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Background Photo‐ageing is a form of skin ageing which affects the entire face. A photo‐aged skin has a diverse variety of wrinkles and dyspigmentation all over the face. Here, we discuss photo‐ageing on the Chinese skin evaluated using a photo‐numeric scale developed and validated on Caucasian skin (i.e., Caucasian scale) and evaluated using a photo‐numeric scale developed and validated on Korean skin (i.e., Korean scale). The Korean scale can be subdivided into two scales that separately address the wrinkling and dyspigmentation constituents of photo‐ageing. Aim As there are currently no photo‐ageing scales for Chinese skin, the main objective of this study is to adapt existing photo‐ageing photo‐numeric scales for use on ethnic Chinese skin. Method Three trained assessors studied facial photo‐ageing on 1,081 ethnic Chinese young adults from the Singapore/Malaysia Cross‐sectional Genetics Epidemiology Study (SMCGES) cohort. Results All assessors are highly internally consistent (Weighted Kappa (κw) values≥0.952). We found that the Caucasian scale and Korean scale give nearly synonymous results for the wrinkling constituent of photo‐ageing (R2 = 0.9386). The two scales are strongly concordant (Spearman's Rank Correlation (ρ) value: 0.62 ± 0.06, p = 1.31×10−84). A weak‐to‐moderate inter‐scalar level of agreement (Cohen's Kappa (κ) values: 0.38 ± 0.05, p = 8.87×10−53) persists and is statistically significant after accounting for agreements due to chance. When tested on ethnic Chinese skin, both scales detect photo‐ageing consistently (Area under curve [AUC] values: 0.76‐0.84). Additionally, the Korean scale for the dyspigmentation constituent of photo‐ageing is concordant with both the Caucasian scale (R2 = 0.7888) and the Korean scale for the wrinkling constituent of photo‐ageing (R2 = 0.7734). Conclusion Our results show that the Caucasian scale is suitable for capturing photo‐ageing on Chinese skin, especially wrinkle variations. The Korean dyspigmentation scale supplements the Caucasian scale to capture dyspigmentation patterns on Chinese skin that may be absent on Caucasian skin. Currently, photo‐ageing scales for Chinese skin are absent. When developed, these photo‐ageing scales must be properly validated for their ability to capture photo‐ageing of the entire face.

To study the epidemiology, symptom characteristics and impact of IBS in an urban Asian population. A validated bowel symptom questionnaire was administered at face-to-face interviews to a random sample of 3,000 households in Singapore. The response rate was 78.2% (n = 2,276, 1,143 males and 1,133 females). The age, sex, and racial distribution of our respondents were similar to the general population and there was no significant difference between respondents and nonrespondents by type of household. The prevalence of IBS was 11.0%, 10.4%, and 8.6% by Manning (>1 criteria), Rome I and Rome II criteria, respectively. There was a higher prevalence of IBS in those <50 years of age (9.7%vs 5.8% 50 or > years, p = 0.002), with more than 6 years of education (9.8%vs 5.9% 6 year or <, p = 0.002) and living in landed property (16.8%vs 8.2% living in apartments and public housing, p = 0.008). There was no striking preponderance of female IBS subjects. Chronic constipation was a more common bowel disturbance than chronic diarrhea among our IBS subjects (51.0%vs 12.8%). The prevalence and impact of IBS in our Asian urban society are greater than previously appreciated. We believe that our results provide a useful window to the future trends of gastrointestinal diseases for health and education authorities in developing Asian countries to look into.

We compared indicators of influenza activity in 2020 before and after public health measures were taken to reduce coronavirus disease (COVID-19) with the corresponding indicators from 3 preceding years. Influenza activity declined substantially, suggesting that the measures taken for COVID-19 were effective in reducing spread of other viral respiratory diseases.

In May 2019, we investigated monkeypox in a traveler from Nigeria to Singapore. The public health response included rapid identification of contacts, use of quarantine, and postexposure smallpox vaccination. No secondary cases were identified. Countries should develop surveillance systems to detect emerging infectious diseases globally.

