Natal and neonatal teeth.

Incidence, causes, complications, and treatment of natal and neonatal teeth are presented. It has been suggested that the terms mature and immature be added to the designation of this anomaly as those would imply the development and prognosis of the tooth and give clinical significance to the terms natal and neonatal. A case in a 2-week-old premature infant is described. As natal or neonatal teeth seldom develop properly and subsequent loss of space is not a long-term sequela, extraction is the preferred treatment.

Doctors' and lawyers' perspectives of child abuse and neglect in Singapore.

AIM OF STUDY: To investigate the Singaporean doctor's and lawyer's definition of child abuse and neglect, their attitudes towards reporting and their manner of handling suspected cases. METHODS: A self-addressed questionnaire survey was carried out in a population of hospital doctors, family physicians and lawyers. A total of 368 respondents participated in the survey. RESULTS: Most respondents had similar parenting attitudes. The majority felt that child abuse occurred sporadically but 25% of family physicians felt it seldom occurred. Thirty-eight per cent of family physicians had a personal definition of child abuse compared to less than a third of hospital doctors. There was a high consensus among all 3 groups concerning 21 behaviours studied. In all 3 groups, more than 80% agreed that having sex, burning child, tying child and not protecting the child from sexual advances were both unacceptable and abusive. More than 80% of respondents felt that some form of compulsory reporting is necessary in Singapore. Doctors preferred to refer cases of physical abuse to the hospital while lawyers preferred the police. All agreed that sexual abuse is a matter for the police. Respondents were more likely to act in cases of physical abuse and sexual abuse than for cases of emotional abuse and neglect. CONCLUSIONS: There is a need to formalise definitions of child abuse in our society. More education and training in the understanding and handling of child abuse by doctors and lawyers may be necessary.

Depression of young and elderly patients.

OBJECTIVE: To compare the presentation and outcome of depression between young and elderly patients. DESIGN: The clinical presentation, treatment and outcome of 47 young patients (21 to 64 years) were compared with 58 elderly (65 years and older) patients admitted to a general hospital psychiatric ward for the treatment of depressive disorders (based on ICD-10). SUBJECTS: There was no significant difference between the sexes in each age group. The majority of the elderly were either widowed (36%) or married (53%) while 45% of the young were single and 51% married. Seventy per cent of the elderly had retired while 64% of the young were in full-time employment. Most patients lived with their families (87% young and 96% elderly). All but one elderly suffered at least one physical disorder with two-thirds having two or more physical disorders; this contrasts greatly to young patients who were physically healthier (p < 0.001). RESULTS: In clinical presentation and symptomatology, the young patients had significantly more suicide ideation (p < 0.003) and psychomotor retardation (p < 0.001) but there was no difference in suicidal attempt, delusion, hallucination or agitation. More young patients (36%) had a past psychiatric illness (often depressive disorders) than elderly patients (8%) (p < 0.001), more elderly patients (88%) were treated with antidepressants than the young patients (62%) (p < 0.002). At one year follow-up, more elderly patients (46%) recovered compared with the young patients (23%) (p < 0.05). CONCLUSION: There were some differences in the symptomatology of depression between young and elderly patients, but the prognosis was better for elderly patients.

Primary care doctors' practice in the management of adult asthma patients.

There is apparent disparity between the international guidelines on asthma management and the current practice in reality. This can be attributed to both patient's and doctor's factors. This study examines the practice of asthma management by a group of family physicians using a self-administered questionnaire. This comprises questions relating to the main principles of asthma management set by international guidelines. The results showed that majority of the doctors (>90%) in the study reviewed patient's asthma status based on symptoms, educate their patients on types of asthma medications and advised them on allergen avoidance including smoking. Fewer of them (50 to <90%) check trigger factors or inhaled device technique, nocturnal symptoms or ER visits. Even fewer doctors (<50%) bothered to check the patient's peak expiratory flow rate (PEFR) or used spirometry.

Dental management for children with chronic renal failure undergoing hemodialysis therapy.

Patients with chronic renal failure who are undergoing hemodialysis therapy demonstrate problems of significant importance for dental treatment. A case is presented in which secondard hyperparathyroidism, resulting from renal failure and hemodialysis, was noted in a child. Other relationships between renal failure, hemodialysis, and dental care were also presented.