Background: Frequent attenders (FAs) place a disproportionate burden on emergency department (ED) resources. Objectives: Our study aimed to describe characteristics of ED visits by FAs to our hospital so as to identify potential strategies to better manage ED demand. Methods: This was a retrospective observational study. All visits to the ED from 1 January 2011 to 31 December 2011 were included. FAs were defined as patients with ⩾5 visits to the ED over the study period. They were further stratified by visit frequency. Results: FAs showed a bimodal age distribution, with visits by FAs aged 16-25 years old and the elderly aged 66 years and above accounting for the largest proportion of ED visits relative to the number of visits by their non-FA counterparts. Using the age group of 26-45 years as reference, the odds ratio (OR) of FAs being 16-25 years old was 3.037 (95% confidence interval (CI) 2.708-3.407, p < 0.001). Above the age of 65, the OR of FAs falling into a given age group increased for every additional decade of life, up to 3.118 (2.495-3.898, p <0.001) for the age group of 86 and above. FAs were more likely to be male. Diagnoses which accounted for a higher percentage of visits with increasing visit frequency were asthma, chronic obstructive pulmonary disease, upper respiratory tract infection and headache. Conclusions: FAs include the high-acuity chronic sick as well as young adults with low-acuity complaints. Disease optimisation programmes, case management, robust community-based healthcare and public education are possible avenues to optimise ED resources in an ageing society.

Introduction: Foreign workers (FWs) on work permit face unique health challenges and potential barriers to healthcare. We aimed to examine the epidemiology, attendance patterns, disposition, and adherence to follow-up, by FWs on work permit to two emergency departments (EDs) in Singapore. Methods: In this retrospective observational study, we included consecutive FWs on work permit who registered at the EDs of two public restructured hospitals from 1 May 2016 to 31 October 2016. Data obtained from electronic medical records included patient demographics, triage acuity, disposition, ED diagnoses and bill information. Results: There were 6,429 individual FWs on work permit who contributed to 7,157 ED visits over the 6-month study period, with male predominance (72.7%, 4672/6429), and median age of 31 (interquartile range 26 to 38) years. A high proportion of these FWs were triaged to low-acuity status compared to the general ED population (66.9% versus 45.9%, P<0.001). Trauma-related injuries contributed to 34.4% of their visits, and were more likely to result in admission compared to non-trauma-related conditions (18.7% vs 15.2%, P<0.001). FWs engaged in shipyard, construction and process industries were more likely to be discharged “against medical advice” (14.8% vs 3.2%, P<0.001), and default their specialist outpatient follow-up (50.1% vs 34.2%, P<0.001) for non-trauma-related conditions compared to trauma-related injuries. Conclusion: In Singapore, the EDs of public restructured hospitals provide healthcare safety nets to FWs on work permit. These workers made more low-acuity visits compared to the general population during the study period and may face potential barriers to admission and follow-up. Keywords: Emergency medicine, epidemiology, migrant workers, occupational medicine, public health

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Immune cells migration at the ocular surface is an active process involving the formation of intrastromal channels, and cell egression through intact basement membrane pores. The preferential migration of CD4 T cells indicates that this is a specific response of conjunctival lymphoid tissue and not a passive movement of cells. A wide range of immune cell phenotypes exist at the ocular surface. This model can serve to test in vitro the effects of injurious agents on the ocular surface.