Prevalence and correlates of depressive symptoms among matriculated university students in Singapore during Covid-19 pandemic: findings from a repeated cross-sectional analysis

BACKGROUND

Depression is a common issue among university students and has been particularly exacerbated during the COVID-19 pandemic. However, limited research has specifically focused on depression among university entrants.

OBJECTIVES

This study aimed to determine the prevalence of depression severity and identify associated factors during different phases of the COVID-19 pandemic using health screening questionnaires completed by matriculated university students in Singapore.

METHODS

A repeated cross-sectional study was conducted at a public university in Singapore. Data from health screening questionnaires administered in 2020 and 2021, involving 15,630 newly enrolled university students, were analyzed. The questionnaires covered students' sociodemographic information, physical health status, own and family medical history, lifestyle behaviours, and the Patient Health Questionnaire (PHQ-9). The PHQ-9 was used to measure the severity of depressive symptoms, categorizing into moderate to severe depressive symptoms (MSDS), mild depressive symptoms (MDS), or no depressive symptom (NDS). Multinomial logistic regression was used to assess the sociodemographic, physical and behavioural correlates of depression.

RESULTS

The prevalence of MSDS was 1% in both 2020 and 2021, while the rates for MDS were 1.93% in 2020 and 1.64% in 2021. In the 2020 cohort, male freshmen who reported better health had a lower likelihood of experiencing depression. Conversely, students of Malay ethnicity, those majoring in Engineering, those with multiple chronic diseases, monthly alcohol consumers, current smokers, and those with a family history of mental disorder had a higher likelihood of experiencing depression. Moreover, students who lived on-campus in the 2021 cohort were less likely to experience depression than those living off-campus. However, the associations between academic majors, alcohol consumption, and smoking with depression were not significant in the 2021 cohort.

CONCLUSIONS

This study reported a low prevalence of both MSDS and MDS among university entrants in Singapore. The study further identified three categories of factors associated with depression: sociodemographic, physical, and behavioural. This study suggests policy interventions to enhance targeted social support that address each student group's specific requirements and susceptibilities. A more extensive and comprehensive study is warranted to assess the changes in student mental health status post-COVID-19 pandemic.

Empowering Foot Care Literacy Among People Living With Diabetes and Their Carers With an mHealth App: Protocol for a Feasibility Study

BACKGROUND

Diabetic foot ulcers (DFUs) cause significant morbidity affecting 19% to 34% of people living with diabetes mellitus. DFUs not only impair quality of life but may also result in limb loss and mortality. Patient education has been advocated to raise awareness of proper foot self-care and the necessity of seeking assistance when a foot wound occurs. Modern technologies, including mobile health (mHealth) interventions such as health apps, bring the potential for more cost-effective and scalable interventions.

OBJECTIVE

This study aims to examine the feasibility and usability of a newly developed mHealth app called Well Feet, which is a diabetes and foot care education app for individuals at risk of developing DFU.

METHODS

Well Feet was developed using an evidence-based and expert panel cocreation approach to deliver educational content available in 3 languages (ie, English, Chinese, and Malay) via animation videos and a range of additional features, including adaptive learning. A nonrandomized, single-arm feasibility study using a mixed methods approach with a series of validated questionnaires and focus group discussions will be conducted. In total, 40 patients and carers will be recruited from a tertiary hospital diabetes clinic to receive a 1-month mHealth intervention. The primary outcomes are the usability of the app and a qualitative perspective on user experience. Secondary outcomes include changes in foot care knowledge, self-management behaviors, and quality of life.

RESULTS

Patient recruitment began in July 2023, and the intervention and data collection will be completed by the end of September 2023. This study has been approved by National Healthcare Group Domain Specific Review Board (2022/00614) on February 10, 2023. The expected results will be published in spring 2024.

CONCLUSIONS

Through this feasibility study, the Well Feet DFU education app will undergo a comprehensive quantitative and qualitative evaluation of its usability and acceptance for future improvement in its design. With local contextualization, cultural adaptation, and its multilingual functionality, the app addresses a critical aspect of DFU health education and self-management in a multiethnic population. Findings from this study will refine and enhance the features of the app based on user feedback and shape the procedural framework for a subsequent randomized controlled trial to assess the effectiveness of Well Feet.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05564728; https://clinicaltrials.gov/study/NCT05564728.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52036.

