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Background: Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition. Objective: The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults. Methods: Participants aged ≥55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3–5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals. Results: Individuals at high nutritional risk score (≥3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01–1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03–2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD. Conclusion: The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders. [ABSTRACT FROM AUTHOR]

Different policy mechanisms to encourage private property developers to adopt sustainable drainage features have been tried in many countries with moderate success. Singapore's ABC Waters Programme encourages the adoption of sustainable drainage by private developers through certification amongst others. However, this has not been implemented by all developers uniformly. Therefore, using Singapore as a case study we analyse the key strategies to promote sustainable drainage features. In-depth interviews with twelve prominent property developers were conducted to understand their knowledge, attitude and adoption behaviour. There were no substantial differences in company characteristics between adopters and non-adopters. Five main types of strategies: right timing, industry engagement, public education, financial incentives, and regulations were suggested to increase the adoption of sustainable drainage features in Singapore. These strategies could be suitable for other countries pursuing similar policy goals as well. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationships between tea consumption habits and incident neurocognitive disorders (NCD) and explore potential effect modification by gender and the apolipoprotein E (APOE) genotype. Design: Population-based longitudinal study. Setting: The Singapore Longitudinal Aging Study (SLAS). Participants: 957 community-living Chinese elderly who were cognitively intact at baseline. Measurements: We collected tea consumption information at baseline from 2003 to 2005 and ascertained incident cases of neurocognitive disorders (NCD) from 2006 to 2010. Odds ratio (OR) of association were calculated in logistic regression models that adjusted for potential confounders. Results: A total of 72 incident NCD cases were identified from the cohort. Tea intake was associated with lower risk of incident NCD, independent of other risk factors. Reduced NCD risk was observed for both green tea (OR=0.43) and black/oolong tea (OR=0.53) and appeared to be influenced by the changing of tea consumption habit at follow-up. Using consistent nontea consumers as the reference, only consistent tea consumers had reduced risk of NCD (OR=0.39). Stratified analyses indicated that tea consumption was associated with reduced risk of NCD among females (OR=0.32) and APOE e4 carriers (OR=0.14) but not males and non APOE e4 carriers. Conclusion: Regular tea consumption was associated with lower risk of neurocognitive disorders among Chinese elderly. Gender and genetic factors could possibly modulate this association. [ABSTRACT FROM AUTHOR]

Summary: The existence of local osteoporosis necessitates patient-specific analysis. Lower and higher ranges of local buckling ratio were found at femoral necks for adequate and inadequate drug response groups, respectively (grouped based on fracture loads). Management of hip fracture risk should be targeted at local geometric abnormalities causing instability. Introduction: Hip fracture amongst the elderly is a growing concern especially with improvements in living standards and increasing lifespan. Approximately half of the total hip fractures result from those without osteoporosis. This escalates the need to observe local osteoporosis. By observing the local buckling ratio (BR) in the femoral neck in ten risedronate-treated subjects over 3 years, we discovered that subjects with improved fracture loads, as predicted by finite element (FE) analysis, were associated with lower local BR and vice versa. Methods: The 3D models of the left proximal femurs were generated, and local BR values at 30° intervals were obtained from femoral neck slices by measuring the respective mean cortical thickness and mean outer radius. Following geometric analysis, structural strength was examined with FE analysis where critical fracture loads ( Fcr) were acquired from sideways fall load simulations. Results: We classified subjects in three groups according to the change in Fcr: adequate (+20 %), inadequate (−22 %) and indefinite (−2 %) drug response groups. A common striking feature was that lower and higher ranges of local BR values (baseline year) were found for adequate (min = 2.14, max = 8.04) and inadequate (min = 1.72, max = 11.38) drug response groups, respectively. Conclusions: Subjects in the inadequate drug response group exhibited high local BR at the supero-anterior and supero-posterior regions. These high local BR values coincided with FE-predicted critical strain regions, whereas subjects from the adequate drug response group showed significantly reduced strain regions. The superiority of coupling geometry (BR) with structure ( Fcr) over bone mineral density measurements alone by monitoring local osteoporosis has been illustrated. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine nurses' use of nonpharmacological methods for school-age children's postoperative pain relief. A survey was conducted in 2008 with a convenience sample of 134 registered nurses from 7 pediatric wards in Singapore. Nurses who were younger, had less education, lower designation, less working experience, and no children of their own used nonpharmacological methods less frequently. Nurses need training and education on nonpharmacological pain relief methods, particularly on methods that have been shown to be effective in prior research but that were less often used by nurses in this study: massage, thermal regulation, imagery, and positive reinforcement. [ABSTRACT FROM AUTHOR]

