Assessment of radon transportation and uranium content in the tectonically active zone of Himalaya, India.

The study shows how geology and tectonic activity affect the soil gas 222Rn concentration. The tectonically active zone, namely the Ghuttu region, which is located within the Himalayan seismic belt, was studied to decipher its impact on soil gas 222Rn concentrations. A soil gas 222Rn study was performed in the soil at a depth of 30 cm, and it varied from 426 ± 156 Bq m-3 to 24,057 ± 1110 Bq m-3 with an average of 5356.5 ± 1634.6 Bq m-3, and at 60 cm below the soil surface, the concentration varied from 1130 ± 416 Bq m-3 to 30,236 ± 1350 Bq m-3 with an average of 8928.5 ± 2039.5 Bq m-3. These concentrations vary in soil from -3.4 % to 437.3 % as the depth moves from 30 cm to 60 cm. The variation in uranium content also shows anomalies, and higher values of uranium content in the soil affect the radon concentration in the study area. The average soil gas 222Rn concentration in the Ghuttu window was found to be higher than that in its surrounding region. This is likely due to transportation from daughter products of uranium. 222Rn mass exhalation rate measurements were also carried out, and a weak correlation with the soil gas 222Rn concentration was observed. A significant variation in the mass exhalation rate was noticed in tectonically active areas. This study is vital to understanding the behavior of radon and uranium in tectonic regions.

Functionalized Moringa oleifera Gum as pH-Responsive Nanogel for Doxorubicin Delivery: Synthesis, Kinetic Modelling and In Vitro Cytotoxicity Study

Environment-responsive-cum-site-specific delivery of therapeutic drugs into tumor cells is a foremost challenge for chemotherapy. In the present work, Moringa oleifera gum-based pH-responsive nanogel (MOGN) was functionalized as a doxorubicin (DOX) carrier. It was synthesized via free radical polymerization through the γ-irradiation method using acrylamide and N,N'-MBA followed by hydrolysis, sonication, and ultracentrifugation. The swelling behavior of MOGN as a function of pH was assessed using a gravimetric method that revealed its superabsorbent nature (365.0 g/g). Furthermore, MOGN showed a very high loading efficiency (98.35 %L) of DOX by MOGN. In vitro release studies revealed that DOX release from DOX-loaded MOGN was 91.92% at pH 5.5 and 12.18% at 7.4 pH, thus favorable to the tumor environment. The drug release from nanogel followed Korsmeyer-Peppas model at pH 5.5 and 6.8 and the Higuchi model at pH 7.4. Later, the efficient DOX release at the tumor site was also investigated by cytotoxicity study using Rhabdomyosarcoma cells. Thus, the synthesized nanogel having high drug loading capacity and excellent pH-triggered disintegration and DOX release performance in a simulated tumor environment could be a promising candidate drug delivery system for the targeted and controlled release of anticancer drugs.

Predictors of peri-operative cardiac events and development of a scoring tool for patients with chronic kidney disease undergoing non-cardiac surgeries: A prospective observational multicentre study.

Background and Aims: Cardiovascular diseases are the leading causes of morbidity and mortality in chronic kidney disease (CKD) patients. Our aim was to derive predictors of cardiac morbidity, mortality, cardiac complications and to develop/validate a scoring tool in patients with CKD undergoing non-cardiac surgery. Methods: A prospective observational multicentre study was done on 770 patients with CKD. The primary outcome ("Event") was one or more than one of sudden cardiac death, pulmonary oedema, acute coronary syndrome, arrhythmia and 30-day mortality. Secondary outcome was hypertension and hypotension. Predictors of cardiac risk were identified. A scoring tool was developed on the 2018 dataset and was validated on the 2019 dataset. Results: The overall incidence of cardiac events was 290 (37.66%) whereas the incidence of major adverse cardiac and cerebrovascular events was 15.04%. Mortality due to cardiac cause was 13 (1.68%). On multivariate regression analysis, seven perioperative variables had significant association with increased risk of events: age > 65 years (P = 0.004), metabolic equivalents (METS) ≤4 (P≤0.032), emergency surgery (P =0.032), mean arterial pressure >119 (P = 0.001), echocardiographic scoring (P = 0.054), type of anaesthesia (P ≤ 0.0001) and type of surgery (P = 0.056). Using these variables, a risk stratification tool was developed. C statistics showed favourable predictive accuracy (0.714) and the model showed good calibration. Conclusion: This risk scoring tool based on preoperative variables will help to predict the risk of events in high-risk CKD patients undergoing non-cardiac surgery. This will help in better counselling and optimisation.

