Proceedings of Singapore Healthcare

The proportion of people exposed to second-hand smoke increases dramatically with a sharp increase in the prevalence of smoking. It is expected that awareness of the effect of second-hand smoke plays an important role in curbing smoking.

The objective of this study is to examine factors affecting awareness of second-hand smoke in Malaysia.

Nationally representative data, covering a large sample size (4153 respondents) and collected based on multistage sampling, are used. Multiple logistic regression is employed to analyse the effects of demographic and lifestyle variables on the likelihood of being aware of second-hand smoke.

Results show that older people are less likely to be aware of second-hand smoke than youngsters and that less-educated individuals are less likely to be aware of second-hand smoke than well-educated individuals. Significant relationships are found between second-hand smoke awareness and wealth index, ethnicity and smoking behaviour.

Demographic profiles should be considered when drawing up policies aimed at improving awareness of second-hand smoke among adults. The government needs to focus more on older people, wealthy individuals, less-educated individuals, Chinese individuals and smokers if a successful policy is to be implemented.

Cardiovascular diseases are the main cause of death globally. Individuals with evidence of coronary artery disease are at increased risk of further cardiovascular events. However, with good secondary prevention, which consists broadly of lifestyle changes, medical therapy and revascularisation, this risk can be reduced. The true extent of secondary prevention in individuals who are re-admitted with a myocardial infarction in such a high-risk cohort has never been explored in Malaysia.

We performed a retrospective, observational study in a tertiary hospital in 100 individuals with previously diagnosed coronary artery disease admitted with a myocardial infarction from August 2016 to February 2017.

Twenty-nine per cent of patients were still smoking; 15% and 47% were not taking antiplatelet or beta-blocker therapy, respectively. A further 45% and 20% of patients were not on any renin–angiotensin–aldosterone inhibition or lipid-lowering therapy, respectively.

In our high-risk cohort, secondary prevention practices were sub-optimal. Poor physician–patient communication was frequently listed as a major factor. Simple strategies taken at various levels of care should be implemented and audited to improve these practices.

Intraoperative hypothermia is detrimental to the patient. This, however, can be minimized with infusion of warmed fluids.

We investigated the warming capabilities of the Ranger^© 24500 (Ranger) and ANIMEC AM-2S (ANIMEC) at various low infusion rates. We also examined the use of two ANIMEC warmers placed in series along the intravenous tubing.

We had three comparative trial groups for our experiment. Trial group 1 involved the use of an ANIMEC fluid warmer. Trial group 2 involved the use of two ANIMEC fluid warmers placed in series. Trial group 3 involved the use of the Ranger. Three different infusion rates (1 ml/min, 5 ml/min and 10 ml/min) were examined.

The use of two ANIMEC fluid warmers delivered the warmest fluid in all three study infusion rates. The mean (SD) delivered temperature was 24.11 (0.62)°C at 1 ml/min, 29.59 (0.10)°C at 5 ml/min and 29.27 (0.10)°C at 10 ml/min. The Ranger delivered the lowest temperatures at infusion rates of 1 ml/min and 5 ml/min. The mean temperatures were 21.01 (0.38)°C and 23.87 (0.34)°C respectively. The mean temperatures of utilizing one ANIMEC fluid warmer were 21.49 (0.35)°C, 25.47 (0.08)°C and 24.78 (0.12)°C at infusion rates of 1 ml/min, 5 ml/min and 10 ml/min respectively.

The ANIMEC performs better than the Ranger at low flow rates of up to 5 ml/min. A novel method of placing the two ANIMEC warming devices in series can further improve its warming capabilities.

Sickness absenteeism has been rising in Singapore with sickness certification commonly performed by primary care physicians. The Primary Care Survey 2014 reported increased primary care demand driven by a rapidly ageing population and the prevalence of chronic disease. This article aims to determine the magnitude of outpatient sickness certification in all the polyclinics in Singapore and identify the demographic characteristics and factors influencing the taking of sick leave by the local multi-ethnic Asian patients.

A one-week, cross-sectional survey using computer-assisted interviews with age-stratified, systematically sampled patients was conducted at all 18 polyclinics in 2014. Sick leave data was then extracted from each polyclinic’s administrative system. Data was analysed with logistic regression to determine statistically significant factors.

The sickness certification rate was 22.6% during the study period with a weighted average duration of 1.42 days. Sickness certification was most associated with the younger age group (17–20 years; adjusted odd ratio (AOR) = 9.51), an acute condition (AOR = 24.8) and those living in 1–2 room public housing (AOR = 4.72). Among employees, those working in manufacturing industries had the most association with sickness certification while the finance and insurance industry had the least. An acute upper respiratory tract infection was the most frequent diagnosis for those who obtained medical certificates (38.7%).

A medical certificate was issued in almost one-quarter of consultations in Singapore polyclinics. Sickness certification was predominated by short-term absence for acute conditions. Characterisation of sickness absenteeism among employees serves as a benchmark for future studies. Mitigation measures were discussed while exclusion of private primary care clinics probably led to an underestimation of the magnitude of sickness certification.

The purpose of this study was to explore perceptions, facilitators, and barriers to healthy eating behaviors among parents of primary school-aged children.

A purposive sampling design was used to select parents of primary school children from four different communities in north-east Trinidad. They were recruited via the school system with letters containing the research purpose and background. Four focus group sessions were conducted between May and June 2013. Each focus group had an average of five participants and lasted for approximately 60 min. The participants were asked to define healthy eating, identify healthy foods, and describe their concerns regarding healthy eating. The interview questions were developed and validated by the research team members. The data were transcribed and analyzed for themes.

