Displaying publications 1 - 20 of 1064 in total

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  1. Kari KA, Wan Muhd Shukeri WF, Yaacob NM, Li AY, Zaini RH, Mazlan MZ
    Malays J Med Sci, 2023 Dec;30(6):120-132.
    PMID: 38239259 DOI: 10.21315/mjms2023.30.6.12
    BACKGROUND: Sepsis and septic shock are the leading causes of critical care-related mortality worldwide. This study aimed to determine the prevalence of sepsis, its intensive care unit (ICU) mortality rate and the factors associated with both ICU mortality and prolonged stay.

    METHODS: A prospective cohort study was conducted from January 2019 to December 2019 with adult patients presenting evidence of sepsis who were admitted to the ICU. Parameters were assessed in the ICU to determine the association with all-cause ICU mortality and prolonged stay.

    RESULTS: Out of 607 adults, 292 with sepsis were admitted to the ICU in 2019, with a mean age of 50.98 (standard deviation [SD] = 17.75) years old. There was, thus, a 48% incidence of sepsis. Mortality was observed in 78 patients (mortality rate = 26.7%) (95% confidence interval [CI]: 21.7, 32.2). Patients with higher Glasgow coma scale (GCS) scores had lower odds of ICU mortality (adjusted odds ratio [OR] = 0.90; 95% CI: 0.82, 0.98; P = 0.019), while patients with higher sequential organ failure assessment (SOFA) scores had higher odds (adjusted OR = 1.22; 95% CI: 1.11, 1.35; P < 0.001). Eighty patients (37.4%) who survived had prolonged ICU stays (95% CI: 30.9, 44.2). Patients with higher albumin levels had lower odds of a prolonged ICU stay (adjusted OR = 0.94; 95% CI: 0.90, 0.98; P = 0.006) and patients on renal replacement therapy had higher odds of a prolonged ICU stay (adjusted OR = 1.25; 95% CI: 1.74, 7.12; P < 0.001).

    CONCLUSION: Our study identified a sepsis prevalence of 48% and an ICU mortality rate of 26.7% among adult patients admitted to the ICU. GCS and SOFA scores were the most important factors associated with ICU mortality.

  2. Sagary R, Malim NHAH, Abdullah NL, Mohamad WNAW, Ahmad AL
    Malays J Med Sci, 2023 Dec;30(6):29-44.
    PMID: 38239257 DOI: 10.21315/mjms2023.30.6.4
    Neurological rehabilitation is a physician-supervised programme for individuals with nervous system diseases, injuries or disorders. Neurological rehabilitation, also known as neurorehabilitation, is part of the rehabilitation process that improves function, reduces severity and enhances a patient's well-being. Because neurological injuries occur in the brain, spine and nerves, affecting multiple body parts including organs, blood vessels, muscles and bones, rehabilitation requires a multidisciplinary approach. This study conducted a systematic literature review (SLR) on the use of mobile game in neurorehabilitation. The steps undertaken in the literature review included the collection, identification, categorisation, summarisation and synthesis of relevant studies in the research domain. A total of 50 related articles were reviewed. The study identified that the effects on cognitive skills, handgrip strength, memory, attention, visuospatial abilities, executive function tasks, motor functionality, and improvements in balance, visual perception, and functional mobility are impacts of the use of mobile games in neurological rehabilitation. Furthermore, several research challenges and recommendations for future research were identified.
  3. Sundrasegaran P, Engkasan JP
    Malays J Med Sci, 2023 Dec;30(6):79-90.
    PMID: 38239256 DOI: 10.21315/mjms2023.30.6.9
    BACKGROUND: Persons with tetraplegia rank improved upper extremity (UE) function as the most important rehabilitation outcome because it allows them greater independence in activities of daily living (ADL). The aim of this study was to describe UE status in patients with tetraplegia using the International Spinal Cord Injury Upper Extremity Basic Data Set version 1.1 (ISCI-UE 1.1) and to determine differences in UE status between tetraplegic individuals with traumatic and non-traumatic SCIs.

    METHODS: This cross-sectional study was conducted among patients with tetraplegia who attended the SCI rehabilitation clinic of a tertiary hospital from September 2021 to August 2022. Both upper limbs were assessed using ISCI-UE 1.1.

