Pusat Pengajian Sains Perubatan - Tesis

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Exploration of image-based stimuli to assess mental toughness among medical students of Universiti Sains Malaysia
(2023-05)
Nordin, Nadia Izzati
Mental toughness (MT) is a psychological construct comprised of cognitive, emotional, and behavioural processes that explain an individual’s capacity to cope with stress and predicts optimal performance in adversity. Apart from psychological-based studies, researchers have been shifting to physiological and neuroscience research to advance the knowledge and understanding of mental toughness. These studies require non-invasive modulation of emotion, stress, and cognitive effort induction. This present study seeks to explore a set of image-based stimuli to assess mental toughness among medical students. The study design consisted of four phases. Phase I involved the validation of the MTQ-48 questionnaire. Phase II involved the assessment of mental toughness, depression, anxiety, and stress in medical students. Phase III involved the selection of 156 image-based stimuli from databases such as the International Affective Picture System (IAPS), the Nencki Affective Picture System (NAPS), the Emotional Picture Set (EmoPics), the Open Affective Standardized Image Set (OASIS), the Geneva Affective Picture Database (GAPED), and online licensed no copyright platforms such as Pexels and PxHere. These images were then content validated by panel of experts according to academic related and clinical related medical context. The valence and arousal of normative evaluations were obtained by medical students using self-assessment manikin (SAM). Phase IV involved the evaluation of the stress intensity of the image-based stimuli from Phase III and its relationship with mental toughness, perceived stress, and stress score. Findings from factor analyses stated that MTQ-48 is unreliable for use in medical context as the fit indices do not meet acceptable standards. Consequently, MTQ-10 resulted from the validation process in Phase I had better model fit and used throughout the study. Besides, a significant inverse relationship was found between mental toughness and depression, anxiety, and stress. Out of 156 images, only 149 images were relevant to academic and clinical related medical context and were obtained valence and arousal mean value for each image. 36 images with negative valence were used to evaluate the stress intensity of the images and its relationship with mental toughness, perceived stress, and stress questionnaire. These findings provide evidence that the stress intensity of the set of image-based stimuli was 19% significantly predicted mental toughness, 43.9 % predicted perceived stress and 19.8% predicted stress. Hence, the set of image-based stimuli possibly to be used to assess mental toughness, perceived stress, and stress along with other variables in future research to facilitate a greater understanding of the affective processes associated with mental toughness in medical students.
The effect of 3-months trigona honey supplementation and associated factors on the progression of mild post-ischaemic stroke cognitive impairment at Hospital Universiti Sains Malaysia: a unicentral randomised controlled trial
(2023-06)
Abdalla, Renad Sadig Muhammed
Background: Affecting up to 80% of ischaemic stroke patients, post-stroke cognitive impairment (PSCI) is a complication that predicts poor quality of life and restricted activity and has also been associated with decreased independence and substantial caretaker and economic burden. Despite the wider attention directed towards stroke sequelae, PSCI remains a major post-stroke complication with limited therapeutic options. Based on current understanding of the pathogenesis of PSCI, Trigona honey makes an attractive therapeutic option, as it can act on numerous neuropathological substrates implicated in PSCI’s pathogenesis via the action of multiple polyphenols. Objectives: To investigate possible benefits of Trigona honey supplements in halting progression of mild PSCI in acute ischaemic stroke patients admitted to Hospital Universiti Sains Malaysia (HUSM). The study also investigated the effect of demographic and clinical characteristics, stroke severity, and pathophysiological subtype and vascular territory on the progression of PSCI. Methods: The study was conducted at Neurology Ward and Specialist Clinic at HUSM, following a unicentral, randomised, concurrent active treatment controlled, open-label superiority trial with two parallel groups model. The interventional group included participants who were administered supplemental honey in addition to standard care regiments, while those in the control group solely continued the standard therapeutic protocol. 48 acute ischaemic stroke patients between the ages of 20 and 70 years old and suffering from mild PSCI were recruited and equally randomised between the two groups. Patients with impeded ability to answer the neuropsychological assessments or are suffering from compromised cognitive functions prior to the stroke were excluded. Two honey sachets were administered for daily oral consumption for the duration of 12 weeks, with a total daily dose of 20 g. Demographic data and clinical characteristics questionnaire, MoCA, and NIHSS were used for data collection. Data collected was analysed using SPSS software. Results and Discussion: Difference in mean gain in MoCA score between the two groups after three months was statistically significant (p = 0.007), with the interventional group having greater mean gain by 3 points. No statistically significant relationship between demographic and clinical characteristics, stroke parameters, and 3-months progression of PSCI was detected, possibly due to small sample size. The only exception was an improved cognitive function in current smokers in the interventional group (p = 0.01, β = 0.514), possibly due to smoking cessation. Conclusion: Trigona honey supplements were effective in halting progression of PSCI, and smoking can affect 3-months progression of PSCI. However, stroke severity, TOAST and OCSP classifications had no effect on 3-months progression of PSCI. While conclusions from this study can be helpful in guiding hypotheses about the employment of Trigona honey in the therapy for PSCI, as well as the different factors and predictors influencing the trajectory of PSCI, they must first be confirmed in a larger population and in homogenous groups.
