Displaying publications 1 - 20 of 40 in total

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  1. Arifin WN, Yusof UK
    Stat Med, 2022 Jan 18.
    PMID: 35043447 DOI: 10.1002/sim.9311
    Diagnostic tests play a crucial role in medical care. Thus any new diagnostic tests must undergo a thorough evaluation. New diagnostic tests are evaluated in comparison with the respective gold standard tests. The performance of binary diagnostic tests is quantified by accuracy measures, with sensitivity and specificity being the most important measures. In any diagnostic accuracy study, the estimates of these measures are often biased owing to selective verification of the patients, which is referred to as partial verification bias. Several methods for correcting partial verification bias are available depending on the scale of the index test, target outcome, and missing data mechanism. However, these are not easily accessible to the researchers due to the complexity of the methods. This article aims to provide a brief overview of the methods available to correct for partial verification bias involving a binary diagnostic test and provide a practical tutorial on how to implement the methods using the statistical programming language R.
  2. Arifin WN, Yusof UK
    Diagnostics (Basel), 2022 Nov 17;12(11).
    PMID: 36428900 DOI: 10.3390/diagnostics12112839
    In medical care, it is important to evaluate any new diagnostic test in the form of diagnostic accuracy studies. These new tests are compared to gold standard tests, where the performance of binary diagnostic tests is usually measured by sensitivity (Sn) and specificity (Sp). However, these accuracy measures are often biased owing to selective verification of the patients, known as partial verification bias (PVB). Inverse probability bootstrap (IPB) sampling is a general method to correct sampling bias in model-based analysis and produces debiased data for analysis. However, its utility in PVB correction has not been investigated before. The objective of this study was to investigate IPB in the context of PVB correction under the missing-at-random assumption for binary diagnostic tests. IPB was adapted for PVB correction, and tested and compared with existing methods using simulated and clinical data sets. The results indicated that IPB is accurate for Sn and Sp estimation as it showed low bias. However, IPB was less precise than existing methods as indicated by the higher standard error (SE). Despite this issue, it is recommended to use IPB when subsequent analysis with full data analytic methods is expected. Further studies must be conducted to reduce the SE.
  3. Arifin WN, Zahiruddin WM
    Malays J Med Sci, 2017 Oct;24(5):101-105.
    PMID: 29386977 MyJurnal DOI: 10.21315/mjms2017.24.5.11
    Animal research plays an important role in the pre-clinical phase of clinical trials. In animal studies, the power analysis approach to sample size calculation is recommended. Whenever it is not possible to assume the standard deviation and the effect size, an alternative to the power analysis approach is the 'resource equation' approach, which sets the acceptable range of the error degrees of freedom (DF) in an analysis of variance (ANOVA). The aim of this article is to guide researchers in calculating the minimum and maximum numbers of animals required in animal research by reformulating the error DF formulas.
  4. Zakaria SF, Shafei MN, Arifin WN
    Cureus, 2023 Sep;15(9):e44742.
    PMID: 37809199 DOI: 10.7759/cureus.44742
    INTRODUCTION: Occupational safety and health are of utmost importance in the palm oil industry, particularly in Malaysia where palm oil plantation workers face various hazards. This study aimed to translate and validate a risk perception questionnaire specifically designed to assess the perceptions of safety and health risks among palm oil plantation workers in Terengganu, Malaysia.

    METHODOLOGY: The original risk perception questionnaire, consisting of 22 items, was translated into the local language and culturally adapted. The translation process involved forward translation, expert panel discussions, and back translation to ensure linguistic equivalence. The translated questionnaire was then administered to a sample of palm oil plantation workers in Terengganu, Malaysia, for validation purposes. Confirmatory factor analysis (CFA) was conducted to assess the model fitness of the questionnaire, and Cronbach's Alpha coefficient was calculated to determine the internal consistency reliability of the final model.

    RESULTS: The translated risk perception questionnaire demonstrated good model fitness as indicated by CFA results (X2=224, df=79, p-value<0.0001, root mean square error of approximation (RMSEA)=0.07, goodness of fit index (GFI)=0.929, comparative fit index (CFI)=0.902). The questionnaire's final version has one factor comprising 13 items, selected based on factor loadings and theoretical relevance. The internal consistency reliability of the 13-item questionnaire was satisfactory, with a Cronbach's Alpha coefficient of α=0.77.

