Search

Using a qualitative life history approach, this article offers to enhance our understanding of how remarriage impacts social mobility trajectories amongst ethnic minority women in Singapore. In particular, the attention to ethnic minority Malay women's biographies reveals how the intersections of "ethnicity" and "class" render visibility to how re-partnership entails social exclusion that is morally and culturally coded concealing the emotional and material struggles that women in stepfamilies cope with. In comparing the lived experiences of remarried middle-class Malay women with their working-class counterparts, this article argues that stepfamily formation in Singapore in fact tends to deepen rather than mitigate vulnerabilities, particularly for the latter, thus failing to live up to the lure of economic stability that repartnerships are conventionally assumed to provide. In so doing, the article also argues for a nuanced understanding of social mobility as a non-linear process rather than an outcome. [ABSTRACT FROM AUTHOR]

The continued emphasis on a decontextualized nuclear family in Asia has often obscured experiences of re-partnered individuals and stepfamilies, wherein transitions including couple dissolution and remarriage or cohabitation have had particular implications for family well-being and social mobility. The eight papers in this special issue expand scholarship beyond acknowledging the increasing prevalence of re-partnership and stepfamilies seeking to facilitate cross-cultural comparisons within the region, and between Asia and the West where notable advancements have been made in theorising diverse family processes. The pertinence of extended family ties and the cultural pressures of collectivism advance shared perspectives of re-partnership and stepfamily formation across East Asia, South Asia and Southeast Asia. At the same time, drawing from quantitative and qualitative methodologies, these papers direct attention to the heterogeneity in re-partnership pathways where broader social categories such as class, ethnicity, gender, sexuality, religion and historicity differentially intersect across national and socio-political contexts. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence and causes of visual impairment and blindness in an urban Indian population. Design: Population-based study. Participants: Ethnic Indians aged more than 40 years living in Singapore. Methods: Participants underwent standardized ophthalmic assessments for visual impairment and blindness, defined using best-corrected visual acuity (BCVA) and presenting visual acuity (PVA), according to US and modified World Health Organization (WHO) definitions. Main Outcome Measures: Unilateral visual impairment or blindness was defined on the basis of the worse eye, and bilateral visual impairment or blindness was defined on the basis of the better eye. Primary causes of visual impairment were determined. Results: A total of 3400 eligible individuals (75.6% response rate) participated. On the basis of US definitions, the age-standardized prevalence was 0.4% for bilateral blindness (≤20/200, better eye) and 3.4% for bilateral visual impairment (<20/40 to >20/200, better eye). Another 0.3% of bilateral blindness and 13.4% of bilateral visual impairment were correctable with refraction. Cataract was the principal cause of best-corrected bilateral blindness (60.0%) and bilateral visual impairment (65.7%). Other major causes of blindness and visual impairment included diabetic retinopathy, age-related macular degeneration, glaucoma, corneal opacity, and myopic maculopathy. Conclusions: The prevalence of bilateral blindness and visual impairment in Indians living in Singapore is lower than estimates from populations living in India, but similar to estimates obtained from Singapore Malay and Chinese populations. Cataract is the leading cause of blindness and visual impairment. One in 20 cases of bilateral blindness and 1 in 10 cases of bilateral visual impairment are attributable to diabetic retinopathy. These data may have relevance to many ethnic Indian persons living outside India. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

We introduced a web-based teledermatology system, the distributed personal health information management system (DPHIMS), into a nursing home in Singapore. The introduction was conducted in two phases. Five staff nurses in Phase 1 and nine nurse aides in Phase 2 performed the data entry and uploaded digital images of the resident's skin condition. By the end of Phase 2, there were 50 residents registered with DPHIMS. The average age of the participants was 82 years and 84% were women. There were 31 first-time referral requests registered in the system during Phase 2. The average time taken to complete a referral request was 86 minutes. The average time taken by the dermatologist to prepare and submit a diagnosis/treatment report was 11 minutes. An online survey form was given to the nurses and the dermatologists to gauge their level of satisfaction and their experience of using DPHIMS. All the nurses said they would readily recommend DPHIMS to other nurses. Overall, the dermatologists felt that DPHIMS was helpful in obtaining specialist care for the residents. However, some skin conditions required a face-to-face consultation. Thus a mixture of face-to-face consultations and consultations via teledermatology may be necessary to provide complete diagnosis and treatment to patients. Our experience suggests that understanding and addressing the organizational concerns is as important as solving the technical problems. [ABSTRACT FROM AUTHOR]

