Chronic diseases have a serious impact on individuals and on society in general. They affect the quality of life of individuals and can be a financial burden on those who are affected. There is a disease continuum of lifestyle, high risk diseases, and end organ damage. Lifestyle change is necessary if we are to reduce the prevalence of these chronic diseases. The Health Choices, Lifestyle Advice Resource for Healthcare Professionals provides a tool for lifestyle counselling.

Obesity is increasing in prevalence in Singapore. This is part of a worldwide phenomenon. Action is being taken in Singapore to prevent and control obesity. Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity, and genetic susceptibility. The basic strategy of obesity prevention and control however is quite straightforward and lies in achieving the caloric balance which is to reduce calorie intake and increase physical activity. To be effective however, obesity prevention and control requires multiple prevention and control interventions across the lifespan. There is a need for Health Promotion Board (HPB) to engage and mobilise various partners and stakeholders. Policies and programs have been customised in Singapore for different segments of the population and conducted at various settings – in schools, workplaces, healthcare institutions, and communities. The current efforts to prevent and control obesity in Singapore can be grouped into 5 areas: (1) Health promotion policies;(2) Promoting supportive environments through social programmes; (3) HPB collaborating with partners to promote healthy behaviour; (4)Empowering partners and individuals; and (5) Raising awareness through health education and communication.

Abscess ; diagnosis ; etiology ; therapy ; Antitubercular Agents ; therapeutic use ; DNA, Bacterial ; analysis ; Debridement ; methods ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Male ; Metacarpus ; Middle Aged ; Mycobacterium tuberculosis ; genetics ; isolation & purification ; Tuberculosis, Pulmonary ; complications ; drug therapy ; microbiology

To highlight the diagnostic challenges in diagnosing a patient with schizoaffective disorder under DSM-IV-TR and to evaluate the effectiveness of changes in DSM-V in addressing these issues. Methods: We present the evolution of the diagnosis from its inception, outline its complex nosology, review the diagnostic difficulties under DSM-IV-TR and critique the proposed changes made in DSM-V. Results: A complex nosology, varied thresholds of diagnosis under DSM-IV-TR, and the inherent difficulty in obtaining a detailed longitudinal history from a patient contribute to the challenge of diagnosing a patient with schizoaffective disorder. Changes in DSM-V attempt to increase the reliability of the diagnosis by specifying and raising temporal thresholds, moving the time of disease observation away from a single episode but towards the lifetime of illness. Conclusion: Changes made in DSM-V only address a small part of the difficulties raised and clinicians will continue to face challenges in diagnosing schizoaffective disorder under DSM-V. However, there might still be value in the proposed changes under DSM-V

The search for ideal brucellosis vaccines remains active today. Currently, no licensed human or canine anti-brucellosis vaccines are available. In bovines, the most successful vaccine (S19) is only used in calves, as adult vaccination results in orchitis in male, prolonged infection, and possible abortion complications in pregnant female cattle. Another widely deployed vaccine (RB51) has a low protective efficacy. An ideal vaccine should exhibit a safe profile as well as enhance protective efficacy. However, currently available vaccines exhibit one or more major drawbacks. Smooth live attenuated vaccines suffer shortcomings such as residual virulence and serodiagnostic interference. Inactivated vaccines, in general, confer relatively low levels of protection. Recent developments to improve brucellosis vaccines include generation of knockout mutants by targeting genes involved in metabolism, virulence, and the lipopolysaccharide synthesis pathway, as well as generation of DNA vaccines, mucosal vaccines, and live vectored vaccines, have all produced varying degrees of success. Herein, we briefly review the bacteriology, pathogenesis, immunological implications, candidate vaccines, vaccinations, and models related to Brucella.
Adult ; Animals ; Bacteriology ; Brucella* ; Brucellosis ; Cattle ; Female ; Humans ; Male ; Metabolism ; Models, Animal ; Orchitis ; Vaccination ; Vaccines* ; Vaccines, Attenuated ; Vaccines, DNA ; Vaccines, Inactivated ; Virulence

Rib fractures account for a significant number of emergency department visits each year. A patient’s disposition often depends on the severity of rib fractures, comorbidities, and ability to achieve adequate analgesia. We present a 44-year-old male patient with severe pain secondary to rib fractures. The initial disposition was to admit for pain control. However, upon performing a serratus anterior plane block, patient was functionally appropriate for discharge with proper return precautions. Serratus anterior plane block is within the skillset of the emergency physician and can be used to achieve analgesia for rib fractures without the sedative and respiratory depressive effects associated with opioids.

INTRODUCTIONNorovirus gastrointestinal disease (GID) outbreaks occur frequently in closed settings, with high attack rates. On October 16, 2008, a norovirus GID outbreak occurred at a Singapore military camp. This study describes the epidemiological investigations conducted to determine the cause of outbreak and the efficacy of the public health measures implemented.

METHODSEpidemiologic investigations included a case-control study of exposure to different food items and an environmental exposure survey. Stool samplings of patients and food handlers for common pathogens, and microbiologic testing of food and water samples were performed. Inspection of dining facilities and health screening of all food-handlers were also conducted.

RESULTSA total of 156 GID cases were reported on October 15-31, 2008. 24 (15.4%) personnel were positive for norovirus. The predominant symptoms were diarrhoea (76.3%) and abdominal pain (69.2%). There was no clinical correlation between any food item and the affected personnel. Testing of food and water samples, dining facility inspections and health screening of food handlers showed satisfactory results. The environmental exposure survey indicated possible transmission due to environmental contamination by vomitus in common areas. Comprehensive environmental decontamination was performed with hypochlorite solution, and personal hygiene measures were enforced. The outbreak lasted 17 days, with a decline in cases post intervention.

