Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 14.582
Filtrar
1.
BMC Health Serv Res ; 22(1): 66, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031040

RESUMO

BACKGROUND: The COVID-19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID-19 patients. OBJECTIVES: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore. METHOD: Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020. SUBJECTS: Data were analyzed from 7569 nationally representative individuals from 2019 January and 2020 December. MEASURES: Healthcare utilization and healthcare spending by medical service categories as well as self-reported health status. RESULTS: Between January and April 2020 (the first peak period of COVID-19 in Singapore), doctor visits decreased by 30%, and out-of-pocket medical spending decreased by 23%, mostly driven by reductions in inpatient and outpatient care. As a result, the probability of any diagnosis of chronic conditions decreased by 19% in April 2020. The decreased healthcare utilization and spending recovered after lifting the national lockdown in June, 2020 and remained similar to the pre-pandemic level through the rest of 2020. CONCLUSIONS: Middle-aged and older Singaporeans' healthcare utilization and the diagnosis of chronic conditions substantially decreased during the first peak period of the COVID-19 outbreak. Further studies to track the longer-term health effect of the pandemic among non-COVID-19 patients are warranted.


Assuntos
COVID-19 , Idoso , Controle de Doenças Transmissíveis , Atenção à Saúde , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , SARS-CoV-2 , Autorrelato , Singapura/epidemiologia
2.
Accid Anal Prev ; 165: 106519, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34902626

RESUMO

Response time (RT) measures in crash reconstruction are inherently constrained by the need to define a start point (onset). In straight-forward situations where the hazard appears abruptly from behind an obstruction (abrupt onset), hazard onset is typically defined as when the hazard is first visible to the motorist. In contrast, in scenarios where there is no clearly defined point of entry (gradual onset), and the potential hazard gradually transitions to an immediate hazard, the onset point is more ambiguous. In this study, a reasonable hazard onset was proposed for measuring RTs of motorcycle riders to gradual-onset hazards, following which the RTs to abrupt- and gradual-onset hazards were determined and compared. A study on motorcycle rider RTs was conducted in Singapore in which a sample of young male adults (licensed riders with more than one year's effective riding experience, and unlicensed subjects) were equipped with eye tracking glasses and were presented with two pairs of abrupt-/ gradual-onset hazard scenarios on a simple motorcycle simulator. Their RTs were recorded. Initial deviation from the straight path (start of turning manoeuvre) of the intruding hazard vehicle was determined to be a more appropriate onset (start point when measuring RTs) for gradual-onset hazards when compared with referencing the onset against travel lane incursions. Participants generally took longer to respond to gradual-onset hazards than abrupt-onset hazards. Unlicensed subjects tended to underperform relative to licensed riders. The findings from this study contribute to the literature in the relatively novel field of motorcycle RTs and should be of interest to crash reconstructionists as well road safety professionals in designing road operations.


Assuntos
Acidentes de Trânsito , Motocicletas , Adulto , Humanos , Masculino , Percepção , Tempo de Reação , Singapura
3.
Environ Pollut ; 295: 118681, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-34933060

RESUMO

Heavy metal or metalloid contamination is a common problem in soils of urban environments. Their introduction can be due to unpremeditated anthropogenic activities like atmospheric deposition produced by diffuse sources, construction activities and landscape maintenance. Phytoremediation is a rapidly evolving, sustainable approach to remediate the contaminated lands where metals and metalloids are highly persistent in the environment. The present work sets out to determine the level of 12 heavy metals and metalloids (As, Cd, Co, Cr, Cu, Fe, Mn, Mo, Ni, Pb, Sb and Zn) in soil and their accumulation by plant foliage found in nature parks and industrial sites in Singapore. The latter also involve the investigation of the remediation capacity of selected tropical plant species found at the sampling sites. The study is done using digestion and inductively coupled plasma-optical emission spectrometry. Eleven soil sampling sites across Singapore with 300 sampling points were selected, where soil (0-10 cm) and plant foliage samples were collected. Bioconcentration factors were determined to assess the phytoremediation potential of the collected plant species. Toxicity risk of heavy metals were assessed by comparing the target and intervention values from the soil quality guidelines by the Dutch Standard. Results of the study revealed there were regions where levels of heavy metals and metalloids were relatively high and could affect the environment and the health of flora and fauna in Singapore. Our study discovered that there were available tropical plant species (e.g., wildflowers, ferns and shrubs) which could potentially play a significant role in the remediation of contaminated lands that could open up a huge possibility of developing a sustainable and environmentally-friendly way of managing this emerging urban problem. Results showed that 12 plant species, including hyperaccumulator like Pteris vittata, Centella asiatica, were effective for the accumulation of heavy metals and metalloids.


