Prevalence and correlates of heart disease among adults in Singapore

Modelling the Potential Public Health Impact of Different COVID-19 Vaccination Strategies with an Adapted Vaccine in Singapore

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 has been a dynamically changing virus, requiring the development of adapted vaccines. This study estimated the potential public health impact alternative vaccination strategies for COVID-19 in Singapore.

RESEARCH DESIGN AND METHODS

The outcomes of alternative vaccination strategies with a future adapted vaccine were estimated using a combined Markov decision tree model. The population was stratified by high- and standard-risk. Using age-specific inputs informed by local surveillance data and published sources, the model estimated health (case numbers, hospitalizations, and deaths) and economic (medical costs and productivity losses) outcomes in different age and risk subpopulations.

RESULTS

Booster vaccination in only the elderly and high-risk subpopulation was estimated to avert 278,614 cases 21,558 hospitalizations, 239 deaths, Singapore dollars (SGD) 277 million in direct medical costs, and SGD 684 million in indirect medical costs. These benefits increased as vaccination was expanded to other subpopulations. Increasing the booster vaccination coverage to 75% of the standard-risk population averted more deaths (3%), hospitalizations (29%), infections (145%), direct costs (90%), and indirect costs (192%) compared to the base case.

CONCLUSIONS

Broader vaccination strategies using an adapted booster vaccine could have substantial public health and economic impact in Singapore.

Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan

This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.

Investigating 5-Level EQ-5D (EQ-5D-5L) Values Based on Preferences of Patients With Heart Disease

OBJECTIVES

Several studies have shown that patients with heart disease value hypothetical health states differently from the general population. We aimed to investigate the health preferences of patients with heart disease and develop a value set for the 5-level EQ-5D (EQ-5D-5L) based on these patient preferences.

METHODS

Patients with confirmed heart disease were recruited from 2 hospitals in Singapore. A total of 86 EQ-5D-5L health states (10 per patient) were valued using a composite time trade-off method according to the international valuation protocol for EQ-5D-5L; 20-parameter linear models and 8-parameter cross-attribute level effects models with and without an N45 term (indicating whether any health state dimension at level 4 or 5 existed) were estimated. Each model included patient-specific random intercepts. Model performance was evaluated for out-of-sample and in-sample predictive accuracy in terms of root mean square error. The discriminative ability of the utility values was assessed using heart disease-related functional classes.

RESULTS

A total of 576 patients were included in the analysis. The preferred model, with the lowest out-of-sample root mean square error, was a 20-parameter linear model including N45. Predicted utility values ranged from -0.727 for the worst state to 1 for full health; the value for the second-best state was 0.981. Utility values demonstrated good discriminative ability in differentiating among patients of varied functional classes.

CONCLUSIONS

An EQ-5D-5L value set representing the preferences of patients with heart disease was developed. The value set could be used for patient-centric economic evaluation and health-related quality of life assessment for patients with heart disease.

Obsessive-Compulsive Disorder in Singapore: Prevalence, Comorbidity, Quality of Life and Social Support

Introduction: Using data from Singapore Mental Health Study 2016 (SMHS 2016), we examined the prevalence of lifetime and 12-month obsessive-compulsive disorder (OCD),its sociodemographics correlates and association with comorbid psychiatric disorders and physical conditions, perceived social support and quality of life. Materials and Methods: The World Mental Health Composite International Diagnostic Interview (version 3.0) was administered by trained interviewers to 6126 residents aged ≥18 years old to assess OCD prevalence and that of other select psychiatric disorders. Details on sociodemographics, perceived social support and health-related quality of life were obtained. Results: Lifetimeand 12-month prevalence of OCD was 3.6% and 2.9%, respectively. Adjusted regression analysis showed that those with OCD had significantly higher odds of major depressive disorder (odds ratio [OR], 5.4), bipolar disorder (OR, 8.9), generalised anxiety disorder (OR, 7.3) and alcohol abuse (OR, 2.7). OCD was significantly associated with suicidal ideation and suicidality (OR, 5.1). OCD subjects also had higher odds of chronic pain (OR, 2.4) and diabetes (OR, 3.1). Finally, OCD subjects had lower mean mental composite summary scores than controls (respondents without any of the psychiatric disorders and physical conditions included in SMHS 2016) and those with other lifetime psychiatric disorders and physical conditions. Conclusion: OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life. Key words: Composite International Diagnostic Interview, Epidemiology, Multi-ethnic, Psychiatric disorder, Survey

