1
|
Dalakoti M, Wong S, Lee W, Lee J, Yang H, Loong S, Loh PH, Tyebally S, Djohan A, Ong J, Yip J, Ngiam KY, Foo R. Incorporating AI into cardiovascular diseases prevention-insights from Singapore. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101102. [PMID: 38855631 PMCID: PMC11154196 DOI: 10.1016/j.lanwpc.2024.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024]
Abstract
Improved upstream primary prevention of cardiovascular disease (CVD) would enable more individuals to lead lives free of CVD. However, there remain limitations in the current provision of CVD primary prevention, where artificial intelligence (AI) may help to fill the gaps. Using the data informatics capabilities at the National University Health System (NUHS), Singapore, empowered by the Endeavour AI system, and combined large language model (LLM) tools, our team has created a real-time dashboard able to capture and showcase information on cardiovascular risk factors at both individual and geographical level- CardioSight. Further insights such as medication records and data on area-level socioeconomic determinants allow a whole-of-systems approach to promote healthcare delivery, while also allowing for outcomes to be tracked effectively. These are paired with interventions, such as the CHronic diseAse Management Program (CHAMP), to coordinate preventive cardiology care at a pilot stage within our university health system. AI tools in synergy allow the identification of at-risk patients and actionable steps to mitigate their health risks, thereby closing the gap between risk identification and effective patient care management in a novel CVD prevention workflow.
Collapse
Affiliation(s)
- Mayank Dalakoti
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Scott Wong
- Group Chief Technology Office, National University Health System, Singapore
| | - Wayne Lee
- Group Chief Technology Office, National University Health System, Singapore
| | - James Lee
- Group Chief Technology Office, National University Health System, Singapore
| | - Hayang Yang
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
| | - Shaun Loong
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
| | - Poay Huan Loh
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Sara Tyebally
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Andie Djohan
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Jeanne Ong
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - James Yip
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
- Group Chief Technology Office, National University Health System, Singapore
| | - Kee Yuan Ngiam
- Group Chief Technology Office, National University Health System, Singapore
| | - Roger Foo
- Cardiovascular Research Institute, National University Heart Centre, Singapore
- Cardiovascular Metabolic Disease Translational Research Programme, NUS Yong Loo Lin School of Medicine, Singapore
| |
Collapse
|
2
|
Kaur-Gill S. "They [Doctors] Don't Really Know What We're Actually Experiencing": Undoing Racializing Frames of Heart Health in Singapore by Centering Listening as Method. HEALTH COMMUNICATION 2024:1-11. [PMID: 38853488 DOI: 10.1080/10410236.2024.2365494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
The mainstream media and local health campaigns in Singapore racialize heart health disparities. Journalists and campaigners report differences in heart health outcomes from a model of race governance known as the Chinese, Malay, Indian, and Others (CMIO) model. This model is then used to frame heart health inequities as an outcome of poor cultural practices and behaviors tied to race. To (un)do the racializing frames of heart health as outcomes of cultural behaviors and practices, I instead center stories of heart health management by Malay participants from lower-income households, identifying the role information asymmetries play in incomplete heart health information retrieval during interactions with providers (social service providers, healthcare workers, doctors, nurses). Cultural and community resources were discussed as critical resources for alleviating urgent heart health episodes or assisting as guides for preventative heart health information. Health campaigners must delve deeper into these findings for more structurally responsive heart health interventions and move away from racializing health disparities based on the CMIO model.
Collapse
|
3
|
Hamzah KQA, Mohd Zulkefli NA, Ahmad N. Health-seeking behaviour during times of illness among urban poor women: a cross-sectional study. BMC Womens Health 2024; 24:334. [PMID: 38849787 PMCID: PMC11157716 DOI: 10.1186/s12905-024-03178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Urban poor women face dual challenges regarding gender inequalities and urban poverty, which make them more likely to have health problems and affect their health-seeking behaviour. This study aimed to determine the prevalence of health-seeking behaviour during times of illness and predictors of sought care among urban poor women in Kuala Lumpur, Malaysia. METHODS This cross-sectional study was performed among 340 randomly selected women residents from April to May 2023. Data was collected using a validated and reliable self-administered questionnaire and analysed using SPSS version 28.0 software. The dependent variable in this study was health-seeking behaviour during times of illness, while the independent variables were sociodemographic characteristics, socioeconomic characteristics, medical conditions, women's autonomy in decision-making, social support, perceived stigma, and attitude towards health. Multiple logistic regression was used to identify the predictors of sought care during times of illness. RESULTS Study response rate was 100%, where 72.4% sought care during times of illness. Being non-Malay (AOR = 4.33, 95% CI: 1.847, 10.161), having healthcare coverage (AOR = 2.60, 95% CI: 1.466, 4.612), rating their health as good (AOR = 1.87, 95% CI: 1.119, 3.118), and having pre-existing chronic diseases (AOR = 1.92, 95% CI: 1.130, 3.271) were identified as predictors of sought care during times of illness. CONCLUSION The present study showed that health-seeking behaviour during times of illness among the participants was appropriate. Health promotion and education, with a focus on educating and raising awareness about the importance of seeking timely healthcare, are crucial to improving health-seeking behaviour among urban poor women. Collaboration with relevant stakeholders is needed to develop comprehensive strategies to improve access to healthcare facilities for these women.
Collapse
Affiliation(s)
- Khadijahtul Qubra Amizah Hamzah
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia.
| | - Norliza Ahmad
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| |
Collapse
|
4
|
Luo D, Zhu X, Qiu X, Zhao J, Li X, Du Y. Healthcare preferences of chronic disease patients under China's hierarchical medical system: an empirical study of Tianjin's reform practice. Sci Rep 2024; 14:11631. [PMID: 38773132 PMCID: PMC11109171 DOI: 10.1038/s41598-024-62118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
To alleviate the contradiction in healthcare resources, the Chinese government formally established the framework of a hierarchical medical system in 2015, which contains the following brief generalities: " separate treatment of emergencies and slows, first-contact care at the primary, two-way referral, and upper and lower linkage, ". This study systematically summarizes and models the connotations of China's hierarchical medical system and a sample of 11,200 chronic disease patients in Tianjin, the largest port city in northern China, was selected for the empirical study to investigate the relationship between chronic disease patients' policy perceptions of the hierarchical medical system and their preference for healthcare. We found that under the strategy of separate treatment, improving the healthcare accessibility, drug supply, and lowering the cost of medical care would have a positive impact on increasing the preference of patients with chronic diseases to go to the primary hospitals. Under the two-way triage strategy, improving the level of physician services, referral convenience and treatment Standards have a positive impact on chronic disease patients' preference for primary care; The impact of the hierarchical medical system on the preference for healthcare differed between groups, focusing on differences in health literacy level, age and household type; The role of " upper and lower linkage " is crucial in the hierarchical medical system and it plays a part in mediating the influence of the " separate treatment of emergencies and slows" design and the "two-way referral " order on the treatment preferences of chronic disease patients. The results of the study provide a reference for the further development of a scientific and rational hierarchical medical system in the future.
Collapse
Affiliation(s)
- Da Luo
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xumin Zhu
- School of Economics and Management, Tiangong University, Tianjin, 300387, China
| | - Xinyu Qiu
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Jing Zhao
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Tianjin Municipal Health Commission, Tianjin, 300070, China
| | - Xiangfei Li
- School of Economics and Management, Tiangong University, Tianjin, 300387, China.
| | - Yue Du
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
| |
Collapse
|
5
|
Zhou Y, Lu Y, Wei D, He S. Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective. Health Place 2024; 87:103241. [PMID: 38599046 DOI: 10.1016/j.healthplace.2024.103241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.
Collapse
Affiliation(s)
- Yuxuan Zhou
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Di Wei
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China; School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China; Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China.
| | - Shenjing He
- Department of Urban Planning and Design, Urban Systems Institute, And the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region of China, China.
| |
Collapse
|
6
|
Tenfelde K, Antheunis ML, Habibovic M, Widdershoven J, Bol N. Instrumental, Affective, and Patient-Centered Communication Between Cardiologists and Patients with Low Socioeconomic Status: An Observational Study. HEALTH COMMUNICATION 2024; 39:297-309. [PMID: 36628493 DOI: 10.1080/10410236.2023.2164955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
One of the essential elements in managing health is having adequate communication with health care providers. Unfortunately, patients with a low socioeconomic status (SES) often experience less adequate communication with their doctor. In the current study, we explore and compare the communication of both doctors and patients from lower and higher sociodemographic backgrounds on three factors: instrumental, affective, and patient-centered communication. In total, 45 cardiology consultations were observed, transcribed, and coded (16 low-SES, 16 middle-SES, 13 high-SES). Our analyses showed that, compared to higher-SES patients, low-SES patients voiced less of their concerns, answered questions of the doctor more often with one word, and expressed less utterances overall. Naturally, we found that doctors expressed more utterances overall toward low-SES patients. For doctors, no differences regarding instrumental, affective, or patient-centered communication were found. These findings suggest that low-SES patients are more passive communicators and communication differences based on SES exist predominantly for patients' communication. The revealed communication differences may lead to a less adequate interaction and potentially worse patient outcomes, further increasing the socioeconomic health gap. Hence, doctors should become even more aware of socioeconomic patient communication differences so that they can appropriately encourage low-SES patients to become more active communicators.
Collapse
Affiliation(s)
- Kim Tenfelde
- Department of Communication and Cognition, Tilburg University, Tilburg
| | | | - Mirela Habibovic
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg
- Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg University, Tilburg
| |
Collapse
|
7
|
Han A, Choi YJ. Comparison of Metabolic Syndrome (MetS) Risk and Nutritional Status According to Menopause Age and the Impact of Socioeconomic Status on MetS Prevalence in Postmenopausal Women: A Cross-Sectional Study Based on the 8th Korea National Health and Nutrition Examination Survey (KNHANES). Nutrients 2024; 16:967. [PMID: 38613001 PMCID: PMC11013047 DOI: 10.3390/nu16070967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
The increased life expectancy and the occurrence of premature menopause prolong the mean postmenopausal phase in women's lifespans. Although the roles of poor socioeconomic status (SES), anthropometric characteristics, and nutritional status in premature menopause and the health of postmenopausal women are well understood, the differences in nutritional status and metabolic syndrome (MetS) prevalence in postmenopausal women depending on their menopause age are less explored. Furthermore, the association between SES and MetS risk in postmenopausal women is not studied. Thus, this study aimed to compare distinct nutritional status and MetS risk between women with premature menopause and natural menopause. Additionally, the association among SES, health-related lifestyle behaviors (HLBs), and MetS risk in postmenopausal women was studied. This study included 31,799 postmenopausal women from the 8th National Health and Nutrition Examination Survey (KNHANES). The relationship between disease prevalence and nutrient intake of the subjects was analyzed using analysis of variance (GLM), and Scheffé test was performed. Multiple logistic regression analysis was used to evaluate the association among SES, HLBs, and MetS as well as premature menopause. Women with premature menopause showed poor SES, anthropometric characteristics, and HLBs compared with women with natural menopause. Additionally, premature menopausal women had markedly lower intakes of protein, polyunsaturated fatty acid, n-3 fatty acid, and β-carotene, but higher intakes of energy, carbohydrate, saturated fatty acid, and sugar than women with natural menopause (p < 0.0001). Premature menopausal women showed significantly higher MetS prevalence by having hypertriglyceridemia (p < 0.0001), hypertension (p = 0.0145), and reduced HDL cholesterol levels (p < 0.0001) relative to natural menopausal women. Furthermore, our findings indicate a substantial link among SES, HLBs, and the risk of premature menopause. In postmenopausal women, deteriorating SES and HLBs appear to influence the prevalence of MetS. Notably, our study reveals that higher intakes of protein, calcium, phosphate, and iron are correlated with a lower risk of developing MetS. These observations suggest that proactive nutritional education for premature menopausal women is necessary to improve MetS risk and their nutritional status. Also, SES-dependent interventions regarding nutrition and HLBs in postmenopausal women will be significant to lower MetS risk, MetS-derived chronic disease, and mortality in postmenopausal women.
