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  1. Yusuf A, Ahmad Z, Keng SL
    Asian Pac J Cancer Prev, 2013;14(1):435-40.
    PMID: 23534769
    BACKGROUND: Breast cancer is the leading cause of cancer-related death among women in Malaysia. A diagnosis is very stressful for women, affecting all aspects of their being and quality of life. As such, there is little information on quality of life of women with breast cancer across the different ethnic groups in Malaysia. The purpose of this study was to examine the quality of life in Malay and Chinese women newly diagnosed with breast cancer in Kelantan.

    MATERIALS AND METHODS: A descriptive study involved 58 Malays and 15 Chinese women newly diagnosed with breast cancer prior to treatment. Quality of life was measured using the Malay version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast-specific module (QLQ-BR23). Socio-demographic and clinical data were also collected. All the data were analyzed using SPSS version 20.0.

    RESULTS: Most of the women were married with at least a secondary education and were in late stages of breast cancer. The Malay women had lower incomes (p=0.046) and more children (p=0.001) when compared to the Chinese women. Generally, both the Malay and Chinese women had good functioning quality-of-life scores [mean score range: 60.3-84.8 (Malays); 65.0-91.1 (Chinese)] and global quality of life [mean score 60.3, SD 22.2 (Malays); mean score 65.0, SD 26.6 (Chinese)]. The Malay women experienced more symptoms such as nausea and vomiting (p=0.002), dyspnoea (p=0.004), constipation (p<0.001) and breast-specific symptoms (p=0.041) when compared to the Chinese.

    CONCLUSIONS: Quality of life was satisfactory in both Malays and Chinese women newly diagnosed with breast cancer in Kelantan. However, Malay women had a lower quality of life due to high general as well as breast-specific symptoms. This study finding underlined the importance of measuring quality of life in the newly diagnosed breast cancer patient, as it will provide a broader picture on how a cancer diagnosis impacts multi-ethnic patients. Once health care professionals understand this, they might then be able to determine how to best support and improve the quality of life of these women during the difficult times of their disease and on-going cancer treatments.

  2. Ying CX, Yusuf A, Keng SL
    Br J Nurs, 2020 Jan 23;29(2):S18-S23.
    PMID: 31972104 DOI: 10.12968/bjon.2020.29.2.S18
    BACKGROUND: Intravenous therapy is an integral part of professional nursing practice. Nurses have a responsibility to recognise risk factors for phlebitis.

    AIMS: To investigate nurses' perceptions of risk factors for phlebitis in a tertiary teaching hospital in north-east Peninsular Malaysia.

    METHODS: A cross-sectional study of 199 randomly selected nurses were surveyed for their perceptions of risk factors for phlebitis using a self-administered questionnaire.

    FINDINGS: More than half of the nurses (56.8%) had a good perception levels of risk factors for phlebitis. There was a significant association between the clinical area and nurses' perceptions of risk factors for phlebitis (p=0.04). Nurses working in medical, orthopaedic, and surgical areas had slightly better perceptions than nurses working in multidisciplinary and oncology areas.

    CONCLUSION: These findings suggest that nurses need to continually improve their knowledge about risk factors for phlebitis to ensure safer nursing practice.

  3. Keng SL, Abdul Wahab SB, Chiu LB, Yusuf A
    Asian Pac J Cancer Prev, 2015;16(2):537-40.
    PMID: 25684484
    BACKGROUND: Ovarian cancer is recognized as the fourth leading cancer in Malaysia. However, women do not always seek help in a timely manner and gaps in awareness may influence screening uptake and presentation. The purpose of this study was to determine levels of awareness of ovarian cancer risk factors in female population in Penang, Malaysia.

    MATERIALS AND METHODS: A cross-sectional study was conducted in Penang, Malaysia from January until February 2014. Eighty-seven women were selected by convenient sampling. Awareness of risk factors of ovarian cancer was assessed using a self-administered questionnaire. Data were analyzed using statistical package for the social sciences (SPSS) version 20.0 for descriptive statistics and Pearson chi-square test for the association between socio-demographic data and awareness. A p value ≤0.05 was considered statistically significant.

