Adult Population In Singapore Research Articles

Establishment of CA19-9 reference intervals in an apparently healthy adult population in Singapore.

CA19-9 is elevated in pancreatic cancer and other malignancies, and commonly used in clinical practice. Unfortunately, CA19-9 immunoassays are not harmonized, and reference intervals may differ between assays. The aim of this study was to establish the reference interval of the ADVIA Centaur/Atellica IM CA19-9 assay in an apparently healthy Singapore adult population. This is a retrospective cross-sectional study. De-identified data from Health Screening participants were extracted from our database. Subjects with biochemical results suggesting anaemia, diabetes mellitus, viral hepatitis or abnormal liver, and renal and tumour markers were excluded. Outlier and subclass analyses by age and sex were performed. CA19-9 reference limits and 90% confidence intervals were then determined for candidate subclasses. Data from 12,174 subjects (5846 males and 6328 females) were available after exclusion criteria were applied. CA19-9 results did not follow a normal distribution and were higher in females compared to males (P < .001). Although CA19-9 means were statistically different between certain age groups, the evaluable 99th percentile reference limits were not statistically different. The overall 99th percentile reference limits for the Centaur/Atellica CA19-9 assay was 37 U/mL for males 21-80years, and 60U/mL for females 21-80years. Our results suggest that separate CA19-9 reference intervals should be applied for males and females.

Chronic low back pain and its impact on physical function, mental health, and health-related quality of life: a cross-sectional study in Singapore

Chronic low back pain, defined as low back pain lasting more than 3 months, is a globally prevalent health problem with significantly high medical and economic burden on individuals and the society. This study aimed to estimate the prevalence of chronic low back pain and examine its association with health outcomes including physical function, mental health, and quality of life among adult population in Singapore. Cross-sectional secondary data analysis was performed using baseline data of the 1941 adults (mean age: 52.6 years, range: 21–97 years) from a representative population health survey conducted in the Central region of Singapore. Those with self-reported chronic low back pain in past six months were identified. The Late-Life Function and Disability Instrument, Patient Health Questionnaire-9, and EQ-5D-5L were used to measure physical function and limitation, mental health, and health-related quality of life, respectively. Generalized Linear Regressions were used to examine the association of chronic low back pain with physical function, limitation, depressive symptoms, and health-related quality of life. There were 8.1% (n = 180) participants reporting having chronic low back pain in past six months, among whom 80.5% sought treatments at either primary care, specialist outpatient, or Traditional Chinese Medicine clinics. Individuals with chronic low back pain reported poorer physical function, more limitations in performing major life tasks and social activities, more depressive symptoms, and lower health-related quality of life (all p < 0.01), even after adjusting for socio-demographics, lifestyle factors, and number of morbidities. The prevalence of chronic low back pain was 8.1% among the study population. Chronic low back pain was associated with poorer physical function, more limitations and depressive symptoms, and lower health-related quality of life. The findings highlight the significant impact of chronic low back pain on physical function and limitation, mental health, and health-related quality of life in a general population. Increased awareness on prevention, early and proper management of low back pain, and rehabilitation policies are required to better tackle the burden of low back pain at the population level.

Psychosis in youth in Singapore: a case series

ObjectiveIn this report, we present a case series of children with psychotic symptoms referred to a child consultation liaison psychiatric service within a tertiary paediatric hospital in Singapore. The purpose of this case series is to identify common symptoms at presentation, review the current practices in our hospital for investigation and treatment of first episode psychosis and short-term outcomes.Case reportWe identified 9 cases over a 1 year period, for which 7 were seen whilst admitted to hospital and 2 in the outpatient clinic. There were 6 females and 5 males ranging in age from 11 to 16 years old. The commonest symptoms on presentation were perceptual disturbance (88%) most commonly auditory hallucinations and altered behaviour (55%). Of the 7 children admitted to hospital, all were seen by the neurology team prior to the request for a psychiatric opinion. All admitted patients had blood and radiological investigations carried out. Most of the children were started on a short course of antipsychotic medication with the majority continuing to attend follow-up outpatient.DiscussionOnly 9 cases were identified in this case series over a 1 year period highlighting that psychosis is not a common presentation in the paediatric population. From the history alone, it can be challenging to distinguish between primary and secondary causes of psychosis. Acute onset of symptoms and the presence of other neurological signs should raise the suspicion of an underlying organic cause. Out of 9 cases, only 1 case was treated for a presumed organic aetiology, which is consistent with findings from other authors who only found underlying organic factors in 12.5% of cases.In this case series, we also noted that 45% of cases reported having symptoms for over 1 year before seeking help. This is also seen in the adult population in Singapore. Stigma, denial and lack of information about psychosis may all contribute to delay in seeking help. Although prolonged duration of untreated psychosis has been shown to be associated with poor long-term outcome, we found in our case series that even patients who reported a long duration of symptoms still responded well to medication.ConclusionThere is room for collaboration with our neurology colleagues in the approach towards children with first presentation of psychosis, both in terms of investigations and management. Identifying reasons for disengagement from psychiatric care is an area for further investigations to improve outcomes in our patients.

