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Yoon S, Goh H, Phang JK, Kwan YH, Low LL. Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study. Sci Rep 2023; 13:20554. [PMID: 37996479 PMCID: PMC10667337 DOI: 10.1038/s41598-023-47168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore.
| | - Hendra Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- Population Health and Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Dubale M, Gizaw K, Dessalegn D. Magnitude and predictors of poor glycemic control in patients with diabetes at Jimma Medical Center, Ethiopia. Sci Rep 2023; 13:15952. [PMID: 37743416 PMCID: PMC10518326 DOI: 10.1038/s41598-023-42774-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/14/2023] [Indexed: 09/26/2023] Open
Abstract
Despite the development of new medications over the past decade to aid in the control of blood glucose, most diabetic patients often do not reach recommended glycemic targets of glycated hemoglobin (HbA1C) < 7% in daily clinical practice because of many contributing factors. This study was designed to assess the magnitude and predictors of poor glycemic control among adult diabetic patients on ambulatory chronic care follow-up at Jimma Medical Center. A cross sectional study was conducted on 307 adult diabetic patients between January 2 and April 30, 2022. Representative samples were selected using a systematic random sampling technique. Predictors of poor glycemic control were assessed using a binary and multi variable logistic regression. Data analysis was performed using Statistical Package for Social Science version 25 and R in the R studio environment. A total of 307 adult diabetic patients were included in the study making a response rate of 93%. Out of 307 adult diabetic patients, majority (62.5%) were males. Mean age of the patients was 48.91 ± 15.68 years. The majority, 221 (72%), of patients had poor glycemic control. Non-adherence of patients to medications (AOR = 3.36, 95% CI 1.16-9.72, p = 0.04), no formal education (AOR = 3.84, 95% CI (1.06-13.93, p = 0.04), therapeutic inertia (AOR = 3.16, 95% CI 1.61-6.20, p = 0.001) and poor diabetic knowledge (AOR = 4.79, 95% CI 1.56-14.68, p = 0.006) were found to be independent predictors of poor glycemic control. Nearly three fourth of diabetic patients in the present study had poor glycemic control and were at higher risk of developing diabetic complications or already developed it. These results highlight the need for appropriate management of patients focusing on adherence to medications, education, therapeutic inertia and diabetic knowledge to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.
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Affiliation(s)
- Mariam Dubale
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia.
| | - Kaleab Gizaw
- Department of Pharmacology, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
- Department of Quantitative Pharmacology, Merck KGaA, Darmstadt, Hessen, Germany
| | - Dula Dessalegn
- Department of Clinical Pharmacy, School of Pharmacy, Jimma University, Jimma, Oromia, Ethiopia
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Yan Y, Wu T, Zhang M, Li C, Liu Q, Li F. Prevalence, awareness and control of type 2 diabetes mellitus and risk factors in Chinese elderly population. BMC Public Health 2022; 22:1382. [PMID: 35854279 PMCID: PMC9295461 DOI: 10.1186/s12889-022-13759-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/29/2022] [Indexed: 12/20/2022] Open
Abstract
Background Type 2 diabetes mellitus is an expanding global public health issue, especially in developing countries. This study aimed to investigate the prevalence, awareness and control rate of type 2 diabetes mellitus, and assess its risk factors in elderly Chinese individuals. Methods The health screening data of 376,702 individuals aged ≥ 65 years in Wuhan, China, were collected to analyse the prevalence, awareness, and control rates of diabetes. Indices, including fasting plasma glucose and other biochemical indicators, were measured for all participants using standard methods at the central laboratory. Multilevel logistic regression analysis was performed to assess the key determinants of the prevalence, awareness, and control rates of diabetes. Results The prevalence, awareness, and control rates of diabetes in the Chinese individuals aged ≥ 65 years were 18.80%, 77.14%, and 41.33%, respectively. There were statistically significant differences in the prevalence, awareness, and control rates by gender. Factors associated with diabetes prevalence were age, body mass index (BMI), and central obesity; while those associated with awareness and control were gender, education level, marital status, physical activity, alcohol consumption, BMI, and central obesity. Conclusions Diabetes is an important public health problem in the elderly in China. The awareness and control rates have improved, but overall remained poor. Therefore, effective measures to raise awareness and control the rates of diabetes should be undertaken to circumvent the growing disease burden in elderly Chinese people. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13759-9.
