Health-related quality of life of patients with inflammatory bowel disease in Singapore

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) is associated with considerable impairment of patients’ health-related quality of life (HRQoL). Knowledge of factors that significantly affect IBD patients’ HRQoL can contribute to better patient care. However, the HRQoL of IBD patients in non-Western countries are limited. Hence, we assessed the HRQoL of Singaporean IBD patients and identified its determinants. METHODS: A prospective, cross-sectional study was conducted at Singapore General Hospital outpatient IBD Centre. The HRQoL of IBD patients was assessed using the short IBD questionnaire (SIBDQ), Short Form-36 physical and mental component summary (SF-36 PCS/MCS) and EuroQol 5-dimensions 3-levels (EQ-5D-3L) and visual analogue scale (VAS). Independent samples t-test was used to compare HRQoL between Crohn’s disease (CD) and ulcerative colitis (UC). Determinants of HRQoL were identified through multiple linear regression. RESULTS: A total of 195 IBD patients (103 UC, 92 CD) with a mean disease duration of 11.2 years were included. There was no significant difference in HRQoL between patients with UC and CD. Factors that significantly worsened HRQoL were presence of active disease (b=−6.293 [SIBDQ], −9.409 [PCS], −9.743 [MCS], −7.254 [VAS]), corticosteroids use (b=−7.392 [SIBDQ], −10.390 [PCS], −8.827 [MCS]), poor medication adherence (b=−4.049 [SIBDQ], −1.320 [MCS], −8.961 [VAS]), presence of extraintestinal manifestations (b=−13.381 [PCS]), comorbidities (b=−4.531 [PCS]), non-employment (b=−9.738 [MCS], −0.104 [EQ-5D-3L]) and public housing (b=−8.070 [PCS], −9.207 [VAS]). CONCLUSIONS: The HRQoL is impaired in this Asian cohort of IBD. The magnitude of HRQoL impairment was similar in UC and CD. Clinical characteristics were better determinants of patients’ HRQoL than socio-demographic factors. Recognizing the factors that impact patients’ HRQoL would improve the holistic management of IBD patients.

Establishing validity of EQ-5D-3L (Tagalog) to measure health-related quality of life states among adult Filipinos (20-50 years old)

@#<p style="text-align: justify;"><b>OBJECTIVE: </b>To establish the validity of EQ-5D-3L in Tagalog language in assessing health-related quality of life states among adult Filipinos 20-50 years old.</p><p style="text-align: justify;"><b>METHODS:</b> A face-to-face cross-sectional community survey of apparently healthy adult Filipinos (20-50 years old) in Metro Manila and in 4 nearby provinces (Bulacan, Batangas, Quezon, Rizal) was conducted. Trained interviewers administered the Tagalog language versions of EuroQoL 5-Dimension 3 Levels (EQ-5D-3L), Short-Form 2 (SF-26V2®), and a socio-economic questionnaire. All questionnaires were pre-tested for cultural appropriateness. Concurrent validity (against the SF-36v2R®) and known group validity of the EQ-5D-3L were evaluated.</p><p style="text-align: justify;"><b>RESULTS:</b> Complete data from 3,056 participants were analyzed. Almost half of the participants reported perfect health on EQ-5D-3L and had higher scores on all SF-36v2® domains compared to those who reported some problems on EQ-5D-3L. Compared to participants who reported some problems on EQ-5D-3L mobility (or anxiety/depression), participants who reported no problem on EQ-5D-3L mobility (or anxiety/depression) reported lower SF-36v2® Physical Functioning (or Mental Health) scores (differences of 7.1 and 10 points, respectively) that were minimally important (i.e. exceeds 5 points). Participants with poorer self-reported health had considerably lower EQ-5D index scores (p < 0.05) irrespective of their socio-demographic characteristics.</p><p style="text-align: justify;"><b>CONCLUSION:</b> EQ-5D-3L (Tagalog) demonstrated construct and known groups validity among adult Filipinos (20-50 years old).</p>

Validation Of The Kessler's Psychological Distress Scale (K10 & K6) In A Malaysian Population