    CONCLUSION: The 13-item risk perception questionnaire demonstrated a good model fit and acceptable internal consistency reliability. It shows that the questionnaire is a valid and reliable tool to evaluate the level of risk perception on safety and health among palm oil plantation workers in Malaysia.

  5. Bay R, Ismail SB, Zahiruddin WM, Arifin WN
    BMC Urol, 2013;13:16.
    PMID: 23522405 DOI: 10.1186/1471-2490-13-16
    During the last few decades, marital tensions and stresses have influenced various dimensions of life. The objective of the current study was to examine the effects of combined psycho-physiological therapy (stretching therapy combined with breathing exercise) on sexual satisfaction among heterosexual men.
  6. Sabo A, Kueh YC, Arifin WN, Kim Y, Kuan G
    PLoS One, 2020;15(9):e0239725.
    PMID: 32986724 DOI: 10.1371/journal.pone.0239725
    BACKGROUND: This study aimed to determine the validity of the Malay-translated version scales for assessing the social support and physical environment for exercise activities.

    METHOD: The study was a cross-sectional design in nature, using self-reported questionnaires among the university students in Malaysia. Participants were selected using a convenience sampling approach. Perceptions regarding social support and physical environment were assessed using the Malay-translated version scales. The standard forward-backwards translation was conducted to translate the English version of the scales to the Malay version. Confirmatory factor analysis (CFA) was used to validate the translated version scales; composite reliability (CR) and average variance extracted (AVE) were computed.

    RESULTS: A total of 857 students participated in this study (female: 49.1%, male: 50.9%). The mean age of the participants was 20.2 (SD = 1.6). The fit indices of the initial hypothesized measurement models (social support and physical environment) were not satisfactory. Further improvements were made by adding covariances between residuals' items within the same factor for each hypothesized model. The final re-specified measurement models demonstrated adequate factor structure for the social support scale with 24 items (CFI = .932, TLI = .920, SRMR = .054, RMSEA = .061), and the physical environment scale with five items (CFI = .994, TLI = .981, SRMR = .013, RMSEA = .054). The CR was .918 for family support, .919 for friend support, .813 for perceived availability, and .771 for perceived quality. The AVEs were .560 for family support, .547 for friend support, .554 for perceived availability, and .628 for perceived quality. The intra-class correlation (ICC) based on test-retest was .920 for family support, .984 for friend support, .895 for availability of facilities, and .774 for quality of facilities.

    CONCLUSION: The Malay version of the social support scale for exercise and the physical environment scale for physical activity were shown to have adequate psychometric properties for assessing perceived social support and physical environment among the university students in Malaysia.

    PERSPECTIVE: This study presented the psychometric properties of the social support and physical environment scales based on CFA and was the first to translate these scales from the original English version to the Malay version.

  7. Ramlay MZ, Saddki N, Tin-Oo MM, Arifin WN
    PMID: 32731318 DOI: 10.3390/ijerph17155407
    Currently, the availability of a functional oral health literacy instrument in the Malay language is limited. This study aimed to cross-culturally adapt Oral Health Literacy Instrument (OHLI) into the Malay language and to determine its psychometric properties in Malaysian adults. Cross-cultural adaptation of the OHLI into the Malay version (OHLI-M) was conducted according to a guideline, followed by a cross-sectional study among outpatients in a selected health clinic. The psychometric evaluations were the comparison of the OHLI-M scores by education levels and last dental visits, the correlation of the reading comprehension section of OHLI-M with the Malay version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA-M), the correlation of OHLI-M with decayed, missing, and filled teeth (DMFT) and Community Periodontal Index (CPI), and the test-retest reliability of OHLI-M. A total of 195 outpatients participated in this study. The OHLI-M scores were significantly different between participants with different levels of education and timing since last dental visit. Participants with lower secondary school qualification and below, and those whose last dental visit was more than two years ago or never, had significantly lower OHLI-M scores. There was a positive correlation between the reading comprehension scores of the OHLI-M and the S-TOFHLA-M (Spearman's rho = 0.37, p < 0.001). There was no significant correlation between the OHLI-M scores and the DMFT index scores or the CPI scores. The internal consistency was good (Cronbach's alpha = 0.83 to 0.88). The test-retest reliability was excellent (intraclass correlation = 0.80 to 0.86). The OHLI-M showed good validity and reliability among adults in Malaysia.
  8. Lim BC, Kueh YC, Arifin WN, Ng KH
    PLoS One, 2021;16(4):e0250627.
    PMID: 33909664 DOI: 10.1371/journal.pone.0250627
    BACKGROUND: Healthy lifestyle habits formed during young adulthood may have a sustaining impact on health across later life. The current study aimed to test the theoretical model of factors (selected demographic variables, knowledge of heart disease, health belief related to cardiovascular disease (CVD), self-efficacy, cues to action, and screening intention) influencing health-promoting behaviours among Malaysian university students.

