Abnormal thalamic volume in treatment-naïve boys with Tourette syndrome.

OBJECTIVE: Thalamic abnormality has been implicated in the pathophysiology of Tourette's syndrome (TS). We examined the presence of aberrant thalamic volume from the treatment-naïve boys with TS using magnetic resonance imaging (MRI). METHOD: Volumetric MRI was performed on 18 treatment-naïve boys with TS, aged 7-14 years, and 16 healthy comparison subjects. The anatomical boundaries were then manually parcellated to measure the thalamic volume. RESULTS: Tourette's syndrome subjects had a significantly larger left thalamus in comparison with those of healthy subjects. On the contrary, no group difference was observed from the right thalamic volume. TS subjects also showed a significant reduction in rightward asymmetry in thalamic volume compared with the healthy subjects. CONCLUSION: Our findings provide new evidence of abnormal thalamic volume in pediatric TS.

Transforming Singapore health care: public-private partnership.

Prudent health care policies that encourage public-private participation in health care financing and provisioning have conferred on Singapore the advantage of flexible response as it faces the potentially conflicting challenges of becoming a regional medical hub attracting foreign patients and ensuring domestic access to affordable health care. Both the external and internal health care markets are two sides of the same coin, the competition to be decided on price and quality. For effective regulation, a tripartite model, involving not just the government and providers but empowered consumers, is needed. Government should distance itself from the provider role while providers should compete - and cooperate - to create higher-value health care systems than what others can offer. Health care policies should be better informed by health policy research.

Complementary and alternative medicine use in multiracial Singapore.

OBJECTIVE: To determine the prevalence of complementary and alternative medicine (CAM) use in Singapore, the factors influencing CAM use, and the attitudes, beliefs and perceptions of the general population towards CAM. DESIGN: An interviewer-administered questionnaire survey in a housing estate with demographic and socioeconomic characteristics closely matching that of Singapore. RESULTS: 76% (95% C.I. 73.9-77.9%) used CAM over a 12-month period. Females were 2.1 times (95% C.I. 1.3-3.4) more likely than males to use CAM. Chinese (84%) were the most frequent users, followed by Malays (69%) and Indians (69%), with adjusted odds ratios of 0.4 (95% C.I. 0.2-0.7) for Malays and 0.4 (95% C.I. 0.2-0.8) for Indians. Traditional Chinese Medicine (88%) was the most widely used form of CAM, followed by Traditional Malay (Jamu) Medicine (8%) and Traditional Indian (Ayuverdic) Medicine (3%). Similar to western studies, CAM was more likely to be used for maintenance of health than for treatment of illness. Different from western studies, CAM use was not independently associated with household income, marital status, age and education. Seventy-four percent did not discuss their use of CAM with their western-trained doctors. CONCLUSIONS: The high prevalence of CAM use in multi-racial Singapore suggests the same may be true in other Asian countries. Western-trained doctors need to understand CAM better and communicate more with their patients regarding CAM use. The lack of a scientific evidence base for most forms of CAM notwithstanding, its ubiquitous use worldwide is something that governments and the medical profession cannot afford to ignore.