Letter to the Editor
Enhancing care in nursing homes: Qualitative insights from the ENHANCE programme
Dear Editor,
Empower Nursing Homes And improve staNdards of CarE (ENHANCE) was a pilot programme introduced by Sengkang General Hospital to address the challenges faced by Singapore’s ageing population. With nearly 1 in 4 Singaporeans projected to be aged 65 years and above by 2030, the demand for effective long-term...
Editorial
Journey towards a smoke-free nation
“A journey of a thousand miles begins with a single step.” Singapore’s journey towards a smoke-free society started early in the 1970s when legislations were introduced to restrict smoking in certain public spaces and ban tobacco advertising.1 The National Smoking Control Programme was launched in 1986 with important objectives...
Original Article
Factors influencing smoking cessation: Insights from Singapore’s nationwide health and lifestyle survey
The global prevalence of smoking has declined over the years. According to authors utilising data from the Global Burden of Disease, Injuries, and Risk Factors Study, from 1990 to 2020, the number of male smokers fell by 27.2%, whereas female smokers fell by 37.9%.1 Moreover, the decline in smoking...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Letter to the Editor
Facing death alone: An exploration of terminally ill individuals living alone in palliative care
Dear Editor,
Home palliative care clinicians provide end-of-life care for patients from diverse social and economic backgrounds. They include patients who live alone—a single-person household.1 Auon et al. found that 7–12% of patients under palliative care lived alone for more than a year.3 Demographic trends increasingly highlight this group to...
Original Article
Predictors of early removal of intragastric balloon due to intolerance: Insights from a multiethnic Asian cohort
Obesity, affecting over 2.1 billion people globally, is an escalating health crisis with serious economic consequences.1 It is associated with multiple comorbidities including type 2 diabetes mellitus (T2DM), hypertension, coronary artery disease, stroke, sleep apnea, osteoarthritis and even certain cancers.2 In the US alone, USD190 billion per year is...
Original Article
Mental wellness and health-related quality of life of young adult survivors of childhood cancer in Singapore
Advancements in technology and cancer treatments have improved childhood cancer survival rates, with up to 85% surviving 5 years or more.1 The Malaysia-Singapore Leukaemia Study Group reported an improvement in overall 5-year survival for the past 20 years in Singapore, from 69% to 91% for acute lymphoblastic leukaemia, which...
Letter to the Editor
Evolving landscape of sports injuries and recommendations on injury preventions: A retrospective analysis in Singapore
Dear Editor,
Sports have become increasingly integral to the daily lives of Singaporeans. According to the National Sport and Exercise Participation Survey, the percentage of Singaporeans exercising weekly rose from 54% in 2015 to 73% in 2023.1 While this surge in sports activities brings numerous health benefits, it also results...
Editorial
How close are we from achieving demographic diversity in clinical trials? Insights from Singapore
Clinical trials are essential for assessing the efficacy and safety of new therapies. Because different patient subgroups may respond variably to treatments, it is important to emphasise diversity among participants. This approach ensures that the trial population accurately reflects the patients who will use the medication in real-world settings...
Editorial
The alcohol flushing syndrome: A risk factor for cancer
Globally, alcohol consumption is responsible for an estimated 3 million deaths annually and contributes to over 740,000 new cancer cases each year.1 Acetaldehyde, a byproduct of alcohol metabolism, has been designated as first-class carcinogens by the International Agency for Research on Cancer.2 In East Asian countries such as China,...
Original Article
Screen time and social-emotional skills in preschoolers with developmental, behavioural or emotional issues in Singapore
Preschool children, particularly those with developmental, behavioural or emotional (DBE) issues, are highly vulnerable to the negative effects of excessive screen viewing time (SVT) on their social and emotional development.1,2 Singapore, an island nation with a declining birth rate,3 places significant emphasis on human potential, particularly the social and...
Editorial
Evaluating the effectiveness of cervical cancer screening and prevention in Singapore
Cervical cancer is the fourth most common cancer in women globally, with approximately 660,000 new cases and 350,000 deaths reported in 2022.1 In Singapore, it ranks as the 11th most common cancer among women and the 5th most frequent cancer among young women aged 15–44 years, with 309 new...
Letter to the Editor
Seroprevalence of cytomegalovirus over the last 2 decades (2001–2020): A retrospective data analysis from a single laboratory in Singapore
Dear Editor,
Cytomegalovirus (CMV) is ubiquitous and infects human of all ages, where it remains latent after primary infection and can reactivate upon various triggers.1 Reactivated CMV may cause complications and end organ damages in immunocompromised hosts, leading to increased morbidity and mortality.2 In addition, the presence of actively replicating...
Review Article
Challenges in genetic screening for inherited endocrinopathy affecting the thyroid, parathyroid and adrenal glands in Singapore
In the current landscape of medicine, it is well known that most diseases incorporate a genetic component to some degree. Genetic testing of human diseases originated in the 1950s, and screening for genetic disorders followed a decade after.1 It is worthwhile noting that the Human Genome Project (1990–2003), which...
Editorial
Illicit drug consumption in Singapore: Where are we in the fight against drugs?
Illicit drug consumption is associated with significant negative health, financial and social consequences. Yet, illicit drug consumption remains highly prevalent and continues to be a growing problem worldwide. In 2021, 1 in 17 people aged 15–64 in the world had used a drug in the past 12 months. Notwithstanding...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Review Article
Polycystic ovary syndrome v.2023: Simplified diagnostic criteria for an East Asian phenotype
Polycystic ovary syndrome (PCOS) is a common endocrine condition affecting 6–19% of women of reproductive age, depending on the reference population and definition used.1,2 The incidence of PCOS is increasing and the syndrome can be considered the single most common endocrine abnormality among women of reproductive age.3 Although its...
Editorial
Enhancing the accuracy of polycystic ovary syndrome diagnosis
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder, experienced by 1 in 10 women of childbearing age. Its aetiology is multifactorial and complex, and its clinical presentation is heterogeneous with menstrual irregularities, high levels of androgens and the presence of multiple follicles or cysts in the ovaries...
Commentary
Value the patient as a person: Answering the call for a person-centred model of care
There has been a change in patients’ attitudes towards healthcare professionals in recent decades, coupled with an increasingly evident shift in the care paradigm. In 2015, the World Health Organization released a framework of care that recommends healthcare professionals consciously consider the perspectives of individuals, carers, families and communities....
Commentary
Singapore’s experience in managing the COVID-19 pandemic: Key lessons from the ground
In the early days of the pandemic when information on COVID-19 infection was lacking, all COVID-19 positive patients were admitted into acute hospitals for isolation and monitoring. With the exponential increase in the number of infections, COVID-19 Treatment Facilities (CTFs) were set up to help hospitals manage in-patient loads....
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Editorial
Perinatal mental health in Singapore: Implementation opportunities and relevance of gender-carer roles in screening
In this issue of the Annals, the consensus statement on perinatal mental health by Chen et al. covers the handling of depression and anxiety symptoms in pregnancy, childbirth and the postnatal period.1 The guidelines were developed by a workgroup involving experts in perinatal mental health and obstetrics using a...
