Relationship between knowledge, attitude, practice, patient-level, and clinic-level factors of diabetic kidney disease among type 2 diabetes mellitus patients

Background: DKD was recognized as a major complication of Type 2 Diabetes Mellitus (T2DM), significantly contributing to the growing burden of chronic kidney disease (CKD) in Malaysia. Although the influence of Knowledge, Attitude, and Practice (KAP) on CKD prevention was well-documented, validated tools to measure these aspects specifically for DKD prevention among T2DM patients were limited. Using the Chronic Care Model as the framework, this study examined the patient-level and clinic-level factors associated with DKD and the relationship between KAP toward DKD. Objective: The objectives were to validate the Malay-translated KAP DKD prevention scale, measure poor KAP levels among T2DM patients in Kelantan, identify factors associated with poor KAP, and assess the relationship between KAP and DKD, considering both patient- and clinic-level factors. Methodology: The study was conducted in two phases. Phase 1 focused on validating the Malay-translated KAP DKD prevention scale for reliability and relevance. Content validity was established by an expert panel of six specialists in family medicine, public health, nephrology, and internal medicine. Items with a Content Validity Index (I-CVI) below 0.83 were removed. A pilot group of 10 T2DM patients evaluated item clarity and comprehensibility, which led to further refinement based on Face Validity Index (FVI) scores. Construct validity was assessed using Two-Parameter Logistic Item Response Theory (2PL-IRT) for the Analysis (CFA) for the Attitude and Practice domains. This phase included 260 participants selected systematically from KRK HPUSM clinics in Kubang Kerian. Phase 2 aimed to determine KAP levels and identify factors associated with poor KAP DKD prevention among T2DM patients across Kelantan, as well as to explore the relationship between KAP levels and DKD. This cross-sectional study included 600 T2DM patients from multiple clinics. Data collected included patient-level variables and clinic-level variables. Multilevel binary logistic regression was used to assess the associations between KAP and DKD, accounting for individual and clinic-level factors. Results: The validated KAP DKD prevention scale demonstrated strong psychometric properties. The Knowledge domain showed unidimensionality and adequate discriminant indices, while the Attitude and Practice domains achieved satisfactory fit indices after model refinement. Composite reliability using Raykov’s Rho confirmed internal consistency. Among participants, 77% had poor knowledge, 58.2% had poor attitudes, and 50.78% had poor practices regarding DKD prevention. Key associated factors of poor knowledge included being single, widowed, or divorced, having lower education, and having diabetic complications, while unemployed participants had lower odds of poor knowledge. Poor attitudes were associated with lower education and unemployment, and poor practices were linked to lower education, ethnicity, and poor attitudes. For DKD factors, participants not working had nearly twice the odds of DKD compared to those working. Microalbuminuria, macroalbuminuria, and persistent albuminuria significantly increased the odds of DKD, as did serum creatinine levels and diabetic foot ulcers. Among KAP domains, only practice was significantly associated with DKD, with poor practice linked to a lower likelihood of DKD. Knowledge domain and Confirmatory Factor Analysis (CFA) for the Attitude and Practice domains. This phase included 260 participants selected systematically from KRK HPUSM clinics in Kubang Kerian. Phase 2 aimed to determine KAP levels and identify factors associated with poor KAP DKD prevention among T2DM patients across Kelantan, as well as to explore the relationship between KAP levels and DKD. This cross-sectional study included 600 T2DM patients from multiple clinics. Data collected included patient-level variables and clinic-level variables. Multilevel binary logistic regression was used to assess the associations between KAP and DKD, accounting for individual and clinic-level factors. Results: The validated KAP DKD prevention scale demonstrated strong psychometric properties. The Knowledge domain showed unidimensionality and adequate discriminant indices, while the Attitude and Practice domains achieved satisfactory fit indices after model refinement. Composite reliability using Raykov’s Rho confirmed internal consistency. Among participants, 77% had poor knowledge, 58.2% had poor attitudes, and 50.78% had poor practices regarding DKD prevention. Key associated factors of poor knowledge included being single, widowed, or divorced, having lower education, and having diabetic complications, while unemployed participants had lower odds of poor knowledge. Poor attitudes were associated with lower education and unemployment, and poor practices were linked to lower education, ethnicity, and poor attitudes. For DKD factors, participants not working had nearly twice the odds of DKD compared to those working. Microalbuminuria, macroalbuminuria, and persistent albuminuria significantly increased the odds of DKD, as did serum creatinine levels and diabetic foot ulcers. Among KAP domains, only practice was significantly associated with DKD, with poor practice linked to a lower likelihood of DKD

