Adult Resident Population Research Articles

Exploring COVID-19 Vaccination Willingness in Italy: A Focus on Resident Foreigners and Italians Using Data from PASSI and PASSI d'Argento Surveillance Systems.

(1) The COVID-19 pandemic exacerbated health disparities, both between foreign and autochthonous populations. Italy was one of the European countries that was the most affected by the COVID-19 pandemic; however, only limited data are available on vaccine willingness. This study aims to assess the propensity of foreign and autochthonous populations residing in Italy to be vaccinated and the relative associated factors. (2) Data were collected and analysed from the two Italian surveillance systems, PASSI and PASSI d'Argento, in the period of August 2020-December 2021. The data include those of the Italian resident adult population over 18 years old. A multinomial logistic regression model, stratified by citizenship, was used to assess the associations of sociodemographic, health, and COVID-19 experience variables with vaccination attitudes. (3) This study encompassed 19,681 eligible subjects. Considering the willingness to be vaccinated, foreign residents were significantly less certain to get vaccinated (49.4% vs. 60.7% among Italians). Sociodemographic characteristics, economic difficulties, and trust in local health units emerged as factors that were significantly associated with vaccine acceptance. Having received the seasonal flu vaccine was identified as a predictor of COVID-19 vaccine acceptance among foreign and Italian residents. (4) This study underscores the significance of tailoring interventions to address vaccine hesitancy based on the diverse characteristics of foreign and Italian residents. This research offers practical insights for public health strategies, highlighting the importance of tailored educational campaigns, improved communication, and nuanced interventions to enhance vaccine acceptance and uptake within both populations.

Perceptions of Leprosy in the Maldives: A cross-sectional study

The aim of the study is to assess the knowledge, attitude and practices regarding leprosy. A cross sectional survey of a nationally representative sample was implemented among the resident adult population (18 years and above) across the islands of Maldives. The survey sample size estimated was 1181 and a total of 1024 respondents completed the survey accounting for a response rate of 86.7%. The questions to measure indicators of knowledge, attitude and practices regarding leprosy were adopted from existing validated instruments used for leprosy KAP studies. The findings show a low level of knowledge with a mean of 3.5 in the KAP measure, where the maximum score is eight. However, the attitude and practices score does not indicate a high level of negative attitudes and practices (below the mid-point). The mean score of EMIC-CSS is 12, slight inclination towards less negative attitudes (EMIC-CSS scale scores ranges from zero = no negative attitudes, to 30 = most negative attitudes). The mean score of SDS is 8.9 indicating moderate level of negative practices (SDS scale scores ranges from zero = no negative practices to 21 = most negative practices). As Leprosy in the Maldives is no longer a public health burden, and the disease prevalence is extremely low, it has created a situation where there is very little awareness and correct knowledge about the disease among the public as well as health care workers. The attitudes and practices from the family and community are not at alarming levels in terms of stigma and social distancing. However, the low level of knowledge raises the concern that cases may be missed and as patients may be missed as they may not seek healthcare for early diagnosis and treatment

A natural experiment to assess how urban interventions in lower socioeconomic areas influence health behaviors: the UrbASanté study

BackgroundMechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach.MethodsThe study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference–in-differences method).DiscussionRelying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies.Trial registrationThis research was registered at the ClinicalTrial.gov (NCT05743257).

Evaluating the response effort and data quality of established political solidarity measures: a pre-registered experimental test in an online survey of the German adult resident population in 2021.

This experimental study aims to check and improve the quality of 16 established survey measures of political solidarities and related concepts, such as redistribution and social trust. Political solidarities are defined as one's willingness to share the costs that result from public redistribution that favours people other than oneself and thus constitute a subset of welfare state attitudes. The pre-registered study plan included suggestions for the development of improved rating scales, which we defined as five-point, end verbalized rating scales without non-substantive answer options. The overall results from an experimental online survey in Germany indicate differences in response effort in terms of response times but almost no differences in data quality in terms of criterion validity. Thus, the 16 survey measures show solid instrument validity as well as minor improvements in respondents' response times. Indeed, the measures are (at least) in the online survey world of Germany of high-quality and warrant inclusion in future surveys with small efficiency gains still attainable.

