The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: Is the whole greater than the sum of its parts?

BACKGROUND: Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure) captures the multidimensional information provided by the SF-36 (a profile measure). METHODS: Using data from a cross-sectional, population-based survey of Chinese, Malay and Indians in Singapore, we developed 9 separate multiple linear regression models, with each SF-36 scale or SF-6D index score being the dependent variable for one model. The influence of DM and a second chronic medical condition (hypertension (HTN), heart disease (HD), musculoskeletal illnesses (MS)) and their interactions were studied after adjusting for the influence of potential confounding variables. RESULTS: Among 5,224 subjects, the prevalence of DM, HTN, HD and MS were 5.9%, 10.7%, 2.4% and 26.6% respectively. DM lowered SF-36 scores by more than 2 points on 3 SF-36 scales and lowered SF-6D scores by 0.03 points. Subjects with DM and HTN, DM and HD or DM and MS experienced further lowering of SF-36 scores exceeding 2 points on at least 6 scales and further lowering of SF-6D scores by 0.05, 0.08 and 0.10 points respectively. Generally, DM and co-existing medical conditions exerted additive effects on HRQoL, with the exception of DM and heart disease, where a subtractive effect was noted. SF-6D index scores generally reflected the patterns of influence of DM and chronic medical conditions on SF-36 scores. CONCLUSION: DM and chronic medical conditions generally reduced HRQoL in this multiethnic general population in an additive, rather than synergistic or subtractive fashion. In this study, the SF-6D was a reasonably good summary measure for the SF-36

Experiences of environmental services workers in a tertiary hospital in Asia during the COVID-19 pandemic: a qualitative study

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic has had a significant impact on all walks of life, in particular, environmental services workers in healthcare settings had higher workload, increased stress and greater susceptibility to COVID-19 infections during the pandemic. Despite extensive literature describing the impact of the pandemic on healthcare workers such as doctors and nurses, studies on the lived experiences of environmental services workers in healthcare settings are sparse and none has been conducted in the Asian context. This qualitative study thus aimed to examine the experiences of those who worked for a year of the COVID-19 pandemic.MethodsA purposive sample of environmental services workers was recruited from a major tertiary hospital in Singapore. Semi-structured interviews were conducted in-person, lasting around 30min, and included open-ended questions pertaining to five main domains: work experiences during COVID-19, training and education needs, resource and supplies availability, communication with management and other healthcare staff, and perceived stressors and support. These domains were identified based on team discussions and literature review. The interviews were recorded and transcribed for thematic analysis, as guided by Braun and Clarke.ResultsA total of 12 environmental services workers were interviewed. After the first seven interviews, no new themes emerged but an additional five interviews were done to ensure data saturation. The analysis yielded three main themes and nine subthemes, including (1) practical and health concerns, (2) coping and resilience, and (3) occupational adaptations during the pandemic. Many expressed confidence in the preventive efficacy of proper PPE, infection control practice and COVID-19 vaccination in protecting them against COVID-19 and severe illness. Having prior experience with infectious disease outbreaks and previous training in infection control and prevention appeared to be useful as well for these workers. Despite the various challenges presented by the pandemic, they could still find meaning in their everyday work by positively impacting the wellbeing of patients and other healthcare workers in the hospital.ConclusionBesides uncovering the concerns shared by these workers, we identified helpful coping strategies, resilience factors and certain occupational adaptations, which have implications for future pandemic planning and readiness

An Exploratory Study of Response Shift in Health-Related Quality of Life and Utility Assessment Among Patients with Osteoarthritis Undergoing Total Knee Replacement Surgery in a Tertiary Hospital in Singapore

AbstractObjectiveTo investigate the influence of response shift (RS) on health-related quality of life (HRQOL) and utility assessment among patients undergoing total knee replacement.MethodsConsenting patients undergoing total knee replacement were interviewed to determine their HRQOL by using the six-dimensional health state short form, derived from SF-36, and the EuroQol five-dimensional questionnaire at baseline (pretest 1) and the six-dimensional health state short form, derived from SF-36, at 6 (pretest 2) and 18 months after surgery (post-test). RS was studied by using a “then-test” approach by contacting participants 18 months after surgery and asking them to evaluate their HRQOL at baseline (then-test 1) and at 6 (then-test 2) and 18 months after surgery. RS was calculated as the score difference between pretest and then-test scores for a given time point. Relationships between RS and external variables were explored by using univariate and multiple liner regression analyses.ResultsIn 74 subjects (63% response rate, median age 68 years), median (interquantile range) six-dimensional health state short form, derived from SF-36, scores for then-tests at baseline (0.48 [0.42–0.49]) and at 6 months (0.72 [0.66–0.79]) after surgery were significantly different from respective pretest scores (0.61 [0.58–0.68] at baseline, P = 0.000; 0.69 [0.63–0.72] at 6 months, P = 0.000), showing RS at both time points. RS at baseline (0.14 [0.08–0.20]) was significantly larger than that at 6 months (−0.05 [0.14 to 0.00], P = 0.000). EuroQol five-dimensional questionnaire pretest and then-test scores at baseline also differed significantly (0.69 [0.17–0.73] vs. −0.18 [−0.23 to 0.00], P = 0.000). RS at baseline was not affected by assessed demographic or medical variables. RS at 6 months was greater in subjects with more years of education (16% of variance in multiple liner regression, P < 0.01).ConclusionRS was present and impacted HRQOL and utility assessment among patients undergoing total knee replacement before and 6 months after surgery

