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Prevalence of diabetes and ethnic differences in cardiovascular risk factors. The 1992 Singapore National Health Survey

Tan CE, Emmanuel SC, Tan BY, Jacob E

Diabetes Care, 1999 Feb;22(2):241-7.
PMID: 10333940 DOI: 10.2337/diacare.22.2.241

OBJECTIVE: The purpose of the 1992 Singapore National Health Survey was to determine the current distribution of major noncommunicable diseases and their risk factors, including the prevalence of diabetes and dyslipidemia, in Singapore.

RESEARCH DESIGN AND METHODS: A combination of disproportionate stratified sampling and systematic sampling were used to select the sample for the survey. The final number of respondents was 3,568, giving a response rate of 72.6%. All subjects fasted for 10 h and were given a 75-g glucose load, except those known to have diabetes. Blood was taken before and 2 h after the glucose load. Diagnosis of diabetes was based on 2-h glucose alone.

RESULTS: The age-standardized prevalence of diabetes in Singapore residents aged 18-69 years was 8.4%, with more than half (58.5%) previously undiagnosed. Prevalence of diabetes was high across all three ethnic groups. The prevalence of impaired glucose tolerance was 16.1%, that of hypertension was 6.5%, and 19.0% were regular smokers. The total cholesterol (mean +/- SD) of nondiabetic Singaporeans was 5.18 +/- 1.02 mmol/l; 47.9% had cholesterol > 5.2 mmol/l, while 15.4% had levels > 6.3 mmol/l. Mean LDL cholesterol was 3.31 +/- 0.89 mmol/l; HDL cholesterol was 1.30 +/- 0.32 mmol/l, and triglyceride was 1.23 +/- 0.82 mmol/l.

CONCLUSIONS: Prevalence of diabetes was high across all three ethnic groups. Ethnic differences in prevalence of diabetes, insulin resistance, central obesity, hypertension, smoking, and lipid profile could explain the differential coronary heart disease rates in the three major ethnic groups in Singapore.
Homeostasis model assessment in a population with mixed ethnicity: the 1992 Singapore National Health Survey

Tai ES, Lim SC, Chew SK, Tan BY, Tan CE

Diabetes Res Clin Pract, 2000 Aug;49(2-3):159-68.
PMID: 10963828 DOI: 10.1016/s0168-8227(00)00152-2

We studied insulin resistance and beta-cell function with reference to ethnic group, glucose tolerance and other coronary artery disease risk factors in a cross section of the Singapore population which comprises Chinese, Malays and Asian Indians. 3568 individuals aged 18-69 were examined. Blood pressure, anthropometric data, blood lipids, glucose and insulin were assayed in the fasting state. Glucose and serum insulin were measured 2 h after an oral glucose challenge. Insulin resistance and beta-cell function were calculated using homeostasis model assessment. Asian Indians had higher insulin resistance than Chinese or Malays. Impaired glucose tolerance (IGT) and diabetes mellitus (DM) were associated with greater insulin resistance and impaired beta-cell function compared to normal glucose tolerance (NGT). Insulin resistance was positively correlated with blood pressure in women and total cholesterol, LDL cholesterol and triglyceride in both men and women. It was negatively correlated with HDL cholesterol and LDL/apolipoprotein B ratio. beta-cell function showed no significant correlations with the cardiovascular risk factors studied. It appears that both impaired beta-cell function and insulin resistance are important for the development of hyperglycemia whereas insulin resistance alone seems more important in the development of coronary artery disease as it correlates with several known coronary artery disease risk factors.
Diabetes mellitus abolishes ethnic differences in cardiovascular risk factors: lessons from a multi-ethnic population

Tan CE, Emmanuel SC, Tan BY, Tai ES, Chew SK

Atherosclerosis, 2001 Mar;155(1):179-86.
PMID: 11223440 DOI: 10.1016/s0021-9150(00)00534-7

AIMS: To compare cardiovascular risk factors in diabetic subjects of different ethnic groups, and between new and known diabetic subjects, in the Singapore National Health Survey '92.

