Pusat Pengajian Sains Kesihatan - Tesis

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    Investigating the validation, reliability and usability of automated method for testing auditory sensitivity (AMTAS) with malay instructional video in clinical and non-clinical settings
    (2025-08)
    Hatta, Nor Hidayah Mohammed
    The Automated Method for Testing Auditory Sensitivity (AMTAS) is a self-administered hearing assessment tool that utilizes a tablet, headphones, and AMTAS software to determine hearing thresholds. While AMTAS has been validated internationally for over two decades and has shown strong potential, such research has never been conducted in Malaysia. This study aimed to assess the validity, reliability, and usability of AMTAS with a Malay instructional video among Malaysian adults through three phases. Phase I involved the verbatim translation of AMTAS instructional video and face validation of the Malay version of the mHealth App Usability Questionnaire (M-MAUQ). Based on responses from 30 participants (mean age = 45.62 ± 14.13 years), the face validity index (FVI) was 0.98 for both Item-FVI and Scale-FVI, indicating excellent clarity and comprehensibility. Phase II, conducted in clinical settings at Hospital Tuanku Ja’afar Seremban (HTJS) and Hospital Rembau (HR), assessed validity by comparing AMTAS and pure-tone audiometry (PTA) thresholds, reliability through AMTAS test-retest measurements, and usability using M-MAUQ. A total of 100 participants (mean age 44.72 ± 14.13) underwent validation testing, while 30 participants (mean age 44.43 ± 14.63) participated in reliability testing. All 130 participants were included in the usability testing. For validity, the mean difference between AMTAS and PTA thresholds ranged from 0.30 dB HL to 3.40 dB HL, with over 95% of results within an acceptable ±10 dB difference. Agreement in hearing loss severity between AMTAS and PTA was high (Kappa = 0.95-0.96). Reliability demonstrated good consistency across all frequencies with intraclass correlation coefficient (ICC) ranged from 0.64 to 0.99. Phase III replicated Phase II in a non-clinical setting at a community centre, involving 22 participants for validation (mean age = 27.41 ± 7.92) and 15 for reliability (mean age = 26.82 ± 8.29). The mean difference between AMTAS and PTA thresholds ranged from 3.18 dB HL to 7.50 dB HL, with strong reliability (ICC > 0.80). Usability showed high ratings in both Phase II and III, with mean scores exceeding 6.0 (out of 7.0) across all domains, reflecting high user satisfaction and feasibility. AMTAS testing was also significantly faster than PTA, reducing test time by an average of 3.03 minutes per person in clinical settings and 2.68 minutes in non-clinical settings. In conclusion, AMTAS meets the standards of conventional PTA in terms of validity, reliability, and usability, supporting its potential for wider use in clinical and non-clinical settings among the Malaysian population
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    Development and characterization of flowable composite derived from rice husk using urethane dimethacrylate
    (2025-09)
    Azlisham, Nor Ain Fatihah
    The study aimed to develop and characterize flowable composites (FCs) using silica derived from rice husk as the primary filler, urethane dimethacrylate (UDMA) as the base monomer, and zirconia as the radiopacifying agent. The resin matrix combined UDMA with triethylene glycol dimethacrylate (UDMA:TEGDMA) at ratios of 20:80, 30:70, 50:50, 60:40, 80:20, and 90:10. Commercial FCs, including Revolution Formula 2, G-aenial Universal Flo, and Filtek Supreme Flowable Composite, were used for comparison. The newly developed FCs were categorized into high (20:80, 30:70), medium (50:50, 60:40), and low-flow (80:20, 90:10), based on the flowability evaluation. These newly developed FCs were subsequently characterized for their chemical, physical, and mechanical properties, as well as polymerization shrinkage. Data were statistically analyzed using one-way ANOVA, followed by posthoc Tukey or Games-Howell tests for comparison, except for the depth of cure, which was analyzed using the Kruskal-Wallis. The chemical properties, assessed through Fourier transform infrared (FTIR) and degree of conversion analyses, confirmed the presence of silica and zirconia in the newly developed FCs and showed an increase in the degree of conversion with higher UDMA ratios (55.38 – 68.58%). The physical properties evaluated included radiopacity, viscosity, depth of cure, surface roughness, water sorption and solubility, and wettability. The newly developed FCs at all ratios were radiopaque (2.87 – 3.06 mmAl) and passed the International Organization for Standardization 4049 (ISO 4049) requirement. As the UDMA ratio in the newly developed FCs increased, both viscosity and depth of cure increased