The outreach activities organized by the Department of Electrical and Computer Engineering (ECE) at National University of Singapore (NUS) are geared towards bringing interesting engineering projects, workshops, talks and other engaging activities to the students and teachers in the various high schools in Singapore. To expand the scope of the outreach activities, a framework and system to facilitate remote electronics experiments has been developed, utilizing remote virtual instrumentation concepts. Using the proposed setup, the students are able to design electronic circuits and observe/analyze the responses from the circuits to excitation, while being physically distant from the laboratory where the electronic circuits and instrumentation/measurement systems are located. [ABSTRACT FROM AUTHOR]

Singapore has been using dual membrane technology (MF/UF RO) to produce high-grade water (NEWater) from secondary treated sewage. Membrane bioreactor (MBR) has very high potential and will lead to the further improvement of the productivity and quality of high-grade water. This study was focused on the technical feasibility of MBR system for water reclamation in Singapore, making a comparison between various membrane systems available and to get operational experience in terms of membrane cleaning and other issues. Three MBR plants were built at Bedok Water Reclamation Plant with a design flow of 300m³/day each. They were commissioned in March 2003. Three different types of submerged membranes were tested. They are Membrane A, plate sheet membrane with pore size of 0.4 µm; Membrane B, hollow fibre membrane with pore size of 0.4 mm; and Membrane C, hollow fibre membrane with pore size of 0.035 µm. The permeate quality of all the three MBR Systems were found equivalent to or better than that of the conventional tertiary treatment by ultrafiltration. MBR permeate TOC was about 2 mg/l lower than UF permeate TOC. GC-MS, GC-ECD and HPLC scan results show that trace organic contaminants in MBR permeate and UF permeate were in the same range. MBR power consumption can be less than 1 kwh/m³. Gel layer or dynamic membrane generated on the submerged membrane surface played an important role for the lower MBR permeate TOC than the supernatant TOC in the membrane tank. Intensive chemical cleaning can temporarily remove this layer. During normal operation conditions, the formation of dynamic membrane may need one day to obtain the steady low TOC levels in MBR permeate. [ABSTRACT FROM AUTHOR]

This is a two-part study looking at depressive symptomatology in pregnancy in Singaporean women, and the associated demographic, and bio-psychosocial characteristics of women at risk of depressive illness. We validated the 10-item Centre for Epidemiological Studies-Depression scale amongst pregnant women, and then used this tool to identify depressive states in an antenatal cohort from the national maternity hospital. Amongst the sample population, the rate of depressive disorders is as high as one in five in the antepartum. The risk factors in the antepartum include being young, history of smoking, having past and current obstetric complications, frequent alcohol use and having medical problems. [ABSTRACT FROM AUTHOR]

Monitoring hydrologic responses of slopes is critical for advancing hillslope hydrologic studies. Storm- and time-based continuous hydrologic responses from three instrumented hillslopes in Singapore were monitored for a period of 420 days to observe the impact of rainfall on the pore-water pressure changes and runoff generation. Analyses of the hydrologic data indicate that only about 37% of the annual rainfall events are capable of producing runoff, and a threshold rainfall of about 10 mm is required to produce runoff. The seasonal distribution of pore-water pressures showed that the slopes experience high matric suctions during dry periods that are comparable to matric suctions observed in other tropical climates, and positive pore-water pressures during wet periods, that are higher than in other geographic locations. A high correlation between the increase in pore-water pressure and the daily rainfall may provide a convenient estimate of the increase in pore-water pressure due to the daily rainfall. The variability of hillslope hydrologic responses from storm to storm is distinctive when compared with previous results at other geographic locations. [ABSTRACT FROM AUTHOR]

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Presents a method for the detection of ketamine in hair in Singapore. Extraction of the hair samples; Method used in analyzing the extracts; Correlation between the amount of ketamine and the frequency of abuse.

