This meta-analytic review aimed to examine the pooled prevalence rates of Internet addiction and gaming disorders in Southeast Asia. Several databases including PubMed, MEDLINE, PsycINFO, Web of Science, Embase, and Cochrane Central were searched and a total of 24 studies were included in this study. The selection of studies was conducted in accordance to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two meta-analyses were conducted to examine data on Internet addiction and gaming disorders separately. A random-effects model was employed to derive the pooled prevalence rate. Mixed-effects meta-regression and subgroup analyses were performed to examine the moderators of the between-study heterogeneity. Publication bias was tested using the Egger’s regression test and funnel plot. Only seven out of the 11 Southeast Asian countries were represented in the literature. All except for two of the included studies were cross-sectional in nature. The findings revealed a pooled prevalence rate of 20.0% (95% confidence interval: 14.5%–27.0%) and 10.1% (95% confidence interval: 7.3%–13.8%) for Internet addiction and gaming disorders respectively. Mean age and study population were significant moderators of the between-study heterogeneity in the prevalence rates of gaming disorders such that samples involving older participants showed higher prevalence rate than those involving younger individuals. Country of study was found to be significant moderator of the between-heterogeneity for both Internet addiction and gaming disorders, however the findings should be interpreted with caution due to the small and unbalanced sample sizes. There was no significant publication bias. Such epidemiology research should be extended to the Southeast Asian countries that have not been studied or are under-studied. Given that the prevalence rates appear to be higher in Southeast Asia than in other world regions, future research should also explore the factors behind these inter-regional differences. Further longitudinal studies should also be conducted to examine the trajectories of such disorders.

There is a trend towards consolidating smaller primary care practices into larger practices worldwide. However, the effects of practice size on quality of care remain unclear. This review aims to systematically appraise the effects of practice size on the quality of care in primary care. A systematic review and narrative synthesis of studies examining the relationship between practice size and quality of care in primary care. Quantitative studies that focused on primary care practices or practitioners were identified through PubMed, CINAHL, Embase, Cochrane Library, CRD databases, ProQuest dissertations and theses, conference proceedings, and MedNar databases, as well as the reference lists of included studies. Independent variables were team or list size; outcome variables were measures of clinical processes, clinical outcomes, or patient-reported outcomes. A narrative synthesis of the results was conducted. The database search yielded 371 articles, of which 34 underwent quality assessment, and 17 articles (13 cross-sectional studies) were included. Ten studies examined the association of practice size and clinical processes, but only five found associations of larger practices with selected process measures such as higher specialist referral rates, better adherence to guidelines, higher mammography rates, and better monitoring of haemoglobin A1c. There were mixed results for cytology and pneumococcal coverage. Only one of two studies on clinical outcomes found an effect of larger practices on lower random haemoglobin A1 value. Of the three studies on patient-reported outcomes, smaller practices were consistently found to be associated with satisfaction with access, but evidence was inconsistent for other patient-reported outcomes evaluated. There is limited evidence to support an association between practice size and quality of care in primary care.

Introduction: Depression in the elderly is a major public health issue. Socioeconomic status (SES) and social support are strong risk factors for depression. This study aimed to investigate the influence of SES and social support in elderly depression, and the modifying effect of social support on the relationship between SES and depression. Materials and Methods: A community-based survey was conducted on residents ≥60 years old. Depressive symptoms were determined with scores ≥5 using the 15-item Geriatric Depression Scale (GDS). Multivariable logistic regression was performed to determine the odds ratio (OR) of depressive symptoms with respect to SES and social support, and interaction terms between the two variables. Results: Of 2447 responses analysed, 188 (7.8%) respondents had depressive symptoms. Living in 2-room housing, living alone/with a domestic helper, infrequent leisure time with children/grandchildren or being childless, and feeling socially isolated were independently associated with depressive symptoms. Relative to residents living with spouse and children in 4-/5-room housing, the highest ORs for depressive symptoms were those living with spouse and children in 2-room (OR: 3.06, P <0.05), followed by living with children only in 3-room (OR: 2.98, P <0.05), and living alone/ with a domestic helper in 4-/5-room (OR: 2.73, P <0.05). Living with spouse only appears to buffer against depressive symptoms across socioeconomic classes, although the effect was not statistically significant. Conclusion: Low social support and low SES significantly increased the odds of depressive symptoms. The moderating effect of social support on depression was however not consistent across SES groups. Specific interventions need to target different SES groups to better help older adults at risk of developing depression. Key words: Asia, Depression, Older adults, Social factors

Palliative care services were not available in nursing homes in Singapore. Project CARE (Care At the end-of-life for Residents in homes for the Elderly) was a pilot programme that aimed to promote advance care planning and improve end-of-life care in nursing homes. We aimed to examine end-of-life care preferences among nursing home residents, and identify factors associated with preference for medical intervention, cardiopulmonary resuscitation and place of death. A cross-sectional study using data from advance care planning discussions was conducted from September 2009 to April 2012 across seven nursing homes. The advance care planning discussion was conducted with the resident (with a prognosis of 6 months or 1 year), their families and staff from the nursing home and hospital. A total of 600 residents and their families completed the advance care planning discussion. Majority (93.2%) preferred not to proceed with cardiopulmonary resuscitation, 52.3% opted for limited additional intervention at the nursing home with escalation to the hospital if necessary and 77.0% preferred to die at the nursing home. Residents 85+ years (relative risk ratio: 3.34, 95% confidence interval: 1.13–9.93, p = 0.030) were more likely to prefer medical intervention at the nursing home only. No associations were found with the preference for cardiopulmonary resuscitation. Residents who were single, or who were Christians or Catholics (adjusted odds ratio: 2.09, 95% confidence interval: 1.04–4.19, p = 0.039), were more likely to prefer to die at the nursing home. Preferences for medical interventions in nursing homes provide support to extend palliative care services to nursing homes, which may benefit residents who are older, single, or Christians or Catholics.

Background: The growing demand for inpatient beds in Singapore has led Tan Tock Seng Hospital to set up an observation medicine unit where patients are monitored and discharged within a 24-h period. Methods: Using the Consumer Assessment of Health Providers and Systems (CAHPS) Hospital Survey, this descriptive study examines the satisfaction levels of patients admitted into an observation unit, in particular the communication between patients and doctors and nurses. The anonymous surveys were either self-administered by the patients or by the research assistant or nurses. Results: 271 patients completed the survey, with 96% of patients satisfied with the politeness (ie, treating them with courtesy and respect, listening carefully to them) of the medical staff. More highly educated patients were more satisfied with the communication between the doctors or nurses, compared with less educated patients (p<0.05). However, less educated patients gave a higher rating of their observation unit stay than more educated patients (p<0.05). Conclusion: With patient satisfaction becoming increasingly important as an indicator of the quality of care in the present healthcare environment, doctors and nurses should seek to improve their communication with their patients so as to ensure that patients are satisfied and receive quality care.