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...
Original Article
Intrapleural fibrinolytic therapy for pleural infections: Outcomes from a cohort study
Pleural infection, defined as bacterial infection and replication in the pleural space,1 remains a significant cause of mortality.2 Over 80,000 cases of pleural infection are diagnosed each year in the US and the UK.3,4 Data from East Asia suggest that the annual incidence of pleural infections is 8.4 to...
Letter to the Editor
Prevalence and causes of rifampicin-resistance genotypic/phenotypic discrepancy detected on Xpert MTB/RIF in Singapore
Dear Editor,
The Xpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) (Cepheid, Sunnyvale, CA, US) has been pivotal in tuberculosis (TB) diagnostics, enabling the rapid detection of both TB and RIF resistance. Xpert, a nucleic acid amplification test (NAAT), is recommended by both the World Health Organization (WHO)1 and Singapore's clinical management guidelines2 as...
Letter to the Editor
Traction alopecia in women: An under-recognised cause of hair loss
Dear Editor,
Alopecia ranks among the most common clinical complaints encountered by dermatologists.1 In particular, affected women often experience great psycho-emotional stress leading to a reduction in quality of life.2
We conducted a prospective epidemiological study conducted over 77 weeks from 1 August 2022 to 23 January 2024 at an outpatient...
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
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...
Original Article
Prevalence of consumption of illicit drugs and associated factors from a nationwide epidemiological survey: The Singapore Health and Lifestyle Survey
Substance use disorders (SUDs) are characterised by the uncontrolled use of a substance by an individual despite its harmful consequences.1,2 The prevalence of consumption of substances and SUDs varies widely across countries. This difference in prevalence can be attributed to factors such as study methodology (the substance included in...
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
Patient’s degree of adherence, challenges & preferences towards medicine taking (PACT) in Singapore
Dear Editor,
Medication nonadherence is a prevalent public health problem that compromises patients’ health outcomes and increases healthcare expenditures.1 Studies in Singapore showed that 25.7%–38.9% of patients are nonadherent.2,3 Studies investigating the association between patients’ reasons for nonadherence and their preferences towards adherence enablers are limited. We aimed to (1)...
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 ...
Review Article
Singapore tuberculosis (TB) clinical management guidelines 2024: A modified Delphi adaptation of international guidelines for drug-susceptible TB infection and pulmonary disease
Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex. For decades, it was the leading cause of death worldwide from a single infectious disease before being displaced by COVID-19 during the pandemic years.1
TB is endemic in Singapore, with over 2000 cases of TB disease (formerly active TB)...
Letter to the Editor
Challenges to smoking cessation in patients with substance use disorders
Dear Editor,
Despite significant progress in tobacco control measures and stringent smoking policies, cigarette smoking remains one of the largest preventable causes of death and disability worldwide. The World Health Organization estimates that over 8 million global deaths are attributed to smoking yearly, and in Singapore, more than 2,000 Singaporeans...
Editorial
Direct oral anticoagulant: Looking beyond convenience
Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications...
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...
Letter to the Editor
Knowledge, attitudes and practices of doctors on constipation management in Singapore
Dear Editor,
Constipation is a common gastrointestinal disorder, affecting about 15% of the global population and severely impacting patients’ quality of life.1 The global constipation treatment market is estimated to worth USD22.93 billion in 2025. Patients with functional constipation had the highest treatment dissatisfaction at 63.4%. Poor satisfaction was reported...
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...
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
Self-esteem and positive body image to overcome female sexual dysfunction
Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...
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...
Letter to the Editor
Delayed treatment with nirmatrelvir/ritonavir could remain effective in patients with Omicron BA2.2 variant of COVID-19
Dear Editor,
In late February 2022, the Omicron BA.2.2 subvariant drove the outbreak of COVID-19 and rapidly spread through many parts of the world. Omicron-infected individuals aged ≥80 years who are unvaccinated are particularly at high risk of poor outcomes.
COVID-19 vaccines and antiviral therapeutics have protected individuals most at risk...
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...
Letter to the Editor
Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial
Dear Editor,
Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of unsafe recovery include sudden unpredictable emergence or delayed return of airway tone and reflex with risk of airway obstruction.1 Agitation includes straining, sitting up, screaming...
Letter to the Editor
Clinical characteristics of macrolide-resistant Mycoplasma pneumoniae infections among hospitalised children in Singapore
Dear Editor,
Mycoplasma pneumoniae has become the leading cause of paediatric community-acquired pneumonia in countries where pneumococcal vaccination is included in the national immunisation programme, including Singapore.1 M. pneumoniae is intrinsically resistant to beta-lactams due to the absence of cell walls. Macrolides, tetracyclines, and fluoroquinolones are used to treat M....
