Singapore Residents Research Articles

Stigma towards mental health disorders - Has anything changed?

IntroductionStigma towards mental disorders has been shown to be a major obstacle to recovery and quality of life among people with psychiatric disorders. Despite significant advances in the treatment of mental disorders, stigma remains concerning to patients, caregivers, and healthcare professionals. Singapore is a city state in South-East Asia with a multi-ethnic population. A nation-wide campaign launched in 2018, Beyond the Label, focusing on addressing stigma and promoting social inclusion for persons with mental health conditions.ObjectivesThe aims of the current study were to (i) establish the dimensions of stigma and examine its correlates in the general population of Singapore using a vignette approach, and (ii) examine whether there was any change in stigma levels from 2016 to 2023.MethodsData for the current study comes from an ongoing nation-wide, cross-sectional study of mental health literacy conducted in Singapore since September 2022. The study population comprises Singapore Residents aged 18–65 years who are currently living in Singapore. Respondents were randomly assigned and presented a vignette describing one of seven specific disorders: alcohol abuse, dementia, depression, depression with suicidality, gambling disorder, obsessive-compulsive disorder, and schizophrenia. Stigma was assessed using Personal and Perceived scales of the Depression Stigma Scale (DSS) (Griffiths et al. Br J Psychiatry; 2004 185 342-349), and the Social Distance scale (SDS) (Link et al. Am J Public Health 1999; 89 1328–1333).Results2500 respondents who completed the survey were included in the current analysis. The mean age of the respondents was 42.8 years. A three-factor model comprising ‘weak-not-sick’, ‘dangerous/undesirable’, and ‘social distance’ provided acceptable fit. Multivariable linear regression analyses revealed that younger age, female gender, students, and dementia vignette were significantly associated with lower weak-not-sick scores while Malay and Indian ethnicity, lower education, and alcohol abuse and gambling disorder vignette were significantly associated with higher weak-not-sick scores. Those of Malay and Indian ethnicities and those with a family member or close friend who had problems similar to the person in the vignette were significantly associated with lower social distance scores.A significant decrease (p<0.001) in all three factor scores was observed from 2016 to 2023 (Table 1).Table 1.Mean stigma scores over time20162023FactorsMean (SD)Mean (SD)Weak-not-sick10.2 (2.1)9.5 (2.3)Dangerous/undesirable11.6 (2.8)11.2 (2.7)Social distance12.0 (3.1)11.6 (3.0)ConclusionsOur study found a significant decrease in stigma from 2016 to 2023 in the Singapore population which indicates the positive impact of anti-stigma initiatives in Singapore. Interventions must be co-developed with males, older adults, and those with a lower education to further reduce stigma in this multi-ethnic population.Disclosure of InterestNone Declared

Flourishing or Frightening? Feelings about Natural and Built Green Spaces in Singapore.

The current study's aim was to better understand people's feelings towards different types of natural and built green space environments in the highly urbanized "garden city" of Singapore. We examined which types of green spaces elicited positive (eudemonic) or negative (apprehensive) affective responses. A total of 288 adult residents of Singapore completed a survey that asked them to report their affective states in response to images of 10 locally different environment types and to complete measures of childhood location, frequency of visiting natural/built environments, nature connectedness, and dispositional anxiety, as well as demographic items on age and gender. The 10 green space environment types were mapped onto an experiential state space representing feelings of apprehension and eudemonia in response to specific types of urban green spaces. In terms of a biophilic response, feelings of eudemonia were no different in natural green spaces compared to built green spaces. A higher frequency of experience in specific environments is associated with enhanced feelings of eudemonia in these environments. The findings indicate that people in Singapore can be apprehensive as much in natural green spaces as in built green spaces, and they can also find eudemonic experiences in built green spaces such as roof-top gardens or town parks.

Public awareness of war on diabetes campaign and its association with behavioural outcomes.

The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (β = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.

