Aims: Patient and provider barriers to cardiovascular disease screening in disadvantaged Asian populations are under-studied. We conducted a qualitative study of attitudes to hypertension/diabetes/dyslipidaemia screening within low-income communities in Singapore. Methods: Interviewers elicited barriers/enablers to blood pressure measurement/fasting blood glucose/fasting blood lipid amongst residents and healthcare providers serving low-income communities. Transcripts were analysed thematically and iterative analysis carried out using established qualitative methodology. Results: Twenty patients and nine providers were interviewed. Comments were grouped into seven content areas: primary care characteristics (PCC), procedural issues, knowledge, costs, priorities, attitudes, and information sources. For hypertension screening, procedural issues were enablers; however, for fasting blood tests, procedural issues were perceived as both enablers and barriers, including issues of pain, needle and blood phobia, and lag between tests and results. Costs of screening and treatment were cited as issues for diabetes and cholesterol screening, but for hypertension screening, concerns about cost of treatment dominated. While blood pressure measurement using sphygmomanometers and fasting lipid tests were generally perceived as the accepted screening tests for hypertension and hyperlipidaemia, fasting glucose tests were not perceived as the accepted screening test for diabetes. Barriers and enablers to cardiovascular screening, as perceived by patients and providers, were largely concordant. Conclusion: Procedural issues predominated in patients’ percept ions of hypertension screening, while knowledge and attitudes played a more significant role for diabetes and dyslipidaemia. Interventions to raise screening uptake in these disadvantaged communities must be tailored to the main barriers for each modality.

INTRODUCTIONWe were interested to determine the participation rates for health screening in a multi-ethnic urban low-income community. We assessed the health screening rates at baseline, collected data on reasons for non-participation and assessed the impact that a 5-month intervention had on health screening in this community.

MATERIALS AND METHODSThe study population involved all residents aged ≥40 years, living in heavily subsidised public rental flats in Taman Jurong Constituency, Singapore. From January 2009 to May 2009, we collected baseline information and offered eligible residents free blood pressure, fasting blood glucose and lipid measurements, fecal occult blood testing and Pap smears. Screenings were conducted either at or near the residents' homes.

RESULTSThe participation rate was 60.9% (213/350). At baseline, 18.9% (24/127), 26.4% (42/159) and 18.7% (31/166) had gone for regular hypertension, diabetes and hyperlipidaemia screening, respectively; 3.8% (6/157) and 2.9% (2/70) had had regular colorectal and cervical cancer screening, respectively. Post-intervention, rates for hypertension screening increased to 97.6% but increases for other modalities were marginal. High cost, lack of time, not at risk, too old, or unnecessary for healthy people were commonly-cited reasons for skipping regular health screening. Being unemployed was associated with missing regular hypertension screening (adjusted OR = 2.48, CI = 1.12-5.53, P = 0.026); those who did not need financial aid were less likely to miss regular hyperlipidaemia screening (adjusted OR = 0.27, CI = 0.10-0.72, P = 0.008).

CONCLUSIONThe participation rates for health screening were poor in this low-income community. More can be done to encourage regular health screening participation amongst this segment of the populace, both by reducing costs as well as addressing misperceptions.

Adult ; Aged ; Female ; Health Services Research ; Humans ; Male ; Mass Screening ; methods ; utilization ; Middle Aged ; Patient Acceptance of Health Care ; ethnology ; Poverty Areas ; Singapore

INTRODUCTIONWe assessed the pedagogical value of a student-led community-based experiential learning project called the Public Health Screening (PHS) run by medical and nursing students of the National University of Singapore's Yong Loo Lin School of Medicine (NUS YLLSoM).

MATERIALS AND METHODSWe conducted a cross-sectional study using a self-administered anonymised questionnaire on medical and nursing students who participated in PHS using the Fund for the Improvement of Postsecondary Education (FIPSE) Survey Instrument. Participants also gave an overall score for their learning experience at the PHS.