P06-10 To what extent is active mobility practiced by adults in Italy?

BackgroundWalking or cycling regularly instead of using motorised vehicles returns benefits not only to our health but also to the environment: in Europe, during 2020 a spotlight has also been put on the importance of accessibility to zero-emission transport, for promoting an inclusive framework that involves everyone. Policies in favour of a diffused active mobility in the general population encourage also to take steps effectively in order to achieve the longer-term goal of a European continent that is carbon-neutral.MethodsIn the Italian Behavioural Risk Factor Surveillance System PASSI, active mobility identifies both adults (aged 18-69) who cycle or walk to go to work or to school or for their usual commuting and those who, thanks to this habit, reach out recommended levels of physical activity to gain health benefits. Basing on their own active mobility levels, people are classified in: physically active (they reach out at least 150 minutes per week by walking or cycling for usual commuting, in bouts of at least 10 minutes); partially active (they use bicycle and/or walk usually, but not till 150 minutes weekly); non-active (they do not practise any active mobility or they do for little time duration).ResultsPASSI data 2016-2019 show that 44% among adults residing in Italy has practised active mobility by cycling (11%) and/or walking (41%) for usual commuting. They do in average for 4-5 days per week: people who cycle and those who walk sum up an average of, respectively, 144 and 181 minutes weekly. In the North, active mobility is experienced more than in the other parts of the Country. Active mobility definitively contributes to reach out recommended levels of physical activity that ensure health benefits and, in Italy, 21% of the resident adult population results to be physically active just thanks to this healthy lifestyle.ConclusionsWalking or cycling for urban commuting, at least for 150 minutes per week in bouts of 10 minutes each, can help to meet the recommendations for physical activity by the WHO, without counting movement in spare time or at work.

High Human T-Cell Leukemia Virus Type 1c Proviral Loads Are Associated With Diabetes and Chronic Kidney Disease: Results of a Cross-Sectional Community Survey in Central Australia.

A link between chronic inflammation and several noncommunicable diseases (NCDs) has been established. Although chronic infection with the human T-cell leukemia virus type 1 (HTLV-1) is the recognized cause of several inflammatory diseases and these are associated with a high number of HTLV-1-infected cells in peripheral blood (proviral load [PVL]), possible interactions between PVL and NCDs have not been studied at a community level. Adult Aboriginal residents of 7 remote communities were invited to complete a health survey between 25 August 2014 and 30 June 2018. Blood was drawn for HTLV-1 serology and PVL, and relevant medical conditions were obtained from health records. Associations between HTLV-1 PVL and diabetes, chronic kidney disease (CKD), and coronary artery disease (CAD) were determined using logistic regression, adjusting for available confounders. Among 510 participants (56% of the estimated adult resident population, 922), 197 (38.6%) were HTLV-1-infected. A high HTLV-1 PVL was associated with a 2-fold increase in the odds of diabetes and CKD (diabetes, adjusted odds ratio [aOR], 1.95; 95% confidence interval [CI], 1.06-3.61; P = .033 and CKD: aOR, 2.00; 95% CI, 1.03-3.8; P = .041). A nonsignificant association between high PVL and CAD (aOR, 7.08; 95% CI, 1.00-50.18; P = .05) was found for participants aged <50 years at the time of angiography. In a community-based study in central Australia, people with HTLV-1 who had high HTLV-1 PVL were more likely to have diabetes and CKD. These findings have potential clinical implications.

