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Confirmed adult dengue deaths in Singapore: 5-year multi-center retrospective study
Yee-Sin Leo, Tun L Thein, Dale A Fisher, Jenny G Low, Helen M Oh, Rajmohan L Narayanan, Victor C Gan, Vernon J Lee, David C Lye
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-123
Abstract: We conducted a multi-center retrospective chart review of all confirmed adult dengue deaths in Singapore from 1 January 2004 to 31 December 2008.Of 28 adult dengue deaths, median age was 59 years. Male gender comprised 67.9% and co-morbidities existed in 75%. From illness onset, patients presented for admission at a median of 4 days and death occurred at a median of 12 days. Intensive care admission was required in 71.4%. Probable dengue was diagnosed in 32.1% by WHO 1997 criteria and 78.6% by WHO 2009. The earliest warning sign was persistent vomiting at a median of 1.5 days. Hematocrit change ≥20% concurrent with platelet count <20 × 10^9/L was associated with the shortest interval to death at a median of 3 days. Only 35.7% of death cases fulfilled DHF criteria by WHO 1997 versus severe dengue in 100.0% by WHO 2009 criteria. Deaths were due to shock and organ failure. Acute renal impairment occurred in 71.4%, impaired consciousness 57.1% and severe hepatitis 53.6%.In our adult fatal dengue cohort, WHO 2009 criteria had higher sensitivity in diagnosing probable dengue and severe dengue compared with WHO 1997. As warning signs, persistent vomiting occurred early and hematocrit change ≥20% concurrent with platelet count <20 × 10^9/L preceded death most closely.Dengue is the most important arthropod-borne viral disease in humans. The World Health Organization (WHO) has estimated that 1.8 billion people, or more than 70% of the global at-risk population, live in the WHO Southeast Asia and the Western Pacific regions which account for nearly 75% of current global disease burden from dengue [1]. Singapore, a developed island city-state in Southeast Asia has experienced resurgent dengue epidemics since the 1990s after previous decades of vector control effectively reduced the Aedes house index [2]. In addition, dengue infections in Singapore in recent years have shifted from primarily a childhood disease to that of adults [2]. With this resurgence, the classification of d
UndergroundTechnologyandRockEngineeringPrograminNanyangTechnologicalUniversity,Singapore  [PDF]
重庆交通大学学报(自然科学版) , 2011, DOI: 10.3969/j.issn.1674-0696.2011.supp2.007
Abstract: :?ThispapersummarizestheresearchworkrecentlycarriedoutintheareaofrockengineeringandundergroundprotectivetechnologyundertheUndergroundTechnologyandRockEngineeringprograminNanyangTechnologicalUniversity,Singapore.
Epidemiological characteristics of the 2005 and 2007 dengue epidemics in Singapore - similarities and distinctions  [cached]
Teck Siang Ler,Li Wei Ang,Grace Siew Lian Yap,Lee Ching Ng
Western Pacific Surveillance and Response , 2011,
Abstract: Introduction: We investigated the epidemiological features of the 2007 dengue outbreak to determine the factors that could have triggered it two years after the previous large outbreak in 2005.Methods: All laboratory-confirmed cases of dengue reported during the year, as well as entomological and virological data, were analysed.Results: A total of 8826 cases including 24 deaths were reported in 2007, giving an incidence of 192.3 cases per 100 000 residents and a case-fatality rate of 0.27%. The median age of the cases was 37 years (interquartile range 25 to 50), with an age range from two days to 101 years, which was higher than the median age of 31 years (interquartile range 20 to 42), with a range from four days to 98 years, in 2005. The overall Aedes premises index in 2007 was 0.68%, lower than the 1.15% observed in 2005. The predominant dengue serotype in 2007 was dengue virus DENV-2 which re-emerged with a clade replacement in early 2007, and overtook the predominant serotype (DENV-1) of 2005. Seroprevalence studies conducted in the three largest outbreak clusters revealed that 73.2% of residents with recent infection were asymptomatic.Discussion: With the exception of an increase in the median age of the cases, and a change in the predominant dengue serotype, the epidemiological features of the 2007 epidemic were largely similar to those of 2005. Singapore remains vulnerable to major outbreaks of dengue, despite sustained vector control measures to maintain a consistently low Aedes premises index.