RESULTSThe participation rate was 93.1% (576/619) for medical students and 100% (37/37) for nursing students. All participants gave the PHS learning experience a high rating (median = 8 out of maximum of 10, inter-quartile range, 7 to 9). A majority of participants felt that PHS had helped them to improve across all domains surveyed. For medical students, those in preclinical years and females were independently more likely to feel that PHS had helped them to improve in communication skills, teamwork, ability to identify social issues, taking action, and gaining and applying their knowledge than those in clinical years and males. Improved ability to interact with patients (β=1.64, 95%CI, 1.01-2.27), appreciation of challenges to healthcare faced by Singaporeans from lower income groups (β=0.93, 95%CI, 0.49-1.37), thinking of others (β=0.70, 95%CI, 0.04-1.37) and tolerance of different people (β =0.63, 95%CI, 0.17-1.10) were strongly associated with the overall rating score.

CONCLUSIONPHS was a positive learning experience in a wide range of domains for all students involved. This suggests that student-organised community-based experiential learning projects have potential educational value for both medical and nursing students.

Attitude of Health Personnel ; Community Health Services ; organization & administration ; Confidence Intervals ; Cross-Sectional Studies ; Data Collection ; Education, Medical ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Learning ; Logistic Models ; Male ; Mass Screening ; Models, Educational ; Odds Ratio ; Program Development ; Program Evaluation ; Public Health Practice ; Schools, Medical ; Singapore ; Students, Medical ; Students, Nursing ; Surveys and Questionnaires ; Teaching ; Volunteers

BACKGROUND: We sought to determine the association between chronic pain and participating in routine health screening in a low socioeconomic-status (SES) rental-flat community in Singapore. In Singapore, ≥ 85% own homes; public rental flats are reserved for those with low-income. METHODS: Chronic pain was defined as pain ≥ 3 months. From 2009−2014, residents aged 40−60 years in five public rental-flat enclaves were surveyed for chronic pain; participation in health screening was also measured. We compared them to residents staying in adjacent owner-occupied public housing. We also conducted a qualitative study to better understand the relationship between chronic pain and health screening participation amongst residents in these low-SES enclaves. RESULTS: In the rental-flat population, chronic pain was associated with higher participation in screening for diabetes (aOR = 2.11, CI = 1.36−3.27, P < 0.001), dyslipidemia (aOR = 2.06, CI = 1.25−3.39, P = 0.005), colorectal cancer (aOR = 2.28, CI = 1.18−4.40, P = 0.014), cervical cancer (aOR = 2.65, CI = 1.34−5.23, P = 0.005) and breast cancer (aOR = 3.52, CI = 1.94−6.41, P < 0.001); this association was not present in the owner-occupied population. Three main themes emerged from our qualitative analysis of the link between chronic pain and screening participation: pain as an association of “major illness”; screening as a search for answers to pain; and labelling pain as an end in itself. CONCLUSIONS: Chronic pain was associated with higher cardiovascular and cancer screening participation in the low-SES population. In low-SES populations with limited access to pain management services, chronic pain issues may surface during routine health screening.
Asian Continental Ancestry Group ; Breast Neoplasms ; Chronic Pain* ; Colorectal Neoplasms ; Dyslipidemias ; Early Detection of Cancer ; Humans ; Mass Screening* ; Pain Management ; Public Housing ; Singapore ; Social Class* ; Uterine Cervical Neoplasms

Cardiac Tamponade/etiology* ; Female ; Humans ; Pericardial Effusion/etiology*

Caregivers are important in post-stroke rehabilitation, but little work has been done on the caregivers of stroke survivors in Asian cultures. We examined the association between patient profile (age, gender, socioeconomic status, functional level, religion, and ethnicity) and caregiver availability, number of potential caregivers and primary caregiver identity amongst Singaporean community hospitals' stroke patients. Data was obtained from all Singaporean community hospitals from 1996-2005. 3796 patients fulfilled inclusion criteria. Mixed logistic regression identified independent predictors of caregiver availability and primary caregiver identity. Mixed Poisson modelling identified independent predictors of the number of caregiver(s). Among recent stroke survivors, 95.8% (3640/3796) had potential caregivers, of which 94.2% (3429/3640) had identified primary caregivers. Of the latter, 41.2% relied on live-in hired help (foreign domestic workers-FDWs), 27.6% on spouses and 21.6% on first-degree relatives. Independent patient factors associated with caregiver availability and number were older, female, married, higher socioeconomic status, having a religion and lower functional level at admission. Independent patient factors associated with FDW caregivers were older age, female, Chinese compared to Malay, with higher socioeconomic class and lower functional level at admission. Caregiver availability for post-stroke patients in Singapore community hospitals is relatively high, with heavy dependence on FDWs.

