INTRODUCTION: Adverse childhood experiences (ACEs) are associated with significant long-term impacts, yet few interventions specifically target ACE exposure, especially in Asian populations. Anchor, Singapore's first home visitation programme, addresses maltreat-ment among preschool children. This study evaluated Anchor's impact on children's developmental and behavioural outcomes. METHOD: We conducted a prospective evaluation of children under 4 years assessed for maltreatment from November 2019 to July 2023. Developmental and behavioural progress was measured every 6 months using the Ages and Stages Questionnaires (ASQ-3) and ASQ:Social-Emotional (ASQ:SE-2), and annually using the Child Behaviour Checklist (CBCL). RESULTS: The results of 125 children (mean age 20.0 months, 48% female) were analysed. The mean length of stay in programme was 21.2 (7.3) months. At baseline, 92 (73.6%) children were at risk of develop-mental delay and 25 (31.7%) children aged ≥18 months had behavioural concerns. The programme was associated with significant improvements in gross motor (P=0.002) and fine motor (P=0.001) domains of the ASQ-3 and internalising problem scale (P=0.001) of the CBCL. CONCLUSION Anchor effectively enhances develop-mental and behavioural outcomes for children exposed to maltreatment. Targeted early intervention through such programmes can mitigate adverse impacts, optimising developmental trajectories and potentially reducing the long-term clinical and economic burdens associated with ACEs.
Humans ; Female ; Male ; Child Abuse/therapy* ; Child, Preschool ; Singapore ; House Calls ; Infant ; Prospective Studies ; Child Development ; Developmental Disabilities/epidemiology* ; Program Evaluation ; Child Behavior Disorders ; Child Behavior

BACKGROUND

PhilHealth serves as the Philippines’ national health insurance provider and is central to implementing the Universal Health Care (UHC) Law. Despite this, existing gaps and ongoing challenges in claims and financial management systems continue to affect public healthcare facilities’ operations and sustainability.

This article examined the effectiveness and challenges of PhilHealth’s claims and financial management systems in public healthcare facilities, focusing on accreditation, claims processing, reimbursements, and financial governance.

A qualitative multiple-case study design was employed in Quezon City and the provinces of La Union, Sorsogon, Leyte, and Bukidnon, with data collected from 2022 to 2023. Prior to data collection, a certificate of exemption was granted by the Department of Health – Single Joint Research Ethics Board (DOH-SJREB). Data were collected through key informant interviews with healthcare facility heads, claims processors, and PhilHealth personnel, supplemented by document reviews and facility observations. Thematic analysis was employed to examine the implementation of national health insurance policies at the facility level.

Accreditation standards are uniformly defined, yet compliance varies widely, directly influencing reimbursement outcomes. Facilities with compliance gaps often face provisional accreditation, downgrades, or suspension, resulting in reduced revenue. Although the Universal Health Care (UHC) Law guarantees patient access to PhilHealth benefits, the efficiency of claims processing remains uneven and highly dependent on administrative capacity, staffing adequacy, and digital infrastructure. Systemic inefficiencies at both PhilHealth and facility levels contribute to delays and claim denials. Reimbursements are further constrained by outdated case rate ceilings, inconsistent financial practices, inadequate recordkeeping, weak information systems, and poor storage conditions—particularly in lower-level hospitals and rural health units.

Reforms in claims processing workflows, information system integration, and financial management capacities are crucial to enhance reimbursement efficiency. Strengthening these systems is fundamental for supporting sustainable, equitable, and high-quality healthcare delivery in the public sector within the Universal Health Care (UHC) framework.

INTRODUCTION: We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study. METHODS: In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework. RESULTS: Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices. CONCLUSION Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.
Humans ; COVID-19/epidemiology* ; Female ; Telemedicine ; Aged ; Male ; Singapore/epidemiology* ; Qualitative Research ; Health Knowledge, Attitudes, Practice ; SARS-CoV-2 ; Aged, 80 and over ; Middle Aged ; Pandemics ; Awareness ; Asian People ; Southeast Asian People

Objective: To develop a low-cost 3D-printed Laryngeal Injection Task Trainer (LITT) for simulation of transcutaneous injection laryngoplasty and evaluate its effectiveness among trainees. Methods: Design: Cross-Sectional Time-Motion Study and Post-Training Evaluation Survey Setting: Tertiary University College of Medicine Anatomy Laboratory Participants: Five residents and 2 consultants in Otolaryngology-Head and Neck Surgery were trained using a LITT fabricated through three-dimensional printing of cartilage models and silicone molds through the UP SIBOL Greenhouse and the Philippine General Hospital Craniomaxillofacial Prosthesis Unit. Participants were asked to perform transcutaneous laryngeal injection on the LITT. The duration in performing the procedure from palpation of landmarks to injection of material was measured in seconds and recorded. After the simulation workshop, participants were asked to evaluate the subjective experience with surgical simulation using the modified Michigan Standard Simulation Experience Scale (MiSSES). Results: The mean time in performing transcutaneous laryngeal injection across different training levels for either trans-cricothyroid or trans-thyrohyoid approach was not statistically significant. Mean time in performing transcutaneous laryngeal injection between 2 approaches, the trans-cricothyroid approach (79.32 seconds with SD 34.89) and the trans-thyrohyoid approach (35.16 seconds with SD of 10.88), was statistically significant. Using the MiSSES tool for evaluation of the simulation training, majority of the participants agreed that the LITT allowed self-efficacy in performing the procedure, had adequate fidelity in terms of its characteristics and components, had high educational value in training participants for knowledge and skills on transcutaneous laryngeal injection and that the simulation provided good teaching quality. For the overall rating, all participants concurred, with 83.3% of participants answering strongly agree and 16.7% of participants responding somewhat agree, that the simulation experience was helpful in knowledge and skills development on transcutaneous laryngeal injection. On final evaluation of the LITT, 75% of the participants responded that it can be used in training but should be improved slightly. Conclusion The laryngeal injection task trainer (LITT) had an acceptable fidelity, educational value, teaching quality to improve self-efficacy in performing transcutaneous injection laryngoplasty - with points for improvement in terms of model and set-up stability, color accuracy and consistency of the visual indicator. It is recommended that the LITT be also used for future workshops and possibly further validation studies after applying the points for improvement gathered from this simulation study.