Assuntos
Metaloides , Metais Pesados , Poluentes do Solo , Biodegradação Ambiental , Monitoramento Ambiental , Metaloides/análise , Metais Pesados/análise , Singapura , Solo , Poluentes do Solo/análise
4.
Sci Total Environ ; 806(Pt 2): 150534, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34600208

RESUMO

Increased urbanization and anthropogenic activities in tropical cities lead to the temperature gradient between the urban and rural environments, causing the urban heat island (UHI) phenomenon. This study is a pioneering attempt that examines the changes in the temporal evolution of the surface energy budget induced by urbanization known as the Anthropogenic Influence (AI) in modifying the urban climate of a tropical city using Weather Research and Forecasting (WRF) numerical modeling system. The AI from buildings, traffic and power plants is determined in five different scenarios and the model is validated with high temporal resolution in-situ data. These increased AIs provide improved WRF capability with root mean square error (RMSE) less than 2 °C and mean bias error (MBE) less than 0.5 °C between different performance indicators. Building envelopes (without indoor activity/equipment) are found to be a major contributor in exacerbating the island wide urban heat ∆TaAI, max to 3.7 °C compared to baseline all green scenario. This is followed by the air-conditioner (AC) systems that contribute up to 1.4 °C. The maximum local contribution of traffic and power plants to urban heat is 0.9 °C and 0.4 °C, respectively.


Assuntos
Temperatura Alta , Cidades , Singapura , Tempo (Meteorologia)
5.
Arch Gerontol Geriatr ; 98: 104572, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34808441

RESUMO

INTRODUCTION: Loneliness is associated with poorer cognitive functions, lower quality of life, with increased mortality and healthcare utilization. Despite an estimated 2-5% of elderly residing in nursing homes, there is limited knowledge on their loneliness experience. This study seeks to obtain an indicative prevalence of loneliness among nursing home residents in Singapore, explore associations of loneliness with different variables, and better understand their loneliness experience. METHODS: A cross-sectional mixed methods study was conducted between May to July 2018. Loneliness was determined by the UCLA three-item loneliness scale, with other information collected on health statuses and social contacts. 57 cognitively-intact nursing home residents above 65 years old were recruited for the quantitative strand, and prevalence ratios were estimated using modified Poisson model with robust estimator. Eight participants were subsequently recruited for the qualitative strand, where analysis was conducted using a line-by-line inductive approach with grounded theory techniques. RESULTS: 59.6% of study participants experienced loneliness. After statistical adjustment, significant associations were detected between frailty and loneliness, and history of falls and loneliness. The estimated prevalence ratio of loneliness among frail elderly is 1.37 times that of those pre-frail (p=0.018), and estimated prevalence ratio of loneliness among elderly with history of falls is 1.35 times that of those without (p <0.0001). The loneliness experience may be amplified by deficiencies in health, social contact, and engagement, and mitigated through reminiscence and anticipation. Individuals' perspective of circumstances and autonomy levels may amplify or mitigate loneliness. CONCLUSION: This study reinforces existing evidence of relationship between frailty and loneliness, and illustrates a potential association between history of falls and loneliness. With older and frailer elderly residents, and circumstances such as structured routines and lack of autonomy, the observed experience may be unique to nursing homes, with potentially higher loneliness prevalence compared to community-dwelling elderly.


Assuntos
Solidão , Qualidade de Vida , Idoso , Estudos Transversais , Idoso Fragilizado , Humanos , Casas de Saúde , Singapura/epidemiologia
6.
Chemosphere ; 287(Pt 1): 132067, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34478959