Ophthalmic primary care in Singapore: Considerations for review

Ophthalmic primary care (OPC) of Singapore residents is mainly provided for by trained specialists. This is due both to the current nature of the public healthcare system as well as societal perceptions and preferences, and it imposes a heavy burden on the country’s ophthalmologist resource. Changing population demographics, escalating costs as well limitations to medical manpower growth have necessitated a shift in Singapore’s healthcare strategy to focus on primary and preventive care. This national policy change further emphasizes the need to invest in OPC as a more structured service. Revisiting the principles of primary care and how they apply to ophthalmology will be an important first step in a timely review of the country’s OPC system.

Development and Evaluation of a Novel Population Needs-Based Sub-Segmentation Model (NBSSM) in Singapore

Background: Population segmentation models are often used to stratify people into groups for care or services planning purposes. These are typically disease-specific or utilisation-based, and target high-risk patient groups. Singapore’s National Health Group (NHG) has developed a River of Life (RoL) segmentation approach stratifying its population into five segments, namely, Living Well, Living with Illness, Crisis and Complex Care, Living with Frailty and Leaving Well. Building on this approach, Yishun Health (YH), a Regional Population Health System under NHG caring for more than 300,000 residents in Northern Singapore, developed the Needs-Based Sub-Segmentation Model (NBSSM) to further stratify Yishun Zone residents who are living with illness and frailty using additional biological, psychological and social criteria. We evaluated the NBSSM’s ability to stratify residents into distinct risk-groups based on a set of person-centred outcomes.&#x0D; Methods: Yishun Zone residents with chronic illness and/or frailty were first identified to generate ‘Living with Illness’ and ‘Living with Frailty’ groups. These residents were further segmented into 10 sub-segments representing different needs and complexity levels, based on biological complexity i.e. number and severity of chronic diseases, as well as presence or absence of psychosocial criteria i.e. presence of mental illness and social issues.&#x0D; To evaluate the NBSSM, we studied its ability to stratify residents into distinct risk-groups using Charlson’s Comorbidity Index (CCI) scores as well as person-centred outcomes such as healthcare utilisation, and healthcare cost. Statistical distinction between NBSSM segments based on the above outcomes was also tested. Data from a Population Health Survey being conducted by YH, which included health behaviours and more detailed mental and social needs data, will next be integrated into the NBSSM to forecast the needs under each sub-segments to enable services planning for segment-specific interventions. &#x0D; Results: All 314,522 Yishun Zone residents were included for RoL segmentation, of which 53,653 residents known to YH were further sub-segmented by the NBSSM according to their biopsychosocial needs. CCI, healthcare utilisation (i.e. number of Emergency Department visits, Specialised Outpatient Clinic visits, admissions and annual bed-days), and annual total healthcare cost were found to be statistically different across the NBSSM segments (p&lt;0.05). Residents with presence of mental health and social issues had significantly higher risk of healthcare utilization and cost.&#x0D; &#x0D; Discussion &amp; Conclusion: Using only data that was readily available data in our electronic medical record system, the NBSSM was able to augment NHG RoL segmentation and effectively sub-segment the Yishun Zone resident population into mutually exclusive and collectively exhaustive groups with similar magnitude of risk of health needs and outcomes. &#x0D; NBSSM enables development of more targeted and aligned clinical governance and leadership of segment-specific interventions through clearer assignment of segment-specific accountability for population outcomes. Integrating comprehensive needs assessment data from the YH Population Health Survey will enable more coherent health system and services planning. &#x0D; In conclusion, needs-based segmentation models are more person-centred than disease-specified or utilization-only segmentation models. NBSSM enhances our health system’s system transformation and service planning capabilities to direct targeted interventions to meet needs and improve population health outcomes.&#x0D;

Health System Transformation Playbook &amp;amp; Unified Care Model: An Integrated Design, Systems &amp;amp; Complexity Thinking Approach for Care Integration &amp;amp; Health System Transformation