To examine the efficacy of laser peripheral iridotomy (LPI) in patients who received a diagnosis of primary angle-closure suspect (PACS). Prospective, randomized controlled trial. This multicenter, randomized controlled trial (ClinicalTrials.gov identifier, NCT00347178) enrolled 480 patients older than 50 years from glaucoma clinics in Singapore with bilateral asymptomatic PACS (defined as having ≥2 quadrants of appositional angle closure on gonioscopy). Each participant underwent prophylactic LPI in 1 randomly selected eye, whereas the fellow eye served as a control. Patients were followed up yearly for 5 years. The primary outcome measure was development of primary angle closure (PAC; defined as presence of peripheral anterior synechiae, intraocular pressure [IOP] of >21 mmHg, or both or acute angle closure [AAC]) or primary angle-closure glaucoma (PACG) over 5 years. Of the 480 randomized participants, most were Chinese (92.7%) and were women (75.8%) with mean age of 62.8 ± 6.9 years. Eyes treated with LPI reached the end point less frequently after 5 years (n = 24 [5.0%]; incidence rate [IR], 11.65 per 1000 eye-years) compared with control eyes (n = 45 [9.4%]; IR, 21.84 per 1000 eye-years; P = 0.001). The adjusted hazard ratio (HR) for progression to PAC was 0.55 (95% confidence interval [CI], 0.37–0.83; P = 0.004) in LPI-treated eyes compared with control eyes. Older participants (per year; HR, 1.06; 95% CI, 1.03–1.10; P < 0.001) and eyes with higher baseline IOP (per millimeter of mercury; HR, 1.35; 95% CI, 1.22–1.50; P < 0.0001) were more likely to reach an end point. The number needed to treat to prevent an end point was 22 (95% CI, 12.8–57.5). In patients with bilateral asymptomatic PACS, eyes that underwent prophylactic LPI reached significantly fewer end points compared with control eyes over 5 years. However, the overall incidence of PAC or PACG was low. [ABSTRACT FROM AUTHOR]

Purpose: To describe the prevalence of and risk factors for diabetic retinopathy (DR) in Indian persons living in a newly urbanized society in Asia. Design: Population-based study. Participants: Ethnic Indians aged ≥40 years living in Singapore. Methods: The Singapore Indian Eye Study was conducted between 2007 and 2009. All participants underwent an extensive ophthalmic examination, including retinal photographs obtained after pupil dilation. These images were graded for the presence and severity of DR using the modified Airlie House classification system. Diabetes was defined as hemoglobin A1c level of ≥6.5%, use of diabetic medication, or a physician diagnosis of diabetes. Risk factors were measured using questionnaires, clinical assessments, or laboratory tests. Main Outcome Measures: Any DR, diabetic macular edema (DME), or vision-threatening DR (VTDR). Results: Among the 3400 participants, the age-standardized prevalence was 33.6% (95% confidence interval [CI], 31.4–35.8) for diabetes and 10.5% (95% CI, 9.3–11.8) for DR. Among those with diabetes only, the age-standardized prevalence was 30.4% (95% CI, 26.5–34.8) for any DR, 7.2% (95% CI, 5.3–9.7) for DME, and 7.1% (95% CI, 5.4–9.5) for VTDR. In multivariate analysis, independent risk factors for any DR were younger age (odds ratio [OR], 0.98; 95% CI, 0.96–1.00, per year increase), longer diabetes duration (OR, 1.09; 95% CI, 1.07–1.11 per year increase), higher hemoglobin A1c (OR, 1.23; 95% CI, 1.13–1.34 per percent increase), higher systolic blood pressure (OR, 1.01; 95% CI, 1.00–1.02 per 1-mmHg increase), lower diastolic blood pressure (OR, 0.97; 95% CI, 0.96–0.99 per 1-mmHg increase), history of previous stroke (OR, 2.16; 95% CI, 1.12–4.16), and insulin treatment (OR, 2.99; 95% CI, 1.84–4.87). Similar independent risk factors, except for blood pressure, were found for VTDR. Additionally, persons with lower income and living in smaller houses were associated with VTDR. Conclusions: One in 3 migrant Indians living in newly urbanized Asian societies have diabetes and 1 in 10 has DR. This is similar to rates reported in Western populations and significantly higher than those reported in India. Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article. [Copyright &y& Elsevier]

