Yemen has been faced with the worst cholera epidemic of modern times, with more than 1 million suspected cases and 3000 deaths at the time of writing. This problem is largely due to the longstanding civil war between pro-government forces and the Houthi armed movement, which has severely damaged already vulnerable sanitation and healthcare facilities and systems in the country. It is further compounded by a dire lack of basic amenities, chronic malnutrition, and unfavourable weather conditions. Another contributory component may be aerial transfer by cholera-infected chironomid insects. To contain the spread of cholera in Yemen, a nation-wide armistice should be negotiated, and national and local committees must be convened to coordinate efforts on the ground. Community isolation facilities with proper sanitation, reliable disposal systems, and a clean water supply should be set up to isolate and treat sick patients. The continuity of vaccination programmes should be ensured. Public health campaigns to educate local communities about good hygiene practices and nutrition are also necessary. The One Health paradigm emphasizes a multi-sectoral and transdisciplinary understanding and approach to prevent and mitigate the threat of communicable diseases. This paradigm is highly applicable to the ongoing cholera crisis in Yemen, as it demands a holistic and whole-of-society approach at the local, regional, and national levels. The key stakeholders and warring parties in Yemen must work towards a lasting ceasefire during these trying times, especially given the extra burden from the mounting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak worldwide.

Objective To evaluate the feasibility and safety of stent implantation in treating patients with symptomatic vertebral artery kinking.Methods Thirty-six patients with vertebral artery kinking confirmed by DSA and accorded with the stent implantation indications were chosen in our study;these patients were performed stent implantation.The stenosis and haemodynamics changes,and recent and postoperative complications were observed; Malek scale was adopted to evaluate the clinical efficacy during the 1-year follow-up.Results The success rate of stent implantation for patients with symptomatic vertebral artery kinking was 100％.The percentage of stenosis was significantly reduced from(76％±15％)to(8％±3％)after stenting(P＜0.05); the mean flow velocity of kinking lesion was obviously decreased from([45.4±22.3]cr/s)to([31.8±15.1]em/s,P＜0.05); cerebellum hematoma was noted in 1 patient subcutaneous hematoma of puncture point in 2 and femoral artery pseudoaneurysms after the stenting in 1; all these complications did not cause serious consequences.Malek scale indicated that 31 patients got 1 point,3 got 2 points,1 got 3 points,1 got 4 points and no one got 5 points; 31patients were asymptomatic during the 1-year follow-up; no significant in-stent restenosis was found.Conclusion Symptomatic vertebral artery kinking can be treated safely and effectively with stent implantation.

INTRODUCTIONAdvance care planning (ACP) is an important aspect of end-of-life care that has been shown to improve patient autonomy in decision-making and reduce stress for surviving family members. Given the rapidly ageing population in Singapore, a greater emphasis on end-of-life care planning is needed. This study therefore sought to examine the awareness and attitudes of the general Singaporean community towards participating in ACP, which are not known hitherto.

MATERIALS AND METHODSA 24-item interviewer-administered questionnaire was constructed and administered via door-to-door survey amongst community-dwelling residents living in Housing and Development Board (HDB) flats across Singapore, selected via a two-stage stratified random sampling.

RESULTSOf the 406 completed surveys, 14.4% of respondents had heard of ACP (n = 58), mostly through the media (67.9%), from family and friends (21.4%) and healthcare providers (21.4%). Only 26.8% of those who had previously heard of ACP knew how to begin an ACP discussion and 12.5% of them had a prior ACP discussion. After education, the majority of respondents were willing to begin an ACP discussion (n = 236, 60.1%). Being of an older age, having a life threatening illness, and having more knowledge about ACP were significant factors associated with willingness to have an ACP discussion. Barriers included perceiving oneself as still healthy and preferring the family to make decisions instead.

CONCLUSIONThere is a low awareness but high expressed willingness to engage in an ACP discussion amongst the Singaporean community. More efforts are needed to educate the public about ACP, engage the family unit and correct the present misconceptions.

Advance Care Planning ; Age Factors ; Health Knowledge, Attitudes, Practice ; Humans ; Independent Living ; Patient Acceptance of Health Care ; Singapore ; Surveys and Questionnaires ; Terminal Care