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Affiliation(s)
- Yaqiong Yan
- Wuhan Centers for Disease Control & Prevention, 288# Machang Road, Wuhan, China
| | - Tingting Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Miao Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China
| | - Changfeng Li
- Wuhan Centers for Disease Control & Prevention, 288# Machang Road, Wuhan, China
| | - Qing Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, 115# Donghu Road, Wuhan, 430071, Hubei, China.
| | - Fang Li
- Wuhan Centers for Disease Control & Prevention, 288# Machang Road, Wuhan, China.
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Moorthy V, Liu W, Chan SP, Chew STH, Ti LK. Elucidation of the novel role of ethnicity and diabetes in poorer outcomes after cardiac surgery in a multiethnic Southeast Asian cohort. J Diabetes 2020; 12:58-65. [PMID: 31210000 DOI: 10.1111/1753-0407.12961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although diabetes is associated with ethnicity and worse cardiac surgery outcomes, no research has been done to study the effect of both diabetes and ethnicity on cardiac surgery outcomes in a multiethnic Southeast Asian cohort. Hence, this study aimed to delineate the association of ethnicity on outcomes after cardiac surgery among diabetics in a multiethnic Southeast Asian population. METHODS Perioperative data from 3008 adult patients undergoing elective cardiac surgery from 2008 to 2011 at the two main heart centers in Singapore was analyzed prospectively, and confirmatory analysis was conducted with the generalized structural equation model. RESULTS Diabetes was significantly associated with postoperative acute kidney injury (AKI) and postoperative hyperglycemia. Postoperative AKI, Malay ethnicity, and blood transfusion were associated with postoperative dialysis. Postoperative AKI and blood transfusion were also associated with postoperative arrhythmias. In turn, postoperative dialysis and arrhythmias increased the odds of 30-day mortality by 7.7- and 18-fold, respectively. CONCLUSIONS This study identified that diabetes is directly associated with postoperative hyperglycemia and AKI, and indirectly associated with arrhythmias and 30-day mortality. Further, we showed that ethnicity not only affects the prevalence of diabetes, but also postoperative diabetes-related outcomes.
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Affiliation(s)
- Vikaesh Moorthy
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Weiling Liu
- Department of Anaesthesia, National University Health System, Singapore
| | - Siew-Pang Chan
- Cardiovascular Research Institute, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Mathematics and Statistics, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | | | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Wong TY, Sabanayagam C. The War on Diabetic Retinopathy: Where Are We Now? Asia Pac J Ophthalmol (Phila) 2019; 8:448-456. [PMID: 31789647 PMCID: PMC6903323 DOI: 10.1097/apo.0000000000000267] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/30/2019] [Indexed: 12/22/2022] Open
Abstract
Diabetic retinopathy (DR), a major cause of blindness in working-age adults, is emerging as a major public health issue worldwide, in particular in low- and middle-income countries (LMIC). Traditionally, the management of DR has been on tertiary-level treatment (eg, laser, anti-VEGF injections and surgery) in specialized settings by highly trained ophthalmologists on individual patients. To win the war on DR, a paradigm shift in strategic focus and resources must be made from such tertiary treatment toward primary and secondary prevention, which are broader, more impactful, and cost-effective for the larger population. These include improving education and awareness of risk of DR among people initially diagnosed with diabetes, promoting behavioral modifications such as physical activity and medication adherence for improving glycemic and blood pressure control, setting up systematic screening programs for DR to detect the onset or progression of the disease, and implementing cost-effective, evidence-based policies and guidelines for managing DR. Additionally, there is a need to leverage on novel technology including the application of digital big data to predict people at risk of diabetes and DR, the use of wearable devices and smart phone apps, behavioral techniques including social media for self-management of diabetes, and telemedicine-based DR screening incorporating artificial intelligence (AI) to broaden access to screening in all settings. To turn the tide on the war on DR, we must reframe DR not only as a specific condition that can be managed by ophthalmologists, but fundamentally, as a preventable condition by shifting the weight of strategies from tertiary to secondary and primary battlegrounds.
