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Introduction: Hyperlipidaemia is a major risk factor for coronary artery disease (CAD). Its effective treatment has been shown to reduce the incidence of cardiovascular events, both in secondary and primary prevention. An essential component of risk factor management at the community level is public awareness and knowledge of treatment benefits. However, this data is limited in Singapore.Methods: A cross-sectional survey questionnaire of public perception and knowledge on cholesterol treatment among adult Singaporeans aged 30-69 years was commissioned by the Singapore Heart Foundation and conducted by a professional market survey company. Regional quota sampling was performed to ensure that the sample was representative of the Singapore population. This was followed by random sampling of households and respondents.Results: Of the 365 respondents, 40.9% were male, 70.3% were Chinese, 18.8% Malay and 10.9% Indian. The mean age was 47.5 years. Although 81.9% of respondents had medical check-ups involving blood tests, only 11.0% knew their actual cholesterol levels. A third of the respondents saw herbal medicine as healthier and safer than Western medication. More than 80% of respondents believed that diet and exercise were equally effective at lowering cholesterol as medication. About half of the respondents associated long-term use of statins with damage to the liver and kidney, while a third associated chronic statin use with the development of cancer.Conclusion: There are gaps in the level of public awareness and understanding of cholesterol treatment in Singapore. Common misconceptions should be addressed, as they could potentially impair effective management or treatment compliance. [ABSTRACT FROM AUTHOR]

Background: While the literature has highlighted the immense challenges in caring for family members, it is still unclear what the needs of family carers of persons with intellectual disability and challenging behaviours are and what has worked for them. This study aims to examine 60 parents' and siblings' experiences in managing the challenging behaviours of their adult family member with intellectual disability whilst living at home., Methods: A qualitative grounded theory approach using semi-structured interviews will be adopted. Purposive sampling will be used to recruit family carers who live with adult persons with intellectual disability and use one community service in Hong Kong. Three special schools for persons with intellectual disability from northern China will be approached., Results: This study will aim to provide an in-depth understanding of the experiences of family carers and compare the different circumstances they face when managing the challenging behaviours of their adult relatives with intellectual disability in their family home., Conclusions: Although this study targets adults with intellectual disability, the findings will provide a point of reference for adolescents and younger persons who exhibit demanding and challenging behaviours and live with their families. Recommendations can guide the development of appropriate strategies to strengthen services for family carers.

Introduction: In 2022, the Minister for Health of Singapore launched Healthier SG, a national strategy in championing the shift towards a population health approach., Method: The Singapore Heart Foundation conducted a series of roundtable discussions, also attended by representatives of the Singapore Cardiac Society and the Chapter of Cardiologists of the Academy of Medicine Singapore. During the meetings, the authors formulated interventions supportive of Healthier SG that specifically aimed to uplift the state of cardiovascular (CV) preventive care in Singapore., Results: In line with Healthier SG, the authors propose a 3-pronged approach ("Healthier Heart SG") to augment the success of Healthier SG in achieving good CV outcomes. This proposal includes the following components: (1) a call to update the standards of care in addressing the 5 main modifiable risk factors of cardiovascular disease (CVD); (2) patient education through cooperation between healthcare professionals and community partners for a whole-of-system approach; and (3) support for integrated care, including access to cardiac rehabilitation in the community, improved referral processes and access to nutrition/dietetics counselling and tobacco cessation, optimal use of information technology, and continued CV research., Conclusion: Healthier Heart SG would bring the standards of care and CV care delivery in Singapore closer to achieving the vision of proactive prevention of CVD and CV morbidity and mortality. This can only be achieved through the concerted efforts of healthcare professionals, policymakers and community partners, coupled with the cooperation of community members., Competing Interests: This paper was undertaken by Singapore Heart Foundation through an unrestricted fund from Amgen Biotechnology Singapore Pte Ltd. The funder played no role in the design, data collection, analysis, interpretation or manuscript writing.