A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study

BACKGROUND

Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease.

OBJECTIVE

The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education.

METHODS

A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype.

RESULTS

Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design.

CONCLUSIONS

Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life.

Empowering Health Care Education Through Learning Analytics: In-depth Scoping Review

BACKGROUND

Digital education has expanded since the COVID-19 pandemic began. A substantial amount of recent data on how students learn has become available for learning analytics (LA). LA denotes the "measurement, collection, analysis, and reporting of data about learners and their contexts, for purposes of understanding and optimizing learning and the environments in which it occurs."

OBJECTIVE

This scoping review aimed to examine the use of LA in health care professions education and propose a framework for the LA life cycle.

METHODS

We performed a comprehensive literature search of 10 databases: MEDLINE, Embase, Web of Science, ERIC, Cochrane Library, PsycINFO, CINAHL, ICTP, Scopus, and IEEE Explore. In total, 6 reviewers worked in pairs and performed title, abstract, and full-text screening. We resolved disagreements on study selection by consensus and discussion with other reviewers. We included papers if they met the following criteria: papers on health care professions education, papers on digital education, and papers that collected LA data from any type of digital education platform.

RESULTS

We retrieved 1238 papers, of which 65 met the inclusion criteria. From those papers, we extracted some typical characteristics of the LA process and proposed a framework for the LA life cycle, including digital education content creation, data collection, data analytics, and the purposes of LA. Assignment materials were the most popular type of digital education content (47/65, 72%), whereas the most commonly collected data types were the number of connections to the learning materials (53/65, 82%). Descriptive statistics was mostly used in data analytics in 89% (58/65) of studies. Finally, among the purposes for LA, understanding learners' interactions with the digital education platform was cited most often in 86% (56/65) of papers and understanding the relationship between interactions and student performance was cited in 63% (41/65) of papers. Far less common were the purposes of optimizing learning: the provision of at-risk intervention, feedback, and adaptive learning was found in 11, 5, and 3 papers, respectively.

CONCLUSIONS

We identified gaps for each of the 4 components of the LA life cycle, with the lack of an iterative approach while designing courses for health care professions being the most prevalent. We identified only 1 instance in which the authors used knowledge from a previous course to improve the next course. Only 2 studies reported that LA was used to detect at-risk students during the course's run, compared with the overwhelming majority of other studies in which data analysis was performed only after the course was completed.

A qualitative study of dementia caregivers' lived experiences in Singapore

Globally, the number of people living with dementia is expected to triple by 2050 owing primarily to the aging population. Dementia is a chronic and progressive disease that affects an estimated 5-8% of the general population aged 60 and above at any given time. This qualitative study aimed to investigate caregivers' overall perceptions, challenges, and coping strategies in dementia care in Singapore. Purposive sampling was used to select the study's sample. Eight Singaporeans were interviewed in semi-structured, in-depth interviews. Three themes emerged from the data analysis for each research question: overall perceptions (i.e. less freedom, strained family relationships, and improved self-competency), challenges (i.e. managing dementia symptoms, emotional drain, and decision-making), and coping mechanisms (i.e. making time for myself, religious belief, and seeking external support). Knowing about these challenges and coping mechanisms allows practitioners to help caregivers to reduce personal struggles, thus improving the patient's and caregiver's quality of life.

Positive Vibes are Not Always Easy: Examining the Association Between Covid-19 Stress and Mental Well-Being

The virus known as Covid-19 caused a global pandemic in 2019 and was found to have a devastating impact on mental well-being. Individuals around the world had difficulty retaining positive emotions such as gratitude, mindfulness, and hope in the face of this disaster. These feelings diminished their sense of mental well-being. This study examined the mediational model of gratitude, mindfulness, and hope as parallel mediators of the relationship between Covid-19 stress and mental well-being. In total, 289 adults from the general population completed the scales of Covid stress, gratitude, mindfulness, hope, and mental well-being. Results indicated that Covid-19 stress was related to mental well-being, with mindfulness and hope acting as mediators. Gratitude, on the other hand, did not mediate the relationship. The study provides evidence that targeting gratitude, mindfulness, and hope may have a meaningful effect on Covid-19 stress as a related symptom and potentially have a negative impact on mental well-being during the pandemic.