Collapse
Affiliation(s)
- Anna Han
- Department of Food Science and Human Nutrition, Jeonbuk National University, Jeonju 54896, Republic of Korea;
- K-Food Research Center, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul 01795, Republic of Korea
| |
Collapse
|
8
|
Ooi JWL, Ong RHS, Oh HC. Exploring factors influencing outpatient radiology attendance based on Health Belief Model (HBM): A qualitative study. Radiography (Lond) 2024; 30:504-511. [PMID: 38241980 DOI: 10.1016/j.radi.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/26/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
INTRODUCTION Non-attendance for radiology outpatient appointments is a global issue and is associated with adverse clinical outcomes and operational inefficiencies. This paper aims to understand the underlying factors influencing outpatient radiology attendances based on the Health Belief Model (HBM). METHODS Purposive sampling was used to recruit patients (n=30) for in-depth semi-structured telephone interviews. Inclusion criteria comprised participants who were above 21 years old and fluent in English, while participants reliant on third-party assistance (e.g., nursing homes and prison services), to attend the appointment were excluded. The interviews were recorded and transcribed verbatim. The COREQ (Consolidated Criteria for Reporting Qualitative Research) was utilised to guide the reporting of this study. The data analysis involved a hybrid thematic analysis approach using NVivo. RESULTS Six key themes associated with appointment adherence in radiology were identified. These themes included: 1) prioritising health and acceptance of current medical conditions; 2) the impact of perceived severity on non-attendance; 3) perceived benefits of attending appointments; 4) perceived barriers to attendance; 5) influential prompts; and 6) confidence in attendance. CONCLUSION This is the first study of its kind to utilise the HBM to examine factors influencing attendance adherence among radiology outpatients in Singapore. Costs, prompts, and the perceived severity of the condition play pivotal roles in shaping the health-seeking behaviours of these outpatients while professionalism of healthcare staff and barriers to attendance present opportunities for providers to address patients' lack of interest towards their appointments. IMPLICATIONS FOR PRACTICE Findings of this study will contribute to the development of personalised, targeted interventions for improving patient engagement and attendance in radiology settings.
Collapse
Affiliation(s)
- J W L Ooi
- Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - R H S Ong
- Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - H C Oh
- Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| |
Collapse
|
9
|
Lim SX, Lim CGY, Müller-Riemenschneider F, van Dam RM, Sim X, Chong MFF, Chia A. Development and validation of a lifestyle risk index to screen for metabolic syndrome and its components in two multi-ethnic cohorts. Prev Med 2024; 179:107821. [PMID: 38122937 DOI: 10.1016/j.ypmed.2023.107821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/23/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is a precursor to cardiovascular diseases and type 2 diabetes. Existing MetS prediction models relied heavily on biochemical measures and those based on non-invasive predictors such as lifestyle behaviours were limited. We aim to (1) develop a weighted lifestyle risk index for MetS and (2) externally validate this index using two Asian-based cohorts in Singapore. METHODS Using data from the Multi-Ethnic Cohort (MEC) 1 (n = 2873, 41% male), multiple logistic regression was used to identify predictors associated with MetS. A weighted lifestyle risk index was generated using coefficients of the selected predictors in the development cohort (MEC1). Subsequently, the performance of the lifestyle risk index in predicting the occurrence of MetS within 10 years was assessed by discrimination and calibration in an external validation cohort (MEC2) (n = 6070, 43% male). RESULTS A lifestyle risk index for MetS with nine predictors was developed (age, sex, ethnicity, having a family history of diabetes, BMI, diet, physical activity, smoking status, and screen time). This index demonstrated acceptable discrimination in the development cohort [AUC (95% CI) = 0.74 (0.71, 0.76)] and the validation cohort [AUC (95% CI) = 0.79 (0.77, 0.81)]. CONCLUSION This lifestyle risk index exhibits potential for risk stratification in population-based screening programmes. Future research could apply a similar methodology to develop disease-specific lifestyle risk indices using nationwide registry-based data.
Collapse
Affiliation(s)
- Shan Xuan Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Charlie Guan Yi Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Digital Health Centre, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mary Foong-Fong Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Airu Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| |
Collapse
|
10
|
Wong A, Lai P, Chong HH, Lien CTC, Graves N. The Clinical and Cost-Effectiveness of an Individualized Nutritional CAre (INCA) Bundle versus Standard Care for Adults with Pressure Injuries Receiving Home Nursing Services: A Protocol for a Cluster Randomized and Pragmatic Clinical Trial with an Economic Evaluation. Nutrients 2024; 16:299. [PMID: 38257192 PMCID: PMC10819700 DOI: 10.3390/nu16020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Pressure injuries (PIs) represent a significant healthcare challenge in Singapore among the aging population. These injuries contribute to increased morbidity, mortality, and healthcare expenditure. Existing research predominantly explores single-component interventions in hospital environments, often yielding limited success. The INCA Trial aims to address this research gap by conducting a comprehensive, cluster randomized controlled trial that integrates education, individualized nutritional support, and community nursing care. This study is designed to evaluate clinical and cost-effectiveness outcomes, focusing on PI wound area reduction and incremental costs associated with the intervention. METHODS The INCA Trial employs a two-group, non-blinded, cluster randomized, and pragmatic clinical trial design, recruiting 380 adult individuals (age ≥ 21 years) living in the community with stage II, III, IV, and unstageable PI(s) who are receiving home nursing service in Singapore. Cluster randomization is stratified by postal codes to minimize treatment contamination. The intervention arm will receive an individualized nutrition and nursing care bundle (dietary education with nutritional supplementation), while the control arm will receive standard care. The 90-day intervention will be followed by outcome assessments extending over one year. Primary outcomes include changes in PI wound area and the proportion of participants achieving a ≥40% area reduction. Secondary outcomes include health-related quality of life (HRQOL), nutritional status, and hospitalization rates. Data analysis will be conducted on an intention-to-treat (ITT) basis, supplemented by interim analyses for efficacy and futility and pre-specified sensitivity and subgroup analyses. The primary outcome for the cost-effectiveness analysis will be based on the change to total costs compared to the change to health benefits, as measured by quality-adjusted life years (QALYs). DISCUSSION The INCA Trial serves as a pioneering effort in its approach to PI management in community settings. This study uniquely emphasizes both clinical and economic outcomes and melds education, intensive dietetic support, and community nursing care for a holistic approach to enhancing PI management.
Collapse
Affiliation(s)
- Alvin Wong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | - Precilla Lai
- Department of Nursing, Home Nursing Foundation, 490 Lorong 6 Toa Payoh, #05-10, Singapore 310490, Singapore;
| | - Hui Hsien Chong
- Department of Dietetics, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore
| | | | - Nicholas Graves
- Health Services and Systems Research, Duke-NUS Medical School Singapore, 8 College Road, Singapore 169857, Singapore
| |
Collapse
|
11
|
Ayenew AA, Mol BW, Bradford B, Abeje G. Prevalence of female genital mutilation and associated factors among women and girls in Africa: a systematic review and meta-analysis. Syst Rev 2024; 13:26. [PMID: 38217004 PMCID: PMC10785359 DOI: 10.1186/s13643-023-02428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/11/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Female genital mutilation (FGM) has zero health benefits. It can lead to short- and long-term risks and complications, including physical, sexual, and mental health and well-being of girls and women. It is a worldwide public health issue with more than 80% prevalence in Africa. It is a global imperative to strengthen work for the elimination, and the United Nations Sustainable Development Goal (SDG) strives to eliminate FGM and monitor the progress made. However, one of a challenge in tracking progress is establishing baseline prevalence data within regions and countries. Therefore, this review aimed to pool the prevalence of FGM in Africa and identify the promoting factors among women and girls. METHODS This review was conducted according to the PRISMA checklist guideline. Both published and unpublished studies conducted from 2012 onwards were eligible. Studies written in non-English languages were excluded. To retrieve relevant studies; PubMed/Medline, Google Scholar, Science Direct, African Journals Online databases, and African Index Medicus (AIM) were searched using a combination of searching terms. The Newcastle-Ottawa Assessment Scale (NOS) tool was used to assess the quality of each included study. The Cochran's Q chi-square and I2 statistical tests were used to evaluate the heterogeneity of the included studies. The Funnel plot and Egger's regression test (p value < 0.05) were used to evaluate meh publication bias. We used STATA for analysis and the overall and subgroup pooled effect size was estimated using the random effect model with DerSimonian and Laired pooled effect method. The overall prevalence of FGM and the adjusted odds ratio (AOR) with 95%CI (confidence interval) for contributing factors were calculated and presented using a forest plot. RESULT This study included 155 primary studies conducted on the prevalence and/or factors associated with FGM in Africa. The pooled prevalence of FGM was 56.4% (95%CI 49.7-63.6). The primary factors promoting the practice of FGM were family history of circumcision (AOR = 13.71, 95%CI 9.11-20.62), being a Muslim religion follower (AOR = 3.51, 95%CI 2.61-4.71), poor wealth index (AOR = 1.38, 95%CI1.27-1.51), higher age (AOR = 2.95, 95%CI 2.49-3.38), not attending formal education (AOR = 3.28, 95%CI 2.62-4.12), and rural residency (AOR = 2.27, 95%CI 1.84-2.80). CONCLUSION The prevalence of FGM in Africa was found to be high. This study also observed a variation in FGM prevalence across regions and countries and a slight temporal decline over the study period. As the global community enters the final decade dedicated to eliminating FGM, there remains much to be done to achieve the elimination goal.
Collapse
Affiliation(s)
- Asteray Assmie Ayenew
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
- Department of Midwifery, Bahir University College of Medicine and Health Science, Bahir Dar, Ethiopia.
| | - Ben W Mol
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Billie Bradford
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Gedefaw Abeje
- Department of Reproductive Health, Bahir Dar University, Amhara, Ethiopia
| |
Collapse
|
12
|
Soh JGS, Mukhopadhyay A, Mohankumar B, Quek SC, Tai BC. Predictors of frequency of 1-year readmission in adult patients with diabetes. Sci Rep 2023; 13:22389. [PMID: 38104137 PMCID: PMC10725424 DOI: 10.1038/s41598-023-47339-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/12/2023] [Indexed: 12/19/2023] Open
Abstract
Diabetes mellitus (DM) is the third most common chronic condition associated with frequent hospital readmissions. Predictors of the number of readmissions within 1 year among patients with DM are less often studied compared with those of 30-day readmission. This study aims to identify predictors of number of readmissions within 1 year amongst adult patients with DM and compare different count regression models with respect to model fit. Data from 2008 to 2015 were extracted from the electronic medical records of the National University Hospital, Singapore. Inpatients aged ≥ 18 years at the time of index admission with a hospital stay > 24 h and survived until discharge were included. The zero-inflated negative binomial (ZINB) model was fitted and compared with three other count models (Poisson, zero-inflated Poisson and negative binomial) in terms of predicted probabilities, misclassification proportions and model fit. Adjusted for other variables in the model, the expected number of readmissions was 1.42 (95% confidence interval [CI] 1.07 to 1.90) for peripheral vascular disease, 1.60 (95% CI 1.34 to 1.92) for renal disease and 2.37 (95% CI 1.67 to 3.35) for Singapore residency. Number of emergency visits, number of drugs and age were other significant predictors, with length of stay fitted as a zero-inflated component. Model comparisons suggested that ZINB provides better prediction than the other three count models. The ZINB model identified five patient characteristics and two comorbidities associated with number of readmissions. It outperformed other count regression models but should be validated before clinical adoption.
