ResearchPad - singapore https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Modeling competitive evolution of multiple languages]]> https://www.researchpad.co/article/elastic_article_7854 Increasing evidence demonstrates that in many places language coexistence has become ubiquitous and essential for supporting language and cultural diversity and associated with its financial and economic benefits. The competitive evolution among multiple languages determines the evolution outcome, either coexistence, or decline, or extinction. Here, we extend the Abrams-Strogatz model of language competition to multiple languages and then validate it by analyzing the behavioral transitions of language usage over the recent several decades in Singapore and Hong Kong. In each case, we estimate from data the model parameters that measure each language utility for its speakers and the strength of two biases, the majority preference for their language, and the minority aversion to it. The values of these two biases decide which language is the fastest growing in the competition and what would be the stable state of the system. We also study the system convergence time to stable states and discover the existence of tipping points with multiple attractors. Moreover, the critical slowdown of convergence to the stable fractions of language users appears near and peaks at the tipping points, signaling when the system approaches them. Our analysis furthers our understanding of evolution of various languages and the role of tipping points in behavioral transitions. These insights may help to protect languages from extinction and retain the language and cultural diversity.

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<![CDATA[Imported Human Babesiosis, Singapore, 2018]]> https://www.researchpad.co/article/N1cb4fd26-11c3-434a-9162-0d270f133f89

In 2018, Babesia microti infection was diagnosed for a 37-year-old man in Singapore who acquired the infection in the United States. This case highlights the recent rise of tickborne infections in the United States and the risk for their spread, because of increasing global interconnectivity, to regions where they are not endemic.

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<![CDATA[Health-related quality of life loss associated with first-time stroke]]> https://www.researchpad.co/article/5c58d61cd5eed0c484031668

Objectives

This study aimed to quantify health-related quality of life (HRQoL) loss associated with first episode of stroke by comparing patient-reported HRQoL before and after stroke onset. The impact of stroke in local population was also evaluated by comparing the pre- and post-stroke HRQoL with that of the general population.

Methods

The HRQoL of stroke survivors was assessed with the EQ-5D-3L index score at recruitment, for recalled pre-stroke HRQoL, and at 3 and 12 month post-stroke. Change in HRQoL from pre-stroke to 3 and 12 month was self-reported by 285 and 238 patients, respectively. Mean EQ index score at each time point (baseline: 464 patients; 3 month post-stroke: 306 patients; 12 month post-stroke: 258 patients) was compared with published population norms for EQ-5D-3L.

Results

There was a significant decrease in HRQoL at 3 (0.25) and 12 month (0.09) post-stroke when compared to the retrospectively recalled patients’ mean pre-stroke HRQoL level (0.87). The reduction at 3 month was associated with the reduction in all EQ-5D-3L health dimensions; reductions remaining at 12 month were limited to dimensions of mobility, self-care, usual activities, and anxiety/depression. Stroke patients had a lower mean EQ index than the general population by 0.07 points pre-stroke (0.87 vs. 0.94), 0.33 points at 3 month (0.61 vs. 0.94) and 0.18 points at 12 month (0.76 vs. 0.94) post-stroke.

Conclusions

Stroke has a substantial impact on HRQoL in Singapore, especially in the first three months post-stroke. Compared to the general population, stroke survivors have lower HRQoL even before stroke onset. This pre-stroke deficit in HRQoL should be taken into account when quantifying health burden of stroke or setting goals for stroke rehabilitation.

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<![CDATA[Psychosomatic symptoms during South East Asian haze crisis are related to changes in cerebral hemodynamics]]> https://www.researchpad.co/article/5c3d0122d5eed0c4840389a2

Objectives

Forest fires in South Asia lead to widespread haze, where many healthy individuals develop psychosomatic symptoms. We investigated the effects of haze exposure on cerebral hemodynamics and new symptoms. We hypothesised that vasoactive substances present in the haze, would lead to vasodilation of cerebral vasculature, thereby altering cerebral hemodynamics, which in turn may account for new psychosomatic symptoms.

