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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...

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...

Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care,...

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%...

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. This article...

Infections in Acute Lymphoblastic Leukaemia

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy....

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...

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...

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)

Persistent pulmonary hypertension (PPHN) is an important cause of neonatal mortality amongst infants who are of term or post-term gestation. The most severely ill...

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

Use of Central Venous Lines in Paediatrics—A Local Experience

Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...

Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric...

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...

Perinatal Drug Abuse in KK Women’s and Children’s Hospital

In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance...

Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery

Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans. This article is available only as a PDF. Please click on...

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...

The Future of Medicine from the Standpoint of the Practising Paediatrician

From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...

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...

Bidirectional Cavopulmonary Anastomosis

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to...

Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Echocardiographic Features and Management of Neonatal Ductal Aneurysm

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...

Transaminitis in Duchenne’s Muscular Dystrophy

Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine...

Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis

Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but...

Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...

A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...

Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder

Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...

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...

Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...

DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore

Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It...

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations,...

Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission

Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which...

Body Mass Index and Its Related Factors in the Elderly

Cardiovascular disease is one of the leading causes of mortality and morbidity in developed countries, especially among the elderly. In Taiwan, cardiovascular disease is...

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...

Book Review

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant

Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely...

A Case Series of Six Children with Primary Pulmonary Hypertension

Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of...

2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore

When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...

Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...

The Use of Vigabatrin in Infantile Spasms in Asian Children

Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been...

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...

Subdural Block—From a Spinal? A Case Report

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...

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...

Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit

With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent...

Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...

Intussusception: A Three-Year Review

Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into...

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”. This...

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...

Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports

Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and...

A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome

Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta. This article is available only...

Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report

Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal...

Imaging of Paediatric Mediastinal Masses

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...

The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis

In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm...

Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore

The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of...

Perinatal Care at the Threshold of Viability—From Principles to Practice

One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is...

Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and...

Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants

With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great...

Exogenous Surfactant Therapy in Newborn Infants

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of...

The Use and Abuse of Steroids in Perinatal Medicine

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....

Mass Newborn Screening in Singapore—Position and Projections

Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome...

Neonatology In Singapore: The Way We Were, The Way Forward

Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....

Chorioamnionitis and Outcome in Extremely Preterm Infants

Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is...

Challenges in Perinatal Medicine

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This...

Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns

Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the...

Autoimmune Liver Disease in Children

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...

HIV/AIDS in Children

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...

Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery

Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually...

Art and “the Language of Well-Being” in Adolescent Health Care

Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....

From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme

In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of...

Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern

The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care...

Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions

Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain...

Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment

Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many...

Strategies to Promote Better Outcomes in Young People with Chronic Illnesses

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to...

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent...

Sexually Transmitted Infections in Singapore Teenagers

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and...

Eating Disorders in Singapore: A Review

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...

Youth Suicide and Parasuicide in Singapore

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...

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...

The Perils of Puberty

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such...

Adolescent Health—A New Perspective in Singapore

In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field...

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...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey

Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an...

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...

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...

A Fatal Turkish Case of Campomelic Dysplasia

Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities)...

Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore

Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase...

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...

Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...

Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...

Gender Disparity in Paediatric Hospital Admissions

Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories...

Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience

Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an...

Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?

Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles...

Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have...

Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore

Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the...

The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004

Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8...

A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...

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...

Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...

Paediatrics to Geriatrics: The Continuum

In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it...

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...

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...

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...

Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...

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...

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...

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...

A Rotavirus Vaccine for Infants: The Asian Experience

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20%...

Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the...

Outcome of Organic Acidurias in China

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Organising Services for IMD in Thailand: Twenty Years Experience

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Newborn Screening in Pakistan – Lessons from a Hospital-based Congenital Hypothyroidism Screening Programme

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Newborn Screening in Bangladesh

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Newborn Screening in China: Phenylketonuria, Congenital Hypothyroidism and Expanded Screening

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Minimising Harm from Newborn Screening Programmes

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Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?

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Financing Newborn Screening Systems: US Experience

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Inborn Errors of Metabolism Presenting as Neonatal Encephalopathy: Practical Tips for Clinicians

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Legal Issues in Neonatal Screening

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Neuroblastoma Screening in Japan: Population-based Cohort Study and Future Aspects of Screening

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External Quality Assurance Programme for Newborn Screening of Glucose-6-Phosphate Dehydrogenase Deficiency

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Glucose-6-Phosphate Dehydrogenase Deficiency: Correlation between the Genotype, Biochemistry and Phenotype

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Disorders of Vitamin B12 Metabolism Presenting Through Newborn Screening

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Diagnosis of Tetrahydrobiopterin (BH4) Responsive Mild Phenylketonuria in Japan over the Past 10 Years

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Fatty Acid Oxidation Defects

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Disorders of the Carnitine Cycle and Detection by Newborn Screening

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Spectrum of Inherited Metabolic Disorders in Malaysia