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Affiliation(s)
- Tien Y. Wong
- Singapore Eye Research Institute, Singapore, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS, Medical School, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore, Singapore National Eye Center, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS, Medical School, Singapore
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Wong I. Study of type 2 diabetes management among patients in a Macau primary care setting. Fam Med Community Health 2019; 7:e000031. [PMID: 32148710 PMCID: PMC6910744 DOI: 10.1136/fmch-2018-000031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 08/12/2019] [Accepted: 08/18/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the primary care setting in Macau, type 2 diabetes mellitus (T2DM) is the seventh most common reason for consultation. Inadequate glycaemic control constitutes a major public health problem and is associated with premature death and disability and decreased quality of life. Moreover, this condition substantially increases healthcare expenditures. Objective The primary objective was to assess the successful glycaemic control rates, blood pressure (BP) and cholesterol control rates in patients with T2DM in a Macau primary care setting. The secondary objective of this study was to assess the delay of insulin initiation in the Sao Lourence Health Center. Methods Patients were stratified according to age (<65 years vs ≥65 years) and sex. Successful glycaemic control was defined as glycated haemoglobin (HbA1c) <7%. Successful cholesterol control was defined as a low-density lipoprotein cholesterol (LDL-C) level <2.6 mmol/L, and BP control was defined as BP <140/90 mm Hg. Results Among the 2157 participants included in this study, 1046 (48.5%) patients had HbA1c <7%, 1209 (56.1%) patients had BP <140/90 mm Hg and 1244 (57.7%) patients had LDL-C <2.6 mmol/L. In conclusion, only 403 (18.7%) patients met the targets for all three measures. Of the 235 patients who were on insulin therapy, the mean (±SD) duration from T2DM diagnosis to insulin initiation was 7.47±6.52 years, the mean (±SD) duration from HbA1c not meeting the target (HbA1c ≥7% over 1 year and persistently) to insulin initiation was 3.34±3.66 years and the mean baseline HbA1c was 9.13%. Compared with patients with a longer duration (≥5 years) of HbA1c not meeting the target before insulin initiation, those who started insulin within 1 year of HbA1c not meeting the target had a better glycaemic control rate (40.7% vs 13%). Conclusions Nearly half of the patients at Sao Lourence Health Center, a primary care centre in Macau, met the glycaemic control target, but less than one-fifth of patients met all three targets for T2DM control. Moreover, there was a delay in insulin initiation for people with T2DM.
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Affiliation(s)
- In Wong
- Health Bureau, Macau SAR Government, Macau, China
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Roderick P, Turner V, Readshaw A, Dogar O, Siddiqi K. The global prevalence of tobacco use in type 2 diabetes mellitus patients: A systematic review and meta-analysis. Diabetes Res Clin Pract 2019; 154:52-65. [PMID: 31202865 DOI: 10.1016/j.diabres.2019.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND A multi-layered association between tobacco use and type 2 diabetes mellitus (T2DM) is well established. However, global epidemiological patterns of tobacco use among T2DM patients are not well documented; this review thus aims to estimate the overall global burden of tobacco use in T2DM. METHODS A systematic review of studies published from Jan 1, 1990 to October 5, 2017 was undertaken, comprising: a comprehensive literature search on multiple electronic databases; quality assessment of studies; data extraction for the primary (prevalence of tobacco use in T2DM patients) and secondary outcomes (patterns of tobacco use in T2DM patients); and a meta-analysis. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. A protocol for this review is available on PROSPERO (CRD42016038793). FINDINGS 74 studies were included in the review, reporting data from 3.2 million participants across 33 countries. Global mean prevalence of tobacco use in T2DM was 20·81% (95% CI 18·93-22·76), and was higher in the WHO East Asia and Pacific and South Asia regions, compared to the Americas, Middle East and North Africa, Europe and Central Asia. In studies which compared prevalence of tobacco use in patients to non-patients, patients with T2DM were 26% less likely to use tobacco (pooled OR = 0·74 (CI 0·61-0·88). INTERPRETATION Tobacco is used by one in five T2DM patients globally, but usage is less likely in patients than in non-patients. Global patterns of use demonstrated by this review have implications for both prevention and The understanding of diabetes burden, and the success of tobacco cessation strategies.