INTRODUCTIONThis study investigated the effect of an access-enhanced intervention on hypertension screening and management, as well as on health behaviours among newly diagnosed hypertensives, in a multi-ethnic low socioeconomic status (SES) community. Factors associated with hypertension screening, treatment, and control in the community were also determined.

MATERIALS AND METHODSThe study involved all residents aged ≥40 years in 2 public rental housing precincts (low SES), between 2009 and 2011, who were followed-up prospectively for 1 year after a 6-month community-based intervention comprising a 3-month access-enhanced screening component and a 3-month follow-up (outreach) component. Blood pressure was measured at baseline and follow-up. Multivariate Cox regression determined predictors of hypertension management at follow-up.

RESULTSThe follow-up rate was 80.9% (467/577). At baseline, 60.4% (282/467) were hypertensive; 53.5% (151/282) were untreated; 54.2% (71/131) uncontrolled. One year later, postintervention, 51.6% (78/151) of untreated hypertensives were treated; combined with treated hypertensives previously uncontrolled, 53.0% (79/149) achieved control. Older age independently predicted treatment (adjusted relative risk, aRR = 1.98, CI, 1.08 to 3.65); majority ethnicity (aRR = 1.76, CI, 1.05 to 2.96), employment (aRR = 1.85, CI, 1.26 to 2.80) and newly treated hypertension (aRR=1.52, CI, 1.01 to 2.32) predicted control. A total of 52.4% (97/185) were irregularly screened at baseline; at follow-up 61.9% (60/97) were regularly screened. Cost and misperceptions were common barriers to screening and treatment. Newly diagnosed hypertensives were also less likely to go for additional cardiovascular screening (aRR = 0.54, CI, 0.29 to 0.99).

CONCLUSIONAn access-enhanced intervention had some success in improving hypertension management within low SES communities; however, it was less successful in improving cardiovascular risk management, especially in encouraging lifestyle changes and additional cardiovascular screening amongst newly diagnosed hypertensives.

Adult ; Age Factors ; Aged ; Antihypertensive Agents ; therapeutic use ; Asian Continental Ancestry Group ; statistics & numerical data ; Diet, Sodium-Restricted ; methods ; Exercise Therapy ; methods ; Female ; Health Services Accessibility ; statistics & numerical data ; Humans ; Hypertension ; diagnosis ; ethnology ; therapy ; Male ; Mass Screening ; Middle Aged ; Multivariate Analysis ; Patient Compliance ; ethnology ; statistics & numerical data ; Patient Dropouts ; statistics & numerical data ; Poverty ; statistics & numerical data ; Proportional Hazards Models ; Prospective Studies ; Risk Reduction Behavior ; Singapore ; Smoking Cessation ; methods ; Social Class ; Treatment Outcome ; Weight Reduction Programs ; methods

INTRODUCTIONLittle is known about the sociodemographic and clinical profile of older adults with intellectual disabilities (ID) in Singapore. We studied the sociodemographic and clinical profile of older adults with ID and investigated factors associated with caregiver availability and identity in this population.

MATERIALS AND METHODSThe study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Information on sociodemographic and clinical profiles, functional status, and availability of caregivers were collected via interviewer-administered questionnaires from guardians of older adults with ID. Descriptive characteristics were computed and chi-square and logistic regression identifi ed predictors of caregiver availability and identity.

RESULTSParticipation was 95% (227/239). There were differences in client age, gender, and caregiver availability between recipients of residential and non-residential services (all P <0.05). Common comorbidities included hyperlipidaemia (17.6%), hypertension (15.9%), psychiatric diagnoses (16.3%) and epilepsy (10.6%). The majority were fully independent in basic activities of daily living, but only 21.1% were fully communicative. Only a small minority (9.4%) were exercising regularly. The majority (73.5%) of clients had a primary caregiver; almost equal proportions relied on either parents or siblings. Older client age was associated independently with the lack of a primary caregiver, independent of greater functional dependence and presence of medical comorbidities in the client.

