Health information needs of 1000 midlife Singaporean women.

OBJECTIVES: Due to demographic changes, aging is a health priority. We aimed to identify midlife women's perceived health information needs and the preferred method(s) of information delivery. METHODS: A questionnaire was offered to women, aged 45-69 years, attending gynecological clinics during April/May 2016, collecting age and ethnicity data. Participants were asked to indicate important midlife health topics out of 26 topics, including 'other'. For each topic, six delivery options were offered. Age was stratified by 5-year intervals. Associations with age and ethnicity were examined using Pearson's chi-square tests (p < 0.05); analyses were performed with SPSS version 22.0. RESULTS: The top health topics chosen were gynecological cancer (66.0%), joint/muscle aches and pain (64.4%), bone health (63.2%), breast screening (55.9%), and heart health (55.3%). Adjusted results from the logistic regression model found that the odds of choosing the topics gynecological cancer, cervical screening, and complementary and alternative medicine for menopausal symptoms were significantly lower in age groups 55-59, 60-64 and 65-69 years compared to age group 45-49 years. Both Malay and Indian women were less likely to report bone health as important (odds ratio = 0.59, 95% confidence interval = 0.41-0.86) and (odds ratio = 0.64, 95% confidence interval = 0.42-0.98), respectively. Written leaflets were chosen by the majority (84.7%). CONCLUSION: This study of over 1000 midlife Asian women found that holistic health information is desired and requires tailoring by age, not ethnicity. Written information was preferred over support groups. These findings will guide clinical health services in delivering patient-centered information resources for midlife women.

A Case of Recurrent Respiratory Papillomatosis Successfully Removed Via Endoscopic Argon Plasma Coagulation (APC) With No Evidence of Recurrence.

Recurrent respiratory papillomatosis (RRP) is a benign disease caused by the human papilloma virus (HPV), characterized by the formation of recurrent, epithelial neoplastic lesions in the airways. While benign, they can cause significant airway obstruction in some cases. Difficulties in treatment arise from the recurrent nature of the lesions despite repeated procedures. Other known procedures that result in deep tissue damage also cause unacceptable collateral damage to the underlying airway mucosa. We describe a case of recurrent papillomatosis that was successfully treated with argon plasma coagulation ( APC) when laser and electrocautery ablation had failed in the past. After the papillomatasis was treated with APC, there is no recurrence on repeat scope at 4 months and 9 months after the initial procedure. The procedure was done as a day case and there is no complication from the procedure. The property of the APC that allows it to cause only superficial thermal damage to the tissue makes it a suitable adjunct therapy to the treatment of papillomas, which are usually superficial lesions.

Diabetes care provision: barriers, enablers and service needs of young adults with Type 1 diabetes from a region of social disadvantage.

AIMS: To determine the barriers to and enablers of engaging with specialist diabetes care and the service requirements of young adults with Type 1 diabetes mellitus from a low socio-economic, multicultural region. METHODS: A cross-sectional survey targeted 357 young adults with Type 1 diabetes, aged 18-30 years. Participants completed questions about barriers/enablers to accessing diabetes care and service preferences, self-reported HbA(1c), plus measures of diabetes-related distress (Problem Areas in Diabetes), depression/anxiety (Hospital Anxiety and Depression Scale), and illness perceptions (Brief Illness Perceptions Questionnaire). RESULTS: Eighty-six (24%) responses were received [55 (64%) female; mean ± sd age 24 ± 4 years; diabetes duration 12 ± 7 years; HbA(1c) 68 ± 16 mmol/mol (8.4 ± 1.5%)]. Logistical barriers to attending diabetes care were reported; for example, time constraints (30%), transportation (26%) and cost (21%). However, 'a previous unsatisfactory diabetes health experience' was cited as a barrier by 27%. Enablers were largely matched to overcoming these barriers. Over 90% preferred a multidisciplinary team environment, close to home, with after-hours appointment times. Forty per cent reported severe diabetes-related distress, 19% reported moderate-to-severe depressive symptoms and 50% reported moderate-to-severe anxiety. CONCLUSIONS: Among these young adults with Type 1 diabetes, glycaemic control was suboptimal and emotional distress common. They had identifiable logistical barriers to accessing and maintaining contact with diabetes care services, which can be addressed with flexible service provision. A substantial minority were discouraged by previous unsatisfactory experiences, suggesting health providers need to improve their interactions with young adults. This research will inform the design of life-stage-appropriate diabetes services targeting optimal engagement, access, attendance and ultimately improved healthcare outcomes in this vulnerable population.

Methacholine challenge test as an adjunctive investigative tool in patients with asthma-like symptoms: the Sabah experience.

