Financing Universal Coverage in Malaysia: a case study

One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges

Habitat Complexity Affects the Structure but Not the Diversity of Sessile Communities on Tropical Coastal Infrastructure

Increasing human population, urbanisation, and climate change have resulted in the proliferation of hard coastal infrastructure such as seawalls and breakwaters. There is increasing impetus to create multifunctional coastal defence structures with the primary function of protecting people and property in addition to providing habitat for marine organisms through eco-engineering - a nature-based solutions approach. In this study, the independent and synergistic effects of physical complexity and seeding with native oysters in promoting diversity and abundances of sessile organisms were assessed at two locations on Penang Island, Malaysia. Concrete tiles with varying physical and biological complexity (flat, 2.5 cm ridges and crevices, and 5 cm ridges and crevices that were seeded or unseeded with oysters) were deployed and monitored over 12 months. The survival of the seeded oysters was not correlated with physical complexity. The addition of physical and biological complexity interacted to promote distinct community assemblages, but did not consistently increase the richness, diversity, or abundances of sessile organisms through time. These results indicate that complexity, whether physical or biological, is only one of many influences on biodiversity on coastal infrastructure. Eco-engineering interventions that have been reported to be effective in other regions may not work as effectively in others due to the highly dynamic conditions in coastal environment. Thus, it is important that other factors such as the local species pools, environmental setting (e.g., wave action), biological factors (e.g., predators), and anthropogenic stressors (e.g., pollution) should also be considered when designing habitat enhancements. Such factors acting individually or synergistically could potentially affect the outcomes of any planned eco-engineering interventions.</jats:p

Acquired T790M Mutation in Patients Failing Treatment with First or Second-Generation EGFR-Tyrosine Kinase Inhibitors

Background: The majority of patients with epidermal growth factor receptor (EGFR)-mutant advanced non-small cell lung cancer (NSCLC) develop resistance to first- or second-generation EGFR-tyrosine kinase inhibitor (TKI) after a median treatment period of 12 months. This study aimed to determine the prevalence and predictors of acquired T790M mutation as a resistance mechanism among these patients. Method: This was a retrospective study of patients with sensitising EGFR-mutant advanced NSCLC who experienced disease progression (PD) while on first- or second-generation EGFR-TKI treatment and underwent investigations to determine the resistance mechanisms in University of Malaya Medical Centre from 1st January 2015 to 31st December 2017. Result: Of 87 patients, acquired T790M mutation was detected in 55 (63.2%) patients at PD. T790M mutation was significantly more frequent in patients who achieved partial response (PR) as the best response (p ¼ 0.008) or had new lung metastasis (p ¼ 0.048); and significantly less frequent in patients who developed new symptomatic brain metastases (p ¼ 0.021). Patients with exon 19 deletion were more likely to acquire T790M mutation compared to those with exon 21 L858R point mutation (p ¼ 0.077). In multivariate analysis, PR with EGFR-TKI treatment was a significant independent predictor of acquired T790M mutation (p ¼ 0.021) while having new symptomatic brain metastases (p ¼ 0.034) or new lymph node metastases (p ¼ 0.038) were significant independent predictors against acquired T790M mutation. Conclusion: Acquired T790M mutation was a common resistance mechanism leading to first- or second-generation EGFR-TKI treatment failure. Patients with tumours harbouring exon 19 deletion mutation were more likely to acquire T790M mutation. A best tumour response of PR to EGFR-TKI treatment was an independent predictor of acquiring this resistance. This information is helpful to clinicians in the early prognostication and management planning for patients with EGFR-mutant NSCLC

Study of prevalence, treatment-seeking behavior, and risk factors of women with lower urinary tract symptoms in Northern Malaysia.

OBJECTIVES: To determine the prevalence, severity, and quality-of-life (QOL) impact of female lower urinary tract symptoms (FLUTS); to determine the patterns, reasons, and factors contributing to the women's treatment-seeking behavior; and to describe the relationship between the social demographic characteristics and FLUTS. METHODS: A total of 2732 women older than 19 years of age were recruited by a series of FLUTS Awareness Campaigns held within Northern Malaysia from January to August 2004. Trained interviewers used surveys to collect information on social demographic characteristics, International Prostate Symptom Score, and King's Health Questionnaire to determine the prevalence, severity, QOL impact, treatment-seeking behavior, and risk factors of FLUTS. RESULTS: The prevalence of FLUTS was 19.0% (n = 519), with 88.6% having moderate and 11.4% severe FLUTS. Using the International Prostate Symptom Score QOL assessment index, 55.3% (n = 287) scored 4 or greater. Using the King's Health Questionnaire, the most affected QOL domain was sleep/energy. The patterns of treatment-seeking behavior revealed that only 23.1% (n = 120) of patients with FLUTS actively sought treatment. The major reason for those (76.9%) who failed to seek treatment was that they did not perceive FLUTS as a major health problem (29.1%). Factors that warranted treatment were the severity, bother, and QOL impact of FLUTS (all P &lt;0.001), hematuria (P &lt;0.001), age (P &lt;0.005), parity, body mass index, and suprapubic pain (all P &lt;0.05). The risk factors for FLUTS (defined as an odds ratio of 2 or more) included age 50 years or older, parity of 4 or more, illiteracy, postmenopausal status, and the presence of one or more concomitant chronic medical illness. CONCLUSIONS: Despite the high prevalence of FLUTS in Northern Malaysia (19.0%), many patients do not seek treatment, with ignorance being the major reason

A global analysis of complexity–biodiversity relationships on marine artificial structures

Aim: Topographic complexity is widely accepted as a key driver of biodiversity, but at the patch-scale, complexity–biodiversity relationships may vary spatially and temporally according to the environmental stressors complexity mitigates, and the species richness and identity of potential colonists. Using a manipulative experiment, we assessed spatial variation in patch-scale effects of complexity on intertidal biodiversity. Location: 27 sites within 14 estuaries/bays distributed globally. Time period: 2015–2017. Major taxa studied: Functional groups of algae, sessile and mobile invertebrates. Methods: Concrete tiles of differing complexity (flat; 2.5-cm or 5-cm complex) were affixed at low–high intertidal elevation on coastal defence structures, and the richness and abundance of the colonizing taxa were quantified after 12 months. Results: The patch-scale effects of complexity varied spatially and among functional groups. Complexity had neutral to positive effects on total, invertebrate and algal taxa richness, and invertebrate abundances. However, effects on the abundance of algae ranged from positive to negative, depending on location and functional group. The tidal elevation at which tiles were placed accounted for some variation. The total and invertebrate richness were greater at low or mid than at high intertidal elevations. Latitude was also an important source of spatial variation, with the effects of complexity on total richness and mobile mollusc abundance greatest at lower latitudes, whilst the cover of sessile invertebrates and sessile molluscs responded most strongly to complexity at higher latitudes. Conclusions: After 12 months, patch-scale relationships between biodiversity and habitat complexity were not universally positive. Instead, the relationship varied among functional groups and according to local abiotic and biotic conditions. This result challenges the assumption that effects of complexity on biodiversity are universally positive. The variable effect of complexity has ramifications for community and applied ecology, including eco-engineering and restoration that seek to bolster biodiversity through the addition of complexity.</p