Overview of trends in cardiovascular and diabetes risk factors in Fiji

CONTEXT

Fiji has undergone an epidemiological transition, characterised by declining infectious disease and childhood mortality, that has been offset by rising cardiovascular disease mortality. Other Pacific Island states are in a comparable situation.

OBJECTIVE

With a focus on Fiji, this study reviews and contextualises research performed by the authors and others that examines cardiovascular disease (CVD) and type 2 diabetes (T2DM) and their risk factors in Pacific Island states.

METHODS

This overview covers evidence for the causes and consequences of CVD risk factors and the epidemiological transition and reflects on biological and evolutionary hypotheses. It is based on studies the authors carried out that synthesised disparate population-based CVD risk factor surveys conducted in Fiji over 1980-2012.

RESULTS

Prevalences of obesity, T2DM and hypertension continue to increase in the Fiji population. Tobacco smoking prevalence has decreased, but remains relatively high in men compared to many developed countries. T2DM and hypertension trends, and CVD consequences related to diet, exercise and tobacco smoking, have placed the Fiji population in a variant of the epidemiological transition manifesting as a plateau in life expectancy similar to that of numerous developed countries during the mid-20th century.

CONCLUSION

There is evidence that risk factors and consequent CVD mortality can be reduced in populations. Obesity and T2DM reductions have been observed only in populations surviving in dire circumstances. Interventions to lower the prevalence of CVD and T2DM risk factors in the Fiji population require multi-faceted approaches, with continual monitoring and evaluation for their impact on these risk factors and morbidity and mortality outcomes.

Psychiatric traits in patients with vasovagal and unexplained syncope

Purpose

Syncope is a common condition affecting almost one-third of the general population. The present study measures the prevalence of psychiatric traits in patients presenting with syncope (unexplained and vasovagal) and whether recurrent attacks have an impact on psychiatric profiles.

Patients and methods

This is a case–control study in a tertiary hospital enrolling all patients aged ≥12 years with single or recurrent syncopal attacks. A self-reporting psychometric questionnaire (The Symptoms Checklist-90-Revised) was used to screen for depression, anxiety, somatization disorder, and phobia. Crude comparisons of average scores were done. Further, multiple logistic regression analyses were carried out to measure the impact of syncope on each psychiatric domain. The control group were matched for age, gender, and chronic illnesses with a ratio of 1:3.

Results

There were 43 cases and 129 control subjects, with predominance of females (67.4%) and an average age of 33.8 years (standard deviation = 16). There were no significant differences in average scores of depression (13 vs 14.53, P = 0.31), anxiety (11.3 vs 10.4, P = 0.51), or phobia (5.4 vs 5.2, P = 0.88). However, the syncope group had a higher average score for somatization disorder (18.53 vs 13.66, P = 0.002). Binary logistic regression model showed that the association between syncope and somatization disorder was independent of competing confounders (odds ratio = 3.75, 95% confidence interval: 1.72, 8.15, P = 0.001). A sub-analysis of the case group showed that patients with multiple syncopal attacks (six or more) had higher average scores of depression, anxiety, phobia, and somatization disorder compared to those who had less than six attacks.

Conclusion

Syncope was independently associated with somatization disorder traits. Further, recurrent syncope resulted in greater deterioration of patients’ psychiatric profiles. Thus, taking into account the psychiatric status in the management of such patients is crucial.