Seroprevalence of cytomegalovirus among pregnant women in Singapore.

BACKGROUND: Cytomegalovirus (CMV) is the most common congenital infection in pregnancy with potential long-term adverse effects on the fetus. There is limited data on CMV seroprevalence in pregnant women in Singapore, with last reported study dating back over two decades. We look at the latest CMV seroprevalence in antenatal population in Singapore. METHODS: Between January 2021 and August 2021, 385 pregnant women receiving antenatal care at Singapore General Hospital were randomly selected for CMV IgG test to be performed on their blood samples collected during the first trimester of their pregnancies. Positivity for CMV IgG represents past exposure prior to pregnancy. RESULTS: Overall CMV seroprevalence was 71.7% (276/385) (95% CI 067, 0.76, p value < 0.001). The trend of CMV IgG positivity increased with age, 68.3% (95% CI 0.60, 0.76, p value < 0.001) in those aged 20-29, 72.5% (95% CI 0.66, 0.78, p value < 0.001) in the 30-39 age group, and 79.0% (95% CI 0.67, 0.76, p value 0.012) in women over 40. CONCLUSIONS: There is a declining trend in CMV seroprevalence among pregnant women in Singapore, which indicates that a substantial portion of this population faces the risk of primary maternal CMV infection during pregnancy. Emerging research suggests that prenatal treatment with valacyclovir effectively reduces the likelihood of vertical transmission. Considering this evidence, it is imperative to reevaluate the recommendations for universal maternal CMV screening during pregnancy.

Measuring the Maturity of Integrated Care in Singapore with the SCIROCCO Exchange Tool.

Background: How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state's management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade. Objective: This study measures the maturity level of Singapore's integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care. Methods: A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis. Results: All participants completed the study. The study found five dimensions in the "Initial" maturity level and five dimensions in the "Progressing" maturity level. There were two dimensions which were "Uncertain" because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal. Implications: The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.

Maternal experiences and preference of maternity services in Singapore: A descriptive qualitative study.

PROBLEM: Little is known about mothers' experiences and preferences for maternity services in Singapore. A more nuanced understanding would identify areas for improvement in perinatal care, reducing the burden on healthcare providers in supporting maternity services. BACKGROUND: Expecting mothers are typically referred to hospital-based antenatal and postnatal services in Singapore. In recent years, Singapore has made maternity services available in primary care community settings called polyclinics, to improve accessibility of such services. AIM: To explore the experiences and preferences of Singaporean mothers in receiving maternity services in acute hospitals and polyclinics. METHODS: A descriptive qualitative study design was adopted, and data were collected from September to October 2023. In total, 13 mothers were recruited from a maternity care hospital in Singapore. Individual semi-structured audio-recorded interviews were conducted, and data were analysed using thematic analysis. FINDINGS: Three themes were identified: (1) Considerations when seeking maternity care, (2) Differing preferences and satisfaction levels, (3) Hopes for better perinatal care for mothers and babies. DISCUSSION: Most mothers preferred seeking hospital-based antenatal care and were more inclined to do postnatal follow-ups in polyclinics. Factors like accessibility, cost and perceived expertise of healthcare providers influenced the decision-making. Maternal satisfaction with care services also fluctuated based on interpersonal factors and whether their informational needs were met. CONCLUSION: Overall, mothers' perceptions of maternity services were positive. Findings suggest the possibility of further expanding maternity services in community settings to increase professional support for mothers. Future research is needed to ascertain these findings in non-English speaking and non-subsidized settings.

Norm Entrepreneurship in Digital Trade: The Singapore-led Wave of Digital Trade Agreements.

Rulemaking in digital trade is proceeding apace. Many preferential trade agreements contain dedicated e-commerce or digital trade chapters and some states have entered into stand-alone digital economy agreements. This article seeks to establish whether, and to what extent, normative change is occurring in digital trade agreements, the nature of any changes, and identify which states are acting as norm entrepreneurs. We employ a new method of legal coding, systematically comparing the nature and prescriptiveness of digital provisions in 12 trade agreements concluded between 2019 and 2023. We find evidence of substantial policy innovation, and identify Singapore as the key norm entrepreneur. A new wave of 'Singapore-led' agreements substantially expands the scope of digital trade, to cover areas such as digital identities, e-invoicing and e-payments, the governance of AI, and regulation of new digital technologies. Commitments are typically couched as soft rather than hard law, reflecting the nascent stages of rulemaking. Norm entrepreneurship on the part of Singapore and its allies reflects a desire to position themselves as 'digital hubs' in the global economy, spur rulemaking in areas where innovation is ahead of regulation, and promote digital interconnectivity at time of regulatory divergence and geopolitical rivalry.

