Multisystem inflammatory syndrome in children (MIS-C) of a toddler initially presenting with fever and pyuria.

We report a case of multisystem inflammatory syndrome in children (MIS-C) in an East Asian toddler. He presented with a 2-day history of fever and pyuria, 5 weeks before that he had recovered from COVID-19. He was initially treated as urinary tract infection.

A 5-year community program in Singapore to prevent cognitive decline.

Introduction: There is a scarcity of naturalistic follow-up studies on cognitive stimulating activities (CSAs), particularly in a real-world setting and over long-term. We thus investigated a pooled novel CSA intervention to prevent cognitive decline amongst community-dwelling older adults without dementia.

Methods: Nested within a community-based longitudinal follow-up cohort study of community-dwelling and multi-ethnic older adults (N = 991), a subset of the cohort (n = 264) underwent four single-blinded randomized controlled trials involving four novel CSAs, including mindfulness, horticulture, art therapy, and choral singing.

Evolution of paediatric eating disorders in Singapore: a historical cohort study.

Objective: Most eating disorders (EDs) develop during adolescence, impacting a critical period of development. There is limited research on EDs in children in Singapore or the rest of South-East (SE) Asia.

Design: We analysed a hospital-based cohort of paediatric patients (≤18 years) with EDs (n=177) in Singapore between 2011 and 2021.

Mindfulness Awareness Practice (MAP) to Prevent Dementia in Older Adults with Mild Cognitive Impairment: Protocol of a Randomized Controlled Trial and Implementation Outcomes.

Background: With an aging population, developing non-pharmacological interventions (NPIs) to delay dementia has become critical. Apart from cognitive decline, dementia is associated with multiple pathophysiology, including increased oxidative stress, dysregulated gene expressions, cytokine, neurotrophin, and stress markers, telomere shortening, and deteriorations in brain connectivity. Although mindfulness practices have been proposed to ameliorate these biological changes, no empirical studies were conducted.

Experience from a Multi-Disciplinary Team Against COVID-19: A Healthcare Perspective.

Globally, the capacity of healthcare systems across continents has been strained and put to the test with the emergence of the Coronavirus disease 2019 (COVID-19) pandemic. The timely need to ensure the availability of healthcare facilities to isolate and manage the surge in COVID-19 cases without overwhelming existing hospital capacity has posed challenges in many countries. In this paper, we discuss the conceptualisation, preparations and operationalisation of a community healthcare facility that was set up within a short time frame to attend to the convalescent needs of a large number of COVID-19 patients in the early phase of handling the pandemic.

Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial.

We conducted a randomized controlled trial to examine choral singing's effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years.

The Art of Remediating Age-Related Cognitive Decline: Art Therapy Enhances Cognition and Increases Cortical Thickness in Mild Cognitive Impairment.

Objective: Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well.

Ageing in Asia: Beyond the Astana Declaration Towards Financing Long-term Care for All Comment on "Financing Long-term Care: Lessons From Japan".

The Astana Declaration on primary healthcare in 2018 was the attempt to revive the ideals of the World Health Organization (WHO) Alma-Ata Declaration 40 years later, together with a call for the political will to provide adequate financing at acceptable quality of care. This approach is taken to achieve the past ideals of Health for All, given the new challenges of universal health coverage. The economic case for primary healthcare is justified against the growing demand due in part to the growing costs of chronic conditions and the rise of ageing population, other than the supply-side factors of the healthcare industry.

Mindfulness improves inflammatory biomarker levels in older adults with mild cognitive impairment: a randomized controlled trial.

Few randomized controlled trials investigated the effects of mindfulness intervention on older adults diagnosed with mild cognitive impairment (MCI). Furthermore, there have been hypotheses and theoretical mechanisms on the benefits of mindfulness intervention on biomarkers of stress, inflammation, and neuroplasticity implicated in MCI that warrant empirical evidence. We conducted a pilot randomized controlled trial to examine whether Mindful Awareness Practice (MAP) improved biomarker levels in older adults with MCI.

Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia.

Objectives: This qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.

Design: Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.

Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study.

Purpose: To determine the effectiveness of Family-Based Therapy (FBT) as a treatment for Anorexia Nervosa (AN) in adolescents in a Singaporean cohort. FBT has proven effective in studies in the West, but no such study has been done in Asia.

