RESUMEN
This study seeks to understand the knowledge/utilisation of osteoporosis guidelines among PCPs in Singapore, their confidence in and barriers to osteoporosis management. Knowledge and usage of guidelines was associated with confidence in management. Effective guideline adoption is therefore crucial. PCPs also need systemic support to overcome barriers to osteoporosis care. PURPOSE: Primary care physicians (PCPs) are at the forefront of offering osteoporosis screening and treatment. However, osteoporosis remains under-treated in primary care, despite the existence of osteoporosis clinical practice guidelines for PCPs. This study aims to determine the self-reported knowledge and utilisation of local osteoporosis guidelines and associated sociodemographic factors and to determine the confidence and barriers to osteoporosis screening and management among PCPs in Singapore. METHODS: An anonymous web-based survey was conducted. PCPs in public and private practice were invited to participate in the self-administered survey via e-mail and messaging platforms. Chi-square test was performed for bivariate analysis; multivariable logistic regression models were used for factors with p value < 0.2. RESULTS: Three hundred thirty-four complete survey datasets were processed for analysis. Two hundred fifty-one PCPs (75.1%) had read the osteoporosis guidelines. 70.5% self-reported good knowledge, and 74.9% use the guidelines. PCPs who self-reported good guideline knowledge (OR = 5.84; 2.96-11.49) and utilisation (OR = 4.54; 2.21-9.34) were more likely to perceive confidence in osteoporosis management. PCPs' perception that patients had other medical priorities during the consultation (79.3%) was the commonest barrier to screening. Limited anti-osteoporosis medication (54.1%) in the practice was a hindrance to management. Polyclinic-based PCPs frequently cited the lack of consultation time as a barrier; more systemic barriers were faced by PCPs in private practices. CONCLUSION: Most PCPs know and use the local osteoporosis guidelines. Knowledge and usage of guidelines was associated with confidence in management. Strategies to address the prevalent barriers to osteoporosis screening and management faced by PCPs are needed.
Asunto(s)
Osteoporosis , Médicos de Atención Primaria , Humanos , Singapur/epidemiología , Encuestas y Cuestionarios , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Actitud del Personal de Salud , Accesibilidad a los Servicios de SaludRESUMEN
INTRODUCTION: Hypertension and dyslipidaemia are major risk factors for cardiovascular diseases and achieving treatment goals mitigates such risks. This study determined demographic and medication-related factors associated with blood pressure (BP) goal attainment in patients with concomitant hypertension and dyslipidaemia. METHODS: This paper is a sub-analysis of the Lipid HEALTH study, a questionnaire survey focusing on adult Asian patients with both dyslipidaemia and hypertension. An interviewer-administered questionnaire was used to obtain demographic and clinical information. Laboratory and prescription data was retrieved from electronic health records. BP goals were defined by international guidelines. Data was audited and analysed, and logistic regression analysis was used to identify factors determining BP goal attainment. RESULTS: Among the 851 included patients, 49.7% attained their BP goals. 37.0% were on monotherapy, 57.6% on ≥ 2 BP-lowering medications, and 5.4% had no pharmacologic treatment. Among those on pharmacotherapy, 51.2% failed to achieve BP goals. Calcium channel blockers were the most frequently prescribed medications. Attainment of BP goals was significantly associated with: not having Type 2 diabetes mellitus (odds ratio [OR] 2.27, 95% confidence interval [CI] 1.61-3.13); attaining low-density lipoprotein cholesterol goal (OR 2.02, 95% CI 1.45-2.81); being solely on dietary control (OR 2.19, 95% CI 1.09-4.39); and receiving monotherapy (OR 1.71, 95% CI 1.18-2.48). CONCLUSION: BP treatment goals were attained by half of the patients with dyslipidaemia and hypertension, and half of those on pharmacotherapy. Type 2 diabetes mellitus and low-density lipoprotein cholesterol control were significantly associated with BP goal attainment.
