How healthy is the Singaporean worker? Results from the Singapore national health survey 2010.

OBJECTIVE: To compare the prevalence of common medical conditions (including mental health and self-rated health) and lifestyle risk factors for disease of the Singapore workforce with the nonworking population, and evaluate the association of these factors with occupation class. METHODS: Data were obtained from a population-representative cross-sectional survey in 2010. Adjusted prevalence ratios (PRs) were obtained by modified Breslow-Cox proportional hazards regression model. RESULTS: Within the workforce, after adjustment for age, sex, and ethnicity, daily smoking (PR = 1.87; 95% confidence interval [CI], 1.40 to 2.51; P < 0.001), no regular exercise (PR = 1.13; 95% CI, 1.07 to 1.20; P < 0.001), and poor self-rated health (PR = 1.46, 95% CI, 1.22 to 1.76; P < 0.001) were more prevalent in the lower-skilled occupation classes. CONCLUSIONS: Lower-skilled occupation classes in Singapore are associated with lifestyle risk factors, and tailored workplace health promotion programs addressing their specific health needs are needed.

Diabetes, metabolic abnormalities, and glaucoma.

OBJECTIVE: To examine the relationship of diabetes mellitus and metabolic abnormalities with intraocular pressure and glaucoma. METHODS: A population-based study was conducted in 3280 (78.7% response) Malay adults aged 40 to 80 years. Diabetes was defined as a random serum glucose level of 200 mg/dL or greater or physician diagnosis of diabetes mellitus. Metabolic abnormalities including body mass index, lipid levels, and blood pressure were measured. Glaucoma was defined from a standardized examination by means of the International Society for Geographical and Epidemiological Ophthalmology criteria. RESULTS: There were 764 persons (23.3%) who had diabetes. After controlling for age, sex, education, smoking, central corneal thickness, and diabetes treatment, intraocular pressure was higher in persons with than without diabetes (16.7 vs 15.0 mm Hg, P < .001) and in those with higher serum glucose levels (P < .001), glycosylated hemoglobin concentrations (P < .001), total cholesterol levels (P = .001), triglyceride levels (P = .002), and body mass index (P = .001). However, the prevalence of glaucoma was similar between persons with and without diabetes (4.7% vs 4.5%). In multivariate logistic regression models adjusting for age, sex, education, smoking, central corneal thickness, and diabetes treatment, diabetes was not associated with glaucoma (odds ratio, 1.00; 95% confidence interval, 0.63-1.61). CONCLUSION: These data suggest that, although diabetes and metabolic abnormalities may be associated with a small increase in intraocular pressure, they are not significant risk factors for glaucomatous optic neuropathy.

Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home.

INTRODUCTION: The place of death of the elderly has implications on the overall healthcare delivery system. The aim of this study is to describe where deaths of elderly occur in Singapore and to determine the association of socio-demographic characteristics and the causes of death on dying at home. MATERIALS AND METHODS: Data of 10,399 Singapore resident decedents aged 65 years and above in 2006 were obtained from the national Registry of Births and Deaths. Distributions of socio-demographic characteristics and causes of death by place of death were analysed, and associations between socio-demographic characteristics and home death for major causes of death were assessed by logistic regression models controlling for age, gender and ethnic group. RESULTS: Most elderly deaths occurred in hospitals (57%), followed by deaths at home (31%). The proportion of deaths at home increased with age while deaths in hospital declined with age. Significantly more elderly women died at home compared to men. Malay elderly had the highest proportion of home deaths (49%), and the lowest proportion of hospital deaths (47%). Elderly persons who died from stroke were most likely to die at home [odds ratio (OR) 2.8, 95% confidence interval (CI), 2.3-3.3] while those who died from lung and respiratory system diseases were less likely to die at home (OR, 0.7; 95% CI, 0.6-0.8). CONCLUSION: Elderly people in Singapore die mainly in hospitals. About a third of them die at home. The proportion of decedents dying at home increased with age. Home deaths among the elderly are most likely in those aged 85 years and above, females, Malays, and those who die of stroke.

