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Backgrounds: The development of the Internet has changed interpersonal interactions, so that people no longer need to physically meet each other. However, some people are more vulnerable to becoming addicted to Internet activities, something to which the ease of Internet access and usage has contributed. In this study, we examined the association between personality traits and feelings about online interpersonal interactions to predict Internet addiction. This was accomplished using an online advertisement that asked participants to complete the questionnaires in the laboratory. Methods: Two hundred and twenty-three participants with a mean age of 22.50 years were recruited for this study and asked to complete the following questionnaires: the Beck Depressive Inventory (BDI), the Beck Anxiety Inventory (BAI), the Chen Internet Addiction Scale (CIAS), the Eysenck Personality Questionnaire (EPQ), the Internet Usage Questionnaire (IUQ) and the Feelings of Internet Interpersonal Interaction Questionnaire (FIIIQ). Results: The results showed that people with a neurotic personality and anxious feelings about Internet interpersonal interactions are more likely to become addicted to the Internet. In addition, people with neuroticism and who are more anxious about Internet interpersonal relationships are more likely to develop Internet addiction. Conclusions: People who tend to develop new interpersonal relationships via the Internet and be anxious about online interpersonal relationships are more vulnerable to becoming addicted to the Internet. The individuals who are more anxious about Internet interpersonal interaction and tend to develop new interpersonal relationships via the Internet are more likely to develop Internet addiction.

In this study, we develop a dynamic multi-activity network DEA (DMNDEA) model that combines the multi-activity network DEA model (MNDEA) with the dynamic network DEA model (DNDEA). This new model is used to measure the efficiency of twenty-seven Taiwanese banks under a multistage and multiactivity production process during the sample period of 2006-12. The proposed model is able to identify whether inefficiencies stem from financial activities or the production stages and provides managers with information to propose better strategies to improve the overall performance of their banks under fluid macroeconomic conditions across time.

Informal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore. A pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups. Primary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time. To our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them. ClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.

Background Autosomal recessive or compound heterozygous mutations in KLHL40 cause nemaline myopathy 8, which is one of the most severe forms of nemaline myopathy. The KLHL40 c.1516A>C variant has recently been reported as a founder mutation in southern Chinese. Methods We report six cases of nemaline myopathy 8 which involves the c.1516A>C variant, from five unrelated families of non‐consanguineous southern Chinese. The pre‐ and postnatal phenotypes of these cases were reviewed with emphasis on prenatal clinical features. Genetic testing for the founder mutation was performed on three patients with homozygous mutations. Results Common prenatal features included reduced fetal movement, polyhydramnios, breech presentation, and clubfeet. Two pregnancies were terminated. Four live‐born patients had postnatal features typical of nemaline myopathy 8. The length of survival ranged from 49 days to 17 months, with respiratory failure and infections being the principal causes of death. Haplotype analysis in three patients with homozygous mutation showed a shared haplotype block of 1.1727 cM spanning over the c.1516A>C variant, suggesting it is a southern Chinese‐specific founder mutation. Conclusion Analysis of the KLHL40 c.1516A>C variant should be considered in prenatal diagnosis of Chinese pregnant patients with suspected congenital neuromuscular disorders or with significant family history of congenital myopathies. We reported six cases from five unrelated families of non‐consanguineous southern Chinese affected by nemaline myopathy 8, with either homozygous variants or compound heterozygous variants involving c.1516A>C in KLHL40. Pre‐ and postnatal phenotypes of the cases were reviewed, with emphasis on the prenatal clinical features.

