Comfort and exertion while using filtering facepiece respirators with exhalation valve and an active venting system among male military personnel

<p><b>INTRODUCTION</b>This study aimed to determine if disposable filtering facepiece respirators (FFRs) that come with an exhalation valve (EV) and a novel active venting system (AVS) provided greater perceived comfort and exertion when compared to standard N95 FFRs without these features among male military personnel performing prolonged essential outdoor duties.</p><p><b>METHODS</b>We used a randomised open-label controlled crossover study design to compare three FFR options: (a) standard FFR; (b) FFR with EV; and (c) FFR with EV+AVS. Male military personnel aged between 18 and 20 years completed a questionnaire at the start of outdoor duty (baseline), after two hours of standardised non-strenuous outdoor duty and after 12 hours of duty divided into two-hour work-rest cycles. Participants rated the degree of discomfort, exertion and symptoms using a five-point Likert scale. The association between outcomes and types of FFR was assessed using a multivariate ordered probit mixed-effects model.</p><p><b>RESULTS</b>For a majority of the symptoms, study participants gave FFR with EV and FFR EV+AVS significantly better scores than standard FFR. Both FFR with EV and FFR with EV+AVS had significantly less discomfort (FFR with EV+AVS: 91.1%; FFR with EV: 57.6%) and exertion (FFR with EV+AVS: 83.5%; FFR with EV: 34.4%) than standard FFR. FFR with EV+AVS also had significantly better scores for exertion (53.4%) and comfort (39.4%) when compared to FFR with EV.</p><p><b>CONCLUSION</b>Usage of FFR with EV+AVS resulted in significantly reduced symptoms, discomfort and exertion when compared to FFR with EV and standard FFR.</p>

Prevalence of Chronic Mental and Physical Disorders, Impact on Work Productivity and Correlates of Alcohol Use Disorders and Nicotine Dependence across Occupations

<p><b>INTRODUCTION</b>This study assessed occupational differences in the prevalence of mental and physical disorders in an employed general population sample in Singapore and investigated the impact of these disorders on work productivity losses in terms of work-loss days and work-cutback days. The association of occupation with alcohol use disorders (AUD) and nicotine dependence (ND) was also investigated.</p><p><b>MATERIALS AND METHODS</b>Data from a population-based mental health survey of a representative sample of multi-ethnic residents aged 18 years and above were used. The World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI) was administered to establish the lifetime diagnosis of key mental disorders. Self-report on sociodemographic characteristics, productivity loss, ND, and lifetime physical conditions were obtained. Nine occupational groups were included in this analysis.</p><p><b>RESULTS</b>The sample comprised 4361 participants with a mean (SD) age of 42.2 (11.9) years, ranging between 19 to 80 years. 'Associate professionals and technicians' (26.2%), 'Services and sales workers' (17.7%) and 'Professionals' (15.4%) were the 3 predominant occupational categories. Sociodemographic characteristics differed significantly across occupations (P <0.001). The lifetime prevalences of having 'any mental disorder' and 'any physical disorder' were 13.0% and 37.9%, respectively; major depressive disorder was the most prevalent mental disorder (5.9%) and hypertension was the most common physical disorder (15.6%). There were no significant differences in work productivity loss across occupations. Sociodemographic and occupational correlates for AUD and ND were identified.</p><p><b>CONCLUSION</b>Sociodemographic and health disparities exist in the major occupational categories in Singapore. The strength of the associations between occupation and AUD and ND are significant, indicating the need for preventative measures in select occupations.</p>

The prevalence of fatigue and associated health and safety risk factors among taxi drivers in Singapore