Examining a Conceptual Model of Maternal and Paternal Warmth, Emotion Regulation and Social Competence among Preadolescent Children in Malaysia

Although parental warmth has been shown to be related to children's social competence, the mediating role of preadolescent children's emotion regulation in this context has been less explored, particularly in Asian cultures. Thus, this study examined the role of emotion regulation as a mediator in the relationship between parental warmth (i.e., paternal and maternal warmth) and social competence among preadolescent children in Malaysia. Preadolescent children (N = 720; Mage = 10.95; SD = 0.59; 58.8% female) completed self-administered questionnaires. Results of correlation analysis showed that higher levels of paternal and maternal warmth were associated with greater emotion regulation in preadolescent children and a greater level of social competence. However, analysis of structural equation modeling revealed that emotion regulation significantly mediated only the relationship between maternal warmth and social competence. These findings underscored the importance of maternal warmth in promoting Malaysian preadolescent children's social competence as well as their emotion regulation as a mediating pathway. This study also highlights the direct effect of paternal warmth on preadolescents' social competence. Theoretical and practical implications of this study are discussed.

An Evaluation of Animal-Assisted Therapy for Autism Spectrum Disorders: Therapist and Parent Perspectives

Although there are a variety of psychological and therapeutic approaches to coping Autism Spectrum Disorder, people with autism still face some challenges in a “normal” therapy setting. Some therapy organizations and services have proposed an alternative therapy approach, Animal-assisted therapy (AAT). The aim of this phenomenological study was to gain a better understanding of the therapists and parents of individuals who choose the alternative approach, AAT. Data were collected through structured interviews with a group of three therapists and four parents. An analysis of the data revealed three main themes; the first theme named the perceived benefits of AAT with three subthemes consisting of physical benefits, sensory benefits and emotional benefits. The second theme is named the way AAT works with subthemes of client-centred therapy and mixed models, and the third theme is potential limitations of AAT. Limitations and suggestions for future research are discussed.

'Dirty foreigners' are to blame for COVID-19: impacts of COVID stress syndrome on quality of life and gratitude among Singaporean adults

The outbreak of COVID-19 has caused widespread emotional distress. The current study sought to ascertain the impact of COVID stress syndrome on quality of life and gratitude. The COVID-19 Stress Scale, COVID-19 Quality of Life Scale, and Gratitude Resentment and Appreciation Scale were administered to 199 Singaporeans. Data were collected online using convenience sampling between December 2020 and March 2021. Pearson correlations and hierarchical regression analyses were used to test the research hypotheses. The results showed that fear of spreading SARSCoV2 by foreigners was the most stressful fear among Singaporeans (M = 2.59), while traumatic stress by COVID-19 was the least stressful fear (M = 0.16). COVID stress syndrome was positively correlated with negative quality of life (r ranged from .25 to .66) and negatively correlated with gratitude (r ranged from -.29 to -.14). Xenophobia was also found to be the most influential factor in reducing quality of life (β = .52) and gratitude (β = -.37) during the pandemic. Study findings demonstrate how COVID-19 increases Singaporeans' xenophobic attitudes towards foreigners, making them more vulnerable to the pandemic.

Testing a Moderated Mediation Model of Social Withdrawal and Intimacy: The Roles of Interpersonal Distrust and Retrospective Bullying Victimization

Given that social withdrawal has been consistently linked to intimacy, an examination of the mediating effect of interpersonal distrust on the relationship between social withdrawal and intimacy could offer potential insights into a possible explanatory mechanism. Therefore, the purpose of this study was to investigate interpersonal distrust as a mediator of the relationship between social withdrawal and intimacy, and whether retrospective bullying victimization moderates this mediation. Participants included 160 university students who completed measures of social withdrawal, interpersonal distrust, intimacy, and retrospective bullying victimization. Results indicated that interpersonal distrust mediated the relationship between social withdrawal and intimacy. Retrospective bullying victimization in primary school, however, did not moderate the mediation model. In light of these findings, appropriate implications and suggestions for interventions are discussed.

