Population In Singapore Research Articles

Patterns of patients with multiple chronic conditions in primary care: A cross-sectional study.

ObjectiveOur aim was to identify the patterns of multimorbidity among a group of patients who visited primary care in Singapore.MethodsA cross-sectional study of electronic medical records was conducted on 437,849 individuals aged 0–99 years who visited National Healthcare Group Polyclinics from 1 Jul 2015 to 30 Jun 2016 for the management of chronic conditions. Patients’ health conditions were coded with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and patient records were extracted for analysis. Patients’ diagnosis codes were grouped by exploratory factor analysis (EFA), and patterns of multimorbidity were then identified by latent class analysis (LCA).ResultsEFA identified 19 groups of chronic conditions. Patients with at least three chronic conditions were further separated into eight classes based on demographics and probabilities of various diagnoses. We found that older patients had higher probabilities of comorbid hypertension, kidney disease and ischaemic heart disease (IHD), while younger patients had a higher probability of comorbid obesity. Female patients had higher probabilities of comorbid arthritis and anaemia, while male patients had higher probabilities of comorbid kidney diseases and IHD. Indian patients presented with a higher probability of comorbid diabetes than Chinese and Malay patients.ConclusionsThis study demonstrated that patients with multimorbidity in primary care could be classified into eight patterns. This knowledge could be useful for more precise management of these patients in the multiethnic Asian population of Singapore. Programmes for early intervention for at-risk groups can be developed based on the findings.

The continuing march of Common Green Iguanas: arrival on mainland Asia

The popularity of the Common Green Iguana (Iguana iguana) as a pet has contributed to its global occurrence as an invasive alien species. Early detection and control of alien I. iguana populations is necessary to prevent the need for large and financially demanding eradication actions. Here, we first collated information from digital footage and interviews regarding sightings of free roaming I. iguana specimens in Singapore and Thailand. We use this information to report and discuss an ongoing invasion with early stage establishment being facilitated by release of pets and escape from recreational parks, as well as the resulting conservation implications. Using species-distribution modeling to assess the potential distribution in Southeast Asia, we identify large regions with suitable habitat that could aid the expansion of these alien populations in the absence of future control measures. In addition, given the availability of suitable habitat throughout the Philippine archipelago and its high number of imported iguanas and within-country trade, we call for awareness of future alien I. iguana populations in the Philippines. Next, the alien population in Singapore is of additional concern given that the excellent swimming capacity of I. iguana allows it to reach neighboring Sumatra and > 3,000 islands of the Indonesian Riau archipelago. Finally, we report I. iguana sightings in Hong Kong and Peninsular Malaysia. We provide strategy recommendations for implementing mitigation efforts and to halt future release and spread in order to prevent negative biodiversity impacts associated with a large invasive alien I. iguana population.

Gravitrap deployment for adult Aedes aegypti surveillance and its impact on dengue cases

House Index, Container Index, and Breteau Index are the most commonly used indices for dengue vector surveillance. However, these larval indices are a poor proxy for measuring the adult population—which is responsible for disease transmission. Information on the adult distribution and density are important for assessing transmission risk as well as for developing effective control strategies. This study introduces a new entomological index, Gravitrap aegypti index (GAI), which estimates the adult female Aedes aegypti population in the community and presents its association with dengue cases. Gravitraps were deployed across 34 treatment sites in Singapore from September 2013 to September 2016. The GAI, derived from the Gravitrap surveillance data, was analysed to investigate the spatio-temporal patterns of the Ae. aegypti population in Singapore. The index was further categorised into low, moderate, and high-risk groups and its association with dengue cases were examined. A Before-After Control Impact analysis was performed to evaluate the epidemiology impact of Gravitrap system on dengue transmission. The Ae. aegypti population exhibits a seasonal pattern, and spatial heterogeneity in Ae. aegypti abundance was observed among treatment sites. The Ae. aegypti population was also found to be unevenly distributed among floors of an apartment block, with low floors (floors 1–4) having a higher abundance of mosquitoes trapped than mid (floors 5–8) and high (floors ≥9) floors. Areas with high GAI were shown to have higher dengue case count. Gravitrap has also demonstrated to be a good dengue control tool. The contribution of cases by treatment sites to the national numbers was lower after Gravitraps deployment. The GAI, which is of better relevance to dengue transmission risk, could be recommended as an indicator for decision making in vector control efforts, and to monitor the spatio-temporal variability of the adult Aedes population in the country. In addition, findings from this study indicate that Gravitraps can be used as a dengue control tool to reduce dengue transmission.

