Climate change and population health in Singapore: a systematic review.

Gaseous emissions have contributed to global warming, an increase in the frequency of extreme weather events and poorer air quality. The associated health impacts have been well reported in temperate regions. In Singapore, key climate change adaptation measures and activities include coastal and flood protection, and mitigating heat impacts. We systematically reviewed studies examining climate variability and air quality with population health in Singapore, a tropical city-state in South-East Asia (SEA), with the aim to identify evidence gaps for policymakers. We included 14 studies with respiratory illnesses, cardiovascular outcomes, foodborne disease and dengue. Absolute humidity (3 studies) and rainfall (2 studies) were positively associated with adverse health. Extreme heat (2 studies) was inversely associated with adverse health. The effects of mean ambient temperature and relative humidity on adverse health were inconsistent. Nitrogen dioxide and ozone were positively associated with adverse health. Climate variability and air quality may have disease-specific, differing directions of effect in Singapore. Additional high quality studies are required to strengthen the evidence for policymaking. Research on effective climate action advocacy and adaptation measures for community activities should be strengthened. Funding: There was no funding source for this study.

Exposure to cooking fumes is associated with perturbations in nasal microbiota composition: A pilot study.

Air pollution is one of the leading causes of overall mortality globally. Cooking emissions are a major source of fine particulate matter (PM2.5). However, studies on their potential perturbations on the nasal microbiota as well as their association with respiratory health are lacking. This pilot study aims to assess the environmental air quality among occupational cooks and its associations with nasal microbiota and respiratory symptoms. A total of 20 cooks (exposed) and 20 unexposed controls (mainly office workers), were recruited in Singapore from 2019 to 2021. Information on sociodemographic factors, cooking methods, and self-reported respiratory symptoms were collected using a questionnaire. Personal PM2.5 concentrations and reactive oxygen species (ROS) levels were measured using portable sensors and filter samplers. DNA was extracted from nasal swabs and sequenced using 16s sequencing. Alpha-diversity and beta-diversity were calculated, and between-group variation analysis of species was performed. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between exposure groups and self-reported respiratory symptoms. Higher daily mean PM2.5 (P = 2 × 10-7) and environmental ROS exposure (P = 3.25 × 10-7) were observed in the exposed group. Alpha diversity of the nasal microbiota between the two groups was not significantly different. However, beta diversity was significantly different (unweighted UniFrac P = 1.11 × 10-5, weighted UniFrac P = 5.42 × 10-6) between the two exposure groups. In addition, certain taxa of bacteria were slightly more abundant in the exposed group compared to unexposed controls. There were no significant associations between the exposure groups and self-reported respiratory symptoms. In summary, the exposed group had higher PM2.5 and ROS exposure levels and altered nasal microbiotas as compared to unexposed controls, though further studies are required to replicate these findings in a larger population.

Second-hand smoke and fine particulate matter exposures among multi-unit housing residents in Singapore: A pilot study.

Globally, approximately 1.2 million deaths among non-smokers are attributed to second-hand smoke (SHS) per year. Multi-unit housing is becoming the common type of residential dwelling in developed cities and the issue of neighbour SHS is of rising concern especially as 'Work From Home' became the norm during and post COVID-19 pandemic. The objective of this pilot study is to measure and compare the air quality of households that are exposed to SHS and unexposed households among smoking and non-smoking households in Singapore. A total of 27 households were recruited from April to August 2021. Households were categorized into smoking households with neighbour SHS, smoking households without neighbour SHS, non-smoking households with neighbour SHS, and non-smoking household without neighbour SHS. Air quality of the households was measured using calibrated particulate matter (PM2.5) sensors for 7-16 days. Socio-demographic information and self-reported respiratory health were collected. Regression models were used to identify predictors associated with household PM2.5 concentrations and respiratory health. Mean PM2.5 concentration was significantly higher among non-smoking households with neighbour SHS (n = 5, mean = 22.2, IQR = 12.7) than in non-smoking household without neighbour SHS (n = 2, mean = 4.1, IQR = 5.8). Smoking activity at enclosed areas in homes had the lowest PM2.5 concentration (n = 7 mean = 15.9, IQR = 11.0) among the three smoking locations. Exposure to higher household PM2.5 concentration was found to be associated with poorer respiratory health. A 'smoke-free residential building' policy is recommended to tackle the issue of rising neighbour SHS complaints and health concerns in densely populated multi-unit housing in Singapore. Public education campaigns should encourage smokers to smoke away from the home to minimize SHS exposure in household members.

