Quality mental health services are pivotal in addressing mental health issues worldwide. Despite this importance, many countries face challenges in providing accessible, high-quality mental health care. This study examines the nexus between mental health services and worry about mental health issues across different countries. This study used data from the Lloyd's Register Foundation 2021 World Risk Poll, the OECD, the World Health Organization, and Our World in Data. The variables include worry about the personal harm that mental health issues could cause, mental health services (i.e. service facilities, service availability, and service utilisation), and estimated prevalences of major mental disorders. The results revealed that structural components - specifically the availability of mental health outpatient facilities - were associated with less worry about mental health issues across countries. However, no significant association was observed between process components - such as service utilisation - and worry about mental health issues. Additionally, the association between the prevalence of various mental disorders and worry about mental health issues showed mixed results. The findings emphasise the importance of increasing the availability of these facilities to ensure universal access to essential mental health care, thereby improving mental well-being across both low-income and high-income countries.
We aimed to develop and test a scale that assesses knowledge of medical and health research for the Singaporean general adult population and examine the implications of 'don't know' (DK) responses from participants in the knowledge assessment. Two studies were conducted among Singaporean community adults. Items in the scale were selected via exploratory factor analysis in a pilot study (N = 223) and evaluated via confirmatory factor analysis and item response modelling in a larger population survey study (N = 999). We also explored characteristics of DK responses. A two-factor structure emerged and reflected two pathways of knowledge formation, including acknowledgement of facts and resistance of myths in medical and health research. The scale showed satisfactory structure validity, reliability, item-level properties, and criterion validity. The two subscales (Facts and Myths) also achieved measurement invariance across genders. Treating DK responses as missing reduced the psychometric quality. DK response tendency in both Facts and Myths subscales was primarily and significantly associated with lower trust in research, suggesting that DK and incorrect answer might not be results of the same response process. DK responses were non-ignorable in the scoring in assessing knowledge of medical research and carried implications separate from incorrect answers. Individuals answering DK may entail both those who truly lack knowledge and those who do not wish to disclose their views. Patient and community engagement strategies for improving the public knowledge of medical and health research should not only consider communicating facts but also strategies to correct misinformation. Assessing knowledge in health should consider the implications of patients' DK responses.
The social norms that guide emotional expression are critical for successful interpersonal interaction. However, the intricate emotional architecture underpinning these norms has remained largely unexplored. Our study is the first to rigorously investigate "display rules" or expressive norms for a comprehensive set of 64 theory-based emotions, utilizing a representative sample from the United Kingdom. The sample reflected national census demographics based on age, sex, and ethnicity. We measured expressive norms ranging from suppression to amplification in four social situations, combining two settings (public vs. private) and interactant types (close relations vs. distant others). Using a theory-building subsample (n = 507), we employed ant colony optimization (AOC) algorithms and a suite of factor analytical techniques to distill the emotions into three domains: affiliative, vulnerable, and disruptive. Subsequent validation in a separate confirmatory subsample (n = 506) supported this structure in all four situations (conditions), providing evidence these domains were robust. Notably, this new Expression Regulation Scale (ERS) demonstrated scalar invariance across all situations using repeated measures confirmatory factor analysis. We introduce scoring metrics and norms to aid researchers and practitioners in their analytical endeavors and highlight potential avenues for future research aimed at enriching our understanding of expression regulation.
Health behaviours and decisions are complex and involve different dimensions of individuals' lives. The current study aimed to investigate considerations and their priorities in health decision and behaviour adoption via a risk-benefit framework unifying elements of mainstream models of health behaviour. We aimed to explore the core dimensions of the outcomes being considered by people and individual differences in perceived importance across dimensions. Two studies were conducted among U.S. adult residents. Study 1 (N = 295) involved eliciting qualitative responses of the health decisions or behaviours that participants encounter in their everyday life, and ratings of the associated dimensions. Study 2 (N = 400) assessed participants' ratings of the importance of outcomes and dimensions across various health decisions and behaviours. Both studies revealed that people considered dimensions beyond health risk and benefit. The dimensions varied their priorities, with health and emotional outcomes being the top considerations. Participants also showed asymmetric considerations of benefit and risk within each dimension. The latent profile analyses in Study 2 also revealed two distinct groups of individuals in risk and benefit considerations across dimensions. The findings highlight that acknowledging individual differences in the weighting and evaluation of outcomes across domains is essential for more tailored health communication and interventions.
