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This article presents the findings of a study conducted in Singapore that examined the use of oral antivirals (OAVs) among older adults with COVID-19 in primary care during the Omicron waves. The study revealed that a small percentage of older adults received OAVs, with nirmatrelvir-ritonavir being the most commonly prescribed medication. The study also identified factors such as primary care characteristics and socioeconomic status (SES) indicators that influenced the likelihood of receiving OAVs. The authors emphasize the importance of addressing disparities in OAV access among older adults and socioeconomically disadvantaged groups. They recommend targeted efforts to improve access for individuals with lower SES. [Extracted from the article]

Education is highly valued in Confucian Heritage Culture (CHC) countries such as China, Taiwan, Singapore, Hong Kong, Japan and Korea but the expectations of parents, teachers and students themselves to excel academically can also be a source of intense stress for many students. The "Academic Expectations Stress Inventory" (AESI), developed by Ang and Huan ("Educ Psychol Meas" 66: 522-539, 2006) to measure parent, teacher and self expectations as sources of academic stress in Asian adolescents, was administered to 176 Singaporean secondary and college students one month before their major examinations. Rasch analyses of the students' responses to the AESI showed the nine items in the inventory formed a robust unidimensional scale of academic stress, with two separate unidimensional subscales of "Expectations of Parents and Teachers" and "Expectations of Self" complementing the factor analysis conducted by Ang and Huan ("Educ Psychol Meas" 66: 522-539, 2006). The item thresholds showed the AESI measured the student trait range adequately, and affirmed the inventory as a brief yet valid measure of academic stress for Asian students from a CHC background. The AESI is a valuable tool for teachers and researchers, as it provides an understanding of the role of parents, teachers and self expectations as sources of academic stress among students from a CHC background.

Purpose: In this real‐world observational study, we analyzed the effects of different drugs on the quality of life (QoL) of patients with systemic lupus erythematosus (SLE). Method: We identified patients in our prospective SLE Registry who received new medications. We measure QoL with MOS 36‐Item Short‐Form Health Survey (SF‐36), a generic health questionnaire, and SLEQOL, a disease‐specific instrument. We compared the patients' scores before and after initiation of treatment. Results: We identified 259 episodes of drug initiation in 193 SLE patients. SLEQOL registered statistically significant changes with intravenous cyclophosphamide (total score and the domains of physical functioning, activities, and self‐image), mycophenolate (total score, treatment, mood, and self‐image) and azathioprine (total score, activities, and mood), but not with cyclosporin A and hydroxychloroquine. Two SF‐36 subscales (general health and physical functioning) showed statistically significant improvement in the patients who received intravenous cyclophosphamide. Both instruments have floor effect. There was weak correlation between changes in the QoL instruments and the patient assessment of disease activity or an objective disease activity index. Conclusion: SLEQOL distinguishes the differential effects on QoL of the various drugs. Treatment with intravenous cyclophosphamide and mycophenolate impacted the highest numbers of domains of SLEQOL, followed by azathioprine, cyclosporin A, and hydroxychloroquine. SLEQOL may be a useful outcome measure in SLE clinical trials. [ABSTRACT FROM AUTHOR]

Many individuals with advanced dementia die in hospital, despite preferring home death. Existing evidence of factors affecting their place of death is inconsistent. To inform policies/practices for meeting needs/preferences, systematically establishing the evidence is pertinent, particularly given the exponential rise in advanced dementia prevalence.To identify factors influencing where people with advanced dementia die.This systematic review with meta-analysis was registered on PROSPERO (CRD42022366722). Medline, CINAHL, PsycINFO, SocINDEX and a grey literature database, Overton, were searched on 21/12/2022, supplemented by hand-searching/citation tracking. Papers reporting quantitative data on factors associated with place of death in advanced dementia were included and appraised using QualSyst. Data were analysed using random effects with the certainty of evidence determined using the GRADE criteria.Thirty-three papers involving >5 million individuals (mean age = 89.2 years) were included. Long-term care setting deaths were relatively common but hospice deaths were rarer. Marriage’s association with home death underscores social networks’ importance, while younger age’s and male gender’s associations with hospital death demonstrate patients’ and families’ interdependency. Pneumonia/COPD’s opposing effects on hospital deaths with cancer/functional impairment highlight the challenges of advanced dementia care. Unlike hospital/nursing home bed availability’s lack of effect, capitated funding (fixed-amount-per-patient-per-period) decreased hospital death likelihood.This comprehensive review of place of death determinants highlight the profound challenges of advanced dementia end-of-life care. Given that bed capacity did not affect place of death, a capitation-based, integrated palliative care model would appear more likely to meet patients’ needs in a resource-constrained environment. [ABSTRACT FROM AUTHOR]

