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Article ; Online: Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore.

Chan, Cindy Mei Jun / Dickens, Borame Sue Lee / Chong, Mary Foong-Fong

2023 Volume 26, Issue 12, Page(s) 2802–2814

Abstract: Objective: This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore.: Design: A cross-sectional online survey was conducted between October ...

Abstract	Objective: This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. Design: A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling. Setting: The survey was conducted in Singapore. Participants: Participants were recruited from the Singapore Population Health Study Online Panel. Results: Participants' mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products. Conclusions: Findings highlighted substantial gaps in participants' knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.
MeSH term(s)	Adult ; Female ; Humans ; Middle Aged ; Male ; Cross-Sectional Studies ; Health Knowledge, Attitudes, Practice ; Singapore ; Sodium Chloride, Dietary ; Sodium ; Sodium, Dietary
Chemical Substances	Sodium Chloride, Dietary ; Sodium (9NEZ333N27) ; Sodium, Dietary
Language	English
Publishing date	2023-11-03
Publishing country	England
Document type	Journal Article
ZDB-ID	1436024-x
ISSN	1475-2727 ; 1368-9800
ISSN (online)	1475-2727
ISSN	1368-9800
DOI	10.1017/S1368980023002422
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Article ; Online: Understanding knowledge, attitudes and behaviours related to dietary sodium intake in a multi-ethnic population in Singapore

Cindy Mei Jun Chan / Borame Sue Lee Dickens / Mary Foong-Fong Chong

Public Health Nutrition, Vol 26, Pp 2802-

2023 Volume 2814

Abstract: Abstract Objective: This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. Design: A cross-sectional online survey was conducted between ... ...

Abstract	Abstract Objective: This study aimed to fill the current gap in the understanding of the knowledge, attitudes and behaviours (KAB) related to dietary Na among adult residents in Singapore. Design: A cross-sectional online survey was conducted between October and December 2020 on 955 participants selected through random sampling. Setting: The survey was conducted in Singapore. Participants: Participants were recruited from the Singapore Population Health Study Online Panel. Results: Participants’ mean age was 46·6 ± 14·1 years old and 58 % of them were females. Most of the participants were Chinese (82·1 %), 10·5 % were Indian and 4·5 % were Malay. Findings from the weighted data showed that most participants were aware of the health impact of high Na consumption. However, many participants were unaware of the recommended intake for salt (68%) and Na (83%), had misconceptions, and were unable to correctly use food labels to assess NA content (69%). Findings also alluded to the presence of knowledge gaps in the sources of Na in their diet. While 59 % of the participants reported to be limiting their consumption of Na, many reported facing barriers such as not knowing how to limit their Na intake. Participants also felt that there were limited options for low-Na foods when eating out and were lacking awareness of low-Na products. Conclusions: Findings highlighted substantial gaps in participants’ knowledge and skills in managing their Na consumption. This suggests the need for more public education and improvements in the food environment.
Keywords	Salt reduction ; Dietary sodium ; Knowledge ; Attitudes ; Practices ; Public aspects of medicine ; RA1-1270 ; Nutritional diseases. Deficiency diseases ; RC620-627
Subject code	950
Language	English
Publishing date	2023-12-01T00:00:00Z
Publisher	Cambridge University Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Acculturation as a Determinant of Obesity and Related Lifestyle Behaviors in a Multi-Ethnic Asian Population.

Park, Su Hyun / Lee, Yu Qi / Müller-Riemenschneider, Falk / Dickens, Borame Sue Lee / van Dam, Rob M

Nutrients

2023 Volume 15, Issue 16

Abstract: Limited attention has been given to the role of cultural orientation towards different ethnic groups in multi-ethnic settings without a dominant host culture. We evaluated whether acculturation levels, reflecting cultural orientation towards other ethnic ...

Abstract	Limited attention has been given to the role of cultural orientation towards different ethnic groups in multi-ethnic settings without a dominant host culture. We evaluated whether acculturation levels, reflecting cultural orientation towards other ethnic groups, were associated with obesity and related lifestyle behaviors in a cosmopolitan Asian population. We conducted the current study based on data from the Singapore Multi-Ethnic Cohort (
MeSH term(s)	Humans ; Acculturation ; Asian/ethnology ; Ethnicity ; Life Style/ethnology ; Obesity/epidemiology ; Obesity/ethnology ; Obesity/etiology ; Young Adult ; Adult ; Middle Aged ; Aged ; Singapore/epidemiology
Language	English
Publishing date	2023-08-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu15163619
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Article ; Online: Modelling the epidemic extremities of dengue transmissions in Thailand.

