Singapore Residents Research Articles

PS-P03-5: QUALITATIVE INSIGHTS INTO THE BARRIERS TOWARDS BLOOD PRESSURE SCREENING, TREATMENT ADHERENCE AND LIFESTYLE MODIFICATIONS IN SINGAPORE

In Singapore, despite numerous blood pressure (BP) campaigns, hypertension prevalence amongst adults has increased to 35%, exceeding the global rate of 31.1%. In light of the worrying trend, this research aims to examine major barriers faced by Singapore residents in their management of BP health. Through a novel reverse socialisation program, the study reached out to at-risk family members through their children and employed an in-depth qualitative lens to gain meaningful insights into the barriers faced at various stages of BP management care. An intergenerational hypertension education program was launched among Singapore grade 5 students. Students were educated about hypertension and taught how to utilize a BP monitor. They then shared their knowledge and measured their family members BP at home. Family members found with borderline or high BP were invited for an interview and had their BP measurements validated by a medical professional. In-depth semi-structured interviews were conducted with 15 adults who were identified to have borderline hypertension or hypertension. Transcripts were analysed using the constant comparative approach, an analytic strategy based on grounded theory. The study identified varying personal, psychosocial, and/or external barriers faced at three different stages of BP management care - regular screening, medical adherence and lifestyle modifications (Table 1). Firstly, a major barrier towards regular BP screening was low perceived need to seek medical care due to a lack of physiological symptoms, suggesting that many respondents perceived themselves as being less susceptible to hypertension. Secondly, barriers towards medical adherence were especially a concern for diagnosed hypertensives. A dominant factor was a lack of self-efficacy in following-up with the required care, such as fear of failing doctors expectations in follow-up appointments, lack of time and inability to comply with prescribed sudden changes to dietary and exercise habits Thirdly, the inability to comply with recommended lifestyle modifications was nuanced by various factors related to ones identity such as age, job, familial obligations and culture. The in-depth qualitative perspectives revealed a complex web of barriers to BP screening, adherence and lifestyle modifications. These have important implications for future health intervention designs. Particularly, health education and communication to at-risk communities require tailored interventions to overcome the varied personal, psychosocial, and external gaps at different stages of hypertension management care. For instance, threat-framed messages could be more effective in tackling the barrier of low perceived susceptibility to hypertension, while coping-framed interventions may be better suited for improving self-efficacy for treatment adherence.

1008. Implementation of Clinical Pathway for Management of Fever in Nursing Home Residents in Singapore

Abstract Background Ageing population is a major health care problem all over the world. In Singapore, as of 2020, senior citizen (65 years and above) consists of 15.2 % of total population. By 2030, one in five Singaporeans will be more than 65 years old. Thus, nursing home (NH) is an important pillar of a health care system. Nursing home staff are in the front line to manage common infections. However, the inexperience and the lack of guidance have led to inappropriate transfer to acute hospitals. Infectious Diseases Community Program (IDCP) is the project to enhance partnerships with NHs. We work with NHs to develop, adapt, and implement appropriate processes related to infection control, prevention, and management. One of our objectives is the enhancement of assessment and appropriate evaluation of fever. The aim is to reduce the inappropriate admissions to acute hospitals. Methods Fever and desaturation pathway (figure 1) was developed by IDCP team. Six participating NHs adopted the pathway and trained their staff. The study was approved by NHG domain specific review board (DSRB). Hospital records were reviewed. We compared the rate of inappropriate admission from 2015-2017 which serve as a baseline and 2019-2020. The wash-out period was 2018 when NHs were implementing the pathway. Inappropriate admission is defined as < ! 1. Admission is against advanced care planning / preferred plan of care or 2. Criteria in the pathway are not met on admission, 48 hours later and no other medical reason for admission. Figure 1 Results Total number of fever transfers was 950 in 2015-2017 and 688 in 2019-2020. Number of inappropriate admissions was 115 in 2015-2017 and 50 in 2019-2020. Inappropriate admission was 12.11% in 2015-2017 and 7.27 % in 2019-2020 (table 1). Figure 2 shows the rate of inappropriate admissions of six participating NHs from 2015-2020. There is a decreasing trend after the pathway has been implemented in 2018. Table 1 Figure 2 Conclusion Adopting fever and desaturation pathway has reduced the rate of inappropriate admission in six participating NHs in Singapore. However, there is an increasing trend in inappropriate admission in 2020. This could be due to the lack of isolation facility in the NHs during the COVID-19 pandemic. We are continuing the implementation of the pathway to the rest of the NHs in the western region of Singapore. Disclosures All Authors: No reported disclosures.

