Background: Sarawak’s vast geography, with remote communities and limited transport infrastructure, poses significant challenges for stroke rehabilitation, yet data on patient attrition in rural Borneo remain limited. This study aimed to evaluate the characteristics of stroke survivors referred for rehabilitation at Hospital Sibu and to identify independent predictors of non-adherence at follow-up. Methods: Inpatient referrals to the Rehabilitation Medicine Department at Hospital Sibu between February 2022 and December 2024 were retrospectively analysed. To avoid competing risk bias, patients who died before their first follow-up were excluded. Factors associated with non-adherence, including functional status, socioeconomic background and travel time, were examined using multivariable binary logistic regression. Results: The analytic cohort comprised 631 survivors (mean age 56.7 ± 15.1 years). Overall, 50.4% (n = 318) defaulted on their first outpatient appointment. Multivariable analysis identified travel time as the dominant barrier: patients living > 30 min from the hospital had a 40-fold higher risk of default (adjusted odds ratio [aOR] = 39.81; 95% confidence interval [CI]: 22.46, 70.58; P < 0.001). Functional dependency also predicted attrition (aOR = 0.98 per Modified Barthel Index point; P < 0.001). Ethnic disparities emerged after adjusting for geography: Chinese ethnicity was associated with lower default risk (aOR = 0.63; P = 0.028), while Melanau ethnicity remained strongly protective (aOR = 0.35; P = 0.001). Conclusion: Post-stroke rehabilitation attrition in central Sarawak is high (50%). Although functional dependency and ethnicity were significant predictors, geographical inaccessibility is the primary driver of non-adherence. Decentralising care is critical to overcoming this logistical barrier.

Background: Formaldehyde exposure in university laboratories poses significant health risks to students and staff. Understanding the prevalence of adverse symptoms and associated factors is essential for guiding preventive measures. This study assessed the prevalence and predictors of formaldehyde-related adverse symptoms among students and laboratory staff at a university in Malaysian Borneo. Methods: This cross-sectional study employed a validated self-administered questionnaire capturing sociodemographic characteristics, medical and allergy history, exposure frequency, and control measures. Data were analysed using bivariable logistic regression and multivariable logistic regression to identify independent predictors. Results: Among 157 respondents, 34.4% (95% confidence interval [CI]: 27.0, 42.4) reported formaldehyde-related adverse symptoms. The most common complaints were headaches/dizziness (19.1%), unusual tiredness or drowsiness (12.1%), and stress/irritability (7.0%). Five independent predictors were identified: female gender (adjusted odds ratio [aOR]: 3.56; 95% CI: 1.26, 10.10), age ≥ 30 years (aOR: 9.08; 95% CI: 2.33, 35.35), and a history of allergy (aOR: 2.80; 95% CI: 1.09, 7.25). Higher exposure frequency markedly increased symptom risk, with fortnightly (aOR: 7.76; 95% CI: 2.31, 26.09) and weekly formaldehyde handling (aOR: 3.32; 95% CI: 1.05, 10.52) associated with significantly higher odds than monthly exposure. Face mask use showed a strong protective effect (aOR: 0.04; 95% CI: 0.01, 0.10). Conclusion: Given the high prevalence of formaldehyde exposure symptoms, particularly among older individuals, women, individuals with allergy, and frequent handlers, strengthening control measures—particularly consistent mask use and reduction of exposure frequency—should be prioritised to minimise risks in university laboratory settings.

Background: In Chinese and collectivist cultures, discussing personal feelings is often considered inappropriate or discouraged, even for postpartum mothers. As a self-reported measure of social responses that inhibit the expression of stressful thoughts, feelings, and experiences, the Social Constraints Scale has been widely validated among cancer and bereaved populations, leaving postpartum mothers unattended. Methods: This study aimed to assess the psychometric properties of the Chinese version of the Social Constraints Scale (C-SCS) among Chinese postpartum women in Malaysia. A cross-sectional quantitative survey was conducted among 130 Malaysian women in their first postpartum year. Results: Exploratory factor analysis revealed three underlying factors in the C-SCS, explaining 61.16% of the total variance. Confirmatory factor analysis based on a three-factor structure showed the best fit (P < 0.001) after omitting item 3 due to low factor loading. The C-SCS demonstrated excellent reliability with a Cronbach’s alpha value of 0.90 and McDonald’s Omega of 0.90. The three-factor model of the C-SCS exhibited different factor loadings compared with the Greek Social Constraints Scale, suggesting that these differences stem from postpartum and sociocultural contexts. Conclusion: The C-SCS displayed excellent psychometric properties, making it a reliable and valid measure for screening social constraints and identifying help-seeking barriers among postpartum women in Malaysia.

