OBJECTIVES: To assess the validity, feasibility and acceptability of standard gamble (SG) and time trade-off (TTO) assessments in a multiethnic Asian population.
METHODS: Through in-depth interviews performed among Chinese, Malay, and Indian Singaporeans (education >or= 6 years), we assessed validity of SG/TTO methods for eliciting health preferences by hypothesizing that 1) SG/TTO scores for three hypothetical health states (HS) would exhibit ranked order (decreasing scores with worse HS); and 2) more subjects would rate the most severe HS as worse than dead. Subjects also evaluated feasibility and acceptability of SG/TTO using a 10-point visual analog scale (VAS) and open-ended questions. Ratings were compared using Kruskal-Wallis, Wilcoxon signed-rank tests or tests of proportions.
RESULTS: VALIDITY: In 62 subjects (90% response rate), as hypothesized, SG and TTO scores exhibited ranked order with increasing HS severity (SG: 0.85, 0.08, -19.00; TTO: 0.85, 0.00, -0.18). More subjects rated the most severe HS as worse than dead (SG: 8%, 39%, 59%; TTO: 8%, 45% and 62%).
FEASIBILITY: Subjects felt SG and TTO were easy to understand (median VAS scores: 8.0 vs. 8.0, P = 0.87) and to complete (8.0 vs. 8.0, P = 0.84). Acceptability: SG and TTO were well accepted, with TTO less so than SG (median [interquartile range] offensiveness: 2.0 [0, 4.0] vs. 2.0 [0, 3.0], P = 0.045). Overall, subjects did not have a clear preference for SG/TTO (50% vs. 45%, P = 0.70).
CONCLUSIONS: This study suggests the validity, feasibility and acceptability of SG and TTO for population-based HS valuation studies in a multiethnic Asian population.
Objectives: The current study aimed to determine the prevalence of Complementary and Alternative Medicines (CAM) and its types used in diabetes patients in Quetta, Pakistan.
Methods: A cross-sectional study was undertaken with diabetes patients, attending different government and private hospitals and clinic of Quetta city, Pakistan. A self-administered questionnaire containing 16 questions (5 questions related with disease and remaining questions were for information regarding CAM use). Descriptive statistics were applied to evaluate the patient’s demographics. Inferential statistics were used to fine the association between demographics characteristics and CAM (p<0.05).
Results: A total of 500 questionnaires were distributed and 451 were returned (with response rate of 90.2%). Out of 451 patients 148 (32.8%) used CAM for the diabetes treatment, out of which 87 (58.8%) were females and 61 (41.2%) were males. Most of the participants were uneducated 51 (34.5%) and belongs to large families 89 (60.1%). Fifty (33.8%) participants were using mind body intervention, followed by alternative medical system (33.1%) and herbal products (31.8%) respectively for treatment of diabetes. Type of family, monthly income and per month medicine cost were significant associated (p<0.05) with CAM use.
Conclusions: The current study indicated that diabetes patients used mind body intervention, alternative medical system and herbal products are the most common CAM type used for diabetes control. Further research is recommended to evaluate the diabetes control in patients with CAM used.
Widespread evidence has demonstrated the negative effects of tobacco smoking in patients with diabetes. Although many studies have explored the prevalence of tobacco smoking in the general population, data are lacking regarding its prevalence in a specific population with a chronic disease such as diabetes.
Objectives: This study aims to determine the prevalence of tobacco smoking among patients with diabetes in Hospital Pulau Pinang, Malaysia.
Methods: A cross-sectional survey was conducted to study diabetic patients who attended the endocrine clinic at Hospital Pulau Pinang in Malaysia from March to August 2012. All the diabetic patients who attended the endocrine clinic during that period were asked about their smoking status, and their medical records were reviewed. A total of 1,118 patients with diabetes were reviewed to determine the prevalence of tobacco smoking in diabetic patients at the endocrine clinic of Hospital Pulau Pinang.
Results: The majority of the study population was male, with Malay and Chinese patients in almost equal proportions and a smaller proportion of Indian patients. Most of these patients had started smoking before they were diagnosed with diabetes. Among the 1,118 diabetic patients, only 108 patients smoked; therefore, the prevalence of tobacco smoking in our patients with diabetes was 9.66%.
Conclusions: A low prevalence of tobacco smoking was estimated in this study. This prevalence is close to the corresponding value in the general population in Malaysia.
Study site: Endocrine clinic, Hospital Pulau Pinang, Malaysia
Objectives: To assess the feasibility of a computer-based Standard Gamble (SG) visual prop whilst measuring utilities of different asthma health states at the same time.
Methods: Twenty adult asthma patients literate in either Malay or English language were conveniently sampled from a public hospital in Penang, Malaysia. They were interviewed by two trained interviewers using a bilingual script. Each patient was requested to value the given health states using Visual Analogue Scale (VAS) prior to SG exercise. There were three chronic health states (C1-C3) for 10 years, three temporary states (T1-T3) for 3 months, and two anchor states (healthy and dead). During the SG exercise, the visual prop was fully operated by the interviewers. The probability of being in a worse state was changed in a ‘ping-pong’ fashion until the indifference point was reached.