Collapse
Affiliation(s)
- Jade Gek Sang Soh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
- Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore.
| | - Amartya Mukhopadhyay
- Respiratory and Critical Care Medicine, National University Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
- Medical Affairs, Alexandra Hospital, Singapore, Singapore
| | | | - Swee Chye Quek
- Department of Pediatric Cardiology, National University Hospital, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
| |
Collapse
|
13
|
Lim ZW, Chee ML, Soh ZD, Majithia S, Sahil T, Tan ST, Sabanayagam C, Wong TY, Cheng CY, Tham YC. Six-Year Incidence of Visual Impairment in a Multiethnic Asian Population: The Singapore Epidemiology of Eye Diseases Study. OPHTHALMOLOGY SCIENCE 2023; 3:100392. [PMID: 38025163 PMCID: PMC10630666 DOI: 10.1016/j.xops.2023.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023]
Abstract
Purpose To examine the 6-year incidence of visual impairment (VI) and identify risk factors associated with VI in a multiethnic Asian population. Design Prospective, population-based, cohort study. Participants Adults aged ≥ 40 years were recruited from the Singapore Epidemiology of Eye Diseases cohort study at baseline. Eligible subjects were re-examined after 6 years. Subjects included in the final analysis had a mean age of 56.1 ± 8.9 years, and 2801 (50.5%) were female. Methods All participants underwent standardized examination and interviewer-administered questionnaire at baseline. Incidences were standardized to the Singapore Population Census 2010. A Poisson binomial regression model was used to evaluate the associations between baseline factors and incident presenting VI. Main Outcome Measures Incident presenting VI was assessed at the 6-year follow-up visit. Visual impairment (presenting visual acuity < 20/40), low vision (presenting visual acuity < 20/40 but ≥ 20/200), and blindness (presenting visual acuity < 20/200) were defined based on United States definition. Results A total of 5551 subjects (2188 Chinese, 1837 Indians, and 1526 Malays) were evaluated, of whom 514 developed incident presenting VI over 6 years. Malays had a higher incidence of low vision and blindness (13.0%; 0.6%) than Indians (7.0%; 0.1%) and Chinese (7.7%; 0.2%). Among Malay individuals with VI at baseline, 52.8% remained visually impaired after 6 years, which was considerably higher than Chinese (32.4%) and Indians (37.2%). Older age (per decade; relative risk [RR] = 1.59), a history of cardiovascular disease (RR = 1.38), current smoking (RR = 1.31), smaller housing type (1- to 2-room public flat; RR = 2.01), and no formal education (RR = 1.63) at baseline were associated with a higher risk of incident VI (all P ≤ 0.027). Older age (> 60 years) contributed the highest population attributable risk to incident VI (27.1%), followed by lower monthly income (Singapore dollar < $2000; 26.4%) and smaller housing type (24.7%). Overall, undercorrected refractive error (49.1%) and cataract (82.6%) were leading causes for low vision and blindness, respectively. This was consistently observed across the 3 ethnicities. Conclusions In this multiethnic Asian population, Malays had a higher VI incidence compared to Indians and Chinese. Leading causes of VI are mostly treatable, suggesting that more efforts are needed to further mitigate preventable visual loss. Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Zhi Wei Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Miao-Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Thakur Sahil
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - See Teng Tan
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
- School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Ching-Yu Cheng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-NUS Medical School, Singapore
- Centre for Innovation and Precision Eye Health & Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yih-Chung Tham
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-NUS Medical School, Singapore
- Centre for Innovation and Precision Eye Health & Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
14
|
Gao Y, Liu J, Zhou W, Tian J, Wang Q, Zhou L. Exploring factors influencing visual disability in the elderly population of China: A nested case-control investigation. J Glob Health 2023; 13:04142. [PMID: 37962345 PMCID: PMC10644848 DOI: 10.7189/jogh.13.04142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
Background Factors influencing visual disability among the elderly in China remain largely unclear. We sought to determine the prevalence and identify risk factors for visual disability among older adults in China. Methods We employed a nested case-control study design, utilising data from the China Health and Retirement Longitudinal Study (CHARLS) collected between 2011 and 2018. Cases and controls were matched by a ratio of 1:3 by age and sex. Conditional logistic regression identified factors associated with visual disability. Results Prior to data matching, the cohort comprised 4729 complete samples, with 785 (16.6%) newly diagnosed cases of visual disability during the follow-up period. Following matching, 3132 subjects remained, with 783 in the case group and 2349 in the control group. Factors associated with the occurrence of visual disability in the elderly included per capita family income (odds ratio (OR) = 0.98; 95% confidence interval (CI) = 0.97-0.99), adequate sleep (OR = 0.75; 95% CI = 0.63-0.90), cognitive function (OR = 0.98; 95% CI = 0.96-0.99), heart disease (OR = 1.51; 95% CI = 1.20-1.89), kidney disease (OR = 1.45; 95% CI = 1.05-1.98), depression (OR = 1.04; 95% CI = 1.03-1.06), history of falls (OR = 1.34; 95% CI = 1.09-1.65), and cataracts (OR = 2.71; 95% CI = 1.81-4.07). Conclusions Visual disability among the elderly in China remains a major concern. Per capita family income, adequate sleep, and cognitive function are protective factors, while heart disease, kidney disease, depression, history of falls, and cataracts are risk factors. Future efforts in preventing and treating visual disability in the elderly should target these high-risk factors and provide early interventions to this population.
Collapse
|
15
|
Jeong E, Park D, Lee SY, Kim H, Kwon HD, Kim MC, Park KW. Clinical Characteristics and Follow-up Assessment in Patients Diagnosed With Alzheimer's Dementia Through Regional Dementia Centers and Conventional Hospital System. J Korean Med Sci 2023; 38:e257. [PMID: 37605496 PMCID: PMC10442502 DOI: 10.3346/jkms.2023.38.e257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/17/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The rapidly increasing socioeconomic strain caused by dementia represents a significant public health concern. Regional dementia centers (RDCs) have been established nationwide, and they aim to provide timely screening and diagnosis of dementia. This study investigated the clinical characteristics and progression of patients diagnosed with Alzheimer's dementia (AD), who underwent treatment in RDCs or conventional community-based hospital systems. METHODS This retrospective single-center cohort study included patients who were diagnosed with AD between January 2019 and March 2022. This study compared two groups of patients: the hospital group, consisting of patients who presented directly to the hospital, and the RDC group, those who were referred to the hospital from the RDCs in Pohang city. The clinical courses of the patients were monitored for a year after AD diagnosis. RESULTS A total of 1,209 participants were assigned to the hospital (n = 579) or RDC group (n = 630). The RDC group had a mean age of 80.1 years ± 6.6 years, which was significantly higher than that of the hospital group (P < 0.001). The RDC group had a higher proportion of females (38.3% vs. 31.9%; P = 0.022), higher risk for alcohol consumption (12.4% vs. 3.3%; P < 0.001), and greater number of patients who discontinued treatment 1 year after diagnosis (48.3% vs. 39.0%; P = 0.001). In the linear regression model, the RDC group was independently associated with the clinical dementia rating sum of boxes increment (β = 22.360, R²\n = 0.048, and P < 0.001). CONCLUSION Patients in the RDC group were older, had more advanced stages of conditions, and exhibited a more rapid rate of cognitive decline than patients diagnosed through the conventional hospital system. Our results suggested that RDC contributed to the screening of AD in a local region, and further nationwide study with the RDC database of various areas of Korea is needed.
Collapse
Affiliation(s)
- Eunhwan Jeong
- Department of Medicine, Graduate School, Dong-A University, Busan, Korea
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Dougho Park
- Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang, Korea
- Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Korea
| | - Su Yun Lee
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Haejong Kim
- Department of Neurology, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Heum Dai Kwon
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Mun-Chul Kim
- Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea
- Department of Translational Biomedical Sciences, Graduate School, Dong-A University, Busan, Korea.
| |
Collapse
|
16
|
Weerasinghe LS, Dunn HP, Fung AT, Maberly G, Cheung NW, Weerasinghe DP, Liew G, Do H, Hng TM, Pryke A, Marks SI, Nguyen H, Jayaballa R, Gurung S, Ford B, Bishay RH, Girgis CM, Meyerowitz-Katz G, Keay L, White AJ. Diabetic Retinopathy Screening at the Point of Care (DR SPOC): detecting undiagnosed and vision-threatening retinopathy by integrating portable technologies within existing services. BMJ Open Diabetes Res Care 2023; 11:e003376. [PMID: 37532459 PMCID: PMC10401227 DOI: 10.1136/bmjdrc-2023-003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of diabetic retinopathy (DR) in a low socioeconomic region of a high-income country, as well as determine the diagnostic utility of point-of-care screening for high-risk populations in tertiary care settings. RESEARCH DESIGN AND METHODS This was a cross-sectional study of patients with diabetes attending foot ulcer or integrated care diabetes clinics at two Western Sydney hospitals (n=273). DR was assessed using portable, two-field, non-mydriatic fundus photography and combined electroretinogram/ pupillometry (ERG). With mydriatic photographs used as the reference standard, sensitivity and specificity of the devices were determined. Prevalence of DR and vision-threatening diabetic retinopathy (VTDR) were reported, with multivariate logistic regression used to identify predictors of DR. RESULTS Among 273 patients, 39.6% had any DR, while 15.8% had VTDR, of whom 59.3% and 62.8% were previously undiagnosed, respectively. Non-mydriatic photography demonstrated 20.2% sensitivity and 99.5% specificity for any DR, with a 56.7% screening failure rate. Meanwhile, mydriatic photography produced high-quality images with a 7.6% failure rate. ERG demonstrated 72.5% sensitivity and 70.1% specificity, with a 15.0% failure rate. The RETeval ERG was noted to have an optimal DR cut-off score at 22. Multivariate logistic regression identified an eGFR of ≤29 mL/min/1.73 m2, HbA1c of ≥7.0%, pupil size of <4 mm diameter, diabetes duration of 5-24 years and RETeval score of ≥22 as strong predictors of DR. CONCLUSION There is a high prevalence of vision-threatening and undiagnosed DR among patients attending high-risk tertiary clinics in Western Sydney. Point-of-care DR screening using portable, mydriatic photography demonstrates potential as a model of care which is easily accessible, targeted for high-risk populations and substantially enhances DR detection.
Collapse
Affiliation(s)
- Lakni Shahanika Weerasinghe
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Hamish Paul Dunn
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glen Maberly
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Ngai Wah Cheung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Daminda P Weerasinghe
- Department of Mathematics and Statistics, Macquarie University, Sydney, New South Wales, Australia
| | - Gerald Liew
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Helen Do
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tien-Ming Hng
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Alison Pryke
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Samuel I Marks
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Helen Nguyen
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajini Jayaballa
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Seema Gurung
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | - Belinda Ford
- Faculty of Medicine, University of New South Wales, Kensington, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Ramy H Bishay
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbeltown, New South Wales, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Endocrinology, Blacktown Hospital, Blacktown, New South Wales, Australia
| | | | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia
| | - Andrew J White
- Department of Ophthalmology, Westmead Hospital, Westmead, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
17
|
Getahun GK, Kinfe K, Minwuyelet Z. The role of community-based health insurance on healthcare seeking behavior of households in Addis Ababa, Ethiopia. Prev Med Rep 2023; 34:102234. [PMID: 37273522 PMCID: PMC10238827 DOI: 10.1016/j.pmedr.2023.102234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/11/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023] Open
Abstract
Community-based health insurance is a new and promising concept for delivering easily accessible, affordable, and efficient healthcare services. More importantly, a significant risk pooling arrangement between the wealthy and poor. So far, little has been done regarding community-based health insurance and healthcare seeking behavior in developing countries. Therefore, the aim of this study was to assess healthcare seeking behavior of households due to the introduction of the scheme and associated factors in Addis Ababa. Community-based cross-sectional study was conducted among 270 male and 207 female respondents. The data was collected using standardized and pretested questionnaire and it was analyzed using SPSS software. A bivariate and multivariable logistic regression analysis was applied to determine the relationship between healthcare seeking behavior and determinant variables. Finally, statistical association was declared with a p-value of less than 0.05 in the multivariable logistic regression analysis. The proportion of people who had appropriate healthcare-seeking behavior was 47.31% (95 %CI: 43.27-51.39%). Furthermore, having more than four children [AOR: 0.171, 95%, CI:(0.403-0.99)], being Muslim [AOR: 1.712, 95 %CI: (1.117 2.625)], owning a government house [AOR: 4.472, 95%, CI: (2.037-9.819)], and having under-five children [AOR: 0.548, 95%, CI: (0.375-0.801)] were factors significantly associated with healthcare-seeking behavior. Even though this study was conducted in an urban area, it showed that the magnitude of appropriate healthcare-seeking behavior was low. Therefore, the government of Ethiopia should work to improve housing conditions and family planning provision for the residents to improve the healthcare seeking behavior of community-based health insurance users.