@#Objective: A quick assessment tool for screening individuals with depression or anxiety is pertinent in mental-health set up. This study aims to validate the K10 and the K6 to screen patients with non-specific psychological distress in a Malaysian population. Methods: Translation of the questionnaire was done from English to Malay. Face validity was conducted on patients, and a pilot study was performed to assess the reliability of the K10 questionnaire. Fieldwork was conducted to determine the reliability and validity of the K10 questionnaire based on convenience sampling of healthy individuals and patients diagnosed with psychiatric illness. Malay version for K10 was administered to healthy participants (group without psychological distress) and patients on psychiatric clinic follow up (psychological distress). Data collection was done between August 2016 and September 2016. Result: A total of 94 subjects were recruited in the study, of which 32 formed the case group. The Cronbach’s alpha coefficients for K10 were 0.837(control) and 0.885 (case), as for K6 were 0.716 (control) and 0.859 (case). The total score of the K10 and the K6 clearly differentiated between the control and case groups (p<0.001). The area under the curve for K10 and K6 were 0.84 with 95% CI (0.81, 0.96) and 0.86 with 95% CI (0.77, 0.94) respectively. For K10, at the optimal cut-off score of 17, the sensitivity and specificity were 84.4% and 75.3% respectively while for K6, at the optimal cut-off score of 11, the sensitivity and specificity were 78.1% and 75.8%, respectively. Conclusion: The Malay version of the K10 and the K6 are reliable and valid to be used for screening patients with non-specific psychological distress in a Malaysian population. Kessler psychological distress scale has minimal items and yet this Kessler psychological distress scales have minimal items and yet are an effective screening tool.

Reliability and Validity of the English-, Chinese- and Malay-Language Versions of the World Health Organization Quality of Life (WHOQOL-BREF) Questionnaire in Singapore

<p><b>INTRODUCTION</b>The World Health Organization Quality of Life (WHOQOL-BREF) questionnaire is a 26-item questionnaire that evaluates 4 domains of quality of life (QoL), namely Physical, Psychological, Social Relationships and Environment. This study aimed to evaluate the validity and reliability of the WHOQOL-BREF among Singapore residents aged 21 and above.</p><p><b>MATERIALS AND METHODS</b>We recruited participants from the general population by using multistage cluster sampling and participants from 2 hospitals by using convenience sampling. Participants completed either English, Chinese or Malay versions of the WHOQOL-BREF and the EuroQoL 5 Dimension 5 Levels (EQ-5D-5L) questionnaires. Confirmatory factor analysis, known-group validity, internal consistency (Cronbach's alpha) and test-retest reliability using the intraclass correlation coefficient (ICC) were performed.</p><p><b>RESULTS</b>Data from 1316 participants were analysed (Chinese: 46.9%, Malay: 41.0% and Indian: 11.7%; 57.5% mean, mean standard deviation [SD, range] age: 51.9 [15.68, 24 to 90] years); 154 participants took part in the retest in various languages (English: 60, Chinese: 49 and Malay: 45). Tucker-Lewis Index (TLI) was 0.919, 0.913 and 0.909 for the English, Chinese and Malay versions, respectively. Cronbach's alpha exceeded 0.7 and ICC exceeded 0.4 for all domains in all language versions.</p><p><b>CONCLUSION</b>The WHOQOL-BREF is valid and reliable for assessing QoL in Singapore. Model fit is reasonable with room for improvement.</p>

Validity of a Revised Short Form-12 Health Survey Version 2 in Different Ethnic Populations

<p><b>INTRODUCTION</b>The Short Form-12 version 2 (SF-12v2) is a shorter version of the Short Form-36 version 2 (SF-36v2) for assessing health-related quality of life. As the SF-12v2 could not be resolved into the physical- and mental-component summary score (PCS and MCS, respectively) in the general population of Singapore, this study aims to determine and validate the Singapore SF-12 version 2 (SG-12v2).</p><p><b>MATERIALS AND METHODS</b>The SG- 12v2 was generated using the same methodology as the SF-12v2. Bootstrap analysis was used to determine if the SG-12v2 were significantly different from the SF-12v2. Content validity was assessed using percentage of variance (R²) of the Singapore version of SF-36v2 PCS and MCS explained by the SG-12v2 items. Agreement between the SF-36v2 and the SG-12v2 was assessed using Bland-Altman diagrams. Criterion validity was demonstrated if effect size differences between SF-36v2 and SG-12v2 were small (Cohen's criteria). Known-group validity of SG-12v2 was reported for participants with and without chronic diseases.</p><p><b>RESULTS</b>Five items differed between the SG-12v2 and SF-12v2. Bootstrap analysis confirmed that SG-12v2 and SF-12v2 were significantly different. The SG12v2 explained 94% and 79% of the R² of the SF-36v2 PCS and MCS, respectively. Agreement was good and effect size differences were small (<0.3). Participants with chronic diseases reported lower SG-12v2 scores compared to participants without chronic diseases.</p><p><b>CONCLUSION</b>The SG-12v2 offers advantage over the SF-12v2 for use in the general population of Singapore. The SG-12v2 is a valid measure and will be particularly useful for large population health surveys in Singapore.</p>