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Affiliation(s)
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, United Kingdom
| | - Omara Dogar
- Department of Health Sciences, University of York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, United Kingdom
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Rautio N, Varanka-Ruuska T, Vaaramo E, Palaniswamy S, Nedelec R, Miettunen J, Karppinen J, Auvinen J, Järvelin MR, Keinänen-Kiukaanniemi S, Sebert S, Ala-Mursula L. Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966. Prim Care Diabetes 2017; 11:365-372. [PMID: 28456438 DOI: 10.1016/j.pcd.2017.03.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
AIMS We explored whether registered unemployment is associated with impaired glucose metabolism in general population. METHODS Based on Northern Finland Birth Cohort 1966 at 46 years, we analyzed the oral glucose tolerance tests of 1970 men and 2544 women in relation to their preceding three-year employment records in three categories of unemployment exposure: no (employed), low (≤1-year) and high exposure (>1-year). RESULTS Among men, pre-diabetes was found in 19.2% of those with no unemployment, 23.0% with low and 27.0% with high exposure, the corresponding figures for screen-detected type 2 diabetes were 3.8%, 3.8% and 9.2% (p<0.01). Among women, analogous figures for pre-diabetes were 10.0%, 12.6% and 16.2% and for screen-detected type 2 diabetes 1.7%, 3.4% and 3.6% (p<0.01). Men with high exposure to unemployment had a higher risk for pre-diabetes (OR 1.61, CI 95% 1.03-2.51) and screen-detected type 2 diabetes (OR 2.58 95% CI 1.23-5.44) than employed men, after adjustment for education, smoking, alcohol intake, physical activity and body mass index. Among women, associations were attenuated in the adjusted models. CONCLUSIONS High exposure to unemployment may predispose to type 2 diabetes in middle-aged men. For clinicians, awareness of the patient's unemployment status may be helpful in recognizing undiagnosed cases.
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Affiliation(s)
- Nina Rautio
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland.
| | - Tuulia Varanka-Ruuska
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Kallio Primary Health Care Unit, Kirkkotie 4, 84100 Ylivieska, Finland.
| | - Eeva Vaaramo
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Saranya Palaniswamy
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Rozenn Nedelec
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Jaro Karppinen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Finnish Institute of Occupational Health, Aapistie 1, 90220 Oulu, Finland.
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland.
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland; MRC-PHE Centre for Environment and Health, Imperial College London, Praed Street Wing, St. Mary's Campus, Paddington, W2 IPG London, United Kingdom; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Unit of Primary Health Care, Oulu University Hospital, OYS, P.O. Box 20, 90029 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Biocenter Oulu, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Department of Genomics, Imperial College London, South Kensington Campus, SW7 London, United Kingdom.
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
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Ng LWC, Malhotra R, Lai D, Tai ES, Østbye T. Perceived Barriers to and Ideas for Weight Control Interventions in Malay Homemakers. Asia Pac J Public Health 2015; 27:NP552-61. [DOI: 10.1177/1010539513479966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. To develop a better understanding of perceived barriers to and ideas for weight loss and maintenance among Malay homemakers in Singapore. Methods. Interventions for weight management were reviewed, and 5 focus groups were conducted among overweight and obese Malay homemakers (n = 24) to explore barriers to and concepts and ideas pertaining to weight loss and maintenance. Results. Barriers identified included the lack of time, finances, and motivation. Ideas that were most appealing included free health screening, workshops on how best to manage children and family, regular fun group activities, monetary incentives for participation in activities for healthy living, and flexible part-time jobs. Conclusion. The focus groups provided useful insights pointing toward possible interventions that could appeal to Malay homemakers in Singapore. The most appealing approaches were those that were time flexible and had the least financial burden or had a financial benefit.
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Affiliation(s)
| | | | - Danny Lai
- ACORN Marketing & Research Consultants PTE LTD, Singapore
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Kim JM, Son NH, Park EC, Nam CM, Kim TH, Cho WH. The relationship between changes in employment status and mortality risk based on the Korea Labor and Income Panel Study (2003-2008). Asia Pac J Public Health 2015; 27:NP993-1001. [PMID: 23674827 DOI: 10.1177/1010539513486923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to analyze the relationship between the mortality rate and changes in employment status. This study used mortality data from the Korean Labor and Income Panel Study. To analyze the relationship between the mortality rate and changes in employment status, the population was classified into employed, unemployed, or economically inactive. Demographic and socioeconomic variables such as gender, age, educational level, annual household income, marital status, and self-rated health status were controlled. In this study, the generalized estimating equations were used to analyze the relationship between the morality rate and the changes in employment status. The mortality rate was higher (odds ratio = 4.31) among the population that experienced a change in economic status from employed to unemployed than those who maintained employment. The mortality rate for the population who became unemployed or economically inactive was higher (odds ratio = 5.05) in cases of death by disease.
