We compared indicators of influenza activity in 2020 before and after public health measures were taken to reduce coronavirus disease (COVID-19) with the corresponding indicators from 3 preceding ...years. Influenza activity declined substantially, suggesting that the measures taken for COVID-19 were effective in reducing spread of other viral respiratory diseases.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As of March 31, 2020, the ongoing COVID-19 epidemic that started in China in December 2019 is now generating local transmission around the world. The geographic heterogeneity and associated ...intervention strategies highlight the need to monitor in real time the transmission potential of COVID-19. Singapore provides a unique case example for monitoring transmission, as there have been multiple disease clusters, yet transmission remains relatively continued.
Here we estimate the effective reproduction number, R
, of COVID-19 in Singapore from the publicly available daily case series of imported and autochthonous cases by date of symptoms onset, after adjusting the local cases for reporting delays as of March 17, 2020. We also derive the reproduction number from the distribution of cluster sizes using a branching process analysis that accounts for truncation of case counts.
The local incidence curve displays sub-exponential growth dynamics, with the reproduction number following a declining trend and reaching an estimate at 0.7 (95% CI 0.3, 1.0) during the first transmission wave by February 14, 2020, while the overall R based on the cluster size distribution as of March 17, 2020, was estimated at 0.6 (95% CI 0.4, 1.02). The overall mean reporting delay was estimated at 6.4 days (95% CI 5.8, 6.9), but it was shorter among imported cases compared to local cases (mean 4.3 vs. 7.6 days, Wilcoxon test, p < 0.001).
The trajectory of the reproduction number in Singapore underscores the significant effects of successful containment efforts in Singapore, but it also suggests the need to sustain social distancing and active case finding efforts to stomp out all active chains of transmission.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Exposure to ambient air pollution is a major risk factor for global disease. Assessment of the impacts of air pollution on population health and evaluation of trends relative to other major risk ...factors requires regularly updated, accurate, spatially resolved exposure estimates. We combined satellite-based estimates, chemical transport model simulations, and ground measurements from 79 different countries to produce global estimates of annual average fine particle (PM2.5) and ozone concentrations at 0.1° × 0.1° spatial resolution for five-year intervals from 1990 to 2010 and the year 2013. These estimates were applied to assess population-weighted mean concentrations for 1990–2013 for each of 188 countries. In 2013, 87% of the world’s population lived in areas exceeding the World Health Organization Air Quality Guideline of 10 μg/m3 PM2.5 (annual average). Between 1990 and 2013, global population-weighted PM2.5 increased by 20.4% driven by trends in South Asia, Southeast Asia, and China. Decreases in population-weighted mean concentrations of PM2.5 were evident in most high income countries. Population-weighted mean concentrations of ozone increased globally by 8.9% from 1990–2013 with increases in most countriesexcept for modest decreases in North America, parts of Europe, and several countries in Southeast Asia.
Full text
Available for:
IJS, KILJ, NUK, PNG, UL, UM
Rationale for redefining obesity in Asians Low, Serena; Chin, Mien Chew; Ma, Stefan ...
Annals of the Academy of Medicine, Singapore,
01/2009, Volume:
38, Issue:
1
Journal Article
Peer reviewed
Open access
There has been extensive research on defining the appropriate body mass index (BMI) cut-off point for being overweight and obese in the Asian population since the World Health Organisation (WHO) ...Expert Consultation Meeting in 2002.
We reviewed the literature on the optimal BMI cut-off points for Asian populations. We searched PubMed, EMBASE, National Institute for Health Research Centre for Reviews and Dissemination (NHS CRD) Database, Cochrane Library and Google. Attempts to identify further studies were made by examining the reference lists of all retrieved articles. There were 18 articles selected for the review.
There were 13 studies which have identified the BMI cut-off points for Asian populations lower than the international BMI cut-off points recommended by the WHO. Many of the studies have recommended lowering BMI cut-off point specific for Asian populations. A few studies concurred with the recommended cut-off point for Asian populations recommended by International Association for the Study of Obesity (IASO), the International Obesity Task Force (IOTF) and the WHO in 2002. Asian populations were also noted to have higher cardiovascular risk factors than Western populations at any BMI level.
Further research would be needed to look at the all-cause mortality at same BMI levels between Asians and Caucasians in order to evaluate the BMI cut-off recommendations for Asian populations. It is necessary to develop and redefine appropriate BMI cut-off points which are country-specific and ethnic-specific for Asians. These will facilitate the development of appropriate preventive interventions to address the public health problem posed by obesity.