Collapse
|
18
|
Robinault L, Niazi IK, Kumari N, Amjad I, Menard V, Haavik H. Non-Specific Low Back Pain: An Inductive Exploratory Analysis through Factor Analysis and Deep Learning for Better Clustering. Brain Sci 2023; 13:946. [PMID: 37371424 DOI: 10.3390/brainsci13060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Non-specific low back pain (NSLBP) is a significant and pervasive public health issue in contemporary society. Despite the widespread prevalence of NSLBP, our understanding of its underlying causes, as well as our capacity to provide effective treatments, remains limited due to the high diversity in the population that does not respond to generic treatments. Clustering the NSLBP population based on shared characteristics offers a potential solution for developing personalized interventions. However, the complexity of NSLBP and the reliance on subjective categorical data in previous attempts present challenges in achieving reliable and clinically meaningful clusters. This study aims to explore the influence and importance of objective, continuous variables related to NSLBP and how to use these variables effectively to facilitate the clustering of NSLBP patients into meaningful subgroups. Data were acquired from 46 subjects who performed six simple movement tasks (back extension, back flexion, lateral trunk flexion right, lateral trunk flexion left, trunk rotation right, and trunk rotation left) at two different speeds (maximum and preferred). High-density electromyography (HD EMG) data from the lower back region were acquired, jointly with motion capture data, using passive reflective markers on the subject's body and clusters of markers on the subject's spine. An exploratory analysis was conducted using a deep neural network and factor analysis. Based on selected variables, various models were trained to classify individuals as healthy or having NSLBP in order to assess the importance of different variables. The models were trained using different subsets of data, including all variables, only anthropometric data (e.g., age, BMI, height, weight, and sex), only biomechanical data (e.g., shoulder and lower back movement), only neuromuscular data (e.g., HD EMG activity), or only balance-related data. The models achieved high accuracy in categorizing individuals as healthy or having NSLBP (full model: 93.30%, anthropometric model: 94.40%, biomechanical model: 84.47%, neuromuscular model: 88.07%, and balance model: 74.73%). Factor analysis revealed that individuals with NSLBP exhibited different movement patterns to healthy individuals, characterized by slower and more rigid movements. Anthropometric variables (age, sex, and BMI) were significantly correlated with NSLBP components. In conclusion, different data types, such as body measurements, movement patterns, and neuromuscular activity, can provide valuable information for identifying individuals with NSLBP. To gain a comprehensive understanding of NSLBP, it is crucial to investigate the main domains influencing its prognosis as a cohesive unit rather than studying them in isolation. Simplifying the conditions for acquiring dynamic data is recommended to reduce data complexity, and using back flexion and trunk rotation as effective options should be further explored.
Collapse
Affiliation(s)
- Lucien Robinault
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Imran Khan Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Faculty of Health and Environmental Sciences, Health and Rehabilitation Research Institute, AUT University, Auckland 1010, New Zealand
- Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Faculty of Rehabilitation and Allied Health Sciences and Department of Biomedical Engineering, Riphah International University, Islamabad 46000, Pakistan
| | - Vincent Menard
- M2S Laboratory, ENS Rennes, University of Rennes 2, 35065 Rennes, France
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| |
Collapse
|
19
|
Uttinger KL, Diers J, Baum P, Hankir M, Germer CT, Wiegering A. Impact of the COVID pandemic on major abdominal cancer resections in Germany: a retrospective population-based cohort study. Int J Surg 2023; 109:670-678. [PMID: 36917131 PMCID: PMC10132304 DOI: 10.1097/js9.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/30/2022] [Indexed: 03/15/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is estimated to have claimed more than 6 million lives globally since it started in 2019. Germany was exposed to two waves of coronavirus disease 2019 in 2020, one starting in April and the other in October. To ensure sufficient capacity for coronavirus disease 2019 patients in intensive care units, elective medical procedures were postponed. The fraction of major abdominal cancer resections affected by these measures remains unknown, and the most affected patient cohort has yet to be identified. METHODS This is a register-based, retrospective, nationwide cohort study of anonymized 'diagnosis-related group' billing data provided by the Federal Statistical Office in Germany. Cases were identified using diagnostic and procedural codes for major cancer resections. Population-adjusted cancer resection rates as the primary endpoint were compared at baseline (2012-2019) to those in 2020. RESULTS A change in resection rates for all analyzed entities (esophageal, gastric, liver, pancreatic, colon, rectum, and lung cancer) was observed from baseline to 2020. Total monthly oncological resections dropped by 7.4% (8.7% normalized to the annual German population, P =0.011). Changes ranged from +3.7% for pancreatic resections ( P =0.277) to -19.4% for rectal resections ( P <0.001). Reductions were higher during lockdown periods. During the first lockdown period (April-June), the overall drop was 14.3% (8.58 per 100 000 vs. 7.35 per 100 000, P <0.001). There was no catch-up effect during the summer months except for pancreatic cancer resections. In the second lockdown period, there was an overall drop of 17.3%. In subgroup analyses, the elderly were most affected by the reduction in resection rates. There was a significant negative correlation between regional SARS-CoV-2 incidences and resections rates. This correlation was strongest for rectal cancer resections (Spearman's r : -0.425, P <0.001). CONCLUSIONS The pandemic lockdowns had a major impact on the oncological surgical caseload in Germany in 2020. The elderly were most affected by the reduction. There was a clear correlation between SARS-CoV-2 incidences regionally and the reduction of surgical resection rates. In future pandemic circumstances, oncological surgery has to be prioritized with an extra focus on the most vulnerable patients.
Collapse
Affiliation(s)
- Konstantin L. Uttinger
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, Leipzig University Hospital, Leipzig
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg
| | - Philip Baum
- Department of Thoracic Surgery, Thoraxklinik Heidelberg University Hospital, Heidelberg
| | - Mohammed Hankir
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg
- Comprehensive Cancer Centre Mainfranken, University of Würzburg Medical Centre
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, Würzburg University Hospital, Würzburg
- Comprehensive Cancer Centre Mainfranken, University of Würzburg Medical Centre
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
20
|
Huang X, Pei X, Jian W, Xu M. Socioeconomic Disparities in Individual-Level Quality-Adjusted Life Years throughout Remaining Lifetimes: A National Representative Longitudinal Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4612. [PMID: 36901620 PMCID: PMC10001792 DOI: 10.3390/ijerph20054612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Socioeconomic disparities in health within and across low- and middle-income countries pose a significant global public health concern. While prior research has demonstrated the importance of socioeconomic status on health outcomes, few studies have employed comprehensive measures of individual-level health such as quality-adjusted life years (QALYs) in exploring the quantitative relationship. In our study, we employed QALYs to measure individual-level health, using health-related quality of life scores based on the Short Form 36 and predicted remaining life years through individual-specific Weibull survival analysis. We then constructed a linear regression model to explore the socioeconomic factors that influence QALYs, providing a predictive model of individual-level QALYs throughout remaining lifetimes. This practical tool can help individuals predict their remaining healthy life years. Using data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we found that education and occupation were the primary factors influencing health outcomes among individuals aged 45 and above, while income appeared to have less of an impact when education and occupation were simultaneously controlled for. To promote the health status of this population, low- and middle-income countries should prioritize the long-term advancement of their population's education while controlling unemployment rates in the short term.
Collapse
Affiliation(s)
- Xinyi Huang
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
| | - Xingtong Pei
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
| | - Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, Xueyuan Road 38, Haidian District, Beijing 100191, China
| | - Mingming Xu
- School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen 518107, China
| |
Collapse
|
21
|
Tan JK, Lim GH, Mohamed Salim NN, Chia SY, Thumboo J, Bee YM. Associations Between Mean HbA1c, HbA1c Variability, and Both Mortality and Macrovascular Complications in Patients with Diabetes Mellitus: A Registry-Based Cohort Study. Clin Epidemiol 2023; 15:137-149. [PMID: 36721457 PMCID: PMC9884453 DOI: 10.2147/clep.s391749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
Background We investigate the association between mean HbA1c, HbA1c variability, and all-cause mortality and diabetes-related macrovascular complications in patients with diabetes. Methods We performed a retrospective cohort study using patients present in the Singapore Health Services diabetes registry (SDR) during 2013 to 2014. We assessed mean HbA1c using three models: a baseline mean HbA1c for 2013-14, the mean across the whole follow-up period, and a time-varying yearly updated mean. We assessed HbA1c variability at baseline using the patient's HbA1c variability score (HVS) for 2013-14. The association between mean HbA1c, HVS, and 6 outcomes were assessed using Cox proportional hazard models. Results We included 43,837-53,934 individuals in the analysis; 99.3% had type 2 diabetes mellitus. The data showed a J-shaped distribution in adjusted hazard ratios (HRs) for all-cause mortality, ischemic heart disease, acute myocardial infarction, peripheral arterial disease, and ischemic stroke, with an increased risk of developing these outcomes at HbA1c <6% (42 mmol/mol) and ≥8% (64 mmol/mol). With the addition of HVS, the J-shaped distribution was maintained for the above outcomes, but HRs were greater at HbA1c <6.0% (42 mmol/mol) and reduced at HbA1c ≥8.0% (64 mmol/mol) when compared to models without HVS. The risk for all outcomes increased substantially with increasing glycaemic variability. Conclusion Both low (<6.0% [42 mmol/mol]) and high (≥8.0% [64 mmol/mol]) levels of glycaemic control are associated with increased all-cause mortality and diabetes-related macrovascular complications. Glycaemic variability is independently associated with increased risk for these outcomes. Therefore, patients with stable glycaemic level of 6-8% (42-64mmol/mol) are at lowest risk of all-cause mortality and diabetes-related macrovascular complications.
Collapse
Affiliation(s)
- Joshua Kuan Tan
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Gek Hsiang Lim
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | | | - Sing Yi Chia
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Julian Thumboo
- Health Services Research Unit, Singapore General Hospital, Singapore, 169608, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore,Correspondence: Yong Mong Bee, Department of Endocrinology, Singapore General Hospital, Singapore, 169608, Singapore, Tel +65 6321 3753, Email
| |
Collapse
|
22
|
Bradley H, Ho HY. Comprehensive Comparisons of Family Health Between Families With One Immigrant Parent and Native Families in Taiwan: Nationwide Population-Based Cohort Study. JMIR Public Health Surveill 2022; 8:e33624. [PMID: 36534459 PMCID: PMC9808584 DOI: 10.2196/33624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/19/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Mothers and children in families with one immigrant parent have been reported to be healthier than those in native families; however, the health of the fathers in these families has rarely been discussed in literature. OBJECTIVE We aimed to comprehensively compare the health of all the family members between families with one immigrant parent (native fathers, immigrant mothers, and their children) and native families (native fathers, native mothers, and their children). METHODS We conducted a cohort study by using the Taiwan Maternal and Child Health Database to recruit live-born children and their parents from 2004 to 2016. Overall, we identified 90,670 fathers, 91,270 mothers, and 132,457 children in families with one immigrant parent and 1,666,775 fathers, 1,734,104 mothers, and 2,637,191 children in native families and followed up with them from 2004 to 2017. The outcomes comprised common physical and mental disorders, catastrophic illnesses, mortality, and child adversities and accidents. The covariates comprised the child's year of birth, parental age, low-income status, and physical or mental disorder status. Logistic regression was performed to compare the risks of the outcomes between families with one immigrant parent and native families. RESULTS The parents in families with one immigrant parent were more likely to be of low-income status and were older than the parents in native families. After adjusting for the covariates, fathers in families with one immigrant parent were found to have higher risks of physical and mental disorders, catastrophic illness, and mortality than fathers in native families. Conversely, mothers in families with one immigrant parent had lower risks of physical and mental disorders, catastrophic illness, and mortality than mothers in native families. Finally, the children in families with one immigrant parent generally had better physical and mental health but higher risks for leukemia, liver diseases, autism spectrum disorder, and road traffic accidents than children in native families. CONCLUSIONS The health status of the members of families with one immigrant parent was nonhomogeneous, and the poorer general health of fathers in such families suggests health inequalities in families with one immigrant parent.