MEASUREMENT OF RADON, THORON AND THEIR PROGENY CONCENTRATIONS IN THE DWELLINGS OF PAURI GARHWAL, UTTARAKHAND, INDIA.

It is well known that inhalation of radon, thoron and their progeny contributes more than 50 % of natural background radiation dose to human being. The time-integrated passive measurements of radon, thoron and their progeny concentrations were carried out in the dwellings of Pauri Garhwal, Uttarakhand, India. The measurements of radon and thoron concentrations were performed by LR-115 detector-based single-entry pin-hole dosemeter, while for the measurement of progeny concentrations, LR-115 deposition-based direct radon and thoron progeny sensors technique was used. The experimental techniques and results obtained are discussed in detail.

STUDY OF RADON FLUX FROM SOIL IN BUDHAKEDAR REGION USING SRM.

In the present study, the radon flux rate of the soil is measured using portable radon monitor (scintillation radon monitor) in the Budhakedar region of District Tehri, India. The study area falls along a fault zone named Main Central Thrust, which is relatively rich in radium-bearing minerals. Radon flux rate from the soil is one of the most important factors for the evaluation of environmental radon levels. The earlier studies in the Budhakedar region shows a high level of radon (>4000 Bq m-3). Hence, it is important to measure the radon flux rate. The aim of the present study is to calculate the average estimate of the surface radon flux rate as well as the effective mass exhalation rate. A positive correlation of 0.54 was found between radon flux rate and radon mass exhalation rate.

A COMPARATIVE STUDY OF RADIUM CONTENT AND RADON EXHALATION RATE FROM SOIL SAMPLES USING ACTIVE AND PASSIVE TECHNIQUES.

Soil is the most important factor affecting the radon level in the human living environments. It depends not only on uranium and thorium contents but also on the physical and chemical properties of the soil. In this paper, the measurements of radium content and mass exhalation rate of radon from the soil samples collected from Uttarkashi area of Garhwal Himalaya are presented. The correlation between radium content and radon mass exhalation rate from soil has also been obtained. The radium was measured by gamma ray spectrometry, while the mass exhalation rate of radon has been determined by both active and passive methods. The radium activity in the soil of study area was found to vary from 45±7 to 285±29 Bq kg-1 with an average of 99 Bq kg-1 The radon mass exhalation rate was found to vary from 0.59 × 10-5 to 2.2 × 10-5 Bq kg-1 h-1 with an average of 1.4 × 10-5 Bq kg-1 h-1 by passive technique and from 0.8 × 10-5 to 3.2 × 10-5 Bq kg-1 h-1 with an average of 1.5 × 10-5 Bq kg-1 h-1 by active technique. The results suggest that the measured radium value is positively correlated with the radon mass exhalation rate measured with both the active and passive techniques.

Quality of life in end stage renal disease patients.

AIM: To understand factors associated with quality of life (QOL), examine types of QOL instruments, and determine need for further improvements in QOL assessment. METHODS: The method used databases (Pubmed, Google scholar) and a bibliographic search using key words QOL, end stage renal disease, Hemodialysis, Peritoneal dialysis, instruments to measure QOL, patients and qualitative/quantitative analysis published during 1990 to June 2014. Each article was assessed for sample size, demographics of participants, study design and type of QOL instruments used. We used WHO definition of QOL. RESULTS: For this review, 109 articles were screened, out of which 65 articles were selected. Out of 65 articles, there were 19 reports/reviews and 12 questionnaire manuals. Of the 34 studies, 82% were quantitative while only 18% were qualitative. QOL instruments measured several phenomenon such as physical/psychological health, effects and burdens of kidney disease, social support etc. those are associated with QOL. Few studies looked at spiritual beliefs, cultural beliefs, personal concerns, as per the WHO definition. Telemedicine and Palliative care have now been successfully used however QOL instruments seldom addressed those in the articles reviewed. Also noticed was that longitudinal studies were rarely conducted. Existing QOL instruments only partially measure QOL. This may limit validity of predictive power of QOL. CONCLUSION: Culture and disease specific QOL instruments that assess patients' objective and subjective experiences covering most aspects of QOL are urgently needed.