    RESULTS: In all, 74.7% of participants answered correctly for the risk factor of increasing age, although 94.3% were unaware of increased risk of tall women. A majority, 71.3%, had a low level of awareness of ovarian cancer risk factors. There was a significant association between age and knowledge (p=0.047). Additionally, there was a significant association between higher education level and level of awareness of ovarian cancer risk factors (p=0.039).

    CONCLUSIONS: This study revealed that awareness of ovarian cancer risk factors among Malaysian women is low. The results show a need for improved public understanding about ovarian cancer risks and provision of important information for health professionals about initiatives needed for future awareness, prevention and screening programs.
  4. Che Johan NAS, Rasani AAM, Keng SL
    Br J Nurs, 2023 Jan 26;32(2):74-80.
    PMID: 36715528 DOI: 10.12968/bjon.2023.32.2.74
    BACKGROUND: The use of mobile health (mHealth) applications, which provide opportunities to improve health and lessen health inequalities, is increasing. Studies assessing the readiness and ability of patients in Malaysia with chronic kidney disease (CKD) to use mobile phone apps to manage their health are limited.

    AIMS: This study aimed to assess the readiness and ability to use mHealth apps among patients with CKD in north-east Peninsular Malaysia.

    METHODS: A cross-sectional study was undertaken, using a convenience sample of 100 CKD medical inpatients in a tertiary teaching hospital. A structured, self-administered questionnaire on readiness and ability to use mHealth apps was adopted.

    FINDINGS: Nearly one in five patients (18%) actively used health applications. More than three-quarters (77%) were aged >40 years and a similar proportion were ready to use mHealth apps (78%), and nearly half (46%) were confident about connecting their device to wifi. There was a correlation between ability and readiness to use mHealth apps (r=0.4; P<0.05).

    CONCLUSIONS: Fewer than half of participants had a good command of mHealth applications. Therefore, support on the use of these apps is needed, and healthcare managers need to consider this.

  5. Mohd Fadzli NFA, Mohd Rasani AA, Keng SL
    Belitung Nurs J, 2021;7(6):529-534.
    PMID: 37497291 DOI: 10.33546/bnj.1804
    BACKGROUND: Patients with chronic kidney disease (CKD) spend substantial money on hemodialysis (HD) treatment. The growing intersection between socioeconomic status and financial burden represents an emerging challenge to the CKD community.

    OBJECTIVE: This study assessed the financial burden of HD treatment on patients at a Malaysian tertiary teaching hospital.

    METHODS: A cross-sectional study was carried out in the HD unit at a Malaysian tertiary teaching hospital from January to February 2021. Patients undergoing HD were purposively selected. A self-administered questionnaire was used to collect data on socio-demographic, finances, the patient's health history, treatment costs, and healthcare utilization. In addition, Pearson Chi-Square tests were used to analyze the data.

    RESULTS: A total of 100 patients receiving HD treatment were included in the study. The mean age was 62.06 years (SD = 27.50), with 52% reporting moderate financial burdens. The financial burden was associated with employment status, salary, and income class among HD patients (p <0.05).

    CONCLUSION: Evidence showed a large proportion of Malaysian patients receiving HD treatment came from the B40 income bracket. The findings indicate that financial burdens can impact HD patients and are related to employment status, salary, and income class. Therefore, the ability to identify HD patients' financial needs is critical in nursing practice.

