Introduction: Poor feeding practices can result in malnutrition, which may have long-term negative effects on children’s physical and cognitive development. There is limited qualitative research exploring feeding practices among caregivers of urban poor, even though their children are highly vulnerable to undernutrition. Aim: This qualitative study aimed to explore and compare the feeding practices, barriers and coping strategies of caregivers of well-nourished and undernourished children aged three to five years living in public low-cost housing in Kuala Lumpur, Malaysia. Methods: Semi-structured in-depth interviews were conducted among 27 caregivers. Caregivers were purposively selected using purposive sampling and categorized into two groups based on their children’s growth status: families with well-nourished children (FWWC; n=15) and families with undernourished children (FWUC; n=12). Thematic analysis was conducted. Results: Two main themes emerged: feeding practices and barriers and coping strategies to feed children. FWWC caregivers demonstrated certain unique yet beneficial practices. They emphasized responsive feeding techniques, such as using nutritious snacks, promising outdoor activities, and involving children in meal preparation at home as effective strategies to increase children’s food intake. Contrarily, FWUC caregivers practiced less responsive feeding techniques, such as forcing, ignorance, and distraction. Caregivers from both groups experienced similar barriers (child barriers and family barriers) and applied comparable coping strategies (ignorance, distraction, pressure and force, compromise, and creativity). Conclusion: Understanding feeding practices of caregivers of healthy and undernourished children can guide the development of culturally tailored interventions and policies. These efforts can help address barriers and improve child nutrition through responsive feeding, ultimately preventing undernutrition.

Introduction: The Lost Food Project (TLFP) is a non-profit organization who continuously working on their strategic plan in combating the food insecurity problem by distributing food surplus to low income households within Klang Valley. This cross-sectional study aims to determine the socioeconomic status, food security status and its coping strategies among TLFP recipients in Klang Valley during COVID-19 pandemic. Methods: This study was conducted from April to June 2021. There were 88 respondents recruited through convenience sampling. A set of questionnaires regarding food assistance, nutrition knowledge, food security and its coping strategies was prepared, and the respondents were interviewed either by phone, face-to-face or self-administered questionnaire. Results: The prevalence of food insecurity among households in this study was 59.1%. Most of them have moderate (37.5%) to good (27.5%) nutrition knowledge. The coping strategy that most of the respondents applied was ‘using less expensive food’ (58.3%) with at least once per week within the past one month. Food insecure households tend to adopt more coping strategies compared to those food secure households (p<0.001). Moreover, households who rent their house (p<0.01), low household income (p<0.05) and high monthly food and drinks expenditure (p<0.01) were associated with the food insecurity among TLFP recipients. Conclusion: The study concluded that lower household income, higher food and drinks expenditure and those who rent the house have negative impacts on household’s food security status. Thus, the situation forced them to apply more food-related coping strategies in their daily life. Further research should be conducted on the effectiveness of TLFP in helping them to improve Malaysian’s food security status.