Food insufficiency, adverse childhood experiences and mental health: results of the Singapore Mental Health Study 2016.

This study aimed to investigate the prevalence and correlates of food insufficiency and its association with mental disorders and adverse childhood experiences (ACE) in Singapore. This analysis utilised data from the Singapore Mental Health Study (SMHS 2016). SMHS 2016 was a population-based, psychiatric epidemiological study conducted among Singapore residents. Interviews were conducted with 6126 respondents. Respondents were included if they were aged 18 years and above, Singapore citizens or permanent residents and able to speak in English, Chinese or Malay. The prevalence of food insufficiency was 2·0 % (95 % CI (1·6, 2·5)) among adult Singapore residents. Relative to respondents who did not endorse any ACE, those with ACE (OR: 2·9, 95 % CI (1·2, 6·6)) had higher odds of food insufficiency. In addition, there were significant associations between lifetime mental disorders and food insufficiency. Bipolar disorder (OR: 2·7, 95 % CI (1·2, 6·0)), generalised anxiety disorder (OR: 4·5, 95 % CI (1·5, 13·5)) and suicidal behaviour (OR: 2·37, 95 % CI (1·04, 5·41)) were shown to be significantly associated with higher odds of food insufficiency. The prevalence of food insufficiency is low in Singapore. However, this study identifies a vulnerable group of food-insufficient adults that is significantly associated with mental disorders, including suicidality. Government-funded food assistance programmes and multi-agency efforts to deal with the social determinants of food insufficiency, such as income sufficiency and early detection and intervention of mental distress, are key to ensuring a sustainable and equitable food system.

ANALYSIS OF THE NEED FOR LABOR MIGRATION POLICY IN SINGAPORE

Singapore is categorized as a Developed Country because of its developed trading industry among Southeast Asian countries. The existence of Singapore is inseparable from the presence of residents. As is known, most residents of Singapore are the result of migration policies due to the lack of population. Singapura recorded a record decline in people over the past year. The government's annual brief report revealed that the restrictions and conditions of the Covid-19 pandemic were one of the leading causes. Singaporean population also fell 0.7% to 3.5 million, while permanent residents (PR) fell 6.2% to 0.49 million. This is the first drop from YoY, both in population and population since data was collected in 1970. Migration is the movement of people from one area to another aimed at living sedentary, which goes beyond the administrative/political boundaries. The move made by a resident is usually immigrant because he has the desire to live a sedentary life for a long time. This research uses a qualitative descriptive method with literature review research. The results showed that one of the factors driving migration from Indonesia to Singapore was the lack of labor in Singapore. The process of self-formation into a Singaporean identity through migration, adaptation, and integration stages. Singapore has a policy toward migrant workers. The policy is specifically related to skills and age. If workers’ skills do not meet the criteria, the Government applies a policy to upgrade skills by conducting certified training. The Basic Skill Certificate (BSC) and Skill Evaluation Certificate (SEC) have been implemented since 1998.

Shotgun metagenomic sequencing analysis of ocular surface microbiome in Singapore residents with mild dry eye.

The ocular surface microbiome has implications for ocular surface inflammation and immunology. Previous shotgun metagenomics analyses were performed in China, showing results that differed according to environment and age. Patients with Sjogren's syndrome were reported to have altered conjunctival microbiome, but such studies have not been done in milder dry eye. The aim of this study is to describe the conjunctival microbiome in people with mild dry eye in Singapore. Samples were collected from 14 participants with mild dry eye and 10 age-matched comparison participants recruited from Singapore National Eye Centre (SNEC) clinics. Shotgun metagenomic sequencing analysis was employed to evaluate the conjunctival microbiome composition. Proteobacteria formed the predominant phylum in the conjunctiva. As in a study from a coastal city in China, Achromobacter spp. was numerically most abundant. Compared to age-matched controls, the conjunctival microbial composition in mild dry eye was similar. Several microorganisms, including Streptococcus spp. increased in representation with age, and the abundance of Staphylococcus correlated with Schirmer readings. In addition, when cultured corneal epithelial cells were exposed to three strains of Achromobacter xylosoxidans, cytokines such as TNF-α and IL-6 were upregulated in the cell lysates and supernatants. Ourresults suggest that age is an important factor that affects composition of the conjunctival microbiome, and relative abundance of specific microorganism may vary according to the environment of the human host.