METHODS: Disproportionate stratified sampling followed by systematic sampling were used in 3568 (total) respondents of whom 2743 were non-diabetics, 179 newly diagnosed diabetics and 150 known diabetics. Amongst the diabetics, there were 185 Chinese, 66 Malays and 78 Asian Indians. Diagnosis of diabetes mellitus (DM) was based on the 2 h glucose alone, after a 75 g oral glucose tolerance test. Blood pressure (BP), lipid profile, glucose, insulin and anthropometric indices were obtained from all subjects.

RESULTS: Subjects with diabetes (new and known) exhibited significantly higher triglyceride (TG), lower high density lipoprotein cholesterol (HDL-C) and low density lipoprotein (LDL)/apolipoprotein B (apo B) ratio (LDL size) compared with normoglycaemic subjects. They were more obese (generalised and central) and had higher systolic and diastolic BP. There was no difference in lipid risk factors between the two groups with diabetes although those with new diabetes were more obese whilst those with known diabetes had higher fasting glucose. Amongst subjects with diabetes, there were no significant differences between ethnic groups in TG, HDL-C, LDL/apo B ratio, or waist to hip ratio (WHR). Female Malays with diabetes had higher total cholesterol and were more obese whilst male Asian Indians with diabetes had higher fasting insulin.

CONCLUSION: Asian Indians had lower HDL-C and LDL/apo B ratio than Chinese or Malays amongst normoglycaemic subjects. However, these differences between ethnic groups were not seen in subjects with DM.
Associations of diabetes mellitus and ethnicity with mortality in a multiethnic Asian population: data from the 1992 Singapore National Health Survey

Ma S, Cutter J, Tan CE, Chew SK, Tai ES

Am J Epidemiol, 2003 Sep 15;158(6):543-52.
PMID: 12965880 DOI: 10.1093/aje/kwg199

Despite the high prevalence of diabetes mellitus, little is known about mortality associated with diabetes in Asia. Therefore, the authors followed 3,492 Chinese, Malay, and Asian Indian adults randomly selected from the general population in Singapore. Data on glucose tolerance, demographic characteristics, and other cardiovascular disease risk factors (lipid profile, blood pressure, smoking status, alcohol consumption, and obesity) were obtained in 1992. Vital status was determined as of December 31, 2001. There were 108 deaths over a period of 9 years. Impaired fasting glycemia or impaired glucose tolerance (IFG/IGT) (hazard ratio (HR)=1.39, 95% confidence interval (CI): 0.84, 2.31) and diabetes mellitus (HR=2.49, 95% CI: 1.58, 3.94) were associated with increased mortality after adjustment for age, gender, ethnic group, and educational level. Compared with Chinese with diabetes, Indians with diabetes experienced significantly greater mortality (HR=3.86, 95% CI: 1.76, 8.44) after adjustment for gender, age, educational level, smoking, hypertension, alcohol intake, and obesity. Undiagnosed diabetes and IFG/IGT were more common than known diabetes and also were associated with increased mortality. For reduction of mortality associated with IFG/IGT and diabetes, the authors recommend a screening program to detect undiagnosed diabetes and IFG/IGT along with aggressive treatment of diabetes after diagnosis.
APOE polymorphism and lipid profile in three ethnic groups in the Singapore population

Tan CE, Tai ES, Tan CS, Chia KS, Lee J, Chew SK, et al.

