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Fulltext Breast-conserving surgery versus mastectomy in young women with breast cancer in Asian settings

Sinnadurai S, Kwong A, Hartman M, Tan EY, Bhoo-Pathy NT, Dahlui M, et al.

BJS Open, 2019 02;3(1):48-55.
PMID: 30734015 DOI: 10.1002/bjs5.50111

Background: Mastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early-stage breast cancer in Asian settings. Survival in women treated with breast-conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared.
Methods: Young women (aged less than 50 years) newly diagnosed with stage I or II (T1-2 N0-1 M0) breast cancer in four hospitals in Malaysia, Singapore and Hong Kong in 1990-2012 were included. Overall survival (OS) was compared for patients treated by BCS and those who had a mastectomy. Propensity score analysis was used to account for differences in demographic, tumour and treatment characteristics between the groups.
Results: Some 63·5 per cent of 3536 women underwent mastectomy. Over a 15-year period, only a modest increase in rates of BCS was observed. Although BCS was significantly associated with favourable prognostic features, OS was not significantly different for BCS and mastectomy; the 5-year OS rate was 94·9 (95 per cent c.i. 93·5 to 96·3) and 92·9 (91·7 to 94·1) per cent respectively. Inferences remained unchanged following propensity score analysis (hazard ratio for BCS versus mastectomy: 0·81, 95 per cent c.i. 0·64 to 1·03).
Conclusion: The prevalence of young women with breast cancer treated by mastectomy remains high in Asian countries. Patients treated with BCS appear to survive as well as those undergoing mastectomy.

Matched MeSH terms: Singapore
A preliminary note on the influence of hen egg yolk on haemopoiesis

Wodak H

Journal of the Malaya Branch of the British Medical Association, 1939;3:258-78.

Matched MeSH terms: Singapore
Haematuria following the administration of M & B 693

Sreenivasan BR

Journal of the Malaya Branch of the British Medical Association, 1940;3:415-8.

Matched MeSH terms: Singapore
Fulltext Musculoskeletal Occupational Injuries in Orthopaedic Surgeons and Residents

Tan K, Kwek E

Malays Orthop J, 2020 Mar;14(1):24-27.
PMID: 32296478 DOI: 10.5704/MOJ.2003.004

Introduction: Orthopaedic surgeons are significantly predisposed to musculoskeletal injury, and these injuries can have negative effects on surgeon function and patient outcomes. While this phenomenon has been studied in the non-Asian population of surgeons, no study has been carried out in the local or regional Asian setting. The aim of this study was to determine the prevalence, characteristics and associations of occupational injuries in orthopaedic surgeons and residents, and to assess its functional impact.
Materials and Methods: The Nordic Musculoskeletal Questionnaire was sent out to all orthopaedic consultants and residents at two institutions in Singapore, via an email link to an online survey. Separately, further questions on symptom description, severity and treatment were surveyed. Additional information like age, gender, height and weight were obtained as well.
Results: A total of 87.5% respondents have at least one injury. Neck symptoms (66.1%) were the most prevalent, and back symptoms had the highest median severity score (4.5/10). The 74.1% of these injuries were reported as directly attributable to work. Age was found to be associated with an increase in the total number of anatomical areas affected (p = 0.016). A seated operating position was associated with more severe back pain (p = 0.040).
Conclusion: There is a high prevalence of occupational injuries sustained in our population of orthopaedic surgeons. Neck symptoms, followed by back and wrist symptoms, were the predominant symptoms in our population. Targeted ergonomic interventions may be considered to prevent specific musculoskeletal injuries in our population of orthopaedic surgeons.

Matched MeSH terms: Singapore
Fulltext Cultural adaptation of a patient decision-aid for insulin therapy

Tan NC, Koong Ying Leng A, Phoon Kwong Yun I, Wang Zhen S, Paulpandi M, Lee YK, et al.

