The Postnatal Depression Intervention Program "PNDIP": A 10-year review.

The Postnatal Depression Intervention Program is a screening program looking at postnatal depression in newly delivered mothers at KK Hospital in Singapore. The primary objective of the paper is to evaluate the outcomes based on changes in scores from baseline to end of intervention with reference to depressive symptoms, using the Edinburgh Postnatal Depression Scale and overall functioning based on the Global Assessment of Functioning. These changes were found to be statistically significant. We also described the demographics of the 10-year cohort with majority being married, Chinese, aged between 25 and 34 years old and received at least tertiary education.

Validation of Faecal Pyruvate Kinase Isoenzyme Type M2 (Faecal M2PK Quick) Test in Detection of Colorectal Adenoma and Adenocarcinoma Among High-Risk Malaysian Population.

BACKGROUND: Colorectal neoplasia is a multistep process that can lead to the development of colorectal cancer. Colonoscopy is the gold standard for diagnosis and screening of colorectal cancer, but its uptake is often hindered by unpleasant experiences and logistic obstacles. Therefore, non-invasive biomarker tests such as the M2-pyruvate kinase (M2PK) test have been explored as a potential screening tool. OBJECTIVE: This study aims to evaluate the efficacy of the M2PK Quick Stool Test (ScheBo®) in detecting colorectal adenoma and adenocarcinoma in high-risk Malaysian populations using colonoscopy as the comparison. METHODS: A prospective, cross-sectional, multicenter study was conducted from December 2017 to December 2019 in four hospitals in Malaysia. Participants were eligible if they met any of the following criteria: personal or family history of colorectal polyps or cancer, inherited syndromes, altered bowel habits, rectal bleeding, unintended weight loss, loss of appetite, abdominal pain or cramps, or unexplained iron deficiency, or an Asia-Pacific Colorectal Screening score of 4-7. Participants provided a stool sample that was tested for M2PK using the M2PK Quick Test. Participants then underwent a colonoscopy, and any lesions found were biopsied and sent for histopathological examination. RESULTS: A total of 562 participants were included in the study, of whom 89 had a positive M2PK test. Presence of adenoma and/or dysplastic lesions were confirmed in 14.4% and adenocarcinoma in 3.0% of the participants. The M2PK Quick Stool Test showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 58.8%, 85.5%, 11.2% and 98.5%, respectively in detecting colorectal adenocarcinoma. For detection of colorectal adenoma, this test yielded a sensitivity, specificity, PPV and NPV of 27.3%, 86.3%, 27.0% and 86.5%, respectively. CONCLUSIONS: The M2PK Quick Stool Test showed a moderate accuracy in detecting colorectal adenocarcinoma and adenomas in the studied population.

Primary health level screening for postpartum depression during well-child visits: Prevalence, associated risk factors, and breastfeeding.

Postpartum depression (PPD) is a public health problem that is associated with detrimental effects on the wellbeing of the mother, child and family. Early detection for PPD at the primary health level provides an opportunity for intervention. We aim to examine: (1) the prevalence rate of PPD in the primary care population, (2) acceptance and attendance rates of intervention for women who screened positive for PPD, (3) sociodemographic and maternal risk factors of PPD, and (4) the impact of PPD on breastfeeding. We implemented a mother-child dyadic screening program using the modified Patient Health Questionnaire-2 during routine well-child visits at 2 or 3 months postpartum between July 2019 and December 2021. We performed multivariable logistic regression to identify independent risk factors for PPD and described using adjusted odds ratio (OR) with corresponding 95 % confidence intervals. Among 5561 mothers, the prevalence rate of probable PPD was 2.4 %. About half (54.4 %) of mothers who screened positive accepted intervention and of these, about two-thirds accepted onward referrals to tertiary care and community mental health service, with higher attendance at the latter. In the final adjusted model, mothers who had probable PPD were more likely to be older than age 35 years (OR 1.88, 95 % CI 1.05-3.45; p < 0.05) and not breastfeeding (OR 1.9, 95 % CI 1.06-3.38; p < 0.05). Overall, our findings highlight the importance of early PPD screening and management in primary care. These findings can help inform maternal mental health service development and utilization, thereby optimizing maternal and infant outcomes.

