Background: Multiple biomarkers have performed well in predicting type 2 diabetes mellitus (T2DM) risk in Western populations. However, evidence is scarce among Asian populations. Methods: Plasma triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), high-sensitivity Creactive protein (hs-CRP), ferritin, adiponectin, fetuin-A, and retinol-binding protein 4 were measured in 485 T2DM cases and 485 age-and-sex matched controls nested within the prospective Singapore Chinese Health Study cohort. Participants were free of T2DM at blood collection (1999 to 2004), and T2DM cases were identified at the subsequent follow-up interviews (2006 to 2010). A weighted biomarker score was created based on the strengths of associations between these biomarkers and T2DM risks. The predictive utility of the biomarker score was assessed by the area under receiver operating characteristics curve (AUC). Results: The biomarker score that comprised of four biomarkers (TG-to-HDL ratio, ALT, ferritin, and adiponectin) was positively associated with T2DM risk (P trend <0.001). Compared to the lowest quartile of the score, the odds ratio was 12.0 (95% confidence interval [CI], 5.43 to 26.6) for those in the highest quartile. Adding the biomarker score to a base model that included smoking, history of hypertension, body mass index, and levels of random glucose and insulin improved AUC significantly from 0.81 (95% CI, 0.78 to 0.83) to 0.83 (95% CI, 0.81 to 0.86; P=0.002). When substituting the random glucose levels with glycosylated hemoglobin in the base model, adding the biomarker score improved AUC from 0.85 (95% CI, 0.83 to 0.88) to 0.86 (95% CI, 0.84 to 0.89; P=0.032). Conclusion A composite score of blood biomarkers improved T2DM risk prediction among Chinese.

INTRODUCTIONThis paper examines the incidence, mortality and survival patterns among all Chinese residents with prostate cancer reported to the Singapore Cancer Registry in Singapore from 1968 to 2002 by metastatic staging.

MATERIALS AND METHODSThis is a retrospective population-based study including all prostate cancer cases aged over 20 reported to the Singapore Cancer Registry (SCR) from 1968 to 2002 who are Singapore Chinese residents. Follow-up was ascertained by matching with the National Death Register until 2002. Metastatic status was obtained from the SCR. Age-standardised incidence and mortality rates, as well as the 5-year relative survival ratios (RSRs), were obtained for each 5-year period and grouped by metastatic stage. A weighted linear regression was performed on the log-transformed age-standardised incidence and mortality rates over the study period.

RESULTSIn the most recent period of 1998 to 2002, the age-standardised incidence and mortality rates (per 100,000) for prostate cancer among the Chinese were 30.9 (95% CI, 29.1 to 32.8) and 9.6 (95% CI, 8.6 to 10.7), respectively. The percentage increase in the age-standardised incidence and age-standardised mortality rates per year were 5.6% and 6.0%, respectively, for all Chinese Singapore residents. There was an improvement in the 5-year RSRs for Chinese diagnosed with non-metastatic cases from 51.3% in 1973 to 1977, to 76.1% in 1998 to 2002. However, the RSR remains poor (range, 11.1% to 49.7%) for Chinese diagnosed with metastatic prostate cancer.

CONCLUSIONSBoth age-standardised incidence and mortality rates for prostate cancer among Chinese Singapore residents are still on the rise especially since the 1990s. Since the 1990s, the improvement in RSRs was substantial for the Chinese non-metastatic cases.

Adult ; Aged ; Aged, 80 and over ; China ; epidemiology ; ethnology ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; diagnosis ; Prostatic Neoplasms ; epidemiology ; ethnology ; mortality ; Registries ; Retrospective Studies ; Singapore ; epidemiology ; Survival Rate ; trends ; Young Adult

INTRODUCTION: The burden of frequent attenders (FAs) of emergency departments (EDs) on healthcare resources is underestimated when single-centre analyses do not account for utilisation of multiple EDs by FAs. We aimed to quantify the extent of multiple ED use by FAs and to characterise FAs. METHODS: We reviewed nationwide ED attendance in Singapore data from 1 January 2006 to 31 December 2018 (13 years). FAs were defined as patients with ≥4 ED visits in any calendar year. Single ED FAs and multiple ED FAs were patients who attended a single ED exclusively and ≥2 distinct EDs within the year, respectively. Mixed ED FAs were patients who attended a mix of a single ED and multiple EDs in different calendar years. We compared the characteristics of FAs using multivariable logistic regression. RESULTS: We identified 200,130 (6.3%) FAs who contributed to1,865,704 visits (19.6%) and 2,959,935 (93.7%) non-FAs who contributed to 7,671,097 visits (80.4%). After missing data were excluded, the study population consisted of 199,283 unique FAs. Nationwide-linked data identified an additional 15.5% FAs and 29.7% FA visits, in addition to data from single centres. Multiple ED FAs and mixed ED FAs were associated with male sex, younger age, Malay or Indian ethnicity, multiple comorbidities, median triage class of higher severity, and a higher frequency of ED use. CONCLUSION A nationwide approach is needed to quantify the national FA burden. The multiple comorbidities and higher frequency of ED use associated with FAs who visited multiple EDs and mixed EDs, compared to those who visited a single ED, suggested a higher level of ED burden in these subgroups of patients. The distinct characteristics and needs of each FA subgroup should be considered in future healthcare interventions to reduce FA burden.
Comorbidity ; Emergency Service, Hospital ; Ethnicity ; Humans ; Logistic Models ; Male ; Retrospective Studies ; Triage

OBJECTIVE: In Singapore, the use of traditional Chinese medicine (TCM) alongside Western medicine (WM) is common. There are risks of adverse herb-drug interactions when taken concurrently. Current literature suggests that TCM use is not regularly reported to WM doctors in Singapore, but the underlying reasons are not understood. METHODS: A cross-sectional study was conducted across Singapore by administering questionnaires to TCM-using patients and WM-practising general practitioners (GPs). The questionnaire examined the following themes: (1) demographics and TCM use pattern; (2) respondents' (patients and GPs) knowledge and beliefs about TCM and the factors influencing the discussion of TCM during the WM consultation; and (3) respondents' qualitative suggestions to increase disclosure rate. RESULTS: A total of 484 patients and 334 GPs were surveyed. Factors associated with patients' initiation of TCM discussion include length of consultation (odds ratio [OR]: 2.1; P < 0.001), comfort level in discussing TCM (OR: 1.6; P < 0.001) and belief in importance of discussion (OR: 1.4; P = 0.017). Doctor's initiation of discussion (74%) was the top patient-ranked factor influencing their discussion of TCM. For doctors, knowledge of TCM indications (OR: 2.2; P < 0.001), belief in importance of discussion (OR: 2.1; P < 0.001) and comfort level in discussing TCM (OR: 1.9; P = 0.001) were associated with their initiation of TCM use discussion. Possible WM-TCM interactions (58%) was the top doctor-ranked factor influencing their discussion of TCM. CONCLUSION The discussion of TCM in a WM setting is multifactorial. Interventions include doctors' active screening for TCM use in patients and equipping doctors with TCM knowledge. Improving communication between patients and doctors is key to avoiding harmful herb-drug interactions.