  6. Lee SSM, Keng SL, Hong RY
    Dev Psychopathol, 2023 Sep 13.
    PMID: 37702069 DOI: 10.1017/S0954579423001116
    This longitudinal study aimed to validate the biosocial theory of borderline personality disorder (BPD) by examining the transactional relationship between individual vulnerabilities and parental invalidation, and their links to BPD symptoms. We recruited a sample of 332 adolescents (mean age = 14.18 years; 58.3% female) residing in Singapore and administered self-report measures across three time-points (six months apart). Results from our path analytic model indicated that parental invalidation, impulsivity, and emotional vulnerability exhibited unique predictive associations with emotion dysregulation six months later. There was also a reciprocal prospective relationship between emotion regulation difficulties and BPD symptoms. Using random-intercepts cross-lagged panel models, we found partial evidence for a within-individual reciprocal relationship between parental invalidation and emotional vulnerability, and a unidirectional relationship of within-individual changes in impulsivity positively predicting changes in parental invalidation six months later. Overall, the study provided partial empirical support for the biosocial model in a Singaporean context.
  7. Phang CK, Mukhtar F, Ibrahim N, Keng SL, Mohd Sidik S
    Adv Health Sci Educ Theory Pract, 2015 Dec;20(5):1115-34.
    PMID: 25697124 DOI: 10.1007/s10459-015-9591-3
    Pursuing undergraduate medical training can be very stressful and academically challenging experience. A 5-week mindfulness-based stress management (MBSM/Mindful-Gym) program was developed to help medical students cope with stress. The aim of this study was to evaluate the effectiveness of the intervention in reducing stress among students in a medical school in Malaysia. Seventy-five medical students participated in the program. They were stratified according to years of studies and randomly allocated to intervention (N = 37) and control groups (N = 38). The following outcome variables were measured at pre- and post-intervention: mindfulness (with Mindful Awareness Attention Scale); perceived stress (with Perceived Stress Scale); mental distress (with General Health Questionnaire), and self-efficacy (with General Self-efficacy Scale). Hierarchical multiple regressions were used to analyse the effect of group (intervention vs. control) on changes in the outcome variables. There were significant improvements at one week post-intervention in all outcome variables: mindfulness (β = 0.19, ΔR2 = 0.04, p = .040, f (2) = 0.05), perceived stress (β = -0.26, ΔR2 = 0.07, p = .009, f (2) = 0.10); mental distress (β = -0.28, ΔR2 = 0.10, p = .003, f (2) = 0.15); and self-efficacy (β = 0.30, ΔR2 = 0.09, p < .001, f (2) = 0.21). Six months after the intervention, those who had joined the program reported higher self-efficacy compared to those in the control group (β = 0.24, ΔR2 = 0.06, p = .020, f (2) = 0.08); but there was no difference in other outcome measures. More than 90% of the participants found the program applicable in helping patients and all reported that they would recommend it to others. This study indicates that the program is potentially an effective stress management program for medical students in Malaysia.
  8. Yusuf A, Ab Hadi IS, Mahamood Z, Ahmad Z, Keng SL
    Asian Pac J Cancer Prev, 2013;14(6):3689-98.
    PMID: 23886167
    Breast cancer is the most common and leading cause of cancer mortality among Malaysian women. Despite good survival rates, the diagnosis of cancer still invokes the feeling of stress, fear and uncertainty. Because very little is known about the experiences of Malaysian women with breast cancer, a qualitative study using semi- structured interviews to explore the lived experience of newly diagnosed breast cancer. Using a purposive sampling method, 20 Malaysian women newly diagnosed with breast cancer, including Malays (n=10) and Chinese (n=10) were recruited in two main public hospitals in Kelantan. Similarities and divergence in women's experience were identified through thematic analysis of interview transcripts. Three themes emerged from the data: uncertainty experience of the illness, transition process and fatalistic view of breast cancer. In many ways, these findings were parallel with previous studies, suggesting that the experience of breast cancer is to a certain extent similar among women newly diagnosed with breast cancer. This study adds to the sparse literature concerning the experience of illness following breast cancer diagnosis among the Malays and Chinese. More importantly, this study addressed areas that were previously lacking, specifically in depth information on breast cancer experience from a developing country with a multi-ethnic population. The results of this investigation provide preliminary information to healthcare professionals on the impact of illness and cultural influence on survivorship to plan for appropriate education and supportive programme in order to meet the needs of breast cancer women more effectively.
  9. Loo JL, Keng SL, Ramírez-Espinosa IG, Nor Hadi NM, Ramírez-Gutiérrez JA, Shoesmith W
    Asia Pac Psychiatry, 2021 Mar;13(1):e12437.
    PMID: 33188568 DOI: 10.1111/appy.12437
    BACKGROUND: Borderline personality disorder (BPD) contributes to suicide-related morbidity and mortality and requires more intensive psychotherapeutic resources due to its high mental health service usage. Accessibility to an evidence-based treatment program is a cornerstone to support patients with BPD and part of broader suicide prevention efforts as well as improving their quality of life.