Background: Understanding the learning needs of patients with heart failure (HF) is important in reducing the incidence of HF-related hospital readmissions. Sociocultural differences are known to influence patient learning needs. However, most HF learning needs studies have been conducted on Western populations. Purpose: The aim of this study was to investigate the learning needs of hospitalized patients with HF in Singapore. Methods: A cross-sectional, descriptive correlational design was adopted using a questionnaire survey that included the Heart Failure Learning Needs Inventory and sociodemographic and clinical datasheets. A convenience sample of 97 patients with HF was recruited from an acute hospital in Singapore. Results: Findings revealed that education topics relating to signs and symptoms, risk factors, general HF information, and medications were perceived by participants as the most important. Contrastingly, education topics relating to diet, activity, and psychological factors were poorly valued. The only significant demographic factor that was correlated to the patients' learning needs was monthly household income, which correlated to education on HF risk factors and general HF information. Conclusions: This study supports the necessity of carefully prioritizing patient education topics in line with patient learning needs. Furthermore, education should be culturally sensitive and take into account the unique values, needs, and situations of patients. [ABSTRACT FROM AUTHOR]

Purpose: To determine the associations of myopia and axial length (AL) with major age-related eye diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR), age-related cataract, and primary open-angle glaucoma (POAG). Design: Population-based, cross-sectional study. Participants: A total of 3400 Indians (75.6% response rate) aged 40 to 84 years in Singapore. Methods: Refractive error was determined by subjective refraction, and AL was determined by noncontact partial coherence laser interferometry. Age-related macular degeneration and DR were defined from retinal photographs according to the Wisconsin Age-Related Maculopathy Grading System and Airlie House classification system, respectively. Age-related cataract was diagnosed clinically using the Lens Opacity Classification System (LOCS) III system. Glaucoma was defined according to International Society for Geographical and Epidemiological Ophthalmology criteria. Main Outcome Measures: Age-related macular degeneration, DR, age-related cataract, and POAG. Results: Myopic eyes (spherical equivalent [SE] <−0.5 diopter [D]) were less likely to have AMD (early plus late AMD) (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25–0.79) or DR (OR, 0.68; 95% CI, 0.46–0.98) compared with emmetropic eyes; each millimeter increase in AL was associated with a lower prevalence of AMD (OR, 0.76; 95% CI, 0.65–0.89) and DR (OR, 0.73; 95% CI, 0.63–0.86). Myopic eyes were more likely to have nuclear (OR, 1.57; 95% CI, 1.13–2.20) and posterior subcapsular (OR, 1.73; 95% CI, 1.10–2.72) cataract, but not cortical cataract (P = 0.64); each millimeter increase in AL was associated with a higher prevalence of posterior subcapsular cataract (PSC) (OR, 1.29; 95% CI, 1.07–1.55), but not nuclear (P = 0.77) or cortical (P = 0.39) cataract. Eyes with high myopia (SE <−6.0 D) were more likely to have POAG (OR, 5.90; 95% CI, 2.68–12.97); each millimeter increase in AL was associated with a higher prevalence of POAG (OR, 1.43; 95% CI, 1.13–1.80). Conclusions: Myopic eyes are less likely to have AMD and DR but more likely to have nuclear cataract, PSC, and POAG. The associations of myopia with AMD, DR, and POAG are mostly explained by longer AL. However, the association between myopia and nuclear cataract is explained by lens refraction rather than AL. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To describe the distribution and determinants of lens vault and to investigate the association of lens vault with narrow angles. Design: Prospective cross-sectional study. Methods: Phakic subjects 50 years and older were evaluated at a primary healthcare clinic with gonioscopy, partial laser interferometry, and anterior segment optical coherence tomography (AS-OCT). Narrow angles were defined as posterior trabecular meshwork not visible for ≥2 quadrants on non-indentation gonioscopy. Lens vault was defined as the perpendicular distance between the anterior pole of the crystalline lens and the horizontal line joining the 2 scleral spurs on horizontal AS-OCT scans. Analysis of covariance, multivariate logistic regression, and area under the receiver operating characteristic curves (AUC) were performed. Results: Of the 2047 subjects recruited, 582 were excluded because of poor image quality or inability to locate scleral spurs, leaving 1465 subjects for analysis. Eyes with narrow angles had greater lens vault compared to eyes with open angles (775.6 µm vs 386.5 µm, P < .0001). Women had significantly greater lens vault than men (497.28 µm vs 438.56 µm, P < .001), and lens vault increased significantly with age (P for trend <.001). Adjusted for age and sex, significant associations with greater lens vault were shorter axial length, shallower anterior chamber depth(ACD), higher intraocular pressure, and more hyperopic spherical equivalent (all P < .001). On multivariate analysis, subjects with lens vault >667.6 µm were more likely to have narrow angles (OR 2.201, 95% CI: 1.070-4.526) compared to those with lens vault ≤462.7 µm. The AUC for lens vault (0.816) and ACD (0.822) for detecting narrow angles were similar (P = .582). Conclusions: Lens vault was independently associated with narrow angles and may be useful in screening to detect eyes with narrow angles. [Copyright &y& Elsevier]