The gradual release exit strategy after lockdown against COVID-19

The gradual release exit strategy after lockdown against COVID-19

Modelling lockdown and exit strategies for COVID-19 in Singapore

BackgroundWith at least 94 countries undergoing or exiting lockdowns for contact suppression to control the COVID-19 outbreak, sustainable and public health-driven exit strategies are required. Here we explore the impact of lockdown and exit strategies in Singapore for immediate planning. MethodsWe use an agent-based model to examine the impacts of epidemic control over 480 days. A limited control baseline of case isolation and household member quarantining is used. We measure the impact of lockdown duration and start date on final infection attack sizes. We then apply a 3-month gradual exit strategy, immediately re-opening schools and easing workplace distancing measures, and compare this to long-term social distancing measures. FindingsAt baseline, we estimated 815 400 total infections (21.6% of the population). Early lockdown at 5 weeks with no exit strategy averted 18 500 (2.27% of baseline averted), 21 300 (2.61%) and 22 400 (2.75%) infections for 6, 8 and 9-week lockdown durations. Using the exit strategy averted a corresponding 114 700, 121 700 and 126 000 total cases, representing 12.07–13.06% of the total epidemic size under baseline. This diminishes to 9 900–11 300 for a late 8-week start time. Long-term social distancing at 6 and 8-week durations are viable but less effective. InterpretationGradual release exit strategies are critical to maintain epidemic suppression under a new normal. We present final infection attack sizes assuming the ongoing importation of cases, which require preparation for a potential second epidemic wave due to ongoing epidemics elsewhere. FundingSingapore Ministry of Health, Singapore Population Health Improvement Centre.

Cost-Effectiveness of Transcatheter Aortic Valve Implantation in Intermediate and Low Risk Severe Aortic Stenosis Patients in Singapore

Singapore has the world's second most efficient healthcare system while costing less than 5% GDP. It remains unclear whether transcatheter aortic valve implantation (TAVI) is cost-effective for treating intermediate-low risk severe aortic stenosis (AS) patients in a highly efficient healthcare system. A two-phase economic model combining decision tree and Markov model was developed to assess the costs, effectiveness, and the incremental cost-effectiveness ratio (ICER) of transfemoral (TF) TAVI versus surgical aortic valve replacement (SAVR) in intermediate-low risk patients over an 8-year time horizon. Mortality and complications rates were based on PARTNER 2 trial cohort A and Singapore life table. Costs were mainly retrieved from Singapore National University Health System database. Health utility data were obtained from Singapore population based on the EuroQol-5D (EQ-5D). A variety of sensitivity analyses were conducted. In base case scenario, the incremental effectiveness of TF-TAVI versus SAVR was 0.19 QALYs. The ICER of TF-TAVI was S$33,833/QALY. When time horizon was reduced to 5 years, the ICER was S$60,825/QALY; when event rates from the propensity analysis was used, the ICER was S$21,732/QALY and S$44,598/QALY over 8-year and 5-year time horizons, respectively. At a willingness to pay threshold of S$73,167/QALY, TF-TAVI had a 98.19% probability of being cost-effective after 100,000 simulations. The model was the most sensitive to the costs of TF-TAVI procedure. TF-TAVI is a highly cost-effective option compared to SAVR for intermediate-low risk severe AS patients from a Singapore healthcare system perspective. Increased procedure experience, reduction in device cost, and technology advance may have further increased the cost-effectiveness of TF-TAVI per scenario analysis.

Supporting Seniors: How Low-Income Elderly Individuals Respond to a Retirement Support Program

Longer life expectancy and insufficient savings expose individuals to financial vulnerability in older ages and prompt government support measures. We study a government cash subsidy program for the low-income elderly population in Singapore. Using comprehensive, high-frequency transaction data, we estimate a marginal propensity to consume (MPC) out of the subsidies of 0.7. More liquidity-constrained recipients exhibit a higher MPC of 1. They also increase their spending immediately after recurring subsidies. We find no evidence of labor supply reduction or other strategic behaviors. We discuss implications for eligibility criteria, payment frequency, and distribution form in policy design.

