HIV Infections ; epidemiology ; Humans ; Singapore ; epidemiology

Coronavirus Infections ; epidemiology ; Humans ; Middle East ; epidemiology ; Respiratory Tract Infections ; epidemiology ; virology ; Singapore ; epidemiology ; Syndrome

INTRODUCTIONType 2 diabetes mellitus is of increasing healthcare concern worldwide, with incidence rising, complications leading to significant morbidity and mortality, posing strain on public healthcare funding. Health-related quality of life of diabetic patients is increasingly being recognised as "the ultimate goal of all health interventions". The aim of our study was to identify the quality of life predictors of diabetic patients in primary care. This study was conducted in 8 public primary care polyclinics from SingHealth Polyclinics.

MATERIALS AND METHODSWe carried out a cross-sectional, questionnaire-based survey on 699 diabetic patients, administered by medical students on a systematic sample of patients during their routine visit. Multiple regression analysis was used to investigate the socio-demographic and clinical characteristics as predictors of quality of life, measured by the Short Form 36 Health Survey (SF-36) and the EQ-5D self-report questionnaire.

RESULTSHigher quality of life in diabetic patients is associated with younger age, male gender, employed status, higher educational level and exercise. Lower quality of life is associated with comorbidities and diabetic complications. Short-term glycaemic control as measured by HbA1c did not correlate with quality of life. Most interestingly, confidence in doctor and satisfaction in clinic were related to better quality of life.

CONCLUSIONHealth-related quality of life is adversely associated with symptomatic complications of diabetes mellitus, but not with short-term diabetic control. This suggests that the diabetic patient may not appreciate the impact of good diabetic control immediately on his or her health-related quality of life. More effort should be invested into patient education of the importance of glycaemic control to prevent these long-term complications.

Analysis of Variance ; Body Mass Index ; Cross-Sectional Studies ; Diabetes Complications ; prevention & control ; psychology ; Diabetes Mellitus, Type 2 ; prevention & control ; psychology ; Female ; Glycated Hemoglobin A ; analysis ; Health Status ; Health Surveys ; Humans ; Linear Models ; Male ; Middle Aged ; Primary Health Care ; Psychometrics ; Quality of Life ; Singapore ; Surveys and Questionnaires ; Time Factors

We describe the public health control measures implemented in Singapore to limit the spread of influenza A (H1N1-2009) and mitigate its social effects. We also discuss the key learning points from this experience. Singapore's public health control measures were broadly divided into 2 phases: containment and mitigation. Containment strategies included the triage of febrile patients at frontline healthcare settings, admission and isolation of confirmed cases, mandatory Quarantine Orders (QO) for close contacts, and temperature screening at border entry points. After sustained community transmission became established, containment shifted to mitigation. Hospitals only admitted H1N1-2009 cases based on clinical indications, not for isolation. Mild cases were managed in the community. Contact tracing and QOs tapered off, and border temperature screening ended. The 5 key lessons learnt were: (1) Be prepared, but retain flexibility in implementing control measures; (2) Surveillance, good scientific information and operational research can increase a system's ability to manage risk during a public health crisis; (3) Integrated systems-level responses are essential for a coherent public health response; (4) Effective handling of manpower surges requires creative strategies; and (5) Communication must be strategic, timely, concise and clear. Singapore's effective response to the H1N1-2009 pandemic, founded on experience in managing the 2003 SARS epidemic, was a whole-of-government approach towards pandemic preparedness planning. Documenting the measures taken and lessons learnt provides a learning opportunity for both doctors and policy makers, and can help fortify Singapore's ability to respond to future major disease outbreaks.
Communicable Disease Control ; organization & administration ; Contact Tracing ; Delivery of Health Care ; Disease Outbreaks ; prevention & control ; Focus Groups ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; prevention & control ; transmission ; Interviews as Topic ; Patient Isolation ; Public Health ; Singapore ; epidemiology ; Triage

INTRODUCTIONThis study reviewed the epidemiological trends of poliomyelitis from 1946 to 2010, and the impact of the national immunisation programme in raising the population herd immunity against poliovirus. We also traced the efforts Singapore has made to achieve certification of poliomyelitis eradication by the World Health Organisation.

