Browse publications by year: 2024

  1. Sajal SSA, Islam DZ, Khandker SS, Solórzano-Ortiz E, Fardoun M, Ahmed MF, et al.
    Cureus, 2024 Nov;16(11):c199.
    PMID: 39583600 DOI: 10.7759/cureus.c199
    [This corrects the article DOI: 10.7759/cureus.72954.].
  2. Liu T, Hassan A, Yousif Alrawas MZ, Cui C, Ariffin Z
    ACS Omega, 2024 Nov 19;9(46):45652-45662.
    PMID: 39583686 DOI: 10.1021/acsomega.4c06268
    Recent advancements in materials synthesis and processing technology, coupled with a deeper understanding of bone nanoscale structure and biology, have provided new avenues for designing bioactive materials in bone tissue regenerative medicine. This Review focuses on the design and application of polydopamine-modified polycaprolactone scaffolds loading metal nanoparticles for bone tissue engineering. We explore their antibacterial properties and their ability to guide cell behavior. Specifically, we discuss the synthesis techniques, protein deposition, morphology variations, and interactions with the extracellular matrix of these scaffolds and biocompatibility and efficacy in promoting bone tissue regeneration in vitro and in vivo. Challenges and unmet needs are reviewed in the development of polymer- and metal-based materials for bone tissue engineering.
  3. Suliman GM, Al-Owaimer AN, Alobre MM, Swelum AA, Algaradi MA, Ba-Awadh H, et al.
    Heliyon, 2024 Nov 15;10(21):e40177.
    PMID: 39583808 DOI: 10.1016/j.heliyon.2024.e40177
    This study aimed to assess the impact of preslaughter handling method and aging on carcass and meat quality traits in goats. Twenty-seven male goats of Ardi breed were assigned into three treatment groups viz., the control (C), ear pulling (EP), and hind-leg pulling (HP). The carcasses were stored for post-mortem aging periods of 1, 7, and 14 days. On day 0 and the respective aging days, samples of the Longissimus thoracic et lumborum (LTL) muscles were collected and examined for various meat quality parameters. The preslaughter handling of goats significantly increase the total bacterial count, total Enterobacteriaceae count, and total Clostridium count. It also had a significant effect on the pH of LTL muscle during aging. A significantly lower values for pH were recorded in the treatment groups (EP and HP) as compared to the pH of the C group on day 1 of aging. Notably, both treatment groups were found to increase the shear force, hardness, and chewiness of the meat, ultimately compromising its quality. The proper treatment of meat animals, especially goats, is crucial for enhancing carcass and meat quality. Careful preslaughter handling practices by avoiding ear and hind-leg pulling can minimize negative impacts on the final product. Therefore, the significance of conducting this study lies in its potential to enhance animal welfare, improve meat quality, boost economic benefits for producers, and foster consumer confidence in meat products.
  4. Kamni SNA, Bahron NANBS, Zulkifli A, Uny I, O'Donnell R, Prabandari YS, et al.
    Tob Prev Cessat, 2024;10.
    PMID: 39583884 DOI: 10.18332/tpc/195460
    INTRODUCTION: Studies have found that parental smoking is the primary source of secondhand smoke (SHS) exposure among children, leading to respiratory illnesses, especially in non-smokers like children and women. Promoting a smoke-free home (SFH) is essential, especially among rural populations, and barriers or challenges to creating a SFH need to be better understood. This study aimed to determine the knowledge levels on SHS and to identify the beliefs, perceptions, barriers and facilitators of SFH practices among the rural population in Kuala Kubu Bharu, Selangor, Malaysia.

    METHODS: This study employed a mixed-methods design, conducted in two rural settlement areas in 2022. Data were collected through surveys on SHS and SFH knowledge and face-to-face interviews using a topic guide. The quantitative data were analyzed using SPSS software while the qualitative data were analyzed using the thematic approach via NVivo 12.

    RESULTS: Sixty participants completed the survey. Most of the respondents had a good (38%) or moderate (48%) knowledge level of SHS. No association was found between sociodemographic factors and knowledge level. Seven of the nine interviewees knew specific SHS-related health risks. Most participants believed that implementing SFH requires quitting or reducing smoking. Barriers to establishing a SFH included personal convenience, habits, attitudes, and social influence. Family encouragement, practicability, government, and quitting smoking were the facilitators for SFH.

