Pusat Pengajian Sains Perubatan - Tesis
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- PublicationStructural equation modelling of holistic health variables, healthy diet, physical activity, and quality of life: comparison between Malaysian and Nigerian undergraduate students(2025-09)Abdulrahman, Abdulwali SaboHolistic health is increasingly recognized as a comprehensive approach that considers the whole person and the interplay of multiple life dimensions. Well-being arises from the interaction between individual potentials (IP), demands of life (DL), social determinants (SDH), and environmental determinants (EDH). Healthy diet (HD) and physical activity (PA) further contribute to overall quality of life. This study therefore aims to evaluate how SDH, EDH, IP, DL, HD, and PA interact within a holistic health model to influence quality of life. The study applied a mixed-methods approach, conducted in three phases, to develop and validate a holistic health model. In Phase I, four new instruments were developed to measure key determinants of holistic health: the Social Determinants of Health Questionnaire (SDHQ), Environmental Determinants of Health Questionnaire (EDHQ), Demands of Life Questionnaire (DLQ), and Individual Potentials Questionnaire (IPQ). These tools were developed through extensive literature review, in-depth interviews, and expert evaluations to ensure content and face validity. Phase II covers a validation study using a cross-sectional survey of 1,460 undergraduate students (730 each from Nigeria and Malaysia). This phase employed exploratory and confirmatory factor analyses (EFA and CFA), alongside assessments of reliability and validity, including composite reliability (CR), average variance extracted (AVE), Cronbach’s alpha, and test-retest reliability. Phase III investigated the structural relationships between SDH, EDH, DL, IP, HD, PA, and quality of life, using independent samples of 1,140 students (570 from each country), as well as the measurement and structural invariance to confirm the cross-cultural applicability of the instruments. Additionally, multigroup SEM was conducted to compare structural relationships across Nigerian and Malaysian samples. In Phase I, four holistic health questionnaires were developed: SDHQ (20 items, 2 factors), EDHQ (18 items, 2 factors), DLQ (18 items, 3 factors), and IPQ (14 items, 2 factors), all showing acceptable content and face validity (indices = 0.83–1.00). In Phase II, demonstrated adequate validity and reliability across all instruments, with adequate fit indices (CFI = 0.928–0.967; TLI = 0.910–0.957; SRMR = 0.039–0.080; RMSEA = 0.041–0.068) and high reliability (Cronbach’s α = 0.815–0.947; CR = 0.760–0.950; ICC = 0.765–0.987). In Phase III, structural equation modeling supported 8 of 10 hypothesized pathways in both Malaysian and Nigerian samples, with good model fit (CFI = 0.972-0.989, TLI = 0.954-0.982, SRMR = 0.021-0.026, RMSEA = 0.039-0.060, RMSEA p-value = 0.110-0.879). The instruments demonstrated measurement and structural invariance across both groups (ΔCFI and ΔTLI < 0.01, ΔRMSEA < 0.015), and multigroup SEM confirmed six similar path relationships (CFI = 0.982, TLI = 0.969, SRMR = 0.020, RMSEA = 0.052, RMSEA p-value = 0.360). The study confirmed that the SDHQ, EDHQ, DLQ, and IPQ are valid, reliable, and invariant across Nigerian and Malaysian students, making them suitable for assessing holistic health factors. It also introduced one of the first quantitative models relating these variables to HD, PA, and quality of life, offering a foundation for future interdisciplinary research on the interrelationship of social, environmental, and individual determinants of health.
