ORCID Profile
0000-0002-9978-4276
Current Organisation
Duke-NUS Medical School
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Publisher: Elsevier BV
Date: 2022
Publisher: S. Karger AG
Date: 25-02-2021
DOI: 10.1159/000513513
Abstract: Ageing is a global concern with major social, health, and economic implications. While in idual countries seek to develop responses to immediate, pressing needs, international attention and collaboration is required to most effectively address the multifaceted challenges and opportunities an ageing global population presents in the longer term. The Ageing, Longevity and Health stream of the International Alliance of Research Universities (IARU-ALH) was built on a solid foundation of first-class interdisciplinary research and on innovative outreach and communication centres. This interdisciplinary network conducts projects that span biology, medicine, social sciences, epidemiology, public health, policy, and demography, and actively engages with the public and other societal stakeholders. Here we posit that such international interdisciplinary networks are needed and uniquely placed to address major challenges related to health and ageing and ultimately will produce new understanding and knowledge to promote the awareness of healthy ageing and encourage societal change via novel, science-informed interventions. Global interdisciplinary research presents great potential and opportunities to accelerate our understanding of human ageing and to produce new, more effective solutions to a pressing, complex problem. However, more focused, strategic efforts and investments are required in order to deliver on these potentials and reap maximum benefits for in iduals and societies. IARU-ALH members are determined to contribute, in collaboration with others, to delivering on this vision.
Publisher: Oxford University Press (OUP)
Date: 27-08-2018
Abstract: research on the role of positive affect, such as happiness, on health outcomes is burgeoning. Within this context, evidence for an inverse effect of happiness on mortality is inconclusive. Furthermore, few studies link happiness with mortality among older people, and in Asian populations. We examine the association between happiness and all-cause mortality among older people in Singapore. data for 4,478 Singaporeans aged ≥60 years enrolled in a nationally-representative longitudinal survey (three waves: 2009 2011 2015) were utilised. Happiness, at baseline, in 2009, was measured using three positively-worded items from the Centre for Epidemiological Studies Depression Scale, and considered in two distinct ways in the analyses-continuous ('happiness score' [0-6]) and binary (happy [score = 6]/unhappy). All-cause mortality, until 31 December 2015, was assessed primarily using administrative databases, supplemented by data from survey waves 2 and 3. Multivariable Cox regression models assessed the association of 'happiness score' and the 'binary happiness variable' (separate models for each) with all-cause mortality. the likelihood of all-cause mortality was lower by 9% (multivariable hazard ratio (HR) [95% confidence interval]: 0.91 [0.87-0.95]) for each unit increase in 'happiness score', and was 19% lower for happy, versus unhappy, older people (HR: 0.81 [0.68-0.97]). happiness is associated with reduced likelihood of all-cause mortality among older people in an Asian population, with the benefit observed even for incremental increases in happiness. Activities, policies and programs that maintain or improve happiness may be beneficial for a longer life among older people.
Publisher: Public Library of Science (PLoS)
Date: 03-06-2022
DOI: 10.1371/JOURNAL.PONE.0265423
Abstract: Older adults aged 65 years and above have a disproportionately higher utilization of emergency healthcare, of which Emergency Department (ED) visits are a key component. They experience higher degree of multimorbidity and mobility issues compared to younger patients, and are consequently more likely to experience a health event which requires an ED visit. During their visit, older adults tend to require more extensive workup, therefore spending a greater amount of time in the ED. Compared to the younger population, older adults are more susceptible to adverse events following discharge. Considering these factors, investigating the determinants of ED utilisation would be valuable. In this paper, we present a protocol for a systematic review of the determinants of ED utilisation among communitydwelling older adults aged 65 years and above, applying Andersen and Newman’s model of healthcare utilisation. Furthermore, we aim to present other conceptual frameworks for healthcare utilisation and propose a holistic approach for understanding the determinants of ED utilisation by older persons. The protocol is developed in accordance with the standards of C bell Collaboration guidelines for systematic reviews, with reference to the Cochrane Handbook for Systematic Review of Interventions. Medline, Embase and Scopus will be searched for studies published from 2000 to 2020. Studies evaluating more than one determinant for ED utilisation among older adults aged 65 years and above will be included. Search process and selection of studies will be presented in a PRISMA flow chart. Statistically significant (p 0.05) determinants of ED utilisation will be grouped according to in idual and societal determinants. Quality of the studies will be assessed using Newcastle Ottawa Scale (NOS). In Andersen and Newman’s model, in idual determinants include predisposing factors, enabling and illness factors, and societal determinants include technology and social norms. Additional conceptual frameworks for healthcare utilisation include Health Belief Model, Social Determinants of Health and Big Five personality traits. By incorporating the concepts of these models, we hope to develop a holistic approach of conceptualizing the factors that influence ED utilisation among older people. This protocol is registered on 8 May 2021 with PROSPERO’s International Prospective Register of Systematic Reviews (CRD42021253770).