    CONCLUSIONS: These rural communities had moderate knowledge level of SHS and SFH. Men's knowledge, beliefs and perceptions like associating SFH with quitting smoking may prevent SFH adoption. It is critical for the government and stakeholders to disseminate information and develop socially and culturally acceptable health promotion programs, incorporating the considerations from this study to increase the chances of SFH implementation in rural areas.

  5. Malik MA, Amjad AI, Aslam S, Fakhrou A
    Front Res Metr Anal, 2024;9:1486832.
    PMID: 39583913 DOI: 10.3389/frma.2024.1486832
    INTRODUCTION: The current study explored the influence of Chat Generative Pre-Trained Transformer (ChatGPT) on the concepts, parameters, policies, and practices of creativity and plagiarism in academic and research writing.

    METHODS: Data were collected from 10 researchers from 10 different countries (Australia, China, the UK, Brazil, Pakistan, Bangladesh, Iran, Nigeria, Trinidad and Tobago, and Turkiye) using semi-structured interviews. NVivo was employed for data analysis.

    RESULTS: Based on the responses, five themes about the influence of ChatGPT on academic and research writing were generated, i.e., opportunity, human assistance, thought-provoking, time-saving, and negative attitude. Although the researchers were mostly positive about it, some feared it would degrade their writing skills and lead to plagiarism. Many of them believed that ChatGPT would redefine the concepts, parameters, and practices of creativity and plagiarism.

    DISCUSSION: Creativity may no longer be restricted to the ability to write, but also to use ChatGPT or other large language models (LLMs) to write creatively. Some suggested that machine-generated text might be accepted as the new norm; however, using it without proper acknowledgment would be considered plagiarism. The researchers recommended allowing ChatGPT for academic and research writing; however, they strongly advised it to be regulated with limited use and proper acknowledgment.

  6. Ye D, Kanesvaran R, Chiong E, Lojanapiwat B, Pu YS, Rawal SK, et al.
    Ther Adv Med Oncol, 2024;16:17588359241293393.
    PMID: 39583953 DOI: 10.1177/17588359241293393
    BACKGROUND: The incidence of prostate cancer (PC) is increasing in Asian countries. The epidemiology of PC, its treatment including the use of novel therapeutic options, impacts on quality of life, and clinical outcomes of patients with PC in Asia, are not well documented.

    OBJECTIVES: To describe the demographic and disease features of the full cohort of patients enrolled in the United in Fight against prOstate cancer (UFO) registry.

    DESIGN: The UFO registry was a multi-national, longitudinal, observational study of patients with PC presenting to participating tertiary care hospitals in eight Asian countries/regions.

    METHODS: Patients with high-risk localized PC (HRL), non-metastatic biochemically recurrent, or metastatic PC were consecutively enrolled from September 14, 2015 until September 1, 2020 and followed for up to 5 years.

    RESULTS: Among the full cohort of 3635 patients, 425 had HRL, 389 had non-metastatic biochemically recurrent, and 2821 had metastatic PC. Median follow-up time was 4.2, 4.2, and 2.6 years, respectively. At first diagnosis, the mean age ranged from 65.7 to 69.1 years, 38.5% had extra-capsular tumor extension, 34.0% had regional lymph node metastases, and 65.1% had distant metastases. Quality-of-life scores at enrollment were significantly worse in patients with metastatic disease. Decisions to start therapy were mainly driven by treatment guidelines and disease progression. The decision to discontinue hormonal therapy was often due to disease progression. Few patients received novel hormonal therapies despite their availability.

    CONCLUSION: The UFO registry provides a detailed, contemporary picture of the characteristics, treatment, and outcomes of patients with PC in Asia. There is an unmet medical need to improve access to novel agents in Asia, aiming to improve quality of life and clinical outcomes.

    TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02546908, Registry Identifier: NOPRODPCR4001.