The prevalence of food allergy is growing among children in the UK. There is increasing evidence suggesting a link between epicutaneous exposure to food proteins and subsequent sensitisation, particularly in those with atopic dermatitis. Skincare products including creams and emollients, widely-used in paediatric populations, may inadvertently contribute to allergen exposure when containing food-derived ingredients. This study investigates the prevalence of food protein allergens in paediatric leave-on skincare products available in the UK. A cross-sectional review was conducted on 130 skincare products marketed for children across three major online retailers: Amazon, Boots, and Lloyds Pharmacy. Ingredient lists were screened for the presence of food allergens, including the 4 major food allergens as defined by UK legislation. Allergenic components were classified by type (e.g. oils, extracts), and descriptive statistical analysis was performed. Of the 130 products assessed, 68 (52.3%) contained at least one food-derived allergen. A total of 102 allergenic ingredients were identified, with almond oil (Prunus Amygdalus Dulcis) and oat flour (Avena Sativa) being the most common. Oil-based allergens accounted for the majority (49%) of identified ingredients. Notably, products sold through Amazon had a higher prevalence of allergens compared to those sold by Lloyds Pharmacy. A significant proportion of paediatric skincare products in the UK contain food allergens, posing potential risks of epicutaneous sensitisation in children, particularly those with compromised skin barriers such as atopic dermatitis. These findings underscore the need for stricter ingredient scrutiny when recommending skincare products to reduce allergen exposure during early life.
Positive psychological functions are associated with various health and life outcomes. This study examined the construct of psychological well-being in the multi-ethnic Singaporean population and evaluated the Comprehensive Inventory of Thriving (CIT) scale that captures 18 aspects of psychological well-being. A two-wave survey study was carried out with 1349 community-dwelling Singaporean adults, of whom 562 completed the second wave. We compared factor structures that have been reported in other populations. The factor model was further tested for replicability in a subsequent household survey sample (N = 1756). A new higher-order factor model emerged in the Singaporean sample consisting of three dimensions: interpersonal well-being, individual well-being, and resistance to threats. The new structure demonstrated gender and age measurement invariance. CIT and the three dimensions had expected associations with mental health symptoms, work/study stress, and participants’ actual social support. The new higher-order factor model was replicated in the subsequent household survey sample. Finally, both CIT and its short form, the Brief Inventory of Thriving (BIT), showed convergent validity, reliability and test-retest reliability in the Singaporean population. CIT demonstrated some evidence of construct validity and reliability in the current large samples of Singaporean community-dwelling adults. BIT can be an efficient tool to assess and monitor population general well-being. The online version contains supplementary material available at 10.1186/s12955-026-02484-1.