RESUMO

Millions of passengers wait for buses at Integrated Transport Hubs (ITH) daily in metropolitan cities. Environmental exposure and associated risk for passengers is of great public concern. In this study, eight volatile organic compounds (VOCs) and the 16 EPA priority polycyclic aromatic hydrocarbons (PAHs) were analyzed in airborne samples collected from indoor waiting areas (Indoor) and bus parks of nine Singapore ITH, which comprises of two types of architectural structure (i.e., fully sheltered and open/partially enclosed). The median concentrations of total VOCs (TVOCs), total gaseous PAHs (TgPAHs) and total airborne particles-adsorbed PAH (TpPAHs) concentrations in Indoor were 30.42 µg/m3, 18.99 ng/m3 and 1.38 ng/m3; respectively. A strong correlation (r ≥ 0.75, p < 0.001) was observed between Indoor and bus parks air compounds. The "Indoor" to bus park pollutant concentration ratio (I/B ratio) showed lower values in the bus interchanges with fully sheltered bus parks (TVOCs: 0.98; TgPAHs: 0.76; TpPAHs: 0.71) than those with open/partially enclosed ones (TVOCs: 1.28; TgPAHs: 1.31; TpPAHs: 0.90). This result suggests that fully sheltered structure may cause the accumulation of air pollutants. The daily VOC and PAH exposure for commuters were further estimated by considering inhalation and dermal doses using Monte Carlo simulation (n = 100,000). Overall, the result showed that the risk is still within international guideline values. In sum, the effect of architecture structure on the migration of air pollutants should be taken into consideration in future transport hub design to reduce pollutant exposure to commuters.


Assuntos
Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Compostos Orgânicos Voláteis , Poluentes Atmosféricos/análise , Monitoramento Ambiental , Hidrocarbonetos Policíclicos Aromáticos/análise , Singapura , Compostos Orgânicos Voláteis/análise
7.
Health Soc Care Community ; 30(1): e222-e233, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34028921

RESUMO

Population ageing resulting from declining fertility and extended life expectancy has been occurring rapidly throughout the world. Older adults are faced with multiple physical, psychological and social changes that challenge their sense of self and capacity for healthy ageing. Intergenerational programmes (IGP) in communities have been developed to address a variety of social issues brought about by the population ageing. These programmes focus on promoting intergenerational social contact, supporting educational programmes and facilitating intellectual and/or physical activities in the older adults. This study intended to explore the perception of community-dwelling older adults towards an IGP in a senior day care centre in Singapore. Purposive sampling was adopted to recruit 15 participants for the study. Individual face-to-face interviews were conducted until data saturation was achieved. Interviews were audio-taped and transcribed verbatim. Thematic analysis was carried out. Four themes and 13 sub-themes emerged: (1) IGP enhances memory and strength; (2) social interaction between older adults and younger generation; (3) emotional responses to IGP; and (4) attitudes and perception towards the younger generation. The current study illustrated the dynamic social interaction between older adults and the younger generation, as well as the perceived benefits of the IGP. The relationship formed between the two generations entailed companionship, mutual care, trust and affection. Participation in the IGP provided the older adults an opportunity for active engagement in society and development. Continuous effort must be put in to ensure continuity of integration and empowerment of older adults, including the removal of obstacles and barriers that exclude or discriminate against them. The study findings will help facilitate the customisation of IGP to meet the needs of the older adults. With a well-planned and structured IGP, significant physical, emotional and psychosocial outcomes could benefit the older adults and the younger generation.


Assuntos
Hospital Dia , Envelhecimento Saudável , Idoso , Humanos , Relações Interpessoais , Pesquisa Qualitativa , Singapura
8.
J Med Microbiol ; 70(12)2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34898420

RESUMO

Introduction. During the early days of coronavirus disease 2019 (COVID-19) in Singapore, Tan Tock Seng Hospital implemented an enhanced pneumonia surveillance (EPS) programme enrolling all patients who were admitted from the Emergency Department (ED) with a diagnosis of pneumonia but not meeting the prevalent COVID-19 suspect case definition.Hypothesis/Gap Statement. There is a paucity of data supporting the implementation of such a programme.Aims. To compare and contrast our hospital-resource utilization of an EPS programme for COVID-19 infection detection with a suitable comparison group.Methodology. We enrolled all patients admitted under the EPS programme from TTSH's ED from 7 February 2020 (date of EPS implementation) to 20 March 2020 (date of study ethics application) inclusive. We designated a comparison cohort over a similar duration the preceding year. Relevant demographic and clinical data were extracted from the electronic medical records.Results. There was a 3.2 times higher incidence of patients with an admitting diagnosis of pneumonia from the ED in the EPS cohort compared to the comparison cohort (P<0.001). However, there was no significant difference in the median length of stay of 7 days (P=0.160). Within the EPS cohort, stroke and fluid overload occur more frequently as alternative primary diagnoses.Conclusions. Our study successfully evaluated our hospital-resource utilization demanded by our EPS programme in relation to an appropriate comparison group. This helps to inform strategic use of hospital resources to meet the needs of both COVID-19 related services and essential 'peace-time' healthcare services concurrently.


