Risk factors for non-communicable diseases at baseline and their short-term changes in a workplace cohort in Singapore

Copyright © 2019 by the authors. We aimed to examine the behavioural and clinical risk factors for non-communicable diseases (NCDs) at baseline and their changes over 12 months in a workplace cohort in Singapore. A total of 464 full-time employees (age ≥ 21 years) were recruited from a variety of occupational settings, including offices, control rooms, and workshops. Of these, 424 (91.4%) were followed-up at three months and 334 (72.0%) were followed up at 12 months. Standardized questionnaires were used to collect data on health behaviours and clinical measurements were performed by trained staff using standard instruments and protocols. Age-adjusted changes in risk factors over time were examined using generalized estimating equations or linear mixed-effects models where appropriate. The mean age of the participants at baseline was 39.0 (SD: 11.4) years and 79.5% were men. Nearly a quarter (24.4%) were current smokers, slightly more than half (53.5%) were alcohol drinkers, two-thirds (66%) were consuming <5 servings of fruit and vegetables per day, and 23.1% were physically inactive. More than two-thirds (67%) were overweight or obese and 34.5% had central obesity. The mean follow-up was 8.6 months. After adjusting for age, over 12 months, there was a significant increase in the proportion consuming <5 servings of fruit and vegetables per day by 33% (p = 0.030), who were physically inactive by 64% (p < 0.001), and of overweight or obese people by 15% (p = 0.018). The burden of several key NCD risk factors at baseline was high and some worsened within a short period of time in this working population. There is a need for more targeted strategies for behaviour change towards a healthy lifestyle as part of the ongoing health and wellness programs at workplaces in SingaporeSingapore Ministry of National Development and the National Research Foundation; Prime Minister’s Office under the Land and Liveability National Innovation Challenge (L2 NIC) Research Programme

Health Effects of Underground Workspaces cohort: study design and baseline characteristics

The development of underground workspaces is a strategic effort towards healthy urban growth in cities with ever-increasing land scarcity. Despite the growth in underground workspaces, there is limited information regarding the impact of this environment on workers’ health. The Health Effects of Underground Workspaces (HEUW) study is a cohort study that was set up to examine the health effects of working in underground workspaces. In this paper, we describe the rationale for the study, study design, data collection, and baseline characteristics of participants. The HEUW study recruited 464 participants at baseline, of whom 424 (91.4%) were followed-up at 3 months and 334 (72.0%) at 12 months from baseline. We used standardized and validated questionnaires to collect information on socio-demographic and lifestyle characteristics, medical history, family history of chronic diseases, sleep quality, health-related quality of life, chronotype, psychological distress, occupational factors, and comfort levels with indoor environmental quality parameters. Clinical and anthropometric parameters including blood pressure, spirometry, height, weight, and waist and hip circumference were also measured. Biochemical tests of participants’ blood and urine samples were conducted to measure levels of glucose, lipids, and melatonin. We also conducted objective measurements of individuals’ workplace environment, assessing air quality, light intensity, temperature, thermal comfort, and bacterial and fungal counts. The findings this study will help to identify modifiable lifestyle and environmental parameters that are negatively affecting workers’ health. The findings may be used to guide the development of more health-promoting workspaces that attempt to negate any potential deleterious health effects from working in underground workspaces.Singapore Ministry of National Development; National Research Foundation; Prime Minister’s Office; Singapore

What clinicians who practice in countries reaching malaria elimination should be aware of: lessons learnt from recent experience in Sri Lanka