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Diabetes Mellitus Tipo 2 , Dislipidemias , Hipertensión , Adulto , Presión Sanguínea , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Objetivos , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Atención Primaria de SaludRESUMEN
STUDY DESIGN: Cross-cultural adaptation and psychometric evaluation. OBJECTIVE: The aim of this study was to translate the Neck Disability Index (NDI) into the simplified-Chinese language and to evaluate the reliability, validity, and responsiveness of the new questionnaire. SUMMARY OF BACKGROUND DATA: Neck pain is a major health problem resulting in major disability. NDI is the most frequently used scale for self-rating of disability due to neck pain. At present, there is no simplified-Chinese version of the NDI. The aims of this study were to culturally adapt and translate the NDI into the simplified-Chinese language (NDI-SC) and to evaluate its psychometric properties in patients with neck pain. METHODS: The NDI was translated into simplified-Chinese version based on established guidelines. A total of 70 patients participated in this study. Patients were asked to complete a set of questionnaires comprising of their demographic information, the NDI-SC, and a visual analog scale (VAS) of pain. Fifty-six patients returned after 1 to 2 weeks to complete the same set of questionnaires and the global rating of change (GROC) scale. Then, the NDI-SC was evaluated for content validity, construct validity, internal consistency, test-retest reliability, and responsiveness. RESULTS: The NDI-SC demonstrated excellent internal consistency (Cronbach αâ=â0.92) and good test-retest reliability (ICC2,1â=â0.85). Content validity was confirmed as no floor or ceiling effects were detected for the NDI-SC total score. Construct validity was established with factor analysis revealing two-factor subscales explaining 66% of the variance. The NDI-SC showed a strong correlation with VAS (Rpâ=â0.61, Pâ<â0.001) and a moderate correlation with GROC (Rsâ=â0.46, Pâ<â0.001). The correlation between NDI-SC change scores and VAS change scores was also moderate (Rpâ=â0.59, Pâ<â0.001). CONCLUSION: The results showed that the NDI-SC is a reliable, valid, and responsive instrument to measure functional limitations in patients with neck pain. LEVEL OF EVIDENCE: 3.
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Pueblo Asiatico/etnología , Comparación Transcultural , Evaluación de la Discapacidad , Dolor de Cuello/etnología , Dimensión del Dolor/normas , Traducciones , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor de Cuello/diagnóstico , Dimensión del Dolor/métodos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Adhesive capsulitis is a common cause of shoulder pain and limited movement. The objectives of this review were to assess the efficacy and safety of corticosteroid injections for adhesive capsulitis and to evaluate the optimum dose and anatomical site of injections. PubMed and CENTRAL databases were searched for randomised trials and a total of ten trials were included. Results revealed that corticosteroid injection is superior to placebo and physiotherapy in the short-term (up to 12 weeks). There was no difference in outcomes between corticosteroid injection and oral nonsteroidal anti-inflammatory drugs at 24 weeks. Dosages of intra-articular triamcinolone 20 mg and 40 mg showed identical outcomes, while subacromial and glenohumeral corticosteroid injections had similar efficacy. The use of corticosteroid injections is also generally safe, with infrequent and minor side effects. Physicians may consider corticosteroid injection to treat adhesive capsulitis, especially in the early stages when pain is the predominant presentation.
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Corticoesteroides/farmacología , Bursitis/tratamiento farmacológico , Articulación del Hombro , Hombro , Bursitis/complicaciones , Bursitis/terapia , Femenino , Humanos , Inyecciones , Masculino , Dolor/complicaciones , Modalidades de Fisioterapia , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Hombro/fisiopatología , Articulación del Hombro/fisiopatología , Resultado del Tratamiento , Escala Visual AnalógicaRESUMEN
BACKGROUND: Dyslipidemia is the primary risk factor for arthrosclerosis. It is the most common chronic disease among the multiethnic Asian population in Singapore. Local national health survey has shown ethnic variability in achieving control of dyslipidemia. OBJECTIVES: This study aimed to determine the proportion of patients in primary care, who achieved their low-density lipoprotein (LDL)-cholesterol treatment goals, stratified by the local major ethnic groups. It also evaluated the factors that affected their dyslipidemia control, including diet, exercise and medication usage. METHODS: Research assistants administered questionnaires on adult patients with physician-diagnosed dyslipidemia to determine their views on diet, exercise, and medications in this cross-sectional study in 2 local primary care clinics. Their lipid profiles were retrieved from their laboratory reports in their electronic health records. Chi-square and Fisher exact tests were used for the categorical demographics and questionnaire variables, (P < .05: statistically significant). Logistic regression was performed using these significant variables to determine the adjusted odds of the ethnic groups. RESULTS: A total of 1093 eligible patients completed the questionnaires. The proportion of Chinese, Malay, and Indian patients who achieved LDL-cholesterol goals was 78.3%, 67.9%, and 68.5%, respectively. Among those who self-reported taking their favorite cholesterol-rich food occasionally when their cholesterol became controlled, 35.8% Indians failed to achieve treatment goals, compared to 20.1% Chinese and 30.9% Malay patients. Regular medication adherence was associated with 81.8% Chinese, 69.0% Malay, and 69.7% Indian reaching treatment goals. CONCLUSIONS: More Chinese met LDL-cholesterol treatment goals compared to Malays and Indians. Lipid-lowering medications enabled but smoking hindered their achievement of these treatment goals.