Assuntos
COVID-19 , Monitoramento Epidemiológico , Recursos em Saúde/organização & administração , Pneumonia , Serviço Hospitalar de Emergência , Hospitalização , Hospitais , Humanos , Pandemias , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Estudos Retrospectivos , Singapura
9.
Nutrients ; 13(12)2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34959783

RESUMO

Excessive consumption of sugar sweetened beverages (SSB) is of growing concern, and several countries are implementing measures to reduce SSB consumption. Understanding perceptions towards SSB policies is crucial to prioritize policy actions and to effectively frame public communication. We conducted a cross-sectional study in a sample of 754 adult Singaporeans to examine support towards 10 hypothetical policies to reduce SSB consumption. Policy scenarios were presented to participants and support was assessed using a 5-point Likert scale. Opinions about policies were elicited by asking participants "What other thoughts do you have about this policy?". We used logistic regression to examine determinants of policy support, and thematic analyses to understand opinions about policies. We observed good public support for a variety of SSB policies. In general, less restrictive policies such as traffic light labels (85.0% agreed/strongly agreed) and free access to water at eateries (77.1%) were better supported as compared to restrictive policies such as portion-size restrictions (64.5%) and taxation (55.0%). There was limited variation by age, ethnicity, income, physical activity and body mass index. Concerns about policies largely centered on loss of personal autonomy and economic implications for businesses. Nevertheless, participants also recognized that policies could support healthier beverage consumption by increasing awareness and enabling informed decision making. Findings from this study provide insights into consumer's perceptions of SSB policies, and can inform public health advocacy and government action in this area.


Assuntos
Preferências Alimentares/psicologia , Política Nutricional , Opinião Pública , Bebidas Adoçadas com Açúcar/legislação & jurisprudência , Adulto , Idoso , Estudos Transversais , Comportamento de Ingestão de Líquido , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Singapura , Impostos , Adulto Jovem
10.
J Health Popul Nutr ; 40(1): 52, 2021 12 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895351

RESUMO

BACKGROUND: Nutrition literacy refers to an individual's knowledge, motivation and competencies to access, process and understand nutrition information to make nutrition-related decisions. It is known to influence dietary habits of individuals including older adults. This cross-sectional study was designed to: (1) understand the nutrition knowledge, competencies and attitudes of community-dwelling older adults in Singapore, (2) examine the differences between their nutrition knowledge, and socio-demographic factors, competencies and attitudes and (3) identify factors associated with better nutrition knowledge in older healthy adults in Singapore. METHODS: A total of 400 (183 males and 217 females) nourished community-dwelling older adults aged 65 years and above took part in this study. Malnutrition Universal Screening Tool (MUST) was used to determine individuals who were at low risk of undernutrition. Nutrition knowledge, competencies, attitudes and sources of nutrition information were measured using a locally developed scale. Nutrition knowledge scores were summed to form the nutrition knowledge index (NKI). Associations between NKI, competencies, attitudes and socio-demographic variables were examined using Chi-square and Fisher's exact tests. Factors associated with NKI were determined using a stepwise regression model with resampling-based methods for model averaging. RESULTS: Bivariate analyses found significant differences in NKI scores for gender, monthly household earnings, type of housing, the self-reported ability to seek and understand nutrition information and having access to help from family/friends. Females had higher NKI scores compared to males (p < 0.001). Compared to females, more males left food decisions to others (p < 0.001), and fewer males reported consuming home-cooked food (p = 0.016). Differences in educational level were found for competencies like the self-reported ability to seek (p < 0.001) and verify nutrition information (p < 0.001). Stepwise regression analysis showed that being female, Chinese, self-reported ability to understand nutrition information and having access to help from family/friends were associated with higher NKI scores. CONCLUSIONS: Our study revealed that nutrition knowledge of older males in Singapore was lower than females and more left food decisions to others. Nutrition education programs could be targeted at both the older male, their caregivers and minority ethnic groups. Trial Registration This study was registered on 7 August 2017 at clinicaltrials.gov (ref. NCT03240952).


