Environmental damage affects many aspects of healthcare, from extreme weather events to evolving population disease. Singapore's healthcare sector has the world's second highest healthcare emissions per capita, hampering the nation's pledge to reduce emissions by 2030 and achieve net zero emissions by 2050. In this review, we provide an overview of the impact environmental damage has on healthcare, including facilities, supply chain and human health, and examine measures to address healthcare's impact on the environment. Utilising the 'R's of sustainability - rethinking, reducing/refusing, reusing/repurposing/reprocessing, repairing, recycling and research - we have summarised the opportunities and challenges across medical disciplines. Awareness and advocacy to adopt strategies at institutional and individual levels is needed to revolutionise our environmental footprint and improve healthcare sustainability. By leveraging evidence from ongoing trials and integrating sustainable practices, our healthcare system can remain resilient against environment-driven challenges and evolving healthcare demands while minimising further impacts of environmental destruction.
Humans ; Climate Change ; Delivery of Health Care ; Singapore ; Conservation of Natural Resources ; Sustainable Development ; Environment

Introduction: Depression is a debilitating illness and has become a leading cause of disability worldwide. According to the National Health Survey IV, the prevalence of lifetime depression was 2.4% and current depression was 1.8%. In a review article published by the Department of Psychological Medicine, University of Malaya, the prevalence of depression in Malaysia was estimated to be between 8% and 12%. A cross-sectional study carried out in Selangor, Malaysia showed that 10.3% of adults aged 18 and above suffered from depression. Depression carries dire societal and health-related consequences that affect both the individual and the community as a whole, and is potentially a chronic illness with high morbidity, rate of relapse and recurrence. This study was performed to identify the prevalence of depression and factors associated with it. Method: A cross-sectional study was done on 354 Malaysian adults above the age of 18 residing in the district of Mantin, Malaysia. Non-Malaysians and people with known-depression were excluded. A questionnaire was developed to detect the sociodemographic factors and Patient Health Questionnaire 9 (PHQ-9) was used to screen for depression. Results: The proportion of the participants shown to score mild to major depression was 44.4%. Higher prevalence was found in individuals who were males (45.2%), in the age group of 38 years and below (48.3%), Malays (45.5%), having low levels of income (46.0%), having lower levels of education (45.7%), not married (48.1%), a parent (45.3%), having positive family history of depression (60%) and suffering from chronic illnesses (48.4%). Satisfaction with family members was a strong and independent factor associated with depression (OR 3.051, CI 1.445-6.444, p-value 0.002). Conclusion The prevalence of depression in the study population of Mantin was high and significantly associated with family satisfaction. Creating awareness regarding depression in this community is recommended. Projects and programmes encouraging individuals to connect with the family should be considered. In addition, policies should be put in place to promote more family time in the community.
Depression ; prevalence ; Patient Health Questionnaire ; Malaysia

INTRODUCTIONStudies have suggested that women who present with non-ST-segment elevation myocardial infarction (NSTEMI) may differ in their clinical response to early invasive strategy compared to male patients. We examined the impact of gender difference in NSTEMI patients on outcomes following invasive versus conservative treatment.

MATERIALS AND METHODSPatients enrolled in our national myocardial infarction (MI) registry between January 2000 and September 2005 with diagnosis of NSTEMI were retrospectively analysed. The study endpoint was the occurrence of major adverse cardiac events (MACE) in the patients at 1 year.

RESULTSA total of 1353 patients (62.2% male) with NSTEMI were studied. The mean age of men was 62 +/- 14 versus 72 +/- 12 years in women in the cohort (P <0.001). The prevalence of hypertension and diabetes mellitus were significantly higher in women. Men were more likely to undergo revascularisation than women (OR, 2.97; 95% CI, 2.18-3.89, P <0.001). Among those who were revascularised, there was no gender difference in survival or recurrent MI rates during hospitalisation and at 1 year. Compared to medical therapy, percutaneous coronary intervention (PCI) was associated with a significant reduction in MACE in both women (OR, 0.44; 95% CI, 0.20-0.95) and men (OR, 0.40; 95% CI, 4.79-12.75). The most important predictor of MACE for females was diabetes mellitus (HR, 1.98; 95% CI, 1.17-3.33).

CONCLUSIONSThere is a gender-based difference in the rate of revascularisation among patients with NSTEMI. Women benefit from an invasive approach as much as men, despite their advanced age, with similar rates of mortality and recurrent MI at 1-year follow-up.

Adrenergic beta-Antagonists ; therapeutic use ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; surgery ; Platelet Aggregation Inhibitors ; therapeutic use ; Practice Patterns, Physicians' ; Recurrence ; Sex Factors ; Survival Analysis