MATERIALS AND METHODSEpidemiological data on all reported cases of poliomyelitis were obtained from the Communicable Diseases Division of the Ministry of Health as well as historical records. Coverage of the childhood immunisation programme against poliomyelitis was based on the immunisation data maintained by the National Immunisation Registry, Health Promotion Board. To assess the herd immunity of the population against poliovirus, 6 serological surveys were conducted in 1962, 1978, 1982 to 1984, 1989, 1993 and from 2008 to 2010.

RESULTSSingapore was among the fi rst countries in the world to introduce live oral poliovirus vaccine (OPV) on a mass scale in 1958. With the comprehensive coverage of the national childhood immunisation programme, the incidence of paralytic poliomyelitis declined from 74 cases in 1963 to 5 cases from 1971 to 1973. The immunisation coverage for infants, preschool and primary school children has been maintained at 92% to 97% over the past decade. No indigenous poliomyelitis case had been reported since 1978 and all cases reported subsequently were imported.

CONCLUSIONSingapore was certified poliomyelitis free along with the rest of the Western Pacific Region in 2000 after fulfilling all criteria for poliomyelitis eradication, including the establishment of a robust acute flaccid paralysis surveillance system. However, post-certification challenges remain, with the risk of wild poliovirus importation. Furthermore, it is timely to consider the replacement of OPV with the inactivated poliovirus vaccine in Singapore's national immunisation programme given the risk of vaccine-associated paralytic poliomyelitis and circulating vaccine-derived polioviruses.

Adolescent ; Certification ; Child ; Child, Preschool ; Disease Eradication ; organization & administration ; Female ; Humans ; Infant ; Male ; Poliomyelitis ; epidemiology ; prevention & control ; virology ; Poliovirus ; immunology ; Singapore ; epidemiology

INTRODUCTIONThe delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies.

MATERIALS AND METHODSWe included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009. Late-stage HIV infection is defined as CD4 count less than 200 mm(3) or AIDS-defining opportunistic infections at fi rst diagnosis or within one year of HIV diagnosis. We determined independent epidemiological risk factors for late-stage HIV infection at first diagnosis using multivariate logistic regression.

RESULTSMultivariate analysis showed that older age corresponded significantly with increasing odds of late-stage HIV infection. Compared to persons diagnosed at 15 to 24 years of age, those diagnosed at age 55 years and above were associated with 5-fold increased likelihood of late-stage infection (adjusted odds ratio (AOR): 5.17; 95% CI, 3.21 to 8.33). Chinese ethnicity, singlehood, and non-professional occupations were also significantly associated with late-stage HIV infection. Persons detected in the course of medical care had over 3.5 times the odds of late-stage infection (AOR: 3.55; 95% CI, 2.71 to 4.65). Heterosexual mode of transmission and having sex workers and social escorts as sexual partners, were the other epidemiological risk factors with significant associations.

CONCLUSIONThe findings of this study emphasises the need to increase HIV awareness and to encourage early and regular HIV testing among at-risk persons.