    RESULTS: One hundred patients were included in this study, of whom 80 were men. The mean (SD) age of the patients was 54.30 (16.95) years old. In these patients, most SCIs (62%) were of traumatic origin. Two hundred UEs were evaluated, of which 109 showed good hand function (level 5) and 10 had the poorest hand function (level 1). Meanwhile, 130 UEs showed good shoulder function (level D) and 10 had the poorest shoulder function (level A). A statistically significant association with UE status (reach-and-grasp ability and shoulder function) was found in both the non-traumatic and traumatic SCI groups, with better hand and shoulder functions in the non-traumatic SCI group (right-hand, P = 0.004 and left hand, P = 0.001; right shoulder, P < 0.001 and left shoulder, P = 0.002).

    CONCLUSION: ISCI-UE 1.1 is a feasible tool for documenting UE function in patients with tetraplegia. Compared with the individuals with traumatic SCI in this study, those with non-traumatic SCI demonstrated better upper extremity functionality.

  4. Chidambaram R, Sivakumar I
    Malays J Med Sci, 2023 Dec;30(6):167-171.
    PMID: 38239260 DOI: 10.21315/mjms2023.30.6.16
    COVID-19 has created panic waves wherein the world is under test and Malaysia is no exception. Intimate partner violence (IPV) is one among the exhaustive list and seen rise in cases especially after the lockdown where families must spend more time with each other. Good news that the movement restrictions are lifted, meanwhile it is likely that family physicians can expect more admissions of IPV. Reports from the Ministry of Health Malaysia state the last year cases have noticed a spike of 42%. Thereby the present communication aims to keep the family physician informed on the rising IPV related injuries. Our prime concern is about the reluctant victims that remain undetected. In reality, situations become tougher especially when victim is accompanied by her perpetrator. Being the first person to contact victim, the family physician should utilise this post-pandemic as a potential strategy to identify the voiceless victims in perpetrators presence.
  5. Nour Azimah Z, Abdullah JM
    Malays J Med Sci, 2023 Dec;30(6):1-4.
    PMID: 38239255 DOI: 10.21315/mjms2023.30.6.1
    This is an annual performance report of Malaysian Journal of Medical Sciences (MJMS) for the year 2022. This report presents data pertaining manuscript submissions to MJMS and its performances are presented in various form of views.
  6. Gima E, Teh CSL, Nik Hassan NFH, Yaacob NM, Md Shukri N
    Malays J Med Sci, 2023 Dec;30(6):156-166.
    PMID: 38239243 DOI: 10.21315/mjms2023.30.6.15
    BACKGROUND: Olfactory disorders (OD) are an umbrella term for a diverse group of smell problems. Numerous tests and questionnaires have been formulated to identify and test the severity of smell impairment, which is not readily available or translated for the Malaysian population. This study aimed to translate the Questionnaire for Olfactory Disorders (QOD) and validate and test the reliability of the Malay Questionnaire for Olfactory Disorders (mQOD).

    METHODS: This cross-sectional study was conducted in two tertiary centres. A forward and backward translation was conducted for the QOD. The translated questionnaire was distributed to subjects with self-reported smell disorders on days 1 and 7. Internal consistency was analysed using Cronbach's alpha and test-retest reliability was tested with an intraclass correlation coefficient. Confirmatory factor analysis was performed to test construct validity.

    RESULTS: A total of 375 participants were recruited, 52 dropped out and 323 completed the questionnaire a second time. The Cronbach's alpha coefficient was 0.537 for parosmia (P), 0.892 for life quality (LQ), 0.637 for sincerity (S) and 0.865 for visual analogue score (VAS). The intraclass correlation coefficient (ICC) for domain scores was > 0.9, while the ICC for all items was good to excellent. A three-factor model for mQOD showed an acceptable fit with indices chi-square value (CMIN)/degree of freedom (DF) = 3.332, Tucker-Lewis fit index (TLI) = 0.923, comparative fit index (CFI) = 0.939, root mean square error of approximation (RMSEA) = 0.079 and standardised root mean square residual (SRMR) = 0.0574.

    CONCLUSION: The mQOD is a valid and reliable tool for assessing OD in patients.

  7. Tan XL, Omar R, Knight VF
    Malays J Med Sci, 2023 Dec;30(6):147-155.
    PMID: 38239245 DOI: 10.21315/mjms2023.30.6.14
    BACKGROUND: Certified training must be provided for lay vision screeners prior to their conduct of a vision screening programme. However, the effectiveness of trained lay screeners does deteriorate over time. This study aims to evaluate the effectiveness of a recertification vision screening training module using the KieVision™ Preschool Vision Screening Kit for preschool teachers in Malaysia.

