1.Epidemiology of Chronic Obstructive Pulmonary Disease (COPD)
The Singapore Family Physician 2013;39(2):8-10
COPD is a major cause of morbidity and mortality. Its social and economic burden is expected to increase worldwide in coming decades. COPD is under-recognised and under-diagnosed. It results in disproportionately more numbers of physician visits, emergency department visits and hospitalisations than most other diagnoses. It is increasingly recognised that COPD is commonly accompanied by co-morbid medical conditions, cardiovascular disease, hypertension, diabetes, osteoporosis, chronic kidney disease, cognitive impairment and depression, due to systemic inflammation which impact on quality of life and survival. The prevalence of COPD among adults aged 40 and above varies widely from 8% to 26%. The most widely recognised risk factor for COPD is smoking, but non-smoking factors include biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.
3.The Modified Mini-Mental State Examination test: normative data for Singapore Chinese older adults and its performance in detecting early cognitive impairment.
Lei FENG ; Mei Sian CHONG ; Wee Shiong LIM ; Tze Pin NG
Singapore medical journal 2012;53(7):458-462
INTRODUCTIONThis study aimed to determine the stratified normative data by age and education for a modified version of the Mini-Mental State Examination (MMSE) test from a large sample of community-dwelling Chinese older adults in Singapore, and to examine the MMSE's value in detecting early cognitive impairment.
METHODSWe studied 1,763 Chinese older adults with normal cognitive function and 121 Chinese older adults with early cognitive impairment (Clinical Dementia Rating global score 0.5). Normative MMSE values were derived for each of the 15 strata classified by age (three groups) and education level (five groups). Receiver operating characteristic curve analysis was conducted for the whole sample and each of the three education subgroups (no education, primary, secondary and above).
RESULTSEducation level and age significantly influenced the normative values of MMSE total scores in Chinese older adults with normal cognitive function. For the purpose of detecting early cognitive impairment, an optimal balance between sensitivity (Se) and specificity (Sp) was obtained at a cutoff score of 25, 27 and 29 for each of the three education groups, respectively. For the whole sample, the optimal cutoff point was 26 (Se 0.61, Sp 0.84, area under curve 0.78).
CONCLUSIONAge and education level must be taken into account in the interpretation of optimal cutoffs for the MMSE. Although widely used, the MMSE has limited value in detecting early cognitive impairment; tests with better performance should be considered in clinical practice.
Age Factors ; Aged ; Area Under Curve ; China ; Cognition Disorders ; diagnosis ; epidemiology ; ethnology ; Dementia ; diagnosis ; epidemiology ; ethnology ; Educational Status ; Female ; Humans ; Male ; Mental Status Schedule ; Middle Aged ; Neuropsychological Tests ; standards ; Psychometrics ; methods ; Reference Values ; Sensitivity and Specificity ; Singapore ; ethnology
4.Integrated care pathway for hip fractures in a subacute rehabilitation setting.
Tsung Wei CHONG ; Gribson CHAN ; Liang FENG ; Susie GOH ; Agnes HEW ; Tze Pin NG ; Boon Yeow TAN
Annals of the Academy of Medicine, Singapore 2013;42(11):579-584
INTRODUCTIONThe effectiveness of integrated care pathways for hip fractures in subacute rehabilitation settings is not known. The study objective was to assess if a hip fracture integrated care pathway at a subacute rehabilitation facility would result in better functional outcomes, shorter length of stay and fewer institutionalisations.
MATERIALS AND METHODSA randomised controlled trial on an integrated care pathway for hip fracture patients in a subacute rehabilitation setting. Modified Barthel Index, ambulatory status, SF-12, length of stay, discharge destination, hospital readmission and mortality were measured. Followup assessments were up to 1 year post-hip fracture.
RESULTSThere were no significant differences in Montebello Rehabilitation Factor Scores and proportions achieving premorbid ambulatory status at discharge, 6 months and 12 months respectively. There was a significant reduction in the median length of stay between the control group at 48.0 days and the intervention group at 35.0 days (P = 0.009). The proportion of readmissions to acute hospitals was similar in both groups up to 1 year. There were no significant differences for nursing home stay up to 1 year post-discharge and mortality at 1 year.
CONCLUSIONOur study supports the use of integrated care pathways in subacute rehabilitation settings to reduce length of stay whilst achieving the same functional gains.