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Affiliation(s)
- Ji Man Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea Institute of Health Services Research, Yonsei University, Seoul, Korea National Health Insurance Corporation Ilsan Hospital, Goyang-si, Korea
| | - Nak-Hoon Son
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chung Mo Nam
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, Korea Graduate School of Public Health, Yonsei University, Seoul, Korea
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Wang H, Lin X, Zhang Z, Wang Q, Chen JM, Liu J, Yuan L. The economic burden of inpatients with type 2 diabetes: a case study in a Chinese hospital. Asia Pac J Public Health 2015; 27:49S-54S. [PMID: 25700857 DOI: 10.1177/1010539515572220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to study the components, influencing factors, and their changing trend in a Chinese hospital, so as to reduce the economic burden of inpatients with type 2 diabetes. Data were collected from 7487 cases. There were 4368 inpatients with type 2 diabetes during 2002-2012 in a Chinese hospital. Multivariate linear regression analysis was performed to explore the influencing factors of hospitalization costs. The number of inpatients and their hospitalization costs had increasing trends in the study period. The medicine, test, and examination charges were the main sources of total costs. Longer hospital stays, older ages, and more times of hospitalization led to higher medical costs. Actions should be taken on all fronts to control the rapidly increasing trend of hospitalization costs and to reduce hospital stays and the number of times of hospitalization to reduce the economic burden of diabetic inpatients.
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Affiliation(s)
- Hao Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | - Xuan Lin
- WISCO General Hospital, Wuhan, China
| | - Zhi Zhang
- WISCO General Hospital, Wuhan, China
| | - Quan Wang
- Wuhan University, School of Public Health/Global Health Institute, Wuhan, China
| | | | - Jing Liu
- WISCO General Hospital, Wuhan, China
| | - Li Yuan
- WISCO General Hospital, Wuhan, China
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12
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Abebe SM, Berhane Y, Worku A. Barriers to diabetes medication adherence in North West Ethiopia. SPRINGERPLUS 2014; 3:195. [PMID: 24834373 PMCID: PMC4021033 DOI: 10.1186/2193-1801-3-195] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/09/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Low adherence to prescribed diabetes medications is one of the major reasons to poor glycemic control in developing countries. Therefore, this study attempted to assess the magnitude of medication adherence and factors associated with it among adult persons with diabetes in northwest Ethiopia. METHOD This study utilized a cross sectional study design with internal comparison. The study population was adult persons with diabetes attending the Diabetes Referral Clinic of Gondar University Hospital. Adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). In addition laboratory tests and chart reviews were carried out to collect relevant data. Ordinary logistic regression was used to identify factors associated with adherence. RESULT A total of 391 patients were studied. Based on the MMAS-8 scale, the self-reported adherence to diabetic medication was low for 25.4% [95% CI: 21, 29] of the patients, medium for 28.7% [95% CI: 24, 33], and high for 45.9% [95% CI: 41, 50] of the patients. The Mean (±SD) of glycosylated hemoglobin for the low adherence group was 8.2% (±2.1). It was 8.1% (±2.0), for the medium, and 7.4% (±1.6) for the high adherence group. In the multivariate analysis poor wealth status (AOR = 1.99; 1.15, 3.43), using traditional treatment (AOR = 2.90; 1.03, 8.15), and service dissatisfaction (AOR = 2.23; 1.04, 4.80) were significantly associated with low adherence to prescribed diabetic medications. CONCLUSION Over half of the persons with diabetes did not adhere to medications. Adherence was poor among users of traditional treatment and those dissatisfied with services. Developing a more intensive communication strategies and improving the quality of services could improve the level of adherence.