Objectives: To investigate the incidence of urinary incontinence (UI) during pregnancy and after delivery, perceptions of UI, effectiveness of pelvic floor muscle exercise (PFME) on UI, and risk factors for UI among pregnant women.Methods: Chinese women aged ≥18 years at 35 to 37 weeks of gestation were invited to participate. Perceptions of UI were assessed using a questionnaire that comprises seven statements. Urinary symptoms were assessed using the self-report six-item Urogenital Distress Inventory (UDI-6). Women were considered to have UI when they had positive scores on any of the incontinence items (items 2 to 4). Women who reported to have UI symptoms were assessed by a physiotherapist in the postnatal ward and were taught PFME. UI impact on QoL was assessed using the self-report seven-item Incontinence Impact Questionnaire (IIQ-7). Participants with UI during pregnancy who delivered in our hospital were followed up at 6 weeks postnatally through telephone. Their adherence to PFME was assessed in terms of the mean number of contractions performed per day.Results: Of 1134 participants, the incidence of UI was 73.0% during pregnancy and 21.9% after delivery. Predictors for UI during pregnancy were a history of UI before pregnancy (odds ratio [OR]=14.40, p<0.001), higher pre-pregnancy body mass index (OR=1.04, p=0.034), and previous vaginal delivery (OR=2.06, p=0.001), whereas predictors for UI after delivery were vaginal delivery in the index pregnancy (OR=3.86, p<0.001), older age (OR=1.12, p<0.001), a history of UI before pregnancy (OR=1.86, p=0.028), and total score of items 2 to 4 on the UDI-6 during pregnancy (OR=1.20, p=0.015). 86.4% of participants reported poor or no adherence to PFME. Adherence to postnatal PFME was not associated with UI after delivery (p=0.477). Women with higher education levels adhered more to PFME (p=0.008). Perceptions of UI were not associated with adherence to postnatal PFME.Conclusion: A history of pre-pregnancy UI is the main predictor for UI during pregnancy, whereas vaginal delivery is the main predictor for UI after delivery. The effect of postpartum PFME on UI after delivery is not significant, probably owing to the low rate of adherence to PFME.

BackgroundInformal caregivers of persons with dementia (PWD) often suffer adverse impacts on their mental health and require interventions for effective support. As they are often occupied with providing care, web-based interventions could be more convenient and efficient for them. However, there is currently a dearth of evidence-based mobile interventions to enhance the mental well-being of dementia caregivers locally, especially ones that are user-centered and culturally relevant. Hence, having designed an app based on feedback from local dementia caregivers, this study will evaluate the effectiveness of this mobile app in promoting the mental health of informal caregivers of PWD in Singapore.MethodsA pilot two-armed randomised controlled trial will be conducted on 60 informal caregivers of PWD recruited via convenience and snowball sampling. Thirty participants will be assigned to the intervention group, while another 30 will be in a waiting-list control group. Questionnaires will be administered at baseline and one month after, with the primary outcome being the difference in the change of depressive symptoms among the two groups.Statistical analysisPrimary analyses will follow the intention-to-treat principle and compare changes from baseline to the one-month follow-up time point relative to the control group. A repeated measures ANOVA will be conducted to examine differences between the groups over time.SignificanceTo our knowledge, this is the first study in Singapore that seeks to promote the mental health of informal dementia caregivers through a mobile-based intervention. The findings can inform the development and evaluation of future evidence-based digital interventions for local informal caregivers of PWD to address the gap in availability of such resources for them.Trial registrationClinicalTrials.gov (NCT05551533). Registration date: September 22, 2022.

Objective: To evaluate the usefulness of serum C-reactive protein (CRP) in women with preterm prelabour rupture of membranes (PPROM) in the prediction of funisitis and early-onset neonatal sepsis (EONS), to determine a CRP cutoff value for their prediction, and to identify other significant risk factors associated with funisitis and EONS. Methods: This was a retrospective study conducted in a tertiary hospital in Hong Kong. Women with a singleton pregnancy at 24 to 34 weeks of gestation and had PPROM were recruited between January 2011 and December 2015. Maternal serum CRP level, histopathological diagnosis of the placenta, and incidence of EONS were evaluated. Results: Among the 123 women recruited, funisitis was present in 21.1% of the women and EONS in 19.5% of the newborns. Maternal serum CRP level was associated with funisitis that was in turn associated with EONS. There was, however, no significant association between maternal serum CRP and EONS. Using a CRP cutoff value of 7.65 mg/l to predict funisitis, the sensitivity, specificity, positive predictive value, and negative predictive value were 65.4%, 78.4%, 44.7%, and 89.4%, respectively. The gestational age at delivery was the most significant risk factor for funisitis and EONS. Birth weight and Apgar score were significantly lower in women with funisitis and newborns with EONS than those without. Other risk factors for EONS included a positive high vaginal swab and placental swab cultures and the presence of group B Streptococcus in a high vaginal swab. Conclusion: Maternal serum CRP may be helpful in the prediction of funisitis in women with PPROM. Nonetheless, the study did not show any association between maternal serum CRP and EONS. The CRP level should be interpreted with caution in a clinical setting. The gestational age at delivery was the most significant determining factor for funisitis and EONS.

