Background 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. Methods 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. Findings 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. Interpretation 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.

An outbreak of invasive group B Streptococcus (GBS) disease occurred in Singapore in mid-2015. We conducted a case–control study of 22 adults with invasive GBS infections during June 21–November 21, 2015. Consumption of raw fish was strongly associated with invasive sequence type 283 infections, but not with non–sequence type 283 infections.

Background  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health.

Introduction: Breast cancer is a leading cause of cancer death among women, and its age-standardised incidence rate is one of the highest in Asia. We aimed to review studies on barriers to breast cancer screening to inform future policies in Singapore. Method: This was a literature review of both quantitative and qualitative studies published between 2012 and 2020 using PubMed, Google Scholar and Cochrane databases, which analysed the perceptions and behaviours of women towards breast cancer screening in Singapore. Results: Through a thematic analysis based on the Health Belief Model, significant themes associated with low breast cancer screening uptake in Singapore were identified. The themes are: (1) high perceived barriers versus benefits, including fear of the breast cancer screening procedure and its possible outcomes, (2) personal challenges that impede screening attendance and paying for screening and treatment, and (3) low perceived susceptibility to breast cancer. Conclusion: Perceived costs/barriers vs benefits of screening appear to be the most common barriers to breast cancer screening in Singapore. Based on the barriers identified, increasing convenience to get screened, reducing mammogram and treatment costs, and improving engagement with support groups are recommended to improve the screening uptake rate in Singapore. Keywords: Barriers, breast cancer, mammography, screening programme

BACKGROUND Singapore, like the rest of Asia, faces persistent challenges to mental health promotion including stigma around unwellness and seeking treatment, low mental health literacy, a lack of trained mental health personnel, and underdevelopment of mental healthcare ecosystems. The COVID-19 pandemic created a surge in mental healthcare needs, giving new impetus to addressing these shortcomings. The pandemic situation also accelerated the acceptance and adoption of digital health solutions, creating a new opportunity for innovative approaches to quickly scale solutions to address mental healthcare needs in the region. OBJECTIVE In June 2020, a subsidiary of the Singaporean government launched mindline.sg, a digital mental health resource website that has grown to include over 500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an AI chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. Carefully selected resources on causative factors (such as financial and employment stress) are also provided. The platform was developed to be anonymous and to contain authoritative and localised content at multiple levels of progressive engagement. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. METHODS Website utilisation is primarily measured through click-level data analytics captured via Google Analytics and custom APIs, which in turn drive a customised analytics infrastructure based on Metabase. Unique, non-bounced, engaged, and return users are reported. Self-assessments are recorded only if completed, and Wysa AI chatbot usage is only measured if a user lands on Wysa’s platform. RESULTS In the two years following launch (1 July 2020 through 30 June 2022), the website received over 447,000 visitors (about 15% of the target population of three million), 62% of which explore the site or engage with resources, and about 10% of those engaged users return. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.5% and 10.8% of non-bounced visitors, respectively. On mindline at work, the rates of non-bounced visitors who explored the site (i.e., spent 40 seconds or more exploring resources) and who returned were 51.6% and 13.4% over a year, respectively, compared to 35.2% and 11.4%, respectively, on the generic mindline.sg site in the same year. CONCLUSIONS The site has achieved desired reach and has seen a strong growth rate in the number of visitors. Substantial and sustained digital marketing campaigns and strategic outreach partnerships, supported by an appropriate analytics infrastructure, are required to achieve this level of reach for such a platform. The site was careful to preserve anonymity, limiting the detail of analytics. Nevertheless, it was observed that the digital therapeutic exercises delivered by the AI chatbot and the self-assessment tool were among the most popular features of the site and improved user engagement. The customised site for working adults appears to have achieved higher engagement than the site designed for the general population. The good levels of overall adoption encourage us to believe that mild-to-moderate mental health conditions, and the social factors that underly them, are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customisation are widely and globally applicable.