In response to rising costs and national health system policy change, the Singapore National Healthcare Group reorganized into three Integrated Care Organizations (ICOs), with Yishun Health (YH) responsible for the health of 320,000 residents in Northern Singapore. YH undertook numerous health system transformation (HST) activities in partnership with health and social care providers to improve outcomes.&#x0D; HST benefits from greater stakeholder involvement that reinforces agency and encourages exaptive innovations, taking system-wide views that generate prescriptive models for change than descriptive models of problems, and embracing iterative re-design through time. Design thinking (DT), systems thinking (ST), and complexity thinking (CT) offer useful methods and tools with inherent limitations. We applied an integrated DT, ST and CT approach (DSCT) to enable HST within our regional population health system through a series of leadership retreats and envisioning workshops with over 100 teams both within YH and with regional partners, and co-created over 1,000 change ideas to transform YH into a people-centred, value-driven, and integrated regional population health system.&#x0D; Health System Transformation Playbook (HSTP) is our DSCT-enabled methodology developed to systematically design, prioritize and test HST actions, anchored on an iterative 3-step process involving story-telling, model building and pathfinding that together tackles the scale of transforming complex adaptive systems through time. HSTP guides that model-building begins with the latest future-state model to ensure new change ideas build on current progress; model boundaries and hierarchy are defined and managed fluidly across scale and time to preserve system coherence; impact analysis of change ideas start at the highest system to optimize primary system purpose, and prescribed interventions with lower agreement or certainty are consciously managed to guard against incremental-only innovations.&#x0D; Also resultant is the YH Unified Care Model (UCM) and its cascade of integrated service delivery models based on UCM design principles: 1) biopsychosocial, needs- and assets-based approach to health, throughout a resident’s life course, for the entire regional population, 2) strength- and relationship-based approach to participatory care involving residents, caregivers and community, 3) single care plan across providers, 4) interactions among providers based on population health needs, are strategic, and organizational, 5) care defined from identification to resolution of needs, and system boundaries are defined by the nature of need, 6) coordination of care to efficiently generate health assets while meeting needs, across all sites and transitions of care, 7) carers and care institutions form an ICO and jointly optimize resident-centred outcomes and population value. In turn, the UCM has generated prescribed interventions and prioritized actions to accelerate YH HST including the Integrated Medical Clinic to meet complex chronic medical and social needs, and the UCM Performance Framework. &#x0D; HST is complex and has potential for unintended systemic consequences, and requires local contextualization. HSTP offers a systemic, practice and learning-based HST and organization development methodology that engages people in all health system sub-systems to accelerate change towards people-centred, integrated and value-driven population health systems, demonstrated through UCM. Deeper resident and stakeholder engagement using HSTP and evaluation of HSTP and UCM is ongoing.

Assessing consumer rationality during a pandemic: Panic buying behaviours and its association with online social media discourse

As an unprecedented, shared global experience in crisis, the Covid-19 pandemic witnessed unusual behaviours amongst populations. Large-scale panic buying was observed in numerous countries. Such behaviours can be detrimental to the population's wellbeing and societal functioning. As global pandemics are a relatively rare phenomenon in history, research examining panic buying behaviours during pandemics and actual panic buying behaviours has been scarce. Within the context of the Covid-19 pandemic, the prevalence of social media has made it possible to monitor panic buying discourse real-time. The present research aims to study the relationship between online public discourse and its relationship with abnormal surges in buying behaviours. We first examined Singapore residents' supermarket purchase patterns based on daily supermarket sales data during Covid-19 and investigated its relationship with parallel social media information on the internet. Analysis involving these two large-scale social media and supermarket datasets revealed distinct purchasing patterns for various types of products such as staple food items and home electronic products. While significant positive correlation was found between purchasing patterns of staple and long-lasting canned foods and online discourse, this was absent for items such as home appliances and entertainment products. The findings point to the potential role of social media data in predicting future abnormal food demand episodes, with implications on food security and crisis management.

Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore.

This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling. The survey was conducted in Singapore. Participants were recruited from the Singapore Population Health Study Online Panel. Participants' mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products. Findings highlighted substantial gaps in participants' knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.