The European Health Literacy Survey 2019 of M-POHL: a summary of its main results

Abstract Background The HLS-EU study in 2011 demonstrated that there exists limited comprehensive health literacy (HL) for considerable proportions of the general population, that there is a social gradient for HL and that limited HL has problematic consequences for healthy lifestyles, self-reported health and utilization of health care services. But distributions and associations of HL differed considerably between the 8 included EU-countries. WHO-Europe initiated the Acton Network on Measuring Population and Organizational Health Literacy (M-POHL) to measure HL regularly, starting with the Health Literacy Survey 2019 (HLS19). Methods Based on the design and instrument of the HLS-EU, an improved core questionnaire was developed for HLS19 to measure comprehensive HL and its relevant correlates. Optional packages introduced specific instruments and measured digital, communication, navigation and vaccination HL and its most relevant correlates. Cross-sectional data were collected by probability samples of at least 1.000 respondents per country for the general population 18+, in 17 member states of the WHO-Europe region, by personal interviews, telephone interviews, or internet surveys. Results Considerable proportions of resident adult populations in participating countries have limited HL and there is a social gradient for HL. HL also has, but to a differing degree, consequences for selected life-style indicators, indicators for self-reported health and use of professional health care services. General trends were found, but also considerable variation by country. Conclusions Results demonstrated that main trends of the HLS-EU study concerning HL hold still true for HLS19 and that there are even more pronounced differences between participating countries. Since HL is relevant for health policy in all countries, policy recommendations for improving HL in the European region were drafted by the HLS19 consortium and will be presented in the second presentation.

Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study

Nutritional psychiatry is an emerging field of study that investigates the role of diet and nutrition in mental health. Studies conducted in the general population have linked depressive symptoms with poor dietary patterns. The aim of this study was to characterise the dietary intake and analyse the dietary pattern using the Dietary Approach to Stop Hypertension (DASH) in a sample of psychiatric patients in a multiethnic Asian nation. Participants were recruited from an outpatient clinic and an inpatient unit at the Institute of Mental Health in Singapore. Self-reported dietary habits of a sample of psychiatric patients (N=380) were analysed using DASH. To examine the variables associated with DASH scores, a linear regression was conducted with the full sample and sociodemographic variables. Persons with depressive disorders had a mean DASH score of 21.3 (±4.2), while persons with psychotic disorders had a mean DASH score of 21.2 (±4.9). Respondents who were older (B=1.94, 95% confidence interval [CI] 0.91-2.96, P<0.001), female (B=1.09, 95% CI 0.07-2.11, P=0.04) and economically inactive (B=1.98, 95% CI 0.006-3.96, P=0.049) were more likely to report a higher diet quality compared with their respective counterparts, while smokers (B= -1.39, 95% CI -2.45 to -0.34, P=0.009) tended to report a lower diet quality compared with their non-smoking counterparts. Dietary patterns of persons with mental disorders were characterised. A host of sociodemographic factors, and not diagnosis of mental disorders, influenced the dietary quality of people with depressive and psychotic disorders. Clinicians treating psychiatric patients need to be aware of the nuanced reasons behind poor dietary choices and provide targeted psychoeducation to specific subgroups within the patient population.

Medición y análisis de la vulnerabilidad a la exclusión social en España (2004-2009)

With the information supplied by the Survey of Living Conditions for each of the years of the 2004-2009, we realize a study of vulnerability to social exclusion of the adult resident population in Spain. Using the techniques of factor analysis we identify key factors that generate social exclusion in Spain each year and we identify vulnerable individuals. With analysis cluster, we obtain the profile of these individuals based on different variables. In addition, the risk has been estimated to the social exclusion for several social groups, using different indicators

Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England

SummaryBackgroundAntidepressants, opioids for non-cancer pain, gabapentinoids (gabapentin and pregabalin), benzodiazepines, and Z-drugs (zopiclone, zaleplon, and zolpidem) are commonly prescribed medicine classes associated with a risk of dependence or withdrawal. We aimed to review the evidence for these harms and estimate the prevalence of dispensed prescriptions, their geographical distribution, and duration of continuous receipt using all patient-linked prescription data in England.MethodsThis was a mixed-methods public health review, comprising a rapid evidence assessment of articles (Jan 1, 2008, to Oct 3, 2018; with searches of MEDLINE, Embase, and PsycINFO, and the Cochrane and King's Fund libraries), an open call-for-evidence on patient experience and service evaluations, and a retrospective, patient-linked analysis of the National Health Service (NHS) Business Services Authority prescription database (April 1, 2015, to March 30, 2018) for all adults aged 18 years and over. Indirectly (sex and age) standardised rates (ISRs) were computed for all 195 NHS Clinical Commissioning Groups in England, containing 7821 general practices for the geographical analysis. We used publicly available mid-year (June 30) data on the resident adult population and investigated deprivation using the English Indices of Multiple Deprivation (IMD) quintiles (quintile 1 least deprived, quintile 5 most deprived), with each patient assigned to the IMD quintile score of their general practitioner's practice for each year. Statistical modelling (adjusted incident rate ratios [IRRs]) of the number of patients who had a prescription dispensed for each medicine class, and the number of patients in receipt of a prescription for at least 12 months, was done by sex, age group, and IMD quintile.Findings77 articles on the five medicine classes were identified from the literature search and call-for-evidence. 17 randomised placebo-controlled trials (6729 participants) reported antidepressant-associated withdrawal symptoms. Almost all studies were rated of very low, low, or moderate quality. The focus of qualitative and other reports was on patients' experiences of long-term antidepressant use, and typically sudden onset, severe, and protracted withdrawal symptoms when medication was stopped. Between April 1, 2017, and March 31, 2018, 11·53 million individuals (26·3% of residents in England) had a prescription dispensed for at least one medicine class: antidepressants (7·26 million [16·6%]), opioids (5·61 million [12·8%]), gabapentinoids (1·46 million [3·3%]), benzodiazepines (1·35 million [3·1%]), and Z-drugs (0·99 million [2·3%]). For three of these medicine classes, more people had a prescription dispensed in areas of higher deprivation, with adjusted IRRs (referenced to quintile 1) ranging from 1·10 to 1·24 for antidepressants, 1·20 to 1·85 for opioids, and 1·21 to 1·85 for gabapentinoids across quintiles, and higher ISRs generally concentrated in the north and east of England. In contrast, the highest ISRs for benzodiazepines and Z-drugs were generally in the southwest, southeast, and east of England, with low ISRs in the north. Z-drugs were associated with increased deprivation, but only at the highest quintile (adjusted IRR 1·11 [95% CI 1·01–1·22]). For benzodiazepines, prescribing was reduced for people in quintiles 4 (0·90 [0·85–0·96]) and 5 (0·89 [0·82–0·97]). In March, 2018, for each of medicine class, about 50% of patients who had a prescription dispensed had done so continuously for at least 12 months, with the highest ISRs in the north and east. Long-term prescribing was associated with a gradient of increased deprivation.InterpretationIn 1 year over a quarter of the adult population in England had a prescription dispensed for antidepressants, opioids (for non-cancer pain), gabapentinoids, benzodiazepines, or Z-drugs. Long-term (>12 months) prescribing is common, despite being either not recommended by clinical guidelines or of doubtful efficacy in many cases. Enhanced national and local monitoring, better guidance for personalised care, and better doctor–patient decision making are needed.FundingPublic Health England.

Prevalence of chronic respiratory symptoms in an urban population of North Kerala

Background: Chronic respiratory diseases are becoming a challenge to public health due to its high morbidity and mortality. Most of these diseases are preceded by variable periods of chronic respiratory symptoms. If chronic respiratory symptoms can be diagnosed and managed properly and timely, we can reduce the incidence and complication of chronic respiratory diseases.Methods: A community based cross sectional survey was conducted in 20 electoral wards of Calicut corporation of Northern Kerala among the adult resident population of 20-70 years to assess the prevalence of chronic respiratory symptoms such as chronic cough, phlegm, wheezing, breathlessness and nasal allergy and the factors associated with these chronic symptoms. The information was collected from 1384 eligible subjects selected by cluster sampling using British research council respiratory questionnaire.Results: About 9.2% (n=95) of study population had at-least one of the chronic respiratory symptoms. 1.8% (n=19) had all the chronic respiratory symptoms. Prevalence of various chronic respiratory symptoms was chronic cough (8.7%), Phlegm (14.3%), wheezing (8.5%), breathlessness (2.2%) and nasal allergy (14.5%). Advancing age, current smoking, family history and past history of various respiratory diseases are significantly associated with the development of chronic respiratory symptoms. Female gender, longer duration of stay in Calicut corporation and regular alcoholism were significantly associated with chronic phlegm in the study population. Wheezing, breathlessness and chronic nasal allergy was significantly higher among lower socio economic status.Conclusions: Prevalence of chronic respiratory symptoms is high among the urban population of Northern Kerala. Older age group, smoking, past and family history of respiratory diseases are the major risk factors associated with these respiratory symptoms.