    METHODS: This was a randomised control trial. Fifty-nine preschool teachers previously enrolled in a Knowledge Transfer Programme were divided into a Study Group (n = 31) to receive recertification training and a Control Group (n = 28) to attend briefing sessions. Subjects was then asked to perform vision screening on 15 preschool children aged 4 years old-6 years old at their respective premises, then verified by optometrists after 2 weeks from the initial screening on the same children.

    RESULTS: A total of 894 children were screened, with the Study Group and Control Group screened 49.7% and 50.3%, respectively. There was higher validity in vision screening findings from the Study Group (sensitivity = 66.7%, positive predictive value (PPV) = 61.5%) compared to the Control Group (sensitivity = 36.0 %, PPV = 40.9%).

    CONCLUSION: Teachers who received recertification training were more competent in detecting children's vision impairment using KieVision™ Preschool Vision Screening Kit. Thus, timely recertification training should be emphasised to ensure sustainable consistency and reliability of vision screening programmes conducted by lay vision screeners.

  8. Murshad SW, Khan AA, Rani S, Kamran M
    Malays J Med Sci, 2023 Dec;30(6):22-28.
    PMID: 38239244 DOI: 10.21315/mjms2023.30.6.3
    Nosocomial infections are common in intensive care units (ICUs) and often cause increased morbidity and mortality rates in ICU patients. With the emergence of the highly infectious COVID-19, the high prevalence of hospital-acquired infections (HAIs) in ICU has caused much more concern because patients admitted to the ICU have a more severe and prolonged form of the disease. These patients are more likely to develop HAIs than non-ICU patients. Medical communities adopted several measures to make ICU management safer during the pandemic all over the world. In this study, we re-examined the challenges faced and the changes made in ICU management during the pandemic to speculate how these changes will be relevant post-pandemic and can be permanently incorporated into the ICU to improve safety, management, and critical care and make critical care better equipped for future disease breakouts.
  9. Tay JEF, Tung SEH, Mok KT, Tan CH, Gan WY, Poon WC
    Malays J Med Sci, 2023 Dec;30(6):133-146.
    PMID: 38239254 DOI: 10.21315/mjms2023.30.6.13
    BACKGROUND: In the current situation of COVID-19, dietary intake that incorporates functional foods may potentially be a preventive measure for defence against viral infection. This study aimed to determine the consumption of functional foods and its associated factors among university students during COVID-19.

    METHODS: This was a cross-sectional study conducted among 284 Malaysian university students in Kuala Lumpur, Malaysia. An online self-administered questionnaire was employed to assess subjects' nutrition knowledge, dietary habits, attitude towards functional foods, recognition and consumption of functional food products.

    RESULTS: Out of 284 respondents, 41.9% had poor level of nutrition knowledge and 57% had moderate level of functional food-related attitude, with seven types of functional foods consumed on average (57.0%). Binary logistic regression showed that university students who consumed fruits at least three times per day (aOR = 11.18; 95% CI: 1.46, 80.17), salty snacks (aOR = 2.90; 95% CI: 1.43, 5.86), soft drinks/sugar-sweetened beverages (SSB) (aOR = 3.12; 95% CI: 1.53, 5.26) and pure juice (aOR = 2.80; 95% CI: 1.48, 5.30) were more likely to consume functional foods during COVID-19 (P < 0.05).

    CONCLUSION: The findings could provide information to public and private sectors in terms of creating a supportive environment to encourage and promote the awareness and consumption of functional foods and their associated health benefits.

  10. Wu SK, Wong JE, Poh BK
    Malays J Med Sci, 2023 Dec;30(6):108-119.
    PMID: 38239253 DOI: 10.21315/mjms2023.30.6.11
    BACKGROUND: Understanding of psychosocial factors of physical activity (PA) in children is crucial in encouraging sustained PA, which in turn is associated with important health outcomes. This study aimed to examine how children's attraction to physical activity (CAPA) is associated with PA.

    METHODS: This cross-sectional study was conducted among 219 primary school children (105 boys; 114 girls) aged 7 years old-10 years old in Kuala Lumpur, Malaysia in 2016-2017. Children from three main ethnicities, namely Malay, Chinese and Indian, were recruited. Weight, height and waist circumference were measured; body composition was assessed by deuterium dilution technique. CAPA and level of PA were obtained through self-administered questionnaires and reported as CAPA and PA scores.