Atherosclerosis, 2003 Oct;170(2):253-60.
PMID: 14612205

BACKGROUND: Serum lipid concentrations are modulated by environmental factors such as exercise, alcohol intake, smoking, obesity and dietary intake and genetic factors. Polymorphisms at the Apolipoprotein E (APOE) locus have consistently shown a significant association with total and LDL-cholesterol (LDL-C). However, their impact on HDL-cholesterol (HDL-C) may be population dependent. Having three major ethnic groups within a similar social environment allows us to study the role of genetics and their interactions with lifestyle factors on the serum lipid profile and coronary risk in Asians.
METHODS: This study included 1740 males (1146 Chinese, 327 Malays and 267 Asian Indians) and 1950 females (1329 Chinese, 360 Malays and 261 Asian Indians) with complete data on anthropometric indices, fasting lipids, smoking status, alcohol consumption, exercise frequency and genotype at the APOE locus.
RESULTS: Malays and Asian Indians were more obese compared with the Chinese. Smoking was uncommon in all females but Malay males had significantly higher prevalence of smokers. Malays had the highest LDL-C whilst Indians had the lowest HDL-C, The epsilon 3 allele was the most frequent allele in all three ethnic groups. Malays had the highest frequency of epsilon 4 (0.180 and 0.152) compared with Chinese (0.085 and 0.087) and Indians (0.108 and 0.075) in males and females, respectively. The epsilon 2 allele was the least common in Asian Indians. Total cholesterol (TC) and LDL-C was highest in epsilon 4 carriers and lowest in epsilon 2 carriers. The reverse was seen in HDL-C with the highest levels seen in epsilon 2 subjects. The association between ethnic group and HDL-C differed according to APOE genotype and gender. Asian Indians had the lowest HDL-C for each APOE genotype except in Asian Indian males with epsilon 2, where HDL-C concentrations were intermediate between Chinese and Malays.
CONCLUSION: Ethnic differences in lipid profile could be explained in part by the higher prevalence of epsilon 4 in the Malays. Ethnicity may influence the association between APOE genotypes and HDL-C. APOE genotype showed no correlation with HDL-C in Malay males whereas the association in Asian Indians was particularly marked. Further studies of interactions between genes and environmental factors will contribute to the understanding of differences of coronary risk amongst ethnic groups.
Dietary fat interacts with the -514C>T polymorphism in the hepatic lipase gene promoter on plasma lipid profiles in a multiethnic Asian population: the 1998 Singapore National Health Survey

Tai ES, Corella D, Deurenberg-Yap M, Cutter J, Chew SK, Tan CE, et al.

J Nutr, 2003 Nov;133(11):3399-408.
PMID: 14608050 DOI: 10.1093/jn/133.11.3399

We have previously reported an interaction between -514C>T polymorphism at the hepatic lipase (HL) gene and dietary fat on high-density lipoprotein-cholesterol (HDL-C) metabolism in a representative sample of white subjects participating in the Framingham Heart Study. Replication of these findings in other populations will provide proof for the relevance and consistency of this marker as a tool for risk assessment and more personalized cardiovascular disease prevention. Therefore, we examined this gene-nutrient interaction in a representative sample of Singaporeans (1324 Chinese, 471 Malays and 375 Asian Indians) whose dietary fat intake was recorded by a validated questionnaire. When no stratification by fat intake was considered, the T allele was associated with higher plasma HDL-C concentrations (P = 0.001), higher triglyceride (TG) concentrations (P = 0.001) and higher HDL-C/TG ratios (P = 0.041). We found a highly significant interaction (P = 0.001) between polymorphism and fat intake in determining TG concentration and the HDL-C/TG ratio (P = 0.001) in the overall sample even after adjustment for potential confounders. Thus, TT subjects showed higher TG concentrations only when fat intake supplied >30% of total energy. This interaction was also found when fat intake was considered as continuous (P = 0.035). Moreover, in the upper tertile of fat intake, TT subjects had 45% more TG than CC individuals (P < 0.01). For HDL-C concentration, the gene-diet interaction was significant (P = 0.015) only in subjects of Indian origin. In conclusion, our results indicate that there are differences in the association of -514C>T polymorphism with plasma lipids according to dietary intake and ethnic background. Specifically, the TT genotype is associated with a more atherogenic lipid profile when subjects consume diets with a fat content > 30%.
Fulltext Do Singapore patients require lower doses of statins? The SGH Lipid Clinic experience

