INTRODUCTION: Positive mental health (PMH) has been identified as a factor of resilience against suicidality. However, PMH encompasses different domains across cultural contexts. This study aimed to investigate the assoc...INTRODUCTION: Positive mental health (PMH) has been identified as a factor of resilience against suicidality. However, PMH encompasses different domains across cultural contexts. This study aimed to investigate the association between PMH and lifetime suicidality and analyse the association between each PMH domain and lifetime suicidality in Singapore. METHODS: This cross-sectional analysis comprised 2270 residents aged ≥18 years who participated in the Singapore Mental Health Study 2016, a population-level survey in which the lifetime prevalence of physical disorders, psychiatric disorders and suicidality was measured. Total PMH among participants was estimated using the PMH Instrument. The associations were investigated using logistic regression models, adjusted for sociodemographic characteristics, mental disorders, perceived social support and number of adverse childhood events. RESULTS: Findings showed that individuals with lifetime suicidality had lower scores for PMH and its components compared with those without lifetime suicidality. Logistic regression models showed that PMH was negatively associated with lifetime suicidality (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.36-0.86). Specifically, higher scores for general coping (OR 0.68, 95% CI 0.48-0.96) and emotional support (OR 0.68, 95% CI 0.48-0.96) were significantly associated with lower odds of lifetime suicidality. CONCLUSION: The findings imply that interventions that include PMH may be beneficial in supporting individuals experiencing suicidality. Future studies can examine the relationship between PMH and lifetime suicidality using longitudinal study designs and employ qualitative methods to provide insights into how individual experiences influence this association.
Chan D, Ong C, Loy SL
… +22 more, Ku CW, Lin J, Loo BKG, Tan YB, Tan N, Ravichandran D, Tan M, Quah PL, Lim C, Pandi M, Leo WZ, Ooi PL, Low KT, Han WM, Chong MF, Chiou FK, Chang ASM, Aw MM, Rajadurai VS, Tan KH, Yap F, Chua MC
INTRODUCTION: Optimal nutrition during the first 1000 days of a child's life is crucial for healthy growth and development. Caregiver feeding practices can significantly affect what foods are offered, which foods are pre...INTRODUCTION: Optimal nutrition during the first 1000 days of a child's life is crucial for healthy growth and development. Caregiver feeding practices can significantly affect what foods are offered, which foods are preferred and how healthy eating patterns are established, highlighting the need for clear guidance and recommendations. Currently, there are no national guidelines focused on the transition from being fed at birth to independent eating by 2 years old. This study aimed to develop concise, evidence-based recommendations to support healthy eating behaviours in children aged 0-2 years. METHODOLOGY: A systematic literature search was conducted on PubMed, Cumulated Index to Nursing and Allied Health Literature and Excerpta Medica Database to identify relevant articles. The GRADE-ADOLOPMENT methodology was employed to adopt, adapt or develop evidence-based recommendations for feeding and eating practices in infants and young children. This includes using the Evidence-to-Decision framework to ensure recommendations considered the balance of benefits and harms, feasibility and cultural appropriateness. A multidisciplinary panel of domain experts reviewed and refined the recommendations, with consensus defined as ≥70% agreement. A total of 64 articles were reviewed, comprising eight observational cohort studies, 25 randomised controlled trials and 31 systematic reviews (including four meta-analyses). The included studies examined key aspects of complementary feeding: 20 focused on timing, 30 on types of food, 13 on self-regulation and one on the feeding environment. RESULTS: Seven consensus statements were developed based on the evidence and organised into four main domains: Variety, Autonomy, Setting and Timing. All statements achieved unanimous agreement among domain experts. CONCLUSION: These guidelines provide clear, evidence-based recommendations for practical nutrition strategies during early childhood.
INTRODUCTION: Exclusive breastfeeding (EBF) rates in Singapore remain below World Health Organization recommendations despite public health campaigns. Understanding maternal experiences and support requirements can help...INTRODUCTION: Exclusive breastfeeding (EBF) rates in Singapore remain below World Health Organization recommendations despite public health campaigns. Understanding maternal experiences and support requirements can help address this gap. METHODS: A cross-sectional face-to-face survey was conducted in March 2024 at two outpatient clinics in a tertiary public hospital in Singapore. Eligible Singaporean mothers aged ≥18 years with at least one child completed a questionnaire, in which data on demographics, breastfeeding practices, motivations, barriers and sources of support were collected. Data were analysed using descriptive statistics. RESULTS: Among 408 respondents, 34.7% of mothers with infants under 6 months were exclusively breastfeeding at the time of the survey. Additionally, 32.9% had exclusive breastfed for at least 6 months. Common motivations included health benefits for the baby (78.8%) and healthcare advice (66.8%). Breastfeeding challenges included nipple pain (47.3%), perceived low milk supply (44.9%) and breast engorgement (38.9%). Respondents cited partners (78.8%) and healthcare professionals (52.4%) as their main sources of support. There was high interest in better antenatal education and digital tools for breastfeeding support. CONCLUSION: While EBF rates have improved since the last national survey, mothers continue to face physical, emotional and logistical challenges with breastfeeding. Enhanced antenatal support, alongside consistent and empathetic healthcare communication, may strengthen breastfeeding success and maternal confidence.