Publisher: Korean Council of EMS Physicians
Date: 30-09-2022
Publisher: Oxford University Press (OUP)
Date: 19-03-2018
DOI: 10.1093/IJE/DYY016
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.EJOGRB.2018.07.028
Abstract: There has not been conclusive evidence in literature on the efficacy of progestogen in the treatment of threatened miscarriage, although some studies showed benefits. In our centre, threatened miscarriage is treated with either micronised progesterone (MP) or dydrogesterone (DYD). The aim of this study is to compare clinical outcomes of miscarriage, extent of vaginal bleeding at follow-up and side effects between treatment groups. This study was a prospective parallel-group, open-label, randomized controlled trial. 141 women presenting with threatened miscarriage were randomised to either MP or DYD of which 118 were included in the analysis. Baseline maternal demographics and serum progesterone levels were collected at presentation. Post-treatment bleeding pattern and self-reported side effects were recorded at the follow-up visit (on day 4-10 of treatment). The occurrence of spontaneous miscarriage was ascertained at week 16 of gestation. The population with miscarriage and resolution of bleeding were not statistically different between MP and DYD groups. A significantly higher percentage of women treated with MP reported drowsiness (p = 0.003). After stratification into low and high serum progesterone levels, a significantly higher miscarriage rate was found in the low progesterone group, regardless of treatment type. In conclusion, extent of bleeding at day 4-10 and subsequent miscarriage rates were comparable between MP and DYD groups. However, fewer patients treated with DYD reported drowsiness and giddiness. The finding of significantly higher miscarriage rates in women with low progesterone levels despite treatment is an important factor to consider in counselling and prognosticating pregnancy outcomes.
Publisher: National University of Singapore
Date: 2022
DOI: 10.25722/NDAG-S5QV
Publisher: SAGE Publications
Date: 22-08-2019
Abstract: Polypharmacy, given its link with drug interactions, potentially inappropriate medications and medication non-adherence, may pose a significant health risk, especially among the elderly. A comprehensive understanding of the epidemiology of polypharmacy is essential for countries facing population ageing and growing chronic disease burden, like Singapore. We assessed the prevalence and risk factors of polypharmacy (⩾5 prescription medications) among community-dwelling elderly in Singapore and established the association of polypharmacy with medication non-adherence. We used data from a national s le of 1499 community-dwelling elderly aged ⩾66 years. Using logistic regression, we assessed the association of socio-demographic, health and healthcare use variables with polypharmacy, and polypharmacy with medication non-adherence. The weighted prevalence of polypharmacy was 14.5%. In multivariable analysis, elderly who were men (versus women), with ⩾2 (versus 0–1) chronic diseases, aged ⩾85 (versus 66–69) years, and of Malay and Indian (versus Chinese) ethnicity were significantly more likely to have polypharmacy healthcare use variables were not associated. Polypharmacy was significantly correlated with medication non-adherence. The prevalence of polypharmacy among community-dwelling elderly in Singapore is lower than that reported in other countries however, polypharmacy is associated with medication non-adherence. Elderly subgroups, defined by gender, health status, age and ethnicity, who are at a higher risk of polypharmacy will benefit from medication review and de-prescribing services.
Publisher: SAGE Publications
Date: 22-01-2020
Abstract: In Singapore, English is predominantly used on prescription medication labels (PMLs). However, many older Singaporeans cannot read English, and among those who read English, their English health literacy (EHL) proficiency varies. It is thus pertinent to examine the link between EHL and medication use outcomes in this population. The present research aims to address this question. Data from a national survey, on 1167 home-dwelling elderly on ⩾1 prescribed medication was analysed. The validated Health Literacy Test for Singapore was used to determine EHL. Medication non-adherence was self-reported. Path analysis examined the association between limited EHL and medication non-adherence and tested possible mediators. Limited EHL was associated with medication non-adherence (total effect=0.35 p-value: 0.032), and ‘uncertainty in taking medications correctly due to difficulty in understanding written information on PMLs’ was a significant mediator (indirect effect=0.23, 95% confidence interval (0.12–0.39)). Elderly people with limited EHL were significantly more likely than those with adequate EHL to report that they were uncertain about taking medications correctly because they had difficulty understanding the information on PMLs and this misunderstanding contributed to medication non-adherence. Interventions focused on incorporating bilingual text and/or pictograms on PMLs may reduce uncertainty in taking medication correctly and improve medication adherence among the elderly.
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.PEC.2021.07.015
Abstract: Pictograms on prescription medication labels enhance medication literacy and medication adherence. However, pictograms need to be contextually validated. We assessed the validity of 52 International Pharmaceutical Federation pictograms among 250 older Singaporeans with limited English proficiency. Participants were randomly assigned 11 pictograms each. For each pictogram, participants were first asked its intended meaning. Then, they were told the intended meaning and asked to rate how well the pictogram represented the meaning, on a scale of 1-7. Pictograms were classified as valid (≥66% participants assigned the pictogram interpreted its intended meaning correctly [transparency criterion] and ≥85% participants rated its representativeness as ≥5 [translucency criterion]), partially valid (only transparency criterion was fulfilled) or not valid. Open-ended questions gathered feedback to improve pictograms. 14 pictograms (26.9%) achieved validity and 6 pictograms (11.5%) achieved partial validity. A greater proportion of pictograms for dose and route of administration, and dosage frequency achieved validity or partial validity versus those depicting precautions, indications or side effects. Majority (61.5%) of the assessed pictograms did not achieve validity or partial validity, highlighting the importance of contextual validation. Low pictogram comprehension emphasizes the importance of facilitating pictogram understanding during medication counseling.
