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In the introduction to this special issue, the editors introduce the reader to research methodologies and analyses not commonly presented in mainstream health policy literature. Intersectional analysis, for example, is a means of drilling down into how the multiple social categories a person occupies (e.g., gender, class, ethnicity) may influence their experience of inequality. When an intersectional framework was applied to US Behavioral Risk Factor Surveillance System data in 2018 and 2019, for example, gender minority Blacks were identified as having distinctly poor health experiences compared with cisgender Black and other non-Black gender minority populations.1 Consequently, health policies and monitoring programs that purport to advance health equity must account for multiply marginalized populations such as these.Looking at drug policy through an intersectional lens reinforces the importance of macrolevel social determinants as they interact with meso and microlevel factors to influence drug harms and mediate policy and intervention effectiveness2 as well as the role of power in excluding certain perspectives, framings, forms of knowledge, and experience.3 Ethnographic, social-scientific, and community-based research methodologies challenge power imbalances by favoring the embodied knowledge of those with lived experience, knowledge gained by direct observation and study of the particular history and economic and political systems in a given location,2 as opposed to forms of professional expertise favored by public authorities seeking to govern society at a distance.

Background Nonsuicidal self-injury (NSSI) is a common phenomenon; a recent meta-analysis of studies conducted among non-clinical adolescents reported a global lifetime prevalence rate of 22.0%. NSSI results in significant impairment and is associated with negative outcomes later in young adulthood. There is, however, a dearth of research on the occurrence of NSSI in Singapore’s youth population. Past studies examining NSSI behaviours among youths in Singapore were conducted using clinical samples, which tend to report a higher prevalence compared to community samples. The present study aims to establish the prevalence of NSSI and examine its associated sociodemographic and psychosocial correlates in the general youth population. Methods This study included 2600 youths aged 15–35 years who participated in the National Youth Mental Health Study, a nationwide cross-sectional survey of the mental health status of youths in Singapore. The Deliberate Self-Harm Inventory and Depression Anxiety Stress Scales Short Form were used to assess NSSI behaviours and mental health symptoms. Data on coping strategies, perceived social support and resilience were also collected. Results The lifetime prevalence of NSSI among youths in Singapore was 25.0%, and the 12-month prevalence was found to be 6.8%. The median age of onset for lifetime NSSI was 14 years. Significantly higher odds of lifetime NSSI were observed among youths aged 15–29 years, females, and youths with lower educational attainment. Youths with severe and extremely severe symptoms of depression and anxiety and those with greater use of avoidance coping strategy were associated with higher odds of lifetime NSSI. Higher resilience scores were associated with lower odds of lifetime NSSI. Conclusion 1 in 4 youths in Singapore had engaged in self-injurious behaviour at least once in their lifetime. Screening and early intervention programs could be targeted at the more vulnerable youth groups such as those in early- and mid- adolescence. Potential areas for future research and interventions could include resilience building and educating youths on adaptive coping strategies. The limitations of the cross-sectional study design and the use of self-reported data should be considered when interpreting the study findings.

IntroductionThe increasing prevalence of diabetes and its associated complications presents a significant public health challenge, particularly in ageing populations. This qualitative study conducted in a healthcare setting in Singapore explored the lived experiences of patients with type 2 diabetes mellitus (T2DM) progression and complications, aiming to uncover challenges and enablers of effective self-care and complication management, thereby informing patient-centred policy and healthcare improvements.MethodsA phenomenological approach was employed, involving one-to-one in-depth interviews with 13 participants with T2DM with complications. Participants were recruited through purposive sampling from the outpatient setting of a community-level diabetes care centre. Data were analysed through a reflexive thematic analysis.ResultsSeven themes emerged from the analysis: (1) pathways to initial diagnosis of diabetes, (2) diagnosis of diabetes-related complications (with subthemes of diagnosis in emergency and non-emergency settings), (3) barriers to help-seeking for complications, (4) barriers to diabetes complications management, (5) enablers of complications management, (6) experience of living with diabetes complications and (7) suggestions and recommendations for better care. Subthemes for barriers and enablers encompassed personal, healthcare-related and social/community factors. Findings revealed significant gaps in symptom recognition, treatment adherence and glycaemic control among participants. Despite these challenges, participants demonstrated considerable resilience and adaptability.ConclusionThis study identified complex trajectories in T2DM progression, from the initial diagnosis to complication management, identifying key challenges and enablers. The findings highlighted the necessity for enhanced public education, tailored interventions and holistic care approaches. These insights have the potential to significantly improve the quality of life of individuals living with T2DM complications and alleviate the burden on healthcare systems, providing a foundation for future patient-centred diabetes management strategies.