Letter to the Editor
Evaluation on the adoption of eHealth App for electronic health record sharing system in Hong Kong
Dear Editor,
In Hong Kong, the eHealth App was launched in January 2021, as part of Stage Two development of the Electronic Health Record Sharing System. It provides the healthcare recipients, that is, those who have registered in the system, a series of functions to manage their health, such as...
Letter to the Editor
Managing and preventing severe hand injuries among sugarcane juicer operators
Dear Editor,
Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is...
Editorial
Impact of pre-existing depression on severe COVID-19 outcomes
The outbreak of the COVID-19 virus in 2019 had rapidly developed into a global pandemic, causing more than 6.8 million deaths and impacting the lives of billions of individuals around the world.1 Public healthcare around the work have mainly focused on the clinical manifestations and treatment of the deadly...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Letter to the Editor
Preferences for oral anticoagulant medications for managing atrial fibrillation
Dear Editor,
Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of serious bleeding events.3 Warfarin and direct oral anticoagulants (DOACs) are the available oral anticoagulants for this indication. We developed a discrete choice experiment (DCE) survey4...
Original Article
Evaluation of a return to work coordination programme for injured workers in a public hospital in Singapore
Workers who have sustained an injury at work often face difficulties returning to work, according to a study showing that over 40% of injured workers in Singapore experienced increased lethargy at work and that about 40% had difficulties in performing work at pre-injury standards.1 One in 4 workers also felt...
Original Article
Comparison of existing methods of low-density lipoprotein cholesterol estimation in patients with type 2 diabetes mellitus
Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major risk factor for the development of atherosclerotic cardiovascular disease (ASCVD). A reduction in LDL-C levels has been shown to significantly reduce the risk of incident ASCVD1 and all-cause mortality.2 LDL-C levels are hence key treatment targets in the prevention of...
Editorial
Proactive steps to population health: Starting early, starting right
The global burden of non-communicable diseases is rising, with continued projected increases in the prevalence of metabolic syndrome (MetS) in the future. This epidemic, albeit of a metabolic nature, poses broad socioeconomic and healthcare burdens worldwide. Population health improvement and optimisation of healthcare are important to addressing these burdens....
Original Article
Risk and protective factors of mental health during the COVID-19 pandemic: A cross-sectional study in Singapore
The COVID-19 pandemic has significantly impacted people’s well-being globally.1 Individuals faced several stressors during the pandemic, including fear of contracting the disease, experiencing severe symptoms of COVID-19, losing loved ones to the disease, financial insecurity, and social isolation. Furthermore, children and youths experienced disruption to their usual routine such...
Commentary
Artificial intelligence innovation in healthcare: Relevance of reporting guidelines for clinical translation from bench to bedside
Artificial intelligence (AI) and digital innovation have revolutionised many sectors and industries, prominently including healthcare during the coronavirus disease 2019 (COVID-19) pandemic.1 For example, deep learning, which is a subset of the state-of-the-art machine learning techniques, has shown robust performance in image recognition, speech recognition and natural language processing.2...
Original Article
Benefits of leisure-related physical activity and association between sedentary time and risk for hypertension and type 2 diabetes
Diabetes mellitus and hypertension are serious public health issues. Approximately 451 million individuals worldwide aged 18–99 years were living with diabetes in 2017, and this number is expected to increase to 693 million by 2045.1 More than 90% of all diabetes cases were type 2 diabetes mellitus (T2DM).2 For...
Editorial
Promoting physical activity for population health
The chronic disease burden has risen globally. In Singapore, between 2007 and 2021, the crude prevalence of hyperlipidaemia (8.2–13.9%), hypertension (12.7–15.7%) and diabetes (4.9–6.9%) has increased.1 Based on the Global Burden of Disease Study (2019), lack of physical activity and other modifiable risk factors contribute 35% of the disability-adjusted...
Original Article
Factors associated with deep infiltrating endometriosis, adenomyosis and ovarian endometrioma
Endometriosis is a chronic inflammatory gynaecologic disease marked by the presence of endometrial-like tissue outside the uterus.1 Debilitating chronic pelvic pain, dysmenorrhoea, and subfertility in women of reproductive age are commonly associated with endometriosis. The disease is estimated to affect about 1 in every 10 women of reproductive age,...
Original Article
Concordance of self-reporting of diabetes compared with medical records: A comparative study using polyclinic data in Singapore
Approximately 422 million people worldwide have diabetes and 1.6 million deaths are attributed to diabetes each year,1 contributing to high economic costs worldwide. Diabetes education and awareness of the disease contribute significantly to minimising complications and reducing morbidity and mortality.2 In addition, there is also a strong impetus to...
Editorial
Diabetes: Know thy foe
During the COVID-19 pandemic in 2022, Singapore’s Minister for Health Ong Ye Kung mentioned, “After the COVID-19 pandemic has passed, we need to tackle a far more challenging pandemic—which is longer-term chronic illness, and diabetes is a major one.”1
Truly, in the past decade, there has been an invisible global...
Review Article
Combating a resurgence of poliomyelitis through public health surveillance and vaccination
Singapore was certified poliomyelitis (polio)-free by the World Health Organization (WHO) on 29 October 2000, together with 36 other countries in the Western Pacific Region.1 Prior to certification, there were multiple outbreaks in 1958, 1960 and 1963 with 415, 196 and 74 paralytic polio cases, respectively.2-4 The nationwide immunisation...
Original Article
Clinical efficacy and long-term immunogenicity of an early triple dose regimen of SARS-CoV-2 mRNA vaccination in cancer patients
The spread of the SARS-CoV-2 virus has led to the ongoing worldwide COVID-19 pandemic. Initial studies have reported an increased vulnerability of patients with solid and haematological malignancies to SARS-CoV-2 infections.1,2 Global efforts to combat SARS-CoV-2 led to the unprecedented rapid development of multiple vaccines, with reported efficacies of...
Editorial
Early COVID-19 booster is beneficial in cancer patients
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its corresponding coronavirus disease (COVID-19) was first reported as a cluster of pneumonia cases in Wuhan, China, on 31 December 20191 and led to an unprecedented pandemic in modern times. It quickly overwhelmed healthcare systems around the world, and rendered...
Editorial
Vaccination and surveillance: Two basic tools for a final poliomyelitis eradication
Over the past 3 decades, the Global Polio Eradication Initiative (GPEI) has strived to achieve a poliomyelitis (polio)-free world. Wild poliovirus (WPV) types 2 and 3 were eradicated in 2015 and 2019, respectively. The World Health Organization (WHO) South-East Asia Region was declared free of poliovirus in 2014, and...
Commentary
Meeting today’s healthcare needs: Medicine at the interface
The demographic of Singapore has undergone dramatic changes. Historically, younger patients with communicable diseases predominated; however, patients are now older with chronic multimorbidity and functional impairment. This demographic shift challenges existing health and social care systems in Singapore, which must pivot to meet the changing need. The consequences of...
Letter to the Editor
A strategy to make COVID-19 vaccination more accessible to the elderly
Dear Editor,
Singapore embarked on the COVID-19 National Vaccination Programme in early 2021. The main modality employed to achieve the mass vaccinations has been the Vaccination Centres (VCs). These are dedicated facilities created with the sole purpose of providing the public with safe and convenient access to vaccination services.