Adolescent ; Adult ; Age Factors ; Delayed Diagnosis ; statistics & numerical data ; Disease Notification ; Female ; HIV ; HIV Infections ; diagnosis ; epidemiology ; Humans ; Logistic Models ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Factors ; Sex Workers ; statistics & numerical data ; Sexual Behavior ; statistics & numerical data ; Singapore ; epidemiology

There is a lack of representative samples to provide reliable and accurate seroprevalence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) as well as behavioural information among men who have sex with men (MSM) in Singapore. We used respondent driven sampling (RDS) to recruit MSM. Participants completed a survey used by Asian Internet MSM Sex Survey (AIMSS) and were tested for HIV and syphilis. We compared the characteristics of the RDS participants with STI diagnosis against those who did not have any STI diagnosis in the past 6 months. We compared RDS participants with AIMSS participants. Of 72 MSM recruited, 1 was positive for HIV (1.3%) and 4 (5.5%) tested positive for syphilis. Median age was 30 years and majority was Chinese (69.4%). RDS participants who had any STI diagnosis reported to have more use of recreational drugs (P = 0.006), and lower condom use (P = 0.054). Comparing RDS participants (n = 72) with the AIMSS participants (n = 2075), RDS respondents had ≥1 male partner in the past 6 months (P = 0.003), more casual sex partners (P = 0.012) and more STI symptoms (P = 0.019). There was no difference in terms of HIV testing and recreational drug use. The HIV and syphilis seroprevalence rates from our study are similar to previous reports conducted in high-risk MSM. In contrast to other settings, RDS did not work well among MSM in Singapore. The public health implications of our study highlight the challenges in obtaining data for HIV surveillance in assessing prevalence and risk behaviours among MSM.
Adult ; HIV Infections ; diagnosis ; epidemiology ; psychology ; Health Literacy ; methods ; Health Surveys ; Homosexuality, Male ; psychology ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Prevalence ; Risk-Taking ; Seroepidemiologic Studies ; Sexual Behavior ; Sexual Partners ; psychology ; Singapore ; epidemiology ; Syphilis ; diagnosis ; epidemiology ; psychology

INTRODUCTIONCommunity-based exercise programmes have been shown to be effective in the Western world. However, there is a dearth of literature on their effectiveness in Asia. This pilot study aims to assess the effectiveness of the Asian community-based Health Wellness Programme (HWP) in Singapore. The HWP provides community cardiac rehabilitation services.

METHODSA retrospective database analysis was conducted on cardiac rehabilitation patients who had completed the one-year wellness programme from 2010 to 2011. Patients were included in the programme if they had an underlying cardiac disease such as ischaemic heart disease and were deemed as stable by their cardiologist. Patients with New York Heart Association Class III or IV heart failure were excluded from this programme. Sociodemographic, anthropometric, clinical and laboratory data was recorded. Changes between the baseline and final measurements were analysed.

RESULTSComplete data from a total of 136 patients was analysed. Improvements were noted in body fat percentage (change [Δ] -1.3%, p < 0.01), distance walked (Δ 9.7 m, p = 0.01), total cholesterol (Δ -7.8 mg/dL, p = 0.03), low-density lipoprotein (Δ -7.8 mg/dL, p = 0.03) and triglyceride (Δ -17.8 mg/dL, p < 0.01).

CONCLUSIONThe low-to-moderate intensity HWP seems to be effective in a multiethnic community setting. To confirm the quality and effectiveness of such a programme in secondary cardiovascular prevention, more evidence from prospective controlled trials with suitable controls is needed.

Aged ; Cardiac Rehabilitation ; methods ; Ethnic Groups ; Female ; Follow-Up Studies ; Health Promotion ; organization & administration ; Heart Failure ; ethnology ; rehabilitation ; Humans ; Male ; Morbidity ; trends ; Pilot Projects ; Retrospective Studies ; Singapore ; epidemiology

INTRODUCTIONAs the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control.

METHODSA retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia.

RESULTSAmong the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L).

CONCLUSIONInpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.

Aged ; Blood Glucose ; analysis ; Diabetes Mellitus ; drug therapy ; Female ; Hospitals ; Humans ; Hyperglycemia ; complications ; drug therapy ; Hypoglycemia ; complications ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Inpatients ; Insulin ; therapeutic use ; Male ; Middle Aged ; Point-of-Care Systems ; Prevalence ; Retrospective Studies ; Singapore ; Treatment Outcome