Tan CE, Loh LM, Tai ES

Singapore Med J, 2003 Dec;44(12):635-8.
PMID: 14770258

A substantial number of physicians in Asian countries believe that Asian patients need lower doses of statins to achieve therapeutic lipid target because of the smaller size of patients. This belief is deep rooted and we looked at the SGH Lipid Clinic to determine if our experience bears out this belief. Between 1996 and August 2000, the Lipid Unit treated a total of 841 patients, of which 548 patients (77.5% Chinese, 12.1% Malays, 7.6% Asian Indians; 49.6% males, 50.4% females; 54.7% diabetics, 45.3% non-diabetic) were on statins alone. These patients had > or =2 coronary risk factors, diabetes mellitus or documented coronary heart disease. The pre-treatment lipid levels or the worst lipid levels available were entered as the baseline lipid values (mean LDL-C: 5.38+1.5 mmol/l). Duration of therapy ranged from six months to five years. The choice and titration of statins were determined by attending physicians. The median statin dose (Simvastatin equivalent) was 20.0 mg with 52.5% requiring 20 mg or more. Statin dose did not differ between diabetic and non-diabetic subjects. The median statin dose was 15 mg for the lower two tertiles and 20 mg for the upper tertile; this difference did not achieve statistical significance. The reduction in LDL cholesterol was 41.5% (40.1-42.8) and total cholesterol was 33.0% (32.9-34.1). Only 25% of our patients achieved LDL cholesterol of less than 2.6 mmol/l whilst 77.5% had LDL cholesterol less than 3.4 mmol/l. Our experience at the Lipid Clinic suggests that the Asian patients require similar statin doses to achieve target cholesterol levels.
The metabolic syndrome in Chinese, Malays and Asian Indians. Factor analysis of data from the 1998 Singapore National Health Survey

Ang LW, Ma S, Cutter J, Chew SK, Tan CE, Tai ES

Diabetes Res Clin Pract, 2005 Jan;67(1):53-62.
PMID: 15620434 DOI: 10.1016/j.diabres.2004.05.003

We used factor analysis to define and compare the manner in which the various features of the metabolic syndrome are linked or clustered in Chinese, Malays and Asian Indians. One thousand nine hundred and fifty seven men (1324 Chinese, 391 Malays and 261 Asian Indians) and 2308 women (1622 Chinese, 391 Malays and 296 Asian Indians) were examined. Anthropometry, blood pressure, serum glucose, lipid concentrations, and serum insulin were measured for all subjects. These data were then subjected to factor analysis which reduced the variables examined to three factors in all ethnic groups and both genders. The first (dyslipidemia) factor was positively loaded for obesity, insulin resistance (IR), fasting triglyceride and negatively loaded for HDL-cholesterol. The second (hyperglycemia) factor was positively loaded for IR and blood glucose. The third (hypertension) factor was positively loaded for obesity and blood pressure. IR was positively loaded in the hypertension factor in Malay women but not in others. Rather than a single entity causally associated with insulin resistance (IR), our findings support a concept in which the metabolic syndrome represents several distinct entities (dyslipidemia, hypertension and hyperglycemia). It appears that Malay females may be more prone to develop hypertension in association with IR.
Intragenic linkage disequilibrium structure of the human perilipin gene (PLIN) and haplotype association with increased obesity risk in a multiethnic Asian population

Qi L, Tai ES, Tan CE, Shen H, Chew SK, Greenberg AS, et al.