CONCLUSIONTimely notification and prompt response can curtail disease transmission. Swift implementation of public health measures, such as emphasis on personal hygiene, isolation of affected cases and comprehensive disinfection of the environment, effectively stopped norovirus transmission and may be adapted for future GID outbreaks.

Acute Disease ; Adolescent ; Caliciviridae Infections ; diagnosis ; epidemiology ; Case-Control Studies ; Communicable Disease Control ; methods ; Diarrhea ; virology ; Disease Outbreaks ; statistics & numerical data ; Feces ; virology ; Food Handling ; Gastroenteritis ; epidemiology ; virology ; Humans ; Male ; Military Facilities ; Norovirus ; isolation & purification ; Singapore ; epidemiology ; Water Microbiology ; Young Adult

An anti-Brucella vaccine candidate comprised of purified Brucella lipopolysaccharide (LPS) and a cocktail of four Salmonella Typhimurium (ST)-Brucella vectors was reported previously. Each vector constitutively expressed highly conserved Brucella antigens (rB), viz., lumazine synthase (BLS), proline racemase subunit A, outer membrane protein-19 (Omp19), and Cu-Zn superoxide dismutase (SOD). The present study determined a relative level of protection conferred by each single strain. Upon virulent challenge, the challenge strain was recovered most abundantly in non-immunized control mice, with the ST-Omp19-, ST-BLS-, LPS-, and ST-SOD-immunized mice showing much less burden. Indirect enzyme-linked immunosorbent assay-based assay also confirmed the induction of antigen-specific immunoglobulin G for each antigen delivered. In a route-wise comparison of the combined vaccine candidate, intraperitoneal (IP), intramuscular (IM), and subcutaneous immunizations revealed an indication of highly efficient routes of protection. Splenocytes of mice immunized via IM and IP routes showed significant relative expression of IL-17 upon antigenic pulsing. Taken together, each of the Brucella antigens delivered by ST successfully induced an antigen-specific immune response, and it was also evident that an individual antigen strain can confer a considerable degree of protection. More effective protection was observed when the candidate was inoculated via IP and IM routes.
Animals ; Brucella ; Brucellosis ; Immunization ; Immunoglobulin G ; Interleukin-17 ; Membranes ; Mice ; Proline ; Salmonella typhimurium ; Salmonella ; Superoxide Dismutase ; Vaccination

BACKGROUND: The efficacy of saline-coupled bipolar sealing devices in joint arthroplasty is uncertain, and the utility in simultaneous bilateral total knee arthroplasty (TKA) has not been reported. METHODS: This study compares the use of bipolar sealing and conventional electrocautery in 71 consecutive patients. The experimental and control groups were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, and preoperative hemoglobin. Variables of interest included blood loss, transfusion requirements, and operative characteristics. RESULTS: In comparison to patients treated with conventional electrocautery, those treated with the bipolar sealer were 35% less likely to require transfusion. The median number of transfusions per case was also significantly lower in the experimental group. Hemoglobin change, total blood loss, and length of stay were not significantly different between the groups. The experimental group had longer operative times. CONCLUSIONS: Bipolar sealing shows promise as a blood loss reduction tool in simultaneous bilateral TKA. The marginal savings attributed to reduced transfusion rates with use of the bipolar sealer did not exceed the additional per-case expense of using the device. The decision to use the device with the goal of less blood loss must come with the additional expense associated with its use.
Adult ; *Arthroplasty, Replacement, Knee ; Blood Loss, Surgical/*prevention & control ; Catheter Ablation/instrumentation ; Electrocoagulation/*instrumentation ; Female ; Humans ; Male

PURPOSE: To conduct a systematic literature review of the epidemiological and economic burden of surgical site infection (SSI) in Korea. METHODS: A search of the EMBASE, Medline and KoreaMed databases for English and Korean language publications was conducted. Searches for epidemiological and economic studies were conducted separately and limited to 1995 to 2010 to ensure the pertinence of the data. RESULTS: Twenty-six studies were included. The overall incidence of SSI in Korea was 2.0 to 9.7%. The National Nosocomial Infections Surveillance risk index was positively correlated with the risk of developing an SSI. Specific risk factors for SSI, identified through multivariate analyses included; diabetes, antibiotic prophylaxis and wound classification. SSIs were associated with increased hospitalisation cost, with each episode of SSI estimated to cost about an additional 2,000,000. A substantial portion of the increased cost was attributed to hospital room costs and the need for additional medication. Studies also found that post-operative stays for patients with SSIs were 5 to 20 days longer, while two studies reported that following cardiac surgery, patients with SSIs spent an additional 5 to 11 days in the intensive care unit, compared to patients without SSIs. CONCLUSION: Data from the included studies demonstrate that SSI represents a significant clinical and economic burden in Korea. Consequently, the identification of high-risk patient populations and the development of strategies aimed at reducing SSI may lead to cost-savings for the healthcare system.
Antibiotic Prophylaxis ; Cross Infection ; Delivery of Health Care ; Dietary Sucrose ; Humans ; Incidence ; Intensive Care Units ; Korea ; Multivariate Analysis ; Risk Factors ; Thoracic Surgery