Effectiveness of Pandemic H1N1-2009 Vaccination in Reducing Laboratory Confirmed Influenza Infections among Military Recruits in Tropical Singapore  [PDF]
Vernon J. Lee, Chi Hsien Tan, Jonathan Yap, Alex R. Cook, Pei-Jun Ting, Jin-Phang Loh, Qiuhan Gao, Mark I. Chen, Wee Lee Kang, Boon Huan Tan, Paul A. Tambyah
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026572
Abstract: Background Limited information is available about pandemic H1N1-2009 influenza vaccine effectiveness in tropical communities. We studied the effectiveness of a pandemic H1N1 vaccination program in reducing influenza cases in Singapore. Methods A surveillance study was conducted among military personnel presenting with febrile respiratory illness from mid-2009 to mid-2010. Consenting individuals underwent nasal washes, which were tested with RT-PCR and subtyped. A vaccination program (inactivated monovalent Panvax H1N1-2009 vaccine) was carried out among recruits. A Bayesian hierarchical model was used to quantify relative risks in the pre- and post-vaccination periods. An autoregressive generalised linear model (GLM) was developed to minimise confounding. Results Of 2858 participants, 437(15.3%), 60(2.1%), and 273(9.6%) had pandemic H1N1, H3N2, and influenza B. The ratio of relative risks for pandemic H1N1 infection before and after vaccination for the recruit camp relative to other camps was 0.14(0.016,0.49); for H3N2, 0.44(0.035,1.8); and for influenza B, 18(0.77,89). Using the GLM for the recruit camp, post-vaccination weekly cases decreased by 54%(37%,67%, p<0.001) from that expected without vaccination; influenza B increased by 66 times(9–479 times, p<0.001); with no statistical difference for H3N2 (p = 0.54). Conclusions Pandemic vaccination reduced H1N1-2009 disease burden among military recruits. Routine seasonal influenza vaccination should be considered.
Exploring if day and time of admission is associated with average length of stay among inpatients from a tertiary hospital in Singapore: an analytic study based on routine admission data
Arul Earnest, Mark IC Chen, Eillyne Seow
BMC Health Services Research , 2006, DOI: 10.1186/1472-6963-6-6
Abstract: This was a historical cohort study based on all admissions from TTSH from 1st September 2003 to 31st August 2004. Data was extracted from routinely available computerized hospital information systems for analysis by episode of care. LOS for each episode of care was log-transformed before analysis, and a multivariate linear regression model was used to study if sex, age group, type of admission, admission source, day of week admitted, admission on a public holiday or eve of public holiday, admission on a weekend and admission time were associated with an increased LOS.In the multivariate analysis, sex, age group, type of admission, source of admission, admission on the eve of public holiday and weekends and time of day admitted were independently and significantly associated with LOS. Patients admitted on Friday, Saturday or Sunday stayed on average 0.3 days longer than those admitted on weekdays, after adjusting for potential confounders; those admitted on the eve of public holidays, and those admitted in the afternoons and after office hours also had a longer LOS (differences of 0.71, 1.14 and 0.65 days respectively).Cases admitted over a weekend, eve of holiday, in the afternoons, and after office hours, do have an increased LOS. Further research is needed to identify processes contributing to the above phenomenon.Optimising of length of stay is one approach to improving hospital performance, particular under funding systems that quantify outputs by the episode of care, as unnecessary inpatient bed-days constitute a significant component of per-episode costs. Casemix funding of inpatient services was introduced to Singapore in October 1999,[1] and it was based on the Australian National Diagnoses Related Group or AN-DRG system. The DRG system, which funds acute public sector hospitals such as Tan Tock Seng Hospital (TTSH), has given additional impetus towards finding factors which may be responsible for prolonging length of stay (LOS).Contribution to inappropriate
Economic Impact of Dengue Illness and the Cost-Effectiveness of Future Vaccination Programs in Singapore  [PDF]
Luis R. Carrasco,Linda K. Lee,Vernon J. Lee,Eng Eong Ooi,Donald S. Shepard,Tun L. Thein,Victor Gan,Alex R. Cook ,David Lye,Lee Ching Ng,Yee Sin Leo