J Mol Med (Berl), 2005 Jun;83(6):448-56.
PMID: 15770500

Perilipin is a lipid droplet surface protein present in adipocytes and steroidogenic cells. We examined five common single nucleotide polymorphisms (SNPs) at the perilipin (PLIN) locus (PLIN 6209C>T, 10171A>T, 11482G>A, 13041A>G, and 14995A>T) to investigate their association with obesity risk. The study population included 4,131 subjects of three ethnic groups (Chinese, Malay, and Indian) from Singapore. The prevalence of obesity in Malays and Indians was much higher than in Chinese. Moreover, in these groups the prevalence of obesity was three times higher in women than in men. Crude analysis indicated that haplotype 11212 (CAAAT) is shared by Malays and Indians and is significantly associated with increased obesity risk as compared to the most common haplotype 21111 (TAGAA): OR 1.65 (95% CI 1.11-2.46) in Malays and 1.94 (95% CI 1.06-3.53) in Indians. No associations between PLIN haplotypes and obesity risk were found in Chinese. To simplify the haplotype analyses we used a subgroup of three SNPs (11482G>A, 13041A>G, and 14995A>T) in positive linkage disequilibrium. These analyses revealed similar associations, showing that haplotypes XX212 (XXAAT) and XX222 (XXAGT) are associated with increased obesity risk in Malays OR 2.04 (95% CI 1.28-3.25) and 2.05 (95% CI 1.35-3.12) respectively, and that haplotype XXX212 (XXAAT) is significantly associated with increased obesity risk in Indians OR 2.16 (95% CI 1.10-4.26) after adjusting for covariates including age, sex, smoking, alcohol consumption, exercise, and diabetes status. Moreover, individual SNP analyses demonstrated that the PLIN 14995A>T SNP is the most informative single genetic marker for the observed haplotype association, being significantly associated with increased obesity risk in both Malays OR 2.28 (95% CI 1.45-3.57) and Indians OR 2.04 (95% CI 1.08-3.64). These results support the role of the PLIN locus as an ethnically dependent modulator of obesity risk in humans.
Uncoupling protein 2 promoter polymorphism -866G/A, central adiposity, and metabolic syndrome in Asians

Shen H, Qi L, Tai ES, Chew SK, Tan CE, Ordovas JM

Obesity (Silver Spring), 2006 Apr;14(4):656-61.
PMID: 16741267

A polymorphism in the promoter region of uncoupling protein 2 gene -866G/A has been associated with its expression levels in adipose tissue, the risk of obesity, and metabolic abnormalities. Our purpose was to examine the associations of -866G/A with body fat and the risk of metabolic syndrome in a random sample of 4018 Asians (1858 men and 2160 women) from three ethnic groups (Chinese, Malay, and Indian). The minor allele frequency of -866G/A polymorphism in South Asians was similar to that in whites. After adjustment for covariates including age, cigarette smoking, and physical activity, the -866A/A genotype was associated with higher waist-to-hip ratio as compared with the wild-type genotype in Chinese and Indian men (p = 0.018 and p = 0.046, respectively). Moreover, Indian men with -866A/A genotype had a significantly increased risk of metabolic syndrome as compared with those homozygous for the wild-type (odds ratio, 2.66; 95% confidence interval, 1.21 to 5.88; p = 0.015). Such a risk was mainly caused by the excess presence of hypertriglyceridemia and central obesity. Our findings indicate that the uncoupling protein 2 gene -866G/A polymorphism may increase the risks of central obesity and metabolic syndrome, with greater effects on Asian men.
Fulltext Palliative care for a child: role of a primary care doctor

Tan CE, Md Radzniwan R, Khairani O, Ednin H

Malays Fam Physician, 2011;6(1):26-28.
PMID: 25606216 MyJurnal

A 7-year-old boy with a diagnosis of advanced medulloblastoma refractory to treatment was discharged from hospital for further palliative care at home. During this short and eventful period, the child developed spinal cord compression with progressive weakness of upper and lower limbs, neck pain, faecal and urinary incontinence. This case highlights the important roles of a primary care doctor in the provision of palliative care for a child in the community.
Fulltext Chronic kidney disease stage 3B among Malaysian diabetics in primary care and its associated factors: a pilot 5-year case control study

Tan CE, Tohit N, Shamsul Azhar S, Lee CC, Mohd Ridzuan AR, Siti Rahimah S, et al.