    AIMS: In this article, the authors aim to discuss and review available dialectical behavior therapy (DBT) and DBT-informed services of selected countries in the Asia-Pacific Rim, namely Singapore, Malaysia, and Mexico.

    MATERIALS & METHODS: We contacted providers of different services and gathered information on the process of setting up the service and adapting the treatment, in addition to reviewing the available literature published in the countries.

    RESULTS: To date, there have been a pair of DBT-informed services in Singapore, four in Malaysia, and several in Mexico with a few of them offering standard DBT. Different efforts have been put in place to increase the accessibility to training and also the number of DBT practitioners.

    DISCUSSION: Important considerations during the process of setting up new services include the use of domestic examples and local language that are contextually appropriate for the local community. Selected challenges faced in common include shortage of workforce, affordability of training programs, and the need for language adaptation with or without translation.

    CONCLUSION: Further long-term evaluation of locally adapted DBT-informed mental health services will help to elucidate the effectiveness and efficacy of the program which will potentially serve as a guide for other resource-scarce regions.

  10. Keng SL, Mohd Salleh Sahimi HB, Chan LF, Woon L, Eu CL, Sim SH, et al.
    BMC Psychiatry, 2021 10 04;21(1):486.
    PMID: 34607589 DOI: 10.1186/s12888-021-03500-y
    AIM/BACKGROUND: Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia.

    METHODS: Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention.

    RESULTS: There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants' feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial.

    CONCLUSION: These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.

  11. Keng SL, Seman NHC, Krishnan KM, Bee CJ, Sook JLW, Ismail SF, et al.
    J Prev Med Public Health, 2023 Mar;56(2):164-171.
    PMID: 37055358 DOI: 10.3961/jpmph.22.399
    OBJECTIVES: Sarcopenia has emerged as a significant aging-related disease that affects many facets of societal-level and patient-level public health. This study analysed knowledge of sarcopenia and associated socio-demographic factors among the general public of Malaysia in order to effectively improve its prevention and countermeasures.

    METHODS: A cross-sectional online survey was conducted in Selangor, Malaysia, using Google Forms among 202 Malaysian adults from January 1, 2021 to March 31, 2021. Descriptive statistics were used to analyse the socio-demographic characteristics and knowledge scores. The continuous variables were evaluated using the independent t-test, Mann-Whitney test, and one-way analysis of variance test. The Spearman correlation coefficient was employed to determine the correlation between socio-demographic characteristics and knowledge score levels.

    RESULTS: The final analysis included 202 participants. The mean±standard deviation age was 49.03±12.65. Only 6.9% of participants had good knowledge of sarcopenia and were aware of sarcopenia's characteristics, consequences, and treatments. Post-hoc comparisons using the Dunnett T3 test showed statistical significance in mean knowledge score and age group (p=0.011) and education level (p≤0.001). The Mann-Whitney test revealed that gender (p=0.026) and current smoking status (p=0.023) significantly influenced knowledge scores.

    CONCLUSIONS: The general public's knowledge of sarcopenia was found to be poor to moderate and associated with age and education status. Therefore, education and interventions by policymakers and healthcare professionals to improve public knowledge of sarcopenia in Malaysia are needed.