Objectives: Motivators and barriers are pivotal factors in the adoption of health behaviors. This study aims to identify patterns of the motivators and barriers influencing heart health behaviors among multi-ethnic Asian adults with behavior-modifiable risk factors for heart disease, namely obesity, physical inactivity and smoking., Methods: A population-based survey of 1,000 participants was conducted in Singapore. Participants were assessed for behavior-modifiable risk factors and asked about motivators and barriers to heart health behaviors. Exploratory and confirmatory factor analyses were conducted to identify factors underlying motivator and barrier question items. Logistic regression was conducted to examine the associations of motivator and barrier factors with sociodemographic characteristics., Results: The twenty-five motivator and barrier items were classified into three (outcome expectations, external cues and significant others including family and friends) and four (external circumstances, limited self-efficacy and competence, lack of perceived susceptibility, benefits and intentions and perceived lack of physical capability) factors respectively. Among participants with behavior-modifiable risk factors, those with lower education were more likely to be low in motivation factor of "outcome expectations" and "external cues". The well-educated were more likely to be high in the barrier factor of "lack of perceived susceptibility, benefits and intention" and were less likely to have the motivation factor of "significant others (family or friends)". Those aged 60-75 years had low motivations and high barriers compared to their younger counterparts. Older age was more likely to be low in motivation factor of "outcome expectations" and "external cues" and high in barrier factor of "limited self-efficacy and competence" and "perceived lack of physical capability"., Conclusions: Findings underscore the importance of a targeted intervention and communication strategy addressing specific motivation and barrier factors in different population segments with modifiable risk factors., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. Hyperlipidemia is one of the important modifiable risk factors for CVDs. Raising public awareness of CVD risks is an important step in reducing CVD burdens. In this study, we aimed to assess public awareness and knowledge of cholesterol and its management in a multiethnic Asian population., Methods: We recruited 1000 participants from three major ethnic groups for this nationwide population-based survey. A structured questionnaire was used to collect socio-demographics, knowledge of cholesterol and cholesterol-lowering medications. Univariate and multivariate analyses were conducted to identify factors associated with good knowledge on cholesterol and its management., Results: Of the participants, 65% thought that high cholesterol produces symptoms and that lifestyle modification would be as effective as medication at lowering cholesterol. Nearly 70% believed that long term statin could lead to kidney or liver damage, and 56% thought that statin was associated with higher risk of cancer. A third saw herbal medicine or supplements as healthier and safer. About 45% believed that statin therapy should not be taken long term and that one could stop taking cholesterol medication when cholesterol is under control. Malays were more likely to have poor knowledge (adjusted OR 0.68; 95% CI 0.47-0.98; P = 0.039) compared to Chinese. Participants with intermediate education were more likely to have good knowledge of cholesterol and its management (adjusted OR 1.67; 95% CI 1.11-2.51; P = 0.013) compared to those with primary education., Conclusion: Public knowledge and awareness of high cholesterol and its management remains poor in Asian multi-ethnic population. Understanding gaps in public knowledge can inform the implementation of health promotion programs to effectively raise awareness of cholesterol and its management., Competing Interests: The authors have declared that no competing interests exist.

Introduction: There is limited information on elderly patients presenting with ST- elevation myocardial infarction (STEMI). This study aimed to study the outcomes of elderly Asian patients with STEMI compared to younger patients., Materials and Methods: The study utilised data from 2007 to 2012 from the Singapore Myocardial Infarction Registry, a mandatory national population-based registry. Elderly patients were defined as ≥80 years of age, middle-aged to old (MAO) patients were defined as 45-80 years of age and young patients were defined as ≤45 years of age. The primary outcome of the study was 1-year mortality and secondary outcomes included in-hospital complications and mortality., Results: There were 12,409 STEMI patients with 1207 (9.7%) elderly patients, 10,093 (81.3%) MAO patients and 1109 (8.9%) young patients. Elderly patients had more cardiovascular risk factors and lower rates of total percutaneous coronary intervention (26.0% vs 72.4% vs 85.5%, respectively; P <0.0001) compared to MAO and young patients. They had higher 1-year mortality (60.6% vs 18.3% vs 4.1%, respectively; P <0.0001) when compared to MAO and young patients., Conclusion: Elderly patients with STEMI have poorer outcomes than MAO and young patients. This is potentially attributable to a myriad of factors including age, higher burden of comorbidities and a lesser likelihood of receiving revascularisation and guideline-recommended medical therapy.