Lim, Jue Tao / Dickens, Borame Sue Lee / Cook, Alex R

Epidemics

2020 Volume 33, Page(s) 100402

Abstract: Significant health risks arise in Thailand from dengue but little work has been conducted to quantify the extremities of dengue outbreaks - where health systems are likely to be most stretched. In this paper, we detail the utility of tools derived from ... ...

Abstract	Significant health risks arise in Thailand from dengue but little work has been conducted to quantify the extremities of dengue outbreaks - where health systems are likely to be most stretched. In this paper, we detail the utility of tools derived from extreme value theory (EVT) in modelling the extremes in dengue case counts observed during outbreaks using 25 years of province level dengue case count data in Thailand from 1993 to 2018. We assess the validity of the EVT toolkit by comparing them against 8 competing benchmarks. The inhomogeneous point process representation (IPP) was found to perform best on 5 in and out of sample criterion such as parameter stability, distributional characteristics and out of sample coverage. Lastly, by using the IPP to infer future extreme dengue events, IPP found stark differences at the province level in the mean level of dengue case counts that is expected to be exceeded over the next 10 years. The IPP model also found that high probability that dengue extreme events will reach levels above and beyond the observed historical maximums. EVT shows considerable potential in aiding health planners for the risk management of dengue. The results in this paper can be easily translatable to any infectious disease observed over a long period.
MeSH term(s)	Dengue/epidemiology ; Dengue/transmission ; Disease Outbreaks ; Epidemics ; Extremities ; Forecasting ; Humans ; Models, Statistical ; Thailand/epidemiology
Language	English
Publishing date	2020-08-22
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2467993-8
ISSN	1878-0067 ; 1755-4365
ISSN (online)	1878-0067
ISSN	1755-4365
DOI	10.1016/j.epidem.2020.100402
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Article ; Online: Cost benefit analysis of alternative testing and quarantine policies for travelers for infection control: A case study of Singapore during the COVID-19 pandemic.

Lou, Jing / Lim, Nigel Wei-Han / Cai, Celestine Grace XueTing / Dickens, Borame Sue Lee / Huynh, Vinh Anh / Wee, Hwee-Lin

Frontiers in public health

2023 Volume 11, Page(s) 1101986

Abstract: Background: Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between ... ...

Abstract	Background: Border control mitigates local infections but bears a heavy economic cost, especially for tourism-reliant countries. While studies have supported the efficacy of border control in suppressing cross-border transmission, the trade-off between costs from imported and secondary cases and from lost economic activities has not been studied. This case study of Singapore during the COVID-19 pandemic aims to understand the impacts of varying quarantine length and testing strategies on the economy and health system. Additionally, we explored the impact of permitting unvaccinated travelers to address emerging equity concerns. We assumed that community transmission is stable and vaccination rates are high enough that inbound travelers are not dissuaded from traveling. Methods: The number of travelers was predicted considering that longer quarantine reduces willingness to travel. A micro-simulation model predicted the number of COVID-19 cases among travelers, the resultant secondary cases, and the probability of being symptomatic in each group. The incremental net monetary benefit (INB) of Singapore was quantified under each border-opening policy compared to pre-opening status, based on tourism receipts, cost/profit from testing and quarantine, and cost and health loss due to COVID-19 cases. Results: Compared to polymerase chain reaction (PCR), rapid antigen test (ART) detects fewer imported cases but results in fewer secondary cases. Longer quarantine results in fewer cases but lower INB due to reduced tourism receipts. Assuming the proportion of unvaccinated travelers is small (8% locally and 24% globally), allowing unvaccinated travelers will accrue higher INB without exceeding the intensive care unit (ICU) capacity. The highest monthly INB from all travelers is $2,236.24 m, with 46.69 ICU cases per month, achieved with ARTs at pre-departure and on arrival without quarantine. The optimal policy in terms of highest INB is robust under changes to various model assumptions. Among all cost-benefit components, the top driver for INB is tourism receipts. Conclusions: With high vaccination rates locally and globally alongside stable community transmission, opening borders to travelers regardless of vaccination status will increase economic growth in the destination country. The caseloads remain manageable without exceeding ICU capacity, and costs of cases are offset by the economic value generated from travelers.
MeSH term(s)	Humans ; COVID-19 ; Quarantine ; Cost-Benefit Analysis ; Singapore ; Pandemics/prevention & control
Language	English
Publishing date	2023-02-23
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1101986
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Article ; Online: Projected burden of type 2 diabetes mellitus-related complications in Singapore until 2050: a Bayesian evidence synthesis.