While the...
Original Article
Non-alcoholic fatty liver disease screening in type 2 diabetes mellitus: A cost-effectiveness and price threshold analysis
Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic and has become a major cause of liver-related mortality and indication for liver transplantations globally. It is estimated that nearly 25% of the world’s population and more than 60% of type 2 diabetes mellitus (T2DM) patients have NAFLD. A prior...
Letter to the Editor
Prevalence of perceived weight-based stigmatisation in a multiethnic Asian population
Dear Editor,
People with obesity contend with obesity-related stigmas, in addition to health complications.1 In contrast to the West, literature documenting the prevalence of such stigmas in Asia is sparse. We report the prevalence of perceived weight-based stigmatisation in Singapore.
An anonymised questionnaire was administered to 101 consecutive patients presenting to...
Original Article
Cost analysis of a Patient-Centred Medical Home for community-dwelling older adults with complex needs in Singapore
The Patient-Centred Medical Home (PCMH) is a model of chronic care that replaces episodic primary care, with the delivery of primary care to patients, families and communities. It is guided by the principles of first-contact accessibility, comprehensiveness and whole-person orientation, integration and care coordination, sustained clinician-patient relationships, and quality...
Editorial
From Astana to Singapore: Primary Health Care is key to the long-term success of Singapore’s health system
The Ministry of Health, Singapore (MOH) has launched a wide-ranging and ambitious initiative for a life-course approach to drive the population’s health.1 This approach aims at ensuring the sustainability of the healthcare system. Crucially, it also embodies core principles of the health systems orientation that have long been advocated...
Editorial
Frequent attenders to multiple emergency departments in Singapore
The problem of overcrowding, of which access block is one of the main causes, continues to plague emergency departments (EDs) worldwide.1 Some of its negative effects include adverse impact on patient safety, medical errors and staff burnout. In addition, high volume of patients waiting to be seen (ED input)...
Original Article
Treating acutely ill patients at home: Data from Singapore
Inpatient hospitalisation is the conventional strategy to care for acutely ill patients. However, demand for hospital beds and clinical manpower is escalating as populations age, and hospitals are expensive to build and run.1 There is increasing recognition of the risk of hospitalisation from potent nosocomial infections2,3 (exacerbated by the...
Letter to the Editor
Attitude towards screening for congenital cytomegalovirus infection in newborns in Singapore
Dear Editor,
Cytomegalovirus (CMV) infection is the most common congenital infection.1 A systematic review that included 77 studies from 36 countries reported that the overall prevalence of CMV was 0.67% in their newborn population.1 Among newborns with CMV, it was estimated that 15–20% will suffer from potentially deleterious effects including...
Commentary
COVID-19 vaccination acceptance of healthcare workers in Singapore
The Coronavirus disease 2019 (COVID-19) pandemic resulted in 511.0 million cases of confirmed SARS-CoV-2 infection and almost 6.2 million deaths globally as of end April 2022.1 With the introduction of vaccines that are effective in reducing severe COVID-19 illnesses and deaths, Singapore had since pivoted from a COVID-19 elimination...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Original Article
Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore
Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the syndrome are varied, and multiple parameters are needed for its diagnosis.2,3 This complicates the diagnosis of PCOS and may cause patient dissatisfaction arising from delayed...
Original Article
A Randomized Trial of the Use of Print Material and Personal Contact to Improve Mammography Uptake Among Screening Non-attenders in Singapore
Breast cancer is the most common cancer among females in Singapore. Although lower than incidence rates in North America and the United Kingdom the incidence of breast cancer here has doubled from 20 to 38.8 per 100,000 women per year over the past 2 decades, and the disease is...
Others
Thyroid Storm Presenting as Jaundice and Complete Heart Block
Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered mental status. With the “apathetic” variant of hyperthyroidism, the classical features may not be evident.
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Others
Hyperthyroidism with Gynaecomastia as the Initial Complaint: A Case Report
Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight reported cases of gynaecomastia as a presenting feature in thyrotoxicosis, and herein we describe an additional case.
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Original Article
Serum Selenium in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease, with cancer...
Original Article
Serum Ferritin and Iron Status in the General Population of Singapore, 1993 to 1995
Iron, a dietary constituent, is an essential element. Body iron stores can be measured by haemoglobin, serum ferritin, transferrin saturation, and erythrocyte protoporphyrin.
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Original Article
Epidemiological Surveillance of Melioidosis in Singapore
Melioidosis was first described in 1911 among vagrants and morphine addicts brought into the mortuary in Rangoon, Burma. However, the disease received little attention until the Vietnam War when French and US military personnel were affected by it.
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Others
Urinary 2/16α-hydroxyestrone Ratio: Correlation with Serum Insulin-like Growth Factor Binding Protein-3 and a Potential Biomarker of Breast Cancer Risk
Breast cancer is the most common cancer among women in Singapore with age-standardised incidence rates increasing markedly from 26.8 to 38.7 per 100 000 per year over the last decade. While many recognised risk factors exist for the development of breast cancer such as demographic factors (personal and family...
Others
A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore
Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...
Others
A Case Report of a Patient with Bronchial Carcinoid Tumour and Late Presentation of Cushing’s Syndrome
Cushing’s syndrome is usually easy to recognise clinically. Determining the cause of non-iatrogenic Cushing’s syndrome is, on the other hand, often a diagnostic enigma.
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Original Article
Population-based Mammographic Screening in Singapore: What are Participants’ Views?
Breast cancer is the most common cancer among women in Singapore and has been increasing in incidence since 1968. This rise is particularly marked among younger women, suggesting that the increase will take place at an even faster rate in future.
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Original Article
Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3% Others) is dominated by non-communicable diseases. There have been increasing trends, though with recent declines, for coronary heart disease (CHD) and cerebrovascular disease.
This article is...
Others
Measurement of Obesity by Anthropometry and Bioelectric Impedance Analysis: Correlation with Fasting Lipids and Insulin Resistance in an Asian Population
Obesity is a risk factor for cardiovascular disease. This risk is partially mediated by the correlation between obesity and other coronary artery disease risk factors.
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Original Article
A Study to Assess the Effect of Dietary Supplementation with Soluble Fibre (Minolest®) on Lipid Levels in Normal Subjects with Hypercholesterolaemia
Hypercholesterolaemia is one of the major risk factors in the development of coronary artery disease (CAD). In recent years, many non-prescription treatments have become available for cholesterol lowering.
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Review Article
Regulation of Insulin Secretion by Nerves and Neuropeptides
The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1% of the pancreatic mass.
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Others
Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report
A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia.
This article...
Editorial
Orlistat (Xenical) in the Management of Obesity
The term “obesity” implies an excess of adipose tissue (fat) and excess adiposity is a health risk. In most cases it develops in the absence of any underlying disease process.
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Others
The Molecular Pathogenesis of Obesity: An Unfinished Jigsaw Puzzle
Obesity is one of the most common health problems in Singapore with escalating prevalence, affecting about 6% of the Singapore population above 18 years of age. The prevalence of obesity is 12.2% in Singapore children aged 6 to 7 years, 12.8% in children aged 11 to 12 years, and...
