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  1. Azit NA, Ismail A, Ahmad N, Ismail R, Ishak S
    BMC Public Health, 2019 Nov 01;19(1):1432.
    PMID: 31675946 DOI: 10.1186/s12889-019-7814-x
    BACKGROUND: With the rise in prevalence of childhood tuberculosis (TB) globally, contact tracing should be a powerful strategy for early diagnosis and management, especially in children who are household contacts of active TB cases. Here, we aimed to determine the prevalence and factors associated with TB disease in children who are household contacts of TB cases.

    METHODS: We used a cross-sectional study with data from the Malaysian TB Information System (TBIS) recorded from 1 January 2014 to 31 December 2017. All children aged 0-14 years who were registered in the TBIS with at least one household contact of TB cases were included in the study. Multiple logistic regression analysis was performed to calculate the adjusted odds ratio (adj. OR) and for adjusting the confounding factors.

    RESULTS: A total of 2793 children were included in the study. The prevalence of active TB was 1.5% (95% confidence interval [CI]: 1.31, 1.77%). Children aged  6 weeks [adj. OR 7.48 (95% CI: 2.88, 19.43), p 

  2. Ng CKC, Lim TY, Ahmad AB, Khaironizam MZ
    Zootaxa, 2019 Mar 18;4567(3):zootaxa.4567.3.5.
    PMID: 31715885 DOI: 10.11646/zootaxa.4567.3.5
    This study investigates the published literature and incorporates our field data from 1997 to September 2018 to generate an inventory report of primary freshwater fishes for Perak State in Malaysia. We critically examined and enumerated 186 species from 2 classes, 16 orders, 43 families and 114 genera in 57 localities. A total of 173 fish species (91.4%) are native to Perak and 17 species (8.6%) are non-native. The provisional checklist presented herein is conservative and excludes doubtful inventory records that lack synthesis and traceability. We encountered seven taxonomic discrepancies and we also could not confidently identify eight species. These are explicitly discussed to inform future workers.
  3. Ahmad R, Rahman NA, Hasan R, Yaacob NS, Ali SH
    Spec Care Dentist, 2020 Jan;40(1):62-70.
    PMID: 31774579 DOI: 10.1111/scd.12436
    AIMS: To investigate the oral health and nutritional status of children with cerebral palsy (CP).

    METHODS AND RESULTS: Oral health assessment included dental caries and dental plaque maturity scores (DPMS) while the nutritional assessment included children's height-for-age Z-score (HAZ), body mass index-for-age Z-score (BAZ), mid-upper-arm circumference (MUAC), nutrient intake, cariogenic food frequency (CFF) and daily sugar exposure (DSE). Ninety-three CP children were recruited. The prevalence of caries was 81.7% (95% CI: 72.7%-88.3%). The median (IQR) of the DMFT and dft scores were 0.5(4.0) and 3.0(8.0), respectively. Most of the participants had acid-producing plaque (90.3%), severely stunted (81.4%), and 45% were severely thin with acute malnutrition. Intakes of calcium, iron, zinc, vitamin A, vitamin D and total fat were below 77% of the Recommended Nutrient Intakes for Malaysian children (RNI 2017). Nine types of cariogenic foods/drinks were consumed moderately, and DSE indicated that 45% of the children were at moderate risk of dental caries.

    CONCLUSION: Untreated dental caries, severe stunting and thinness were prevalent, and cariogenic foods/drinks were consumed moderately suggesting a moderate risk of caries. Therefore, controlling cariogenic food intake is crucial, but monitoring daily nutrient intake is needed for the optimum growth of children with CP.

  4. Ahmad P, Vincent Abbott P, Khursheed Alam M, Ahmed Asif J
    Dent Traumatol, 2020 Apr;36(2):89-99.
    PMID: 31800153 DOI: 10.1111/edt.12534
    BACKGROUND/AIMS: The impact of a scientific article in its respective field is reflected by its citation count. The purpose of this review was to conduct a citation analysis in order to identify and analyze the top 50 most cited articles published in Dental Traumatology since its inception in order to highlight the contribution of the journal to the field of Dental Traumatology.