Efficacy and safety of standardized extract of Trigonella foenum-graecum L seeds as an adjuvant to L-Dopa in the management of patients with Parkinson's disease.

The objective of this study is to evaluate disease modifying efficacy and safety of a standardized extract of Trigonella foenum-graecum L, Fenugreek (IBHB) (family Fabaceae) as a nutritional adjuvant to Levo-dopa (L-Dopa) in Parkinson's disease (PD) patients. We conducted double-blind placebo-controlled proof of concept clinical study of IBHB capsules (300 mg, twice daily) with matching placebo for 6 months of period in 50 patients of PD stabilized on L-Dopa therapy. The efficacy outcome measures were the scores of Unified Parkinson's Disease Rating Scale (UPDRS - total and its subsections), and Hoehn and Yahr (H&Y) staging at baseline and end of 6-months treatment duration. Safety evaluation included haematology, biochemistry, urinalysis parameters and adverse event monitoring. Total UPDRS scores in IBHB treatment (0.098%) showed slower rise as opposed to steep rise (13.36%) shown by placebo. Further, Clinically Important Difference for total UPDRS scores and scores of motor subsection of UPDRS was found to be 5.3 and 4.8, respectively, in favour of IBHB treatment. Similar improvement was shown by IBHB in terms of H&Y staging as compared with placebo. IBHB was found to have excellent safety and tolerability profile. In conclusion, IBHB can be useful adjuvant treatment with L-Dopa in management of PD patients.

Public awareness and perception of clinical trials: Quantitative study in Pune.

CONTEXT: Studies have reported that clinical research has experienced tremendous growth during past few decades with many multinational pharmaceutical companies recruiting millions of Indians in clinical trials (CTs). However, there is hardly any literature that talks about the participants, their knowledge, and awareness of CTs. It is important that the general public is aware about CTs so that they can take their own informed decision to participate in CTs. AIM: To assess public awareness, perceptions, and attitudes toward CTs and their views on various methods to create awareness about CTs. MATERIALS AND METHODS: Cross sectional survey was conducted with 200 non trial participants (NTPs) and 40 trial participants (TPs). RESULTS: TPs were significantly (P < 0.0001) older than NTPs. More than 80% of both TPs and NTPs mentioned participation in CT helps advance medical science and strongly felt that there is a need to create awareness about CTs. Nearly 70% of TPs could not remember the phase of the trial while 20% did not know which type of trial they had participated. The main reason for participation in the trial was physician's advice. About 80% of both TPs and NTPs felt that participation in CT will increase with free medications and advice from friends/relatives who had good experience with trial. CONCLUSION: Results of this pilot study revealed need to create CT awareness among the general public. However, considering ethno-cultural, regional, and literacy-level differences throughout the country, a nationwide study would be appropriate to provide reliable results about awareness of CTs among Indians.

Validation of the English version of the Kidney Disease Quality of Life questionnaire (KDQOL-36) in haemodialysis patients in Singapore.

