Breast Feeding ; psychology ; Female ; Global Health ; Health Policy ; Health Promotion ; Humans ; Pregnancy ; Singapore ; Women's Health ; World Health Organization

Anti-Bacterial Agents ; administration & dosage ; adverse effects ; blood ; Bacteremia ; drug therapy ; Body Weight ; Drug Dosage Calculations ; Female ; Gentamicins ; administration & dosage ; adverse effects ; blood ; Gestational Age ; Humans ; Infant, Newborn ; Injections, Intramuscular ; Male

Child ; Child Welfare ; trends ; Delivery of Health Care ; trends ; Humans ; Maternal Welfare ; trends ; Pediatrics ; methods ; trends ; Physician's Role ; Singapore

Early childhood intervention programmes can shift the odds toward more favourable outcomes in development, especially for children at risk. However, there is no quick fix in the world for early childhood interventions. Programmes that work are rarely simple, inexpensive, or easy to implement. Each country must decide its own model and strategies and develop its resources based on existing infrastructures. Since its independence to become a sovereign nation in 1965, Singapore has undergone significant socio-economic changes. The infant and under-5 childhood mortality rates are among the lowest in the world. A number of "new morbidities" have been identified to pose major challenges to child health in the next decades. They are chronic medical illnesses, developmental disabilities, learning problems, injuries and neglect, behavioural disturbances and disorders, sequelae associated with unhealthy life-styles, and social and emotional disorders. The need for a comprehensive child development programme is therefore obvious. The main objectives are identification and treatment of children with developmental and behavioural problems so as to correct developmental dysfunctions, minimise the impact of a child's disability or of prevailing risk factors, strengthen families, and establish the foundations for subsequent development. A child development programme has evolved in Singapore over the last 20 years. The programme is multi-disciplinary, community-based, family-focused, and child-centric, with partnership and integration between government and voluntary community organisations.
Child ; Child Behavior Disorders ; Child Development ; Child Health Services ; history ; organization & administration ; Child, Preschool ; Community Participation ; Disabled Children ; History, 20th Century ; Humans ; Program Development ; Singapore ; Social Support

Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Premature, Diseases ; therapy ; Intensive Care, Neonatal ; methods ; Patient Outcome Assessment ; Risk Factors

PURPOSE: Endoscopic thyroid surgery has been widely used because of the cosmetic advantage and the development of laparoscopic instruments. We have performed endoscopic thyroidectomy by breast approach and gasless transaxillary approach on papillary thyroid microcarcinomas. In this study, we describe these two types of endoscopic procedures with the technique of the method and surgical outcomes. METHODS: From Oct. 1999 to Oct. 2009, each procedure was performed in 162 patients divided into two groups. Breast approach group was in 91 patients and gasless transaxillary approach group was in 71 patients. We compared the results of mean ages, sex ratio, extent of operation, mean hospital stay, operating time, pathologic characteristics and postoperative complications between the breast approach group and gasless transaxillary approach group. RESULTS: Ninety-one cases treated using breast approach, and seventy-one cases treated using gasless transaxillary approach. The operation time was 197.4+/-60.7 minutes (95~350) in breast approach group, and 100.1+/-19.8 minutes (65~140) in gasless transaxillary approach group. Post operative complications are; 2 cases of transient hoarseness, 8 cases of hypocalcemia (including 2 cases of permanent hypocalcemia), 2 cases of chest wall discomfort in breast approach group, and 1 case of transient hoarseness, 2 cases of transient hypocalcemia, 1 case of postoperative bleeding in gasless axillary approach group. CONCLUSION: Endoscopic thyroidectomy is a safe and technically feasible alternative to conventional thyroidectomy in patients with benign and highly selected malignant disease. We expect it can increase the extent of surgery.
Breast ; Carcinoma, Papillary ; Cosmetics ; Hemorrhage ; Hoarseness ; Humans ; Hypocalcemia ; Imidazoles ; Length of Stay ; Nitro Compounds ; Postoperative Complications ; Sex Ratio ; Thoracic Wall ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

INTRODUCTIONChildhood developmental and behavioural disorders (CDABD) have been increasingly recognised in recent years. This study evaluated the profiles and outcomes of children referred for developmental and behavioural concerns to a tertiary child developmental centre in Singapore. This is the first such regional database.

METHODSBaseline information, obtained through a questionnaire, together with history at first consultation, provided information for referral, demographic and presentation profiles. Clinical formulations were then made. Definitive developmental and medical diagnoses, as well as outcomes based on clinical assessment and standardised testing, were recorded at one year post first consultation.

RESULTSOut of 1,304 referrals between January 1, 2003 and December 1, 2004, 45% were 2-4 years old and 74% were boys. The waiting time from referral to first consultation exceeded four months in 52% of children. Following clinical evaluation, 7% were found to be developmentally appropriate. The single most common presenting concern was speech and language (S&L) delay (29%). The most common clinical developmental diagnosis was autism spectrum disorder (ASD) (30%), followed by isolated S&L disorder, global developmental delay (GDD) and cognitive impairment (CI). Recommendations included S&L therapy (57%), occupational therapy (50%) and psychological/behavioural services (40%). At one year, ASD remained the most common definitive developmental diagnosis (31%), followed by S&L disorder, CI and GDD. Most were children with high-prevalence, low-moderate severity disorders who could potentially achieve fair-good prognosis with early intervention.

