This systematic review examines the challenges and strategies for sustaining Universal Health Coverage (UHC) in Malaysia, with a focus on the country’s health financing framework. Despite Malaysia’s significant progress in providing affordable public healthcare through a tax-funded system, rising healthcare costs, underfunding, and increasing out-of-pocket (OOP) payments threaten long-term sustainability. Using the PRISMA framework, 22 studies published between 2010 and 2025 were analysed, encompassing policy reviews, systematic reviews, and mixed-method studies. The findings reveal key challenges such as fiscal constraints, demographic shifts, inequities in rural access, and a fragmented public–private sector. Comparative insights from regional models, including Thailand and Singapore, highlight the importance of diversified funding sources, strategic purchasing, and stronger governance. Policy recommendations include broadening revenue streams through sin taxes and social health insurance, enhancing digital health adoption, improving preventive and primary care, and fostering public–private partnerships. The review highlights the urgency for Malaysia to implement progressive, evidence-based reforms to build a healthcare system that is fair, financially protective, and resilient for all. Keywords: healthcare funding, healthcare financing, health finance, Universal Health Coverage, UHC, access to care, private health insurance, social health insurance, Malaysia

The maternal mortality rate (MMR) is defined as the number of maternal deaths per 100,000 live births, and it serves as an important indicator of the quality of healthcare systems and the overall health of women in a given population. There is hybrid system in Malaysia in which the public sector and private sector coexist to provide medical services to the society where that are different structures of expenditure such as public expenditure, private expenditure and OOP expenditure. Each different expenditure plays their role in determining the outcome of interest, MMR. Increase in public expenditure helps to reduce MMR. While there is a consensus that increased public health expenditure is critical to improving maternal health outcomes, its efficacy is contingent upon strategic planning and implementation that addresses the unique health challenges faced by specific populations. An intricate relationship between private expenditure and maternal mortality underscores a pressing need for comprehensive policy approaches that emphasize financial investment in healthcare infrastructure, capacity building, and improved access to care. Higher private spending on maternal healthcare has been associated with decreased maternal deaths in some contexts, suggesting that private healthcare can complement public efforts, particularly in regions with limited public resources. combined strategy that incorporates both public investments and the optimization of private healthcare resources is imperative for advancing maternal health and reducing mortality rates effectively. OOP expenditure is a significant determinant of access to and utilization of maternal health services, with profound implications for maternal mortality rates. Keyword GDP, MMR, OOP, public expenditure

This research aims to study the acceptance of the IJNPulse mobile application among IJN staff using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. It focuses on understanding the adoption and usability of this novel staff mobile application, exploring staff attitudes and experiences with its use, and identifying key factors that influence their intention to adopt the application. A cross-sectional survey design was employed to collect data from a diverse sample, incorporating a defined research paradigm, specific sampling techniques, and systematic data collection and analysis methods. The findings reveal that performance expectancy, social influence, and facilitating conditions positively influence IJN staff’s behavioral intentions and actual use of the IJNPulse application. However, effort expectancy was not found to significantly affect adoption or user behavior. These results provide valuable insights into the factors that shape staff acceptance of mobile health applications in a healthcare setting.

This study investigates the key factors influencing undergraduate students’ intention to purchase medical health insurance (MHI) in Malaysia, a context where health insurance uptake remains modest despite rising healthcare costs and a growing private sector. Grounded in the Theory of Planned Behaviour (TPB), Health Belief Model (HBM), and Protection Motivation Theory (PMT), the research evaluates how knowledge, social influence, financial literacy, and product attributes shape students’ intentions toward health insurance acquisition. A cross-sectional survey was conducted among 109 final-year undergraduate students across six academic schools at a Malaysian university using stratified sampling. The results revealed that students generally hold a moderate to high intention to purchase MHI, particularly in the context of long-term financial planning. However, immediate intent to act remains low. Multiple regression analysis identified knowledge, product attributes, and social influence as significant predictors of intention. Financial literacy also played a critical role in shaping students' perception of health insurance benefits and necessity. Interestingly, neither gender nor academic background significantly influenced insurance intention. These findings suggest a need for targeted education and policy strategies to improve insurance literacy and design student-friendly insurance products. The study contributes to the broader understanding of youth insurance behaviour and offers actionable insights for insurers, universities, and policymakers aiming to boost MHI uptake among young adults.