BACKGROUND: To validate a widely used health outcomes instrument for patients with chronic kidney disease and on dialysis, the Kidney Disease Quality of Life questionnaire (KDQOL-36), in English-speaking haemodialysis patients in Singapore. METHODS: This study is a secondary data analysis using the KDQOL-SF (version 1.3) data collected from a cross-sectional survey of haemodialysis patients in Singapore. Cronbach's α was used to test internal consistency reliability. Multi-item scales were assessed using item-to-scale correlation and factor analysis. Both confirmatory and exploratory factor analyses were performed separately for generic and disease-targeted scales. Construct validity was assessed by correlation between disease-targeted and generic scales. Criterion validity was assessed by correlation of the physical component summary (PCS-12) and mental component summary (MCS-12) from KDQOL-36 with the corresponding PCS-36 and MCS-36 from the KDQOL-SF. RESULTS: Three hundred ninety-four patients who completed the interviews in English [male 55.8 %, mean age (SD) 52.4 (11.7) years] were involved. Kidney disease scales exhibited desirable internal consistency (Cronbach's α 0.822-0.906) and item-to-scale correlation (range 0.763-0.903), and a three-factor model fit the data well [comparative fit index (CFI) 0.934, root mean square error of approximation (RMSEA) 0.085]. For the generic Short Form 12 Health Survey (SF-12) items, a two-factor model (physical and mental) showed poor overall fit, but a three-factor structure (role, physical and mental functions) achieved good model fit (CFI 0.999, RMSEA 0.027). Correlation between disease-targeted and generic scales was weak to moderate (range 0.286-0.418). Correlation between SF-12 and SF-36 was 0.750 for PCS and 0.797 for MCS. CONCLUSION: The English version of the KDQOL-36 appears to be reliable and valid to measure quality of life for haemodialysis patients in Singapore.

Validity and reliability of English and Marathi Oswestry Disability Index (version 2.1a) in Indian population.

STUDY DESIGN: A total of 200 patients with low back pain (LBP) completed an English and Marathi Oswestry Disability Index (ODI) questionnaires (100 each), visual analogue scale, and Roland-Morris Disability Questionnaire. OBJECTIVE: To validate the English and Marathi versions of ODI (version 2.1a). SUMMARY OF BACKGROUND DATA: Patient-orientated assessment methods are important in the evaluation of treatment outcome. The ODI is one of the condition-specific questionnaires recommended for the use of patients with LBP. METHODS: An adaptation of the ODI (version 2.1a) for Marathi language was carried out according to established guidelines. RESULTS: Average age of patients who answered the English ODI was 42 ± 15, whereas that of Marathi-speaking patients was 52 ± 15 years. About 40% were males. The Cronbach α reliability score was 0.877 for English and 0.943 for Marathi. Forty-seven and 53 of these patients were retested with English and Marathi ODI within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient (ICC) for the test-retest reliability of the questionnaire was 0.877 and 0.943 for English and Marathi respectively. The ODI scores correlated with visual analogue scale pain intensity (r = 0.67, P < 0.0001) and Roland-Morris Disability Questionnaire score (r = 0.71, P < 0.0001) for English and visual analogue scale (r = 0.325, P < 0.001) and Roland-Morris Disability Questionnaire scores (r = 0.503, P < 0.0001) for Marathi. The receiver operating characteristic curve analysis showed comparable performance in discriminating the existence of sign and symptoms (area under curve = 0.947, P < 0.0001, 95% confidence interval: 0.893-0.999 for English and Marathi (area under curve: 0.834, P < 0.0001, 95% confidence interval: 0.735-0.933) for severe compared with nonsevere LBP proving discriminative validity. Results showed that English ODI is valid and reliable. CONCLUSION: The Marathi version of Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as the English version. It should represent a valuable tool for use in future patient-orientated outcome studies for population with LBP in India.

What factors really matter? Health-related quality of life for patients on kidney transplant waiting list.

INTRODUCTION: Waiting times for kidney transplant are long in Singapore. Healthrelated quality of life (HRQoL) of patients might be affected as a result of the stress of the long wait and the uncertainty of being called to undergo a surgical operation. This study aimed to measure the HRQoL of patients on the kidney transplant waiting list and to identify factors which could impact on the HRQoL scores in this group of patients. MATERIALS AND METHODS: This was a cross-sectional study of kidney transplant waiting list patients managed at a tertiary renal unit using the SF-36. A SF-36 normative calculator was used to generate HRQoL scores for the Singapore general population matched with the study cohort's age, gender and ethnicity. RESULTS: There were 265 respondents with a response rate was 81%. Our study shows that HRQoL scores for the kidney transplant waiting list patients were lower than the population norms across all subscales and were clinically significant for General Health, Role Physical, Bodily Pain, Social Functioning and Mental Component Summary scores. Factors such as being Chinese, married, employed and undergoing haemodialysis predicted better HRQoL scores after adjusting for possible confounders. Age, gender, educational level, household income, history of kidney transplant, duration on the transplant waiting list and years on dialysis did not significantly influence SF-36 across all subscales scores. CONCLUSION: Kidney transplant waiting list patients had worse HRQoL compared to the general population. Factors such as ethnicity, marital status, employment status, and type of dialysis treatment significantly influenced patients' perception of their HRQoL.

