Adolescent ; Adult ; Anti-HIV Agents ; adverse effects ; Child ; Guideline Adherence ; HIV Infections ; drug therapy ; Humans ; Medical Audit ; Middle Aged ; Practice Guidelines as Topic ; Retrospective Studies ; Safety-Based Drug Withdrawals ; Singapore ; Stavudine ; adverse effects ; World Health Organization ; Young Adult

Absenteeism ; Emergency Service, Hospital ; Hospitals, General ; Humans ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; epidemiology ; Personnel, Hospital ; Sentinel Surveillance ; Singapore ; epidemiology

BACKGROUND: Noise-induced hearing loss (NIHL) is a major preventable occupational health problem with 250 million people worldwide known to have disabling impairment of moderate to greater severity. The aims of the study are to estimate the prevalence of NIHL in the police force; and study its association with age, sex, duration of service (years), smoking and alcohol habits, use of hearing protective devices, as well as preexisting chronic diseases. METHODS: A cross-sectional study was conducted on 543 police personnel who had undergone periodic medical examination over a 12-month period. The diagnostic criteria for NIHL were (1) history of occupational noise exposure, (2) bilateral hearing loss, (3) hearing loss of > or = 25 dBA at 4,000 Hz in two consecutive audiograms, and (4) no significant medical history affecting hearing. Severity of NIHL was based on the World Health Organization grading. RESULTS: Males (74.8%) made up the majority of the police force. The mean age for police personnel was 35.55 +/- 9.57 years, and the mean duration of service was 14.75 +/- 9.39 years. Compliance with the usage of hearing protective devices was seen in 64.4%. The prevalence of NIHL in this study population was 34.2%, with a higher prevalence in males (37.7%) than in females (23.9%). The study also showed strong associations between NIHL and male sex (odds ratio, 1.9; P < 0.05), and hypertension (odds ratio, 3.3; P < 0.001). Overall, 93% were found to have mild NIHL, 3.5% had moderate NIHL, and 3.5% had severe NIHL. No police personnel were found to have profound hearing loss. CONCLUSION: The prevalence of NIHL in this study is high compared to other similar studies among police personnel. This study shows that increasing age, male, presence of hypertension, diabetes, and longer duration of service are significant associated factors for NIHL. Preventative strategies include health surveillance, implementation of a hearing conservation program, and legislation.
Chronic Disease ; Compliance ; Cross-Sectional Studies ; Ear Protective Devices ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Noise-Induced* ; Humans ; Hypertension ; Male ; Noise, Occupational ; Occupational Health ; Police* ; Prevalence ; Smoke ; Smoking ; World Health Organization

INTRODUCTIONOutbreaks of acute respiratory illness occur commonly in long-term care facilities (LTCF), due to the close proximity of residents. Most influenza outbreak reports have been from temperate countries. This study reports an outbreak of influenza B among a highly immunised resident population in a welfare home in tropical Singapore, and discusses vaccine efficacy and the role of acute respiratory illness surveillance for outbreak prevention and control.

MATERIALS AND METHODSDuring the period from 16 to 21 March 2007, outbreak investigations and active case finding were carried out among residents and nursing staff at the welfare home. Interviews and medical notes review were conducted to obtain epidemiological and clinical data. Hospitalised patients were tested for respiratory pathogens. Further genetic studies were also carried out on positive respiratory samples.

RESULTSThe overall clinical attack rate was 9.4% (17/180) in residents and 6.7% (2/30) in staff. All infected residents and staff had received influenza immunisation. Fifteen residents were hospitalised, with 2 developing severe complications. Genetic sequencing revealed that the outbreak strain had an 8.2% amino acid difference from B/Malaysia/2506/2004, the 2006 southern hemisphere influenza vaccine strain, which the residents and staff had earlier received.

CONCLUSIONSA mismatch between the vaccine and circulating influenza virus strains can result in an outbreak in a highly immunised LTCF resident population. Active surveillance for acute respiratory illness in LTCFs could be implemented for rapid detection of antigenic drift. Enhanced infection control and other preventive measures can then be deployed in a timely manner to mitigate the effect of any outbreaks.

Adult ; Aged ; Disease Outbreaks ; prevention & control ; Female ; Humans ; Influenza B virus ; immunology ; Influenza Vaccines ; therapeutic use ; Influenza, Human ; epidemiology ; prevention & control ; virology ; Interviews as Topic ; Male ; Medical Audit ; Middle Aged ; Nursing Homes ; Singapore ; epidemiology ; Social Welfare ; Young Adult

INTRODUCTIONHighly active antiretroviral therapy (HAART) has greatly changed the epidemiology of human immunodefi ciency virus (HIV) mortality. The aim of this study is to compare the causes of death and factors associated with early death in HIV-infected persons in the pre- and peri-highly active antiretroviral therapy (HAART) periods.