Do English and Chinese EQ-5D versions demonstrate measurement equivalence? an exploratory study

BACKGROUND: Although multiple language versions of health-related quality of life instruments are often used interchangeably in clinical research, the measurement equivalence of these versions (especially using alphabet vs pictogram-based languages) has rarely been assessed. We therefore investigated the measurement equivalence of English and Chinese versions of the EQ-5D, a widely used utility-based outcome instrument. METHODS: In a cross-sectional study, either EQ-5D version was administered to consecutive outpatients with rheumatic diseases. Measurement equivalence of EQ-5D item responses and utility and visual analog scale (EQ-VAS) scores between these versions was assessed using multiple regression models (with and without adjusting for potential confounding variables), by comparing the 95% confidence interval (95%CI) of score differences between these versions with pre-defined equivalence margins. An equivalence margin defined a magnitude of score differences (10% and 5% of entire score ranges for item responses and utility/EQ-VAS scores, respectively) which was felt to be clinically unimportant. RESULTS: Sixty-six subjects completed the English and 48 subjects the Chinese EQ-5D. The 95%CI of the score differences between these versions overlapped with but did not fall completely within pre-defined equivalence margins for 4 EQ-5D items, utility and EQ-VAS scores. For example, the 95%CI of the adjusted score difference between these EQ-5D versions was -0.14 to +0.03 points for utility scores and -11.6 to +3.3 points for EQ-VAS scores (equivalence margins of -0.05 to +0.05 and -5.0 to +5.0 respectively). CONCLUSION: These data provide promising evidence for the measurement equivalence of English and Chinese EQ-5D versions

Leucocyte subset-specific type 1 interferon signatures in SLE and other immune-mediated diseases.

OBJECTIVES: Type 1 interferons (IFN-1) are implicated in the pathogenesis of systemic lupus erythematosus (SLE), but most studies have only reported the effect of IFN-1 on mixed cell populations. We aimed to define modules of IFN-1-associated genes in purified leucocyte populations and use these as a basis for a detailed comparative analysis. METHODS: CD4+ and CD8+ T cells, monocytes and neutrophils were purified from patients with SLE, other immune-mediated diseases and healthy volunteers and gene expression then determined by microarray. Modules of IFN-1-associated genes were defined using weighted gene coexpression network analysis. The composition and expression of these modules was analysed. RESULTS: 1150 of 1288 IFN-1-associated genes were specific to myeloid subsets, compared with 11 genes unique to T cells. IFN-1 genes were more highly expressed in myeloid subsets compared with T cells. A subset of neutrophil samples from healthy volunteers (HV) and conditions not classically associated with IFN-1 signatures displayed increased IFN-1 gene expression, whereas upregulation of IFN-1-associated genes in T cells was restricted to SLE. CONCLUSIONS: Given the broad upregulation of IFN-1 genes in neutrophils including in some HV, investigators reporting IFN-1 signatures on the basis of whole blood samples should be cautious about interpreting this as evidence of bona fide IFN-1-mediated pathology. Instead, specific upregulation of IFN-1-associated genes in T cells may be a useful biomarker and a further mechanism by which elevated IFN-1 contributes to autoimmunity in SLE.SMF holds a Translational Medicine and Therapeutics PhD studentship from the Wellcome Trust and GlaxoSmithKline and has also received funding for this work from the Addenbrooke’s Charitable Trust. KGCS is the Khoo Oon Teik Professor of Nephrology, National University of Singapore. Singapore recruitment was supported by the Khoo Investigator Grant from the Duke-NUS Graduate Medical School, Singapore, and by National Medical Research Council of Singapore grants (NMRC/1164/2008 and IRG07nov089). This work was also supported by UK National Institute of Health Research Cambridge Biomedical Research Centre, the Lupus Research Institute (Distinguished Innovator Award, KGCS), the Medical Research Council UK (programme grant MR/L019027/1) and the Wellcome Trust (programme grant 083650/Z/07/Z and project grant 094227/Z/10/Z). The Cambridge Institute for Medical Research is in receipt of Wellcome Trust Strategic Award 079895.This is the final version of the article. It first appeared from BMJ Group via https://doi.org/10.1136/rmdopen-2015-00018