    METHODS: Elsevier's Scopus was used to search and analyze the 50 most frequently cited scientific papers. After the screening process, two reviewers arranged the articles in a descending order based on their citation counts. Each article was then cross-matched with Google Scholar. The articles were analyzed, and information including citation counts, citation density, publication year, authorship, contributing institutions and countries, article topic, study design, and keywords was extracted.

    RESULTS: The literature search identified 2421 articles. The citation counts of the 50 selected articles varied from 117 to 580 (Scopus) and 206 to 1130 (Google Scholar). The year in which most top 50 articles were published was 2002 (n = 5). Among 105 authors, the greatest contribution was made by JO Andreasen (n = 12). Most of the articles originated from the United States (n = 12) with the greatest contributions from the University Hospital (Rigshospitalet), Copenhagen, Denmark (n = 6). Original research article was the most frequent study design (n = 34). The majority of the top 50 articles were focused on traumatic dental injuries. Among 131 unique key words, root resorption (n = 6) was the most frequently used. A non-significant correlation occurred between citation count (correlation coefficient = 0.127, P = .378), citation density (correlation coefficient = 0.654, P = 2.493), and publication age.

    CONCLUSIONS: This study identified the top 50 most cited articles published in this journal in the specialty of Dental Traumatology. The publication year of an article was not significantly associated with citation count nor citation density.

  5. Zin CS, Alias NE, Taufek NH, Ahmad MM
    J Pain Res, 2019;12:1251-1257.
    PMID: 31118748 DOI: 10.2147/JPR.S199243
    Purpose: This study evaluated the risk of opioid dose escalation as it relates to sex differences among patients receiving opioids for long-term therapy. Patients and methods: This retrospective cohort study was conducted in tertiary hospital settings in Malaysia using electronic prescription records. Opioid naïve patients, aged ≥18 years, who were undergoing long-term opioid therapy of ≥90 days, with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1st January 2011 and 31st December 2016, were included in the study. They were followed until (i) the end of the study period, (ii) death from any cause or (iii) discontinuation of therapy from their first opioid prescription without any intervals of ≥120 days between successive prescriptions. The risk of high opioid dose escalation to ≥100 mg/day and ≥200 mg/day relative to men and women was measured. Results: A total of 4688 patients (58.8% women, 41.3% men) on long-term opioid therapy were identified. Among these patients, 248 (5.29%) were escalated to high opioid doses of ≥100 mg/day and 69 (1.47%) were escalated to ≥200 mg/day. The escalation to high-dose opioid therapy was more likely to occur in men than in women, even after adjustment for age (dose ≥100 mg/day [adjusted hazard ratio 2.32; 95% confidence interval (CI), 1.79 to 3.00; p<0.0001] and ≥200 mg/day [adjusted hazard ratio 6.10; 95% CI, 3.39 to 10.98; p<0.0001]). Conclusion: The risk of opioid dose escalation differed between men and women, as men were at higher risk than women for high opioid dose escalation.
  6. Islam R, Ahmad R, Ghailan K, Hoque KE
    J Relig Health, 2020 Jun;59(3):1327-1343.
    PMID: 31134517 DOI: 10.1007/s10943-019-00832-8
    People with HIV/AIDS (PLWHA) commonly pose problems to their family as well as to society because of their vulnerable health and economic conditions. Contrarily, PLWHA encounter social discrimination and adverse realities while finding it difficult to continue in their jobs. These complex phenomena interact to push them into a low economic status. A microfinance program can hopefully assist poor patients to cope with the negative economic consequences of this disease. But the conventional market-oriented microfinance institutions show reluctance to serve this group of people due to the possibilities of having credit risk. In this paper, we propose an alternative microfinancing technique that can provide a better economic life of the PLWHA while absorbing the credit risks. A comprehensive model is designed using specific Islamic financial instruments in conjugation with household economic portfolio theory. Critical realism method was adopted to construct this model. We concluded that the application of Islamic microfinance can enhance income of HIV patients while reducing the productivity-loss. This model can be useful to the microfinance practitioners and policymakers for addressing a different market segment, diversifying products, and formulating policy.
  7. Oyekanmi AA, Ahmad A, Hossain K, Rafatullah M
    PLoS One, 2019;14(5):e0216878.
    PMID: 31091269 DOI: 10.1371/journal.pone.0216878
    The adsorption of rhodamine B (RhB) using acid modified banana peels has been examined. Chemical characteristics of the adsorbents were observed in order to determine active functional groups. The major functional groups on the surface were OH, C = O, C = C and C-O-C. Interactions between operational parameters were studied using the central composite design (CCD) of response surface methodology (RSM). The predictions of the model output indicated that operational factors influenced responses at a confidence level of 95% (P<0.05). The optimum conditions for adsorption were pH 2 at a 0.2 g/L dose within 60 minutes of contact time. Isotherm studies were carried out using the optimized process variables. The data revealed that RhB adsorption fitted the Langmuir isotherm equation while the reduction of COD followed the Freundlich isotherm. Kinetic experiments fitted the pseudo second order model for RhB removal and COD reduction. The adsorption mechanism was not the only rate controlling step. Diffusion through the boundary layer described the pattern of adsorption.
  8. Ahmad Hassali MA, Shafie AA, Ooi GS, Wong ZY
    DOI: 10.1016/B978-0-12-801714-2.00002-2 ISBN: 978-0-12-801714-2
    Citation: Ahmad Hassali MA, Shafie AA, Ooi GS, Wong ZY. Chapter 2. Pharmacy Practice in Malaysia. In: Fathelrahman AI, Mohamed Ibrahim MI, Wertheimer AI (editors). Pharmacy Practice in Developing Countries: Achievements and Challenges. Amsterdam: Academic Press, Elsevier, 2016