Association between food security status, negative emotional states and academic performance among undergraduate students at School of Health Sciences in Universiti Sains Malaysia

Food security status needed to get more concerned by university students. Food security status could influence students’ emotional well-being and academic performance. Thus, this study aimed to determine the association between food security status, negative emotional states and academic performance. A total of 136 undergraduate health sciences students from USM were recruited in this study using the convenience sampling method. An online and self-administered questionnaire was distributed to obtain sociodemographic characteristics, food security status (US AFSSM), negative emotional states (DASS-21) and academic performance (CGPA). SPSS version 29 was used to perform data analysis. The results indicated that nearly half of the respondents experienced food insecurity with 27.9% of low food security and 20.6% were identified as very low food security. Among food secure respondents, there were 16.2% of high food security and 35.3% of marginal food security which was the highest among four of the food security degrees. Meanwhile, normal depression, anxiety and stress were the highest percentages within their categories at 63.2%, 36.1%, and 58.9% respectively. In terms of academic performance, 61.8% of respondents obtained excellent CGPA followed by 38.2% with good CGPA. It revealed a significant association between food security status and negative emotional states including depression (χ2 = 9.582; p-value = 0.048), anxiety (χ2 = 14.266; p-value = 0.006) and stress (χ2 = 13.784; p-value = 0.005). Additionally, food-insecure students were less likely to report excellent CGPA than food-secure students (χ2 = 4.275; p-value= 0.039). While depression (χ2 = 18.579; p-value < 0.001), anxiety (χ2 = 14.825; p-value = 0.005), and stress (χ2 = 12.188; p-value = 0.009) were negatively associated with academic performance. These findings highlighted the need to address food security status. Targeted intervention programs should have been carried out to improve students’ food security status which further supported their emotional health and excel in academics

The evaluation of etlingera elatior flower (bunga kantan) aqueous extract (EEAE) on fatty liver disease in hypercholesterolaemic rats

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease with increasing prevalence worldwide. Hypercholesterolaemia (HC) is the leading cause of NAFLD because excessive high-cholesterol diet (HCD) intake disrupts cholesterol homeostasis. The current medications for NAFLD treatment bring various side effects, and there are no drugs approved by the Food and Drug Administration (FDA). A medicinal plant, Etlingera elatior flower, exhibits antioxidants and hepatoprotective properties. This study aims to evaluate the effects of Etlingera elatior flower (bunga kantan) aqueous extract (EEAE) on the HCD-induced hypercholesterolaemic rat model. Eighteen male Sprague-Dawley (SD) rats were randomly divided into three groups (n = 6): control rat (Group 1), HC-untreated rat (Group 2), and HC-treated 1000 mg/kg EEAE rat (Group 3). The rats were fed HCD for six weeks to induce HC, followed by six weeks of oral EEAE treatment. EEAE significantly reduced body mass index (BMI) and blood cholesterol levels. The histopathological examination of livers for Haematoxylin and Eosin (H&E) staining and Masson’s Trichrome (MT) staining was evaluated. The HC-untreated group developed non-alcoholic steatohepatitis (NASH), characterised by macrovesicular steatosis, inflammation, ballooning degeneration, and fibrosis. In contrast, the liver tissue in the HC-treated EEAE group was reversible from NASH to non-alcoholic fatty liver (NAFL). Furthermore, E. elatior flower was evaluated for its nutritional composition, and HPLC analysis demonstrated that EEAE contains high levels of cyanidin-3-O-glucoside chloride. The effect of EEAE on the liver weight to body weight ratio required further evaluation. Liver function tests (LFT) and lipid profile tests were conducted to evaluate the effect of EEAE in hypercholesterolaemic rats. Overall, EEAE exhibits antioxidant, anti-inflammatory, and antihypercholesterolaemia effects in the live