BMJ Open, 2020 03 08;10(3):e033791.
PMID: 32152165 DOI: 10.1136/bmjopen-2019-033791

INTRODUCTION: Patient decision-aids (PDAs) support patients in selecting evidence-based treatment options. PDA is useful only if the user understands the content to make personalised decisions. Cultural adaptation is a process of adjusting health messages so that the information is accurate, relevant and understandable to users from a different population. A PDA has been developed to assist Malaysian patients with secondary drug failure to initiate insulin therapy to control their type 2 diabetes mellitus (T2DM). Likewise, patients with T2DM in neighbouring Singapore face similar barriers in commencing insulin treatment, which a PDA may facilitate decision-making in selecting personalised therapy.
OBJECTIVE: The study aimed to explore the views and perceptions of Singaporean primary care providers on the Malaysia PDA to initiate insulin therapy and described the cultural adaptation process used in the design and development of a new PDA, which would be trialled in a Singapore primary healthcare institution.
METHOD: Qualitative research method was deployed to conduct one-to-one in-depth interviews of the healthcare providers at the trial site (SingHealth Polyclinics-SHP), including six primary care physicians and four nurses to gather their views and feedbacks on the Malaysian PDA. The interviews were transcribed, audited and analysed (standard content analysis) to identify themes relating to the content, layout, concerns of the original PDA and suggestions to the design of the new SHP PDA.
RESULTS: Cultural adaptation of the new PDA includes change to the overall design, graphics (including pictograms), presentation styles, additional contextualised content (personalisation, subheadings, cost and treatment option), modified phrasing of the subtitles and concerns (choice of words) relevant to the new users.
CONCLUSION: A PDA on insulin therapy underwent cultural adaptation before its implementation in another population in a neighbouring country. Its relevance and effectiveness will be evaluated in future research.

Matched MeSH terms: Singapore
Investment risk and natural resource potential in "Belt & Road Initiative" countries: A multi-criteria decision-making approach

Hussain J, Zhou K, Guo S, Khan A

Sci Total Environ, 2020 Mar 16;723:137981.
PMID: 32208210 DOI: 10.1016/j.scitotenv.2020.137981

Chinese enterprises that conduct overseas investment projects encounter diverse challenges that emerge from political, economic, social, and environmental risks in the host countries. To better assess the overseas investment risks faced by Chinese enterprises, this study introduced and assessed novel aspects and an indicator system. Moreover, the "Technique for Order Preference by Similarity to Ideal Solution" (TOPSIS) method based on entropy weight was performed to generate a comprehensive assessment of China's foreign investment risk and natural resource potential in 63 "Belt & Road Initiative" (BRI) countries. This study aims to encourage Chinese enterprises to devise suitable overseas investment decision-making strategies concerning natural resource potential in host countries. A Geographic Information System (GIS) map was also created to assess the potential risks and opportunities for Chinese enterprises when making investment decisions in host countries. The findings indicate that the majority of countries in Central and Eastern Europe and other BRI countries such as Singapore, Malaysia, Nepal, Bhutan, Russia, Armenia, and the United Arab Emirates were the most suitable choices for Chinese enterprises engaging in overseas investment. Based on these results, Chinese enterprises could manage and execute BRI projects more effectively to minimise potential risks and maximise their investment benefits.

Matched MeSH terms: Singapore
Investigation of the Malaysian form of Culex tritaeniorhynchus as a potential vector of Japanese B encephalitis virus on Singapore Island

HALE JH, COLLESS DH, LIM KA

Ann Trop Med Parasitol, 1957 Mar;51(1):17-25.
PMID: 13425313
Matched MeSH terms: Singapore
Fulltext Data on Indicators used in Southeast Asian nations' 4th and 5th National Reports to the Convention on Biological Diversity

Han X, Young BE, Gill MJ, Hamilton H, Vergara SG

Data Brief, 2020 Aug;31:105705.
PMID: 32490077 DOI: 10.1016/j.dib.2020.105705

The data presented in this article are related to the research article entitled "Progress on National Biodiversity Indicator Reporting and Prospects for Filling Indicator Gaps in Southeast Asia " (Han et al., 2020). We examined quantifiable information about biodiversity indicators from the most recent two national reports (i.e., 4th in 2010 and 5th in 2015) to the United Nation's Convention on Biological Diversity (CBD) by the 10-member countries of the Association of Southeast Asian Nations (ASEAN): Brunei Darussalam, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. This article presents the number of indicators, their level of development, and detailed lists of indicators for each country, and demonstrates general improvement in indicator use by the highest level of government reporting about implementation of the CBD at the national scale.