    METHODS: In a cross-sectional survey, the undergraduate students in Universiti Sains Malaysia were invited to complete the self-administered questionnaires. Participants were selected using a purposive sampling method. The proposed hypothesised model was analysed using a structural equation modelling with Mplus 7.3 program. A total of 788 (70.7% female) undergraduate students with a mean age of 20.2 (SD = 1.02) participated in the study. The primary outcome of knowledge, health beliefs, and health-promoting behaviours related to CVD were measured by questionnaires namely: Knowledge of Heart Disease, Health Beliefs Related to CVD, and Health Promoting Lifestyle Profiles-II.

    RESULTS: The final hypothetical structural model showed a good fit to the data based on several fit indices: with comparative fit index (CFI) at .921, standardised root mean square residual (SRMR) at .037, and root mean square error of approximation (RMSEA) at .044 (90% CI: .032, .054). The final structural model supported 13 significant path estimates. These variables explained 12% of the total variance in health-promoting behaviours. Through perceived benefits, total knowledge had an indirect effect on health-promoting behaviours.

    CONCLUSION: The results suggest that perceived barriers, perceived benefits, family history of CVD, and screening intention enable young adults to engage in health-promoting behaviours.

  9. Lim BC, Kueh YC, Arifin WN, Ng KH
    MyJurnal
    Objective: To determine the factor structure of the Health Promoting Behaviours (HPB) component of Health Promoting Lifestyle Profile-II among undergraduate students in Universiti Sains Malaysia (USM) by confirmatory factor analysis (CFA).
    Methods: A cross sectional study was conducted among undergraduate students. The data was collected in the USM campus using a proportionate cluster sampling method. The HPB questionnaire was handed to students in the lecture hall and collected immediately when the lecture finished. CFA was conducted using robust maximum likelihood estimation due to violation of multivariate normality assumption. A three-factor model was tested for measurement model validity and construct validity.
    Results: A total of 788 students participated in the study. CFA of a 21-item, three-factor model yielded an adequate goodness-of-fit values. The measurement model also showed a good convergent and discriminant validity after model re-specification.
    Conclusion: The health promoting behaviours scale was proven to have a valid measurement model and reliable constructs. It was deemed suitable for use to measure the health promoting behaviours components of a healthy lifestyle among Malaysian undergraduate students. It was recommended to further conduct cross-validation studies in other Malaysian public universities to provide additional empirical evidence to support its use.
  10. Hassim SR, Arifin WN, Kueh YC, Yaacob NA
    Int J Environ Res Public Health, 2020 May 28;17(11).
    PMID: 32481559 DOI: 10.3390/ijerph17113820
    BACKGROUND: At present, the validity and reliability evidence of the Malay version of the Smartphone Addiction Scale (SAS-M) is only available by exploratory factor analysis (EFA). The aim of this study is to validate and determine the psychometric properties of the SAS-M by confirmatory factor analysis (CFA).

    METHODS: A cross-sectional study was conducted among 323 medical students in Universiti Sains Malaysia. The students were given questionnaire forms consisting of socio-demographic information, the SAS-M and the Malay version of the Internet Addiction Test (MVIAT). The CFA was conducted using robust maximum likelihood estimator. The internal consistency reliability was determined by Raykov's rho coefficient. The concurrent validity was assessed by the Pearson's correlations between the factor scores of the SAS-M and the MVIAT.

