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Objective: To evaluate the psychometric properties of the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and Knee injury and Osteoarthritis Outcome Score (KOOS-12) for use in evaluating outcomes after joint replacement for osteoarthritis. Design: Patient-reported outcomes data collected by the Australian Orthopaedic Association National Joint Replacement Registry were used for this analysis. HOOS-12 and KOOS-12 domain (pain, function, quality of life) and summary impact data were available. The Oxford Hip Score (OHS), Oxford Knee Score (OKS) and EQ-5D-5L were used as comparators. Instruments were administered pre-operatively and at 6 months post-operatively. Internal consistency reliability, floor and ceiling effects, convergent validity, known groups validity, and responsiveness were evaluated using standard psychometric techniques. Results: Baseline HOOS-12 and KOOS-12 data were available for 3,023 patients undergoing primary total hip replacement and 4,010 patients undergoing primary total knee replacement. At baseline, high internal consistency was demonstrated for all domains and summary scores (Cronbach's alpha: HOOS-12 = 0.81–0.93; KOOS-12 = 0.82–0.92). Post-operative ceiling effects (>15% of patients scoring the best possible score) were identified for the HOOS-12 pain (46%), function (39%) and quality of life domains (26%) and summary score (17%), and for the KOOS-12 pain (21%) and function domains (18%). The HOOS-12 and KOOS-12 could differentiate between two known groups (lowest/highest OHS or OKS quartiles post-operatively; p < 0.001) and were highly responsive to change (effect sizes for HOOS-12: 2.20–2.83; KOOS-12: 1.82–2.35). Conclusion: The HOOS-12 and KOOS-12 have good psychometric properties for capturing joint replacement outcomes including excellent responsiveness, although ceiling effects may limit monitoring of post-operative improvement Refereed/Peer-reviewed

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.

Summary Objective To evaluate the structural validity of the 12-item Hip disability and Osteoarthritis Outcome Score (HOOS-12) and 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) using Rasch analysis and consider psychometric implications for research and clinical use. Method Individual-level HOOS-12 and KOOS-12 data from the Australian Orthopaedic Association National Joint Replacement Registry, collected before and after primary total hip and knee replacement, were used for this analysis. Using the Rasch analytic approach, overall model fit and item fit were examined, together with potential reasons for misfit including response threshold ordering, differential item functioning, internal consistency, unidimensionality and item targeting. Results Overall misfit to the Rasch model was evident for both instruments. A degree of item misfit was also observed, although most items demonstrated logical sequencing of response options. Only two items (hip/knee pain frequency and awareness of hip/knee problems) displayed disordered response thresholds. The pain, function, and quality of life domains of the HOOS-12 and KOOS-12 demonstrated excellent internal consistency reliability (person separation index: 0.80–0.93) and unidimensionality. A mismatch between item difficulty and person ability scores at the highest end of the HOOS-12 and KOOS-12 scales contributed to post-operative ceiling effects (mean logit for HOOS-12: 3.57; KOOS-12: 2.58; ≈0 indicates well-targeted scale). Conclusion We found evidence to support the structural validity of the three HOOS-12 and KOOS-12 domains for evaluating joint replacement outcomes. However, there may be missing content in both instruments particularly for high-functioning patients. Minor refinement of some response options may be warranted to improve item performance.

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 SARS-CoV-2 positive cases and 564 controls, accounting for the time course of illness at point of assessment. Clinical differentiators of cases and controls were used to derive model-based risk scores. Significant symptoms included abdominal pain, cough, diarrhea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5°C and 37.9°C, and temperature above 38°C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, we firstly used leave-one-out cross-validation, which confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. Secondly, in a separate ongoing prospective study of 237 COVID-19 and 346 primary care patients presenting with symptoms of acute respiratory infection, the baseline model had a sensitivity of 0.57 and specificity of 0.89, and in retrospective notes review of 100 COVID-19 cases diagnosed in primary care, sensitivity was 0.56. A web-app based tool has been developed for easy implementation as an adjunct to laboratory testing to differentiate COVID-19 positive cases among patients presenting in outpatient settings.