Matched MeSH terms: Singapore
Fulltext Ecology of bat flies in Singapore: A study on the diversity, infestation bias and host specificity (Diptera: Nycteribiidae)

Lim ZX, Hitch AT, Lee BPY, Low DHW, Neves ES, Borthwick SA, et al.

Int J Parasitol Parasites Wildl, 2020 Aug;12:29-33.
PMID: 32420022 DOI: 10.1016/j.ijppaw.2020.04.010

Bat flies are highly-specialized, hematophagous arthropods that are globally ubiquitous. There is little published research on bat flies (Diptera: Nycteribiidae) in Singapore and understanding the diversity of nycteribiids, host association and infestation rates can provide insight into this host-ectoparasite relationship. Nycteribiids were collected from bats trapped in Singapore (2011-2016) and identified using morphological keys. Host-ectoparasite relationships were investigated with logistic regression and Bayesian poisson regression. Nycteribiids were found to be monoxenously associated with their host bat species and host age, sex, species, and BBCI appear to contribute to differences in prevalence and intensity. Differences in host specificity between bat fly species in Singapore and their conspecifics in less disturbed habitats with higher bat biodiversity, such as Malaysia, Philippines and Thailand, suggest that the high host specificity in Singapore derives from the paucity of suitable hosts and abundance of single species roosts and not from their coevolved restrictions to them.

Matched MeSH terms: Singapore
Educational environments in Asian medical schools: A cross-national comparison between Malaysia, Singapore, and China

Arokiamary B, Russell V, Lim HA, Koay JM, Xia J, Zhao XH, et al.

Asia Pac Psychiatry, 2021 Jun;13(2):e12454.
PMID: 33646626 DOI: 10.1111/appy.12454

INTRODUCTION: Perceptions of the educational environment (EE) represent an important source of information on medical students' learning experience. Understanding and addressing these perceptions can help inform initiatives designed to improve the learning experience and educational outcomes, while comparison of student perceptions across medical schools can provide an added perspective. The aim of the study was to compare the EEs of three Asian medical schools: Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Yong Loo Lin School of Medicine, Singapore and Xiangya School of Medicine, China.
METHODS: Medical students in the clinical years (N = 1063) participated in a cross-sectional study using the Dundee Ready Educational Environment Measure (DREEM). Data were analyzed using SPSS version 22.
RESULTS: There were significant differences between the three medical schools in the total DREEM scores (F [2, 1059] = 38.29, p

Matched MeSH terms: Singapore
Fulltext Comparative Studies on Patient Safety Culture to Strengthen Health Systems Among Southeast Asian Countries

Kang S, Ho TTT, Lee NJ

Front Public Health, 2020;8:600216.
PMID: 33511097 DOI: 10.3389/fpubh.2020.600216

