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Sum G, Koh GCH, Mercer SW, Lim YW, Majeed A, Oldenburg B, Lee JT. Patients with more comorbidities have better detection but poorer management of chronic diseases. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have significant clinical implications as highlighted in the recent National Institute for Care Excellence (NICE) guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, intreated, and uncontrolled for NCDs, in six large MICs.
Methods
Cross-sectional analysis of WHO SAGE Wave 1 (2007-10), which consisted of adults aged ≥18 years from six populous MICs including, China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557).
Results
Higher number of comorbidities was associated with better detection of hypertension, angina and arthritis, and better odds of having treatment for hypertension and angina. However, increasing comorbidity had the opposite effect on being uncontrolled, and was associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. Comorbidity with concordant conditions was not associated with decreased nor increased odds of being uncontrolled for all NCDs.
Conclusions
Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Improving continuity of care and monitoring treatment are priorities for health systems with ageing populations.
Key messages
Patients with more comorbidities have better diagnosis of chronic conditions. but this does not translate into better management and control of these conditions.
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Affiliation(s)
- G Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - G C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - S W Mercer
- Usher Institute of Population Health Sciences, University of Edinburgh, UK
| | - Y W Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, UK
| | - B Oldenburg
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Sin DYE, Chew TCT, Chia TK, Ser JS, Sayampanathan A, Koh GCH. Evaluation of Constructing Care Collaboration - nurturing empathy and peer-to-peer learning in medical students who participate in voluntary structured service learning programmes for migrant workers. BMC Med Educ 2019; 19:304. [PMID: 31395101 PMCID: PMC6686532 DOI: 10.1186/s12909-019-1740-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/30/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Experiential learning through service provides opportunities to nurture and practice empathy. Of growing concern, studies showed significantly decreased empathy scores as students progress through medical school. Additionally, peer-to-peer learning provides an effective way for students to learn. Constructing Care Collaboration (CCC) is a student initiated, structured-service-learning-program that promotes the development of empathy and peer-to-peer teaching. CCC is conducted in cycles of 6 sessions. This is a mixed methods study that explores the effectiveness of CCC as a service learning platform in developing student participants' empathy, social and cultural competencies, communication skills and peer-to-peer teaching skills, ultimately aiming to promote a culture of serving the underprivileged. METHODS The study comprised of a self-administered quantitative questionnaire and qualitative interviews. Both evaluated if CCC participation developed volunteers' social-awareness, cultural competency, communication, confidence and motivation to teach their peers. RESULTS Quantitative data were collated from 38 completed student volunteers' questionnaires. Volunteers generally agreed CCC improved social-awareness and cultural competency. It increased confidence of participants in approaching migrant-workers, communicating with people from different social backgrounds, and promoted a culture of peer-to-peer teaching. Thematic analysis of 17 interviews was conducted. Themes identified include: increased empathy towards migrant-workers, improved communication skills, and identifying benefits and challenges in peer-to-peer teaching. CONCLUSION From the quantitative and qualitative information gathered, CCC has been shown to be effective in nurturing participants' self-reported empathy, cultural competence, communication skills and improved attitude towards peer-to-peer teaching. Given its effectiveness, CCC can be adopted as a model for structured service-learning.
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Affiliation(s)
- DYE Sin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - TCT Chew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - T. K. Chia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - J. S. Ser
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A. Sayampanathan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - GCH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Sum G, Koh GCH, Atun R, Oldenburg B, Lee JT, Vellakkal S. Multimorbidity Patterns and Implications for healthcare utilisation and quality of life in six LMICs. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - GCH Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - R Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, USA
| | - B Oldenburg
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - JT Lee
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
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Singh SR, Srivastava A, Haldane V, Chuah FLH, Koh GCH, Seng Chia K, Legido-Quigley H. Community participation in health services development: A systematic review on outcomes. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- SR Singh
- National University of Singapore, Singapore
| | | | - V Haldane
- National University of Singapore, Singapore
| | - FLH Chuah
- National University of Singapore, Singapore
| | - GCH Koh
- National University of Singapore, Singapore
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Koh GCH, Shek LP, Kee J, Tai BC, Wee A, Ng V, Koh D. An association between floor vacuuming and dust-mite and serum eosinophil cationic protein in young asthmatics. Indoor Air 2009; 19:468-473. [PMID: 19682104 DOI: 10.1111/j.1600-0668.2009.00610.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Although vacuum cleaning is recommended to reduce allergen levels and improve asthma and allergic rhinitis symptoms, some studies suggest it may increase allergen load in homes. We conducted a cross-sectional study to determine if home floor vacuuming was associated with sensitization to dust-mites and cockroaches, and serum eosinophil cationic protein (ECP), a biomarker for atopy, in 102 physician-diagnosed spirometry-confirmed asthmatics. We collected data on floor type, floor cleaning method and frequency, asthma severity, allergy medications used, serum ECP and skin prick tests (SPT) to three dust-mites [Dermatophagoides pteronyssisinus (Der p), Dermatophagoides farinae (Der f) and Blomia tropicalis (Blo t)] and two cockroaches [Periplanata americana (Per a) and Blatella germanica (Bla g)]. Those who vacuumed had increased sensitization to three dust-mites [adjusted ORs (95%CI) = Der p: 26.6 (1.8-405.2); Der f: 44.8 (3.2-620.9); Blo t: 14.1 (1.8-108.1)] but not to cockroaches, adjusted for cleaning frequency and other methods of floor cleaning. Subjects who vacuumed their floor had higher levels of serum ECP than those who did not [adjusted median difference (95%CI): 9.4 (1.1-17.7)], adjusted for use of nasal corticosteroids among those with allergic rhinitis. Vacuuming is associated with increased sensitization to dust-mite allergens and higher serum ECP. PRACTICAL IMPLICATIONS We found an association between floor vacuuming and increased sensitization to dust-mite allergens and higher levels of an atopy biomarker. Current recommendations to use vacuuming to control allergen exposure and allergic conditions may need to be reconsidered until further studies are performed.