Assuntos
Nível de Saúde , Vida Independente , Idoso , Atitude , Estudos Transversais , Feminino , Humanos , Masculino , Singapura
11.
BMC Health Serv Res ; 21(1): 1347, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34915884

RESUMO

BACKGROUND: A valid and reliable measure is essential to assess patient engagement and its impact on health outcomes. This study aimed to examine the psychometric properties of the 8-item Altarum Consumer Engagement Measure™ (ACE Measure) among English-speaking community-dwelling adults in Singapore. METHODS: This cross-sectional study involved 400 randomly selected community-dwelling adults (mean age: 49.7 years, 50.0% were female, 72.3% were Chinese) who completed the English version of the 8-item ACE Measure independently. The item-level statistics were described. The internal consistency of the measure was measured by Cronbach alpha and item-rest correlations. Validity of the tool was assessed by 1) factorial validity using confirmatory factor analysis (CFA), 2) hypothesis-testing validity by correlating ACE subscales (Commitment and Navigation) with health-related outcomes, and 3) criterion validity against the Patient Activation Measure and Health Confidence Measure. RESULTS: There was no floor or ceiling effect for Commitment and Navigation subscales, and the Cronbach alpha for each subscale was 0.76 and 0.54, respectively. The two-factor structure was confirmed by CFA. In general, Commitment and Navigation subscales were positively correlated with frequency of activity participation (rho = 0.30 - 0.33) and EQ-5D visual analog scale (rho = 0.15 - 0.30). Individuals who perceived better health than peers had higher subscale scores (p < 0.01). Each subscale score had moderate and positive correlations with activation score (rho = 0.48 - 0.55) and health confidence score (rho = 0.35 - 0.47). CONCLUSIONS: The two-subscale ACE Measure demonstrated good construct validity in English-speaking Singapore community-dwelling adults. Evidence in internal consistency was mixed, indicating further investigation.


Assuntos
Vida Independente , Projetos de Pesquisa , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Singapura
12.
BMC Bioinformatics ; 22(1): 604, 2021 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-34922440

RESUMO

BACKGROUND: In population genomics, polymorphisms that are highly differentiated between geographically separated populations are often suggestive of Darwinian positive selection. Genomic scans have highlighted several such regions in African and non-African populations, but only a handful of these have functional data that clearly associates candidate variations driving the selection process. Fine-Mapping of Adaptive Variation (FineMAV) was developed to address this in a high-throughput manner using population based whole-genome sequences generated by the 1000 Genomes Project. It pinpoints positively selected genetic variants in sequencing data by prioritizing high frequency, population-specific and functional derived alleles. RESULTS: We developed a stand-alone software that implements the FineMAV statistic. To graphically visualise the FineMAV scores, it outputs the statistics as bigWig files, which is a common file format supported by many genome browsers. It is available as a command-line and graphical user interface. The software was tested by replicating the FineMAV scores obtained using 1000 Genomes Project African, European, East and South Asian populations and subsequently applied to whole-genome sequencing datasets from Singapore and China to highlight population specific variants that can be subsequently modelled. The software tool is publicly available at https://github.com/fadilla-wahyudi/finemav . CONCLUSIONS: The software tool described here determines genome-wide FineMAV scores, using low or high-coverage whole-genome sequencing datasets, that can be used to prioritize a list of population specific, highly differentiated candidate variants for in vitro or in vivo functional screens. The tool displays these scores on the human genome browsers for easy visualisation, annotation and comparison between different genomic regions in worldwide human populations.


Assuntos
Genômica , Metagenômica , Sequenciamento Completo do Genoma , China , Humanos , Singapura
13.
Artigo em Inglês | MEDLINE | ID: mdl-34948700

RESUMO

OBJECTIVE: The study aims to estimate the prevalence of disability and the association of disability with socio-demographic correlates and health outcomes among the Singapore population. METHODS: Face-to-face interviews were conducted with a representative sample of Singapore's population. Using the Washington Group's questionnaire, disability was defined using both the 'standard' (a lot of difficulty or higher in one or more domains) and the 'wider' threshold (of 'some' or greater difficulty). Data on socio-demographic correlates, self-reported lifestyle, physical activity, chronic conditions, and health-related quality of life were also collected. RESULTS: The prevalence of any disability using the standard threshold was 3.1% (95% CI: 2.4-4.1). When separated by disability type, mobility (1.8%) was the most prevalent, followed by vision (0.8%), cognition (0.5%), hearing (0.3%), and self-care (0.2). In the adjusted regression analysis, lower education and unemployed and economically inactive status (versus employed) were significantly associated with disability. CONCLUSIONS: Although this prevalence is lower than other countries, it is a significant finding in terms of actual numbers and impact at both the individual and the societal levels. Our findings also highlight the need to strengthen health services and preventive interventions targeting older adults and those who are physically inactive to reduce the burden of disability in these groups.


