Background: While peer support interventions have shown to benefit adults with certain chronic conditions, there is limited evidence on its feasibility and effectiveness among people with metabolic syndrome (MetS). This paper describes the outcomes of a pre-post feasibility trial of "PEeR SUpport program for ADults with mEtabolic syndrome" (PERSUADE), an evidence-based and community-specific nutrition and lifestyle behavior peer support program for Malaysian adults with MetS. Methods: We recruited 48 peers (median age: 46 (IQR = 11) years old) into four peer groups, who underwent 3 months of PERSUADE, followed by 3 months of follow-up period. Statistical analyses were conducted at post-intervention and post-follow-up to assess the changes in nutrition intake, anthropometry, and metabolic parameters. Results: Although there were significant overall increases in total carbohydrate intake and glycemic load (both p < 0.001), we noted significant reductions in the intakes of total energy and fat (both p < 0.001). Physical activity (total METS/week) also showed a significant improvement (p < 0.001). Overall, significant but marginal improvements in anthropometric and vital metabolic parameters were also observed. Conclusions: The feasibility trial supported the adoption of PERSUADE, though there is a need to assess the long-term impact of the peer support program in local community settings.

Metabolic Syndrome (MetS) is a cluster of risk factors that increases the risk for diabetes and cardiovascular diseases. Lifestyle intervention is the gold standard of MetS management and prevention. Despite the growing positive influence of peer support-based interventions on management of various chronic diseases, its potential among adults with MetS has not been elucidated. We describe the development and process evaluation of a nutrition and lifestyle behavior “PEeR SUpport program for ADults with mEtabolic syndrome” (PERSUADE) using a systematic five-step approach—(i) review of evidence; (ii) focus group discussions; (iii) behavioral matrix development; (iv) module development; and (v) feasibility and process evaluation. High program adherence was recorded with 81.3% of participants attending all peer sessions. Participants’ content satisfaction score was high (93.3%) while peer leadership score was satisfactory (70.0%). There were significant reductions in all anthropometric and metabolic parameters assessed post intervention, except for diastolic blood pressure. Significant correlations were found between reductions in body fat and triglyceride, and content satisfaction. Peer leadership was only significantly correlated with reduction in triglyceride. Future studies can explore aspects of module interactivity, use of social media, and other means to stimulate consistent engagement of participants, as well as extending the implementations to other lifestyle-related diseases.

Background and Objectives: Group-based lifestyle interventions reap social support benefits and have been implemented among individuals with various chronic diseases. However, there is a lack of consolidated evidence on its approaches to prevent or manage metabolic syndrome (MetS). This scoping review aims to assess the group-based lifestyle interventional strategies for MetS and provide a strategic framework for future research in this area. Materials and Methods: Scholarly databases (OVID Medline, SCOPUS, PUBMED, PsycINFO, EMBASE, and Cochrane Central Register of Controlled Trials) and reference lists of included publications were systematically searched using appropriate keywords and MeSH terms. Peer-reviewed articles published from the start of indexing to 31 December 2020 focused on individuals with or at risk for MetS were included. Results: Thirteen interventions were identified, with seven conducted among adults with MetS and six in the population at risk for MetS. Three study designs were reported—randomised controlled trials (RCTs), pre–post interventions, and quasi-experiments. Most of the interventions were based in the community or community organisations, multifaceted, led by a multidisciplinary healthcare team, and assisted by peer educators. Waist circumference showed the most promising MetS-related improvement, followed by blood pressure. Conclusions: There is growing evidence supporting group-based lifestyle interventions to improve MetS-related risk factors. In summary, four strategies are recommended for future research to facilitate group-based interventions in preventing and managing MetS.

The differentiation between a pseudo-pneumoperitoneum and true pneumoperitoneum on an initial chest radiograph is challenging but essential to clinical practice. The former is managed conservatively whereas the latter may require surgical intervention. Chilaiditi’s sign describes a rare incidental radiological finding of gas filled bowel interpositioned between the right hemi-diaphragm and the liver, which is visible on a plain abdominal or chest radiograph. It is often misdiagnosed as a pneumoperitoneum. Correct diagnosis of Chilaiditi’s sign in an asymptomatic patient can prevent unnecessary procedures. We have reported one incidental chest radiograph with Chilaiditi’s sign in a patient presenting and treated for pneumonia. The report aims to illustrate the diagnostic dilemma experienced by clinicians in distinguishing a true versus pseudo-pneumoperitoneum on a chest radiograph.

BACKGROUND Type 2 diabetes is becoming more prevalent around the world, including in Singapore. Diabetes education programs have been proven to be effective in improving health outcomes and diabetes self-management skills. Several effective approaches to diabetes education in patients with type 2 diabetes have been established, including the use of mobile health applications. Despite strong evidence of their efficacy, these apps are not always well-utilized or accepted by the target population. End-user feedback is essential for designing a feasible and acceptable app that can improve outcomes for chronic disease populations. OBJECTIVE We applied a mixed-methods, end-user-engaged approach to co-design an education app prototype for patients with type 2 diabetes to explore their perceptions, acceptance and usability of the prototype, as well their diabetes experience and perspectives on digital diabetes education. METHODS The study was conducted between August 2021 and January 2022. Participants were eight diabetic patients recruited from diabetes management Facebook groups. A total of six data points were collected: four web-based surveys and two structured interviews via Zoom. Descriptive statistics and thematic analyses of discussion and iterative feedback on the app prototype were used to assess perceptions of living with diabetes, attitudes toward digital diabetes education, and acceptance of the prototype. RESULTS The data collected were grouped into 3 deductive themes: (1) challenges of living with diabetes, (2) validation, acceptability, and usability of diabetes education app prototype, and (3) perspectives on digital diabetes education. The first theme highlighted the importance and burden of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second indicated that the diabetes education app prototype is acceptable, with information being the key, power of appearance, ambivalent and polarized opinions toward the chatbot, and potential impact of the app on self-management. The third theme comprised the necessity of utilizing a variety of information seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based, gamification, guidance, integration, personalization, and up-to-date. CONCLUSIONS Our findings could be used for the development of apps to address the health needs of patients with type 2 diabetes. They also add context for understanding type 2 diabetes patients in Singapore, including challenges in self-management and perspectives on diabetes education.