Autoantibodies ; COVID-19 ; Humans ; Singapore/epidemiology*

INTRODUCTIONWe aimed to evaluate the effectiveness and safety of canagliflozin as compared to sitagliptin in a real-world setting among multiethnic patients with Type 2 diabetes mellitus (T2DM) in Singapore.

METHODSThis was a new-user, active-comparator, single-centre retrospective cohort study. Patients aged 18-69 years with T2DM and estimated glomerular filtration rate ≥ 60 mL/min/1.73 m were eligible for inclusion if they were initiated and maintained on a steady daily dose of canagliflozin 300 mg or sitagliptin 100 mg between 1 May and 31 December 2014, and followed up for 24 weeks.

RESULTSIn total, 57 patients (canagliflozin 300 mg, n = 22; sitagliptin 100 mg, n = 35) were included. The baseline patient characteristics in the two groups were similar, with overall mean glycated haemoglobin (HbA1c) of 9.4% ± 1.4%. The use of canagliflozin 300 mg was associated with greater reductions in HbA1c (least squares [LS] mean change -1.6% vs. -0.4%; p < 0.001), body weight (LS mean change -3.0 kg vs. 0.2 kg; p < 0.001) and systolic blood pressure (LS mean change: -9.7 mmHg vs. 0.4 mmHg; p < 0.001), as compared with sitagliptin 100 mg. About half of the patients on canagliflozin 300 mg reported mild osmotic diuresis-related side effects that did not lead to drug discontinuation.

CONCLUSIONOur findings suggest that canagliflozin was more effective than sitagliptin in reducing HbA1c, body weight and systolic blood pressure in patients with T2DM, although its use was associated with an increased incidence of mild osmotic diuresis-related side effects.

Adolescent ; Adult ; Aged ; Blood Glucose ; drug effects ; Blood Pressure ; Body Mass Index ; Body Weight ; Canagliflozin ; administration & dosage ; Diabetes Mellitus, Type 2 ; drug therapy ; Female ; Glomerular Filtration Rate ; Hemoglobins ; analysis ; Humans ; Hypoglycemic Agents ; administration & dosage ; Least-Squares Analysis ; Male ; Middle Aged ; Osmosis ; Retrospective Studies ; Singapore ; Sitagliptin Phosphate ; administration & dosage ; Systole ; Treatment Outcome ; Young Adult

Liver fibrosis is a slow, insidious process involving accumulation of extracellular matrix protein in the liver. The stage of liver fibrosis in chronic liver disease (CLD) determines overall morbidity and mortality; the higher the stage, the worse the prognosis. Noninvasive composite scores can be used to determine whether patients with CLD have significant or advanced fibrosis. Patients with low composite scores can be safely followed up in primary care with periodic reassessment. Those with higher scores should be referred to a specialist. As the epidemic of diabetes mellitus, obesity and non-alcoholic fatty liver diseases is rising, CLD is becoming more prevalent. Easy-to-use fibrosis assessment composite scores can identify patients with minimal or advanced fibrosis, and should be an integral part of decision-making. Patients with cirrhosis, high composite scores, chronic hepatitis B with elevated alanine aminotransferase and aspartate aminotransferase, or deranged liver panel of uncertain aetiology should be referred to a specialist.
Alanine Transaminase ; blood ; Aspartate Aminotransferases ; blood ; Decision Making ; End Stage Liver Disease ; complications ; diagnosis ; therapy ; Hepatitis B ; complications ; Humans ; Liver ; pathology ; Liver Cirrhosis ; complications ; diagnosis ; therapy ; Non-alcoholic Fatty Liver Disease ; complications ; diagnosis ; therapy ; Prognosis ; Referral and Consultation ; Treatment Outcome

Medical students choose their future careers based on many factors, of which many have been proposed. There are no clear reasons why medical students choose one specialty over others. This literature review serves as a starting point for a proposed study on Singaporean medical students’ attitudes towards FM as a career choice. The search covered period from 1993 - 2012 using Medline database and the keywords: medical students, career choice, Family Medicine or general practitioner/ general practice. Twenty articles (out of 274) met the review criteria. Three themes emerged - career choice specific to FM and in general and on attitudes towards FM. Positive factors included: female gender, older age, perceived lifestyle, rural background, a patient/societal orientation and experience with role-models. Negative factors included: research interest, nature of work, low income/prestige and debt repayment. Proportion of students interested in FM as a career was below 30% in most studies. The review showed that factors affecting career choices are complex. Difference in healthcare systems were also important factors. It is uncertain if studies conducted in different countries are reproducible. This review identified possible factors affecting medical students’ interest in a FM career and their attitudes towards FM as a profession.

INTRODUCTIONThis study examines the prevalence of overweight and obesity in 6- to 72-month-old Chinese preschoolers in Singapore using 3 references.

MATERIALS AND METHODSThis was a population-based cross-sectional study of 3009 Chinese preschoolers aged 6 to 72 months from southwestern and western parts of Singapore. Overweight and obesity were defi ned by using the Center for Disease Control (CDC) (85th and 95th percentile, respectively), the International Obesity Task Force (IOTF) and the local National Health Group Polyclinics (NHGP), Singapore (90th and 97th percentile, respectively) references.