Association between food management behaviours and household food waste among working adults in health campus, Universiti Sains Malaysia, Kubang Kerian, Malaysia

Recent research has begun to demonstrate the vital role of daily food provision practices in influencing household food waste. Food waste occurs throughout the food chain, yet homes are the primary contributor. The purpose of this research, is to investigate the association between food management behaviours and household food waste among working adults at Universiti Sains Malaysia in Kubang Kerian, Malaysia. In this study, a sample size of 215 working adults from the School of Health Sciences, School of Medicine, and School of Dentistry was recruited using stratified random sampling based on inclusion criteria. However, only 180 responses were gathered and analyzed with SPSS version 29.0. Among the five investigated factors, Food Storage Behaviour (FSB) (p=0.876) and Leftover Consumption Behavior (LCB) (p=0.764) were not significantly associated with household food waste (p > 0.05). However, Food Purchase Planning Behaviour (FPB) (p < .001), Food Purchase Behaviour in Store (FPBI-S) (p < .001), and Food Planning Preparation Behaviour (FPPB) (p=.039), demonstrated significant associations. The findings of this study, as well as previous studies by other researchers, can be utilized to drive effective interventions that focus on specific food waste situations and interactions in greater depth. The intervention could particularly help to shift the focus from analysis to solutions

An Improved Static Analysis Approach For Detecting Input Validation Vulnerabilities In Web Application

This thesis proposes a novel approach for detecting XSS and SQLi vulnerabilities. First, a static analysis technique is introduced to identify feasible execution paths in the PHP source code, an area currently lacking dedicated tools or methods. Identifying feasible paths significantly reduces false positives in static analysis outcomes. Second, taint analysis is employed to trace the sources of vulnerabilities, confirm their execution, and assess the application of appropriate sanitisation along those feasible paths

Pre-Service Teachers’ International Mindedness And Intercultural Competence In Public Universities Of Pakistan

The modern wave of globalization has created a demand for increased international mindedness (im) and intercultural competence (ic) among graduates who will soon enter the 21st-century workforce. To meet this end, educational institutes must focus on im and ic as these notions broaden thinking and build tolerance and respect for other cultures and communities, thus contributing to peace and harmony. Hence, the importance of internationally minded and interculturally aware teachers cannot be underestimated in today’s global scenario. However, in pakistan, pre-service teachers are merely exposed to the course contents which enhance their im and ic. Therefore, the present study investigates the im and ic among pre-service teachers in universities of pakistan in relation to their year of study and gender. The study also aims to identify the factors that influence the development of these skills and to explore the relationship between im and ic and their dimensions. Using a concurrent mixed-methods approach, the study collected data from a sample of 516 pre-service teachers from two public universities in pakistan. The data collection tools included a survey questionnaire and semi-structured interviews

Study On Cross-Cultural Connections Of Malaysia-China Shadow Puppet Through Iconological And Contextual Analyses

This study explores the cross-cultural connections between malaysian wayang kulit and chinese shadow puppetry, focusing on their shared artistic features and unique cultural dimensions through iconological and contextual analyses. By conducting a comprehensive investigation, this research unveils the profound artistic essence of shadow puppetry, fostering a deeper understanding of these traditions and promoting their preservation and evolution. The study begins by tracing shadow puppetry's historical trajectory and development in both nations. Using meticulous document analysis, it examines the origins of shadow puppetry in malaysia and its evolution within china’s central plains. This exploration highlights the potential pathways through which chinese shadow puppetry influenced malaysian wayang kulit, shedding light on the intricate web of cultural exchange and interaction. An essential focus of this research is the analysis of cultural characteristics embedded in shadow puppetry. Employing panofsky’s iconological approach, the study identifies shared cultural metaphors and symbols in puppet designs, colours, and forms. Additionally, it applies malinowski’s contextual theory to understand the influence of cultural and situational contexts on the development and adaptation of shadow puppetry in both traditions