Others
1990-2000: Progress in Determining High Blood Pressure Genes
Essential hypertension and its complications, coronary heart disease, stroke and renal failure are leading causes of morbidity and mortality in western societies.1 While the aetiology of essential hypertension is not known, it is recognised as being a multifactorial disease caused by both genetic and environmental factors.
This article is available...
Others
Cardiovascular Disease: Genes and Public Health
The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is assumed that the identification of mutations that confer susceptibility will provide the basis for new means of detection, prevention and treatment.
This article is available only...
Original Article
A Rational Alternative for the Diagnosis of Diabetes Mellitus in High Risk Individuals
The “gold standard” for the diagnosis of diabetes mellitus has all along been the oral glucose tolerance test (OGTT). As diabetes mellitus defines a group of individuals at high risk for macrovascular and microvascular disease, it is essential that the diagnosis be made promptly.
This article is available only as...
Original Article
Evaluation of a Rapid Screening Test for Microalbuminuria with a Spot Measurement of Urine Albumin-Creatinine Ratio
In 1989, the St Vincent Declaration was formulated by all European countries to address the growing problem of diabetes, with the general goals of improving health care and quality of life for the diabetic patient. One of the targets in the declaration was the need to implement effective measures...
Letter to the Editor
Graves’ disease after COVID-19 vaccination
Dear Editor,
Case 1 was a 41-year-old man with a history of primary hyperthyroidism. At the time of diagnosis, thyroglobulin antibodies were elevated although no thyrotropin receptor antibodies (TRAB) were available. The patient was treated with carbimazole for 20 months. At the time of cessation of carbimazole in May 2020,...
Original Article
Severe Diabetes in Remission: A Singapore’s Perspective
Diabetic ketoacidosis is generally believed to be the result of an acute and severe degree of insulin insufficiency, classically occurring at the presentation of a newly diagnosed individual with Type 1 diabetes.
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Editorial
Obesity in Singapore
The word obesity implies an excess of adipose tissue (fat) and not merely an excess of body weight. An increase in body weight may be due to fat (as in an obese person) or due to lean muscles (as in Hercules or in a body builder).
This article is available...
Others
A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report
Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...
Original Article
Body Mass Index and Its Related Factors in the Elderly
Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is the third leading cause of death after neoplasm and cerebrovascular disease.
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Others
Problem-based Learning (PBL) as an Approach in the Teaching of Biochemistry of the Endocrine System at the Angeles University College of Medicine
The Angeles University College of Medicine (AUCOM) was established in 1983 with a curriculum that is conventionally teacher-centred. Biochemistry is a basic science subject introduced in the first year of the medical curriculum.
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Others
46, XY Female—A Case Report
The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...
Others
A Case Report of Primary Hyperparathyroidism with Severe Bony Involvement and Nephrolithiasis
Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively benign course in the majority of patients. In a 1981 study, the incidence of radiologically detectable bone disease was found in 24% of patients but...
Others
Current Therapeutic Strategies for Type 2 Diabetes Mellitus
Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on glycaemic control to one addressing global cardiovascular risk factors in a particular individual, glycaemic control remains one of the key challenges that the physician faces...
Review Article
Evidence-based Health Promotion: Applying it in Practice
There has been a growing interest in health promotion among health professionals and policy makers in Singapore. This is partly in response to the rising trend of chronic diseases and the finding that many of these diseases are lifestyle related and amenable to change.
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Others
Treating Thyrotoxicosis with Radioiodine
Iodine is an essential component of thyroid hormone and is actively taken up by thyroid follicles. This is the physiological basis for the use of radioiodine in the treatment of thyrotoxicosis.
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Others
Subdural Block—From a Spinal? A Case Report
There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an epidural gone astray, and the lowest reported volume of local anaesthetic used was 3.5 mL.
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Original Article
A Preliminary Evaluation of a Disease Management Programme for Patients with Diabetes Mellitus and Hypertension in a Primary Healthcare Setting
Chronic diseases are the main causes of morbidity and mortality in developed countries. In most developed countries, the problems of a rising prevalence of chronic disease and escalating costs have forced healthcare policymakers to look for ways to provide cost-effective healthcare for chronic disease patients.
This article is available only...
Review Article
Thyroid Diseases in Pregnancy
Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy.
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Original Article
Gestational Diabetes Mellitus: A Call for Systematic Tracing
The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually.
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Commentary
Statins and Bone Morphogenetic Proteins: New Pathways in Bone Formation
Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip fractures will occur in Asia in 50 years’ time.
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Others
Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports
Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up to 3 months) after starting allopurinol.
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Original Article
Comparing Fasting Plasma Glucose against Two-hour Post-load Glucose Concentrations for the Diagnosis of Diabetes Mellitus and Glucose Intolerance in Singaporean Hospital Patients
Prior to 1997, the diagnosis of diabetes mellitus in asymptomatic individuals was based upon the 1985 World Health Organisation (WHO) diagnostic criteria in which, utilising the 75g oral glucose tolerance test (OGTT), diabetes was defined either by a fasting plasma glucose (FPG) concentration of >7.8 mmol/L or by a...
Others
Clinical Update on Osteoporosis
Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...
Commentary
The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease
The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative.
This article...
Commentary
Osteoporosis—A Worldwide Problem and the Implications in Asia
Osteoporosis is a condition characterised by low bone mineral density, microarchitectural deterioration of bony tissue, and a consequent increase in fracture risk. With rapid ageing of the Asian population, osteoporosis has become one of the most prevalent and costly health problems.
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Review Article
Bone Fragility in Asian and Caucasian Men
Bone fragility in men has been receiving greater attention during the last few years. Epidemiological studies have been done in Caucasian and Asian populations.
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Review Article
Steroid-induced Osteoporosis
Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed. The most important effects appear to be on bone formation due to direct effects on cells of the osteoblastic lineage although indirect effects related to...
Review Article
Medical Treatment of Osteoporosis—Increasing Options
The current practice and management of osteoporosis differs greatly from even the recent past. Up to 15 years ago, bone mineral density (BMD) measurements were not widely available, osteoporosis was still largely diagnosed only at the stage of fractures, the epidemiology of osteoporosis was not well studied yet and...
Review Article
Osteoporosis Risk Factor Assessment and Bone Densitometry—Current Status and Future Trends
Osteoporosis affects predominantly elderly women; although younger women and men may also be affected. Demographically, the number and proportion of the elderly (aged 65 years and above) in many countries is increasing rapidly, and the problem of osteoporosis will increase concomitantly.
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Review Article
Osteoporosis in Relation to Menopause
Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...
Review Article
An Asian Perspective to the Problem of Osteoporosis
Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West.
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Editorial
Osteoporosis: A Treatable Disease
Osteoporosis twenty years ago was a very different disease from what we know of it today. At that time a diagnosis of osteoporosis was made at the point of sustaining a fracture as there was no routine method of pre-fracture diagnosis such as bone mineral density measurement.
This article is...
Others
Is Healthcare Competition Healthy?
There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: “money no enough”.
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Others
Public Disclosure of Healthcare Performance Information and Its Application to the Singapore Context
It has been said that apart from the prevention of diseases, the best chance of improving health is through improving the quality of care delivered to patients.1 The public disclosure of healthcare performance information is a phenomenon that has come to the fore in the United States (US) and...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
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Others
The Diagnosis and Management of Hypercalcaemia
Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years.