Medicine & Health, 2013;8(2):55-63.
MyJurnal

The present study aimed to determine the factors associated with CKD stage 3b among type 2 diabetics attending primary care follow-up, specifically the role of angiotensin blockade dosage. This was a pilot unmatched case-control study conducted in a teaching primary care centre. Clinical data of 25 cases of diabetic patients with CKD stage 3b (GFR 30-45ml/min/1.73m2) in 2012 were selected for this study, as well as 103 controls who were diabetic patients with GFR more than 45ml/min/1.73m2 in 2012. Systematic random sampling was employed. Data was obtained from patients’ diabetic records, computerised clinical medical information system and medical case notes. Univariate analysis was done using Chi-square, t-test, Fisher’s exact test and Mann-Whitney U-test. Multiple logistic regression was used to determine the associated factors for development of CKD stage 3b. Cases and controls were different in terms of age, duration of diabetes, use and dosage of angiotensin blockade medications, systolic blood pressure and baseline GFR. Multiple logistic regression revealed that systolic blood pressure (Adjusted OR= 1.08, 95% CI= 1.02-1.14, p=0.013) and baseline GFR (Adjusted OR= 0.90, 95% CI= 0.85-0.95, p
Fulltext Generalised pruritus as a presentation of Grave's disease

Tan CE, Loh KY

Malays Fam Physician, 2013;8(1):20-3.
PMID: 25606263 MyJurnal

Pruritus is a lesser known symptom of hyperthyroidism, particularly in autoimmune thyroid disorders. This is a case report of a 27-year-old woman who presented with generalised pruritus at a primary care clinic. Incidental findings of tachycardia and a goiter led to the investigations of her thyroid status. The thyroid function test revealed elevated serum free T4 and suppressed thyroid stimulating hormone levels. The anti-thyroid antibodies were positive. She was diagnosed with Graves' disease and treated with carbimazole until her symptoms subsided. Graves' disease should be considered as an underlying cause for patients presenting with pruritus. A thorough history and complete physical examination are crucial in making an accurate diagnosis. Underlying causes must be determined before treating the symptoms.
Fulltext Comprehensive Healthcare module: medical and pharmacy students' shared learning experiences

Tan CE, Jaffar A, Tong SF, Hamzah MS, Mohamad N

Med Educ Online, 2014 Jan;19(1):25605.
PMID: 28440130 DOI: 10.3402/meo.v19.25605

Introduction The Comprehensive Healthcare (CHC) module was developed to introduce pre-clinical medical and pharmacy students to the concept of comprehensive healthcare. This study aims to explore their shared learning experiences within this module. Methodology During this module, medical and pharmacy students conducted visits to patients' homes and to related community-based organisations in small groups. They were required to write a reflective journal on their experiences regarding working with other professions as part of their module assessment. Highly scored reflective journals written by students from the 2011/2012 academic session were selected for analysis. Their shared learning experiences were identified via thematic analysis. We also analysed students' feedback regarding the module. Results Analysis of 25 selected reflective journals revealed several important themes: 'Understanding of impact of illness and its relation to holistic care', 'Awareness of the role of various healthcare professions' and 'Generic or soft skills for inter-professional collaboration'. Although the primary objective of the module was to expose students to comprehensive healthcare, the students learnt skills required for future collaborative practice from their experiences. Discussion The CHC module provided early clinical exposure to community-based health issues and incorporated some elements of inter-professional education. The students learnt about the roles of other healthcare professions and acquired soft skills required for future collaborative practice during this module.
Insertional torque and pullout strength of pedicle screws with or without repositioning: a porcine study