Sexual dysfunction among six months postpartum women in north-eastern Malaysia.

Female sexual dysfunction (FSD) is a common problem among postpartum women. However, little is known about this topic in Malaysia. This study aimed to determine the prevalence of sexual dysfunction and its associated factors in postpartum women in Kelantan, Malaysia. In this cross-sectional study, we recruited 452 sexually active women at six months postpartum from four primary care clinics in Kota Bharu, Kelantan, Malaysia. The participants were asked to fill in questionnaires consisting of sociodemographic information and the Malay Version of the Female Sexual Function Index-6. The data were analyzed using bivariate and multivariate logistic regression analyses. With a 95% response rate, the prevalence of sexual dysfunction among sexually active, six months postpartum women was 52.4% (n = 225). FSD was significantly associated with the older husband's age (p = 0.034) and lower frequency of sexual intercourse (p<0.001). Therefore, the prevalence of postpartum sexual dysfunction in women is relatively high in Kota Bharu, Kelantan, Malaysia. Efforts should be made to raise awareness among healthcare providers about screening for FSD in postpartum women and for their counseling and early treatment.

Monkeypox: A review of data essential in primary care.

Monkeypox is known to be endemic in Africa, but recently, the unusually increasing number of cases of monkeypox in non-endemic countries has caught the attention of the world. The World Health Organization has declared the monkeypox outbreak a public health emergency. The spread pattern is unlikely associated with the previous outbreak outside of Africa, which is related to travelling or contact with exotic animals. The current outbreak is linked to sexual history and presents with atypical localised genital eruptions with an unpredictable onset of viral prodromal symptoms. Although the monkeypox virus is not easily transmittable compared with severe acute respiratory syndrome coronavirus 2, anyone who has been in close contact with a patient with monkeypox is at risk. Most patients will present to a primary care centre for assessment and treatment; therefore, it is important to increase awareness of the infection among primary care providers for early recognition of monkeypox, containment of the outbreak and prevention of healthcare-associated infection. A physician who suspects any patient with monkeypox should notify local or state health authorities immediately.

An alternative assessment approach to national higher education system evaluation.

While the assessment of higher education systems is informative to both policy makers and individuals, it is subjective and performed according to experts' judgment. The present study proposes a relatively objective approach, hierarchical data envelopment analysis (H-DEA), to rank higher education systems. Unlike the subjective approach, H-DEA utilizes endogenous weight determination, allowing assessors to identify the relative importance of each attribute and subattribute. Utilizing the U21 Ranking of National Higher Education System 2020 data, our analysis indicates that the output attribute is a crucial factor influencing the overall performance of higher education systems, even considering countries' stage of development and culture. The computed weights of the H-DEA framework show various attributes' different contributions by group. Resources allocated to the higher education system are important for developing countries, while a high degree of internationalization and a strong link between academia and industry matter for advanced countries. Surprisingly, Asian and Western cultures experience similar performance in their higher education systems, reflecting the Asian higher education system's development toward the Western style. The performance of countries with non-Asian-non-Western cultures, as expected, lags behind, and putting more resources into these countries' higher education system is a way to enhance the overall performance.

Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease.