Introduction:To evaluate the neonatal survival rate and maternal and neonatal morbidities after conservative treatment for previable preterm prelabour rupture of membranes (PPROM) at our hospital over the past 10 years. Methods: Maternal and neonatal records of women with PPROM before 24 weeks who delivered at Princess Margaret Hospital between 1 April 2007 and 31 March 2017 were retrospectively reviewed. Patients with PPROM before 20 weeks of gestation were compared with those with PPROM between 20 and 23+6 weeks of gestation. The primary outcome was neonatal survival rate until discharge. Secondary fetal/neonatal outcomes included the live birth rate, latency period, gestational age at delivery, and short- and long-term neonatal complications of survivors. Secondary maternal outcomes included chorioamnionitis, placental abruption, cord prolapse, caesarean section, postpartum haemorrhage, maternal intensive care unit admission, hysterectomy, and maternal death. Results: Of 80 women (77 singleton and 3 twin pregnancies), 30 opted for pregnancy termination and 50 opted for conservative management. Of the latter, 18 and 32 had PPROM before 20 weeks and between 20 and 23+6 weeks of gestation, respectively. Maternal characteristics of the two groups were comparable. The mean gestational age at PPROM was 20.2 weeks and the mean latency period was 16 days. The overall neonatal survival rate until discharge was 32.1% (n=17); it was lower in women with PPROM before 20 weeks of gestation than after 20 weeks of gestation (10.5% vs. 44.1%, p=0.012). The surviving neonates had various neonatal complications including respiratory distress syndrome (100%), probable or confirmed neonatal sepsis (81.8%), bronchopulmonary dysplasia (59.1%), and intraventricular haemorrhage (31.8%). Maternal complications included caesarean section (71.4%) and chorioamnionitis (26%). Conclusion: The prognosis of PPROM remains grave, with only one third of neonates surviving to discharge. The neonatal complication rate remains high for survivors.

Objectives: Methotrexate is commonly used in the treatment of ectopic pregnancy. Outcomes with a suboptimal drop in human chorionic gonadotrophic (hCG) level are unknown. This study aimed to determine the optimal cutoff value for hCG drop in detecting treatment success, to investigate the predictors of success, and to evaluate outcome following a single dose of methotrexate as treatment of ectopic pregnancy. Methods: A retrospective study was conducted of 182 patients with ectopic pregnancy treated with methotrexate. Outcomes included resolution of hCG or further surgical intervention. The optimal cutoff value for hCG drop in prediction of treatment success was evaluated using receiver operating characteristic curve analysis. Results: The success rate was 79.1%. The cutoff value for hCG drop between day 4 and day 7 for prediction of success following a single dose of methotrexate was 3.34%, with a positive predictive value of 91.67%. Compared with subjects with initial hCG level of <1000 IU/L, there was a significant reduction in success for those with initial hCG levels ranging from 1000 to 3999 IU/L (odds ratio=0.184; p=0.02), 4000 to 4999 IU/L (odds ratio=0.116; p=0.03), and ≥5000 IU/L (odds ratio=0.057; p=0.01). Conclusions: Pretreatment hCG level and hCG drop between day 4 and day 7 are good predictors of success following methotrexate treatment. With a high positive predictive value for success, conservative management with serial hCG monitoring may be considered when drop in hCG level between day 4 and day 7 is ≥3.34%.

Objective: To evaluate the difference in serum human chorionic gonadotrophin (hCG) level in pregnant women when using assays calibrated against the World Health Organization (WHO) 3rd versus 5th International Standard (IS), and to determine the implications for management of pregnancy of unknown location (PUL). Methods: 105 samples of serum hCG obtained from pregnant women were tested using assays calibrated against the WHO 3rd IS versus 5th IS. The clinical course, ultrasound findings, final diagnosis, and clinical outcome were evaluated. The optimal cut-off value of ‘discriminatory zone’ for management of PUL was determined using receiver operating characteristic curve analysis. Results: Both WHO 3rd IS and 5th IS were highly correlated (Pearson’s r=0.996, r2=0.992) but not equivalent. The mean percentage difference was 12.9%. 34 paired samples were included in a diagnostic-validation study, and the cut-off value of ‘discriminatory zone’ was 1500 IU/L for the 3rd IS (sensitivity=50.0%, specificity=87.5%, area under curve=77.9%) and 1745 IU/L for the 5th IS (sensitivity=60.0%, specificity=87.5%, area under curve=79.2%). Conclusion: Calibration of serum hCG using the WHO 3rd IS and 5th IS was highly correlated but not equivalent. A larger prospective study is required before recommendations can be made with regard to the cut-off value of a new ‘discriminatory zone’.