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  1. Alvi Q, Baloch GM, Chinna K, Dabbagh A
    F1000Res, 2020;9:901.
    PMID: 32802322 DOI: 10.12688/f1000research.24866.1
    Ovarian cancer is a fatal gynaecological cancer and eighth most common cancer in women globally. Lifestyle, reproductive and sociodemographic factors are among the influential parameters that may significantly affect the risk of ovarian cancer and its mortality rate. However, the epidemiological investigations have shown that the risk of ovarian cancers associated with these factors is different in varied geographical distributions. Lifestyle and reproductive factors have not been investigated thoroughly across a wide cultural diversity. The objective of this study is to investigate the association of these factors with ovarian cancer in Pakistan. This investigation will focus on the lifestyle effects of fat intake, intake of tea, habitual exercise, use of talc, personal hygiene, habit of holding urine for long time, obesity on ovarian cancer among Pakistani women.  Reproductive variables will include age at menarche, natural menopausal age, parity, nulliparity (miscarriages, abortion, stillbirths), infertility, fertility treatment, tubal ligation, oral contraceptive use, and family history of breast or ovarian cancer. Sociodemographic variables will include effect of age, income, education, and geographical location. A case-control study will be conducted in the major cancer hospitals of Pakistan and the patients will also be interviewed. The controls will be recruited outside the hospital. For controls the same age limit and residency requirements will be applied. The information gained from this research will be an important contribution to develop programs for health promotion, with a focus on ovarian cancer prevention and women's health. The findings could be used for health policies and planning to prevent ovarian cancer. The research will pave the way for a public policy and interventions to reduce the burden of ovarian cancer in Pakistan.
  2. Kamaludin K, Chinna K, Sundarasen S, Khoshaim HB, Nurunnabi M, Baloch GM, et al.
    Heliyon, 2020 Nov;6(11):e05339.
    PMID: 33134570 DOI: 10.1016/j.heliyon.2020.e05339
    This study examined how university students in Malaysia coped with the psychological impact of the COVID-19 pandemic and restrictions on movement (also known as MCO). A total of 983 students participated in a survey conducted online between April 20 and May 24, 2020. The psychological impact was measured using Zung's Self-Rating Anxiety Scale (SAS). The students were assessed on the usage of adaptive (humanitarian and seeking social support) and maladaptive coping strategies (acceptance and mental disengagement). The results showed that the students used maladaptive coping strategies more than adaptive coping strategies to deal with anxiety caused by the pandemic and the effect of restriction of movement. Seeking social support and acceptance coping strategies were significantly associated with the level of anxiety. The student's gender, age, ethnicity, level and type of study, and living arrangement were associated with coping strategies. The students' selection of coping strategies mirrors typical Asian culture, that is, submissiveness. The study proposes several practical and professional suggestions to address students' mental health issues.
  3. Far Abid Hossain S, Nurunnabi M, Sundarasen S, Chinna K, Kamaludin K, Baloch GM, et al.
    J Public Health Res, 2020 Nov 17;9(Suppl 1):1911.
    PMID: 33575227 DOI: 10.4081/jphr.2020.1911
    Background: The socio-psychological impact of COVID-19 has affected the whole world. Bangladesh, one of the most dangerous places as stated by WHO, was first infected at the beginning of March 2020, later than other countries. Bangladesh is now one of the 20 most affected countries in the world, but the psychological effects for university students during the epidemic period are not researched. Design and methods: To address this gap, the present study attempts to discover the socio-psychological impact of COVID-19 on university students in Bangladesh. We conducted an online survey using a questionnaire with a simple random sampling technique and we received 474 responses. Results: In this study, numerous psychological concerns were reported. The study is limited to university students, which may affect the generalizability of the research. Conclusions: Our findings suggest a need to build awareness of the mental health implications of the pandemic for university students.
  4. Baloch GM, Sundarasen S, Chinna K, Nurunnabi M, Kamaludin K, Khoshaim HB, et al.
    PeerJ, 2021;9:e10612.
    PMID: 33604167 DOI: 10.7717/peerj.10612
    BACKGROUND: As of the present, the twenty-first century is experiencing what may be one of its most devastating events, in respect to infected and dead people by the virus. Now known to the world as COVID-19, the devastating disease of what has become a pandemic started its spread from Wuhan, China and swiftly engulfed the whole world with almost 11 million cases, in a span of around six months. It has not only increased the global burden of disease but has heavily dented many social institutions, including education.

