Pusat Pengajian Sains Perubatan - Tesis
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- PublicationSurvival rate and prognostic factors of death among patients with non-hodgkin lymphoma in Kelantan from 2008-2017(2024-06)Nazmi, OmarBackground: Non-Hodgkin lymphoma is the 12th most common cancer globally, the 4th in Malaysia, and the 5th in Kelantan. Studying the survival rate, median survival time, and prognostic factors of non-Hodgkin Lymphoma can provide valuable insights specific to the Kelantan population and assist in developing better intervention programs. Improving the survival rate aligns with Sustainable Development Goal 3.0, which aims to ensure healthy lives and promote well-being. Objectives: This study aimed to describe Kelantan's non-Hodgkin lymphoma survival rate and median survival time. This study also aimed to determine the prognostic factors for death among non-Hodgkin lymphoma patients in Kelantan. Methodology: A retrospective record review was conducted using secondary data among the patients diagnosed with non-Hodgkin lymphoma from January 1st, 2008, until December 31st, 2017. An additional five-year follow-up until December 31, 2022, was done to verify the patient's status. The inclusion criteria included Malaysian patients aged 15 years or older with Hodgkin lymphoma who resided and registered in the Kelantan Cancer Registry between January 1st, 2008, and December 31st, 2017. The exclusion criteria included missing data greater than 30% and duplicate data. All patients who fulfilled the inclusion and exclusion criteria were included in the study. The data were analysed using SPSS version 28. Kaplan-Meier was used to calculate survival estimates, while the Cox proportional hazards model was used to determine prognostic factors. Results: There were 448 patients included in this analysis. The mean (SD) age at diagnosis was 50.19 (18.01). Most patients were male, 60.7% and Malay 96.4%. The most common histological subtypes were Mature B-cell neoplasm (74.3%) and the aggressive type (87.3%). The 5-year overall survival rate was 28.3% (95% CI: 24.1, 32.5). The median survival time of ≥ 15-year-old non-Hodgkin lymphoma patients in Kelantan was 9.01 (95% CI: 5.95, 12.06) months, respectively. The proportional Hazard Cox model showed that age more than 60 years old had a higher hazard of death of 1.55 (Adj. HR:1.55; 95% CI: 1.24, 1.93; p=<0.001) times compared to age less 60 years old; being male had a higher hazard ratio of death of 1.39 (Adj. HR: 1.39; 95% CI: 1.12, 1.73; p =0.003) times compared to female; and being in stage IV had a higher hazard ratio of death of 1.88 (Adj. HR: 1.88; 95% CI: 1.17, 3.04; p=0.010) times compared to stages I and II. When other variables were adjusted, the patient who did not undergo chemotherapy treatment had a significantly higher hazard of death of 1.50 (Adj. HR: 1.50; 95% CI: 1.18, 1.92; p = 0.001) times compared to the patient who received chemotherapy. Conclusion: The overall 5-year survival rate was 28.3% (95% CI: 24.1, 32.5). The median survival time of ≥ 15-year-old non-Hodgkin lymphoma patients in Kelantan was 9.01 (95% CI: 5.95, 12.06) months. The significant factors of death among non-Hodgkin lymphoma patients in Kelantan were age ≥ 60, male gender, stage IV, and patients who did not receive chemotherapy treatment, which was consistent with other studies globally. This study provides essential data for policymakers to design targeted health interventions, such as early detection and treatment programs, to increase survival rates, reduce non-Hodgkin lymphoma mortality, and improve Kelantan's blood cancer care services.