    RESULTS: The analysis showed the five-factor model of the SAS-M has an acceptable model fit after the inclusion of 12 correlated errors (SRMR = 0.067, RMSEA 0.059 (90% CI: 0.054, 0.065), CFI = 0.895, TLI = 0.882). The factor loadings ranged from 0.320 to 0.875. The internal consistency reliability was good (Raykov's rho = 0.713 to 0.858) and it showed good concurrent validity with the MVIAT.

    CONCLUSIONS: The CFA showed that the SAS-M is a valid and reliable self-administered questionnaire to measure the level of smartphone addiction among medical students.

  11. Ting LK, Kuan G, Arifin WN, Cheng KY
    Malays J Med Sci, 2019 May;26(3):119-128.
    PMID: 31303856 MyJurnal DOI: 10.21315/mjms2019.26.3.10
    Background: Self-efficacy (SE) is a person's belief in his or her own capability to perform and accomplish a task that could produce a favourable outcome, despite facing obstacles. This study aimed to confirm the validity and reliability of an SE scale among undergraduate students at the Health Campus of the Universiti Sains Malaysia.

    Methods: A cross-sectional study was conducted among the undergraduate students using a self-administered questionnaire. After using a purposive sampling method, 562 students completed the questionnaire. Mplus 8 was employed to conduct the confirmatory factor analysis on the psychometric properties of Bandura's 18-item SE scale with three factors (internal feeling, competing demands and situational). Then, the composite reliability was calculated for each factor.

    Results: Most of the students were Malay (73.3%) females (79.0%) who exercised 2.62 times a week for an average of 43.37 min per session. The final measurement model was obtained after removing six problematic items, and the model was deemed fit based on several indices [Root Mean Square Error of Approximation (RMSEA) = 0.067, Standardised Root Mean Square Residual (SRMR) = 0.004, Comparative Fit Index (CFI) = 0.924]. The composite reliability values of the three factors were acceptable (0.65 to 0.84).

    Conclusion: The simplified 12-item SE scale with three factors displayed good fit indices with regard to the data, and they were considered to be acceptable for the current sample.

  12. Lim BC, Kueh YC, Arifin WN, Ng KH
    Malays J Med Sci, 2016 Jul;23(4):33-45.
    PMID: 27660543 MyJurnal DOI: 10.21315/mjms2016.23.4.5
    Heart disease knowledge is an important concept for health education, yet there is lack of evidence on proper validated instruments used to measure levels of heart disease knowledge in the Malaysian context.
  13. Baharuddin IH, Arifin WN, Kueh YC, Rahman NA
    Malays J Med Sci, 2018 May;25(3):111-119.
    PMID: 30899192 DOI: 10.21315/mjms2018.25.3.11
    Background: Many questionnaires have been developed to measure dental anxiety and fear. Among them is the Index of Dental Anxiety and Fear Scale (IDAF-4C+), which consists of a dental anxiety and fear module (IDAF-4C), a phobia module (IDAF-P) and a stimulus module (IDAF-S). The objective of this research was to report the adaptation and validation of the IDAF-4C+ for Malaysian secondary school children.

    Methods: This was a cross-sectional validation study. The original English version of the IDAF-4C+ was translated into Malay, back-translated, and then sent for content validation via an expert validation and face validation by the target student population. Three hundred and seventy questionnaires were then distributed among 16-year-old school children. Confirmatory factor analysis (CFA) was conducted for the IDAF-4C module using a bootstrapped maximum likelihood estimator. Spearman's rank correlation was used to assess the relationship between the IDAF-S and IDAF-4C modules. Intraclass correlation (ICC) was used to determine the stability of the IDAF-S and IDAF-4C modules, while kappa values were used for the IDAF-P module.

    Results: The response rate was 86.5% for CFA and 76.9% for stability. CFA showed the existence of only one factor with a reliability estimate of 0.921, obtained via Raykov's procedure. All items in the IDAF-S module were significantly correlated with the IDAF-4C module (P < 0.001). The IDAF-S and IDAF-4C modules were stable, as determined via a two-way mixed model with absolute agreement, a single measure and a Case 3 ICC (A, 1). The IDAF-P module showed satisfactory stability, as assessed via kappa values.