Aims: Acute myocardial infarction (AMI) and stroke are important causes of mortality and morbidity. Our aims are to determine the comparative epidemiology of AMI and ischaemic stroke; and examine the differences in cardiovascular outcomes or mortality occurring after an AMI or stroke., Methods and Results: The Singapore National Registry of Diseases Office collects countrywide data on AMI, stroke, and mortality. Index events of AMI and ischaemic stroke between 2007 and 2012 were identified. Patients were then matched for occurrences of subsequent AMI, stroke, or death within 1-year of the index event. There were 33 222 patients with first-ever AMI and 20 982 with first-ever stroke. AMI patients were significantly more likely to be men (66.3% vs. 56.9%), non-Chinese (32.1% vs. 24.1%), and smokers (43.1% vs. 38.6%), but less likely to have hypertension (65.6% vs. 79%) and hyperlipidaemia (61.1% vs. 65.5%), compared with stroke patients. In total 6.8% of the AMI patients had recurrent AMI, whereas 4.8% of the stroke patients had recurrent stroke within 1 year; 31.7% of the AMI patients died, whereas 17.1% of the ischaemic stroke patients died within 1 year. Older age, Malay ethnicity, and diabetes mellitus were statistically significant risk factors for all-cause mortality and for the composite endpoint of AMI, stroke, and all-cause mortality, at 1 year., Conclusions: Risk profiles of patients with AMI and stroke are significantly different. Patients suffer recurrent events in vascular territories similar to the index event. Age and diabetes mellitus are significant predictors of recurrent vascular events and mortality., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For Permissions, please email: journals.permissions@oup.com.)

Background: Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services., Method: A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken., Discussion: The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

Background: Understanding the difficulties and needs of the family carers in taking care of a person with ID can facilitate the development of appropriate intervention programmes and services to strengthen their caring capacity and empower them to continue with their caring roles. This study aims to explore ageing family carers' caregiving experiences and the plans they have to provide care for themselves and their ageing children with mild or moderate intellectual disability (ID)., Method: A constructivist grounded theory will be used to interview around 60 carers who have a family member with mild or moderate ID and attending sheltered workshops in Hong Kong. Constant comparative analysis methods will be used for data analysis., Discussion: The theory will capture family caregiving experiences and the processes of carers in addressing caregiving needs, support received and plans to continue to provide care for themselves and their relatives with ID in their later life. New insights into the emerging issues, needs and plights of family caregivers will be provided to inform the policies and practices of improving the preparation for the ageing process of the persons with ID, and to better support the ageing carers. The theoretical framework that will be generated will be highly practical and useful in generating knowledge about factors that influence the caregiving processes; and, tracking the caregiving journey at different time-points to clearly delineate areas to implement practice changes. In this way, the theoretical framework will be highly useful in guiding timely and appropriate interventions to target at the actual needs of family carers as they themselves are ageing and will need to continue to take care of their family members with ID in the community.