Improved surface roughness and reduced water sorption were also observed with higher UDMA ratios. For solubility, the values were independent of the UDMA ratios. Wettability, assessed through contact angle measurements, revealed a significant increase in contact angle after polymerization, indicating a shift from hydrophilic (24.218 – 50.617º) to more hydrophobic behaviour (85.901 – 88.669º). The mechanical properties evaluated included Vickers hardness, flexural strength and modulus, and compressive strength and modulus. Most properties improved with increasing UDMA ratios, with some flexural strength values (79.61 – 102.1 MPa) meeting the requirement of ISO 4049. Polymerization shrinkage was also reduced as the UDMA ratio increased. Overall, higher UDMA ratios (80:20, 90:10) exhibited superior chemical, physical, and mechanical properties, along with reduced polymerization shrinkage. Moderate (50:50, 60:40) and lower UDMA ratios (20:80, 30:70) demonstrated intermediate and inferior performance, respectively. These findings suggest that the newly developed FCs, particularly at higher UDMA ratios, could serve as viable alternatives to commercially available FCs, supporting a green-based industry that reduces waste and promotes sustainability
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    Identification of potential amino acids profile with the protein expression of idh1, mgmt, atrx and oxidative stress markers in the primary brain tumour
    (2025-08)
    Ling, Michelle Tiong Hui
    Primary central nervous system (CNS) tumours are heterogeneous neoplasms originating within the CNS, each category exhibiting distinct histological and molecular features that influence clinical progression and prognosis. Protein alterations are central to CNS tumour development, involving IDH1, ATRX, MGMT, CAT, and SOD1, alongside amino acid disruptions as key contributors to tumour progression. This study aimed to determine the amino acid profile and expression patterns of ATRX, MGMT, IDH1, 1p/19q, CAT, and SOD1 in primary CNS tumours. Amino acid profiles were characterised using gas chromatography-mass spectrometry (GCMS), protein expression of IDH1, ATRX, MGMT, CAT, and SOD1 was evaluated using immunohistochemistry (IHC), and the fluorescence in situ hybridization (FISH) protocol for 1p/19q co-deletion was optimised. GCMS analysis identified 11 amino acids across 40 FFPE CNS tumour samples. IHC revealed ATRX expression in 65% (26 cases), MGMT in 67.5% (27 cases), IDH1 in 27.5% (11 cases), CAT in 67.5% (27 cases), and SOD1 in all cases (100%), with significant associations between marker expression, tumour grade, and type (p < 0.001). The optimised FISH protocol successfully detected 1p/19q co-deletion in 2 oligodendroglioma cases, with negative co-deletion in 2 anaplastic astrocytoma and positive co-deletion in 1 glioblastoma case. These findings provide new insights into amino acid profiling and the expression of ATRX, MGMT, IDH1, CAT, dan SOD1 proteins in primary CNS tumours. Further research is warranted to expand on these results, contributing to a deeper understanding of tumour biology and the potential identification of novel diagnostic and therapeutic biomarkers
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    A prospective case-control study on nutritional status and lifestyle risk factors towards quality of life among colorectal cancer and polyp patients in Malaysia
    (2025-08)
    Ashari, Lydiatul Shima
    In Southeast Asian countries, there is a growing incidence and prevalence rate of disease-related malnutrition colorectal cancer (CRC) and its precursor, colorectal polyp, however there are only few reports of this condition. Treatments and the disease itself may affect and impair the overall quality of life (QOL) of CRC survivors. The study aimed to determine the nutritional status and lifestyle risk factors among CRC and polyp patients and their impact on QOL through a prospective case-control study in Malaysia. This study was conducted in two university hospitals in Peninsular Malaysia from June 2020 until December 2022. Patients were recruited through purposive sampling method and a total of 313 patients consisting of 99 and 74 pathologically confirmed CRC and colorectal polyp cases respectively, and 140 controls were included in the analysis. The following information was gathered pre- treatment: Socio-demographic, family and personal medical history, dietary intake, sedentary behaviour, nutritional risk, smoking, clinicopathological, biochemical parameters, and anthropometric profiles. Six months post-treatment, sedentary behaviour, nutritional risk, biochemical parameters, and anthropometric profiles were gathered again, together with treatment and QOL. Multiple logistic regression model revealed that the Kuala Lumpur state (OR=8.89, 95% CI=3.19-24.83; p<0.001), type 2 diabetes mellitus (T2DM) (OR=4.91, 95% CI=1.81-13.29, p=0.002), vitamin/mineral supplements (OR=5.15, CI=2.33-11.39, p<0.001), and saturated fatty acids (SFA) (OR=1.19, 95% CI=1.08-1.31, p<0.001) intake were associated with greater risks of CRC while non-Malay (OR=0.36, 95% CI=0.15-0.87, p=0.024), overweight (OR=0.14, 95% CI=0.04-0.48, p=0.002), increased intake of vitamin D (OR=0.71, 95% CI=0.55-0.92, p=0.008) and dietary fibre (OR=0.81, 95% CI=0.74-0.89, p<0.001) were associated with reduced risk of CRC after the data were adjusted for age and gender. For colorectal polyp, the Kuala Lumpur state (OR=4.36, 95% CI=2.02-9.41, p<0.001) and high cholesterol (OR=1.003, 95% CI=1.001-1.005, p=0.006) intake were associated with increased risk while high thiamin (OR=0.02, 95% CI= 0.00-0.11, p<0.001) and fruits (OR=0.997, 95% CI=0.995-1.000, p=0.035) intake were found associated with decreased of risk. Multiple linear regression model showed that malnourish (β=-18.40, p<0.001) and abdominal obesity (β=-10.07, p=0.020) were negatively associated with QOL after six months of post-treatment. This study advances current understanding of the nutritional and metabolic pathways underlying colorectal cancer and polyp development, providing a foundation for future mechanistic and intervention studies
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    The combined effects of exercise and music on sports anxiety, exercise beliefs, coping effectiveness, and mental toughness among chinese college students with sports anxiety
    (2025-06)
    Zhutang, Liu
    Sports anxiety is a worldwide concern that impacts athletes’ performance and discourages non-athletes from participating in sports. In China, with a population exceeding 1.4 billion and an increasing emphasis on physical education in the school curriculum, students are encountering growing challenges related to sports participation. This study comprises two phases. The aim of Phase 1 is to examine the validity and reliability of the Chinese-translated versions of the Physical Education State Anxiety Scale (PESAS), the Exercise Beliefs Questionnaire (EBQ), the Coping Effectiveness (CE) scale, and the Mental Toughness for Youth Questionnaire (MTYQ) utilizing Confirmatory Factor Analysis (CFA) and internal consistency reliability assessments. Additionally, Phase 1 aims to construct a Structural Equation Modelling (SEM) to explore the relationships among sports anxiety, exercise beliefs, coping effectiveness, and mental toughness in Chinese university students with sports anxiety. A total of 1,055 participants completed the questionnaires, of which 755 responses were valid. According to the research results, the final SEM of phase 1 has a good model fitting index: comparative fit index (CFI)=0.926, tucker lewis index (TLI) = 0.923, standardised root means square residual (SRMR) = 0.029, root mean square error of approximation (RMSEA) (90% CI) = 0.045 (0.041, 0.048), RMSEA p-value < 0.001. The 6 SEM specific hypotheses (2 additional alternative hypotheses and 4 hypotheses from the initial model) were produced a significant interrelationship with cognitive processes (CP), coping effectiveness (CE), somatic anxiety (SA), exercise beliefs (EB), and mental toughness (MT) in the final SEM. CE and CP were constructs that directly affected MT. The objective of Phase 2 is to investigate time effects, group effects, and time*group effects between experimental and control groups of Chinese university students with sports anxiety. The exercise intervention consisted of an intensity of at least 50% to 60% of the average maximum heart rate, progressing by 5% every four weeks. For the music intervention, tracks with a tempo range of 110–120 beats per minute were selected. The combination of music and exercise interventions were conducted simultaneously. A total of 108 university students with sports anxiety were randomly assigned to two groups. The intervention lasted for 12 weeks, with sessions conducted three times a week, each lasting 40 minutes. Participants completed the PESAS, EBQ, CE, and MTYQ at four time points: one week before the intervention, during the intervention at four weeks, during the intervention at eight weeks, and after the intervention at twelve weeks. According to the research results of phase 2, experimental group significantly exhibited the higher scores than the control group on sports anxiety, exercise beliefs, mental toughness, and coping effectiveness with respectively p-values =0.001, =0.046, =0.022, <0.001. The music and exercise intervention has a positive impact on sports anxiety SA, SB, MT, and CE among Chinese university students with sports anxiety. The research findings contribute to the diversity of measurement tools for assessing SA, sports anxiety, EB, CE, and MT in the Chinese context, offering effective instruments for advancing psychological research in China