Review Article
Managing adult asthma during the COVID-19 pandemic: A 2022 review and current recommendations
Asthma is the most prevalent chronic respiratory disease, estimated to affect more than 300 million people worldwide.1 First recognised in December 2019, the coronavirus disease 2019 (COVID-19), which is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has evolved into an ongoing global pandemic.2 In May...
Letter to the Editor
Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series
Dear Editor,
Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC).
In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...
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...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
Original Article
Global monkeypox outbreak 2022: First case series in Singapore
Monkeypox has been declared a public health emergency of international concern. Up until 2022, most cases of monkeypox have been reported in parts of Africa. On 7 May 2022, a returning traveller from Nigeria to the UK was confirmed to have contracted monkeypox. By the end of May 2022,...
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)...
Editorial
The global emergence of monkeypox
Monkeypox is so named because the poxvirus was first identified in 2 outbreaks among cynomolgus monkeys housed at the Statens Serum Institut, Denmark, in 1958.1 Both outbreaks occurred approximately 2 months after the monkeys arrived by plane from Singapore.1 However, the natural reservoir of the virus is not monkeys...
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
Perception of disease, well-being and financial burden by patients with chronic hepatitis B: A self-reported assessment
Dear Editor,
Chronic hepatitis B (CHB) infection affects approximately 248 million individuals in the world1 and 3.6% of the Singapore population.2 Given the natural history of CHB, regular surveillance with blood tests is necessary to ensure early detection of complications such as cirrhosis and hepatocellular carcinoma in patients. Our study...
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...
Letter to the Editor
Evaluation of a health screening protocol for recovered COVID-19 patients before “return-to-play” and strenuous physical activity
Dear Editor,
We conducted a prospective, single-centre cohort study to develop guidance for military personnel returning to strenuous activities following SARS-CoV-2 infection. The patients underwent a clinical review followed by a protocol to screen for cardiac, respiratory, haematological, endocrine/renal and neurological complications after recovery from infection.
Both the study and screening...
Others
Case Series of Bronchoscopic Removal of Tracheobronchial Foreign Body in Six Adults
Gustav Killian reported the first case of bronchoscopic removal of foreign body (FB) from the trachea in 1897. Since then, rigid bronchoscopy under general anaesthesia by the cardiothoracic surgeon has remained the procedure of choice for FB removal in the airways, failing which thoracotomy and bronchotomy is performed.
This article...
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...
Original Article
Glaucoma Pattern Amongst the Elderly Chinese in Singapore
Glaucoma is a major cause of world blindness in developing and developed nations. The WHO Global data on blindness show that over half of the blind due to glaucoma reside in Asia, the majority being Chinese.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Bronchoscopy in the Intensive Care Unit (ICU)
Flexible fibreoptic bronchoscopy (FFB) has become an indispensable tool in the optimal management of intensive care unit (ICU) patients with both diagnostic and therapeutic goals. Its safety and usefulness, in well-trained hands with appropriate precautions, have led to its increasing use even in unstable and mechanically ventilated patients.
This article...
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.
This article is available only as a PDF. Please click on “Download...
Others
Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report
The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...
Review Article
Contributions of Respiratory Care Practitioners to Intensive Care: A Review
The intensive care unit (ICU) is a complex environment in which multidisciplinary expertise has been shown to enhance clinical outcomes. For example, the availability of full-time intensivists has been associated with improved survival.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Ventilatory Strategies for Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) was first described by Ashbaugh et al in 1967. The original authors detailed the presence of tachypnoea, hypoxaemia, decreased respiratory compliance, bilateral pulmonary infiltrates and reported a survival rate of 42%.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
The Oxygen Delivery Debate—A Review
Multisystem organ failure occurs in a large proportion of critically ill patients and is a major cause of death in this group of patients. The mechanisms responsible for the development of multisystem organ failure in the critically ill patient are unknown.
This article is available only as a PDF. Please...
Review Article
Controlled Observations in Critical Care Medicine: The Therapeutic Trial
Central to the combined diagnostic and therapeutic approach to the critically ill subject is the evaluation of both the basal physiologic status and its subsequent change over time consequent to a therapeutic intervention.
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Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed only seven papers on the epidemiology of poisoning since 1975 (the earliest year covered by the database) and none targeting those severe enough to require...