Methods

Seventy-four healthy volunteers were recruited, and serial transcranial Doppler (TCD) ultrasonography was performed to record blood flow parameters of bilateral middle cerebral arteries (MCA). The first TCD was performed in an air-conditioned environment. It was repeated outdoors after the participants spent 30-minutes in the haze environment. The prevailing level of pollutant standards index (PSI) was recorded. Appropriate statistical analyses were performed to compare cerebral hemodynamics at baseline and after haze exposure in all participants. Subgroup analyses were then employed to compare the findings between symptomatic and asymptomatic participants.

Results

Study participants’ median age was 30 years (IQR 26–34), and new psychosomatic symptoms were reported by 35 (47.3%). There was a modest but significant decrease in pulsatility index (PI) and resistivity index (RI) in the left MCA after haze exposure (PI: p = 0.026; RI: p = 0.021). When compared to baseline parameters, haze exposure resulted in significantly lower mean PI (p = 0.001) and RI (p = 0.001) in symptomatic patients, but this difference was not present in asymptomatic patients (PI: p = 0.919; RI: p = 0.970).

Conclusion

Haze causes significant alterations in cerebral hemodynamics in susceptible individuals, probably responsible for various psychosomatic symptoms. The prognostic implications and health effects of haze require evaluation in a larger study.

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<![CDATA[Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity]]> https://www.researchpad.co/article/5989d9d6ab0ee8fa60b6610a

Background

To reduce readmissions, it may be cost-effective to consider risk stratification, with targeting intervention programs to patients at high risk of readmissions. In this study, we aimed to derive and validate a prediction model including several novel markers of hospitalization severity, and compare the model with the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, Emergency department visits in past 6 months), an established risk stratification tool.

Method

This was a retrospective cohort study of all patients ≥ 21 years of age, who were admitted to a tertiary hospital in Singapore from January 1, 2013 through May 31, 2015. Data were extracted from the hospital’s electronic health records. The outcome was defined as unplanned readmissions within 30 days of discharge from the index hospitalization. Candidate predictive variables were broadly grouped into five categories: Patient demographics, social determinants of health, past healthcare utilization, medical comorbidities, and markers of hospitalization severity. Multivariable logistic regression was used to predict the outcome, and receiver operating characteristic analysis was performed to compare our model with the LACE index.

Results

74,102 cases were enrolled for analysis. Of these, 11,492 patient cases (15.5%) were readmitted within 30 days of discharge. A total of fifteen predictive variables were strongly associated with the risk of 30-day readmissions, including number of emergency department visits in the past 6 months, Charlson Comorbidity Index, markers of hospitalization severity such as ‘requiring inpatient dialysis during index admission, and ‘treatment with intravenous furosemide 40 milligrams or more’ during index admission. Our predictive model outperformed the LACE index by achieving larger area under the curve values: 0.78 (95% confidence interval [CI]: 0.77–0.79) versus 0.70 (95% CI: 0.69–0.71).

Conclusion

Several factors are important for the risk of 30-day readmissions, including proxy markers of hospitalization severity.

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<![CDATA[Psychometric Evaluation of 5- and 4-Item Versions of the LATCH Breastfeeding Assessment Tool during the Initial Postpartum Period among a Multiethnic Population]]> https://www.researchpad.co/article/5989db3aab0ee8fa60bd4ab1

Objectives

The aim of this study was to evaluate the internal consistency, structural validity, sensitivity and specificity of the 5- and 4-item versions of the LATCH assessment tool among a multiethnic population in Singapore.

Methods

The study was a secondary analysis of a subset of data (n = 907) from our previous breastfeeding survey from 2013 to 2014. The internal consistency of the LATCH was examined using Cronbach’s alpha. The structural validity was assessed using an exploratory factor analysis (EFA), and the proposed factors were confirmed by confirmatory factor analysis (CFA) using separate samples. Receiver operating characteristic analysis was used to evaluate the sensitivity and specificity of the LATCH score thresholds for predicting non-exclusive breastfeeding.

