INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.
Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Disease Outbreaks ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Patient Acceptance of Health Care/statistics & numerical data* ; Patient Admission/trends* ; Pediatrics ; Retrospective Studies ; Severe Acute Respiratory Syndrome/epidemiology* ; Singapore/epidemiology*

Adolescent ; COVID-19/prevention & control* ; Child ; Child, Preschool ; Emergency Service, Hospital/trends* ; Facilities and Services Utilization/trends* ; Female ; Health Policy ; Humans ; Infant ; Infant, Newborn ; Male ; Pandemics ; Patient Acceptance of Health Care/statistics & numerical data* ; Retrospective Studies ; Singapore/epidemiology*

BACKGROUND: The primary preventive services of TSeKaP promote disease prevention among marginalized groups. The threat of non-utilization, however, undermines the effective implementation of the program. To fill in the knowledge gap regarding utilization of primary preventive services, rate of utilization and factors associated with utilization of primary preventive services must be determined.

OBJECTIVE: To determine the rate of utilization and the association of selected factors with utilization of primary preventive services of TSeKaP among PhilHealth Indigent Member of Manila.

METHODS: Using a two-stage cluster sampling, 145 PhilHealth Indigent Members were randomly selected and interviewed. Chi-square test and Fisher's exact test were used to determine associations. FGDs were also conducted to gather reasons related to utilization.

RESULTS AND CONCLUSION: Among those surveyed, 68.28% were found to have utilized at least one primary preventive service. Age (p-value=0.021), knowledge (p-value=0.015), familiarity (p-value=0.029), and accessibility (p-value=0.013) were found to be associated with utilization. Utilization generally increases as the age group increases. Those with satisfactory knowledge on TSeKaP, those familiar with their health center, and those who report that their health center is accessible were 1.45 times, 2.12 times and 2.83 times more likely to utilize than their counterparts, respectively. Results showing a significant proportion of non-utilization emphasize the need to improve implementation strategies by improving not only the knowledge of respondents' on TSeKaP but also their familiarity with their health centers. The use of various communication channels, such as barangay bulletin, public address system, radio or television, may aid the dissemination of pertinent information regarding the program as perceived by the respondents.

Human ; Male ; Female ; Aged 80 And Over ; Aged (a Person 65 Through 79 Years Of Age) ; Middle Aged (a Person 45-64 Years Of Age) ; Health Promotion ; Preventive Health Services ; Health Services, Indigenous ; Facilities And Services Utilization

INTRODUCTIONThe objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.

MATERIALS AND METHODSData for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.

RESULTSDM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.

CONCLUSIONGiven the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; statistics & numerical data ; Comorbidity ; Cross-Sectional Studies ; Depression ; epidemiology ; Depressive Disorder ; epidemiology ; Diabetes Mellitus ; epidemiology ; Ethnic Groups ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Middle Aged ; Prevalence ; Severity of Illness Index ; Singapore ; epidemiology ; Surveys and Questionnaires

Reproductive health (RH) education and services of female migrants in China have become an important health issue. This research aimed to investigate the RH knowledge and utilization among married female migrants, and to explore the influencing factors from the perspectives of population and sociology. We conducted a cross-section survey in Shenzhen and Wuhan, China, using the purposive sampling method. A total of 1021 rural-to-urban married migrants were recruited, with 997 valid survey results obtained. A face-to-face structured questionnaire survey was used, with primary focus on knowledge of fertility, contraception, family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome (STD/AIDs), and RH service utilization. The results showed that the RH service utilization (38.0%) was at a low level in married migrants and the accessibility of RH service was poor. Females who migrated to (OR=0.32) Wuhan obtained fewer RH consultations than those in Shenzhen. The workers with high school education received additional RH consultations and checkup services than those with other background education, apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers (P<0.05). We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China. RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.
Adolescent ; Adult ; China ; Cities ; statistics & numerical data ; Female ; Humans ; Population Dynamics ; Reproductive Health Services ; utilization ; Socioeconomic Factors ; Spouses ; statistics & numerical data ; Transients and Migrants ; statistics & numerical data

INTRODUCTIONMany alcohol-related problems often go undetected and untreated. In Singapore, no epidemiological studies have been done in general hospitals on alcohol use disorders (AUD), i.e. alcohol dependence and abuse (DSM-IV-TR). Such findings are useful in planning AUD liaison services. In this study, we aim to estimate the prevalence of AUD among non-psychiatric inpatients and to determine the rates of identification and intervention rendered by medical staff.