BACKGROUND & AIM: We studied FibroTouch (FT) and Fibroscan (FS) examination results and their repeatability when performed by healthcare personnel of different background. METHODS: FT and FS examinations were performed on patients with chronic liver disease by two operators, a doctor and a nurse, twice on each patient, at two different time points, independent of each other. RESULTS: The data for 163 patients with 1304 examinations was analyzed. There was strong correlation between FT and FS for attenuation parameter (Spearman's rho 0.76, p<0.001) and liver stiffness measurement (LSM) (Spearman's rho 0.70, p<0.001). However, FT produced higher value at lower attenuation parameter and LSM, and lower value at higher attenuation parameter and LSM. There was substantial agreement when using 15kPa LSM cut-off, but only moderate agreement when using 10kPa and 20kPa LSM cut-offs and 248dB/m, 268dB/m and 280dB/m attenuation parameter cut-offs. The IQR for attenuation parameter and IQR/median for LSM were significantly lower for FT compared with FS (4dB/m vs 27dB/m, p<0.001, and 10 vs 12, p<0.001, respectively). The intra- and inter-observer reliability of attenuation parameter and LSM using FT and FS were good to excellent with intraclass correlation coefficients 0.89-0.99. FT had shorter examination time (33s vs 47s, p<0.001) and less invalid measurements (0 vs 2, p<0.001). CONCLUSION: Measurements obtained with FT and FS strongly correlated, but significant differences in their absolute values, consistency, examination time and number of invalid measurements were observed. Either device can be used by healthcare personnel of different backgrounds when sufficiently trained.

Coronavirus Disease 2019 Presenting as Conjunctivitis.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The world is currently challenged to handle this pandemic. The common symptoms of COVID-19 are fever, cough, fatigue, and shortness of breath. There are few reports on the association of SARS-CoV-2 with ocular abnormalities including conjunctivitis. We report a case of a 54-year-old woman who presented solely with conjunctivitis subsequently diagnosed with COVID-19. A lack of full history of her travel abroad was another issue leading to a delay in evaluating her COVID-19 status that increased the infection risk to her managing team. Thus, primary care practitioners should be suspicious of this atypical feature of COVID-19, thus enabling us to identify such patients at entry points. Maintaining safety measures while managing patients is also crucial.

ALICE: a hybrid AI paradigm with enhanced connectivity and cybersecurity for a serendipitous encounter with circulating hybrid cells.

A fully automated and accurate assay of rare cell phenotypes in densely-packed fluorescently-labeled liquid biopsy images remains elusive. Methods: Employing a hybrid artificial intelligence (AI) paradigm that combines traditional rule-based morphological manipulations with modern statistical machine learning, we deployed a next generation software, ALICE (Automated Liquid Biopsy Cell Enumerator) to identify and enumerate minute amounts of tumor cell phenotypes bestrewed in massive populations of leukocytes. As a code designed for futurity, ALICE is armed with internet of things (IOT) connectivity to promote pedagogy and continuing education and also, an advanced cybersecurity system to safeguard against digital attacks from malicious data tampering. Results: By combining robust principal component analysis, random forest classifier and cubic support vector machine, ALICE was able to detect synthetic, anomalous and tampered input images with an average recall and precision of 0.840 and 0.752, respectively. In terms of phenotyping enumeration, ALICE was able to enumerate various circulating tumor cell (CTC) phenotypes with a reliability ranging from 0.725 (substantial agreement) to 0.961 (almost perfect) as compared to human analysts. Further, two subpopulations of circulating hybrid cells (CHCs) were serendipitously discovered and labeled as CHC-1 (DAPI+/CD45+/E-cadherin+/vimentin-) and CHC-2 (DAPI+ /CD45+/E-cadherin+/vimentin+) in the peripheral blood of pancreatic cancer patients. CHC-1 was found to correlate with nodal staging and was able to classify lymph node metastasis with a sensitivity of 0.615 (95% CI: 0.374-0.898) and specificity of 1.000 (95% CI: 1.000-1.000). Conclusion: This study presented a machine-learning-augmented rule-based hybrid AI algorithm with enhanced cybersecurity and connectivity for the automatic and flexibly-adapting enumeration of cellular liquid biopsies. ALICE has the potential to be used in a clinical setting for an accurate and reliable enumeration of CTC phenotypes.

Anticancer therapy within the last 30 days of life: results of an audit and re-audit cycle from an Australian regional cancer centre.