Intrinsic capacity (IC) is central to the World Health Organization's life course approach to healthy ageing. Population-level data across the lifespan remain limited. This study aimed to assess the prevalence of IC deficits and to identify sociodemographic, clinical, and lifestyle factors associated with these deficits in a nationally representative community cohort in Singapore. Cross-sectional survey of adults aged ≥21 years in the Queenstown Study. IC was assessed using a modified WHO ICOPE Step 1 screening approach. Sociodemographic and health data were collected. Among 4274 participants, 29.2 % had ≥1 IC deficit; prevalence rose stepwise with age from 10.3 % (20-39 years) to 19.1 % (40-59), 45.0 % (60-79) and 74.5 % (≥80 years). Locomotion (16.8 %) and sensory (11.4 %) deficits were most common. In multivariable analysis, IC deficits were associated with older age (OR 1.05 per year, 95 % CI 1.04-1.06, p < 0.001), female sex (OR 1.19, 95 % CI 1.01-1.40, p = 0.037), underweight (OR 1.61, 95 % CI 1.18-2.20, p = 0.003), and obesity (OR 1.36, 95 % CI 1.07-1.71, p = 0.011), frailty (OR 10.94, 95 % CI 3.57-48.14, p < 0.001), impaired instrumental ADLs (OR 3.93, 95 % CI 2.11-7.84, p < 0.001), low handgrip strength (OR 1.68, 95 % CI 1.43-1.97, p < 0.001), diabetes (OR 1.45, 95 % CI 1.12-1.87, p = 0.004), and social isolation (OR 1.23, 95 % CI 1.04-1.45, p = 0.014). Higher quality of life was protective (OR 0.84, 95 % CI 0.80-0.89, p < 0.001). IC deficits were prevalent even in midlife and linked to modifiable factors. These findings support the need for early, multidomain interventions to preserve function and promote healthy ageing across adulthood.
To determine whether adding compartment specific knee bracing with an adherence intervention to advice, written information, and exercise instruction (AIE+B) is superior to advice, written information, and exercise instruction (AIE) only in improving patient reported outcomes in people with knee osteoarthritis. Multicentre, parallel group, superiority, statistician blinded, randomised (1:1; block; stratified; centralised web based) controlled trial. Recruitment through general practices and the community in Cheshire, Manchester, North Tyneside, and Staffordshire, England; enrolment 25 November 2019 to 16 September 2022. 466 adults aged ≥45 years with symptoms of knee osteoarthritis. AIE was delivered in one in-person consultation by a trained physiotherapist. Individuals randomised to the AIE+B group were also fitted with a patellofemoral, tibiofemoral unloading, or neutral stabilising knee brace, according to their predominant compartmental distribution of knee osteoarthritis, and were offered a two week follow-up consultation. Brief motivational interviewing with targeted text reminders supported brace adherence. The primary outcome was a composite patient reported Knee Osteoarthritis Outcomes Score (KOOS)-5 (0-100) at six months after randomisation. Key secondary outcomes were KOOS-5 at three and 12 months, KOOS-5 subscale scores, and pain on weight bearing activity at three, six, and 12 months. 466 participants (mean age 64 (standard deviation 9) years; 46% female participants) were randomised, with 401 (86%), 394 (85%), and 370 (79%) participants followed up with analysable data at three, six, and 12 months, respectively. At six months, greater improvement in KOOS-5 was seen in the AIE+B group than in the AIE group (adjusted mean difference 3.39, 95% confidence interval (CI) 0.96 to 5.82; effect size 0.24). Secondary outcomes showed the benefits of AIE+B over AIE that diminished over time. The largest effects observed were for pain reduction (KOOS pain (0-100) adjusted mean difference at six months 6.13, 95% CI 3.36 to 8.91; effect size 0.39). Adverse events were minor and expected. Adding compartment specific knee bracing and an adherence intervention to advice, written information, and exercise instruction resulted in small improvements in patient reported outcomes among individuals with knee osteoarthritis. This safe intervention offers a potential treatment option for this common condition. ISRCTN28555470.