Assuntos
Pessoas com Deficiência , Qualidade de Vida , Idoso , Estudos Transversais , Humanos , Prevalência , Singapura/epidemiologia
14.
Ann Acad Med Singap ; 50(10): 742-750, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34755168

RESUMO

INTRODUCTION: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. METHODS: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. RESULTS: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. CONCLUSION: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate.


Assuntos
Laparoscopia , Neoplasias Hepáticas , Hepatectomia , Humanos , Tempo de Internação , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia , Estudos Retrospectivos , Singapura/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34769680

RESUMO

Patient-Centered Medical Home (PCMH) has been found to improve care for complex needs patients in some countries but has not yet been widely adopted in Singapore. This study explored the ground-up implementation of a PCMH in Singapore by describing change strategies and unpacking initial experience and perception. In-depth interviews were conducted for twenty-two key informants from three groups: the implementers, their implementation partners, and other providers. "Diffusion of innovations" emerged as an overarching theory to contextualize PCMH in its early implementation. Three core "innovations" differentiated the PCMH from usual primary care: (i) team-based and integrated care; (ii) empanelment; and (iii) shared care with other general practitioners. Change strategies employed to implement these innovations included repurposing pre-existing resources, building a partnership to create supporting infrastructure and pathways in the delivery system, and doing targeted outreach to introduce the PCMH. Initial experience and perception were characterized by processes to "adopt" and "assimilate" the innovations, which were identified as challenging due to less predictable, self-organizing behaviors by multiple players. To work with the inherent complexity and novelty of the innovations, time, leadership, standardized methods, direct communication, and awareness-building efforts are needed. This study was retrospectively registered (Protocol ID: NCT04594967).


Assuntos
Assistência Centrada no Paciente , Atenção Primária à Saúde , Difusão de Inovações , Humanos , Pesquisa Qualitativa , Singapura
16.
Artigo em Inglês | MEDLINE | ID: mdl-34769759

RESUMO

Although there has been an increase in awareness of the struggles experienced by caregivers, discourse on caregiving remains confined mostly to academia, policy circles or the family unit. There have been suggestions that public discourse on informal caregiving dwells overwhelmingly on the outsize toll it takes on the health of caregivers. However, few studies have examined societal narratives on caregivers-a gap our study aims to fill. We leveraged an online media database of 12 billion words collated from over 30 million articles to explore societal narratives on caregivers in six Asian countries. Computational linguistics and statistical analysis were applied to study the content of narratives on caregivers. The prevalence of societal narratives on caregivers was highest in Singapore-five times higher than Sri Lanka, which evidenced the lowest prevalence. Findings reveal that the inadequacies of institutional care as well as the need to train and empower caregivers are pressing issues that need to be prioritized on the policy agenda in Asia. Of broader significance, the diverse capabilities across Asia present opportunities for cross-country learning and capacity-building.


Assuntos
Cuidadores , Narração , Humanos , Singapura , Sri Lanka
17.
ANZ J Surg ; 91(11): 2550, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34766682
18.
J Pak Med Assoc ; 71(11): 2611-2616, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783745

RESUMO

Universal health coverage is a global agenda and, currently for Pakistan, achieving this goal is a challenge because of a number of constraints. The current narrative review was planned to describe an overview of the provision of health insurance in Malaysia, Thailand and Singapore that have achieved universal health coverage, and to propose a roadmap for Pakistan. Literature search was conducted on Google Scholar and PubMed databases as well as on the World Bank website to retrieve relevant articles. The three studied countries achieved universal health coverage by gradually increasing allocation for health and through various mechanisms, such as health insurance schemes which covered different segments of the population, and partnerships with private-sector care-providers. Pakistan needs to prioritise health in policy agenda because health insurance is negligible in Pakistan. Additionally, Pakistan also needs to efficiently utilise partnerships with the private sector to further increase healthcare coverage.