Change of air quality knowledge, perceptions, attitudes, and practices during and post-wildfires in the United States.

Amid worsening climate change, the recurrent wildfires have substantially worsened air quality in the Western United States (U.S.). Understanding the knowledge, attitudes, perception, and practices (KAPP) over time in response to natural disasters such as wildfires is crucial for public health interventions and disaster preparedness. This is the first study to investigate the change in air quality KAPP over time in response to natural disasters. Previous studies have only assessed KAPP at a fixed time point. Using a two-wave panel survey (during and post-wildfires), we assessed the association between KAPP and respiratory health indicators as well as the changes over time in 212 participants in the U.S. Between the two waves, we found a significant 8% increase in knowledge, which was mainly driven by participants in areas unaffected by the wildfires. In addition, we found differential associations between KAPP and respiratory health indicators between areas affected and unaffected by the wildfires. These findings suggest that experiencing wildfires may affect KAPP and more longitudinal studies are warranted, particularly during periodic air quality crises.

Development and validation of a new scale to assess air quality knowledge (AQIQ).

BACKGROUND: Air pollution is a leading public health concern around the world. Assessing the public's knowledge about air quality is critical to calibrate public health interventions. However, previous efforts to measure knowledge about air quality (AQIQ) have not relied on consistent and validated measures, thus precluding cross-country comparisons. We aimed to develop a robust scale to assess AQIQ and tested it in multiple countries. METHODS: To evaluate the psychometric properties and select the best performing items out of 10 AQIQ questions, we used methods from classical test theory and item response theory. We evaluated the scales using several scalability measures, including the Kuder-Richardson Formula 20 (KR-20), Loevinger's H, as well as trace lines. Volunteers from the United States (US, n = 400), India (n = 403), and China (n = 443) were recruited to validate the scale. Multiple linear regression was used to estimate the association between demographic factors and AQIQ. RESULTS: We found that participants from India had the highest AQIQ. In addition, not all questions performed well in each country. The scale was pruned and shorter subscales were validated. In the US, we obtained a 4-item scale (KR20 = 0.53, Loevinger's H = 0.34). In India, we obtained a 6-item scale (KR20 = 0.56; Loevinger's H = 0.48 for just 2 items). In China, we obtained a 5-item scale (KR20 = 0.39; Loevinger's H = 0.41 for just 2 items). Compared to the 10-item scale, the pruned scales showed stronger associations between measures of socioeconomic status and AQIQ. The results were robust to the scale used. CONCLUSIONS: Overall, general knowledge questions measured AQIQ more effectively in the US and India whereas knowledge of the air quality index better measured AQIQ in China. The findings suggest that careful measurement and validation are essential to develop knowledge scales for use in public health and environmental research.

Association between previous lung diseases and lung cancer risk: a systematic review and meta-analysis.