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the Asian population, making Asia home to the largest number of patients worldwide. The prevalence of MASLD and its associated complica...Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 30% of the Asian population, making Asia home to the largest number of patients worldwide. The prevalence of MASLD and its associated complications continues to rise. Notably, certain genetic polymorphisms, such as PNPLA3, are highly prevalent in Asians. While European and American guidelines often advocate for the Mediterranean diet in managing MASLD, this approach may be impractical in many Asian countries due to cultural and societal differences. Asian researchers have significantly advanced the development and validation of non-invasive liver fibrosis tests, which are essential for selecting patients for treatment and monitoring. However, Asians remain underrepresented in clinical trials for metabolic dysfunction-associated steatohepatitis, which is concerning given the differences in body size and potential drug metabolism. A broader Asian representation in drug development is essential to ensure effective treatments for this population.
Liow CJ, Sun Y, Yang JX
… +4 more, Kan SJ, Ricci V, Kim PA, Expert Group for Atopic Dermatitis ACG
Singapore Med J
· 2026 May · PMID 41937409
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This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the management of mild and moderate atopic dermatitis (AD), providing rationale and justifications for the guideline recommen...This Evidence-to-Recommendation (EtR) framework underpins the ACE Clinical Guideline (ACG) for the management of mild and moderate atopic dermatitis (AD), providing rationale and justifications for the guideline recommendations. Atopic dermatitis is highly prevalent in Singapore, with a significant impact on quality of life, psychological burden and healthcare utilisation costs. The ACG addresses management gaps, including diagnostic uncertainty, inappropriate prescribing and suboptimal treatment adherence, that contribute to unnecessary specialist referrals and poor clinical outcomes. The Grading of Recommendations Assessment, Development and Evaluation framework was followed to develop nine evidence-based recommendations that cover AD diagnosis, severity assessment, trigger management and pharmacological interventions, including the use of topical anti-inflammatories and proactive therapy strategies. This EtR framework summarises the factors that have informed the direction and strength of the ACG recommendations, including balance of benefits and risks, certainty of evidence, patient preferences and values, resources and feasibility considerations, and acceptability.
Rui SLZ, Wu SLR, Marimuttu VJ
… +5 more, Kwan R, Chan YH, Ng YH, Ang ASY, Chew ECS
Singapore Med J
· 2026 Mar · PMID 41902474
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INTRODUCTION: One in three Singaporean adolescents report significant mental health (MH) symptoms, highlighting the urgent need for the development of innovative care models. We describe a paediatrician-led MH service, t...INTRODUCTION: One in three Singaporean adolescents report significant mental health (MH) symptoms, highlighting the urgent need for the development of innovative care models. We describe a paediatrician-led MH service, the Paediatric and Adolescent Wellness Service (PAWS), which was set up in a tertiary pediatric hospital as part of a collaborative tiered-care model to improve access to care for children and adolescents with MH symptoms. METHODS: This study described the development of the PAWS within a tiered-care model. Clinical outcome measures were prospectively collected to evaluate clinical improvement, with scores reported at baseline and post-treatment. Service utilisation data were collected to evaluate improvement in wait time for MH appointments after PAWS was available. RESULTS: In 2023, PAWS started providing MH services for children and adolescents aged 7 to 18 years. From January 2023 to December 2023, the service saw 180 patients. Mean patient-reported function scores improved by 4.4 points (95% confidence interval [CI] 2.9-5.9), from a baseline of 11.3 to post-treatment scores of 6.9, with 75% of patients reporting improvement. Similarly, mean physician-reported function scores improved by 7.0 points (95% CI 5.5-8.4), from baseline of 66.4 to 73.4 post-treatment, with 72% of patients showing improvement. Overall, the wait time for MH appointments improved from 28.7 days in 2022 to 11.3 days in 2023. CONCLUSION: PAWS, a mental health service by paediatricians for children and adolescents with Tier 3 mental health symptom severity, has improved access to care, with patients demonstrating improved clinical outcomes, highlighting the service's potential.