Translation and validation on household covid-19 food insecurity experience scale (covid-19 fies) and its association with psychological well being among low income women in Kelantan during the covid-19 pandemic
(2023-08)
Haron, Muhammad Zulfahmi
Introduction: The COVID-19 pandemic is a public health and humanitarian crisis that threatens the food security and nutrition of millions of people around the globe. Worsening food insecurity level during pandemic may have long-term implications and lower the psychological well-being level of the vulnerable group particularly low-income women. Currently, there is no validated Malay instrument available to measure the food insecurity experience scale due to COVID-19 crisis and its association with psychological well-being in the country. Objectives Thus, the objective of first phase of this study was to translate the COVID-19 Food Insecurity Experience Scale (COVID-19 FIES) into Malay and to determine its construct validity and reliability. The second phase was to describe the proportion of individual and household food insecurity experience and its association with psychological well-being among low-income women in Kelantan during the COVID-19 pandemic. Methodology: Phase one involved ten and 68 mothers or women caretakers from Kota Bharu district were invited for face and construct validity, respectively. The second phase was a cross sectional study involving 252 mothers or women caretakers of malnourished children who were the recipients of Food Basket Program conducted at 24 health clinics in Kelantan from November 2022 to March 2023. All respondents were randomly selected by proportionate stratified sampling. The face validity has been tested by Face Validity Index (FVI) and the construct validity and reliability has been tested using exploratory factor analysis and Cronbach's alpha coefficient, respectively. The association between individual and household food insecurity experience with psychological well-being has been identified through Analysis of Covariance (ANCOVA) analysis. Results: The Item-Level Face Validity Index (I-FVI) range was 0.9 to 1.0 and the Scale-Level Face Validity Index (S-FVI) was 0.73. Three major components have been identified from exploratory analysis factors which are uncertainty component, quality component, and quantity component with factor loading range from 0.428 to 0.866 and acceptable reliability index (Cronbach's α = 0.710). A total of 26 (10.3%) households were identified as food security, 122 (48.4%) mild, 85 (33.8%) moderate and 19 (7.5%) severe food insecurity. There was no significant association between food security and food insecurity group for both individual and household experience level with mean psychological well-being score [-0.37 (-4.38, 5.11), p=0.880] among low-income women in Kelantan during COVID-19 even after controlling for possible sociodemographic confounders (ethnic, educational level and receiving supplementary food assistance) and covariates (age, number of children, number of household members and total household income). Conclusion: Malay version of COVID-19 Food Insecurity Experience Scale (COVID-19 FIES) is valid and a reliable tool to measure household food insecurity among low-income women in Kelantan. Although there was no significant association between food insecurity and psychological well-being, however, other study on structural relationship between sociodemographic with food insecurity as mediating effect, toward psychological well-being need to be carried out.