MATERIALS AND METHODSNon-psychiatric medical and surgical wards inpatients aged 21 years and above were recruited over a 3-month period. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for AUD and the MINI International Neuropsychiatric Interview (MINI English Version 5.0.0) was administered to diagnose AUD if the AUDIT score was 8 or above. Case notes were independently reviewed for AUD identification and if interventions were offered during admissions.

RESULTSA total of 5599 inpatients were screened, of which 673 (12%) completed the screening using the AUDIT, and of these, 154 (2.8% of total sample) were positive for AUDIT. In this group, 107 were diagnosed with AUD. The estimated prevalence was 1.9% (approximately 400 cases per year per hospital). The medical staff identified only 25 (23.4%) cases of AUD, out of which, majority of them (76%) were rendered interventions.

CONCLUSIONThe rate of AUD identification by medical staff was low. Of those identified, majority were given interventions. Thus, the training of health care staff to identify AUD together with the implementation of brief interventions should be considered.

Adult ; Aged ; Alcoholism ; diagnosis ; epidemiology ; therapy ; Female ; Hospitalization ; Hospitals, General ; Humans ; Male ; Mass Screening ; utilization ; Mental Health Services ; Middle Aged ; Prevalence ; Referral and Consultation ; Singapore ; epidemiology ; Young Adult

OBJECTIVETo understand the infection status of enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) among children receiving health examination for child care setting entrance in Beijing and their related medical care seeking practice and provide evidence for the estimation of disease burden caused by hand foot and mouth disease (HFMD).

METHODSSerological survey was conducted in the local children receiving health examination for child care setting entrance. Enzyme-linked immunosorbent assay (ELISA) was conducted to detect anti-EV71 and anti-Cox A16 IgG and IgM.

RESULTSA total of 813 children were surveyed (mean age: 3.5 ± 1.0 year old). The seropositive rate was 61.9% and 4.4% for anti-Cox A16 IgG and IgM. The seropositive rate was 9.3% and 1.1% for anti-EV71 IgG and IgM. No significant difference was observed in sex specific seropositive rate (P > 0.05). However, significant differences were found in seropositive rate among different age groups (P < 0.05). Among the children who were anti-Cox A16 positive, 7.8% had ever had rashes on their hands and feet, mouth or buttocks (HFMD-like rashes). Among the children who were anti-EV71 positive, 10.7% had ever had HFMD-like rashes. For the children who were anti-Cox A16 or anti-EV71 positive, only 7.1% were brought to see doctors by their parents. However, among the seropositive children with rashes, 80.5% were brought to see doctors.

CONCLUSIONIn the healthy children at the age to go to child care setting in Beijing, most had ever infected with Cox A16. The anti-EV71 positive rate was much lower than the anti-Cox A16 positive rate. It was necessary to strengthen the prevention and control of EV71 infection in child cares settings.

Antibodies, Anti-Idiotypic ; blood ; Beijing ; epidemiology ; Child Health Services ; utilization ; Child, Preschool ; Cost of Illness ; Enterovirus A, Human ; isolation & purification ; Enzyme-Linked Immunosorbent Assay ; Female ; Hand, Foot and Mouth Disease ; epidemiology ; virology ; Humans ; Male ; Parents ; psychology ; Patient Acceptance of Health Care ; statistics & numerical data

INTRODUCTIONStudies examining mental health treatment dropout have primarily focused on Western populations and less so on Asian samples. The current study explored the prevalence and correlates of mental health treatment dropout across the various healthcare sectors in Singapore.