Background In recent years, behaviourally driven policies such as nudges have been increasingly implemented to steer desired outcomes in public health. This study examines the different nudges and the socio-demographic characteristics and lifestyle behaviours that are associated with public acceptance of lifestyle nudges. Methods The study used data from the nationwide Knowledge, Attitudes and Practices study (KAP) on diabetes in Singapore. Three types of nudges arranged in increasing order of intrusiveness were examined: (1) information government campaigns, (2) government mandated information and (3) default rules and choice architecture. Acceptance was assessed based upon how much respondents ‘agreed’ with related statements describing heathy lifestyle nudges. Multivariable linear regressions were performed with socio-demographics and lifestyle behaviours using scores calculated for each nudge. Results The percentage of respondents who agreed to all statements related to each nudge were: 75.9% (information government campaigns), 73.0% (government mandated information), and 33.4% (default rules and choice architecture). Respondents of Malay/Others ethnicity (vs. Chinese) were more likely to accept information government campaigns. Respondents who were 18 – 34 years old (vs 65 years and above), female, of Malay/Indian ethnicity (vs Chinese), were sufficiently physically active, and with a healthier diet based on the DASH (Dietary Approach to Stop Hypertension) score were more likely to accept nudges related to government mandated information. Respondents of Malay/Indian ethnicity (vs Chinese), and who had a healthier diet were more likely to accept default rules and choice architecture. Conclusion Individuals prefer less intrusive approaches for promoting healthy lifestyle. Ethnicity and lifestyle behaviours are associated with acceptance of nudges and should be taken into consideration during the formulation and implementation of behaviourally informed health policies.

Background Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (β: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (β: −0.058; p < 0.05). Conclusion Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.

Background: The isolation of microsatellite markers remains laborious and expensive. For some taxa, such as Lepidoptera, development of microsatellite markers has been particularly difficult, as many markers appear to be located in repetitive DNA and have nearly identical flanking regions. We attempted to circumvent this problem by bioinformatic mining of microsatellite sequences from a de novo-sequenced transcriptome of a butterfly (Euphydryas editha). Principal Findings: By searching the assembled sequence data for perfect microsatellite repeats we found 10 polymorphic loci. Although, like many expressed sequence tag-derived microsatellites, our markers show strong deviations from Hardy-Weinberg equilibrium in many populations, and, in some cases, a high incidence of null alleles, we show that they nonetheless provide measures of population differentiation consistent with those obtained by amplified fragment length polymorphism analysis. Estimates of pairwise population differentiation between 23 populations were concordant between microsatellite-derived data and AFLP analysis of the same samples (r = 0.71, p<0.00001, 425 individuals from 23 populations). Significance: De novo transcriptional sequencing appears to be a rapid and cost-effective tool for developing microsatellite markers for difficult genomes.