  12. Nisa CF, Bélanger JJ, Faller DG, Buttrick NR, Mierau JO, Austin MMK, et al.
    Sci Rep, 2021 05 06;11(1):9669.
    PMID: 33958617 DOI: 10.1038/s41598-021-88314-4
    This paper examines whether compliance with COVID-19 mitigation measures is motivated by wanting to save lives or save the economy (or both), and which implications this carries to fight the pandemic. National representative samples were collected from 24 countries (N = 25,435). The main predictors were (1) perceived risk to contract coronavirus, (2) perceived risk to suffer economic losses due to coronavirus, and (3) their interaction effect. Individual and country-level variables were added as covariates in multilevel regression models. We examined compliance with various preventive health behaviors and support for strict containment policies. Results show that perceived economic risk consistently predicted mitigation behavior and policy support-and its effects were positive. Perceived health risk had mixed effects. Only two significant interactions between health and economic risk were identified-both positive.
  13. van Breen JA, Kutlaca M, Koç Y, Jeronimus BF, Reitsema AM, Jovanović V, et al.
    Pers Soc Psychol Bull, 2021 Aug 25.
    PMID: 34433352 DOI: 10.1177/01461672211036602
    We examine how social contacts and feelings of solidarity shape experiences of loneliness during the COVID-19 lockdown in early 2020. From the PsyCorona database, we obtained longitudinal data from 23 countries, collected between March and May 2020. The results demonstrated that although online contacts help to reduce feelings of loneliness, people who feel more lonely are less likely to use that strategy. Solidarity played only a small role in shaping feelings of loneliness during lockdown. Thus, it seems we must look beyond the current focus on online contact and solidarity to help people address feelings of loneliness during lockdown. Finally, online contacts did not function as a substitute for face-to-face contacts outside the home-in fact, more frequent online contact in earlier weeks predicted more frequent face-to-face contacts in later weeks. As such, this work provides relevant insights into how individuals manage the impact of restrictions on their social lives.
  14. Resta E, Mula S, Baldner C, Di Santo D, Agostini M, Bélanger JJ, et al.
    PMID: 34898961 DOI: 10.1002/casp.2572
    The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis. Consequently, many countries have adopted restrictive measures that caused a substantial change in society. Within this framework, it is reasonable to suppose that a sentiment of societal discontent, defined as generalized concern about the precarious state of society, has arisen. Literature shows that collectively experienced situations can motivate people to help each other. Since societal discontent is conceptualized as a collective phenomenon, we argue that it could influence intention to help others, particularly those who suffer from coronavirus. Thus, in the present study, we aimed (a) to explore the relationship between societal discontent and intention to help at the individual level and (b) to investigate a possible moderating effect of societal discontent at the country level on this relationship. To fulfil our purposes, we used data collected in 42 countries (N = 61,734) from the PsyCorona Survey, a cross-national longitudinal study. Results of multilevel analysis showed that, when societal discontent is experienced by the entire community, individuals dissatisfied with society are more prone to help others. Testing the model with longitudinal data (N = 3,817) confirmed our results. Implications for those findings are discussed in relation to crisis management. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
  15. Mula S, Di Santo D, Resta E, Bakhtiari F, Baldner C, Molinario E, et al.
    PMID: 35098189 DOI: 10.1016/j.cresp.2021.100028
    Tightening social norms is thought to be adaptive for dealing with collective threat yet it may have negative consequences for increasing prejudice. The present research investigated the role of desire for cultural tightness, triggered by the COVID-19 pandemic, in increasing negative attitudes towards immigrants. We used participant-level data from 41 countries (N = 55,015) collected as part of the PsyCorona project, a cross-national longitudinal study on responses to COVID-19. Our predictions were tested through multilevel and SEM models, treating participants as nested within countries. Results showed that people's concern with COVID-19 threat was related to greater desire for tightness which, in turn, was linked to more negative attitudes towards immigrants. These findings were followed up with a longitudinal model (N = 2,349) which also showed that people's heightened concern with COVID-19 in an earlier stage of the pandemic was associated with an increase in their desire for tightness and negative attitudes towards immigrants later in time. Our findings offer insight into the trade-offs that tightening social norms under collective threat has for human groups.