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Others
The Perils of Puberty
Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such as cytochrome P450 systems, accretion of peak bone mass, and the development of sexually dimorphic adult patterns in blood lipids, blood pressure, haemoglobin and red...
Letter to the Editor
Patterns and predictors of sound levels in hospital rooms
Dear Editor,
Excessive sound levels in the hospital can impair the work performance of healthcare professionals and affect patient well-being.1 Previous studies have also linked excessive sound levels with sleep disturbances and cardiovascular morbidity.2 While there have been data published regarding noise levels in the intensive care unit (ICU),3...
Others
The Role of Public Health and Occupational Physicians in the New Millennium
I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4 years old, and yet I cannot see beyond the next decade, with things moving so rapidly.
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Original Article
A Study on SARS Awareness and Health-seeking Behaviour – Findings from a Sampled Population Attending National Healthcare Group Polyclinics
There was a worldwide outbreak of Severe Acute Respiratory Syndrome (SARS) caused by the novel coronavirus between November 2002 and July 2003. Singapore was one of the hot spots, in addition to China, Taiwan, Hong Kong, Toronto and Vietnam.
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Original Article
How Much do Diabetic Patients Know About Diabetes Mellitus and its Complications?
Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control.
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Review Article
The Epidemiology of Myopia in Hong Kong
Myopia is a refractive condition in which the image of a distant object is formed anterior to the retina of the unaccommodated (relaxed) eye. It occurs when the refractive power of the eye is too great compared to the length of the eyeball and this may occur because the...
Editorial
Issues and Challenges for Myopia Research
Myopia is an ocular disorder of major public health and socioeconomic significance in many East Asian urban cities. In Singapore, the prevalence of myopia is one of the highest worldwide, affecting 28% of school children at the start of their primary education and 70% of those completing university education.
This...
Others
Unravelling the Mystery in a Case of Persistent ACTH-independent Cushing’s Syndrome
A Malaysian Chinese male patient, CMO, first presented at the age of 22 years with a 2-week history of severe spontaneous low backache with no prior trauma or back injury. A lumbar spine X-ray showing marked osteopenia and compression fracture of the first lumbar vertebra led to findings of...
Commentary
Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease
For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within the scientific community. The unraveling of the human genome project brings hope and great optimism that a verdict on such debates may be in the...
Editorial
Environmental Planning and Urban Health
Environmental exposures to the adverse effects from climate change are expected to increase for many urban populations in the United States during the next 50 years, potentially due to increased summertime heat stress, increased ambient ozone concentrations, and other pathways such as increased vector- and water-borne disease. Vulnerable elderly...
Others
A Hyperthyroid Patient with Measurable Thyroid-stimulating Hormone Concentration – A Trap for the Unwary
Free thyroxine (FT4), total tri-iodothyronine (T3) and thyrotropin (TSH) are the commonly measured biochemical indices in the assessment of thyroid function in a patient with suspected thyrotoxicosis. These indices give sufficient information regarding the functional status of the thyroid gland under most circumstances.
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Review Article
SARS Revisited: Managing “Outbreaks” With “Communications”
In the short span of 3 years since SARS first appeared on the Asian landscape, terms like “risk communications” and “outbreak communications” have assumed greater import and found common usage in the lexicon of governance by public health systems in our part of the world.
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Review Article
SARS and Emerging Infectious Diseases: A Challenge to Place Global Solidarity above National Sovereignty
The majority of the world’s information about infectious disease outbreaks no longer comes from voluntary reporting by countries, the willingness of which is influenced by fears of severe decreases in travel, tourism and trade as a result of aggressive protective measures undertaken by other countries. It now comes from...
Review Article
SARS in Singapore – Key Lessons from an Epidemic
The 2003 severe acute respiratory syndrome (SARS) outbreak represented the most severe communicable disease challenge to the public health system and the government and people of Singapore. The SARS outbreak in Singapore began on 1 March 2003 and the last case of the outbreak was isolated on 11 May...
Original Article
Clinical Assessment of Absence of the Palmaris Longus and its Association With Other Anatomical Anomalies – A Chinese Population Study
The prevalence of absence of the palmaris longus (PL) has been extensively studied following the first report of its absence in 1559 by Colombos in De Re Anatomica Libri. It is well known that there is a wide variation in the reported prevalence of PL absence in different ethnic...
Original Article
Rising Trends of STIs and HIV Infection in Singapore – A Review of Epidemiology Over the last 10 Years (1994 to 2003)
A review of the epidemiology and trends of sexually transmitted infections (STIs) in Singapore from 1977 to 1996 showed a declining number of all STIs notified in Singapore from 22,427 in 1978 to 5570 in 1996, with the 20-to-29 years age group consistently accounting for the highest proportion of...
Original Article
Variables Determining Perceived Global Health Ranks: Findings from a Population-based Study
In 1982, Mossey and Shapiro first demonstrated that global self-rating of health was a better predictor of 7-year survival than medical records or self-reports of medical conditions in participants of the Manitoba Longitudinal Study. Since then, many population-based longitudinal studies have confirmed that global self-rated health remains an independent...
Others
Public Healthcare – Welfare, Market Share or Laissez-faire? – A Sentosa Carlsberg Skytower View
Recently, two doctor-administrators commented to me separately, “Singapore probably has the best public healthcare system in the world.” While I understand the basis for their view, the accolade of world’s best healthcare system, according to the World Health Organization’s ranking, actually goes to France.
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Others
Disaster Relief and Initial Response to the Earthquake and Tsunami in Meulaboh, Indonesia
A massive earthquake and tsunami hit the South Asian region on 26 December 2004, killing more than 200,000 people and displacing countless more.1 The epicentre of the earthquake was near the coast of Aceh in Sumatra, Indonesia. 2 The subsequent tsunami, one of the deadliest in history, affected more...
Commentary
Graduate Public Health Education – Singapore’s Contribution to Strengthening Capacity in the Region and Beyond
The effectiveness with which the world tackles its most pressing public health problems depends crucially on the calibre of its public health workforce. Institutions of higher learning play a critical leadership role in this regard, both to build capacity at the national, regional and global levels, and to ensure...
Original Article
Diabetes Outcomes in Specialist and General Practitioner Settings in Singapore: Challenges of Right-Siting
The long lasting debate on the role of generalists and specialists in the management of diabetes is still ongoing. Nonetheless, the last 3 decades have seen the increasing shift of chronic disease management from specialist outpatient clinic-based to more general practice-based services.
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Editorial
Diabetes in Asia – From Understanding to Action
In the present pandemic of diabetes and obesity, 60% of the affected population will come from Asia. Between India and China, these two most populous nations will contribute more than 100 million to the world’s population of people with diabetes, many of whom remain undiagnosed, untreated or suboptimally managed.
This...
Original Article
The Metabolic Syndrome in Hypertensive and Normotensive Subjects: The Isfahan Healthy Heart Programme
The metabolic syndrome (MS) is characterised by a clustering of metabolic risk factors and an insulin-resistant state.1 Its prevalence is high in Western, as well as Asian, populations.2-4 There are numerous correlations between the MS and hypertension, although this is not always the case.5 Resistance to insulin-mediated glucose disposal...