The aim of the present study was to follow the time trends of mortality from gastric and duodenal ulcer in countries outside Europe and compare them with previous reports of ulcer mortality from Europe and North America. Mortality data from eight different countries were analyzed, including Argentina, Australia, Chile, Hong Kong, Japan, Mexico, Singapore, and Taiwan. The age-standardized death rates of individual countries were followed from 1971 to 2004. Japan and Australia had mortality data for more than 50 yr that provided the opportunity to conduct a birth-cohort analysis. The data from all countries were characterized by a decline in gastric and duodenal ulcer mortality. Except for Hong Kong, mortality from gastric ulcer was higher than mortality from duodenal ulcer. In Japan and Australia, mortality from gastric and duodenal ulcer displayed time trends that were consistent with an underlying birth-cohort phenomenon. The risk of dying from gastric and duodenal ulcer increased in consecutive generations born between the mid- and the end of the nineteenth century and decreased in all subsequent generations. The peak mortality from gastric ulcer occurred among generations born in 1875, whereas peak mortality from duodenal ulcer occurred among generations born 10-20 yr later. The ubiquitous decline in ulcer mortality in countries from different parts of the world is likely to be associated with a worldwide decline in the occurrence of H. pylori infection. The events accompanying the receding infection in developed countries must have similarly affected populations exposed to increasing standards of hygiene.

This study aimed to determine time trends in the frequency of endoscopic esophagitis, and Helicobacter pylori (H. pylori) infection in a large Singaporean teaching hospital over a 10-yr period. We studied a consecutive series of 16,375 patients who had been newly referred for diagnostic esophagogastroduodenoscopy from 1992 to 2001. All endoscopic findings were prospectively recorded. From 1995, an antral biopsy was taken from 6,185 unselected patients for an in-house biopsy urease test. Endoscopic esophagitis was defined as the presence of erosions and/or ulceration. The relationship between erosive esophagitis and various relevant factors was analyzed. The overall prevalence of endoscopic esophagitis was 6.9% (95% CI, 6.5-7.3). It was 7.3% (95% CI, 6.2-8.4) in patients with a positive urease test, and 9.0% (95% CI, 8.1-9.9) in those in whom the urease test was negative (p < 0.001). From 1992 to 2001, the frequency of endoscopic esophagitis increased (p < 0.001 for trend) while that of positive urease test decreased from 1995 to 2001 (p < 0.001 for trend). The increase in the prevalence of endoscopic esophagitis (RR 1.99, 95% CI 1.18-3.36, p= 0.0098), and its inverse relationship with positive urease test results (RR 0.991, 95% CI 0.983-0.999, p= 0.049) remained significant even after adjusting for age, gender, ethnic distribution, and hiatal hernia. The frequency of endoscopic esophagitis increased in Singapore from 1992 to 2001. This increase within a short period of time suggests that environmental factors, of which the decreasing rate of H. pylori infection may be one, are important in the pathogenesis of gastroesophageal reflux disease.

The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant predictors of burnout included patient-facing roles: doctor (OR 2.10; 95% CI 1.49–2.95), nurse (OR 1.38; 95% CI 1.04–1.84), and ‘other clinical’ (OR 2.02; 95% CI 1.45–2.82); being redeployed (OR 1.27; 95% CI 1.02–1.58), bottom quartile SAQ score (OR 2.43; 95% CI 1.98–2.99), anxiety (OR 4.87; 95% CI 3.92–6.06) and depression (OR 4.06; 95% CI 3.04–5.42). Significant factors inversely correlated with burnout included being tested for SARS-CoV-2 (OR 0.64; 95% CI 0.51–0.82) and top quartile SAQ score (OR 0.30; 95% CI 0.22–0.40). Significant factors associated with anxiety and depression, included burnout, gender, safety attitudes and job role. Our findings demonstrate a significant burden of burnout, anxiety, and depression amongst healthcare workers. A strong association was seen between SARS-CoV-2 testing, safety attitudes, gender, job role, redeployment and psychological state. These findings highlight the importance of targeted support services for at risk groups and proactive SARS-CoV-2 testing of healthcare workers.