  16. Enea V, Eisenbeck N, Carreno DF, Douglas KM, Sutton RM, Agostini M, et al.
    Health Commun, 2023 Jul;38(8):1530-1539.
    PMID: 35081848 DOI: 10.1080/10410236.2021.2018179
    Understanding the determinants of COVID-19 vaccine uptake is important to inform policy decisions and plan vaccination campaigns. The aims of this research were to: (1) explore the individual- and country-level determinants of intentions to be vaccinated against SARS-CoV-2, and (2) examine worldwide variation in vaccination intentions. This cross-sectional online survey was conducted during the first wave of the pandemic, involving 6697 respondents across 20 countries. Results showed that 72.9% of participants reported positive intentions to be vaccinated against COVID-19, whereas 16.8% were undecided, and 10.3% reported they would not be vaccinated. At the individual level, prosociality was a significant positive predictor of vaccination intentions, whereas generic beliefs in conspiracy theories and religiosity were negative predictors. Country-level determinants, including cultural dimensions of individualism/collectivism and power distance, were not significant predictors of vaccination intentions. Altogether, this study identifies individual-level predictors that are common across multiple countries, provides further evidence on the importance of combating conspiracy theories, involving religious institutions in vaccination campaigns, and stimulating prosocial motives to encourage vaccine uptake.
  17. Stroebe W, vanDellen MR, Abakoumkin G, Lemay EP, Schiavone WM, Agostini M, et al.
    PLoS One, 2021;16(10):e0256740.
    PMID: 34669724 DOI: 10.1371/journal.pone.0256740
    During the initial phase of the COVID-19 pandemic, U.S. conservative politicians and the media downplayed the risk of both contracting COVID-19 and the effectiveness of recommended health behaviors. Health behavior theories suggest perceived vulnerability to a health threat and perceived effectiveness of recommended health-protective behaviors determine motivation to follow recommendations. Accordingly, we predicted that-as a result of politicization of the pandemic-politically conservative Americans would be less likely to enact recommended health-protective behaviors. In two longitudinal studies of U.S. residents, political conservatism was inversely associated with perceived health risk and adoption of health-protective behaviors over time. The effects of political orientation on health-protective behaviors were mediated by perceived risk of infection, perceived severity of infection, and perceived effectiveness of the health-protective behaviors. In a global cross-national analysis, effects were stronger in the U.S. (N = 10,923) than in an international sample (total N = 51,986), highlighting the increased and overt politicization of health behaviors in the U.S.
  18. Westgate EC, Buttrick NR, Lin Y, El Helou G, Agostini M, Bélanger JJ, et al.
    Emotion, 2023 Dec;23(8):2370-2384.
    PMID: 36913277 DOI: 10.1037/emo0001118
    Some public officials have expressed concern that policies mandating collective public health behaviors (e.g., national/regional "lockdown") may result in behavioral fatigue that ultimately renders such policies ineffective. Boredom, specifically, has been singled out as one potential risk factor for noncompliance. We examined whether there was empirical evidence to support this concern during the COVID-19 pandemic in a large cross-national sample of 63,336 community respondents from 116 countries. Although boredom was higher in countries with more COVID-19 cases and in countries that instituted more stringent lockdowns, such boredom did not predict longitudinal within-person decreases in social distancing behavior (or vice versa; n = 8,031) in early spring and summer of 2020. Overall, we found little evidence that changes in boredom predict individual public health behaviors (handwashing, staying home, self-quarantining, and avoiding crowds) over time, or that such behaviors had any reliable longitudinal effects on boredom itself. In summary, contrary to concerns, we found little evidence that boredom posed a public health risk during lockdown and quarantine. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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