Betacoronavirus ; Coronavirus Infections ; epidemiology ; Global Health ; Humans ; Morbidity ; trends ; Pandemics ; Pneumonia, Viral ; epidemiology ; Public Health ; Survival Rate ; trends

HIV Infections ; epidemiology ; prevention & control ; Humans ; Mass Screening ; organization & administration ; Morbidity ; trends ; Singapore ; epidemiology

The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The 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.
Disease Management ; Evidence-Based Medicine ; methods ; Government ; Humans ; Morbidity ; trends ; Practice Guidelines as Topic ; Singapore ; epidemiology ; Tuberculosis ; diagnosis ; epidemiology ; prevention & control

INTRODUCTIONThe elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments.

METHODSFrom 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups - elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared.

RESULTSElderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment.

CONCLUSIONElderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.

Acute Coronary Syndrome ; epidemiology ; Age Factors ; Aged ; Cardiovascular Diseases ; epidemiology ; Databases, Factual ; Female ; Humans ; Malaysia ; epidemiology ; Male ; Middle Aged ; Morbidity ; trends ; Registries ; Survival Rate ; trends

Although there is a controversy, several reports have shown that gastric cardia cancer has tended upwards in recent years. The aim of this study was to investigate the changing trend of stomach cancer according to the location of cancer and histologic type in Korea, where is known to be one of the most prevalent areas for gastric cancer. All the patients newly diagnosed as gastric cancer from 1991 through 2000 were recruited in Hallym University Medical Center. The periods were divided into the first (1991 through 1995) and the second (1996 through 2000) period. We analyzed the characteristics of cancer in the aspects of age, sex, tumor locations (cardia and non-cardia), and tumor grade of differentiation (well, moderate, and poor differentiated type). The number of cases was 2,395 and that of cardia cancer was 158 (6.6%). There was no evidence about the changes in the incidence of cardia cancer and histologic differentiation between two periods. The development of cardia cancer was not associated with the factors of age and sex with having no difference in the point of tumor grade. We could not find an upward tendency of cardia cancer development in recent 10 yr in Korea.
Adenocarcinoma/epidemiology* ; Adenocarcinoma/pathology ; Cardia* ; Cell Differentiation ; Comparative Study ; Female ; Human ; Incidence ; Korea/epidemiology ; Male ; Morbidity/trends ; Retrospective Studies ; Stomach Neoplasms/epidemiology* ; Stomach Neoplasms/pathology

INTRODUCTIONCommunity-based exercise programmes have been shown to be effective in the Western world. However, there is a dearth of literature on their effectiveness in Asia. This pilot study aims to assess the effectiveness of the Asian community-based Health Wellness Programme (HWP) in Singapore. The HWP provides community cardiac rehabilitation services.

METHODSA retrospective database analysis was conducted on cardiac rehabilitation patients who had completed the one-year wellness programme from 2010 to 2011. Patients were included in the programme if they had an underlying cardiac disease such as ischaemic heart disease and were deemed as stable by their cardiologist. Patients with New York Heart Association Class III or IV heart failure were excluded from this programme. Sociodemographic, anthropometric, clinical and laboratory data was recorded. Changes between the baseline and final measurements were analysed.

RESULTSComplete data from a total of 136 patients was analysed. Improvements were noted in body fat percentage (change [Δ] -1.3%, p < 0.01), distance walked (Δ 9.7 m, p = 0.01), total cholesterol (Δ -7.8 mg/dL, p = 0.03), low-density lipoprotein (Δ -7.8 mg/dL, p = 0.03) and triglyceride (Δ -17.8 mg/dL, p < 0.01).

CONCLUSIONThe low-to-moderate intensity HWP seems to be effective in a multiethnic community setting. To confirm the quality and effectiveness of such a programme in secondary cardiovascular prevention, more evidence from prospective controlled trials with suitable controls is needed.

Aged ; Cardiac Rehabilitation ; methods ; Ethnic Groups ; Female ; Follow-Up Studies ; Health Promotion ; organization & administration ; Heart Failure ; ethnology ; rehabilitation ; Humans ; Male ; Morbidity ; trends ; Pilot Projects ; Retrospective Studies ; Singapore ; epidemiology

INTRODUCTIONThere has been a rising trend in childhood developmental and behavioural disorders (CDABD). This study reports the profile of children with autistic spectrum disorders (ASD) initially referred for evaluation of CDABD.

METHODSThe CDABD database prospectively collected data of all consenting children referred in 2003 to the then Child Development Unit at KK Women's and Children's Hospital. All received medical consultation, followed by further assessments and intervention. Patients were tracked for one year.

RESULTSAmong 542 referred children, 32% (n = 170) received a diagnosis of ASD one year after the first consultation. Most were male, with a male to female ratio of 4.5:1. The median age at the first consultation was 41 (19,109) months. The main presenting concern was a delay in the development of speech and language skills in 78% of the children. A significant number had behavioural (63%) and social interaction (34%) issues. Criteria for the diagnosis of ASD according to the Diagnostic Statistical Manual IV-Revised were fulfilled in almost 90%. With the remaining refusing or deferring evaluation, only 74% received a psychological assessment. ASD was assessed to be severe or moderate in 86% of the children. Three-quarters remained on follow-up one year after the first consultation. The majority were referred for either centre- or school-based intervention programmes, with 70% assessed to have improved at the one-year mark.

