Risk Factors for Tardive Dyskinesia among Asian Patients with Schizophrenia

Ph.DDOCTOR OF MEDICIN

Sustainable tourism, deforestation and growth: a case for Malaysia

Sustainable tourism perceived as a significant driver of income and creates job opportunities for local communities, which, as a result, deliver significant incentives to preserve biodiversity. Preserving the quality of environment becomes the prime concern to attract more tourists, which as a result, increase funds for biodiversity conservation. Massive increase in tourism together with limited environmental resources capacity, there is an urgent need to raise the awareness on the issue of biodiversity for tourism development. For the purpose of this research, we examine the impact and economic growth on sustainable tourism for the period 1996 – 2012 in Malaysia. For the purpose of this study, we construct a Sustainable Tourism Index (STI) and employed few methods which are the Ordinary Least Squares (OLS), Canonical cointegrating regression (CCR), Dynamic OLS (DOLS) and Fully-Modified OLS (FMOLS) methods to test the long-run model of sustainable tourism. Generally, our results found that economic growth and mitigating do contribute to sustainable tourism in Malaysia

Trends in Subjective Quality of Life Among Patients With First Episode Psychosis—A 1 Year Longitudinal Study

Quality of life (QoL) is often used as an outcome assessment in programs treating patients with first-episode psychosis (FEP). The aim of this study was to examine the longitudinal trend of subjective QoL among patients with FEP and identify the potential influence of patients' social-demographic/lifestyle factors on the trend of QoL. Two hundred and eighty subjects participated in the study. Patient's demographics and subjective QoL were collected at baseline, 6 months and 1 year follow-up. Data were analyzed with a fixed-effect general linear regression model. Subjective QoL demonstrated significant trends of improvement in all four subdomains (physical health, psychological health, social relationships, and environment). Compared with unemployed participants, employed participants were significantly associated with better social relationships (p = 0.005) and environment (p = 0.029) after adjusting for age and gender. Moderation analysis demonstrated a significant improvement of physical health, social relationships, and environment for participants with a higher level of educational achievement, but not for participants with a lower level of educational achievement. Our results indicate that patients with FEP experienced significant improvement in subjective QoL over a 1 year period. Being employed was associated with overall better social relationships and environment among patients with FEP and higher educational achievement was associated with improvement of physical health, social relationship, and environment. Hence, educational achievement and employment could be considered for future optimization of early psychosis intervention programs

Prevalence of and factors related to the use of antidepressants and benzodiazepines: results from the Singapore Mental Health Study

BACKGROUND: Prescription and use of antidepressants and benzodiazepines are common in the general population. Prescription of psychotropic drugs is a complex process: patient, physician and healthcare characteristics mediate, interact and influence it. The current study aimed to establish the prevalence and factors associated with the use of antidepressants (ADs) and benzodiazepines (BZDs) in Singapore. METHODS: The Singapore Mental Health Study (SMHS) was a nationally representative survey of Singapore Residents aged 18 years and above. Face-to-face interviews were conducted from December 2009 to December 2010. The diagnoses of mental disorders were established using the Composite International Diagnostic Interview version 3.0 (CIDI-3.0). The pharmacoepidemiology section was used to collect information on medication use. RESULTS: The overall prevalence estimates for ADs and BZDs use during the 12 months prior to the interview were 1.1% and 1.2% respectively. In all, 2.0% had used ADs and/or BZDs. ‘Help seeking for emotional or mental health problems’ was the most important predictor for the use of ADs and BZDs—help seekers were much more likely to use ADs (adjusted OR: 31.62, 95% CI: 13.36–74.83) and more likely to use BZDs than non-help seekers in the previous 12 months (adjusted OR: 34.38, 95% CI: 12.97–91.16). Only 27.6% of those with 12-month major depressive disorder (MDD) had sought formal medical help for their problems and ADs were being used by just over a quarter of this ‘help-seeking group’ (26.3%). CONCLUSIONS: We found that the use of ADs and BZDs in our population was relatively low, and ‘help-seeking’ was the most important predictor of the use of ADs and BZDs. In concordance with research from other Western countries, use of ADs was low among those with 12-month MDD

Smoking and Socio-demographic correlates of BMI

Abstract Background The aim of the current study was to examine the associations between Body Mass Index (BMI) and socio-demographic factors and to examine the relationship between BMI, smoking status and ethnicity. Methods The Singapore Mental Health Study (SMHS) surveyed Singapore Residents (Singapore Citizens and Permanent Residents) aged 18 years old and above. BMI was calculated using height and weight which were self-reported by respondents. Socio-demographic characteristics and smoking status were recorded in a standardized data collection form. Results Six thousand and six hundred sixteen respondents completed the study (response rate of 75.9 %) which constituted a representative sample of the adult resident population in Singapore. Ethnicity, gender and education status were associated with obesity. There was an interaction effect between ethnicity smoking status, and BMI. Indian and Malay smokers were less likely to be obese compared to Chinese smokers. The relationship between ethnicity and BMI was thus reversed when smoking was taken into account. Conclusions The study identified certain subgroups and risk factors that are associated with obesity. There is a need for further research to explore and identify genetic, metabolic and ethnic differences that underlie the interaction between ethnicity and smoking status which affects BMI

Hoarding Among Outpatients Seeking Treatment at a Psychiatric Hospital in Singapore