    RESULTS: Median CAPA and PA scores were 3.40 (Q1 = 3.00, Q3 = 3.80) and 2.31 (Q1 = 1.95, Q3 = 2.74), respectively. Significant gender differences were found in CAPA and PA scores, with boys being more attracted to PA (3.16 [Q1 = 2.90, Q3 = 3.44]; P = 0.001) and more physically active compared with girls (2.47 [Q1 = 2.07, Q3 = 3.07]; P = 0.001). CAPA and PA scores correlated positively in both sexes. Boys scored higher than girls in 'liking of games and sports' (ρ = 0.301, P = 0.002) and 'liking of vigorous PA' (ρ = 0.227, P = 0.02) CAPA subscales, which also correlated positively with PA scores. Girls' PA scores correlated with 'peer acceptance in games and sports' (ρ = 0.329, P < 0.001).

    CONCLUSION: Boys are more physically active and have higher attraction to PA compared with girls. Differences in PA scores between the sexes were related to gender differences in CAPA scores. Thus, attention should be given to gender differences in CAPA related psychosocial factors when planning interventions to promote PA among children.

  11. Legiawati L, Yusharyahya SN, Astriningrum R, Pulungan AA, Kusumahapsari RW
    Malays J Med Sci, 2023 Dec;30(6):54-60.
    PMID: 38239249 DOI: 10.21315/mjms2023.30.6.6
    BACKGROUND: Elderly people are susceptible to various skin diseases. To monitor disease trends in the geriatric population, epidemiologic data on skin diseases are essential. However, studies on skin diseases in geriatric patients in Indonesia, particularly those who are hospitalised, are limited. Therefore, this retrospective study aims to determine the skin disease profile in geriatric patients at a tertiary referral hospital in Indonesia.

    METHODS: The subjects were all geriatric inpatients who were consulted at the Department of Dermatology and Venereology, Dr. Cipto Mangunkusumo National General Hospital between 2017 and 2019. The patients were analysed according to sex, age and comorbidities. They were divided into 15 groups according to the diseases. Chi-square test or Fisher's exact test was used to compare categorical variables.

    RESULTS: The most common skin diseases were infections (35.8%), dermatitis (21.8%), ulcers (12.8%), age-related skin changes (8.4%) and vascular diseases (5.3%). Dermatitis was significantly more common in males (P < 0.05), whereas infections were significantly more common in females (P < 0.05).

    CONCLUSION: Consistent with previous studies, our inpatient data showed that infections were significantly more common in females, whereas dermatitis was significantly more common in males. The data collected may contribute to epidemiologic data on skin diseases in the geriatric population.

  12. Shahadan SZ, Rahman SJA, Mohamad Ismail MF, Risdiana N
    Malays J Med Sci, 2023 Dec;30(6):45-53.
    PMID: 38239246 DOI: 10.21315/mjms2023.30.6.5
    Physical activity (PA) maintains weight and reduces postnatal weight retention (PWR), thereby lowering obesity-related comorbidities. There is only limited evidence on the most effective postnatal PA for Malaysian women. This review identified evidence-based literature on the effectiveness of PA interventions in managing weight in postnatal women and the preferred type of intervention for them. A systematic literature search was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. Randomised controlled trials and quasi-experimental research related to PA interventions for women during the postnatal period (18 months after delivery) published in English from 2011 to 2021 were searched in ProQuest, Scopus, Springer Link and PubMed using the following keywords: 'physical activity', 'weight management' and 'postnatal women'. Intervention groups with weight and body mass index measured after any supervised PA guidance/counselling with a minimum follow-up of 10 weeks were included in the analysis. Those with pharmacological management and a comparator control group were excluded. A total of six articles met the inclusion criteria. Using the revised Cochrane risk of bias tool for randomised trials, one of these articles was classified as low-risk, two as having some concerns and three as having a high risk of bias. Walking, yoga and Pilates were found to be the most appropriate and preferred types of physical activity, despite having a small but significant impact on postnatal women's weight management. Healthcare professionals should adopt programmes that explicitly target these PA interventions to manage PWR.
  13. Abu Hasan NI, Ganggayah MD, Suhaimi S, Abu Hasan N, Jamal NF
    Malays J Med Sci, 2023 Dec;30(6):91-107.
    PMID: 38239247 DOI: 10.21315/mjms2023.30.6.10
    BACKGROUND: Online distance learning (ODL) known as the flexible learning environment can trigger a negative impact on students' mental health. The study aimed to identify the influence of fear as mediator between mental health problem and university students' perception on ODL.