Original Article
Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation
Critical care is costly as it is labour intensive and involves expensive life support technology. In the United States, the intensive care units (ICUs) use about 15% of the total hospital cost or about 1% of the gross national product.
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Editorial
Intensivists for the Intensive Care Unit—Do They Make a Difference?
Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have arrived at different paradigms—open versus closed models, specialty-based intensive care units (ICUs) versus general ICUs, internist versus pulmonologist or anaesthetist, and so forth.
This article is...
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...
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.
This article is available only as a PDF. Please...
Others
9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?
The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter pylori gastritis, and the new information regarding its molecular biology. Nevertheless, gastric cancer remains the second commonest cancer in the world in terms of morbidity...
Original Article
One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
Pityriasis rosea is a common, self-limited disorder of unknown but suspected viral aetiology, that develops abruptly with few or no prodromal symptoms. Classically, the first sign is the presence of a single lesion, 2 to 5 cm in diameter known as a “herald patch”.
This article is available only as...
Others
Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report
A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior release approach and posterior instrumentation. Preoperative assessment revealed good effort tolerance.
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Original Article
A Prospective Study of Infections with Atypical Pneumonia Organisms in Acute Exacerbations of Chronic Bronchitis
Chronic obstructive pulmonary disease (COPD) is a disease state characterised by the presence of airflow limitation that is generally progressive, partially reversible and caused by either intrinsic airway disease (bronchitis) or parenchymal destruction (emphysema). COPD is a leading cause of death and a major medical and economic problem.
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Original Article
Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings
Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated cost of hospitalisation is enormous and approaches nearly US$4 billion per year.
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Original Article
Long-term Outcome and Disease Control in Near-fatal Asthma
Rising trends in mortality in asthma have been reported from many countries, including Asian countries such as Hong Kong. Asthma deaths have been associated with a number of avoidable factors such as deficiencies in personal and professional management that can potentially be remedied if identified.
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Others
Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children
Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
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Original Article
Ethnicity, Obstructive Sleep Apnoea and Ischaemic Heart Disease
Obstructive sleep apnoea (OSA) is a condition whereby there is snoring associated with complete or partial cessation of breathing during sleep, associated with nocturnal oxygen desaturation and sleep fragmentation. This condition can lead to the effects of sleep fragmentation such as motor vehicular accidents, accidents in the workplace, social...
Original Article
Rapid Mycobacterial Tuberculosis Detection in Bronchoalveolar Lavage Samples by Polymerase Chain Reaction in Patients with Upper Lobe Infiltrates and Bronchiectasis
Pulmonary tuberculosis (PTB), the incidence of which is rising, poses a major health problem. It is caused by <i>Mycobacterium tuberculosis</i>. The isolation of <i>Mycobacterium tuberculosis</i> by culture has been the “gold standard” for the diagnosis of tuberculosis, as it gives a specificity that approaches 100% and permits susceptibility testing...
Others
Beneficial Effect of Combination Therapy with Ozagrel and Pranlukast in Exercise-induced Asthma Demonstrated by Krypton-81m Ventilation Scintigraphy—A Case Report
Exercise is a common stimulus of bronchoconstriction in subjects with asthma. Exercise-induced asthma is a temporary increase in airway resistance that occurs after several minutes of strenuous exercise, usually after the exercise has ceased.
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Original Article
Cross-Sectional Study of Near-work and Myopia in Kindergarten Children in Singapore
Myopia is the commonest eye disease worldwide, and is especially prevalent in certain Asian countries such as Taiwan, Japan and Hong Kong. Physiologic myopia is thought to be a multifactorial disease with both genetic and environmental factors.
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Original Article
Granuloma Annulare: A Review of 41 Cases at the National Skin Centre
Granuloma annulare (GA) is a benign, inflammatory disorder of the skin that has no proven aetiology or widely accepted theory of pathogenesis. There are several clinical manifestations, ranging from localised GA, which is the commonest form and is characterised by erythematous or flesh-coloured papules in an annular arrangement, to...
Others
Cardiopulmonary Exercise Testing in Patients with Chronic Obstructive Pulmonary Disease
Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD). Although exertional symptoms may be mild at the outset, exercise limitation is the most disabling and distressing consequence of COPD for the majority of patients.
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Others
Ethnic Differences in Genetic Susceptibility to Atopy and Asthma in Singapore
Twin studies have indicated that both asthma and atopy are largely regulated by genetic factors. However, the genetics is complex, involving an interaction of multiple susceptibility genes and environmental factors.