Surveillance of veterinary drug residues in food commonly consumed in Singapore and assessment of dietary exposure

Non-judicious and indiscriminate use of veterinary drugs in animal husbandry may result in accumulation of residues in animal tissues, and consequently in food for human consumption. The abuse of veterinary drugs presents a potential risk to consumer health, especially if the residue level is higher than the health-based guidance value (HBGV) such as the acceptable daily intake (ADI). Contamination of drug residues in food also promotes the emergence of antimicrobial resistance (AMR) which poses a serious threat to public health globally. There has been limited information on the occurrence and dietary exposure to veterinary drug residues in Singapore to date. In this study, the occurrence of four classes of veterinary drugs, namely beta-agonists, coccidiostats, fluoroquinolones and macrolides, were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS) in food widely consumed by Singapore residents. The magnitude of dietary exposure was assessed based on the consumption profile of Singapore population. Out of 216 food samples, 9.72 % were detected positive with veterinary drug residues, where majority of the positive samples were poultry and its derived products, followed by eggs and egg products. 7 veterinary drugs, specifically ciprofloxacin, enrofloxacin, clopidol, diclazuril, lasalocid, nicarbazin and tilmicosin, were detected in the samples, with clopidol and enrofloxacin being the most frequently detected drugs. Dietary exposure was evaluated using the estimated daily intake (EDI) of the detected drugs and benchmarked against the corresponding acceptable daily intake (ADI). All the %ADI values were far less than 100 in both the average and high consumer scenarios, indicating that the health risk associated with dietary exposure to these drugs in Singapore is low.

Physical activity and sedentary time distribution among adult residents during COVID-19 circuit breaker movement restrictions in Singapore: a public health perspective.

Social lockdowns and quarantines have been enforced in various populations to mitigate the spread of coronavirus disease 2019 (COVID-19) in the community. This study investigated the impact of COVID-19 lockdown, known as circuit breaker movement restrictions (CBMR), on physical activity (PA) and sedentary time (ST) distribution patterns among Singapore residents aged 21-65 years. This was a cross-sectional retrospective study that utilised a 44-item questionnaire that included sections to determine PA and ST distribution patterns before and during CBMR. It also included information on sleep duration, PA preference and routine, awareness of local initiatives and perceptions on barriers towards PA during the CBMR period. There was an overall decrease in PA and a significant increase in physical inactivity and ST during the CBMR period. A greater proportion of participants reported sleeping for longer hours, suggesting positive adaptations in sleep habits during CBMR. Majority were unaware of online exercise initiatives and programmes offered during the CBMR period, and >50% of the respondents never used an online resource for exercise. Singapore residents seemed to prefer outdoor and facility-based venues for exercise and PA, and closure of facilities was the primary barrier for PA during the CBMR period. Reduced PA and increased ST during CBMR reflect negative lifestyle adaptations and may have adverse public health implications. Increased sleep duration suggests successful coping, which may consequently lead to physical and mental health benefits. While Singapore adult residents may be flexible with certain aspects of being physically active, they seemed less adaptive to changes in type of exercise, facility and environment.

Green Spaces as Healthy Places: Correlates of Urban Green Space Use in Singapore.

During the COVID-19 pandemic, when stress levels were heightened and social connections were threatened, a spike in green space visits was observed. Drawing upon the value-belief-norm (VBN) theory, which explains the influence of personal values and world view on perceived obligations to the environment and to action, relevant correlates were examined in relation to people's psychological wellbeing in a bid to better elucidate this phenomenon. We aimed to explore the associations amongst a number of protective factors for psychological wellbeing and to examine the applicability of the VBN theory to wellbeing rather than environmental behaviour. Our research aim was to understand some of the correlates of the use of urban green spaces in Singapore during COVID-19. In total, 268 adult residents of Singapore completed an online survey measuring proximity/frequency of visits to green space, value orientations, nature connectedness, social connectedness, religious belief, spirituality and psychological wellbeing, along with sociodemographic variables such as age and gender. As predicted by the VBN theory, biospheric value orientation and spirituality were positively associated with nature connectedness. The nature connectedness association with psychological wellbeing was completely mediated by spirituality. Frequency of visits to nature was also positively associated with nature connectedness. Neither proximity to nature nor social connectedness were associated with nature connectedness. An altruistic value orientation was associated only with religious belief. Our results indicate that during uncertain times, people are drawing on either social or nature connections as coping mechanisms to fulfil psychological needs and enhance psychological wellbeing. Spirituality mediates this pathway for nature connectedness but not for social connectedness.

