Persons with disabilities (PWDs) form an integral part of our community. The Ministry of Social and Family Development (MSF) in Singapore has developed the Enabling Masterplan (EMIC) 2012 – 2016 with the vision of an inclusive society where PWDs are enabled to participate fully. A life course and integrated approach is adopted in caring for such persons with the 4 pillars of early intervention; education and healthy lifestyle; employment; and adult care. Five cross cutting issues need to be addressed: caregiver support and transition management; manpower and technology; Transport; Public education; and accessibility. Family Physicians being the medical practitioners in the frontline of medical care are touchpoints in accessibility to healthcare services and benefit schemes for this group of people.

A review was made of the current literature on cardiovascular diseases. The following key findings were found: (1) CVDs need to be reduced in Singapore and worldwide. (2) CVD risk assessment tools are population specific – use the FRS modified score for Singapore. (3) New ideas about therapeutic lifestyle change as primary prevention are to take note of the individuals who fail in lifestyle change early and to direct them to alternative strategies; educating patients to reduce sitting time, increasing physical activity, and cardio-respiratory fitness is beneficial; higher protein diets help in creating weight loss and reducing weight regain; trans fats are associated with all-cause mortality, total CHD, and CHD mortality. (4) Paradigm shifts in secondary prevention are: statin treatment intensity recommended in the 2013 ACC/AHA cholesterol treatment guidelines; setting the blood pressure targets for patients with diabetes mellitus to be less than 140/90 mmHg; and noting that the older patient (beyond 70 to 74 years) with diabetes mellitus need to be managed as one would do so with a middle-aged patient. (5) The iCVH model as the 2020 impactful strategy for cardiovascular disease reduction for Americans provides food for thought as a potential Singapore strategy -- Promote in each patient especially the young patient, the simultaneous presence of optimal levels of 4 health behaviours (body mass index, physical activity, nonsmoking status, and diet quality) and reduction of 3 disease factors (total cholesterol, blood pressure, and fasting blood glucose).

Under ElderShield, policyholders who are not able to perform at least 3 of the following ADLs, will be eligible for the insurance pay-outs. The conditions that result in disability in adults can be grouped into six: Disorders from childhood – sequelae of infections, injuries, and intellectual disorders reach adulthood and contribute to the pool of adults with disability; Injuries – spinal cord injuries in younger adults, traumatic brain injury in young and old, musculoskeletal injury in particular hip fractures in the older adult; Cardiovascular system disorders - strokes, ischaemic heart disease, peripheral vascular disease, retinopathy, nephropathy, and neuropathy; Degenerative musculoskeletal disorders – osteoarthritis of the knee, hip; cervical and lumbar spondylosis. Health conditions with a high potential to result in ADL disability are strokes, pelvic/femoral fractures, and osteoporosis. Prevention of strokes through attention to the high risk diseases (obesity, hypertension, diabetes, and hyperlipidemia). In the elderly, falls is an important cause of traumatic brain injury and musculoskeletal injury. Patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.

Emerging infections may be defined as infectious diseases whose incidence in humans has increased in the past 2 decades or threatens to increase in the near future. They include: new infections resulting from changes or evolution of existing organisms; known infections spreading to new geographic areas or populations; previously unrecognised infections appearing in areas undergoing ecological transformation; and old infections re-emerging as a result of antimicrobial resistance in known agents. Emerging infections occur as the result of four groups of factors: novel zoonotic emergence factors; climate change; nonzoonotic emergence factors; and human practices. As frontline doctors, family physicians have at least five roles that they must perform well: participate in global and local surveillance of emerging infections; assist in societal learning; pandemic preparedness; legislation compliance; and antibiotic stewardship.

The scope of health literacy demanded of the present day health services user is broad. Enhancing physician skills consists of improving on 6 things : Recognise and assist patients with low literacy to overcome their information handling problems ; Improve usability of health information ; Improve the usability of health services ; Build knowledge to improve health decision making ; Advocate for health literacy in your organisation ; and Learn more about health literacy.

INTRODUCTION. This 2021 paper is an update of the 2019 version. In this current update, two new items of information added. Firstly, the 2020 Consensus statement of the Taiwan Hypertension Society and the Taiwan Society of Cardiology on HPDM, provided recommendations on additional medications to be considered in uncontrolled morning or night blood pressure (BP) are noted.9 Secondly, the nephroprotective properties of the SGLT-2 inhibitors are highlighted.19 Similar to the content of the 2019 version, four related areas are reviewed. They are (1) BP definition and classification; (2) Hypertension diagnosis; (3) Hypertension and proteinuria in non-diabetic patients; and (4) Proteinuria and hypertension in the patient with diabetes. METHODOLOGY. PubMed searches were done for papers to the above four topics published in the last five years (2014 to 2019). These were supplemented by papers from hand searches. RESULTS. For diagnosis of hypertension, the current cut off of 140/90 mmHg can be reduced to 130/80 to improve cardiovascular outcomes and all-cause mortality. Diagnosis of hypertension should not be based on office BP readings alone. Hypertension in older patients should be treated to prevent worse outcomes and should be individualised. In non-diabetic patients, both low grade and microalbuminuria needs to be treated; adequate BP control is needed to prevent cardiovascular outcomes and all-cause mortality. In the diabetic patient, a BP target of less than 140/90 mmHg applies to most patients, but individualisation of the BP goal is important. CONCLUSIONS. Much development in the management of proteinuria and hypertension has taken place in the last five years.

Obesity is increasing in prevalence in Singapore. This is part of a worldwide phenomenon. Action is being taken in Singapore to prevent and control obesity. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility. The basic strategy of obesity prevention and control however is quite straightforward and lies in achieving the caloric balance which is to reduce calorie intake and increase physical activity. To be effective however, obesity prevention and control requires multiple prevention and control interventions across the lifespan. There is a need for Health Promotion Board (HPB) to engage and mobilise various partners and stakeholders. Policies and programs have been customised in Singapore for different segments of the population and conducted at various settings – in schools, workplaces, healthcare institutions, and communities. The current efforts to prevent and control obesity in Singapore can be grouped into 5 areas: (1) Health promotion policies;(2) Promoting supportive environments through social programmes; (3) HPB collaborating with partners to promote healthy behaviour; (4)Empowering partners and individuals; and (5) Raising awareness through health education and communication.

A 20-day-old previously well neonate presented with a 3-day vesiculopapular rash and was admitted to the paediatrics ward. He received extensive workup and treatment with IV acyclovir. The disease ran a mild, uncomplicated course, and recovery. His mother was found to be immune to varicella, having had the disease as a child. However, her immunity had not transferred to the neonate, which was unexpected. A literature review revealed that maternal varicella antibodies do not necessarily prevent infection but may help the infant avoid severe or complicated disease. A review of the management of neonatal varicella in both the immune and the non-immune mother which put the child at risk is also done. Vaccination of all susceptible young females prior to pregnancy will help to reduce the incidence of neonatal varicella in infants and is strongly encouraged. Vaccination of household contacts especially siblings, is also encouraged. Family Physicians should remain open to the diagnosis of neonatal varicella, even when the mother has a history having chickenpox as a child.

Chronic diseases have a serious impact on individuals and on society in general. They affect the quality of life of individuals and can be a financial burden on those who are affected. There is a disease continuum of lifestyle, high risk diseases, and end organ damage. Lifestyle change is necessary if we are to reduce the prevalence of these chronic diseases. The Health Choices, Lifestyle Advice Resource for Healthcare Professionals provides a tool for lifestyle counselling.