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Introduction: Singapore's recent ongoing journey of health system transformation was marked by key milestones such as War on Diabetes (2016) and the Three Beyonds (2018). In 2022, there will be a new population health narrative, vision and paradigm announced that will drive Singapore's health system transformation for the next decade and beyond. The healthcare sector had been extensively planning and preparing for this tectonic change and new journey. Description: Three key planning considerations are highlighted: Developing an inclusive and shared vision - changing how we perceive health and enable every citizen to stay healthy. In this next stage of the nation's health sector developments, the national-level shared vision and values builds on the previous iterations to further the concept of healthy communities, and people as partners in health and healthcare. It will further emphasise preventive care and require that the healthcare providers include residents who do not have yet health issues or healthcare needs, as part of the population that they need to plan for and engage with. Making health and healthcare local - by engaging with and understanding the local residents' needs and building a community of care amongst providers and residents. In this new model of care, healthcare providers will have a strong mandate and responsibility to understand the health needs of their local community, build a network of integrated care providers, and pursue strong community activation for health. There will be stronger emphasis on health and social services integration - and providers will have a common digital platform to communicate and share information. System wide change for health systems, governance and leadership - starting with the healthcare sector DNA. This fundamental change in the healthcare system is centrally led by a national Population Health Steering Committee. Furthermore, we will use technology and digital health solutions to make healthcare services accessible and person-centric, improve avenues for health information and behavioural change, and make it easy for providers to connect with the patients and with one another. Payment-wise, there will be a phased transition from the traditional fee-forservice payment model, towards a progressively capitated model. These changes in the DNA of the health system will shape how we design health systems, develop programmes and consume health services in the future. Discussion: Healthcare sector leaders in the midst of this massive and long-term system change understand that we are progressing towards a healthcare system that is more people-centric, community-based and on where patients and the community are more engaged. While this engineered change takes a top-down approach and is well-planned, one observation is that the front-end strategic planning process has not been heavy on patient engagement and consultation. Conclusion: In the Singapore context, this new narrative is a big step towards a more peoplecentred health system. We expect the change to take more than a decade, but the first three years will be critical. Healthcare sector leaders will need to work closely with politicians, patients, providers and the social sector to produce long lasting and sustainable change for the system. [ABSTRACT FROM AUTHOR]

Background: Systematically planning appropriate medical coverage for mass-participation running events is a challenge that has received relatively little attention in the medical literature, despite its potentially severe consequences. In particular, the literature lacks quantitative information on running events that medical planners can utilize for decisions on medical resource allocation and deployment. Methods: Using a case-study approach, this study provides a detailed quantitative medical services utilization profile for the Singapore Army Half-Marathon, constructed from participant and casualty data spanning three years and comprising over 80,000 data points. Casualty rates for participants of varying age and sex in different running events were also estimated using a multivariate logistic regression model. Qualitatively, planning processes and practices were described and discussed. Results: The quantitative profile yielded three main findings. Firstly, the analysis reveals that the gross Medical Usage Rate had remained fairly stable at between 16.9 and 26.0 casualties per 10,000 participants over the three years. Secondly, comparing injury types, musculoskeletal and soft-tissue injuries were the most commonly-presented injuries. Thirdly, more casualties presented at the race end-point as compared to the along the race routes. The regression analysis showed that, of the four modeled variables, the longer event distance (21 km vs. 10 km) had the largest effect on the likelihood that a participant would become a casualty. Conversely, being of an older age, being male, and running in a non-competitive event were each associated with lower casualty risk. Conclusions: The stable and intuitive casualty patterns detailed in this study provide a strong basis for further quantitative research on the medical aspects of running events, as well as for mass-participation sporting events in general. The qualitative aspects of this report may serve as a useful resource to medical planners for running events. [ABSTRACT FROM AUTHOR]

This study examines the prevalence and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among migrant workers in Singapore. [ABSTRACT FROM AUTHOR]

Precise and accurate knowledge of the optical properties of amorphous silica is important because of the increasing application of SiO[sub 2] in optical and electrooptical devices, including photolithography masks for semiconductor fabrication, recently as a potential 157 nm mask substrate. The optical properties in the vacuum ultraviolet (VUV) region have been investigated, because they convey detailed information on the electronic structure and interatomic bonding of the material. In this work, we have combined spectroscopic ellipsometry and VUV spectroscopy to directly determine the optical functions of SiO[sub 2] in this range, thereby reducing the uncertainty in the low-energy extrapolation of the data, essential for KramersKronig analysis of VUV reflectance. We report the complex optical properties of SiO[sub 2], over the range of 1.5 to 42 eV, showing improved agreement with theory when contrasted with earlier results. In addition to the features previously reported at 10.4, 11.6, 14.03, and 17.10 eV, new interband transitions have been observed at 21.3 eV along with O 2s transitions at 32 eV. We found the bulk plasma peak to be 23.7 eV in the energy loss function spectrum. Based on the magnitude of these new results, the Hamaker constant for SiO[sub 2]Vacuum+SiO[sub 2] is 71.6 zJ, which is larger than the previously reported value of 66 zJ. [ABSTRACT FROM AUTHOR]