MATERIALS AND METHODSWe conducted a retrospective review of 483 HIV-infected persons who were diagnosed with HIV from 1985 to 2000, and had died within 5 years of the diagnosis. We examined the temporal change in the primary causes of death between those who were diagnosed in the pre-HAART (1985 to 1995) and peri-HAART (1996 to 2000) periods, and compared the demographic and clinical characteristics of the 2 groups.

RESULTSDuring the peri-HAART period, HIV encephalopathy, cryptococcal meningitis, and lymphoma were no longer the leading causes of death. Opportunistic infections remained important causes of death. Early deaths from the peri-HAART period were older (60 years and above) at diagnosis (Adj OR 7.50; 95% CI, 1.78 to 31.58), more likely to be divorced (Adj OR 5.05, 95% CI, 1.96 to 13.02) and tended to have a low baseline CD4 cell count of <50 cells/ uL (Adj OR 2.18, 95% CI, 1.14 to 4.16) , and were more likely to have received HAART (Adj OR 5.19; 95% CI, 2.22 to 12.12) than early deaths from the pre-HAART period.

CONCLUSIONIn the peri-HAART era, HIV-infected persons who died within 5 years of diagnosis were those who were older (≥60 years), divorced, or who presented with very late-stage disease (CD4 <50) at diagnosis. More targeted public health interventions, such as targeted public health messages and outreach to increase access to HIV testing and treatment should be developed for these subpopulations.

AIDS-Related Opportunistic Infections ; mortality ; Adult ; Anti-Retroviral Agents ; therapeutic use ; Antiretroviral Therapy, Highly Active ; CD4 Lymphocyte Count ; Cause of Death ; trends ; Confidence Intervals ; Female ; HIV Seropositivity ; drug therapy ; immunology ; mortality ; HIV-1 ; drug effects ; immunology ; Humans ; Male ; Medical Audit ; Middle Aged ; Mortality, Premature ; trends ; Odds Ratio ; Retrospective Studies ; Singapore ; epidemiology

INTRODUCTIONAlthough Singapore national guidelines recommend influenza vaccination for individuals with comorbidities, the vaccine uptake remains relatively low. This study examines the rates of influenza vaccine prescriptions in a clinic population, and patient, doctor and clinic factors that could affect the vaccine prescribing rates.

MATERIALS AND METHODSThis retrospective review utilised electronic medical records from HIV-infected patients seen in an infectious disease (ID) specialist clinic. Data from 40 randomly selected patients per physician were analysed for the outcome of influenza vaccine prescriptions from 1 January to 31 December 2007. All 7 consultants and the 6 ID registrars who had spent at least 4 months in the Department during 2007 were included. Data analysed included patient, physician, and clinic characteristics, and clinically relevant outcomes of admission within a year, and the length of hospital stay.

RESULTSOf the 461 HIV-infected patients analysed for this study, only 107 (23%) were prescribed influenza vaccine in 2007. Vaccine prescribing rates by individual physicians ranged from 0% to 77%. The outcome of vaccine prescribing was analysed by patient demographics (age >40 years, gender, race), physician characteristics (doctor grade, gender and training), and clinic volumes (number of patients per clinic session). Multivariate analysis demonstrated that patients with female doctors (OR 1.8, 95% CI, 1.1 to 3.0, P = 0.017), and doctors with overseas medical training (OR 11.6, 95% CI, 6.0 to 22.2, P <0.001) were significantly more likely to have influenza vaccine prescribed. On univariate analysis, patients were more likely to be admitted if they were male (OR 2.1, 95% CI, 1.0 to 5.1, P = 0.041), and over 40 years old (OR 2.1, 95% CI, 1.1 to 4.5, P = 0.024). Patients prescribed influenza vaccine showed a non-significant trend for protection against admission (OR 0.7, P = 0.288), and shorter length of stay (median 5 vs 9 days, P = 0.344).

CONCLUSIONInfluenza vaccine prescribing for HIV-infected outpatients in 2007 was only 23%, even in an ID specialist clinic. There was substantial variability in prescribing rates by individual physicians. Neither patient demographics nor patient volumes per clinic session had an impact on the prescribing rates, but significant predictors included physician gender and medical school training. Patients prescribed influenza vaccine had fewer admissions and shorter hospital lengths of stay, although these trends were non-significant.