Objectives: Arts-based programmes for persons with dementia have shown promise in alleviating some of the caregiving challenges for family care partners. The present study sought to broaden the sociocultural perspectives of arts-based programmes by investigating the impact of a locally developed Arts & Dementia programme for persons with dementia on their family care partners in Singapore. Methods: Thirty-two family care partners of persons with dementia who participated in the Arts & Dementia programme were recruited. A mixed-methodological study was employed utilising quantitative pre- and post-programme data from the Zarit Burden Interview and Gain in Alzheimer care Instrument, and qualitative data from semi-structured group interviews. Results: Although there were no self-reported short-term changes in perceived caregiving difficulties and gains, semi-structured group interviews revealed potential caregiving benefits. Six overarching themes were identified: (1) contentment and social engagement, (2) re-connecting and developing new interests, (3) positive influence on caregiving, (4) enhancements to the programme, (5) more arts programmes, and (6) more support for families living with dementia. Conclusion: The present study highlights potential benefits of community-based arts activities in enabling caregiving to be a more positive experience for care partners.Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2008306'I kept blaming myself for not spending enough time with him. Communication with him is different now. Watching him on the stage, he is happy and with a purpose'. (Gary, male).

Objective: To investigate the impact of a locally developed Arts and Dementia Program on the short-term well-being of older persons with dementia in Singapore., Methods: Single-arm study with 21 persons with dementia. Behavioural tendencies and mood and engagement values were assessed using Dementia Care Mapping at baseline and during the program. The averaged mood and engagement value over the mapping period produced a well-/ill-being score for each person with dementia., Results: Well-/ill-being scores were significantly higher during the program compared to at baseline. The behavioural tendencies most frequently captured during the program were creative expression, reminiscence and leisure. In contrast, there were more eating or drinking behaviours during the baseline. Analyses revealed that the changes in occurrences of reminiscence, leisure, and eating or drinking behaviours across time were significant., Conclusions: The present study suggests potential benefits of the Arts and Dementia Program in enhancing the well-being of persons with dementia., (© 2021 AJA Inc.)

Purpose: The COVID-19 pandemic and resultant lockdown measures potentially delay management of non-communicable, life-limiting diseases like colorectal cancer (CRC) through avoidance of healthcare facilities by the public and diversion of resources within healthcare systems. This study aims to evaluate the impact of Singapore's "Circuit Breaker (CB)" lockdown measures on CRC disease presentation and short-term surgical outcomes, while comparing Singapore's approach against other countries which employed similar lockdown measures., Methods: Patients whose initial diagnosis of CRC was made within the 6-month pre-CB (6/10/19-6/4/20) ("pre-CB group") and post-CB (7/4/20-7/10/20) ("post-CB group") period were enrolled retrospectively. The groups were compared based on severity of disease on presentation and short-term operative outcomes., Results: In total, 105 patients diagnosed with CRC were enrolled in this study. When comparing pre-CB and post-CB groups, there was no significant difference in stage of CRC on presentation (p = 0.850). There was also no increase in need for emergent operations (p = 0.367). For patients who had undergone an operation, postoperative morbidity was not significantly higher in the post-CB group (p = 0.201). Both groups of patients had similar length of stay in the hospital (p = 0.438)., Conclusion: Unlike similar high-income countries, Singapore did not see later stage disease on presentation and poorer operative outcomes after lockdown measures. Possible reasons include lesser healthcare avoidance behaviours amongst Singaporeans, and adequate preparation of resources and contingency plans formed by hospitals after previous pandemics., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The prevalence of dementia in Singapore is on the rise. Due to the negative perceptions associated with the condition, persons with dementia and their care partners face an increased risk of social isolation and loneliness. One objective of the Arts and Dementia programme offered by the Alzheimer's Disease Association is to increase inclusivity of persons with dementia in the community. To investigate the impact of the programme on perceptions towards dementia, a mixed-method approach involving 75 artists and volunteers was conducted. Findings from the Approaches to Dementia Questionnaire revealed that participants involved in the programme had significantly more positive perceptions than new volunteers. A thematic analysis was conducted on the focus group discussions and four themes were identified: (1) meaningful and rewarding interactions, (2) focus on abilities, (3) learning process and (4) more can be done. These findings suggest that meaningful experiences during the programme may be a driving force behind positive perceptions towards dementia.

