Knowledge and perceptions regarding colorectal cancer screening among Chinese--a community-based survey in Singapore.

OBJECTIVE: Despite the increase in colorectal cancer (CRC) incidence among Chinese in Asia, there are no data on predictors of CRC screening uptake in this population. This study investigated how knowledge and perceptions about CRC correlated with screening behavior in Singaporean-Chinese. METHODS: A community-based cross-sectional study was carried out on Singaporean-Chinese at least 50 years old in Queenstown Estate, Singapore between 1/1/2006 and 1/2/2006. A questionnaire administered via face-to-face interviews elicited knowledge, perceptions and screening behavior of subjects. RESULTS: The response rate was 72.4%, with 514 completed responses. Expense was the commonest perceived barrier to screening (56.6% agreed), unlike for other populations. Social influence is important, with 67.5% agreeing to the statement "I would go for CRC screening if my family wanted me to". After excluding confounders, Chinese who had been for fecal occult blood test (FOBT) screening had higher knowledge score (p<0.001), lower perceived severity (p<0.01), were more likely to have been influenced by their family/friends to go for screening (p=0.04) and to have attended screening tests for other diseases (p<0.001). CONCLUSION: FOBT screening uptake is associated with specific areas of knowledge and perception among Singaporean-Chinese. To increase screening uptake within Chinese populations, clinicians should consider these factors in their approach to patients.

Teaching community, occupational and family medicine at the National University of Singapore: past, present and future.

INTRODUCTION: We describe how the curriculum of community, occupational and family medicine (COFM) has evolved in response to social and educational forces and local health needs. Challenges in the teaching of the curriculum are also discussed. CURRICULUM: The COFM Department aims to produce medical undergraduates and graduates with the skills to critically appraise evidence, prevent and manage diseases, and promote health in the community and primary healthcare setting. Its teaching programmes consist of the medical undergraduate programme and the Master of Medicine programmes in Occupational Medicine, Public Health and Family Medicine. The undergraduate modules consist of evidence-based medicine, public health in the community, disease prevention and control, occupational medicine practice, health promotion and behaviour, and communication with patients. The university's first completely online module on SARS was jointly implemented by the Department and the Centre for Instructional Technology for the entire student population last year. The COFM curriculum has shifted from giving students factual information through lectures to developing students' critical thinking and problem-solving skills through small group teaching, case studies and community health projects. Innovative assessment methods such as open-book examinations; objective structured communication stations with simulated patients; and evaluation of students' participation in group work are used to assess students' skills in problem-solving, communication and teamwork respectively. CONCLUSION: While the Department has made significant progress in developing a relevant and updated curriculum based on appropriate learning and assessment approaches, it will strive to do more to develop students' critical thinking skills by using newer approaches.

Normal bowel habits and prevalence of functional bowel disorders in Singaporean adults--findings from a community based study in Bishan. Community Medicine GI Study Group.

BACKGROUND/AIM OF STUDY: Data on the epidemiology of bowel frequency and functional bowel disorders in the East are limited. The aims of this study were to determine the most common bowel frequency and the prevalence of functional bowel disorders in Singaporean adults. METHODS: A cross sectional study, using a reliable and valid questionnaire was carried out in a random sample of residents aged 16 years and above in Bishan, 68% responded (n = 271). RESULTS: The most common (59.0 +/- 6.5%) bowel frequency was once a day with 96.8 +/- 5.6% of individuals having bowel frequency between 3 times/week and 3 times/day. The prevalences of irritable bowel syndrome, chronic constipation and chronic diarrhoea were 3.2 +/- 2.3%, 7.3 +/- 3.5% and 6.9 +/- 3.4%, respectively. Women were found to have a lower bowel frequency (p < 0.001) and a higher prevalence of chronic constipation (11.3 +/- 6.0% vs. 3.6 + 3.5%, p < 0.05) than men. CONCLUSIONS: Normal bowel frequency may be defined as bowel movements between 3 times per week and three times per day. The prevalence of irritable bowel syndrome in the general population of Singapore was low compared with those reported in the West.

Trends in mortality, incidence, hospitalisation, cardiac procedures and outcomes of care for coronary heart disease in Singapore, 1991-1996.