Barriers and facilitators for adopting a healthy lifestyle in a multi-ethnic population: A qualitative study.

A healthy lifestyle is defined as 'a way of living that lowers the risk of being seriously ill or dying early.' Although barriers and facilitators of healthy lifestyles have been well-studied among populations like those with chronic non-communicable diseases, adolescents, and older adults in Asia, less information is available on barriers and facilitators perceived by the general adult population. Using a qualitative methodology and leveraging the socio-ecological model, the current study aimed to understand the barriers and facilitators of a healthy lifestyle in a sample of Singapore residents. Overall, 30 semi-structured interviews were conducted in English and other local languages from August 2020 to March 2021. Transcripts were analysed using framework analysis. Five main themes pertaining to personal, interpersonal, environmental, socio-cultural, and policy-level factors were classified under the two overarching categories of barriers and facilitators of healthy lifestyles. The results of this study offer important insights into understanding the barriers and facilitators to the adoption of a healthy lifestyle among people in Singapore. Furthermore, our findings illustrate the complex interplay between individuals, social relationships, environment, and policy that can act as either a barrier or a facilitator to adopting a healthy lifestyle.

Development and validation of a lockdown preparedness scale: Understanding lockdown preparedness through a social vulnerability perspective

Millions of people around the world were subjected into nationwide or community wide lockdowns in response to the COVID-19 pandemic. Scientists also predict that as we enter into a new normal, another pandemic is not impossible, and that lockdowns may be implemented again. Therefore, examining factors affecting lockdown preparedness (LDP) is important. Through a survey of 800 adult residents in Singapore during the pandemic, this study proposed and tested an LDP scale and found that quality of social interactions, news consumption, as well as education and income affect the extent of psychological and emotional preparedness for lockdowns.

Sources of information on diabetes and its demographic correlates: a nationwide survey among Singapore residents.

Diabetes is a major public health concern in Singapore, and the Singapore Government declared a 'War on Diabetes', which included a nationwide public health campaign. It is important to identify what sources of diabetes information reach the general population, whether this differs by socio-demographic characteristics and if the sources of information influence knowledge of diabetes to aid the successful dissemination of health information. Two thousand eight hundred ninety-five respondents were part of a population-based cross-sectional study conducted from February 2019 to September 2020. Respondents rated on a five-point scale whether they had obtained information on diabetes from eight different information sources, and responses were dichotomized into 'endorsed receiving information' or 'not endorsed receiving information'. Poisson regression models were conducted with the 'endorsement of receiving information' from each source as the outcome and socio-demographic variables as predictors. 95.9% of the study population had received information on diabetes from at least one source, and the mean number of sources was 4.2 ± 2.0. The leading source was media articles (82.1%), followed by health promotion videos/advertisements (77.9%), online websites (58.5%), books (56.5%), healthcare professionals (55.0%), radio (54.4%), public forums (27.7%) and support groups (15.5%). Endorsing a greater number of informational sources was associated with being younger, belonging to Malay or Indian instead of Chinese ethnicity, and having diabetes. An intensive nationwide diabetes awareness campaign successfully reached the public in Singapore with specific sources of information depending on socio-demographic characteristics. Findings suggest that diabetes information campaigns should utilize multiple channels for dissemination considering the different socio-demographic subgroups.

Attitudes and preferences of wildlife and their relationship with childhood nature experience amongst residents in a tropical urban city.

How people relate to biodiversity and whether they are supportive of conservation programs and policies has implications on global and local biodiversity conservation efforts. Nature experiences in childhood has been shown to be strongly correlated to positive attitudes towards nature and wildlife in adulthood. In this study, we examined wildlife experience, attitudes and willingness to coexist with 26 vertebrates and invertebrates amongst residents in a highly urbanized tropical city, Singapore. A total of 1004 respondents were surveyed and their childhood nature experience and various socioeconomic variables were obtained. The animals were grouped by their likeability and preferred habitat from the respondents’ answers. Three main groups of animals were discerned – unfavorable animals, mammals, and favorable animals. Singapore residents generally had high direct experiences of animals that are common in urban settings, for both favorable and unfavorable animals, such as butterflies, dragonflies, crows and bees, but low direct experiences of forest-dependent wildlife. Animals that were well-liked and acceptable near homes include the common urban ones and some forest-dependent ones, while animals that were disliked included stinging insects (bees and hornets) and reptiles (snakes and water monitors). Structured equation modelling showed that both childhood nature experience and wildlife experience had strong effects on wildlife likeability and habitat preference. The apparent mismatch between greening policies and people’s willingness to coexist with wildlife may be problematic as urban development further encroaches on forest habitats, and this study highlights the importance of preserving forest habitats so that young children and adults have opportunities to be exposed to them.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11252-022-01280-1.

