INTRODUCTIONWeight-and-height-based anthropometric indices have long been used for obesity screening among adolescents.However, the ability of their age-and-sex-specific reference values in classifying adolescent as "obese" in different populations was not fully established. Our study aimed to validate the existing international (BMI-for-age charts from WHO, CDC, IOTF) and local cut-offs [percent weight for height (PWH)] for obesity against body fat percentage, as assessed by 4 skinfolds measurement.

MATERIALS AND METHODSA cross-sectional sample of 6991 adolescents aged 12 to 18 years was measured. All anthropometric measurements were compliant with the internationally accepted protocol. Obesity was defined as percentage body fat greater than or equal to 95 percentile, specific to age and sex. The validity of the existing classification criteria in detecting obesity was evaluated by comparing their respective diagnostic accuracy.

RESULTSBoth prevalence of obesity and diagnostic accuracy indices varied by the classification criteria. While all criteria generated very high specificity rates with the lowest being 95%, their sensitivity rates were low ranging from 43% to 71%. Youden's index suggested that CDC and WHO criteria had optimal sensitivity and specificity. ROC analysis showed that overall performance could be improved by refining the existing cut-offs.

CONCLUSIONSClinical validity of weight-and-height-based classification systems for obesity screening in Asian adolescents is poorer than expected, and this could be improved by refining the existing cut-offs.

Adolescent ; Anthropometry ; Asian Continental Ancestry Group ; Body Height ; Body Mass Index ; Body Weight ; Child ; Cross-Sectional Studies ; Female ; Humans ; Male ; Mass Screening ; Obesity ; diagnosis

INTRODUCTION: Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers. METHODS: A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledge based questionnaire. Satisfaction was evaluated using a satisfaction scale. RESULTS: In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28-5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group. CONCLUSION Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.

INTRODUCTIONUp to 30% of patients with rheumatoid arthritis (RA) respond inadequately to conventional non-biologic disease modifying antirheumatic drugs (nbDMARDs), and may benefit from therapy with biologic DMARDs (bDMARDs). However, the high cost of bDMARDs limits their widespread use. The Chapter of Rheumatologists, College of Physicians, Academy of Medicine, Singapore aims to define clinical eligibility for government-assisted funding of bDMARDs for local RA patients.

MATERIALS AND METHODSEvidence synthesis was performed by reviewing 7 published guidelines on use of biologics for RA. Using the modified RAND/UCLA Appropriateness Method (RAM), rheumatologists rated indications for therapies for different clinical scenarios. Points reflecting the output from the formal group consensus were used to formulate the practice recommendations.

RESULTSTen recommendations including diagnosis of RA, choice of disease activity measure, initiation and continuation of bDMARD and option of first and second-line therapies were formulated. The panellists agreed that a bDMARD is indicated if a patient has (1) active RA with a Disease Activity Score in 28 joints (DAS28) score of ≥3.2, (2) a minimum of 6 swollen and tender joints, and (3) has failed a minimum of 2 nbDMARD combinations of adequate dose regimen for at least 3 months each. To qualify for continued biologic therapy, a patient must have (1) documentation of DAS28 every 3 months and (2) at least a European League Against Rheumatism (EULAR) moderate response by 6 months after commencement of therapy.

CONCLUSIONThe recommendations developed by a formal group consensus method may be useful for clinical practice and guiding funding decisions by relevant authorities in making bDMARDs usage accessible and equitable to eligible patients in Singapore.

Antirheumatic Agents ; economics ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Financing, Government ; Humans ; Practice Guidelines as Topic ; Singapore

The new coronavirus disease (COVID-19) outbreak has challenged us to take unprecedented steps to bring this pandemic under control. In view of the urgency of this situation, convalescent plasma which was used in previous coronavirus outbreaks has emerged as one of the treatment options in this current pandemic. This is mainly due to the fact that convalescent plasma has been studied in a few case series with promising outcomes. In addition, on-going large clinical trials aimed to further evaluate the effectiveness, safety, and optimal dosage, duration and timing of administration of convalescent plasma are indeed revealing a certain level of promising results. Therefore, this article aims to provide an overview of possible mechanisms of actions of convalescent plasma, its benefits and its level of usage safeness by summarizing the existing evidence on the use of convalescent plasma in COVID-19 patients.