    METHODS: This study investigates how the COVID-19 pandemic and subsequent measures of lockdown, quarantine, and social distancing have affected students. We look specifically into the effects on individuals' mental health, that is, the stress and anxiety levels of college and university students using the Zung Self-rating Anxiety Scale (SAS).

    RESULTS: Among 494 respondents, 61% were females, and the majority (77.3%) of the students were in the age group of 19-25 years. Among the respondents, 125 (25.3%), 45 (9.1%) and 34 (6.9%) experienced minimal to moderate, severe, and most extreme levels of anxiety, respectively. The variables of gender, age and year of study were significant at the 0.25 level by univariate analyses. Nevertheless, the ordinal regression indicates that only gender was significant. The odds of a female student being more anxious are higher compared to a male student (OR = 1.779, 95% CI [1.202-2.634], P = 0.004). The most prominent stressors attained from the qualitative feedback from the Pakistani students are associated with online teaching, concerns about their academic performance and completion of the current semester, uncertainty related to exam dates, and the status of the following semester.

    CONCLUSIONS: This study will add to the existing body of literature on the impacts of the COVID-19 pandemic on the social and psychological health of students. The study outcomes will provide basic data for further applied and action research and a framework for universities and policy makers in Pakistan and the neighboring countries in the region with the same cultural contexts. Thus, relevant health interventions can be designed for better mental health and educational attainments of students from higher educational institutions. This pathological pandemic may well lead to another pandemic of mental and behavioral illness. All stakeholders should join force regardless of pre-existing differences and inequalities to ensure the well-being of future generations, specifically students from higher educational institutions. The long-lasting impacts and the aftermath of this pandemic will unquestionably need further and future investigations. Keywords: Anxiety, students, mental health, COVID-19, Pakistan.

  5. Sundarasen S, Chinna K, Kamaludin K, Nurunnabi M, Baloch GM, Khoshaim HB, et al.
    Int J Environ Res Public Health, 2020 Aug 27;17(17).
    PMID: 32867024 DOI: 10.3390/ijerph17176206
    The COVID-19 pandemic and the lockdown has taken the world by storm. This study examines its impact on the anxiety level of university students in Malaysia during the peak of the crisis and the pertinent characteristics affecting their anxiety. A cross-sectional online survey, using Zung's self-rating anxiety questionnaire was conducted during the COVID-19 pandemic and lockdown. Out of the 983 respondents, 20.4%, 6.6%, and 2.8% experienced minimal to moderate, marked to severe, and most extreme levels of anxiety. Female gender (OR = 21.456, 95% CI = 1.061, 1.998, p = 0.020), age below 18 years (OR = 4.147, 95% CI = 1.331, 12.918, p = 0.014), age 19 to 25 (OR = 3.398, 95% CI = 1.431, 8.066, p = 0.006), pre-university level of education (OR = 2.882, 95% CI = 1.212, 6.854, p = 0.017), management studies (OR = 2.278, 95% CI = 1.526, 3.399, p < 0.001), and staying alone (OR = 2.208, 95% CI = 1.127, 4.325, p = 0.021) were significantly associated with higher levels of anxiety. The main stressors include financial constraints, remote online teaching and uncertainty about the future with regard to academics and career. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
  6. Baloch GM, Kamaludin K, Chinna K, Sundarasen S, Nurunnabi M, Khoshaim HB, et al.
    PMID: 33673237 DOI: 10.3390/ijerph18041799
    COVID-19 has speedily immersed the globe with 72+ million cases and 1.64 million deaths, in a span of around one year, disturbing and deteriorating almost every sphere of life. This study investigates how students in Pakistan have coped with the COVID-19. Zung's self-rating anxiety scale (SAS) was used for measuring anxiety and the coping strategies were measured on four strategies i.e., seeking social support, humanitarian, acceptance, and mental disengagement. Among 494 respondents, 61% were females and 77.3% of the students were in the age group of 19-25 years. The study findings indicate that approximately 41 percent of students are experiencing some level of anxiety, including 16% with severe to extreme levels. Seeking social support seemed to be the least preferred coping strategy and that female students seek social support, humanitarian, and acceptance coping strategies more than males. Students used both emotion-based and problem-based coping strategies. The variables of gender, age, ethnicity, level and type of study, and living arrangement of the students were associated with usage of coping strategies. Findings showing that students do not prefer to seek social support. The study outcomes will provide basic data for university policies in Pakistan and the other countries with same cultural contexts to design and place better mental health provisions for students.
  7. Nurunnabi M, Hossain SFAH, Chinna K, Sundarasen S, Khoshaim HB, Kamaludin K, et al.
    F1000Res, 2020;9:1115.