    Conclusion: The Malay version of the IDAF-4C+ is valid and reliable in measuring dental anxiety and fear among Malaysian secondary school children.

  14. Sattar K, Yusoff MSB, Arifin WN, Yasin MAM, Nor MZM
    Pak J Med Sci, 2021 7 23;37(4):1221-1229.
    PMID: 34290812 DOI: 10.12669/pjms.37.4.4004
    Background and Objectives: Medical Professionalism (MP) establishes the trust between society and doctors. We aimed at finding frequently highlighted qualities of MP in the literature.

    Methods: We searched PubMed and Scopus for attributes of MP, using terms, "Professionalism," "Medical Students," and "Undergraduate Medical Education". We included English language, original research articles with MP attributes from the perspective of undergraduate medical education, any nationality, race, gender, and age range, as the central topic of the article. Papers published from January 1st 1986 to 29th February 2020 were included.

    Results: From 1349 identified articles, finally, 18 were included, authored in 10 countries, collectively contributing to answering the scoping review question. Two themes were identified: (1) Nurturing of MP, 11 (61.11%) out of 18 included articles, highlighted "respect" as the most dominant attribute as it appeared in 6 (54.55%) out of 11 reviews, "communication" 5 (45.45 %) studies and "honesty" and "integrity" 4 (36.36%). (2) Assessment of MP, 7 (38.89%) studies, and majority, 4 (57.14 %) assessed MP using American Board of Internal Medicine's elements of MP, viz, "altruism, accountability, excellence, duty, honor and integrity, respect for others."

    Conclusions: Themes exemplified MP's most discoursed issues. The attributes are frequently used worldwide. MP deliberates as a commitment toward the individual patient, society, and necessitates transforming from its present generic form to more explicit details.