Introduction: Family caregivers of cancer patients often suffer from impaired quality of life (QOL) due to stress arising from the responsibility of caregiving. Most research on such QOL impairments was conducted in Western populations. Thus, this exploratory study sought to (a) examine the QOL levels of family caregivers of cancer patients in an Asian population in Singapore, in relation to caregivers from other countries within and outside of Asia; and (b) investigate the association between sociodemographic factors and QOL impairments in family caregivers in Singapore.Methods: A total of 258 family caregivers of cancer patients who were receiving outpatient treatment completed the Caregiver Quality of Life Index-Cancer (CQOLC) and a sociodemographic survey. We compared the published CQOLC total scores from Turkey, Iran, Taiwan, South Korea, the United Kingdom, the United States and Canada with the Singapore dataset and examined the demographic relationships.Results: Caregivers in Singapore and Asia had lower CQOLC total scores than their Western counterparts. Caregivers who were male, of Chinese ethnicity, had parental relationships with their care recipient, or cared for advanced-stage cancer patients were found to have impaired QOL.Conclusion: The findings of this study highlight possible areas in which support can be provided for family caregivers of cancer patients, and underscore the need to reconcile cultural diversity, values, societal expectations and demographic characteristics in Singapore. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Family caregivers of cancer patients experience many negative effects due to the heavy responsibility involved. Although various psychosocial interventions have been found to improve caregivers' quality of life (QOL), the sustainability of the benefits of these interventions over time has been less consistently investigated and hence less clearly established. Extending previous research on the immediate post‐intervention effects, this study aims to examine the trajectories of change in caregivers QOL over an 8‐week follow‐up period. Methods: Caregivers of patients attending an outpatient clinic at a cancer center in Singapore were recruited. Participants had to fulfill the following criteria: (a) between 21 and 74 years; (b) willing to attend hour‐long weekly programs for 4 weeks; (c) able to understand, speak, and read English; (d) a family member living with and providing care and support for the patient; and (e) provide written informed consent. Participants completed the Caregiver QOL–Cancer scale at baseline, immediately post‐intervention, and at 4 and 8 weeks after the end of the intervention. Data from 56 participants were analyzed. Results: Majority of participants exhibited a stable trajectory of change in their QOL, while a small number of participants either improved or declined. Discussion: Understanding the sustainability of the effects of the intervention is important in determining the need to initiate periodic “booster” sessions to provide consistent support for caregivers. Further research could investigate the sustainability over an even longer period, as well as intra‐individual change trajectories using growth modeling among a larger sample. [ABSTRACT FROM AUTHOR]

In T cell-deficient conditions, naive T cells undergo spontaneous 'homeostatic' proliferation in response to contact with self-MHC/peptide ligands. With the aid of an in vitro system, we show here that homeostatic proliferation is also cytokine-dependent. The cytokines IL-4, IL-7, and IL-15 enhanced homeostatic proliferation of naive T cells in vitro. Of these cytokines, only IL-7 was found to be critical; thus, naive T cells underwent homeostatic proliferation in IL-[4.sup.-] and IL-[15.sup.-] hosts but proliferated minimally in IL-[7.sup.-] hosts. In addition to homeostatic proliferation, the prolonged survival of naive T cells requires IL-7. Thus, naive T cells disappeared gradually over a 1-month period upon adoptive transfer into IL-[7.sup.-] hosts. These findings indicate that naive T cells depend on IL-7 for survival and homeostatic proliferation.