Disabling foot pain and its impact on daily living among people with psoriatic arthritis in Singapore: a cross-sectional observational investigation.

BACKGROUND: Psoriatic Arthritis (PsA)-related foot involvement has been shown to have a profound impact on daily functioning, with most studies having focused on predominantly Caucasian populations. The aim was to describe disabling foot pain (DFP) and its impact on daily living in PsA in Singapore. METHODS: A cross-sectional, retrospective study was conducted using clinical data collected during a single-visit to a rheumatology clinic in Singapore. Records for adults with physician-diagnosed PsA were reviewed for sociodemographic information, disease characteristics, global disease activity and burden. Foot-specific measures included clinical assessment and the Manchester Foot Pain and Disability Index used to define DFP and evaluate between-group differences. RESULTS: Forty-two participants with PsA (83% female, 57% Chinese, 31% Malay, 9.5% Indian, mean (SD) age 54-years (16)) attended the rheumatology clinic over the study-period. The median (IQR) disease duration was 2-years (11) and all were taking current DMARDs. Global disease measures demonstrated mild-to-moderate global disease activity and mild functional impairment, and were significantly higher in those with DFP. Despite 90% reporting to be coping well with their condition, self-care and having emotional support (n = 38), this study sample demonstrated high levels of anxiety/depression (29%), sleep disturbance (34%) and fatigue (24%), and a lack of disease- and drug-specific knowledge (64%). Further management was indicated for medication adherence counselling (48%), occupational therapy (43%), physiotherapy (36%) and podiatry (30%). Nearly half had current foot pain with 40% reporting DFP (n = 17), which caused significantly greater difficulty walking 3 km than those without DFP (p < 0.05). Rearfoot enthesitis (plantar fasciitis, Achilles enthesitis) was the most common cause of DFP (67%) with pain lasting longer than 1-year. 72% were overweight or obese, with a high proportion not engaging in any cardiovascular exercise (70%). Three of 42 participants had previously seen a podiatrist. CONCLUSIONS: People with DFP in PsA experience more severe global disease activity, reduced mobility and higher levels of negative impact on their daily lives in Singapore. In the absence of working in a multidisciplinary-team, there is value in comprehensive assessments that have potential to capture a holistic view of personal impact and improve person-centred care in PsA.

The Essential Function of Cathepsin X of the Orange-spotted Grouper, Epinephelus coioides during SGIV Infection.

Cathepsin X, a class of cysteine proteases in the lysosome, involved in intracellular protein degradation processes. Numerous reports revealed that many kinds of cysteine proteases played a crucial role in pathogen invasion. To investigate the relationship between cathepsin X of teleost fish and virus infection, EcCX was cloned and characterized in the orange-spotted grouper, Epinephelus coioides. The open reading frame (ORF) of EcCX included 909 nucleotides and encoded a protein consisting of 302 amino acids, which shared 75% and 56% identity with zebrafish and humans, respectively. The protein EcCX mainly consisted of a signal peptide (1-19 aa), a pro-pre-peptide region (20-55 aa), and a mature cysteine protease region (56-302 aa). Subcellular localization analysis showed that EcCX was mainly distributed in the cytoplasm, but EcCX ectoped to the vicinity of apoptotic vesicles in FHM cells during SGIV infection. Following stimulation with SGIV or Poly (dA:dT), there was a notable rise in the expression levels of EcCX. EcCX overexpression facilitated virus infection, upregulated the production of inflammatory factors, and induced the activation of the NF-κB promoter. Furthermore, the overexpression of EcCX also accelerated the process of SGIV-induced apoptosis, potentially by enhancing the promoter activity of P53 and AP-1. Overall, our findings demonstrated a correlation between the function of EcCX and SGIV infection, providing a new understanding of the mechanisms involved in fish virus infection.

Health Services Costs of Clinical Heart Failure With Reduced Ejection Fraction in Singapore.