Epstein-Barr virus (EBV) is a class I carcinogen human herpes virus which has infected 90% of humanity and most prevalent among Asians, especially Chinese. After primary infection, EBV establishes the lifelong virus carrier state. EBV can be detected in two different tissues namely, B lymphocytes and epithelial cells. EBV is linked to the pathogenesis of a variety of human tumors and disorders, such as Burkitt’s lymphoma, and nasopharyngeal carcinoma. Algae are a potential source of antiviral compounds; however, there have been very few reports on the antiviral activity of microalgae extracts against EBV. The objective of this study was to investigate the antiviral activity of extracts from three microalgae, namely Ankistrodesmus convolutus UMACC 101, Synechococcus elongatus UMACC 105 and Spirulina platensis UMACC 161 against EBV in Burkitt’s lymphoma (BL) cell lines. Three EBV-positive BL cell lines, namely Akata, B95-8 and P3HR-1 were used as in vitro study model. A bioassay-guided fractionation approach was used for the screening of antiviral activity. The antiviral activity of the microalgae extracts was elucidated based on their inhibition efficacy in reducing number of cell-free viral particles being released by chemically induced lytic BL cells. This was assessed by quantifying the cell-free DNA using real-time PCR technique. In addition, the inhibition activity of microalgae extracts against the expression of the viral proteins LMP1, EBNA1 and ZEBRA in BL cells was assessed using immunocytochemistry technique. Two antiviral drugs namely acyclovir and foscarnet were chosen as positive controls. Methanol extracts from Ankistrodesmus convolutus and Synechococcus elongatus displayed low cytotoxicity (IC50 >200 µg/mL) and reduced the cell-free EBV viral load most effectively (EC50 <0.01 µg/mL) and thus, displayed high therapeutic index (>28000). The extracts decreased the expression of EBNA1 (>45%), LMP1 (>38%) and ZEBRA (>67%) effectively in P3HR-1 cells. After column chromatography fractionation, the non-polar fraction of the extract from Synechococcus elongatus (SEF1) reduced the amount of cell-free EBV DNA most effectively (EC50= 2.9μg/mL; therapeutic index >69) with low cytotoxicity (IC50 >200 μg/mL). SEF1 inhibited the expression of EBNA1 and ZEBRA (>40%) effectively in P3HR-1 cells. When SEF1 was further fractionated using HPLC, the sub-fraction SEF1’a was most active in reducing the cell-free EBV DNA (EC50= 1.38µ/mL; therapeutic index >14.5). It inhibited the expression of LMP1 moderately (25%) in P3HR-1 cells. The microalgae extracts did not interact with the cytoskeleton components (actin and tubulin) of BL cells during the release of cell-free EBV particles as revealed by the immunofluorescence study. The active constituents in the microalgae extracts tested might consist of pigments such as chlorophylls, carotenoids, phaeophytins and phycobilins. In conclusion, methanol extracts from Ankistrodesmus convolutus, Synechococcus elongatus and Spirulina platensis showed antiviral activity by inhibiting the release of EBV from the BL cells and the expression of the viral proteins LMP1, EBNA1 and ZEBRA in the host cells. The potential of the microalgae as a source of antiviral drugs against EBV is worth exploring.

Introduction: Currently there is an uptrend in the provision of Extended Pharmacy Services (EPS) among community pharmacists (CPs). EPS referred to various services that beyond the traditional pharmacists’ roles of dispensing medicines such as public health educational program, clinical services and medicine use review. However, such services were only reported in other developed countries but not in Malaysia. Within this context, the present study aimed to explore the types of EPS available, CPs’ perceptions and attitudes towards the provision of EPS. This study also identified the perceived barriers and facilitators towards the provision of EPS. Methods: A descriptive cross-sectional study was conducted. A total of 236 samples were collected through convenience sampling around Selangor and Kuala Lumpur region. The questionnaire consisted of 6 domains including demographic profile, the type of EPS, pharmacist’s perception, perceived barriers, perceived facilitator and pharmacist attitude towards the provision of EPS. All questions were scored using five-point Likert Scale. All the data were analysis through SPSS using descriptive statistics analysis, Mann-Whitney and Kruskal Wallis test. Results: CPs are willing to provide EPS in near future. For the time being, health screening test were the most performed EPS. CPs often/always performed blood pressure test, (97.8%), glucose test (96.6%) and cholesterol test (83.0%). Besides that, the often/always performed counselling sessions for cough and cold (95.8%) and nutritional supplement (94.5%). However, other advanced services like smoking cessation and weight management services were not frequently performed. The top 5 perceived barriers identified includes the lack of standardized practice model for EPS (87.3%), high pressure on generating sales (86.4%), lack of patient awareness (84.4%), 4 lack of access to patient medical record (83.5%) and shortage of time (80.5%). Whereas the support and encouragement from government and other pharmacy organization were identified as the most prominent facilitator towards the implementation of EPS. Conclusion: CPs showed a positive attitude towards the provision of EPS. For the time being, there are various EPS that had already been developed and implemented. However, the identified barriers should be intervened, and facilitators should be executed to implement EPS successfully in near future. Keywords: Pharmaceutical Care Services, Extended Pharmacy Services, Expanded Pharmacy Services, Enhanced Pharmacy Services, Barriers, Facilitators, Community Pharmacy