This editorial is written not only from a policymaker perspective, but also as a reflection from citizens who will one day depend on the system we are rebuilding. Malaysia’s public healthcare system, a comprehensive and heavily subsidised national asset built over generations, stands at a critical crossroads. While past investments have yielded equitable access and strong health outcomes, mounting pressures, including a surge in non-communicable diseases, rapid population ageing, and unsustainable medical inflation, now threaten its foundations. Meaningful reform is therefore an act of collective responsibility, not as evidence of past failures. We outline a transformation anchored in three interdependent drivers: (i) sustainable financing through a hybrid model that pools diversified revenues while protecting the poor from catastrophic payments; (ii) integrated service delivery that repositions primary care as the system’s backbone, supported by digital connectivity and strategic public-private partnerships to ensure seamless patient journeys; (iii) a resilient workforce characterized by clearer career pathways, equitable deployment, and genuine investment in well-being. Ultimately, reform succeeds only when it preserves the trust between those who give and those who receive care.

Background: Myopia is a common eye problem that has increased in prevalence worldwide, including in Malaysia. This study aimed to determine the prevalence of myopia among children and adolescents aged 0 to 18 years in Malaysia and its associated sociodemographic factors. Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline were used in this study. We searched PubMed and Scopus, supplemented by a targeted Google Scholar search, for studies published from 1990 to 2024 on the prevalence of myopia in Malaysia. Myopia was defined as a refractive error ≥ –0.50 D. Results: The meta-analysis included 14 quality-assessed studies from seven states in Malaysia, covering 13,367 children and adolescents. The overall pooled prevalence of childhood myopia from 1990 to 2024 was 17.18% (95% CI: 9.98, 25.86). The prevalence of myopia was notably lower among children aged 0 to 6 years at 2.54% (95% CI: 0.66, 5.60) than among children aged 7 to 12 years at 26.48% (95% CI: 17.29, 36.84) and adolescents aged 13 to 18 years at 42.71% (95% CI: 26.80, 59.44). The prevalence of myopia was higher in females than in males (odds ratio: 1.20; 95% CI: 1.09, 1.32). The Chinese population had the highest prevalence of myopia at 44.62% (95% CI: 35.94, 53.47) compared with other ethnicities. Conclusion: Our findings indicate that at least four in 10 children and adolescents aged 13 to 18 years are likely to have myopia in Malaysia. Targeted clinical and public health interventions should prioritise high-risk groups, particularly females, individuals of Chinese ethnicity, and those aged 7 to 18 years.

Sudden cardiac arrest (SCA) remains a major global health concern, with an estimated 300,000 to 400,000 deaths annually in the United States and around two million worldwide. In 2020, the American Heart Association (AHA) updated the Chain of Survival by adding a new component recovery to highlight the importance of post-resuscitation care. However, the implementation of this recovery phase remains limited and requires further exploration. This study aimed to review the implementation of the recovery phase within the Chain of Survival. A scoping review design was employed, with literature searches conducted in ScienceDirect, ProQuest, Sage, and PubMed databases using the keywords (“Cardiac Arrest”) AND (“Chain of Survival”) AND (“Recovery”) AND (“Rehabilitation”). The inclusion criteria included articles published within the last five years, written in English, and available in full-text open access format. Of the 330 articles initially identified, 13 met the eligibility criteria and were analysed using the Joanna Briggs Institute framework, with the findings reported in accordance with the PRISMA-ScR guidelines. Three major themes emerged: (i) multidimensional challenges among survivors, including physical, cognitive, psychological, and social impairments; (ii) multidisciplinary interventions, such as the ROCK and SCARF programmes, which were shown to improve quality of life, reduce fatigue, and enhance independence; and (iii) factors influencing recovery, including biomarkers, prognostic scores, and socioeconomic status. The recovery phase is a crucial yet often neglected component of the Chain of Survival. Post-cardiac arrest care should adopt a comprehensive and integrated approach involving evidence-based rehabilitation, psychological support, and family counselling to achieve optimal recovery and long-term quality of life.

