The National Breastfeeding Survey 2001 was the first comprehensive study on breastfeeding conducted on a national level in Singapore. It aimed to establish the prevalence of breastfeeding among Chinese, Malay and Indian mothers and to identify factors influencing breastfeeding. A total of 2098 mothers were interviewed in this two-phase study, with the first interview conducted 2 months after delivery and the second interview 6 months after birth among mothers who were still breastfeeding at 2 months. Frequency distributions of breastfeeding prevalence and types of breastfeeding practices at different time intervals (from birth to 6 months) were produced. Multivariate logistic regression was carried out to construct a model with predictive information on factors which influence continued breastfeeding till 2 months and 6 months after delivery respectively. The study found that about 94.5% of the mothers attempted breastfeeding. At 1 month, 71.6% were still breastfeeding, 49.6% continued to do so at 2 months, and 29.8% persisted till 4 months. By 6 months, the breastfeeding prevalence rate fell to 21.1%. The results of this study show higher breastfeeding prevalence rates compared to past studies in Singapore. Despite this, exclusive breastfeeding is still not a common practice. Various factors were found to be significant in influencing mothers' decision to breastfeed. Factors such as ethnicity, age, educational attainment, religion and baby's sex are non-modifiable in the short term or at an individual level. However, factors such as awareness of breastfeeding benefits, advice from health professionals and previous breastfeeding experience are potentially modifiable. Efforts aimed at promoting breastfeeding in Singapore need to take these modifiable factors into consideration so as to better tailor health promotion efforts on breastfeeding to women.

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Background: Conventional therapy may be inadequate for many patients with axial spondyloarthritis (axSpA). Traditional Chinese medicine (TCM) may be a viable alternative, but its effectiveness for axSpA is unknown. We are currently conducting a pragmatic randomised controlled trial (RCT) to investigate the effectiveness of a TCM collaborative model of care (TCMCMC), which combines usual rheumatologic care with acupuncture for patients with axSpA. This nested qualitative sub-study aims to identify facilitators of and barriers to the implementation of the TCMCMC. Methods: We conducted individual in-depth interviews with participants who had completed the acupuncture regimen to elicit opinions on the facilitators of and barriers to the implementation of the TCMCMC. The interviews were transcribed and analysed using thematic analysis. Results: Twelve participants were included, with data saturation occurring after 10 interviews. The analysis revealed both a number of important ‘facilitators’ and ‘barriers’. Facilitators to the implementation of the TCMCMC included effectiveness of TCM to relieve symptoms, inadequacy of conventional treatment and positive social perceptions of TCM. Barriers included scepticism towards TCM, inability of TCM to provide instant relief, needle-related discomfort, variable effectiveness of TCM influenced by physicians’ skills and experience and the high cost of TCM. Recommendations to overcome barriers included further patient education about TCM. Conclusion: Policymakers should take into account the various feasibility factors identified in this study when developing and implementing a TCMCMC. Trial registration number: NCT03420404 (ClinicalTrials.gov)

Background Despite therapeutic advances, treatment of patients with axial spondyloarthritis (axSpA) continue to pose as a challenge as many do not respond well to conventional Western medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDs) and biologic disease‐modifying antirheumatic drugs (bDMARDs). Hence, acupuncture is a possible alternative. Some studies found electroacupuncture to be better than manual acupuncture, though no trials have been conducted in patients with axSpA. This clinical trial aims to evaluate the clinical efficacy, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA. Methods/Design This randomized controlled trial will recruit 100 patients diagnosed with axSpA, who have active disease despite NSAIDs and bDMARDs. Eligible patients will be randomized to receive either electroacupuncture or manual acupuncture in a 1:1 ratio. All participants will receive standard rheumatologic care in addition to 20 acupuncture sessions. The mean difference in Bath Ankylosing Spondylitis Disease Activity Index score between the 2 groups over 12 weeks will serve as the primary outcome. Secondary outcomes include improvements in other clinical, quality of life, and economic outcomes over 24 weeks. All adverse events will be recorded. Discussion Results from this trial may provide evidence regarding the clinical effectiveness, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA, and guide implementation into clinical practice. Limitations of this trial include the lack of patient blinding, use of a repeated measures design, and possible variation in acupuncture technique amongst the various Traditional Chinese Medicine practitioners.