Collapse
Affiliation(s)
| | - Hsing-Ying Ho
- Department of Healthcare Administration, Asia University, Taichung, Taiwan.,Department of Psychology, Asia University, Taichung, Taiwan
| |
Collapse
|
23
|
Han M, Lee SR, Choi EK, Park SH, Lee H, Chung J, Choi J, Han KD, Oh S, Lip GYH. The impact of socioeconomic deprivation on the risk of atrial fibrillation in patients with diabetes mellitus: A nationwide population-based study. Front Cardiovasc Med 2022; 9:1008340. [DOI: 10.3389/fcvm.2022.1008340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022] Open
Abstract
ObjectiveTo evaluate the relationship between socioeconomic status and the risk of atrial fibrillation (AF) in patients with diabetes mellitus (DM).Research design and methodsFrom the National Health Insurance Service (NHIS) database, we identified 2,429,610 diabetic patients who underwent national health check-ups between 2009 and 2012. Tracing back the subjects for 5 years from the date of health check-up, we determined the subjects’ income and whether they received medical aid (MA) during the past 5 years. Subjects were divided into six groups according to the number of years of receiving (MA groups 0 through 5) and into four groups according to socioeconomic status change during the past 5 years. We estimated the risk of AF for each group using the Cox proportional-hazards model.ResultsDuring a median follow-up of 7.2 ± 1.7 years, 80,257 were newly identified as AF. The MA groups showed a higher risk of AF than the non-MA group with the hazard ratios (HRs) and 95% confidence interval (CI) 1.32 (1.2–1.44), 1.33 (1.22–1.45), 1.23 (1.13–1.34), 1.28 (1.16–1.4), and 1.50 (1.39–1.63) for MA groups 1 through 5, respectively. Dividing subjects according to socioeconomic condition change, those who experienced worsening socioeconomic status (non-MA to MA) showed higher risk compared to the persistent non-MA group (HR 1.54; 95% CI 1.38–1.73).ConclusionLow socioeconomic status was associated with the risk of AF in patients with diabetes. More attention should be directed at alleviating health inequalities, targeting individuals with socioeconomic deprivation to provide timely management for AF.
Collapse
|
24
|
Tan V, Chen C, Merchant RA. Association of social determinants of health with frailty, cognitive impairment, and self-rated health among older adults. PLoS One 2022; 17:e0277290. [PMID: 36367863 PMCID: PMC9651553 DOI: 10.1371/journal.pone.0277290] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objectives Recently, the role of social determinants of health on frailty and dementia has received increased attention. The aim of the present study is to explore the association of social determinants on cognitive impairment, frailty, and self-rated health. As health is influenced by many factors, we also examine other health determinants including lifestyle, health seeking behaviour, socio-demographics, and multimorbidity in the analysis. Research design and methods Cross-sectional analysis of the Healthy Older People Everyday (HOPE) study in Singapore was carried out on 998 older adults above the age of 65. We used forward stepwise multivariable logistic and linear regression analyses to assess the association of five health determinants (social determinants, lifestyle, health seeking behaviour, socio-demographics and multimorbidity) on frailty, cognitive impairment, and self-rated health. Results Mean age of participants was 71.1 ± 0.2 years; 154 (15.4%) were cognitively impaired; 430 (43.1%) were pre-frail or frail; mean self-rated health was 80.4 ± 15.6. Social determinants contributed between 29% to 57% of the overall variation found in the full model with all five health determinants adjusted for. Participants with higher education had significantly lower odds of cognitive impairment and frailty. Leisure physical activity was significantly associated with lower odds of frailty and cognitive impairment, and better self-rated health. Discussion and implications Understanding the dynamics of different health determinants is crucial to protect the vulnerable in an ageing population. Our study highlights the need for a multidimensional, multidisciplinary and multisectoral approach in the prevention of frailty, cognitive impairment, and associated disability.
Collapse
Affiliation(s)
- Vanessa Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, United States of America
- Department of Non-Communicable Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
25
|
Zhang J, Liang X, Su T, Li X, Ge J, An Z, Xu Y. The mediating effect of geospatial thinking on the relationship between family capital and sense of place. Front Psychol 2022; 13:918326. [DOI: 10.3389/fpsyg.2022.918326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Few studies have examined how family capital affects the sense of place, and the effect of spatial thinking on the relationship between the two is unclear. This study constructs a mediation model to examine the impact of family capital on sense of place and the mediation effect of geospatial thinking. A total of 1,004 upper-secondary-school students were surveyed using the Family Capital Questionnaire, the Geospatial Thinking Test, and the Sense of Place Scale. The correlation analysis showed that family capital has a positive effect on both sense of place and geospatial thinking. Moreover, there is also a significant positive correlation between geospatial thinking and sense of place. The results of mediation analysis indicated that geospatial thinking plays mediating and buffering roles in the relationship between family capital and sense of place after controlling for gender and residential address. The direct and indirect effects accounted for 73.31 and 26.69% of the total effect, respectively. Specifically, family capital is a significant positive predictor of both sense of place and geospatial thinking, and geospatial thinking partially mediates the relationship between family capital and sense of place. Students from better family backgrounds are more likely to have a better geospatial thinking and sense of place, as well as geospatial thinking promotes the development of a sense of place. Therefore, both family capital and geospatial thinking should be considered when we want to examine and develop individuals’ level of sense of place.
Collapse
|
26
|
Consumption Patterns of Processed Foods in Singapore-A Cross-Sectional Study. Foods 2022; 11:foods11182782. [PMID: 36140910 PMCID: PMC9498269 DOI: 10.3390/foods11182782] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/19/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
The consumption of processed foods is increasingly widespread and could have an impact on diet quality and health. Understanding the factors influencing people's eating habits is useful for assessing such impact. There are limited data on the consumption patterns of processed foods and associated factors influencing the dietary patterns in Singapore. This cross-sectional study based on a food frequency questionnaire aimed to examine how the consumption of processed foods among 2079 Singapore residents aged 18 to 89 years varies with sociodemographic factors. The analysis of the consumption by processed food groups showed that the studied factors, i.e., age, gender, ethnicity, housing and health status, all contributed to differences in processed food consumption to varying extents, with ethnicity being the key factor driving the variation. Such differences were also confirmed to a limited degree by determining another measure of consumption, i.e., a processed food variety score. The findings in this study could inform further work in relation to dietary risks.
Collapse
|
27
|
AshaRani PV, Devi F, Wang P, Abdin E, Zhang Y, Roystonn K, Jeyagurunathan A, Subramaniam M. Factors influencing uptake of diabetes health screening: a mixed methods study in Asian population. BMC Public Health 2022; 22:1511. [PMID: 35941579 PMCID: PMC9360713 DOI: 10.1186/s12889-022-13914-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health screens are the cornerstones for health promotion and preventive interventions at a community level. This study investigated the barriers and facilitators to the uptake of diabetes health screening in the general population of Singapore. METHODS In this mixed methods study, participants without diabetes were recruited from the general population. The quantitative phase (n = 2459) included face to face survey of participants selected through disproportionate stratified random sampling. Those who participated in the quantitative survey were then randomly chosen for a one-to-one semi-structured interview (n = 30). RESULTS Among the survey respondents, 73.09% (n = 1777) had attended a diabetes health screening in their lifetime whilst 42.36% (n = 1090) and 57.64% (n = 1328, p < 0.0001) attended the health screens regularly (every 12 months) and irregularly, respectively. A significantly higher proportion of older adults (≥ 40 years) attended regular diabetes health screening compared to younger adults (less than 40 years; 55.59% vs 24.90%, p < 0.001). The top 3 reasons for attending regular health screens were to detect diabetes early, to make lifestyle changes in case of a diagnosis and being health conscious. Qualitative interviews identified similar issues and complex nuances that influenced the uptake of regular diabetes health screening. Several personal factors (laziness, self-reliance, psychological factors, etc.), competing priorities, fatalistic beliefs, affordability, misconceptions about the screens, and appointment related factors (inconvenient location, time, etc.) were identified as barriers, while affordable screens, sense of personal responsibility, perception of susceptibility /risk, role of healthcare team (e.g. reminders and prescheduled appointments) and personal factors (e.g. age, family, etc.) were facilitators. Age, household income, ethnicity and educational level were associated with the uptake of regular diabetes health screening. CONCLUSION The uptake of regular diabetes health screening can be improved. Several barriers and enablers to the uptake of diabetes health screening were identified which should be addressed by the policy makers to alleviate misconceptions and create greater awareness of the importance of the programme that will improve participation.
Collapse
Affiliation(s)
- P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.,Saw Swee Hock School of Public Health and Department of Medicine, National University of Singapore, Singapore, 117549, Singapore
| |
Collapse
|
28
|
AshaRani PV, Sin KY, Abdin E, Vaingankar JA, Shafie S, Shahwan S, Chang S, Sambasivam R, Subramaniam M. The Relationship of Socioeconomic Status to Alcohol, Smoking, and Health: a Population-Level Study of the Multiethnic Population in Singapore. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00882-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
29
|
Tan SB. Changes in neighborhood environments and the increasing socioeconomic gap in child obesity risks: Evidence from Singapore. Health Place 2022; 76:102860. [PMID: 35863272 DOI: 10.1016/j.healthplace.2022.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
Most empirical research studying the link between neighborhood environments and child obesity risks are conducted in contexts such as the U.S., with pronounced patterns of residential segregation, making it difficult to extrapolate how far built environment characteristics contribute to socioeconomic disparities in obesity risks in less segregated contexts. Using a large national dataset of almost 625,000 students' height and weight data collected at ages 7, 11 and 14, between 2004 and 2015, this paper explores whether differences in eight neighborhood characteristics measuring access to different type of food outlets, parks and other active spaces, and public transport infrastructure might be responsible for socioeconomic differences in child obesity risks in Singapore, a city-state with relatively low levels of residential segregation. Through descriptive analyses we find that socioeconomic disparities in child BMIz in Singapore widened from 2004 onwards. However, while longitudinal regression models with individual and time fixed effects suggest that family socioeconomic status modified the relationship between environmental exposures and BMIz, there does not seem to be a clear, unequivocal relationship between built environment changes and the observed widening of the socioeconomic obesity gap.