In this study, we used Singapore population-based data from 1991 to 1996 to examine recent trends in mortality, incidence and hospitalisation for acute myocardial infarction (AMI), and explored the roles of primary prevention and medical care interventions in explaining these trends. We examined trends in medical interventions, namely coronary angiography (catheterisation), coronary artery bypass graft (CABG), and percutaneous transluminal coronary angioplasty (PTCA), length of stay, and payment methods, and explored the roles of technological, healthcare financing and delivery, and regulatory factors in influencing the diffusion and outcomes of these medical interventions. During the period 1991 to 1996, there were parallel declines in resident population rates of mortality, incidence and hospitalisation for AMI. The rates of angiograms, CABG and PTCA among residents also increased greatly, with the greatest increase among elderly aged 60 years and above. The rates of invasive cardiac procedures for AMI were all lower in females than in males. The population case-fatality rate of AMI declined slightly only for persons below 40 years of age. The case-fatality rate was higher in females than in males. The number of hospitalisations and cardiac procedures all rose sharply, and was phenomenal for PTCA (247%). The increase in volume of resource use was starkly greater in private hospitals than in restructured hospitals. The ratios of PTCA to CABG from 1991 to 1996 for private and restructured hospitals showed a greater rate of technology substitution in restructured hospitals than in private hospitals. The average length of stay (LOS, 6.7 days) was fairly constant in restructured hospitals. For private hospitals, LOS declined from 7.6 days in 1991 to 5.6 in 1996. LOS varied little among individual restructured hospitals, but widely among private hospitals. The most common method of payment for AMI hospitalisation was Medisave alone (50%), but for CABG surgery, the proportion of payment made through this method was only 12%. Out-of-pocket payments, Medisave, Medishield and private insurance have increased steadily. These data indirectly suggest that primary prevention and medical care interventions might have begun to succeed in reducing the rates of coronary heart disease in Singapore. The sharp increases in cardiac procedures may be explained by changing supply and demand factors for care of AMI and chronic ischaemic heart disease, including consumer preference for cardiac procedures, overuse of medical intervention, and technological change. More studies are needed to test these hypotheses.

An economic analysis of AIDS--towards a proposed model of costing: a Singapore experience.

With the increasing prevalence of HIV infection/AIDS and the extending range of care and treatment, the economic implications of the various prevention and control strategies, and of treatment, have become the subject of interest to policy-makers, public health specialists and health economists. This paper presents an overview of the methods used for the economic analysis of AIDS/HIV infection. It proposes an activity-oriented, cost center-based model for the costing of the economic impact of AIDS, using cost figures in Singapore since 1985, when the National AIDS Control Program was started. Priorities for future research are also identified.

Calculating the GP consultation fee in Singapore: towards a rational costing approach.

PURPOSES: The General Practitioner (GP) consultation fee in Singapore, unlike that of his specialist colleague, has been left very much undefined over the years. There is a need for an objective way of calculating the GP consultation fee. METHOD: A proposed method of calculating the GP consultation fee based on the model of estimating the total cost of producing the service plus the doctor's remuneration is described. Known prevailing costs were used in the computation. This model allows us to work out the cost to the patient by dividing the total cost of producing the service by the number of patients (referred to as patient encounter load) seen by each duration of consultation--4, 6, 10, 15 and 30 minutes. Different monthly remuneration levels for the doctor were used to compute the different consultation fees that would result for each of the duration of consultations. RESULTS: Using this method of calculation, for a doctor with a desired monthly remuneration of $7000, and seeing a patient every 6 minutes over a 150-hour month, the consultation fee is $13.00. This drops to $11.00 if the doctor receives a remuneration of $4000 per month. Using the same parameters, a 15 minute consultation will cost the patient $30.00 and $25.00 respectively. CONCLUSION: This method can be used to derive a consultation fee for services requiring different durations and varying remuneration brackets for the doctor.

Sudden unexplained death syndrome. A review and update.

Sudden unexplained death syndrome (SUDS) among young healthy Thai construction workers in Singapore has been given much publicity recently. From May 1982 to July 1990, 226 SUDS were reported among them. In this article we review and compare studies on SUDS in the United States and South-east Asia. So far, studies to identify the causal factors have been inconclusive and they cannot explain the male preponderance and occurrence of death during sleep. Current hypotheses about the cause of SUDS have included stress, genetic factors, dietary deficiency (particularly thiamine), potassium deficiency, melioidosis and sleep disorders. The following areas are suggested for further research: epidemiological investigations on SUDS at its source; in-depth case studies of families with and without SUDS; role of dietary factors, biochemical studies with respect to thiamine, pyruvate and potassium metabolism in the victims and susceptibles; and histopathological studies of cases and controls.

Ageing: socio-economic implications for health care in Singapore.

In planning for the health of the population, especially of the aged, demographic variables which interact with social and economic factors must all be considered to assess their impact on the health services. Demographic trends such as the dependency ratio, sex ratio, marital status and family formation would also have a bearing on the care of the elderly at home. Trends in labour force participation and the extent of financial security among the elderly can therefore affect policy implications concerning public subsidy of health care and social services. As health needs are expected to rise in relation to the increasing proportion of the elderly as well as the survival of the older population itself, hence the urgency for innovative approaches to the organization and financing of health care. The aged accounts for a major share of the utilization and expenditure for hospitalization and medical services and yet have inadequate coverage. In Singapore, the Medisave Scheme was implemented to impose compulsory savings for medical care and to promote family support for the elderly. Pressures can be expected to emphasize the development of cost-effective programmes for the aged, such as community-based primary care, disease prevention and health promotion.