To evaluate how public perceptions and trust in government communications affected the adoption of protective behaviour in Singapore during the coronavirus disease 2019 (COVID-19) pandemic.We launched our community-based cohort to assess public perceptions of infectious disease outbreaks in mid-2019. After the first case of COVID-19 was reported in Singapore on 23 January, we launched a series of seven COVID-19 surveys to both existing and regularly enrolled new participants every 2 weeks. As well as sociodemographic properties of the participants, we recorded changing responses to judge awareness of the situation, trust in various information sources and perceived risk. We used multivariable logistic regression models to evaluate associations with perceptions of risk and self-reported adopted frequencies of protective behaviour.Our cohort of 633 participants provided 2857 unique responses during the seven COVID-19 surveys. Most agreed or strongly agreed that information from official government sources (99.1%; 528/533) and Singapore-based news agencies (97.9%; 522/533) was trustworthy. Trust in government communication was significantly associated with higher perceived threat (odds ratio, OR: 2.2; 95% confidence interval, CI: 1.6-3.0), but inversely associated with perceived risk of infection (OR: 0.6; 95% CI: 0.4-0.8) or risk of death if infected (OR: 0.6; 95% CI: 0.4-0.9). Trust in government communication was also associated with a greater likelihood of adopting protective behaviour.Our findings show that trust is a vital commodity when managing an evolving outbreak. Our repeated surveys provided real-time feedback, allowing an improved understanding of the interplay between perceptions, trust and behaviour.Évaluer dans quelle mesure la perception du public et la confiance envers les communications du gouvernement ont influencé l'adoption d'un comportement de protection à Singapour durant la pandémie de maladie à coronavirus (COVID-19).Nous avons lancé notre cohorte communautaire afin d'identifier la manière dont le public percevait les épidémies de maladies infectieuses au milieu de l'année 2019. Après l'annonce du premier cas de COVID-19 à Singapour le 23 janvier, nous avons débuté une série de sept sondages sur la COVID-19 auprès de participants existants et de nouveaux inscrits à intervalles réguliers, toutes les deux semaines. Nous avons pris note des caractéristiques sociodémographiques de ces participants ainsi que de l'évolution des réponses afin de déterminer le degré de sensibilisation à la situation, la confiance vis-à-vis de diverses sources d'information et le risque perçu. Nous avons employé des modèles de régression logistique multivariée pour examiner les liens qui existent entre la perception du risque et la fréquence à laquelle les répondants déclarent avoir adopté un comportement de protection.Notre cohorte de 633 participants a fourni 2857 réponses uniques lors des sept sondages sur la COVID-19. La plupart étaient d'accord ou totalement d'accord pour dire que les informations provenant de sources gouvernementales officielles (99,1%; 528/533) et d'agences de presse établies à Singapour (97,9%; 522/533) étaient fiables. La confiance envers la communication du gouvernement était étroitement liée à l'intensité de la menace ressentie (odds ratio, OR: 2,2; intervalle de confiance de 95%, IC: 1,6–3,0), mais inversement proportionnelle au risque d'infection perçu (OR: 0,6; IC de 95%: 0,4–0,8) ou au risque de