Diabetes Health Profile-18 is Reliable, Valid and Sensitive in Singapore

<p><b>INTRODUCTION</b>The Diabetes Health Profile-18 (DHP-18) measures diabetes-related psychological well-being in patients with type 2 diabetes mellitus (T2DM). It includes 3 subscales: psychological distress (PD), barriers to activity and disinhibited eating. The psychometric properties of the DHP have not been evaluated in Asia. The aim of this study was to determine the psychometric properties of the DHP in multiethnic Singapore.</p><p><b>MATERIALS AND METHODS</b>Patients between the ages of 18 to 65 diagnosed with diabetes (either type 1 or type 2) for at least 1 year were recruited from a diabetes outpatient clinic in a tertiary hospital. They completed a set of self-administered questionnaires including sociodemographic information and the DHP. Validity of the DHP was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Reliability was assessed with internal consistency and sensitivity was determined by effect size, associated with detecting a statistically significant and clinically important difference between various patient subgroups.</p><p><b>RESULTS</b>A total of 204 patients with mean age 45.4 (11.9) years, comprising 64% males and 50% Chinese, 27% Indian and 12% Malay were studied. In CFA, model fit was poor. Forced 3-factor EFA supported the original 3-factor structure of the DHP. Convergent and discriminant validity was demonstrated (100% scaling success). DHP was sensitive across majority of social demographic, clinical and social-functioning determinants (i.e., effect size >0.3). Cronbach's alpha exceeded 0.70 for all subscales. Ceiling effects were negligible but large floor effects were seen for the PD subscale (23%).</p><p><b>CONCLUSION</b>The DHP is valid, reliable and sensitive for measuring well-being in Asian patients with T2DM.</p>

PRIMARY CARE NETWORK (PCN) AS A MODEL OF CARE FOR GP CHRONIC DISEASE MANAGEMENT

Objectives: The Primary Care Network (PCN), comprising small private General Practitioner (GP) clinics supported by a mobile team of dedicated nursing and allied health professionals, as well as a chronic disease register (CDR), can be an alternative model for good chronic disease management. GPs in the network manage the mobile team, set common goals for each clinic and self-evaluate. In this paper we share the data and experience of the first year of the pilot PCN in Singapore. Methodology: Process indicators for diabetic patients seen from April 2011 to March 2012 (pre-PCN) and April 2012 to March 2013 were compared. McNemar test was performed. Results: There was statistically significant improvement in process indicators of yearly DRP, DFS and Urine ACR screening for diabetes in the first year post-PCN compared to baseline data. Rates of regular HbA1c and LDL-C testing, as well as smoking blood pressure and weight assessment also showed statistically significant improvement. Conclusion: The PCN has shown promise in improving quality of care for diabetes among small private GP clinics. Key challenges to the success of PCN include good clinician leadership, suitable IT support, and creating a viable business model for GPs.

Normative Data for the Singapore English and Chinese SF-36 Version 2 Health Survey

<p><b>INTRODUCTION</b>The aim of this study is to report normative data for the Short-Form 36 version 2 (SF-36v2) for assessing health-related quality of life, in the Singapore general population.</p><p><b>MATERIALS AND METHODS</b>Data for English and Chinese-speaking participants of the Singapore Prospective Study Programme were analysed. The SF-36v2 scores were norm-based with the English-speaking Singapore general population as reference and reported by age (in decades), gender and ethnicity as well as for the 5 most prevalent chronic medical conditions. Scores were reported separately for the English and Chinese language versions.</p><p><b>RESULTS</b>A total of 6151 English-speaking (61.5% Chinese and 19.2% Malay) and 1194 Chinese-speaking participants provided complete data. Mean (SD) age of all participants was 49.6 (12.58) years with 52.4% being women. In both languages, women reported lower scores than men on all scales. Among the chronic medical conditions, stroke had the largest impact on all English SF-36v2 scales and on 3 Chinese SF-36v2 scales (role-physical, general health and social functioning).</p><p><b>CONCLUSION</b>We have provided detailed normative data for the Singapore English and Chinese SF-36v2, which would be valuable in furthering HRQoL research in Singapore and possibly the region.</p>