Well-being and needs of Malay carers of people with mental illness in Singapore.

Despite the importance of carers supporting the lives of people with mental illness, there are limited studies investigating the well-being and needs of Malay carers in multicultural Singapore. The Malays consist of 13.4% of Singapore's population. A mixed methods qualitative dominant research approach was used to explore the well-being and needs of Malay carers in a voluntary welfare organisation. The Kessler-10, Friendship Scale and Carers' and Users' Expectations of Services-Carer version were used to assess the needs and well-being of 17 Malay carers. Findings show that Malay carers experienced poor well-being and had numerous unmet needs. Four main themes were found: (a) Concerns related to relatives with mental illness, (b) Mental health practices related to carers, (c) Holistic support for carers and (d) Preference for greater spiritual support in mental health. Recovery-oriented mental health practice implications are discussed. Spirituality of Malay carers needs to be given greater consideration in recovery-oriented mental health services.

The incidence of squamous cell carcinoma of the oral tongue is rising in young non-smoking women: An international multi-institutional analysis.

Increasing evidence is accumulating for an alarming rising incidence of oral tongue SCC in a younger cohort, particularly in developed countries. The aim of this study is to analyse the change in incidence of OSCC in patients under the age of 45 in developed nations in the Asia-Pacific region. Population data was extracted from the Australian Cancer Incidence and Mortality 2017 database and National Registry of Diseases Office, Singapore to allow calculation of the incidence in the Australian and Singaporean populations. This was compared to multi-institutional data from four tertiary Australian institutions. The inclusion criteria were as follows: a) diagnosis of primary SCC of the mobile tongue; b) treatment with curative intent; c) complete histopathologic data; d) complete adjuvant treatment data; e) follow up data. Analysis of ACIM data demonstrated that there was a significant increase in the incidence of tongue SCC in those under the age of 45 in the Australian and Singaporean populations (p<0.001). When analysed for gender, the incidence of tongue SCC increased at a significantly higher rate in females than males (p<0.001). Similarly, in the multi-institutional analysis including 1814 patients, the number of females under the age of 45 with tongue SCC significantly increased over time (p<0.001), with the proportion of smokers in this cohort decreasing over time. The incidence of tongue SCC is rising in young females in developed nations in the Asia Pacific region, in keeping with observed epidemiological trends worldwide.

Factors associated with health-related quality of life in a working population in Singapore.

OBJECTIVESThis study aimed to evaluate the determinants of health-related quality of life (HRQoL) among workers in Singapore.METHODSWe analysed data from a cross-sectional study of 464 participants from 4 companies in Singapore. Physical and mental components of HRQoL were assessed using the Short-Form 36 version 2.0 survey. A generalized linear model was used to determine factors associated with the physical component summary (PCS) and mental component summary (MCS) scores of HRQoL.RESULTSThe overall mean PCS and MCS scores were mean±standard deviation 51.6±6.7 and 50.2±7.7, respectively. The scores for subscales ranged from 62.7±14.7 for vitality to 83.5±20.0 for role limitation due to emotional problems. Ethnicity, overweight/obesity, and years working at the company were significantly associated with physical HRQoL, and age and stress at work were significantly associated with mental HRQoL. Moreover, sleep quality was significantly associated with both physical and mental HRQoL.CONCLUSIONSThese findings could help workplaces in planning strategies and initiatives for employees to maintain a worklife balance that encompasses their physical, emotional, and social well-being.

Impact of seasonal influenza on polyclinic attendances for upper respiratory tract infections in Singapore.