Review Article
The Emerging Challenge of Age-related Eye Diseases in Singapore
Singapore has one of the fastest ageing populations in the world today. The current elderly population, defined as persons 65 years or older, comprises 7% of Singapore’s total population and is expected to multiply almost threefold to 19% by the year 2030.1 Although the current figure stands at 7%,...
Original Article
Magnesium, Zinc, Copper, Manganese, and Selenium Levels in Postmenopausal Women with Osteoporosis. Can Magnesium Play a Key Role in Osteoporosis?
Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as a result of an imbalance between bone formation and bone resorption.
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Commentary
Risk Communications: In Search of a Pandemic
The first decade of the new millennium has seen a string of disasters worldwide – earthquakes, tsunamis, floods, typhoons and acts of terrorism – bringing in its wake, scenes of utter devastation and death. Predictably, these disasters have been accompanied by public outrage, directed more often than not at...
Review Article
Prevention and Control of Avian Influenza in Singapore
Avian influenza (AI) or “bird flu” is a highly infectious disease of birds. AI viruses are negative single-stranded enveloped RNA viruses that belong to the influenza A genus of the Orthomyxoviridae family.
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Review Article
Preparing for an Influenza Pandemic in Singapore
The last influenza pandemics occurred in 1957 and 1968. Few remember the pandemic in 1968 in Singapore as it was relatively mild.
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Review Article
Avian Influenza and Pandemic Influenza Preparedness in Hong Kong
In 1997, Hong Kong became reputed by identifying the first instance of human infection with avian influenza H5N1. A total of 18 cases occurred that year resulted in 6 deaths. The outbreak was completely terminated after the culling of over 1.5 million chickens.
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Review Article
Towards Mutual Trust, Transparency and Equity in Virus Sharing Mechanism: The Avian Influenza Case of Indonesia
Since July 2005 to December 2007, Indonesia has reported the highest number of influenza A (H5N1) human cases in the world, i.e., 116 cases with an extremely high fatality proportion of 81% . Those patients were reported from 12 out of 33 provinces (Fig. 1).
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Review Article
A Global Perspective on Avian Influenza
The world is confronted by many important public health challenges, some of which constitute potentially devastating global threats. Prime among these is the threat of a influenza pandemic.
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Review Article
Twentieth Century Influenza Pandemics in Singapore
Tropical countries such as Singapore, although without well-defined influenza seasons, are also affected by influenza epidemics and pandemics. Twenty per cent of Singapore’s population is clinically infected by seasonal influenza annually, and excess mortality over the past decade was about 14.8 per 100,000 person-years – comparable to temperate United...
Original Article
A Cross-sectional Study of Primary-care Physicians in Singapore on Their Concerns and Preparedness for an Avian Influenza Outbreak
Outbreaks of avian influenza (AI) caused by the H5N1 subtype in several Asian countries have raised concern all over the world. AI is endemic in several parts of Asia. To date, there have been more than 200 human cases of AI virus infection, mainly as a result of poultry-to-human...
Original Article
Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry
Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death.
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Editorial
Singapore and the Tobacco Pandemic
The World Health Organization, in its 2008 Report on the Global Tobacco Epidemic, has framed the problem in almost apocalyptic terms, in stating that tobacco smoking is now the number one preventable cause of death globally. Smoking will kill up to 1 in 2 smokers and is a major...
Original Article
The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow
Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram. Many aetiological factors, such as microvascular and endothelial dysfunction, have been implicated.
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Original Article
Consequences of Right Siting of Endocrinology Patients – A Financial and Caseload Simulation
Right siting, defined as “patients treated in the most appropriate locations by medically competent teams at the lower possible cost”, has been on the national healthcare agenda for a number of years, even meriting mention and discussion in the Singapore Parliament. Internationally, the term “appropriate siting” is more commonly...
Original Article
Concerns, Perceived Impact and Preparedness in an Avian Influenza Pandemic – a Comparative Study between Healthcare Workers in Primary and Tertiary Care
The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the threat of an avian influenza (AI) pandemic is imminent. Healthcare institutions are expected to be key players during a pandemic, with healthcare workers (HCWs) at...
Original Article
Public Perceptions of Healthcare in Singapore
Healthcare is increasingly dominating the policy agenda in developed countries. In the United States, healthcare has been ranked only behind the war in Iraq as the issue the American public would “most like the president and Congress to act on next year”, while 19% of Canadians deemed healthcare the...
Letter to the Editor
Phaeochromocytoma the Great Mimicker: A Case Report
Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule of 10” where 10% are extra-adrenal, of which 10% are extra-abdominal, 10% are malignant, 10% occurs in normotensive patients and 10% are hereditary.
This article is...
Original Article
Metabolic Control in Type 2 Diabetes Correlates Weakly with Patient Adherence to Oral Hypoglycaemic Treatment
Diabetes mellitus is one of the most common chronic diseases affecting Singaporeans. In 2004, 8.2% of the population was afflicted, placing a significant burden on healthcare resources and affecting the well-being of the community.
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Original Article
Public Misperceptions About Transmission of Hepatitis B Virus in Singapore
Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia, as 4% to 10% of the total population are affected, and approximately 75% of patients with CHB worldwide reside in Asia.1,2 During the course of...
Others
A History of the Chapter of Public Health and Occupational Physicians
The history of the Chapter of Public Health and Occupational Physicians began with the founding of the Academy of Medicine in 1957. It was the first professional corporate body of medical and dental specialists in Singapore.
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Original Article
Elevated Level of Carbonyl Compounds Correlates with Insulin Resistance in Type 2 Diabetes
With rapid development of therapy, the mortality from acute complications of diabetes mellitus (DM) has decreased, but mortality from chronic complications like diabetic nephropathy has increased. The incidence and prevalence of type 2 DM is increasing in developing countries.
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Clinical Update
The Evolving Role of the Community Pharmacist in Chronic Disease Management – A Literature Review
Pharmacy has matured as a clinical profession and is presently well positioned to transform itself from a product and task oriented (dispensing) to a patient oriented profession (provision of care, advice and counselling). Every day, millions of people across the world visit community pharmacies for their healthcare needs for...
Original Article
Pathological Video-Gaming among Singaporean Youth
Video-gaming and internet use are a part of the lives of children and adolescents today. Among countries that are highly wired with high speed internet access, Singapore had the second highest broadband penetration rate in 2008 next to South Korea in the world, with 88% of households having broadband...
Original Article
Psychological Symptoms in People Presenting for Weight Management
Multiple factors contribute to the genesis and maintenance of obesity which is a difficult condition to treat and weight loss is often not maintained. The psychological problems found in obese patients have recently received increasing attention.
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Original Article
Trends in Importation of Communicable Diseases into Singapore
Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining 25% constitute of immigrant workers on work permit, foreigners on employment pass, and student pass holders.
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Original Article
Validity and Reliability of the Zarit Burden Interview in Assessing Caregiving Burden
Dementia is a growing public health issue in the Asia-Pacific region. The number of people with dementia in the Asia-Pacific region will increase from 13.7 million people in 2005 to 64.6 million people in 2050.