CONCLUSIONOlder adults with ID have multiple medical, functional, and social issues. More can be done to support the care of this unique group of adults with special needs.

Activities of Daily Living ; Adult ; Age Factors ; Caregivers ; classification ; statistics & numerical data ; supply & distribution ; Chi-Square Distribution ; Comorbidity ; Demography ; Epilepsy ; epidemiology ; Female ; Humans ; Hyperlipidemias ; epidemiology ; Hypertension ; epidemiology ; Intellectual Disability ; epidemiology ; physiopathology ; psychology ; therapy ; Logistic Models ; Male ; Mental Disorders ; epidemiology ; Quality of Life ; Singapore ; epidemiology ; Social Support ; Socioeconomic Factors

INTRODUCTION: Healthcare workers (HCWs) are a critical resource in the effort to control the COVID-19 pandemic. They are also a sentinel surveillance population whose clinical status reflects the effectiveness of the hospital's infection prevention measures in the pandemic. METHODS: This was a retrospective cohort study conducted in Singapore General Hospital (SGH), a 1,822-bed tertiary hospital. Participants were all HCWs working in SGH during the study period. HCW protection measures included clinical workflows and personal protective equipment developed and adapted to minimise the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. HCW monitoring comprised staff contact logs in high-risk locations, twice-daily temperature monitoring, assessment of HCWs with acute respiratory illnesses (ARIs) in the staff clinic and, in the event of an exposure, extensive contact tracing, detailed risk assessment and risk-based interventions. HCW surveillance utilised monitoring data and ARI presentations and outcomes. RESULTS: In the ten-week period between 6 January 2020 and 16 March 2020, 333 (17.1%) of 1,946 HCWs at risk of occupational COVID-19 presented with ARI. 32 (9.6%) screened negative for SARS-CoV-2 from throat swabs. Five other HCWs developed COVID-19 attributed to non-clinical exposures. From the nine COVID-19 exposure episodes investigated, 189 HCW contacts were identified, of whom 68 (36.2%) were placed on quarantine and remained well. CONCLUSION Early in an emerging infectious disease outbreak, close monitoring of frontline HCWs is essential in ascertaining the effectiveness of infection prevention measures. HCWs are at risk of community disease acquisition and should be monitored and managed to prevent onward transmission.
Humans ; COVID-19/epidemiology* ; Pandemics/prevention & control* ; SARS-CoV-2 ; Infectious Disease Transmission, Patient-to-Professional/prevention & control* ; Sentinel Surveillance ; Retrospective Studies ; Infection Control ; Health Personnel

INTRODUCTIONThis study aimed to determine if disposable filtering facepiece respirators (FFRs) that come with an exhalation valve (EV) and a novel active venting system (AVS) provided greater perceived comfort and exertion when compared to standard N95 FFRs without these features among male military personnel performing prolonged essential outdoor duties.

METHODSWe used a randomised open-label controlled crossover study design to compare three FFR options: (a) standard FFR; (b) FFR with EV; and (c) FFR with EV+AVS. Male military personnel aged between 18 and 20 years completed a questionnaire at the start of outdoor duty (baseline), after two hours of standardised non-strenuous outdoor duty and after 12 hours of duty divided into two-hour work-rest cycles. Participants rated the degree of discomfort, exertion and symptoms using a five-point Likert scale. The association between outcomes and types of FFR was assessed using a multivariate ordered probit mixed-effects model.

RESULTSFor a majority of the symptoms, study participants gave FFR with EV and FFR EV+AVS significantly better scores than standard FFR. Both FFR with EV and FFR with EV+AVS had significantly less discomfort (FFR with EV+AVS: 91.1%; FFR with EV: 57.6%) and exertion (FFR with EV+AVS: 83.5%; FFR with EV: 34.4%) than standard FFR. FFR with EV+AVS also had significantly better scores for exertion (53.4%) and comfort (39.4%) when compared to FFR with EV.

CONCLUSIONUsage of FFR with EV+AVS resulted in significantly reduced symptoms, discomfort and exertion when compared to FFR with EV and standard FFR.