    The professional roles of pharmacists have evolved in many parts of the world in the recent years, including Malaysia. Malaysia is a developing country with a two-tier healthcare system consisting of the public and private sectors. Pharmacy service in Malaysia came into existence in 1951 with the enactment of three main legislations governing its profession namely, the Registration of Pharmacist Act 1951, Poison Act 1952, and Dangerous Drug Act 1952. Currently, there are approximately 10,000 registered pharmacists in Malaysia, with 33% working in the private sector. Clinical pharmacy services at public hospitals have expanded the traditional dispensing role of the pharmacist to a profession that provides pharmaceutical care to patients and drug information to both public and professionals. However, the practice of dispensing private general practitioners has limited the community pharmacist's professional roles to optimize their clinical knowledge and to deliver pharmaceutical care. Transformation of the healthcare system is essential in order to improve pharmacy practice in Malaysia.
  9. Masud H, Ahmad MS, Cho KW, Fakhr Z
    Community Ment Health J, 2019 08;55(6):1015-1030.
    PMID: 31102163 DOI: 10.1007/s10597-019-00400-0
    There is ample research on aggression amongst children and adolescents that highlights several antecedents of aggression. While researchers have remarked on the relationship between parenting styles and aggression in children, there are few studies that integrate and systemize the available studies on parenting styles and aggression. The present review is an attempt to fill this gap. For this review, relevant studies were first searched, then coded and classified. As a result of thorough review, 34 relevant studies were identified. The review shows that parenting styles have a direct impact on aggression in children. Authoritative parenting styles play a positive role in psychological behavior in children while authoritarian and permissive parenting styles result in aggressive and negative behaviors in children. The current study also suggests that there is room to conduct studies on this topic in developing countries. Future research should be undertaken in developing and under-developed countries and should focus on mixed modes of research and examine the direct influence of parenting styles on aggressive behavior in children in different cultural contexts.
  10. Wan Mahmood ZU, Ahmad Z, Mohamed CAR
    Sains Malaysiana, 2010;39(1):13-20.
    Sediment cores were taken at eight stations along Sarawak and Sabah coastal waters using a gravity box corer on July 2004. The sediment cores were cut into 2 cm interval for measurement of Mn and Fe concentration using the Inductive Couple Plasma-Mass Spectrometer (ICP-MS). Overall, the sediment cores contained much mud which include a mixture of silt (46 – 67%) and clay (18 – 53%) compared to sand (0.4 – 16%). The concentrations of Mn and Fe were in the range of 154 – 366 µg/g and 0.9 – 3.4%, respectively. The variation was studied by ANOVA, which showed a significant difference (p = 0.000) for both of Mn and Fe concentrations at all sampling stations. In those ranges, Fe concentration was higher compared to Mn. It is believed that dissolving and diluting process influenced the concentration of Mn in the water column and sediment. Fe showed a significant correlation (r > 0.5, p < 0.01) with Mn at all stations except SR 03, indicating the natural occurrence of Mn and Fe in the water column. Meanwhile, Müller classification proved that sediment cores taken at 8 stations along Sarawak and Sabah coastal waters were not polluted with Fe and Mn with geoaccumulation index, Igeo < 1 and classification 0 – 1.
    Keywords: Fe; Mn; Müller classification; organic carbon; particle size; sediment core
  11. Khan SU, Ullah N, Ahmed I, Ahmad I, Mahsud MI
    Curr Med Imaging Rev, 2019;15(3):243-254.
    PMID: 31989876 DOI: 10.2174/1573405614666180726124952
    BACKGROUND: Medical imaging is to assume greater and greater significance in an efficient and precise diagnosis process.