<p><b>INTRODUCTION</b>Driver fatigue is one of the biggest health and safety concerns within the road transport sector. This study aimed to find out the prevalence of fatigue among taxi drivers in Singapore, to better understand the general working and health conditions of this group of people and to determine the risk factors associated with fatigued driving.</p><p><b>METHODS</b>A total of 340 taxi drivers were randomly selected for participation in this self-administered questionnaire survey, with height and weight measurements. The response rate was 68.2%. The survey consisted of four main categories: personal particulars; social habits; work patterns and sleep profile; and Epworth Sleepiness Scale, which was used to estimate the level of daytime sleepiness and fatigue. Multiple logistic regression analysis was used to estimate the adjusted odd ratios and 95% confidence intervals associated with the risk factors related to fatigue among the taxi drivers.</p><p><b>RESULTS</b>A high proportion of the taxi drivers were obese and had self-reported hypertension, diabetes mellitus and high cholesterol. Driver fatigue was associated with very poor/poor self-rating of the quality of sleep, having an additional part-time job, drinking three or more caffeinated drinks daily, and driving more than 10 hours a day.</p><p><b>CONCLUSION</b>We hope that the findings of the present study will improve the awareness regarding the work and health conditions of taxi drivers, and contribute toward the effort to achieve a healthier workforce. A lower prevalence of fatigued driving will lead to lower risks of road traffic accidents, decreased economic loss, increased productivity, and safer roads for all.</p>

Prevalence of cardiovascular risk factors among healthcare staff in a large healthcare institution in Singapore

<p><b>INTRODUCTION</b>This study aimed to determine the prevalence of modifiable cardiovascular risk factors among health workers (HWs) and non-health workers (NHWs) in a large hospital in Singapore.</p><p><b>METHODS</b>A cross-sectional prevalence survey of 3,384 hospital staff was conducted. The study comprised a self-administered questionnaire, body mass index, systolic and diastolic blood pressure measurements, and laboratory analysis of fasting blood samples of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides and plasma glucose. HWs were doctors and nurses, while NHWs were health administrators, facility staff, clerks and administrative personnel.</p><p><b>RESULTS</b>A total of 3,384 out of 3,987 eligible staff (response rate 84.9%) participated in the survey. The majority of the participants were female (81%, n = 2,755), and 64% (n = 2,179) were 20-39 years old. HWs comprised almost two-thirds of the staff employed (61.3%, n = 2076), of whom 87.7% were female, while 72.5% of NHWs were female. Compared to HWs, NHWs had a higher adjusted (age, ethnic group and gender) prevalence of personal history of diabetes mellitus (adjusted prevalence rate ratio [PRR] 1.64, 95% confidence interval [CI] 1.02-2.64), cigarette smoking (adjusted PRR 1.85, 95% CI 1.48-2.32), obesity (adjusted PRR 1.36, 95% CI 1.05-1.75) and elevated systolic pressure (adjusted PRR 1.74, 95% CI 1.31-2.31).</p><p><b>CONCLUSION</b>The prevalence of modifiable cardiovascular risk factors in NHWs is higher than that in HWs. Health promotion programmes should address this captive and neglected audience in healthcare organisations.</p>

Knowledge, attitudes and practices of the Advance Medical Directive in a residential estate in Singapore

<p><b>INTRODUCTION</b>This study investigates the knowledge, attitudes and practices of residents in a residential estate in Singapore on the Advance Medical Directive (AMD).</p><p><b>MATERIALS AND METHODS</b>A community-based cross-sectional study was conducted with residents in the residential estate of Toa Payoh Lorong 6, Singapore. A stratifi ed random sampling was conducted to obtain a representative sample of the estate. Only residents aged 21 years and older were included. An interviewer-administered questionnaire was conducted, and only those who understood the AMD suffi ciently were further evaluated on their knowledge, attitudes and practices.</p><p><b>RESULTS</b>A total of 414 residents were enrolled (50.1% response rate). Only 37.9% of the participants knew about the AMD prior to this study. Participants who had a higher knowledge level of AMD, did not wish "for an artifi cially prolonged life", "to be kept alive indefi nitely on a life-support machine", wished to "lessen the fi nancial burden of loved ones", "avoid prolonged suffering" and accepted the "imminence of death" were more willing to sign an AMD. However, "religious beliefs", "personal ethical views", "dissuasion by family members" and "unclear terminology in the AMD" discouraged the participants from signing an AMD. After adjusting for signifi cant factors, participants who did not wish "to be kept alive indefi nitely on a life-support machine" and accepted the "imminence of death" were found to correlate signifi cantly with the willingness to sign an AMD [Prevalence Rate Ratio (PRR) = 2.050 [1.140-3.685], P = 0.016; PRR = 2.669 [1.449-4.917], P = 0.02, respectively].</p><p><b>CONCLUSIONS</b>There is a need to increase awareness on the AMD. Public education methods can be improved to inform residents on the implications of the AMD.</p>