Immigration factors and potentially avoidable hospitalizations in Canada

ObjectiveEstimate the effect of immigration characteristics on the risk of a hospitalization for an ambulatory care sensitive condition (ACSC). Research designWe analyzed data on the Canadian resident adult population aged 18 to 74 years who responded to the 2006 long form Census. The Census data were linked to the Canadian Institute for Health Information (CIHI)’s Discharge Abstract Database (DAD) for fiscal years 2006–2007, 2007–2008, and 2008–2009. We conducted a logistic regression on the binary variable we created for an ACSC admission. MeasuresThe CIHI definition of ACSC hospitalizations was used to identify potentially avoidable hospitalizations in the DAD. Immigration factors analyzed included years in Canada, ethnic origin, and ability to speak one of the official languages. ResultsThere were 3,342,450 respondents aged between 18 and 74. Using the Canadian at birth as our reference population, recent immigrants (up to five years in Canada) had lower odds of an ACSC hospitalization, regardless of their ethnic origins, with the exception of immigrants from Oceania and from other North American countries for whom the effect was not significant. The protective effect was still present in children of immigrants (AOR=0.89). Immigrants from the Caribbean, from Southern, Eastern, and Western Europe, as well as those from East Asia had lower odds across categories of time spent in Canada. The protective effect was stronger in immigrants from East Asia and lower in those of Oceanic and other North American countries. ConclusionsOur results suggest that the healthy immigrant effect dissipates with time in Canada but remains even in children of immigrants. The protective effect differs depending on the ethnic origin of the immigrant.

Ruling out deep vein thrombosis in patients with superficial vein thrombosis: external validation of the ICARO score.

A clinical score was recently proposed to rule out concomitant DVT in patients with a clinical suspicion of SVT. This study aimed to assess the external validity of this score in patients from the STEPH study. We performed a post-hoc analysis of data from the STEPH study. The STEPH study was a prospective multicenter community-based study conducted during a 1-year period in the resident adult population of the Greater Saint-Etienne urban area (France). Every patient with a clinical suspicion of SVT underwent a venous compression ultrasonography, to confirm SVT and to assess the presence of a concomitant DVT or not. Odds ratios for concomitant DVT were calculated for each item of the ICARO score. We then computed the score for each patient, and performed a receiver operating characteristic (ROC) curve analysis. In univariate analysis, none of the ICARO items were significantly different given the presence of a concomitant DVT. Given computed scores, 55 patients (45.1%) had a low risk, 17 (13.9%) had an intermediate risk and 50 (41.0%) had a high risk of a concomitant DVT. The area under the ROC curve was 0.386 [95% CI, 0.268-0.504]. When risk levels were dichotomized as low vs intermediate-high risk, the ICARO score had a sensitivity of 36.0%, a specificity of 40.2%, a positive predictive value of 13.4% and a negative predictive value of 70.9%. Our study does not confirm the utility of the ICARO clinical score to rule out concomitant DVT in case of SVT.

Seroprevalence of antibodies against chikungunya virus in Singapore resident adult population.