Background: Mild cognitive impairment (MCI) is a critical pre-dementia target for preventive interventions. There are few brief screening tools based on self-reported personal lifestyle and health-related information for predicting MCI that have been validated for their generalizability and utility in primary care and community settings., Objective: To develop and validate a MCI risk prediction index, and evaluate its field application in a pilot community intervention trial project., Design: Two independent population-based cohorts in the Singapore Longitudinal Ageing Study (SLAS). We used SLAS1 as a development cohort to construct the risk assessment instrument, and SLA2 as a validation cohort to verify its generalizability., Setting: community-based screening and lifestyle intervention Participants: (1) SLAS1 cognitively normal (CN) aged ≥55 years with average 3 years (N=1601); (2) SLAS2 cohort (N=3051) with average 4 years of follow up. (3) 437 participants in a pilot community intervention project., Measurements: The risk index indicators included age, female sex, years of schooling, hearing loss, depression, life satisfaction, number of cardio-metabolic risk factors (wide waist circumference, pre-diabetes or diabetes, hypertension, dyslipidemia). Weighted summed scores predicted probabilities of MCI or dementia. A self-administered questionnaire field version of the risk index was deployed in the pilot community project and evaluated using pre-intervention baseline cognitive function of participants., Results: Risk scores were associated with increasing probabilities of progression to MCI-or-dementia in the development cohort (AUC=0.73) and with increased prevalence and incidence of MCI-or-dementia in the validation cohort (AUC=0.74). The field questionnaire risk index identified high risk individuals with strong correlation with RBANS cognitive scores in the community program (p<0.001)., Conclusions: The SLAS risk index is accurate and replicable in predicting MCI, and is applicable in community interventions for dementia prevention., Competing Interests: The authors declare that they have no competing interests.

Contamination of water by fecal matter and potential human enteric pathogens is a serious health concern. Microbiological water quality has been assessed by conventional culture-based methods of fecal indicator bacteria (FIB). Recently, molecular techniques for FIB have been introduced as alternative tools for rapid detection. However, such molecular techniques require a modern laboratory setting, expensive equipment, and skilled personnel. In this study, we developed a simple and rapid DNA extraction method based on a syringe filter without any specialized equipment. Furthermore, loop-mediated isothermal amplification (LAMP) PCR for fecal indicator bacteria (FIB) (i.e. E. coli and E. faecalis) was carried out using the DNA extracts from the syringe-filter based DNA extraction method. The efficiency of the extracted DNA from the syringe-filter based method was comparable to the results of the commercial kit method. We also tested fresh and marine-water collected directly from different locations in Singapore that were spiked with E. coli or E. faecalis. The LAMP assays combined with our DNA extraction method showed higher sensitivity and more tolerance to PCR inhibitors than that of conventional PCR methods. We further developed a portable LAMP device to conduct isothermal PCR reactions for rapid on-site measurement of FIB. As the color changes in the end point of the LAMP reaction can be observed with the naked eye, the portable LAMP device was easily operated and quick, obtaining results in 30 min. The simple, portable and user-friendly platform can be used as an initial screening for the rapid detection of the presence FIB in lower-resource settings. In conclusion, the portable LAMP device coupled with a syringe-filter based DNA extraction method enables us to detect the presence of FIB for assessing microbial water quality within 1 h without any sophisticated laboratory equipment or highly trained personnel., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Depression is prevalent among patients with late life neurocognitive disorders but its role as an independent risk factor is not established. We aimed to examine the longitudinal relationship between depression and the incidence of mild neurocognitive disorders (NCD) in a Chinese population., Methods: We analyzed data from 889 community-living Chinese elderly in the Singapore Longitudinal Aging Study (SLAS) cohort. All subjects were cognitively normal at baseline based on their performance on the Mini-Mental State Examination (MMSE). Depression was defined as total score of 5 or more on the 15-item Geriatric Depression Scale. Incident cases of mild NCD were ascertained at follow up after an average of 45 moths (range: 10-62). Odds ratios (OR) of associations were calculated in logistic regression models that adjusted for potential confounders., Results: A total of 59 mild NCD cases were identified. Increased risk of mild NCD was observed for subjects who had depressive symptom at baseline (OR=2.56, 95%CI 1.17-5.60) after controlling for age, gender, education, hypertension, diabetes mellitus, heart disease, APOE genotype and length of follow-up. The interaction between depression and APOE genotype was not statistically significant., Conclusion: Depressive symptom was independently associated with increased risk of mild NCD among Chinese elderly. Effective management of late life depression may potentially reduce incident cases of NCD in the population.

