Objectives To evaluate the cost-effectiveness of a systematic screening program for thalassemia-related peripheral neuropathy (ThalPN) compared with standard care in Malaysia. Methods A hybrid decision-Markov model was developed to simulate the lifetime health outcomes and costs for a hypothetical cohort of adult thalassemia patients (both transfusion-dependent and non-transfusion-dependent). The analysis was conducted from a healthcare provider perspective, utilizing the neuropathy symptomatic score and neuropathy disability score as screening tools. The model was populated with data from the Malaysian Thalassemia Registry, a clinical cohort study for prevalence and utility values, and published literature. Costs and health outcomes were discounted at 3% annually. Results The screening strategy for ThalPN was found to be highly cost-effective across all age cohorts compared with standard care. The incremental cost-effectiveness ratio was most favorable in the ≥40 age group at USD 2027 per quality-adjusted life-year gained. The incremental cost-effectiveness ratios for the 18 to 29 and 30 to 39 age groups were USD 2951 and USD 3209 per quality-adjusted life-year gained, respectively. Conclusions Incorporating a ThalPN screening program into standard care is a cost-effective strategy. By facilitating early intervention, screening can prevent or slow irreversible disease progression, thereby improving health-related quality of life and potentially reducing long-term costs for this patient population.
Applications of data science and artificial intelligence (AI) in global health are expanding, yet research remains fragmented and often misaligned with the needs of low-income and middle-income countries (LMICs). To address this misalignment, we conducted a global research priority-setting exercise using the Child Health and Nutrition Research Initiative (CHNRI) method. 155 research ideas were scored by 51 experts based on feasibility, potential impact on disease burden, paradigm shift potential, implementation potential, and equity. Top-ranked priorities focused on epidemic preparedness, including AI-based outbreak prediction, improved diagnostics for infectious diseases, and early-warning systems. Other highly ranked topics included AI-assisted resource allocation, telemedicine, culturally adapted mobile health services, and chronic disease management tools. Experts from LMICs prioritised infectious disease control and diagnostic equity, whereas experts from high-income countries emphasised infrastructure and climate-related analytics. The resulting agenda provides a roadmap for aligning AI and data science research with global health priorities, particularly in LMICs.
Abstract Objective Menopause, a universal yet diverse life stage, profoundly influences women's physical, emotional, and social well‐being. In Malaysia's multi‐ethnic context, experiences are shaped by cultural meanings, religious beliefs, healthcare structures, and socioeconomic factors. Despite this, policies and services remain limited, with low uptake of hormone replacement therapy (HRT), poor workplace recognition, and uneven access to care. This study is designed to identify the different experiences of menopause in Malaysian population. Design Qualitative study using semi‐structured interviews. Setting and Population Women in perimenopause, menopause, and post‐menopause stages from the general population. Methods Part of the Malaysian chapter of the MARIE WP2a project, this study explored lived experiences among women aged over 18, purposively recruited across ethnic, religious, and socioeconomic groups. Interviews conducted in English, Malay, or Mandarin were analysed thematically using the Delanerolle and Phiri equity‐oriented framework to identify determinants at individual, community, health system, and policy levels. Results Eleven women described a range of symptoms, from mild discomfort to severe vasomotor, psychological, and musculoskeletal issues. Surgical menopause caused abrupt, compounded symptoms. Coping strategies included exercise, herbal remedies, religious practices, and selective biomedical use. HRT uptake remained low due to cancer fears, cultural perceptions, and limited clinician engagement. Workplace support was minimal, with most relying on informal networks. Healthcare engagement was reactive, and anticipatory guidance was scarce. Equity gaps emerged around affordability, rural–urban divides, religious norms, workplace stigma, and lack of culturally appropriate information. Conclusion Menopause in Malaysia is shaped by biological, sociocultural, and systemic factors. Culturally sensitive clinical pathways, workplace reforms, and equity‐focused primary care policies are urgently needed.
BACKGROUND:Accurate classification of seizure types guides diagnostic investigations and antiseizure medication (ASM) selection, and is particularly critical in resource-limited settings. We validated a pragmatic three-item focal seizure screening tool (aura, unilateral motor phenomena, oral automatisms) intended for rapid use by non-specialist clinicians. METHODS:Through a multicentre cross-sectional study spanning from 1 August 2024-31 August 2025, we recruited consecutive adults (≥18 years) with neurologist-confirmed seizure types at seven public hospitals in Malaysia. Clinicians applied the tool and finalized the scores (0-3). Diagnostic accuracy was evaluated using receiver operating characteristic analysis and area under the curve (AUC). Sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), positive predictive value (PPV), and negative predictive value (NPV) were calculated at every cut-off score, respectively. RESULTS:Among the 428 participants (mean age 36.4 ± 14.6 years), 83.41% had focal seizures. The tool achieved an AUC of 0.751 (95% CI 0.688-0.815; p < 0.001). A cut-off score of ≥ 1 yielded high sensitivity (84.0%) and fair specificity (59.2%), with LR + of 2.06 and PPV of 91.19%, supporting its role for screening. A cut-off score of ≥ 2 improved specificity to 88.73% and PPV to 94.74%, making it suitable for diagnosis. CONCLUSIONS:The three-item focal seizure screening tool is feasible, rapid to administer, and may assist general clinicians in classifying focal-onset seizures. Cut-off scores can be selected according to clinical priorities, namely, sensitive case-finding versus high-specificity confirmation.
Despite extensive research on the pharmacodynamics of follitropin alfa, a comprehensive synthesis of its pharmacokinetic variability is lacking. Understanding the interindividual and intraindividual variability in the pharmacokinetics of follitropin alfa may help inform dosing strategies by reducing variability in systemic exposure. This systematic review aimed to characterise the variability in the pharmacokinetics of follitropin alfa. Embase, PubMed, Scopus and citation mining of included articles were searched from database inception to 10 November 2025. Studies performed in humans, published in English which reported the pharmacokinetics, route of administration and dosing regimen of follitropin alfa were eligible for inclusion. Fifteen eligible studies were evaluated. The pharmacokinetics of follitropin alfa were described by a two-compartment model following intravenous administration, and a one-compartment model with first-order absorption after intramuscular or subcutaneous administration. Follitropin alfa exhibited dose-proportional pharmacokinetics. Moderate interindividual variability (26–42