Objective:To investigate the clinical characteristics of circadian rhythm disorder of blood pressure and its impact on orthostatic hypotension (OH) in Parkinson′s disease (PD).Methods:A total of 165 PD patients from Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from August 2019 to October 2021 were consecutively enrolled. Medical history and scores of motor and non-motor symptoms of patients were collected. Twenty-four-hour ambulatory blood pressure and OH data were collected, and the OH questionnaire was completed. The incidence of each type of circadian rhythm disorder of blood pressure was investigated. The t test, chi-square test and Mann-Whitney U test were used to determine between-group differences of circadian rhythm disorder of blood pressure. The linear trends in clinical characteristics were tested by linear regression analysis. Logistic regression analysis was used to analyze the relationship between different circadian rhythm disorders of blood pressure and OH as well as symptomatic OH (SOH). Results:In 165 PD patients, the incidence of reverse dipping pattern was 39.39% (65/165), nocturnal hypertension was 43.64% (72/165), and awakening hypotension was 31.52% (52/165). Compared with patients without reverse dipping pattern, patients with reverse dipping pattern were older [(71.72±7.81) years vs (65.29±9.68) years, t=-4.491, P<0.001], had later onset age [(66.67±9.10) years vs (62.16±10.66) years, t=-2.809, P=0.006], longer duration [36.00(20.50, 95.50) months vs 24.00(12.00, 41.75) months, Z=-3.393, P<0.001], higher dose of levodopa (LD) [(426.15±267.38) mg/d vs (284.00±235.58) mg/d, t=-3.590, P<0.001], higher levodopa equivalent dose (LED) [(514.80±360.03) mg/d vs (341.44±284.57) mg/d, t=-3.440, P=0.001], higher Unified Parkinson′s Disease Rating Scale (UPDRS)-Ⅱ scores (12.92±6.38 vs 9.54±5.59, t=-3.434, P=0.001), higher UPDRS-Ⅲ scores (28.34±11.60 vs 21.41±12.18, t=-3.508, P=0.001) and higher percentages of hallucinations [18.46% (12/65) vs 7.00% (7/100), χ2 =5.079, P=0.024]. Compared with patients without awakening hypotension, patients with awakening hypotension were older [(70.83±7.09) years vs (66.44±10.16) years, t=-2.811, P=0.006]. Compared with patients without nocturnal hypertension, patients with nocturnal hypertension had longer duration [39.50(15.00, 96.00) months vs 24.00 (12.00, 36.00) months, Z=-2.944, P=0.003], higher LD [(398.61±251.19) mg/d vs (294.62±254.25) mg/d, t=-2.619, P=0.010], higher LED [(493.28±344.02) mg/d vs (345.05±298.59) mg/d, t=-2.959, P=0.004], higher percentages of hallucinations [19.44% (14/72) vs 5.38% (5/93), χ2 =7.882, P=0.005], higher UPDRS-Ⅱ scores (12.08±6.33 vs 10.00±5.86, t=-2.086, P=0.039), higher UPDRS-Ⅲ scores (26.50±11.72 vs 22.42±12.66, t=-2.034, P=0.044), and greater blood pressure variability (BPV) (20.66±5.47 vs 17.44±5.36, t=-3.798, P<0.001). Trend analysis showed that the variety of circadian rhythm was positively correlated with age and duration, use of levodopa and monoamine oxidase B inhibitors and amantidine, morning and daily LD and LED, UPDRS-Ⅱ, UPDRS-Ⅲ and Hamilton Anxiety Scale scores, hallucinations, OH and SOH, and BPV in PD ( P<0.05). Multivariate Logistic regression analysis showed that awakening hypotension ( OR=3.35, 95% CI 1.55-7.22, P=0.002) and nocturnal hypertension ( OR=2.44, 95% CI 1.20-4.97, P=0.014) were risk factors for OH, and LED ( OR=1.21, 95% CI 1.01-1.43, P=0.035), UPDRS-Ⅲ scores ( OR=1.09, 95% CI 1.02-1.16, P=0.009) and w-BPV ( OR=1.14, 95% CI 1.01-1.29, P=0.029) were independent risk factors for SOH. Conclusions:Circadian rhythm disorder of blood pressure was correlated with age, duration, severity of motor symptoms. Awakening hypotension and nocturnal hypertension are independent risk factors for OH in PD.

BACKGROUND/OBJECTIVES: This study aimed to examine the food security status of urban poor adolescents and its association with diet quality. SUBJECTS/METHODS: A cross-sectional survey was conducted among 188 adolescents aged 13–18 yrs living in Kuala Lumpur, Malaysia. Household food insecurity and dietary intake data were collected using the Radimer/Cornell hunger and food insecurity instrument and 2-day 24-h dietary recalls, respectively. Diet quality was determined using the Malaysian Healthy Eating Index (HEI). Weight and height were measured and body mass index-for-age, as well as height-for-age z scores were calculated. RESULTS: The present study revealed that 47.9% of the adolescents experienced household food insecurity, 24.5% experienced individual food insecurity, 18.6% household food security, and 9.0% child hunger. The mean score of diet quality was 56.83 ± 10.09, with a significantly lower HEI score among food insecure adolescents (household food insecure, individual food insecure, and child hunger) than household food secure adolescents (P = 0.001). The differences between food secure and food insecure households were found to be significant for energy (P = 0.001) and nutrients including proteins (P = 0.006), carbohydrates (P = 0.005), dietary fiber (P = 0.001), folate (P < 0.001), and vitamin C (P = 0.006). The multiple linear regression showed that adolescents who experienced food insecurity (β = −0.328; P = 0.003) were found to be significantly associated with poor diet quality (F = 2.726; P < 0.01), wherein 13.3% of the variation in the diet quality was explained by the food security status. CONCLUSIONS Experiencing food insecurity contributed to poor diet quality among urban poor adolescents. Further longitudinal studies are needed to comprehensively understand this association to improve food insecurity and diet quality among urban poor communities.