Limited knowledge of chronic kidney disease among primary care patients--a cross-sectional survey.

BACKGROUND: Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients. METHODS: We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points. RESULTS: 1435 completed all 7 questions on CKD. Mean age was 48.9 ± 5.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of ≤ $2000. 43.7% had chronic diseases. Mean score was 3.44 ± 1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60 years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40-60 years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [

Factors influencing living kidney donation in Singapore.

CONTEXT: Kidney transplantation is the best treatment option for kidney failure, but the supply of donor kidneys remains small. OBJECTIVE: To understand the public's attitude toward living donor kidney donation in Singapore. DESIGN, SETTING AND PARTICIPANTS, INTERVENTION, OUTCOME MEASURES: A crosssectional study of a convenience sample of 1520 members of the general public seeking care at local medical centers. A self-administered questionnaire included questions on demographics and subjects' willingness and unwillingness to donate a kidney. Respondents were aged at least 18 years and did not have underlying chronic kidney disease, end-stage renal disease requiring dialysis, or history of kidney transplant. RESULTS: Overall mean age of respondents was 49 (SD, 15) years and 50% were male. Response rate to the question on "willingness to donate kidney while alive" was 96% (1460); 707 (48.4%) were willing to donate a kidney while alive. Respondents who were willing to donate were younger (<40 years; P<.001); had above a secondary level education (P<.001); had monthly household income 2000 SGD (or US$1660; exchange rate at 1 SGD = US$0.83) or higher (P<.001); were not married, single, or divorced (P<.001); and were professionals (P<.001). Fear of surgical risks (86.5% strongly agree or agree) and poorer health consequent to donation (87.5% strongly agree or agree) were the main reasons for not considering being a living kidney donor. Demographic factors and concerns of surgical risks and ill health after transplant influenced willingness to donate a kidney while alive. Addressing these concerns may alleviate anxiety with regard to living kidney donation.

Public awareness of clinical trials: A qualitative pilot study in Pune.

CONTEXT: Medical expertise combined with availability of patients with varied diseases have resulted in rapid increase in number of clinical trials (CTs) recruiting millions of patients in India. Yet, few researchers have tried to understand if the public in India is aware of CTs. AIMS: To explore the awareness, perceptions of and attitude towards participating in CTs among general public in Pune. MATERIALS AND METHODS: Focus group discussions (FGDs) and interviews were conducted by contacting people in the community of various age groups and socio economic status with 7 Trial participants (TPs) and 17 Non Trial Participants (NTPs). The survey tool consisted of open-ended questions that assessed the awareness and attitudes of the individuals regarding the CTs. Interview were recorded on paper and translated from (Marathi) local language to English for analysis. Qualitative analysis was used to report the findings. RESULTS: Most participants could associate CTs with medicine or development of new medicine; however they did not have a good understanding of the manner and safeguards with which CTs are conducted. Participants were not aware about different types of CTs and phases of the CTs. CTs were felt to be of benefit to the community and advancement of science. However, due to fear of adverse effects, 80% of the respondents were not ready to participate in the CTs. CONCLUSIONS: The Indian Pharmaceutical company is the world's 3(rd) largest by volume as per Dr. Shivathanu Pillai's report 17th March 2010, in spite of that it has been noticed that the awareness about CTs is very low; therefore there is a need to create awareness about CTs which helps the participants to participate in CTs based on their own decision. These FGD findings require validation in a larger sample.

Validation of the kidney disease quality of life-short form: a cross-sectional study of a dialysis-targeted health measure in Singapore.