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Affiliation(s)
- G C H Koh
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Koh GCH, Wong TY, Cheong SK, Koh DSQ. Avian Influenza: a global threat needing a global solution. Asia Pac Fam Med 2008; 7:5. [PMID: 19014538 PMCID: PMC2588555 DOI: 10.1186/1447-056x-7-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 11/13/2008] [Indexed: 05/06/2023]
Abstract
There have been three influenza pandemics since the 1900s, of which the 1919-1919 flu pandemic had the highest mortality rates. The influenza virus infects both humans and birds, and mutates using two mechanisms: antigenic drift and antigenic shift. Currently, the H5N1 avian flu virus is limited to outbreaks among poultry and persons in direct contact to infected poultry, but the mortality rate among infected humans is high. Avian influenza (AI) is endemic in Asia as a result of unregulated poultry rearing in rural areas. Such birds often live in close proximity to humans and this increases the chance of genetic re-assortment between avian and human influenza viruses which may produce a mutant strain that is easily transmitted between humans. Once this happens, a global pandemic is likely. Unlike SARS, a person with influenza infection is contagious before the onset of case-defining symptoms which limits the effectiveness of case isolation as a control strategy. Researchers have shown that carefully orchestrated of public health measures could potentially limit the spread of an AI pandemic if implemented soon after the first cases appear. To successfully contain and control an AI pandemic, both national and global strategies are needed. National strategies include source surveillance and control, adequate stockpiles of anti-viral agents, timely production of flu vaccines and healthcare system readiness. Global strategies such as early integrated response, curbing the disease outbreak at source, utilization of global resources, continuing research and open communication are also critical.
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Affiliation(s)
- GCH Koh
- Community, Occupational and Family Medicine Department, Yong Loo Lin School of Medicine, Singapore
| | - TY Wong
- Community, Occupational and Family Medicine Department, Yong Loo Lin School of Medicine, Singapore
| | - SK Cheong
- Community, Occupational and Family Medicine Department, Yong Loo Lin School of Medicine, Singapore
| | - DSQ Koh
- Community, Occupational and Family Medicine Department, Yong Loo Lin School of Medicine, Singapore
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Saxena SK, Koh GCH, Ng TP, Fong NP, Yong D. Determinants of length of stay during post-stroke rehabilitation in community hospitals. Singapore Med J 2007; 48:400-7. [PMID: 17453097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Length of stay (LOS) in hospitals is the largest contributor of direct stroke care cost. Rehabilitation accounts for 16 percent of healthcare cost in the six-month post-stroke period. It is important to determine factors extending LOS in rehabilitation hospitals to identify focus areas of cost-control strategies. The aim of the study was to ascertain the predictors of LOS of post-stroke patients admitted into two community hospitals offering rehabilitation. METHODS An observational cohort study was conducted on 200 stroke patients admitted from acute hospitals into two community hospitals. Data collected included baseline sociodemographical variables, and the National Institute of Health Stroke Scale, Abbreviated Mental Test, Geriatric Depression Scale and Barthel Index were used to assess neurological impairment, cognitive impairment, depressive symptoms and functional disability, respectively. Medical complications (defined as new or exacerbated medical problems that generated additional physician evaluation, a change in medication or additional medical intervention), after patients were admitted to the community hospitals until discharged, were recorded. The outcome variables measured were length and cost of stay. RESULTS The mean LOS in our study was 34.4 (standard deviation [SD] 18.4) days, and the mean cost of hospital stay was S$2,410.83 (SD S$2,167.26). Length and cost of hospital stay were significantly correlated (r equals 0.52; p-value is less than 0.01). On multiple linear regression analysis, the significant variables positively associated with LOS were medical complications and functional dependence on admission. Significant variables negatively associated with LOS were unplanned discharge and recurrent strokes. CONCLUSION Medical complication is a key reversible determinant of increased LOS of post-stroke patients receiving rehabilitation in community hospitals. Strategies for prevention, early detection and treatment of medical complications during stroke rehabilitation are discussed.
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Affiliation(s)
- S K Saxena
- Department of Psychological Medicine, National University Hospital, Singapore 119074
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