Original Article

Chew WF, Masyita M, Leong PP, Boo NY, Zin T, Choo KB, Yap SF
Correspondence: Ms Chew Wai Fong, waifong.chew@gmail.com

ABSTRACT
INTRODUCTION Obesity is a major modifiable risk factor associated with most chronic diseases. The aim of this study was to determine the prevalence of obesity, and its associated risk factors, among apparently healthy Chinese adults in a Malaysian suburban village.
METHODS This was a cross-sectional study conducted among the Chinese residents in Seri Kembangan New Village, Klang Valley, Selangor, Malaysia. Convenience sampling was used for the selection of participants. Body weight, height, waist and hip circumferences, and blood pressure were measured. Fasting venous plasma was drawn for the measurement of fasting glucose level and lipid profile. Data on sociodemographic factors, dietary habits, physical activity, perceived stress level and sleep duration were collected using interviewer-administered, pretested and validated questionnaires. 
RESULTS Among the 258 Chinese residents (mean age 41.4 ± 10.0 years) recruited, the prevalence of obesity was 40%. The obese participants had significantly higher mean blood pressure, and triglyceride and fasting plasma glucose levels than the non-obese participants (p < 0.05). The obese participants also had a significantly lower high-density lipoprotein cholesterol level than the non-obese participants. Logistic regression analysis showed that drinking soy milk (adjusted odds ratio [OR] 0.447; 95% confidence interval [CI] 0.253–0.787; p < 0.05) and the perception that a balanced diet consists mainly of vegetables (adjusted OR 0.440; 95% CI 0.215–0.900; p < 0.05) were associated with a reduced risk of obesity. The risk of obesity was higher in younger participants (adjusted OR 2.714; 95% CI 1.225–6.011; p < 0.05).
CONCLUSION The prevalence of obesity was high among the apparently healthy suburban Chinese. Our findings suggest that soy milk consumption and the perception that a balanced diet consists mainly of vegetables are associated with a lower risk of developing obesity in this population.

Keywords: dietary habits, obesity, perception of balanced diet
Singapore Med J 2014; 55(2): 84-91; http://dx.doi.org/10.11622/smedj.2014020

REFERENCES

Lim RB, Ng BB, Ng KM
Correspondence: Dr Raymond Lim Boon Tar, raymondlim1302@gmail.com

ABSTRACT
INTRODUCTION The Patient Safety Leadership Walkabout (PSLWA) programme is a commonly employed tool in the West, in which senior leaders visit sites within the hospital that are involved in patient care to talk to healthcare staff about patient safety issues. As there is a lack of perspective regarding PSLWA in Asia, we carried out an evaluation of its effectiveness in improving the patient safety culture in Tan Tock Seng Hospital, Singapore.
METHODS A mixed methods analysis approach was used to review and evaluate all documents, protocols, meeting minutes, post-walkabout surveys, action plans and verbal feedback pertaining to the walkabouts conducted from January 2005 to October 2012. 
RESULTS A total of 321 patient safety issues were identified during the study period. Of these, 308 (96.0%) issues were resolved as of November 2012. Among the various categories of issues raised, issues related to work environment were the most common (45.2%). Of all the issues raised during the walkabouts, 72.9% were not identified through other conventional methods of error detection. With respect to the hospital’s patient safety culture, 94.8% of the participants reported an increased awareness in patient safety and 90.2% expressed comfort in openly and honestly discussing patient safety issues.
CONCLUSION PSLWA serves as a good tool to uncover latent errors before actual harm reaches the patient. If properly implemented, it is an effective method for engaging leadership, identifying patient safety issues, and supporting a culture of patient safety in the hospital setting.

