Severe acute respiratory syndrome (SARS) was imported into Singapore in late February 2003 by a local resident who returned from a holiday in Hong Kong and started an outbreak in the hospital where she was admitted on 1 March 2003. The disease subsequently spread to 4 other healthcare institutions and a vegetable wholesale centre. During the period between March and May 2003, 238 probable SARS cases, including 8 imported cases and 33 deaths, were reported. Transmission within the healthcare and household settings accounted for more than 90% of the cases. Factors contributing to the spread of infection included the failure to recognise the high infectivity of this novel infection, resulting in a delay in isolating initial cases and contacts and the implementation of personal protective measures in healthcare institutions; and the super-spreading events by 5 index cases, including 3 with co-morbid conditions presenting with atypical clinical manifestations of SARS. Key public health measures were directed at prevention and control within the community and hospitals, and the prevention of imported and exported cases. An isolated laboratory-acquired case of SARS was reported on 8 September 2003. Based on the lessons learnt, Singapore has further strengthened its operational readiness and laboratory safety to respond to SARS, avian flu and other emerging diseases.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Disease Outbreaks ; prevention & control ; statistics & numerical data ; Disease Transmission, Infectious ; prevention & control ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Middle Aged ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; epidemiology ; transmission ; Singapore ; epidemiology

INTRODUCTION: Advanced breast cancer (ABC) remains common in Singapore. In 2019, 22.1% of breast cancer patients presented with ABC in our institution. Despite increasing affluence and the advent of national mammographic screening, the incidence of ABC has not changed significantly. This suggests inherent differences in women who present late. We aim to explore the socio-economic background, knowledge and attitudes of women who present with ABC. METHODS: Between December 2013 and July 2015, 100 patients who presented consecutively with ABC in a tertiary institution in Singapore were recruited to participate in an interviewer-led questionnaire exploring psychosocial and economic issues. RESULTS: Among the 100 patients, 63 and 37 presented with stages 3 and 4 breast cancer respectively. Median age was 57 (27-86), 52% had at least secondary education, 53% had no formal employment and 71% were married; 88% were aware of breast cancer symptoms, 82% were aware that mammography can help detect cancer, 82% believed that current treatment modality for breast cancer is effective, 96% had never undergone a mammography and 52.9% felt mammograms were unnecessary. A total of 64% presented symptomatic from the breast tumour, with a median duration of 3 months. Many of the patients were aware of breast cancer symptoms and the utility of mammography. However, a group of patients did not comply with screening. This may be due to poor understanding about breast screening and detection in its asymptomatic phase. CONCLUSION Further public education to improve understanding of breast cancer and screening mammography may help to improve rates for earlier detection of breast cancer.

INTRODUCTION: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition that can cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impact the quality of life of affected women. This study aims to evaluate effective treatment modalities, as well as understand the demographics and clinical presentation of patients with IGM. METHODS: An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January 2008 to 31 December 2018 at a tertiary breast unit. RESULTS: A total of 77 patients were included in the study. The median age at presentation was 36 years old. IGM presented most commonly as a breast lump (98.1%). The median number of flares was 2 (1-12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and 44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patients with IGM required a multimodal treatment approach to achieve remission. There was no significant difference in the number of flares no matter the initial treatment ( CONCLUSION IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition that affects young females with no superior treatment modality. Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients.
Adult ; Anti-Bacterial Agents/therapeutic use* ; Female ; Granulomatous Mastitis/therapy* ; Humans ; Quality of Life ; Retrospective Studies ; Treatment Outcome

INTRODUCTION: Diabetes mellitus is a major public health issue in Singapore. To shape healthcare policies for the primary prevention of diabetes, it is crucial to understand Singaporeans' knowledge, attitudes and practices related to diabetes and its prevention. This study aimed to assess the knowledge, attitudes and lifestyles of individuals without diabetes. MATERIALS AND METHODS: A cross-sectional household survey was performed between 31 January to 3 February 2019 to examine knowledge, attitudes and practices related to diabetes. Inclusion criteria of the participants included: 1) Singaporeans/permanent residents, 2) between 30 to 64 years old, and 3) who did not have a diagnosis of diabetes. Logistic and linear regression models were used to analyse the association of knowledge and attitudes with physical activity and diet habits, respectively. RESULTS: Among 806 participants, 72.2% did not meet the Health Promotion Board's physical activity recommendation. Physical activity was associated with better diabetes knowledge (odds ratio [OR] 5.38, 95% confidence interval [CI] = 1.65-17.53, = 0.049), stronger beliefs in diabetes prevention (OR 3.36, 95% CI = 1.02-11.12, = 0.047) and lower levels of worry about diabetes (OR 0.41, 95% CI 0.17-1.00, = 0.049). Neither knowledge nor beliefs or worries about diabetes was associated with diet. CONCLUSION There is a need to reinforce the importance of physical activity and healthy diet in preventing diabetes. Although improving the knowledge level of diabetes may increase physical activity of the population, it is unlikely to improve dietary choices without effective behavior change interventions.