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Teo C.T.,National University of Singapore | Yeo Y.W.S.,National Healthcare Group Polyclinics | Lee S.-C.,National University of Singapore
American Journal of Health Behavior | Year: 2013

Objectives: To determine attitudes of Singaporean women toward screening mammography and its potential barriers. Methods: The study included 208 cancerfree Asian women. Data about mammogram knowledge, motivators, barriers, and adherence to surveillance mammography were obtained. Results: Only 37% underwent regular mammography. Lack of time (56.7%) and cost (54.3%) were the most commonly cited barriers. On multivariate analysis, being Chinese, having higher education, mammography knowledge, positive motivator scores, and receiving reminders were predictors to regular mammography. Participants were only willing to pay ~US$24 for mammogram compared to subsidized cost of ~US$40. Older Malays were less likely than Chinese and Indians to undergo regular mammography (p = .003). Conclusions: Surveillance adherence may be improved by lowering cost and increasing public education. Source


Bebakar W.M.W.,Universiti Sains Malaysia | Lim-Abrahan M.A.,University of the Philippines | Jain A.B.,Novo Nordisk AS | Seah D.,National Healthcare Group Polyclinics | Soewondo P.,University of Indonesia
Diabetes Research and Clinical Practice | Year: 2013

Aim: To examine the clinical safety and effectiveness of insulin aspart (IAsp) therapy in type 2 diabetes (T2D) patients from the ASEAN cohort of the international, 24-week, non-interventional A1chieve study. Methods: T2D patients from Indonesia, Malaysia, Philippines and Singapore, who started IAsp therapy with or without oral glucose-lowering drugs, were included. The primary endpoint was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemic events. Secondary endpoints included hypoglycaemia, glycated haemoglobin A1c [HbA1c], fasting plasma glucose [FPG], postprandial plasma glucose [PPPG], systolic blood pressure [SBP], body weight and lipids. Quality of life (QoL) was assessed using the EQ-5D questionnaire. Results: Overall, 312 T2D patients (222 insulin-naive and 90 insulin-experienced) with a mean±SD age of 56.6±11.2 years, BMI of 24.2±3.9 kg/m2 and diabetes duration of 7.0±5.7 years were included. The mean daily IAsp dose was 0.51±0.31U/kg at baseline titrated up to 0.60±0.29U/kg at Week 24. No SADRs or major hypoglycaemic events were reported in the entire subgroup. The proportion of patients who reported overall hypoglycaemia decreased from baseline to Week 24 (7.1% vs. 0.3%, p < 0.0001). The mean HbA1c improved from 9.5±1.6% at baseline to 7.6±1.3% after 24 weeks (p < 0.001). The mean FPG, post-breakfast PPPG and SBP also improved (p < 0.001). Health-related QoL scores increased in the entire subgroup (mean increase: 9.8±14.6 points, p < 0.001). Conclusions: Starting IAsp therapy was well-tolerated and was associated with significantly improved overall glycaemic control in the ASEAN cohort. © 2013 Elsevier Ireland Ltd. Source


Ang Y.G.,National Healthcare Services | Heng B.H.,National Healthcare Services | Saxena N.,National Healthcare Services | Liew S.T.A.,Renal Medicine | Chong P.-N.,National Healthcare Group Polyclinics
Journal of Clinical and Translational Endocrinology | Year: 2016

Background The prognosis of diabetic kidney disease is poor because epidemiological data have shown that all-cause mortality increases with declining renal function. This study aims to estimate the annual mortality rate of diabetic kidney disease stratified by chronic kidney disease (CKD) stages and to identify the predictors of mortality. Methods Patients with Stage 3-5 CKD (estimated glomerular filtration rate [eGFR] less than 60 mL/min per 1.73 m2) with diabetic kidney disease from the National Healthcare Group CKD Registry from 1 January 2007 to 31 December 2007 were included in this study. The patients were followed up till 30 November 2013. Cox's proportional hazards regression modelling was used to assess the factors associated with all-cause mortality. Results Over a median follow up period of 6.0 years, 985 out of 3008 patients (32.8%) died. Of those who died, 363 (36.9%) died from cardiovascular causes. The annual mortality rate was 64.1 per 1000 individuals (95% confidence interval [CI] 60.2-68.3) and the mortality rate increased with severity of CKD [Stage 3A (37.0), Stage 3B (57.5), Stage 4 (98.3) and Stage 5 (198.5)]. Predictors of mortality were age, male gender, CKD stages, albuminuria, comorbid conditions such as peripheral vascular disease, neuropathy, retinopathy and the use of antiplatelet agents. Conclusion Our study estimated the annual all-cause mortality rate for Singaporean patients with diabetic kidney disease by CKD stages and identified predictors of all-cause mortality. This study has affirmed the poor prognosis of these patients and an urgency to intervene early so as to retard the progression to later stages of CKD. © 2016 The Authors. Published by Elsevier Inc. Source


Goh I.X.W.,National Healthcare Group Polyclinics | How C.H.,Singhealth Polyclinics | Tavintharan S.,Diabetes Center
Singapore Medical Journal | Year: 2013

Statins are commonly used in the treatment of hyperlipidaemia. Although the benefits of statins are well-documented, they have the potential to cause myopathy and rhabdomyolysis due to the complex interactions of drugs, comorbidities and genetics. The cytochrome P450 family consists of major enzymes involved in drug metabolism and bioactivation. This article aims to highlight drug interactions involving statins, as well as provide updated recommendations and approaches regarding the safe and appropriate use of statins in the primary care setting. Source


Heng B.H.,National Healthcare Services | Sun Y.,National Healthcare Services | Cheah J.T.S.,National Healthcare Group Polyclinics | Jong M.,Tan Tock Seng Hospital
Annals of the Academy of Medicine Singapore | Year: 2010

Introduction: The National Healthcare Group (NHG) launched an enterprise-wide diabetes registry in 2007. We describe the epidemiology of type 2 diabetes mellitus from 2005 to 2008. Materials and Methods: Patients with encounters in NHG from 2005 were identified for inclusion into the Diabetes Registry from existing stand-alone diabetes registries, ICD9CM diagnosis codes, anti-hyperglycaemic medication and laboratory confirmation. Variables extracted for analysis were demographics (age, gender, ethnicity), diabetes-related comorbidities and complications, most recent anti-hyperglycaemic agents dispensed, and the most recent glycated haemoglobin (HbA1C) measurement. Results: The diabetes registry grew 32% from 129,183 patients in 2005 to 170,513 patients in 2008, making up 12% to 15% of all patients in NHG. About half of the type 2 diabetes patients were aged 45 to 64 years. Females were generally older with a median age of 63 to 64 years vs 59 to 61 years in males. The Indian ethnic group accounted a disproportionately higher 13% of patients. Over 95% of type 2 patients had at least one diabetes-related comorbid condition, and diabetes-related complications were principally renal and cardiovascular complications. The majority (86.2% to 89.2%) of primary care patients were on oral anti-hyperglycaemic agents; however, the rate of insulin treatment increased from 10.8% to 13.8%. HbA1C levels in 2008 improved over that in 2005, with the percentage of patients with good glycaemic control improving with age. Conclusion: The registry has enabled a baseline assessment of the burden and the care of type 2 diabetes patients in NHG, which will provide critical evidence for planning future programmes. Source

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