Collapse
Affiliation(s)
- Shin Bin Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, National University of Singapore, 259772, Singapore; Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
| |
Collapse
|
30
|
Xu Y, Koh XH, Chua YTS, Tan CGI, Aloweni FAB, Yap BEJ, Tan PC, Chua X, Lim YKS, Oh HC, Teo SHS, Lim SF. The impact of community nursing program on healthcare utilization: A program evaluation. Geriatr Nurs 2022; 46:69-79. [DOI: 10.1016/j.gerinurse.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
|
31
|
Sum KK, Tint MT, Aguilera R, Dickens BSL, Choo S, Ang LT, Phua D, Law EC, Ng S, Tan KML, Benmarhnia T, Karnani N, Eriksson JG, Chong YS, Yap F, Tan KH, Lee YS, Chan SY, Chong MFF, Huang J. The socioeconomic landscape of the exposome during pregnancy. ENVIRONMENT INTERNATIONAL 2022; 163:107205. [PMID: 35349911 DOI: 10.1016/j.envint.2022.107205] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND While socioeconomic position (SEP) is consistently related to pregnancy and birth outcome disparities, relevant biological mechanisms are manifold, thus necessitating more comprehensive characterization of SEP-exposome associations during pregnancy. OBJECTIVES We implemented an exposomic approach to systematically characterize the socioeconomic landscape of prenatal exposures in a setting where social segregation was less distinct in a hypotheses-generating manner. METHODS We described the correlation structure of 134 prenatal exogenous and endogenous sources (e.g., micronutrients, hormones, immunomodulatory metabolites, environmental pollutants) collected in a diverse, population-representative, urban, high-income longitudinal mother-offspring cohort (N = 1341; 2009-2011). We examined the associations between maternal, paternal, household, and areal level SEP indicators and 134 exposures using multiple regressions adjusted for precision variables, as well as potential effect measure modification by ethnicity and nativity. Finally, we generated summary SEP indices using Multiple Correspondence Analysis to further explore possible curved relationships. RESULTS Individual and household SEP were associated with anthropometric/adiposity measures, folate, omega-3 fatty acids, insulin-like growth factor-II, fasting glucose, and neopterin, an inflammatory marker. We observed paternal education was more strongly and consistently related to maternal exposures than maternal education. This was most apparent amongst couples discordant on education. Analyses revealed additional non-linear associations between areal composite SEP and particulate matter. Environmental contaminants (e.g., per- and polyfluoroalkyl substances) and micronutrients (e.g., folate and copper) showed opposing associations by ethnicity and nativity, respectively. DISCUSSION SEP-exposome relationships are complex, non-linear, and context specific. Our findings reinforce the potential role of paternal contributions and context-specific modifiers of associations, such as between ethnicity and maternal diet-related exposures. Despite weak presumed areal clustering of individual exposures in our context, our approach reinforces subtle non-linearities in areal-level exposures.
Collapse
Affiliation(s)
- Ka Kei Sum
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore.
| | - Mya Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rosana Aguilera
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue Choo
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Li Ting Ang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Desiree Phua
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Evelyn C Law
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Sharon Ng
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Karen Mei-Ling Tan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Bioinformatics Institute, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Johan G Eriksson
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore; Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Yap-Seng Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Fabian Yap
- Duke-NUS Medical School, Singapore, Singapore; Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore; Department of Maternal-Fetal Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jonathan Huang
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore; Centre for Quantitative Medicine (CQM), Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
32
|
Kuo BJ, Busmanis I, Tan BP, Tan PH, Teoh WC, Tan BS. The Lancet Commission on diagnostics: What it means for Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:300-303. [PMID: 35658153 DOI: 10.47102/annals-acadmedsg.202242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
|
33
|
Mohd Noh SN, Jawahir S, Tan YR, Ab Rahim I, Tan EH. The Health-Seeking Behavior among Malaysian Adults in Urban and Rural Areas Who Reported Sickness: Findings from the National Health and Morbidity Survey (NHMS) 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063193. [PMID: 35328878 PMCID: PMC8954644 DOI: 10.3390/ijerph19063193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
Understanding care-seeking behavior among urban and rural populations can help to support the planning and implementation of appropriate measures to improve health in the community. This study aims to determine the factors associated with the health-seeking behavior among Malaysian adults in urban and rural areas who reported sickness. This study used data of Malaysian adults aged 18 years and over from the National Health and Morbidity Survey 2019; a cross-sectional, national household survey that targeted all non-institutionalized residents in Malaysia. Respondent’s characteristics and health-seeking behavior were described using complex sample descriptive statistics. Multivariable logistic regression analysis was conducted to examine the association between potential factors (sociodemographic characteristics, enabling, and health need) and health-seeking behaviors (seeking treatment from healthcare practitioners and self-medication). A total of 10,484 respondents, estimated to represent 18.9 million Malaysian adults aged 18 years and over, were included in the analysis. Prevalence of seeking treatment from healthcare practitioners and self-medication among Malaysian adults with self-reported sickness were 57.3% and 23.3%, respectively. Self-reported sickness among both the urban and rural populations who rated their health as poor to very poor was more likely to seek treatment than those who rated good to excellent. However, among the urban population, those who rated their health as poor to very poor were less likely to self-medicate. Among the urban population, government employees were more likely to seek treatment, and being without formal education significantly increased the likelihood to self-medicate. Among the rural population, those with at least one long-term condition were more likely to seek treatment than those with none. Understanding the factors which influence health-seeking behavior among the urban and rural population could close the gaps in healthcare utilization among the population in Malaysia.
Collapse
Affiliation(s)
- Sarah Nurain Mohd Noh
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.J.); (Y.R.T.); (I.A.R.); (E.H.T.)
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Correspondence: ; Tel.: +60-333627500
| | - Suhana Jawahir
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.J.); (Y.R.T.); (I.A.R.); (E.H.T.)
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Yeung R’ong Tan
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.J.); (Y.R.T.); (I.A.R.); (E.H.T.)
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Iqbal Ab Rahim
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.J.); (Y.R.T.); (I.A.R.); (E.H.T.)
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Ee Hong Tan
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia; (S.J.); (Y.R.T.); (I.A.R.); (E.H.T.)
- Melaka State Health Department, Ministry of Health Malaysia, Ayer Keroh 75450, Malaysia
| |
Collapse
|
34
|
Public Rental Housing and Obesogenic Behaviors among Adults in Hong Kong: Mediator Role of Food and Physical Activity Environment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052960. [PMID: 35270652 PMCID: PMC8910218 DOI: 10.3390/ijerph19052960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/05/2022]
Abstract
Public rental housing (PRH) for low-income families has been shown in several studies to be associated with poor health status and obesity. However, the causes of this health disparity are controversial, and the associations and pathways between PRH and obesogenic behaviors remain unknown. Using cross-sectional survey data of 1977 adults living in Hong Kong (aged or over 18) together with multi-source GIS-based environmental data, we examined the associations between PRH and obesogenic behaviors and the extent to which those associations can be explained by neighborhood food and physical environment. The unhealthy food environment, which relates with infrequent fruit and vegetables consumption, was calculated based on the relative density of fast food restaurants and convenience stores to grocery stores. The physical activity environment, which relates to physical inactivity and prolonged sitting, was assessed in terms of density of sports facilities and street greenery, separately. Regressions and mediation analyses show that PRH was negatively associated with physical inactivity directly and also indirectly via higher sports facilities density; however, PRH was positively associated with unhealthy diet largely directly and positively associated with prolonged sitting indirectly via less street greenery. We advanced the international literature of PRH health impact assessment and its environmental health pathways by providing evidence from the least housing-affordable city in the world. The findings provide planning implications in formulating a healthier PRH community for these low-income PRH households and mitigating health disparities induced by housing type.
Collapse
|
35
|
Tang XR, Pek PP, Siddiqui FJ, Malhotra R, Kwan YH, Tiah L, Ho AFW, Ong MEH. Determinants of emergency department utilisation by older adults in Singapore: A systematic review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:170-179. [PMID: 35373240 DOI: 10.47102/annals-acadmedsg.2021437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Adults aged ≥60 years contribute to disproportionately higher visits to the emergency departments (ED). We performed a systematic review to examine the reasons why older persons visit the ED in Singapore. METHODS We searched Medline, Embase and Scopus from January 2000 to December 2021 for studies reporting on ED utilisation by older adults in Singapore, and included studies that investigated determinants of ED utilisation. Statistically significant determinants and their effect sizes were extracted. Determinants of ED utilisation were organised using Andersen and Newman's model. Quality of studies was evaluated using Newcastle Ottawa Scale and Critical Appraisal Skills Programme. RESULTS The search yielded 138 articles, of which 7 were used for analysis. Among the significant individual determinants were predisposing (staying in public rental housing, religiosity, loneliness, poorer coping), enabling (caregiver distress from behavioural and psychological symptoms of dementia) and health factors (multimorbidity in patients with dementia, frailty, primary care visit in last 6 months, better treatment adherence). The 7 included studies are of moderate quality and none of them employed conceptual frameworks to organise determinants of ED utilisation. CONCLUSION The major determinants of ED utilisation by older adults in Singapore were largely individual factors. Evaluation of societal determinants of ED utilisation was lacking in the included studies. There is a need for a more holistic examination of determinants of ED utilisation locally based on conceptual models of health seeking behaviours.
Collapse
Affiliation(s)
- Xuan Rong Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | | | |
Collapse
|
36
|
Kousiouris P, Klavdianou O, Douglas KAA, Gouliopoulos N, Chatzistefanou K, Kantzanou M, Dimtsas GS, Moschos MM. Role of Socioeconomic Status (SES) in Globe Injuries: A Review. Clin Ophthalmol 2022; 16:25-31. [PMID: 35027817 PMCID: PMC8749045 DOI: 10.2147/opth.s317017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Globe injury is a serious worldwide public health issue frequently leading to permanent vision impairment. The plethora of different types of globe injuries is classified into categories, including open and closed globe injuries. Globe injury occurs mainly in the workplace and at home, affecting predominantly middle-aged working men. Socioeconomic status (SES) is defined by income level, educational attainment, and employment status. Low socioeconomic status has been associated with a higher incidence of globe injury and can be utilized to identify at-risk populations. For managing open and closed globe injuries, different strategies are applied and the implementation of adequate globe injury prevention measures is needed for reducing the occurrence of globe injury. The following article aims to provide an overview of globe injury characteristics and their correlation with socioeconomic status and to highlight the significance of considering SES as a variable in globe injury prevention.
Collapse
Affiliation(s)
- Panagiotis Kousiouris
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| | - Olga Klavdianou
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| | - Konstantinos A A Douglas
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| | - Nikolaos Gouliopoulos
- 2nd Department of Ophthalmology, National and Kapodistrian University of Athens, "Attikon" General Hospital, Athens, Greece
| | - Klio Chatzistefanou
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios S Dimtsas
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| | - Marilita M Moschos
- 1st Department of Ophthalmology, National and Kapodistrian University of Athens, "G. Gennimatas" General Hospital, Athens, Greece
| |
Collapse
|
37
|
Wang W, Yan Y, Guo Z, Hou H, Garcia M, Tan X, Anto EO, Mahara G, Zheng Y, Li B, Kang T, Zhong Z, Wang Y, Guo X, Golubnitschaja O. All around suboptimal health - a joint position paper of the Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine. EPMA J 2021; 12:403-433. [PMID: 34539937 PMCID: PMC8435766 DOI: 10.1007/s13167-021-00253-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 02/07/2023]
Abstract
First two decades of the twenty-first century are characterised by epidemics of non-communicable diseases such as many hundreds of millions of patients diagnosed with cardiovascular diseases and the type 2 diabetes mellitus, breast, lung, liver and prostate malignancies, neurological, sleep, mood and eye disorders, amongst others. Consequent socio-economic burden is tremendous. Unprecedented decrease in age of maladaptive individuals has been reported. The absolute majority of expanding non-communicable disorders carry a chronic character, over a couple of years progressing from reversible suboptimal health conditions to irreversible severe pathologies and cascading collateral complications. The time-frame between onset of SHS and clinical manifestation of associated disorders is the operational area for an application of reliable risk assessment tools and predictive diagnostics followed by the cost-effective targeted prevention and treatments tailored to the person. This article demonstrates advanced strategies in bio/medical sciences and healthcare focused on suboptimal health conditions in the frame-work of Predictive, Preventive and Personalised Medicine (3PM/PPPM). Potential benefits in healthcare systems and for society at large include but are not restricted to an improved life-quality of major populations and socio-economical groups, advanced professionalism of healthcare-givers and sustainable healthcare economy. Amongst others, following medical areas are proposed to strongly benefit from PPPM strategies applied to the identification and treatment of suboptimal health conditions:Stress overload associated pathologiesMale and female healthPlanned pregnanciesPeriodontal healthEye disordersInflammatory disorders, wound healing and pain management with associated complicationsMetabolic disorders and suboptimal body weightCardiovascular pathologiesCancersStroke, particularly of unknown aetiology and in young individualsSleep medicineSports medicineImproved individual outcomes under pandemic conditions such as COVID-19.
