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Sia CH, Simon O, Loh PH, Poh KK. Atherosclerotic cardiovascular disease landscape in Singapore. Front Cardiovasc Med 2024; 11:1342698. [PMID: 38720921 PMCID: PMC11076755 DOI: 10.3389/fcvm.2024.1342698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide, accounting for over one-third of all deaths in Singapore. An analysis of age-standardized mortality rates (ASMR) for CVD in Singapore revealed a deceleration in the initial rapid decline in ASMR. A decrease in smoking prevalence may have contributed to the initial rapid decline in ASMR. Furthermore, other major risk factors, such as diabetes mellitus, hypertension, elevated low-density lipoprotein levels, and obesity, are steadily rising. Singapore's CVD economic burden is estimated to be 8.1 billion USD (11.5 billion SGD). The burden of CVD can only be reduced using individual and population-based approaches. Prevention programs must also be developed based on an understanding of risk trends. Therefore, this article attempts to capture the burden of CVD, trends in risk factor control, preventive care, disparities, and current unmet needs, particularly in atherosclerotic cardiovascular disease management in Singapore.
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Affiliation(s)
- Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Oliver Simon
- Medical Affairs, Novartis (Singapore) Ltd Pte, Singapore, Singapore
| | - Poay-Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Poon Z, Tan NC. A qualitative research study of primary care physicians' views of telehealth in delivering postnatal care to women. BMC PRIMARY CARE 2022; 23:206. [PMID: 35964001 PMCID: PMC9375064 DOI: 10.1186/s12875-022-01813-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/27/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND The postpartum period is a critical time for women to optimise their physical and mental health. Primary care physicians (PCP) often manage postpartum women in the community setting after uneventful births. However, women encounter difficulties accessing care before and after their conventional 6-week physical review. Telehealth-based interventional studies have demonstrated their successful applications in several areas of postpartum care but is not widely adopted. The study aimed to explore the PCPs' views on their acceptability and perceived barriers of telehealth in delivering postpartum care to women in primary care. METHODS Twenty-nine PCPs participated in eleven in-depth interviews and four focus group discussions for this qualitative study conducted in Singapore. The purposively sampled PCPs had varied demographic background and medical training. Two investigators independently coded the audited transcripts. Thematic content analysis was performed using the codes to identify issues in the pertaining to the perceived usefulness, ease of use and attitudes towards telehealth in postpartum care as described in the "Telehealth Acceptance Model" framework. RESULTS Most PCPs perceived usefulness and ease of use of video consultation in delivering postpartum care. They recognised telehealth service to complement and support the current face-to-face postpartum care amidst the pandemic. However, training, leadership support, organizational infrastructure, healthcare financial policy and personal demographic profile influence their acceptance of a new care model for postnatal mothers. CONCLUSION Addressing the barriers and strengthening the facilitators will enhance PCPs' acceptance and utilisation of the proposed hybrid (telehealth and in-person) postnatal care model for mothers.
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Affiliation(s)
- Zhimin Poon
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore.
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167, Jalan Bukit Merah, Connection One, Tower 5, #15-10, Singapore, 150167, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Jacob C, Sezgin E, Sanchez-Vazquez A, Ivory C. Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis. JMIR Mhealth Uhealth 2022; 10:e36284. [PMID: 35318189 PMCID: PMC9121221 DOI: 10.2196/36284] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 12/23/2022] Open
Abstract
Background Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. Objective The aim of this review was to systematically investigate the literature to understand the factors affecting patients’ adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). Methods A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. Results The technical factors affecting patients’ adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team’s role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients’ insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions This review builds on the growing body of research that investigates patients’ adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools’ fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption.