    METHODS: This is a cross-sectional study involving a convenient sampling of 258 undergraduate students. Self-administered structured questionnaires adapted from the Depression, Anxiety and Stress Scale-21 (DASS-21) and the Fear of COVID-19 Scale (FCV-19S), were used to assess the severity of psychological symptoms (depression, anxiety and stress) and fear. The perception towards ODL is also designed to assess the students' perception related to ODL implementation. The data were analysed using descriptive statistics and Structural Equation Modelling-Partial Least Square (SEM-PLS).

    RESULTS: Overall, 84.2%, 95.0% and 67.4% of the participants experienced moderate to very severe level of depression, anxiety and stress, respectively. In addition, 82.6% of them suffering with moderate to extreme level of fear, of which 81.8% of participants had a negative view on ODL. The results of SEM-PLS revealed that there are complementary partial mediation effects of fear on the relationship between depression and students' perception during ODL (β = 0.502, t-value = 0.828, P-value = 0.017). The anxiety (β = 0.353, t-value = 5.401, P-value = 0.000) and stress (β = 0.542, t-value = 8.433, P-value = 0.000) have directly influenced on fear.

    CONCLUSION: This study demonstrated that university students had the prevalence of psychological symptoms and fear during ODL. In line with this, fear contributes significantly to the mental health status of university students and has negatively impacted the students' perception during ODL implementation.

  14. Kerisnon Krishnan T, Mohtarrudin N, Wan Yaacob WA, Hussin H
    Malays J Med Sci, 2023 Dec;30(6):70-78.
    PMID: 38239248 DOI: 10.21315/mjms2023.30.6.8
    BACKGROUND: Colorectal carcinoma (CRC) is the third most common cancer globally. In Malaysia, CRC is most prevalent among males and the second most common cancer among females. The CRC arises mainly from the adenocarcinoma sequence. Poorly differentiated clusters (PDCs) and tumour budding (TB) are believed to represent sequential steps in tumour growth. Therefore, this study analysed the association between PDC grades with clinicopathological and demographic characteristics of CRC.

    METHODS: A total of 47 CRC cases previously diagnosed by histopathological examination were reviewed for the presence of PDCs and graded accordingly. The association between PDC grades with clinicopathological and demographic characteristics was statistically analysed.

    RESULTS: Out of the 47 cases with PDCs, most of them were of grade 3 (G3) (n = 27, 57.4%), followed by grade 2 (G2) (n = 13, 27.7%) and grade 1 (G1) (n = 7, 14.9%). Higher PDC grades (G2 and G3) were mainly observed in higher tumour stage (T); T3 (n = 26, 83.9%), T4 (n = 12, 92.3%), N1 (n = 20, 86.9%), N2 (n = 15, 100%). In addition, there was a significant association between PDC grades with the nodal stage (N) (P = 0.013) and the tumour, node and metastasis (TNM) stages (P = 0.012).

    CONCLUSION: The PDC grades are useful for assessing the disease prognosis in CRC. A statistically significant association between PDC grades with N and TNM stages suggested that PDC grades are potential predictive parameters for invasive and metastatic risks in CRC.

  15. Panneerchelvam S, Norazmi MN
    Malays J Med Sci, 2023 Dec;30(6):5-21.
    PMID: 38239252 DOI: 10.21315/mjms2023.30.6.2
    Forensic DNA typing has been widely accepted in the courts all over the world. This is because DNA profiling is a very powerful tool to identify individuals on the basis of their unique genetic makeup. DNA evidence is capable of not only identifying the presence of specific biospecimens in a crime scene, but it is also used to exonerate suspects who are innocent of a crime. Technological advancements in DNA profiling, including the development of validated kits and statistical methods have made this tool to be more precise in forensic investigations. Therefore, validated combined DNA index system (CODIS) short tandem repeats (STRs) kits which require very small amount of DNA, coupled with real-time polymerase chain reaction (PCR) and the statistical strengths are used routinely to identify human remains, establish paternity or to match suspected crime scene biospecimens. The road to modern DNA profiling has been long, and it has taken scientists decades of work and fine tuning to develop highly accurate testing and analyses that are used today. This review will discuss the various DNA polymorphisms and their utility in human identity testing.
  16. Saleh U, Tan GY, Fuad M, Abdullah JM, Idris Z, Ghani ARI, et al.
    Malays J Med Sci, 2023 Dec;30(6):61-69.
    PMID: 38239251 DOI: 10.21315/mjms2023.30.6.7
    BACKGROUND: Brachial plexus injury is a severe peripheral nerve injury that affects the upper extremities and causes functional damage and disability. A detailed and accurate clinical examination is required to accurately localise the site of injury. This video manuscript aims to provide guidelines for the structured assessment of a patient with brachial plexus injury, specifically tailored to Malaysian medical students and trainees.