The Ministry of Health (MOH) has updated the clinical practice guidelines on Dementia to provide doctors and patients in Singapore with evidence-based treatment for dementia. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Dementia, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh&#95;web/healthprofessionalsportal/doctors/guidelines/cpg&#95;medical/2013/cpgmed&#95;dementia&#95;revised.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Multidrug-resistant Gram-negative bacteria (MDR-GNB) are an emerging public health threat. Accurate estimates of their clinical impact are vital for justifying interventions directed towards preventing or managing infections caused by these pathogens. A retrospective observational cohort study was conducted between 1 January 2007 and 31 July 2009, involving subjects with healthcare-associated and nosocomial Gram-negative bacteraemia at two large Singaporean hospitals. Outcomes studied were mortality and length of stay post-onset of bacteraemia in survivors (LOS). There were 675 subjects (301 with MDR-GNB) matching study inclusion criteria. On multivariate analysis, multidrug resistance was not associated with 30-day mortality, but it was independently associated with longer LOS in survivors (coefficient, 0.34; 95% CI, 0.21-0.48; p < 0.001). The excess LOS attributable to multidrug resistance after adjustment for confounders was 6.1 days. Other independent risk factors for higher mortality included male gender, higher APACHE II score, higher Charlson comorbidity index, intensive care unit stay and presence of concomitant pneumonia. Concomitant urinary tract infection and admission to a surgical discipline were associated with lower risk of mortality. Appropriate empirical antibiotic therapy was neither associated with 30-day mortality nor LOS, although the study was not powered to assess this covariate adequately. Our study adds to existing evidence that multidrug resistance per se is not associated with higher mortality when effective antibiotics are used for definitive therapy. However, its association with longer hospitalization justifies the use of control efforts., (© 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.)

We performed a prospective matched case-control study, with six-month follow-up for discharged subjects, to evaluate the direct clinical and financial impact of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) infections in Singaporean hospitals. Consecutive nosocomial MRSA-infected cases at both tertiary public sector hospitals in Singapore were matched for age, specialty service, major surgical procedure (if applicable) and Charlson comorbidity index with up to two non-infected controls each. Chart reviews and subject interviews were performed during hospitalisation and also upon six months post-discharge for survivors. The outcomes analysed were: mortality, length of hospitalisation (LOS), healthcare-associated financial costs, and health-related quality of life. The last was evaluated via an interviewer-administered EuroQol-5D questionnaire on discharge, with conversion to a single health state summary index. Attributable outcomes were ascertained by conditional logistic and linear regression. There were 181 cases and 351 controls. MRSA infection was independently associated with in-hospital death [14.4% vs 1.4%; odds ratio (OR): 5.54; 95% confidence interval (CI): 1.63-18.79, P=0.006], longer LOS (median of 32 days vs 7 days; coefficient: 1.21; 95% CI: 1.02-1.40, P<0.001), higher hospitalisation costs (median of US$18,129.89 vs US$4,490.47; coefficient: 1.14; 95% CI: 0.93-1.35; P<0.001), higher post-discharge healthcare-associated financial costs (median of US$337.24 vs US$259.29; coefficient: 0.39; 95% CI: 0.06-0.72; P=0.021), and poorer health-related quality of life (coefficient: -0.14; 95% CI: -0.21 to -0.08; P<0.001). Outcomes were not significantly different between both hospitals. The attributable individual, institutional and societal impact of MRSA infections is considerable in Singapore. Preventing such infections will result in substantial improvements in patient outcomes and healthcare delivery., (Copyright © 2010 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: There has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003-March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD., Methods: We interviewed 2,847 households from an ethnically stratified random sample of adults aged 20-59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD., Results: Lifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD., Conclusions: We challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