Consumption Patterns of Processed Foods in Singapore-A Cross-Sectional Study.

The consumption of processed foods is increasingly widespread and could have an impact on diet quality and health. Understanding the factors influencing people’s eating habits is useful for assessing such impact. There are limited data on the consumption patterns of processed foods and associated factors influencing the dietary patterns in Singapore. This cross-sectional study based on a food frequency questionnaire aimed to examine how the consumption of processed foods among 2079 Singapore residents aged 18 to 89 years varies with sociodemographic factors. The analysis of the consumption by processed food groups showed that the studied factors, i.e., age, gender, ethnicity, housing and health status, all contributed to differences in processed food consumption to varying extents, with ethnicity being the key factor driving the variation. Such differences were also confirmed to a limited degree by determining another measure of consumption, i.e., a processed food variety score. The findings in this study could inform further work in relation to dietary risks.

Beyond Asian ‘mask culture’: understanding the ethics of face masks during the Covid-19 pandemic in Singapore

ABSTRACT During the Covid-19 pandemic, face masks became widely used and sometimes mandatory anti-infection devices across the world. While anti-mask protests emerged in several Western countries, nearly universal mask-wearing is commonly seen in Asian countries. Journalistic and popular accounts suggest that an Asian ‘mask culture’ explains the acceptance of mask-wearing and associates mask culture with political authoritarianism in Asian countries. Based on in-depth interviews conducted with residents of Singapore, an Asian city-state that implemented a mask mandate in 2020, we uncover a wide diversity of beliefs, motivations, and practices of mask-wearing that challenges the existence of a homogeneous ‘mask culture’. Drawing on a recent theoretical movement known as the anthropology of ethics, we draw attention to individual judgments and engagements with cultural norms and obligations in order to characterise how it became ‘desired and desirable’ for a diverse population of Singapore residents to wear masks.

Geographical clusters of dengue outbreak in Singapore during the Covid-19 nationwide lockdown of 2020

Dengue, a mosquito-transmitted viral disease, has posed a public health challenge to Singaporean residents over the years. In 2020, Singapore experienced an unprecedented dengue outbreak. We collected a dataset of geographical dengue clusters reported by the National Environment Agency (NEA) from 15 February to 9 July in 2020, covering the nationwide lockdown associated with Covid-19 during the period from 7 April to 1 June. NEA regularly updates the dengue clusters during which an infected person may be tagged to one cluster based on the most probable infection location (residential apartment or workplace address), which is further matched to fine-grained spatial units with an average coverage of about 1.35 km2. Such dengue cluster dataset helps not only reveal the dengue transmission patterns, but also reflect the effects of lockdown on dengue spreading dynamics. The resulting data records are released in simple formats for easy access to facilitate studies on dengue epidemics.

Burn-out and relationship with the learning environment among psychiatry residents: a longitudinal study

ObjectivesRecent research suggests that burn-out is high and appears to be rooted in system-level factors including the local learning environment (LE). While most studies on this topic have been cross-sectional,...

Analysis of COVID-19 Incidence and Severity Among Adults Vaccinated With 2-Dose mRNA COVID-19 or Inactivated SARS-CoV-2 Vaccines With and Without Boosters in Singapore