Accuracy of self-reported height, weight and BMI in a multiethnic Asian population

The study assessed whether self-reported height, weight and derived body mass index (BMI) can provide an accurate measure of anthropometric data in a multiethnic adult population in Singapore. Standardised anthropometric measurements were compared against the self-reported values from 5,132 adult residents in a cross-sectional, epidemiological survey. Discrepancies in self-reports from measurements were examined by comparing overall mean differences. Intraclass correlations, Cohen's kappa and Bland-Altman plots with limits of agreement, and sub-analysis by sex and ethnicity were also explored. Data were obtained from 5,132 respondents. The mean age of respondents was 43.9 years. Overall, the height was overestimated (0.2cm), while there was an underestimation of weight (0.8kg) and derived BMI (0.4kg/m2). Women had a larger discrepancy in height (0.35cm, 95% confidence interval [CI] 0.22 to 0.49), weight (-0.95kg, 95% CI -1.11 to -0.79) and BMI (-0.49kg/m2, 95% CI -0.57 to -0.41) compared with men. Height reporting bias was highest among Indians (0.28cm, 95% CI 0.12 to 0.44) compared with Chinese and Malays, while weight (-1.32kg, 95% CI -1.53 to -1.11) and derived BMI (-0.57kg/m2, 95% CI -0.67 to -0.47) showed higher degrees of underreporting among Malays compared with Chinese and Indians. Substantially high self-reported versus measured values were obtained for intraclass correlations (0.96-0.99, P<0.001) and kappa (0.74). For BMI categories, good to excellent kappa agreement was observed (0.68-0.81, P<0.0001). Self-reported anthropometric estimates can be used, particularly in large epidemiological studies. However, sufficient care is needed when evaluating data from Indians, Malays and women as there is likely an underestimation of obesity prevalence.

Normative data for the 10/66 dementia research group neuropsychological test battery from Singapore's older adult population.

Cognitive impairment in older adults is a major public concern for Singapore's aging population. The study aimed to (1) examine the effects of age, gender, and education on neuropsychological test performance, and (2) establish regression-based norms in the Singapore older adult (≥ 60 years) population. Data on neuropsychological test performance was extracted from the Well-being of the Singapore Elderly (WiSE) study (n = 2033). Participants who met criteria for dementia were excluded. The data included scores from the 10/66 Dementia Research Group neuropsychological test battery measuring verbal fluency, immediate memory recall, delayed memory recall, and global cognitive function. The General Linear Model (GLM) was used to examine the effects of age, gender, and education on neuropsychological test performance. Stratified weighted means and standard deviations by age, gender and education were reported to establish regression-based normative data. Results from GLM showed that older age and having lower education were associated with poorer performance on all four neuropsychological test measures, and females showed better performance on the tests for immediate memory recall and delayed memory recall. The current study provides useful information on cognitive functioning based on the 10/66 neuropsychological test battery in the older adult population in Singapore. This may help to improve neuropsychological assessments for older adults.

Genetic diversity of respiratory enteroviruses and rhinoviruses in febrile adults, Singapore, 2007-2013.