    DISCUSSION: It is a set of various methodologies which are used to capture internal or external images of the human body and organs for clinical and diagnosis needs to examine human form for various kind of ailments. Computationally intelligent machine learning techniques and their application in medical imaging can play a significant role in expediting the diagnosis process and making it more precise.

    CONCLUSION: This review presents an up-to-date coverage about research topics which include recent literature in the areas of MRI imaging, comparison with other modalities, noise in MRI and machine learning techniques to remove the noise.

  12. Abd-Hamid NA, Ahmad-Fauzi MI, Zainal Z, Ismail I
    Planta, 2020 Feb 18;251(3):68.
    PMID: 32072251 DOI: 10.1007/s00425-020-03356-8
    The SCF complex is a widely studied multi-subunit ring E3 ubiquitin ligase that tags targeted proteins with ubiquitin for protein degradation by the ubiquitin 26S-proteasome system (UPS). The UPS is an important system that generally keeps cellular events tightly regulated by purging misfolded or damaged proteins and selectively degrading important regulatory proteins. The specificity of this post-translational regulation is controlled by F-box proteins (FBPs) via selective recognition of a protein-protein interaction motif at the C-terminal domain. Hence, FBPs are pivotal proteins in determining the plant response in multiple scenarios. It is not surprising that the FBP family is one of the largest protein families in the plant kingdom. In this review, the roles of FBPs, specifically in plants, are compiled to provide insights into their involvement in secondary metabolites, plant stresses, phytohormone signalling, plant developmental processes and miRNA biogenesis.
  13. Rosli NA, Ahmad I, Anuar FH, Abdullah I
    Carbohydr Polym, 2019 Jun 01;213:50-58.
    PMID: 30879689 DOI: 10.1016/j.carbpol.2019.02.074
    In this study, modified agave cellulose fibre combined by graft copolymerisation with methylmethacrylate was tested as a potential reinforcement for polylactic acid (PLA)-natural rubber/liquid natural rubber blends. Mechanical, morphological, thermal, wetting, and biodegradation characterisations were performed to assess the influence of cellulose-graft-polymethylmethacrylate (cell-g-PMMA) content on the properties of biocomposites. The addition of cell-g-PMMA improved the mechanical properties of the composites because of the chemical interaction between PLA and PMMA. Thermal stability decreased slightly upon cell-g-PMMA addition because of the low thermal stability of PMMA. A soil burial test revealed that the degradation of composites decreased with an increase in the cell-g-PMMA content. However, the weight loss after burial, which directly affected the water absorption capacity, was still higher for the cell-g-PMMA composites than for the polymer alone.
  14. Ahmad SS, Suan ALL, Alexander SM
    J Ophthalmic Vis Res, 2019 3 2;14(1):97-100.
    PMID: 30820294 DOI: 10.4103/jovr.jovr_65_17
    Purpose: To report the unusual case of an immunocompetent individual with herpes zoster ophthalmicus who developed central retinal artery occlusion and subsequent neovascular glaucoma.