- PublicationTime to non-persistence of sodium-glucose co-transporter 2 inhibitors and its prognostic factors among patients with type 2 diabetes in Universiti Malaya Medical Centre(2024-08)Sofian, Nurul Farhana MohdIntroduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have emerged as a new guideline-directed medical therapy (GDMT) for managing cardiovascular-kidney-metabolic (CKM) syndrome. Understanding the pattern of SGLT2i treatment persistence can help prevent unwarranted non-persistence of this GDMT and simultaneously, develop interventions to mitigate its negative consequences. This study aimed to evaluate the treatment persistence time on SGLT2i and to identify the prognostic factors for SGLT2i persistence time among adults with type 2 diabetes (T2D) at the Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia. Methods: This was a retrospective cohort study involving adults aged 18 years and above with T2D who were initiated with SGLT2i between January 2016 and December 2021. The study outcome was time to SGLT2i non-persistence, defined as the time to first 90-day gap after the estimated end date of pharmacy supply. Kaplan-Meier estimate was used for median SGLT2i persistence time, life table analysis was used for obtaining persistence rates and Cox Proportional Hazard regression was used to identify the prognostic factors for the time to treatment persistence. Results: This study involved 602 adults with T2D, with the majority being male (52.0%). The mean age of patients was 60.1 years (standard deviation (SD) = 10.7). The median treatment persistence time was 40.5 months (95% confidence interval (CI): 34.6, 54.0). Treatment persistence rates reduced from 94.5% at 6 months to 78.0% at 1 year, and 62.7% at 2 years. Patients with baseline estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m2 had an adjusted hazard ratio (AHR) of 1.57 (95% CI 1.20, 2.04; p = 0.001) for non-persistence of SGLT2i, compared to those with eGFR ≥60 ml/min/1.73m2. The use of DPP4i had an AHR of 0.75 (95% CI 0.57, 0.98; p = 0.042) for non-persistence of SGLT2i. Conclusions: Half of the patients discontinued SGLT2i within 3.5 years. Those with baseline eGFR <60 ml/min/1.73m2 and without concomitant DPP4i use were significantly associated with SGLT2i non-persistence. This study provides valuable insights into the time to SGLT2i non-persistence in adults with T2D and the underlying factors to facilitate more personalised diabetes management to optimise health outcomes.
- PublicationPoor sleep quality and its associated factors among nurses in tertiary hospitals, Kelantan(2024-06)Supian, Nur ShuhaizaIntroduction: Understanding the significance of good sleep quality will help to improve quality of healthcare services and enhance patient safety. Thus, the purpose of this study was to determine poor sleep quality and its associated factors among nurses in tertiary hospitals in Kelantan. Methodology: This cross-sectional study examines nurses from two tertiary hospitals in Kelantan, Malaysia. The nurses were proportionately and randomly selected from the hospitals and included in the study. The nurses worked in tertiary hospitals and had at least two months of working experience in current department. The study used self-administered questionnaire with 19 items in seven component scores. The data were analysed using SPSS version 28 and logistic regression analyses were used to identify the associated factors. Results: A total of 470 nurses participated in this study. The results indicate that prevalence of poor sleep quality among nurses was 69.8%. The study identifies the sleep duration (aOR 0.291; 95% CI: 0.215,0.393; p<0.001), working experience (aOR 0.953; 95% CI: 0.924, 0.984; p=0.003), history of involvement in medication error (aOR 2.669; 95% CI: 1.413, 5.041; p=0.002) and commuting injury (aOR 1.869; 95% CI: 1.119, 3.121; p=0.017) as the significant associated factors. Conclusion: The study found that nurses generally had poor sleep quality with some significant associated factors. To improve sleep quality among nurses, ongoing education and establishing a nurturing work environment are important.
- PublicationModelling of knowledge and conspiracy beliefs on childhood vaccine hesitancy among parents in Kelantan using Malay validated questionnaires(2024-06)Zin, Nur Dalilah MohdBackground: Globally, childhood vaccine hesitancy remains a significant public health concern. Knowledge is well-known influence on the parental’s vaccination decision. Additionally, in light of COVID-19 pandemic, vaccine conspiracies theories worsen the hesitancy. However, local studies looking on this relationship towards vaccine hesitancy using Malay language validated tools were scarce. Objectives: This study aimed, firstly to translate and validate One-dimensional Knowledge scale (OKS), Vaccine Conspiracy Beliefs scale (VCBS) and Modified Vaccine Hesitancy scale (MVHS) into Malay language and secondly, to model relationship of demographic variables, knowledge, and conspiracy belief on childhood vaccine hesitancy among parents in Kelantan using structural equation modelling. Methodology: This was a cross-sectional study conducted in two phases. Phase I, involved translation of the OKS, VCBS and MVHS into Malay version, from April 2023 till June 2023. The scales were translated into Malay based on established guidelines. Content and face