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Others
Human Genetic Susceptibility to Tuberculosis
The World Health Organization has declared that the recent resurgence of tuberculosis (TB) is a global emergency. Southeast Asia, which is seeing the greatest increase in new TB patients, is at the epicentre of this pandemic.
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Others
Myopia: Gene-environment Interaction
Myopia affects up to 70% of adults in Singapore, Taiwan, Hong Kong and Japan. The prevalence rates in these Asian countries are higher than those among Caucasians and Blacks in the United States and Europe.
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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.
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Others
A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis
The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as separate entities but clinical overlap occurs.
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Others
Upper Airway Resistance Syndrome—Report of Three Cases
Sleep-related breathing disorders are widely recognised as important causes of morbidity and mortality over the past 3 decades. The obstructive sleep apnoea syndrome (OSAS) and the sleep hypopnoea syndrome are well-known and well-described breathing disorders during sleep.
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Original Article
Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study
Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental or lifestyle factors that may be involved. This is aided when the ethnic groups live in the same country, so that differences in completeness and...
Original Article
Audit of Oxygen Therapy in Acute General Medical Wards Following an Educational Programme
The rational basis for supplemental oxygen (O<sub>2</sub>) treatment is well established. Long-term O<sub>2</sub> therapy improves survival and quality of life in patients with chronic obstructive pulmonary disease who are severely hypoxaemic. Short-term supplemental O<sub>2</sub> is required in medical emergencies and various acute disease states such as respiratory failure, circulatory...
Others
Active Management of a Patient with Endstage Pulmonary Emphysema Using Lung Volume Reduction Surgery and Intensive Rehabilitation
A 65-year-old Chinese man with a 30-pack year history of cigarette smoking was referred to our institution for further management of chronic obstructive pulmonary disease (COPD). Despite smoking cessation for 5 years, and pharmacological treatment with oral theophylline, inhaled ipratropium bromide and ventolin, his dyspnoea had progressed to the...
Others
Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection
Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man.
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Others
Endobronchial Mass in a Patient with Burkholderia pseudomallei Infection
The diagnosis of Burkholderia pseudomallei infection is based on culture of clinical specimens such as blood or other body fluids, or serology using indirect haemagglutination (IHA) test and various antigen detection tests. Gram stain shows a bipolar “safety-pin” pattern or small gram-negative rods.
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Original Article
Endobronchial Stenting in Patients Requiring Mechanical Ventilation for Major Airway Obstruction
Few things are as dramatic as respiratory arrest from major airway obstruction. Major airway obstruction frequently leads to well-defined clinical sequelae, namely shunt-associated hypoxaemia and post-obstructive pneumonia.
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Others
Clinical Update on Occupational Asthma
Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult asthmatics where the cause could be occupational range from 4% to 9%.
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Original Article
Body Mass Index Profile in Hong Kong Chinese Adults
Obesity is considered a chronic disease and not just a social stigma due to the associated morbidity and early mortality. Obesity has now become an epidemic with increasing prevalence in most parts of the world.
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Original Article
Effect of Different Endotracheal Suctioning Systems on Cardiorespiratory Parameters of Ventilated Patients
Endotracheal suctioning is a routine procedure performed in the intensive care unit (ICU) to remove secretions from the tracheobronchial tree. This is to maintain patency and reduce the risk of pulmonary atelectasis in mechanically ventilated patients.
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Original Article
The Role of Early Tracheostomy in Critically Ill Neurosurgical Patients
In medical history, tracheostomy is one of the oldest operations performed. There are indications that the Egyptians first employed this procedure more than 3500 years ago when Asclepiades of Bithynia described it in the second century BC.
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Original Article
Effects of a Pulmonary Rehabilitation Programme on Physiologic and Psychosocial Outcomes in Patients with Chronic Respiratory Disorders
Pulmonary rehabilitation is a multi-disciplinary programme of care for patients with chronic respiratory impairment that is individually designed to optimise physical and social performance and autonomy. In recent years, the efficacy and scientific foundation of pulmonary rehabilitation have been firmly established.
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Review Article
Recent Advances in the Obstructive Sleep Apnoea/Hypopnoea Syndrome
The past decade has seen a rapid increase in the number of patients being referred for investigation for the obstructive sleep apnoea/hypopnoea syndrome (OSAHS). Indeed, in many centres, possible OSAHS is now the most common respiratory referral and OSAHS is the most common outpatient respiratory diagnosis.
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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
All that Wheezes is not Asthma—Broncholithiasis, a Forgotten Disease
Asthma is a very common condition which presents clinically with cough, shortness of breath and wheezing. However, ‘all that wheezes is not asthma’, is an important adage not to be forgotten.