This article describes the development of undergraduate and postgraduate anaesthesia teaching and training in Singapore. Anaesthesia teaching has evolved from art and apprenticeship to become systematic, scientific and evidence-based, while retaining an emphasis on hands-on practical training. Simulator training provides unique advantages, which the University Department of Anaesthesia has utilised in integrated medical student teaching.

Objectives: To assess the extent to which middle-aged women in Singapore engage in physical activity of a level which would result in long-term health benefits, and to determine the factors associated with this., Methods: We conducted a cross-sectional survey of women aged between 35 and 60 years residing in Marine Terrace. A standardised questionnaire incorporating a modified Seven-Day Recall Questionnaire was used to record the level and type of physical activity engaged in over the past week. Demographic information and factors promoting or discouraging sports and exercise were also elicited. The total energy expenditure for household, occupational and sports activities of moderate intensity and above was calculated using metabolic equivalents (METs) in kcal/kg/week., Results: Of the 341 respondents, 50.7% reported engaging in at least moderate activity for 30 minutes or more every day during the past week, thus fulfilling the WHO recommendations on physical activity. Housework contributed significantly to the energy expenditure on these activities among our target population. After adjusting for age, body mass index and educational level, we found that housewives without domestic help were most likely to fulfill the WHO recommendations. Housewives or working women with domestic help were the two groups at highest risk of low physical activity. A lack of time was the reason most commonly cited for not engaging in sports or exercise., Conclusion: Studies assessing physical activity in relation to disease risk among women should include domestic work in addition to the traditional leisure-time activities. There is a scope for further efforts to improve the level of activity in this population, which could be facilitated by the support of health professionals, employers and family members.

The trend of illicit drug seizures and analysis in Singapore over a 10-year period from 1986 to 1995 was examined and reviewed. The main drugs were heroin, opium, cannabis, and illicit tablets containing benzodiazepines and amphetamines. The emergence of amphetamines in early 1996 was a major departure from the traditional drug abuse pattern in Singapore. Changes in the legal definitions of opium and cannabis were also reviewed.

In a case-control, cross-cultural study of the psychiatric morbidity of systemic lupus erythematosus in an Oriental population, 30 patients suffering from SLE and 29 controls with rheumatoid arthritis were interviewed. The SLE patients in Singapore exhibited greater psychiatric morbidity than their Western counterparts. Significant correlation was observed between psychiatric morbidity and the clinical disease activity. The patient's perception of the severity of arthritis, myalgia and dermatological lesions was an important aetiological factor. Culturally determined, disease-related psychological stresses also contributed to the psychopathology.

The aim of this study was to investigate the incidence of pre-induction coughing, after an iv bolus of fentanyl. The study sample was 250 ASA physical status I-II patients, scheduled for various elective surgical procedures. The first 100 were randomly allocated to receive 1.5 micrograms.kg-1 fentanyl via a peripheral venous cannula (Group 1), or an equivalent volume of saline (Group 2). Twenty-eight per cent of patients who received fentanyl, but none given saline, coughed within one minute (P less than 0.0001). The second 150 patients were then randomly assigned to three equal pretreatment groups. Group 3 received 0.01 mg.kg-1 atropine iv one minute before fentanyl. Groups 4 and 5 received 0.2 mg.kg-1 morphine im, and 7.5 mg midazolam po, respectively, one hour before fentanyl. Thirty per cent of patients in Group 3, 6% in Group 4, and 40% in Group 5, had a cough response to fentanyl. Fentanyl, when given through a peripheral cannula, provoked cough in a considerable proportion of patients. This was not altered by premedication with atropine or midazolam, but was reduced after morphine (P less than 0.01). Coughing upon induction of anaesthesia is undesirable in some patients, and stimulation of cough by fentanyl in unpremedicated patients may be of clinical importance.