We collated contact tracing data from COVID-19 clusters in Singapore and Tianjin, China and estimated the extent of pre-symptomatic transmission by estimating incubation periods and serial intervals. The mean incubation periods accounting for intermediate cases were 4.91 days (95%CI 4.35, 5.69) and 7.54 (95%CI 6.76, 8.56) days for Singapore and Tianjin, respectively. The mean serial interval was 4.17 (95%CI 2.44, 5.89) and 4.31 (95%CI 2.91, 5.72) days (Singapore, Tianjin). The serial intervals are shorter than incubation periods, suggesting that pre-symptomatic transmission may occur in a large proportion of transmission events (0.4–0.5 in Singapore and 0.6–0.8 in Tianjin, in our analysis with intermediate cases, and more without intermediates). Given the evidence for pre-symptomatic transmission, it is vital that even individuals who appear healthy abide by public health measures to control COVID-19. The first cases of COVID-19 were identified in Wuhan, a city in Central China, in December 2019. The virus quickly spread within the country and then across the globe. By the third week in January, the first cases were confirmed in Tianjin, a city in Northern China, and in Singapore, a city country in Southeast Asia. By late February, Tianjin had 135 cases and Singapore had 93 cases. In both cities, public health officials immediately began identifying and quarantining the contacts of infected people. The information collected in Tianjin and Singapore about COVID-19 is very useful for scientists. It makes it possible to determine the disease’s incubation period, which is how long it takes to develop symptoms after virus exposure. It can also show how many days pass between an infected person developing symptoms and a person they infect developing symptoms. This period is called the serial interval. Scientists use this information to determine whether individuals infect others before showing symptoms themselves and how often this occurs. Using data from Tianjin and Singapore, Tindale, Stockdale et al. now estimate the incubation period for COVID-19 is between five and eight days and the serial interval is about four days. About 40% to 80% of the novel coronavirus transmission occurs two to four days before an infected person has symptoms. This transmission from apparently healthy individuals means that staying home when symptomatic is not enough to control the spread of COVID-19. Instead, broad-scale social distancing measures are necessary. Understanding how COVID-19 spreads can help public health officials determine how to best contain the virus and stop the outbreak. The new data suggest that public health measures aimed at preventing asymptomatic transmission are essential. This means that even people who appear healthy need to comply with preventive measures like mask use and social distancing.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) region of the genome have been detected in Singapore and other countries. We investigated the effect of this deletion on the clinical features of infection. We retrospectively identified patients who had been screened for the ∆382 variant and recruited to the PROTECT study—a prospective observational cohort study conducted at seven public hospitals in Singapore. We collected clinical, laboratory, and radiological data from patients' electronic medical records and serial blood and respiratory samples taken during hospitalisation and after discharge. Individuals infected with the ∆382 variant were compared with those infected with wild-type SARS-CoV-2. Exact logistic regression was used to examine the association between the infection groups and the development of hypoxia requiring supplemental oxygen (an indicator of severe COVID-19, the primary endpoint). Follow-up for the study's primary endpoint is completed. Between Jan 22 and March 21, 2020, 278 patients with PCR-confirmed SARS-CoV-2 infection were screened for the ∆382 deletion and 131 were enrolled onto the study, of whom 92 (70%) were infected with the wild-type virus, ten (8%) had a mix of wild-type and ∆382-variant viruses, and 29 (22%) had only the ∆382 variant. Development of hypoxia requiring supplemental oxygen was less frequent in the ∆382 variant group (0 [0%] of 29 patients) than in the wild-type only group (26 [28%] of 92; absolute difference 28% [95% CI 14–28]). After adjusting for age and presence of comorbidities, infection with the ∆382 variant only was associated with lower odds of developing hypoxia requiring supplemental oxygen (adjusted odds ratio 0·07 [95% CI 0·00–0·48]) compared with infection with wild-type virus only. The ∆382 variant of SARS-CoV-2 seems to be associated with a milder infection. The observed clinical effects of deletions in ORF8 could have implications for the development of treatments and vaccines. National Medical Research Council Singapore.

Elucidation of the chain of disease transmission and identification of the source of coronavirus disease 2019 (COVID-19) infections are crucial for effective disease containment. We describe an epidemiological investigation that, with use of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serological assays, established links between three clusters of COVID-19. In Singapore, active case-finding and contact tracing were undertaken for all COVID-19 cases. Diagnosis for acute disease was confirmed with RT-PCR testing. When epidemiological information suggested that people might have been nodes of disease transmission but had recovered from illness, SARS-CoV-2 IgG serology testing was used to establish past infection. Three clusters of COVID-19, comprising 28 locally transmitted cases, were identified in Singapore; these clusters were from two churches (Church A and Church B) and a family gathering. The clusters in Church A and Church B were linked by an individual from Church A (A2), who transmitted SARS-CoV-2 infection to the primary case from Church B (F1) at a family gathering they both attended on Jan 25, 2020. All cases were confirmed by RT-PCR testing because they had active disease, except for A2, who at the time of testing had recovered from their illness and tested negative. This individual was eventually diagnosed with past infection by serological testing. ELISA assays showed an optical density of more than 1·4 for SARS-CoV-2 nucleoprotein and receptor binding domain antigens in titres up to 1/400, and viral neutralisation was noted in titres up to 1/320. Development and application of a serological assay has helped to establish connections between COVID-19 clusters in Singapore. Serological testing can have a crucial role in identifying convalescent cases or people with milder disease who might have been missed by other surveillance methods. National Research Foundation (Singapore), National Natural Science Foundation (China), and National Medical Research Council (Singapore).