PLOS Neglected Tropical Diseases , 2011, DOI: 10.1371/journal.pntd.0001426
Abstract: Background Dengue illness causes 50–100 million infections worldwide and threatens 2.5 billion people in the tropical and subtropical regions. Little is known about the disease burden and economic impact of dengue in higher resourced countries or the cost-effectiveness of potential dengue vaccines in such settings. Methods and Findings We estimate the direct and indirect costs of dengue from hospitalized and ambulatory cases in Singapore. We consider inter alia the impacts of dengue on the economy using the human-capital and the friction cost methods. Disease burden was estimated using disability-adjusted life years (DALYs) and the cost-effectiveness of a potential vaccine program was evaluated. The average economic impact of dengue illness in Singapore from 2000 to 2009 in constant 2010 US$ ranged between $0.85 billion and $1.15 billion, of which control costs constitute 42%–59%. Using empirically derived disability weights, we estimated an annual average disease burden of 9–14 DALYs per 100 000 habitants, making it comparable to diseases such as hepatitis B or syphilis. The proportion of symptomatic dengue cases detected by the national surveillance system was estimated to be low, and to decrease with age. Under population projections by the United Nations, the price per dose threshold for which vaccines stop being more cost-effective than the current vector control program ranged from $50 for mass vaccination requiring 3 doses and only conferring 10 years of immunity to $300 for vaccination requiring 2 doses and conferring lifetime immunity. The thresholds for these vaccine programs to not be cost-effective for Singapore were $100 and $500 per dose respectively. Conclusions Dengue illness presents a serious economic and disease burden in Singapore. Dengue vaccines are expected to be cost-effective if reasonably low prices are adopted and will help to reduce the economic and disease burden of dengue in Singapore substantially.
Statistical Modeling Reveals the Effect of Absolute Humidity on Dengue in Singapore  [PDF]
Hai-Yan Xu,Xiuju Fu ,Lionel Kim Hock Lee,Stefan Ma,Kee Tai Goh,Jiancheng Wong,Mohamed Salahuddin Habibullah,Gary Kee Khoon Lee,Tian Kuay Lim,Paul Anantharajah Tambyah,Chin Leong Lim,Lee Ching Ng
PLOS Neglected Tropical Diseases , 2014, DOI: 10.1371/journal.pntd.0002805
Abstract: Weather factors are widely studied for their effects on indicating dengue incidence trends. However, these studies have been limited due to the complex epidemiology of dengue, which involves dynamic interplay of multiple factors such as herd immunity within a population, distinct serotypes of the virus, environmental factors and intervention programs. In this study, we investigate the impact of weather factors on dengue in Singapore, considering the disease epidemiology and profile of virus serotypes. A Poisson regression combined with Distributed Lag Non-linear Model (DLNM) was used to evaluate and compare the impact of weekly Absolute Humidity (AH) and other weather factors (mean temperature, minimum temperature, maximum temperature, rainfall, relative humidity and wind speed) on dengue incidence from 2001 to 2009. The same analysis was also performed on three sub-periods, defined by predominant circulating serotypes. The performance of DLNM regression models were then evaluated through the Akaike's Information Criterion. From the correlation and DLNM regression modeling analyses of the studied period, AH was found to be a better predictor for modeling dengue incidence than the other unique weather variables. Whilst mean temperature (MeanT) also showed significant correlation with dengue incidence, the relationship between AH or MeanT and dengue incidence, however, varied in the three sub-periods. Our results showed that AH had a more stable impact on dengue incidence than temperature when virological factors were taken into consideration. AH appeared to be the most consistent factor in modeling dengue incidence in Singapore. Considering the changes in dominant serotypes, the improvements in vector control programs and the inconsistent weather patterns observed in the sub-periods, the impact of weather on dengue is modulated by these other factors. Future studies on the impact of climate change on dengue need to take all the other contributing factors into consideration in order to make meaningful public policy recommendations.