BACKGROUND: The therapeutic landscape in medical oncology continues to expand significantly. Newer therapies, especially immunotherapy, offer the hope of profound and durable responses with more tolerable side effect profiles. Integrating this information into the decision making process is challenging for patients and oncologists. Systemic anticancer treatment within the last thirty days of life is a key quality of care indicator and is one parameter used in the assessment of aggressiveness of care. METHODS: A retrospective review of medical records of all patients previously treated at Goulburn Valley Health oncology department who died between 1 January 2015 and 30 June 2018 was conducted. Information collected related to patient demographics, diagnosis, treatment, and hospital care within the last 30 days of life. These results were presented to the cancer services meeting and a quality improvement intervention program was instituted. A second retrospective review of medical records of all patients who died between 1 July 2018 and 31 December 2018 was conducted in order to measure the effect of this intervention. RESULTS: The initial audit period comprised 440 patients. 120 patients (27%) received treatment within the last 30 days of life. The re-audit period comprised 75 patients. 19 patients (25%) received treatment within the last 30 days of life. Treatment rates of chemotherapy reduced after the intervention in contrast to treatment rates of immunotherapy which increased. A separate analysis calculated the rate of mortality within 30 days of chemotherapy from the total number of patients who received chemotherapy was initially 8% and 2% in the re-audit period. Treatment within the last 30 days of life was associated with higher use of aggressive care such as emergency department presentation, hospitalisation, ICU admission and late hospice referral. Palliative care referral rates improved after the intervention. CONCLUSION: This audit demonstrated that a quality improvement intervention can impact quality of care indicators with reductions in the use of chemotherapy within the last 30 days of life. However, immunotherapy use increased which may be explained by increased access and a better risk benefit balance.

A cross-sectional survey of what patients find most therapeutic in perinatal mental healthcare in Singapore.

Supportive counselling is an important part of the treatment process for perinatal mood disorders in KK Women's and Children's Hospital (KKH). This study aims to investigate the extent to which patients deem each component of supportive counselling important to their treatment and recovery process. Sixty-six patients seen during their pregnancy or postnatal period for anxiety or depressive disorders were surveyed at the point of their discharge. Patients were asked to rate on a four-point scale the importance they attributed to each of thirteen components of supportive counselling practised by the perinatal mental health team at KKH. Patients were also asked to identify the three most important components in their treatment experience. The final two survey questions assessed the effects of the treatment process on patients' perceived partner support and patients' optimism towards motherhood. Results corroborate the importance of building a trusting relationship between treatment providers and patients, providing empathic support while patients learn to accept the changes in their lives and engaging patients' partners in the treatment process. It is recommended that perinatal mental healthcare providers continue to build on the therapeutic effects of empathic understanding and engaging patients' partners in the treatment process.

Fear of Crime: The Influence of General Fear, Risk, and Time Perspective.

Prior research on fear of crime has focused less on psychological causes than on sociological and demographic factors. This study, however, introduces time perspective (TP) as an important psychological variable in the understanding of fear of crime. Specifically, the article assesses the relationship between TP as a stable personality factor and the mediation of risk and general fear on fear of crime levels. Data were collected using the survey method from a sample of 375 respondents utilizing the following scales: Zimbardo Time Perspective Inventory (ZTPI) consisting of five TP subscales, Ferraro's perceived risk of victimization and fear of crime scales, and a general (non-crime) fear scale measuring pragmatic and abstract fear. Path analysis shows no significant direct relationships between the five TP subscales and fear of crime. However, indirect effects are observed for Past Negative TP and Present Fatalistic TP, with general fear (pragmatic and abstract) and risk of victimization mediating the relationship, and pragmatic fear having the greatest significant effect size. Results are discussed in the context of risk and general fear sensitivity and construal level theory. We conclude with recommendations for future research.

Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore.