BACKGROUND: In Singapore, the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. We aimed to determine the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. METHODS: From December 2006 through January 2007, this cross-sectional study gathered data on patients ≥21 years old, who were undergoing haemodialysis at National Kidney Foundation in Singapore. We used exploratory factor analysis to determine construct validity of the eight KDQOL-SF™ sub-scales, Cronbach's alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. RESULTS: Of 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers' proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach's α above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), except for Social function (0.66). Correlation of items within subscales was higher than correlation of items outside subscales in 90% of the cases. The overall health rating positively correlated with kidney disease-targeted scales, confirming validity. General health subscales were found to have significant associations with age, income and education, confirming convergent and divergent validity. CONCLUSIONS: The psychometric properties of the KDQOL-SF™ resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF™ as a measure of quality of life of haemodialysis patients in Singapore. It is, however, necessary to determine the test-retest reliability of the KDQOL-SF™ among the haemodialysis population of Singapore.

Validity and reliability of the expectations regarding aging (ERA-12) instrument among middle-aged Singaporeans.

INTRODUCTION: The 12-item Expectations Regarding Aging (ERA-12) instrument measures expectations that individuals have about how their health and cognitive function will be when they age. To date, primarily assessed among older adults in Western settings, expectations regarding ageing have been associated with physical activity and healthcare seeking behaviour. It has been suggested that it may be possible to develop interventions that promote positive expectations about ageing. Assessment of expectations regarding ageing among today's middle-aged population would allow for earlier interventions to help give them positive (but realistic) ageing expectations, and age successfully. We assess the reliability and validity of ERA-12 for middle-aged Singaporeans. MATERIALS AND METHODS: A questionnaire that included ERA-12 was administered to 1020 patients aged 41 to 62 years attending 2 SingHealth polyclinics in Singapore. Data from 981 respondents who completed the ERA-12 instrument were analysed. ERA-12's construct validity was determined using Exploratory Factor Analysis (EFA), and through its correlation with depressive symptoms, and self-rated health and education. Internal consistency reliability was assessed using Cronbach's alpha. RESULTS: EFA confirmed that the ERA-12 consisted of 3 factors (each with 4 items)--expectations regarding physical health, mental health and cognitive function, together explaining 64% of the variance in ERA-12 total score with high factor loadings (range, 0.6 to 0.8). The ERA-12 total score was positively correlated with self-rated health (r = 0.13) and education (r = 0.19), and negatively correlated with depressive symptoms (r = -0.25). Cronbach's alpha exceeded 0.7 for ERA-12 overall, and for each subscale. CONCLUSION: ERA-12 can be used to evaluate expectations regarding ageing not only among elderly populations in the West, but also among middle-aged Singaporeans.

Public perceptions of healthcare in Singapore.

INTRODUCTION: Understanding public perceptions of healthcare delivery is important to guide policy formulation and practice as well as to identify areas where public health communication needs to be strengthened to overcome misconceptions and allay unfounded concerns. We conducted a survey of Singapore residents to determine perceptions of the affordability and quality of healthcare in Singapore. MATERIALS AND METHODS: A sampling frame was drawn from the 2005/2006 edition of the telephone directory. One thousand seven hundred and eighty-three respondents were interviewed via telephone and asked to rank their agreement with statements pertaining to healthcare cost and quality on a 5-point Likert scale. RESULTS: Respondents were representative of the general population in ethnicity and housing type but lower income households were over-represented. 79.6% of respondents agreed that Singapore had a good healthcare system and 57.5% agreed that the government provided good and affordable healthcare to Singaporeans. The majority agreed that healthcare was generally affordable, especially at polyclinics (78%) and restructured hospitals (50%) and that the quality of healthcare in Singapore was high. Comparing primary and tertiary care, there was uniformity in the perception of quality at both levels but respondents assessed tertiary healthcare to be less affordable (P <0.0001). CONCLUSION: Singaporeans are confident in the healthcare system. The quality of Singapore healthcare is generally regarded to be high although there are growing concerns regarding the affordability of healthcare.