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1.
PLoS One ; 19(3): e0298823, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38427651

RESUMO

BACKGROUND: Care continuity by a dedicated, well-trained primary care physician (PCP) has shown to improve health outcomes of patients with non-communicable diseases (NCDs). In Singapore's fee-for-service primary care system, patients can choose to consult any PCP in either a public (polyclinic), private (General Practitioners/ GP), or both types of clinics, resulting in potential fragmented care. Decision-making by patients in selecting their preferred PCP remains unclear. This study aims to explore the personal factors influencing the choice of PCP among patients with NCDs in primary care. METHODS: This qualitative research study was conducted in a typical polyclinic. In-depth interviews were conducted on patients with NCDs. Purposive sampling was implemented to enrol patients who had previously consulted PCPs in polyclinics and GP clinics, garnering their perspectives and experiences of care received from both providers. Interviews were audio-recorded, transcribed, and audited. Data was coded and analysed using thematic content analysis to identify emerging themes. The physician-specific factors which influence patients' decision-making of PCP selection are presented here. RESULTS: Twenty-one Asian patients aged 38 to 82 years were interviewed. They preferred PCPs with an approachable and genuine demeanour, exhibiting empathy and compassion. They valued the PCPs' verbal, non-verbal and listening skills. Regarding professional qualities, patients wanted PCPs to demonstrate competency and a patient-centred care approach. Some selected their PCP based on compatible age and gender that they felt comfortable with. Establishing good rapport with their PCP and maintaining continuity of care were deemed as major factors in patients' PCP selection. CONCLUSION: Patients tended to select PCPs based on their personal characteristics, interpersonal skills, professional attributes, demographics, and the physician-patient relationship. PCPs should be aware of these attributes and demonstrate them during their patient interaction. Leveraging on this enables PCPs to build rapport with their patients and maintain care continuity to optimize their health outcomes.


Assuntos
Preferência do Paciente , Médicos , Humanos , Singapura , Pesquisa Qualitativa , Assistência Centrada no Paciente
2.
BMC Public Health ; 24(1): 786, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38481239

RESUMO

BACKGROUND: The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants' baseline characteristics, and preliminary DR progression rates at the first annual follow-up. METHODS: DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated. RESULTS: Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55-67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline. CONCLUSIONS: In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Edema Macular , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Estudos de Coortes , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Estudos Longitudinais , Estudos Prospectivos , Singapura/epidemiologia
3.
J UOEH ; 46(1): 55-65, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38479875

RESUMO

Digital and technological solutions constitute a key enabler to achieving better workplace safety and health outcomes. Fundamentally, the success of their implementation is underscored by a need for employers, employees, industry stakeholders and policymakers to collaborate in adopting a "digital first" mindset. This review provides a background on the evolution of work and the workforce in post-independence Singapore, and introduces pertinent local workplace safety and health trends. It delves into how a "digital first" approach may be adopted and effected, followed by challenges and opportunities in the digitalization of Singapore's workplace safety and health landscape. Illustrative examples are used to highlight applications of digital and technological solutions in the control of occupational hazards. In our discussion, workplace strategies are built around the hierarchy of controls framework, whereas worker-related strategies are divided into workspace optimization for productivity/performance enhancement, training/education, and instituting surveillance/open reporting mechanisms. We demonstrate that with an open and forward-looking mind, and well-executed change management, we will be able to capitalize on technological advances to improve work and working conditions for all workers.


Assuntos
Saúde Ocupacional , Local de Trabalho , Humanos , Singapura , Condições de Trabalho
4.
BMC Med Educ ; 24(1): 292, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38491363

RESUMO

BACKGROUND: Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students. METHODS: Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy- Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach. RESULTS: There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation. CONCLUSION: This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.