  15. Goni MD, Naing NN, Hasan H, Wan-Arfah N, Deris ZZ, Arifin WN, et al.
    Front Public Health, 2019;7:268.
    PMID: 31620419 DOI: 10.3389/fpubh.2019.00268
    This study aimed to assess the uptake of recommended vaccines and to identify the factors associated with the vaccines' uptake among Malaysian Hajj and Umrah pilgrims. A cross-sectional survey among Malaysian Hajj and Umrah pilgrims in 2018. The uptake of the recommended vaccines was surveyed through an anonymous self-administered questionnaire to pilgrims attending a pre-departure Hajj/Umrah orientation course. Descriptive statistics were used for elaborating the demographic characteristics and vaccines uptake of the respondents. Multiple logistic regression was used for predicting the factors associated with the vaccines' uptake. A total of 1,274 pilgrims participated in the study with a mean age (standard deviation) of 42.42 (15.6). A total of 833 (65.4%) participants were females and 232 of the participants (18.2%) had at least more than one chronic disease. The uptake of influenza and pneumococcal vaccines were 28.6% (364/1,274) and 25.4% (324/1,274), respectively. Among the 527 pilgrims who were "at increased risk" of infections, 168 (31.9%) and 184 (34.9%) received influenza and pneumococcal vaccines, respectively. Gender, marital status and occupation were the common predictors associated with vaccines uptake. The vaccination uptake among Malaysian Hajj and Umrah pilgrims is low and declining from previous years. Educating the pilgrims toward vaccine uptake is essential and exploring the barriers for vaccination.
  16. Hidrus AB, Kueh YC, Arifin WN, Konter E, Kuan G
    PMID: 32155904 DOI: 10.3390/ijerph17051736
    Sports courage is one of the most important attributes to help competitive athletes overcome anxiety, nervousness, and other psychological obstacles, but this field of study is still being overlooked by most athletes and coaches. The purpose of this study is to validate the Malay language version of the Sports Courage Scale (SCS-M) for Silat athletes using confirmatory factor analysis (CFA). Data were collected during 9th UPSI International Pencak Silat Championship in Malaysia. A total of 258 competitors (male = 66.7%, female = 33.3%), with a mean age of 18 years (SD = 2.6), volunteered to participate in this study. The original SCS with 50 items underwent forward and backward translations into the Malay language and was pre-tested with ten martial arts athletes. Then, Silat athletes were asked to complete the translated SCS-M questionnaire. There were five factors in the SCS-M (i.e., mastery, determination, assertiveness, venturesome, and self-sacrificial behaviour). The first hypothesised model with 50 items did not result in a good fit to the data (RMSEA = 0.06, CFI = 0.93, NFI = 0.87, NNFI = 0.93, RMR = 0.14, SRMR = 0.09). A total of 17 problematic items were identified and were removed iteratively. The final measurement model with 33 items fit the data well (RMSEA = 0.06, CFI = 0.94, NFI = 0.89, NNFI = 0.94, RMR = 0.05, SRMR = 0.07). The reliability of each subscale based on Cronbach's alpha ranged from 0.64 to 0.76. The convergent and discriminant validities were achieved for the final measurement model. The revised version of SCS-M with 33 items was considered valid and reliable for measuring the sports courage in Silat athletes in Malaysia.
  17. Goni MD, Hasan H, Naing NN, Wan-Arfah N, Deris ZZ, Arifin WN, et al.
    J Immigr Minor Health, 2023 Aug;25(4):870-881.
    PMID: 36695987 DOI: 10.1007/s10903-022-01443-4
    This study was aimed at demonstrating the impact of a health education intervention on reducing the incidence of influenza-like illnesses symptoms among Malaysian Hajj pilgrims. This study utilizes a quasi-experimental study in the evaluation of the impact of the intervention. Participants were recruited during Hajj orientation courses organized by private Hajj companies. Participants from two companies were assigned to an intervention group and control group, respectively. The intervention group received a smartphone-based health education intervention guided by the Health Belief Model (HBM), while the control group received a regular Hajj guide intervention smartphone application before departure to Hajj. Data on the incidence of influenza-like illnesses (ILI) were collected from participants from two Hajj companies before and after returning from Hajj. Data analysis was conducted using SPSS with descriptive analysis, and analytical tests were conducted at 5% significance level. A total of 102 pilgrims completed the study in both intervention and control groups. The incidence of ILI and Non-ILI symptoms were statistically significant when the intervention and control groups (p = 0.049) were compared. In conclusion, health education has an impact on reducing the incidence of ILI and non-ILI among Hajj pilgrims.
  18. Liu KT, Kueh YC, Arifin WN, Kim Y, Kuan G
    Front Psychol, 2018;9:2402.
    PMID: 30618907 DOI: 10.3389/fpsyg.2018.02402
    This study's purpose was to examine the structural relationship of the transtheoretical model (TTM) and the amount of physical activity (PA) among undergraduate students in health and medicine at Universiti Sains Malaysia. A cross-sectional study was carried out among students who took part in the co-curricular program. Co-curricular program includes activities that take place outside of the regular lectures or tutorials in the University. Students recruited through purposive sampling were informed that their participation was entirely voluntarily. Those interested completed the self-administered questionnaire, which consisted of the decisional balance, processes of change, self-efficacy, stages of change scales, and Godin leisure-time exercise questionnaire. Data were analyzed using Mplus version 8 for descriptive statistics and structural equation modeling analysis for inferential statistics. A total of 562 students participated in the study. The majority of the students was female (79.0%) and Malay (73.3%) and average of exercise sessions per week was 2.62, with a mean of 43.37 min per exercise session. The final structural model fit the data well based on several fit indices (SRMR = 0.046, RMSEA (CI: 90%) = 0.061 (0.045, 0.078), RMSEA p = 0.130). The model showed that stages of change significantly affected self-efficacy (p < 0.001), pros (benefits of exercise; p < 0.001), cons (barriers to exercise; p = 0.022), and processes of change (p < 0.001). The model also showed significant inter-relationships among the TTM constructs and supported seven hypotheses. Among all the variables examined, only processes of change significantly affected PA (p < 0.001). However, stages of change (p < 0.001) and pros (p =< 0.001) had significant indirect effects on PA via processes of change. The findings support that individuals' stages of change affect their self-efficacy level, or the ability to make positive and negative decisions and perform behavior accordingly. The study confirms that making correct decisions and taking action accordingly can increase PA levels.
  19. Liu KT, Kueh YC, Arifin WN, Ismail Ibrahim M, Shafei MN, Kuan G
    PMID: 32316170 DOI: 10.3390/ijerph17082748
    Decisional balance (DB) is the perceived positive aspects (advantages) and negative aspects (disadvantages) that are associated with behavioural change. Behavioural change is dependent on an individual's thoughts after considering the advantages of engaging in exercise. When the benefits exceed the barriers, people are more likely to make changes after cognitively evaluating the functional aspects. The purpose of the present study is to determine the validity and reliability of the DB scale among Malaysian university students using a confirmatory factor analysis (CFA). A cross-sectional study was carried out among students who took part in the co-curricular program. By using the purposive sampling method, students were recruited and given written informed consent forms after acknowledging they understood the purpose of the study. The DB scale, which consists of two factors, namely, advantages and disadvantages, was used as the instrument in the study. The advantages referred to the benefits of participating in exercise, whereas the disadvantages referred to the barriers to exercise. The 10-item, self-administered questionnaires were distributed to participating students. Data were analysed using Mplus 8 for the CFA. A total of 562 students (females = 444, males = 118) with a mean age of 19.81 years (SD = 1.22) participated in the study. Most of the students were engaged in regular physical activity for at least three exercise sessions (mean = 2.62) per week, and the average duration per session was 43 minutes. The hypothesised measurement model of DB did not fit the data well; thus, the measurement model was re-specified. The final measurement model fit the data well (comparative fit index (CFI) = 0.960, Tucker-Lewis index (TLI) = 0.943, standardised root mean square residual (SRMR) = 0.055, root mean square error of approximation (RMSEA) (90% confidence interval (CI)) = 0.061 (0.047, 0.074), RMSEA p-value = 0.096). The composite reliability values of 0.757 for the advantages and 0.792 for the disadvantages were acceptable. The 10-item DB scale with two factors displayed a good model fit for the data with good scale reliability. This could be beneficial for Malaysian undergraduate students in making decisions before engaging in physical activity. The benefits of, and barriers to, exercise could be an important component that affects their decision making.
  20. Daud MRHM, Yaacob NA, Arifin WN, Sani JAM, Ibadullah WAHW
    Osong Public Health Res Perspect, 2024 Oct;15(5):429-439.
    PMID: 39164020 DOI: 10.24171/j.phrp.2024.0156
    BACKGROUND: Despite effective vaccination strategies, measles remains a global public health challenge. The study explored individual and contextual factors associated with measles infection in Malaysia from 2018 to 2022, informing the development of targeted public health interventions.