Adult ; Drug Prescriptions ; statistics & numerical data ; Female ; HIV Infections ; complications ; Humans ; Influenza A virus ; immunology ; Influenza Vaccines ; pharmacology ; Influenza, Human ; prevention & control ; Male ; Prescription Drugs ; Retrospective Studies ; Singapore ; Vaccination ; trends

Objective: Physical exercise can provide many health benefits in humans. Exercise-induced reactive oxygen species (ROS) formation and its downstream signaling cascades are reported to induce mitochondrial biogenesis in exercising tissues. Selenoprotein P (SELENOP) is the antioxidant hepatokine whose hypersecretion is associated with various metabolic diseases. It was reported to impair exercise-induced reactive oxygen species signaling and inhibit subsequent mitochondrial biogenesis in mice. However, the relationship between selenoprotein P and mitochondrial dynamics in humans has not yet been reported. While reduction of plasma selenoprotein P becomes an attractive therapeutic target for metabolic diseases, the role of regular exercise in this regard is still unknown. This study aimed to analyze the influence of regular habitual exercise on plasma selenoprotein P levels and its association with leucocyte mitochondrial DNA copy number in healthy young adults. Methodology: Plasma selenoprotein P levels and leucocyte mitochondrial DNA copy numbers were compared in 44 regularly exercising subjects and 44 non-exercising controls, and the correlation between the two parameters was analyzed. Plasma selenoprotein P levels were measured by Enzyme-linked Immunosorbent Assay, and leucocyte mitochondrial DNA copy numbers were measured using the qPCR method. Results: The regular-exercise group had lower plasma selenoprotein P levels with higher leucocyte mitochondrial DNA copy numbers than the non-exercise group. There was a tendency of negative correlation between the two variables in our studied population. Conclusion Regular habitual exercise has a beneficial effect on reducing plasma selenoprotein P levels while raising mitochondrial DNA copy numbers.
mitochondria ; physical exercise ; reactive oxygen species ; selenoprotein P

Peripheral artery disease (PAD) broadly encompasses vascular diseases caused primarily by atherosclerosis and thromboembolic pathophysiologic processes that alter the normal structure and function of the aorta, its visceral arterial branches, and the arteries of the lower extremity. The aims of the Myanmar clinical practice guidelines for the management of patients with PAD are to assist physicians in selecting the best management strategies for an individual patient with peripheral artery disease with main focus on lower extremity artery disease (LEAD) due to atherosclerosis, to help the physician to make decisions in their daily practice, and to aid in appropriate referrals to specialists. Early detection and treatment guidelines for the treatment of PAD are important to reduce the morbidity and mortality of patients with vascular problems in Myanmar.
Peripheral Arterial Disease ; Practice Guideline ; Myanmar

Introduction: Simulation of the clinical setting incorporates an educational approach connecting a learner to a particular environment of learning. Undergraduate students in the health sector experience anxiety during simulation that influences their performance which ultimately affects their learning outcome. This study attempts to correlate the impact of stressors on learning outcome of high-fidelity patient simulation (HFPS) in undergraduate medical education. Objective: This research is to analyze the impact of stressors and its relevance on the learning outcome of HFPS as a teaching-learning tool for the management of emergency surgical conditions including trauma. Materials and Methods: This study is a Quasi-experimental time series design. A total number of 347 final-year undergraduate (MBBS) students of Melaka-Manipal Medical College, Malaysia. They were grouped and assessed individually by pre-test and post-tests on their knowledge, performance and associated stressor scores. The one-way repeated measure of Analysis of Variance (ANOVA) was used to determine the statistically significant differences in total score at pre-test simulation and post-test-simulation sessions. Friedman test was used for assessment of individual components of stressors. Pre-test and post-tests scores were compared to note progress in confidence and stress reduction. P value <0.001 was considered statistically significant. Results: ANOVA with Bonferroni post hoc analysis showed a statistically significant (p <0.001) difference in stressor score over time. The drop-in stress was significant initially but flattened out later. Conclusion: Stress significantly decreased as the students were exposed to more sessions of HFPS which ultimately translated into better learning outcome.

Dengue viruses are single-stranded RNA viruses of the Flavivirus genus. It is a common viral infection worldwide, especially in tropical regions. Various neurological manifestations such as encephalitis, encephalopathy, meningitis, acute disseminated encephalomyelitis (ADEM) acute viral myositis, Guillain–Barré syndrome and others are increasingly reported. However, acute haemorrhagic encephalitis is a very rare presentation. Currently, there are only few previous case reports