Assuntos
Educação em Farmácia , Medicina Narrativa , Estudantes de Medicina , Humanos , Singapura , Estudantes de Medicina/psicologia , Empatia , Pessoal de Saúde
5.
Sci Rep ; 14(1): 6408, 2024 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-38494533

RESUMO

Since the start of the pandemic, many national responses, such as nationwide lockdowns, have been implemented to curb the spread of COVID-19. We aim to assess the impact of Singapore's national responses on primary care utilisation. We performed an interrupted time series using acute and chronic primary care data of 3 168 578 visits between 1 September 2019 and 31 August 2020 over four periods: before any measures were put in place, during Disease Outbreak Response System Condition (DORSCON) Orange, when Circuit Breaker was instituted, and when Circuit Breaker was lifted. We found significant mean reductions in acute and chronic primary care visits immediately following DORSCON Orange and Circuit Breaker. DORSCON Orange was associated with - 2020 mean daily visits (95% CI - 2890 to - 1150). Circuit Breaker was associated with a further - 2510 mean daily visits (95% CI - 3660 to - 1360). Primary care utilisation for acute visits remained below baseline levels even after the Circuit Breaker was lifted. These significant reductions were observed in both acute and chronic visits, with acute visits experiencing a steeper drop during DORSCON Orange. Understanding the impact of COVID-19 measures on primary care utilisation will be useful for future public health planning.


Assuntos
COVID-19 , Humanos , Análise de Séries Temporais Interrompida , Singapura/epidemiologia , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Atenção Primária à Saúde
6.
Waste Manag ; 178: 339-350, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38430748

RESUMO

Leaching of potentially hazardous substances, especially the heavy metals from Incineration Bottom Ash (IBA) is a major problem in its recyclable usage. To address this concern, treatment of IBA is indispensable before it can be reused. IBA subjected to laboratory-scale treatment typically yields clearer conclusions in terms of leaching behaviors, benefiting from the controlled laboratory environment. However, the leaching behaviors of commercially treated IBA appear to be more ambiguous due to the complex and comprehensive nature of industrial-scale treatments, where multiple treatment techniques are involved concurrently. Furthermore, treatment efficiencies vary among different plants. In this study, three types of commercially treated IBA were sampled from leading waste treatment companies in Singapore. Characterization and leaching tests were performed on the treated IBAs in both standardized and modified manners to simulate various scenarios. Besides deionized water, artificial seawater was used as a leachant in leaching tests for simulating seawater intrusion. The results reveal the promoting effect of seawater on the leaching levels of several elements from three types of treated IBA, which may require special attention for IBA application and landfill near the coast. Furthermore, the elements examined in these three types of commercially treated IBA generally comply with the non-hazardous waste acceptance criteria outlined in Council Decision, 2003/33/EC (2003), except Sb. By combining two leaching tests, the elements were categorized into different types of leaching behavior, making it possible to prepare and respond to the concerning leaching scenarios in future engineering applications.


Assuntos
Cinza de Carvão , Metais Pesados , Singapura , Incineração , Metais Pesados/análise , Conservação dos Recursos Naturais , Resíduos Sólidos/análise
7.
Int J Qual Health Care ; 36(1)2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38506629

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower, and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for three emergency bellwether procedures. A retrospective cohort study of patients who underwent any of the three emergency procedures [Caesarean section (CS), emergency laparotomy (EL), and open fracture (OF) fixation] between 1 January 2018 and 31 December 2021 was conducted using clinical and surgical data from electronic medical records. The volumes and outcomes of each surgery were compared across four time periods: pre-COVID (January 2018-January 2020), elective postponement (February-May 2020), recovery (June-November 2020), and postrecovery (December 2020-December 2021) using Kruskal-Wallis test and segmented negative binomial regression. There was a total of 3886, 1396, and 299 EL, CS, and OF, respectively. There was no change in weekly volumes of CS and OF fixations across the four time periods. However, the volume of EL increased by 47% [95% confidence interval: 26-71%, P = 9.13 × 10-7) and 52% (95% confidence interval: 25-85%, P = 3.80 × 10-5) in the recovery and postrecovery period, respectively. Outcomes did not worsen throughout the four time periods for all three procedures and some actually improved for EL from elective postponement onwards. Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume for EL after the postponement without any worsening of outcomes.