Hypertension is a common disease, and hypertensive patients are at increased risk of cardiovascular events. The prevalence and socioeconomic burden of hypertension in the Asia-Pacific region are predicted to increase in the coming decades. Effective blood pressure lowering reduces overall cardiovascular morbidity and mortality in patients, yet doubt has been raised regarding the use of (mainly older generation) β-blockers as initial therapy in hypertension. Consequently, several international treatment guidelines do not recommend β-blockers for the treatment of hypertension. However, in contrast to first-generation and second-generation β-blockers, the third-generation, vasodilating β-blocker nebivolol has a considerably better metabolic, haemodynamic and side effect profile. In addition to providing effective blood pressure control similar to other β-blockers and drugs from other antihypertensive classes, nebivolol exerts a dual mechanism for increasing the bioavailability of the naturally occurring vasodilator nitric oxide. The clinical benefits and significance of enhancing nitric oxide levels in hypertensive patients have been shown in direct comparisons of nebivolol with other β-blockers. While β-blockers generally provide comparable blood pressure reductions, only nebivolol demonstrated enhanced vasodilation and blood flow by increasing the expression of endothelial nitric oxide synthase and therefore increasing nitric oxide release from the endothelium. In contrast to other β-blockers, therefore, it has been suggested that nebivolol has beneficial effects in several hypertensive subgroups due to its vasodilating properties. Considering the existing data, it may be timely for treatment guidelines to recommend third-generation vasodilating β-blockers as a first-line option for the pharmacotherapy of hypertension.

Background: Cardiovascular diseases, to which coronary artery disease (CAD) is a significant contributor, are a leading cause of long-term morbidity and mortality worldwide. In the years ahead, it is estimated that approximately half of the world's cardiovascular burden will occur in the Asian region. Currently there is a large gap in secondary prevention, with unrealized health gains resulting from underuse of evidence-based medications, including beta-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aspirin and other antiplatelet agents, and lipid-lowering drugs. Despite the almost universal recommendation for these drugs in unstable CAD, their under-prescription is well documented for patients with acute heart failure, non-obstructive CAD, and for secondary prevention of CAD., Objective: This article reviews the burden of CAD in Asian countries together with guidelines supporting evidence-based medication use from a secondary prevention perspective., Methods: The MEDLINE database was searched from 2000 to 2013, inclusive, for country-specific data related to CAD and supplemented with unpublished registry data., Results: In the post-discharge setting following hospital admission for acute coronary syndromes, medication prescription rates were low. Beta-blocker prescription rates ranged from 49% in China to 99% in Singapore, ACE-inhibitor/ARB prescription rates ranged from 28% in China to 96% in Singapore, and lipid-lowering therapy rates ranged from 47% in China to 97% in Singapore. Aspirin/antiplatelet drug prescription rates ranged from 86% in Indonesia to 99.5% in Singapore. Recommendations are provided to improve patient outcomes and reduce the disease burden in Asia., Conclusions: Despite recommendations issued in international and national guidelines, use of CAD medications in Asia remains suboptimal. In the absence of clear contraindications, all patients with unstable CAD should receive these agents as secondary prevention. This averts the need to target drug use according to risk, with high-risk features paradoxically associated with under-prescribing of such drugs.

Background: Older adults with major chronic illnesses are very susceptible to influenza and its serious complications, but many do not obtain vaccinations. Little is known about factors associated with intention to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong., Objectives: The aim of this study was to identify factors associated with intent to obtain influenza vaccination among at-risk Chinese older adults in Hong Kong., Methods: This multicenter descriptive correlational study recruited a convenience sample of 306 Chinese older adults with medical risk factors for influenza and its serious complications from the general outpatient clinics in Hong Kong. Interviews were conducted to assess intent to obtain influenza vaccination for the coming year, health beliefs about influenza, and discomfort following past vaccinations., Results: The current influenza vaccination rate was 58.5%; only 36.3% intended to get vaccinated the following year. After controlling for clinical and demographic factors in a logistic regression model, perceived susceptibility predicted intention to obtain future vaccination (OR = 1.42, 95% CI [1.14, 1.78]), whereas postvaccination discomfort was negatively associated with intention (OR = 0.063, 95% CI [0.006, 0.63])., Conclusions: Intention to obtain influenza vaccination was low among at-risk Chinese older adults. Strengthening health beliefs and creating strategies to provide positive influenza vaccination experiences are possible approaches to interventions to improve uptake of influenza vaccination rates.