Tan, Ken Wei / Dickens, Borame Sue Lee / Cook, Alex R

BMJ open diabetes research & care

2020 Volume 8, Issue 1

Abstract: Objective: We examined the effects of age, gender, and ethnicity on the risk of acute myocardial infarction, stroke, and end-stage renal disease according to type 2 diabetes mellitus status among adults aged 40-79 in Singapore.: Methods: A Bayesian ... ...

Abstract	Objective: We examined the effects of age, gender, and ethnicity on the risk of acute myocardial infarction, stroke, and end-stage renal disease according to type 2 diabetes mellitus status among adults aged 40-79 in Singapore. Methods: A Bayesian inference framework was used to derive age-specific, gender-specific and ethnicity-specific prevalence of type 2 diabetes mellitus from the 2010 Singapore National Health Survey, and age-standardized gender and ethnicity-specific incidence rates of acute myocardial infarction, stroke and end-stage renal disease from the National Registry of Diseases Office. Population forecasts were used in tandem with incidence rates to project the future chronic disease burden until 2050. Results: The highest relative risk of acute myocardial infarction was observed in the youngest age group (aged 40-44), with higher relative risk for women (men: 4.3 (2.7-6.4); women: 16.9 (9.3-28.3)). A similar trend was observed for stroke (men: 6.5 (4.2-9.7); women: 10.7 (6.0-17.4)). For end-stage renal disease, the highest relative risk was for men aged 45-50 (11.8 (8.0-16.9)) and women aged 55-60 (16.4 (10.7-24.0)). The annual incidence of acute myocardial infarction is projected to rise from 9300 (in 2019) to 16 400 (in 2050), the number of strokes from 7300 to 12 800, and the number of end-stage renal disease cases from 1700 to 2700. Conclusions: Type 2 diabetes mellitus was associated with an increased risk of complications and is modulated by age and gender. Prevention and early detection of type 2 diabetes mellitus can reduce the increasing burden of secondary complications.
MeSH term(s)	Adult ; Age Factors ; Aged ; Aged, 80 and over ; Bayes Theorem ; Cost of Illness ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Humans ; Kidney Failure, Chronic/epidemiology ; Kidney Failure, Chronic/etiology ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Myocardial Infarction/etiology ; Sex Factors ; Singapore/epidemiology ; Stroke/epidemiology ; Stroke/etiology
Language	English
Publishing date	2020-03-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2732918-5
ISSN	2052-4897 ; 2052-4897
ISSN (online)	2052-4897
ISSN	2052-4897
DOI	10.1136/bmjdrc-2019-000928
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Article ; Online: Correction to 'Explicit characterization of human population connectivity reveals long run persistence of interregional dengue shocks'.

Tao, Lim Jue / Lee Dickens, Borame Sue / Yinan, Mao / Kwak, Chae Woon / Ching, Ng Lee / Cook, Alex R

Journal of the Royal Society, Interface

2020 Volume 17, Issue 169, Page(s) 20200620

Language	English
Publishing date	2020-08-26
Publishing country	England
Document type	Journal Article ; Published Erratum
ZDB-ID	2156283-0
ISSN	1742-5662 ; 1742-5689
ISSN (online)	1742-5662
ISSN	1742-5689
DOI	10.1098/rsif.2020.0620
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Article ; Online: Strategies to Mitigate Establishment under the

Soh, Stacy / Ho, Soon Hoe / Ong, Janet / Seah, Annabel / Dickens, Borame Sue / Tan, Ken Wei / Koo, Joel Ruihan / Cook, Alex R / Sim, Shuzhen / Tan, Cheong Huat / Ng, Lee Ching / Lim, Jue Tao

Viruses

2022 Volume 14, Issue 6

Abstract: The Incompatible Insect Technique (IIT) strategy involves the release of male mosquitoes infected with the ... ...

Abstract	The Incompatible Insect Technique (IIT) strategy involves the release of male mosquitoes infected with the bacterium
MeSH term(s)	Aedes/microbiology ; Animals ; Female ; Male ; Mosquito Control/methods ; Mosquito Vectors/microbiology ; Population Dynamics ; Wolbachia
Language	English
Publishing date	2022-05-24
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2516098-9
ISSN	1999-4915 ; 1999-4915
ISSN (online)	1999-4915
ISSN	1999-4915
DOI	10.3390/v14061132
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Article ; Online: Time varying methods to infer extremes in dengue transmission dynamics.