Assuntos
COVID-19 , Humanos , Feminino , Gravidez , COVID-19/epidemiologia , Estudos Retrospectivos , Pandemias , Cesárea , Singapura/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos
8.
BMC Health Serv Res ; 24(1): 357, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509565

RESUMO

BACKGROUND: Medication discrepancies commonly occur when patients are transferred between care settings. Despite the presence of medication reconciliation services (MRS), medication discrepancies are still prevalent, which has clinical costs and implications. This study aimed to explore the perspectives of various stakeholders on how the MRS can be optimized in Singapore. METHODS: This is a descriptive qualitative study. Semi-structured interviews with 30 participants from the National Healthcare Group, including family physicians (N = 10), pharmacists (N = 10), patients recently discharged from restructured hospitals (N = 7) and their caregivers (N = 3) were conducted. All transcribed interviews were coded independently by three coders and inductive thematic analysis approach was used. RESULTS: Five core themes were identified. (1) The MRS enhanced healthcare services in various aspects including efficiency and health literacy; (2) There were several challenges in delivering the MRS covering processes, technology and training; (3) Issues with suitable patient selection and follow-up; (4) Barriers to scaling up of MRS that involve various stakeholders, cross-sector integration and environmental restrictions; and finally (5) Role definition of the pharmacist to all the stakeholders. CONCLUSION: This study identified the role of MRS in enhancing healthcare services and explored the challenges encountered in the provision of MRS from family physicians, pharmacists, patients and their caregivers. These findings supported the need for a shift of MRS towards a more comprehensive medication review model. Future improvement work to the MRS can be conducted based on the findings.


Assuntos
Reconciliação de Medicamentos , Serviço de Farmácia Hospitalar , Humanos , Alta do Paciente , Farmacêuticos , Centros de Atenção Terciária , Singapura
9.
Med Mycol ; 62(2)2024 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-38366631

RESUMO

Complete genome sequences from two Trichophyton indotineae isolates were obtained from a 23-year-old male presenting with tinea cruris after an overseas recreational water exposure and from a 53-year-old female patient with unknown travel history. Analysis of the squalene epoxidase gene and the cyp51 gene family showed an absence of mutations, correlating with phenotypic drug susceptibility. The Single Nucleotide Polymorphisms (SNPs) distance between both isolates was 92. Within the T. indotineae cluster, SNPs ranged from 7 to 182, suggesting a high genetic relatedness with other South Asian isolates. This study suggests that the prevalence of T. indotineae is under-reported and more widespread than previously thought.


Trichophyton indotineae, is a fungus causing difficult to treat ringworm infections. Two isolates were sequenced and their relationship and to other isolates was characterized. We also studied the genes responsible for first-line antifungal treatment.


Assuntos
Arthrodermataceae , Tinha , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Adulto , Antifúngicos/farmacologia , Terbinafina , Singapura , Tinha/epidemiologia , Tinha/veterinária , Farmacorresistência Fúngica , Testes de Sensibilidade Microbiana/veterinária , Trichophyton
10.
PLoS One ; 19(2): e0298968, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38408072

RESUMO

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.


Assuntos
Exercício Físico , Sono , Lactente , Humanos , Pré-Escolar , Criança , Singapura , Escolaridade , Fidelidade a Diretrizes
11.
Vet Parasitol Reg Stud Reports ; 48: 100991, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38316506

RESUMO

A German Shepherd dog was presented to a referral practice for screwworm myiasis affecting the ear. The successful management involved killing the larvae with afoxolaner plus milbemycin oxime and using video otoscopy to completely remove dead larvae. To the best of our knowledge, this is the first case report of auricular myiasis by Chrysomya bezziana in a dog in Singapore and the first report of video otoscopic management of myiasis.


Assuntos
Dípteros , Doenças do Cão , Miíase , Infecção por Mosca da Bicheira , Animais , Cães , Infecção por Mosca da Bicheira/diagnóstico , Infecção por Mosca da Bicheira/terapia , Infecção por Mosca da Bicheira/veterinária , Singapura , Miíase/diagnóstico , Miíase/veterinária , Larva , Doenças do Cão/diagnóstico
12.
BMC Public Health ; 24(1): 454, 2024 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-38350881

