Annals of the Academy of Medicine, Singapore最新文献

Introduction: Menopause is a universal life transition with lived experiences shaped by biological, psychological, sociocultural and systemic factors. In Singapore, where diverse cultural norms intersect with a high-pressure professional environment, little is known about how these influences converge to shape symptom recognition, coping and care.

Method: This qualitative study formed part of the multicountry MARIE project on menopause and midlife health. Eighteen participants with different menopausal stages were purposively sampled ensuring variation in age, ethnicity, socio-economic status and health status. Semi-structured interviews explored symptom profiles, psychosocial well-being, family and workplace dynamics, and healthcare experiences. Data were analysed using the Delanerolle and Phiri framework, integrating biological, psychological, sociocultural and health system domains.

Results: Participants described heterogeneous symptom trajectories, with vasomotor, genitourinary and cognitive symptoms as most prominent. Multimorbidity and surgical menopause intensified symptom burden and narrowed treatment options. Anxiety, low mood and brain fog impaired work, particularly without workplace support. Sociocultural silences and misinformation reinforced selfmanagement and delayed care-seeking. Resilience rooted in peer and family support, and culturally familiar coping strategies buffered distress for some. Health system gaps included inconsistent general practitioner's knowledge, reluctance to prescribe hormone therapy and private care costs. Study participation itself triggered symptom recognition and help-seeking in some, underscoring menopause invisibility in routine care.

Conclusion: Findings highlight that menopause in Singapore is navigated through intersecting clinical, cultural and structural determinants. Addressing inequities requires embedding women's voices into clinical pathways, training clinicians in culturally competent care, and implementing workplace and public health policies that legitimise menopause as a health and occupational issue.

Introduction: Tuberculosis (TB) remains endemic in Asia, with latent TB infection (LTBI) being prevalent, especially among older adults. People with rheumatic diseases (PRD) who are treated with tumour necrosis factor-alpha inhibitors (TNF-I) are at increased risk of TB reactivation, prompting a strong recommendation for screening and treatment of LTBI prior to initiating TNF-I. However, the need for screening before starting non- TNF-I immunosuppressive agents remains unclear. This consensus statement from Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore, offers recommendations on LTBI screening before initiating non-TNF-I immunosuppressive agents, and the need for repeat LTBI testing in patients on TNF-I who initially tested negative.

Method: Systematic literature reviews were performed to evaluate published guidelines and recommendations for LTBI screening before starting non-TNF-I immunosuppressive agents, and the need for repeat testing for LTBI during TNF-I use. Recommendations were formulated based on the evidence and expert opinion according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: The consensus comprises 3 overarching principles and 5 recommendations. We conditionally recommend that LTBI screening should be done before starting tocilizumab, Janus kinase inhibitors and moderate-to-high dose glucocorticoids. Conversely, routine screening need not be performed before starting cyclophosphamide. Annual testing for LTBI need not be performed routinely for patients on TNF-I if initial screening is negative.

Conclusion: These recommendations provide guidance for LTBI screening in PRD. All recommendations in this consensus are conditional, reflecting a lack of evidence or low-level evidence. These will be updated as new evidence emerges.

Introduction: Human papillomavirus (HPV) causes over 95% of cervical cancers. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines support a risk-based approach using the most informative test, which may include high-risk (HR) or extended genotyping. Most laboratories perform partial genotyping. This study reports findings from the comprehensive genotyping of all 14 HR HPV genotypes in cervical samples from the Singapore population.

Method: A total of 2497 cervical specimens collected in ThinPrep PreservCyt vials underwent full HPV genotyping using real-time polymerase chain reaction TOCE technology (Seegene Inc, Seoul, South Korea). Among these, 327 (13.1%) tested positive for HPV. Cytology results were available for 275 (84.1%) of these HPV-positive cases. The authors examined genotype prevalence and cytology correlations, and compared follow-up management under the Society for Colposcopy & Cervical Pathology of Singapore (SCCPS) guidelines versus ASCCP 2019 guidelines.

Results: HPV52 and 58 were the most prevalent genotypes, accounting for 32.2% of all detected HPV genotypes. Co-infections were seen in 20.2% of samples. Among 31 (9.5%) HPV16/18 cases, most had normal cytology, though some showed atypical or low-grade changes. Under the ASCCP guidelines for primary screening, 16.8% of cases could defer to repeat HPV testing in 1 year instead of immediate cytology triage under SCCPS. In co-testing, ASCCP-guided management reduced colposcopy referrals by 7.4% since these cases would only require repeat HPV testing in 1 year.

Conclusion: Comprehensive HPV genotyping enhances risk stratification and enables more efficient patient management. Compared to SCCPS, the ASCCP guidelines reduce unnecessary procedures while preserving safety, supporting broader adoption of full genotyping and risk-based triage in cervical screening programmes in Singapore.

Introduction: Singapore's Active Ageing Centres (AACs) are central to the national strategy to enable older adults to age in place through preventive, community-based services. Under the Healthier SG and Age Well SG reforms, AACs are being transformed from targeted social support points for vulnerable seniors into population-wide health-social hubs, with a goal of reaching 80% of seniors by 2025.

Method: This policy commentary draws on national policy documents, programme reports and practitioner insights to examine the evolution and implementation of AAC 2.0, and to identify emerging opportunities and system-level challenges.

Results: We highlight governance shifts, regional coordination mechanisms and health-social integration strategies. Innovations such as thematic centres, peer-led programmes and extended operating hours aim to engage diverse senior populations. Key challenges include centralised policy design, limited community voice, workforce constraints and fragmented coordination. Promising pilots, such as integrated wellness hubs, are underway but require greater alignment, relationship-building and local adaptation to scale.

Conclusion: We propose strategies to strengthen community partnerships, invest in trust-based engagement and embed robust evaluation frameworks informed by implementation science. Singapore's experience offers actionable insights for health systems seeking to design scalable, community-rooted models for healthy ageing that integrate social and healthcare services.