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"Health Services history Singapore."
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Reliability and validity of the English (Singapore) and Chinese (Singapore) versions of the Short-Form 36 version 2 in a multi-ethnic Urban Asian population in Singapore
Purpose We aimed to evaluate the measurement properties of the Singapore English and Chinese versions of the Short-Form 36 version 2 (SF-36v2) Questionnaire, an improved version of the widely used SF-36, for assessing health-related quality of life (HRQoL) in a multi-ethnic urban Asian population in Singapore. Methods SF-36v2 scores and data on medical history, demographic and lifestyle factors from the Singapore Prospective Study Programme were analyzed. Convergent and divergent validity, internal consistency, floor and ceiling effects, known group validity and factor structure of the SF-36v2 were assessed for the English and Chinese versions, respectively. Results Complete data for 4,917 participants (45.8 %) out of 10,747 eligible individuals were analyzed (survey language: 4,115 English and 802 Chinese). Item-scale correlations exceeded 0.4 for all items of the English SF-36v2 and for all except one item of the Chinese SF-36v2 (bathe and dress: item-scale correlation: 0.36). In the English SF-36v2, Cronbach's alpha exceeded 0.70 for all scales. In the Chinese SF-36v2, Cronbach's alpha exceeded 0.7 on all scales except social functioning (Cronbach's alpha: 0.68). For known groups validity, respondents with chronic medical conditions expectedly reported lower SF-36v2 score on most English and Chinese SF-36v2 scales. In confirmatory factor analysis, the Singapore three-component model was favored over the United States two-component and Japan three-component models. Conclusions The English and Chinese SF-36v2 are valid and reliable for assessing HRQoL among English and Chinese-speaking Singaporeans. Test–retest reliability and responsiveness of the English and Chinese SF-36v2 in Singapore remain to be evaluated.
Journal Article
Increasing airline travel may facilitate co-circulation of multiple dengue virus serotypes in Asia
The incidence of dengue has grown dramatically in recent decades worldwide, especially in Southeast Asia and the Americas with substantial transmission in 2014-2015. Yet the mechanisms underlying the spatio-temporal circulation of dengue virus (DENV) serotypes at large geographical scales remain elusive. Here we investigate the co-circulation in Asia of DENV serotypes 1-3 from 1956 to 2015, using a statistical framework that jointly estimates migration history and quantifies potential predictors of viral spatial diffusion, including socio-economic, air transportation and maritime mobility data. We find that the spread of DENV-1, -2 and -3 lineages in Asia is significantly associated with air traffic. Our analyses suggest the network centrality of air traffic hubs such as Thailand and India contribute to seeding dengue epidemics, whilst China, Cambodia, Indonesia, and Singapore may establish viral diffusion links with multiple countries in Asia. Phylogeographic reconstructions help to explain how growing air transportation networks could influence the dynamics of DENV circulation.
Journal Article
The Citizen as a Public Health Actor: Complaints as Public Engagement with Aedes Mosquito Control in Singapore, 1965–1985
In 1986, the World Health Organization heralded Singapore as a model for the control of dengue fever, a viral disease spread by the Aedes aegypti mosquito. Between 1965 and 1985, public health officials successfully employed educational campaigns and mandatory home inspections to convince citizens to guard against mosquito breeding at home. Although this story appears to recapitulate standard narratives of top-down progress in Singapore, this paper argues that the significant role of the public in public health has been overlooked. Citizens complained frequently, sometimes publicly, to public health authorities and often compelled direct responses from them. Through these complaints, citizens modified official anti-mosquito measures and expanded the reach of public health. Public health in Singapore thus appears not simply as the imposition of an autonomous state’s vision onto a docile or even resistant citizenry but as a coevolution of the state and the public.
Journal Article
Does financial subsidy equalise cancer genetic testing uptake across socioeconomic groups? A retrospective observational study in Singapore
ObjectiveTo examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.DesignRetrospective cohort study.SettingTertiary care cancer genetics service in Singapore.ParticipantsThe study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.Primary and secondary outcome measuresThe primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.ResultsReceipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.ConclusionsFinancial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.