RESUMO

BACKGROUND: Depression is a common issue among university students and has been particularly exacerbated during the COVID-19 pandemic. However, limited research has specifically focused on depression among university entrants. OBJECTIVES: This study aimed to determine the prevalence of depression severity and identify associated factors during different phases of the COVID-19 pandemic using health screening questionnaires completed by matriculated university students in Singapore. METHODS: A repeated cross-sectional study was conducted at a public university in Singapore. Data from health screening questionnaires administered in 2020 and 2021, involving 15,630 newly enrolled university students, were analyzed. The questionnaires covered students' sociodemographic information, physical health status, own and family medical history, lifestyle behaviours, and the Patient Health Questionnaire (PHQ-9). The PHQ-9 was used to measure the severity of depressive symptoms, categorizing into moderate to severe depressive symptoms (MSDS), mild depressive symptoms (MDS), or no depressive symptom (NDS). Multinomial logistic regression was used to assess the sociodemographic, physical and behavioural correlates of depression. RESULTS: The prevalence of MSDS was 1% in both 2020 and 2021, while the rates for MDS were 1.93% in 2020 and 1.64% in 2021. In the 2020 cohort, male freshmen who reported better health had a lower likelihood of experiencing depression. Conversely, students of Malay ethnicity, those majoring in Engineering, those with multiple chronic diseases, monthly alcohol consumers, current smokers, and those with a family history of mental disorder had a higher likelihood of experiencing depression. Moreover, students who lived on-campus in the 2021 cohort were less likely to experience depression than those living off-campus. However, the associations between academic majors, alcohol consumption, and smoking with depression were not significant in the 2021 cohort. CONCLUSIONS: This study reported a low prevalence of both MSDS and MDS among university entrants in Singapore. The study further identified three categories of factors associated with depression: sociodemographic, physical, and behavioural. This study suggests policy interventions to enhance targeted social support that address each student group's specific requirements and susceptibilities. A more extensive and comprehensive study is warranted to assess the changes in student mental health status post-COVID-19 pandemic.


Assuntos
COVID-19 , Humanos , Masculino , COVID-19/epidemiologia , Depressão/epidemiologia , Estudos Transversais , Prevalência , Universidades , Pandemias , Singapura/epidemiologia , Estudantes/psicologia
13.
Soc Sci Res ; 118: 102979, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38336422

RESUMO

How do people deal with events they cannot control? Religious beliefs and practices are common responses to uncontrollable situations. We analyzed the responses of Singaporeans surveyed between November 2019 and March 2020-just before and just after Covid-19 hit the region-to understand how the beliefs and actions of both religious and non-religious people were affected by the emergence of the previously unknown virus. We find that after the emergence of Covid-19, religious respondents reported significantly higher levels of belief and service attendance frequency, while prayer frequency was not affected. We argue that the decrease in perceived controllability over people's lives explains these results. We discuss the implications of our findings for understanding the dynamics of religious beliefs and practices during times of uncertainty.


Assuntos
COVID-19 , População do Sudeste Asiático , Humanos , Singapura , COVID-19/epidemiologia , Religião , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-38397673

RESUMO

Amidst population ageing trends and epidemiological transitions, there has been a growing emergence of young family caregivers, about whom most studies have been conducted in Western countries. Their subjective experiences and perceptions toward caregiving remain underexplored in Asia. This qualitative study explored the lived experiences of caregiving for older family members by young caregivers in Singapore. Interpretative phenomenological analysis was employed to collect and analyse data from semi-structured, in-depth interviews with six young adult caregivers aged between 23 and 29. Interviews were supplemented with photo-elicitation techniques to deepen interview discussions and uncover experiential significance. Findings illustrated transitions into caregiving, challenges across role conflicts and expectations amidst developmental tasks and transitions, and navigation of intergenerational conflicts and ambivalence. Although no definitive conclusions can be reached from this small-scale study, the findings offer important insights into the convergence and intensity of young caregivers' experiences. Given that caregiving challenges are likely to continue amidst Singapore's rapidly ageing population, these necessitate further in-depth research efforts. Implications for policy and practice across multiple stakeholders interfacing with youth and older adults are presented. A whole-of-society approach is called for to enable young caregivers to realise their full potential while contributing to their ageing families and nation.