The Power of Everyday Networks in Nation-Building: The Case of Inter-Ethnic Friendships in Singapore

Abstract While scholars commonly see nation-building as a modernist project or a cultural assertion, we suggest that a “third way” is equally important. Analysing data from a representative survey of 2,001 Singaporean residents collected in 2020 during the COVID-19 pandemic, we demonstrate that everyday social networks have been key to creating and maintaining Singaporean nationalism. We make the point that despite ambitious plans at transforming society, modernist projects must rely upon organic, routinised, and quotidian mechanisms such as friendship-making within and between ethnic groups for national cohesion to materialise.

Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study

Emergence of the SARS-CoV-2 omicron (B.1.1.529) variant with high immune evasion has led to the development and roll-out of bivalent mRNA vaccines targeting original and omicron strains. However, real-world observational data on effectiveness of bivalent vaccines are scarce. We aimed to assess the relative effectiveness of a fourth vaccine dose with the BA.1-adapted or BA.4/BA.5-adapted bivalent vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals in Singapore. We conducted a retrospective cohort study among Singapore residents aged 18 years and older who had received three monovalent mRNA vaccine doses and were eligible for a fourth dose. Data were collected from official databases on COVID-19 cases and vaccinations maintained by the Singapore Ministry of Health. We analysed the incidence of medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission between Oct 14, 2022, and Jan 31, 2023, by previous infection status and type of fourth vaccine dose received. Inverse probability-weighted Cox regressions were used to estimate hazard ratios (HRs). 2 749 819 individuals were included in the analysis. For the SARS-CoV-2-naive group, a fourth monovalent vaccine dose did not confer additional protection over three monovalent doses against symptomatic infection (HR 1·09 [95% CI 1·07-1·11]), whereas the bivalent vaccine did provide additional protection (0·18 [0·17-0·19]). Among individuals with previous infection, the HR was 0·87 (95% CI 0·84-0·91) and 0·14 (0·13-0·15) with receipt of the fourth monovalent and bivalent doses, respectively. Against COVID-19-related hospital admission, the bivalent vaccine (HR 0·12 [95% CI 0·08-0·18] in SARS-CoV-2-naive participants and 0·04 [0·01-0·15] in previously infected participants) conferred greater benefit compared with the fourth monovalent dose (0·84 [0·77-0·91] in SARS-CoV-2-naive participants and 0·85 [0·69-1·04] in previously infected participants). A fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. None.

A qualitative study of Singaporean perspectives on returning to work after stroke.

Post-stroke return-to-work (RTW) rates reported in Singapore ranged between 38% and 55%, indicating challenges in the RTW process among individuals with stroke. We sought to understand the lived experience of returning to work among individuals with stroke in Singapore. This was a qualitative study using a phenomenological approach. We recruited individuals with stroke who were citizens or permanent residents of Singapore. We conducted semi-structured interviews to collect data on their lived experience of returning to work and analyzed the interview data inductively. Twenty-seven participants completed the interviews. Their median age was 61 years (interquartile range = 54 - 64). They were mostly male (n = 19, 70.4%) and married (n = 21, 78%). Twenty participants (74%) returned to work after their stroke. Three major themes emerged from the interviews that underpinned the participants' RTW experience. They were i) direct impact of stroke, ii) realignment of life priorities, and iii) engagement with support and resources. RTW after stroke is complex and influenced by personal and environmental factors. Our findings suggest that individuals with stroke need continuing support to overcome stigma and discrimination, to manage expectations of their recovery process, and to better navigate resources during their RTW process in Singapore. We recommend future studies to design and test the feasibility of appropriate interventions based on our proposed strategies to better support individuals with stroke to return to work.

Age and adult attachment style predict psychological distress in the Singapore general population during COVID-19

ABSTRACT To date, there is increasing evidence to suggest that age and adult attachment styles, such as secure, anxious and avoidant attachment are predictive or protective for psychological distress. The study aimed to investigate the extent to which age and adult attachment style, measured by the Attachment Style Questionnaire, predicted psychological distress, measured by the Kessler 10 Psychological Distress Scale, in the Singapore general population during COVID-19. Ninety-nine residents of Singapore (44 females, 52 males, 3 prefer not to state their gender) aged between 18 and 66 completed an online survey, which collected information on age, adult attachment styles and levels of psychological distress. Multiple regression analysis was performed to study the influence of predictive factors on psychological distress. The study identified 20.2%, 13.1% and 14.1% of participants reporting psychological distress at the mild, moderate and severe levels, respectively. The study also reported that age and psychological distress were negatively correlated, and that psychological distress was negatively correlated with both anxious and avoidant attachment styles. It was concluded that age and adult attachment style significantly predicted psychological distress in the Singapore general population during COVID-19. Further studies exploring other variables and risk factors are required to further consolidate these results. At the global level, these findings may help countries predict residents’ reactions to future outbreaks and help them prepare strategies and approaches to address these situations.