décès en cas d'infection (OR: 0,6; IC de 95%: 0,4-0,9). Cette confiance était également associée à une probabilité accrue d'adoption d'un comportement de protection.Nos résultats montrent que la confiance est un outil indispensable pour gérer la progression d'une épidémie. Les multiples études réalisées par nos soins ont livré un retour d'expérience en temps réel qui a permis de mieux comprendre les interactions entre perception, confiance et comportement.Evaluar cómo las percepciones y la confianza del público en las comunicaciones del gobierno influyeron en la adopción de un comportamiento protector en Singapur durante la pandemia de la enfermedad por coronavirus de 2019 (COVID-19).A mediados de 2019, se inició el estudio de cohorte de la población local para evaluar la percepción que tiene el público sobre los brotes epidémicos de las enfermedades infecciosas. Tras la notificación del primer caso de la COVID-19 en Singapur el 23 de enero, se iniciaron una serie de siete sondeos sobre la COVID-19, tanto a personas que ya estaban participando como a personas nuevas que se inscribían con regularidad, cada dos semanas. Además de las propiedades sociodemográficas de las personas participantes, se registraron las nuevas respuestas para juzgar el conocimiento de la situación, la confianza en las diversas fuentes de información y la percepción del riesgo. Se emplearon modelos de regresión logística multivariante para evaluar las asociaciones con las percepciones de riesgo y las frecuencias adoptadas de comportamientos protectores que facilitaron las personas participantes.La cohorte de esta investigación integrada por 633 personas aportó 2857 respuestas únicas durante los siete sondeos de la COVID-19. La mayoría estuvo de acuerdo o muy de acuerdo en que la información de las fuentes oficiales del gobierno (99,1 %; 528/533) y de las agencias de noticias con sede en Singapur (97,9 %; 522/533) era fiable. La confianza en las comunicaciones del gobierno se asoció de manera significativa con una mayor percepción de amenaza (oportunidad relativa, OR: 2,2; intervalo de confianza del 95 %, IC: 1,6-3,0), pero se asoció de manera inversa con la percepción de riesgo de infección (OR: 0,6; IC del 95 %: 0,4-0,8) o de riesgo de muerte si había contagio (OR: 0,6; IC del 95 %: 0,4-0,9). La confianza en las comunicaciones del gobierno también se asoció con una mayor probabilidad de adoptar comportamientos protectores.Los resultados indican que la confianza es un elemento vital para gestionar un brote epidémico en evolución. Los estudios que se realizaron de manera repetida aportaron información en tiempo real, lo que permitió mejorar la comprensión de la interacción entre las percepciones, la confianza y el comportamiento.الغرض تقييم مدى تأثير التصورات العامة والثقة في الاتصالات الحكومية على تبني السلوك الوقائي في سنغافورة أثناء جائحة مرض فيروس كورونا (كوفيد 19). الطريقة أطلقنا مجموعتنا المجتمعية لتقييم التصورات العامة لحالات تفشي هذا المرض المعدي في منتصف عام 2019. وبعد الإبلاغ عن الحالة الأولى للإصابة بكوفيد 19 في سنغافورة في 23 يناير/كانون ثاني، أطلقنا سلسلة من المسوح السبعة عن كوفيد 19 لكل من المشاركين الجدد الحاليين والمسجلين بانتظام كل أسبوعين. وبالإضافة إلى الخصائص الاجتماعية الديموغرافية للمشاركين، قمنا بتسجيل استجابات متغيرة للحكم على الوعي بالموقف، والثقة في مصادر المعلومات المتنوعة والمخاطر المتصورة. وقمنا باستخدام نماذج تحوّف لوجيستي متعدد المتغيرات لتقييم الارتباطات مع تصورات المخاطر وأنماط التكرار المتبعة، والتي تم الإبلاغ عنها ذاتيًا، للسلوك