Singapore is one of the most rapidly ageing populations in the world. Nearly half of all disease burdens in Singapore are attributable to modifiable risk factors. This indicates that many illnesses ...are preventable by modifying behaviours such as increasing physical activity levels or maintaining a healthy diet. Prior cost-of-illness studies have estimated the cost of selected modifiable risk factors. However, no local study has compared costs between groups of modifiable risks. This study aims to estimate the societal cost attributable to a comprehensive list of modifiable risks in Singapore.
Our study builds on the comparative risk assessment framework from the Global Burden of Disease (GBD) 2019 study. A top-down prevalence-based cost-of-illness approach was undertaken to estimate the societal cost of modifiable risks in 2019. These include healthcare costs from inpatient hospitalisation and productivity losses from absenteeism and premature mortality.
Metabolic risks had the highest total cost of US$1.62 billion (95% uncertainty interval UI US$1.51-1.84 billion), followed by lifestyle risks of US$1.40 billion (95% UI US$1.36-1.66 billion) and substance risks of US$1.15 billion (95% UI US$1.10-1.24 billion). Across the risk factors, the costs were driven by productivity losses, heavily skewed towards the older working-age group and among males. Most of the costs were driven by cardiovascular diseases.
This study provides evidence of the high societal cost of modifiable risks and highlights the importance of developing holistic public health promotion programmes. As modifiable risks often do not occur in isolation, implementing effective population-based programmes targeting multiple modifiable risks has a strong potential to manage the cost of the rising disease burden in Singapore.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVES
Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the ...impact of self‐reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs).
DESIGN
Life table analysis, using a nationally representative longitudinal survey of community‐dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly.
SETTING
Singapore.
PARTICIPANTS
Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011‐2012 and 2015.
MEASUREMENTS
Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health‐related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self‐reported sensory impairment status as time varying.
RESULTS
Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 95% confidence interval CI = 1.9‐5.7 less years; 20.7 95% CI = 18.9‐22.5 vs 24.9 95% CI = 23.8‐26.0) but also more years of life with limitations in physical function (3.3 95% CI = .9‐5.8 more years; 12.8 95% CI = 10.7‐14.8 about 61.7% of LE vs 9.5 95% CI = 8.4‐10.5 about 38.0% of LE).
CONCLUSION
Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528–2536, 2019
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background There has been a substantial increase in the prevalence of peanut and tree nut allergy in Western populations in the last 2 decades. However, there is an impression that peanut and tree ...nut allergy is relatively uncommon in Asia. Objective To evaluate the prevalence of peanut, tree nut, and shellfish allergy in schoolchildren in 2 Asian countries (Singapore and Philippines). Methods A structured written questionnaire was administered to local and expatriate Singapore (4-6 and 14-16 years old) and Philippine (14-16 years old) schoolchildren. Results A total of 25,692 schoolchildren responded to the survey (response rate, 74.2%). Of these, 23,425 responses fell within the study protocol's 4 to 6 and 14 to 16 year age groups and were included in the analysis. The prevalence of convincing peanut and tree nut allergy were similar in both local Singapore (4-6 years, 0.64%, 0.28%; 14-16 years, 0.47%, 0.3%, respectively) and Philippine (14-16, 0.43%, 0.33%, respectively) schoolchildren, but was higher in the Singapore expatriates (4-6 years, 1.29%, 1.12%; 14-16 years, both 1.21%, respectively; 4-6 years, expatriates vs local Singaporeans: peanut, P = .019; tree nut, P = .0017; 14-16 years, P > .05). Conversely, shellfish allergy was more common in the local Singapore (4-6 years, 1.19%; 14-16 years, 5.23%) and Philippine (14-16 years, 5.12%) schoolchildren compared with expatriate children (4-6 years, 0.55%; 14-16 years, 0.96%; P < .001). When data were pooled, respondents born in Western countries were at higher risk of peanut (adjusted odds ratios 95% CIs: 4-6 years, 3.47 1.35-8.93; 14-16 years, 5.56 1.74-17.76) and tree nut allergy (adjusted odds ratios 95% CIs: 4-6 years, 10.40 1.61-67.36; 14-16 years, 3.53 1.00-12.43) compared with those born in Asia. Conclusion This study substantiates the notion that peanut and tree nut allergy is relatively low in Asian children, and instead shellfish allergy predominates. Environmental factors that are yet to be defined are likely to contribute to these differences.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Can We Apply the National Cholesterol Education Program Adult Treatment Panel Definition of the Metabolic Syndrome to Asians?
