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For several decades, health systems in developed countries have faced rapidly rising healthcare costs without concomitant improvements in health outcomes. Fee for service (FFS) reimbursement mechanisms (RMs), where health systems are paid based on volume, contribute to this trend. In Singapore, the public health service is trying to curb rising healthcare costs by transitioning from a volume-based RM to a capitated payment for a population within a geographical catchment area. To provide insight into the implications of this transition, we developed a causal loop diagram (CLD) to represent a causal hypothesis of the complex relationship between RM and health system performance. The CLD was developed with input from government policymakers, healthcare institution administrators, and healthcare providers. This work highlights that the causal relationships between government, provider organizations, and physicians involve numerous feedback loops that drive the mix of health services. The CLD clarifies that a FFS RM incentivizes high margin services irrespective of their health benefits. While capitation has the potential to mitigate this reinforcing phenomenon, it is not sufficient to promote service value. This suggests the need to establish robust mechanisms to govern common pool resources while minimizing adverse secondary effects.

Oncogenic mutations in the RAS family of small GTPases are commonly found in human cancers and they promote tumorigenesis by altering gene expression networks. We previously demonstrated that Casein Kinase 1α (CK1α), a member of the CK1 family of serine/threonine kinases, is post-transcriptionally upregulated by oncogenic RAS signaling. Here, we report that the CK1α mRNA contains an exceptionally long 5′-untranslated region (UTR) harbouring several translational control elements, implicating its involvement in translational regulation. We demonstrate that the CK1α 5′-UTR functions as an IRES element in HCT-116 colon cancer cells to promote cap-independent translation. Using tobramycin-affinity RNA-pulldown assays coupled with identification via mass spectrometry, we identified several CK1α 5′-UTR-binding proteins, including SFPQ. We show that RNA interference targeting SFPQ reduced CK1α protein abundance and partially blocked RAS-mutant colon cancer cell growth. Importantly, transcript and protein levels of SFPQ and other CK1α 5′-UTR-associated RNA-binding proteins (RBPs) are found to be elevated in early stages of RAS-mutant cancers, including colorectal and lung adenocarcinoma. Taken together, our study uncovers a previously unappreciated role of RBPs in promoting RAS-mutant cancer cell growth and their potential to serve as promising biomarkers as well as tractable therapeutic targets in cancers driven by oncogenic RAS.

Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.