Background: Hospitals are crucial in implementing the referral and National Health Insurance (NHI) systems. The reimbursement structure by the Social Security Administrator for Health (SSAH) relies on the Indonesian Case-Based Groups (INA-CBG) method. This study aims to discern the variance between hospital inpatient costs and the corresponding inpatient INA-CBG rates, specifically for patients with suspected acute hepatitis of unknown aetiology (AHUA). Methods: This research used a descriptive cross-sectional method. We compared the actual hospitalisation cost and INA-CBG’s tariff in an Indonesian tertiary hospital from July to December 2022. The study encompasses patients with AHUA and uses a saturation sampling method. Results: Of the 17 patients suspected of AHUA, 16 made payments through NHI. A comprehensive analysis reveals that the total hospital costs based on INA-CBG rates show a deficit of IDR 21,604,464, reflecting a difference of 13.96%. The primary diagnoses among patients vary, with presentations of a combination of viral, bacterial, and parasitic infections alongside bile or liver disorders. The hospital incurred losses from services rendered to 10 patients. Notably, the significant allocations of hospital costs include laboratory (46.84%), pharmacy (19.01%), and accommodation (17.28%). Conclusion: To maintain effective cost control in inpatient services, the focus should prioritise medical appropriateness, explicitly referencing Clinical Practice Guidelines (CPG) and Clinical Pathways.

Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer with a five-year survival of approximately 6% that is largely driven by cancer stem cells (CSCs), which promote resistance, metastasis, and recurrence. Mutations in the Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (K-RAS) are common in human PDAC and activate the rat sarcoma (RAS) pathway, thus supporting tumour growth, maintenance, and metastasis. Newcastle Disease Virus (NDV) is a tumour-selective oncolytic virus with a strong safety profile that targets cancer cells and therapy-resistant CSCs, thereby highlighting its potential as an anticancer virotherapy. This study examines NDV AF2240’s ability to target CSCs through RAS pathway modulation and apoptosis induction. Methods: NDV AF2240 was titrated by hemagglutination (HA) and plaque assays using Vero cells. CSCs were isolated from Panc-1 cells and confirmed by sphere-formation, flow cytometry, and RT-qPCR for CD24, CD44, and EpCAM/ESA. Cells were infected at multiplicities of infection (MOIs) of 0.1, 0.5, 1, and 10 for 24–72 h. Cytopathic effects were assessed with an MTS assay, and apoptosis was assessed by the expression of Caspase-3, -8, and -9, Bax, and Bcl-2. NDV reduced CSC viability in a time- and dose-dependent manner, with significant declines at 24–48 and 72 h (P < 0.05). Apoptosis markers Caspase-3, -8, and -9, and Bcl-2 were significantly upregulated (M = 3.4613, 5.9173, 2.4610, and 2.2083, respectively; P < 0.05). An MOI of 0.1 was used for pathway analysis in 1 × 10⁶ CSCs. Results: NDV AF2240 induced effective cytopathic effects in PDAC stem cells, downregulating the K-RAS effectors ERK1/2 and C-FOS, triggering apoptosis, and reducing the viability of PDAC CSCs in vitro. Conclusion: These findings highlight NDV’s potential as an oncolytic agent against PDAC stem cells via the modulation of ERK1/2 and C-FOS, thus supporting its therapeutic development.

Background: A range of factors, sociodemographic and lifestyle-related, are instrumental in shaping male fertility, including dietary practices. However, limited studies have examined these associations in the Malaysian context. This study investigates the connections between dietary habits and sperm quality among male patients attending fertility clinics. Methods: A cross-sectional design was used to examine male patients attending four fertility clinics in Peninsular Malaysia. Sociodemographic data, dietary habits, and sperm quality classifications (normal vs abnormal) were collected. Assessment of dietary consumption involved the use of validated food frequency questionnaires, while data on sperm quality were retrieved from patient’s medical records. Analysis of binary logistic regression was executed to assess food group consumption’s association with sperm quality, while controlling for household income and education level. Results: Sperm quality was significantly associated with education level (P = 0.001) and household income (P = 0.017), but not with age or body mass index (BMI). Higher fruit consumption was significantly associated with better sperm quality (aOR = 0.83; 95% CI: 0.73, 0.94; P = 0.004), while frequent fast-food intake was linked to poorer sperm quality (aOR = 1.55; 95% CI: 1.02, 2.35; P = 0.039). Vegetable, dairy, meat, caffeine, and sugar-sweetened beverage consumptions were not significantly associated with sperm quality. Conclusion: This study demonstrates the associations between dietary practices, socioeconomic variables, and male fertility. Higher fruit intake and socioeconomic status were associated with better sperm quality, whereas fast-food consumption was linked to poorer outcomes. The study reinforces the significance of diet and socioeconomic status in shaping male reproductive well-being.