AIM: To evaluate the cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury (TBI). Secondary aim was to identify factors associated with high inpatient rehabilitation cost. METHOD: Retrospective review of a tertiary hospital's trauma registry was performed from 2011-2017. All patients aged 16 years or younger who sustained TBI with Glasgow Coma Scale ≤13 were included. Data on patient demographics, mechanism and severity of injury, hospital duration and inpatient rehabilitation cost were collected. We performed a regression analysis to identify factors associated with high rehabilitation cost. RESULTS: There were a total of 51 patients. The median duration of inpatient rehabilitation was 13.5 days (interquartile range [IQR] 4-35), amounting to a median cost of SGD8,361 (IQR 3,543-25,232). Daily ward costs contributed the most to total inpatient rehabilitation cost. Those with severe TBI had longer duration of inpatient rehabilitation that resulted in higher cost of inpatient rehabilitation. Presence of polytrauma, medical complications, post-traumatic amnesia and TBI post-non-accidental injury (NAI) were associated with higher cost of inpatient rehabilitation. CONCLUSION The cost of inpatient rehabilitation for paediatric patients post-TBI is significant in Singapore. Patients with TBI secondary to NAI had significantly higher cost of inpatient rehabilitation. Ways to reduce duration of hospitalisation post-TBI and early step-down care or outpatient rehabilitation should be explored to reduce cost.

Introduction: Pap smear screening may increase the quality of women’s health through early detection of cervical cancer thus providing a better prognosis for women with cervical cancer. While the benefit of Pap smear screening is well documented, the screening uptake among Malaysian women in general was unsatisfactory with only 47.3% being screened. This study aimed to determine the prevalence of Pap smear uptake and its associated factors among Orang Asli women who lives in rural areas in Selangor. Methods: A cross sectional study was conducted in Hulu Langat and Kuala Langat districts from April to July 2017. Through cluster sampling, five Orang Asli settlements in the two districts were chosen. All women in the selected village aged between 18 to 65 years were invited to participate and interviewed using a structured, pretested questionnaire. Data were analysed using SPSS Version 22. Univariate and bivariate analysis were conducted to identify factors associated with Pap smear uptake among the participants. All hypotheses tests were two-sided and level of significance was set at 0.05. Results: Out of the 147 respondents, 114 (77.6%) had undergone Pap smear for at least once in the past. Women aged more than 35 years (p=0.013) were shown to be significantly more likely to take Pap smear compared to women who were 35 years old and less. There were significant associations between marital status (p<0.001), knowledge (p<0.001), attitude (p<0.001) and use of oral contraceptive (p=0.001) with Pap smear uptake. Conclusion: This study showed a high prevalence of Pap smear uptake among Orang Asli women in Selangor.

The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn's and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn's disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
Adalimumab ; Asia ; Asian Continental Ancestry Group ; Biological Factors ; Biosimilar Pharmaceuticals ; Colitis ; Colitis, Ulcerative ; Consensus ; Cooperative Behavior ; Crohn Disease ; Gastroenterology ; Hepatitis B ; Humans ; Immunologic Factors ; Inflammatory Bowel Diseases ; Infliximab ; Pharmacogenetics ; Philippines ; Practice Guidelines as Topic ; Tuberculosis ; Ulcer