Collapse
Affiliation(s)
- Wei Wang
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
- First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Yuxiang Yan
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Zheng Guo
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Haifeng Hou
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Monique Garcia
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Xuerui Tan
- First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Enoch Odame Anto
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- Department of Medical Diagnostics, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Gehendra Mahara
- First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Yulu Zheng
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Bo Li
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- School of Nursing and Health, Henan University, Kaifeng, China
| | - Timothy Kang
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- Institute of Chinese Acuology, Perth, Australia
| | - Zhaohua Zhong
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- School of Basic Medicine, Harbin Medical University, Harbin, China
| | - Youxin Wang
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- Department of Medical Diagnostics, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Xiuhua Guo
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
| | - Olga Golubnitschaja
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - On Behalf of Suboptimal Health Study Consortium and European Association for Predictive, Preventive and Personalised Medicine
- Centre for Precision Health, Edith Cowan University, Perth, Australia
- Beijing Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai’an, China
- First Affiliated Hospital, Shantou University Medical College, Shantou, China
- Suboptimal Health Study Consortium, Kumasi, Ghana
- Suboptimal Health Study Consortium, Perth, Australia
- Suboptimal Health Study Consortium, Beijing, China
- Suboptimal Health Study Consortium, Bonn, Germany
- European Association for Predictive, Preventive and Personalised, Medicine, Brussels, Belgium
- Department of Medical Diagnostics, College of Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- School of Nursing and Health, Henan University, Kaifeng, China
- Institute of Chinese Acuology, Perth, Australia
- School of Basic Medicine, Harbin Medical University, Harbin, China
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| |
Collapse
|
38
|
Liow MHL, Ganesan G, Chen JDY, Koh JSB, Howe TS, Yong EL, Kramer MS, Tan KB. Excess mortality after hip fracture: fracture or pre-fall comorbidity? Osteoporos Int 2021; 32:2485-2492. [PMID: 34129060 DOI: 10.1007/s00198-021-06023-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED Comorbidity and hip fracture independently increased mortality risk for 9 years in both sexes, with a significant additive interaction in the first year among women and through 6 years among men. INTRODUCTION Hip fracture is associated with a persistently elevated mortality risk, but it is unknown whether the elevated risk is due to the fracture or to pre-fracture comorbidity. METHODS In a population-based study in Singapore with 9 years of follow-up, patients age > 50 with first hip fracture from 2008 to 2017 were pair-matched to a cohort without hip fracture by age, sex, ethnicity, and pre-fracture Charlson Comorbidity Index (CCI). We investigated additive interaction using the relative excess risk due to interaction (RERI) and multiplicative interaction using the ratio of relative risks. RESULTS Twenty-two thousand five hundred ninety of 22,826 patients with a first hip fracture in 2008-2017 were successfully matched. Hip fracture and comorbidity independently increased mortality risk for 9 years in both sexes. After adjustment for comorbidity, excess mortality risk continued to persist for 9 years post-fracture in both men and women. Women with a hip fracture and pre-fracture CCI > 4 had a higher relative risk (RR) of mortality at 9 years of 3.29 [95% confidence interval (CI) 3.01, 3.59] than those without comorbidity (RR 1.51, 95%CI 1.36, 1.68) compared to the referent without hip fracture or comorbidity. An additive interaction between hip fracture and pre-fracture CCI > 4 was observed in the first post-fracture year` [relative excess risk due to interaction (RERI) 1.99, 95%CI 0.97, 3.01]. For men with CCI ≥ 4, the positive additive interaction was observed through 6 years. CONCLUSIONS Excess mortality risks post-fracture are attributable to both the fracture and pre-fracture comorbidity. Early interventions in hip fracture patients with high comorbidity could reduce their excess mortality.
Collapse
Affiliation(s)
- M H L Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - G Ganesan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore, Singapore
| | - J D Y Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - J S B Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - T S Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - E-L Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, Singapore
| | - M S Kramer
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology, Biostatistics and Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Quebec, Montreal, H3G 1Y6, Canada
| | - K B Tan
- Division of Policy, Research and Evaluation, Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
39
|
Ng Yin Ling C, Seshasai S, Chee ML, He F, Tham YC, Cheng CY, Wong TY, Sabanayagam C. Visual Impairment, Major Eye Diseases, and Mortality in a Multi-Ethnic Asian Population and a Meta-analysis of Prospective Studies. Am J Ophthalmol 2021; 231:88-100. [PMID: 33965416 DOI: 10.1016/j.ajo.2021.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Vision impairment (VI) is associated with poor quality of life and increased risk of falls. Few prospective data are available on Asians. This study investigates the longitudinal impact of VI and the major eye diseases on mortality risk in Asians. DESIGN Prospective cohort study with meta-analysis. METHODS We conducted a multi-ethnic prospective study of adults (40-80 years old) in the Singapore Epidemiology of Eye Diseases Study (baseline: 2004-2011). All-cause mortality was obtained from the National Death Registry until May 2017. VI was defined by best-corrected visual acuity (BCVA) <20/40 in the better eye. Major eye diseases were assessed using standard protocols. We examined associations using multivariate-adjusted Cox proportional hazards regression models. Finally, we conducted a meta-analysis of the associations between VI and mortality. RESULTS Of 9,986 participants, 1,210 deaths occurred (12.1%) over a median follow-up of 8.8 years. Compared to participants with normal vision, persons with VI had increased risk of mortality (hazards ratio [HR]: 1.53; 95% confidence interval [CI:] 1.30-1.81) in multivariate models. In ethnicity-specific analyses, this association was significant across Chinese (HR: 1.63; 95% CI: 1.08-2.48); Malays (HR: 1.31; 95% CI: 1.06-1.62); and Indians (HR: 2.25; 95% CI: 1.61-3.15). Cataract, under-corrected refractive errors (URE), and diabetic retinopathy (DR) were significantly associated with mortality (HRs: 1.30, 1.22, and 1.54, respectively). In a meta-analysis of 12 studies including 58,034 persons, VI was associated with 30% increased risk of mortality (HR: 1.3; 95% CI: 1.2-1.5). CONCLUSIONS In this multi-ethnic Asian population, VI and preventable eye conditions (cataract, URE, and DR) were associated with mortality, emphasizing the need for early detection and intervention to prevent and treat VI and major eye diseases.
Collapse
|
40
|
Chowdhury TK, Hoque MM, Kabir M, Banu T. Delayed presentation of congenital rectal stenosis associated with Down's syndrome and hypothyroidism: Case report. Clin Case Rep 2021; 9:e05083. [PMID: 34815875 PMCID: PMC8593885 DOI: 10.1002/ccr3.5083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/05/2021] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
Rectal stenosis is a rare variety of rectal atresia. A membrane separates the rectum from the anal canal in the presence of a normal anus. We report a case of rectal stenosis associated with Down's syndrome and hypothyroidism in whom rectal stenosis was diagnosed at the age of 17 years.
Collapse
Affiliation(s)
| | | | | | - Tahmina Banu
- Chittagong Research Institute for Children SurgeryChattogramBangladesh
| |
Collapse
|
41
|
Seow-En I, Chok AY, Matchar DB, Yoon S, Chong DQ, Tan EKW. Long-term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort. Colorectal Dis 2021; 23:2348-2360. [PMID: 34097342 DOI: 10.1111/codi.15768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/15/2021] [Accepted: 05/31/2021] [Indexed: 01/22/2023]
Abstract
AIM As populations age and cancer management improves, long-term survivorship and quality-of-life (QOL) outcomes are becoming equally important as oncological results. Data from Asian populations are scarce. We aimed to evaluate the sexual health, gastrointestinal function and QOL amongst colorectal cancer survivors in a tertiary referral centre in Singapore. METHOD Adults who had undergone elective curative surgery for non-metastatic colorectal cancer at least 2 years prior were included. Exclusion criteria were cognitive disease, serious postoperative complications or recurrent cancer. Participants were invited to complete the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires EORTC-QLQ-C30 and QLQ-CR29. Using multiple bivariate analysis, r scores were used to examine relationship trends between QOL domains and survivor sociodemographic and disease-specific characteristics. RESULTS From February 2017 to July 2019, 400 responses were recorded. Median age and follow-up duration were 64 years (range 32-90) and 78 months (interquartile range 49-113) respectively. Patients who had Stage III cancer had better overall QOL scores compared to Stage I/II. Rectal (vs. colon) cancer negatively influenced sexual health and gastrointestinal function, but did not appear to affect overall QOL. Amongst our cohort, 57% (n = 129) of men and 43% (n = 75) of women were sexually active. Markers of socioeconomic status, including employment, education and housing type, were found to significantly impact perception of various aspects of QOL. CONCLUSION Knowledge of factors which influence well-being can identify individuals who may benefit from tailored management strategies. Regular patient-doctor contact may play a role in building and maintaining positive perspectives of cancer survivors. Normative data should be obtained from local populations to facilitate future comparative research.
Collapse
Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| | - David Bruce Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore.,Department of Medicine, Duke University Medical School, Durham, NC, USA
| | - Sungwon Yoon
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore City, Singapore
| | - Dawn Qingqing Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore City, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore City, Singapore
| |
Collapse
|
42
|
Gwee SXW, Chua PEY, Wang MX, Pang J. Impact of travel ban implementation on COVID-19 spread in Singapore, Taiwan, Hong Kong and South Korea during the early phase of the pandemic: a comparative study. BMC Infect Dis 2021; 21:799. [PMID: 34380452 PMCID: PMC8355580 DOI: 10.1186/s12879-021-06449-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background The COVID-19 pandemic has elicited imposition of some form of travel restrictions by almost all countries in the world. Most restrictions currently persist, although some have been gradually eased. It remains unclear if the trade-off from the unprecedented disruption to air travel was well worth for pandemic containment. Method A comparative analysis was conducted on Singapore, Taiwan, Hong Kong and South Korea’s COVID-19 response. Data on COVID-19 cases, travel-related and community interventions, socio-economic profile were consolidated. Trends on imported and local cases were analyzed using computations of moving averages, rate of change, particularly in response to distinct waves of travel-related interventions due to the outbreak in China, South Korea, Iran & Italy, and Europe. Results South Korea’s travel restrictions were observed to be consistently more lagged in terms of timeliness and magnitude, with their first wave of travel restrictions on flights departing from China implemented 34 days after the outbreak in Wuhan, compared to 22–26 days taken by Singapore, Taiwan and Hong Kong. South Korea’s restrictions against all countries came after 91 days, compared to 78–80 days for the other three countries. The rate of change of imported cases fell by 1.08–1.43 across all four countries following the first wave of travel restrictions on departures from China, and by 0.22–0.52 in all countries except South Korea in the fifth wave against all international travellers. Delayed rate of change of local cases resulting from travel restrictions imposed by the four countries with intrinsic importation risk, were not observed. Conclusions Travel restriction was effective in preventing COVID-19 case importation in early outbreak phase, but may still be limited in preventing general local transmission. The impact of travel restrictions, regardless of promptness, in containing epidemics likely also depends on the effectiveness of local surveillance and non-pharmaceutical interventions concurrently implemented. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06449-1.
Collapse
Affiliation(s)
- Sylvia Xiao Wei Gwee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore.,Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, 117549, Singapore
| | - Pearleen Ee Yong Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore.,Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, 117549, Singapore
| | - Min Xian Wang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore.,Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, 117549, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, 117549, Singapore. .,Centre for Infectious Disease Epidemiology and Research, National University of Singapore, Singapore, 117549, Singapore.
| |
Collapse
|
43
|
Mwoka M, Biermann O, Ettman CK, Abdalla SM, Ambuko J, Pearson M, Rashid SF, Zeinali Z, Galea S, Valladares LM, Mberu B. Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission. J Urban Health 2021; 98:15-30. [PMID: 34480327 PMCID: PMC8415197 DOI: 10.1007/s11524-021-00557-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/31/2022]
Abstract
Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.