- PublicationPatient-doctor relationships and its associated factors perceived by patients at non govermental hemodialysis clinics in Malaysia(2025-09)Aziz, Ab Farid Fajilah AbBuilding strong patient-doctor relationships and effective communication are crucial for enhancing care quality and outcomes, particularly for hemodialysis patients. However, limited research exists on how these relationships impact patient outcomes in Malaysia, despite frequent interactions between hemodialysis patients and healthcare providers. This study aimed first to translate and validate the Malay versions of the Patient-Doctor Relationship Questionnaire and Doctor-Patient Communication Questionnaire, and subsequently to employ the validated tools to assess patient-doctor relationships and communication among hemodialysis patients in Malaysia. The study was conducted in two phases. In Phase I, expert panels translated and validated the PDRQ-9 and DPCQ into Malay. Cognitive debriefing involving eight hemodialysis care personnel and seven patients confirmed comprehensibility. Psychometric properties were assessed among 300 respondents using Confirmatory Factor Analysis (CFA) and internal consistency. The initialMyPDRQ demonstrated high internal consistency (Raykov’s rho=0.906), with CFA indices indicating good model fit (SRMR=0.025, RMSEA<0.001, CFI=1.000, TLI=1.000). The initialMyD-PCQ showed high reliability (Raykov’s rho=0.887) and good model fit (SRMR=0.037, RMSEA=0.029, CFI=0.982, TLI=0.979). In Phase II, a cross-sectional study using the validated MyPDRQ and MyD-PCQ was conducted among 640 hemodialysis patients across Malaysia. The majority were female (54.5%), aged 48 years or older (57.1%), Malay (47.0%), and married (58.8%). Nearly 60% had an income below RM 4360. The mean patient-doctor relationship score was 35.40 (SD=7.74), and the mean doctor-patient communication score was 51.09 (SD=8.14). Communication emerged as the most significant factor associated with relationships (Adj β=1.163, p<0.001). Younger patients (18–27 years) scored lower (Adj β=-0.044, p=0.027), while higher education levels were positively associated with better scores (Adj β=0.034, p=0.023). Employment and income were not statistically significant. The MyPDRQ and MyD-PCQ are valid and reliable instruments, providing appropriate tools for assessing patient-doctor relationships and communication among Malaysian hemodialysis patients. These findings have important implications for policy, practice, and future research, as they support the integration of culturally adapted measures into routine clinical care, inform targeted interventions to enhance communication, and contribute evidence for strategies aimed at improving long-term patient satisfaction and clinical outcomes
- PublicationA structural equation model and effects of music on mental energy, mental toughness, psychological skills, mindfulness, athletic identity and sports performance among young basketball players in shandong province, China(2025-06)Shaoshen, WangThis study examines how psychological variables are related to sports performance and the effects of music interventions among young basketball players in Shandong Province, China, through a two-study research design. Study 1 (n=604) validated Chinese versions of six psychological measures and developed a structural equation model examining relationships between psychological variables and sports performance. Study 2 (n=42) explored the effects of different music interventions on these variables through a 12-week randomized controlled trial. Study 1's confirmatory factor analyses demonstrated excellent psychometric properties for all translated instruments: AMES-C, TMTIS-C, APSI-C, AIMSP-C, MAAS-C and SSS-C. All scales showed strong construct validity (CFI>0.94, RMSEA<0.06), convergent validity (AVE>0.50), discriminant validity, and test-retest reliability (ICC>0.89). The structural equation model revealed Mental Energy as a crucial mediator between psychological factors and sports performance, with Mindfulness (β=0.314, p<0.001), Psychological Skills (β=0.267, p<0.001), and Mental Toughness (β=0.238, p<0.001) showing significant direct effects on Mental Energy, which in turn influenced Sports Success (β=0.322, p<0.001). Study 2 demonstrated significant differential effects of music interventions on both psychological variables and basketball performance. Motivational music showed superior effects on complex motor tasks like dribble layup performance (MD=4.04, p<0.001), while self-selected music was more effective for precision tasks like shooting accuracy (MD=-6.86, p<0.001). Both music conditions significantly enhanced mental energy, psychological skills, and mental toughness compared to controls. This research provides empirical evidence supporting the integration of structured music sessions into athletic training programs, with findings suggesting that different types of music may be optimal for different aspects of basketball performance. The validated psychological measures and structural equation model offer valuable tools for future research and practical applications in sports psychology.