Assessing booster effectiveness of COVID-19 mRNA vaccine and inactivated SARS-CoV-2 vaccine over longer time intervals and in response to any further SARS-CoV-2 variants is crucial in determining optimal COVID-19 vaccination strategies. To determine levels of protection against severe COVID-19 and confirmed SARS-CoV-2 infection by types and combinations of vaccine boosters in Singapore during the Omicron wave. This cohort study included Singapore residents aged 30 years or more vaccinated with either at least 2 doses of mRNA COVID-19 vaccines (ie, Pfizer-BioNTech BNT162b2 or Moderna mRNA-1273) or inactivated SARS-CoV-2 vaccines (Sinovac CoronaVac or Sinopharm BBIBP-CorV) as of March 10, 2022. Individuals with a known SARS-CoV-2 infection prior to December 27, 2021, an infection on or before the date of their second vaccine dose, or with reinfection cases were excluded. Two or 3 doses of Pfizer-BioNTech BNT162b2, Moderna mRNA-1273, Sinovac CoronaVac, or Sinopharm BBIBP-CorV. Notified infections from December 27, 2021, to March 10, 2022, adjusted for age, sex, race, housing status, and calendar days. Estimated booster effectiveness, defined as the relative incidence-rate reduction of severe disease (supplemental oxygen, intensive care, or death) or confirmed infection following 3-dose vaccination compared with 5 months after second mRNA dose, was determined using binomial regression. Among 2 441 581 eligible individuals (1 279 047 [52.4%] women, 846 110 (34.7%) aged 60 years and older), there were 319 943 (13.1%) confirmed SARS-CoV-2 infections, of which 1513 (0.4%) were severe COVID-19 cases. mRNA booster effectiveness against confirmed infection 15 to 60 days after boosting was estimated to range from 31.7% to 41.3% for the 4 boosting combinations (homologous BNT162b2, homologous mRNA-1273, 2-dose BNT162b2/mRNA-1273 booster, and 2-dose mRNA-1273/BNT162b2 booster). Five months and more after boosting, estimated booster effectiveness against confirmed infection waned, ranging from -2.8% to 14.6%. Against severe COVID-19, estimated mRNA booster effectiveness was 87.4% (95% CI, 83.3%-90.5%) 15 to 60 days after boosting and 87.2% (95% CI, 84.2%-89.7%) 5 to 6 months after boosting, with no significant difference comparing vaccine combinations. Booster effectiveness against severe COVID-19 15 days to 330 days after 3-dose inactivated COVID-19 vaccination, regardless of combination, was estimated to be 69.6% (95% CI, 48.7%-81.9%). Booster mRNA vaccine protection against severe COVID-19 was estimated to be durable over 6 months. Three-dose inactivated SARS-CoV-2 vaccination provided greater protection than 2-dose but weaker protection compared with 3-dose mRNA.

Vaccine effectiveness against Delta, Omicron BA.1, and BA.2 in a highly vaccinated Asian setting: a test-negative design study

ObjectivesWe compared the vaccine effectiveness over time of the primary series and booster against infection and severe disease with the Delta, Omicron BA.1, and BA.2 variants in Singapore, an Asian setting with high vaccination coverage. MethodsWe conducted a test-negative case-control study on all adult residents in Singapore who underwent PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute hospitals. Individuals with a negative PCR from 1 September, 2021, to 30 November, 2021, and 1 December, 2021, to 25 April, 2022, served as controls for the Delta and Omicron variants respectively, and PCR-positive individuals within these two time periods served as cases. Associations between vaccination status and SARS-CoV-2 infection and severe disease with the Delta or Omicron variants were measured using Poisson regressions. Vaccine effectiveness was calculated by taking 1 minus risk ratio. ResultsThere were 68 114 individuals comprising 58 495 controls and 9619 cases for the Delta period, of whom 53 093 completed the primary series and 9161 were boosted. For the Omicron period, 104 601 individuals comprising 80 428 controls, 8643 BA.1 cases, and 15 530 BA.2 cases were included, of whom 29 183 and 71 513 were vaccinated with the primary series and boosted, respectively. The primary series provided greater protection against infection with Delta (45%, 95% CI 40–50%) than against infection with Omicron (21%, 95% CI 7–34% for BA.1; 18%, 95% CI 6–29% for BA.2) at <2 months from vaccination. Vaccine effectiveness of the booster was similar against infection with BA.1 (44%, 95% CI 38–50%) and BA.2 (40%, 95% CI 35–40%). Protection against severe disease by the booster for BA.1 (83%, 95% CI 76–88%) and BA.2 (78%, 95% CI 73–82%) was comparable to that by the primary series for Delta (80%, 95% CI 73–85%). ConclusionOur findings support the use of a booster dose to reduce the risk of severe disease and mitigate the impact on the healthcare system in an Omicron-predominant epidemic.