Following progressive reduction in confirmed cases of malaria from 2002 to 2007 (41,411 cases in 2002, 10,510 cases in 2003, 3,720 cases in 2004, 1,640 cases in 2005, 591 cases in 2006, and 198 cases in 2007). Sri Lanka entered the pre-elimination stage of malaria in 2008. One case of indigenous malaria and four other cases of imported malaria are highlighted here, as the only patients who presented to the Professorial Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka over the past eight years, in contrast to treating several patients a week about a decade ago. Therefore, at the eve of elimination of malaria from Sri Lanka, it is likely that the infection is mostly encountered among travellers who return from endemic areas, or among the military who serve in un-cleared areas of Northern Sri Lanka. They may act as potential sources of introducing malaria as until malaria eradication is carried out. These cases highlight that change in the symptomatology, forgetfulness regarding malaria as a cause of acute febrile illness and deterioration of the competency of microscopists as a consequence of the low disease incidence, which are all likely to contribute to the delay in the diagnosis. The importance regarding awareness of new malaria treatment regimens, treatment under direct observation, prompt notification of suspected or diagnosed cases of malaria and avoiding blind use of anti-malarials are among the other responsibilities expected of all clinicians who manage patients in countries reaching malaria elimination

Epochal changes in the association between malaria epidemics and El Niño in Sri Lanka

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Proton-Assisted Amino Acid Transporter PAT1 Complexes with Rag GTPases and Activates TORC1 on Late Endosomal and Lysosomal Membranes

Mammalian Target of Rapamycin Complex 1 (mTORC1) is activated by growth factor-regulated phosphoinositide 3-kinase (PI3K)/Akt/Rheb signalling and extracellular amino acids (AAs) to promote growth and proliferation. These AAs induce translocation of mTOR to late endosomes and lysosomes (LELs), subsequent activation via mechanisms involving the presence of intralumenal AAs, and interaction between mTORC1 and a multiprotein assembly containing Rag GTPases and the heterotrimeric Ragulator complex. However, the mechanisms by which AAs control these different aspects of mTORC1 activation are not well understood. We have recently shown that intracellular Proton-assisted Amino acid Transporter 1 (PAT1)/SLC36A1 is an essential mediator of AA-dependent mTORC1 activation. Here we demonstrate in Human Embryonic Kidney (HEK-293) cells that PAT1 is primarily located on LELs, physically interacts with the Rag GTPases and is required for normal AA-dependent mTOR relocalisation. We also use the powerful in vivo genetic methodologies available in Drosophila to investigate the regulation of the PAT1/Rag/Ragulator complex. We show that GFP-tagged PATs reside at both the cell surface and LELs in vivo, mirroring PAT1 distribution in several normal mammalian cell types. Elevated PI3K/Akt/Rheb signalling increases intracellular levels of PATs and synergistically enhances PAT-induced growth via a mechanism requiring endocytosis. In light of the recent identification of the vacuolar H+-ATPase as another Rag-interacting component, we propose a model in which PATs function as part of an AA-sensing engine that drives mTORC1 activation from LEL compartments

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Prevalence of vitamin D deficiency and its associated work-related factors among indoor workers in a multi-ethnic Southeast Asian Country

Little is known about the effect of working conditions on vitamin D status in Southeast Asia, where vitamin D deficiency is common despite the presence of sunlight all year round in most places. We examined the prevalence of vitamin D deficiency and its associated work-related factors among indoor workers using the data of 213 participants (aged ≥21 years) from a workplace cohort study in Singapore. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/L. Data on work-related factors, socio-demographic characteristics, and lifestyle habits were collected using standardized questionnaires. Clinical and biochemical measurements were performed using standard tools and protocols. Multivariate Poisson regression was used to examine the independent association of work-related factors with vitamin D deficiency. Mean serum 25(OH)D concentration was 59.6 nmol/L. The prevalence of vitamin D deficiency was 32.9% (95% confidence interval (CI): 26.6-39.6%). In the multivariate analysis, office workers (prevalence ratio (PR): 2.16, 95% CI: 1.12-4.16 versus control room workers), workshop workers (PR: 2.25, 95% CI: 1.05-4.81 versus control room workers), and night shift workers (PR: 1.31, 95% CI: 1.03-1.67) were at a greater risk for vitamin D deficiency. Workplace policies and wellness programs should encourage workers to take regular breaks to go outdoors for sunlight exposure and to consume adequate amounts of vitamin D-rich foods to maintain optimal vitamin D levels