Background: and Purpose Outcomes following mechanical thrombectomy (MT) are strongly correlated with successful recanalization, traditionally defined as modified Thrombolysis in Cerebral Infarction (mTICI) ≥2b. This retrospective cohort study aimed to compare the outcomes of patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS; 2–5) who achieved mTICI 2b versus those who achieved mTICI 2c/3 after MT. Methods: This study utilized data from the Stroke Thrombectomy and Aneurysm Registry (STAR), which combined databases from 32 thrombectomy-capable stroke centers between 2013 and 2023. The study included only patients with low ASPECTS who achieved mTICI 2b, 2c, or 3 after MT for internal carotid artery or middle cerebral artery (M1) stroke. Results: Of the 10,229 patients who underwent MT, 234 met the inclusion criteria. Of those, 98 (41.9%) achieved mTICI 2b, and 136 (58.1%) achieved mTICI 2c/3. There were no significant differences in baseline characteristics between the two groups. The 90-day favorable outcome (modified Rankin Scale score: 0–3) was significantly better in the mTICI 2c/3 group than in the mTICI 2b group (adjusted odds ratio 2.35; 95% confidence interval [CI] 1.18–4.81; P=0.02). Binomial logistic regression revealed that achieving mTICI 2c/3 was significantly associated with higher odds of a favorable 90-day outcome (odds ratio 2.14; 95% CI 1.07–4.41; P=0.04). Conclusion In patients with low ASPECTS, achieving an mTICI 2c/3 score after MT is associated with a more favorable 90-day outcome. These findings suggest that mTICI 2c/3 is a better target for MT than mTICI 2b in patients with low ASPECTS.

OCCUPATIONAL STRESS, COPING STRATEGIES, AND QUALITY OF LIFE AMONG NURSES IN ABHA CITY Background: The nursing profession is inherently stressful, and nurses in Abha City face unique challenges due to rapid population growth and evolving healthcare needs. Objective: The purpose of the present study is to identify the correlation between “Occupational stress, coping strategies and quality of life” among nurses in Abha city. Method: The present study utilized a cross-sectional, descriptive survey, and correlational research design. A convenience sampling throughout an online questionnaire was used to recruit 411 nurses from three hospitals in Abha city, and data was collected using three validated instruments: The Expanded Nursing Stress Scale, the Brief Cope Scale, and the World Health Organization-Quality of Life Scale. SPSS version 26 was used for data analysis, including descriptive statistics, independent samples t-test, ANOVA, and Pearson’s correlation coefficient. Results: Findings revealed a moderate level of occupational stress (mean score 2.31 ± 0.56 on the ENSS-59 scale), with the main sources being dealing with patients and their families (2.35 ± 0.65), uncertainty concerning treatment (2.33 ± 0.66), and discrimination (2.32 ± 0.88). Nurses employed coping strategies such as planning (2.49 ± 0.75), religion (2.47 ± 0.72), and substance use (2.45 ± 0.77), while the least adopted strategies were self-blame (2.40 ± 0.71), self-distraction (2.37 ± 0.73), and behavioral disengagement (2.32 ± 0.73). Significant associations were found between sources of occupational stress and coping strategies, such as death and dying stress source correlating with self-distraction (r=0.202), use of instrumental support (r=0.111), positive reframing (r=0.154), humor (r=0.111), religion (r=0.142), and self-blame (r=0.141). Conflict with peers as a stress source was significantly correlated with self-distraction (r=0.157), denial (r=0.158), substance use (r=0.183), use of instrumental support (r=0.130), behavioral disengagement (r=0.106), venting (r=0.121), humor (r=0.203), religion (r=0.106), and self-blame (r=0.152). A significantly negative association between occupational stress and quality of life was also identified (r=-0.451). Conclusion: Significant correlation were found between sources of occupational stress and coping strategies. The study also demonstrated a significant negative association between occupational stress and quality of life, emphasizing the need for interventions to reduce occupational stress and enhance nurses’ well-being. ASEAN Journal of Psychiatry, Vol. 25 (2) February, 2024; 1-14.