Patient safety is an important issue in health systems worldwide. A systematic review of previous studies on patient safety culture in Southeast Asian countries is necessary for South Korea's partnership with these countries, especially given South Korea's assistance in strengthening the health systems of these developing countries. Studies on patient safety culture in Southeast Asian countries, published in English and Thai languages, were retrieved from computerized databases using keywords through a manual search. Data extraction, quality assessment, and analyses were performed using several tools. The review included 21 studies conducted in Indonesia (n = 8), Thailand (n = 5), Malaysia (n = 3), Vietnam (n = 2), Singapore (n = 1), and the Philippines (n = 1). They were analyzed and categorized into 12 dimensions of safety culture, and differences in response rate or scores were identified compared to the mean of the dimensions. The heterogeneous of safety culture's situation among Southeast Asian countries, both in practice and in research, can be explained since patient safety policy and its application are not prioritized as much as they are in developed countries in the priority compared to the developed countries. However, Vietnam, Cambodia, Myanmar, and Laos are the priority countries for South Korea's official healthcare development assistance in the Southeast Asia region. Vietnam, for instance, is an economically transitioning country; therefore, consolidated patient safety improvement by inducing patient safety culture in the provincial and central health system as well as strengthening project formulation to contribute to health policy formation are needed for sustainable development of the partner countries' health systems. It is recommended that more evidence-based proactive project planning and implementation be conducted to integrate patient safety culture into the health systems of developing countries, toward health policy on patient safety and quality service for the attainment of sustainable development goals in South Korea's development cooperation.

Matched MeSH terms: Singapore
Fulltext Determining if Positive Predictive Value using Laboratory Risk Indicator for Necrotising Fasciitis is Applicable in Malaysian Patients with Necrotising Fasciitis

Syed A, Alvin T, Fazrina A, Abdul R

Malays Orthop J, 2017 Jul;11(2):36-39.
PMID: 29021877 MyJurnal DOI: 10.5704/MOJ.1707.005

Introduction: Necrotising fasciitis (NF) is a rapidly progressive infection of the subcutaneous tissue and fascia which spreads rapidly. The scoring system of Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) developed by Wong et al has been proposed as a tool for distinguishing NF and other soft tissue infections (STI) in Singapore. We set out to establish whether the LRINEC score is applicable in our Malaysian setting. Materials and Methods: A cross sectional study of all patients admitted to our hospital diagnosed with NF or To Rule Out NF (TRO NF) between January 1st 2016 to 30th June 2016. The sensitivity, specificity, positive and negative predictive values were then calculated for LRINEC score of ≥ 6 and ≥ 8. Results: Fourty-four patients were identified with the diagnosis of NF or TRO NF in the study. Twenty-seven patients (61.4%) were deemed post-operatively as having NF and 17 patients (38.6%) not having NF. A sensitivity of 59.3% and specificity of 47.1% when a LRINEC score of ≥ 6 was taken with positive predictive value (PPV) of 64.0% and the negative predictive value (NPV) of 42.1%. When score ≥ 8 was taken, the sensitivity was 48.1% and specificity of 58.8% with PPV of 65% and NPV of 41.7%. Conclusion: The low sensitivity and low PPV achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections.

Matched MeSH terms: Singapore
Fulltext Macroeconomic dataset for generating macroeconomic volatility among selected countries in the Asia Pacific region

Chow YP, Muhammad J, Amin Noordin BA, Cheng FF

Data Brief, 2018 Feb;16:23-28.
PMID: 29167816 DOI: 10.1016/j.dib.2017.11.015

This data article provides macroeconomic data that can be used to generate macroeconomic volatility. The data cover a sample of seven selected countries in the Asia Pacific region for the period 2004-2014, including both developing and developed countries. This dataset was generated to enhance our understanding of the sources of macroeconomic volatility affecting the countries in this region. Although the Asia Pacific region continues to remain as the most dynamic part of the world's economy, it is not spared from various sources of macroeconomic volatility through the decades. The reported data cover 15 types of macroeconomic data series, representing three broad categories of indicators that can be used to proxy macroeconomic volatility. They are indicators that account for macroeconomic volatility (i.e. volatility as a macroeconomic outcome), domestic sources of macroeconomic volatility and external sources of macroeconomic volatility. In particular, the selected countries are Malaysia, Thailand, Indonesia and Philippines, which are regarded as developing countries, while Singapore, Japan and Australia are developed countries. Despite the differences in level of economic development, these countries were affected by similar sources of macroeconomic volatility such as the Asian Financial Crisis and the Global Financial Crisis. These countries were also affected by other similar external turbulence arising from factors such as the global economic slowdown, geopolitical risks in the Middle East and volatile commodity prices. Nonetheless, there were also sources of macroeconomic volatility which were peculiar to certain countries only. These were generally domestic sources of volatility such as political instability (for Thailand, Indonesia and Philippines), natural disasters and anomalous weather conditions (for Thailand, Indonesia, Philippines, Japan and Australia) and over-dependence on the electronic sector (for Singapore).

