Antirheumatic Agents ; therapeutic use ; Arthritis, Rheumatoid ; complications ; drug therapy ; Atlanto-Axial Joint ; injuries ; Humans ; Joint Dislocations ; etiology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Syringomyelia ; diagnosis ; etiology ; physiopathology

INTRODUCTIONAlthough joint aspiration with synovial fluid analysis is useful in the diagnosis of crystal or septic arthritis, the frequency with which it provides a diagnosis or aids subsequent management of patients with arthritis has not been well quantified. We therefore evaluated the usefulness of joint aspiration in the diagnosis and management of patients with arthritis in a hospital-based rheumatology service.

MATERIALS AND METHODSWe reviewed records of all patients with joint aspiration performed by an inpatient rheumatology service in a tertiary referral hospital from November 2003 to December 2004. Data were extracted on the frequency with which joint aspiration provided a diagnosis or aided management.

RESULTSAmong 76 patients [mean +/- standard deviation (SD), 60.9 +/- 15.9 years; 41 males, 35 females, Chinese (50), Malay (20), Indian (4) and others (2)] with 86 joint aspirations, a definitive diagnosis was obtained in 44% of procedures which showed gout (n = 28), septic arthritis (n = 8) or pseudogout (n = 2). In another 47% of procedures, joint aspiration aided diagnosis by allowing categorisation of synovial fluid as inflammatory (n = 25), non-inflammatory (n = 16) or blood-stained (n = 2). Joint(s) aspirated were knees (71%), ankles (15%), elbows (8%), shoulders (2%) and wrists, metacarpo-phalangeal and metatarso-phalageal (approximately 1% each).

CONCLUSIONJoint aspiration provides a definitive diagnosis or information that aids diagnosis in a significant number of patients in a hospital-based rheumatology service.

Aged ; Arthritis ; diagnosis ; therapy ; Arthritis, Infectious ; diagnosis ; Chondrocalcinosis ; diagnosis ; Female ; Gout ; diagnosis ; Hospital Departments ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Rheumatology ; Singapore ; Synovial Fluid ; chemistry

INTRODUCTION: The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore. METHODS: An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore. RESULTS: The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005). CONCLUSION There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.
Burnout, Professional/psychology* ; Delivery of Health Care ; Health Personnel/psychology* ; Humans ; Prevalence ; Singapore/epidemiology* ; Surveys and Questionnaires

INTRODUCTIONRheumatoid arthritis (RA) is a chronic, deforming arthritis that can lead to disabilities and poor quality of life. Cytokines are protein mediators of inflammation and are produced as a result of the activation of various cellular reactions. They are the final mediators and/or regulators of the inflammatory process.

MATERIALS AND METHODSThe sera from 64 RA patients were assayed for both Th-1 and Th-2 related cytokines and soluble TNF-alpha receptors (IFN-gamma, TGF-beta, TNF-alpha, IL-1beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-18, sTNF-R1 and sTNFR2) using ELISA.

RESULTSThe pro-inflammatory cytokines (IL-1, IL-6, IL-8, IL-18 and TNF- alpha) were significantly elevated in RA patients, while TGF-beta, an immunomodulatory cytokine, was elevated in control individuals. When the RA patients were categorised as active or inactive based on DAS scores, similar cytokines profiles were observed in both RA sub-groups. However, assays of sTNF-R1 and sTNFR-2 were noted to be significantly elevated in inactive RA patients when compared to active patients.

CONCLUSIONOur findings indicate that local production of cytokine inhibitors is capable of diminishing disease activity and cytokine activity.

Adult ; Aged ; Arthritis, Rheumatoid ; blood ; pathology ; Cell Differentiation ; Cytokines ; blood ; Female ; Humans ; Male ; Middle Aged ; Receptors, Tumor Necrosis Factor, Type I ; chemistry ; Receptors, Tumor Necrosis Factor, Type II ; chemistry ; Transforming Growth Factor beta ; chemistry

INTRODUCTIONInterleukin-18 (IL-18) is a Th1 cytokine, which is postulated to play a role in systemic lupus erythematosus (SLE). Two single nucleotide polymorphisms (SNPs) in the IL-18 promoter gene region were found to influence the quantitative expression of the IL-18 protein. The aim of this study was to determine whether IL-18 promoter gene polymorphisms are associated with SLE.

MATERIALS AND METHODSOne hundred and thirteen Chinese SLE patients and 218 Chinese healthy individuals were recruited. Genomic DNA was extracted from peripheral venous blood. Sequence-specific primer PCR and restriction fragment length polymorphism (RFLP) analysis were used to genotype the DNA samples for SNP-137 and SNP- 607. The following genotypes were obtained: SNP(-607) AA, AC, CC and SNP(-137) GG, GC, CC. Plasma IL-18 concentrations of patients and control subjects were measured by enzyme-linked immunosorbent assay.

