37 severely abused, the parents were either divorced or separated in 14 cases. There was a personality disorder in seven of the cases. Six of the abusers were also using drugs and nine were alcoholics. This paper shows that, even in a developing country, the social milieu is important in the type of abuse inflicted.

Matched MeSH terms: Child of Impaired Parents/psychology; Child of Impaired Parents/statistics & numerical data
Smoking stage relations to peer, school and parental factors among secondary school students in Kinta, Perak

Jeganathan PD, Hairi NN, Al Sadat N, Chinna K

Asian Pac J Cancer Prev, 2013;14(6):3483-9.
PMID: 23886133

BACKGROUND: To identify the prevalence of different stages of smoking and differences in associated risk factors.
MATERIALS AND METHODS: Thos longitudinal study started in February 2011 and the subjects were 2552 form one students aged between twelve to thirteen years of from 15 government secondary schools of Kinta, Perak. Data on demographic, parental, school and peer factors were collected using a self-administered questionnaire. We examined the effects of peer, school and parental factors on the five stages of smoking; never smokers, susceptible never smokers, experimenters, current smokers and ex-smokers, at baseline.
RESULTS: In the sample, 19.3% were susceptible never smokers, 5.5% were current smokers 6% were experimenters and 3.1% were ex-smokers. Gender, ethnicity, best friends' smoking status, high peer pressure, higher number of relatives who smoked and parental monitoring were found to be associated with smoking stages. Presence of parent-teen conflict was only associated with susceptible never smokers and experimenters whereas absence of home discussion on smoking hazards was associated with susceptible never smokers and current smokers.
CONCLUSIONS: We identified variations in the factors associated with the different stages of smoking. Our results highlight that anti-smoking strategies should be tailored according to the different smoking stages.

Matched MeSH terms: Parents*
Smoking among students in a rural secondary school

Teh KH, Ling KH

JUMMEC, 2000;5:86-88.

A cross-sectional study on the prevalence of smoking among Form 3, 4 and 5 students of a rural national co-educational school was carried out using a selfadministered questionnaire. By the age of 18 years old, three quarters of boys had tried smoking compared with 12% of girls. About a third of boys were still smokers while only 0.7% of girls were still smokers. There was a higher prevalence of smokers among students who stayed with their parents and those who were working part-time. Most smokers knew about the dangerous and addictive effect of cigarette smoking but smoked because of "influence by school peers", "curiosity" and "to increase concentration and decrease tension".

Matched MeSH terms: Parents
Fulltext Smoking among school-going adolescents in selected secondary schools in Peninsular Malaysia- findings from the Malaysian Adolescent Health Risk Behaviour (MyaHRB) study

Lim KH, Lim HL, Teh CH, Kee CC, Khoo YY, Ganapathy SS, et al.

Tob Induc Dis, 2017;15:9.
PMID: 28163668 DOI: 10.1186/s12971-016-0108-5

BACKGROUND: A multitude of studies have revealed that smoking is a learned behaviour during adolescence and efforts to reduce the incidence of smoking has been identified as long-term measures to curb the smoking menace. The objective of this study was to determine the prevalence as well as the intra and inter-personal factors associated with smoking among upper secondary school students in selected schools in Peninsular Malaysia.
METHODS: A study was carried out in 2013, which involved a total of 40 secondary schools. They were randomly selected using a two-stage clustering sampling method. Subsequently, all upper secondary school students (aged 16 to 17 years) from each selected school were recruited into the study. Data was collected using a validated standardised questionnaire.
RESULTS: This study revealed that the prevalence of smoking was 14.6% (95% CI:13.3-15.9), and it was significantly higher among males compared to females (27.9% vs 2.4%, p

Matched MeSH terms: Parents
Sleep problems among children with neurological disorders

Khoo, T.B., Muhammad Ismail, H.I., Abdul Manaf, A.M.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):22-28.
MyJurnal

A study was conducted to evaluate the extent of sleep problems among children aged between 6 to 15 years old who were followed up at Penang Hospital Paediatric Clinic for various neurological disorders and compared to those with other paediatric illnesses and their healthy siblings. A parental questionnaire was used to assess sleep problems in 48 children with neurological disorders and compared to 46 of their healthy siblings, 59 children with non-neurological paediatric illnesses and 67 of their healthy siblings. Sleep problems were clustered into five subscales: bedtime difficulties, parental involvement at time of sleep, sleep fragmentation, parasomnias and daytime drowsiness. Children with neurological disorders had significantly more sleep problems than did their siblings, those with non-neurological paediatric illnesses and their healthy siblings (p < 0.001). This was particularly so in areas of bedtime difficulties (p>0.001), the amount of parental involvement (p

Study site: Penang Hospital Paediatric Clinic

Matched MeSH terms: Parents
Fulltext Skills amongst parents of children with asthma: a pilot interventional study in primary care setting