Previous lung diseases (PLD) are known risk factors for lung cancer. However, it remains unclear how the association varies by lung cancer subtype and socio-demographic characteristics. We conducted a systematic literature search in three electronic databases from the inception of each database up until 13 January 2021. A total of 73 studies (18 cohort and 55 case-control studies) consisting of 97 322 cases and 7 761 702 controls were included. Heterogeneity was assessed using the I2 statistic. Based on the heterogeneity, either the fixed-effects or random-effects model was used to estimate the pooled summary estimate (PSE) and 95% confidence interval (CI) for the association between PLD and lung cancer risk. A history of asthma, chronic bronchitis, emphysema, pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD) was associated with higher lung cancer risk, with a history of COPD and emphysema having at least twofold relative risk. A history of hay fever was associated with lower lung cancer risk (PSE= 0.66, 95% CI= 0.54-0.81), particularly among ever-smokers (PSE= 0.55, 95% CI= 0.41-0.73). Individuals with a diagnosis of asthma, emphysema, or pneumonia within 1-10 years prior to lung cancer diagnosis were observed to have a higher lung cancer risk as compared to those who were diagnosed more than 10 years prior to lung cancer diagnosis. Ever-smokers with a history of COPD or emphysema were observed to have at least twofold relative risk of lung cancer compared to those without this history. Due to the observed association between PLD with higher risk of lung cancer, it is advisable that individuals with PLD should be closely monitored and prioritised for lung cancer screening.

Association between Metabolites and the Risk of Lung Cancer: A Systematic Literature Review and Meta-Analysis of Observational Studies.

Globally, lung cancer is the most prevalent cancer type. However, screening and early detection is challenging. Previous studies have identified metabolites as promising lung cancer biomarkers. This systematic literature review and meta-analysis aimed to identify metabolites associated with lung cancer risk in observational studies. The literature search was performed in PubMed and EMBASE databases, up to 31 December 2019, for observational studies on the association between metabolites and lung cancer risk. Heterogeneity was assessed using the I2 statistic and Cochran's Q test. Meta-analyses were performed using either a fixed-effects or random-effects model, depending on study heterogeneity. Fifty-three studies with 297 metabolites were included. Most identified metabolites (252 metabolites) were reported in individual studies. Meta-analyses were conducted on 45 metabolites. Five metabolites (cotinine, creatinine riboside, N-acetylneuraminic acid, proline and r-1,t-2,3,c-4-tetrahydroxy-1,2,3,4-tetrahydrophenanthrene) and five metabolite groups (total 3-hydroxycotinine, total cotinine, total nicotine, total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (sum of concentrations of the metabolite and its glucuronides), and total nicotine equivalent (sum of total 3-hydroxycotinine, total cotinine and total nicotine)) were associated with higher lung cancer risk, while three others (folate, methionine and tryptophan) were associated with lower lung cancer risk. Significant heterogeneity was detected across most studies. These significant metabolites should be further evaluated as potential biomarkers for lung cancer.

Association between family history of lung cancer and lung cancer risk: a systematic review and meta-analysis.

BACKGROUND: Familial risk of lung cancer has been widely studied but the effects of sociodemographic factors and geographical regions are largely unknown. METHODS: PubMed and Embase were systematically searched until 1st October 2019. A total of 84 articles were identified and (19 cohort and 66 case control studies) included in this systematic review and meta-analysis. Pooled summary estimates and 95% confidence intervals were estimated, and the analysis was stratified by sociodemographic factors and geographical regions. RESULTS: Geographical regions, sex, age of proband, smoking status, type of first-degree relatives, number of affected relatives, and early onset of lung cancer in affected relatives were significant determinants of familial risk of lung cancer. Higher risk of familial lung cancer was found among Asians as compared to non-Asians, younger individuals (age≤50) as compared with older individuals (age>50), individuals with ≥2 affected relatives as compared with individuals with one affected relative, ever-smokers as compared with never-smokers, Asian females as compared with Western females, and never-smokers in Asia as compared with never-smokers in the West. CONCLUSIONS: Familial risk of lung cancer is influenced by both genetic and environmental factors. Future studies should control for environmental factors such as air pollution and environmental tobacco smoke which are prevalent in Asia.

Efficacy of mind-body therapies and exercise-based interventions on menopausal-related outcomes among Asian perimenopause women: A systematic review, meta-analysis, and synthesis without a meta-analysis.