Tan CE, Fok MW, Luk KD, Cheung KM

J Orthop Surg (Hong Kong), 2014 Aug;22(2):224-7.
PMID: 25163961

PURPOSE. To evaluate the insertion torque and pullout strength of pedicle screws with or without repositioning. METHODS. 20 fresh porcine lumbar vertebrae of similar size were used. The entry point was at the site just lateral and distal to the superior facet joint of the vertebra, and to a depth of 35 mm. A 6.2-mm-diameter, 35-mm-long pedicle screw was inserted parallel to the superior end plate on one side as control. On the other side, an identical screw was first inserted 10º caudal to the superior end plate, and then repositioned parallel to the superior end plate. The insertional torque and pullout strength were measured. RESULTS. Three of the specimens were excluded owing to pedicle fractures during the pullout test. Repositioned pedicle screws were significantly weaker than controls in terms of the maximum insertional torque (3.20 ± 0.28 vs. 2.04 ± 0.28 Nm, 36% difference, p<0.01) and pullout strength (1664 ± 378 vs.1391 ± 295 N, p<0.01). CONCLUSION. Repositioning pedicle screws should be avoided, especially when the pedicle wall is breached. If repositioning is deemed necessary, augmentation with polymethyl methacrylate or a screw with a larger diameter should be considered.
Fulltext Intention to seek medical consultation for symptoms of upper respiratory tract infection – a cross-sectional survey

Tan CE, Mohd Roozi AH, Wong WHR, Sabaruddin SAH, Ghani NI, Che Man Z

International Medical Journal Malaysia, 2015;14(2):9-16.
MyJurnal

Introduction: The common cold is the commonest reason for primary care encounters worldwide. This paper aims to describe the reasons that influence patients to seek medical consultation for the common cold.
Methods: This was a cross-sectional survey conducted among adult patients of an urban teaching primary care clinic. An adapted bilingual survey form was administered by the researchers to obtain data regarding their decision to seek medical consultation for a cold and the reasons for their decision. Quantitative analyses were done to describe the close-ended responses. Open-ended responses were analysed using a qualitative approach and
the frequencies of the themes were reported. Results: A total of 320 respondents participated in this study, with a response rate of 91.4%. They were predominantly females (59.4%), Malay (70.9%), and had tertiary education (65.9%). More than half of the patients (52.5%) said they would seek consultation for cold symptoms. Fever was the commonest symptom (57-61%) which compelled them to seek consultation. The commonest reason for seeking consultation was to get medications (41.7%), whereas the commonest reason not to seek consultation was the practice of self-medication (44.2%). Ethnicity was found to be significantly associated with the decision to seek doctor’s consultation.
Conclusion: Colds are usually self-limiting and do not result in complications. Empowering
patients by providing appropriate self-care knowledge can help to reduce the burden of primary care services.
Patients should be taught about red flag symptoms as well as drug safety for medications commonly taken for
colds.
Keywords: Upper respiratory tract infections, patient acceptance of health care, primary health care.
Fulltext Patients' perceptions of participation in educational home visits

Jaffar A, Tan CE, Hamzah Z, Mohd Hashim S, Mohd Tohit N

Educ Health (Abingdon), 2016;29(1):63-4.
PMID: 26996805 DOI: 10.4103/1357-6283.178930
Fulltext Exploring patients' reasons for participation in a medical education home visit program: a qualitative study in Malaysia

Tan CE, Jaffar A, Tohit N, Hamzah Z, Hashim SM

Perspect Med Educ, 2017 Jun;6(3):182-188.
PMID: 28386758 DOI: 10.1007/s40037-017-0353-1

