This review examines strategies for the prevention and management of obesity, hypertension, type 2 diabetes mellitus and dyslipidaemia, conditions that are increasing in Singapore, as components of individualised health plans in 'Healthier SG' and beyond. We describe cardiometabolic disease prevention and management initiatives in Changi General Hospital (CGH), including collaborations with SingHealth Polyclinics, Active SG, Exercise is Medicine Singapore and community partners in the Eastern Community Health Outreach programme, and highlight advances in curable hypertension (e.g., primary hyperaldosteronism) and novel cardiovascular risk markers such as lipoprotein(a). We also outline technology-based interventions, notably the CGH Health Management Unit, which demonstrate the utility and convenience of telemedicine, and digital therapeutics in the form of apps that have been shown to improve treatment adherence and clinical outcomes. Individual empowerment, in partnership with community and healthcare providers and supported by research and innovation of care delivery, is key to building a healthier and stronger nation.
Humans ; Singapore ; Diabetes Mellitus, Type 2/therapy* ; Hypertension/therapy* ; Obesity/therapy* ; Dyslipidemias/therapy* ; Telemedicine ; Cardiovascular Diseases/prevention & control* ; Exercise ; Metabolic Diseases/prevention & control*

INTRODUCTION: Physical activity (PA) and sedentary behaviour (SB) independently influence the health outcomes of older adults. Both provide interventional opportunities for successful ageing. We aimed to determine levels of PA and SB in ambulatory older adults and their associated factors in a developed Asian population known for its longevity. METHODS: We conducted a cross-sectional observational study in a Singapore public primary healthcare centre. Multi-ethnic Asian adults aged ≥ 60 years took an interviewer-administered questionnaire survey. PA and SB were assessed using the Physical Activity Scale for the Elderly (PASE; score range 0 to > 400) and the Sedentary Behaviour Questionnaire for the Elderly, respectively. RESULTS: Among 397 participants (50.9% female; 73.2% Chinese; 47.9% aged ≥ 70 years; 33.5% employed, including voluntary work), 58.7% had ≥ 3 chronic illnesses and 11.1% required walking aids. The median PASE score was 110.8 (interquartile range 73.8-171.6) and decreased significantly with increasing age. Higher PASE score was associated with higher educational level, employment, independent ambulation without aid, and fewer chronic illnesses (p < 0.01). Employment status significantly influenced PASE score (β = 84.9, 95% confidence interval [CI] 66.5-103.4; p < 0.01). 37.0% spent ≥ 8 hours daily on sedentary activity and were twice as likely to do so if they were employed (odds ratio 2.19, 95% CI 1.34-3.59; p < 0.01). CONCLUSION The PA of the older adults decreased with increasing age and increased with employment. One-third of them were sedentary for ≥ 8 hours daily. Those who were employed were twice as likely to have SB.

INTRODUCTIONAcute pulmonary embolism (PE) is an uncommon but potentially fatal disease. Acute right ventricular failure, which can be demonstrated by echocardiography, is known to be an adverse prognostic factor in patients with acute PE. However, this diagnostic test is not always available in emergency departments and it is also an operator-dependent investigation. This study aimed to investigate whether cardiac troponin I (cTnI) levels could predict clinical outcomes in Chinese patients with PE.

METHODSThis was a retrospective cohort study performed in a tertiary regional hospital in Hong Kong. For this study, 100 patients who were diagnosed with acute PE between January 1, 2002 and December 31, 2009 were recruited. Information, including demographic data, presenting symptoms and vital signs at presentation, predisposing factors for PE, results of diagnostic procedures and clinical outcomes, was collected from the medical records of these patients.

RESULTS71% of recruited patients had elevated cTnI levels. High cTnI levels were associated with haemodynamic instability (odds ratio [OR] 5.30, 95% confidence interval [CI] 1.32-27.71; p = 0.019) and complicated clinical course (OR 6.34, 95% CI 1.76-22.9; p = 0.002).

CONCLUSIONElevated cTnI level was associated with a complicated clinical course in patients with acute PE. We suggest that measurements of cTnI levels be used for the early risk stratification of patients with PE in the emergency departments of hospitals.

Acute Disease ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; Biomarkers ; blood ; Cohort Studies ; Critical Care ; Female ; Hemodynamics ; Hong Kong ; Hospitalization ; Humans ; Male ; Middle Aged ; Odds Ratio ; Prognosis ; Pulmonary Embolism ; blood ; diagnosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Troponin I ; blood