To understand the genetic diversity and patterns of circulation of rhinoviruses (RV) and enteroviruses (EV) in Singapore, we retrospectively screened 2950 nasal swab samples collected from adults presenting to primary care services with signs of febrile illness in Singapore during 2007‐2013 using sequencing and phylogenetic methods. Through sequencing and phylogenetic analysis, our results show the year‐round circulation of the three rhinovirus species, A, B, and C. A diverse set of RV/EV serotypes were detected in Singapore with a predominance of RV‐A in all years, whereas serotypes EV‐C A21 and EV‐D68 were only sporadically detected. This study highlights the previously unrecognized diversity and burden in the adult population in Singapore.

Exploring Singapore\u2019s consumption of local fish, vegetables and fruits, meat and problematic alcohol use as risk factors of depression and subsyndromal depression in older adults

BackgroundDepression is a chronic mental disorder that severely impacts the older adult population globally. Nutritional psychiatry is an approach that has gained traction over the years. Exploring locally relevant consumption of common types of fish, vegetables and fruits (V&F), meat and problematic alcohol use (PAU) as risk factors associated with depression and subsyndromal depression (SSD) could reveal modifiable factors that could be targeted in the local older adult population in Singapore.MethodsData collected from the Well-being of the Singapore Elderly (WiSE) study, a cross-sectional population-based epidemiological study of Singapore’s older adult population was analysed for the purposes of this study. Two thousand five hundred sixty-five participants were recruited and comprised of Singapore citizens and permanent residents aged ≥60 years. Data on fish, meat, and V&F consumption were collected using the sociodemographic and risk factor questionnaire. The CAGE (Cut, Annoyed, Guilt, and Eye-opener) questionnaire was used to determine PAU. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) was used to obtain participants’ diagnosis of depression or SSD. A multinomial logistic regression was used to explore the relationship between depression and dietary factors.ResultsConsumption of V&F in the last 3 days was less likely to be associated with depression and SSD. Frequent consumption of specific species of fish was associated with depression and SSD. PAU and the frequent consumption of Himantura gerrardi (stingray) were more likely to be associated with SSD. Finally, meat consumption was more likely to be associated with depression and SSD.ConclusionsThe preliminary findings of the study support a need for healthy eating for the older adult population in Singapore. Further directions include a more thorough health and nutrition survey to capture accurate diets among the older adults in Singapore.

Prevalence and correlates of traumatic brain injury (TBI) in older adults: results from the Well-being of the Singapore Elderly (WiSE) study.

Older adults are among the most susceptible to sustain traumatic brain injury (TBI). The study aimed to determine the (1) prevalence of TBI among older adults in Singapore, and (2) socio-demographic, lifestyle, and clinical correlates of TBI. Data were extracted from the cross-sectional, Well-being of the Singapore Elderly (WiSE) study. The study included 2,565 participants aged 60 years and above (Mean = 72.75, SD = 9.54). Information on TBI, socio-demographic, and lifestyle factors were collected using participant self-report and verified with the informant report where necessary. Disability was measured using the World Health Organization - Disability Assessment Schedule 2.0 (WHO-DAS 2.0). Data were analyzed using logistic regression analysis. The prevalence of TBI was 3.6%. Being female (vs. male) was found to be associated with decreased odds of having TBI. Having completed secondary education or lower (vs. tertiary education) was found to be associated with increased odds of having TBI. A history of fainting and diabetes were associated with the presence of TBI. Those with TBI were associated with higher disability scores on the WHO-DAS 2.0 than those without TBI. The current study provides information on the prevalence and associated factors of TBI in the older adult population in Singapore. Since TBI was associated with older adults with diabetes, they must be cautioned about fall risk. Also, given the association with disability, older adults with TBI are likely to require support and rehabilitative care to ensure good quality of life.

Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study

BackgroundOrthostatic hypotension (OH) is commonly reported among older adults and is associated with an increased risk of mortality. This study aimed to describe the prevalence and investigate the possible associations between OH with sociodemographic variables, chronic medical conditions, health service utilisation, dementia and cognitive status among older adults residing in Singapore. MethodsData was collected from 2266 participants aged 60 years and older who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Face-to-face interviews were conducted and data collected includes sociodemographic information, blood pressure measurements, medical history, health services utilisation, and cognitive status. ResultsThe prevalence of OH among older adults in Singapore was 7.8%. OH was highest in participants aged 85 years and above (OR: 2.33; 1.26–4.30; p=0.007) compared to those aged 75–84 years (OR: 1.76; 1.08-2.85; p=0.023). Participants with hypertension were more likely to have OH (OR: 3.03; 1.56–5.88, p=0.001) than those without hypertension. Those with dementia were also more likely to have OH than those with normal cognitive status (p=0.007). ConclusionsOlder age, hypertension, and dementia were independently associated with OH in the older adult population in Singapore. Interventions such as home safety assessment and preventive measures should be implemented to improve older adult’s functional capacity and quality of life to prevent injury.

Head circumference, leg length and its association with dementia among older adult population in Singapore.

Head circumference and leg length serve as reliable proxy indicators of early-life environment. Research studies have shown that these anthropometric measurements are associated with cognitive impairment and dementia among older adults. The aim of the present study was to assess the associations between dementia with head circumference and leg length among the older adult population in Singapore. This study also aimed to examine the sociodemographic correlates of these anthropometric measurements. Data were collected from 2565 older adults aged 60 years and above, in a population study on the Well-being of the Singapore Elderly. Head circumference and leg length measurements were obtained, and sociodemographic information was recorded. Dementia diagnosis was made using the 10/66 dementia algorithm. Anthropometric measurements were first stratified into quarters, and then logistic regression analysis was used to examine factors associated with head circumference and leg length, as well as to examine the association between dementia with these measurements. Sociodemographic correlates of head circumference and leg length include age, gender, ethnicity and education level. Smaller head circumference was independently associated with higher odds of 10/66 dementia (OR = 2.173-2.709). When the regression analysis was stratified by gender, the association was found only in the male sample. Leg length was not significantly associated with dementia after controlling for sociodemographic variables. Smaller head circumference is independently associated with dementia among older adults in Singapore. Findings from this study suggest that risk factors for dementia begin their influence in early life. Copyright © 2017 John Wiley & Sons, Ltd.

Prevalence and characteristics of adverse drug reactions at admission to hospital: a prospective observational study.

AimsAdverse drug reactions (ADRs) contribute to poorer patient outcomes and additional burden to the healthcare system. However, data on the true burden, relevant types and drugs causing ADRs are lacking. The aim of this study was to determine the prevalence of ADR‐related hospitalization in the general adult population in Singapore and to investigate their characteristics.MethodsWe prospectively recruited 1000 adult patients with unplanned admission to a large tertiary‐care hospital. Two independent reviewers evaluated all suspected ADRs for causality, type, severity and avoidability. The prevalence of ADR‐related hospitalization was calculated based on ‘definite’ and ‘probable’ ADRs. Logistic regression was used to evaluate predictors for having an ADR at admission.ResultsThe prevalence of all ADRs at admission was 12.4% (95% CI: 10.5–14.6%) and ADRs causing admission was 8.1% (95% CI: 6.5–10.0%). The most common ADRs were gastrointestinal‐related. The most common drug category causing ADRs were cardiovascular drugs. Patients with ADRs had a longer length of stay than those who did not (median 4 vs. 3 days, P = 1.70 × 10−3). About 30% of ADRs at admission were caused by at least one drug with a clinical annotation in the Pharmacogenomics KnowledgeBase (PharmGKB), suggesting that some of these ADRs may have been predicted by pharmacogenetic testing.ConclusionsWe have quantified the burden and characteristics of clinically impactful ADRs in the Singaporean general adult population. Our results will provide vital information for efforts in reducing ADRs through targeted vigilance, patient education and pharmacogenomics in Singapore.

Association of Grip Strength, Upper Arm Circumference, and Waist Circumference with Dementia in Older Adults of the WiSE Study: A Cross-Sectional Analysis.