CONCLUSIONBetter appreciation of the profile and outcome of children with CDABD in Singapore could enable better resource planning for diagnosis and intervention.

Adolescent ; Adult ; Child ; Child Behavior Disorders ; diagnosis ; epidemiology ; Child Development Disorders, Pervasive ; epidemiology ; therapy ; Child, Preschool ; Databases, Factual ; Developmental Disabilities ; diagnosis ; epidemiology ; Female ; Humans ; Infant ; Male ; Occupational Therapy ; Psychotherapy ; Registries ; Singapore ; Speech Disorders ; epidemiology ; therapy ; Speech Therapy ; Surveys and Questionnaires ; Time Factors ; Treatment Outcome

PURPOSE: The incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector. METHODS: We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES). RESULTS: There were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS. CONCLUSION: In this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.
Body Mass Index ; Cicatrix ; Female ; Follow-Up Studies ; Humans ; Incidence ; Silicones ; Surgical Instruments ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy* ; Wounds and Injuries

PURPOSE: Several studies have reported the plausible association of neutrophil-to-lymphocyte ratio (NLR) with the prognosis of papillary thyroid cancer (PTC), but the results are inconsistent. In PTC, chronic inflammation is closely related to tumor progression, and the age of the patient has a great influence on prognosis. Therefore, considering the changes in the immune system with aging, we classified the patients according to age and assessed the prognostic value of individual hematologic parameters. METHODS: This retrospective analysis included 1,921 patients who underwent thyroidectomy for PTC. Patients were divided into 2 groups based on their age: Y-group (age < 45) and O-group (age ≥ 45). Blood counts were measured within 14 days before surgery. RESULTS: The Y-group consisted of 914 patients aged < 45 years and the O-group consisted of 932 patients aged ≥ 45. In both groups, the common prognostic factors related to disease recurrence were only 6 or more metastatic lymph node and grossly extrathyroidal extension, and hematologic parameters were different between the 2 groups. High Platelet-lymphocyte ratio (PLR) in the Y-group and high NLR in the O-group were identified as independent predictors of disease recurrence (NLR: hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.23–8.73; P = 0.018; PLR: HR, 3.08; 95% CI, 1.26–7.52; P = 0.014). CONCLUSION: The results suggest that changes in immunity with aging may affect prognosis in patients with PTC, and thus hematologic parameters might be employed as prognostic markers depending on the age of the patients.
Aging ; Hematologic Tests ; Humans ; Immune System ; Inflammation ; Lymph Nodes ; Lymphocytes ; Neutrophils ; Prognosis ; Recurrence ; Retrospective Studies ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

PURPOSE: This study aimed to compare the diagnostic performance of contrast-enhanced digital mammography (CEDM) and contrast-enhanced magnetic resonance imaging (CEMRI) in preoperative evaluations, and to evaluate the effect of each modality on the surgical management of women with breast cancer. METHODS: This single-center, prospective study was approved by the Institutional Review Board, and informed consent was obtained from all patients. From November 2016 to October 2017, 84 patients who were diagnosed with invasive carcinoma (69/84) and ductal carcinoma in situ (15/84), and underwent both CEDM and CEMRI, were enrolled. Imaging findings and surgical management were correlated with pathological results and compared. The diagnostic performance of both modalities in the detection of index and secondary cancers (multifocality and multicentricity), and occult cancer in the contralateral breast, was compared. The authors also evaluated whether CEDM or CEMRI resulted in changes in the surgical management of the affected breast due to imaging-detected findings. RESULTS: Eighty-four women were included in the analysis. Compared with CEMRI, CEDM demonstrated a similar sensitivity (92.9% [78/84] vs. 95.2% [80/84]) in detecting index cancer (p=0.563). For the detection of secondary cancers in the ipsilateral breast and occult cancer in the contralateral breast, no significant differences were found between CEDM and CEMRI (p=0.999 and p=0.999, respectively). Regarding changes in surgical management, CEDM resulted in similar changes compared with CEMRI (30.9% [26/84] vs. 29.7% [25/84], p=0.610). Regarding changes in surgical management due to false-positive findings, no significant differences were found between CEDM and CEMRI (34.6% [9/26] vs. 44.0% [11/25], p=0.782). CONCLUSION: CEDM demonstrated a diagnostic performance comparable with CEMRI in depicting index cancers, secondary cancers, and occult cancer in the contralateral breast. CEDM demonstrated similar changes in surgical management compared with CEMRI.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Contrast Media ; Ethics Committees, Research ; Female ; Humans ; Informed Consent ; Magnetic Resonance Imaging* ; Mammography* ; Prospective Studies