Adverse childhood experiences and positive psychotic symptoms: A nationally representative study in Singapore

BackgroundEpidemiological studies show that adverse childhood experiences (ACE) are associated with positive psychotic symptoms in Western populations; however, there is a lack of population-based data in multi-ethnic, Asian societies. ObjectiveWe investigated the associations between ACE (type and dosage) and positive psychotic symptoms in a nationally representative study in Singapore. Participants and settingA total of 4441 adult Singapore residents were recruited via door-to-door surveys; they were assessed for ACE and positive psychotic symptoms (i.e., hallucinations, delusions, thought insertion, thought control, and telepathic powers) on structured interviews. MethodsLifetime experiences of positive psychotic symptoms were regressed on (1) the experience of any ACE; (2) cumulative ACE; and (3) the experience of either no ACE, interpersonal victimization only, dysfunctional home environments only, neglect only or multiple exposures to ACE in weighted and adjusted regression models. Results5.2 % of the sample experienced positive psychotic symptoms during their lifetime. Individuals exposed to dysfunctional home environments (OR = 2.84, 95 % CI 1.26 to 6.37) and multiple adverse childhood experiences (OR = 3.31, 95 % CI 2.18 to 5.01) were at an elevated risk of experiencing positive psychotic symptoms. The exposure to three or more ACE was associated with a near five-fold higher risk of experiencing positive psychotic symptoms (OR = 4.51, 95 % CI 2.89 to 7.05). ConclusionsIndividuals exposed to dysfunctional home environments or multiple adverse childhood experiences are at an elevated risk of experiencing positive psychotic symptoms. Given the intrafamilial nature of these childhood adversities, dual-generation approaches and family-centered interventions are key.

Connection to nature and time spent in gardens predicts social cohesion

A person’s health and wellbeing are contingent on the amount of social support that they receive. Similarly, experiencing nature has been shown to improve people’s health and wellbeing. However, we do not know how relationships between social cohesion, nature experiences and nature connection could interrelate and vary across different types of urban green spaces, and in non-Westernised cultures. We conducted a study on 1249 residents in Singapore, a tropical city-state, and measured three dimensions of social cohesion (i.e. general social cohesion; trust and sense of community; and social interactions), various types of nature experiences (i.e. amount of green space around one’s residence; frequency and duration of urban green space visits; frequency and duration of visits to gardens), and three dimensions of one’s connection to nature: self-identity with nature, desire to experience nature, and environmental concern (using the nature relatedness scale). We found that people who strongly identify with nature, who enjoy being in nature, and who had more frequent gardens visits were more likely to have a stronger sense of social cohesion across two dimensions. However, those with stronger environmental concern reported an overall weaker sense of social cohesion, possibly due to the perception that society’s contributions to conserve environmental problems was insufficient. Further, people who gardened more frequently were also more likely to visit green spaces, self-identify with nature and exhibit a stronger desire to experience nature. We propose that strategies targeted at encouraging people to engage in nature-related, collaborative activities at the local community level, such as spending time in local gardens, will increase urban residents’ daily nature experiences and its associated benefits such as improving social cohesion.

Dietary patterns and predicted 10-year cardiovascular disease risk in a multiethnic Asian population

Background and aimsStudies examining associations between dietary patterns and Framingham risk score (FRS) and predicted 10-year cardiovascular diseases (CVD) risk in an Asian population are lacking. This study aimed to identify a posteriori dietary patterns across three major ethnic groups in Singapore and ascertain their associations with locally modified FRS and predicted 10-year CVD risk. Methods and resultsThis cross-sectional study included 8594 Singapore residents (aged 21–75 years) from the Singapore Multi-Ethnic Cohort. Data on sociodemographic and lifestyle factors were collected via questionnaires. Food consumption was assessed using a validated Food Frequency Questionnaire. Dietary patterns were identified using principal component analysis and associations with CVD risk factors, FRS and predicted CVD risk (%) were analysed using multiple linear and logistic regression. Four dietary patterns emerged that explained 25.6% of variance. The ‘processed food and sugar-sweetened beverages’ pattern was significantly associated with higher FRS (β: 0.13; 95% CI: 0.04, 0.23), while the ‘ethnic breads, legumes and nuts’ (β: 0.13; 95% CI: 0.22, −0.04) and ‘whole grains, fruit and dairy’ (β: 0.17; 95% CI: 0.24, −0.10) patterns were significantly associated with lower FRS. The ‘meat and vegetables’ pattern was not significantly associated with FRS. Increased adherence to the ‘whole grains, fruit and dairy’ pattern was associated with lower odds of having predicted CVD risk of ≥10% (p-trend: 0.03). ConclusionAdherence to the ‘ethnic breads, legumes and nuts’ and ‘whole grains, fruit and dairy’ patterns was associated with a lower predicted CVD risk, and an inverse association for the ‘processed food and sugar-sweetened beverages’ pattern in an Asian population. These findings can inform the development of culturally sensitive dietary interventions to prevent CVD.