Results

The Cronbach’s alpha values of the 5- and 4-item LATCH assessments were 0.70 and 0.74, respectively. The EFA demonstrated a one-factor structure for the 5- and 4-item LATCH assessments among a randomized split of 334 vaginally delivered women. Two CFA of the 4-item LATCH demonstrated better fit indices of the models compared to the two CFA of the 5-item LATCH among another randomized split of 335 vaginally delivered women and 238 cesarean delivered women. Using cutoffs of 5.5 and 3.5 were recommended when predicting non-exclusive breastfeeding for 5- and 4-item versions of the LATCH assessment among vaginally delivered women (n = 669), with satisfactory sensitivities (94% and 95%), low specificities (0% and 2%), low positive predictive values (25%) and negative predictive values (20% and 47%). A cutoff of 5.5 was recommended to predict non-exclusive breastfeeding for 5- and 4-item versions among cesarean delivered women (n = 238) with satisfactory sensitivities (93% and 98%), low specificities (4% and 9%), low positive predictive values (41%) and negative predictive values (65% and 75%). Therefore, the tool has good sensitivity but poor specificity, positive and negative predictive values.

Conclusions

We found that the 4-item version demonstrated sound psychometric properties compared to the 5-item version. Health professionals can use the 4-item LATCH as a clinical tool because it is a concise, easy-to-use and valid tool for assessing breastfeeding techniques among a multiethnic population.

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<![CDATA[A Sequence of Flushing and Drying of Breeding Habitats of Aedes aegypti (L.) Prior to the Low Dengue Season in Singapore]]> https://www.researchpad.co/article/5989da9fab0ee8fa60ba52de

In dengue-endemic areas, transmission shows both a seasonal and interannual variability. To investigate how rainfall impacts dengue seasonality in Singapore, we carried out a longitudinal survey in the Geylang neighborhood from August 2014 to August 2015. The survey comprised of twice-weekly random inspections to outdoor breeding habitats and continuous monitoring for positive ones. In addition, observations of rainstorms were collected. Out of 6824 inspected habitats, 67 contained Aedes aegypti, 11 contained Aedes albopictus and 24 contained Culex spp. The main outdoors habitat of Aedes aegypti was storm drains (54/67). We found that 80% of breeding sites in drains (43/54) were lost after intense rainstorms related to the wet phase of the Northeast monsoon (NE) between November 2014 and early January 2015. Subsequently, 95% (41/43) of these flushed drains had dried out during the dry phase of the NE in late January-February 2015. A return in the outdoor breeding of Aedes aegypti was observed after the onset of Southwest monsoon (SW) between May and August 2015. There was also a reduction in productivity of breeding habitats for larvae and pupae after the onset of the NE. In wet equatorial regions like Singapore, rainfall varies with the monsoons. A monsoon-driven sequence of flushing and drying shapes the outdoor seasonal abundance of Aedes aegypti. This finding can be used to optimize vector control strategies and better understand dengue in the context of climate change.

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<![CDATA[Routine Primary Prophylaxis for Febrile Neutropenia with Biosimilar Granulocyte Colony-Stimulating Factor (Nivestim) or Pegfilgrastim Is Cost Effective in Non-Hodgkin Lymphoma Patients undergoing Curative-Intent R-CHOP Chemotherapy]]> https://www.researchpad.co/article/5989da11ab0ee8fa60b79d13

Objective

This study aims to compare the cost-effectiveness of various strategies of myeloid growth factor prophylaxis for reducing the risk of febrile neutropenia (FN) in patients with non-Hodgkin lymphoma in Singapore who are undergoing R-CHOP chemotherapy with curative intent.

Methods

A Markov model was created to compare seven prophylaxis strategies: 1) primary prophylaxis (PP) with nivestim (biosimilar filgrastim) throughout all cycles of chemotherapy; 2) PP with nivestim during the first two cycles of chemotherapy; 3) secondary prophylaxis (SP) with nivestim; 4) PP with pegfilgrastim throughout all cycles of chemotherapy; 5) PP with pegfilgrastim during the first two cycles of chemotherapy; 6) SP with pegfilgrastim; and 7) no prophylaxis (NP). The perspective of a hospital was taken and cost-effectiveness was expressed as the cost per episode of FN avoided over six cycles of chemotherapy. A probabilistic sensitivity analysis was conducted.