The Brain Care Score (BCS) is a recently developed tool that measures modifiable risk factors for brain health. This study evaluated the association between BCS and cognitive performance in a community-based cohort from Singapore. Data were drawn from the Health District @ Queenstown baseline study, a representative multiethnic community cohort. The BCS (range 0-21; higher scores = healthier profiles) was derived from baseline questionnaires across physical, lifestyle, and socioemotional domains. Cognitive recall was assessed with the five-item word recall test, and executive function with the Eriksen flanker task. A total of 5224 participants (mean age 52.8 ± 17.5 years; 53.1% women) were surveyed between September 2023 and May 2024. Participants with impairment had lower mean BCS than those without (14.9 ± 3.1 vs. 16.2 ± 2.8; p < 0.001). Each one-point BCS increase was linked to 5% lower odds of impaired recall (odds ratios [OR] 0.95; 95% confidence intervals [CI] 0.92-0.98; p = 0.002), whereas per five-point higher BCS corresponded to 23% lower odds (OR 0.77; 95% CI 0.66-0.91; p = 0.002). Each one-point BCS increase was also associated with a 0.03-point higher executive function score (β 0.03; 95% CI 0.01-0.05; p = 0.02), with per five-point higher BCS yielding a 0.15-point higher score (β 0.15; 95% CI 0.03-0.27; p = 0.02). Associations were stronger among younger, Chinese, and higher income participants. Higher BCS was associated with better cognitive performance. These findings support its use as a potential community-based tool for brain health risk assessment in Asian populations.
Obtaining consent in antibiotic trials targeting patients with severe infections can be challenging due to time sensitivity and the frequent lack of decision-making capacity among these patients. This study reviews (1) the current common informed consent procedures and (2) recruitment loss due to consent failures in randomized controlled trials (RCTs) that involve critically ill patients with severe infections. We conducted a scoping review of RCTs published between 2010 and 2023. Antibiotic RCTs involving patients with severe infections were identified in databases including PubMed, Embase, CINAHL, PsycINFO, Cochrane Central, Web of Science, and Scopus. Title and abstract screening and full-text review were performed by 2 independent reviewers. Information relating to consent procedures and enrolled participants was extracted and summarized in a tabulated format. A total of 926 records were identified, and 112 eligible RCTs were included. Of these, 107 RCTs stated that consent was required, and the majority reported obtaining consent before study procedures (74.8%), requiring written consent (82%), and allowing for surrogate consent (85%). Substantial underreporting of consent rate information was observed, with only 58% of the RCTs reporting details of consent failure before randomization. Substantial heterogeneity in consent failure rates among these studies was also observed, with the rate being up to 66% and a median of 13%. There is substantial heterogeneity in consent failure rates across antibiotic RCTs involving critically ill patients. Understanding and addressing barriers in recruitment and consent in those trials requires more standardized reporting of consent rate information.
Asia faces significant barriers to accessing newer antibiotics despite a high burden of antimicrobial resistance. We conducted a literature review to identify key gaps and challenges in access to newer antibiotics in Asian countries. Peer-reviewed and gray literature from January 2010 to October 2024 were searched for articles discussing access to Food and Drug Administration (FDA)-approved antibiotics post-2010 with an Asian perspective. A total of 134 articles were reviewed. Key challenges spanned 7 main stakeholders: pharmaceutical industries, drug regulatory agencies, health technology assessment agencies, funders/nongovernmental organizations, healthcare practitioners, patient advocates, and ministries of health/policymakers. These challenges included limited and fragmented epidemiological data, insufficient health economic assessments, manufacturing constraints, complex regulatory frameworks, inefficient distribution systems, poor affordability in low-resource settings, and weak governance structures. These findings underscore the urgent need for a deeper understanding of stakeholder- and context-specific perspectives to address critical gaps and improve antibiotic access in the region.
Peripheral intravenous catheter (PIVC) insertion is a critical component of patient care in out-of-hospital settings, with its use becoming routine for a wide array of therapies. However, repeated failed attempts at catheter insertion are both a source of patient distress and a contributing factor to suboptimal clinical and economic outcomes. This study examined the challenges associated with PIVC placement in out-of-hospital settings, specifically within the Lloyds Clinical service, where a diverse group of patients receives intravenous therapies, including oncology medications, antibiotics, and treatments for rare disorders. The study retrospectively analysed 16 241 nursing visits, identifying cases of failed initial PIVC insertion and exploring the causes behind these instances. Findings suggest that patient-related anatomical and physiological factors, such as vein visibility and previous medical interventions, account for the majority of failed insertions. A review of current literature highlighted the importance of addressing variability in nursing practices, enhancing educational frameworks, and adopting evidence-based guidelines to optimise PIVC insertion and management. Strategies such as patient education, localised warming techniques, and targeted nurse retraining were identified as potential ways to improve outcomes. The implementation of these strategies aims to enhance the overall patient experience and ensure optimal venous access success rates in out-of-hospital settings.