Publisher: Cambridge University Press (CUP)
Date: 09-12-2021
DOI: 10.1017/S0144686X2100180X
Abstract: Prior research has established a positive association between social support and psychological resilience. In this study, we seek to examine whether and to what extent aspects of in iduals’ social network – specifically size (how many relatives and friends one has) and strength (how often did one communicate with close network members and at the time of important decisions) – are related to greater psychological resilience. We use data pertaining to 1,609 respondents from the Panel on Ageing and Transitions in Health Survey (PATHS), 2016–2017, a national study of 1,654 older midlife adults, aged 50–59, in Singapore. We estimate the relationship between social networks and psychological resilience, using inverse probability weighted regression adjustment to account for the possibility of a selection bias whereby in iduals with larger or stronger social networks may be more resilient at the outset. We find that strong social networks are associated with greater psychological resilience among older midlife adults, regardless of the size of the network. Having a large social network is associated with greater resilience only if it is also a strong network. Maintaining stronger, even if small, social networks may enable in iduals at the cusp of older ages to be better prepared to deal with stressful life events and challenges associated with older midlife.
Publisher: eLife Sciences Publications, Ltd
Date: 09-03-2021
DOI: 10.7554/ELIFE.60060
Abstract: From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 02-07-2020
DOI: 10.1186/S12874-020-01059-Y
Abstract: Since the beginning of the COVID-19 outbreak in December 2019, a substantial body of COVID-19 medical literature has been generated. As of June 2020, gaps and longitudinal trends in the COVID-19 medical literature remain unidentified, despite potential benefits for research prioritisation and policy setting in both the COVID-19 pandemic and future large-scale public health crises. In this paper, we searched PubMed and Embase for medical literature on COVID-19 between 1 January and 24 March 2020. We characterised the growth of the early COVID-19 medical literature using evidence maps and bibliometric analyses to elicit cross-sectional and longitudinal trends and systematically identify gaps. The early COVID-19 medical literature originated primarily from Asia and focused mainly on clinical features and diagnosis of the disease. Many areas of potential research remain underexplored, such as mental health, the use of novel technologies and artificial intelligence, pathophysiology of COVID-19 within different body systems, and indirect effects of COVID-19 on the care of non-COVID-19 patients. Few articles involved research collaboration at the international level (24.7%). The median submission-to-publication duration was 8 days (interquartile range: 4–16). Although in its early phase, COVID-19 research has generated a large volume of publications. However, there are still knowledge gaps yet to be filled and areas for improvement for the global research community. Our analysis of early COVID-19 research may be valuable in informing research prioritisation and policy planning both in the current COVID-19 pandemic and similar global health crises.
Publisher: Elsevier BV
Date: 06-2023
Publisher: Springer Science and Business Media LLC
Date: 02-05-2018
Publisher: Springer Science and Business Media LLC
Date: 29-03-2023
DOI: 10.1038/S41586-023-05772-8
Abstract: Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being 1–6 . Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was .1 kg m –2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have lified.
Publisher: Elsevier BV
Date: 11-2020
Publisher: Springer Science and Business Media LLC
Date: 05-2019
Publisher: Wiley
Date: 26-08-2022
DOI: 10.1002/JPPR.1824
Abstract: Prescription medication labels (PMLs) are central in guiding patients to use their medications appropriately. For PMLs to achieve this purpose, their content must enable medication use as desired and be presented in a clear and legible manner. This study assesses the extent to which the format and content of PMLs used in Singapore meet national and/or international recommendations, and if the extent varies across public and private healthcare institutions. The format and content variables of 113 PMLs were compared against published recommendations. Variability in the extent to which the format and content of PMLs met the recommendations across public and private institutions was assessed through the Chi‐square test or Fisher's exact test. Less than 50% of the PMLs conformed with the format recommendations of printing instructions in sentence case (35.4%), and the content recommendations for providing drug–food administration instructions (45.3%), using specific dosing intervals for dosing instructions (21.2%), providing an expiry date (17.7%), and generating bilingual labels (5.3%). A higher proportion of private institution PMLs followed the format recommendations of printing instructions in sentence case (p = 0.004) and numeric characters for quantitative values (p = 0.003), and the content recommendations for providing drug indication (p 0.001). In contrast, a higher proportion of public institution PMLs followed the content recommendations of using specific dosing intervals (p = 0.001), providing side effects recautions (p = 0.003), and providing drug‐food administration instructions (p = 0.021). There is definite scope for improving the format and content of PMLs in Singapore. Future studies could explore the possible logistical, financial, and administrative reasons that contribute to PML variability across healthcare institutions.
Publisher: Korean Council of EMS Physicians
Date: 15-11-2021
Publisher: Elsevier BV
Date: 12-2021
No related grants have been discovered for Rahul Malhotra.