Second-hand smoke and fine particulate matter exposures among multi-unit housing residents in Singapore: A pilot study

Globally, approximately 1.2 million deaths among non-smokers are attributed to second-hand smoke (SHS) per year. Multi-unit housing is becoming the common type of residential dwelling in developed cities and the issue of neighbour SHS is of rising concern especially as ‘Work From Home’ became the norm during and post COVID-19 pandemic. The objective of this pilot study is to measure and compare the air quality of households that are exposed to SHS and unexposed households among smoking and non-smoking households in Singapore. A total of 27 households were recruited from April to August 2021. Households were categorized into smoking households with neighbour SHS, smoking households without neighbour SHS, non-smoking households with neighbour SHS, and non-smoking household without neighbour SHS. Air quality of the households was measured using calibrated particulate matter (PM2.5) sensors for 7–16 days. Socio-demographic information and self-reported respiratory health were collected. Regression models were used to identify predictors associated with household PM2.5 concentrations and respiratory health. Mean PM2.5 concentration was significantly higher among non-smoking households with neighbour SHS (n = 5, mean = 22.2, IQR = 12.7) than in non-smoking household without neighbour SHS (n = 2, mean = 4.1, IQR = 5.8). Smoking activity at enclosed areas in homes had the lowest PM2.5 concentration (n = 7 mean = 15.9, IQR = 11.0) among the three smoking locations. Exposure to higher household PM2.5 concentration was found to be associated with poorer respiratory health. A ‘smoke-free residential building’ policy is recommended to tackle the issue of rising neighbour SHS complaints and health concerns in densely populated multi-unit housing in Singapore. Public education campaigns should encourage smokers to smoke away from the home to minimize SHS exposure in household members.

Obliged smart freedom: The Singaporean experience of advanced neoliberal-developmental governance

Despite criticism, the smart city solutionist rhetoric has gained popularity and investment across the world. In response, this paper interrogates the notion of neutrality in smart city projects and investigates the resulting rationales of the smart brand as a technology of control. The paper develops Nikolas Rose’s argument that a central tenet of liberal governance is to create, and then obligate, a desirable form of freedom, through a framework of economic maximisation, self-responsibility and autonomy. This framework is applied to the Singaporean Smart Nation as a neoliberal-developmental state to consider how the Smart City can be understood as a governance technique. The research is undertaken through a mixed method analysis to unpick the discursive frameworks shaping how individuals navigate the smart city. This approach identifies one of the many ways realities have become governable, to provide a relational perspective through the juxtaposition of government and citizen experiences. Data is drawn from three key government documents, an online survey of Singaporean residents ( n = 255), and key informant interviews ( n = 9). The results demonstrate the potential of the digital environment of Singapore to oblige freedom to engender a compliant population. In addition, the Singaporean case highlights the need for contextualised analysis of smart city projects to explore the governance potential, especially beyond the western perspective.

Emergency and Disaster Preparedness Amongst Emergency Medicine Residents in Singapore