Hoarding symptoms commonly co-occur with other psychiatric disorders, such as major depressive disorder, and have been observed across cultures. Yet, few studies have examined hoarding in other disorders or in an Asian context. The present study aimed to determine: (1) the prevalence of clinically significant hoarding, (2) differences between participants with and without significant hoarding, and (3) predictors of hoarding severity in a Singaporean clinical sample. Five hundred outpatients with anxiety disorders, depressive disorders, schizophrenia, and pathological gambling completed a battery of questionnaires on hoarding, anxiety, depression, functional impairment due to clutter, and quality of life. Thirty percent of our sample reported significant hoarding. However, clutter levels in the hoarding group were low, and hoarding severity was not significantly linked to quality of life, after adjusting for anxiety and depression. In addition, depression - but not anxiety - predicted hoarding severity. Our results provide a cross-cultural perspective on hoarding symptoms, and replicate findings that support a link between depression and hoarding. The differential presentation of hoarding in our sample could be due to true cultural differences in hoarding pathology or to variant psychometric properties of the measures used. Further research evaluating hoarding in Asian contexts with different methodology is needed

Does biodiversity attract the number of tourist arrivals? a cross-country analysis

It has been recognized that biodiversity is vital for tourism. Biodiversity become the main attraction of nature tourism, for instance scuba diving, wildlife tourism and tourism in protected areas. Biodiversity can be the determining factor that influencing the tourists’ choices where to go for their next trip. In this study we analyse whether biodiversity is the attractor for international tourists’ destinations for a cross-section of 107 countries for 2013. Apart from the level of economic development, we employed three biodiversity indicators – stock of forest cover, protected areas, and number of fish species threatened as tourists’ destination choices. Further, we also included the governance indicators to account for the level of risk and safety offered to tourists. Our results suggest that the level of economic development, forest area, protected areas, and number of fish species threatened, and also governance are important factors determining tourist destination choices worldwide. The results of our study clearly justify the importance of biodiversity conservation that will benefit the tourism sector and related industries

The number of tourist arrivals, governance and their impact on threatened bird species: worldwide evidence

The number of international tourist arrivals is crucial for the tourism sector. However, there are positive and negative sides of tourism. Unsustainable tourism will result in the destruction of the forest and consequently led to biodiversity loss. The great benefits of forest which is a home for a wide variety of animals and plants which help to stored carbon, preventing the risk of flood and drought to occur, influencing climate change, stabilizing soils as well as providing food and a place for the indigenous people to live. As long as these benefits are being concerned, the role of international community is needed to prevent them from any harm in the future. The government of both the developed and developing nations recognized the importance of sustainable biodiversity for the national ecosystem as well as to the global environment. In this study we also investigate the response of biodiversity loss (measured by the number of threatened bird species on six measures of governance: voice and accountability, political stability and absence of violence, government effectiveness, regulatory quality, rule of law, and control of corruption. The OLS outcomes suggest that tourism exhibit positive relationship with biodiversity loss. On the other hand, the six governance indicators suggest that good governance reduces biodiversity loss. Our further analysis using quantile regression estimates suggest that tourism affect positively biodiversity loss for all quantiles (0.05 0.25 0.50 0.75 0.90 0.95); while governance affect negatively biodiversity loss only at certain quartiles. One main policy implication of this study is that sustainable tourism is important to mitigate biodiversity loss, and effort for biodiversity conservation is supported by this study

Gambling and family: A two-way relationship

Families play an important role in the evolution of gambling and are also adversely affected by the disordered gambling of any one of their members. The aims of this study were to explore both the role families play in gambling initiation, maintenance, and help-seeking, and the harm caused to families by the gambling behavior using a qualitative approach. Methods Regular older adult gamblers were included in the study. In-depth interviews were conducted with 25 older adults to gain an understanding of gambling from their perspective. Older adult gamblers described their lived experience of gambling ranging from initiation to harm and attempts to cut down or limit gambling. Data were analyzed using thematic network analysis. Results The mean age of the 25 participants was 66.2 years. The majority were male (n = 18), of Chinese ethnicity (n = 16), had secondary education (n = 9), were married (n = 20), and currently employed (n = 15). Four organizing themes related to the role of families in initiation and maintenance of gambling, harm caused to family members, and their role in help-seeking were identified. Discussion and conclusions The study emphasizes the role of Asian families in both initiation and maintenance of gambling. Hence, families must be involved in prevention and outreach programs. Family members must be educated, so that they can encourage help-seeking to ensure early treatment and recovery. There is a need for interventional studies for reducing stress and improving coping among family members

Religiosity, Religious Coping and Distress Among Outpatients with Psychosis in Singapore

This study aimed to investigate the prevalence of religious coping and explore the association between religious coping, religiosity, and distress symptoms amongst 364 outpatients diagnosed with psychosis in Singapore. Positive and Negative Religious Coping (PRC and NRC), religiosity (measuring the constructs of Organised Religious Activity (ORA), Non-Organised Religious Activity (NORA), and Intrinsic Religiosity (IR)) and severity of distress symptoms (depression, anxiety and stress) were self-reported by the participants. The majority of participants (68.9%) reported religion to be important in coping with their illness. Additionally, multiple linear regression analyses found that NRC was significantly associated with higher symptoms of distress. In contrast, ORA was significantly associated with lower anxiety symptom scores. Overall, the study indicates the importance of religion in coping with psychosis and the potential value in incorporating religious interventions in mental health care