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Original Article
Sexually Transmitted Diseases in the Older Population in Singapore
Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. There is very little published data focussing on this group of patients which is relevant to Singapore or this part of the world.
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Others
Asthma Disease Management: A Provider’s Perspective
The burden of asthma appears to be increasing worldwide, especially in societies undergoing rapid urbanisation, and both morbidity and mortality from asthma have increased in many parts of the world, making it a global health concern. In Singapore, asthma is a highly prevalent problem, with an increasing societal and...
Original Article
Emergency Department Asthma: Compliance with an Evidence-based Management Algorithm
Attendance at the emergency medicine department (EMD) for acute exacerbation is an important milestone in the natural history of patients with asthma. It is an indication of clinically severe disease, inadequate preventive treatment and failure of self-medication for acute symptoms.
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Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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Original Article
Four-month Chemotherapy in the Treatment of Smear-negative Pulmonary Tuberculosis: Results at 30 to 60 Months
Patients with active pulmonary tuberculosis (PTB) are usually treated with a 6-month regimen in which chemotherapy is administered daily, intermittently or as a combined (daily and intermittent) regimen. However, patients with smear-negative PTB who have small lesions in the lung may not require the full duration of chemotherapy.
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Original Article
Bullous Pemphigoid Seen at the National Skin Centre: A 2-year Retrospective Review
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder affecting mainly the elderly. It is characterised by autoantibodies to the basement membrane zone (BMZ), which are detectable on immunofluorescent studies.
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Original Article
Bacteriologically-negative Pulmonary Tuberculosis—The Singapore Tuberculosis Control Unit Experience
The management of a patient as for pulmonary tuberculosis (PTB) in the setting of negative bacteriology would have to take into account not only the likelihood that the patient has active PTB, but also the consequences of a mistaken diagnosis and the adverse effects of TB treatment. Patients with...
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...
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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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
Asthma in Light of Patient Documents. A Factor Analytic Study
The lack of uniform criteria for asthma handicaps the diagnosis, the systematic documentation of cases and the consistent reporting of studies addressing asthma. It restricts also the use of patient documents of asthmatics especially in detailed causal analysis, although they could give important information for research and administration.
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Original Article
Malignant Mesothelioma: Experience at the Singapore General Hospital
Malignant mesothelioma is a rare tumour and is typically associated with asbestos exposure. In endemic areas, it has an estimated incidence as high as 66 per million for men aged 35 and above.
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Original Article
Five-Year Review of Adolescent Mental Health Usage in Singapore
The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in almost every area, including epidemiology, classification and treatment.
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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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Others
Pulmonary Hypereosinophilia
Eosinophilic lung diseases encompass a heterogenous spectrum of lung disorders defined by increased eosinophils in blood and/or tissue. In 1952, Crofton et al proposed the term “pulmonary eosinophilia” for disorders characterised by chest radiographic infiltrates and peripheral eosinophilia.
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Original Article
Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature
The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only 15% had arthritis and 6% had eye complications with no other systemic manifestations. These findings are different from epidemiological studies from other countries published in...
Others
An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis
Strongyloides stercoralis is an intestinal nematode which causes a chronic but usually asymptomatic infection in humans. However, in immunocompromised patients, parasitic larvae can develop rapidly and re-invade the host.
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Others
A Case Report of Occupational Asthma due to Gluteraldehyde Exposure
Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...
Original Article
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment.
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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...
Commentary
The Haze and Health: A Blog About the Fog
The haze is an atmospheric phenomenon where pollutant particles accumulate in the air and obscure the normal clarity of the sky. In Singapore, this usually happens when the prevailing southwest monsoon winds blow the smoke from regional forest fires to Singapore.
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Original Article
Eye Injuries in Singapore – Don’t Risk It. Do More. A Prospective Study
The issue of ophthalmic trauma is a major cause for concern. An estimated 55 million eye injuries occur each year worldwide, leaving 1.6 million patients blind from their injuries.
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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...
Review Article
Community-associated Methicillin-resistant Staphylococcus aureus: Overview and Local Situation
The emergence and spread of methicillin-resistant Staphylococcus aureus (MRSA) isolates from the community that are distinct from their archetypal healthcare-associated counterparts (HA-MRSA) marked a critical evolutionary milestone for the organism. In less than 2 decades, particularly in the last 3 years, this initially sporadic phenomenon of community-associated methicillin-resistant Staphylococcus...