MATERIALS AND METHODSData was utilised from the Singapore Mental Health Study (SMHS), a cross-sectional epidemiological survey conducted among an adult population (n = 6616) aged 18 years and above. Statistical analyses were done on a subsample of respondents (n = 55) who had sought treatment from the various treatment providers (i.e. mental health, medical, social services and religious healers) in the past 12 months. The World Mental Health (WMH) Composite International Diagnostic Interview version 3.0 (CIDI 3.0) was used to determine diagnoses of mental disorders, chronic medical disorders and service utilisation.

RESULTSOf those who had received treatment, 37.6% had ended treatment prematurely, 23.2% had completed treatment and 39.2% were still in treatment. The religious and spiritual sector (83.1%) had the highest dropout, followed by the general medical sector (34.6%), mental health services sector (33.9%) and the social services sector (30%). Marital status emerged as the only sociodemographic factor that significantly predicted treatment dropout-with those who were married being significantly less likely to drop out than those who were single.

CONCLUSIONThe overall dropout rate across the various healthcare sectors was comparable to past studies. While the small sample size limits the generalisability of findings, the current study provides useful insight into treatment dropout in an Asian population.

Adolescent ; Adult ; Age Factors ; Asian Continental Ancestry Group ; statistics & numerical data ; Cross-Sectional Studies ; Educational Status ; Employment ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; Income ; statistics & numerical data ; Male ; Marital Status ; statistics & numerical data ; Mental Disorders ; epidemiology ; therapy ; Mental Health Services ; utilization ; Middle Aged ; Patient Dropouts ; statistics & numerical data ; Prevalence ; Sex Factors ; Singapore ; epidemiology ; Social Work ; statistics & numerical data ; Spiritual Therapies ; utilization ; Surveys and Questionnaires ; Young Adult

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.
Aged ; Aged, 80 and over ; *Cultural Characteristics ; Evidence-Based Medicine ; Female ; Health Care Rationing/*statistics & numerical data ; Health Equity/*statistics & numerical data ; Health Services for the Aged/*utilization ; Humans ; Income/*statistics & numerical data ; India/epidemiology ; Male ; Middle Aged ; Socioeconomic Factors ; *Utilization Review

INTRODUCTIONThere is a high prevalence of polypharmacy and inappropriate medication use in Singapore nursing homes. This study primarily explored the benefits of pharmacist reviews in local nursing homes. The secondary aims were to review the potential cost savings gained from following the pharmacists' recommendations and to identify the possible risks associated with polypharmacy and inappropriate medication use.

METHODSA retrospective period prevalence study was performed. We analysed the pharmacotherapy problems highlighted by pharmacists in three nursing homes and the rate of acceptance of pharmacists' recommendations. Data was collected in two phases: (a) a one-month pre-setup period, during which 480 patients were reviewed (i.e. one-time review before weekly pharmacist visits); and (b) a six-month post-setup period, during which the 480 patients were reviewed again. Pharmacotherapy problems were classified according to a clinical pharmacist recommendation taxonomy and potential risks were identified. Monthly cost savings were calculated and compared with the monthly costs of pharmacist reviews.

RESULTSA total of 392 pharmacotherapy problems were identified, with pharmacist recommendations noted for each problem. Among the 392 recommendations, 236 (60.2%) were accepted. The pharmacotherapy problems were analysed for potential risks, including falls (16.0%) and constipation (13.1%). The acceptance rates were higher during the post-setup period compared to the pre-setup period (p < 0.0001). Total direct acquisition cost savings during the pre- and post-setup periods were SGD 388.30 and SGD 876.69, respectively.

CONCLUSIONThe provision of pharmaceutical care to nursing home residents resulted in improved medication safety and quality of care.

Aged ; Drug Costs ; Drug Utilization Review ; economics ; statistics & numerical data ; Female ; Health Care Costs ; Humans ; Inappropriate Prescribing ; economics ; statistics & numerical data ; Male ; Nursing Homes ; Pharmaceutical Services ; economics ; Pharmacists ; Polypharmacy ; Prevalence ; Retrospective Studies ; Risk ; Singapore