We examined the associations of handgrip strength, upper arm circumference, and waist circumference with dementia among Singapore older adults. Cross-sectional epidemiological study. Residential homes, day care centres, nursing homes and institutions. 2,565 men and women aged 60 years and above who participated in the Well-being of the Singapore Elderly (WiSE) study in 2013. Socio-demographic correlates, dietary habits, health behaviours, grip strength, upper arm circumference, and waist circumference were collected. Grip strength was measured using a hand dynamometer with the dominant hand. Upper arm circumference was measured using a measuring tape around the thickest part of the upper arm while waist circumference measured in centimetres was measured at the narrowest part of the body between the chest and hips for women, and measured at the level of the umbilicus for men. Dementia was diagnosed using the 10/66 dementia diagnostic criteria. Mean grip strength was 13.07 kg (SE=0.60) for people with dementia and 21.98 kg (SE=0.26) for people without dementia. After adjusting for all factors, grip strength remained significantly associated with dementia (p <0.0001). Upper arm circumference was associated with dementia (p <0.0001) but this association was only significant in the univariate analysis. Waist circumference was not significantly associated with dementia. Lower grip strength was independently associated with dementia in the older adult population in Singapore. Further research needs to be done to ascertain whether this association exists for specific types of dementia and look into the relationship of other anthropometric measurements with dementia in Singapore.

Dengue seroprevalence of healthy adults in Singapore: serosurvey among blood donors, 2009.

Routine national notifications of dengue cases typically do not reflect the true dengue situation due to large proportion of unreported cases. Serosurveys, when conducted periodically, could shed light on the true dengue infections in the population. To determine the magnitude of dengue infections of the adult population in Singapore following the outbreak in 2007, we performed a cross-sectional study on blood donor samples from December 2009 to February 2010. The residual blood of 3,995 donors (aged 16–60 years) was screened for the presence of dengue-specific immunoglobulin G (IgG) and IgM using enzyme-linked immunosorbent assay (ELISA) kits. The age-weighted IgG prevalence of residents was 50.8% (N = 3,627, 95% confidence interval [CI] = 49.4–52.3%). Dengue IgG prevalence increased with age, with the lowest in 16–20 years age group (16.1%) and the highest in 56–60 years age group (86.6%). Plaque reduction neutralization test (PRNT) on samples of young resident adults (aged 16–30 years) revealed lower prevalence of neutralizing antibodies to each serotype, ranging from 5.4% to 20.3% compared with the older age groups. The level of exposure to dengue among the young adults is relatively low despite the endemicity of the disease in Singapore. It partially explains the population’s susceptibility to explosive outbreaks and the high incidence rate among young adults.

Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) as predictors of cardiovascular disease in an adult population in Singapore

Comparison of body mass index (BMI), body adiposity index (BAI), waist circumference (WC), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) as predictors of cardiovascular disease in an adult population in Singapore

Seroepidemiology of hepatitis B virus infection among adults in Singapore: A 12-year review

We undertook a national hepatitis B seroprevalence study to assess the seroprevalence of hepatitis B virus (HBV) markers in the adult population in Singapore in 2010 and make comparisons with the seroprevalence in 1998 and 2004. The study involved residual sera from national health surveys conducted every six years since 1998. The tests for HBV markers were carried out using commercial chemiluminescent microparticle immunoassay. In 2010, the prevalence of hepatitis B surface antigen (HBsAg) among 3293 Singapore residents aged 18–79 years was 3.6% (95% confidence interval [CI] 2.9–4.2%). Hepatitis B e antigen (HBeAg) was detected in 4.2% of those who were HBsAg positive. About 22.5% (95% CI 21.1–23.9%) were positive for antibody to hepatitis B core antigen (anti-HBc). The overall population immunity to HBV, as determined by antibody to hepatitis B surface antigen (anti-HBs)≥10mIU/mL, was 43.9% (95% CI 42.2–45.6%). Among young adults below 30 years of age, HBsAg prevalence (1.1%) was half that in 1998 and 2004, and in those positive for HBsAg, none was positive for HBeAg in 2010, compared to 20.8% in 1998 and 15.8% in 2004. In this age group, anti-HBc prevalence also decreased significantly from 22.1% in 2004 to 4.4% in 2010, while anti-HBs (≥10mIU/mL) prevalence increased significantly from 27.9% in 1998 to 43.3% in 2010 (p<0.001). The national childhood HBV immunisation and catch-up programmes implemented in 1987 and 2001–2004, respectively, had a significant impact in reducing HBV infection and in raising the immunity of the adult population 18–29 years of age.