Commentary
SARS: How to Manage Future Outbreaks?
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV), which crossed from wild animals at live markets to man in mid-November 2002 in Guangdong, southern China. SARS was the first pandemic of the 21st century.
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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
Modelling the Utility of Body Temperature Readings From Primary Care Consults for SARS Surveillance in an Army Medical Centre
There has been increasing interest in building surveillance systems capable of detecting outbreaks of infectious diseases, at the stage where clinical presentation would still be undifferentiated. The thrust of such systems is to detect both intentionally induced and naturally occurring outbreaks in their earliest stages, and if possible, at...
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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Original Article
The Clinical Predictors of Hypertension and Sleepiness in an Asian Population with Sleep-disordered Breathing
Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These studies have helped identify the risk factors for identifying sleep apnoea, particularly in the Western population.
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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...
Letter to the Editor
Sarcoidosis with Granulomatous Hepatitis and Autoimmune Endocrine Involvement
Sarcoidosis is a systemic granulomatous disease of unknown aetiology. It emerges in the form of hiler adenopathy and interstitial pulmonary disease in most cases.
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Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes.
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Original Article
Diabetic Retinopathy in Diabetics Referred to a Tertiary Centre from a Nationwide Screening Programme
Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM) worldwide, with 8.2% of Singapore adults between the ages of 18 and 69 having diabetes and there is little data on the prevalence of diabetic...
Review Article
Cardiovascular Changes in Children with Snoring and Obstructive Sleep Apnoea
Sleep disordered breathing (SDB) is a spectrum of diseases ranging from primary snoring to obstructive sleep apnoea (OSA). A recent review suggested that the prevalence of childhood OSA diagnosed by varying criteria was 1% to 4%.
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Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
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Review Article
Sleep Disorders in Children: The Singapore Perspective
Sleep problems are common in children. For example, snoring occurs in more than 25% of Singapore children1 and obstructive sleep apnoea (OSA) occurs in 1% to 3% of children.
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Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share a bedroom, since the child is often unaware of what happens when he or she is asleep.
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Review Article
The Scope of Paediatric Sleep Medicine
Despite apparent similarities to adult sleep medicine, the disorders of paediatric sleep medicine have a distinct epidemiology and pathophysiology. During childhood, the physiology of sleep develops and matures, resulting in changing patterns of normal behaviours and of sleep disorders.
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Original Article
Obstructive Sleep Apnoea in Singapore: Polysomnography Data From a Tertiary Sleep Disorders Unit
Overnight attended polysomnography (PSG) in the sleep laboratory has been the gold standard to confirm the presence and severity of obstructive sleep apnoea (OSA). Standard PSG scoring rules using the criteria of Rechtschaffen and Kales have recently been revised and updated by the American Academy of Sleep Medicine.
This article...
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%,...
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...
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
Impact of the Singapore National Asthma Program (SNAP) on Preventor-Reliever Prescription Ratio in Polyclinics
According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world.
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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...
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
Survival of Small-cell Lung Cancer and its Determinants of Outcome in Singapore
Lung cancer is the leading cause of cancer mortality around the world.1 Small-cell lung cancer (SCLC) constitutes about 15% to 25% of all lung cancer cases in North America and Europe.2,3 In contrast, SCLC constitutes a smaller percentage of lung cancer cases in Asian countries. In a Taiwanese hospital,...
Original Article
Lack of Awareness amongst Community Patients with Diabetes and Diabetic Retinopathy: The Singapore Malay Eye Study
Diabetes is a major public health problem, and diabetic retinopathy is the leading cause of blindness in working-aged people.1 Previous studies have documented poor attainment of guidelines of glycosylated haemoglobin (HbA1c) and blood pressure control2 and eye care utilisation3-6 in the prevention of diabetic retinopathy. Studies have also documented...
Original Article
Pain Prevalence in Singapore
Population studies on pain prevalence are useful in determining the impact that chronic pain has on the society. It draws the attention of healthcare administrators to chronic pain as a problem and direct healthcare spending accordingly. Previous studies performed using variations in definitions and methodology, yielded rates between 10%...
Original Article
An Update of Paediatric Intussusception Incidence in Singapore: 1997-2007, 11 Years of Intussusception Surveillance
This is an update to the previously published paper by Boudville et al1 on 8 years of intussusception (IS) surveillance in Singapore. IS is a rare but serious gastrointestinal disease in infants and young children.2,3 The focus on natural rotavirus infection as a potential cause of IS followed the...