The relationship of intraocular pressure with age, systolic blood pressure, and central corneal thickness in an asian population.

PURPOSE: To describe the distribution of intraocular pressure (IOP) and its cross-sectional relationship to age, systolic blood pressure (sBP), and central corneal thickness (CCT) in an Asian population. METHODS: This was a population-based, cross-sectional study of 3280 Malay subjects (78.7% response) aged 40 to 80 years residing in Singapore. The participants had a standardized interview, examination, and ocular imaging at a centralized study clinic. IOP was measured with Goldmann applanation tonometry (GAT) before pupil dilation, CCT measurements were obtained with an ultrasound pachymeters, and sBP was taken with participants seated after 5 minutes of rest with an automatic blood pressure monitor. RESULTS: IOP increased with age to the sixth decade, after which a decrease in IOP was seen with further increase in age, resulting in an inverted U pattern. sBP increased linearly with age whereas CCT decreased linearly with age. In regression models, age, CCT, and sBP were all significant determinants of IOP (P < 0.001 for all three). In younger persons aged 40 to 59 years, both CCT and sBP were positively associated with IOP (P < 0.001 for both), but in older persons of 60 to 80 years, only age and sBP had a positive association with of IOP (P = 0.001 for age, P < 0.001 for sBP). CONCLUSIONS: Age, CCT and sBP are significant determinants of IOP in persons aged 40 to 80 years, with CCT being a more important determinant in younger persons. The opposing effects of age-specific changes in sBP and CCT interact to lead to a relatively flat profile of IOP with age, possibly with a subtle inverted U-shaped relationship.

Evidence of retinal vascular narrowing in glaucomatous eyes in an Asian population.

PURPOSE: To examine the relationship between retinal vascular caliber and glaucoma in an Asian population. METHODS: A population-based, cross-sectional study of 3019 persons of Asian Malay ethnicity aged 40 to 80 years residing in Singapore. All participants had dilated digital retinal photographs taken of both eyes. From these, retinal vascular caliber was measured with a computer-based technique according to a standardized protocol. Glaucoma was diagnosed based on the International Society of Geographic and Epidemiologic Ophthalmology classification and included people with glaucomatous optic neuropathy and compatible visual field loss. RESULTS: There were 127 (4.2%) participants with glaucoma. Mean retinal arteriolar and venular calibers were significantly narrower in persons with than in those without glaucoma (136.4 microm vs. 139.7 microm, P = 0.02 and 209.2 microm vs. 219.7 microm, P < 0.001, respectively). After adjusting for age, sex, smoking, IOP, and other vascular risk factors, persons with narrower retinal arteriolar and venular caliber were more likely to have glaucoma (odds ratio [OR], 1.29; 95% confidence interval [CI], 1.07-1.56 and OR, 1.49; 95% CI, 1.24-1.79, for each SD reduction in arteriolar and venular caliber, respectively) and a vertical cup-to-disc ratio >or= 0.7 (OR, 1.35; 95% CI, 1.12-1.63 and OR, 1.65; 95% CI, 1.38-1.98, respectively). Retinal vascular caliber was not associated with intraocular pressure. CONCLUSIONS: These findings support an association of narrower retinal arteriolar and venular caliber changes with glaucomatous optic neuropathy, independent of intraocular pressure.

Visual acuity and mortality in a chinese population. The Tanjong Pagar Study.