Assuntos
Cuidadores , Família , Adulto Jovem , Humanos , Idoso , Adolescente , Adulto , Singapura , Envelhecimento , Cuidados Paliativos , Pesquisa Qualitativa
15.
J Environ Manage ; 354: 120398, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38387356

RESUMO

This study investigates the relationship between economic growth, renewable energy consumption, financial openness, and environmental degradation in selected ASEAN (Association of Southeast Asian Nations) countries (Cambodia, Indonesia, Malaysia, Philippines, Singapore, Thailand, and Vietnam) from 1996 to 2018. We aim to analyze how macroeconomic situation, energy-related factors, and financial determinants contribute to environmental deprivation in selected countries whose growth has recently been substantial. To address this issue, we employ second-generation panel data regression models and quantiles with fixed-effects estimators. Initially, the cointegration analysis supports a long-run association between the variables of our interest. Empirical findings confirm the environmental Kuznets curve hypothesis, but it seems valid only for Singapore. Moreover, results highlight the ecological role of renewable energy for ASEAN countries to achieve Sustainable Development Goals, such as transitioning to a low-carbon economy and reducing air pollution. On the contrary, financial openness is a cause that positively influences CO2 emissions. This research offers practical policy recommendations for many countries, including the ASEAN economies, to attain sustainable development.


Assuntos
Desenvolvimento Econômico , Energia Renovável , Filipinas , Indonésia , Singapura , Dióxido de Carbono/análise
16.
J Clin Neurosci ; 121: 119-128, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38394955

RESUMO

BACKGROUND: Total/near-total resection (TR/NTR) of complex lumbosacral lipomas (CSL) is reported to be associated with better long-term functional outcomes and lower symptomatic re-tethering rates. We report our institutional experience for CSL resection in affected children. METHODS: This is a single-institution, retrospective study. Inclusion criteria consist of patients with CSL with dorsal, transitional and chaotic lipomas based on Pang et al's classification. The study population is divided into 2 groups: asymptomatic patients with a normal preoperative workup referred to as 'prophylactic intent' and 'therapeutic intent' for those with pre-existing neuro-urological symptoms. Primary aims are to review factors that affect post-operative clean intermittent catheterization (CIC), functional outcomes based on Necker functional score (NFS), and re-tethering rates. RESULTS: 122 patients were included from 2000 to 2021. There were 32 dorsal lipomas (26.2 %), 74 transitional lipomas (60.7 %), and 16 chaotic lipomas (13.1 %). 82 % patients achieved TR/NTR. Favourable NFS at 1-year was 48.2 %. The re-tethering rate was 6.6 %. After multivariable analysis, post-operative CIC was associated with median age at surgery (p = 0.026), lipoma type (p = 0.029), conus height (p = 0.048) and prophylactic intent (p < 0.001). Next, extent of lipoma resection (p = 0.012) and the post-operative CSF leak (p = 0.004) were associated with re-tethering. Favourable NFS was associated with lipoma type (p = 0.047) and prophylactic intent surgery (p < 0.001). CONCLUSIONS: Our experience shows that TR/NTR for CSL is a feasible option to prevent functional deterioration and re-tethering. Efforts are needed to work on factors associated with post-operative CIC.


Assuntos
Lipoma , Neoplasias da Medula Espinal , Criança , Humanos , Lactente , Estudos Longitudinais , Estudos Retrospectivos , Resultado do Tratamento , Singapura/epidemiologia , Neoplasias da Medula Espinal/diagnóstico por imagem , Neoplasias da Medula Espinal/cirurgia , Medula Espinal , Lipoma/cirurgia , Hospitais , Região Lombossacral/cirurgia
17.
Skin Res Technol ; 30(2): e13620, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38376131

RESUMO

BACKGROUND: We evaluate skin sagging phenotypes (eyebags, droopy eyelids, low eyebrow positioning) using written descriptive scales and photo-numeric scales. We also study how anti-ageing interventions and digital screen time influence skin sagging. AIM: We compare the two phenotype assessment methods with each other. METHOD: Skin sagging and personal lifestyle data obtained from 2885 ethnic Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort were collated and compared. RESULTS: Significant correlations (p-value < 0.001) between written descriptive scales and photo-numeric scales were observed for eyebags (0.25) and eyebrow positioning (0.08). Significant correlations (p-value < 0.001) were observed after combining both scales for eyebags (0.38), droopy eyelids (0.30), and eyebrow positioning (0.30). Anti-ageing interventions are associated with delayed progression of eyebags from 18-45 years old, droopy eyelids from 31-45 years old, and eyebrow positioning from 35-40 years old. Significantly lower (p-value < 0.02) eyebrow positioning is associated with both <1 and 1-3 h of screen time stratified by age. CONCLUSION: Written descriptive scales provide comparable results to photo-numeric scales. However, validating and adapting photo-numeric scales for different populations identifies phenotypes better. Anti-ageing interventions are beneficial at different age ranges. Screen time is associated with skin sagging in young (18-30 years old) participants.