Results

Strategies 3, 6, and 7 were dominated in the base case analysis by strategy 5. The costs associated with strategies 2, 5, 1, and 4 were US$3,813, US$4,056, US$4,545, and US$5,331, respectively. The incremental cost-effectiveness ratios for strategy 5 vs. strategy 2, strategy 1 vs. strategy 5, and strategy 4 vs. strategy 1 were US$13,532, US$22,565, and US$30,452, respectively, per episode of FN avoided. Strategy 2 has the highest probability to be cost-effective (ranged from 48% to 60%) when the willingness to pay (WTP) threshold is lower than US$10,000 per FN episode prevented.

Conclusion

In Singapore, routine PP with granulocyte colony-stimulating factor (nivestim or pegfilgrastim) is cost-effective for reducing the risk of FN in patients receiving R-CHOP.

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<![CDATA[Molluscs for Sale: Assessment of Freshwater Gastropods and Bivalves in the Ornamental Pet Trade]]> https://www.researchpad.co/article/5989d9ecab0ee8fa60b6cb92

The ornamental pet trade is often considered a key culprit for conservation problems such as the introduction of invasive species (including infectious diseases) and overharvesting of rare species. Here, we present the first assessment of the biodiversity of freshwater molluscs in the ornamental pet trade in Singapore, one of the most important global hubs of the ornamental aquarium trade, and discuss associated conservation concerns. We recorded freshwater molluscs from ornamental pet shops and major exporters including non-ornamental species (e.g., hitchhikers, molluscs sold as fish feed). We recorded an unexpectedly high diversity—59 species—of freshwater bivalves and gastropods, with the majority (38 species or 64%) being from the Oriental region. In addition to morphological examination, we sequenced the DNA barcode region of mitochondrial CO1 and 16S genes to provide molecular data for the confirmation of the identification and for future re-identification. DNA barcodes were obtained for 50 species, and all but four were separated by > 3% uncorrected pairwise distances. The trade has been considered a main introduction pathway for non-native species to Singapore, and we found that out of 15 species in the trade as well as in the wild in Singapore, 12 are either introduced or of unknown origin, representing almost half of the known non-native freshwater molluscs in Singapore. Particularly prevalent are non-ornamental species: six hitchhikers on aquarium plants and six species sold as fish feed. We found that a quarter of the trade species have a history of introduction, which includes 11 known or potentially invasive species. We conclude that potential overharvesting is difficult to assess because only half of the trade species have been treated by IUCN. Of these, 21 species are of Least Concern and three are Data Deficient. Our checklist, with accompanying DNA barcodes, images, and museum vouchers, provides an important reference library for future monitoring, and constitutes a step toward creating a more sustainable ornamental pet trade.

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<![CDATA[Does ethnicity matter in risk and protective factors for suicide attempts and suicide lethality?]]> https://www.researchpad.co/article/5989db51ab0ee8fa60bdc42b

This study explored ethnic differences in risk and protective factors for suicide attempts, for the major ethnic groups in Singapore, and ethnic differences in prediction of lethality. Three years of medical records related to suicide attempters (N = 666) who were admitted to the emergency department of a large teaching hospital in Singapore were subjected to analysis. Of the sample, 69.2% were female, 30.8% male; 63.8% Chinese, 15.8% Indian, and 15.0% Malay. Indians were over-represented in this sample, as compared with the ethnic distribution in the general population. Ages ranged from 10 to 85 years old (M = 29.7, SD = 16.1). Ethnic differences were found in risk and protective factors, and perceived lethality of suicide attempts. All available variables were subjected to regression analyses for Chinese, Indian and Malay attempters to arrive at parsimonious models for prediction of perceived lethality. The findings were discussed in regards to implications in assessment of suicide risk and primary prevention for the multiethnic society in Singapore.