Twenty-three (N = 23) parents (78% female and 22% male) participated in the study. The participants define healthy foods as vegetables, starchy foods, porridge, tea, fiber, and foods low in fat. Parents also acknowledged that food cost, availability, parent’s inability to influence children to consume fruits and vegetables, and social barriers are some major challenges impeding healthy eating.

Our study demonstrates that several barriers exist to healthy eating among primary school children in Trinidad. Community health professionals, school teachers, dietitians, and nutritionists need to play a more prominent role in teaching children and parents about the benefits of healthy eating. Future studies need to address the barriers to healthy eating. This might help to reduce the growing obesity prevalence in Trinidad.

One of the techniques used to achieve productivity, employees’ job satisfaction and higher quality goods and services, as well as to solve the problems by using a team, is the formation of quality control circles. Quality control circles enable managers to meet the organization’s and employees’ needs through making effective use of resources and facilities. On the other hand, the quality of services is always affected by uncertainty and ambiguous and implicit judgments, which make its measurement uncertain.

The present study aimed to identify important factors affecting the effectiveness of quality control circles in a hospital, as well as rank them using a combination of fuzzy VIKOR and Grey Relational Analysis (GRA).

This was an applied, cross-sectional and descriptive–analytical study conducted in 2016. The study population consisted of five academic members and five experts in the field of nursing working in a hospital, who were selected using a purposive sampling method. Also, a sample of 107 nurses was selected through a simple random sampling method using their employee codes and the random-number table. The required data were collected using a researcher-made questionnaire which consisted of 12 factors. The validity of this questionnaire was confirmed through giving the opinions of experts and academic members who participated in the present study, as well as performing confirmatory factor analysis. Its reliability also was verified (α=0.796). The collected data were analyzed using SPSS 22.0 and LISREL 8.8, as well as VIKOR–GRA and IPA methods.

The results of ranking the factors affecting the effectiveness of quality control circles showed that the highest and lowest ranks were related to ‘Managers’ and supervisors’ support’ (Š = 6.80, R ~ = 0.36) and ‘Group leadership’ (Š = 2.63, R ~ = 0.98). Also, the highest hospital performance was for factors such as ‘Clear goals and objectives’ and ‘Group cohesiveness and homogeneity’, and the lowest for ‘Reward system’ and ‘Feedback system’, respectively.

The results showed that although ‘Training the members’, ‘Using the right tools’ and ‘Reward system’ were factors that were of great importance, the organization’s performance for these factors was poor. Therefore, these factors should be paid more attention by the studied hospital managers and should be improved as soon as possible. Applying quality control circles in any organization is very helpful and provides opportunities for maximum use of employees’ creativity, initiative and skills in reaching their and their organization’s goals and objectives, and prepares favorable working conditions for the employees’ optimal performance through increasing the managers’ sense of responsibility and commitment.

A recent systematic review alludes to the effectiveness of social media in facilitating smoking cessation. However, most interventions center on mobile applications in engaging smokers. A novel portable exhaled-carbon-monoxide self-monitoring device, the Smoke-analyzer to Track and Expedite Actions and Decisions to Eliminate Smoking (STEADES) linked to a specially-designed mobile phone application has been developed, which relays exhaled carbon monoxide-related data from the smokers to their selected quit supporters via social media.

The study aimed to determine the precision and feasibility of using the STEADES device among smokers in primary care.

This pilot study recruited 15 Asian adult smokers from a primary care polyclinic in Singapore. Their exhaled carbon monoxide measurements were measured serially using STEADES, compared to a commercial smokerlyzer as reference. The subjects could use the device to transmit their exhaled carbon monoxide measurements via mobile application and social media to their acquaintances in the next two weeks. Data on the subjects’ demographic and clinical characteristics, their views on STEADES (from a questionnaire), and its utility (from the application) were collated on enrolment and at the end of study.

Measurements using STEADES were significantly correlated with those from a commercial smokerlyzer (Pearson correlation=0.882, p<0.01). The majority of the subjects perceived that the exhaled carbon monoxide data would allow them to track progress of their quit attempts, perceived recipients of these data would support their smoking cessation (92.3%), and reported willingness to use it with improved accuracy.

The STEADES prototype had shown feasibility in this proof of concept study. Most subjects were in favor of using it to support their smoking cessation but its accuracy required enhancement.

Seven landmark randomised controlled trials, with some that began as early as the 1990s, observed the prediabetic state, namely, impaired glucose tolerance and impaired fasting glucose conditions, against the impact of lifestyle interventions such as physical activity, to prevent or delay the onset of type 2 diabetes mellitus. In addition to the landmark trials, this systematic review examines 14 studies that retained a focus on prediabetic individuals and measured the efficacy of physical activity on improving glucose tolerance.

Type, duration and intensity of structured physical activity can have unique benefits to prediabetic individuals. It is posited that diabetes prevention programmes must target prediabetic individuals as belonging to a high-risk group, separate and distinct from those identified with overall risk factors. While the transition from prediabetes to type 2 diabetes mellitus is not completely deterministic, the conversion rate is phenomenally higher among those with impaired glucose tolerance than those with normal glucose levels.

Tenets of health behaviour models do support inferences that prediabetic individuals are potentially more inclined to weighing the risks and benefits of progressive illnesses and would therefore be more receptive to active participation in interventions. More research is required to develop evidence-based diabetes prevention programmes linked to structured physical activity intervention.