Height and mental health and health utility among ethnic Chinese in a polyclinic sample in Singapore

<p><b>INTRODUCTION</b>Whether fi nal height is associated with quality of life and mental health is a matter of epidemiological and medical concern. Both social and biological explanations have been previously proposed. This study aims to assess the associations in ethnic Chinese in Singapore.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional study of 4414 respondents aged at least 21 years seen at a major polyclinic was performed. Socioeconomic and behavioural features of the sample and the Singapore population of similar ages were comparable. Height was measured by clinic nurses using an ultrasonic height senor. Participants were interviewed for socioeconomic, behavioural, health and quality of life information. Clinical morbidity data was collected from the participants' treating physicians. The SF-6D utility index and its Mental Health domain were the main endpoints. Linear and ordinal logistic regression models were used to analyse the utility index and the Mental Health scores, respectively.</p><p><b>RESULTS</b>Having adjusted for age and gender, the Mental Health domain (P <0.01) was associated with height but the utility index was not. Further adjustment for health, socioeconomic and behavioural covariates made little difference. Analyses based on height categories showed similar trends.</p><p><b>CONCLUSION</b>Adult height has a positive association with mental health as measured by the SF-6D among ethnic Chinese in Singapore. Socioeconomic status and known physical health problems do not explain this association. Adult height had no association with SF-6D utility index scores.</p>

Sociodemographic factors influencing the effectiveness of public health education - a comparison of two studies in Singapore

<p><b>INTRODUCTION</b>We aimed to evaluate if sociodemographic factors influenced the effectiveness of public education programmes in Singapore.</p><p><b>MATERIALS AND METHODS</b>Data were extracted from 2 independent cross-sectional studies that assessed the effectiveness of diabetes and HIV/ AIDS public health education programmes. The influence of sociodemographic factors including age, gender, ethnicity and years of education on diabetes and HIV/AIDS knowledge scores (surrogate marker for programme effectiveness) were assessed using separate univariable and multiple linear regression models for each outcome variable.</p><p><b>RESULTS</b>A total of 1321 subjects [46% male, mean (SD) age: 33.9 (13.44) years] participated in the diabetes study while 400 subjects [44% male, mean (SD) age: 33.9 (13.44) years] participated in the HIV/AIDS study. In univariable analyses, age, years of education and ethnicity influenced both diabetes and HIV/ AIDS knowledge scores. However, in multiple linear regression analyses, only age and years of education influenced both diabetes and HIV/AIDS knowledge scores.</p><p><b>CONCLUSION</b>We found that age and years of education influenced the effectiveness of public health education, suggesting that there is a need to tailor public health education programmes to meet the needs of younger subjects and those with fewer years of education. That knowledge scores were similar between male and female subjects was surprising but could potentially be explained by equal access to information, high availability of information technology and heightened awareness of HIV/AIDS in Singapore.</p>

Cross-cultural adaptation and validation of Singapore Malay and Tamil versions of the EQ-5D

<p><b>INTRODUCTION</b>The aims of this study were to cross-culturally adapt and evaluate the validity of the Singaporean Malay and Tamil versions of the EQ-5D.</p><p><b>MATERIALS AND METHODS</b>The EQ- 5D was cross-culturally adapted and translated using an iterative process following standard guidelines. Consenting adult Malay- and Tamil-speaking subjects at a primary care facility in Singapore were interviewed using a questionnaire (including the EQ-5D, a single item assessing global health, the SF-8 and sociodemographic questions) in their respective language versions. Known-groups and convergent construct validity of the EQ-5D was investigated by testing 30 a priori hypotheses per language at attribute and overall levels.</p><p><b>RESULTS</b>Complete data were obtained for 94 Malay and 78 Indian patients (median age, 54 years and 51 years, respectively). At the attribute level, all 16 hypotheses were fulfilled with several reaching statistical significance (Malay: 4; Tamil: 5). At the overall level, 42 of 44 hypotheses related to the EQ-5D/ EQ-VAS were fulfilled (Malay: 22; Tamil: 20), with 21 reaching statistical significance (Malay: 9; Tamil: 12).</p><p><b>CONCLUSION</b>In this study among primary care patients, the Singapore Malay and Tamil EQ-5D demonstrated satisfactory known-groups and convergent validity.</p>