  7. Amin MHF, Kim HW, Then AY, Oktavitri NI, Kim AR, Lee SR, et al.
    MethodsX, 2024 Dec;13:103020.
    PMID: 39583998 DOI: 10.1016/j.mex.2024.103020
    Environmental DNA (eDNA) metabarcoding is a valuable tool for assessing aquatic biodiversity, but the high cost and complexity of DNA extraction pose challenges for widespread adoption, especially in developing countries. This study presents a cost-effective eDNA extraction method using a guanidine hydrochloride (GuHCl) buffer, proteinase-K digestion, and isopropanol precipitation to improve the detection of fish communities. Comparison with the Qiagen DNeasy Blood & Tissue Kit using MiFish universal primers showed that the GuHCl protocol detected more fish species in freshwater samples, with comparable performance in relative read abundance metrics. However, the GuHCl method exhibited higher PCR inhibition in brackish samples, likely due to salinity and natural inhibitors. The results suggest that the GuHCl-based method is a viable alternative, offering enhanced sensitivity for low-abundance species in freshwater samples and cost savings. This protocol facilitates large-scale eDNA metabarcoding for ecological studies and conservation management efforts.•The GuHCl protocol identified a greater diversity of fish species in freshwater samples than the Qiagen kit, but detected fewer species in brackish water samples.•Both extraction methods demonstrated robust positive correlations in metrics of relative read abundance.
  8. Netthong R, Donsamak S, John DN, Kane R, Armani K
    Explor Res Clin Soc Pharm, 2024 Dec;16:100535.
    PMID: 39584022 DOI: 10.1016/j.rcsop.2024.100535
    BACKGROUND: Antimicrobial resistance (AMR) is increasing globally and poses a significant public health challenge. Community pharmacists, especially in primary care settings, play a pivotal role in mitigating the irrational use of antibiotics, a key driver of AMR.

    OBJECTIVES: This study aims to explore qualitative insights from community pharmacists regarding antibiotic supply and usage, analyze sentiments related to AMR, and highlight the crucial role of community pharmacists in AMR stewardship at the primary care/community level.

    METHODS: This study engaged community pharmacists in Thailand through semi-structured interviews to obtain in-depth insights into the antibiotic supply and perceptions of AMR. Additionally, sentiment analysis, which evaluates the emotional tone of the pharmacists' responses, was conducted to enrich the findings.

    RESULTS: Interviews with 23 community pharmacists highlighted the practices, challenges, and strategies related to antibiotic supply and use. Key findings include the identification of barriers such as patient demand and lack of awareness about antimicrobial resistance (AMR), alongside strategies for improvement such as public education and professional development. Sentiment analysis reveals a cautiously optimistic perspective toward enhancing rational antibiotic use, underscoring the importance of comprehensive approaches that combine education, ethics, and regulatory measures to address the complexities of antibiotic management at community pharmacies.

    CONCLUSION: This study underscores the necessity of public awareness, pharmacist-patient relationships, and regulatory reforms for the rational use of antibiotics in community pharmacies. These findings emphasize that pharmacist education and adherence to professional ethics are essential for mitigating antimicrobial resistance and promoting rational antibiotic use.