INTRODUCTION: Patients with asthma-like symptoms pose a diagnostic dilemma when physical examination is normal. The usual practice in Malaysia would be to give empirical asthma treatment. Bronchial challenge test (BCT) is widely used in many countries to diagnose asthma objectively but it is not widely available in Malaysia. OBJECTIVE: To describe our experience with BCT using methacholine at Queen Elizabeth Hospital as a supporting tool in the investigation of patients with asthma-like symptoms. METHODOLOGY: Review of case notes of patients who underwent BCT from July 2008 till April 2009. BCT was performed via dosimeter technique. Results were classified as high hyper responsiveness if the provocative dose of methacholine required to achieve 20% fall in FEV1 (PD20) was less than or equal to 0.125 micromol, moderate hyper responsiveness if PD20 was between 0.125 to 1.99 micromol or mild hyper responsiveness if PD20 was between 2.00 to 6.6 micromol. PD20 of more than 6.6 micromol constitutes a negative MCT. RESULTS: 29 patients had BCT during the study period. 19 cases were included in this review. The age ranged from 13 to 70 years old. There were 12 males and 7 females. Duration of symptoms ranged from 2 weeks to 23 years. BCT was positive (mild or moderate hyper responsiveness) in 10 out of 19 patients. No patient had high bronchial hyper responsiveness. CONCLUSIONS: BCT is a useful adjunctive tool in the investigation of patients presenting with asthma-like symptoms. This test obviates empirical asthma treatment. BCT should be made available in all major hospitals in Malaysia.

The repeatability of vegetation classification and mapping.

The mapping of habitats as defined by plant communities is a common component of the planning and monitoring of conservation management. However, there are major concerns about the subjectivity and risk of observer bias in most commonly used plant community mapping protocols. This study provides the first test of the consistency of habitat maps based on the mapping units defined by the National Vegetation Classification (NVC), the most widely used classification of plant communities used for habitat mapping on conservation sites in the UK. Seven surveyors mapped the same upland site within five weeks in summer 2008 and the spatial correspondence of the resulting maps was assessed. The NVC is a hierarchical classification and pair-wise spatial agreement between maps decreased with lower levels of sub-classification. The average area of agreement between maps was 77.6% at the habitat level, 34.2% at the community level and 18.5% at the sub-community level. Spatial disparity in the location of mapped boundaries between vegetation types only made a small contribution to overall differences; the majority of variation between maps was due to discrepancies in classification, with vegetation types containing similar species composition most often confused. Factors relating to surveyor effort (cost, time taken and length of route) were not able to explain the substantial differences between maps. However, the methods used to assign areas to vegetation type did seem to have an effect, with surveyors who relied primarily on their own experience having the highest levels of mean agreement with other maps. The study raises serious concerns with current practice of using the NVC for site description and monitoring/surveillance. Since this is just a single case study, we recommend that further work is carried out with the aim of determining the degree and source of variation between surveyors and how consistency can be increased.

Antimicrobial regimens used in the treatment of mandibular fractures in UK maxillofacial units: changes over 12 years.

In the case of most mandibular fractures, the prescription of antimicrobials for more than 24 hours postoperatively confers no clinical benefit. To establish the prescribing patterns for mandibular fractures in UK OMFS units, and to compare them with those used 12 years ago, we did a telephone and email survey of OMFS units in the UK. Antimicrobials were prescribed for more than 24 hours postoperatively by 76 units (65%) (considerably fewer than the 82 (87%) in 2005). The most commonly prescribed first-line antimicrobial was co-amoxiclav (75%). Although there has been some improvement since 2005, most units still prescribe antimicrobials for periods longer than 24 hours. National collaboration may improve their appropriate prescription.

Low prevalence of Staphylococcus aureus colonization among dental students in a teaching hospital in Malaysia.

Staphylococcus aureus is an important microorganism which is associated with infections in the hospital setting. It is spread mainly through contaminated hands of the healthcare worker or through the underlying colonization of this microorganism in the nasal cavity of the healthcare worker. Apart from the healthcare worker, medical and dental students also can be source of the transmission because they are also engaged with the patients during their training period. The objective of this study was to determine the prevalence and risk of S. aureus colonization among dental students. Cross sectional study was conducted in the month of May 2014 involving a total of 205 dental students (104 pre-clinical years and 101 clinical years) from School of Dental Sciences, Universiti Sains Malaysia. The questionnaires were distributed and nasal swabs were collected. A total of 205 dental students participated in this study which comprises 50.7% pre-clinical year and 49.3% clinical year students. Their age ranged from 20 to 26 years old, with a mean (standard deviation) of 22.29 (1.73) years. The male to female ratio was 1:2.5. Eighteen percent of dental students had S. aureus colonized in their nasal cavity. No colonization of Methicillin resistant S. aureus strain was found in their nasal cavity. A carriage of S. aureus was significantly associated with the presence of health care worker among their family member. Healthcare worker may acquire S. aureus from the hospital, colonized in their nasal cavity and spread it to other family members via inhalation and close contact, however further study on this area is recommended to find out their relationship. S. aureus carrier among dental students worth screening to look whether the carry resistant strain i.e. MRSA to prevent spread to other patients. This is because they also involved in the clinical management during their clinical year study.