Methods: This is a retrospective analysis of a hospital-based cohort, which included all paediatric patients (≤ 18-years) with AN treated at a tertiary hospital in Singapore between 2011 and 2017 (n = 119).

Study Protocol for a Randomized Controlled Trial of Choral Singing Intervention to Prevent Cognitive Decline in At-Risk Older Adults Living in the Community.

: This study is a parallel-arm randomized controlled trial evaluating choral singing's efficacy and underlying mechanisms in preventing cognitive decline in at-risk older participants. : Three-hundred and sixty community-dwelling, non-demented older participants are recruited for a 2-year intervention. Inclusion criteria are self-reported cognitive complaints, early cognitive impairment based on neuropsychological test scores or multiple risk factors of dementia.

Outcome predictors in elderly head and neck free flap reconstruction: A retrospective study and systematic review of the current evidence.

Free flap tissue transfer has become the gold standard for reconstruction of composite head and neck defects. We sought to investigate the efficacy and morbidity of these procedures in the elderly. We retrospectively reviewed 245 head and neck free flap procedures (234 patients).

Legal medicine: assessing mental capacity and writing medical reports for deputy applications.

Medical reports are required to support court applications to appoint a deputy to make decisions on behalf of a person who has lost mental capacity. The doctor writing such a medical report needs to be able to systematically assess the mental capacity of the person in question, in order to gather the necessary evidence for the court to make a decision. If the medical report is not adequate, the application will be rejected and the appointment of the deputy delayed.

Integrating rheumatology care in the community: can shared care work?

Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, "right siting" aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.

Developing a primary care research agenda through collaborative efforts - a proposed "6E" model.

Background: Primary care research is at a crossroad in South Pacific. A steering committee comprising a member of WONCA Asia Pacific Regional (APR) council and the President of Fiji College of General Practitioners garnered sponsorship from Fiji Ministry of Health, WONCA APR and pharmaceutical agencies to organize the event in October 2013. This paper describes the processes needed to set up a national primary research agenda through the collaborative efforts of local stakeholders and external facilitators using a test case in South Pacific.

How do primary care physicians in Singapore keep healthy?

Introduction: Not much is known regarding how primary care physicians (PCPs) in Singapore keep themselves healthy and mitigate ill health. This study aims to determine the health-seeking behaviour of local PCPs and to identify the predictors of local PCPs attaining the recommended level of exercise.

Methods: This study was a cross-sectional questionnaire survey, which included questions on the demographic characteristics, practice profiles and health-seeking behaviour of PCPs.

Education and training in family medicine: progress and a proposed national vision for 2030.

This review provides an update of education and training in family medicine in Singapore and worldwide. Family medicine has progressed much since 1969 when it was recognised as the 20th medical discipline in the United States. Three salient changes in the local healthcare landscape have been noted over time, which are of defining relevance to family medicine in Singapore, namely the rise of noncommunicable chronic diseases, the care needs of an expanding elderly population, and the care of a larger projected population in 2030.

Teacher led school-based surveillance can allow accurate tracking of emerging infectious diseases - evidence from serial cross-sectional surveys of febrile respiratory illness during the H1N1 2009 influenza pandemic in Singapore.

Background: Schools are important foci of influenza transmission and potential targets for surveillance and interventions. We compared several school-based influenza monitoring systems with clinic-based influenza-like illness (ILI) surveillance, and assessed the variation in illness rates between and within schools.

Methods: During the initial wave of pandemic H1N1 (pdmH1N1) infections from June to Sept 2009 in Singapore, we collected data on nation-wide laboratory confirmed cases (Sch-LCC) and daily temperature monitoring (Sch-DTM), and teacher-led febrile respiratory illness reporting in 6 sentinel schools (Sch-FRI).

Qualities of a psychiatric mentor: a quantitative Singaporean survey.

Objective: Psychiatric mentors are an important part of the new, seamless training program in Singapore. There is a need to assess the qualities of a good psychiatric mentor vis-à-vis those of a good psychiatrist.

Method: An anonymous survey was sent out to all psychiatry trainees and psychiatrists in Singapore to assess quantitatively the relative importance of 40 qualities for a good psychiatrist and a good mentor.