  9. Tao X, Jin X, Gao S, Yi X, Liu Y, Rockett TBO, et al.
    ACS Photonics, 2024 Nov 20;11(11):4846-4853.
    PMID: 39584037 DOI: 10.1021/acsphotonics.4c01343
    The presence of large bismuth (Bi) atoms has been shown to increase the spin-orbit splitting energy in bulk GaAsBi, reducing the hole ionization coefficient (β) and thereby reducing the excess noise seen in avalanche photodiodes. In this study, we show that even very thin layers of GaAsBi introduced as quantum wells (QWs) in a GaAs matrix exhibit a significant reduction of β while leaving the electron ionization coefficient, α, largely unchanged. The optical and avalanche multiplication properties of a series of GaAsBi/GaAs multiple quantum well (MQW) p-i-n structures with nominally 5 nm thick, 4.4% Bi GaAsBi QWs, varying from 5 to 63 periods and corresponding barrier widths of 101 to 4 nm were investigated. From photoluminescence, ω-2θ X-ray diffraction, and cross section transmission electron microscopy measurements, the material was found to be of high quality despite the strain introduced by the Bi in all except the samples with 54 and 63 QW periods. Photomultiplication measurements undertaken with different wavelengths showed that α in these MQW structures did not change appreciably with the number of QWs; however, β decreased significantly, especially at lower values, the noise factor, F, is reduced by 58% to 3.5 at a multiplication of 10, compared to a similar thickness bulk GaAs structure without any Bi. This result suggests that Bi-containing QWs could be introduced into the avalanching regions of APDs as a way of reducing their excess noise.
  10. Hasan IH, Ismail I, Hamidon MN, Mustaffa MS, Abdullah NH, Shafiee FN
    Heliyon, 2024 Nov 30;10(22):e39966.
    PMID: 39584123 DOI: 10.1016/j.heliyon.2024.e39966
    Carbon nanotube-Yttrium iron garnet (CNT-YIG) nanohybrid has been successfully synthesized using chemical vapor deposition (CVD) with yttrium iron garnet (YIG) nanopowders as catalyst, ethanol as carbon stock, and argon as carrier gas. Carbon nanotube (CNT) was observed to have grown from the YIG nanopowders with bamboo-like structures of CNT at a synthesis temperature of 900 °C. FESEM and RAMAN characterization indicated that the CNT-YIG nanohybrid exhibited the growth of bamboo-like CNT with high graphitization. Further analysis of electrical properties showed that the CNT-YIG nanohybrid has exhibited conductivity due to the CNT growth. The nanohybrid in the form of powders was then mixed with an organic vehicle to produce thick film paste and screen-printed onto a substrate as the working material for patch antenna application. Initial measurements using VNA indicated that CNT-YIG nanohybrid gave significant results regarding return loss and bandwidth, proving that the materials could have great potential to enhance patch antenna performance due to their combined electrical and magnetic properties.
  11. He Y, Hamdan SL, Faizal SM
    Heliyon, 2024 Nov 30;10(22):e40304.
    PMID: 39584129 DOI: 10.1016/j.heliyon.2024.e40304
    This study investigates the effect of busy independent directors on earnings management in Chinese initial public offering (IPO) companies from 2010 to 2020. Using various measures of busy independent directors, the results indicate that directors in IPO companies play a significant role in supervision and governance, thereby significantly mitigating earnings management. Busy independent directors, serving on multiple boards, may face time constraints, but, intriguingly, companies with such directors show a lower inclination for earnings manipulation. This suggests that despite potential time pressures, the independent oversight provided by these directors serves as a deterrent to financial reporting manipulation in the context of Chinese IPOs, underscoring the importance of robust corporate governance structures for transparency and reliability. Additionally, this study identifies specific conditions that amplify the constraining effect and finds that the effect of busy independent directors on earnings management in IPO companies is more significant in companies with high compensation for independent directors, independent directors serving off-site, and companies that receive higher media attention. Mechanism testing indicated that busy independent directors mitigate IPO firms' earnings management by engaging reputable audit firms and enhancing the effectiveness of internal controls. This nuanced analysis offers valuable insights into how busy, independent directors actively contribute to alleviating the risks associated with earnings management during the IPO process. This study enhances our understanding of the governance benefits of active independent directors in multiple roles and offers novel perspectives on how stakeholders can influence and constrain earnings management in IPO companies.
  12. Oh AL, Makmor-Bakry M, Islahudin F, Ting CY, Chan SK, Tie ST
    Health Promot Int, 2024 Dec 01;39(6).
    PMID: 39584467 DOI: 10.1093/heapro/daae176
