Disease Outbreaks ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Singapore ; epidemiology ; World Health Organization

INTRODUCTIONThere has been extensive research on defining the appropriate body mass index (BMI) cut-off point for being overweight and obese in the Asian population since the World Health Organisation (WHO) Expert Consultation Meeting in 2002.

MATERIALS AND METHODSWe reviewed the literature on the optimal BMI cut-off points for Asian populations. We searched PubMed, EMBASE, National Institute for Health Research Centre for Reviews and Dissemination (NHS CRD) Database, Cochrane Library and Google. Attempts to identify further studies were made by examining the reference lists of all retrieved articles. There were 18 articles selected for the review.

RESULTSThere were 13 studies which have identified the BMI cut-off points for Asian populations lower than the international BMI cut-off points recommended by the WHO. Many of the studies have recommended lowering BMI cut-off point specific for Asian populations. A few studies concurred with the recommended cut-off point for Asian populations recommended by International Association for the Study of Obesity (IASO), the International Obesity Task Force (IOTF) and the WHO in 2002. Asian populations were also noted to have higher cardiovascular risk factors than Western populations at any BMI level.

CONCLUSIONSFurther research would be needed to look at the all-cause mortality at same BMI levels between Asians and Caucasians in order to evaluate the BMI cut-off recommendations for Asian populations. It is necessary to develop and redefine appropriate BMI cut-off points which are country-specific and ethnic-specific for Asians. These will facilitate the development of appropriate preventive interventions to address the public health problem posed by obesity.

Asian Continental Ancestry Group ; Body Mass Index ; Humans ; Obesity ; diagnosis ; Reference Values

INTRODUCTIONThe Short Form-12 version 2 (SF-12v2) is a shorter version of the Short Form-36 version 2 (SF-36v2) for assessing health-related quality of life. As the SF-12v2 could not be resolved into the physical- and mental-component summary score (PCS and MCS, respectively) in the general population of Singapore, this study aims to determine and validate the Singapore SF-12 version 2 (SG-12v2).

MATERIALS AND METHODSThe SG- 12v2 was generated using the same methodology as the SF-12v2. Bootstrap analysis was used to determine if the SG-12v2 were significantly different from the SF-12v2. Content validity was assessed using percentage of variance (R²) of the Singapore version of SF-36v2 PCS and MCS explained by the SG-12v2 items. Agreement between the SF-36v2 and the SG-12v2 was assessed using Bland-Altman diagrams. Criterion validity was demonstrated if effect size differences between SF-36v2 and SG-12v2 were small (Cohen's criteria). Known-group validity of SG-12v2 was reported for participants with and without chronic diseases.

RESULTSFive items differed between the SG-12v2 and SF-12v2. Bootstrap analysis confirmed that SG-12v2 and SF-12v2 were significantly different. The SG12v2 explained 94% and 79% of the R² of the SF-36v2 PCS and MCS, respectively. Agreement was good and effect size differences were small (<0.3). Participants with chronic diseases reported lower SG-12v2 scores compared to participants without chronic diseases.

CONCLUSIONThe SG-12v2 offers advantage over the SF-12v2 for use in the general population of Singapore. The SG-12v2 is a valid measure and will be particularly useful for large population health surveys in Singapore.

Asian Continental Ancestry Group ; Chronic Disease ; Ethnic Groups ; Health Status ; Health Surveys ; Humans ; Quality of Life ; Reproducibility of Results ; Singapore

INTRODUCTIONThe aim of this study is to report normative data for the Short-Form 36 version 2 (SF-36v2) for assessing health-related quality of life, in the Singapore general population.

MATERIALS AND METHODSData for English and Chinese-speaking participants of the Singapore Prospective Study Programme were analysed. The SF-36v2 scores were norm-based with the English-speaking Singapore general population as reference and reported by age (in decades), gender and ethnicity as well as for the 5 most prevalent chronic medical conditions. Scores were reported separately for the English and Chinese language versions.

RESULTSA total of 6151 English-speaking (61.5% Chinese and 19.2% Malay) and 1194 Chinese-speaking participants provided complete data. Mean (SD) age of all participants was 49.6 (12.58) years with 52.4% being women. In both languages, women reported lower scores than men on all scales. Among the chronic medical conditions, stroke had the largest impact on all English SF-36v2 scales and on 3 Chinese SF-36v2 scales (role-physical, general health and social functioning).

CONCLUSIONWe have provided detailed normative data for the Singapore English and Chinese SF-36v2, which would be valuable in furthering HRQoL research in Singapore and possibly the region.