    Case Report: A 40-year-old, immunocompetent patient was diagnosed with herpes zoster ophthalmicus and central retinal artery occlusion on initial presentation. Subsequently, he developed neovascular glaucoma.

    Conclusion: There are a few case reports of central retinal artery occlusion developing after varicella zoster virus infection. However, a literature search found no reports of neovascular glaucoma following central retinal artery occlusion secondary to varicella zoster virus infection. The present case report indicates that neovascular glaucoma is a possible complication in such a scenario.

  15. Jamal F, George J, Aziz AA, Ahmad D
    Family Practitioner, 1986;9(1):38-39.
    Pharyngeal carriage of group A streptococcus was determined in 432 primary school children between the ages of 6 and 8 years. Beta-haemolytic streptococci were isolated from throat swab culture of 71 pupils, with a carrier rate of 16.4% (71/432) of which 9.4% (39/432) belonged to Lancefield's group A. Serogrouping of the isolates was determined by the coagglutination method and Lancefield's hot acid extraction method. 54.9% (39/71) of the total beta-hemolytic streptococci isolated belonged to group A , 25.3% (18/71) to group G, 15.4% (11/71) to group C and 1.4%(1/71) to group F. T typing pattern of group A streptococcus was determined by the standard agglutination method. Sensitivity to antibiotics was determined by the disc diffusion technique (comparative method). All group A streptococcal isolates were sensitive to penicillin and erythromycin, 6 strains (15.4%) were resistant to tetracycline and 1 strain (2.5%) was resistant to cephaloridine.
  16. Mohd Heikal MY, Ahmad Nazrun S, Chua KH, Norzana AG
    Cytotechnology, 2019 Apr;71(2):521-537.
    PMID: 30719603 DOI: 10.1007/s10616-019-00298-2
    The proinflammatory cytokines, metalloproteinases family (MMPs), inflammatory mediators PGE2, COX-2 and NO are the most important group of compounds responsible for the loss of metabolic homeostasis of articular cartilage by promoting catabolic and destructive processes in the pathogenesis of osteoarthritis (OA). Stichopus chloronotus, a marine sea cucumber which is rich in n-3 PUFAs and phenolic compound, may exert a favorable influence on the course of the disease. The objective of this study was to investigate the regeneration and anti-inflammatory potential of S. chloronotus aqueous extract (SCAE) on human OA articular chondrocytes (HOC).

    METHODS: The HOC isolated from knee joint cartilage removed during surgery were cultured with SCAE for 7 days. The effect of SCAE on anabolic and catabolic gene expression was verified by real-time PCR. Monolayer chondrocytes were stained with toluidine blue whereas sGAG, NO and PGE2 production in medium were analyzed by ELISA.