Recovery and amplification of touch DNA on porous surfaces using modified chelex extraction method

Prayer is an obligation of every individual Muslim in any condition and situation. The obligation to perform prayer is not dropped even in a state of illness or difficult situation. Learning about prayer when sick is seen to enter a new dimension when the rapid development of information technology is fully utilized. However, the difference in views among sects regarding the approach to prayer when sick means that some patients are treated in hospitals that do not perform prayer. The lack of knowledge about prayer procedures when ill and the relief provided by Islam also leads to a lack of prayer practice. This study aims to verify the questionnaire through the validation and reliability process, develop the Patient Prayer Digital Health Education website (PKDSP), and intervene on the website. A total of 174 respondents were involved in the pre-and post-study phases using the 'snowball' sampling method. The results of the questionnaire validity study show that the construct of knowledge and practice is a validated instrument when it meets the suitability requirements of the questionnaire model by producing the construct of knowledge: PCMIN/DF: 1.46, GFI: 0.96, CFI: 0.95 and RMSEA 0.05 and the construct of practice: PCMIN/DF: 2.04, GFI: 0.93, CFI: 0.90 and RMSEA 0.75. The Cronbach's alpha values obtained for the knowledge and practice sections are 0.66 and 0.64, respectively, which are accepted values for the reliability of a questionnaire. The results of the pre- and post-tests showed that there was an increase in the respondents' knowledge pre-test which was 9.94 and post-test which was 12.24 with a standard deviation (SD) of 1.95 after referring to the PKDSP website. Meanwhile, the average value (mean) also showed an increase in the respondents' practice pre-test which was 7.06 and post-test which was 17.76 with a standard deviation (SD) of 3.25. This study also used the Mobile Application Usability Scale (SKAMA) to evaluate the Patient Prayer Digital Health Education website (PKDSP) used in the post-study phase. The findings show that respondents who used the PKDSP website for the post-phase obtained an average value of 77.28 (SD 16.78), passing the cutoff value 68 for application usability score based on SKAMA the proposed Mobile Application Usability Scale (SKAMA) score. In conclusion, the PKDSP website that was developed has had the impact of increasing knowledge and practice for the respondents involved. Therefore, this PKDSP website is expected to help Muslims improve their knowledge and practice when they are ill, whether they receive treatment in a hospital or not

Removal of lead, cadmium, and nickel ions from aqueous solution using okra and chilli seeds as adsorbent

Heavy metal contamination in water sources, especially lead (Pb), cadmium (Cd), and nickel (Ni), poses a significant threat to human health, due to their toxicity, persistence in the environment, and bioaccumulative nature. This study examined the effectiveness of okra (Abelmoschus esculentus), and chilli (Capsicum annuum L) seeds as adsorbents for these metals removal from aqueous solution. Several parameters, including initial concentration, adsorbent dosage, contact time, and temperature, were conducted for this adsorption experiment. Flame Atomic Absorption Spectroscopy (FAAS) was used to measure Pb, Cd, and Ni ion concentrations. Fourier Transform Infrared Spectroscopy (FTIR) was used to characterise biosorbents before and after treatment to discover functional groups involved in the adsorption process. The optimal parameters for Pb, Cd, and Ni removal using okra seeds were 1 ppm of initial concentration, 0.5 g adsorbent dosage, 20 minutes of contact time, and 30°C temperature, resulting in removal efficiencies of 84.9%, 87.3%, and 28%, respectively. For chili seeds, the same conditions with a 1.0 g adsorbent dosage resulted in 92% removal efficiency for Pb, 82.4% for Cd, and 37.4% for Ni. Based on the observations, Pb yielded the highest percentage removal efficiency compared to Cd and Ni, whereas Ni had the lowest for both adsorbent types. However, the findings indicated that both okra and chilli seeds have the potential to remove Pb, Cd, and Ni heavy metals from aqueous solution