Exploring mental toughness and perceived stress of nursing students of Universiti Sains Malaysia
(2023-06)
Celina, Tan
Possessing mental toughness (MT) enables one to bounce back from adversities, feel confident in completing tasks and be assertive in social situations while remaining committed in the face of stress. Stress can serve as a driving force, but too much stress can cause poor performance and stress-related disorders. Nursing students are vulnerable groups with higher risk of burning out, with anxiety and self-efficacy being among the strongest intrinsic predictors of stress. MT has not been explicitly studied in the context of nursing students hence this research was carried out to contribute to the gap in research. This study aimed to explore the suitability of MT in the nursing context and identify stressors pertaining to the current study’s population of interest and pin-pointing visual themes useful for developing exploratory stress-coping neuroimaging paradigm suited for healthcare education context. The current research was broken down and carried out in three phases with nursing students from Universiti Sains Malaysia (USM) exploring: 1) the suitability of the 4/6Cs MT model via reliability testing of MTQ-48 and its correlation with the Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM) scale; 2) the visual themes nursing students perceive as stressful by validating images showing scenarios from daily life, academic and clinical situations; lastly, 3) the relationship between Perceived Stress and MT with images/ visual cues perceived as stressful using Perceived Stress Scale (PSS-10) and MTQ-10. Findings from this research show MT have fair to moderate significant correlations with Anxiety (r=-0.293, p<0.001) and Self-Confidence (r=0.429, p<0.001). The initial 48-item MTQ-48 has good reliability with Cronbach’s coefficient alpha of 0.851 but reported unsatisfactory fit across indices after running confirmatory factor analysis (CFA). After refining the items, a modified 10-item Mental Toughness Questionnaire (MTQ-10) presented decent reliability (α=0.789) achieving all recommended minimum values for CFA fit indices. Image validation via Self-Assessment Manikin (SAM) yielded 36 images with low valence and low arousal reflecting stressful emotions when viewing the images. Finally, concurrent stress rating of images with assessment of MT and Perceived Stress reported 31 images have significant correlation with both MT and Perceived Stress, with strong significant negative correlation between total MT scores and Perceived Stress scores (r=-0.768, p<0.001). The goal of this research to explore the suitability of MT in nursing student context and produce relevant visual themes for perceived stress-coping as surrogate of MT for future neuroimaging research is achieved.
Development and effectiveness of educational module on pre-pregnancy care among women of reproductive age with diabetes in Terengganu
(2024-03)
Fauzi, Tengku Muhammad Fakhruddin Tengku Md
Background: Diabetes Mellitus (DM) stands as one of the major global health challenges of the twenty-first century. When DM is not well-managed, marked by maternal hyperglycaemia before and during the early stages of pregnancy, it significantly increases the risk of severe complications for both the mother and the developing foetus. Pre-Pregnancy Care (PPC) is particularly crucial for mothers with diabetes, as it provides substantial benefits to both the mother and the developing foetus. Objective: To develop and assess the effectiveness of the Educational Module on Pre-Pregnancy Care Among women of reproductive age with diabetes in Terengganu. Methodology: This study was structured in two primary phases: The first phase involved conducting a needs assessment, developing the educational module, and validating it. The second phase was a quasi-experimental study aimed at evaluating the module's effectiveness. The module's development followed the ADDIE model and included five stages: 1) Needs Assessment (A) 2) Consulting Experts for Module Design (D) 3) Post-Development Validation of the Educational Module for Pre-Pregnancy Care in women of reproductive age with diabetes (D), and 4) Implementing PPC Health Education. The quasi-experimental phase involved 90 diabetic women of reproductive age, with 45 in the intervention group from Dungun and 45 in the control group from Kuala Nerus, selected via simple random sampling. The intervention group utilized the newly developed module (I). The effectiveness of the module is determined through data analysis, encompassing improvements in knowledge and attitudes regarding PPC using Repeated Measures Analysis of Variance (RM-ANOVA) (E). Result: Focus Group Discussions (FGDs) was employed to assess needs and found four main themes: knowledge-related needs, attitude-related needs, health service-related needs, and perception-related needs. The module, divided into five units, covers the impact of diabetes on mothers and babies, the importance of PPC for diabetic mothers, PPC components, benefits of contraception, and maintaining controlled diabetes for the safety of both mother and baby. Experts assessed its content validity (S-CVI) as 1.0 and face validity as 0.99. There were significant changes in knowledge scores over time (F (1,88) = 76.87, p < 0.001), with a notable difference between the intervention and control groups in mean knowledge scores (F (1,88) = 5.71, p < 0.019) and a significant interaction effect (F (1,88) = 210.32, p < 0.001). Attitude scores also showed significant overall changes within groups over time (F (1,88) = 71.31, p < 0.001), with a significant mean score difference between groups regardless of time (F (1,88) = 67.47, p < 0.001) and a notable group-time interaction (F (1,88) = 127.81, p = 0.042). Conclusion: The study in Terengganu identified a significant need for a Pre-Pregnancy Care (PPC) educational module tailored for diabetic women of reproductive age, motivated by their desire for a healthy pregnancy. The developed module, validated for both reliability and relevance, effectively improved knowledge and attitudes towards PPC among the intervention group, as demonstrated by the quasi-experimental study's results.

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