Hip Fractures ; Humans ; Prospective Studies
5.Predictors of Participation in Supervised Therapy by Post-Stroke Patients in the Singapore Community: a One Year Cohort Study
Gerald Choon-Huat Koh ; Denise Yan-Yin Lim ; Steven Liben Zhang ; Cynthia Chen Huijun ; Sanjiv Kishore Saxena ; Fong Ngan Phoon ; David Yong ; Tze-Pin Ng
The Singapore Family Physician 2015;41(1):63-74
Introduction: To determine the relationship between participation in supervised and unsupervised therapy, and predictors of participation in supervised therapy during the first post-stroke year.
Materials & Methods:
Design: Prospective longitudinal study with interviews at admission, discharge, one month, six months and one year after discharge.
Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore.
Participants: 215 subacute non-aphasic stroke patients.
Intervention: Participation rate in supervised therapy (at outpatient rehabilitation centres) and unsupervised therapy (at home) defined as proportion of time spent performing therapy as prescribed by the subacute hospital’s multidisciplinary rehabilitation team at discharge.
Main Outcome Measure: Predictors of participation in supervised and unsupervised therapy.
Results: Patients who participated in supervised therapy (i.e. at an outpatient rehabilitation centre) >25% of the time recommended were more likely to participate in unsupervised therapy (i.e. at home) >75% of the time recommended at one, six and 12 months (crude odds ratio, OR = 4.41 [95%CI:2.09–10.17], 4.45 [95%CI:2.17–9.12], 6.93 [95%CI:2.60–18.48] respectively). Greater participation in supervised therapy at one and six months independently predicted greater participation in supervised therapy at six (adjusted OR=11.64 [95%CI:4.52-29.97]) and twelve months (adjusted OR=76.46 [95%CI:12.52-466.98]) respectively. Caregiver availability at six months independently predicted poorer participation in supervised therapy at 12 months.
Conclusion: Interventions to increase participation in supervised therapy in the first post-stroke year should focus on transition of care in the first month after discharge. Further studies are needed to understand why caregiver availability was associated with low participation in supervised therapy.
6.Coexistence of osteoporosis, sarcopenia and obesity in communitydwelling adults e The Yishun Study
Benedict Wei Jun PANG ; Shiou-Liang WEE ; Kenneth Kexun CHEN ; Lay Khoon LAU ; Khalid Abdul JABBAR ; Wei Ting SEAH ; Daniella Hui Min NG ; Queenie Lin Ling TAN ; Mallya Ullal JAGADISH ; Tze Pin NG
Osteoporosis and Sarcopenia 2021;7(1):17-23
Objectives:
To 1) report prevalence of ‘osteosarcopenia’ (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population.
Methods:
We performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21–90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO’s value investigated using linear regressions with functional performance.
Results:
OS and OSO prevalence were 1.8% and 0% (21–59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO.
Conclusions
Our results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.
7.Coexistence of osteoporosis, sarcopenia and obesity in communitydwelling adults e The Yishun Study
Benedict Wei Jun PANG ; Shiou-Liang WEE ; Kenneth Kexun CHEN ; Lay Khoon LAU ; Khalid Abdul JABBAR ; Wei Ting SEAH ; Daniella Hui Min NG ; Queenie Lin Ling TAN ; Mallya Ullal JAGADISH ; Tze Pin NG
Osteoporosis and Sarcopenia 2021;7(1):17-23
Objectives:
To 1) report prevalence of ‘osteosarcopenia’ (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population.
Methods:
We performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21–90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO’s value investigated using linear regressions with functional performance.
Results:
OS and OSO prevalence were 1.8% and 0% (21–59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO.
Conclusions
Our results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.
8.Electrocardiographic Criteria for Left Ventricular Hypertrophy in Asians Differs from Criteria Derived from Western Populations--Community-based Data from an Asian Population.
Chang Fen XU ; Eugene S J TAN ; Liang FENG ; Rajalakshmi SANTHANAKRISHNAN ; Michelle M Y CHAN ; Shwe Zin NYUNT ; Tze Pin NG ; Lieng Hsi LING ; A Mark RICHARDS ; Carolyn S P LAM ; Toon Wei LIM
Annals of the Academy of Medicine, Singapore 2015;44(8):274-283
INTRODUCTIONElectrocardiographic (ECG) criteria for left ventricular hypertrophy (LVH), such as the Cornell and Sokolow-Lyon voltage criteria were derived from Western populations. However, their utility and accuracy for diagnosing echocardiographic LVH in Asian populations is unclear. The objective of this study was to assess the accuracy of ECG criteria for LVH in Asians and to determine if alternative gender-specific ECG cut-offs may improve its diagnostic accuracy.