BACKGROUND: The effect of maternal weight on pregnancy and birth outcomes is of great public health concern. For example, overweight and obesity among pregnant women is associated with adverse reproductive health outcomes including gestational diabetes, birth defects, macrosomia and infant mortality. OBJECTIVES: To understand the knowledge, perceptions and experiences during pregnancy among overweight and obese women in Singapore. METHODS: This is a cross-sectional study which employed qualitative techniques. The inclusion criteria is as follows: (1) Women who were overweight or obese before or during first trimester of pregnancy, (2) are able to report their specific pre-pregnancy or first trimester Body Mass Index (BMI), or weight and height, (3) had singleton pregnancy when overweight, are post-delivery for the pregnancy in which they were overweight, and (4) are 21 to 55 years old. Fifteen interviews were voice-recorded and transcribed verbatim. Then, two researchers independently performed the thematic analysis of the transcripts. RESULTS: The findings revealed that women had gaps in knowledge on the adverse effects of maternal overweight and obesity during pregnancy, and various misconceptions on diet and weight management during pregnancy were prevalent. Conflicting data was obtained for perceptions on the importance, difficulty and levels of motivation for weight management during pregnancy. CONCLUSION: There is a pressing need to address knowledge gaps and misconceptions of pregnant women who are overweight or obese. The importance of weight management during pregnancy should be emphasized, and enabling factors put in place.

Self-critical perfectionism and depression maintenance over one year: The moderating roles of daily stress-sadness reactivity and the cortisol awakening response.

This study of depressed outpatients (N = 43) examined daily stress-sadness reactivity and the cortisol awakening response (CAR) as moderators of the relationship between self-critical (SC) perfectionism and depression over one year. Participants completed perfectionism measures at baseline (Time 1), daily diaries and salivary sampling six months later (Time 2), and an interviewer-rated depression measure at Time 1, Time 2, and one year after baseline (Time 3). Hierarchical multiple regression analyses of moderator effects demonstrated that patients with higher SC perfectionism and higher levels of daily stress-sadness reactivity (i.e., greater increases in daily sadness in response to increases in daily stress) had less improvement in depressive symptoms at Time 3 relative to those of other patients, adjusting for the effects of Time 1 and Time 2 depression. Furthermore, higher SC perfectionism in conjunction with an elevated CAR predicted higher levels of depression at Time 3. In addition, lower SC perfectionism in combination with higher levels of stress-sadness reactivity/CAR was associated with the lowest levels of depression at Time 3. These findings highlight the importance of targeting dysfunctional self-critical characteristics that exacerbate the impact of heightened stress-sadness reactivity and CAR to generate better treatment outcomes for patients with higher SC perfectionism. (PsycINFO Database Record

Salivary Cortisol and Cortisone After Low-Dose Corticotropin Stimulation in the Diagnosis of Adrenal Insufficiency.

CONTEXT: Basal and poststimulation salivary cortisol and cortisone levels can be useful in the diagnosis of adrenal insufficiency. However, little is known about the optimal cutoffs and performance characteristics of these tests. OBJECTIVE: To derive the cutoff values and study the performance characteristics of salivary cortisol and salivary cortisone in the diagnosis of adrenal insufficiency. DESIGN AND SETTING: Prospective study in a regional hospital in Hong Kong from January 2014 to September 2015. PARTICIPANTS: Fifty-six Chinese healthy volunteers and 171 patients suspected of having adrenal insufficiency. MAIN OUTCOME MEASURES: All participants underwent low-dose short Synacthen test (LDSST) with intravenous injection of 1 µg of tetracosactide (Synacthen 1-24). Serum cortisol, salivary cortisol and cortisone levels were measured at baseline and 30 and 60 minutes afterward. RESULTS: Using the reference cutoff (mean - 2 standard deviations of post-LDSST peak serum cortisol) derived from healthy volunteers as the gold standard, receiver operating characteristic analysis of patients' data revealed that both post-LDSST peak salivary cortisol and cortisone performed better than basal tests. The most optimal cutoff values for serum cortisol as measured by immunoassay and for salivary cortisol and salivary cortisone as measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) were 376, 8.6, and 33.5 nmol/L, respectively, for post-LDSST peak values, and 170, 1.7, and 12.5 nmol/L, respectively, for basal values. CONCLUSIONS: We established method-specific reference cutoffs for serum cortisol, salivary cortisol, and salivary cortisone during LDSST. Both post-LDSST peak salivary cortisol and cortisone performed well as diagnostic tests for adrenal insufficiency. Their measurements by LC-MS/MS can alleviate problems associated with serum cortisol immunoassays.