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<![CDATA[The queenslandensis and the type Form of the Dengue Fever Mosquito (Aedes aegypti L.) Are Genomically Indistinguishable]]> https://www.researchpad.co/article/5989dad5ab0ee8fa60bb7b0d

Background

The mosquito Aedes aegypti (L.) is a major vector of viral diseases like dengue fever, Zika and chikungunya. Aedes aegypti exhibits high morphological and behavioral variation, some of which is thought to be of epidemiological significance. Globally distributed domestic Ae. aegypti have often been grouped into (i) the very pale variety queenslandensis and (ii) the type form. Because the two color forms co-occur across most of their range, there is interest in understanding how freely they interbreed. This knowledge is particularly important for control strategies that rely on mating compatibilities between the release and target mosquitoes, such as Wolbachia releases and SIT. To address this question, we analyzed nuclear and mitochondrial genome-wide variation in the co-occurring pale and type Ae. aegypti from northern Queensland (Australia) and Singapore.

Methods/Findings

We typed 74 individuals at a 1170 bp-long mitochondrial sequence and at 16,569 nuclear SNPs using a customized double-digest RAD sequencing. 11/29 genotyped individuals from Singapore and 11/45 from Queensland were identified as var. queenslandensis based on the diagnostic scaling patterns. We found 24 different mitochondrial haplotypes, seven of which were shared between the two forms. Multivariate genetic clustering based on nuclear SNPs corresponded to individuals’ geographic location, not their color. Several family groups consisted of both forms and three queenslandensis individuals were Wolbachia infected, indicating previous breeding with the type form which has been used to introduce Wolbachia into Ae. aegypti populations.

Conclusion

Aedes aegypti queenslandensis are genomically indistinguishable from the type form, which points to these forms freely interbreeding at least in Australia and Singapore. Based on our findings, it is unlikely that the presence of very pale Ae. aegypti will affect the success of Aedes control programs based on Wolbachia-infected, sterile or RIDL mosquitoes.

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<![CDATA[Integrative Analysis of the Physical Transport Network into Australia]]> https://www.researchpad.co/article/5989daeaab0ee8fa60bbeb9d

Effective biosecurity is necessary to protect nations and their citizens from a variety of threats, including emerging infectious diseases, agricultural or environmental pests and pathogens, and illegal wildlife trade. The physical pathways by which these threats are transported internationally, predominantly shipping and air traffic, have undergone significant growth and changes in spatial distributions in recent decades. An understanding of the specific pathways and donor-traffic hotspots created by this integrated physical transport network is vital for the development of effective biosecurity strategies into the future. In this study, we analysed the physical transport network into Australia over the period 1999–2012. Seaborne and air traffic were weighted to calculate a “weighted cumulative impact” score for each source region worldwide, each year. High risk source regions, and those source regions that underwent substantial changes in risk over the study period, were determined. An overall risk ranking was calculated by integrating across all possible weighting combinations. The source regions having greatest overall physical connectedness with Australia were Singapore, which is a global transport hub, and the North Island of New Zealand, a close regional trading partner with Australia. Both those regions with large amounts of traffic across multiple vectors (e.g., Hong Kong), and those with high levels of traffic of only one type (e.g., Bali, Indonesia with respect to passenger flights), were represented among high risk source regions. These data provide a baseline model for the transport of individuals and commodities against which the effectiveness of biosecurity controls may be assessed, and are a valuable tool in the development of future biosecurity policy.

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<![CDATA[Longitudinal Community-Based Study of QT Interval and Mortality in Southeast Asians]]> https://www.researchpad.co/article/5989da94ab0ee8fa60ba1160

Introduction

The prognostic impact of QT interval prolongation has not been well studied in healthy Asians. We investigated the association between the QT interval with mortality and cardiovascular events in a healthy Southeast Asian population.

Methods

The QT interval corrected for heart rate using the Bazett’s formula (QTc) was measured in 2536 (825 men, mean age 65.7±7.5 years) Singaporean adults free of cardiovascular disease in the population-based Singapore Longitudinal Ageing Study. Outcomes were all-cause mortality and incident cardiovascular events (cardiovascular mortality, myocardial infarction (MI) and/or stroke).