validity were assessed involving six expert panels and 10 parents respectively. The data was analysed using Microsoft Excel 365. Then, Phase II was continued between July 2023 till March 2024 involving 270 parents with children aged ≤ 7 years. Confirmatory Factor Analysis (CFA) was used to ensure the scales used were valid and reliable to measure the study variables, then, structural equation modelling (SEM) was performed to determine the relationship between variables. Test-retest reliability was determined to ensure stability of newly translated scales. Data was analysed using IBM SPSS version 26 and Mplus version 8. Results: Phase 1, the M-OKS, M-VCBS and M-MVHS achieved recommended scores of ≥ 0.83 for item indices and scale indices for content and face validity indices. Phase II, the measurement model of M-OKS, consist of unidimensional 10-items demonstrated good model fit (CFI= 0.976, TLI= 0.969, RMSEA (90%CI) = 0.053 (0.030, 0.074), WRMR = 0.877). The 8-item of M-VCBS with correlated items showed good model fit (CFI= 0.977, TLI= 0.967, RMSEA (90% CI) = 0.053 (0.020, 0.082), SRMR = 0.028). The 9-item of M-MVHS consist of two domain “Lack of confidence” and “Risk perception” incorporating correlated items achieved good model fitness (CFI= 0.970, TLI= 0.957, RMSEA (90% CI) = 0.057 (0.031, 0.082), SRMR= 0.031). Composite reliability for M-OKS, M-VCBS and M-MVHS ranged from 0.741 to 0.935 and AVE values of ≥ 0.5, indicating all scales demonstrated good convergent validity. The test-retest reliability, measured by the Intra-class Correlation Coefficient (ICC) ranged from 0.730 to 0.854, indicating good stability for all scales. The final structural model consist of ten hypotheses exhibits good model fit based on the fit indices (CFI= 0.961, TLI= 0.954, RMSEA (90% CI) = 0.040 (0.032, 0.053), SRMR= 0.043). Several indirect relationships were identified between pathways towards vaccine hesitancy. Conclusion: This study provides valid and reliable Malay-language tools to measure knowledge and conspiracy beliefs on childhood vaccine hesitancy among parents in Kelantan. The present study demonstrated the significant relationship of knowledge and conspiracy beliefs on parental vaccination decision, offering valuable insights for public health authorities and policy maker to devise targeted strategies in increasing vaccination uptake.
- PublicationKnowledge, attitude, and practice (kap) questionnaire on melioidosis: development and validation and associated factors among field agricultural farmers in Kelantan, Malaysia(2024-06)Abdullah, Nor AzlinaBackground: Melioidosis, caused by the bacterium Burkholderia pseudomallei, is a significant public health concern in Malaysia, particularly among field agricultural farmers who face a heightened risk of exposure due to their occupational activities. Despite its importance, there is a lack of validated questionnaires to assess the knowledge, attitude, and practices (KAP) regarding melioidosis and study its associated factors among this high-risk population. Objectives: This study aimed to develop and validate a new questionnaire assessing KAP towards melioidosis among fields agricultural farmers in Kelantan, Malaysia. Additionally, it was aimed to determine the KAP scores and associated factors among them. Methods: This two-phase study was conducted between May 2023 and March 2024. In Phase 1, a KAP questionnaire was developed and validated through rigorous processes involving literature review, content validation, face validation, item response theory (IRT), exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). The questionnaire was administered to 432 field agricultural farmers in Kelantan (222 for EFA, 210 for CFA). In Phase 2, a cross-sectional study was conducted among 392 farmers to assess their KAP scores and identify associated factors using the validated questionnaire. In the first phase, data were analysed usinR software, while in the second phase, the analysis was conducted using SPSS version 26. Results: The proposed melioidosis KAP questionnaire named M-KAP, which consisted of 62 items has demonstrated excellent content validity (S-CVI/Ave: 0.97 for knowledge, 0.96 for attitude, 0.99 for practice) and face validity (S-FVI/Ave: 0.99 for knowledge, 0.95 for attitude, 1.0 for practice). IRT, EFA and CFA confirmed the construct validity and reliability of the questionnaire with analysis revealed an acceptable range of difficulty and discrimination in IRT, reliable internal consistency with Cronbach's alpha values of 0.7 and above in EFA, and satisfactory composite reliability, as indicated by Raykov's rho values exceeding 0.70 in CFA. In Phase 2, the total mean percentage for knowledge, attitude and practice were 36.4%, 62.6% and 77.6% respectively. Factors significantly associated with higher knowledge scores were female gender (adjusted β= 3.84, p=0.013), and individuals with affected close contacts (adjusted β= 7.20, p=0.008). However, those working with non-paddy crops (adjusted β= -6.17, p<0.001) associated with lower knowledge of melioidosis. Smoker associated with lower attitude (adjusted β= -1.69, p=0.008) and non-paddy crop workers (adjusted β= 1.67, p=0.007) associated high higher attitude score. Higher education level (adjusted β= -1.56, p=0.011) and having multiple job scopes (adjusted β= -1.58, p<0.001), were associated with lower practice scores.