OBJECTIVES: This study aimed to estimate the annual healthcare burden of heart failure (HF) with reduced ejection fraction (<40%) in Singapore. METHODS: Retrospective longitudinal descriptive cohort study was conducted using a linked national administrative data set (Singapore Cardiovascular Longitudinal Outcomes Database). In Singapore, during 2011, there were a total of 3267 HF-related hospital admissions. Among these, 1631 patients (49.9%), who had an ejection fraction of less than 40%, were followed up for 9 years. The primary outcomes were annual healthcare costs related to hospital admissions and outpatient visits. RESULTS: There was a consistent decline in HF-related hospital admissions over the years, and the average per-hospital admission cost and average cost per day for HF varied over the 9 years. The average all-cause per-patient admission cost remained stable annually, ranging between S$16 000 and S$18 800. In the final year of life, there was a significant increase in both all-cause and HF-related hospital admission costs (by 24% and 54% from the previous year, respectively), and this rise in costs reflected increased frequency of admissions and longer hospital stays. There was an upward trend in the cost of outpatient visits as the patients neared death. CONCLUSIONS: Hospital-based HF care imposes a significant financial impact on Singapore's healthcare system. This suggests a need for cost-efficient management strategies to reduce the reliance on hospital-based treatment, thus mitigating economic pressures on the healthcare system.

Examining bystander intervention for peer depression and sociodemographic correlates among university students in Singapore.

Introduction: The Advancing Research To Eliminate Mental Illness Stigma (ARTEMIS) study evaluated the impact of an intervention developed and implemented in Singapore on attitudes towards depression in university students. We aimed to assess the likelihood of university students intervening when their peers suffer from depression, before and after the ARTEMIS intervention. Methods: 390 students were recruited from a university in Singapore. The ARTEMIS intervention comprised a lecture by a trained mental health professional, a sharing session by a person with lived experience of depression, and a question-and-answer segment with a panel. The Bystander Intervention Scale for Depression (BISD) was administered at baseline, post-intervention, and 3-month follow-up. BISD assessed four factors: acceptance of responsibility to intervene, knowledge on how to intervene, awareness of depression among peers, and vigilance towards possible symptoms of depression. Linear mixed models were conducted to investigate associations. Sociodemographic correlates were also examined. Results: A favourable shift in all factors was observed at post-intervention, which weakened at 3-month follow-up. Having past experience in the mental health field (ß=1.50) and older age (ß=0.18) were significantly associated with knowledge on how to intervene. Having social contact with mental illness (SCMI) and past experience in the mental health field (PEMHF) were significantly associated with awareness of depression among peers (SCMI ß=0.89, PEMHF ß=0.43) and vigilance towards possible symptoms of depression (SCMI ß=0.39, PEMHF ß=0.61). Discussion: The short-term results of the intervention appeared promising across all BISD factors; however, these results were not sustained after 3 months. Future research should include the impact of 'booster' interventions over time. Sociodemographic factors that were identified to be significant correlates should also be considered when planning for future interventions.

Associations Between Anthropogenic Factors, Meteorological Factors, and Cause-Specific Emergency Department Admissions.

Unpredictable emergency department (ED) admissions challenge healthcare systems, causing resource allocation inefficiencies. This study analyses associations between air pollutants, meteorological factors, and 2,655,861 cause-specific ED admissions from 2014 to 2018 across 12 categories. Generalized additive models were used to assess non-linear associations for each exposure, yielding Incidence Rate Ratios (IRR), while the population attributable fraction (PAF) calculated each exposure's contribution to cause-specific ED admissions. IRRs revealed increased risks of ED admissions for respiratory infections (IRR: 1.06, 95% CI: 1.01-1.11) and infectious and parasitic diseases (IRR: 1.09, 95% CI: 1.03-1.15) during increased rainfall (13.21-16.97 mm). Wind speeds >12.73 km/hr corresponded to increased risks of ED admissions for respiratory infections (IRR: 1.12, 95% CI: 1.03-1.21) and oral diseases (IRR: 1.58, 95% CI: 1.31-1.91). Higher concentrations of air pollutants were associated with elevated risks of cardiovascular disease (IRR: 1.16, 95% CI: 1.05-1.27 for PM10) and respiratory infection-related ED admissions (IRR: 2.78, 95% CI: 1.69-4.56 for CO). Wind speeds >12.5 km/hr were predicted to contribute toward 10% of respiratory infection ED admissions, while mean temperatures >28°C corresponded to increases in the PAF up to 5% for genitourinary disorders and digestive diseases. PM10 concentrations >60 µg/m3 were highly attributable toward cardiovascular disease (PAF: 10%), digestive disease (PAF: 15%) and musculoskeletal disease (PAF: 10%) ED admissions. CO concentrations >0.6 ppm were highly attributable to respiratory infections (PAF: 20%) and diabetes mellitus (PAF: 20%) ED admissions. This study underscores protective effects of meteorological variables and deleterious impacts of air pollutant exposures across the ED admission categories considered.