Aim: The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation., Method: This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview., Results: Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings., Conclusion: Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Following publication of the National Institute of Clinical Excellence (NICE) Guidelines in 2006, the use of β-blockers as first-line therapy in hypertension has been somewhat controversial. However, a recent reappraisal of the European Society of Hypertension guidelines highlights that these agents exhibit similar BP lowering efficacy to other classes of agents, prompting a re-examination of the utility of these agents in various patient populations. The authors felt that it is important to address this controversy and provide an Asian perspective on the place of β-blockers in current clinical practice and the benefits of β-blockade in selected patient populations. In addition to their use as a potential first-line therapy in uncomplicated hypertension, β-blockers have a particular role in patients with hypertension and comorbidities such as heart failure or coronary artery disease, including those who had a myocardial infarction. One advantage which β-blockers offer is the additional protective effects in patients with prior cardiovascular events. Some of the disadvantages attributed to β-blockers appear more related to the older drugs in this class and further appraisal of the efficacy and safety profile of newer β-blockers will lend support to the current guideline recommendations in Asian countries and encourage increased appropriate use of β-blockade in current clinical practice within Asia.

The Ministry of Health (MOH) publishes clinical practice guidelines on Screening of Cardiovascular Disease and Risk Factors to provide doctors and patients in Singapore with evidence-based guidance on the screening of cardiovascular disease and risk factors. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Screening of Cardiovascular Disease and Risk Factors, for the information of readers of the Singapore Medical Journal. Page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=25776). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Aims: This study aims to explore nurses' experiences of caring for non-catheterised older infirmed patients who had suffered from recurrent urinary tract infection and strategies adopted to prevent and manage the problem., Background: Urinary tract infection is a complex and significant infection affecting frail older patients. Most literature focuses on prescribing treatment to treat the micro-organisms causing the infection, with less emphasis to understand nursing perspectives of caring for frail and highly dependent older patients suffering from this condition., Design: Qualitative., Methods: A qualitative research methodology was conducted in a hospital-based infirmary unit (composing of four wards) in Hong Kong. Fourteen nurses were interviewed using a semi-structured interview guide., Results: When managing recurrent urinary tract infection of non-catheterised older patients, nurses described the need to promptly recognise the urinary tract infection symptoms and to know the causes of the symptoms before administering any care. These formed the basis for deciding whether the patient's urinary condition should be managed by nurses themselves or be referred to the physician for medical treatment. Based on this initial judgement, subsequent non-invasive measures perceived by nurses to be effective were undertaken to manage the non-medically intervened problem. Ways to improve nurses' existing roles and work practices to better manage recurrent urinary tract infection of non-catheterised older patients were also identified., Conclusion: Nurses working in infirmary wards refocused on the value of providing basic nursing care to manage this emergent and overlooked clinical problem., Relevance to Clinical Practice: Asymptomatic urinary tract infection cases should continue to receive 'basic urinary tract infection care' on a daily basis, as ignoring these symptoms could bring on adverse consequences. Prior knowledge and experiences acquired by nurses who cared for previously infected patients can assist in the development of interventions, so comparison of different nursing measures is possible to determine which one is the most effective in managing this clinical issue.

The time taken to initiate early defibrillation is crucial to improve survival, prevent neurological deficit and improve the quality of life of patients suffering from sudden cardiac arrest. Despite the extension of training and the authorization of nurses to perform early defibrillation (advocated by the American Heart Association), such practice has not been widely adopted in hospitals. Inadequate knowledge, lack of skill retention, insufficient organizational support and the passive culture of nurses are barriers preventing the move towards nurse-led defibrillation. This paper discusses the need to extend the registered nurses' role in the early defibrillation of cardiac patients in Hong Kong. Current nursing practice in emergency resuscitation care and the hurdles constraining early defibrillation will be discussed. Recommendations to facilitate the future development of nurse-led defibrillation will also be provided. The successful extension of the registered nurses' role in early defibrillation will enable them to possess broader knowledge to be clinically competent in providing efficient patient care.