Collapse
Affiliation(s)
- Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Olivia Biermann
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Catherine K Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA. .,Department of Epidemiology, Boston University School of Public Health, Boston, USA.
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,OECD, Paris, France
| | - Sabina Faiz Rashid
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Brac James P Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
44
|
Dietary Soy Consumption and Cardiovascular Mortality among Chinese People with Type 2 Diabetes. Nutrients 2021; 13:nu13082513. [PMID: 34444673 PMCID: PMC8398979 DOI: 10.3390/nu13082513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Randomized controlled trials showed that soy intervention significantly improved blood lipids in people with diabetes. We sought to prospectively examine the association of soy consumption with the risk of cardiovascular death among individuals with diabetes. A total of 26,139 participants with a history of diabetes were selected from the Chinese Kadoorie Biobank study. Soy food consumption was assessed by a food frequency questionnaire. Causes of death were coded by the 10th International Classification of Diseases. The Cox proportional hazard regression was used to compute the hazard ratios. During a median follow-up of 7.8 years, a total of 1626 deaths from cardiovascular disease (CVD) were recorded. Compared with individuals who never consumed soy foods, the multivariable-adjusted risks (95% confidence intervals) of CVD mortality were 0.92 (0.78, 1.09), 0.89 (0.75, 1.05), and 0.77 (0.62, 0.96) for those who consumed soy foods monthly, 1–3 days/week, and ≥4 days/week, respectively. For cause-specific cardiovascular mortality, significant inverse associations were observed for coronary heart disease and acute myocardial infarction. Higher soy food consumption was associated with a lower risk of cardiovascular death, especially death from coronary heart disease and acute myocardial infarction, in Chinese adults with diabetes.
Collapse
|
45
|
Roohafza H, Feizi A, Gharipour M, Khani A, Dianatkhah M, Sarrafzadegan N, Sadeghi M. Development and validation of a socioeconomic status short-form questionnaire (SES-SQ). ARYA ATHEROSCLEROSIS 2021; 17:1-9. [PMID: 35685230 PMCID: PMC9137231 DOI: 10.22122/arya.v17i0.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/11/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Evaluation of socioeconomic status (SES) is an important aspect in community-based health studies and it is a major predictor of health and nutritional status as well as mortality and morbidity from many diseases. This study aimed to construct and validate socioeconomic status short-from questionnaire (SES-SQ) in Iranian population. METHODS This cross-sectional methodological study was conducted among 1437 Iranian general population. Face and content validity of the developed questionnaire was evaluated qualitatively. Internal consistency, construct validity using exploratory factor analysis (EFA) and latent class analysis (LCA), and convergent and known-group validity were also evaluated. RESULTS The SES-SQ consisted of 6 items. The overall Cronbach's alpha was 0.64, showing acceptable internal consistency. EFA resulted in two factors explaining 47.78% of total variance. Three SES classes (low/middle/high) were extracted by LCA. The score of SES-SQ ranged from 0 to 17; two cutoff scores of 4.5 and 8.5 were determined by receiver operating characteristic (ROC) analysis for differentiating low from middle and middle from high SES classes, respectively. CONCLUSION An efficient, reliable, and valid short-form questionnaire was developed for evaluating SES in Iranian general population. The relevancy of questionnaire items is not lost over time.
Collapse
Affiliation(s)
- Hamidreza Roohafza
- Associate Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Gharipour
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azam Khani
- Research Assistant, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Science, Isfahan, Iran
| | - Minoo Dianatkhah
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Sadeghi
- Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
46
|
Maree P, Hughes R, Radford J, Stankovich J, Van Dam PJ. Integrating patient complexity into health policy: a conceptual framework. AUST HEALTH REV 2021; 45:199-206. [PMID: 33208225 DOI: 10.1071/ah19290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/19/2020] [Indexed: 11/23/2022]
Abstract
Objective Clinicians across all health professions increasingly strive to add value to the care they deliver through the application of the central tenets of people-centred care (PCC), namely the 'right care', in the 'right place', at the 'right time' and 'tailored to the needs of communities'. This ideal is being hampered by a lack of a structured, evidence-based means to formulate policy and value the commissioning of services in an environment of increasing appreciation for the complex health needs of communities. This creates significant challenges for policy makers, commissioners and providers of health services. Communities face a complex intersection of challenges when engaging with healthcare. Increasingly, complexity is gaining prominence as a significant factor in the delivery of PCC. Based on the World Health Organization (WHO) components of health policy, this paper proposes a policy framework that enables policy makers, commissioners and providers of health care to integrate a model of complexity into policy, subsequent service planning and development of models of care. Methods The WHO components of health policy were used as the basis for the framework. Literature was drawn on to develop a policy framework that integrates complexity into health policy. Results Within the framework, complexity is juxtaposed between the WHO components of 'vision', 'priorities' and 'roles'. Conclusion This framework, supported by the literature, provides a means for policy makers and health planners to conduct analyses of and for policy. Further work is required to better model complexity in a manner that integrates consumer needs and provider capabilities. What is known about the topic? There is a growing body of evidence regarding patient complexity and its impact on the delivery of health services, but there is little consideration of patient complexity in policy, which is an important consideration for service provision. What does this paper add? This paper presents an argument for the inclusion of patient complexity in health policy and provides a framework for how that might occur. What are the implications for practitioners? The inclusion of patient complexity in policy could provide a means for policy makers to consider the factors that contribute to patient complexity in service provision decisions.
Collapse
Affiliation(s)
- Peter Maree
- Tasmanian School of Medicine, College of Health and Medicine University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia. ; ; and Department of Health, 22 Elizabeth Street, Hobart, Tas. 7000, Australia; and Corresponding author.
| | - Roger Hughes
- Tasmanian School of Medicine, College of Health and Medicine University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia. ;
| | - Jan Radford
- General Practice, Tasmanian School of Medicine, College of Health and Medicine University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia.
| | - Jim Stankovich
- Tasmanian School of Medicine, College of Health and Medicine University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia. ; ; and Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Vic. 3004, Australia.
| | - Pieter Jan Van Dam
- Tasmanian School of Medicine, College of Health and Medicine University of Tasmania, Private Bag 34, Hobart, Tas. 7001, Australia. ;
| |
Collapse
|
47
|
Zambelli Z, Halstead EJ, Fidalgo AR, Dimitriou D. Good Sleep Quality Improves the Relationship Between Pain and Depression Among Individuals With Chronic Pain. Front Psychol 2021; 12:668930. [PMID: 34025533 PMCID: PMC8138032 DOI: 10.3389/fpsyg.2021.668930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Individuals with chronic pain often experience co-existing sleep problems and depression-related states. Chronic pain, sleep problems, and depression interrelate, and have been shown to exacerbate one another, which negatively impacts quality of life. This study explored the relationships between pain severity, pain interference, sleep quality, and depression among individuals with chronic pain. Secondly, we tested whether sleep quality may moderate the relationship between pain and depression. A cross-sectional survey was completed by 1,059 adults with non-malignant chronic pain conditions (M age 43 years, 88% identified as women) and collected measures related to pain severity, pain interference, sleep quality, and depression. Multiple regression analyses found that pain severity, pain interference, and sleep quality are all significantly associated with depression. Secondly, moderated regression analyses revealed that sleep quality moderates the relationship between pain interference and depression among individuals with chronic pain such that good sleep quality attenuates the effect of pain interference on depression, and poor sleep quality amplifies the effect of pain interference on depression. These findings suggest that sleep quality may be a relevant therapeutic target for individuals with chronic pain and co-existing depression.
Collapse
Affiliation(s)
- Zoe Zambelli
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
| | - Elizabeth J. Halstead
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
| | - Antonio R. Fidalgo
- Department of Psychology, University of East London, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology and Human Development, University College London-Institute of Education, London, United Kingdom
| |
Collapse
|
48
|
Foo CD, Surendran S, Tam CH, Ho E, Matchar DB, Car J, Koh GCH. Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study. BMJ Open 2021; 11:e046010. [PMID: 33947737 PMCID: PMC8098912 DOI: 10.1136/bmjopen-2020-046010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN. DESIGN We conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved. SETTING Singapore. RESULTS Our results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a 'one-stop-shop', (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients' health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. CONCLUSION PCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population.
Collapse
Affiliation(s)
- Chuan De Foo
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Shilpa Surendran
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Chen Hee Tam
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - Elaine Ho
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| | - David Bruce Matchar
- Internal Medicine, Duke University, Durham, North Carolina, USA
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Gerald Choon Huat Koh
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University Singapore, Singapore
| |
Collapse
|
49
|
Ooi JWL, Leong GKW, Oh HC. The impact of common variables on non-attendance at a radiology centre in Singapore. Radiography (Lond) 2021; 27:854-860. [PMID: 33608204 DOI: 10.1016/j.radi.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With the increasing demand for medical imaging, non-attendance inhibits private and public radiology practices in Singapore from providing timely care and achieving maximal efficiency. Missed radiological appointments adversely affect clinical and economic outcomes and strain the finite healthcare resources. We examined the prevalence and predictors of patient non-attendance for radiological services at a regional public hospital in Singapore and compared them against other medical imaging centres globally. METHODS Outpatient records of patients who were scheduled for specialised medical imaging obtained from Radiological Information System (RIS) were retrospectively reviewed. Analysed variables include patient demographics, radiology modalities, visit statuses and appointment lead times where Pearson's chi-square test and Fisher's exact test were used for categorical variables, and independent sample t-test was used for continuous variables. The association between each patient characteristic and non-attendance status was assessed using Binary Logistics Regression. Variables that showed statistical significance in univariate analysis were included in the multivariate logistic regression model to identify the independent risk factors associated with non-attendance. RESULTS Among the 59,748 outpatient appointments with medical imaging requests, 15.5% did not turn up for their appointments. Logistic regression indicated that patient's age, ethnicity, subsidy status, house ownership, living vicinity to regional hospital cluster, appointment wait times, appointment hours and appointment months were significant factors associated with the failure to attend scheduled radiological examinations. CONCLUSION Even though predictors of non-attendance remained consistent across medical imaging centres worldwide, Singapore reported a higher prevalence of missed appointments calling for future exploratory studies to understand the population's health-seeking behaviours and ordering patterns of clinicians. IMPLICATIONS FOR PRACTICE Comparison and identification of these predictors will assist in the design of targeted interventions that may improve patient's adherence and utilisation of imaging services.
Collapse
Affiliation(s)
- J W L Ooi
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889.
| | - G K W Leong
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889.
| | - H C Oh
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889.
| |
Collapse
|
50
|
Patient Activation and its Predictors in Hospitalized Older Adults in Singapore. Geriatr Nurs 2021; 42:336-343. [PMID: 33556900 DOI: 10.1016/j.gerinurse.2021.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patient activation is critical in hospitalized older adults preparing for discharge as it enhances their ability to self-care at home. Little is known about how person-centred care and demographic predictors could influence activation in Asian patients. AIMS To explore patient activation and its predictors in hospitalized older adults in Singapore. METHODS Multi-centre cross-sectional survey of hospitalized older adults. Multivariable analysis conducted with age, gender, education, socioeconomic status, functional dependency and perception of person-centred care as potential predictors to patient activation. RESULTS 300 older adults were surveyed, 65% were at the top two levels of activation. Perception of person-centred nursing care was the strongest predictor with the largest effect on patient activation, (β=0.22, b=3.48, 95% CI:1.70-5.26, p<0.001). Other predictors were age, education, income and independence in care. CONCLUSION Our study highlights the importance of person-centred nursing care in raising patient activation in hospitalized older adults, enhancing their capacity to self-care.
Collapse
|