Retrospective Reports of Perceived 'Guan' Parenting: Relationships to Adult Attachment Styles, Emotion Regulation, and Self-Esteem

To determine how parental guan is related to social-emotional development in adulthood and how demographic controls might influence the prediction of parental guan on social-emotional development, 176 adults completed a series of questionnaires. We expected that both maternal and paternal guan would be positively related to secure attachment in adulthood, emotion regulation, self-esteem, and social self-esteem, but negatively related to avoidance and anxious attachment in adulthood. Pearson correlations largely supported these expectations. Moreover, the results of hierarchical regression analyses indicated that paternal guan was positively related to self-esteem but negatively related to anxious attachment in adulthood. Maternal guan, on the other hand, significantly predicted emotion regulation. Both maternal and paternal guan were significantly related to secure adult attachment and social self-esteem. Age, gender, and family structure contributed additional variance in some variables. We discuss our results in terms of the protective role of guan parenting in a child's life.

Misdiagnosis of community-acquired pneumonia in patients admitted to respiratory wards, Penang General Hospital

INTRODUCTION

Pneumonia continues to be as one of the top causes of hospitalisations and deaths in Malaysia despite the advancement in prevention and treatment of pneumonia. One of the possible explanations is the frequent misdiagnosis of pneumonia which had been reported elsewhere but such data is not available locally.

OBJECTIVES

This is an audit project aiming to evaluate the proportion of misdiagnosis among hospitalised communityacquired pneumonia (CAP) patients in the Respiratory wards of Penang General Hospital based on their initial presentation data, and their associated outcomes.

METHODS

We reviewed the medical notes and initial chest radiographs of 188 CAP patients who were admitted to respiratory wards. Misdiagnosis was defined as cases which lack suggestive clinical features and/or chest radiograph changes. In-hospital mortality and length of stay (LOS) were the outcomes of interest.

RESULTS

The study found that 38.8% (n=73) of the hospitalised CAP patients were misdiagnosed. The most common alternative diagnosis was upper respiratory tract infection (32.8%, n=24). There was no statistical difference between misdiagnosis and CAP patients in the demographic and clinical variables collected. In terms of outcomes, misdiagnosed patients were discharged earlier (mean LOS= 3.5±3.28 days vs. 7.7±15.29 days, p=0.03) but the in-hospital mortality difference was not statistically significant (p=0.07).

CONCLUSIONS

One third of our CAP admissions were misdiagnosed. Although initial misdiagnosis of CAP in our study did not show any increase in mortality or morbidity, a proper diagnosis of CAP will be helpful in preventing inappropriate prescription of antibiotics and unnecessary admission.

Attitude Toward Online Relationship Formation and Psychological Need Satisfaction: The Moderating Role of Loneliness

Our study explores the moderating role of loneliness in the relationship between attitude toward online relationship formation and psychological need satisfaction in online friendships. Participants included 1572 adolescents who completed self-report measures of loneliness, attitude toward online relationship formation, and psychological need satisfaction in online friendships. As hypothesized, attitude toward online relationship formation was positively related to psychological need satisfaction in online friendships. Results of moderation also demonstrated that lonely adolescents would report more positive attitude toward online relationship formation and higher psychological need satisfaction in online friendships compared to adolescents with nonlonely. Overall, these results extend self-determination theory's contentions regarding the critical role of socialization initiatives to increase the fulfilment of psychological needs for adolescents, regardless of whether the relationship was formed through the Internet or in-person.

Investigation of a Preliminary Mixed Method of Phubbing and Social Connectedness in Adolescents

Background

The exponential growth of smartphones has afforded many users with ubiquitous access to socialization as seen in the various mobile apps used to communicate and connect with others. The present study employed mixed-method approaches to analyse the impact of phubbing on social connectedness among adolescents in Malaysia.

Methods

A total of 568 adolescents were participated in quantitative surveys, and of these participating adolescents, 6 were further invited to join focus group interviews.

Findings

Quantitative findings supported the mediating role of communication disturbance in the relationships between phone obsession and familial connectedness, school connectedness, and self-connectedness, but not for friendship connectedness. Qualitative findings further elucidated the detrimental effect of phone obsession on their sense of belonging from the perspectives of adolescents.

Conclusion

This study reaffirms that phubbing behaviour is predictive of social disconnectedness. Therefore, preventive and treatment interventions should be developed to avoid and control a potential risk of social disconnectedness epidemics attribute to phubbing.

