1.Assessment of the risk posed to Singapore by the 2015 Middle East respiratory syndrome outbreak in the Republic of Korea
Emma Xuxiao Zhang ; Olivia Seen Huey Oh ; Wanhan See ; Preaj Raj ; Lyn James ; Kamran Khan ; Jeannie Su Hui Tey
Western Pacific Surveillance and Response 2016;7(2):17-25
OBJECTIVE: To assess the public health risk to Singapore posed by the Middle East respiratory syndrome (MERS) outbreak in the Republic of Korea in 2015.
METHODS: The likelihood of importation of MERS cases and the magnitude of the public health impact in Singapore were assessed to determine overall risk. Literature on the epidemiology and contextual factors associated with MERS coronavirus infection was collected and reviewed. Connectivity between the Republic of Korea and Singapore was analysed. Public health measures implemented by the two countries were reviewed.
RESULTS: The epidemiology of the 2015 MERS outbreak in the Republic of Korea remained similar to the MERS outbreaks in Saudi Arabia. In addition, strong infection control and response measures were effective in controlling the outbreak. In view of the air traffic between Singapore and MERS-affected areas, importation of MERS cases into Singapore is possible. Nonetheless, the risk of a serious public health impact to Singapore in the event of an imported case of MERS would be mitigated by its strong health-care system and established infection control practices.
DISCUSSION: The MERS outbreak was sparked by an exported case from the Middle East, which remains a concern as the reservoir of infection (thought to be camels) continues to exist in the Middle East, and sporadic cases in the community and outbreaks in health-care settings continue to occur there. This risk assessment highlights the need for Singapore to stay vigilant and to continue enhancing core public health capacities to detect and respond to MERS coronavirus.
2.Causes of death and factors associated with early death among human immunodeficiency virus (HIV)-infected persons in Singapore: pre-highly active antiretroviral therapy (HAART) and Peri-HAART.
Angela CHOW ; Jeannie TEY ; Mar Kyaw WIN ; Yee Sin LEO
Annals of the Academy of Medicine, Singapore 2012;41(12):563-570
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
3.Determinants of late-stage HIV disease at diagnosis in Singapore, 1996 to 2009.
Jeannie S H TEY ; Li Wei ANG ; Joanne TAY ; Jeffery L CUTTER ; Lyn JAMES ; Suok Kai CHEW ; Kee Tai GOH
Annals of the Academy of Medicine, Singapore 2012;41(5):194-199
INTRODUCTIONThe delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies.
MATERIALS AND METHODSWe included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009. Late-stage HIV infection is defined as CD4 count less than 200 mm(3) or AIDS-defining opportunistic infections at fi rst diagnosis or within one year of HIV diagnosis. We determined independent epidemiological risk factors for late-stage HIV infection at first diagnosis using multivariate logistic regression.
RESULTSMultivariate analysis showed that older age corresponded significantly with increasing odds of late-stage HIV infection. Compared to persons diagnosed at 15 to 24 years of age, those diagnosed at age 55 years and above were associated with 5-fold increased likelihood of late-stage infection (adjusted odds ratio (AOR): 5.17; 95% CI, 3.21 to 8.33). Chinese ethnicity, singlehood, and non-professional occupations were also significantly associated with late-stage HIV infection. Persons detected in the course of medical care had over 3.5 times the odds of late-stage infection (AOR: 3.55; 95% CI, 2.71 to 4.65). Heterosexual mode of transmission and having sex workers and social escorts as sexual partners, were the other epidemiological risk factors with significant associations.
CONCLUSIONThe findings of this study emphasises the need to increase HIV awareness and to encourage early and regular HIV testing among at-risk persons.
Adolescent ; Adult ; Age Factors ; Delayed Diagnosis ; statistics & numerical data ; Disease Notification ; Female ; HIV ; HIV Infections ; diagnosis ; epidemiology ; Humans ; Logistic Models ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Risk Factors ; Sex Workers ; statistics & numerical data ; Sexual Behavior ; statistics & numerical data ; Singapore ; epidemiology
4.Leveraging social networking sites for disease surveillance and public sensing: the case of the 2013 avian influenza A(H7N9) outbreak in China
Zhang Emma Xuxiao ; Yang Yinping ; Di Shang Richard ; Simons Joseph John Pyne ; Quek Boon Kiat ; Yin Xiao Feng ; See Wanhan ; Oh Olivia Seen Huey ; Nandar Khine Sein Tun ; Ling Vivienne Ruo Yun ; Chan Pei Pei ; Wang Zhaoxia ; Goh Rick Siow Mong ; James Lyn ; Tey Jeannie Su Hui
Western Pacific Surveillance and Response 2015;6(2):66-72
We conducted in-depth analysis on the use of a popular Chinese social networking and microblogging site, Sina Weibo, to monitor an avian influenza A(H7N9) outbreak in China and to assess the value of social networking sites in the surveillance of disease outbreaks that occur overseas. Two data sets were employed for our analysis: a line listing of confirmed cases obtained from conventional public health information channels and case information from Weibo posts. Our findings showed that the level of activity on Weibo corresponded with the number of new cases reported. In addition, the reporting of new cases on Weibo was significantly faster than those of conventional reporting sites and non-local news media. A qualitative review of the functions of Weibo also revealed that Weibo enabled timely monitoring of other outbreak-relevant information, provided access to additional crowd-sourced epidemiological information and was leveraged by the local government as an interactive platform for risk communication and monitoring public sentiment on the policy response. Our analysis demonstrated the potential for social networking sites to be used by public health agencies to enhance traditional communicable disease surveillance systems for the global surveillance of overseas public health threats. Social networking sites also can be used by governments for calibration of response policies and measures and for risk communication.