Introduction: Elevated blood pressure is a principal risk factor for cardiovascular and renal diseases. Early detection and adequate treatment of hypertension are essential components in the primary prevention of these end-stage events. Microalbuminuria is recognised as an early marker of renal disease and increased cardiovascular risk. Screening alerts physicians to implement timely intervention strategies to delay disease progression and minimise consequent complications. Although the value and significance of microalbuminuria screening has been widely documented, its use is still suboptimal., Methods: Survey forms were sent to randomly-selected general practitioners in Singapore to capture their self-reported attitudes and practices regarding microalbuminuria screening in the management of hypertension., Results: Results from this survey revealed that microalbuminuria screening was practised by 88 percent of the physicians surveyed; however, only 56 percent of hypertensive patients without risk factors were screened. Quantitative analysis of urine samples was the preferred screening method of 90 percent of the physicians surveyed., Conclusion: A concerted effort should be made to address the lack of public awareness on the importance of screening for microalbuminuria. Continuing medical education should also emphasise the usefulness of surrogate markers in the therapeutic prevention of end-organ damage in hypertensive patients. There is also a need to form a consensus guideline on microalbuminuria screening, to aid in the standardisation of practice.

Aims: Rosuvastatin is more efficacious than other statins in lowering low-density lipoprotein cholesterol (LDL-C). Studies showing higher blood levels in Asians have resulted in concerns regarding increased adverse drug reactions. This study aimed to evaluate the efficacy and safety of rosuvastatin in hypercholesterolemic Asian patients., Methods: This retrospective observational study was conducted on statin-naive patients and statin-switch patients. Patients were treated with rosuvastatin for > or =8 weeks. Primary outcomes were changes in LDL-C levels and proportions of patients achieving their goals (primary prevention, LDL-C < or =130 mg/dL; secondary prevention, LDL-C< or =100 mg/dL)., Results: Of 1007 hypercholesterolemic patients, 483 were statin-naive (LDL-C 161+/-40.8 mg/dL) and 524 were statin-switch patients (LDL-C 132.7+/-36.9 mg/dL). In statin-naive patients, rosuvastatin significantly reduced LDL-C, total cholesterol, and triglycerides by 39.9%, 28.8%, and 9.2%, respectively (p<0.001). Eighty-one percent of these patients achieved LDL-C goals. In the statin-switch cohort, LDL-C, total cholesterol, and triglycerides levels were significantly reduced by 24.5%, 16.6%, and 3.8%, respectively (p<0.001). Achievement of target LDL-C levels increased from 29% to 72.9%. There was no significant adverse drug reaction., Conclusion: Rosuvastatin was well tolerated and effective in lowering LDL-C in hypercholesterolemic Asian patients. Patients whose LDL-C levels were suboptimal on other statins improved their levels and more achieved LDL-C goals after switching to rosuvastatin.

Introduction: Atherothrombosis is the leading cause of cardiovascular mortality. The Reduction of Atherothrombosis for Continued Health (REACH) Registry provided information on atherosclerosis risk factors and treatment. Singapore was one of the 44 participating countries in the REACH Registry. The objective of this study was to determine the atherosclerosis risk factor profile and treatment patterns in Singapore patients enrolled in the REACH Registry., Materials and Methods: The REACH Registry is an international prospective observational registry of subjects with or at risk for atherothrombosis. Patients aged 45 years or older with established vascular disease [coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral arterial disease (PAD)] or 3 or more atherosclerosis risk factors were recruited between 2003 and 2004., Results: A total of 881 patients (64.4% male) were recruited in Singapore by 63 physicians. The mean age was 64 +/- 9.8 years (range, 45 to 95). Seven hundred and one (79.6%) patients were symptomatic (CAD 430, CVD 321, PAD 72) while 180 (20.4%) patients had > or =3 risk factors. Approximately 13% of symptomatic patients had symptomatic polyvascular disease. There was a high proportion of diabetes mellitus (57%), hypertension (80.6%) and hypercholesterolemia (80.1%). A substantial proportion of symptomatic patients were current smokers (14.1%). Approximately half of the patients were either overweight or obese [abdominal obesity, 54.3%; body mass index (BMI) 23-27.5, 45.9%; BMI > or =27.5, 23.3%]. Patients were undertreated with antiplatelet agents (71.9% overall; range, 23.9% for > or =3 risk factors to 84.7% for PAD) and statins (76.2% overall; range, 73.6% for PAD to 82.1% for CAD). Risk factors remained suboptimally controlled with a significant proportion of patients with elevated blood pressure (59.4% for > or =3 risk factors and 48.6% for symptomatic patients), elevated cholesterol (40% for > or =3 risk factors and 24.4% for symptomatic patients) and elevated blood glucose (45% for > or =3 risk factors and 19.8% for symptomatic patients)., Conclusion: Established atherosclerosis risk factors are common in Singapore patients in the REACH Registry; and obesity is a major problem. Most of these risk factors remained suboptimally controlled.