PURPOSE: . This study aimed to evaluate the effects of fatigue and misfit on the reverse torque, load-bearing capacity, and failure modes of cemented and screwretained two-implant-supported fixed dental prostheses (FDPs). MATERIALS AND METHODS: . Eighty CAD-CAM zirconia frameworks with porcelain veneering were assigned to three groups based on engaging (E) and non-engaging (N) abutment configurations: N-N, N-E, and E-E. Misfit scenarios included a control cast and 100 μm horizontal or vertical misfits. Frameworks were mounted on implants as screw-retained or cement-retained 3-unit FDPs, forming seven test groups and one control group (n = 10). Reverse torque was measured before and after thermomechanical cycling, followed by maximum failure load (Fmax) testing and failure mode analysis. Fmax was evaluated using two-way ANOVA, and reverse torque using mixed-effects ANOVA accounting for engagement, misfit, and implant position (α = 0.05). RESULTS: . No significant differences in Fmax were observed across zirconia specimen groups or engagement configurations under various misfit conditions (P > .05). Engagement configuration did not significantly impact fracture strength or reverse torque (P = .421). A significant difference was found in the horizontal misfit group compared to controls (P < .001). Reverse torque values differed between distal (13.5 ± 0.5 Ncm) and mesial implants (18.6± 0.5 Ncm) (P = .000), suggesting distal implants may be more prone to preload loss and mechanical issues. CONCLUSION . The engagement configuration of implants did not significantly affect reverse torque, fracture strength, or failure modes of cemented and screw-retained restorations, although horizontal misfit reduced load-bearing capacity.

INTRODUCTION: Pharmacogenomic testing in psychiatry is an emerging area with potential clinical application of guiding medication choice and dosing. Interest has been fanned by commercial pharmacogenomic providers who have commonly marketed combinatorial panels that are direct-to-consumer. However, this has not been adopted widely due to a combination of barriers that include a varying evidence base, clinician and patient familiarity and acceptance, uncertainty about cost-effectiveness, and regulatory requirements. This review aims to examine recent updates in this field and provide a contextualised summary and recom-mendations for Asian populations in order to guide healthcare professionals in psychiatric practice. METHOD: A review of recent literature about current evidence and guidelines surrounding pharmacoge-nomics in psychiatric practice was carried out with particular attention paid to literature evaluating Asian populations. The Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework was applied. Consensus meetings comprising workgroup psychiatrists from the public and private sectors were held prior to arriving at the key recommendations. RESULTS: Pharmacogenomic testing should be mainly limited to drug-gene pairs with established clinical evidence, such as antidepressants and CYP2C19/ CYP2D6. Direct-to-consumer pharmacogenomic panels that assay multiple genes and analyse them via proprietary algorithms, are not presently recommended in Singapore's psychiatric setting due to inconclusive evidence on clinical outcomes. CONCLUSION Pharmacogenomic testing in psychiatry is not recommended as standard clinical practice. Exceptions may include concerns about drug concentrations or potential severe adverse drug reactions. Studies investigating newly identified drug-gene associations, and clinical effectiveness and cost-effectiveness of utilising pharmacogenomic testing in psychiatry is encouraged.
Humans ; Psychiatry/methods* ; Pharmacogenetics ; Cytochrome P-450 CYP2C19/genetics* ; Asian People/genetics* ; Pharmacogenomic Testing/methods* ; Antidepressive Agents/therapeutic use* ; Cytochrome P-450 CYP2D6/genetics* ; Practice Guidelines as Topic ; Singapore ; Mental Disorders/genetics* ; Psychotropic Drugs/therapeutic use*

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of liver disease worldwide. The estimated global incidence of NAFLD is 47 cases per 1,000 population and is higher among males than females. The estimated global prevalence of NAFLD among adults is 32% and is higher among males (40%) compared to females (26%). The global prevalence of NAFLD has increased over time, from 26% in studies from 2005 or earlier to 38% in studies from 2016 or beyond. The prevalence of NAFLD varies substantially by world region, contributed by differing rates of obesity, and genetic and socioeconomic factors. The prevalence of NAFLD exceeds 40% in the Americas and South-East Asia. The prevalence of NAFLD is projected to increase significantly in multiple world regions by 2030 if current trends are left unchecked. In this review, we discuss trends in the global incidence and prevalence of NAFLD and discuss future projections.

Humans ; Carcinoma, Hepatocellular/epidemiology* ; Liver Neoplasms/epidemiology* ; Prothrombin ; Biomarkers

Humans ; Extremities ; Sarcoma/radiotherapy* ; Soft Tissue Neoplasms/radiotherapy* ; Neoplasm Recurrence, Local