Incidence, mortality and five-year relative survival ratio of prostate cancer among Chinese residents in Singapore from 1968 to 2002 by metastatic staging

<p><b>INTRODUCTION</b>This paper examines the incidence, mortality and survival patterns among all Chinese residents with prostate cancer reported to the Singapore Cancer Registry in Singapore from 1968 to 2002 by metastatic staging.</p><p><b>MATERIALS AND METHODS</b>This is a retrospective population-based study including all prostate cancer cases aged over 20 reported to the Singapore Cancer Registry (SCR) from 1968 to 2002 who are Singapore Chinese residents. Follow-up was ascertained by matching with the National Death Register until 2002. Metastatic status was obtained from the SCR. Age-standardised incidence and mortality rates, as well as the 5-year relative survival ratios (RSRs), were obtained for each 5-year period and grouped by metastatic stage. A weighted linear regression was performed on the log-transformed age-standardised incidence and mortality rates over the study period.</p><p><b>RESULTS</b>In the most recent period of 1998 to 2002, the age-standardised incidence and mortality rates (per 100,000) for prostate cancer among the Chinese were 30.9 (95% CI, 29.1 to 32.8) and 9.6 (95% CI, 8.6 to 10.7), respectively. The percentage increase in the age-standardised incidence and age-standardised mortality rates per year were 5.6% and 6.0%, respectively, for all Chinese Singapore residents. There was an improvement in the 5-year RSRs for Chinese diagnosed with non-metastatic cases from 51.3% in 1973 to 1977, to 76.1% in 1998 to 2002. However, the RSR remains poor (range, 11.1% to 49.7%) for Chinese diagnosed with metastatic prostate cancer.</p><p><b>CONCLUSIONS</b>Both age-standardised incidence and mortality rates for prostate cancer among Chinese Singapore residents are still on the rise especially since the 1990s. Since the 1990s, the improvement in RSRs was substantial for the Chinese non-metastatic cases.</p>

A cross-sectional study of primary-care physicians in Singapore on their concerns and preparedness for an avian influenza outbreak

<p><b>INTRODUCTION</b>During an avian influenza (AI) pandemic, primary-care physicians (PCPs) are expected to play key roles in the prevention and control of the disease. Different groups of PCPs could have different concerns and preparedness level. We assessed the concerns, perceived impact and preparedness for an outbreak among PCPs in Singapore.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional survey of PCPs working in private practice (n=200) and public clinics (n=205) from March to June 2006 with an anonymous self-administered questionnaire on concerns (12- items), perceived impact (10 items) and preparedness (10 items) for an outbreak.</p><p><b>RESULTS</b>Two hundred and eighty-five PCPs responded - 149 (response rate: 72.7%) public and 136 (response rate: 67.3%) private. The majority were concerned about risk to their health from their occupation (95.0%) and falling ill with AI (89.7%). Most (82.5%) accepted the risk and only 33 (11.8%) would consider stopping work. For perceived impact, most felt that people would avoid them (69.6%) and their families (54.1%). The majority (81.3%) expected an increased workload and feeling more stressed at work (86.9%). For preparedness, 78.7% felt personally prepared for an outbreak. Public PCPs were more likely to be involved in infection-control activities and felt that their workplaces were prepared.</p><p><b>CONCLUSIONS</b>Most PCPs felt personally prepared for an outbreak but were concerned about their exposure to AI and falling ill. Other concerns included social ostracism for themselves and their families. Public PCPs appeared to have a higher level of preparation. Addressing concerns and improving level of preparedness are crucial to strengthen the primary-care response for any AI outbreak.</p>

Concerns, perceived impact and preparedness in an avian influenza pandemic--a comparative study between healthcare workers in primary and tertiary care

<p><b>INTRODUCTION</b>With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting.</p><p><b>MATERIALS AND METHODS</b>An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness.</p><p><b>RESULTS</b>We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).</p><p><b>CONCLUSIONS</b>HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.</p>