Results

Over a mean 7.78 years (19695 person-years) of follow-up, there were 202 deaths (45 from cardiovascular causes), 62 cases of myocardial infarction and 64 cases of stroke. Adjusting for age, sex, and cardiovascular risk factors, QTcB prolongation remained independently associated with increased all-cause mortality (HR(per standard deviation) 1.27 (1.10–1.48), p = 0.0015), as well as increased risk of cardiovascular events (HR 1.20 (1.01–1.43), p = 0.0415) and MI/stroke (HR 1.22 (1.01–1.47), p = 0.0455), but not cardiovascular mortality alone (HR 1.05 (0.77–1.44), p = 0.7562).

Conclusions

We provide the first community-based estimates of the independent association of QT prolongation with all-cause mortality and cardiovascular events in Southeast Asians.

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<![CDATA[Applying the Integrated Practice Unit Concept to a Modified Virtual Ward Model of Care for Patients at Highest Risk of Readmission: A Randomized Controlled Trial]]> https://www.researchpad.co/article/5989da3eab0ee8fa60b8926a

Background

Emerging evidence from the virtual ward care model showed that multidisciplinary case management are inadequate to reduce readmissions or death for high risk patients. There is consensus that interventions should encompass both pre-hospital discharge and post-discharge transitional care to be effective. Integrated practice units (IPU) had been proposed as an approach of restructuring the organization and work processes of multidisciplinary teams to achieve value in healthcare. Our primary objective is to evaluate if the novel application of the IPU concept to organize a modified virtual ward model incorporating pre-hospital discharge transitional care can reduce readmissions of patients at highest risk for readmission.

Methods

We conducted an open label, assessor blinded randomized controlled trial on patients with one or more unscheduled readmissions in the prior 90 days and LACE score ≥ 10. 840 patients were randomized in 1:1 ratio and blocks of 6 to the intervention program (n = 420) or control (n = 420). Allocation concealment was effected via an off-site telephone service maintained by a hospital administrator. Intervention patients received discharge planning, medication reconciliation, coaching on self-management of chronic diseases using standardized action plans and an individualized care plan complete with written discharge instructions, appointments schedule, medication changes and the contact information of the outpatient VW nurse before discharge. At discharge, care is handed over to the outpatient VW team. Patients were closely monitored in the VW for three months that included a telephone review within 72 hours of discharge, home assessment, regular telephone reviews to identify early complications and early review clinics for patients who destabilize. The VW meet daily to discuss new patients and review care plans for patients. Control patients received standard hospital care that included a standardized patient copy of the hospital discharge summary listing their medical diagnoses and medications; and follow up is arranged with a primary care provider or specialist as considered necessary. The primary outcome was the unplanned readmission rate to any hospital within 30 days of discharge. Secondary outcomes included the unplanned readmission rate, emergency department (ED) attendance rate to any hospital and the probability without readmission or death up to 180 days of discharge. Length of stay and mortality rate at 90-day were compared between the two groups. Outcome data were objectively retrieved from the hospital and National Electronic Health Records by a blinded outcome assessor.

Findings

All patients’ outcomes were included in an intention-to-treat analysis. The characteristics of both study groups were similar. Patients in the intervention group had a significant reduction in the number of 30-day readmissions, IRR 0.67 (95% CI, 0.52 to 0.86, p = 0.001) and the number of 30-day emergency department attendances, IRR 0.60 (95% CI, 0.46 to 0.79, p<0.001) compared to those receiving standard hospital care. The effectiveness was sustained at 90 and 180 days. The intervention group utilized 1164 fewer hospital bed days at 90-day post discharge. No adverse events were reported.

Conclusion

Applying the integrated practice unit concept to the virtual ward program resulted in reduced readmissions in patients who are at highest risk of readmission.

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<![CDATA[Factors associated with false-positive mammography at first screen in an Asian population]]> https://www.researchpad.co/article/5c900d51d5eed0c48407e642

Introduction

False-positive recall is an issue in national screening programmes. The aim of this study is to investigate the recall rate at first screen and to identify potential predictors of false-positive recall in a multi-ethnic Asian population-based breast cancer screening programme.

Methods

Women aged 50–64 years attending screening mammography for the first time (n = 25,318) were included in this study. The associations between potential predictors (sociodemographic, lifestyle and reproductive) and false-positive recall were evaluated using multivariable logistic regression models.