Journal Article
Increasing the accessibility to colorectal cancer screening in the community via faecal immunochemical test kits dispensed via automated kiosk
Colorectal cancer (CRC) screening uptake was low in Singapore. An automated kiosk (KIPFIT) dispensing Faecal Immunochemical Test (FIT) kits was developed to facilitate CRC screening. A prospective observational study leveraged on case-encounter approach to recruit community-dwelling adults aged 50–85 years. They were guided to collect two FIT kits from the kiosk on passing by a local multi-purpose mall. The study aimed to determine their CRC screening uptake by returning minimally one completed kit within two months after its collection. Data on their demographics, awareness, and prior screening history, and kiosk usability (as measured by the System Usability Scale SUS) were analysed using bivariate tests, followed by logistic regression for CRC screening completion and linear regression for SUS scores. Among the 350 participants (mean age 66.1 years; 57.4% female; 91.4% Chinese), 68.9% completed CRC screening, which was associated with Chinese ethnicity (AOR = 3.13, 95%CI = 1.42–6.90) and awareness of screening (AOR = 2.18, 95%CI = 1.10–4.33). Benchmarked at 68, the mean SUS score was 57.7, with lower scores in older and lower-educated participants. Guided use of the KIPFIT kiosk had increased CRC screening uptake. Further research is needed to assess its utility without assistance and its effects on CRC screening in real-world setting.
Journal Article
Dietary cholesterol, fats and risk of Parkinson's disease in the Singapore Chinese Health Study
BackgroundProspective studies on lipids and risk of Parkinson's disease (PD) in Asian populations are sparse. This study prospectively examined the associations between dietary cholesterol and major fatty acids, and risk of PD among the Chinese in Singapore.MethodsThis study used data from the Singapore Chinese Health Study, a population-based prospective cohort of 63 257 men and women aged 45–74 years in Singapore enrolled in 1993–1998. Dietary intakes of cholesterol and fatty acids were derived from a validated semiquantitative food frequency questionnaire and the Singapore Food Composition Table. Incident PD cases were identified either through follow-up interviews or record linkage analysis with hospital discharge and PD outpatient registries.ResultsAfter an average of 14.6 years, 218 men and 193 women in the cohort developed PD. Dietary cholesterol was associated with statistically significantly lower risk of PD in a dose–dependent manner among men after adjustment for established risk factors for PD and intakes of major fatty acids. Compared to the lowest quartile, HR (95% CI) for the highest quartile was 0.53 (95% CI 0.33 to 0.84) (P for trend=0.006). Among women, dietary monounsaturated fatty acid was inversely associated with PD risk (P for trend=0.033). Compared to the lowest quartile, HR for the highest quartile was 0.44 (95% CI 0.22 to 0.88). There was no statistically significant association between dietary saturated, n-3 and n-6 fatty acids and PD risk.ConclusionsHigher intakes of cholesterol and monounsaturated fatty acids may reduce risk of PD in men and women, respectively.
Journal Article
Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: A qualitative study
Background End‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. Objective This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. Design Qualitative study design using semi‐structured interviews. Setting and participants Twenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. Results While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. Discussion and conclusion This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.
Journal Article
Two distinct healthcare utilisation trajectories prior to a COPD diagnosis in a multi-ethnic Asian population: a comparison of transient and chronic users
IntroductionChronic obstructive pulmonary disease (COPD) imposes substantial clinical and economic burdens. Early detection can allow for monitoring and timely treatment to slow its progression. Tracking of patient trajectories prior to their diagnosis can inform the timing and targeting of interventions. We aimed to identify pre-diagnosis healthcare utilisation patterns in a COPD cohort and profile the associated subgroups.MethodsWe conducted a retrospective cohort study of patients with a new inpatient or specialist outpatient clinic (SOC) diagnosis of COPD from 2018 to 2019 in a regional health system in Singapore. Their healthcare utilisation, expenditure and diagnoses from the 3 years prior to diagnosis were extracted. Patients were classified into subgroups with different expenditure and utilisation patterns using Bayesian mixture modelling and compared against a propensity score–matched non-respiratory control group.Results1171 patients with COPD were matched to a control and classified as either chronic (n=688) or transient healthcare users (n=483) prior to a first COPD diagnosis. Chronic users had increasing utilisation over time across all settings, recording multiple SOC visits (median, 25th–75th percentile: 10, 5–20). Transient users had low utilisation throughout, reporting fewer SOC visits than controls (transient: 0, 0–1, control: 2, 0–9). The prevalence of hypertension or hyperlipidaemia was >50% in chronic users, >30% in controls and <30% in transient users.ConclusionEarly detection strategies should focus on case-finding among patients with known risk factors in SOCs for referral to respiratory care and outreach to socially disadvantaged communities to facilitate timely access to healthcare.
Journal Article
The burden of costs on health services from patients with venous leg ulcers in Singapore
Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost‐related outcomes. Retrospective patient‐level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S $). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$ 7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.
Journal Article