    RESULTS: The HOC cultured in various SCAE have polygonal morphology maintaining their chondrocytes characteristic. SAE supplementation tested was found to be effective pro-chondrogenic, anti-inflammatory and anti-oxidative agents, as evidenced by upregulation of cartilage specific markers collagen type II, aggrecan core protein and sox-9 expression and downregulation of collagen type 1, IL-1, IL-6, IL-8, MMP-1, MMP-3, MMP-13, COX-2, iNOS and PAR-2 expression. The presence of SCAE in the culture was able to increase sGAG and reduce NO and PGE2 production significantly.

    CONCLUSIONS: These results suggested that SCAE demonstrated chondroprotective ability by suppressing catabolic activities, oxidative damage and effectively promoting chondrocytes growth.

  17. Tan CL, Yahaya MH, Ahmad NS, Lim CH
    BMJ Case Rep, 2020 Mar 12;13(3).
    PMID: 32169986 DOI: 10.1136/bcr-2019-233330
    An 18-year-old male adolescent presented with prolonged high spiking temperature, photosensitive rash, oral ulcers and reduced hearing bilaterally of recent onset. Examination revealed malar rash, vasculitis rash over bilateral palms and soles, oral and buccal ulcers, palpable posterior auricular and inguinal lymph nodes, and reduced hearing bilaterally. His further investigations noted pancytopaenia, elevated transaminases, hyperferritinaemia, low C3 and C4 levels, positive antinuclear antibody, double-stranded DNA and direct Coombs test, while bone marrow aspiration revealed active phagocytic activity suggestive of hemophagocytic syndrome. We made a diagnosis of systemic lupus erythematosus with macrophage activation syndrome. We treated him with pulse intravenous methylprednisolone and his condition improved drastically. Temperature resolved on the next day after intravenous methylprednisolone; bilateral sensorineural hearing loss improved to near-normal hearing after treatment. He remained well during follow-up with a tapering dose of prednisolone.
  18. Rao M, Rashid FA, Shukor S, Hashim R, Ahmad N
    Can J Infect Dis Med Microbiol, 2020;2020:5021064.
    PMID: 32318127 DOI: 10.1155/2020/5021064
    Background: The spread of carbapenem-resistant A. baumannii (CrAb) is gaining worldwide attention. The spread of this pathogen is largely due to its ability to acquire various resistance genes of intrinsic and extrinsic origins that confer unpredictable susceptibility to β-lactams. The aim of this study was to analyze β-lactamase genetic compositions of CrAb in Malaysia.

    Methods: Whole-genome sequencing (WGS) was carried out on 13 CrAb isolates from clinical samples in Malaysia from 2011 to 2016.

    Results: Endotracheal aspirate was the dominant clinical sample source (n = 6), and only one isolate was obtained from wound swab. A total of 6 sequence types (STs) of the Oxford scheme were identified, including 4 reported STs and 2 novel STs. Eleven isolates were classified into clonal complex 92 (CC92/ICII), among which ST195 and ST208 were the most prevalent STs. All 13 CrAb isolates harbored multiple β-lactamase genes. blaOXA-23 (n = 13) and blaOXA-66 (n = 11) were the dominant carbapenemase gene families found in these isolates. All isolates harbor blaADC, blaOXA-51-like, and blaOXA-23-like genes. blaTEM (n = 7), blaNDM-1 (n = 3), blaCARB-8 (n = 1), and blaPER-3 (n = 1) are amongst other β-lactamase genes found in this study. ISAba1 was found upstream to blaOXA-23 (n = 13), blaOXA-66 (n = 1), and blaADC (n = 11). All blaNDM-1 isolates had ISAba125 (mobile genetic element) upstream to the genes. All isolates were positive for Tn2006/2008 and Tn2009 but were negative for Tn2007.

    Conclusion: Most of the isolates were grouped under the CC92 clonal complex which belongs to international clonal lineage 2. These findings predict that carriage of carbapenem-resistant genes possibly constitutes the underlying basis of high level of international clone II prevalence. Therefore, molecular surveillance and antimicrobial stewardship are essential in implementing policies to prevent and control the spread of CrAb in hospital settings.