PurposeThe burden of influenza on primary health-care services is not well established in tropical countries, where there are no clearly defined influenza seasons. We aimed to estimate the association between influenza infection activity and polyclinic attendance rates for upper respiratory tract infections (URTIs) in the Singapore population.MethodsWe used generalized additive time series models to estimate the association between the proportion of respiratory tests positive for influenza infection in Singapore reported to the World Health Organization every week, and the population rate of polyclinic attendances in Singapore for physician-diagnosed URTI, which includes influenza-like illness (ILI), for six years from 2012 through 2017. Where data were available, we controlled for other infections that can cause fever or respiratory symptoms.ResultsInfluenza, dengue fever and chickenpox (varicella) were positively associated with acute URTI polyclinic attendances. The estimated URTI polyclinic attendance rates attributable to influenza, dengue fever and chickenpox were 618.9 (95% confidence interval [CI]: 501.6–736.3), 153.3 (95% CI: 16.5–290.2) and 1751.5 (95% CI: 1246.3–2256.8) per 100 000 population per year, respectively.ConclusionInfluenza poses a considerable burden on primary health-care services in Singapore. However, a substantial number of polyclinic attendances due to febrile infections such as dengue fever and chickenpox appear to be recorded as URTI in the polyclinic database. These associations require further investigation.

Belonging, Citizenship and Ambivalence among Young Gay, Bisexual and Queer Indian Singaporean Men

ABSTRACT This article explores the attitudes and experiences of young ethnic Indian gay, bisexual and queer (GBQ) men in Singapore, where the state’s investments in economic progress, racial governmentality and “traditional” family policies significantly influence sexual and cultural citizenship. Based on abductively analysed in-depth interviews conducted on a subset of a larger qualitative study involving Singaporean lesbian, gay, bisexual and queer young adults, this article uses the concept of sociological ambivalence – which attends to the tensions between social structures and participants’ lives – to understand everyday experiences at the intersections of ethnicity, sexuality, gender and youth status. Three themes were identified from participants’ experiences: significant feelings of racialised liminality and marginality; tensions between personal desires and family pressures to get married and have children; and strategies taken in response to complex marginality. While participants were broadly satisfied with the material aspects of life in Singapore, their responses signal significant frustration with societal and sexual racism, a deeply ambivalent sense of belonging, and the desire for emigration to mitigate conflicting responsibilities to themselves and their families. By examining belonging and citizenship through the lens of sociological ambivalence, this article makes a theoretical and empirical contribution towards limited knowledge about the experiences of marginalised populations in Singapore.

Differentiation of Asian population samples using the Illumina ForenSeq kit

The Kidd set of ancestry informative SNPs are included in Illumina’s ForenSeq DNA Signature Kit. We had previously reported on the capability of these SNPs together with some phenotypic SNPs with ancestry informative properties in differentiating individuals from the Chinese, Malay and Indian populations in Singapore.The Singapore population is primarily made up of Chinese, Malays and Indians, with individuals from other Asian countries making up the rest. In this study, we evaluated the ancestry prediction capabilities of the ForenSeq kit in 484 unrelated individuals of self-declared Bangladeshi, Burmese, Filipino, Indonesian and Vietnamese origin. 750 Chinese, Malay and Indian individuals previously reported were included in this study. 48 ancestry SNPs and 12 phenotypic SNPs with ancestry informative properties were selected for analyses. Ancestry modelling in STRUCTURE showed that the eight tested populations could be better classified as five. Principal component analysis also showed that the eight populations clustered in five groups based on general geographic location within Asia; with Chinese clustering with Vietnamese, Malays clustering with Indonesians, Indians clustering with Bangladeshi, and the Burmese and Filipino populations clustering in-between and overlapping with the Chinese and Malay populations. The 60 SNPs analysed could account for only 23 % of the variation between the populations. The lack of distinction between the populations resulted in poor (43 % correct self-classification) cross-validation using Snipper. While this was improved by merging the co-clustering populations into five groups (East, South-East, South Asian, Burmese & Filipino), successful self-classification was still relatively low (69 %).While the 60 tested ancestry informative markers were able to differentiate between individuals of East, South-East and South Asian origin, they are not sufficiently informative to effectively discriminate between Chinese, Malays and Indians, and Bangladeshi, Burmese, Filipino, Indonesian and Filipino populations in the country.