Results: All patients understood the SG exercise and rated SG easier than VAS. Around 85% (n=17) completed SG within 30 minutes. There was 90% (n=18) who ranked T3 as the worst temporary health state during VAS. Two patients provided logical inconsistency data in SG. The preferences by SG were higher than VAS. Preferences were also higher in temporary states measured by chained SG than other states by conventional SG. The mean utilities for C1=0.56 (SD 0.38), C2=0.47 (SD 0.33), C3=0.53 (SD 0.38), T1=0.65 (SD 0.31), T2=0.53 (SD 0.35), and T3=0.38 (SD 0.38).
Conclusions: The SG methods including the props are feasible for utilities measurement in asthma, based on the agreements achieved with other studies on the pattern of utilities measured in this preliminary study.
Conference abstract:
Objectives: The aim of the study was to explore the association of waist circumference with glycaemic control in Malaysian patients with type 2 diabetes.
Methods: We utilised data of type 2 diabetes patients followed up in Malaysian public sector primary care clinics contained in the National Diabetes Registry in the year 2012. The variable of interest was poor glycaemic control, defined as HbA1c≥ 6.5%. Multiple logistic regression was used to explore the association between glycaemic control and waist circumference, which was adjusted for age, sex, duration of diabetes, systolic blood pressure, total cholesterol, use of insulin and other medications.
Results: A total of 98,825 patients with type 2 diabetes were included in the study. The mean age of patients was 59.9 years (SD: 10.9) and 38.9% were males. The mean duration of diabetes was 6.8 years (SD: 5.0) and 76.2% of patients had HbA1c ≥ 6.5%. The mean waist circumference was 94.0 cm (SD: 11.8) for male and 90.7 cm (SD: 11.8) for female; while 78.3% of the patients had waist circumference above the cut-off (≥ 90 cm for men and ≥ 80 cm for women). Larger waist circumference was found to be significantly associated with HbA1c≥ 6.5% (adj. OR 1.009; p< 0.001; 95% CI: 1.007–1.011) after adjusting for confounding factors.
Conclusions: Analysis showed that glycaemic control was poorer in patients with higher waist circumference than in patients with lower waist circumference.
Conference abstract:
Objectives: The aim of the study was to explore the association of waist circumference with microvascular complications in Malaysian patients with type 2 diabetes.
Methods: We utilised data of type 2 diabetes patients followed up in Malaysian public sector primary care clinics contained in the National Diabetes Registry in the year 2012. Variables of interest were the presence of microvascular complications, namely nephropathy and retinopathy. Multiple logistic regression was used to explore the association between presence of microvascular complications and waist circumference, which was adjusted for age, sex, duration of diabetes, systolic blood pressure, insulin use, total cholesterol and HbA1c.
Results: A total of 114,719 patients with type 2 diabetes were included in the study. The mean age of patients was 59.8 years (SD: 11.2) with mean duration of diabetes of 6.8 years (SD: 5.1). Male
patients comprised 39.9% of the sample population and 83.5% of the patients were overweight with BMI ≥ 23 kg/m2. Nephropathy and retinopathy was present in 9.1% and 7.9% of patients respectively. The mean waist circumference was 94.1 cm (SD: 11.8) for males and 90.8 cm (SD: 11.8) for females; while 78.4% of the patients had waist circumference above the cut off (≥ 90 cm for men and ≥ 80 cm for women). Larger waist circumference was found to be significantly associated with nephropathy (adj. OR 1.005; p-value< 0.001; 95% CI: 1.003–1.008) after adjusting for confounding factors. However, waist circumference was not significantly associated with retinopathy (adj. OR 0.998; p= 0.209; 95% CI: 0.996–1.001).
Conclusions: Analysis showed that patients with higher waist circumference were more likely to have nephropathy than patients with lower waist circumference. The analysis also showed that waist circumference was not associated with retinopathy in the study population.
To evaluate the association between body mass index (BMI) and health-related quality of life (HRQoL) in a multiethnic Asian population in Singapore, and to explore if the World Health Organization (WHO) recommendation of alternative BMI cutoffs for Asians could be further strengthened by evidence of higher risk of impaired HRQoL using these criteria.
Conference abstract;
Objectives: Warfarin use in atrial fibrillation has been established for preventing occurrence of stroke in patients with atrial fibrillation. However, safety and clinical monitoring of warfarin use is crucial due to its risk of bleeding complications. This study aims to compare and establish relation of time in therapeutic range (TTR) of warfarin in patients with atrial fibrillation in the first 6 months and 6 month thereafter of anticoagulation therapy.
Methods: This is a retrospective study carried out at a tertiary-care hospital with anticoagulation clinic in the state of Selangor, Malaysia. Data collected included patients’ demographics, co-morbidities, and international normalized ratio (INR). TTR were determined using Rosendaal method based on records found in database (INR Desk 4.0 system) and patients’ hemorrhage events were also recorded. Samples of the study were patient who started warfarin from January 2009 until March 2013.
Results: A total of 167 patients with atrial fibrillation were enrolled and only 6% (n=10) achieved TTR of more than 75% for the first 6 months of warfarin use as compared to 16.8% (n=28) of TTR more than 75% 6 months thereafter. As for bleeding incidences, 29% (n=45) of patients in the group of TTR less than 75% in the first 6 months had bleeding complications as compared to 18.7% (n=26) in patients of TTR less than 75% 6 months after.
Conclusions: A more regular follow up is necessary during the first 6 months of new warfarin users as they tend to be out of the TTR and have a higher bleeding risk.
Study site: anticoagulation clinic, tertiary hospital, Selangor, Malaysia