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
T Lymphocyte Activation Profiles in Peripheral Blood of Long-Versus Short-Term Residents of Kuwait: Comparison with Asthmatics
The Gulf Wars of 1991 and 2003 exposed the residents of Kuwait and several neighbouring countries to high levels toxicants with the capacity to cause long-term deleterious alterations in the immune reactivity. The impact of these influences on the epidemiology and pathogenesis of chronic illness in affected populations is...
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...
Editorial
Lung Cancer: Recent Advances
Lung cancer is the leading cause of cancer related mortality in the world. It accounts for almost a million deaths annually and resulted in more deaths than prostate, breast and colon cancers combined.
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Original Article
Difference in Asthma Control Test™ (ACT) Scores in Three Different Clinical Practice Settings
The prevalence of asthma ranges from 1% to 18% worldwide and it remains a significant cause of morbidity and economic burden despite advances in its knowledge, detection and treatment. Asthma is very common in Singapore and it consumes a considerable amount of healthcare service resources.
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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
Venous Thromboembolism at the National Healthcare Group, Singapore
Venous thromboembolism (VTE) is a potentially fatal disease which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). About 30% of patients with VTE die within 30 days while 20% suffer sudden death from pulmonary embolism.1 Risk factors commonly seen in hospitalised patients, include immobilization, acute medical illness and...
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
Clinical Features of Allergic Rhinitis and Skin Prick Test Analysis Based on the ARIA Classification: A Preliminary Study in Malaysia
Allergic rhinitis (AR) is a common disease worldwide and is known to cause serious implications to the physical and mental health status of the individual sufferer. It also impacts significantly on healthcare expenditure. For instance, the direct costs of allergic rhinitis in the United States (US) alone were approximately...
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
Evaluation on the Effectiveness of the National Childhood Immunisation Programme in Singapore, 1982-2007
Singapore has a comprehensive National Childhood Immunisation Programme (NCIP) which first covered smallpox (1862), followed by diphtheria (1938), tuberculosis (TB) (1957), poliomyelitis (1958), pertussis and tetanus (1959) and measles and rubella (1976). In October 1985, hepatitis B vaccination was introduced into the programme for babies born to hepatitis B...
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
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...
Letter to the Editor
Inadvertent Haemodialysis in a Pulmonary Tuberculosis Patient with Hypercalcaemia
Malaysia is a country with an intermediate burden of tuberculosis (TB) with a prevalence of 121 cases per 100,000 population per year. TB usually presents with fever, chronic cough, weight loss and lack of appetite, dypsnoea and night sweats.
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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...
Original Article
Outbreak of Novel Influenza A (H1N1-2009) Linked to a Dance Club
Influenza A (H1N1-2009) is a novel strain of influenza virus. The infection is thought to have first occurred in Mexico in March 2009, and then spread worldwide, resulting in the first influenza pandemic of the 21st century.
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Original Article
An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009
On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties in southern California was caused by a novel influenza A (H1N1) virus. The virus is thought to be a re-assortment of 4 known strains of...
Original Article
Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009
The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas in the United States in late April 2009. This was linked to outbreaks of influenza in Mexico, which included reports of large numbers of cases...
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
Prevalence of Metabolic Syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization Definitions and their Association with Coronary Heart Disease in an Elderly Iranian Population
Coronary heart disease (CHD) is one of the most common causes of morbidity and mortality in different communities.1,2 Despite the lack of accurate data, there is evidence to indicate that CHD is increasing in magnitude in Iran.3 While age-adjusted mortality from CHD is gradually decreasing in developed countries,2,4 this...
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,...
Others
Sir John Wenman Crofton
Sir John Crofton, a world famous expert on the treatment of tuberculosis died in Edinburgh at the age of 97. John Crofton was born in Dublin in 1912, the son of a doctor. His earliest recollection was of hearing the bullets hitting the ceiling of his nursery in the...
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...
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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Images in Medicine
Rapidly Vanishing Pulmonary Pseudotumour
A 51-year-old male ex-smoker with a history of pulmonary tuberculosis was referred for exertional dyspnoea for 5 days. He had no fever, cough or constitutional symptoms. Physical examination revealed stony dullness to percussion over the right lower thorax posteriorly.
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Commentary
Policy Implications of The Singapore Mental Health Study
Mental health issues have taken on greater importance with the growing awareness among policy makers of the importance of mental health for the development of human, social and economic capital of a country and the realisation that it is illogical to introduce health-sector reforms without paying due attention to...