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Original Article
Multi-disease Health Screening in an Urban Low-income Setting: A Community-based Study
With the burden of chronic disease rising amongst rapidly urbanising Asian populations, active participation in health screening would allow for early detection and management of disease. However, participation in health screening can vary greatly within populations and is influenced significantly by sociodemographic and attitudinal factors.
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Original Article
The Pedagogical Value of a Student-run Community-based Experiential Learning Project: The Yong Loo Lin School of Medicine Public Health Screening
Experiential learning brings medical students out of the comfort zone of learning in their classrooms to acquire and apply knowledge and skills in an immediate and relevant setting. By linking theory and practice, experiential education differs from the traditional education in that it actively engages students in experiences that...
Original Article
Comparison of Clinical Outcomes and Cost Between Surgical and Transcatheter Device Closure of Atrial Septal Defects in Singapore Children
Congenital heart defects (CHD), with an incidence of approximately 1 in 100 live births, are the most important and frequent congenital malformations. It can cause significant morbidity and mortality in children as well as adults.
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Original Article
Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics
In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and primary care clinics. Most studies have found that patients are agreeable to seeing medical students and value the opportunity to interact with them.
This article is...
Original Article
Peripheral Arterial Disease in Community-based Patients with Diabetes in Singapore: Results from a Primary Healthcare Study
Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients with diabetes. In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of death and ischaemic events.
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Original Article
Foot Screening for Diabetics
Prevalence of diabetes is high in Singapore (8.2%). Five per cent to 15% of diabetics developed foot ulcers. In fact, the lifetime risk for a person with diabetes of developing a foot ulcer could be as high as 25%.
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Original Article
Knowledge, Attitudes and Practices of the Advance Medical Directive in a Residential Estate in Singapore
The Advance Medical Directive (AMD) Act was passed in Parliament in May 1996. The AMD is a legal document that an individual can sign in advance to inform his or her attending doctor that he or she does not want any extraordinary life-sustaining treatment to be used to prolong...
Original Article
The Singapore National Healthcare Group Diabetes Registry – Descriptive Epidemiology of Type 2 Diabetes Mellitus
Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity from complications, which lead to disability, poor quality of life and an enormous health cost.
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Original Article
Attitudes of Patients, Visitors and Healthcare Workers at a Tertiary Hospital Towards Influenza A (H1N1) Response Measures
Following the announcement by the World Health Organization (WHO) that outbreaks of a novel influenza virus had occurred in Mexico and several parts of the United States of America,1 the Emergency Preparedness Teams of the Singapore General Hospital and its sister institutions on the Outram Campus were activated. Measures...
Review Article
Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?
In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...
Original Article
Trends in Long-term Cancer Survival in Singapore: 1968-2002
With increasing health awareness and the greater extent of healthcare provision over the years, the life expectancy of Singaporeans has increased from 75.3 in 1990 to 78.4 in 2001. This suggests that cancer patients are surviving longer than before, due to an increasing number of delayed cancer deaths. Hence,...
Review Article
The Role of Leptin-Melanocortin System and Human Weight Regulation: Lessons from Experiments of Nature
Obesity predisposes to significant morbidities and premature mortality, and the increasing obesity prevalence all over the world has been attributed to industrialisation and modernisation which encourages a sedentary lifestyle and increased calorie intake. This results in energy intake and expenditure imbalance and the net deposition of calories as fat....
Others
Knowledge and Practice of Household Mosquito Breeding Control Measures between a Dengue Hotspot and Non-Hotspot in Singapore
Dengue is the most common mosquito-borne viral disease in the world and its severity is reflected by a 30-fold increase over the last 50 years. Today, 2.5 billion people over 100 endemic countries remain susceptible to this disease with an estimated annual incidence of 50 million leading to 22,000...
Review Article
The Role of Genes in the Current Obesity Epidemic
Obesity is a global pandemic and a major health concern because of the consequent morbidity and premature mortality; obesity predisposes to serious morbidities such as type 2 diabetes, hypertension and coronary heart disease. Industrialisation and modernisation is rightly blamed for the increasing obesity prevalence all over the world, as...
Review Article
The Relevance of the Metabolic Syndrome
Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected by chance alone. These risk factors include hypertension, hyperglycaemia, dyslipidaemia and obesity. The underlying pathophysiology is as yet unclear, but has been closely linked to...
Original Article
Development of Bariatric Surgery: The Effectiveness of a Multi-disciplinary Weight Management Programme in Hong Kong
Obesity is one of the most common chronic illnesses in the Western World with a frequency of 10% to 15%. It causes or exacerbates many diseases and is associated with major physical and psychological disability. Data from US national population surveys have shown that the prevalence of being overweight...
Original Article
Epidemiological Surveillance and Control of Rubella in Singapore, 1991-2007
Rubella is a mild febrile viral exanthematous disease transmitted through droplets or direct contact with the nasopharyngeal secretion of an infected person. It is of public health importance because of the teratogenic effects of the virus on the developing fetus.
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Original Article
Comparison of Oral Glucose Insulin Sensitivity with Other Insulin Sensitivity Surrogates from Oral Glucose Tolerance Tests in Chinese
Patients with type 2 diabetes mellitus are at an increased risk of developing atherosclerosis and cardiovascular diseases leading to higher morbidity and mortality. These complications cause serious economic burdens, not only to patients, but also to the family and society.
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Original Article
Prevalence of Metabolic Syndrome Among Patients with Schizophrenia in Singapore
Schizophrenia has been linked to metabolic disturbances such as obesity, dyslipidaemia and hyperglycaemia. It has also been associated with a more than 3-fold increase in mortality associated with cardiovascular causes. This increase in cardio-metabolic morbidity and mortality might be due to several factors such as inherent genetic vulnerability or...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000
man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...
Editorial
Sleep, Public Health and Wellness: The Elephant in the Room
The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of city dwellers can implement
to reduce their risk of accidents, coronary artery disease, diabetes, cancer and all-cause mortality while improving their cognitive performance. Unlike costly supplements...
Original Article
Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting
The rising occurrence of individuals suffering from multiple chronic diseases, namely multimorbidity, is of public health concern globally.1 The current prevalence of multimorbidity in Singapore ranges from 26 to 89% by various studies depending on the definition used and the population studied.2-5 With Singapore’s fast ageing population, where 1...
Editorial
Prevention and management of multimorbidity to ensure healthcare sustainability
Singapore has a healthcare system that is distinguished by its ability to achieve top health outcomes at very low healthcare expenditures.1 Yet one of the Ministry of Health’s (MOH) foremost policy concerns is the sustainability of the healthcare system in the face of a rapidly ageing society. With an...
Original Article
Prevalence of Overweight and Obesity in Chinese Preschoolers in Singapore
The increasing prevalence of childhood overweight and obesity and its associated adverse health outcomes have become an important health issue. Childhood obesity can persist into adulthood and increases the risk of cardiovascular metabolic diseases, giving rise to an increased healthcare burden. In Singapore, the prevalence of obesity for adults...
Commentary
Is Cost-Effective Healthcare Compatible with Publicly Financed Academic Medical Centres?
Nearly all legislation involves a weighing of public needs as against private desires; and likewise a weighing of relative social values.