Chee-Eng Tan , PHD, MMED 1 ,
Stefan Ma , PHD 2 ,
Daniel Wai , MRCP 1 ,
...Suok-Kai Chew , MSC 2 and
E.-Shyong Tai , MRCP 1
1 Department of Endocrinology, Singapore General Hospital, Singapore
2 Ministry of Health, College of Medicine Building, Singapore
Address correspondence and reprint requests to Dr. C.E. Tan, Department of Endocrinology, Singapore General Hospital, Block
6 Level 6, Outram Road, Singapore 169608, Republic of Singapore. E-mail: ce_tan{at}sgh.com.sg
Abstract
OBJECTIVE —Limited information is available about the metabolic syndrome in Asians. Furthermore, the definition of central obesity using
waist circumference may not be appropriate for Asians. The objectives of this study were to determine the optimal waist circumference
for diagnosing central obesity in Asians and to estimate the prevalence of the metabolic syndrome in an Asian population.
RESEARCH DESIGN AND METHODS —We used data from the 1998 Singapore National Health Survey, a cross-sectional survey involving 4,723 men and women of Chinese,
Malay, and Asian-Indian ethnicity aged 18–69 years. Receiver operating characteristic analysis suggested that waist circumference
>80 cm in women and >90 cm in men was a more appropriate definition of central obesity in this population. The prevalence
of the metabolic syndrome was then determined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP
ATP III) criteria with and without the modified waist circumference criteria.
RESULTS —In Asians, decreasing waist circumference increased the crude prevalence of the metabolic syndrome from 12.2 to 17.9%. Using
the modified Asian criteria, the prevalence of the metabolic syndrome increased from 2.9% in those aged 18–30 years to 31.0%
in those aged 60–69 years. It was more common in men (prevalence 20.9% in men versus 15.5% in women; P < 0.001) and Asian Indians (prevalence 28.8% in Asian-Indians, 24.2% in Malays, and 14.8% in Chinese; P < 0.001).
CONCLUSIONS — NCEP ATP III criteria, applied to an Asian population, will underestimate the population at risk. With a lower waist circumference
cutoff, the prevalence of the metabolic syndrome is comparable to that in Western populations. Ethnic differences are likely
to exist between populations across Asia.
CVD, cardiovascular disease
IGT, impaired glucose tolerance
NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III
NHANES III, Third National Health and Nutrition Examination Survey
ROC, receiver operating characteristic
WHO, World Health Organization
Footnotes
Accepted January 19, 2004.
Received October 13, 2003.
DIABETES CARE
Air pollution has a significant health impact. Most data originate from temperate regions. We aim to study the health impact of air pollution, particularly among the elderly, in a tropical region.
A ...daily time-series analysis was performed to estimate excess risk (ER) of various air pollutants on daily death counts amongst the general population in Singapore from 2001 to 2013. Air pollutants included particulate matters smaller than 10 μm, and 2.5 μm (PM
, PM
), carbon monoxide (CO), nitrogen dioxide (NO
), ozone (O
) and sulphur dioxide (SO
). The studied outcomes were non-accidental and cardiovascular mortality. Single-day lag and distributed lag models were studied and adjusted for confounders.
In single-day lag models, a 10 μg/m
increase in particulate matter was associated with significant increases in non-accidental (PM
ER: 0.627%; 95% confidence interval (CI): 0.260-0.995% and PM
ER: 0.660%; 95% CI: 0.204-1.118%) and cardiovascular mortality (PM
ER: 0.897; 95% CI: 0.283-1.516 and PM
ER: 0.883%; 95% CI: 0.121-1.621%). This was significant in the elderly ≥ 65 years but not in those < 65 years and were seen in the acute phase of lag 0-5 days. Effects by other pollutants were minimal. For cardiovascular mortality, the effects turned protective at a cumulative lag of 30 days in the elderly and could due to "harvesting".
These first contemporary population-based data from an equatorial country with tropical climate show that exposure to particulate air pollution was significantly associated with non-accidental mortality and cardiovascular mortality, especially in the elderly.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