Association Between Macronutrient Intakes and Sleep Quality in Middle-Aged and Older Population in Singapore

Abstract Objectives Quality sleep is essential to health and poor sleep may increase the risk of obesity and type 2 diabetes. Previous studies have reported that macronutrient intakes, such as dietary protein, may be associated with sleep quality. However research, on this relationship in older adults who often exhibit poorer sleep quality is still limited. Therefore, the objective of this research is to assess the association between macronutrient intakes and sleep quality in middle-aged and older population in Singapore. Methods In this cross-sectional study, 104 men and women (59 ± 6 years) were recruited within Singapore. Their food intakes and sleep quality were assessed using 3-day food records and Pittsburg Sleep Quality Index questionnaire, respectively. In addition, plasma amino acid concentration was measured from the collected blood samples. The relationship between diet, plasma amino acids and sleep quality were evaluated using multiple linear regression and adjusted for age, BMI and gender. Results From this study, no association were observed between total energy intake (%E) from protein and tryptophan (Trp) intakes and sleep quality parameters. However, %E from fat was positively associated with sleep efficiency (SE%) (β-coefficient = 19.6, P = 0.02). A similar positive association with SE% was also observed for mono- and poly-unsaturated fatty acids. In contrast, %E from carbohydrate was inversely associated with SE% (β-coefficient = −21.2, P = 0.03). Sugar intake was also inversely associated with sleep quality parameters. Although plasma Trp concentration was not associated with sleep quality parameters, Trp and large neutral amino acids concentration ratio was inversely associated with sleep duration (β-coefficient = −19.2, P = 0.02). Conclusions In conclusion, consuming a diet with a higher energy from fat and lower energy from carbohydrate may improve sleep quality in Singapore middle-aged and older adults. The type of fat and carbohydrate consumed may also affect sleep quality. Funding Sources This research study is funded by the National University of Singapore (Grant number: R-143–000-A03–133).

Skin Carotenoid Status Is a Potential Surrogate Marker for Cardiovascular Disease Risk Determination in Middle-Aged and Older Adults

Abstract Objectives The study aimed to examine the associations between skin carotenoid status and plasma carotenoids with classical cardiovascular disease (CVD) risk factors among a middle-aged and older Singaporean population. It was hypothesized that skin carotenoid status and plasma carotenoids could be used as an indicator for CVD risk. Methods This cross-sectional study recruited 45 men and 59 women, aged 50 to 75 years, from a community in Singapore (n = 104). Dietary information was obtained using 3-day food records, skin carotenoid status was measured using resonance Raman spectroscopy and plasma carotenoids were analyzed with high-performance liquid chromatography. CVD risk was determined using classical risk factors including blood pressure (BP), serum lipid-lipoprotein concentrations, as well as overall CVD risk predictors such as the number of metabolic syndrome components and a 10-year CVD risk prediction using the Framingham Heart Study risk score calculator. Results Multiple linear regression with covariate adjustments indicated that skin carotenoid status and plasma carotenoids were inversely associated with systolic BP (skin: standardized regression coefficient (β) = −0.341, P &amp;lt; 0.001; plasma: β = −0.258, P &amp;lt; 0.05), diastolic BP (skin: β = −0.378, P &amp;lt; 0.001; plasma: β = −0.309, P &amp;lt; 0.005) as well as both the number of metabolic syndrome components (skin: β = −0.383, P &amp;lt; 0.001; plasma: β = −0.434, P &amp;lt; 0.001) and the 10-year CVD risk prediction (skin: β = −0.347, P &amp;lt; 0.001; plasma: β = −0.334, P &amp;lt; 0.001). The associations between skin carotenoid status with metabolic syndrome and the 10-year CVD risk were null with the inclusion of plasma carotenoids as a covariate which suggested its role as a mediator. Despite the positive linear association between skin carotenoid status and dietary carotenoids intake (Pearson's coefficient: 0.204, P &amp;lt; 0.001), dietary carotenoids were not directly correlated with the CVD risk factors analyzed. Conclusions Skin carotenoid status can function not only as a dietary biomarker, but also, as a potential surrogate marker for CVD risk in middle-aged and older Singaporeans. Funding Sources National University of Singapore Ministry of Education, Singapore Agency for Science, Technology and Research (Singapore).