Adult ; Female ; Health Surveys ; standards ; statistics & numerical data ; Humans ; Language ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Singapore ; Young Adult

INTRODUCTIONThis study assessed the health screening behaviour of Singaporeans and evaluated factors associated with low uptake of screening tests.

MATERIALS AND METHODSData from the 2010 National Health Survey, which was conducted on Singapore citizens and permanent residents, was used in this analysis. Multivariate Cox regression was used to evaluate the relationship between sociodemographics and health screening behaviour for selected chronic diseases (hypertension, diabetes and hypercholesterolaemia) and cancers (cervical, breast and colorectal). National recommendations for age at which screening should be initiated and appropriate screening interval were used to define appropriate screening behaviour.

RESULTSMore respondents have had their last chronic disease screening done within the recommended time period compared to cancer screening. A total of 77.8%, 63.4% and 54.9% of the respondents had their last hypertension, diabetes and hypercholesterolaemia done within the recommended time period respectively, while less than 50% of the respondents had their cervical (45.8%), breast (32.9%) and colorectal (20.2%) cancer screenings done within the recommended time period. Respondents with higher household income or more years of education were more likely to have undergone screening within the recommended time period. Indians, who are at higher risk of chronic diseases such as diabetes and hypercholesterolaemia, were also more likely to have been screened. A total of 69.9% and 79.5% of the respondents with previously undiagnosed diabetes and hypertension had reported to have done diabetes and hypertension screenings respectively, within the recommended time period.

CONCLUSIONSociodemographic factors that could be associated with a lower uptake of screening tests include: 1) low household income, 2) low education level, and 3) Malay ethnicity. Health promotion programmes and outreach to these groups can be enhanced to further improve screening uptake.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; Colonoscopy ; utilization ; Colorectal Neoplasms ; diagnosis ; Diabetes Mellitus ; diagnosis ; Early Detection of Cancer ; utilization ; Female ; Health Behavior ; Humans ; Hypercholesterolemia ; diagnosis ; Hypertension ; diagnosis ; Male ; Mammography ; utilization ; Mass Screening ; utilization ; Middle Aged ; Neoplasms ; diagnosis ; Occult Blood ; Papanicolaou Test ; utilization ; Proportional Hazards Models ; Singapore ; Surveys and Questionnaires ; Uterine Cervical Neoplasms ; diagnosis ; Vaginal Smears ; utilization

BACKGROUND: Chronic urticaria is a common skin condition that causes significant impact on patient's quality of life. OBJECTIVE: The purpose of the study was to assess adherence to therapy and quality of life of patients with chronic urticaria. We also aimed to study the relationship of medication adherence and quality of life of patients with chronic urticaria. METHODS: A cross sectional study was conducted with 103 patients from the dermatology clinic of National University Hospital, Singapore. Patients with chronic urticaria were asked to fill out a questionnaire for assessment of adherence to therapy and quality of life. We used the Morisky 8-Item Medication Adherence Scale to categorize adherence as high, medium, low. For assessment of quality of life, we used the validated chronic urticaria quality of life questionnaire (CU-Q2oL) by Bairadani et al. RESULTS: The highest median scores for the items measuring quality of life were interference with sleep and pruritus. We also observed that the majority of patients (71.9%) had low adherence to medical therapy. No difference in adherence was noted in patients on once daily medication or more frequent dosing. There was no significant difference in the quality of life among patients with low and medium adherence to therapy. CONCLUSION: Quality of life of patients with chronic urticaria does not depend on the patients' adherence to medications. Dosing frequency does not affect adherence in our study population. It is also important to recognize the symptoms and issues most affecting quality of life of patients with chronic urticaria, so as to improve overall management.
Adult ; Dermatology ; Humans ; Medication Adherence ; Pruritus ; Quality of Life ; Singapore ; Skin ; Urticaria

INTRODUCTIONThe objectives of this current study were to: 1) examine the prevalence and correlates of diabetes mellitus (DM) among older adults (aged 60 years and above) in a multi-ethnic population; 2) examine the prevalence and correlates of comorbid DM and depression among them; and 3) assess the effect of comorbid depression on disability, cognition and healthcare utilisation.

MATERIALS AND METHODSData for the current study came from the Well-being of the Singapore Elderly (WiSE) study; a single phase, cross-sectional survey conducted among Singapore residents aged 60 years and above. A total of 2565 respondents completed the survey; depression was assessed using the Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT) while a diagnosis of DM was considered if respondents stated that a doctor had diagnosed them with DM.