    Tuberculosis (TB) treatment interruption undermines the effectiveness of TB medications and jeopardizes treatment outcomes. This study aimed to explore barriers, challenges, coping strategies and facilitators of TB treatment interruption to understand the treatment pathway in achieving successful outcomes. In-depth interviews were conducted at public health clinics in Sarawak, Malaysia, utilizing a phenomenological approach. Thirty patients who experienced TB treatment interruption with eventual successful treatment were purposively selected based on various reasons for treatment interruption to obtain diverse viewpoints. The audio-recorded transcriptions underwent thematic and content analysis. Five major themes emerged under barriers and challenges: socioeconomic, patient, therapy, healthcare and condition-related factors. Notably, financial burdens led individuals to prioritize work over health. Adverse drug reactions resulted in inappropriate self-medication and healthcare dissatisfaction. Medication error with suboptimal dosing was another facet leading to treatment forfeiture. Lack of knowledge about treatment duration and medication adherence, along with negative personal factors such as laziness, dishonesty and forgetfulness were reported. Participants employed coping strategies to confront barriers and challenges, including acceptance and commitment to disease and treatment, self-adaptation in mental, physical and social aspects, and self-management of minor adverse events. Fear of disease worsening, previous experiences, social and financial supports, along with intrinsic motivators, were essential facilitators that prevented interruptions. Interconnectivity across the explored dimensions contextualized the understanding of TB treatment interruption and offered valuable information for designing patient-centered intervention strategies. Improving patient education coupled with tailored interventions addressing psychosocial and economic barriers is crucial for ensuring TB treatment completion.
    MeSH terms: Adaptation, Psychological*; Adult; Female; Humans; Interviews as Topic; Health Knowledge, Attitudes, Practice; Malaysia; Male; Middle Aged; Socioeconomic Factors; Qualitative Research*
  13. Pasi H, Mohamad E, Azlan AA, Hamzah MR, Sulong MR, Isa A, et al.
    PMID: 39585202 DOI: 10.1089/vbz.2024.0023
    Background: Highlighting the individual, host-vector interactions, and environmental risk factors for knowlesi malaria were consequential toward more focused and effective prevention and control strategies. This study aims to identify the individual, host-vector interactions, and environmental risk factors for Plasmodium knowlesi malaria among at-risk communities in Peninsular Malaysia. Materials and Methods: A case-control study was conducted involving laboratory-confirmed cases of P. knowlesi malaria, while a locality-matched individual with no history of fever and tested negative for malaria was taken as control. Univariate and multiple logistic regression were applied to evaluate the potential risk factors among respondents using IBM SPSS Statistics for Windows, Version 26.0. Results: Results showed higher cases among males as compared to females (76.1% vs. 23.9%). Multiple logistic regression analysis showed being male is 3.51 higher risk (p < 0.001) to become a case. Respondents whose place of work or study is near the forest edge have 44.0% lower risk (p = 0.030), while those living in the Orang Asli village were 56.0% lower risk as compared to the organized village to become a case (p = 0.035). Conclusion: These findings demonstrated that gender emerges as an independent individual risk factor while residing near a forest edge, in an Orang Asli village, or occupying workers' longhouses situated in hilly areas lowered the environmental risk among respondents. These findings attested that alternative directions must be considered in addressing the known risk factors associated with this type of malaria and the design of prevention and control programs should be tailored to the unique characteristics of each population.
  14. Geller S, Sommer W, Hildebrandt A
    Cogn Emot, 2024 Nov 25.
    PMID: 39585690 DOI: 10.1080/02699931.2024.2430403
    Superior recognition of positive emotional facial expressions compared to negative expressions is well established. However, it is unclear whether this superiority effect differs between non-parents and parents, for whom emotion perception (EP) is an indispensable skill. Although EP has been shown to be modulated by the neuropeptide oxytocin, a central factor in the development of parental care, very little research has addressed the relationship between EP skills, the transition to parenthood, and plasma oxytocin levels. In the present study, we assessed EP abilities with a test battery and measured plasma oxytocin in 77 non-parent and 79 parent couples and applied structural equation modelling to the data. The results showed increased happiness perception abilities in both parents and individuals with elevated oxytocin levels. Furthermore, non-parents showed superior abilities to recognise anger expressions. No significant associations were found regarding the perception of other basic emotion categories or with a general EP factor. The findings are consistent with previous research indicating that elevated oxytocin levels are associated with enhanced EP abilities. They also extend the existing literature by demonstrating that mothers and fathers, regardless of their oxytocin levels, exhibit increased EP superiority.
  15. Yassi N, Yogendrakumar V, Churilov L, Meretoja A, Wu T, Campbell BCV, et al.
    Neurology, 2024 Dec 24;103(12):e210104.
    PMID: 39586046 DOI: 10.1212/WNL.0000000000210104
    BACKGROUND AND OBJECTIVES: The antifibrinolytic agent tranexamic acid has been tested in intracerebral hemorrhage trials with overall neutral results. Ongoing contrast extravasation on CT angiography (spot sign) can identify individuals with ongoing bleeding who may benefit from anti-fibrinolytic therapy. We aimed to investigate the effect of tranexamic acid on hematoma growth in patients with spot signs treated within 4.5 hours of onset.