CONCLUSIONThis is the first presentation of local data that aids programme planning and resource allocation. Children with ASD have varied outcomes. It is important to identify and intervene early in order to optimise development and functionality.

Autistic Disorder ; diagnosis ; epidemiology ; Child Development ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Morbidity ; trends ; Population Surveillance ; Referral and Consultation ; Retrospective Studies ; Singapore ; epidemiology ; Tertiary Care Centers

PURPOSE: To investigate normative angle kappa data and to examine whether correlations exist between angle kappa and ocular biometric measurements (e.g., refractive error, axial length) and demographic features in Koreans. METHODS: Data from 436 eyes (213 males and 223 females) were analyzed in this study. The angle kappa was measured using Orbscan II. We used ocular biometric measurements, including refractive spherical equivalent, interpupillary distance and axial length, to investigate the correlations between angle kappa and ocular biometry. The IOL Master ver. 5.02 was used to obtain axial length. RESULTS: The mean patient age was 57.5 +/- 12.0 years in males and 59.4 +/- 12.4 years in females (p = 0.11). Angle kappa averaged 4.70 +/- 2.70 degrees in men and 4.89 +/- 2.14 degrees in women (p = 0.48). Axial length and spherical equivalent were correlated with angle kappa (r = -0.342 and r = 0.197, respectively). The correlation between axial length and spherical equivalent had a negative correlation (r = -0.540, p < 0.001). CONCLUSIONS: Angle kappa increased with spherical equivalent and age. Thus, careful manipulation should be considered in older and hyperopic patients when planning refractive or strabismus surgery.
Anterior Chamber/*pathology ; *Axial Length, Eye ; Diagnostic Techniques, Ophthalmological/*instrumentation ; Equipment Design ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Morbidity/trends ; Refractive Errors/*diagnosis/epidemiology ; Republic of Korea/epidemiology ; Retrospective Studies

INTRODUCTIONDengue is a major public health problem in Singapore. Age-specific dengue morbidity rates are highest in the young adult population, unlike in many other Southeast Asian countries where dengue is mainly a paediatric disease. Hence, the World Health Organization (WHO) guidelines on dengue diagnosis and management which were developed using the paediatric experiences, may not be suitable for the management of adult dengue infections.

MATERIALS AND METHODSThe Early DENgue (EDEN) infection and outcome study is a collaborative longitudinal study to investigate epidemiological, clinical, viral and host-specific features of early dengue-infected adults, in an effort to identify new early markers for prognostication. Patients presenting with early undifferentiated fever were included in the study. We carried out an interim analysis to look for early indicators of severe disease.

RESULTSDuring the period of this interim study analysis, 455 febrile patients were recruited. Of these, 133 were confirmed as acute dengue cases based on dengue-specific polymerase chain reaction (PCR) results. There were significant clinical and epidemiological differences between dengue and febrile non-dengue cases. Nine per cent of the dengue cases experienced persistent tiredness, drowsiness and loss of appetite beyond 3 weeks of illness. Quantitation of viral loads using the crossover (Ct) value of real-time RT-PCR correlated with the duration of symptoms. More than half of both primary and secondary dengue cases were hospitalised. There was no dengue-related mortality in this study.

CONCLUSIONThe duration of illness and prolonged symptom duration in 9% of the subjects indicate that the burden of dengue illness is substantially different from other non-dengue febrile illness in our study cohort. Our study also highlights the paucity of early prognostic markers for dengue fever in adults.

Adult ; Antibodies, Viral ; analysis ; Dengue ; diagnosis ; epidemiology ; virology ; Dengue Virus ; genetics ; immunology ; isolation & purification ; Enzyme-Linked Immunosorbent Assay ; Female ; Follow-Up Studies ; Humans ; Male ; Morbidity ; trends ; Prognosis ; RNA, Viral ; analysis ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Singapore ; epidemiology

PURPOSE: To assess the relationships between optic cup-to-disc ratio (CDR) and age, sex, and other demographic and health characteristics in the healthy Korean population. METHODS: The study design was retrospective and population-based. A total of 28,377 subjects who participated in the Korea National Health and Nutrition Examination Survey between 2008 and 2011 were enrolled in this study. Participants underwent structured interviews as well as systemic and ophthalmic examinations. Patients with glaucoma who were diagnosed using the International Society of Geographical and Epidemiological Ophthalmology classification were excluded. Changes in vertical CDR were examined by age in relation to systemic variables on multiple regression analysis. RESULTS: The mean vertical CDR was 0.34 +/- 0.12. The vertical CDR increased with age from subjects in their 20s to those in their 80s (p < 0.001). The mean CDR in males was significantly higher than that of females (p < 0.001). On multiple regression analysis, the vertical CDR was positively associated with age (p < 0.001), male sex (p < 0.001), diastolic blood pressure (p = 0.009), and intraocular pressure (p < 0.001) but was negatively associated with body mass index (p < 0.001). CONCLUSIONS: Greater vertical CDR was related to age, male sex, higher diastolic blood pressure, higher intraocular pressure, and lower body mass index in healthy Koreans.
Age Distribution ; Cross-Sectional Studies ; Female ; Glaucoma/diagnosis/*epidemiology ; Humans ; *Intraocular Pressure ; Male ; Morbidity/trends ; Optic Disk/*pathology ; Optic Nerve Diseases/diagnosis/*epidemiology ; *Population Surveillance ; Reference Values ; Republic of Korea/epidemiology ; Retrospective Studies ; Sex Distribution ; Tonometry, Ocular