RESULTSDM was reported by 25.5% of the population. The prevalence of depression was significantly higher in those diagnosed with DM than those without DM (6% vs 3%). After adjusting for sociodemographic correlates, smoking and other chronic conditions, DM remained significantly associated with depression and subsyndromal depression. However, after including measures of functioning and cognitive impairment as covariates, DM was not significantly related to depression and subsyndromal depression. Those with comorbid DM and depression were more likely to be of Indian and Malay ethnicity, aged 75 to 84 years (versus 60 to 74 years) and widowed.

CONCLUSIONGiven the significant association of certain sociodemographic groups with comorbid depression among those with DM, targeted interventions for prevention and early diagnosis in these groups should be considered.

Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; statistics & numerical data ; Comorbidity ; Cross-Sectional Studies ; Depression ; epidemiology ; Depressive Disorder ; epidemiology ; Diabetes Mellitus ; epidemiology ; Ethnic Groups ; statistics & numerical data ; Female ; Health Services ; utilization ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Middle Aged ; Prevalence ; Severity of Illness Index ; Singapore ; epidemiology ; Surveys and Questionnaires

INTRODUCTIONMental illnesses are not only a growing public health concern but also a major social and economic issue affecting individuals and families throughout the world. The prevalence of mental disorders, the extent of disability caused by these disorders, and services utilisation of these patients has been well studied in developed countries. The aim of this study was to establish the prevalence of select mental disorders and their associated sociodemographic correlates in the adult Singapore resident population.

MATERIALS AND METHODSThis was a cross-sectional, populationbased, epidemiological study of adult Singapore residents aged 18 years and above. The subjects were randomly selected using a disproportionate stratified sampling method. The diagnoses of selected mental disorders including major depressive disorder (MDD), dysthymia, bipolar (bipolar I & II) disorders, generalised anxiety disorder (GAD), obsessive compulsive disorder (OCD), alcohol abuse and alcohol dependence were established using the Composite International Diagnostic Interview, which is a fully structured diagnostic instrument that assesses lifetime and 12-month prevalence of mental disorders.

RESULTSAmong the 6616 respondents (response rate of 75.9%), 12.0% had at least one lifetime affective, anxiety, or alcohol use disorders. The lifetime prevalence of MDD was 5.8% and that of bipolar disorder was 1.2%. The combined lifetime prevalence of the 2 anxiety disorders, GAD and OCD was 3.6%, with the latter being more common than GAD (0.9% and 3.0% respectively). The lifetime prevalence of alcohol abuse and dependence were found to be 3.1% and 0.5% respectively. Age, gender, ethnicity, marital status and chronic physical illnesses were all significant correlates of mental disorders.

CONCLUSIONThe identified associated factors would help guide resource allocation, policy formulation and programme development in Singapore.

Adolescent ; Adult ; Aged ; China ; ethnology ; Cross-Sectional Studies ; Female ; Health Surveys ; Humans ; India ; ethnology ; Malaysia ; ethnology ; Male ; Mental Disorders ; classification ; diagnosis ; epidemiology ; ethnology ; Middle Aged ; Risk Assessment ; Singapore ; epidemiology ; Young Adult

INTRODUCTION: Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS: We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS: The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
Adult ; Alcoholism/epidemiology* ; Comorbidity ; Cross-Sectional Studies ; Depressive Disorder, Major/epidemiology* ; Humans ; Mental Disorders/epidemiology* ; Prevalence ; Singapore/epidemiology*

The World Health Organization verified that Singapore had eliminated endemic transmission of measles in October 2018. This report summarizes the evidence presented to the Regional Verification Commission for Measles and Rubella Elimination, comprising information about immunization schedules; laboratory testing protocols and the surveillance system; and data on immunization coverage and the epidemiology of cases. Between 2015 and 2017, a total of 246 laboratory confirmed cases of measles were reported. The source or country of infection was unknown for most cases (195; 79.3%). There were 22 clusters, ranging from two to five cases. The most common genotypes detected were D8 and D9. Transmission of B3 was interrupted in 2017, and H1 cases were sporadic and imported. Phylogenetic analyses of the D8 isolates showed the existence of 13 lineages or clusters. Although a few lineages were circulating concurrently, no lineage propagated continuously for a prolonged period, and transmission of each lineage eventually stopped. Although cases and clusters were reported yearly, molecular data showed that none of the lineages resulted in prolonged transmission. There were fewer measles cases in 2017 compared with 2016. The higher number of clusters was likely due to the overall increase in cases because cluster sizes remained small. The occurrence of small clusters is not unexpected since measles is highly infectious. The majority of imported cases did not result in secondary transmission. With the global increase in the number of measles cases, Singapore needs to stay vigilant and continue to promptly test suspected cases; vaccination is the key to preventing infection.