Assuntos
Cobertura Universal do Seguro de Saúde , Humanos , Malásia , Paquistão , Singapura , Tailândia
19.
Zootaxa ; 5040(1): 33-65, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34811055

RESUMO

The intertidal serpulid polychaete Spirobranchus kraussii was originally described from South Africa and has since been reported in numerous sub (tropical) localities around the world. Recently, however, S. kraussii was uncovered as a complex of morphologically similar and geographically restricted species, raising the need to revise S. cf. kraussii populations. We formally describe S. cf. kraussii from Singapore mangroves as Spirobranchus bakau sp. nov. based on morphological and molecular data. Despite their morphological similarities, Maximum Likelihood and Bayesian Inference analyses of 18S and Cyt b DNA sequence data confirm that S. bakau sp. nov. is genetically distinct from S. kraussii and other known species in the complex. Both analyses recovered S. bakau sp. nov. as part of a strongly supported clade (96% bootstrap, 1 posterior probability), comprising S. sinuspersicus, S. kraussii and S. cf. kraussii from Australia and Hawaii. Additionally, paratypes of S. kraussii var. manilensis, described from Manila Bay in the Philippines, were examined and elevated to the full species S. manilensis. Finally, we tested the hypothesis that fertilisation and embryonic development of S. bakau sp. nov. can occur under the wide range of salinities (19.630.9 psu) and temperatures (2531C) reported in the Johor Strait. Fertilisation success of ≥70% was achieved across a temperature range of 2532C and a salinity range of 2032 psu. Embryonic development, however, had a narrower salinity tolerance range of 2732 psu. Clarifying the taxonomic status of S. cf. kraussii populations reported from localities elsewhere in Singapore and Southeast Asia will be useful in establishing the geographical distribution of S. bakau sp. nov. and other members of the S. kraussii-complex.


Assuntos
Poliquetos , Animais , Teorema de Bayes , Filipinas , Filogenia , Singapura
20.
AIDS Res Ther ; 18(1): 80, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34724931

RESUMO

BACKGROUND: The efficacy and tolerability of an antiretroviral regimen are important considerations for selection of HIV-1 infection maintenance therapy. Abacavir/lamivudine plus rilpivirine (ABC/3TC + RPV) has been shown in international studies to be effective and well-tolerated in virologically suppressed individuals. This study evaluated the effectiveness and safety of switching to ABC/3TC + RPV as maintenance therapy in virologically suppressed HIV-1 infected individuals in Singapore. METHODS: In this retrospective, single-centre study, we included individuals who were prescribed ABC/3TC + RPV, had HIV-1 viral load (VL) < 50 copies/ml immediately pre-switch, and had no documented history of resistance mutations or virologic failure to any of the components. The follow-up period was 48 ± 12 weeks. The primary outcome was the proportion of individuals who maintained virologic suppression of HIV-1 VL < 50 copies/ml at the end of follow-up period based on on-treatment analysis. The secondary outcomes were the resistance profiles associated with virologic failure, changes in immunologic and metabolic parameters, and the safety profile of ABC/3TC + RPV. RESULTS: A total of 222 individuals were included in the study. The primary outcome was achieved in 197 individuals [88.8%, 95% confidence interval: 83.7-92.4%]. There were 21 individuals (9.5%) who discontinued treatment for non-virologic reasons. The remaining 4 individuals experienced virologic failure, of whom, 3 of these individuals had developed emergent antiretroviral resistance and had HIV-1 VL > 500 copies/ml at the end of the 48 ± 12 weeks follow-up period. The remaining individual experienced sustained low level viremia and subsequently achieved viral suppression without undergoing resistance testing. A total of 49 adverse events were observed in 31 out of 222 individuals (14.0%), which led to 13 individuals discontinuing therapy. Neuropsychiatric adverse events were most commonly observed (53.1%). A statistically significant increase in CD4 was observed (p < 0.01), with a median absolute change of 31 cells/uL (interquartile range: - 31.50 to 140.75). No significant changes in lipid profiles were detected. CONCLUSION: ABC/3TC + RPV is a safe and effective switch option for maintenance therapy in virologically suppressed HIV-1 individuals with in Singapore.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Lamivudina , Fármacos Anti-HIV/efeitos adversos , Didesoxinucleosídeos , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Humanos , Lamivudina/efeitos adversos , Estudos Retrospectivos , Rilpivirina/efeitos adversos , Singapura/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...