AIMS: To evaluate the efficacy of exercise-based interventions and mind-body therapies on quality of life, menopausal symptoms, and depression among Asian perimenopausal women. DESIGN: A systematic review, meta-analysis, and synthesis without meta-analysis (SWiM). DATA SOURCES: Six electronic databases were systematically searched: PubMed, CINAHL, Embase, PsycINFO, Scopus, and ProQuest. REVIEW METHODS: The point of inception of each database to 15 November 2018 were systematically searched. A meta-analysis and SWiM were used to present the results. Review Manager 5.3 and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively. RESULTS: In all, 23 studies were reviewed. Significant effects in exercise-based interventions and mind-body therapies were found for quality of life, menopausal symptoms, and depression but not for hot flashes. Limitations of this review include insufficient blinding of participants and/or researchers found in most of the included studies and high levels of heterogeneity in the meta-analyses. Evidence found in this review is to be interpreted with caution. CONCLUSION: Healthcare professionals can consider exercise-based interventions or mind-body therapies to manage menopausal symptoms. Future trials of good quality can examine the cost-effectiveness and optimal intervention duration. Intervention effects on specific menopausal symptoms such as sleeplessness in Asia can be examined in future. IMPACT: Exercise-based interventions and mind-body therapies suggest effectiveness on quality of life, menopausal symptoms, and depression among Asian perimenopausal women. Exercise-based interventions and mind-body therapies improve quality of life, menopausal symptoms, and depression but not hot flashes. Long-term exercise-based interventions is effective in managing depression. Due to varied limitations in the review and included studies, firm conclusions cannot be reached. Healthcare professionals in Asia can consider implementing exercise-based interventions and mind-body therapies for symptomatic perimenopausal Asian women.

A systematic mixed-studies review on mindfulness-based childbirth education programs and maternal outcomes.

BACKGROUND: Mindfulness-based childbirth education programs are gaining popularity among expectant parents. PURPOSE: To synthesize knowledge on current available evidence of mindfulness-based childbirth education programs on maternal outcomes and to provide recommendations to improve future mindfulness-based childbirth education programs. METHOD: A mixed-studies systematic review using a narrative synthesis was conducted. Four electronic databases were searched from each database's inception, through November 26, 2018. FINDINGS: Three themes emerged from the synthesis: (a) the duration and receptivity of the programs, (b) improved maternal psychosocial outcomes, and (c) the practice of mindfulness during the postpartum period. A conceptual map was produced. DISCUSSION: The programs resulted in improved maternal psychosocial outcomes. A greater focus on the practice of informal mindfulness should be taught in future mindfulness-based childbirth education programs. Nurses can consider teaching mindfulness techniques in current antenatal classes. The cost effectiveness and receptivity of the programs should be examined. Future mixed-methods longitudinal studies with ideal sample sizes and the exclusion of participants with prior yoga or medication experiences should be conducted.

The Progression and Future of Nursing in Singapore: A Descriptive Qualitative Study.

Introduction: Nursing professionalism and nursing identity are important for retention of nurses. Despite of much attention on nurses in Singapore, there is still a shortage of nurses. This study aims to understand the perceptions of the progression and future of the nursing profession in Singapore. Methodology: A descriptive qualitative study design was used. The participants were 20 nurse educators, clinical nurses, and student nurses. Data were collected through focus group and online interviews and analyzed thematically. Results: Nurses felt a need to bridge the theory-practice gap and various factors to the underlying cause of the shortage of nurses were highlighted. Nurses shared their desires to see greater autonomy among nurses and a greater focus on community nursing in the future. Discussion: Collaboration between nurse academics and clinical nurses may bridge the theory-practice gap. To reduce the issue of the shortage of nurses, efforts to promote nursing professionalism are required.

Experiences, needs, and perceptions of paternal involvement during the first year after their infants' birth: A meta-synthesis.