Background Chronic conditions are a leading cause of death and disability worldwide and respective data on dietary patterns remain scant. The present study aimed to investigate dietary patterns and identify sociodemographic factors associated with Dietary Approaches to Stop Hypertension (DASH) scores within a multi-ethnic population with various chronic conditions. Methods The present study utilised data from the 2019-2020 Knowledge, Attitudes, and Practices study on diabetes in Singapore – a nationwide survey conducted to track the knowledge, attitudes, and practices pertaining to diabetes. The study analysed data collected from a sample of 2,895 Singapore residents, with information from the sociodemographic section, DASH diet screener, and the modified version of the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0 checklist of chronic physical conditions. Results Respondents with no chronic condition had a mean DASH score of 18.5 (±4.6), those with one chronic condition had a mean DASH score of 19.2 (±4.8), and those with two or more chronic conditions had a mean DASH score of 19.8 (±5.2). Overall, the older age groups [35– 49 years (B = 1.78, 95% CI: 1.23 – 2.33, p <0.001), 50–64 years (B = 2.86, 95% CI: 22.24 – 3.47, p <0.001) and 65 years and above (B = 3.45, 95% CI: 2.73 – 4.17, p <0.001)], Indians (B = 2.54, 95% CI: 2.09 – 2.98, p <0.001) reported better diet quality, while males (B = -1.50, 95% CI: -1.87 – -1.14, p <0.001) reported poorer diet quality versus females. Conclusion Overall, respondents with two or more chronic conditions reported better quality of diet while the sociodemographic factors of age, gender and ethnicity demonstrated a consistent pattern in correlating with diet quality, consistent with the extant literature. Results provide further insights for policymakers to refine ongoing efforts in relation to healthy dietary practices for Singapore.

Until recently the isolation of microsatellite markers from Lepidoptera has proved troublesome, expensive and time-consuming. Following on from a previous study of Edith's checkerspot butterfly, Euphydryas editha, we developed novel microsatellite markers for the vulnerable marsh fritillary butterfly, E. aurinia. Our goal was to optimize the process in order to reduce both time and cost relative to prevailing techniques. This was accomplished by using a combination of previously developed techniques: in silico mining of a de novo assembled transcriptome sequence, and genotyping the microsatellites found there using an economic method of fluorescently labelling primers. In total, we screened nine polymorphic microsatellite markers, two of which were previously published, and seven that were isolated de novo. These markers were able to amplify across geographically isolated populations throughout Continental Europe and the UK. Significant deviations from Hardy-Weinberg equilibrium were evident in some populations, most likely due to the presence of null alleles. However, we used an F(st) outlier approach to show that these markers are likely selectively neutral. Furthermore, using a set of 128 individuals from 11 populations, we demonstrate consistency in population differentiation estimates with previously developed amplified fragment length polymorphism (AFLP) markers (r = 0.68, p<0.001). Rapid development of microsatellite markers for difficult taxa such as Lepidoptera, and concordant results with other putatively neutral molecular markers, demonstrate the potential of de novo transcriptional sequencing for future studies of population structure and gene flow that are desperately needed for declining species across fragmented landscapes.

We present a case for using Global Community Innovation Platforms (GCIPs), an approach to improve innovation and knowledge exchange in international scientific communities through a common and open online infrastructure. We highlight the value of GCIPs by focusing on recent efforts targeting the ecological sciences, where GCIPs are of high relevance given the urgent need for interdisciplinary, geographical, and cross-sector collaboration to cope with growing challenges to the environment as well as the scientific community itself. Amidst the emergence of new international institutions, organizations, and meetings, GCIPs provide a stable international infrastructure for rapid and long-term coordination that can be accessed by any individual. This accessibility can be especially important for researchers early in their careers. Recent examples of early-career GCIPs complement an array of existing options for early-career scientists to improve skill sets, increase academic and social impact, and broaden career opportunities. We provide a number of examples of existing early-career initiatives that incorporate elements from the GCIPs approach, and highlight an in-depth case study from the ecological sciences: the International Network of Next-Generation Ecologists (INNGE), initiated in 2010 with support from the International Association for Ecology and 20 member institutions from six continents.

Over a decade of genome-wide association, studies have made great strides toward the detection of genes and genetic mechanisms underlying complex traits. However, the majority of associated loci reside in non-coding regions that are functionally uncharacterized in general. Now, the availability of large-scale tissue and cell type-specific transcriptome and epigenome data enables us to elucidate how non-coding genetic variants can affect gene expressions and are associated with phenotypic changes. Here, we provide an overview of this emerging field in human genomics, summarizing available data resources and state-of-the-art analytic methods to facilitate in-silico prioritization of non-coding regulatory mutations. We also highlight the limitations of current approaches and discuss the direction of much-needed future research.