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Background Cancer represents a significant global public health challenge, with escalating incidence rates straining healthcare systems. Malaysia, like many nations, has witnessed a rise in cancer cases, particularly among the younger population. This study aligns with Malaysia’s National Strategic Plan for Cancer Control Programme 2021–2025, emphasizing primary prevention and early detection to address cancer’s impact. Therefore, we aim to describe the timeliness of cancer care for symptom presentation, socio-demographic, patient, as well as organizational-related factors among patients in Malaysia diagnosed with breast, colorectal, nasopharyngeal, and cervical cancer. Methods This cross-sectional study enrolled adult cancer patients diagnosed with breast, cervical, colorectal, or nasopharyngeal cancer from 2015 to 2020 in seven public hospitals/oncology centres across Malaysia. Data were collected through patient-administered surveys and medical records. Presentation delay, defined as the duration between symptom onset and the patient's first visit to a healthcare professional exceeding 30 days, was the primary outcome. Statistical analysis included descriptive statistics and chi-square tests. Results The study included 476 cancer patients, with breast cancer (41.6%), colorectal cancer (26.9%), nasopharyngeal cancer (22.1%), and cervical cancer (9.5%). Over half (54.2%) experienced presentation delays with a median interval of 60 days. Higher proportions of presentation delay were observed among nasopharyngeal cancer patients, employed patients with lower socioeconomic statuses, and those without family history of cancer. Most patients self-discovered their first cancer symptoms (80%), while only one-third took immediate action for medical check-ups. Emotional and organizational factors, such as long waiting times during doctor's visits (47%), were potential barriers to seeking cancer care. Conclusion This study highlights the significant problem of presentation delay among cancer patients in Malaysia. The delay is influenced by various factors encompassing sociodemographic characteristics, health-seeking behaviours, and healthcare system-related issues. A comprehensive approach addressing both individual barriers and institutional obstacles is imperative to mitigate this presentation delay and improve cancer outcomes.

IntroductionVaccine safety is a primary concern among vaccine-hesitant individuals. We examined how seven persuasive messages with different frames, all focusing on vaccine safety, influenced Malaysians to accept the COVID-19 vaccine, and recommend it to individuals with different health and age profiles; that is, healthy adults, the elderly, and people with pre-existing health conditions.MethodsA randomised controlled experiment was conducted from 29 April to 7 June 2021, which coincided with the early phases of the national vaccination programme when vaccine uptake data were largely unavailable. 5784 Malaysians were randomly allocated into 14 experimental arms and exposed to one or two messages that promoted COVID-19 vaccination. Interventional messages were applied alone or in combination and compared against a control message. Outcome measures were assessed as intent to both take the vaccine and recommend it to healthy adults, the elderly, and people with pre-existing health conditions, before and after message exposure. Changes in intent were modelled and we estimated the average marginal effects based on changes in the predicted probability of responding with a positive intent for each of the four outcomes.ResultsWe found that persuasive communication via several of the experimented messages improved recommendation intentions to people with pre-existing health conditions, with improvements ranging from 4 to 8 percentage points. In contrast, none of the messages neither significantly improved vaccination intentions, nor recommendations to healthy adults and the elderly. Instead, we found evidence suggestive of backfiring among certain outcomes with messages using negative attribute frames, risky choice frames, and priming descriptive norms.ConclusionMessage frames that briefly communicate verbatim facts and stimulate rational thinking regarding vaccine safety may be ineffective at positively influencing vaccine-hesitant individuals. Messages intended to promote recommendations of novel health interventions to people with pre-existing health conditions should incorporate safety dimensions.Trial registration numberNCT05244356.

Background: The publication rates of abstracts after they were presented at the National Conference for Clinical Research (NCCR), a scientific conference held in Malaysia, was determined to gauge the scientific value of the conference, whilst providing comparative information with other scientific conferences. Methods: All the abstracts that were presented at the NCCR from 2014 to 2016 were analysed. Keywords from the abstract title, along with the first, second, and last author’s name, were searched via PubMed, Google Scholar, and Scopus to determine publication status. Results: A total of 320 abstracts were analysed. Of those, 57 abstracts (17.8%) were published. Almost 70% of published abstracts appeared in open access journals that charge article processing fees. Early publications (≤18 months from the conference date) had higher median journal impact factors compared to later publications. Approximately 42% of the published abstracts had collaborations with the Institute for Clinical Research (ICR) or Clinical Research Centres (CRCs). An increasing number of authors in an abstract and having the first author from a research centre, reduced and increased the odds of publication, respectively. Conclusions: The NCCR publication rate is lower compared to the reported average in other scientific conferences abroad. More encouragement and support to publish should be provided to the presenting authors. Clinicians should also be encouraged to collaborate with research centres such as those from the ICR or CRCs to boost publication likelihoods.