    PMID: 33274049 DOI: 10.12688/f1000research.25557.1
    Background: COVID-19 has severely affected university students everywhere in the world. Due to fear of infection, government and local authorities in China immediately closed academic institutions and tried to find survival techniques to cope with market turbulence. COVID-19 was present in China at the end of 2019. However, little attention has been paid by researchers to coping strategies during the COVID-19 pandemic, and few measures were taken to assess the coping strategies of university students, specifically following the closure of their institutions. To address this gap, this study attempted to discover the coping strategies of Chinese students during the COVID-19 pandemic in China. Methods: We conducted an online survey using a semi-structured questionnaire with a simple random sampling technique and received 559 responses. The survey questions captured information about students' lives during the COVID-19 outbreak, actions to control anxiety, and what students care about during the pandemic. The associations between coping strategies used and levels of anxiety were tested using analysis of variance (ANOVA) procedures. SPSS Statistics v27 was used for statistical analysis in this study. Results: The university students reported that coping strategies and survival techniques were required due to high levels of anxiety and psychological pressure during the COVID-19 pandemic. Most of the respondents reported the prompt closure of their academic institutions due to COVID-19. Psychological concerns, such as lack of sleep, emotional support, mental support and social appeal, were also reported. Conclusions: This is one of the very first studies on coping strategies for anxiety in China. The study reveals that university students employ a number of coping strategies in relation to COVID-19, but also suggests a need to strengthen such strategies in this population. However, the study was limited to a small number of provinces in China, which may affect the generalizability of the research.
  8. Lugova H, Andoy-Galvan JA, Patil SS, Wong YH, Baloch GM, Suleiman A, et al.
    Community Ment Health J, 2021 11;57(8):1489-1498.
    PMID: 33417170 DOI: 10.1007/s10597-020-00765-7
    Growing prevalence of mental illnesses and the role they play in the global disease burden is an emerging public health issue. The prevalence of depression and anxiety is on the rise in Malaysia. Low-income urban communities are among the key affected populations with regards to mental health problems. This cross-sectional study was aimed to determine the prevalence and severity of depression, anxiety and stress, and their associated factors among adults in the low-income community of Kuala Lumpur, Malaysia. A total of 248 participants aged 18-60 years old were recruited. Data were collected via face-to-face interviews using the Depression, Anxiety and Stress Scale-21 Items (DASS-21). Chi-squared test was used to examine the association between the variables. Multiple ordinal regression model was introduced to identify the predictors of depression, anxiety and stress. The proportions of participants with depression, anxiety and stress were 24.2% (95% CI: 19.6-30.4), 36.3% (95% CI: 29.9-43.0), and 20.6% (95% CI: 15.4-26.5), respectively. There was a statistically significant association of ethnicity (p = 0.002) and age (p = 0.014) with the severity of depression, ethnicity (p = 0.001) and age (p = 0.024) with the severity of anxiety, and ethnicity (p 
  9. Mohd Radi MF, Hashim JH, Jaafar MH, Hod R, Ahmad N, Mohammed Nawi A, et al.
    Am J Trop Med Hyg, 2018 05;98(5):1281-1295.
    PMID: 29532771 DOI: 10.4269/ajtmh.16-0922
    Severe floods increase the risk of leptospirosis outbreaks in endemic areas. This study determines the spatial-temporal distribution of leptospirosis in relation to environmental factors after a major flooding event in Kelantan, Malaysia. We conducted an observational ecological study involving incident leptospirosis cases, from the 3 months before, during, and three months after flood, in reference to the severe 2014 Kelantan flooding event. Geographical information system was used to determine the spatial distribution while climatic factors that influenced the cases were also analyzed. A total of 1,229 leptospirosis cases were notified within the three study periods where incidence doubled in the postflood period. Twelve of 66 subdistricts recorded incidence rates of over 100 per 100,000 population in the postflood period, in comparison with only four subdistricts in the preflooding period. Average nearest neighborhood analysis indicated that the cases were more clustered in the postflood period as compared with the preflood period, with observed mean distance of 1,139 meters and 1,666 meters, respectively (both at P < 0.01). Global Moran's I was higher in the postflood period (0.19; P < 0.01) as compared with the preflood period (0.06; P < 0.01). Geographic weighted regression showed that living close to water bodies increased the risk of contracting the disease. Postflooding hotspots were concentrated in areas where garbage cleanup occurred and the incidence was significantly associated with temperature, humidity, rainfall, and river levels. Postflooding leptospirosis outbreak was associated with several factors. Understanding the spatial distribution and associated factors of leptospirosis can help improve future disease outbreak management after the floods.