Results

The recall rate was 7.6% (n = 1,923), of which with 93.8% were false-positive. Factors independently associated with higher false-positive recall included Indian ethnicity (odds ratio [95% confidence interval]: 1.52 [1.25 to 1.84]), premenopause (1.23 [1.04 to 1.44]), nulliparity (1.85 [1.57 to 2.17]), recent breast symptoms (1.72 [1.31 to 2.23]) and history of breast lump excision (1.87 [1.53 to 2.26]). Factors associated with lower risk of false-positive recall included older age at screen (0.84 [0.73 to 0.97]) and use of oral contraceptives (0.87 [0.78 to 0.97]). After further adjustment of percent mammographic density, associations with older age at screening (0.97 [0.84 to 1.11]) and menopausal status (1.12 [0.95 to 1.32]) were attenuated and no longer significant.

Conclusion

For every breast cancer identified, 15 women without cancer were subjected to further testing. Efforts to educate Asian women on what it means to be recalled will be useful in reducing unnecessary stress and anxiety.

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<![CDATA[Determinants of Heterosexual Adolescents Having Sex with Female Sex Workers in Singapore]]> https://www.researchpad.co/article/5989da79ab0ee8fa60b97d45

Objectives

We assessed the proportion of and socio-ecological factors associated with ever having had sex with female sex workers (FSWs) among heterosexual adolescents. We also described the characteristics of the adolescents who reported inconsistent condom use with FSWs.

Methods

This is a cross-sectional study (response rate: 73%) of 300 heterosexually active male adolescents of 16 to 19 years attending a national STI clinic in Singapore between 2009 and 2014. We assessed the ecological factors (individual, parental, peer, school and medial influences) and sexual risk behaviors using a self-reported questionnaire. Poisson regression was used to obtain the adjusted prevalence ratios (aPR) and confidence intervals (CI).

Results

The proportion of heterosexual male adolescents who had ever had sex with FSWs was 39%. Multivariate analysis showed that significant factors associated with ever having had sex with FSWs were sex initiation before 16 years old (aPR 1.79 CI: 1.30–2.46), never had a sexually active girlfriend (aPR 1.75 CI 1.28–2.38), reported lower self-esteem score (aPR 0.96 CI: 0.93–0.98), higher rebelliousness score (aPR 1.03 CI: 1.00–1.07) and more frequent viewing of pornography (aPR 1.47 CI: 1.04–2.09). Lifetime inconsistent condom use with FSWs was 30%.

Conclusions

A significant proportion of heterosexual male adolescents attending the public STI clinic had ever had sex with FSWs. A targeted intervention that addresses different levels of influence to this behavior is needed. This is even more so because a considerable proportion of adolescents reported inconsistent condom use with FSWs, who may serve as a bridge of STI transmission to the community. National surveys on adolescent health should include the assessment of frequency of commercial sex visits and condom use with FSWs for long-term monitoring and surveillance.

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<![CDATA[Attitudes to Mental Illness and Its Demographic Correlates among General Population in Singapore]]> https://www.researchpad.co/article/5989db09ab0ee8fa60bc9935

Background

Public attitudes to mental illness could influence how the public interact with, provide opportunities for, and help people with mental illness.

Aims

This study aims to explore the underlying factors of the Attitudes to Mental Illness questionnaire among the general population in Singapore and the socio-demographic correlates of each factor.

Methods

From March 2014 to April 2015, a nation-wide cross-sectional survey on mental health literacy with 3,006 participants was conducted in Singapore.

Results

Factor analysis revealed a 4-factor structure for the Attitudes to Mental Illness questionnaire among the Singapore general population, namely social distancing, tolerance/support for community care, social restrictiveness, and prejudice and misconception. Older age, male gender, lower education and socio-economic status were associated with more negative attitudes towards the mentally ill. Chinese showed more negative attitudes than Indians and Malays (except for prejudice and misconception).

Conclusions

There is a need for culture-specific interventions, and the associated factors identified in this study should be considered for future attitude campaigns.