Dietary fat when consumed reduces hunger and impairs food intake by eliciting satiety signals and these signals are evoked by entry of triacylglycerol after hydrolization to fatty acids into the small intestine. 1,3-dipalmitoyl-2-oleoyglycerol (POP-), 1,3-distearoyl-2-oleoylglycerol (SOS-) and 1,2,3-triolein (OOO-) type of fats have different melting characteristics that may affect postprandial blood lipids, gut hormone concentrations, insulinemic response and selected cardiovascular disease markers in human volunteers. The main objective of this study is to compare the effects of edible fats with either palmitic acid (16:0) (palm mid-fraction) or stearic acid (18:0) (shea stearin) predominantly at the sn-1 and sn-3 positions on postprandial lipemia and gut hormone concentrations. A randomized, double-blind crossover (3 × 3 arms) orthogonal Latin-square design was used on 36 healthy adults (18 males, 18 females; mean age = 23 years). Each subject received 3 different test muffins (each containing 53 g of test fat) in random order separated by 2 weeks over a 6-week period. The test fats of different melting points were palm mid- fraction (PMF; POP-rich), shea stearin (SS; SOS-rich) and high- oleic sunflower oil (HOSF; OOO-rich) During a postprandial test, each subject was provided with a test muffin plus milkshake (total 3.67 MJ or 876 kcal) in the morning and blood samples were collected at half-hourly intervals until 4.0 hours. No significant difference (p>0.05) was observed between the 3 test meals for postprandial responses in plasma TC, Lp(a), apo(B), NEFA, GLP-1, PYY, ghrelin, VAS, PAI-1, IL-6, TNF-α, glucose, insulin and satiety (VAS scores). Plasma TAG peaked at about 4 hours; levels in the PMF- and HOSF- subjects were significantly higher (p<0.05) compared with SS-subjects after 90 minutes. PMF and HOSF exerted a higher postprandial GIP response (p<0.05) as compared to SS. Plasma C-peptide levels, as a measure of insulinemic response, rose sharply 5.5- folds in all groups, peaking after 90 minutes; levels in the SS group declined at a faster rate (p<0.05) than in the PMF- and HOSF- groups. The POP- and OOO- fats induced similar effects on all the biochemical/physiological outcome measures investigated. In contrast, the SOS- type fat (shea stearin) induced a slower rise (p<0.05) in postprandial TAG and GIP levels and a faster return of plasma C-peptide levels to baseline.

Multidrug resistance (MDR) is a serious problem that causes failure in chemotherapy. P-glycoprotein (P-gp) is widely distributed in the intestine, liver and kidneys contributing as one of the major mechanism that causes efflux of chemotherapeutic agents, resulting in ineffective therapeutic level during treatment. However, recent advances in drug delivery systems have made it possible to circumvent MDR issues. In this study, an attempt was made to develop Poly-lactide co-glycolide (PLGA) nanoparticles for oral chemotherapy by co encapsulating doxorubicin (Dox) as the chemotherapeutic agent and cyclosporine-A (CysA) as the chemosensitizer that will function to inhibit P-gp to increase uptake of Dox. High Performance Liquid Chromatography (HPLC) methods were developed and validated for detection and quantification of Dox and CysA. Optimized Dox-CysA nanoparticles were reported to be in 214±4.56 nm of size, zeta potential of -30.1±9.42 and polydispersity index of 0.139±0.09.Transmission Electron Microscopy (TEM) image shows spherical nanoparticles. Differential Scanning Calorimetry (DSC) thermogram indicates Dox and CysA exist in amorphous form in PLGA nanoparticles. Dox and CysA nanoparticles were formulated separately alongside optimized nanoparticle for comparison purposes in drug release and cytotoxicity studies. Dox released slowest from Dox-CysA nanoparticles whilst CysA from CysA nanoparticles in Phosphate Buffer Saline (PBS), promising a controlled release. Cytotoxicity studies conducted on Caco 2 cell line, showed the lowest cell viability of 34%, for Dox-CysA loaded nanoparticles and 76.8% for Dox loaded nanoparticles while a combination of Dox loaded nanoparticles and CysA loaded nanoparticles at the same concentration gave a cell viability of 47.1%, with all treatment containing Dox at 0.71μg/ml. Co-administration of CysA together with Dox in the same nanoparticles formulation proves to increase the uptake of Dox in vitro.