INTRODUCTION: Direct contact with patients for medical education is essential in healthcare professional training. Patients who were recruited for a medical education home visit program in Malaysia did so on a voluntary basis without remuneration. This paper aims to explore their reasons for participation in this program.
METHODS: An exploratory qualitative study was conducted on patients who had been visited during the 2012/2013 academic session. Purposive sampling was done to select adult participants from varying ethnicities and ages from the list of patients. In-depth interviews were conducted at the participants' homes and were audio recorded. The transcripts of these interviews were analyzed using thematic analysis.
RESULTS: A total of nine in-depth interviews were conducted. Four main themes were identified from thematic analysis: 1) Perceived meaning of the visit; 2) Perceived benefits and risks; 3) Past healthcare experiences; 4) Availability for visits. The home visits meant different things to different participants, including a teaching-learning encounter, a social visit, a charitable deed or a healthcare check-up. The benefits and risks of accepting unknown students to their homes and sharing their health issues with them had been weighed prior to participation. Prior experience with healthcare services such as gratitude to healthcare providers or having a relative in the healthcare profession increased their receptivity for involvement. Lastly, enabling factors such as availability of time would determine their acceptance for home visits.
DISCUSSION: Patients agree to participate in medical education activities on a voluntary basis for various reasons. Providing good healthcare service and sufficient preparation are crucial to increase patient receptivity for such activities.
Social support, self-efficacy and their correlation among patients with Type 2 Diabetes Mellitus: A primary care perspective

Rashid AA, Zuhra H, Tan CE

Med J Malaysia, 2018 08;73(4):197-201.
PMID: 30121681 MyJurnal

INTRODUCTION: Social support and self-efficacy are factors that influence patients' health behaviour. However, the relationship between these two factors among patients with Type 2 Diabetes Mellitus (T2DM) has not been adequately explored. This study aims to report social support and selfefficacy of Malaysian T2DM patients, and their correlations.
METHODS: This cross-sectional questionnaire study involved 329 patients with T2DM who received their follow up at a public primary care clinic. Patients were selected via systematic random sampling. Patients self-completed locally adapted versions of the Medical Outcomes Study (MOS) Social Support Survey and Diabetic Management Self Efficacy Scale (DMSES). The scores of both tools were analysed to determine the association and correlation between social support and self-efficacy.
RESULTS: The mean score for overall social support was 72.7±21.40 score range (0-100). "Affectionate support" was rated the highest averaged mean score at 78.31±23.71 (score range: 0-100). The mean DMSES score was 147.6±35.5 (score range :0-200), of which "medications" subscale was rated the highest with averaged mean scores 9.07±1.67 (score range: 0-10). Overall social support and self-efficacy were found to be weakly correlated (r=0.197, p<0.001). However, all subscales of social support were moderately correlated with "medications" subscale of self-efficacy.
CONCLUSION: Social support is significantly associated with patients' self-efficacy in handling their own medications.
Fulltext Knowledge and Concerns of Parents Regarding Childhood Fever at a Public Health Clinic in Kuching, East Malaysia

Bong WT, Tan CE

Open Access Maced J Med Sci, 2018 Oct 25;6(10):1928-1933.
PMID: 30455776 DOI: 10.3889/oamjms.2018.339

BACKGROUND: Parental anxiety regarding fever may be unwarranted as most cases are owing to self-limiting causes.
AIM: To assess the level of knowledge and concerns regarding childhood fever among parents with young children in a public health clinic in Kuching, East Malaysia.
METHODS: This cross-sectional study was conducted among parents recruited from a maternal and child health clinic, with children aged 6 months to 6 years. The participants completed a self-administered questionnaire regarding their knowledge and concerns about childhood fever. Descriptive statistical analyses were performed, and associations between dependent and independent variables were determined.
RESULTS: Only 26.1% of participants were found to have good knowledge. Knowledge regarding childhood fever was significantly associated with parent's ethnicity, education level, and household income. About 72% of parents were always worried about their child's illness. Three major reasons for their concerns were persistently rising temperature; discomfort caused by the fever, and feared complications of fever.
CONCLUSION: Excessive parental anxiety due to poor knowledge and misconceptions about fever may lead to poor quality of life and inappropriate management of fever. Healthcare providers may help by educating parents about fever and serious signs that indicate the need to seek healthcare advice.

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