RESULTSThe prevalence of overweight and obesity in 24 to 72 months old Chinese children were 8.1% and 7.1% (the CDC reference), 7.6% and 3.9% (the IOTF reference) and 7.5% and 5.3% (the local reference [NHGP]) respectively. For preschoolers aged 6 to 72 months, the prevalence of overweight and obesity was 7.0% and 5.3%, respectively, using the local reference. An increasing trend in the prevalence of obesity with increasing age was seen in both genders, using the CDC and IOTF references (P ≤0.001 and 0.001, respectively). The boys were more likely to be obese than the girls using the CDC reference (OR = 1.42, 95% CI, 1.02 to 1.97, P = 0.03).

CONCLUSIONOur study showed a lower prevalence of overweight and obesity among Chinese preschoolers in Singapore when compared to other countries like the United States, Italy, Chile using the CDC and/or IOTF references. The CDC reference overestimated whereas the IOTF reference underestimated the prevalence of overweight and obesity for our population when compared to using the local NHGP reference.

Body Mass Index ; Child ; Child, Preschool ; China ; ethnology ; Cross-Sectional Studies ; Female ; Humans ; Infant ; Male ; Obesity ; diagnosis ; ethnology ; Overweight ; diagnosis ; ethnology ; Prevalence ; Sex Distribution ; Singapore ; epidemiology

Postgraduate Family Medicine (FM) training is important to train future primary care doctors to provide accessible and cost effective healthcare. In Singapore, a structured postgraduate FM training programme has been available for 20 years. This programme is characterised by involvement of both FM and non-FM doctors, well written modules and a rigorous assessment process. However, challenges faced by both the current healthcare system and training structure underlie the need to review the training structure to ensure its relevancy for future Family Physicians (FPs) to manage the needs of their patients. A workgroup was formed to review the current FM postgraduate programme and to explore the possibility of using the Accreditation Council for Graduate Medical Education (ACGME) framework to enhance our current system. The workgroup felt that broad-based training and comprehensive coverage of topics are areas that are important to retain in any new FM residency programme. Weaknesses identified included a lack of early FM exposure and the need to strengthen formative assessments. New organisational structures such as Family Medicine Centres (FMC) need to be established and the involvement of the private sector in any FM residency progammes could be enhanced. The implementation of the FM Residency Programme in 2011 presented a unique opportunity to realign FM postgraduate education in line with the national objectives and to equip FPs with the necessary knowledge and skills for managing the future healthcare needs of Singaporeans.
Clinical Competence ; standards ; Curriculum ; standards ; Education, Medical, Graduate ; organization & administration ; standards ; Family Practice ; education ; Humans ; Internship and Residency ; organization & administration ; Program Development ; Singapore

INTRODUCTIONPrevious studies on patient acceptance of medical student teaching were from Western populations and in one setting only. However, there has been no prospective study comparing patient acceptability before and after an actual experience. We studied patient acceptability of medical student teaching in private and public family practices and public hospital specialist outpatient clinics in Singapore, and before and after an actual medical student teaching consultation.

MATERIALS AND METHODSWe conducted an anonymous cross-sectional survey from March through October 2007 of Singaporean or permanent resident patients attending 76 teaching private family practices, 9 teaching public family practices and 8 specialty clinics in a teaching public hospital. We used pre-consultation cross-sectional patient surveys in all three settings. For private family practice setting only, post-consultation patient survey was conducted after an actual experience with medical student presence.

RESULTSOut of 5123 patients, 4142 participated in the cross-sectional survey (80.9%) and 1235 of 1519 patients in the prospective cohort study (81.3%). Eighty percent were comfortable with medical students present, 79% being interviewed and 60% being examined. Regarding being examined by medical students, parents of children were least comfortable while patients between 41 to 60 years were most comfortable (adjusted OR = 1.99 [1.55-2.57]). Females were less comfortable with medical student teaching than males. Chinese patients were the least comfortable about being interviewed or examined by medical students among the ethnic groups. Indians were most comfortable with being interviewed by medical students (adjusted OR = 1.38 [1.02-1.86]) but Malays were the most comfortable being examined by them (adjusted OR = 1.32 [1.07-1.62]). Family practice patients were more receptive to medical student teaching than the hospital's specialist outpatients. Common barriers to patient acceptance were lack of assurance of patient privacy, dignity and confidentiality. Actual exposure to medical student teaching did not change levels of patient acceptance.

CONCLUSIONSCompared to similar studies from Western countries, Asian patients appear to be less receptive to medical student teaching than Western patients. Family practice settings offer medical students a more receptive learning environment.

Adult ; Cross-Sectional Studies ; Education, Medical, Undergraduate ; Family Practice ; Female ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Odds Ratio ; Outpatient Clinics, Hospital ; Patient Satisfaction ; Physician-Patient Relations ; Private Practice ; Students, Medical ; Young Adult

INTRODUCTIONIt is important that medical students possess the correct attitude towards the elderly and not have an ageist attitude. This is because they will be caring for an increasing proportion of elderly patients. We thus sought to assess the attitudes of our medical students towards the elderly.