As early as 2005, the World Health Organization's Regional Office for the Western Pacific (WPRO) had worked closely with countries in its region to promote people-centred health care and provide practical guidance on health policies and interventions that can lead to better quality of health care, better health outcomes and improved well-being. The people-centred approach to health makes the perspectives of individuals, families and communities central to the organization of health services and systems, and is critical in improving service quality and contributing to progress towards Universal Health Coverage (UHC). WHO convened a policy roundtable to in Asia on the topic of "People-Centred Integrated Health Services", and brought together 36 policy-makers and experts from 12 countries in the WHO Western Pacific Region. Challenges of implementing people-centred, integrated health services were shared and good practices for developing health services that were people-centred and integrated were discussed. The sessions discussed good practices on engagement with patients and families, ideas to strengthening governance and accountability, and coordination of services around the needs of people. Participants shared on the challenges of the current health systems, which were historically developed to provider-centric and hospital-centric, built on the bio-medical model of health. Recent changes in population demographics, healthcare needs and community expectations require health systems to evolve and adapt, to be more needs- and value-based. However in many settings, health services and social services are not well-integrated, and have contributed to poor outcomes and resource optimization. These can be worsened by technological or system barriers to timely communication and information sharing between healthcare providers. In several areas, lack of regulatory oversight has led to over-commercialization and commoditization of healthcare services. To advance people-centred, integrated health services and move towards universal health coverage, patients, families and communities need to be recognized as key partners and stakeholders in health, and be engaged accordingly. Links between health and social sectors need to be strengthened at all levels to better address the co-dependency between social and health for the population. Health systems need to promote communications and teamwork between providers and create platforms to facilitate information sharing. Alignment of policy directions and incentives is critical to generate the desired behaviors in healthcare providers and users. Health systems should collect data on what is meaningful to patients, families and communities, and shift our health systems' KPIs to become more value-based. [ABSTRACT FROM AUTHOR]

Introduction: Military forces around the world face an increased risk of the spread of communicable diseases, due to the close living quarters and congregated nature of the military camps. The Singapore Armed Forces (SAF) implemented a multi-pronged surveillance and containment strategy to reduce the risk of a coronavirus disease 2019 (COVID-19) outbreak within the local military camps. This paper details the epidemiological investigations of the COVID-19 cases in the SAF and highlights the strategies and public health measures undertaken, aligned with the national COVID-19 control strategy, to reduce the risk of COVID-19 transmission in the military camps. Materials and Methods: Medical data of our military personnel who were infected with COVID-19 during the first 180 days of the pandemic were extracted from the military electronic health records. Contact tracing and activity mapping results were obtained from unit-level epidemiological data. A review of the organization's response plans, instructions, and orders was conducted to collate the measures implemented across the same time period. Results: Prompt contact tracing and activity mapping was done for each of the 24 SAF military personnel diagnosed with COVID-19 between February 2020 and June 2020, with possible links among the cases identified and investigated. Conclusion: A combination of strategies in the formulation of public health measures based on key principles of early warning and surveillance, prompt diagnosis, and early containment were successful in preventing the formation of COVID-19 clusters within the SAF. This will provide a framework for the management of future pandemics within the military setting, driven by strong governance and leadership, to meet the military's need to maintain operational readiness in a safe manner. [ABSTRACT FROM AUTHOR]

Background: Systematically planning appropriate medical coverage for mass-participation running events is a challenge that has received relatively little attention in the medical literature, despite its potentially severe consequences. In particular, the literature lacks quantitative information on running events that medical planners can utilize for decisions on medical resource allocation and deployment.Methods: Using a case-study approach, this study provides a detailed quantitative medical services utilization profile for the Singapore Army Half-Marathon, constructed from participant and casualty data spanning three years and comprising over 80,000 data points. Casualty rates for participants of varying age and sex in different running events were also estimated using a multivariate logistic regression model. Qualitatively, planning processes and practices were described and discussed.Results: The quantitative profile yielded three main findings. Firstly, the analysis reveals that the gross Medical Usage Rate had remained fairly stable at between 16.9 and 26.0 casualties per 10,000 participants over the three years. Secondly, comparing injury types, musculoskeletal and soft-tissue injuries were the most commonly-presented injuries. Thirdly, more casualties presented at the race end-point as compared to the along the race routes. The regression analysis showed that, of the four modeled variables, the longer event distance (21 km vs. 10 km) had the largest effect on the likelihood that a participant would become a casualty. Conversely, being of an older age, being male, and running in a non-competitive event were each associated with lower casualty risk.Conclusions: The stable and intuitive casualty patterns detailed in this study provide a strong basis for further quantitative research on the medical aspects of running events, as well as for mass-participation sporting events in general. The qualitative aspects of this report may serve as a useful resource to medical planners for running events. [ABSTRACT FROM AUTHOR]

