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Autism spectrum disorder (ASD) is a group of complex neurodevelopmental disorders with uncertain etiology. Evidence shows that genetic testing can explain about 20% of cases. This study aims to assess the level of awareness and perception of medical genetic services among Malaysian parents with ASD children.

A cross-sectional survey using an interviewer-administered questionnaire was done among 111 parents of children with ASD from August 2017 to September 2019 in two clinics in Malaysia.

A majority of children with ASD (80.20%) were male and diagnosed at the age of 3–4 years old (47.80%). When the autistic child was born, most mothers and fathers were aged 26–30 (40.50%) and 31–35 years old (42.30%), respectively. Another child with ASD in nuclear and extended families was reported for 11.70% and 13.50%, respectively. Only 24.30% have seen a professional genetic consultant, and 19.8% have done genetic testing for affected children. The mean score of awareness of genetic services for ASD was 2.48 ± 3.30. Having medical insurance and another child with ASD in the nuclear family was significantly associated with a higher level of awareness (p = 0.01 and p < 0.001, respectively). Most of the participants have a positive perception of these services.

Regardless of demographic factors, participants have poor awareness of genetic services for ASD, likely because the primary physician did not recommend it upon diagnosis. Increasing health-care providers’ knowledge about the current potential of genetic testing for ASD and educational campaigns for the public are critical components of using available genetic tests to improve ASD management.

Under the carbon tax policy, the authors examine the operational decisions of the low-carbon supply chain with the triple bottom line.

This paper uses the Stackelberg game theory to obtain the optimal wholesale prices, retail prices, sales quantities and carbon emissions in different cases, and investigates the effect of the carbon tax policy.

This study’s main results are as follows: (1) the optimal retail price of the centralized supply chain is the lowest, while that of the decentralized supply chain where the manufacturer undertakes the carbon emission reduction (CER) responsibility and the corporate social responsibility (CSR) is the highest under certain conditions. (2) The sales quantity when the retailer undertakes the CER responsibility and the CSR is the largest. (3) The supply chain obtains the highest profits when the retailer undertakes the CER responsibility and the CSR. (4) The environmental performance impact decreases with the carbon tax.

The results of this study can provide decision-making suggestions for low-carbon supply chains. Besides, this paper provides implications for the government to promote the low-carbon market.

Most of the existing studies only consider economic responsibility and social responsibility or only consider economic responsibility and environmental responsibility. This paper is the first study that examines the operational decisions of low-carbon supply chains with the triple bottom line under the carbon tax policy.