Letter to the Editor
Plasma IP-10 could identify early lung disease in severe COVID-19 patients
Dear Editor,
The global pandemic of SARS-Coronavirus-2 (SARS-CoV-2) infection has imposed tremendous strain on healthcare resources worldwide, as a significant proportion of patients require intensive care. Although the majority have mild infections, up to 20% are estimated to become critically ill from severe disease.1 Age, concurrent comorbidities, more severe...
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
Outcomes of second-tier rapid response activations in a tertiary referral hospital: A prospective observational study
Despite its widespread adoption, rapid response systems (RRS) and rapid response teams (RRT) vary significantly in composition and set-up.1-3 While implementation of RRSs appear to be associated with reduced cardiac arrest rate and improved mortality,4,5 their optimal composition, activation criteria and how they should be evaluated, remain controversial.6-9 It...
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...
Letter to the Editor
An Unusual Cause of Severe Pulmonary Hypertension in a Young Woman
Dear Editor,
A 25-year-old Cambodian lady diagnosed with pulmonary hypertension in her native country came for second opinion on the further management of her condition. She had become increasingly breathless in the last 2 years, with further deterioration from New York Heart Association (NYHA) II to III in the last...
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...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were constant distractions from the other
things he needed to attend to quickly. The patient, Madam Sumar was referred by her family doctor for chest pain with...
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
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...
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...
Review Article
Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review
Colorectal cancer (CRC) is the one of most common cancers worldwide. Metastatic disease occurs in approximately half of all CRC patients, in either synchronous or metachronous presentations.1 These patients form a heterogenous group that vary in presentation, disease progression and treatment options.
Advancements in surgery and chemotherapy have revolutionised the...
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
Heterogeneity of non-cystic-fibrosis bronchiectasis in multiethnic Singapore: A prospective cohort study at a tertiary pulmonology centre
Bronchiectasis is a chronic lung disease of significant morbidity and mortality. The pathological hallmarks of the disease are abnormal dilatation of airways resulting from recurrent inflammation, airway obstruction and mucous plugging. The past 2 decades have seen a significant increase in its prevalence, exceeding the threshold of 5 per...
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...
Letter to the Editor
Impact of pulmonary rehabilitation in patients with interstitial lung disease in Singapore
Interstitial lung diseases (ILD) encompass a heterogeneous group of lung parenchymal disorders. ILD-related symptoms impact significantly on quality of life (QoL). Dyspnoea is the most important factor determining health-related QoL in ILD; contributing factors include reduced exercise capacity, loss of mental well-being and social isolation.
This article has been updated...
Letter to the Editor
Radiological changes on chest CT following COVID-19 infection
COVID-19 infection is associated with high rates of hospitalisation and mortality, placing healthcare systems under strain. There are many reports regarding the non-contrast-enhanced high-resolution computed tomography (HRCT) features of the lungs during the onset of COVID-19; however, few studies have described the radiological changes and outcome of residual lesions...
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
Incidence and trends of ophthalmic cancer in Singapore: Data from Singapore Cancer Registry
Ophthalmic cancers are commonly encountered in clinical practice and are an important cause of morbidity and mortality. Globally, the incidence of ophthalmic cancers have been increasing in the past 2 to 3 decades.3-6 Data on recent incidence of primary ophthalmic cancers, comprising intraocular and extraocular cancers, have not been...
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.
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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...
Review Article
COVID-19 and Singapore: From Early Response to Circuit Breaker
The COVID-19 pandemic first broke out in Wuhan, China, in December 2019, where a cluster of pneumonia cases was reported and the novel coronavirus later identified. Since then, the virus has spread rapidly across the world, registering a total of 85000 reported cases across 53 countries/territories by 29 February...
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
Controversies in Sepsis Management—What is the Way Forward?
Sepsis is a common and life-threatening medical condition which has high incidence and mortality rates. Health care professionals are increasingly familiar with this syndrome, and the public is increasingly conscious of its burden to society. A population survey conducted in Singapore in 2010 showed that 53 out of 1067...
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...
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...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to most intubations performed in the operating room (OR). Additionally, difficult airways are more prevalent in emergency department (ED) populations due to acute conditions such as...
Original Article
Rapid Progression to Acute Respiratory Distress Syndrome: Review of Current Understanding of Critical Illness from Coronavirus Disease 2019 (COVID-19) Infection
In this report, we describe a patient who developed acute respiratory distress syndrome (ARDS) with rapid clinical deterioration. Unfortunately, not much is known about the clinical features and risk factors for ARDS and critical illness even as the number of COVID-19 cases continues to climb at an alarming rate...