Interference lithography (IL) offers high throughput, excellent uniformity, and maskless patterning capabilities. Compared to other methods, IL enables large-area, cost-effective fabrication of periodic structures with subwavelength resolution, which is particularly valuable for sensing applications, enabling the development of more sensitive, high-resolution, and reliable sensors. This review provides a comprehensive analysis of IL from the perspective of optical field control. We first introduce the principles of interference field formation and summarize key system architectures, including Mach-Zehnder and Lloyd's mirror configurations, as well as advanced schemes such as multi-beam interference and multi-step exposure for complex pattern generation. We then examine how wavefront engineering, polarization modulation, and phase stabilization influence pattern morphology, contrast, and large-area uniformity. To address dynamic drifts caused by environmental perturbations, both passive vibration isolation and active fringe-locking techniques are discussed. For fringe-locking systems, we review methods for drift monitoring, control algorithms, and feedback implementation. These developments enhance the capability of IL systems to deliver nanoscale accuracy under dynamic conditions, which is essential for stable and high-performance sensing. Looking ahead, IL is evolving into a versatile platform for sensor-oriented nanofabrication. By integrating physical modeling, precision optics, and real-time control, IL provides a robust foundation for advancing next-generation sensing technologies with higher sensitivity, resolution, and reliability.
Naturally occurring materials are often disordered, with the dependence of their bulk properties on structure being challenging to predict due to the lack of underlying crystalline axes. In this paper, we develop a digital pipeline from algorithmically created configurations with tunable disorder to 3D printed materials, as a tool to aid in the study of such materials, using electrical resistance as a test case. The designed material begins with a random point cloud that is iteratively evolved using Lloyd's algorithm to approach uniformity, with the points being connected via a Delaunay triangulation to form a disordered network metamaterial. Utilizing laser powder bed fusion additive manufacturing with stainless steel 17-4 PH and titanium alloy Ti-6Al-4V, we are able to experimentally measure the bulk electrical resistivity as a function of the degree of disorder in the network. The effective resistance of the structure calculated from the combinatorial weighted graph Laplacian is in good agreement with experimental data. However, the effective resistance is sensitive to anisotropy and global network topology, preventing a single network statistic or disorder characterization from predicting global resistivity.
Agriculture sector is a major contributor to greenhouse gas emissions, yet the lack of asset-level farm data, including ownership, land use, and production, hinders effective transition finance and decarbonisation efforts. To address this gap, we developed an open-source farm-level dataset using natural language processing (NLP) and unsupervised learning, mapping farm names to spatial polygons to fill ownership and entity gaps. In England, this approach identified 117,116 farming entities with essential attributes such as addresses, land areas, crop types, production output, and geospatial coordinates. Such emerging datasets are also critical for financial instruments supporting sustainable agriculture, enabling verification of carbon credits, enhance sustainability-linked loans and improve risk assessment for climate finance.