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Affiliation(s)
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Hassali MA, Ching MW, Yusoff ZM, Hussein Z, Alrasheedy AA, AL-Tamimi SK, Saleem F, ul Haq N, Aljadhey H, Khan T. ‘Why I do not want to take insulin shots’: Findings from a qualitative study among diabetic patients in Malaysia. J Public Health (Oxf) 2013. [DOI: 10.1007/s10389-013-0594-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Yeoh LY, Tan FLG, Willis GC, Ooi ST. Methicillin-resistantStaphylococcus aureuscarriage in hospitalized chronic hemodialysis patients and its predisposing factors. Hemodial Int 2013; 18:142-7. [DOI: 10.1111/hdi.12061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lee Ying Yeoh
- Department of Medicine; Khoo Teck Puat Hospital; Singapore
| | | | | | - Say Tat Ooi
- Department of Medicine; Khoo Teck Puat Hospital; Singapore
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Tan AG, Tay WT, Mitchell P, Sandar M, Aung T, Saw SM, Wang JJ, Yin Wong T. Prevalence of Lens Opacities in Asian Malays. Ophthalmic Epidemiol 2012; 19:380-7. [DOI: 10.3109/09286586.2012.733479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chew BH, Mastura I, Shariff-Ghazali S, Lee PY, Cheong AT, Ahmad Z, Taher SW, Haniff J, Mustapha FI, Bujang MA. Determinants of uncontrolled hypertension in adult type 2 diabetes mellitus: an analysis of the Malaysian diabetes registry 2009. Cardiovasc Diabetol 2012; 11:54. [PMID: 22607105 PMCID: PMC3434063 DOI: 10.1186/1475-2840-11-54] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/07/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Uncontrolled blood pressure (BP) is a significant contributor of morbidity and even mortality in type 2 diabetes (T2D) patients. This study was done to determine the significant determinants of uncontrolled blood pressure in T2D patients in Malaysia. METHODS Between 1st January 2009 to 31st December 2009, data from 70 889 patients with Type 2 diabetes was obtained from the Adult Diabetes Control and Management Registry for analysis; 303 centers participated in the study. Their demographic characteristics, the nature of their diabetes, their state of hypertension, treatment modalities, risk factors, and complications are described. Based on their most recent BP values, subjects were divided into controlled BP and uncontrolled BP and their clinical determinants compared. Independent determinants were identified using multivariate logistic regression. RESULTS The mean age of patients at diagnosis of diabetes was 52.3 ± 11.1 years old. Most were women (59.0 %) and of Malay ethnicity (61.9 %). The mean duration of diabetes was 5.9 ± 5.6 years. A total of 57.4 % were hypertensive. Of the 56 503 blood pressure (BP) measured, 13 280 (23.5 %) patients had BP <130/80 mmHg. Eighteen percent was on > two anti-hypertensive agents. Health clinics without doctor, older age (≥ 50 years old), shorter duration of diabetes (< 5 years), Malay, overweight were determinants for uncontrolled blood pressure (BP ≥130/80 mmHg). Patients who were on anti-hypertensive agent/s were 2.7 times more likely to have BP ≥130/80 mmHg. Type 2 diabetes patients who had ischaemic heart disease or nephropathy were about 20 % and 15 % more likely to have their blood pressure treated to target respectively. CONCLUSIONS Major independent determinants of uncontrolled BP in our group of T2D patients were Malay ethnicity, older age, recent diagnosis of diabetes, overweight and follow-up at health clinics without a doctor and possibly the improper use of anti hypertensive agent. More effort, education and resources, especially in the primary health care centres are needed to improve hypertensive care among our patients with diabetes.
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Affiliation(s)
- Boon How Chew
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | | | - Sazlina Shariff-Ghazali
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Ping Yein Lee
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Ai Theng Cheong
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Zaiton Ahmad
- Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | | | - Jamaiyah Haniff
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Mohd Adam Bujang
- Clinical Research Centre, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Lin YC, Liu CC, Hwang SL, Li CY, Chou LP, Liu CC. Are diabetic physicians at a lower risk of hospitalization for coronary heart disease? A nationwide cohort study in Taiwan. Asia Pac J Public Health 2012; 27:NP361-71. [PMID: 22535555 DOI: 10.1177/1010539512443279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is not uncommon for physicians to work through illness and to be reluctant to seek health care from their colleagues, which is detrimental for quality of care. This study sought to assess the risk of admission for coronary artery diseases (CADs) in diabetic physicians. A cohort of 995 diabetic physicians and 9950 age- and sex-matched controls with diabetes were identified in 2000 and were followed to the end of 2008. Over an 8-year period, 200 (20.1%) diabetic physicians and 2255 (22.7%) controls were admitted for CAD. After controlling for potential confounders, diabetic physicians experienced a reduced, but insignificantly, adjusted odds ratio (OR) of CAD admission (OR = 0.89; 95% confidence interval = 0.75-1.06). Diabetic physicians in Taiwan were not at a significantly reduced risk of CAD admission. Future studies are needed to further explore the barriers that impede diabetic physicians from appropriately managing their disease.