    METHODS: We conducted a systematic review and individual patient meta-analysis, which we report according to the Preferred Reporting Items for Systematic Review and Meta-analyses of Individual Participant Data guidelines. PubMed and Embase were searched from inception to May 29, 2023, using the terms ((stroke) AND (randomised OR randomized) AND (tranexamic acid) AND (haemorrhage OR hemorrhage)). We included randomized trials comparing tranexamic acid with placebo in participants with primary intracerebral hemorrhage who had a spot sign and who had follow-up imaging within the required timeframe. Individual patient data were provided by each study and were integrated by the coordinating center. Data were pooled using a random-effects model. The primary endpoint was hematoma growth within 24 hours, defined as ≥33% relative or ≥6 mL absolute hematoma expansion compared with baseline, analyzed using mixed-effects-modified Poisson regression with robust standard errors, adjusted for baseline hematoma volume. Safety outcomes were mortality and major thromboembolic events within 90 days.

    RESULTS: Of 197 studies identified, 3 were eligible, contributing 162 participants for the primary analysis (60 female and 102 male). Hematoma growth occurred in 36 of 74 (49%) participants treated with tranexamic acid, compared with 48 of 88 (55%) participants treated with placebo (adjusted risk ratio 0.86, 95% CI 0.84-0.89, p < 0.001). Adjusted median absolute hematoma growth was 1.60 mL (95% CI 0.77-2.43) lower with tranexamic acid vs placebo. No differences in functional outcome or safety were observed.

    DISCUSSION: Tranexamic acid modestly reduced hematoma growth in patients with CT angiography spot signs treated within 4.5 hours of onset. Given the trials in the meta-analysis were individually neutral, these results require further validation before clinical application.

    MeSH terms: Hematoma/drug therapy; Humans; Computed Tomography Angiography*
  16. Ng WL, Kee BP, Hussein N, Ng CJ, Kuan SW, Mohd Zaidan FZ, et al.
    J Community Genet, 2024 Nov 25.
    PMID: 39586937 DOI: 10.1007/s12687-024-00753-4
    HLA-B*58:01 allele is associated with allopurinol-induced severe cutaneous reaction (SCAR). Malaysia has a multiethnic population with limited data on the prevalence of HLA-B*58:01 among patients with gout treated in primary care settings. This cross-sectional study aimed to determine the prevalence of HLA-B*5801 in patients with gout from the Malay, Chinese and Indian ethnicities attending primary clinics in Malaysia.We collected blood samples from patients with gout attending three primary care clinics in Klang Valley, Malaysia, using convenience sampling. Genomic DNA samples were subjected to typing of HLA-B*5801 by a multiplex probe-based assay in a real-time PCR system, validated by PCR-resequencing approach.547 patients (194 Malay, 266 Chinese and 87 Indian) were recruited. The overall prevalence of HLA-B*58:01 was 16.8% (Chinese 21.8%, Indian 12.6% and Malay 11.9%). None of our 61 HLA-B*58:01 carriers who ever used allopurinol developed SCAR.The overall prevalence of HLA-B*58:01 allele in our patients with gout was high, particularly among the Chinese ethnicity (21.8%). None of our HLA-B*58:01 positive patients treated with allopurinol reported allopurinol-induced SCAR. A more accurate predictive model for allopurinol-induced SCAR is needed.
  17. Samir H, Redouane F, Batool K, Batool S, Isa SSPM, Abd-Elmonem A, et al.
    Sci Rep, 2024 Nov 25;14(1):29149.
    PMID: 39587175 DOI: 10.1038/s41598-024-80760-0
    The purpose of this work is to probe the analytical formulation of the mechanical response [Formula: see text], which is the consequence of determining the connection between charge and depth values. It is possible to acquire the [Formula: see text] expression by doing an indentation experiment while the loading process is unfolding. In this particular piece of research, the formulation of [Formula: see text] takes into consideration the pile-up mode for an indenter with a spherical structure. The remarkable concordance that exists involving the newly propositioned appearance and the outcome of the experiments has been presented in this academic work. An experimental investigation is being conducted on ductile materials, namely copper and the alloys of copper.
  18. Liu Y, Gong L, Niu H, Jiang F, Du S, Jiang Y
    Cost Eff Resour Alloc, 2024 Nov 26;22(1):86.
    PMID: 39587581 DOI: 10.1186/s12962-024-00588-3
    BACKGROUND: Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.

    METHODS: Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.

    RESULTS: The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.

    CONCLUSION: ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.

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