OBJECTIVE: To examine the relationship between visual acuity and mortality in a Chinese population. DESIGN: Population-based cohort study. PARTICIPANTS: Chinese persons in Singapore ages 40 to 79 years at baseline examination. METHODS: The Tanjong Pagar Study in Singapore examined 1232 persons (response rate, 71.8%) at the baseline examination in 1997 and 1998. Participants had measurements of presenting and best-corrected visual acuity (VA) using standardized protocols. Mortality data were obtained from the National Death Registry, which linked subjects who had died since the baseline examination. Cause of death was determined from the International Classification of Diseases 9 codes. Analysis was performed on 1225 (99.4%) participants with VA data. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: By December 31, 2004 (median follow-up, 6.8 years), 126 persons had died. Participants with presenting VA in the better eye worse than 20/40 (logarithm of the minimum angle of resolution [logMAR] score, 0.3) had a significantly higher mortality rate (hazard ratio [HR], 2.9; 95% confidence interval [CI], 1.4-6.3, adjusting for age, gender, hypertension, diabetes, smoking, heart attack, stroke, and income) as compared with participants with VA of 20/20 (logMAR, 0.0). Associations were similar for best-corrected VA in the better eye (HR, 2.7; 95% CI, 1.4-5.5). Among clinic participants with logMAR VA measurements, each 1-line difference in presenting VA (logMAR gain, 0.10) was associated with a 4-fold increased risk of mortality (HR, 4.4; 95% CI, 1.9-10.2). CONCLUSIONS: In this Chinese population in Singapore, visual impairment was associated independently with an increased risk of mortality.

Trends in alcohol consumption in Singapore 1992 2004.

AIMS: To present trends in alcohol consumption between 1992 and 2004 in Singapore. METHODS: Alcohol consumption data were derived from national health surveys conducted in 1992, 1998 and 2004. Age-adjusted prevalence of frequent (drinking 1-4 days a week), regular (drinking more than 4 days a week) and binge (having five or more drinks during a drinking session at least once in the month) drinking by gender and age group for the three surveys were compared. Multivariate analyses for binge drinking in 2004 were performed using logistic regression models. RESULTS: Prevalence of frequent, regular and binge drinking increased between 1992 and 2004. Prevalence increase in binge drinking was highest (from 5.1 to 10.0%), followed by frequent drinking (from 4.5 to 7.5%) and regular drinking (from 2.9 to 3.1%). Uptake in binge drinking increased in both genders and across all age groups but was most evident among adults aged 18-29. Frequent drinking increase was observed for both genders but was most pronounced among women aged 18-29. The level of regular drinking declined in men but increased in women, especially those aged 18-29 and 30-49. Being younger, male, separated, divorced or widowed, a current smoker, or having a monthly household income of S$6000 and above were attributes positively associated with binge drinking. CONCLUSIONS: Alcohol consumption, especially binge drinking, has increased among Singaporeans between 1992 and 2004. There is gender convergence in alcohol consumption.

Risk factors for contact lens-related fusarium keratitis: a case-control study in Singapore.

OBJECTIVE: To evaluate the specific contact lens-related or other factors that may contribute to the outbreak of Fusarium keratitis. METHODS: A case-control study was conducted of Fusarium keratitis in contact lens users in Singapore from March 1, 2005, to May 31, 2006, and included 61 patients with Fusarium keratitis and 188 population-based and 179 hospital-based control subjects. Interviewers asked about contact lens solution use and other risk factors. RESULTS: Patients with Fusarium keratitis were more likely to use ReNu contact lens solutions (Bausch & Lomb, Rochester, NY) 58 [95.1%] of 61 cases) than were either population-based (62 [34.3%] of 181) or hospital-based (50 [30.1%] of 166) control subjects. After controlling for age, sex, contact lens hygiene, and other factors, the use of ReNu with MoistureLoc significantly increased the risk of Fusarium keratitis (odds ratio, 99.3; 95% confidence interval, 18.4-535.4; P<.001), and the risk was 5 times higher compared with the risk with use of ReNu MultiPlus, a multipurpose solution (odds ratio, 21.5; 95% confidence interval, 4.0-115.5; P<.001). CONCLUSIONS: The use of ReNu contact lens solutions significantly increased the risk of contact lens-related Fusarium keratitis in Singapore. Our data support the recall of ReNu MultiPlus from the Singapore market and the need for further investigations into the role of ReNu MultiPlus in the development of Fusarium keratitis in other populations.