Donor-derived infections-Insights from Singapore, Japan, and Thailand.

BACKGROUND: Solid organ transplantation (SOT) has expanded significantly in Asia over past few decades. Donor-derived infections (DDIs) remain a significant concern as they may adversely impact transplant outcomes. We aim to review the existing regulatory frameworks, screening protocols, and management practices for DDIs in Asia. METHODS: We reached out to transplant infectious diseases experts in Asia to provide standardized data on annual SOT numbers, incidence of DDIs, regulatory frameworks, donor and recipient screening protocols, and DDI surveillance measures. We present the data from Singapore, Japan, and Thailand. RESULTS: Donor screening for HIV, hepatitis B, hepatitis C, and syphilis is mandatory in all countries. Additionally, Japan screens for HTLV-1 antibody due to its endemicity. We also reviewed the protocols for screening and prevention of endemic infections in Asia. Singapore is the only country implementing universal screening for all donors for dengue, Zika, and chikungunya via blood and urine RT-PCR. Strongyloidiasis screening is not routinely done, although some transplant centers empirically give ivermectin prophylaxis to organ recipients. Tuberculosis screening with a donor questionnaire and chest radiograph is common for deceased donors, and some centers do Interferon Gamma Release Assay test for living donors. We also found a significant gap in the surveillance and reporting of potential DDIs in Asia and the overall incidence of DDIs in Asia is unknown and likely underreported. CONCLUSION: The experiences of Singapore, Japan, and Thailand offer valuable insights into current practices and the unmet needs regarding a DDI registry and call for coordinated efforts to address this critical issue in the region.

A qualitative study on general practitioners' perspectives on late-life depression in Singapore-part I: patient presentations and behaviours.

Background: Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting. Methods: Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis. Findings: To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families' involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients. Interpretation: Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs' ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families. Funding: This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project "Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients' Voice in Primary Care" [NUHSRO/2022/049/NUSMed/DFM].

The two lives of the Mental Capacity Act: rethinking East-west binaries in comparative analysis.

The Mental Capacity Act 2005 in England and Wales and Singapore's Mental Capacity Act 2008 (which substantially transplants provisions from the former statute) might appear to be twins on paper, but they have gone on to lead very different lives. In this article, we examine how two broadly identical laws have taken on divergent identities within their respective jurisdictions when implemented and interpreted in the courtroom. We reveal and analyse differences in parliamentary intent concerning at what stage a person's decision-making agency is putatively empowered; judicial development of central concepts; underlying socio-cultural commitments; and outline opportunities for bi-directional learning in mental capacity law across both jurisdictions.

Crisis and Emergency Risk Communication and Emotional Appeals in COVID-19 Public Health Messaging: Quantitative Content Analysis.

BACKGROUND: Although COVID-19 is no longer a global health emergency, it remains pervasive in Singapore, a city-state situated in Southeast Asia, with periodic waves of infection. In addition to disease management, strong communication strategies are critical in the government's response to the pandemic to keep the public updated and equip them in protecting themselves. OBJECTIVE: Grounded in the crisis and emergency risk communication (CERC) framework and emotional appeals, this study aimed to analyze public health communication strategies in Singapore during the COVID-19 pandemic. METHODS: Quantitative content analysis was conducted on 696 Facebook (Meta Platforms Inc) posts and 83 website articles published by Singapore-based public health institutions between January 2020 and September 2022. RESULTS: The results showed that increasing communication on message themes, such as inquisitive messaging and clarification, can enhance communication strategies. The use of emotional appeals also varies with time and should be carefully used as they are context-specific. CONCLUSIONS: Theoretically, this study contributes to advancements in the CERC framework and concepts of emotional appeals by exploring the applications and changes of CERC message types and emotional appeals at different phases. The findings can provide practical guidance for authorities and communication practitioners in developing effective communication strategies.