MATERIALS AND METHODSWe conducted a cross-sectional study assessing the attitudes towards the elderly of 225 fi rst-year and 135 third-year students using a self-administered questionnaire that incorporated the Kogan's Attitudes Toward Old People Scale (KAOP). Elderly people were defined as those aged 65 years and above for this study.

RESULTSThe majority of fi rst- (98.2%) and third-year (99.2%) medical students had positive attitudes towards elderly people (KAOP score above 102). KAOP scores were not significantly different regardless of seniority (medical student year), gender, race, household income, or having a doctor-parent. Although the mean KAOP score of third-year students was higher than that of fi rst-year students, this was not significantly different (P = 0.062).

CONCLUSIONSMedical students in Singapore have a positive attitude towards the elderly. It is important that their medical curriculum continues to have an increasing geriatric component in view of the increasing numbers of older persons that they will be caring for due to the ageing population.

Age Factors ; Aged ; Aged, 80 and over ; Attitude of Health Personnel ; Cross-Sectional Studies ; Female ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Pilot Projects ; Prejudice ; Psychometrics ; Self-Assessment ; Singapore ; Social Perception ; Students, Medical ; psychology ; Surveys and Questionnaires ; Young Adult

INTRODUCTIONHypertension is a common chronic condition usually managed by primary-care practitioners in Singapore. This study assessed the characteristics, control and complications of non-diabetic hypertensive patients managed at government primary healthcare clinics.

MATERIALS AND METHODSA cross-sectional study involving 9 clinics was conducted over 1-week in 2006. Five hundred and six non-diabetic hypertensive patients were systematically sampled from all clinic attendees. Data relating to socio-demographic, lifestyle factors, treatment and complications were collected by interviewer-administered questionnaires and review of clinic medical records. Blood pressure (BP) measurements were taken with validated automated sets following a standard protocol.

RESULTSThe prevalence of good BP control (<140/90 mmHg) was 37.7% (95% CI: 33.6% to 41.8%). Ninety seven percent were on medication with about half on monotherapy. Seventy percent of patients had a body mass index (BMI) of 23.0 kg/m(2) or higher, 64% did not exercise regularly and 8% were current smokers. After adjusting for age and lifestyle factors, male hypertensive patients had poorer BP control compared to females. Nineteen percent of patients reported at least 1 complication of hypertension, especially cardiac disease. After multivariate analysis and duration of disease, age and the male gender were associated with the presence of hypertensive complications.

CONCLUSIONSMore than half of the patients were not controlled to target levels. Male patients were more likely to have poorer control of hypertension and significantly higher risks of complications. Control of BP could be further improved by lifestyle modifications - weight reduction, promotion of physical activity, healthier eating habits and smoking cessation.

Aged ; Blood Pressure ; Body Mass Index ; Community-Based Participatory Research ; Confidence Intervals ; Cross-Sectional Studies ; Diet, Reducing ; Female ; Humans ; Hypertension ; complications ; diagnosis ; epidemiology ; prevention & control ; Life Style ; Male ; Middle Aged ; Motor Activity ; Multivariate Analysis ; Prevalence ; Primary Health Care ; statistics & numerical data ; Risk ; Sex Factors ; Singapore ; epidemiology ; Surveys and Questionnaires ; Weight Loss

INTRODUCTIONSubjective indicators of health like self-rated health (SRH) have been shown to be a predictor of mortality and morbidity. We determined the prevalence of poor SRH in Singapore and its association with various lifestyle and socioeconomic factors and disease states.

MATERIALS AND METHODSCross-sectional survey by interviewer-administered questionnaire of participants aged 40 years and above. SRH was assessed from a standard question and categorised into poor, fair, good or excellent. Lifestyle factors, socioeconomic factors and presence of disease states were also assessed.

RESULTSOut of 409 participants, 27.6% rated their health as poor or fair, 53.1% as good and 19.3% as excellent. Smaller housing-type (PRR: 1.64, 95% CI: 1.10- 2.44) and lack of exercise (PRR: 1.54, 95% CI: 1.06-2.22) were found to be associated with poor SRH. Presence of chronic diseases such as coronary artery disease (PRR: 1.89, 95% CI: 1.13-3.17), diabetes mellitus (PRR: 1.85, 95% CI: 1.18-2.91), history of cancer (PRR: 2.15, 95% CI: 1.05-4.41) and depression (PRR: 1.73, 95% CI: 1.13-2.65) were associated with poor SRH.

CONCLUSIONPrevalence and factors associated with poor SRH in Singapore was comparable to other developed countries. SRH is an important subjective outcome of health and has the potential for wider use in clinical practice in Singapore.

Adult ; Aged ; Chronic Disease ; epidemiology ; Cross-Sectional Studies ; Female ; Health Status Indicators ; Humans ; Male ; Middle Aged ; Prevalence ; Singapore ; epidemiology ; Socioeconomic Factors