RESULTSthe frequency of SNP-607/CC genotype was significantly higher in SLE patients (Pc < 0.05) while genotype SNP-607/AC was significantly decreased in SLE patients compared to the control group (Pc <0.05). Plasma IL-18 concentrations were significantly higher in SLE patients than in control subjects (P <0.05). Both patients and control subjects with CC and AC genotypes have significantly higher IL-18 concentrations than those with AA genotype.

CONCLUSIONThe IL-18 promoter gene polymorphism SNP-607 C allele is associated with SLE and may result in the enhanced production of IL-18 protein in SLE and normal individuals.

Adolescent ; Adult ; Aged ; Asian Continental Ancestry Group ; genetics ; Female ; Gene Frequency ; Genotype ; Humans ; Interleukin-18 ; genetics ; Lupus Erythematosus, Systemic ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length ; Polymorphism, Single Nucleotide

INTRODUCTIONThe aims of this study were to cross-culturally adapt and evaluate the validity of the Singaporean Malay and Tamil versions of the EQ-5D.

MATERIALS AND METHODSThe EQ- 5D was cross-culturally adapted and translated using an iterative process following standard guidelines. Consenting adult Malay- and Tamil-speaking subjects at a primary care facility in Singapore were interviewed using a questionnaire (including the EQ-5D, a single item assessing global health, the SF-8 and sociodemographic questions) in their respective language versions. Known-groups and convergent construct validity of the EQ-5D was investigated by testing 30 a priori hypotheses per language at attribute and overall levels.

RESULTSComplete data were obtained for 94 Malay and 78 Indian patients (median age, 54 years and 51 years, respectively). At the attribute level, all 16 hypotheses were fulfilled with several reaching statistical significance (Malay: 4; Tamil: 5). At the overall level, 42 of 44 hypotheses related to the EQ-5D/ EQ-VAS were fulfilled (Malay: 22; Tamil: 20), with 21 reaching statistical significance (Malay: 9; Tamil: 12).

CONCLUSIONIn this study among primary care patients, the Singapore Malay and Tamil EQ-5D demonstrated satisfactory known-groups and convergent validity.

Acculturation ; Cohort Studies ; Female ; Health Status ; Humans ; India ; ethnology ; Language ; Malaysia ; ethnology ; Male ; Middle Aged ; Primary Health Care ; Psychometrics ; instrumentation ; Quality-Adjusted Life Years ; Retrospective Studies ; Singapore ; Surveys and Questionnaires ; standards

INTRODUCTIONWhether fi nal height is associated with quality of life and mental health is a matter of epidemiological and medical concern. Both social and biological explanations have been previously proposed. This study aims to assess the associations in ethnic Chinese in Singapore.

MATERIALS AND METHODSA cross-sectional study of 4414 respondents aged at least 21 years seen at a major polyclinic was performed. Socioeconomic and behavioural features of the sample and the Singapore population of similar ages were comparable. Height was measured by clinic nurses using an ultrasonic height senor. Participants were interviewed for socioeconomic, behavioural, health and quality of life information. Clinical morbidity data was collected from the participants' treating physicians. The SF-6D utility index and its Mental Health domain were the main endpoints. Linear and ordinal logistic regression models were used to analyse the utility index and the Mental Health scores, respectively.

RESULTSHaving adjusted for age and gender, the Mental Health domain (P <0.01) was associated with height but the utility index was not. Further adjustment for health, socioeconomic and behavioural covariates made little difference. Analyses based on height categories showed similar trends.

CONCLUSIONAdult height has a positive association with mental health as measured by the SF-6D among ethnic Chinese in Singapore. Socioeconomic status and known physical health problems do not explain this association. Adult height had no association with SF-6D utility index scores.

Adult ; Aged ; Aged, 80 and over ; Body Height ; ethnology ; China ; ethnology ; Cross-Sectional Studies ; Female ; Health Behavior ; Health Status ; Health Surveys ; Humans ; Linear Models ; Logistic Models ; Male ; Mental Health ; ethnology ; Middle Aged ; Quality of Life ; Singapore ; epidemiology ; Socioeconomic Factors ; Surveys and Questionnaires ; Young Adult

INTRODUCTIONUntil recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles.

MATERIALS AND METHODSStudy patients were selected from the hospital inpatient census population during the VRE outbreak (aged 16 years or more). Clinical information from 84 cases and 377 controls were analysed.

RESULTSSignificant predictors of VRE carriage included: age>65 years Odds ratio (OR), 1.98; 95% CI (confidence interval), 1.14 to 3.43); female gender (OR, 2.15; 95% CI, 1.27 to 3.65); history of diabetes mellitus (OR, 1.94; 95% CI, 1.14 to 3.30), and staying in a crowded communal ward (OR, 2.75; 95% CI, 1.60 to 4.74). Each additional day of recent hospital stay also posed increased risk (OR, 1.03; 95% CI, 1.01 to 1.04).