Persuasive health communication is key to promoting breast cancer screening. Due to existing gaps over how public health messages should be framed, a study was conducted to explore the preferences and perceptions of Malaysian women towards messages that incorporate different types of appeals to promote breast cancer screening. In-depth qualitative interviews were conducted among Malaysian women aged 40 and above with no previous history of breast cancer or other cancers. They were exposed to messages that promoted breast cancer screening using seven different appeals; authority, hope, social, humour, fear, sadness, and shame-guilt. Qualitative expressions for preferences and perceptions were analysed using interpretive thematic analysis. 41 Malaysian women were interviewed. The majority preferred messages that incorporated hope, authority, or fear appeals. Messages with an authority appeal were favoured for their personalised and authoritative effect. Messages using hope and fear appeals elicited emotional reactions and cognitive appraisals that contributed to their favourability. In contrast, humour, sadness, and shame-guilt were the most disliked appeals. The humour appeal was generally disliked because it caused interpretations that weakened the persuasive impact of the advocated behaviour in the message. Messages incorporating sadness and shame-guilt appeals were disliked primarily due to their negative framing. In conclusion, public health messages incorporating hope, authority, or fear appeals show promising potential to motivate breast cancer screening among Malaysian women, and their effectiveness in influencing actual behaviour change should be further explored.

Background Older persons living alone have been associated with poorer health outcomes and higher mortality rate. However, little is known about the drug related problems (DRPs) faced by this population group in Singapore. Objectives This study aims to elucidate the prevalence and type of DRPs associated with older persons living alone. Setting Eleven Senior Activity Centers in Singapore. Method Individuals aged above 55 years, taking at least one oral chronic medication and living in the housing estate served by the Senior Activity Centers were recruited to participate in an individual interviewer-administered cross-sectional survey. Those who were unable to comprehend the survey or communicate their responses fully were excluded. DRPs were identified by the interviewers and reported using a modified DOCUMENT system. Main outcome measure The main outcome measure was the difference in prevalence and types of DRPs between survey participants with different living arrangements. Results Among 360 respondents, 152 (42.2%) were older persons living alone. A higher prevalence (61.2% vs. 47.6%, adjusted OR = 1.86 [1.12–3.10], p = 0.016) and mean number of DRPs (1.23 ± 1.4 vs. 0.95 ± 1.33, p = 0.018) were observed among older persons living alone in comparison with those who were not living alone. Specifically, those living alone were more likely to have DRP related to the category ‘Taking too little’ (adjusted OR = 2.32 [1.28–4.20], p = 0.006) and which involved the use of HMG-CoA reductase inhibitors (adjusted OR = 2.78 [1.16–6.69], p = 0.022). Conclusion Besides having a significantly higher prevalence of DRP, older persons living alone were more likely to be non-adherent to their medications, particularly statins. Targeted interventions to reduce these DRPs and ensure appropriate management of chronic conditions should be derived, especially for those who lack the ability to help themselves.

Background and objectives Nirmatrelvir/ritonavir was administered orally to manage mild to moderate symptoms of COVID-19 in adult patients. The objectives of this study were to (i) evaluate the cost-effectiveness of prescribing nirmatrelvir/ritonavir within 5 days of a COVID-19 illness in order to avert hospitalization within a 30-day period in the Malaysia setting; (ii) determine how variations in pricing and hospitalization rates will affect the cost-effectiveness of nirmatrelvir/ritonavir. Methods The 30-day hospitalization related to COVID-19 was determined using 1 to 1 propensity score-matched real-world data in Malaysia from 14 July 2022 to 14 November 2022. To determine the total per-person costs related to COVID-19, we added the cost of drug (nirmatrelvir/ritonavir or control), clinic visits and inpatient care. Incremental cost-effectiveness ratio (ICER) per hospitalization averted was calculated. Results Our cohort included 31,487 patients. The rate of hospitalization within 30 days was found to be 0.35% for the group treated with nirmatrelvir/ritonavir, and 0.52% for the control group. The nirmatrelvir/ritonavir group cost an additional MYR 1,625.72 (USD 358.88) per patient. This treatment also resulted in a reduction of 0.17% risk for hospitalization, which corresponded to an ICER of MYR 946,801.26 (USD 209,006.90) per hospitalization averted. Conclusion In Malaysia, where vaccination rates were high, nirmatrelvir/ritonavir has been shown to be beneficial in the outpatient treatment of adults with COVID-19 who have risk factors; however, it was only marginally cost effective against hospitalization for healthy adults during the Omicron period.