Introduction: The Singapore Armed Forces (SAF) recognises the potential benefits and looks to harnessing telemedicine for primary health care services. In this prospective self-controlled pilot study, we aimed to evaluate the safety, efficiency and user satisfaction outcomes of virtual care (VC) at a military medical centre.Methods: Out of 320 patients seen during the study period, 28 were enrolled in this study and underwent on-premises VC, comprising digital symptoms collection and telemedicine in addition to the usual in-person physician consultation. Safety outcomes were measured based on the diagnostic concordance between physicians. Efficiency was measured based on consultation times, and user satisfaction was evaluated using a standard questionnaire.Results: There was a higher caseload of both upper respiratory infections and dermatological conditions in our population, in which telemedicine performed well. In terms of safety, telemedicine achieved a mean diagnostic concordance of 92.8% compared to in-person consultations. In terms of efficiency, consultation times were 26.2% - or 2 minutes and 15 seconds - shorter on average with telemedicine (p = 0.0488). User satisfaction was favourable, with 85.5% of patients satisfied with the VC experience.Discussion: This study has been invaluable in showing that on-premises telemedicine is a safe, efficient and effective means to extend and increase our surge capacity for primary health care. Our results have given us reasonable confidence to explore a larger-scale implementation in our network of military medical centres in the future. [ABSTRACT FROM AUTHOR]

Starting with a handful of SARS-CoV-2 infections in dormitory residents in late March 2020, rapid transmission in their dense living environments ensued and by October 2020, more than 50,000 acute infections were identified across various dormitories in Singapore. The aim of the study is to identify combination of factors facilitating SARS-CoV-2 transmission and the impact of control measures in a dormitory through extensive epidemiological, serological and phylogenetic investigations, supported by simulation models. Our findings showed that asymptomatic cases and symptomatic cases who did not seek medical attention were major drivers of the outbreak. Furthermore, each resident had about 30 close contacts and each infected resident spread to 4.4 (IQR 3.5–5.3) others at the start of the outbreak. The final attack rate of the current outbreak was 76.2% (IQR 70.6–98.0%) and could be reduced by further 10% under a modified dormitory housing condition. These findings are important when designing living environments in a post COVID-19 future to reduce disease spread and facilitate rapid implementation of outbreak control measures. [ABSTRACT FROM AUTHOR]

Between 2016 and 2018, tobacco control legislation has undergone several amendments to further restrict tobacco use in Singapore. This study explored the attitudes toward these policy changes and the perceived effectiveness of legislations from the perspectives of young male adults in Singapore. Twenty-nine semi-structured telephone interviews were conducted among young male adults who have completed their National Service in 2017/18 and self-reported as a smoker at pre-enlistment screening. Young male smoker perspectives on Singapore tobacco policies including taxation, smoke-free environment, point-of-sale display ban on tobacco products, graphic health warnings, and raising the minimum legal age of smoking to 21, were evaluated. Participants held the view that cigarette pricing was a highly effective approach to control their smoking behavior because it has a direct impact on tobacco affordability, and they shared that the least effective approaches were point-of-sale display bans and graphic health warnings. Results demonstrate that participants were well aware of tobacco control policies in Singapore, but they did not always fully accept them or understand the rationale behind them. Tobacco control measures should be implemented along with public education to correct misperceptions and increase public support for tobacco control measures in Singapore. [ABSTRACT FROM AUTHOR]

Summary Background Simultaneous acute gastroenteritis (AGE) outbreaks occurred at two military camps. This study details the epidemiological findings, explores possible origins, and discusses preventive measures. Methods Investigations included attack rate surveys, symptom surveys, hygiene inspections, and the testing of water, food, and stool samples. DNA/RNA was extracted from stool samples and amplified via real-time reverse transcription PCR (RT-PCR). Partial and full-length capsid nucleotide sequences were obtained, phylogenetic relationships inferred, and homology modelling of antigenic sites performed. Results The military outbreaks involved 775 persons and were preceded by two AGE outbreaks at restaurants in the local community. The outbreak was longer and larger in the bigger camp (21 days, attack rate 15.0%) than the smaller camp (6 days, attack rate 8.3%). Of 198 stool samples, norovirus GI.2 was detected in 32.5% (larger camp) and 28.6% (smaller camp). These were essentially identical to preceding community outbreaks. Antigenic site homology modelling also showed differences between identified and more common AGE outbreak strains (norovirus GII.4). Conclusion Differences observed highlight difficulties in controlling person-to-person outbreaks among large groups in close proximity (e.g., military trainees). Distinct differences in antigenic sites may have contributed to increased immunological susceptibility of the soldiers to infection. [ABSTRACT FROM AUTHOR]