ObjectivesWe determined the seroprevalence of chikungunya virus (CHIKV) infection in the adult resident population in Singapore following local outbreaks of chikungunya fever (CHIKF) in 2008–2009.MethodsOur cross-sectional study involved residual sera from 3,293 adults aged 18–79 years who had participated in the National Health Survey in 2010. Sera were tested for IgG antibodies against CHIKV and dengue virus (DENV) and neutralizing antibodies against CHIKV.ResultsThe prevalence of CHIKV-neutralizing antibodies among Singapore residents aged 18–79 years was 1.9% (95% confidence interval: 1.4%– 2.3%). The CHIKV seroprevalence was highest in the elderly aged 70–79 years at 11.5%, followed by those aged 30–39 years at 3.1%. Men had significantly higher CHIKV seroprevalence than women (2.5% versus 1.3%, p = 0.01). Among the three main ethnic groups, Indians had the highest seroprevalence (3.5%) compared to Chinese (1.6%) and Malays (0.7%) (p = 0.02 and p = 0.01, respectively). Multivariable logistic regression identified adults aged 30–39 years and 70–79 years, men, those of Indian ethnicity and ethnic minority groups, and residence on ground floor of public and private housing apartments as factors that were significantly associated with a higher likelihood of exposure to CHIKV. The overall prevalence of anti-DENV IgG antibodies was 56.8% (95% CI: 55.1%– 58.5%), while 1.5% (95% CI: 1.1%– 2.0%) of adults possessed both neutralizing antibodies against CHIKV and IgG antibodies against DENV.ConclusionsSingapore remains highly susceptible to CHIKV infection. There is a need to maintain a high degree of vigilance through disease surveillance and vector control. Findings from such serological study, when conducted on a regular periodic basis, could supplement surveillance to provide insights on CHIKV circulation in at-risk population.

Gender differences in major depressive disorder: findings from the Singapore Mental Health Study.

Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide and has been associated with various sociodemographic risk factors, including age, gender and ethnicity. The present study aimed to establish whether gender-specific differences relating to the prevalence and correlates of MDD exist in the Singapore adult resident population. The Singapore Mental Health Study was a population-based, cross-sectional epidemiological study among Singapore citizens and permanent residents aged 18 years and above. Face-to-face interviews were completed with 6,616 respondents between December 2009 and December 2010. Psychiatric conditions were established using version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI). In addition, data relating to chronic medical conditions was captured using a modified version of the CIDI checklist for chronic medical conditions. The lifetime prevalence of MDD was higher among women (7.2%) than men (4.3%). MDD was more prevalent among men and women who were divorced/separated and widowed women, as compared to those who were single. Among men, MDD was more prevalent among Indian and other ethnicities as compared to Chinese. Of the 417 respondents with MDD, women had significantly higher odds of having generalised anxiety disorder but lower odds of having high blood pressure, as compared to men. The study highlighted key gender-specific correlates of MDD. Given the comorbidities associated with MDD and other psychiatric disorders and/or physical illnesses, these correlates pose additional challenges for care providers.

Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study.

BackgroundStudies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking.MethodsUsing data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years.ResultsInstalling and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness.ConclusionsIn low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).

Age-Related Changes in the Cardiometabolic Profiles in Singapore Resident Adult Population: Findings from the National Health Survey 2010.

We describe the centile trends of the blood pressure, glycemia and lipid profiles as well as renal function of a representative population who participated in the Singapore National Health Survey in 2010. Representative survey population was sampled in two phases, first using geographical/ residential dwelling type stratification, followed up ethnicity. 2,407 survey participants without any self-reported medical or medication history for diabetes mellitus, hypertension and dyslipidemia were included in this analysis. All biochemistry analyses were performed on Roche platforms. After excluding outliers using Tukey's criteria, the results of the remaining participants were subjected to lambda-mu-sigma (LMS) analysis. In men, systolic blood pressure increased linearly with age. By contrast, an upward inflection around late 40s was seen in women. The diastolic blood pressure was highest in men in the late 30s-50s age group, and in women in the late 50s-60s age group. All glycemia-related parameters, i.e. fasting and 2-hour plasma glucose and HbA1c concentrations increased with age, although the rate of increase differed between the tests. Total cholesterol and LDL-cholesterol concentrations increased with age, which became attenuated between the early 30s and late 50s in men, and declined thereafter. In women, total cholesterol and LDL-cholesterol concentrations gradually increased with age until late 30s, when there is an upward inflection, plateauing after late 50s. Our findings indicate that diagnostic performance of laboratory tests for diabetes may be age-sensitive. Unfavourable age-related cardiovascular risk profiles suggest that the burden of cardiovascular disease in this population will increase with aging population.