Background: and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT). Methods: This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS). Results: Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, P=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, P<0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (P=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, P=0.026), less mortality (34% vs. 63%, P<0.001), and better discharge NIHSS (P<0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, P<0.001), baseline NIHSS (aOR 0.91, P=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, P=0.041), and collaterals scores (aOR 1.41, P=0.027) were associated with 90-day functional independence. Conclusion In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.

Background: Corona anxiety is present in medical students who must attend hospital. Due to the prevalence of Coronavirus Disease (COVID-19) disease and more attention to holding virtual classes and the need to pay attention to corona anxiety in inter-ship students of nursing, midwifery and operating room, this study aims to determine the impact of virtual education on transmission, control and Prevention of COVID-19 disease due to corona anxiety was performed in these students. Materials and methods: This quasi-experimental study was performed on 90 internship students of nursing, midwifery and operating room. The instruments of this study included the Demographic Profile Questionnaire and the Corona Disease Anxiety Scale (CDAS). In the intervention group, e-learning on methods of transmission, prevention and treatment of coronavirus in 6 sessions of 45 minutes three times a week (for two weeks) online by creating an educational channel for group discussion and information exchange and another channel only for Educational content was provided in WhatsApp Independent t-test was used to compare the mean and standard deviation of coronavirus anxiety scores between the two groups, before the intervention and after the intervention. Data were analyzed using SPSS software version 21, and paired t-test was used to compare the mean scores in each group before and after the intervention. Results: The mean and standard deviation of the age of the research units was 23.02 ± 1.3. The results of independent t-test showed that after the intervention, there was no significant difference between the intervention and control groups in terms of mean score of coronary anxiety (p>0.05). The results of paired t-test showed that there was no statistically significant difference in the mean score of coronavirus anxiety in the intervention and control groups before and after the intervention (p>0.05). Conclusion: The results of this study showed that virtual education did not have a significant effect on reducing anxiety caused by Corona virus and the mean score of students’ anxiety did not change. This indicates proper planning and education about this disease in the country and achieving the goal of increasing people’s awareness by the Ministry of Health, Treatment and Medical Education and it is recommended that the training be directed to students other than the medical sciences and others.

Introduction: SABINA III assessed short-acting β2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Methods: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1–2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27–0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44–2.89). Conclusion The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.
Asthma ; Malaysia

SOCIAL SUPPORT AND THE ASSOCIATED RISK FACTORS FOR POSTPARTUM DEPRESSION AMONG MOTHERS ATTENDING PRIMARY CARE CENTERS IN MALAYSIA. Abstract Background/Objectives: Postpartum Depression (PPD) is the most common maternal distress worldwide. PPD negatively impacts mothers, infants, and the family, affecting psychosocial and economic well-being. The study aims to determine the prevalence of Postpartum Depression in mothers attending primary care centres and the associated risk factors, including perceived social support and breastfeeding experiences. Methods: This cross-sectional study assessed 230 mothers up to three months postpartum attending two maternal and child clinics in Alor Setar, Kedah, Malaysia, from August to November 2022. Three self-report measures were used, namely the sociodemographic and clinical questionnaires, The Edinburgh Postnatal Depression Scale (EPDS) to assess depression and the Multidimensional Scale of Perceived Social Support (MSPSS) to measure the level of perceived social support. Results: The prevalence of Postpartum Depression was 2.6%. Univariate analysis found that duration of postpartum, employment status, income groups, depressed mood during pregnancy and presence of breastfeeding difficulties were significantly associated with Postpartum Depression. Predictors of Postpartum Depression were the high-income group (P 0.044 or 10.76 95% CI 1.07-108.76), depressed mood during pregnancy (P 0.026 or 8.31 95% CI 1.29-53.47) and breastfeeding difficulties (P 0.018 or 15.14 95% CI 1.59-144.54). Conclusion: Postpartum Depression is prevalent in the community. General and targeted Postpartum Depression screening should be done early. Breastfeeding educators’ services should be feasible for the mother to reduce the risk of Postpartum Depression.