Aim: This paper reports a study to examine Chinese older people's perceptions of privacy in residential care homes., Background: With increasing numbers of older people moving into residential care homes in Hong Kong, the emphasis on providing high quality of care is paramount. Yet, studies have identified the poor quality of psychosocial care provided in these homes, particularly the lack of attention given to promoting a sense of privacy. While privacy is a fundamental principle of gerontological care, little is known older people's perceptions of privacy in residential care practices. This lack of understanding makes it difficult to know how to provide appropriate care to this population., Method: A descriptive qualitative study was conducted in 2005 with a purposive sample of 20 informants from four residential care homes in Hong Kong. In-depth interviews were used to collect the data, which were analysed using content analysis., Results: Most informants perceived that privacy was unnecessary and not a pre-requisite in residential living. They had seemingly accepted the expectations of home life, with its emphasis on unity, harmony and meeting the collective needs of the majority rather than focusing on their individual needs. Informants also described the enjoyment of communal living and 'living together'. While at first privacy was perceived as not necessary, further prompting identified that informants used own efforts to support their privacy. There were also day-to-day circumstances/activities in homes where privacy was violated., Conclusion: The emphasis in Chinese culture on the importance of maintaining balance and harmony inevitably shaped participants' perceptions of what privacy meant to them. The findings will inform the development of culturally-sensitive care practices to support Chinese older people's privacy in residential care settings.

Aim and Objectives: The aim of this study was to examine the sleep experiences of older patients during a period of hospitalization on an extended care ward., Background: Hospital wards have been demonstrated as environments that are not conducive to sleep for patients. Findings highlight the difficulties of falling asleep and getting insufficient sleep as the major causes of sleep disturbances. Such studies limit themselves to patients of Intensive Care Units and acute care settings. Relatively little is known about understanding the sleep experiences of older patients whilst hospitalized on extended care wards., Method: An exploratory qualitative design was used with a convenience sample of six Chinese male informants, recruited from an extended care ward of a Rehabilitation Hospital in Hong Kong. Multiple data collection methods were used, including repeated semi-structured interviews and a one-week sleep diary., Results: The findings demonstrated that all informants experienced dynamic changes in their sleeping patterns during hospitalization, resulting in sleep disruption and deprivation. The public nature of the ward environment and perceived sense of helplessness significantly interfered with sleep. Some cultural beliefs and practices were perceived by older patients to be associated with the quality of their sleep experiences., Conclusion: The findings contributed to an understanding of the sleep experiences of older patients during hospitalization., Relevance to Clinical Practice: Implications for nursing practice indicate the significance of including focused sleep assessment of patients during admission into the ward, so strategies perceived by older patients as being able to improve sleep would be included as part of the usual ward routine and nursing practice, where possible.