Introduction:Emergency Medicine (EM) physicians are crucial members of the disaster medical response. In Singapore, the EM residency program spans five years, with junior residents (JRs) progressing to senior residents (SRs) in three years after passing the MRCEM exam or its local equivalent. This study aims to assess the knowledge, attitudes and perceptions toward disaster medicine among EM residents in Singapore.Method:A cross-sectional study was performed for 90 EM residents for the academic year 2020/2021. A self-administered, 44-item online questionnaire based on the Emergency Preparedness Information Questionnaire (EPIQ) was delivered via GoogleForms™. This assessed familiarity through 10 dimensions, with a minimal score of one and a maximal score of five. The survey also included questions on attitudes towards emergency preparedness and preferred learning methods. Data was collected from May 2020 to November 2020, and analyzed with SPSS.Results:The response rate was 41%. Of these, 75% were JRs and 25% SRs. The overall mean familiarity with disaster preparedness was 2.43 ± 0.90. There was no statistically significant difference of overall mean familiarity between JRs and SRs. Overall, they fared best in the dimension on isolation &amp; quarantine with a mean score of 2.91 ±1.05 and worst in the dimension on psychological issues with a mean score of 2.34 ±0.95.Residents felt that disaster medicine was relevant to their practice with a mean score of 4.22 ± 0.98. They also felt that it was necessary to learn more about it, with a mean score of 4.16 ±0.90. The highest ranked preferred learning method was workshop/simulation training (45.5%), followed by lectures (23.4%).Conclusion:EM Residents have a poor overall familiarity with emergency preparedness, however, they recognized its importance and relevance. The preferred formats of learning were simulation/workshop training. More must be done to improve the overall competency of EM residents in disaster medical response.

Psychological antecedents of telehealth acceptance: A technology readiness perspective

The ongoing coronavirus pandemic has been threatening the healthcare system. In this context, telehealth is a potential solution to deliver effective and safe health care to the public. To facilitate the application and acceptance of telehealth, a good understanding of psychological determinants is of great importance. Therefore, this study aims to examine the public's positive and negative mindsets towards telehealth. A theoretical model was established by employing the technology readiness model and perceived value theory. To empirically test the relationships between constructs, a total of 500 responses from residents in Singapore were collected; thereafter, structural equation modeling was performed. The results indicate that discomfort negatively impacts perceived value whereas optimism and innovativeness positively impact users' perceived value. Further, perceived value positively impacts the acceptance of telehealth via attitude. Demographic factors (i.e. internet literacy, age, education) can also influence certain aspects of technology readiness (e.g. innovativeness, optimism). Moreover, social influence is an important moderator between perceived value and the acceptance of telehealth. The empirical findings enhance the understanding of users' psychology concerning telehealth and provide policy recommendations regarding the development of telehealth to improve public health.

Isocaloric Substitution of Plant-Based Protein for Animal-Based Protein and Cardiometabolic Risk Factors in a Multiethnic Asian Population

BackgroundEvidence is accumulating that intake of animal-based and plant-based proteins has different effects on cardiometabolic health, but less is known about the health effect of isocaloric substitution of animal-based and plant-based proteins. Data from Asian populations are limited. ObjectivesThis study aimed to evaluate the effects of isocaloric substitution of total plant-based proteins for total and various animal-based protein food groups and to evaluate the effects of substituting protein from legumes and pulses for various animal-based protein food groups on cardiovascular disease (CVD) risk factors and predicted 10-y CVD risk. MethodsWe conducted a cross-sectional analysis using data collected from 9211 Singapore residents (aged 21–75 y) from the Singapore Multi-Ethnic Cohort. Data on sociodemographic and lifestyle factors were collected using questionnaires. Dietary intakes were assessed using a validated FFQ. BMI, waist circumference, and blood pressure were measured during a physical examination, and blood samples were collected to measure lipid profiles. Associations were assessed by substitution models using a multiple linear regression analysis. ResultsIsocaloric substitution of total plant-based proteins for total and all specific animal-based protein food groups were associated with lower BMI (β: −0.30; 95% CI: −0.38, −0.22), waist circumference (β: −0.85; 95% CI: −1.04, −0.66), and LDL cholesterol concentrations (β: −0.06; 95% CI: −0.08, −0.05) (P < 0.0056). Replacement of processed meat and processed seafood proteins with total plant-based proteins was associated with improvement in most CVD risk factors and predicted 10-y CVD risk. Replacement of oily fish with legume proteins was associated with lower HDL cholesterol and higher TG concentrations. ConclusionsThe substitution of plant-based proteins for animal-based proteins, especially from processed meat and processed seafood, was inversely associated with the established CVD risk factors such as BMI, waist circumference, and lipid concentrations and predicted 10-y CVD risk. These findings warrant further investigation in independent studies in other Asian populations.