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Establishing a Universal Newborn Hearing Screening Programme

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Current Understanding of Auditory Neuropathy

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A Multidisciplinary Approach to Paediatric Hearing Loss: Programme at the Centre for Hearing Intervention and Language Development, National University Hospital, Singapore

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Early Intervention For Hearing Impairment: Appropriate, Accessible and Affordable

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Impact of the National Hearing Screening Programme in China

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Outcome of Early Cochlear Implantation

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Eliminating Iodine Deficiency: Obstacles and Their Removal

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Neuro-developmental Deficits in Early-treated Congenital Hypothyroidism

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Issues on Universal Screening for Galactosemia

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Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case

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Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: Supporting Arguments

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My Early Experiences in Establishing Neonatal Screening and the Reason for Regional Meetings of the International Society for Neonatal Screening

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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...

Diagnosis and Management Support for an Expanded Newborn Screening Programme

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Considerations in Choosing Screening Conditions: One (US) Approach

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Clinical Applications of Molecular Genetics: The Model of Congenital Adrenal Hyperplasia

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Newborn Screening in Japan: Restructuring for the New Era

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Improved Health and Development of Children who are Deaf and Hard of Hearing Following Early Intervention

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Towards Universal Newborn Screening in Developing Countries: Obstacles and the Way Forward

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Improving Child Health – Newborn Screening for All?

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Neonatal Screening – A Global Perspective

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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...

Prevalence of Refractive Error in Malay Primary School Children in Suburban Area of Kota Bharu, Kelantan, Malaysia

Refractive error remains one of the primary causes of visual impairment in children worldwide. Prevalence of visual impairment in children, is defined as uncorrected...

Diabetes in Asia – From Understanding to Action

In the present pandemic of diabetes and obesity, 60% of the affected population will come from Asia. Between India and China, these two most...

Assessment of Medical Graduates Competencies

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

When Words Really Matter

I think a lot these days about doctors giving advice. Nobody taught me, back in medical school, how to give advice. This article is available...

Behavioural Sleep Disorders in Children and Adolescents

Overall, children spend one-third to one-half of their life sleeping. Although sleep comprises such a significant portion of a child’s day, sleep disturbances are...

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...

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...

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...

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...

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 Disturbances in Singaporean Children with Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder with various studies reporting prevalence rates of between 1.7% and 16%. The most...

Inflammatory Cytokines and Childhood Obstructive Sleep Apnoea

Obstructive sleep apnoea (OSA) is characterised by repeated episodes of upper airway occlusion during sleep that are associated with daytime behavioural changes and abnormalities...

Nasal Obstruction in Children with Sleep-disordered Breathing

Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in...

The Metabolic Syndrome in Hypertensive and Normotensive Subjects: The Isfahan Healthy Heart Programme

The metabolic syndrome (MS) is characterised by a clustering of metabolic risk factors and an insulin-resistant state.1 Its prevalence is high in Western, as...

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...

Immunogenicity, Reactogenicity and Safety of a Diphtheria-Tetanus-Acellular Pertussis-Inactivated Polio and Haemophilus Influenzae Type b Combination Vaccine in a Placebo-controlled Rotavirus Vaccine Study

Singapore’s national immunisation programme for the 6 traditional Expanded Programme on Immunisation (EPI) vaccines (i.e. BCG, diphtheria, tetanus, pertussis, polio and measles) and hepatitis...

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 –...

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...

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. This article is...

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...

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...

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...

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...

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...

Transfusion-dependent Microcytic Anaemia in a 10-year-old Girl

A 10-year-girl from Bangladesh presented with a moderately severe anaemia (lowest recorded haemoglobin level of 5.6 g/dL) and a mild jaundice (latest serum bilirubin,...

Caudal Regression Syndrome

A white female with an uncomplicated history of birth delivery and a familial history of diabetes mellitus presented to the orthopaedic clinic at the...

3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…

In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and...

Auricular Anthropometry of Newborns at the Singapore General Hospital

Abnormalities of the external ear are described in many syndromes and genetic conditions. Melnick et al reported an incidence of 1 in 90 births...

Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry

Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death. This article is available...

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...

Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations,...

Screening Tools for Bacteraemia in a Selected Population of Febrile Children

Bacteraemia refers to the presence of bacteria in the bloodstream. The presence or absence of toxicity differentiates occult bacteraemia, which is relatively asymptomatic, from...

Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined

Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications...

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...

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...

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,...

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...

Paediatric perineal skin pit: More than skin deep?

A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth,...

Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis

Maternal Group B streptococcal colonisation can lead to neonatal pneumonia, meningitis or sepsis. Neonatal Group B Streptococcal (GBS) sepsis is common, but infective endocarditis...

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...

Morbidity of Parainfluenza 3 Outbreak in Preterm Infants in a Neonatal Unit

Parainfluenza type 3 virus (PIV-3) is an important nosocomial pathogen. It closely mimics respiratory syncytial virus (RSV) in its clinical presentations, and in infants....