Hematological malignancies in the adolescent and young adult (AYA) population in Singapore.

e13630 Background: Hematological malignancies is thought to be one of the more common Adolescent and Young Adult (AYA) cancers and constitute leukemias and lymphomas. However, little is known about its incidence and prevalence in Asia. We also do not have any data on its behavior or its prognosticators. The outcomes of this group of patients is also unknown when compared to the pediatrics or geriatrics, but is expected to be not as ideal. There is no consensus on whether this group of patients should be treated as pediatrics or as the older adults. We have sought to evaluate the prevalence and trends in a single large-volume tertiary cancer centre in Asia. Methods: We extracted data on all patients with cancer between 16-39 years old who were seen at our centre (National Cancer Centre Singapore) during the period of 1st January 2015 and 31st December 2019. In total, we had 2583 patients. We then excluded all other cancer types except those with a hematological malignancy and 5 other patients due to incomplete data. Results: There were 319 patients with a hematological malignancy. 153 (48%) were female and 166 were male(52%). Most of the patients presented between 30-39 years old (171, 53.6%). There were 54 (2.1%) leukemias and 265 (83.1%) lymphomas. Of those with leukemias, 46 (85.2%) had acute leukemia and 9 (14.8%) had chronic leukemias. Among the lymphoma patients, there were 194 (73.2%) Non Hodgkin Lymphoma (NHL) patients and 69 (26.0%) Hodgkin Lymphoma (HL) patients. There were 149 (46.7%) B Cell lymphomas and 38 (11.9%) T Cell lymphoma patients. The most common B cell Lymphomas is Diffuse Large B Cell Lymphoma (128, 85.9%) and the most common T Cell Lymphomas is Peripheral T-cell Lymphoma (28, 73.7% patients). Conclusions: AYAs with a hematological malignancy form a significant portion of the cancers we see in this age group. Yet, little information is available with regards to their clinico-pathological characteristics, especially in Asia. Work is underway to further elucidate these differences so that we can better their outcomes.

S155. DIETARY PATTERNS AND OBESITY IN INDIVIDUALS WITH SCHIZOPHRENIA

BackgroundIt is well established that individuals with schizophrenia, compared to the general population, have reduced lifespan of up to 20–25 years. High mortality rates in schizophrenia is mainly attributed to physical illnesses which include cardiovascular diseases and diabetes. Obesity is a major risk factor for these diseases and is highly prevalent in the schizophrenia population. Although the mechanisms underlying weight gain in schizophrenia is unclear, it is generally accepted that the high obesity rate is a result of various factors which include metabolic effects of antipsychotic treatment, inadequate physical activity and unhealthy diets. This study aimed to (i) examine dietary practices of individuals with schizophrenia in comparison to the general population and (ii) to examine dietary practice correlates with Body Mass Index (BMI) classification of overweight/obese.MethodsA sample of 107 community-dwelling individuals with schizophrenia were enrolled in this cross-sectional study. Height and weight were taken, and BMI was calculated. A 24-hour food recall which allows derivation of nutritional information, and the Dietary Practices Questionnaire (DPQ) which examines dietary habits, were administered based on participants’ usual diet. Dietary information was compared against the general Singapore population based on the National Nutrition Survey 2010 and the National Health Survey 2010. Logistic regression was performed to study the relationship between dietary practice and BMI status; the model was adjusted for age, gender, antipsychotic medication and energy intake.ResultsNutritional information reported by participants showed that the total daily energy (1895.3kcal ± 684), macronutrient intake (protein: 68.6g ± 35, carbohydrate: 251.8g ± 104.8 and total fat: 67.5g ± 31.8) and dietary fibre intake (16.1g ± 9.0) was lower than both the recommended Singapore guidelines and intake of the general population. In terms of dietary habits, participants were often eating out and frequented fast food places as much as the general population, and do not usually skip breakfast. The proportion of participants who do not consume sweet desserts (32.7% vs 14.9%) and deep-fried food (21.5% vs 9.6%) were higher than the general population, however the proportion of individuals reporting no intake of sweetened drinks was higher in the latter (20.6% vs 54.6%). The proportion of overweight/obese participants (Male: 70%, Female: 66%) was about twice that of the general population (Male:46.6%, Female: 33.8%). Based on the dietary habits explored, participants who did not consume deep-fried food were less likely to be overweight/obese compared to those who do (OR: 0.3, 95% CI:0.09–0.82, p=0.02).DiscussionDespite potential inaccuracies due to recall or social desirability bias, the results seem to suggest that individuals with schizophrenia were below the recommended energy intake; their nutritional intake and dietary habits were either similar or lower/poorer than the recommended guidelines or the general population. Consumption of deep-fried food was the only dietary habit identified as a potential factor towards overweight/obesity. Despite this, the rate of overweight/obese individuals with schizophrenia were high. As overweight/obesity is the result of imbalance between energy intake and expenditure, future research should explore other lifestyle factors such as physical activity, in addition to dietary practices.