Smoking and Socio-demographic correlates of BMI.

BackgroundThe aim of the current study was to examine the associations between Body Mass Index (BMI) and socio-demographic factors and to examine the relationship between BMI, smoking status and ethnicity.MethodsThe Singapore Mental Health Study (SMHS) surveyed Singapore Residents (Singapore Citizens and Permanent Residents) aged 18 years old and above. BMI was calculated using height and weight which were self-reported by respondents. Socio-demographic characteristics and smoking status were recorded in a standardized data collection form.ResultsSix thousand and six hundred sixteen respondents completed the study (response rate of 75.9 %) which constituted a representative sample of the adult resident population in Singapore. Ethnicity, gender and education status were associated with obesity. There was an interaction effect between ethnicity smoking status, and BMI. Indian and Malay smokers were less likely to be obese compared to Chinese smokers. The relationship between ethnicity and BMI was thus reversed when smoking was taken into account.ConclusionsThe study identified certain subgroups and risk factors that are associated with obesity. There is a need for further research to explore and identify genetic, metabolic and ethnic differences that underlie the interaction between ethnicity and smoking status which affects BMI.

Factores de riesgo para hipertensión arterial en población adulta de una región urbana de Ecuador

Objectives . To determine the risk factors for arterial hypertension (HTN) in the adult resident population of the city of Cuenca, Ecuador Materials and methods A cross-sectional analytical study of adults selected via multistage random sampling who underwent clinical, anthropometric, and laboratory evaluations. The diagnosis of HTN was defined according to the JNC-7 criteria. A multiple logistic regression model was performed Results A total of 318 persons were included. The prevalence of HTN was 25.8% (males: 27.2% vs. females: 24.7%; p = 0.617). In the multiple logistic regression model, the risk factors for HTN were age > 60 years (OR, 8.68; 95% CI, 3.56-21.14; p < 0.001), obesity according to body mass index (OR, 2.36; 95% CI, 1.04-5.70; p = 0.042), high caloric intake (OR, 2.06; 95% CI, 1.01- 4.53; p = 0.044), and family history of HTN (OR, 1.58; 95% CI, 1.02-2.90; p = 0.040) Conclusions The presence of HTN in this population is associated with both intrinsic and environmental factors, which should be considered in routine evaluations to ensure its early identification and control.

Seroepidemiology of dengue virus infection in the adult population in tropical Singapore.

To assess the impact of past dengue epidemics in Singapore, we undertook a national seroepidemiological study to determine the prevalence of past dengue virus (DENV) infection in the adult population in 2010 and make comparisons with the seroprevalence in 2004. The study involved residual sera from 3293 adults aged 18-79 years who participated in a national health survey in 2010. The overall prevalence of anti-DENV IgG antibodies was 56·8% (95% confidence interval 55·1-58·5) in 2010. The seroprevalence increased significantly with age. Males had significantly higher seroprevalence than females (61·5% vs. 53·2%). Among the three major ethnic groups, Malays had the lowest seroprevalence (50·2%) compared to Chinese (57·0%) and Indians (62·0%). The age-standardized seroprevalence in adults was significantly lower in 2010 (54·4%) compared to 2004 (63·1%). Older age, male gender, Indian ethnicity, permanent residency and being home-bound were independent risk factors significantly associated with seropositivity. About 43% of the Singapore adult resident population remain susceptible to DENV infection as a result of the successful implementation of a comprehensive nationwide Aedes surveillance and control programme since the 1970s. Vector suppression and concerted efforts of all stakeholders in the community remain the key strategy in the prevention and control of dengue.