Underwater Radiated Noise (URN) from vessels has become a significant area of focus in the marine pollution research agenda due to its potentially adverse effects on marine life. URN monitoring and mitigation efforts have been directed primarily toward large commercial vessels (e.g., container ships), which has led to the accumulation of extensive data through standardized measurements. However, this is not the case for small vessels. Small vessels, such as motorboats and yachts are much more abundant in coastal waters and previous studies have implied that URN levels from such vessels may be comparable to those emitted by large commercial vessels. Nevertheless, the complexity of measuring URN emissions from small vessels in the shallow coastal area infers that such vessels have not been subjected to extensive standardized measurements. To address this gap, we created a designated web-front dataset named "HearMyShip" comprised of in-situ acoustic and optical data from >1000 small vessels (<55 m in length) in the coastal area of Croatia. In this paper, we provide a detailed analysis of this dataset, including the relation between the vessel's speed, size, and type on URN levels and frequency characteristics compared against current commercial notations (Lloyd's Transit and Lloyd's Silent). Our analysis provides novel insights regarding the frequency and level characteristics of URN emitted by different types of small vessels under various operating conditions, the conclusions of which can be utilized to promote URN mitigation efforts in coastal waters.
This dataset was generated within the scope of the CONNECTOR and FARADAI projects to support the development and training of machine learning models for identifying vessels with a high likelihood of engaging in illegal maritime activities. The data generation process was informed by extensive expert knowledge, obtained through structured consultations with the Cross-border Research Association (CBRA) and end user partners within the CONNECTOR project. These sessions translated operational insights into a set of probabilistic and rule-based simulation criteria, modeling vessel behavior, crew attributes, compliance history, cargo-related information, and operational patterns. The dataset, which is based on non-nominal and non-confidential information, comprises 100,000 rows, each representing a simulated vessel profile described by features such as crew criminal record, abnormal routing, frequency of port calls, inspection history, prior violations, insurance claims, ship condition, and cargo characteristics. Variables were generated using appropriate statistical distributions and condition-dependent rules based on domain knowledge. A synthetic binary target variable indicates whether the vessel is likely to be involved in illegal activity, with probability values derived from cumulative risk factors and capped at a defined threshold. To enhance realism and validate the plausibility of feature combinations, intelligence was also extracted from anonymized real-world vessel behavior reports provided by Lloyd's List Intelligence. These real-world examples served as qualitative baselines for simulating typical and edge-case activity patterns, ensuring that the dataset remains relevant for operational risk modeling while preserving ethical safeguards. The dataset is provided in CSV format, ready for immediate ingestion into analytics pipelines, machine learning workflows, or maritime surveillance tools. It is designed for reuse in the development of maritime anomaly detection systems, predictive analytics, risk profiling tools, and decision-support frameworks. It is particularly suited for researchers, enforcement agencies, and developers of maritime AI systems seeking high-quality, realistic training data for binary classification tasks. A detailed specification of each variable, its value range, simulation logic, and associated domain rationale is included in the accompanying documentation.
Patient experience is invaluable for identifying gaps in the provision of healthcare. Patient-Reported Experience Measures (PREMs) are essential tools for evaluating the quality of care from the patient's viewpoint. Research with PREMs in Asian countries is limited. We aimed to develop and test a Patient Reported Experience Measure for Singapore (PREM-SG) among chronic disease patients in the multi-ethnic population in Singapore. We carried out a nationwide cross-sectional household survey with a proportionate stratified by broad dwelling types random sampling in Singapore. Participants were Singapore citizens and permanent residents aged 45 years old or above and had at least one common chronic condition. A total of 1462 patients who completed the 13-item PREM-SG (English, Chinese, Malay) for their regular or most recently visited healthcare provider were included in the current analysis. The PREM-SG had a unidimensional structure, and satisfactory reliability (Cronbach's alpha = 0.89) and construct validity. Item response theory models revealed that two items (continuity, safety) discriminated poorly and had low item information (slopes < 0.7). Examining differential item functioning of the PREM-SG without these two items demonstrated measurement equivalence across genders. One item (coordination) elicited more positive ratings in the Chinese version compared to the English version given the same level of latent trait, without a substantially impact on the overall scores. Having a regular care provider, being of older age, and having better self-reported health was associated with higher PREM scores. Preliminary evidence documented satisfactory psychometric properties of PREM-SG for individuals (age 45+) with chronic conditions. Refinement and more research are needed to further evaluate the validity and usefulness of PREM-SG.