Shyness, Loneliness Avoidance, and Internet Addiction: What are the Relationships?

Given that shyness has been consistently linked to Internet addiction in youth, an examination into the mediating effect of a desire to avoid loneliness on the shyness-Internet addiction link could offer potential insights into a possible explanatory mechanism as well as directions for Internet addiction prevention and intervention in young adulthood. Thus, the aim of this study is to investigate the mediating role of loneliness avoidance in the relationship between shyness and Internet addiction among 286 youth Internet users. Shyness was significantly and positively correlated with loneliness avoidance and Internet addiction. In addition, loneliness avoidance was significantly and positively correlated with Internet addiction. Most importantly, loneliness avoidance may predispose shy youth to become addicted to the Internet. Theoretical and practical implications of the research findings for youth wellness are addressed in this study.

Ability to Resist Temptations of Technology Use: A Qualitative Analysis of Children's Views on Factors Associated with Delay of Gratification

Excessive technology use among young children remains a public health concern with diverse serious consequences. It is important to find out how children resist the temptation to use technology. Using focus group interviews, the authors explored what factors influence children's ability to delay gratification in using technology. Four specific themes emerged from the interview data: they found (a) fear of punishment, (b) self-directed speech, (c) reinforcement, and (d) parental modeling are effective measures to train children to forgo immediate pleasures of using technology. These findings provided some support for the hypothesis that children's self-control of technology use can be modified and improved. This study suggests methods to leverage and strengthen existing initiatives to promote self-control of technology use for children.

Mass Spectrometry-Based Analysis for the Discovery and Validation of Potential Colorectal Cancer Stool Biomarkers

Colorectal cancer (CRC) is the third leading cause of cancer mortality for both men and women, and the second leading cause of cancer death for men and women combined. If detected early, before metastasis has occurred, survival following surgical resection of the tumor is >90%. Early detection is therefore critical for effective disease surveillance. Unfortunately, current biomarker assays lack the necessary sensitivity and specificity for reliable early disease detection. Development of new robust, non- or minimally invasive specific and sensitive biomarkers or panels with improved compliance and performance is therefore urgently required. The use of fecal samples offers several advantages over other clinical biospecimens (e.g., plasma or serum) as a source of CRC biomarkers, including: collection is noninvasive, the test can be performed at home, one is not sample limited, and the stool effectively samples the entire length of the inner bowel wall contents (including tumor) as it passes down the gastrointestinal tract. Recent advances in mass spectrometry now facilitate both the targeted discovery and validation of potential CRC biomarkers. We describe, herein, detailed protocols that can be used to mine deeply into the fecal proteome to reveal candidate proteins, identify proteotypic/unitypic peptides (i.e., peptides found in only a single known human protein that serve to identify that protein) suitable for sensitive and specific quantitative multiplexed analysis, and undertake high-throughput analysis of clinical samples. Finally, we discuss future directions that may further position this technology to support the current switch in translation research toward personalized medicine.

A Review of Coronary Artery Disease Research in Malaysia

Coronary artery disease is the major cause of mortality and morbidity in Malaysia and worldwide. This paper reviews all research and publications on coronary artery disease in Malaysia published between 2000-2015. 508 papers were identified of which 146 papers were selected and reviewed on the basis of their relevance. The epidemiology, etiology, risk factors, prevention, assessment, treatment, and outcomes of coronary artery disease in the country are reviewed and summarized. The clinical relevance of the studies done in the country are discussed along with recommendations for future research.

CT and MRI of primary and metastatic fibrolamellar carcinoma: a case series of 37 patients

OBJECTIVE

Fibrolamellar carcinoma (FLC) is a rare disease, with limited radiographic reported information. We assessed the imaging patterns of primary and metastatic FLC.

METHODS

CT and MR examinations of patients with FLC were retrospectively reviewed. Imaging features were assessed for primary and recurrent liver tumours, including dimension, enhancement characteristics, and presence or absence of central scars. Locations of nodal and extranodal metastases were also recorded.