CONCLUSIONElderly diabetic females with prolonged hospitalisation in crowded communal wards formed the profile that significantly predicted VRE carriage in this major hospital-wide outbreak of VRE in Singapore. It is imperative that active VRE surveillance and appropriate infection control measures be maintained in these wards to prevent future VRE outbreaks.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cross Infection ; drug therapy ; epidemiology ; microbiology ; Disease Outbreaks ; Enterococcus ; drug effects ; Enterococcus faecalis ; isolation & purification ; Enterococcus faecium ; isolation & purification ; Female ; Humans ; Infection Control ; Male ; Medical Audit ; Middle Aged ; Risk Factors ; Singapore ; epidemiology ; Streptococcal Infections ; drug therapy ; epidemiology ; Vancomycin ; pharmacology ; therapeutic use ; Vancomycin Resistance

OBJECTIVE: To determine the prevalence, factors associated with and patterns of concomitant Chinese medicine (CM) with Western treatment use among patients with rheumatoid arthritis (RA) in a tertiary referral centre (Singapore General Hospital) in Singapore. METHODS: We conducted a cross-sectional interviewer-administered survey of a consecutive sample of patients with RA in Singapore General Hospital centre regarding their CM use including data on patient demographics, disease characteristics, concomitant use of CM and reasons, concerns and disclosure patterns from March to August 2015. Univariate and multivariate logistic regression analyses were performed to determine the associations of CM use. RESULTS: Prevalence of CM use among the 258 patients surveyed (male: female 42: 216; Chinese: Malay: Indian 191: 29: 34; mean age: 61 years; mean duration of RA: 10 years) was 46.1% (119/258). On multivariate analysis, Chinese ethnicity (OR, 95% CI: 4.11, 1.49-11.36), Chinese speakers (OR, 95% CI: 2.35, 1.03-5.54), middle-income group (OR, 95% CI: 2.53, 1.01-6.31) and greater learned helplessness (OR, 95% CI: 1.13, 1.04-1.22) were significantly associated with CM use. More CM users disclosed their CM use to CM physicians (87.3%, 96/110), sought advice from them on treatment interactions (59.4%, 57/96) and how best to combine treatments (49.0%, 47/96) than did so with rheumatologists (42.0%, 50/119; 40.0%, 20/50; and 42.0%, 21/50, respectively). Forty-two percentage (29/69) of patients who concealed CM use from rheumatologists because their rheumatologists did not specifically enquire about CM use. CONCLUSIONS Concomitant CM use among patients with RA treated in a tertiary referral centre in Singapore is high but voluntary disclosure is low. The associations identified can help doctors identify and enquire about CM use, minimizing potential adverse interactions.
Arthritis, Rheumatoid/epidemiology* ; Cross-Sectional Studies ; Ethnicity ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Prevalence

INTRODUCTIONPneumonia is associated with considerable mortality. However, there is limited information on age-specific prognostic factors for death from pneumonia.

METHODSPatients hospitalised with a diagnosis of pneumonia through the emergency department were stratified into three age groups: 18-64 years, 65-84 years and ≥ 85 years. Multivariate logistic regression and receiver operating characteristic curve analyses were conducted to evaluate prognostic factors for mortality and the performance of pneumonia severity scoring tools for mortality prediction.

RESULTSA total of 1,902 patients were enrolled (18-64 years: 614 [32.3%]; 65-84 years: 944 [49.6%]; ≥ 85 years: 344 [18.1%]). Mortality rates increased with age (18-64 years: 7.3%; 65-84 years: 16.1%; ≥ 85 years: 29.7%; p < 0.001). Malignancy and tachycardia were prognostic of mortality among patients aged 18-64 years. Male gender, malignancy, congestive heart failure and eight other parameters reflecting acute disease severity were associated with mortality among patients aged 65-84 years. For patients aged ≥ 85 years, altered mental status, tachycardia, blood urea nitrogen, hypoxaemia, arterial pH and pleural effusion were significantly predictive of mortality. The Pneumonia Severity Index (PSI) was more sensitive than CURB-65 (confusion, uraemia, respiratory rate ≥ 30 per minute, low blood pressure, age ≥ 65 years) for mortality prediction across all age groups.

CONCLUSIONThe predictive effect of prognostic factors for mortality varied among patients with pneumonia from the different age groups. PSI performed significantly better than CURB-65 for mortality prediction, but its discriminative power decreased with advancing age.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Algorithms ; Community-Acquired Infections ; diagnosis ; mortality ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Patient Admission ; Pneumonia ; diagnosis ; mortality ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Risk Factors ; Sensitivity and Specificity ; Severity of Illness Index ; Singapore ; epidemiology ; Young Adult