  10. Khoshaim HB, Al-Sukayt A, Chinna K, Nurunnabi M, Sundarasen S, Kamaludin K, et al.
    Front Psychiatry, 2020;11:579750.
    PMID: 33362601 DOI: 10.3389/fpsyt.2020.579750
    COVID-19 is the worst pandemic of this millennium, and it is considered to be the "public enemy number one." This catastrophe has changed the way we live in the blink of an eye. Not only has it threatened our existence and health status, but the damage associated with it could equally affect our economic, social, and educational systems. The focus of this study was on the anxiety level of university students during the COVID-19 pandemic in Saudi Arabia. The study was conducted between March and June 2020. A questionnaire was administered online, and 400 completed questionnaires were returned. In this study, the Zung self-rating anxiety scale was used to determine the anxiety levels among the respondents. The results indicated that about 35% of the students experienced moderate to extreme levels of anxiety. Anxiety was highly associated with age, sex, and level of education. These findings can enlighten government agencies and policy makers on the importance of making prompt, effective decisions to address students' anxiety during the COVID-19 pandemic. Researchers are encouraged to focus their future studies on how to develop strategies to boost students' resilience and enhance their adaptability skills for similar disasters in the future.
  11. Andoy-Galvan JA, Lugova H, Patil SS, Wong YH, Baloch GM, Suleiman A, et al.
    F1000Res, 2020;9:160.
    PMID: 32399203 DOI: 10.12688/f1000research.22236.1
    Background: Recent studies have shown that higher income is associated with a higher risk for subsequent obesity in low- and middle-income countries, while in high-income countries there is a reversal of the association - higher-income individuals have a lower risk of obesity. The concept of being able to afford to overeat is no longer a predictor of obesity in developed countries. In Malaysia, a trend has been observed that the prevalence of obesity increases with an increase in income among the low-income (B40) group. This trend, however, was not further investigated. Therefore, this study was performed to investigate the association of income and other sociodemographic factors with obesity among residents within the B40 income group in an urban community.  Methods: This cross-sectional study used a systematic sampling technique to recruit participants residing in a Program Perumahan Rakyat (PPR), Kuala Lumpur, Malaysia. The sociodemographic characteristics were investigated through face-to-face interviews. Weight and height were measured, and body mass index (BMI) was calculated and coded as underweight, normal, overweight and obese according to the cut-off points for the Asian population. A chi-squared test was used to compare the prevalence of obesity in this study with the national prevalence. A generalized linear model was introduced to identify BMI predictors. Results: Among the 341 participants, 25 (7.3%) were underweight, 94 (27.6%) had normal weight, 87 (25.5%) were overweight, and 135 (39.6%) were obese. The proportion of obese adults (45.8%) was significantly higher than the national prevalence of 30.6% (p<0.001). Among all the tested variables, only income was significantly associated with BMI (p=0.046). Conclusion: The proportion of obesity in this urban poor community was higher compared with the national average. BMI increased as the average monthly household income decreased.
  12. Chinna K, Sundarasen S, Khoshaim HB, Kamaludin K, Nurunnabi M, Baloch GM, et al.
    PLoS One, 2021;16(8):e0253059.
    PMID: 34343187 DOI: 10.1371/journal.pone.0253059
    The COVID-19 pandemic and the lockdown measures have taken a toll on every level of the society, worldwide. This study examines their psychological impact on university students in Asia. A cross-sectional online survey was conducted between April and May 2020 in Malaysia, Saudi Arabia, Pakistan, Bangladesh, China, India and Indonesia. The Zung's self-rating anxiety scale (SAS) and questions on adaptive and maladaptive coping strategies were used in this study. A total of 3,679 students from the seven countries participated in this study. Overall, 21.9% and 13.7% of the students in this study experienced mild to moderate and severe to extreme levels of anxiety. More than 20% of the students from China and Bangladesh reported severe to extreme level of anxiety compared to below 10% of the students from Indonesia, Malaysia and India. Among the female students, 15.9% experienced severe to extreme level of anxiety compared to 10.6% among the males. Females from Bangladesh, China, Malaysia, Pakistan and Saudi Arabia experienced significantly higher levels of anxiety compared to their male counterparts. Acceptance was the most used and Seeking Social Support was the least used coping strategies among the students. There were significant differences in the usage of the four strategies by countries. Stressors are predominantly financial constraints, remote online learning, and uncertainty related to their academic performance, and future career prospects.
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