RESULTS

Of 37 patients (18 males and 19 females; average age, 23.5 years) with FLC, 24 had imaging of their primary tumour; 13 had metastases at presentation and 7 developed metastases on follow-up. The remaining 13 patients had follow-up imaging of metastatic disease. Primary FLC had a mean diameter >11 cm, with central scars in ten (46%) patients. Most tumours enhanced heterogeneously (96%) and showed arterial enhancement (81%). On MRI, 62% of FLCs were hypointense on T1 weighted imaging and 54% were hyperintense on T2 weighted imaging. 13 patients (54%) had nodal metastases at presentation, mostly in the upper abdomen (92%) and commonly in the chest (38%). Extrahepatic metastases were most frequently pulmonary or peritoneal. Predominantly small and homogeneous intrahepatic recurrences were detected on follow-up in 15 patients.

CONCLUSION

FLC often presents as a large hepatic tumour with nodal and distant metastases. Thoracic adenopathy and lung metastases were frequently found in our series, suggesting the need for pre-operative and follow-up chest imaging.

ADVANCES IN KNOWLEDGE

Thoracic nodal and lung metastases are common in FLC; therefore, dedicated chest imaging should be part of the evaluation of a patient with FLC.

Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.

The role of social media for patients and consumer health. Contribution of the IMIA Consumer Health Informatics Working Group

OBJECTIVES

: To provide an overview on social media for consumers and patients in areas of health behaviours and outcomes.

METHODS

A directed review of recent literature.

RESULTS

: We discuss the limitations and challenges of social media, ranging from social network sites (SNSs), computer games, mobile applications, to online videos. An overview of current users of social media (Generation Y), and potential users (such as low socioeconomic status and the chronically ill populations) is also presented. Future directions in social media research are also discussed.

CONCLUSIONS

: We encourage the health informatics community to consider the socioeconomic class, age, culture, and literacy level of their populations, and select an appropriate medium and platform when designing social networked interventions for health. Little is known about the impact of second-hand experiences faciliated by social media, nor the quality and safety of social networks on health. Methodologies and theories from human computer interaction, human factors engineering and psychology may help guide the challenges in designing and evaluating social networked interventions for health. Further, by analysing how people search and navigate social media for health purposes, infodemiology and infoveillance are promising areas of research that should provide valuable insights on present and emergening health behaviours on a population scale.

Septooptic dysplasia

The term septooptic dysplasia was coined in 1956 by de Morsier, who pointed out the association of optic nerve hypoplasia and absence of the septum pellucidum. Patients with this condition may present with clinical features of hypopituitarism, decreased visual acuity and neurodevelopmental disabilities that lead to this diagnosis. The case that is presented here is unusual in that this patient was initially diagnosed as having low tension glaucoma during a routine screening examination and was treated for glaucoma for over a year before he was discovered to have septooptic dysplasia, also known as de Morsier's syndrome.

Visual disturbances with clomiphene

Clomiphene is a widely prescribed drug for the treatment of infertility. Visual symptoms that occur as a side effect of this drug are uncommon. Some doctors may neglect to mention this side effect when prescribing clomiphene. Thus these visual disturbances can be very alarming to the patient and may also pose a hazard if the patient is doing activities such as driving or operating machinery. The patient should be told to stop taking clomiphene and ophthalmologic evaluation should be performed. Although visual disturbances generally cease on stopping clomiphene, some women may experience persistent visual disturbances.

Ocular fishhook injuries

Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.

The visible embryo project: embedded program objects for knowledge access, creation and management through the World Wide Web

We have designed a prototype knowledge management online environment for the biomedical sciences which integrates access to online representations of the scientific literature, bibliographic databases, high-performance visualization technologies, large-scale scientific databases, and tools for authoring new-generation scientific publications. This system will provide widespread access to its resources by using the World Wide Web for its underlying architecture. This system expands upon our Weblet Interactive Remote Visualization (IRV) server technology to produce a set of dedicated Internet "visualization servers" which provide interactive control of real-time visualizations from the Visible Embryo Project database from within Web pages viewed with our WebRouser software package. This system will be used to develop a set of prototype applications for both online education of medical students in developmental anatomy and for an interactive patient education system for expectant parents. We recognize that knowledge represented by these national resource databases is not static, therefore it is essential to include tools for both the creation of new "compound documents" which incorporate embedded objects, as well as for managing the peer-review of scholarly publications, in order to ensure the integrity of new knowledge as it is added to these databases in the future. We have therefore begun to design integrated tools for our system which facilitate both the creation of and the validation of new generations of scientific knowledge.