OBJECTIVES: Fatherhood has evolved in recent decades from 'a moral teacher' to 'an involved father'. However, fatherhood experiences have not been examined in detail. This meta-synthesis aimed to examine fathers' experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth. METHOD: Six electronic databases were systematically searched: PubMed, CINAHL, Embase, Scopus, PsycINFO, ProQuest (grey literature). The search resulted in 13 studies that met the inclusion criteria. Quality appraisal was conducted using the Critical Appraisal Skills Programme Checklist. All 13 studies met the appraisal criteria and were included in the meta-synthesis. The findings of the 13 studies were synthesized using the steps of Sandelowski and Barroso in conducting meta-synthesis. RESULTS: The 13 included studies comprised studies conducted in the West, Africa, and Asia. Fatherhood experiences differed according to different sociocultural contexts. Three themes were identified: (1) trajectory of the father-infant relationship, (2) reinforcements and hindrances to involvement, and (3) change from self-oriented to family-oriented behavior. Changes in a father's relationship with his infant were influenced by relationships with his spouse and family members after the birth of the infant. Reinforcements, hindrances, and needs to fathers' involvement were identified. Fathering responsibility and parenting satisfaction that developed overtime influenced a father's behavior, changing from self-oriented to family-oriented. SIGNIFICANCE: This is the first meta-synthesis that examined fathers' experiences, needs, and perceptions of their involvement with their infants during the first 12 months of birth. Multiple factors were found to influence the socially-defined fathering ideology. Cultural practices of fatherhood and fathers' own perceptions shaped their actual fathering behaviors. The findings of this study may guide healthcare professionals as frontline personnel to understand fathers' needs and experiences in order to promote fathers' involvement in the early days after their infants' birth.

Factors influencing paternal involvement during infancy: A prospective longitudinal study.

AIMS: To explore factors influencing paternal involvement at 6 months postpartum and to detail the trend of these factors over a period of 6 months. BACKGROUND: There is a dearth of studies on paternal involvement during infancy in the unique Asian context. DESIGN: A prospective four-time point longitudinal design was adopted. METHODS: A total of 201 participants were recruited from a local hospital from May 2016 - December 2017 using convenience sampling. Self-administered questionnaires were used for data collection. Data were statistically analysed. RESULTS: Parenting self-efficacy at 6-month postpartum, paternal involvement, and paternal postnatal depression on the day of wife's hospital discharge, wife in paid work and wife's antenatal class attendance significantly influenced paternal involvement at 6 months postpartum. A sub-analysis of first-time and experienced fathers revealed that parenting self-efficacy at 6-month postpartum, paternal involvement on the day of wife's hospital discharge and wife in paid work were significant factors influencing paternal involvement for first-time fathers. Significant factors influencing paternal involvement for experienced fathers were paternal involvement on the day of wife's hospital discharge and wife's antenatal class attendance. CONCLUSION: Fathers (first-time and experienced) who were involved during their infant's birth were also involved at 6-month postpartum. Healthcare professionals may encourage paternal involvement through teaching fathers infant care skills during the antenatal period, especially first-time fathers as they may be lacking in such skills, which may hinder their parenting satisfaction. Paternal involvement throughout the perinatal period can be enforced by healthcare professionals to promote paternal involvement.

Informational interventions on paternal outcomes during the perinatal period: A systematic review.

PROBLEM: The perinatal period is a stressful transition for new parents. BACKGROUND: Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes. AIM: This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only. METHODS: The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaboration's tools were used to assess the eligibility of the studies. FINDINGS: A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes. DISCUSSION: Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia. CONCLUSION: Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

Paternal involvement of Singaporean fathers within six months postpartum: A follow-up qualitative study.