5.Ministry of Health Clinical Practice Guidelines: Lipids.
E Shyong TAI ; Boon Lock CHIA ; Amber Carla BASTIAN ; Terrance CHUA ; Sally Chih Wei HO ; Teck Siew KOH ; Lip Ping LOW ; Jeannie S TEY ; Kian Keong POH ; Chee Eng TAN ; Peter TING ; Tat Yean THAM ; Sue-Anne TOH ; Rob M van DAM
Singapore medical journal 2017;58(3):155-166
The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. 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_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.
Adult
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Cardiovascular Diseases
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complications
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therapy
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Child
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Coronary Artery Disease
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complications
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therapy
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Decision Support Systems, Clinical
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Dyslipidemias
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blood
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complications
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therapy
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Evidence-Based Medicine
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Female
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Humans
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Kidney Failure, Chronic
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complications
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therapy
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Life Style
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Lipids
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blood
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Lipoproteins, LDL
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blood
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Male
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Practice Guidelines as Topic
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Pregnancy
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Pregnancy Complications
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Risk Assessment
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Risk Factors
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Singapore
6.Assessment of the risk posed to Singapore by the emergence of artemisinin-resistant malaria in the Greater Mekong Subregion
Emma Xuxiao Zhang ; Jean-Marc Chavatte ; Cherie See Xin Yi ; Charlene Tow ; Wong Jia Ying ; Kamran Khan ; Olivia Seen Huey Oh ; Sarah Ngeet Mei Chin ; Khong Wei Xin ; Zubaidah Said ; Lyn James ; Jeffery Cutter ; Marc Ho ; Jeannie Su Hui Tey
Western Pacific Surveillance and Response 2019;10(2):6-13
Objective:
To assess the public health risk to Singapore posed by the emergence of artemisinin-resistant (ART-R) malaria in the Greater Mekong Subregion (GMS).
Methods:
We assessed the likelihood of importation of drug-resistant malaria into Singapore and the impact on public health of its subsequent secondary spread in Singapore. Literature on the epidemiology and contextual factors associated with ART-R malaria was reviewed. The epidemiology of malaria cases in Singapore was analysed. The vulnerability and receptivity of Singapore were examined, including the connectivity with countries reporting ART-R malaria, as well as the preparedness of Singaporean health authorities. Sources of information include international journals, World Health Organization guidelines, data from the Singapore Ministry of Health and National Public Health Laboratory of the National Centre for Infectious Diseases, and the International Air Transport Association.
Results:
The importation of ART-R malaria into Singapore is possible given the close proximity and significant travel volume between Singapore and the GMS countries reporting artemisinin resistance. Singapore’s vulnerability is further enhanced by the presence of foreign workers from neighbouring endemic countries. Nonetheless, the overall likelihood of such an event is low based on the rarity and decreasing trend of imported malaria incidence.
With the presence of Anopheles vectors in Singapore, imported cases of drug-resistant malaria could cause secondary transmission. Nevertheless, the risk of sustained spread is likely to be mitigated by the comprehensive surveillance and control system in place for both infected vectors and human cases.
Discussion
This risk assessment highlights the need for a continued high degree of vigilance of ART-R malaria locally and globally to minimize the risk and public health impact of drug-resistant malaria in Singapore.
7.Ministry of Health Clinical Practice Guidelines: Hypertension.
Jam Chin TAY ; Ashish Anil SULE ; E K CHEW ; Jeannie S TEY ; Titus LAU ; Simon LEE ; Sze Haur LEE ; Choon Kit LEONG ; Soo Teik LIM ; Lip Ping LOW ; Vernon Min Sen OH ; K Y PHOON ; Kian Wee Kenneth TAN ; Akira WU ; Loo See YEO
Singapore medical journal 2018;59(1):17-27
The Ministry of Health (MOH) has updated the clinical practice guidelines on hypertension to provide doctors and patients in Singapore with evidence-based treatment for hypertension. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on hypertension, for the information of SMJ readers. 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_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.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.
Antihypertensive Agents
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therapeutic use
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Blood Pressure
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Evidence-Based Medicine
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Health Promotion
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Humans
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Hypertension
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diagnosis
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therapy
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Life Style
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Risk Factors
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Singapore