Cross-cultural adaptation and content validation of the Singapore English version of EQ-5D-Y: a qualitative study.

BACKGROUND: The EQ-5D-Y is a generic preference-weighted measure for children and adolescents which was developed within Europe. Two versions exist, the EQ-5D-Y-3L (Y-3L) and EQ-5D-Y-5L (Y-5L). This study aimed to cross-culturally adapt the Y-3L and Y-5L for use in Singapore and to assess the content validity, specifically, the relevance and comprehensiveness of the EQ-5D-Y descriptive system (DS) in Asia. METHODS: To culturally adapt the instruments, an expert panel consisting of paediatricians and primary school educators were consulted. Modifications suggested by the expert panel were tested via cognitive debriefing interviews with children aged 8-12 in Singapore. To assess the content validity of the EQ-5D-Y DS, interviews were conducted with both healthy (n = 8) and ill children (n = 6) aged 8-15. In the interviews, children discussed their experience with poor health and commented on the comprehensiveness and relevance of the EQ-5D-Y DS. RESULTS: The cross-cultural adaptation process led to minor modifications to the UK English Y-3L and Y-5L versions, including using phrases familiar to the local children and adding examples to facilitate understanding. The five health dimensions in the EQ-5D-Y DS were spontaneously elicited when children discussed their experience with poor health. All health dimensions related to poor health elicited from the interviews fell into three broad categories: physical health (e.g. Appetite, Mobility, and Sleep), mental well-being (e.g. Annoyed/Frustrated and Scared/Worried), and social relationships (e.g. Family and Friends). The EQ-5D-Y DS was generally found to be relevant and comprehensive, although some health dimensions that may be relevant to the local population (Social relationship and Appetite) were not covered. CONCLUSIONS: The UK English EQ-5D-Y instruments were adapted to produce the Singapore English EQ-5D-Y instrument that were comprehensible to local children as young as 8 years old. The EQ-5D-Y DS was generally relevant and comprehensive to measure poor health of local children. Future studies should ascertain the benefits of adding bolt-on items related to social relationships and appetite to the EQ-5D-Y DS.

Adding Hyponatremia to the "Rule-of-6" Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes.

The 'rule-of-6' prediction tool was shown to be able to identify COVID-19 patients at risk of adverse outcomes. During the pandemic, we frequently observed hyponatremia at presentation. We sought to evaluate if adding hyponatremia at presentation could improve the 'rule-of-6' prediction tool. We retrospectively analysed 1781 consecutive patients admitted to a single tertiary academic institution in Singapore with COVID-19 infection from February 2020 to October 2021. A total of 161 (9.0%) patients had hyponatremia. These patients were significantly older, with more co-morbidities and more likely to be admitted during the Delta wave (2021). They were more likely to have radiographic evidence of pneumonia (46.0% versus 13.0%, p < 0.001) and more adverse outcomes (25.5% vs. 4.1%, p < 0.001). Hyponatremia remained independently associated with adverse outcomes after adjusting for age, lack of medical co-morbidities, vaccination status, year of admission, CRP, LDH, and ferritin. The optimised cut-off for serum sodium in predicting adverse outcomes was approximately <135 mmol/L as determined by the Youden index. Although derived in early 2020, the 'rule-of-6' prediction tool continued to perform well in our later cohort (AUC: 0.72, 95%CI: 0.66-0.78). Adding hyponatremia to the 'rule-of-6' improved its performance (AUC: 0.76, 95%CI: 0.71-0.82). Patients with hyponatremia at presentation for COVID-19 had poorer outcomes even as new variants emerged.

Predictors of mortality in culture-proven Burkholderia pseudomallei infections in a Singapore Tertiary Hospital.

Burkholderia pseudomallei is a pathogen expanding in geographic range. We performed a retrospective study analyzing the clinical, microbiologic features of culture-proven melioidosis, and predictors of mortality based on data from a Singapore tertiary hospital between 2006- 2016. We found ICU admission, bacteremia, and mechanical ventilation to be associated with mortality.

Preuniversity Students' Perceptions and Attitudes About an Anatomy and Physiology Outreach Program: Survey Study and Inductive Thematic Analysis.