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Affiliation(s)
- Christine Jacob
- University of Applied Sciences Northwestern Switzerland, Olten, Switzerland
| | - Emre Sezgin
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States.,NORC at the University of Chicago, Chicago, IL, United States
| | - Antonio Sanchez-Vazquez
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Chris Ivory
- Innovative Management Practice Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
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Ho AHY, Dutta O, Tan-Ho G, Tan THB, Low XC, Ganapathy S, Car J, Ho RMH, Miao CY. A Novel Narrative E-Writing Intervention for Parents of Children With Chronic Life-Threatening Illnesses: Protocol for a Pilot, Open-Label Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17561. [PMID: 32623367 PMCID: PMC7380996 DOI: 10.2196/17561] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background A novel evidence-based Narrative e-Writing Intervention (NeW-I) has been developed and tested in Singapore to advance psychosociospiritual support for parents of children with chronic life-threatening illnesses. NeW-I is informed by an international systematic review and a Singapore-based qualitative inquiry on the lived experience of parental bereavement and supported by literature on anticipatory grief interventions for improving the holistic well-being of parent caregivers of seriously ill children. Objective This study's aim was to provide an accessible platform, NeW-I—which is a strengths- and meaning-focused and therapist-facilitated mobile app and web-based counseling platform—that aims to enhance quality of life, spiritual well-being, hope, and perceived social support and reduce depressive symptoms, caregiver burden, and risk of complicated grief among parents of children with chronic life-threatening illnesses. Methods The NeW-I therapist-facilitated web-based platform comprises a mobile app and a website (both of which have the same content
and functionality). NeW-I has been implemented in Singapore as a pilot open-label randomized controlled trial comprising intervention and control groups. Both primary and secondary outcomes will be self-reported by participants through questionnaires. In collaboration with leading pediatric palliative care providers in Singapore, the trial aims to enroll 36 participants in each group (N=72), so that when allowing for 30% attrition at follow-up, the sample size will be adequate to detect a small effect size of 0.2 in the primary outcome measure, with 90% power and two-sided significance level of at least .05. The potential effectiveness of NeW-I and the accessibility and feasibility of implementing and delivering the intervention will be assessed. Results Funding support and institutional review board approval for this study have been secured. Data collection started in January 2019 and is ongoing. Conclusions NeW-I aspires to enhance holistic pediatric palliative care services through a structured web-based counseling platform that is sensitive to the unique cultural needs of Asian family caregivers who are uncomfortable with expressing emotion even during times of loss and separation. The findings of this pilot study will inform the development of a full-scale NeW-I protocol and further research to evaluate the efficacy of NeW-I in Singapore and in other Asian communities around the world. Trial Registration ClinicalTrials.gov NCT03684382; https://clinicaltrials.gov/ct2/show/NCT03684382 International Registered Report Identifier (IRRID) DERR1-10.2196/17561
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Affiliation(s)
- Andy Hau Yan Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Oindrila Dutta
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Geraldine Tan-Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Toh Hsiang Benny Tan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Xinyi Casuarine Low
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Ringo Moon-Ho Ho
- Psychology Program, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Chun Yan Miao
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
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Hirano R, Yamaguchi S, Waki K, Kimura Y, Chin K, Nannya Y, Nangaku M, Kadowaki T, Ohe K. Willingness of Patients Prescribed Medications for Lifestyle-Related Diseases to Use Personal Health Records: Questionnaire Study. J Med Internet Res 2020; 22:e13866. [PMID: 32463368 PMCID: PMC7290452 DOI: 10.2196/13866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 12/03/2019] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
Background Personal health record (PHR) systems let individuals utilize their own health information to maintain and improve quality of life. Using PHRs is expected to support self-management in patients with lifestyle-related diseases. Objective The aim of this study was to identify predictors of the willingness to use PHRs among patients who are prescribed medications for lifestyle-related diseases. Methods We recruited pharmacy patrons, aged 20 years or older, who had received at least one medication indicated for hypertension, dyslipidemia, or diabetes. Participants completed self-administered questionnaires regarding their previous diseases, awareness of health care, experience in using PHRs, willingness to use PHRs, and barriers to using PHRs. Data were analyzed using multivariate logistic regression models. Results Of the 3708 subjects meeting eligibility criteria, 2307 replies (62.22%) were collected. While only 174 (7.54%) participants had previous PHR experience, 853 (36.97%) expressed willingness to use PHRs. In the multivariate analysis, considering exercise to be important for health management (odds ratio [OR] 1.57, 95% CI 1.12-2.21; P=.009), obtaining medical information from books or magazines (OR 1.23, 95% CI 0.96-1.59; P=.10), and obtaining medical information from the internet (OR 1.45, 95% CI 1.13-1.87; P=.004) were newly identified predictors. These were in addition to known predictors, such as being employed, owning information terminals, and previous PHR experience. Conclusions Patients who have an active and positive attitude toward health seem to be more willing to use PHRs. Investigating willingness should contribute to the development of more useful PHRs for self-management among patients prescribed medications for lifestyle-related diseases.