[Familiar case of granular dystrophy and oculocutaneous albinism]. / Asociación de albinismo oculocutáneo y distrofia granular en una familia.

CLINICAL CASE: A 35-year-old female patient with blurred vision since childhood, for which no treatment had been given, presented with poor visual acuity. She had white skin and fair yellow hair. There were several well circumscribed deposits in the central and anterior corneal stroma, and iris transillumination and foveal hypoplasia were evident. The clinical diagnosis was oculo-cutaneous albinism and granular corneal dystrophy. We found oculo-cutaneous albinism in two brothers and granular dystrophy in three brothers, the mother and a son. DISCUSSION: Corneal dystrophy is an autosomal dominant disorder inherited independently of oculocutaneous albinism, which is inherited as an autosomal recessive condition. This is the first case report of granular dystrophy concurrent with oculocutaneous albinism.

Vinyl chloride mutagenicity via the metabolites chlorooxirane and chloroacetaldehyde monomer hydrate.

Mutagenicity tester strains of Bacillus and Salmonella were used to assay vinyl chloride in nutrient broth at a practical concentration level. Also screened without exogenous activation were seven potential metabolites of vinyl chloride in their pure forms as well as the related epichlorohydrin. Chlorooxirane, chloroacetaldehyde, chloroacetaldehyde monomer hydrate, chloroacetaldehyde dimer hydrate, chloroacetaldehyde trimer, and epichlorohydrin produced significant mutagenic acitivity in Salmonella typhimurium strains sensitive to base-pair mutation. A recombination repair deficient strain of Bacillus subtilis was inhibited in growth by these compounds, whereas excision repair deficient and wild type strains of Bacillus subtilis were relatively unaffected. On the basis of these assays a working hypothesis for the vinyl chloride carcinogenesis mechanism is proposed which involves chlorooxirane and chloroacetaldehyde monomer hydrate as the ultimate carcinogenic metabolites of vinyl chloride.

Serum lipid profiles in patients receiving endocrine treatment for breast cancer--the results from the Celecoxib Anti-Aromatase Neoadjuvant (CAAN) Trial.

BACKGROUND: Anti-aromatase therapy is important in the treatment of breast cancer. Cyclooxygenase-2 (COX-2) inhibitors may be effective in chemoprevention. A proof of principle study was performed to investigate the efficacy and side effects including changes in lipid profiles of combining anti-aromatase therapy and COX-2 inhibitor preoperatively in hormone sensitive postmenopausal breast cancers. METHODS: From February 2002 to April 2003, 41 postmenopausal women with histologically proven LABC were recruited. The patients were randomly assigned to receive exemestane 25 mg daily and celecoxib 400 mg twice-daily (group A), exemestane 25 mg daily (group B) and letrozole 2.5 mg daily (group C. RESULTS: Observed clinical response rates were 61.5%, 60% and 54.5% for Groups A-C, respectively, with no pathologic complete response. Cholesterol levels for Group A dropped progressively and a statistical difference was observed between fifth week after operation and preoperative level (P = 0.026). In addition, Group A has significantly lowered cholesterol and LDL levels than Groups B and C after 18 weeks of treatment. CONCLUSION: The initial results show that different neoadjuvant anti-aromatase therapies has similar efficacy but the combination with celecoxib may have an advantageous effects on the serum lipid profiles.

Gender differences of inducible nitric oxide production in SJL/J mice with experimental autoimmune encephalomyelitis.

We identified gender related differences of inducible nitric oxide synthase (iNOS) expression and NO production in mice with experimental autoimmune encephalomyelitis (EAE). When myelin basic protein-specific T-lymphocytes derived from female mice were transferred, the female recipients developed more severe EAE and expressed higher levels of iNOS and NO than male recipients. When the T-lymphocytes derived from males were transferred, severe EAE was induced in neither female or male recipients and neither iNOS nor NO were detectable. These data show an association between No production and EAE severity, suggesting a possible role of NO in the pathogenesis of EAE.

Antisense blockade of inducible nitric oxide synthase in glial cells derived from adult SJL mice.