Matched MeSH terms: Singapore
Fulltext Fine-scale population structure of Malays in Peninsular Malaysia and Singapore and implications for association studies

Hoh BP, Deng L, Julia-Ashazila MJ, Zuraihan Z, Nur-Hasnah M, Nur-Shafawati AR, et al.

Hum Genomics, 2015 Jul 22;9:16.
PMID: 26194999 DOI: 10.1186/s40246-015-0039-x

Fine scale population structure of Malays - the major population in Malaysia, has not been well studied. This may have important implications for both evolutionary and medical studies. Here, we investigated the population sub-structure of Malay involving 431 samples collected from all states from peninsular Malaysia and Singapore. We identified two major clusters of individuals corresponding to the north and south peninsular Malaysia. On an even finer scale, the genetic coordinates of the geographical Malay populations are in correlation with the latitudes (R(2) = 0.3925; P = 0.029). This finding is further supported by the pairwise FST of Malay sub-populations, of which the north and south regions showed the highest differentiation (FST [North-south] = 0.0011). The collective findings therefore suggest that population sub-structure of Malays are more heterogenous than previously expected even within a small geographical region, possibly due to factors like different genetic origins, geographical isolation, could result in spurious association as demonstrated in our analysis. We suggest that cautions should be taken during the stage of study design or interpreting the association signals in disease mapping studies which are expected to be conducted in Malay population in the near future.

Matched MeSH terms: Singapore
Fulltext Lumbar puncture refusal in febrile convulsion

Ling SG, Boey CC

Singapore Med J, 2000 Oct;41(10):485-8.
PMID: 11281439

A descriptive study was carried out on patients admitted for febrile convulsion over a two-year period to determine rate of lumbar puncture (LP) refusal, factors associated with LP refusal and outcome of such patients. From 77 patients indicated and requested for LP, 19 (25%) patients refused the procedure. Refusal of LP was significantly more common among the Malay ethnic group (p = 0.01) but not significantly associated with age,gender or whether the patient was admitted for a first or recurrent febrile convulsion. Half of the patients who refused LP had to be started empirically on antibiotics for meningitis. Patients who refused LP were also 8.5 times more likely to discharge themselves "at own risk" (AOR), compared to other patients with febrile convulsion (p = 0.004). In conclusion, LP refusal is a common problem in the local setting and is a hindrance to the proper management of patients with fever and seizure. Appropriate measures must be carried out to educate the public, particularly those from the Malay ethnic group on the safety and usefulness of the procedure. Reasons for patients discharging AOR following LP refusal also need to be addressed and problems rectified.

Matched MeSH terms: Singapore
Fulltext Designer drugs--the Ecstasy and the agony

Kua EH

Singapore Med J, 1997 Jan;38(1):6.
PMID: 9269344
Matched MeSH terms: Singapore
Fulltext Utility of COX1 phylogenetics to differentiate between locally acquired and imported Plasmodium knowlesi infections in Singapore

Loh JP, Gao QH, Lee VJ, Tetteh K, Drakeley C

Singapore Med J, 2016 Dec;57(12):686-689.
PMID: 26805667 DOI: 10.11622/smedj.2016016