Introduction: Three selected dietary supplements (DS), barley grass (BG), wheatgrass (WG), and Chlorella vulgaris (CV), are commercially available. However, more information is needed about the antioxidant properties of the three DS and their potential health benefits on adults’ health and well-being. Thus, this study aimed to determine the antioxidant properties and adults’ knowledge, attitudes and practices (KAP) of the three selected DS. Methods: In phase 1, an experimental study was conducted on antioxidant analysis, total phenolic content (TPC) and DPPH radical scavenging activity for the three DS. For phase 2, a cross-sectional survey (n=338) was conducted for the three DS through an online platform where convenience sampling was performed. Results: In phase 1, BG (2.83±0.50mg GAE/g DW) had the highest TPC, followed by WG (2.02±0.20mg GAE/g DW) and CV (1.74±0.65mg GAE/g DW); DPPH radical scavenging activity, BG (198.23±0.15µg/mL) and WG (177.25±0.17µg/mL) had lower IC50 compared to CV (1185.84±0.28µg/mL). Significant differences (p<0.05) were found between IC50 of the three DS and standards, butylated hydroxytoluene (24.51±0.37µg/mL) and quercetin (26.04±0.55µg/mL). While in phase 2, poor knowledge (51.5%), moderate attitude (39.6%), and poor practice (43.2%) levels were observed in most of the participants. Moreover, working adults reported higher scores in knowledge (3.70±1.51) compared to students (3.33±1.63, p=0.037). Males had higher scores (29.27±2.42) in attitude compared to females (28.49±2.68, p=0.030). Besides, participants who were single and completed tertiary education with 4-6 years of working experience showed better practice scores. The overall knowledge (r=0.134, p=0.013) and attitude (r=0.273, p<0.001) scores correlated significantly with practice scores. Conclusion: Participants’ poor knowledge, moderate attitude, and inadequate practice in phase 2 caution against over-reliance on supplements, emphasizing the importance of an active lifestyle and balanced diet for optimal health and longevity.

Objective: Social media addiction and internet gaming disorder may cause mental health problems among a minority of university students. The Bergen Social Media Addiction Scale (BSMAS) and the 9-item Internet Gaming Disorder Scale-Short Form (IGDS9-SF) are commonly used worldwide. However, they have not been translated or validated into Indonesian. The present study aimed to translate and validate the BSMAS and IGDS9-SF in an Indonesian context among young adults. Methods: A multi-center, web-based cross-sectional study was conducted among 458 university students (74% female; mean age 22.5 years) in Indonesia from June to December 2021. The BSMAS and IGDS9-SF were translated into Indonesian. Internal consistency (using Cronbach’s α and McDonald’s ω) and factor structure (using confirmatory factor analysis) of the two instruments were examined. Concurrent validity of BSMAS and IGDS9-SF was examined using their correlations with two external concepts: nomophobia and psychological distress. Results: Internal consistency of the Indonesian BSMAS and IGDS9-SF were both acceptable (Cronbach’s α=0.80 and 0.90; McDonald’s ω=0.86 and 0.92). Both instruments were unidimensional with good factor loadings (0.54–0.78 for BSMAS; 0.63–0.79 for IGDS9-SF). Moreover, BSMAS and IGDS9-SF had stronger associations with nomophobia (r=0.58 and 0.12; p<0.001) than with psychological distress (r=0.43 and 0.15; p<0.001). Conclusion The Indonesian versions of the BSMAS and IGDS9-SF had good psychometric properties in terms of linguistic validity, unidimensionality, and reliability. The findings indicate the tools are appropriate for assessing the risk of social media addiction and internet gaming disorder among university students in Indonesia.

Objective:To investigate whether the presynaptic dopamine neuronal depletion in different striatal subregions predicts future development of wearing-off (WO) in Parkinson′s disease (PD) patients.Methods:A retrospective longitudinal study included 57 PD patients who were referred to the Department of Neurology of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2020, and completed 11C-2β-carbomethoxy-3β-(4-fluorophenyl) tropane dopamine transporter (DAT) positron emission tomography scans at the initial evaluation and received dopaminergic drugs for at least 12 months during follow-up. The time of starting dopaminergic drug treatment and the occurrence of WO were recorded. After adjusting for clinical related factors, the predictive value of DAT uptake and related parameters in striatal subregions for WO was evaluated by Cox proportional hazards model. Results:During a median follow-up period of 23 months, 10 patients (18.18%) developed WO. Patients with WO exhibited less DAT uptake in the caudate nucleus and anterior putamen nucleus (0.66±0.52 vs 1.08±0.42, t=2.76, P=0.008 and 0.66±0.20 vs 0.87±0.28, t=2.27, P=0.027 respectively), especially in these subregions contralateral to the less-affected side of the body, compared to those without WO. Cox proportional hazard models revealed that after adjusting for gender, age, course of disease, baseline Unified Parkinson′s Disease Rating Scale Ⅲ score and increment of levodopa equivalent dosage, the lower the DAT uptake of the caudate ipsilateral to the less-affected side of the body ( HR=0.20, 95% CI 0.07-0.63, P=0.006), as well as the lower the DAT uptake of the caudate nucleus and posterior putamen nucleus ( HR=0.28, 95% CI 0.11-0.69, P=0.006 and HR=0.08, 95% CI 0.01-0.64, P=0.018 respectively) and the higher the ratio of putamen/caudate contralateral to the less-affected side of the body ( HR=2.33, 95% CI 1.02-5.33, P=0.045), the higher the risk of WO. Conclusion:The presynaptic dopamine neuronal loss, particularly bilateral caudate nucleus dopaminergic depletion at the early stage, has predictive value of development of WO in PD.