BACKGROUND: Science and health outreach activities are aimed at motivating and sparking interest among prospective students to pursue careers in these fields; however, research studies supporting this hypothesis are limited. OBJECTIVE: The aim of our study was to organize an integrated Anatomy and Physiology outreach to examine preuniversity students' learning experiences (learning tools, activities, and facilitators) and motivation to pursue a career in health care and to gather evidence on their attitudes and perceptions of such activities. METHODS: A 2-day course on cardiorespiratory and gastrointestinal anatomical systems was presented at the Lee Kong Chian School of Medicine in Singapore using its key pedagogies, that is, multimodal practical and team-based learning. Ninety preuniversity students from 21 preuniversity institutions in Singapore participated in this 2-day course, and their experiences were evaluated using a 4-point Likert scale and open-ended survey questions. Free-text comments were analyzed using inductive thematic analysis. RESULTS: The survey using the 4-point Likert scale was completed by 81 (92%) of the 88 participants. Most students felt that the course materials were adequate (mean 3.57, SD 0.57) and met the learning objectives (mean 3.73, SD 0.52). The students felt that the instructors were clear (mean 3.73, SD 0.52) and effective (mean 3.70, SD 0.53). They liked the organization of the outreach session (mean 3.64, SD 0.48) and were highly motivated to study medicine or allied/biomedical sciences (mean 3.69, SD 0.54). Practical and team-based learning were regarded as exceedingly satisfactory (mean 3.63, SD 0.53 and mean 3.58, SD 0.54, respectively). All the respondents said that they would recommend this course to peers. Thematic analysis revealed that the participants gained a new perspective of the human body structure and function, they liked the unique learning settings, they were motivated to pursue a career in health care, they were satisfied with the sessions, and interactions with the facilitators increased their understanding of the human anatomy and physiology. CONCLUSIONS: Structured health outreach activities provide students with unique opportunities to experience a preclinical learning environment in a medical school, deepen their understanding of human body structure and function, and increase their motivation and interest in science. Further, outreach programs may lay the foundations for potential students aiming to pursue health profession education.

Patients' Expectations of Doctors' Clinical Competencies in the Digital Health Care Era: Qualitative Semistructured Interview Study Among Patients.

BACKGROUND: Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients' expectations of doctors' clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. OBJECTIVE: This study explores patients' perceptions of doctors' use of DHTs in clinical care. Using Singapore as a case study, it examines patients' expectations regarding doctors' communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. METHODS: Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. RESULTS: Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor's efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. CONCLUSIONS: By identifying patients' expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients' expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era.

Prevalence of dermatoses in geriatric singaporeans in the community - a cross-sectional study.

BACKGROUND: Little is known about the prevalence of dermatoses in "skin-well" geriatric Singaporeans. We aim to identify the prevalence of dermatoses and their associations within the geriatric population in Singapore, and to understand the distribution of dermatological encounters presenting to primary care physicians, and the resultant referral behaviour. METHODS: A joint quantitative-qualitative study was performed across 8 months. Patients aged 65 years and above who visited a local polyclinic for management of non-dermatological chronic diseases were recruited. They were administered questionnaires, and underwent full skin examinations. Online surveys were disseminated to polyclinic physicians under the same healthcare cluster. RESULTS: 201 patients and 53 physicians were recruited. The most common dermatoses identified in patients were benign tumours and cysts (97.5%), and asteatosis (81.6%). For every 1-year increase in age, the odds of having asteatosis increased by 13.5% (95% CI 3.4-24.7%, p = 0.008), and urticarial disorders by 14.6% (95% CI 0.3-30.9%, p = 0.045). Patients who used any form of topical preparations on a daily basis had higher odds of having eczema and inflammatory dermatoses (OR 2.51, 95% CI 1.38 to 4.56, p = 0.003). Physicians reported dermatological conditions involving 20% of all clinical encounters. Eczema represented the most commonly reported dermatosis within the first visit. 50% of dermatology referrals were done solely at the patient's own request. CONCLUSION: The prevalence of dermatoses in the elderly in Singapore is high, especially asteatosis. Prompt recognition by the primary healthcare provider potentially prevents future morbidity. Outreach education for both primary care physicians and the general public will be key. ETHICS APPROVAL: National Healthcare group (NHG) Domain Specific Review Board (DSRB), Singapore, under Trial Registration Number 2020/00239, dated 11 August 2020.