INTRODUCTION: Trastuzumab deruxtecan (T-DXd) has revolutionised treatment for metastatic breast cancer (MBC). While effective, its high cost and toxicities, such as fatigue and nausea, pose challenges. METHOD: Medical records from the Joint Breast Cancer Registry in Singapore were used to study MBC patients treated with T-DXd (February 2021-June 2024). This study was conducted to address whether reducing dose intensity and density may have an adverse effect on treatment outcomes. RESULTS: Eighty-seven MBC patients were treated with T-DXd, with a median age of 59 years. At the time of data cutoff, 32.1% of patients were still receiving T-DXd. Over half (54%) of the patients received treatment with an initial relative dose intensity (RDI) of <;85%. Overall median real-world progression-free survival (rwPFS) was 8.1 months. rwPFS was similar between RDI groups (<85%: 8.7 months, <85%: 8.1 months, P=0.62). However, human epidermal growth receptor 2 (HER2)-positive patients showed significantly better rwPFS outcomes compared to HER2-low patients (8.8 versus 2.5 months, P<0.001). Only 16% with central nervous system (CNS) involvement had CNS progressive disease on treatment. No significant progression-free survival (PFS) differences were found between patients with or without CNS disease, regardless of RDI groups. Five patients (5.7%) developed interstitial lung disease (ILD), with 3 (3.4%) having grade 3 events. Two required high-dose steroids and none were rechallenged after ILD. There were no fatalities. CONCLUSION Our study demonstrated that reduced dose intensity and density had no significant impact on rwPFS or treatment-related toxicities. Furthermore, only 5.7% of patients developed ILD. T-Dxd provided good control of CNS disease, with 82% of patients achieving CNS disease control.
Humans ; Female ; Breast Neoplasms/mortality* ; Middle Aged ; Trastuzumab/adverse effects* ; Aged ; Adult ; Singapore/epidemiology* ; Antineoplastic Agents, Immunological/adverse effects* ; Camptothecin/adverse effects* ; Immunoconjugates/adverse effects* ; Retrospective Studies ; Progression-Free Survival ; Receptor, ErbB-2/metabolism* ; Neoplasm Metastasis ; Dose-Response Relationship, Drug ; Treatment Outcome ; Registries

Curriculum ; Epidemics ; Health Occupations ; Humans ; Pandemics/prevention & control*

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

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

There has been a growing concern about obesity worldwide. We performed a review on the prevalence and trends of obesity among adults and children. We reviewed the data on the prevalence of adult obesity and being overweight from the Global Database on Body Mass Index on the World Health Organisation (WHO) Website and prevalence of children being overweight from the International Obesity Task Force website. Various databases were also searched for relevant reviews and these include PubMed, EMBASE, NHS CRD databases and Cochrane. The prevalence of obesity is high in many parts of the world. Generally, there is an increasing trend of prevalence of adult obesity with age. The peak prevalence is reached at around 50 to 60 years old in most developed countries and earlier at around 40 to 50 years old in many developing countries. Obesity is a major health concern. Appropriate strategies need to be adopted to tackle obesity which itself brings about significant disability and premature deaths. Further observation may be needed to see if the trend of prevalence abates or increases in the near future.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Developed Countries ; statistics & numerical data ; Developing Countries ; statistics & numerical data ; Disease Outbreaks ; Female ; Humans ; Male ; Middle Aged ; Obesity ; epidemiology ; Prevalence ; Rural Population ; Urban Population ; Young Adult

INTRODUCTIONWeight-and-height-based anthropometric indices have long been used for obesity screening among adolescents.However, the ability of their age-and-sex-specific reference values in classifying adolescent as "obese" in different populations was not fully established. Our study aimed to validate the existing international (BMI-for-age charts from WHO, CDC, IOTF) and local cut-offs [percent weight for height (PWH)] for obesity against body fat percentage, as assessed by 4 skinfolds measurement.

MATERIALS AND METHODSA cross-sectional sample of 6991 adolescents aged 12 to 18 years was measured. All anthropometric measurements were compliant with the internationally accepted protocol. Obesity was defined as percentage body fat greater than or equal to 95 percentile, specific to age and sex. The validity of the existing classification criteria in detecting obesity was evaluated by comparing their respective diagnostic accuracy.

RESULTSBoth prevalence of obesity and diagnostic accuracy indices varied by the classification criteria. While all criteria generated very high specificity rates with the lowest being 95%, their sensitivity rates were low ranging from 43% to 71%. Youden's index suggested that CDC and WHO criteria had optimal sensitivity and specificity. ROC analysis showed that overall performance could be improved by refining the existing cut-offs.

CONCLUSIONSClinical validity of weight-and-height-based classification systems for obesity screening in Asian adolescents is poorer than expected, and this could be improved by refining the existing cut-offs.

Adolescent ; Anthropometry ; Asian Continental Ancestry Group ; Body Height ; Body Mass Index ; Body Weight ; Child ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mass Screening ; Obesity ; diagnosis

Adolescent ; Adult ; Aged ; Child ; Disease Outbreaks ; Humans ; Middle Aged ; Obesity ; epidemiology ; Singapore ; epidemiology ; Young Adult

Mental disorders are both common and costly. The mental health system in Singapore lacks co-ordination as well as being underdeveloped in certain areas. To address these gaps as well to face emerging challenges like an ageing population, and other socioeconomic changes, the Ministry of Health of Singapore has commissioned a Committee to formulate a 5-year Mental Health Policy and Blueprint. A task group has been formed to implement this blueprint and evaluation of these various initiatives with performance measures are inevitable. The choice of these measures, however, can be a daunting task with the various and diverse interests of multiple stakeholders. This paper describes the process of choosing the relevant measures with the appropriate attributes, and suggests a framework, which can serve as a guide for selecting mental health performance measures.
Humans ; Mental Health Services ; standards ; Quality Assurance, Health Care ; methods ; standards ; Quality Indicators, Health Care ; standards ; Singapore

The growth trends of Singapore children spanning 5 decades are reviewed, based on 8 anthropometric studies from 1957 till 2002. The heights of pre-school children and school age children appear to have optimised according to their genetic potential, but the weights and body mass indices of children still appear to be increasing from 6 to 18 years for both sexes, probably as a consequence of increasing affluence. This trend is reflected in the increasing obesity prevalence in school children over the past 30 years, and the concomitant increased morbidity associated with the metabolic syndrome, necessitates further research into the causes of obesity. Barker's hypothesis first suggested that changes in the intra-uterine environment can cause fetal adaptations which persist into adulthood, and are responsible for many chronic diseases of adult life. More recently, intense research in the field of epigenetics suggests that the environment can also influence the phenotype through gene expression, through modification of DNA methylation and histones which, in turn, influences gene expression. The challenge for the future is to determine if there are clear epigenetic changes, which are responsible for the increased prevalence of childhood and adolescent obesity, and whether these changes are transmitted through generations. Unravelling these epigenetic mechanisms may be the key to the prevention of obesity and the metabolic syndrome.
Adolescent ; Adolescent Development ; Anthropometry ; Body Height ; genetics ; Body Mass Index ; Child ; Child Development ; Child, Preschool ; Epigenesis, Genetic ; Humans ; Infant ; Infant, Newborn ; Obesity ; genetics ; Singapore