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ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention. Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (

Purpose: The aim of the study was to examine associations between speaking fundamental frequency (f[subscript os]), vowel formant frequencies (F), listener perceptions of speaker gender, and vocal femininity-masculinity. Method: An exploratory study was undertaken to examine associations between f[subscript os], F[subscript 1]-F[subscript 3], listener perceptions of speaker gender (nominal scale), and vocal femininity-masculinity (visual analog scale). For 379 speakers of Australian English aged 18-60 years, f[subscript os] mode and F[subscript 1]-F[subscript 3] (12 monophthongs; total of 36 F[subscript s]) were analyzed on a standard reading passage. Seventeen listeners rated speaker gender and vocal femininity-masculinity on randomized audio recordings of these speakers. Results: Model building using principal component analysis suggested the 36 F[subscript s] could be succinctly reduced to seven principal components (PCs). Generalized structural equation modeling (with the seven PCs of F and f[subscript os] as predictors) suggested that only F[subscript 2] and f[subscript os] predicted listener perceptions of speaker gender (male, female, unable to decide). However, listener perceptions of vocal femininity-masculinity behaved differently and were predicted by F[subscript 1], F[subscript 3], and the contrast between monophthongs at the extremities of the F[subscript 1] acoustic vowel space, in addition to F[subscript 2] and f[subscript os]. Furthermore, listeners' perceptions of speaker gender also influenced ratings of vocal femininity-masculinity substantially. Conclusion: Adjusted odds ratios highlighted the substantially larger contribution of F to listener perceptions of speaker gender and vocal femininity-masculinity relative to f[subscript os] than has previously been reported.

Objective: Metabolic dysfunction‐associated steatotic liver disease (MASLD) and obesity increases risk of cardiovascular disease. This cohort study examines the prognostic value of MASLD, across body weight categories, in a secondary preventative acute myocardial infarction (AMI) cohort. Methods: Patients with AMI were stratified into four phenotypes—obesity MASLD, non‐obesity MASLD, obesity non‐MASLD, non‐obesity non‐MASLD. The primary outcome was all‐cause mortality. Cox regression analysis was performed to investigate determinants of long‐term all‐cause mortality. Results: Of 5702 patients, majority were in the non‐obesity non‐MASLD group (66.7%), followed by obesity MASLD (16.1%), non‐obesity MASLD (11.2%) and non‐obesity MASLD (6.0%). Across the four phenotypes, obesity MASLD had the highest cardiometabolic burden, followed by non‐obesity MASLD. Non‐obesity MASLD had the highest risk of heart failure (p = 0.034), cardiogenic shock (p < 0.001), and all‐cause long‐term mortality (p = 0.019). The non‐obesity MASLD (HR 1.400, 95%CI 1.077–1.820, p = 0.012) and obesity MASLD phenotypes (HR 1.222, 95%CI 1.005–1.485, p = 0.044) were independently associated with long‐term all‐cause mortality. Conclusions: Obesity and non‐obesity MASLD phenotypes were predictors of all‐cause mortality following AMI, with an even larger magnitude of mortality risk in the non‐obesity MASLD group. The recognition of MASLD and its body weight phenotypes will be beneficial in the prognostication following AMI. [ABSTRACT FROM AUTHOR]

Screening for autism in childhood has been advocated as a part of standard care. Challenges exist with screening implementation and performance of screening tools in clinical practice. This study aimed to examine the validity and feasibility of using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) for screening of autism in Singapore. Caregivers completed the M-CHAT-R/F as a part of the routine 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by trained nursing staff. Children screened positive and a subset of those screened negative underwent diagnostic assessments for autism, which included an Autism Diagnostic Observation Schedule, Second Edition. Participants were 5336 multiethnic children (mean age 18.6 ± 0.9 months, 51.3% male gender). In total, 113 (2.1%) were screened positive, of which 54 (1.0%) were classified to have autism after their diagnostic assessment. Sensitivity of the M-CHAT-R/F was 88.6%, specificity 71.4%, and positive predictive value 90.7% for an autism diagnosis. The majority of respondents rated the screening process as feasible within the clinic setting. The M-CHAT-R/F had acceptable psychometric properties and high feasibility when used in primary care settings in Singapore. Recommendations for implementation of systematic screening and future research are presented. Systematic screening for autism in early childhood has been suggested to improve eventual outcomes by facilitating earlier diagnosis and access to intervention. However, clinical implementation of screening has to take into account effectiveness and feasibility of use within a healthcare setting for accurate diagnosis of autism. In Singapore, autism screening using a structured screening tool is not currently employed as a part of routine well-child visits for children in primary care clinics. In this study, 5336 children (aged 17–20 months) were screened for autism using the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) during their 18-month well-child visit in seven primary care clinics. Screening and follow-up interviews were administered by nursing staff at each clinic. Children screened positive and a portion of those screened negative then underwent diagnostic assessments to determine whether they met the diagnostic criteria for autism. In total, 113 (2.1%) were screened positive, of which 54 (1.0%) met the criteria for autism. Children who screened positive and received a diagnosis accessed autism-specific intervention at an average age of 22 months. Nurses and physicians rated the acceptability and practicality of the M-CHAT-R/F highly. Therefore, the M-CHAT-R/F questionnaire was an effective and feasible tool for autism screening among 18-month-old children in this study. Future studies will be designed to determine the optimal age of screening and role of repeated screening in Singapore, as well as to better understand any potential improved outcomes nationwide compared with pre-implementation of autism screening. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to provide a systematic review of the aspects of verbal communication contributing to listener perceptions of speaker gender with a view to providing clinicians with guidance for the selection of the training goals when working with transsexual individuals. Method: Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines were adopted in this systematic review. Studies evaluating the contribution of aspects of verbal communication to listener perceptions of speaker gender were rated against a new risk of bias assessment tool. Relevant data were extracted, and narrative synthesis was then conducted. Meta-analyses were conducted when appropriate data were available. Results: Thirty-eight articles met the eligibility criteria. Meta-analysis showed speaking fundamental frequency contributing to 41.6% of the variance in gender perception. Auditory-perceptual and acoustic measures of pitch, resonance, loudness, articulation, and intonation were found to be associated with listeners' perceptions of speaker gender. Tempo and stress were not significantly associated. Mixed findings were found as to the contribution of a breathy voice quality to gender perception. Nonetheless, there exists significant risk of bias in this body of research. Conclusions: Speech and language clinicians working with transsexual individuals may use the results of this review for goal setting. Further research is required to redress the significant risk of bias.