Characterization and comparative overview of complete sequences of the first plasmids of Pandoraea across clinical and non-clinical strains

To date, information on plasmid analysis in Pandoraea spp. is scarce. To address the gap of knowledge on this, the complete sequences of eight plasmids from Pandoraea spp. namely Pandoraea faecigallinarum DSM 23572 (pPF72-1, pPF72-2), Pandoraea oxalativorans DSM 23570 (pPO70-1, pPO70-2, pPO70-3, pPO70-4), Pandoraea vervacti NS15 (pPV15) and Pandoraea apista DSM 16535 (pPA35) were studied for the first time in this study. The information on plasmid sequences in Pandoraea spp. is useful because these plasmid sequences did not match to any known plasmid sequence deposited in public databases. Replication genes were not identified in some plasmids, a situation that has led to the possibility of host interaction involvement. Some plasmids were also void of par genes and intriguingly, repA gene was also not discovered in these plasmids. This further leads to the hypothesis of host-plasmid interaction. Plasmid stabilization/stability protein-encoding genes were observed in some plasmids but were not established for participating in plasmid segregation. Toxin-antitoxin systems MazEF, VapBC, RelBE, YgiT-MqsR, HigBA and ParDE were identified across the plasmids and their presence would improve plasmid maintenance. Conjugation genes were identified portraying the conjugation ability amongst Pandoraea plasmids. Additionally, we found a shared region amongst some of the plasmids that consists of conjugation genes. The identification of genes involved in replication, segregation, toxin-antitoxin systems and conjugation, would aid the design of drugs to prevent the survival or transmission of plasmids carrying pathogenic properties. Additionally, genes conferring virulence and antibiotic resistance were identified among the plasmids. The observed features in the plasmids shed light on the Pandoraea spp. as opportunistic pathogens

Digital competencies for Singapore’s national medical school curriculum: a qualitative study

ABSTRACTStudies have shown that national-level initiatives to equip medical students with relevant digital competencies carry many benefits. Yet, few countries have outlined such competencies for clinical practice in the core medical school curriculum. This paper identifies current training gaps at the national level in digital competencies needed by students in the formal curricula of all three medical schools in Singapore from the perspectives of clinical educators and institutional leaders. It bears implications for countries that intend to implement standardized learning objectives for training in these digital competencies. Findings were drawn from in-depth interviews with 19 clinical educators and leaders of local medical schools. Participants were recruited using purposive sampling. Data were interpreted using qualitative thematic analysis. Thirteen of the participants were clinical educators while 6 were deans or vice deans of education from one of the three medical schools in Singapore. While the schools have introduced some relevant courses, they are not standardized nationally. Moreover, the school’s niche areas have not been leveraged upon for training in digital competencies. Participants across all schools acknowledged that more formal training is needed in digital health, data management, and applying the principles of digital technologies. Participants also noted that the healthcare needs of the population, patient safety, and safe procedures in the utilization of digital healthcare technologies should be prioritized when determining the competencies needed by students. Additionally, participants highlighted the need for stronger collaboration among medical schools, and for a stronger link between current curriculum and clinical practice. The findings highlighted the need for better collaboration among medical schools in the sharing of educational resources and expertise. Furthermore, stronger collaborations with professional bodies and the healthcare system should be established to ensure that the goals and outcomes of medical education and the healthcare system are aligned

The impact of health literacy on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases

Objectives: The objective of this study was to investigate the impact of health literacy (HL) on health-related quality of life (HRQoL) and utility assessment among patients with rheumatic diseases. Methods: HL was measured by the rapid estimate of adult literacy in medicine (REALM) and was characterized as low or adequate. HRQoL and utility scores were assessed using the SF-36, SF-6D, and EQ-5D. Comparisons of sociodemographics and HRQoL in patients with low or adequate HL were made using t test, chi-square, or Mann–Whitney U tests. Spearman’s correlation and partial correlations were used to study the relationship between HL, HRQoL, and utility scores, with significant correlations further explored using multiple linear regression models. Results: Data were analyzed from 199 subjects. Patients with adequate HL had significantly higher education levels, better dwelling status, lower disease activity, and better physical functioning (PF). There was a significant although weak correlation between HL level and PF. After adjustment, HL level was shown to independently explain 3.7% of the variance in the PF score. Nevertheless, there was no impact of HL on utility assessment or other HRQoL domains. Conclusion: HL did not impact HRQoL in general, but was found to have a weak impact on the PF of patients with rheumatic diseases