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Affiliation(s)
- Ryoma Hirano
- Nihon Chouzai Co, Ltd, Tokyo, Japan.,Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayo Waki
- Department of Ubiquitous Health Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | - Yasuhito Nannya
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Ohe
- Department of Biomedical Informatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Wei X, Hicks JP, Pasang P, Zhang Z, Haldane V, Liu X, Yin T, Wang L, Shi D, Ge S, Walley J, Upshur R, Hu J. Protocol for a randomised controlled trial to evaluate the effectiveness of improving tuberculosis patients' treatment adherence via electronic monitors and an app versus usual care in Tibet. Trials 2019; 20:273. [PMID: 31097023 PMCID: PMC6521492 DOI: 10.1186/s13063-019-3364-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment non-adherence is a serious challenge to effective tuberculosis (TB) control in Tibet. In this study we will pilot and evaluate the effectiveness of using new electronic monitors (e-monitors) and a smartphone app to improve treatment adherence among new pulmonary TB patients in Tibet. METHODS We will use a multicentre, parallel-group, individually randomised controlled, superiority trial with blinded outcome evaluation and unblinded treatment. We will randomise new pulmonary TB outpatients (aged ≥ 15 years old and free from communication impairment) from Shigatse, Tibet to either the intervention or control arm in a 1:1 ratio at the time of their diagnosis. All patients will be treated according to the World Health Organisation standard 6-month TB treatment regimen and the China National TB programme guidelines. Intervention arm patients will be given their medication via e-monitors that have automatic voice reminders, and record medication adherence data and share it with health staff via Cloud connection. Intervention patients will also be encouraged to receive smartphone-based video-observed treatment if their adherence is problematic. Control arm patients will receive their medication in e-monitors that will collect medication adherence history, but will have their reminder function deactivated and are not linked to the app. The primary outcome is the rate of poor adherence, measured monthly during treatment as a binary indicator where poor adherence means missing ≥ 20% of doses in a month. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and an analysis of the long-term effects of the intervention on TB control. DISCUSSION Our study is one of the first trials to evaluate the use of e-monitors and smartphone apps for customised treatment support in low- and middle-income countries (LMICs). All intervention activities are designed to be embedded into routine TB care with strong local ownership. Through the trial we intend to understand the feasibility of our intervention, its effectiveness, its cost-effectiveness and its long-term impacts to inform future scale-up in remote areas of China and other LMICs. TRIAL REGISTRATION Current Controlled Trials, ID: ISRCTN52132803 . Registered on 9 November 2018.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Joseph Paul Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Pande Pasang
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Zhitong Zhang
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Victoria Haldane
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Xiaoqiu Liu
- China National Centre for Tuberculosis Prevention and Control, China National Centre for Disease Control and Prevention, Beijing, China
| | - Tingting Yin
- Weifang Medical College, Weifang, Shandong China
| | - Lixia Wang
- China National Centre for Tuberculosis Prevention and Control, China National Centre for Disease Control and Prevention, Beijing, China
| | - Dachun Shi
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
| | - Shiliang Ge
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Jun Hu
- Shigatse Centre for Disease Control and Prevention, 7 Keji Road, Samzhubze District, Shigatse, Tibet China
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Hossain I, Ang YN, Chng HT, Wong PS. Patients' attitudes towards mobile health in Singapore: a cross-sectional study. Mhealth 2019; 5:34. [PMID: 31620461 PMCID: PMC6789194 DOI: 10.21037/mhealth.2019.08.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smartphone-mediated mobile health (mHealth) has the potential to assist patients with medication adherence and disease monitoring. This study aimed to describe the awareness and usage of, and attitudes towards, mHealth among smartphone-owning patients in a tertiary hospital in Singapore. METHODS A self-administered cross-sectional survey was systematically offered to patients at the Singapore General Hospital from August to September 2018. Participants were included if they were at least 18 years old, owned a smartphone, and could speak and read simple English. No identifiable data was collected. Responses were summarized using descriptive statistics. Multiple logistic regression analysis was used to identify factors associated with awareness and usage of, and attitudes towards, mHealth. RESULTS Four-hundred and two eligible responses were received, with most participants reporting having completed tertiary education (63.7%) and having chronic medical conditions (71.1%), with a mean age of about 43 years. On average, participants were aware of 3.7 out of 7 mHealth functions and used 1.9 functions. Most patients were aware that smartphones could be used for general health/fitness tracking, obtaining health information, and appointment management. Most (76.3%) participants were keen to learn to use mHealth in future, and 63.2% agreed that mHealth could help them better manage their health. CONCLUSIONS Although mHealth usage among patients was low, most patients held positive attitudes towards mHealth. For mHealth to fulfill its potential, strategies to improve the awareness and usage among patients need to be explored.
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Affiliation(s)
- Ihtimam Hossain
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Ying Na Ang
- Department of Pharmacy, National University of Singapore, Singapore
| | - Hui Ting Chng
- Department of Pharmacy, National University of Singapore, Singapore
| | - Pei Shieen Wong
- Department of Pharmacy, Singapore General Hospital, Singapore
- Department of Pharmacy, National University of Singapore, Singapore
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