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Affiliation(s)
| | - Chih-Ching Liu
- Bureau of Health Promotion, Department of Health, Executive Yuan, Taipei, Taiwan
| | - Shiow-Li Hwang
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chung-Yi Li
- National Cheng Kung University, Tainan, Taiwan
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Xu F, Wang Y, Ware RS, Tse LA, Wang Z, Hong X, Dunstan DW, Owen N. Joint impact of physical activity and family history on the development of diabetes among urban adults in Mainland China: a pooled analysis of community-based prospective cohort studies. Asia Pac J Public Health 2012; 27:NP372-81. [PMID: 22535551 DOI: 10.1177/1010539512443700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To examine the joint influences of physical activity (PA) and family history (FH) of diabetes on subsequent type 2 diabetes (T2D), the authors pooled and analyzed data from 2 community-based urban adult prospective cohort studies in 2011 in Nanjing, China. Among 4550 urban participants, the 3-year cumulative incidence of T2D was 5.1%. After adjustment for potential confounders, compared with those with FH+ and insufficient PA, the adjusted odds ratio (95% confidence interval) of developing T2D was 0.42 (0.18, 0.98) for participants with sufficient PA and FH+, 0.32 (0.22, 0.46) for participants with insufficient PA and FH-, and 0.15 (0.08, 0.28) for participants with sufficient PA and FH-. Such significant graduated associations between PA/FH and risk of developing T2D were also identified in either men or women, separately. Sufficient PA and FH- may jointly reduce the risk of developing T2D in urban Chinese adults.
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Affiliation(s)
- Fei Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China Nanjing Medical University, Nanjing, China
| | - Youfa Wang
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Lap Ah Tse
- The Chinese University of Hong Kong, Hong Kong, China
| | - Zhiyong Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Xin Hong
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - David W Dunstan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Neville Owen
- The University of Queensland, Brisbane, Australia Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Hwang J, Johnson JA. Relationship between duration of type 2 diabetes and self-reported participation in diabetes education in Korea. Asia Pac J Public Health 2012; 27:NP311-21. [PMID: 22500039 DOI: 10.1177/1010539512440592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The increasing prevalence of diabetes is a pressing issue in Korea. The aim of this study was to determine the relationship between duration of diabetes and self-reported participation in diabetes education among diabetic patients in Korea. This study used data from the Korean National Health and Nutrition Examination Survey in 2005. A total of 1405 respondents older than 19 years and having diabetes were included in the analyses. The relationship between these variables was assessed using logistic regression after adjusting for age, sex, and socioeconomic status. The authors observed that duration of diabetes was associated with having never attended diabetes education programs (odds ratio = 0.95; 95% confidence interval = 0.93-0.96; P < .001), with the greatest risk of not attending seen in recently diagnosed patients. In addition, having lower educational attainment and living in non-Metro Seoul regions were independent factors for never attending diabetes education programs among diabetic patients in Korea. This finding suggests the need for developing effective education programs to encourage diabetic patients, particularly recently diagnosed patients, to participate. Such programs could help deliver appropriate information for diabetes management to all diabetic patients in Korea.
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Ekpanyaskul C, Sithisarankul P, Wattanasirichaigoon S. Overweight/Obesity and related factors among thai medical students. Asia Pac J Public Health 2011; 25:170-80. [PMID: 22199148 DOI: 10.1177/1010539511428665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted to assess the prevalence of overweight/obesity and the related demographic data and health behaviors of Thai medical students. A cross-sectional study of 5441 medical students from all the 13 medical schools in Thailand was conducted in 2006 by means of a self-administered questionnaire. Demographic data, health behaviors, and self-reported body weight and height were recorded. The results revealed that Thai medical students have a lower prevalence of overweight/obesity than the general population of the same age group. The multiple logistic regression analysis showed that higher academic year was associated with being overweight or obesity in males, having improper dietary habits were associated with being overweight or obesity in both genders, whereas alcohol consumption was associated with being overweight in male only. Therefore, medical curricula should place an emphasis not only on knowledge but also on attitudes and behaviors for healthy lifestyles.