Objective:To determine the evolution of gait impairment over the course of Parkinson′s disease (PD) by assessing the changes of gait characteristics in different disease stages, which could be helpful for disease monitoring.Methods:A total of 276 PD patients [PD group, Hoehn-Yahr (H-Y) stage 1-3] and 63 healthy controls (control group) enrolled in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to September 2021 were included in this cross-sectional study. The gait spatiotemporal variables were recorded by a portable inertial measurement unit system. Exploratory factor analysis was performed to obtain gait domains representing different gait characteristics. One way analysis of variance was used to evaluate the differences of gait variables and gait domains among the control group and 3 different H-Y stages of the PD group, as well as the differences among the control group and 2 motor subtypes of PD in different stages. The sensitivity of different gait variables and gait domains in evaluating the severity of gait impairments at different disease stages was compared.Results:Eleven gait spatiotemporal variables were grouped in 4 gait domains: pace (step length, gait speed and stride length), rhythm/phase (cadence, stride time and double support time), pace-related variability/asymmetry [step length coefficient of variation (CV), gait speed CV and step length asymmetry] and rhythm/phase-related variability/asymmetry (swing time CV and swing time asymmetry). As the disease progresses, most evolution trends of the 4 gait domains in the tremor-dominant PD patients were consistent with those in the non-tremor-dominant subtype. Compared with the control group, PD patients at H-Y stage 1 began to show the mild impairment of rhythm/phase-related variability/asymmetry (effect size 0.42; standardized score -0.03±0.69 vs -0.33±0.49, P<0.05), especially swing time asymmetry in tremor-dominant patients; the pace domain was damaged moderately in PD patients at H-Y stage 2 (effect size 0.64; standardized score 0.12±0.80 vs 0.64±0.81, P<0.05), especially in non-tremor-dominant PD patients, but not in PD patients at H-Y stage 1 ( P>0.05). Pace-related variability/asymmetry showed great impairment in PD patients at H-Y stage 3 (effect size 0.62; standardized score 0.27±1.12 vs -0.27±0.52, P<0.05), but not in PD patients at H-Y stages 1 and 2 ( P>0.05). Conclusions:The characteristic impairments of gait in PD evolve in the process of disease progression. The rhythm/phase-related variability/asymmetry domain may be a marker to distinguish early PD from healthy controls. The pace domain and the pace-related variability/asymmetry domain are important markers to evaluate the progression of PD.

Introduction: Literatures suggest that insufficient physical activity as one of the contributors to non-communicable chronic diseases; nevertheless, data on the physical activity level is sparsely reported among individuals practising a vegetarian diet in Malaysia. The current study aims to determine the prevalence of insufficient physical activity and its association with socio-demographic factors, lifestyle factors and body weight status among 273 individuals practising a vegetarian diet in Klang Valley, Malaysia. Methods: A set of self-administered questionnaire was distributed to all vegetarians and their data on physical activity was determined using the Global Physical Activity Questionnaire (GPAQ). Results: The average years of practising vegetarianism was 14.2±9.6 years, and most of the vegetarians were practised ovo-vegetarian diet (44.0%). A majority of them were Chinese (54.9%) and female (64.8%), with an average age of 47.5 ± 13.1 years. The prevalence of overweight and obesity were 27.5% and 8.1%, respectively. According to GPAQ, about two in five vegetarians (46.2%) were having insufficient physical activity. Being females, older age, Chinese, married individuals, and those with high total household income level were found to be significantly associated with low physical activity level among Malaysian vegetarians (p<0.05). Conclusion: Since insufficient physical activity is one of the factors contributing to non-communicable chronic diseases, it is crucial to educate the importance of physical activity on overall health status, specifically for those who at risk of physically inactive. In addition, future studies can focus the causal associations based on the currently identified factors and physical activity levels, which can help to develop an effective intervention program among Malaysia vegetarians.