الوقائي. النتائج قدمت مجموعتنا المكونة من 633 مشاركًا، 2857 استجابة فريدة أثناء المسوح السبعة حول كوفيد 19. وافقت الغالبية، أو وافقت بشكل مؤكد، على أن المعلومات الواردة من المصادر الحكومية الرسمية (99.1%؛ 528/533)، وأن وكالات الأنباء في سنغافورة (97.9%؛ 522/533) كانت جديرة بالثقة. ارتبطت الثقة في الاتصالات الحكومية بشكل كبير بالتهديد الملموس بشكل أكبر (نسبة الاحتمالات: 2.2؛ فاصل الثقة 95%: 1.6 إلى 3.0) ولكنها ارتبطت بشكل عكسي مع الخطر المتصور للإصابة بالعدوى (نسبة الاحتمالات: 0.6؛ ‏بفاصل ثقة 95%: 0.4 إلى 0.8) أو خطر الوفاة في حالة الإصابة بالعدوى (نسبة الاحتمالات: 0.6؛ ‏بفاصل ثقة 95%: 0.4–0.9). كما ارتبطت الثقة في الاتصالات الحكومية باحتمالية أكبر لاتباع السلوك الوقائي. الاستنتاج توضح النتائج التي توصلنا إليها أن الثقة هي ضرورة حيوية عند إدارة حالة التفشي الجارية. قدمت المسوح المتكررة الخاصة بنا ملاحظات في الوقت الفعلي، مما سمح بتحقيق فهمًا أفضل للتفاعل بين التصورات والثقة والسلوك.旨在评估在冠状病毒病（新型冠状病毒肺炎）大流行期间，公众对政府通信的看法和信任如何影响新加坡采取保护措施。.我们发起了基于社区的群组研究，以评估公众对 2019 年年中传染病疫情的看法。1 月 23 日新加坡报告首例新型冠状病毒肺炎病例后，我们发起了一系列的（7 项）新型冠状病毒肺炎调查，每 2 周对现有的参与者和定期招募的新参与者进行一次调查。结合参与者的社会人口统计特征，我们记录了不断变化的应对方式以判断是否了解情况、信任各种信息源和感知风险。我们采用多变量逻辑回归模型评估风险感知与自我报告保护行为实施频率之间的关联。.我们的 633 名参与者在 7 项新型冠状病毒肺炎调查中提供了 2857 份独特的答案。大多数人赞同或非常赞同政府提供的官方信息（99.1%；528/533）和新加坡本地新闻机构提供的信息（97.9%；522/533）值得信赖。对政府通信的信任与较高的感知威胁显著相关（比值比，OR：2.2；95% 置信区间，CI：1.6-3.0），但与感知的感染风险（OR：0.6；95% CI：0.4–0.8）或感染后的死亡风险（OR：0.6；95% CI：0.4-0.9）成反比。对政府通信的信任也与更有可能采取保护行为相关。.我们的研究结果表明，在处理不断发展的疫情时，信任是至关重要的因素。我们反复进行的调查提供了实时反馈，让人可以更好地理解感知、信任和行为之间的相互影响。.Оценить, как общественное мнение и доверие к заявлениям правительства повлияли на принятие мер защитного поведения в Сингапуре во время пандемии коронавируса (COVID-19).В середине 2019 года из местного населения была сформирована когорта для оценки общественного мнения о вспышках инфекционных заболеваний. После того как 23 января в Сингапуре был зарегистрирован первый случай заболевания COVID-19, авторы запустили серию из семи опросов по COVID-19, проводимых каждые 2 недели, для существующих и регулярно набираемых новых участников. Помимо социально-демографических характеристик участников, авторы регистрировали изменения в ответах, чтобы оценить осведомленность о ситуации, доверие к различным источникам информации и предполагаемый риск. Авторы использовали многовариантные модели логистической регрессии для оценки ассоциаций с восприятием риска и принятой частотой применения мер защитного поведения, о которой сообщали участники.Когорта из 633 участников предоставила 2857 уникальных ответов в ходе семи опросов по COVID-19. Большинство участников согласились или полностью согласились с тем, что информация из официальных государственных источников (99,1%; 528/533) и сингапурских информационных агентств (97,9%; 522/533) заслуживает доверия. Доверие к заявлениям правительства было в значительной степени связано с более высокой предполагаемой угрозой (отношение шансов, ОШ: 2,2; 95%-й доверительный интервал, ДИ: 1,6–3,0), но обратно пропорционально связано с предполагаемым риском заражения (ОШ: 0,6; 95%-й ДИ: 0,4–0,8) или с риском смерти в случае заражения (ОШ: 0,6; 95%-й ДИ: 0,4–0,9). Доверие к заявлениям правительства также было связано с большей вероятностью принятия мер защитного поведения.Полученные результаты свидетельствуют о том, что доверие является жизненно важным ресурсом в борьбе с развивающейся вспышкой. Неоднократные опросы обеспечили обратную связь в режиме реального времени, позволяя лучше понять взаимосвязь между восприятием, доверием и поведением.

COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R2 Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children's vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R2 Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults' vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised. Published version This research was funded by estate of the late Irene Tan Liang Kheng.

It is our impression that children with rhinitis often dislike or struggle with the administration of topical nasal sprays and drops. This study aims to investigate children's acceptance of topical nasal sprays/drops, and to identify patient factors that may affect their acceptance. An interview (by WYZI) questionnaire survey was carried out on parents/guardians of children aged 1-15 with rhinitis, where information on the diagnosis and treatment, patients' use and responses to these medications, and their preferred treatment routes were collected. Two hundred questionnaires were completed, of which 194 were valid for analysis. The mean age of patients was 7.54 yr; male to female ratio was 1:1.6, and Chinese made up the majority (62.4%). About one quarter (24.7%) of children disliked the use of topical nasal sprays/drops sufficiently to affect compliance with the medication. Furthermore, of those who could indicate their preferred route of drug administration (n = 75), 73% indicated a preference for oral medication, while only 11% preferred the nasal route. Topical nasal sprays/drops were more acceptable in older children (7-15 yr) compared to the younger ones (1-6 yr) (OR = 2.383, CI 1.223-4.644). The acceptance of nasal sprays/drops was not associated with gender, ethnic group, concurrent use by other family members, length and amount of usage, and the response to therapy. A substantial proportion of children prescribed topical nasal sprays/drops did not find it acceptable. Age played a significant factor to the acceptance of the use of topical nasal sprays/drops.

Background The role of probiotics in allergy prevention remains uncertain but has been shown in some studies to have a possible protective effect on eczema. Objective We aimed to assess the effect of probiotic supplementation in the first 6 months of life on eczema and allergic sensitization at 1 year of age in Asian infants at risk of allergic disease. Methods A double-blind, placebo-controlled randomized clinical trial involving 253 infants with a family history of allergic disease was carried out. Infants received at least 60 mL of commercially available cow's milk formula with or without probiotic supplementation [Bifidobacterium longum (BL999) 1 x 10(7) colony forming unit (CFU)/g and Lactobacillus rhamnosus (LPR) 2 x 10(7) CFU/g] daily for the first 6 months. Clinical evaluation was performed at 1, 3, 6 and 12 months of age, with serum total IgE measurement and skin prick tests conducted at the 12-month visit. The primary and secondary end-points were eczema and allergen sensitization, respectively. Results The incidence of eczema in the probiotic (22%) group was similar to that in the placebo group (25%) (P=0.53). The median Scoring Atopic Dermatitis score at 12 months was 17.10 (9.74) in the probiotic group and 11.60 (8.40) in the placebo group (P=0.17). The prevalence of allergen sensitization showed no difference (probiotic=24% vs. placebo=19%, P=0.26). The total IgE geometric mean (95% confidence interval) was 18.76 (12.54-24.98) kU/L in the probiotic group and 23.13 (16.01-30.24) kU/L in the placebo group (P=0.15). Atopic eczema (with sensitization) in the probiotic (7.3%) group was comparable to the placebo group (5.8%) (P=0.86). Conclusion Early life administration of a cow's milk formula supplemented with probiotics showed no effect on prevention of eczema or allergen sensitization in the first year of life in Asian infants at risk of allergic disease. Further work is needed to determine whether timing of supplementation, dose and probiotic strain are important considerations.