Objectives: Voluntary testing (VT) plays a crucial role in the prevention and control of infectious diseases. The present study investigated the perceptions and utilization of VT services for coronavirus disease 2019 (COVID-19) among the inhabitants of Saudi Arabia. Methods: In total, 3,510 adult participants from all provinces of Saudi Arabia were recruited via a national online survey. Results: Of the 3,510 participants, 88.9% were aware of the testing services available to them and of those, more than half (59.5%) had used the VT services and 96.1% were satisfied with the services. Contact with a positive COVID-19 case was the top reason for accessing VT, while a lack of awareness about the availability of VT services was the top perceived limiting factor. A history of chronic health conditions, anxiety and/or depression, and previous symptoms suggestive of COVID-19 were found to be predictors of the utilization of VT services (OR 1.55, 95% CI 1.22−1.96; OR 1.48, 95% CI 1.16−1.88; OR 3.31, 95% CI 2.77−3.95; and OR 1.62, 95% CI 1.34−1.96; respectively), respectively. Conclusion The awareness of voluntary COVID-19 testing services was satisfactory among the Saudi Arabian population, but can be improved. Sociodemographic and health history predictors of the utilization of VT services were identified.

This study explored the psychometric properties of the Arabic version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale for assessing people's anxiety in response to the viral epidemic in Lebanon. The 406 participants responded voluntarily to the online survey that included the SAVE-6, Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9) tools. The single-structure SAVE-6 model showed good internal consistency (Cronbach's α = 0.773). The SAVE-6 scale also showed good convergent validity with the GAD-7 (Spearman's ρ = 0.42, P < 0.001) and PHQ-9 (ρ = 0.38, P < 0.001). Receiver operating characteristic (ROC) analysis revealed an Arabic SAVE-6 cut-off score of 12 points (area under the curve [AUC] = 0.753; sensitivity = 62.74%; specificity = 78.26%) for an at least mild degree of anxiety (GAD-7 score ≥ 5). The Arabic version of the SAVE-6 was a reliable, valid, and solely usable scale for measuring the anxiety response of the general population to the viral epidemic.

Objective: We aimed to investigate the association of increased smartphone screen time with insomnia, bedtime procrastination, depression, anxiety, body mass index (BMI), and physical activity during the coronavirus disease of 2019 (COVID-19) pandemic. Methods: An online survey was performed for university students from all regions of Lebanon during the lockdown. The survey included questionnaires about smartphone screen time, diet, physical activity, psychological symptoms, and bedtime procrastination. We defined 6 hours of smartphone use as critical based on a survey done in United States. Results: Among female students, smartphone use duration, physical activity levels, BMI, depression, anxiety, and insomnia severity were significantly higher than in male. When we stratified participants based on 6 hours of smartphone use, females, unhealthy food consumption, insomnia, anxiety, depression, and bedtime procrastination were significantly higher in the group with ≥6 hours of smartphone use. When we divided based on 7 hours, physical activity and body weight also differed between the two groups. Logistic regression analysis revealed that female, overweight, insomnia, and bedtime procrastination were significant predictors of a phone screen time of 7 hours. Conclusion Our findings suggest that adults should be more cautious and responsible when using smartphones and be more concerned about the health-related risks.

Objective: We aimed to investigate the association of increased smartphone screen time with insomnia, bedtime procrastination, depression, anxiety, body mass index (BMI), and physical activity during the coronavirus disease of 2019 (COVID-19) pandemic. Methods: An online survey was performed for university students from all regions of Lebanon during the lockdown. The survey included questionnaires about smartphone screen time, diet, physical activity, psychological symptoms, and bedtime procrastination. We defined 6 hours of smartphone use as critical based on a survey done in United States. Results: Among female students, smartphone use duration, physical activity levels, BMI, depression, anxiety, and insomnia severity were significantly higher than in male. When we stratified participants based on 6 hours of smartphone use, females, unhealthy food consumption, insomnia, anxiety, depression, and bedtime procrastination were significantly higher in the group with ≥6 hours of smartphone use. When we divided based on 7 hours, physical activity and body weight also differed between the two groups. Logistic regression analysis revealed that female, overweight, insomnia, and bedtime procrastination were significant predictors of a phone screen time of 7 hours. Conclusion Our findings suggest that adults should be more cautious and responsible when using smartphones and be more concerned about the health-related risks.