Mutual Exclusion of Methanobrevibacter Species in the Human Gut Microbiota Facilitates Directed Cultivation of a Candidatus Methanobrevibacter Intestini Representative.

ABSTRACTMethanogenic Archaea (methanogens) are a phylogenetically diverse group of microorganisms and are considered to be the most abundant archaeal representatives in the human gut. However, the gut methanogen diversity of human populations in many global regions remains poorly investigated. Here, we report the abundance and diversity of gut methanogenic Archaea in a multi-ethnic cohort of healthy Singaporeans by using a concerted approach of metagenomic sequencing, 16S rRNA gene amplicon sequencing, and quantitative PCR. Our results indicate a mutual exclusion of Methanobrevibacter species, i.e., the highly prevalent Methanobrevibacter smithii and the less prevalent Candidatus Methanobrevibacter intestini in more than 80% of the samples when using an amplicon sequencing-based approach. Leveraging on this finding, we were able to select a fecal sample to isolate a representative strain, TLL-48-HuF1, for Candidatus Methanobrevibacter intestini. The analyzed physiological parameters of M. smithii DSM 861T and strain TLL-48-HuF1 suggest high similarity of the two species. Comparative genome analysis and the mutual exclusion of the Methanobrevibacter species indicate potentially different niche adaptation strategies in the human host, which may support the designation of Candidatus M. intestini as a novel species.IMPORTANCE Methanogens are important hydrogen consumers in the gut and are associated with differing host health. Here, we determine the prevalence and abundance of archaeal species in the guts of a multi-ethnic cohort of healthy Singapore residents. While Methanobrevibacter smithii is the most prevalent and abundant methanogen in the human gut of local subjects, the recently proposed Candidatus Methanobrevibacter intestini is the abundant methanogen in a minority of individuals that harbor them. The observed potential mutual exclusion of M. smithii and Ca. M. intestini provides further support to the proposal that the two physiologically similar strains may belong to different Methanobrevibacter species.

Residential secondhand smoke in a densely populated urban setting: a qualitative exploration of psychosocial impacts, views and experiences

BackgroundPeople remain exposed to secondhand smoke, a serious health hazard, inside their home as households face challenges in setting no-smoking rules or are exposed to secondhand smoke drifting in from neighbouring homes. This study explores the psychosocial impacts, views, and experiences with residential secondhand smoke in a densely populated urban setting. MethodsIn-depth online or face to face interviews with 18 key informants who had been involved in public discourse, policy, advocacy or handling complaints related to residential secondhand smoke, 14 smokers, and 16 non-smokers exposed to secondhand smoke inside their home. All participants were residents of Singapore, a densely populated, multi-ethnic city-state. Interview transcripts were coded in NVivo using a deductive and inductive coding process.FindingsSecondhand smoke has wide-reaching impacts on physical and psychosocial wellbeing, even if smokers tried to minimise secondhand smoke. Feelings of anxiety and stress are generally tied to feeling discomfort in one’s personal space, a perceived lack of control over the situation, resentment towards smokers, and concerns over the health effects. Family, community, and cultural dynamics add complexities to tackling the issue, especially in patriarchal households. Secondhand smoke exposure from neighbours is considered a widespread issue, exacerbated by structural factors such as building layout and the COVID-19 pandemic. Resolving the issue amicably is considered challenging due to the absence of regulations and a reluctance to stir up conflict with neighbours. While smokers took measures to reduce secondhand smoke, these were described as ineffective by other participants. Smokers appeared to have contrasting views from other participants on what it means to smoke in a socially responsible manner.ConclusionGiven the wide-reaching psychosocial impacts of residential secondhand smoke, there is a case for stronger interventions, especially in densely populated urban settings where it is more difficult to avoid.