Purpose: To investigate the relationship between quantitative iris parameters (iris curvature [I-Curv], iris area [I-Area], and iris thickness) and the presence of narrow angles. Design: Cross-sectional, community-based study. Participants: We recruited 2047 subjects >50 years old without ophthalmic symptoms from a community clinic in Singapore. Methods: All subjects underwent gonioscopy and anterior segment optical coherence tomography (AS-OCT) under dark conditions. An eye was considered to have narrow angles if the posterior pigmented trabecular meshwork was not visible for ≥180° on nonindentation gonioscopy with the eye in the primary position. Customized software was used on horizontal AS-OCT scans to measure I-Curv, I-Area, and iris thickness 750 μm (IT750) and 2000 μm (IT2000) from the scleral spur. The average of both temporal and nasal measured values of the right eye was used for analysis. Main Outcome Measures: The association between iris parameters and narrow angles on gonioscopy. Results: Iris parameters from 1465 eyes (71.6%) were available for analysis. Of these, 315 subjects (21.5%) had narrow angles. The mean I-Curv (0.366 vs 0.259 mm; P<0.020), IT750 (0.476 vs 0.453 mm; P<0.001), and IT2000 (0.491 vs 0.482 mm; P = 0.010) were greater in persons with than without narrow angles. After adjusting for age, gender, anterior chamber depth, axial length, and pupil size, the greater I-Curv, I-Area, IT750, and IT2000 were significantly associated with narrow angles (odds ratio [OR] 2.5 and 95% confidence interval [CI], 1.3–5.1; OR, 2.7 and 95% CI, 1.6–4.8; OR, 2.6 and 95% CI, 1.6–4.1; OR, 2.7 and 95% CI, 1.5–4.7, comparing 4th with 1st quartile for each parameter, respectively). In stratified analysis, women and subjects aged ≥60 years had stronger associations for most iris parameters with narrow angles than men and younger subjects. Conclusions: Quantitative iris parameters (I-Curv, I-Area, and iris thickness) are independently associated with narrow angles, particularly in women and older subjects. These data provide further insights into the pathogenesis of angle closure in Singaporeans. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references. [Copyright &y& Elsevier]

Purpose: To assess the influence of factors related to migration and acculturation on myopia in migrant Indians in Singapore. Design: Population-based cross-sectional study. Methods: A total of 3400 Singaporean Indians (75.6% response rate) aged over 40 years participated in this study. Information regarding country of birth, migration age, and language of interview were collected from interviews. Indians born outside of Singapore were defined as “first-generation” immigrants, while Indians born in Singapore were defined as “second-generation (or higher)” immigrants. Refraction was determined by autorefraction and refined by subjective refraction. Ocular biometry including axial length (AL), anterior chamber depth (ACD), and corneal radius (CR) were measured by partial coherence interferometry. Myopia and high myopia were defined as spherical equivalents (SE) of less than −0.5 diopter (D) for myopia, and < −5 D for high myopia, respectively. Results: The prevalence of myopia (30.2% vs 23.4 %) and high myopia (4.8% vs 2.5%) were higher in second-generation immigrants compared with first-generation immigrants. Second-generation immigrants had longer AL (23.50 mm vs 23.37 mm, P = .004) than first-generation immigrants after multivariate adjustment. The excess prevalence of myopia was reduced by 37.5% but remained statistically significant (P = .02) after further controlling for educational level. Among first-generation immigrants, those migrating to Singapore before the age of 21 had significantly higher prevalence of myopia (odds ratio [OR]: 1.85; 95% confidence interval [CI]: 1.32, 2.59) and longer AL (regression coefficient: 0.27; 95% CI: 0.11, 0.43) than those migrating after 21 years of age. Also, first-generation immigrants interviewed in English had higher prevalence of myopia (OR: 1.46; 95% CI: 1.00, 2.17) than their non-English-interviewed counterparts. Conclusions: The prevalence of myopia among second-generation (or higher) Indian immigrants in Singapore is higher than first-generation immigrants. Country-specific environmental factors may be important for the increasing prevalence of myopia in Asia. [Copyright &y& Elsevier]