Economic Analysis of Pandemic Influenza Vaccination Strategies in Singapore  [PDF]
Vernon J. Lee, Mei Yin Tok, Vincent T. Chow, Kai Hong Phua, Eng Eong Ooi, Paul A. Tambyah, Mark I. Chen
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0007108
Abstract: Background All influenza pandemic plans advocate pandemic vaccination. However, few studies have evaluated the cost-effectiveness of different vaccination strategies. This paper compares the economic outcomes of vaccination compared with treatment with antiviral agents alone, in Singapore. Methodology We analyzed the economic outcomes of pandemic vaccination (immediate vaccination and vaccine stockpiling) compared with treatment-only in Singapore using a decision-based model to perform cost-benefit and cost-effectiveness analyses. We also explored the annual insurance premium (willingness to pay) depending on the perceived risk of the next pandemic occurring. Principal Findings The treatment-only strategy resulted in 690 deaths, 13,950 hospitalization days, and economic cost of USD$497 million. For immediate vaccination, at vaccine effectiveness of >55%, vaccination was cost-beneficial over treatment-only. Vaccine stockpiling is not cost-effective in most scenarios even with 100% vaccine effectiveness. The annual insurance premium was highest with immediate vaccination, and was lower with increased duration to the next pandemic. The premium was also higher with higher vaccine effectiveness, attack rates, and case-fatality rates. Stockpiling with case-fatality rates of 0.4–0.6% would be cost-beneficial if vaccine effectiveness was >80%; while at case-fatality of >5% stockpiling would be cost-beneficial even if vaccine effectiveness was 20%. High-risk sub-groups warrant higher premiums than low-risk sub-groups. Conclusions The actual pandemic vaccine effectiveness and lead time is unknown. Vaccine strategy should be based on perception of severity. Immediate vaccination is most cost-effective, but requires vaccines to be available when required. Vaccine stockpiling as insurance against worst-case scenarios is also cost-effective. Research and development is therefore critical to develop and stockpile cheap, readily available effective vaccines.
Dissemination and Development of Wuqinxi in Singapore  [PDF]
Bin Zhang, Lei Ru, Hong Lin, Jie Liang, Chichou Lao, Daiyin Peng, Chunsong Cheng
Open Journal of Social Sciences (JSS) , 2016, DOI: 10.4236/jss.2016.43033
Abstract: Our investigations indicate that Wuqinxi in Singapore has now been studied and is mainly promoted through performing exercises, exchanges and competition. The Singapore government has regarded for Qigong for many years, and thus helps Chinese Wuqinxi developed a successful foundation in Singapore. Besides, this research promptes that the Wuqinxi practitioners are mostly women who are around the age of 20 - 40 and their occupations are mainly workman, civil servants and self-employment. Most of them learn Wuqinxi through Wuqinxi exercises classes or in the Wushu clubs. In Singapore, people improve their health through learning and practice Wuqinxi which cater the demand for municipal and have been promoted and advocated by levels of government departments. It is encouraging that the data indicate that 75.7% of the Wuqinxi practitioners practice 1 - 3 times per week. The data seem to indicate that China Wu-qinxi will well developed in Singapore. However, The main obstacles affecting the promotion of Wuqinxi in Singapore are the lack of professional action coaches and theoretical education of sports action.
The Singapore Statement on Research Integrity
Roshan Hewapathirana
Sri Lanka Journal of Bio-Medical Informatics , 2010, DOI: doi: 10.4038/sljbmi.v1i4.2491
Abstract: The Singapore Statement on Research Integrity was developed as part of the 2nd World Conference on Research Integrity, 21‐24 July 2010, in Singapore, as a global guide to the responsible conduct of research. It is not a regulatory document and does not represent the official policies of the countries and organizations that funded and/or participated in the Conference. For official policies, guidance, and regulations relating to research integrity, appropriate national bodies and organizations should be consulted.
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