Assuntos
Sobrancelhas , Pálpebras , Adulto Jovem , Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Malásia , Estudos Transversais , Singapura/epidemiologia
18.
Nurse Educ Today ; 136: 106143, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38422796

RESUMO

BACKGROUND: Newly graduated nurses undergo stress and role adjustment as they transition into practice during the first year and continue to struggle beyond the first year. Determining their practice readiness can aid in the development of interventions to facilitate workplace readiness for nurses in their first two years entering the nursing profession. OBJECTIVES: To examine (i) extent of practice readiness of new nurses in their role; and (ii) associations between nurses' practice readiness and demographic and occupational variables, and reasons for choosing nursing profession. DESIGN: A cross-sectional study. SETTINGS AND PARTICIPANTS: A total of 445 registered nurses who graduated within the last two years and working in an academic medical centre in Singapore. METHODS: Participants completed an online questionnaire with questions from Casey-Fink Readiness for Practice Survey and questions related to key competencies for future practice. RESULTS: More than half (57.5 %) identified at least three skills and procedures which they were uncomfortable performing independently as they transition into the clinical practice, including: (i) responding to emergency (ii) tracheostomy care; and (iii) chest tube care. The top three reasons for choosing nursing as a career were: (i) nursing is a stable industry (54.2 %); (ii) I want to help people (52.1 %); and (iii) able to work anywhere in the world (44.3 %). Nurses were most concerned with areas of trials and tribulations (42.5 %) and clinical competency (36.6 %). When compared to nurses in their first-year post-graduation, those working in their second year reported more confidence in the ability to problem solve (p = 0.003), care for a person who is dying (p = 0.004), and less difficulties in prioritizing care needs (p = 0.04). They also perceived themselves as a good problem solver (p = 0.03). CONCLUSIONS: It is critical to continue supporting nurses' practice readiness beyond their first year of practice in their confidence and development of skills of higher complexity.


Assuntos
Competência Clínica , Enfermeiras e Enfermeiros , Humanos , Estudos Transversais , Local de Trabalho , Inquéritos e Questionários , Singapura
19.
Singapore Med J ; 65(2): 61-67, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38343123

RESUMO

INTRODUCTION: Modern magnetic resonance imaging (MRI) scanners utilise superconducting magnets that are permanently active. Patients and healthcare professionals have been known to unintentionally introduce ferromagnetic objects into the scanning room. In this study, we evaluated the projectile risk of Singapore coinage as well as some common healthcare equipment within a 3 T MRI scanner. METHODS: A rig termed 'Object eNtry Guidance and Linear Acceleration Instrument' (ONG LAI) was custom-built to facilitate safe trajectory of the putative ferromagnetic objects. A ballistic gel target was utilised as a human tissue surrogate to estimate tissue penetration. The point at which objects would self-propel towards the scanner was named 'Huge Unintended Acceleration Towards Actual Harm (HUAT AH)'. RESULTS: Singapore third-series coins (10-cent to 1-dollar coins) are highly ferromagnetic and would accelerate towards the MRI scanner from more than one metre away. Cannulas with their needles are ferromagnetic and would self-propel towards the scanner from a distance of 20 cm. Standard surgical masks are ferromagnetic and may lose their sealing efficacy when they are worn too close to the magnet. Among the tested objects, a can of pineapple drink (Lee Pineapple Juice) had the highest HUAT AH at a distance of more than 1.5 m. CONCLUSION: Some local coinage and commonly found objects within a healthcare setting demonstrate ferromagnetic activity with projectile potential from a distance of more than 1 m. Patients and healthcare professionals should be cognisant of the risk associated with introducing these objects into the MRI scanning room.


Assuntos
Equipamentos e Provisões Hospitalares , Imageamento por Ressonância Magnética , Humanos , Singapura , Imageamento por Ressonância Magnética/métodos , Desenho de Equipamento
20.
Singapore Med J ; 65(2): 129, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38343126
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