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<![CDATA[Transporting Ocean Viromes: Invasion of the Aquatic Biosphere]]> https://www.researchpad.co/article/5989dad5ab0ee8fa60bb7a72

Studies of marine viromes (viral metagenomes) have revealed that DNA viruses are highly diverse and exhibit biogeographic patterns. However, little is known about the diversity of RNA viruses, which are mostly composed of eukaryotic viruses, and their biogeographic patterns in the oceans. A growth in global commerce and maritime traffic may accelerate spread of diverse and non-cosmopolitan DNA viruses and potentially RNA viruses from one part of the world to another. Here, we demonstrated through metagenomic analyses that failure to comply with mid-ocean ballast water exchange regulation could result in movement of viromes including both DNA viruses and RNA viruses (including potential viral pathogens) unique to geographic and environmental niches. Furthermore, our results showed that virus richness (known and unknown viruses) in ballast water is associated with distance between ballast water exchange location and its nearest shoreline as well as length of water storage time in ballast tanks (voyage duration). However, richness of only known viruses is governed by local environmental conditions and different viral groups have different responses to environmental variation. Overall, these results identified ballast water as a factor contributing to ocean virome transport and potentially increased exposure of the aquatic bioshpere to viral invasion.

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<![CDATA[Bubbles Are Departures from Equilibrium Housing Markets: Evidence from Singapore and Taiwan]]> https://www.researchpad.co/article/5989db05ab0ee8fa60bc8334

The housing prices in many Asian cities have grown rapidly since mid-2000s, leading to many reports of bubbles. However, such reports remain controversial as there is no widely accepted definition for a housing bubble. Previous studies have focused on indices, or assumed that home prices are lognomally distributed. Recently, Ohnishi et al. showed that the tail-end of the distribution of (Japan/Tokyo) becomes fatter during years where bubbles are suspected, but stop short of using this feature as a rigorous definition of a housing bubble. In this study, we look at housing transactions for Singapore (1995 to 2014) and Taiwan (2012 to 2014), and found strong evidence that the equilibrium home price distribution is a decaying exponential crossing over to a power law, after accounting for different housing types. We found positive deviations from the equilibrium distributions in Singapore condominiums and Zhu Zhai Da Lou in the Greater Taipei Area. These positive deviations are dragon kings, which thus provide us with an unambiguous and quantitative definition of housing bubbles. Also, the spatial-temporal dynamics show that bubble in Singapore is driven by price pulses in two investment districts. This finding provides a valuable insight for policymakers on implementation and evaluation of cooling measures.

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<![CDATA[Public Health Responses to and Challenges for the Control of Dengue Transmission in High-Income Countries: Four Case Studies]]> https://www.researchpad.co/article/5989da3aab0ee8fa60b87a45

Dengue has a negative impact in low- and lower middle-income countries, but also affects upper middle- and high-income countries. Despite the efforts at controlling this disease, it is unclear why dengue remains an issue in affluent countries. A better understanding of dengue epidemiology and its burden, and those of chikungunya virus and Zika virus which share vectors with dengue, is required to prevent the emergence of these diseases in high-income countries in the future. The purpose of this review was to assess the relative burden of dengue in four high-income countries and to appraise the similarities and differences in dengue transmission. We searched PubMed, ISI Web of Science, and Google Scholar using specific keywords for articles published up to 05 May 2016. We found that outbreaks rarely occur where only Aedes albopictus is present. The main similarities between countries uncovered by our review are the proximity to dengue-endemic countries, the presence of a competent mosquito vector, a largely nonimmune population, and a lack of citizens’ engagement in control of mosquito breeding. We identified important epidemiological and environmental issues including the increase of local transmission despite control efforts, population growth, difficulty locating larval sites, and increased human mobility from neighboring endemic countries. Budget cuts in health and lack of practical vaccines contribute to an increased risk. To be successful, dengue-control programs for high-income countries must consider the epidemiology of dengue in other countries and use this information to minimize virus importation, improve the control of the cryptic larval habitat, and engage the community in reducing vector breeding. Finally, the presence of a communicable disease center is critical for managing and reducing future disease risks.

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