    METHODS: A video demonstrating the examination of the brachial plexus was made. This video, created at the School of Medical Sciences at Universiti Sains Malaysia (USM), demonstrates the proper examination technique for brachial plexus.

    CONCLUSION: We hope that this video will help students and young doctors evaluate patients with brachial plexus injury and reach accurate localisation of the injury.

  17. Othman MF, Zakaria AD, Yahya MM, Md Hashim MN, Wan Mokhter WM, Wan Zain WZ, et al.
    Malays J Med Sci, 2023 Oct;30(5):106-115.
    PMID: 37928791 DOI: 10.21315/mjms2023.30.5.9
    BACKGROUND: Polyethylene glycol (PEG) solution is widely used as a colonoscopic bowel cleaning agent, although some patients are intolerant due to the need for ingesting large solution volumes and unpleasant taste. A low-volume solution may enhance patient tolerability and compliance in bowel preparation. Accordingly, this study compared the effectiveness of two difference PEG volumes for bowel preparation before colonoscopy in terms of bowel cleanliness, completeness of colonoscopy, patient tolerability and colonoscopy duration.

    METHODS: Using a prospective randomised controlled single-blinded study design, 164 patients scheduled for colonoscopy were allocated to two groups (n = 82 patients in each) to receive either the conventional PEG volume (3 L, control group) or the low volume (2 L, intervention group). The Boston Bowel Preparation Scale (BBPS), a validated scale for assessing bowel cleanliness during colonoscopy, was used to score bowel cleanliness in three colon segments. Secondarily, colonoscopy completeness, tolerability to drinking PEG and the duration of colonoscopy were compared between the groups.

    RESULTS: There were no statistically significant differences between the two intervention groups in terms of bowel cleanliness (P = 0.119), colonoscopy completion (P = 0.535), tolerability (P = 0.190) or the amount of sedation/analgesia required (midazolam, P = 0.162; pethidine, P = 0.708). Only the duration of colonoscopy differed between the two groups (longer duration in the control group, P = 0.039).

    CONCLUSION: Low-volume (2 L) PEG is as effective as the standard 3 L solution in bowel cleaning before colonoscopy; however, the superiority of either solution could not be established.

  18. Mohamad Yazid MN, Nik Husain NR, Daud A, Osman Y, Mustapa N, Abdul Hadi A
    Malays J Med Sci, 2023 Oct;30(5):192-205.
    PMID: 37928796 DOI: 10.21315/mjms2023.30.5.16
    BACKGROUND: Workplace violence prevention initiatives are undeniably lacking in healthcare facilities. The aim of this study was to validate a newly developed questionnaire and assess employers' perceptions and practices towards workplace violence prevention at healthcare facilities.

    METHODS: A cross-sectional study was conducted from October 2021 to November 2021 by recruiting 333 employers at healthcare facilities in Kelantan, Malaysia. The original draft of the Malay version of the questionnaire comprised 62 items constructed under two domains (perception and practice). A confirmatory factor analysis was conducted to evaluate construct validity and internal consistency using R software.

    RESULTS: The final model for the perception and practice domain of the questionnaire consisted of 13 factors and 56 items. The factor loadings for all items were above 0.6. The fit indices used for confirmatory factor analysis in the final model were as follows: χ2 = 2092.6 (P < 0.001), standardised root mean squared residual (SRMR) = 0.053, root mean square error of approximation (RMSEA) = 0.042, comparative fit index (CFI) = 0.928 and Tucker Lewis index (TLI) = 0.920. The construct reliability for all factors was reliable, with Raykov's rho coefficients above 0.70.

    CONCLUSION: The newly developed questionnaire demonstrated excellent psychometric properties and adequate validity and reliability, confirming that this instrument is reliable and valuable for evaluating employers' perceptions and practices towards workplace violence prevention at healthcare facilities.

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