Aziz NA, Norzila MZ, Hamid MZ, Noorlaili MT

Med J Malaysia, 2006 Dec;61(5):534-9.
PMID: 17623952 MyJurnal

The increasing prevalence of childhood asthma has become a concern among health practitioners. Effective management emphasizes long-term management and inhaled therapy has become the mainstay home management for children. However, proper utilization of medication is pertinent in improving control. Proper asthma education is mandatory in improving skills and confidence amongst parents. To assess the skills of using the metered-dose inhaler (MDI) with a spacer among asthmatic children before and after educational intervention and to analyse any difficulties which may occur amongst the participants in executing the assessment steps. A cross-sectional clinic based study involving 85 parents and children with asthma. A standardized metered-dose inhaler-spacer checklist of eight steps of medication usage and five steps of cleaning the spacer were used as the assessment tools for pre and post intervention. The performance on using the inhaler-spacer and spacer cleaning knowledge pre and two months post intervention was evaluated. One point was given for each correct step and zero points for incorrect answers/steps. The mean score for skills of inhaler technique improved significantly after educational intervention (3.51 to 6.01, p < 0.0001) as did the mean score for parental knowledge of spacer cleaning technique (1.35 to 3.16, p 0.001). Analysis showed only a limited improvement even after an educational session in three steps of inhalation technique: step 5 (23.5%/69.4%), step 6 (28.2%/68.2%) and step 7 (25.9%/61.2%). Parents with asthmatic children had poor skills in utilizing their children's medication. A short-term educational intervention was able to improve overall knowledge and skill but certain skills need more emphasizing and training.
Study site: Klink HUKM Taman Jaya, Cheras, Kuala Lumpur, Malaysia (primary care clinic for Hospital University Kebangsaan Malaysia)

Matched MeSH terms: Parents/education*
Fulltext Should parental decision override best interest of a handicapped child? A case illustration in a Malaysian child with Down Syndrome

Fashiham Taib, Nur Arzuar Abdul Rahim, Mohd Rizal Mohd Zain, Mohamad Ikram Ilias, Nik Mohd Rizal Mohd Fakri, Zabidi Azhar Hussin

Education in Medicine Journal, 2015;7(1):67-71.
MyJurnal

The paper discusses on the complexity of the issues surrounding a patient with subluxation of cervical spine in a Down syndrome child. Several relevant issues are discussed including consent in a minor, conflicting decision making between parents and doctors, end-of-life issues, supporting handicapped child with minimal co-morbidities, community ethics, neglect of care by the caregiver and decision making after allowing zonal of parental discretion. Despite the difficulties surrounding parental actions, there are still ethical priorities which have to be considered individually to alleviate the suffering of the patients and the family members. Dealing with patients with chronic illnesses is a challenge for any medical doctors. The case warrants sensitive approach to allow appropriate respect for parental decision despite in disagreement with the clinical team. The term ‘zone of parental discretion’ refers to a controversial area of decision making; and has still many potential conflicts on day to day clinical cases, especially among the conservative society in the East Coast of Peninsular Malaysia.

Matched MeSH terms: Parents
Sex preference and fertility in Peninsular Malaysia

Pong SL

Stud Fam Plann, 1994 May-Jun;25(3):137-48.
PMID: 7940619 DOI: 10.2307/2137940

This study uses data from the Second Malaysian Family Life Survey, conducted in 1988, to examine parents' preferences for the sex of their children within each of Malaysia's three ethnic groups. While Malay and Indian parents do not show a consistent sex preference, Chinese parents prefer to have all sons, or a combination of sons and daughters, with more sons than daughters, or at least an equal number of them. Son preference among the Chinese does not seem to be a constraint to fertility decline among that population. Since 1970, Chinese fertility has dropped rapidly; at the same time, Chinese son preference has become more pronounced. Evidence indicates that further reductions in Chinese fertility, through the reduction in sex preference, would be small.

Matched MeSH terms: Parents/psychology*
Severe mental retardation following asymptomatic hypoglycaemia in an infant with nesidioblastosis

Rahmah, R., Wu, L.L., Roziana, A., Swaminathan, M., Kuhnle, U.

Malaysian Journal of Child Health, 1997;9(1):93-96.
MyJurnal

Nesidioblastosis is a rare metabolic disease characterised by inappropriate insulin secretion often associated with life-threatening hypoglycaemia. While severe cases present in the newborn period, patients have been described later in infancy. Familial cases suggest an autosomal recessive trait, and recently mutations in the sulphonlurea receptor gene, possibly a regulator of insulin secretion, have been identified and associated with disease expression. We report a twin boy who developed normally until the age of six months when he was noted to regress. The boy is the older twin born to non-consanguinous parents. He presented to a hospital first at the age of 13 months with fever and generalised seizures. Low blood glucose was noted, but he recovered easily and was able to maintain euglycaemia during a 48-hour period of observation. Microcephaly and developmental delay were documented and anticonvulsant therapy was started. At 18 months, low blood glucose with high C-peptide was documented during reevaluation. Follow-ing a short trial of subcutaneous long-acting somatostatin analogue, the child was subjected to near-total pancreatectomy. The histology revealed findings consistent with nesidioblastosis. The child's condition improved but he remained significantly delayed This case emphasises the importance of recognising and treating hypoglycaemia early to avoid irreversible brain damage. It is interesting to note that the twin brother has always been well and is developmentally normal. Further studies to identify the inheritance pattern in the family would be of great interest.

Matched MeSH terms: Parents

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