—Louis D Brandeis
As a small island state with finite resources, Singapore’s healthcare philosophy is governed by pragmatism, rationing and cost-effectiveness (see Appendix 1 for definition) with an unrelenting emphasis...
Original Article
A Review of Back Injury Cases Notified to the Ministry of Manpower from 2011 to 2012
Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over the world. Studies estimate that between 60% and 90% of people will suffer from low back disorders at some point in their life. Among the...
Original Article
How do English-speaking Cancer Patients Conceptualise Personhood?
Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral and legal status of an individual, is central to the protection of rights and privileges and is pivotal to the maintenance of the distinctiveness of...
Editorial
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary...
Editorial
MERS-CoV: Where Are We Now?
Prior to 2002, coronaviruses were known mainly for causing mild human upper respiratory tract infections (URTIs) and enteric and respiratory infections in many animals. However, their full pathogenic potential was only realised when an outbreak of severe pneumonia with a high fatality rate occurred in southern China, and they...
Original Article
An External Independent Validation of APACHE IV in a Malaysian Intensive Care Unit
Over the past 30 years, different versions of severity of illness scoring systems and prognostic models have been developed for prediction of patient outcomes in critical care. These physiological-based systems and models allow patients to be stratified according to their severity of illness and provide prediction of in-hospital mortality....
Original Article
Anaerobic Bacteraemia Revisited: Species and Susceptibilities
Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...
Original Article
Factors and experiences associated with unscheduled 30-day hospital readmission: A mixed method study
Readmission leads to a greater demand for healthcare services, especially hospital beds, and contributes to the rising healthcare costs.1,2 With estimated one-third of the readmissions considered preventable,3 early identification of the underlying risk factors can offer better management and discharge planning.4 Some risk factors of readmissions related to patient...
Editorial
Potentially avoidable readmissions: Understanding drivers and technology-enabled solutions
Hospital admissions places high resource demands on the health system, and is a major cost-driver in Singapore and globally.1-3 Admissions have and will continue to increase given Singapore’s ageing population and growing chronic disease and multimorbidity burden, impacting care quality and patient/provider experience.2,4 While majority of admissions are clinically...
Letter to the Editor
Health professions education in pandemics and epidemics: A proposed framework for educators
The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and after pandemics and epidemics. We developed a crisis management framework which
draws from diverse theories to emphasise preparedness, leadership, stakeholder perceptions and organisational learning to provide...
Letter to the Editor
The “Jeff Cut”: A simple innovation to minimise up-riding sleeves of protective gown
Personal protective equipment (PPE) including the N95 mask, face shield, cap, splash-resistant gown and gloves are worn by frontline healthcare workers for various duties in the care of patients with communicable diseases like COVID-19. PPE is also worn by ancillary staff such as security personnel, porters, medical transport crew...
Commentary
Merits of a harmonised system to classify drug-related problems in Singapore
A drug-related problem (DRP) is commonly defined as an event or circumstance involving drug treatment that actually or potentially interferes with the optimal outcome of a patient’s medical care. It broadly includes events related to errors, adverse effects or adherence issues. DRPs are associated with increased healthcare costs and...
Original Article
New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore
Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown. Ascites and gastrointestinal dysmotility in advanced cirrhosis, compounded by the need for dietary restrictions, often result in early satiety and anorexia. Inevitably, liver transplant wait-list...
Original Article
Factors influencing protective behaviours during haze episodes in Singapore: A population-based study
Southeast Asia suffers from recurrent episodic air pollution from biomass smoke known as haze, which is mainly caused by human activities such as the extensive use of fire to clear land for agriculture,1 or to settle disputes over land rights.2 It is a major public health problem affecting an...
Editorial
Seasonal haze: Knowledge gaps and risk perception behaviours
The seasonal haze in Southeast Asia has been a recurrent concern whenever we enter the southwest monsoon season (June–September). This phenomenon, caused by agricultural fires, has vast effects on multiple countries in the region.
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Original Article
Impact of unemployment on mental disorders, physical health and quality of life: Findings from the Singapore Mental Health Study
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work pass issued to semiskilled workers, comprise 26.0% of Singapore’s entire labour force. Two other work passes held by FWs, “S pass” and “employment pass”, are...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Original Article
Vulnerability to rumours during the COVID-19 pandemic in Singapore
The global outbreak of coronavirus disease 2019 (COVID-19) has come with increased psychological burden. In several meta-analyses, depression and anxiety symptoms have been found to be elevated among healthcare workers and the general population. Others have reported a higher incidence of stress-related symptoms or post-traumatic stress disorder. These findings...
Original Article
Behavioural changes during the COVID-19 pandemic: Results of a nationwide survey in Singapore
In response to the global outbreak of coronavirus disease 2019 (COVID-19), Singapore undertook a multipronged approach to contain the pandemic. Of note, when community transmission began early in the outbreak, the government started emphasising the role that individuals had to play by adopting health-preventive behaviours.
This article is available only...
Editorial
The Novel Coronavirus (SARS-CoV-2) Pandemic
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began in early December in Wuhan, the 7th most populous city in Mainland China, and was reported to the World Health Organization (WHO) on 31 December 2019. An outbreak of unknown aetiology was suspected because many early cases were linked...
Original Article
Comparative Analysis of Symptomatic and Asymptomatic SARS-CoV-2 Infection in Children
Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February 4, 2020. As of 24 July 2020, Singapore has reported 49,071 cases of COVID-19. Singapore initiated a comprehensive surveillance, testing and contact tracing strategy as...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...
Review Article
Coronavirus Disease 2019 (COVID-19): The Singapore Experience. A Review of the First Eight Months
Singapore reported its first imported case of COVID-19 on 23 January 20201 and its first COVID-19 deaths on 21 March 2020.2 The WHO declared COVID-19 to be a pandemic on 11 March 2020;3 as of 27 October 2020, there have been more than 42 million confirmed cases and 1.1...
Letter to the Editor
Adipsic diabetes insipidus and SGLT2 inhibitor: A perplexing conundrum
A 70-year-old man with poorly controlled type 2 diabetes mellitus (DM), hypertension, hypercholesterolemia and alcohol dependence presented intoxicated, with occipital scalp lacerations after a fall. A brain computerised tomography (CT) revealed occipital skull fracture with bilateral subarachnoid haemorrhages, subdural haemorrhages and parenchymal contusions. He was admitted for close observation...
Review Article
Metformin use in patients with type 2 diabetes mellitus and chronic kidney disease: An evidence-based review
Diabetes is a chronic disease characterised by elevated levels of blood glucose. The most common type of diabetes is type 2 diabetes mellitus (T2DM). This usually occurs in adults and arises through insulin resistance or an insufficiency of insulin production. Diabetes is one of the priority non-communicable diseases targeted...
Original Article
Chronic disease self-management competency and care satisfaction between users of public and private primary care in Singapore
Primary care in Singapore is set to face challenges in managing a rapidly ageing population. The expected population of older adults aged 65 years and above will be close to 1.5 million by 2030, corresponding to 2.7 working adults per older adult in 2030.2 Between 2019 and 2050, Singapore...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases worldwide to date and a case fatality rate of approximately 1%. In comparison, the 2003 outbreak of severe acute respiratory syndrome (SARS) had 8,422 cumulative...