  19. Ahmad P, Asif JA, Alam MK, Slots J
    Periodontol. 2000, 2020 Feb;82(1):286-297.
    PMID: 31850637 DOI: 10.1111/prd.12328
    The continually high impact factor of Periodontology 2000 (7.861 for 2018), the level of which is unprecedented among dental journals, prompted the present bibliometric analysis of the Journal. Since the inception of Periodontology 2000 in 1993 and until July 2019, the top 100 most-cited articles have received a total of 21,276 (Web of Science), 23,009 (Elsevier's Scopus), and 43,518 (Google Scholar) citations. The citations of the 100 most-cited articles were found to vary from 118 to 827 (Web of Science), 10 to 1069 (Scopus), and 15 to 2028 (Google Scholar). Three articles had more than 600 (Web of Science) citations, 5 had between 400 and 600 citations, 25 had between 200 and 400 citations, and 67 had between 100 and 200 citations. The first authors of the 100 most-cited articles were based in the USA (51%), Switzerland (14%), and Australia (10%). The 5 dental institutions with the most frequently cited articles were The Forsyth Institute, USA (9 articles), The University of Queensland, Australia (8 articles), University of Bern, Switzerland (7), University of Texas Health Science Center at San Antonio, USA (6 articles), and University of Washington, USA, and Temple University School of Dentistry, USA (5 articles each). The likely reason for the high impact factor of Periodontology 2000 is publication of insightful and timely review articles produced by eminent researchers and clinicians from a wide range of dental institutions and countries.
  20. Ismail NE, Jimam NS, Dapar MLP, Ahmad S
    Front Pharmacol, 2019;10:1521.
    PMID: 31998125 DOI: 10.3389/fphar.2019.01521
    Background: This study assessed the validity and reliability of healthcare workers' knowledge, attitudes, and practices instrument for uncomplicated malaria (HKAPIUM) for evaluation of healthcare workers' knowledge, attitudes, and practices (KAP) on uncomplicated malaria management in primary healthcare (PHC) facilities in Plateau state, Nigeria. Methods: Relevant variables from literature, malaria treatment guidelines for Nigeria, and World Health Organization (WHO) were used to generate and present the items for the draft HKAPIUM scale, which was first screened by six experts before administered to 121 respondents who filled and returned immediately. The data were sorted and analyzed using Rasch measurement model (Bond & Fox software®). Results: The outcome of the initial screening showed high items content validity indices (I-CVI) (0.83-1.00) and high scale-CVI (S-CVI) {universal agreement (UA) within the experts (S-CVI/UA) (0.67-0.89) and the average CVI [S-CVI/Ave (0.94-0.98)]} for relevance, clarity, simplicity, and comprehensiveness. The Rasch analysis outputs showed good items' reliability for the three factors (KAP) > 0.9 with high separation index values of > 2.0; however person reliability were poor (< 0.6) which were confirmed by their low separation values. Goodness of fit statistics indicated nine items not fitting the model based on the suggested fit index values of 0.6 to 1.5, and ± 2 for mean square (MNSQ) and standardized Z-score (Zstds) respectively, and 0.3 to 0.7 for "point-measure correlation coefficients" (PTMEA Corr). Deletion of misfit items resulted in the items and persons' reliabilities falling above the minimum accepted limit of 0.6, with their separation values were all in the range of 1 and 2 which were acceptable. Similarly, fit index values for MNSQ infit and outfit, and Zstd parameters items in the new scale were all within the acceptable range of 0.6 to 1.5, and ±2 respectively, in addition to the positive PTMEA Corr as further confirmation of the items' fitness to the model. Conclusion: The reduction of 27-items draft HKAPIUM scale to 18 items was successful with good reliability and fitness to the model.
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