    METHODS: This cross-sectional study utilised data from the Ministry of Health, the Department of Statistics, and the Department of Environment Malaysia. Multilevel logistic regression analysis was employed to examine individual-level factors, including age, sex, ethnicity, nationality, contact history, travel history, and vaccination status. Concurrently, contextual factors were assessed, encompassing district-level determinants such as population density, median household income, urbanisation, the number of health and rural clinics, vaccination rates, fine particulate matter less than 2.5 μm (PM2.5) levels, relative humidity, and temperature, to determine their impact on measles infection risk.

    RESULTS: Measles infection was significantly associated with various individual factors. These included age (adjusted odds ratio [aOR], 1.02; 95% confidence interval [CI], 1.02-1.03), ethnicity, non-Malaysian nationality (aOR, 34.53; 95% CI, 8.42- 141.51), prior contact with a measles case (aOR, 2.36; 95% CI, 2.07-2.69), travel history (aOR, 2.30; 95% CI, 1.13-4.70), and vaccination status (aOR, 0.76; 95% CI, 0.72-0.79). Among contextual factors, urbanisation (aOR, 1.56; 95% CI, 1.16- 2.10) and the number of clinics (aOR, 0.98; 95% CI, 0.97-0.99) were significant determinants.

    CONCLUSION: This multilevel logistic regression analysis illuminates the complexities of measles transmission, advocating public health interventions tailored to individual and contextual vulnerabilities. The findings highlight the need for a synergistic approach that combines vaccination campaigns, healthcare accessibility improvements, and socioeconomic interventions to effectively combat measles.

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