OBJECTIVE: This study aims to understand paternal involvement within the six-month postpartum period to identify the challenges and needs of Singaporean fathers. DESIGN: The study used a descriptive qualitative design. SETTING AND PARTICIPANTS: This research is a follow-up study of 50 first-time and experienced fathers who were originally interviewed in the early postpartum period. Fathers were recruited from a local public hospital in Singapore. MEASUREMENTS: Individual semi-structured interviews using an interview guide were conducted at six months postpartum with the fathers. The interview recordings were transcribed and analysed using thematic analysis. RESULTS: Four major themes emerged from the analysis: (1) fathers' understanding of their involvement at six months postpartum, (2) challenges of paternal involvement, (3) impact on marital relationship, and (4) needs of fathers. The respondent fathers were determined to be motivated differently during this timepoint as compared to at one week postpartum, but hindrances from work commitments and the presence of support limited paternal involvement. Strained marital relationship and sexual needs surfaced in this study. One father reported to be at risk for depression. Co-parenting practices buffered against marital dissatisfaction. Moreover, the informational needs of fathers differed at one week and six months postpartum. KEY CONCLUSIONS: This follow-up study revealed that the concerns and needs of fathers continue to emerge in accordance with their infants' growth and needs in different postpartum periods. Necessary assistance in the form of long-term follow-ups and online educational resources may be dynamic in supporting the emerging needs of fathers. IMPLICATIONS FOR PRACTICE: Healthcare professionals should engage in interventions that are dynamic in suiting fathers' needs at different time points and cultural contexts.

Lived experiences of Asian fathers during the early postpartum period: Insights from qualitative inquiry.

OBJECTIVE: this study aims to understand fathers' expectations, needs, and experiences in infant care during the early postpartum period in Singapore. DESIGN: a descriptive qualitative study design was adopted. SETTING: the study was conducted in a tertiary public hospital in Singapore. PARTICIPANTS: fifty participants (first-time as well as experienced fathers) were recruited from postnatal wards of a public hospital. FINDINGS: thematic analysis was used to analyze the interviews data. Four main themes emerged from the analysis: (1) support system of fathers, (2) paternal involvement in childcare, (3) challenges of fatherhood, and (4) recommendations by fathers. KEY CONCLUSION: this study found that the postpartum period is a stressful period for both first-time and experienced fathers. Fathers desired to be involved but were hindered in many ways, such as maternal gatekeeping, work commitments, and a lack of infant care skills. Experienced fathers faced difficulty in assimilating older children with the newborn. IMPLICATIONS FOR PRACTICE: fathers' needs to be involved in the infant and maternal care activities in the postpartum period. Necessary help from healthcare professionals and policymakers are needed for fathers to assimilate to fatherhood.

Hyperglycemia and type 2 diabetes among Filipino women in the Philippines, Hawaii, and San Diego.

BACKGROUND: Diabetes risk increases as immigrant populations adopt western lifestyles. We compared the prevalence of fasting hyperglycemia among Filipino women aged 40-79 years in the Philippines, Hawaii, and San Diego. METHODS: Data were obtained from the (1) Philippine National Nutrition Survey (1998), (2) Native Hawaiian Health Research Project (1997-2001), and (3) University of California San Diego Filipino Women's Health Study (1995-1999). Fasting glucose after an 8h fast, blood pressure, and body mass index (BMI) were measured in all three regions; a 75 g oral glucose tolerance test was performed in San Diego and Hawaii. RESULTS: The proportion of Filipinas with BMI > or = 30 kg/m2 was higher in Hawaii (20%) compared to women in San Diego (9.3%) or the Philippines (5.2%, p<0.001). Fasting hyperglycemia prevalence (fasting plasma glucose > or = 126 mg/dl or fasting whole blood glucose > or = 110 mg/dl) did not differ among Filipinas in the Philippines (11.8%), San Diego (14.1%), and Hawaii (14.7%, p = 0.323). Type 2 diabetes prevalence was similar among Filipinas in San Diego (31.6%) and Hawaii (24.9%, p = 0.79). CONCLUSIONS: Despite regional differences in obesity, fasting hyperglycemia was similar among Filipinas in the Philippines, San Diego, and Hawaii and type 2 diabetes prevalence was similar among Filipinas in San Diego and Hawaii.