Development and validation of a functional health literacy test

Background: Three validated functional health literacy tests (FHLTs) have been developed for use in healthcare settings. However, none of these tests has been shown to be readily applicable for use in the general public. Objective: To develop and validate an FHLT for screening the functional health literacy level of the general public and patients in healthcare settings. Methods: Maze procedure, expert judgment, and interviews with 55 respondents were used to develop the 21-item FHLT, which was modified from public health education material entitled Guidelines on Taking Medicines published by the Singapore Health Promotion Board. The finalized FHLT was then distributed by convenience sampling among eligible English-speaking respondents from the general public and rheumatic patients in Singapore. Descriptive analysis was used to summarize the sociodemographic characteristics and health status of the respondents. Cronbach's α was used to assess the reliability of the test. Partial correlation coefficients were used to investigate the convergent validity between scores on the FHLT and the Rapid Estimate of Adult Literacy in Medicine (REALM), and the divergent validity between the FHLT score and education level. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). Results: Data were analyzed from 223 respondents from the general public (mean [SD] age: 43.8 [14.2] years, 49.3% female, 45.7% with >12 years of education) and 200 rheumatic patients (mean [SD] age: 46.6 [14.7], 70.5% female, 45.5% with >12 years of education). Cronbach's α for the FHLT was 0.72 and 0.68 for the general public and rheumatic patients, respectively, suggesting adequate reliability. Convergent validity was demonstrated with a strong correlation between scores on the FHLT and REALM (0.65 [p < 0.01] for the general public, 0.68 [p < 0.01] for rheumatic patients). Divergent validity was shown by the weak correlation between the FHLT score and education level (0.33 [p < 0.01] for the general public, 0.28 [p < 0.01] for rheumatic patients). Test-retest reliability of the FHLT among rheumatic patients (n = 112, response rate = 56%) was shown to be high (ICC = 0.95). ICC was not calculated for the test-retest reliability among the general public because of a poor response rate of 9%. Conclusions: The 21-item FHLT has been shown to be a reliable and valid screening test for measuring functional health literacy levels of the general public as well as patients in healthcare settings. The availability of the FHLT would contribute to the effectiveness of health education programs and better health-related outcomes in the general population

Development and Validation of a Functional Health Literacy Test

Background: Three validated functional health literacy tests (FHLTs) have been developed for use in healthcare settings. However, none of these tests has been shown to be readily applicable for use in the general public. Objective: To develop and validate an FHLT for screening the functional health literacy level of the general public and patients in healthcare settings. Methods: Maze procedure, expert judgment, and interviews with 55 respondents were used to develop the 21-item FHLT, which was modified from public health education material entitled Guidelines on Taking Medicines published by the Singapore Health Promotion Board. The finalized FHLT was then distributed by convenience sampling among eligible English-speaking respondents from the general public and rheumatic patients in Singapore. Descriptive analysis was used to summarize the sociodemographic characteristics and health status of the respondents. Cronbach's α was used to assess the reliability of the test. Partial correlation coefficients were used to investigate the convergent validity between scores on the FHLT and the Rapid Estimate of Adult Literacy in Medicine (REALM), and the divergent validity between the FHLT score and education level. Test-retest reliability was assessed by intraclass correlation coefficient (ICC). Results: Data were analyzed from 223 respondents from the general public (mean &lsqb;SD&rsqb; age: 43.8 &lsqb;14.2&rsqb; years, 49.3% female, 45.7% with >12 years of education) and 200 rheumatic patients (mean &lsqb;SD&rsqb; age: 46.6 &lsqb;14.7&rsqb;, 70.5% female, 45.5% with >12 years of education). Cronbach's α for the FHLT was 0.72 and 0.68 for the general public and rheumatic patients, respectively, suggesting adequate reliability. Convergent validity was demonstrated with a strong correlation between scores on the FHLT and REALM (0.65 &lsqb;p < 0.01&rsqb; for the general public, 0.68 &lsqb;p < 0.01&rsqb; for rheumatic patients). Divergent validity was shown by the weak correlation between the FHLT score and education level (0.33 &lsqb;p < 0.01&rsqb; for the general public, 0.28 &lsqb;p < 0.01&rsqb; for rheumatic patients). Test-retest reliability of the FHLT among rheumatic patients (n - 112, response rate - 56%) was shown to be high (ICC - 0.95). ICC was not calculated for the test-retest reliability among the general public because of a poor response rate of 9%. Conclusions: The 21-item FHLT has been shown to be a reliable and valid screening test for measuring functional health literacy levels of the general public as well as patients in healthcare settings. The availability of the FHLT would contribute to the effectiveness of health education programs and better health-related outcomes in the general population.