How Is Climate Change Knowledge Distributed among the Population in Singapore? A Demographic Analysis of Actual Knowledge and Illusory Knowledge

Due to the crucial role of knowledge in promoting public engagement with climate change, this study made an in-depths examination of the distribution of climate change knowledge among different demographic groups. Guided by information deficit model and cognitive miser model, two types of knowledge were investigated, including actual knowledge and illusory knowledge. Using a nationally representative survey in Singapore, this study found demographic effects in climate change knowledge distribution. Specifically, a series of independent sample t-test revealed that the males had more actual knowledge of climate change than the females. The middle aged and elderly adults had less actual knowledge but more illusory knowledge of climate change than the young adults. Compare to the more educated people, the less educated people had more illusory knowledge but less actual knowledge of climate change. People from low-income households reported lower levels of actual knowledge but higher levels of illusory knowledge than those from high-income households. Regarding these significant differences in climate change knowledge among different demographic groups, possible reasons for these variations and implications for designing public education programs are discussed.

Refractive outcomes, corneal haze and endothelial cell loss after myopic photorefractive keratectomy in an Asian population: The Singapore Armed Forces' experience.

This study reports outcomes of myopic photorefractive keratectomy (PRK) in a mainly ethnic Chinese population in Singapore. To assess the incidence and associations of corneal haze and endothelial cell count (ECC) loss up to 12 months after PRK. This was a retrospective case series conducted in a tertiary eye centre. A total of 158 patients (309 eyes) with a mean age of 22.1 ± 3.4 years were included. The majority was Chinese (97.4%) and male (97.4%). Mean preoperative spherical equivalent was -3.33 ± 1.15 D. Eyes were categorized based on postoperative haze severity. A multivariate analysis adjusting for age and use of intraoperative mitomycin-C (MMC), preoperative sphere and cylinder was performed. Refractive outcomes and corneal haze 3 and 12 months after PRK were assessed. ECC measurements were obtained before PRK and at variable periods postoperatively. At 12 months, overall efficacy index was 0.98, and safety index was 1.09. Eight (2.5%) eyes underwent enhancement surgery. An analysis was performed on 295 eyes that did not undergo enhancement and had complete clinical data, which demonstrated a decrease in the incidence of haze from 38.2% at 3 months to 9.3% at 12 months. Higher myopia was associated with increased haze severity at 3 months (OR, 1.36; P = .005). Higher astigmatism was associated with increased haze severity at 3 (OR, 1.65; P = .018) and 12 months (OR, 2.32; P = .015). Intraoperative MMC was not associated with haze severity or ECC loss. Myopia and astigmatism were associated with increased corneal haze severity. Intraoperative MMC did not accelerate ECC loss. Overall, PRK is effective, predictable and safe in Asian eyes.

Development and preliminary evaluation of a brief epistemic beliefs instrument

This study was conducted to develop and validate a brief instrument to measure the epistemic beliefs of Singaporean polytechnic students. The Brief Epistemic Beliefs Instrument (BEBI) comprised 12 items, organized in four subscales: Malleable Ability (MA), Need for Effort (NE), Fallible Authority (FA) and Evolving Knowledge (EK). The instrument was completed by both groups of students within the research. An Exploratory Factor Analysis (EFA) was used to explore the latent structure of the BEBI on data from polytechnic A, while a Confirmatory Factor Analysis (CFA) was used on data from polytechnic B. While the EFA indicated a three-factor structure for the instrument (in which the factor Fallible Authority – FA – failed to emerge), the CFA confirmed the original four-factor model proposed. Cronbach alphas also indicated moderately high levels of internal consistency for the four subscales. These results suggested the internal structure of the instrument to be sound for use within the Singapore population cohort, although the factor structure of the instrument did appear to differ somewhat across samples.