Singapore Med J
· 2026 Mar · PMID 41877413
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INTRODUCTION: The revised European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2017 criteria and European Neuromuscular Centre's (ENMC) 2018 criteria have improved diagnostic accuracy for der...INTRODUCTION: The revised European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2017 criteria and European Neuromuscular Centre's (ENMC) 2018 criteria have improved diagnostic accuracy for dermatomyositis (DM). However, electromyography (EMG) was not included in the diagnostic criteria. We evaluated the usefulness of EMG under both criteria in the classification of DM and its amyopathic subtypes for patients who had rash with or without muscle weakness. METHODS: In this retrospective study, 20 patients who were classified into DM and alternative diagnoses groups based on the Bohan and Peter (BP) criteria and histopathological findings of muscle and/or skin were included. We then compared the diagnostic accuracy to that of the EULAR/ACR and ENMC criteria. Differences in proportion were determined using Fisher's exact test. RESULTS: Two patients who had weakness with elevated creatine kinase but no typical DM features on muscle biopsies were incorrectly excluded as alternative diagnoses using BP criteria. Both EMGs demonstrated presence of myopathic recruitment pattern and spontaneous activity in the proximal and distal muscles, consistent with the clinical phenotype. Two patients with a final diagnosis of systemic lupus erythematosus were incorrectly classified as DM by EULAR/ACR and ENMC criteria, but EMG demonstrated no evidence of muscle inflammation. CONCLUSION: Electromyography is valuable in identifying mild myopathy among DM patients with subtle clinical muscle weakness, allowing better classification of DM subtypes. Absence of EMG signs indicating muscle involvement provides clues for alternative diagnosis. In addition, EMG aids in interpretation of inconclusive muscle biopsy results. Therefore, EMG should be performed for every suspected DM patient.
Chan KS, Lei GY, Koh AJQ
… +5 more, Srinivasan S, Lim WW, Low S, Goo JTT, Lee DJK
Singapore Med J
· 2026 Mar · PMID 41833978
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INTRODUCTION: Sarcopenia and low skeletal muscle index (SMI) are associated with high major morbidity and mortality following emergency laparotomy (EL). Existing preoperative risk models often focus on short-term outcome...INTRODUCTION: Sarcopenia and low skeletal muscle index (SMI) are associated with high major morbidity and mortality following emergency laparotomy (EL). Existing preoperative risk models often focus on short-term outcomes. This study aimed to develop a personalised preoperative score using SMI to predict 1-year mortality in older patients undergoing EL. METHODS: This was a retrospective study conducted in patients aged ≥65 years who underwent EL from January 2016 to December 2022. Patients who underwent EL for trauma, vascular surgery or cholecystectomy were excluded. The cut-off values for low SMI were <33.4 and 26.3 cm 2 /m 2 for males and females, respectively. Univariate and multivariate logistic regression analyses were performed to identify the predictors of 1-year mortality. Receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test were used to evaluate the model performance. RESULTS: A total of 477 patients (training cohort: n = 334, validation cohort: n = 143) were included in the analysis. Of these patients, 41.5% had sarcopenia. The incidences of Clavien-Dindo grade III morbidity, grade IV morbidity, in-hospital mortality and 1-year mortality were 6.7%, 8.0%, 6.3% and 18.5%, respectively. Multivariate analyses showed that sarcopenia (odds ratio [OR] 4.42, 95% confidence interval [CI] 1.69-11.57), American Society of Anesthesiologists score (OR 2.37, 95% CI 1.23-4.54) and clinical frailty scale (OR 1.83, 95% CI 1.30-2.59) were independent predictors for 1-year mortality. The area under the ROC curve was 0.79 (95% CI 0.71-0.88) and 0.73 (95% CI 0.58-0.87) in the training and validation cohorts, respectively. Hosmer-Lemeshow test was not statistically significant. CONCLUSION: We developed an easy-to-use preoperative calculator to predict 1-year mortality in older patients undergoing EL.
Gao Y, Yeo JJY, Tan JR
… +3 more, Yan YY, Oh HC, Goh SH
Singapore Med J
· 2026 Mar · PMID 41801181
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INTRODUCTION: This study aimed to validate a deep learning (DL) model for automated hip fracture detection on pelvic X-rays in emergency departments (EDs) and benchmark its performance against that of junior doctors and...INTRODUCTION: This study aimed to validate a deep learning (DL) model for automated hip fracture detection on pelvic X-rays in emergency departments (EDs) and benchmark its performance against that of junior doctors and radiographers in the ED. METHODS: We analysed 600 frontal pelvic radiographs for external validation of a DenseNet-121 DL model developed to detect hip fracture. The performance of the DL model was also compared to that of radiographers and junior doctors in the ED, with or without acesss to the DL model's reading outputs before their reading decisions. The performance was assessed in terms of area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), sensitivity, specificity, and positive and negative predictive values. Ground truth of all sampled radiographs was based on the consensus findings of two musculoskeletal radiologists. The difference in classification errors was assessed using McNemar's test. RESULTS: The DL model trained on 512 by 512 images achieved an AUROC of 0.96 and AUPRC of 0.91, showing reduced performance compared with development metrics (AUROC 0.99, AUPRC 0.95). On original high-resolution images, radiographers significantly outperformed the DL model (McNemar's test: P < 0.001), achieving a sensitivity of 99% compared to the model's sensitivity of 85%. There was no significant difference in performance between the DL model and ED junior doctors, who read the original radiographs independently or with support from the DL model. CONCLUSION: The DL model could not match radiographers' performance, highlighting the importance of clinical context in fracture detection. While the model's short reading time could reduce diagnostic delays, further development incorporating higher-resolution images and multimodal clinical data integration is needed before clinical deployment.