X-ray services were first established in Singapore in 1898. With the opening of the General Hospital in 1926, there was subsequent increase in workload. However, a radiology department was not formed until the 1950s. Angiography was introduced in the same decade initially for diagnosis. By the 1960s and 1970s, both vascular and non-vascular interventions were performed. Subsequently, interventional radiology experienced exponential growth, with newer technology and better facilities established over the past 3 decades. With more trained interventional radiologists, the service is currently available in all public hospitals and in most private hospitals in Singapore today. It is envisaged that structured training and formal credentialing will be established, eventually leading to recognition of interventional radiology as a specialty in its own right.

INTRODUCTIONUnderstanding the burden of uncontrolled severe asthma is essential for disease-targeted healthcare planning. There is a scarcity of data regarding the proportion, healthcare utilisation and costs of patients with uncontrolled severe asthma in Asia. This study aimed to plug the knowledge gap in this area.

MATERIALS AND METHODSConsecutive patients with asthma managed in our respiratory specialist clinic were evaluated prospectively. Healthcare utilisation comprising unscheduled asthma-related primary care visits, emergency department (ED) visits and hospital admissions were obtained from the national health records system. We defined uncontrolled severe asthma as poor symptom control (Asthma Control Test score <20); 2 or more asthma exacerbations requiring ≥3 days of systemic corticosteroids in the previous year; 1 or more serious asthma exacerbation requiring hospitalisation in the previous year; or airflow limitation with pre-bronchodilator forced expiratory volume in 1 second (FEV) <80% predicted despite high dose inhaled corticosteroids and another controller medication.

RESULTSOf the 423 study participants, 49 (11.6%) had uncontrolled severe asthma. Compared to non-severe asthma, patients with uncontrolled severe asthma were older and more likely to be female and obese. They had a median of 2 (interquartile range: 0 to 3) exacerbations a year, with 51% having ≥2 exacerbations in the past 12 months. They were responsible for 43.9% of the hospital admissions experienced by the whole study cohort. Mean annual direct asthma costs per patient was S$2952 ± S$4225 in uncontrolled severe asthma vs S$841 ± S$815 in non-severe asthma.

CONCLUSIONApproximately 12% of patients with asthma managed in a hospital-based respiratory specialist clinic in Singapore have uncontrolled severe asthma. They account for a disproportionate amount of healthcare utilisation and costs. Healthcare strategies targeting these patients are urgently needed.

INTRODUCTIONSleep problems are common in all ages, but may be particularly acute in urban Singapore. This study aims to describe the sleep behaviour of, and to identify any sleep problems in, preschool children.

MATERIALS AND METHODSThis was a cross-sectional questionnaire survey of 372 children attending local childcare centers. The questionnaire was based on the Children's Sleep Habits Questionnaire (CSHQ), a validated parent-report sleep screening questionnaire that contains 54 items identifying sleep behaviours in children.

RESULTSA total of 372 (40.0%) children participated. The mean age was 4.1 (SD 1.3) years (range, 2 to 6 years). Average total sleep duration was 10.8 hours (SD 1.1) with average night-time sleep duration of 8.5 hours (SD 0.6) and average nap duration of 1.6 hours (SD 1.0). Co-sleeping was common; 80.9% of children shared a room with someone else. The most common sleep problems were in the domains of sleep resistance and morning behaviour; namely: requiring company to fall asleep (n = 272, 73.1%), being afraid to sleep alone (n = 228, 61.6%) and diffi culty in waking up (n = 165, 44.4%). Among parents, 84.1 % (n = 313) perceived that their child's sleep duration was adequate.

CONCLUSIONThe duration of sleep in the Singaporean preschool population sampled is signifi cantly lower than recommended values and that of previously described Caucasian populations. Parental perception of sleep adequacy deviates from current recommendations. Given the clear relation of sleep duration with cognitive functioning, learning, and physical growth, this sleep deprivation should be addressed with parental education and opportunistic screening of sleep in well-child follow-ups.

Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Habits ; Humans ; Male ; Prevalence ; Singapore ; Sleep ; Sleep Deprivation ; epidemiology ; Sleep Wake Disorders ; epidemiology ; Surveys and Questionnaires ; Urban Population

INTRODUCTIONThis study aimed to determine the sleep patterns and dysfunctions in children with learning problems in comparison against a local population-based sample.

MATERIALS AND METHODSParents of 200 children with learning problems and 372 parents of a local population-based sample of typically developing (TD) children were recruited to complete a questionnaire on their child's sleep patterns and sleep problems. The Children's Sleep Habits Questionnaire (CSHQ) is a validated parent-reported sleep screening questionnaire that contains 54 items identifying sleep behaviours in children.

RESULTSThe mean age of the sample was 4.2 years (SD: 1.4; range, 2 to 6 years). Sleep duration was similar between the 2 groups. The difference in mean CSHQ subscale scores between children with learning problems and TD children was significant for sleep-disordered breathing (1.3 vs 1.2,= 0.001). Among children with learning problems, 36.5% snored (vs 26.6% of TD children), 30.5% had noisy breathing (vs 18.8%), and 9.0% (vs 4.6%) experienced difficulty breathing 2 or more times a week. Children with learning problems woke up in a more irritable mood (= 0.01), had more difficulty in getting out of bed (<0.001), and took a longer time to be alert (<0.001). They exhibited fewer behaviours of daytime drowsiness (= 0.009). Among this group of children, 15.0% of parents reported that their child had a sleep problem compared to 9.0% in the TD group.

CONCLUSIONSleep breathing disorders and symptoms of morning sleepiness are more prevalent in children with learning problems. Symptoms of daytime lethargy are similar between the 2 groups. We suggest that a simple outpatient screening targeted at these problems be instituted in the initial workup of any child with learning difficulties.

Case-Control Studies ; Child ; Child, Preschool ; Comorbidity ; Female ; Humans ; Irritable Mood ; Learning Disorders ; epidemiology ; Male ; Prevalence ; Singapore ; epidemiology ; Sleep ; Sleep Apnea Syndromes ; epidemiology ; Sleep Hygiene ; Sleep Wake Disorders ; epidemiology ; Snoring ; epidemiology