INTRODUCTION: Although there have been several phylogenetic studies on Plasmodium knowlesi (P. knowlesi), only cytochrome c oxidase subunit 1 (COX1) gene analysis has shown some geographical differentiation between the isolates of different countries.
METHODS: Phylogenetic analysis of locally acquired P. knowlesi infections, based on circumsporozoite, small subunit ribosomal ribonucleic acid (SSU rRNA), merozoite surface protein 1 and COX1 gene targets, was performed. The results were compared with the published sequences of regional isolates from Malaysia and Thailand.
RESULTS: Phylogenetic analysis of the circumsporozoite, SSU rRNA and merozoite surface protein 1 gene sequences for regional P. knowlesi isolates showed no obvious differentiation that could be attributed to their geographical origin. However, COX1 gene analysis showed that it was possible to differentiate between Singapore-acquired P. knowlesi infections and P. knowlesi infections from Peninsular Malaysia and Sarawak, Borneo, Malaysia.
CONCLUSION: The ability to differentiate between locally acquired P. knowlesi infections and imported P. knowlesi infections has important utility for the monitoring of P. knowlesi malaria control programmes in Singapore.

Matched MeSH terms: Singapore
Fulltext Ministry of health clinical practice guidelines: cancer screening

Lee HP, Chew CT, Consigliere DT, Heng D, Huang DT, Khoo J, et al.

Singapore Med J, 2010 Feb;51(2):170-3; quiz 174-5.
PMID: 20358158

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with key recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on cancer screening, for the information of readers of the Singapore Medical Journal. 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/mohcorp/publications.aspx?id=24018). 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.

Matched MeSH terms: Singapore
Fulltext Awareness and perceptions of fibromyalgia syndrome: a survey of Malaysian and Singaporean rheumatologists

Arshad A, Kong KO

Singapore Med J, 2007 Jan;48(1):25-30.
PMID: 17245512

INTRODUCTION: Fibromyalgia syndrome (FMS) is a common but controversial condition. There appears to be different levels of belief of its existence and awareness. We set out to explore the variations of perceptions and awareness of this condition among rheumatologists from Malaysia and Singapore.
METHODS: 48 rheumatologists from Malaysia (28) and Singapore (20) were approached to participate in this survey by answering a specific questionnaire regarding their belief in FMS. 23 respondents from Malaysia and 20 from Singapore completed the questionnaire.
RESULTS: 91 percent of Malaysian rheumatologists and 95 percent of the Singaporean believe that FMS is a distinct clinical entity and that this condition is considered an illness rather than a disease. 87 percent and 90 percent of rheumatologists from Malaysia and Singapore, respectively, believe that FMS is a mixture of medical and psychological illness. However, not many of those in the university setting include FMS in their undergraduate teaching. 87 percent and 80 percent of the respondents from Malaysia and Singapore, respectively, also ordered blood tests to exclude other serious pathologies, and 100 percent of the respondents from both countries also prescribed some form of drugs to their FMS patients.
CONCLUSION: This study confirmed that there was a variation of perceptions and knowledge of FMS among rheumatologists from Malaysia and Singapore. The majority of rheumatologists recognise that FMS is a distinct clinical entity, and is diagnosed by excluding other well-defined clinical diseases through a combination of clinical evaluation and screening tests.

Matched MeSH terms: Singapore
Fulltext Ventilatory function in Malay office workers in Malaysia

Che' Man AB, Lim HH

Singapore Med J, 1983 Jun;24(3):135-9.
PMID: 6635675

A study was carried out to determine ventilatory capacity (Forced Expiratory Volume or FEV1 and Forced Vital Capacity or FVC) in apparently normal Malay office workers in Malaysia. The subjects, 78 males and 113 females, were interviewed using a standardized questionnaire to exclude those with symptoms or past history of cardiopulmonary disease. Measurements of age, height, weight, FEV, and FVC were made on each subject; the FEV, and FVC were measured using Vitalograph spirometers. The mean FEV, and FVC for males were 3.35 litres and 3.76 Iitres, respectively. For females, the mean FEV, and FVC were 3.46 and 2.72 Iitres, respectively. Height was positively correlated with FEV, and FVC (p

Matched MeSH terms: Singapore

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