Early-onset epileptic encephalopathies are severe disorders often associated with specific genetic mutations. In this context, the CDKL5 deficiency disorder (CDD) is a neurodevelopmental condition characterized by early-onset seizures, intellectual delay, and motor dysfunction. Although crucial for proper brain development, the precise targets of CDKL5 and its relation to patients’ symptoms are still unknown. Here, induced pluripotent stem cells derived from individuals deficient in CDKL5 protein were used to generate neural cells. Proteomic and phosphoproteomic approaches revealed disruption of several pathways, including microtubule-based processes and cytoskeleton organization. While CDD-derived neural progenitor cells have proliferation defects, neurons showed morphological alterations and compromised glutamatergic synaptogenesis. Moreover, the electrical activity of CDD cortical neurons revealed hyperexcitability during development, leading to an overly synchronized network. Many parameters of this hyperactive network were rescued by lead compounds selected from a human high-throughput drug screening platform. Our results enlighten cellular, molecular, and neural network mechanisms of genetic epilepsy that could ultimately promote novel therapeutic opportunities for patients.

Despite the ubiquity of sea anemones (Cnidaria: Actiniaria) in tropical ecosystems, our understanding of their biodiversity and taxonomy is limited. Here we re-establish the identity of an intertidal zooxanthellate species, Phymanthuspinnulatus Martens in Klunzinger, 1877. Originally described from a single preserved specimen in the Berlin Museum by CB Klunzinger, his brief footnote lacked crucial details to positively identify the species. Our redescription is based on more than 50 living individuals of P.pinnulatus collected from its type locality, Singapore. These were examined and compared with type materials of the species and its congeners. Specimens of P.pinnulatus differ from syntypes of species described as Phymanthuslevis Kwietniewski, 1898 from Indonesia, as well as Phymanthussansibaricus Carlgren, 1900 and Phymanthusstrandesi Carlgren, 1900, both described from East Africa. Phymanthuspinnulatus was encountered on the lower intertidal, among coral rubble and between rocky crevices. It is vibrantly coloured and has 96 marginal tentacles with branching outgrowths along each, resulting in a ‘frilly’ appearance. The anemone has a flat expanded oral disc, with discal tentacles that are inconspicuous and reduced, unlike syntypes of its congeners. Details of its live appearance, musculature, and cnidom are also provided for the first time. Overall, types of cnidae and capsule sizes differ from other known species of Phymanthus documented elsewhere. It is inferred that P.pinnulatus has a wide distribution that extends eastwards from Singapore, as far as Ambon and the Torres Straits. Some individuals reported as Phymanthusmuscosus Haddon and Shackleton, 1893 and Phymanthusbuitendijki Pax, 1924 are probably P.pinnulatus . This morphological analysis provides new insights into the characters used to delimit P.pinnulatus , clarifies its geographical distribution, and contributes to an ongoing revision of the genus Phymanthus .

Cyclin-dependent kinase-like 5 (CDKL5) syndrome is a neurodevelopmental disorder characterized by early-onset intractable seizures, mental retardation, and hand stereotypies. Studies have shown that loss of CDKL5 protein function is responsible for aberrations in neuronal morphogenesis, and decreased synaptogenesis. In order to understand the effects of CDKL5 mutations on human neural disease pathology, we utilized induced pluripotent stem cell (iPSC) technology to generate human iPSC-derived neurons from CDKL5 patients. Furthermore, to circumvent in vitro iPSC disease modeling limitations and to take advantage of an in vivo brain environment, we integrated these two systems by engrafting human iPSC-derived neural progenitor cells (NPCs) into immunodeficient mice. Here, we report defects in neuronal morphology in CDKL5- mutant neurons differentiated in vitro that are retained in human neurons differentiated in a mouse brain. Furthermore, we found that using a histone deacetylase inhibitor, LMK235, specific to histone deacetylase 4 (HDAC4), was able to rescue defects in synaptogenesis and neural electrical activity in CDKL5 iPSC-derived neurons in vitro . Ultimately, we hope our work will provide further insights into CDKL5 disease pathology and accelerate the development of treatments for this complex neurodevelopmental disorder.