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...

Psychological Symptoms in People Presenting for Weight Management

Multiple factors contribute to the genesis and maintenance of obesity which is a difficult condition to treat and weight loss is often not maintained....

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...

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...

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...

An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child

We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the...

Temporary Tattoo Associated Type IV Delayed Hypersensitivity Dermatitis in a Child – A Case Report and Call for Parental Caution in Singapore

A 5-year-old, previously healthy French Caucasian boy was seen at a Paediatric Emergency Department for a skin rash over his left forearm. This article is...

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...

A Case of Congenital Haemolytic Anaemia and Thrombocytopenia

A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to...

An Exanthem with An Annular Pattern in a 2-year-old Girl

A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the...

Clinical Features Differentiating Biliary Atresia from Other Causes of Neonatal Cholestasis

Causes of neonatal cholestasis (NC) are long and diverse but the responses of newborn liver, either physiological or anatomical, are limited. This is because...

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...

Bannayan Riley Ruvalcaba Syndrome

Bannayan-Riley-Ruvalcaba syndrome (BRRS) classically presents with macrocephaly, subcutaneous and visceral lipomata, haemangiomata, hamartomatous intestinal polyps and pigmented macules involving the genitalia. This autosomal dominant...

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...

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...

Dyke-Davidoff-Masson Syndrome

An 8-year-old boy presented with uncontrolled seizures. He was born as the second child to non-consanguineous parents. He had significant perinatal asphyxia in the...

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...

Childhood Food Allergy: A Singaporean Perspective

Food allergy is defined as reaction to a food which has an immunologic mechanism. If immunoglobulin E (IgE) is involved in the reaction, the...

Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of...

Survey of Healthcare Workers’ Attitudes, Beliefs and Willingness to Receive the 2009 Pandemic Influenza A (H1N1) Vaccine and the Impact of Educational Campaigns

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise...

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...

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...

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...

The Role of Leptin-Melanocortin System and Human Weight Regulation: Lessons from Experiments of Nature

Obesity predisposes to significant morbidities and premature mortality, and the increasing obesity prevalence all over the world has been attributed to industrialisation and modernisation...

Reply from Author: Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

We would like to thank the author for suggesting that the definition of ADHD should be revised. This is an important consideration in the...

Is It Time to Revise the Definition of Attention Deficit Hyperactivity Disorder?

I read with interest the article published in the Annals entitled “Attention Deficit Hyperactivity Disorder: Coping or Curing?”, which concluded that coping rather than...

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...

The Role of Genes in the Current Obesity Epidemic

Obesity is a global pandemic and a major health concern because of the consequent morbidity and premature mortality; obesity predisposes to serious morbidities such...

The Relevance of the Metabolic Syndrome

Metabolic syndrome describes a constellation of interrelated metabolic risk factors, in which components coexist more frequently in a given individual than could be expected...

Development of Bariatric Surgery: The Effectiveness of a Multi-disciplinary Weight Management Programme in Hong Kong

Obesity is one of the most common chronic illnesses in the Western World with a frequency of 10% to 15%. It causes or exacerbates...

Dedicated Cytogenetics Factor is Critical for Improving Karyotyping Results for Childhood Leukaemias – Experience in the National University Hospital, Singapore 1989-2006

Acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) make up the bulk of childhood leukaemia cases. With risk stratified therapy being one of...

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...

Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health...

A Missed Bilateral Choanal Atresia

What do you see in the image? a) Deviated posterior nasal septum b) Nasopharyngeal tumour c) Rhinolith with mucous plug d) Bilateral choanal atresia e) Nasal pyriform aperture stenosis This...

Health-related Quality of Life in Children with Cancer Undergoing Treatment: A First Look at the Singapore Experience

Health-related quality of life (HRQOL) has been progressively acknowledged as an essential health outcome measure in clinical trials and health services research and evaluation....

Prevalence of Metabolic Syndrome Among Patients with Schizophrenia in Singapore

Schizophrenia has been linked to metabolic disturbances such as obesity, dyslipidaemia and hyperglycaemia. It has also been associated with a more than 3-fold increase...

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...

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...

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...

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...

Short- and Long-Term Outcomes at 2, 5 and 8 Years Old for Neonates at Borderline Viability—An 11-Year Experience

Singapore was listed consistently among the top 3 countries in the world with the lowest infant mortality rate. In particular, Asia had seen its...

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...

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...

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...

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....

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...

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...

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...

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...

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...

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...

Prevalence of vitamin D deficiency and insufficiency in Malaysian infants

Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either...

Impact of true fetal mosaicism on prenatal screening and diagnosis

Over the past decade, the non-invasive prenatal test (NIPT) has increasingly been used as a method for prenatal screening for trisomy 21 (T21) and...

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...

New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Epidemiology and risk stratification of minor head injuries in school-going children

Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...