MATERIALS AND METHODSECG and echocardiographic assessments were performed on 668 community-dwelling Asian adults (50.9% women; 57 ± 10 years) in Singapore. The accuracy of ECG voltage criteria was compared to echocardiographic LVH criteria based on the American Society of Echocardiography guidelines, and Asian ethnicity and gender-specific partition values.
RESULTSEchocardiographic LVH was present in 93 (13.6%) adults. Cornell criteria had low sensitivity (5.5%) and high specificity (98.9%) for diagnosing LVH. Modified gender specific cut-offs (18 mm in women, 22 mm in men) improved sensitivity (8.8% to 17.5%, 0% to 14.7%, respectively) whilst preserving specificity (98.2% to 94.2%, 100% to 95.8%). Similarly, Sokolow-Lyon criteria had poor sensitivity (7.7%) and high specificity (96.1%) for diagnosing LVH. Lowering the cut-off value from 35 mm to 31 mm improved the sensitivity in women from 3.5% to 14% while preserving specificity at 94.2%. A cut-off of 36 mm was optimal in men (sensitivity of 14.7%, specificity of 95.5%).
CONCLUSIONCurrent ECG criteria for LVH derived in Western cohorts have limited sensitivity in Asian populations. Our data suggests that ethnicity- and gender-specific ECG criteria may be needed.
Aged ; Asian Continental Ancestry Group ; statistics & numerical data ; Dimensional Measurement Accuracy ; Echocardiography ; methods ; Female ; Humans ; Hypertrophy, Left Ventricular ; diagnosis ; ethnology ; Male ; Middle Aged ; Sensitivity and Specificity ; Sex Factors ; Singapore ; epidemiology
9.Modified Criteria for Diagnosing “Cognitive Frailty”.
Chang Won WON ; Yunhwan LEE ; Sunyoung KIM ; Jinho YOO ; Miji KIM ; Tze Pin NG ; Haena KIM ; Sang Joon SON
Psychiatry Investigation 2018;15(9):839-842
The concept of cognitive frailty has recently been proposed by an International Consensus Group as the presence of physical frailty and cognitive impairment [defined using the Clinical Dementia Ratings (CDR)=0.5], without concurrent dementia. However, CDR is difficult to implement and not often available in epidemiologic studies or busy clinical settings, and an alternative to CDR is required. We suggest an alternative definition of cognitive frailty as: 1) physical frailty, 2) more than 1.5 standard deviation below the mean for age-, gender-, and education-adjusted norms on any cognitive function test (e.g., the Montreal Cognitive assessment test, the Alzheimer’s disease assessment scale-cognitive subscale, verbal learning test, Digit Span, Boston Naming Test, Trail Making Test, and Frontal Assessment Battery), and 3) no dependency in instrumental activities of daily living. The redefined criteria for cognitive frailty would be more feasible to implement and thus more applicable in epidemiologic studies and busy clinical settings.
Activities of Daily Living
;
Cognition
;
Cognition Disorders
;
Consensus
;
Dementia
;
Epidemiologic Studies
;
Mild Cognitive Impairment
;
Trail Making Test
;
Verbal Learning
10.Ministry of Health Clinical Practice Guidelines: Chronic Obstructive Pulmonary Disease.
Tow Keang LIM ; Cynthia B CHEE ; Patsy CHOW ; Gerald Sw CHUA ; Soo Kiang ENG ; Soon Keng GOH ; Kwee Keng KNG ; Wai Hing LIM ; Tze Pin NG ; Thun How ONG ; S T Angeline SEAH ; Hsien Yung TAN ; K H TEE ; Vimal PALANICHAMY ; Meredith T YEUNG
Singapore medical journal 2018;59(2):76-86
The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Chronic Obstructive Pulmonary Disease (COPD) to provide doctors and patients in Singapore with evidence-based treatment for COPD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on COPD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: https://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Adult
;
Aged
;
Evidence-Based Medicine
;
Humans
;
Middle Aged
;
Palliative Care
;
Prevalence
;
Pulmonary Disease, Chronic Obstructive
;
diagnosis
;
therapy
;
Pulmonary Medicine
;
standards
;
Quality Improvement
;
Radiography, Thoracic
;
Risk Factors
;
Singapore
;
Steroids
;
therapeutic use