Lim, Jue Tao / Han, Yiting / Sue Lee Dickens, Borame / Ng, Lee Ching / Cook, Alex R

PLoS computational biology

2020 Volume 16, Issue 10, Page(s) e1008279

Abstract: Dengue is an arbovirus affecting global populations. Frequent outbreaks occur, especially in equatorial cities such as Singapore, where year-round tropical climate, large daily influx of travelers and population density provide the ideal conditions for ... ...

Abstract	Dengue is an arbovirus affecting global populations. Frequent outbreaks occur, especially in equatorial cities such as Singapore, where year-round tropical climate, large daily influx of travelers and population density provide the ideal conditions for dengue to transmit. Little work has, however, quantified the peaks of dengue outbreaks, when health systems are likely to be most stretched. Nor have methods been developed to infer differences in exogenous factors which lead to the rise and fall of dengue case counts across extreme and non-extreme periods. In this paper, we developed time varying extreme mixture (tvEM) methods to account for the temporal dependence of dengue case counts across extreme and non-extreme periods. This approach permits inference of differences in climatic forcing across non-extreme and extreme periods of dengue case counts, quantification of their temporal dependence as well as estimation of thresholds with associated uncertainties to determine dengue case count extremities. Using tvEM, we found no evidence that weather affects dengue case counts in the near term for non-extreme periods, but that it has non-linear and mixed signals in influencing dengue through tvEM parameters in the extreme periods. Using the most appropriate tvEM specification, we found that a threshold at the 70th (95% credible interval 41.1, 83.8) quantile is optimal, with extreme events of 526.6, 1052.2 and 1183.6 weekly case counts expected at return periods of 5, 50 and 75 years. Weather parameters at a 1% scaled increase was found to decrease the long-run expected case counts, but larger increases would lead to a drastic expected rise from the baseline correspondingly. The tvEM approach can provide valuable inference on the extremes of time series, which in the case of infectious disease notifications, allows public health officials to understand the likely scale of outbreaks in the long run.
MeSH term(s)	Computational Biology/methods ; Dengue/epidemiology ; Dengue/transmission ; Disease Outbreaks/statistics & numerical data ; Humans ; Models, Statistical ; Singapore/epidemiology ; Time Factors ; Weather
Language	English
Publishing date	2020-10-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2193340-6
ISSN	1553-7358 ; 1553-734X
ISSN (online)	1553-7358
ISSN	1553-734X
DOI	10.1371/journal.pcbi.1008279
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Article ; Online: Inference on dengue epidemics with Bayesian regime switching models.

Jue Tao Lim / Borame Sue Dickens / Sun Haoyang / Ng Lee Ching / Alex R Cook

PLoS Computational Biology, Vol 16, Iss 5, p e

2020 Volume 1007839

Abstract: Dengue, a mosquito-borne infectious disease caused by the dengue viruses, is present in many parts of the tropical and subtropical regions of the world. All four serotypes of dengue viruses are endemic in Singapore, an equatorial city-state. Frequent ... ...

Abstract	Dengue, a mosquito-borne infectious disease caused by the dengue viruses, is present in many parts of the tropical and subtropical regions of the world. All four serotypes of dengue viruses are endemic in Singapore, an equatorial city-state. Frequent outbreaks occur, sometimes leading to national epidemics. However, few studies have attempted to characterize breakpoints which precede large rises in dengue case counts. In this paper, Bayesian regime switching (BRS) models were employed to infer epidemic and endemic regimes of dengue transmissions, each containing regime specific autoregressive processes which drive the growth and decline of dengue cases, estimated using a custom built multi-move Gibbs sampling algorithm. Posterior predictive checks indicate that BRS replicates temporal trends in Dengue transmissions well and nowcast accuracy assessed using a post-hoc classification scheme showed that BRS classification accuracy is robust even under limited data with the AUC-ROC at 0.935. LASSO-based regression and bootstrapping was used to account for plausibly high dimensions of climatic factors affecting Dengue transmissions, which was then estimated using cross-validation to conduct statistical inference on long-run climatic effects on the estimated regimes. BRS estimates epidemic and endemic regimes of dengue in Singapore which are characterized by persistence across time, lasting an average of 20 weeks and 66 weeks respectively, with a low probability of transitioning away from their regimes. Climate analysis with LASSO indicates that long-run climatic effects up to 20 weeks ago do not differentiate epidemic and endemic regimes. Lastly, by fitting BRS to simulated disease data generated from a stochastic Susceptible-Infected-Recovered model, mechanistic links between infectivity and regimes classified using BRS were provided. The model proposed could be applied to other localities and diseases under minimal data requirements where transmission counts over time are collected.
Keywords	Biology (General) ; QH301-705.5
Subject code	310 ; 333
Language	English
Publishing date	2020-05-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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