Background: The prevalence of the metabolic syndrome among a number of Asian populations as defined by several current criteria has been increasing rapidly and appears to resemble that among Western populations., Methods: We review 25 surveys of the metabolic syndrome in Asian populations (PR China, Hong Kong, Taiwan, Japan, Philippines, Singapore) that report adequate information published during the last 5 years., Results: Using Asian-adapted definitions of obesity (BMI > or = 25 kg/m(2)) and increased waist circumference (for male > or = 90 cm; for female > or =80 cm) prevalence appears to be between 10 to 30%. Those with the syndrome are more likely to have a history of diabetes and cardiovascular disease. The risk of developing Type 2 diabetes is 10 times higher among middle-aged Japanese men with the metabolic syndrome compared to healthy subjects. In Chinese and Japanese populations, people who have the metabolic syndrome are 3 to 10 times more likely to develop cardiovascular disease. Variance in prevalence estimates of the metabolic syndrome even within the same country result from differences in sampling and possibly from definitions., Conclusions: The outstanding conclusion from recent surveys across the Asian-Pacific region is that of a consistent increase in the prevalence of the metabolic derangements associated with abdominal adiposity that lead to high risk of morbidity and mortality.

Aims: AGATHA (a Global Atherothrombosis Assessment) was designed to assess the extent of atherothrombosis and the use of the ankle-brachial index (ABI) in vascular patients. The principal hypotheses were that (1) in diseased patients, a low ABI was related to the number and site of vascular beds affected and (2) in at-risk patients without disease, a low ABI was related to the number of risk factors present., Methods and Results: Patients were recruited consecutively by 482 clinicians in 24 countries and the ABI measurement was performed at a single visit. Of 8891 patients recruited, 1792 were defined as at risk and 7099 as with disease. Of the with-disease patients, 65.2% had one arterial bed affected, 27.6% two and 7.1% all three. Abnormal ABI (< or =0.9) was present in 30.9% of at-risk and 40.5% of with-disease patients. A lower ABI was weakly associated with an increasing number of risk factors in at-risk patients (r=-0.056, P=0.02) and with the site and number of arterial beds affected in with-disease patients (P<0.001)., Conclusion: This large international study confirms that atherothrombotic disease often occurs at more than one site. The ABI is related to the risk factor profile and to the site and extent of atherothrombosis.

Previous studies have demonstrated a high prevalence of sleep disturbance among elderly people which can exacerbate during a period of hospitalization. Whilst studies on patients' sleep experiences have largely been conducted in acute care settings, relatively little is known about the sleep experiences of elderly patients hospitalized in extended care settings. This paper aims to provide a literature review on the sleep experiences of older patients admitted into hospitals, with reference also made to studies conducted in the community in order to substantiate the existence of sleep disruptions before elderly people are admitted into hospitals. Electronic databases and specific search terms from 1980 to 2004 were used to conduct the literature search. Nurses play a crucial role in ensuring that patients get a good night's sleep and will need an in-depth understanding of older patients' sleep experiences to effectively manage different sleeping patterns and sleep needs in the clinical areas.

Ten patients, all below 30 years of age (8 females and 2 males) developed Stokes-Adams attacks from complete heart block due to acute nonspecific myocarditis. Coexisting thyrotoxicosis was present in two patients and cardiogenic shock was seen in four. Temporary transvenous pacing was instituted in all but one patient. Except for two patients who developed permanent complete heart block, normal A-V conduction returned in between 1 to 12 hours after ventricular pacing in seven patients and after 12 hours of isoprenaline therapy in the final patient. The ECG returned to normal in six patients and all 10 patients survived their acute illness.

Acebutolol is a relatively "cardioselective" beta-adrenergic blocking agent with an antihypertensive action. The aims of this investigation were to establish the effective dosage range, to study the effect on supine, standing and exercise blood pressure (BP) and heart rate (HR), and to compare the efficacy of once daily (OM) with twice daily (BD) dosing of acebutolol. This was a within patient, double-blind, randomised study. This study shows that the optimum dosage of acebutolol for control of BP and heart rate is 400mg or more daily, and that OM dosing seems to be as effective as BD dosing for supine, standing and post exercise BP control, but is less so for heart rate control.