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Chan JCN, Chan SP, Deerochanawong C, Go RT, Lee KO, Ma RCW, Pan CY, Sheu WHH, Barter P. Diabetic dyslipidaemia in Asian populations in the Western Pacific Region: what we know and don't know. Diabetes Res Clin Pract 2011; 94:1-13. [PMID: 21742396 DOI: 10.1016/j.diabres.2011.05.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 05/10/2011] [Accepted: 05/31/2011] [Indexed: 11/28/2022]
Abstract
Approximately 77 million persons with diabetes reside in the Western Pacific Region. This number is estimated to rise to 113 million in 2030 with increasing burden of cardio-renal disease, affecting an increasingly young population. Randomized clinical trials have confirmed the benefits of using statins to reduce low-density lipoprotein cholesterol in preventing cardiovascular disease (CVD) in Caucasians, although similar data are lacking in Asia. Experts from the Western Pacific Region met and reviewed evidence regarding risk association of diabetic dyslipidaemia with cardio-renal disease, effects of lipid lowering, recommended guidelines and clinical practices in Asian populations. There is strong evidence supporting the role of diabetic dyslipidaemia in cardio-renal disease and the benefits of lipid lowering in these populations. The high rate of diabetic kidney disease, its close links with CVD, and the benefits of lipid lowering on renal function are particularly relevant to this population. While most national guidelines use criteria similar to the West in management of diabetic dyslipidaemia, there are consistently low rates of use of lipid-lowering drugs and attaining treatment goals in the region. The group recommends conducting randomized studies, strengthening of the health care system to promote early detection, and intervention of diabetic dyslipidaemia to prevent end organ damage.
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Affiliation(s)
- Juliana C N Chan
- Hong Kong Institute of Diabetes and Obesity and Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong Special Administrative Region.
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Taiyeb-Ali TB, Raman RPC, Vaithilingam RD. Relationship between periodontal disease and diabetes mellitus: an Asian perspective. Periodontol 2000 2011; 56:258-68. [DOI: 10.1111/j.1600-0757.2010.00370.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wee LE, Koh GCH, Toh ZJ. Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n10p750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: We were interested to determine the participation rates for health screening in a multi-ethnic urban low-income community. We assessed the health screening rates at baseline, collected data on reasons for non-participation and assessed the impact that a 5-month intervention had on health screening in this community. Materials and Methods: The study population involved all residents aged ≥40 years, living in heavily subsidised public rental flats in Taman Jurong Constituency, Singapore. From January 2009 to May 2009, we collected baseline information and offered eligible residents free blood pressure, fasting blood glucose and lipid measurements, fecal occult blood testing and Pap smears. Screenings were conducted either at or near the residents’ homes. Results: The participation rate was 60.9% (213/350). At baseline, 18.9% (24/127), 26.4% (42/159) and 18.7% (31/166) had gone for regular hypertension, diabetes and hyperlipidaemia screening, respectively; 3.8% (6/157) and 2.9% (2/70) had had regular colorectal and cervical cancer screening, respectively. Post-intervention, rates for hypertension screening increased to 97.6% but increases for other modalities were marginal. High cost, lack of time, not at risk, too old, or unnecessary for healthy people were commonly cited reasons for skipping regular health screening. Being unemployed was associated with missing regular hypertension screening (adjusted OR = 2.48, CI = 1.12-5.53, P = 0.026); those who did not need financial aid were less likely to miss regular hyperlipidaemia screening (adjusted OR = 0.27, CI = 0.10-0.72, P = 0.008). Conclusion: The participation rates for health screening were poor in this low-income community. More can be done to encourage regular health screening participation amongst this segment of the populace, both by reducing costs as well as addressing misperceptions.
Key words: Cervical cancer, Colorectal cancer, Diabetes, Hyperlipidaemia, Hypertension
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Gerald CH Koh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Zheng Jie Toh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
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