Increasing evidence suggests a correlation between cytokine-induced nitric oxide synthase (iNOS) and demyelination in Multiple sclerosis (MS). Inhibition of iNOS may therefore be a novel therapeutic approach in MS. To test an antisense oligodeoxynucleotide (ODN) knockdown strategy for inhibiting iNOS, we used lipopolysaccharide (LPS) together with gamma-interferon (IFN-gamma) to induce iNOS in adult mouse mixed glial cell cultures. We administered an iNOS-derived antisense phosphorothiorate oligodeoxynucleotide (S-ODN) to block the induction. The antisense ODN treatment resulted in significant inhibition of LPS and IFN-gamma induced iNOS mRNA and protein expression. It also inhibited nitric oxide (NO) and cyclic GMP (cGMP) production in a dose dependent fashion. Sense and random S-oligo had no effect in any of these studies. These data indicate the efficacy and specificity of the antisense oligodeoxynucleotide approach in inhibiting iNOS in glial cells.

Base rate and simulated symptoms of mild head injury among normals.

This study examined the vulnerability of several self-report instruments commonly used in neuropsychological evaluation - the Iowa Interview for Partial Seiwre-Like Symptoms, Postconcussion Checklist (PCL). Postconcussion Syndrome Checklist (PCSC), and Beck Depression Inventory (BDI) - to exaggerated or feigned complaints. Two hundred twenty-nine college student volunteers completed the instruments under one of three conditions: I) Base Rate/Control; simulated Head Injured, but 2) without or 3) with prospect of financial gain for the injury. Although the simulated Head Injured groups did not differ significantly from one another, both groups endorsed more symptoms than the Base Rate group, suggesting that the instruments are vulnerable, to simulation. Base rates of head injury symptoms in the normal population, laypersons' knowledge about the sequelae of mild head injury, and implications of using symptom checklists in medicolegal evaluations were discussed, as was the desirability of replicating this study with noncollege student populations.

Revised norms and decision rules for the Luria-Nebraska Neuropsychological Battery, Form II.

All control subjects from a previous Luria-Nebraska Neuropsychological Battery, Form II (LNNB2) normative study were combined with a considerably larger normative sample to produce a composite normative sample of 392 subjects with a mean high school educational level. Revised norms for the LNNB2 were developed based on this sample and were scaled with uniform T-scores to make scale elevations comparable across LNNB2 measures. Differences between the scalewise LNNB2 normative values and published alternatives were highly significant. A critical level and actuarial decision rules for differentiation of normal from neurologically impaired performance level were developed for the LNNB2 using the current empirical norms (86% accuracy with current sample empirical critical level; 89% accuracy with LNNB1 critical level). The normative prediction values of Golden, Purisch, and Hammeke for the LNNB2 were not satisfactory (69% overall, with 45% accuracy among brain damaged sample). There was no significant effect of sex of subject on LNNB2 performance level among the control subjects.

Nickel speciation of residual oil fly ash and ambient particulate matter using X-ray absorption spectroscopy.

The chemical speciation of Ni in fly ash produced from approximately 0.85 wt % S residual (no. 6 fuel) oils in laboratory (7 kW)- and utility (400 MW)-scale combustion systems was investigated using X-ray absorption fine structure (XAFS) spectroscopy, X-ray diffraction (XRD), and acetate extraction [1 M NaOAc-0.5 M HOAc (pH 5) at 25 degrees C]-anodic stripping voltammetry (ASV). XAFS was also used to determine the Ni speciation of ambient particulate matter (PM) sampled near the 400-MW system. Based on XAFS analyses of bulk fly ash and their corresponding acetate extraction residue, it is estimated that > 99% of the total Ni (0.38 wt %) in the experimentally produced fly ash occurs as NiSO4.xH2O, whereas > 95% of the total Ni (1.70 and 2.25 wt %) in two fly ash samples from the 400-MW system occurs as NiSO4.xH2O and Ni-bearing spinel, possibly NiFe2O4. Spinel was also detected using XRD. Acetate extracts most of the NiSO4.xH2O and concentrates insoluble NiFe2O4 in extraction residue. Similar to fly ash, ambient PM contains NiSO4.xH2O and NiFe2O4; however, the proportion of NiSO4.xH2O relative to NiFe2O4 is much greater in the PM. Results from this and previous investigations indicate that residual oil ash produced in the 7-kW combustion system lack insoluble Ni (e.g., NiFe2O4) but are enriched in soluble NiSO4.xH2O relative to fly ash from utility-scale systems. This difference in Ni speciation is most likely related to the lack of additive [e.g., Mg(OH)2] injection and residence time in the 7-kW combustion system.

Cancer incidence in Singapore, 1998 to 1999.

The age-standardised incidence rates for all cancers for 1998-1999 were 235.0 per 100,000 in males and 199.8 per 100,000 in females. The corresponding rates for 1993-1997 were 233.1 per 100,000 in males and 198.1 per 100,000 in females. The greatest difference was for breast cancer in females with age-standardised incidence rates increasing from 46.1 to 53.1 cases per 100,000 persons per year between these time periods. There also appears to be a shift of the peak age-specific incidence for breast cancer from premenopausal to postmenopausal years over this period. This suggests that our breast cancer incidence pattern is rapidly becoming more similar to populations in the West.