Prevalence and Associations of Excessive Daytime Sleepiness in an Asian Multiethnic Adult Population

Objectives: Investigate the prevalence and associations of excessive daytime sleepiness (EDS) in a multi-ethnic Asian adult population in Singapore. Methods: A cross-sectional study was conducted in an urban town using an interviewer-administered questionnaire in 2008. 1003 subjects over 40 years of age were selected after randomization. EDS was assessed using the Epworth Sleepiness Scale. A score of 10-12 indicated mild-moderate EDS; a score greater than 12 indicated severe EDS. Information on lifestyle, socio-economic conditions and medical comorbidities were collected. Results: The prevalence of EDS was 21.43%. Increased risk of EDS was associated with larger housing types, Prevalence Ratio (PR) 2.21 (95% CI 1.73-2.82); clinical depression, PR 1.95 (95% confidence interval [CI] 1.07-3.59); monthly household income higher than US$4846 (S$6000), PR 1.79 (95% CI 1.27-2.05); desk-bound vocations, PR 1.77 (95% CI 1.39-2.25); younger age (40-49 years old), PR 1.67 (95% CI 1.23-2.26); alcohol consumption, PR 1.62 (95% CI 1.23-2.14); employment, PR 1.61 (95% CI 1.27-2.05); working night shift, PR 1.60 (95% CI 1.09-2.36); tertiary education, PR 1.50 (95% CI 1.15-1.93); male gender, PR 1.49 (95% CI 1.13-1.95); and presence of 2 or more symptoms of depression PR 1.39 (95% CI 1.00-1.93). Conclusions: The prevalence of EDS is comparable to the levels in the United States. EDS was associated with socioeconomic, lifestyle factors, depression, and depressive symptoms. Ethnicity, body-mass-index, and waist circumference were not found to be significant.

Prevalence and Causes of Low Vision and Blindness in an Urban Malay Population

To describe the prevalence and causes of low vision and blindness in a Malay population. A population-based, cross-sectional study of 3280 participants of Malay ethnicity, aged 40 to 79 years, was conducted. Participants underwent standardized ophthalmic assessments to determine (1) presenting and best-corrected visual acuity according to US and modified World Health Organization definitions of blindness and low vision and (2) the primary causes of visual impairment. Of 4168 eligible individuals, 3280 participated in the study (78.7%). The population-weighted prevalence of bilateral blindness was 0.3% and of bilateral low vision, 4.4% (US definition of presenting visual acuity). After best-corrected visual acuity, the population-weighted prevalence of bilateral blindness was reduced to 0.1% and bilateral low vision to 1.0%. Cataract was the main cause of presenting unilateral (38.9%) and bilateral (65.2%) blindness, whereas undercorrected refractive error was the main cause of presenting unilateral (68.8%) and bilateral (52.2%) low vision. Diabetic retinopathy, age-related macular degeneration, and glaucoma were the other leading causes of blindness and low vision. The age-standardized prevalences of bilateral blindness and low vision in a Malay population were lower when compared with other Asian studies. Undercorrected refractive error and cataract are the leading causes of visual impairment among the Malay adult population in Singapore.

Serological evidence for the co-circulation of multiple dengue virus serotypes in Singapore

We did a seroepidemiological study to determine the circulating dengue virus serotypes and the extent to which the Singapore population has been exposed to multiple dengue virus serotypes, using the plaque reduction neutralization assay (PRNT). Of 164 enrolled subjects aged between 18-30 years, 49 subjects (29.8%) were PRNT positive for at least one dengue serotype. The seroprevalence was 39 (23.8%) for dengue virus serotype 1, 37 (22.6%) for type 2, 43 (26.2%) for type 3, and 30 (18.3%) for type 4. Of the 49 subjects with PRNT-positive dengue virus results, 28 (57.1%) were positive to all four virus serotypes, seven (14.3%) to three serotypes, two (4%) to two serotypes, and 12 (24.5%) to a single serotype. All four dengue virus serotypes circulate in Singapore, and a substantial proportion of the adult population in Singapore had exposure to more than one dengue virus serotype. In spite of multiple circulating types, the rate of dengue haemorrhagic fever is low in Singapore.