- PublicationInterrelationship between emotions, personality, courage and sports performance in adolescent football players in shandong province, China(2025-05)Ying, ShuaiThis study investigates the complex interplay between personality traits, emotions, courage, and performance in adolescent football players in Shandong Province, China, addressing critical gaps by developing the first culturally specific measure of football-related emotions and examining its relationships with established psychological constructs. Using a two-phase research design, this study systematically developed measurement instruments and tested theoretical relationships. Phase 1 employed a cross-sectional design conducted in junior high schools across Shandong Province from May to July 2023, focusing on the development and initial validation of the Football Emotions Scale (FES) through literature review, expert consultation, content validity assessment, and exploratory factor analysis. Participants included 492 Chinese adolescent football players (255 males, 237 females) aged 12-15 years who were active school team members with at least one year of training and competition experience. Phase 2 utilized an independent cross-sectional design in the same geographic region from October to December 2023, concentrating on confirmatory factor analysis of all measurement instruments, validation of the complete structural equation model, and examination of hypothesized relationships. This phase involved 450 participants (235 males, 215 females) aged 12-15 years meeting identical eligibility criteria, excluding those who participated in Phase 1. The study employed multiple validated instruments: the newly developed Football Emotions Scale (FES) for assessing sport-specific emotions, the Big Five Inventory-2 (BFI-2) for personality trait measurement, the Sports Courage Scale (SCS) for courage assessment, and the Sport Performance Questionnaire (SPQ) for performance evaluation. The Football Emotions Scale demonstrated robust psychometric properties through confirmatory factor analysis (RMSEA = 0.033, CFI = 0.971, TLI = 0.968, SRMR = 0.037) with strong reliability evidence (Composite Reliability: 0.85 for Football Positive Emotion, 0.818 for Football Negative Emotion; Average Variance Extracted: 0.655 and 0.6 respectively). Chinese adaptations also demonstrated strong validity evidence: BFI-2 (RMSEA = 0.029, CFI = 0.964, TLI = 0.962, SRMR = 0.036; CR: 0.923-0.950, AVE: 0.503-0.611), SCS (RMSEA = 0.021, CFI = 0.976, TLI = 0.975, SRMR = 0.039; CR: 0.891-0.923, AVE: 0.492-0.518), and SPQ (RMSEA = 0.067, CFI = 0.968, TLI = 0.959, SRMR = 0.027; CR: 0.932, AVE: 0.559). The structural equation model examining relationships among all variables demonstrated excellent fit (RMSEA = 0.024, CFI = 0.929, TLI = 0.928, SRMR = 0.041). Key findings revealed that Conscientiousness was most strongly associated with Football Positive Emotions (β = 0.303, p < 0.001), while Negative Emotionality significantly predicted Football Negative Emotions (β = 0.562, p < 0.001). Notably, Sports Courage emerged as a significant mediator between personality traits and performance (β = 0.277, p = 0.001), highlighting its crucial role in youth football development. These findings provide theoretical insights into the psychological mechanisms underlying football performance in Chinese adolescents and offer practical implications for talent identification, coaching strategies, and psychological intervention programs in youth football development.
- PublicationExploring novel cancer-associated fibroblast markers of colorectal tumour microenvironment in differentiating the mechanisms of right-sided and left-sided colorectal cancer(2025-06)Zawawi, Sahira Syamimi AhmadColorectal cancer (CRC) is a heterogeneous disease, often classified into right-sided CRC (RCRC) and left-sided CRC (LCRC), which differ in many ways, including their histological and molecular phenotypes. Tumour environment (TME) of the colon and cancer-associated fibroblasts (CAFs), the main cellular component of TME have been described to drive CRC progression. Accumulation of CAF reflect poor prognosis in CRC. Due to its vital role, CAFs are being studied as a prime target for cancer therapy. In contrast to previous reports in which RCRC and LCRC were classified based on the epithelial cancer cell mutational profiles or histology, CAFs influence in differentiating mechanism of these two CRC entities has yet to be discovered. This study aimed to explore novel CAF markers of colorectal TME in differentiating the mechanisms of RCRC and LCRC. CAFs derived from CRC and non-activated fibroblasts (NFs) derived from adjacent normal colon tissues were established. For fibroblast phenotypic characterisation, immunofluorescence (IF) staining of amine oxidase copper containing 3 (AOC3), leucine-rich repeat-containing 17 (LRRC17), and alpha smooth muscle actin (α-SMA) were performed and the fibroblasts morphology was recorded. The contractile and proliferation phenotype of the fibroblasts were compared through collagen contraction and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assays. Their gene profiles were analysed via microarray analysis (Clariom S (Human) assay) to screen differentially expressed genes (DEGs). Epithelial marker, epithelial cellular adhesion molecule (EpCAM) was included. Epithelial cell lines of CRC (SW620) and cervical cancer (C33A) were incorporated as controls. Fibroblasts treated with TGFβ (10ng/ml) showed significant AOC3 downregulation, LRRC17, and α-SMA upregulation, along with increased contractility, compared to serum free medium (p<0.05). Conditioned medium (CM) derived from fibroblasts promoted SW620 cells proliferation. CAFs from RCRC (RC) denote prominent inflammatory phenotype with chemokines-rich markers expression whereas, CAFs from LCRC (LC) demonstrate myofibroblastic CAFs (myoCAFs) phenotype with myoCAF markers expression. RNA-binding protein with multiple splicing (RBPMS) expression was significantly upregulated in fibroblasts, with distinct patterns of expression between fibroblasts from different colon sidedness as indicated by microarray (p<0.05), and validated via western blot. Additionally, TGFβ1 promoted RBPMS expression in LC but suppressed RBPMS expression in RC. This is the first study to explore the role of CAFs in CRC based on the colon sidedness. The regulation of RBPMS expression in CAFs by TGFβ elucidate the different mechanisms of RCRC and LCRC. In conclusion, RBPMS could serve as a novel CAFs marker for targeted approach against CRC based on its sidedness.