Keywords: leadership walkabout, leadership walkaround, patient safety, quality of care
Singapore Med J 2014; 55(2): 78-83; http://dx.doi.org/10.11622/smedj.2014019

REFERENCES

Lee JC, Lim MY, Kuan YW, Teo HW, Tan HG, Low WK
Correspondence: Mr Gary Jek Chong Lee, jekchong@tp.edu.sg

ABSTRACT 
INTRODUCTION Noise-induced hearing loss (NIHL) is a preventable condition, and much has been done to protect workers from it. However, thus far, little attention has been given to leisure NIHL. The purpose of this study is to determine the possible music listening preferences and habits among young people in Singapore that may put them at risk of developing leisure NIHL.
METHODS In our study, the proportion of participants exposed to > 85 dBA for eight hours a day (time-weighted average) was calculated by taking into account the daily number of hours spent listening to music and by determining the average sound pressure level at which music was listened to. 
RESULTS A total of 1,928 students were recruited from Temasek Polytechnic, Singapore. Of which, 16.4% of participants listened to portable music players with a time-weighted average of > 85 dBA for 8 hours. On average, we found that male students were more likely to listen to music at louder volumes than female students (p < 0.001). We also found that the Malay students in our study listened to louder music than the Chinese students (p < 0.001).
CONCLUSION We found that up to one in six young persons in Singapore is at risk of developing leisure NIHL from music delivered via earphones. As additional risks due to exposure to leisure noise from other sources was not taken into account, the extent of the problem of leisure NIHL may be even greater. There is a compelling need for an effective leisure noise prevention program among young people in Singapore.

Keywords: MP3 players, personal listening devices, portable music players, leisure noise-induced hearing loss, youths
Singapore Med J 2014; 55(2): 72-77; http://dx.doi.org/10.11622/smedj.2014018

REFERENCES

Lim SC, Mamun K, Lim KH
Correspondence: Dr Lim Si Ching, si_ching_lim@cgh.com.sg

ABSTRACT
INTRODUCTION This study aimed to examine the various factors associated with inpatient falls among patients with and without dementia in a hospital setting.
METHODS This was a retrospective one-year study using data collected from Singapore General Hospital’s electronic reporting system for inpatient falls. 
RESULTS In the study period, 298 patients aged ≥ 65 years fell during their hospital stay. The majority of the patients (n = 248) did not have dementia. In our study, fallers with dementia were more likely to use ambulatory aids, be visually impaired and have urinary incontinence. More patients with dementia than those without had a history of previous falls, and were placed on fall precaution with restricted freedom of movement, which at times, included restraints. However, the difference between patients who were put on restraints and those who were allowed to move freely was not statistically significant. The majority of falls in both groups occurred at the bedside. We found that fallers without dementia were more likely to fall during the morning shift, whereas fallers with dementia were more likely to fall during the night shift. Fallers with dementia were more likely to be confused at the time of the fall.
CONCLUSION In our study, we found that fallers with dementia were more likely to have visual impairment, have urinary incontinence, use walking aids, and to be confused and physically restrained at the time of the fall. The fallers without dementia in our study may have undiagnosed dementia.

Keywords: delirium, dementia, inpatient falls, restraint use, urinary incontinence
Singapore Med J 2014; 55(2): 67-71; http://dx.doi.org/10.11622/smedj.2014017

REFERENCES

Kumar A, Sharma A, Singh P
Correspondence: Dr Anu Sharma, anuashwani2003@yahoo.com

ABSTRACT
INTRODUCTION Detailed anatomical knowledge of the suprascapular notch (SSN) is important for the management of entrapment neuropathy and interventional procedures. The objective of the present study was to collect data on the morphological features and anatomical variations of the SSN in an Indian population. 
METHODS We studied 268 human scapulae of unknown sex (126 right-sided, 142 left-sided) taken from the Department of Anatomy, Dayanand Medical College and Hospital, India. SSNs were classified as either type I, II, III, IV or V, based on the shape of the inferior border of the incisura, and comparison of the SSN’s vertical and transverse diameters. The shape of the SSN (i.e V- or U-shaped), if present, was also recorded. 
RESULTS Type II SSN was the most common (50.00%), followed by type I, type IV and type III (32.46%, 9.70% and 7.84%, respectively). For right-sided type II SSNs, the transverse and vertical diameters were 9.1 ± 3.2 mm and 5.2 ± 1.9 mm, respectively, while those for left-sided type ll SSNs were 9.2 ± 2.4 mm and 5.1 ± 1.8 mm, respectively. Generally, the transverse diameter of type II SSN was found to be greater than that of type III SSN. The incidence of U-shaped SSN was 51.49%, while that of V-shaped SSN was 2.99%.
CONCLUSION This study of the morphometrical characteristics and anatomical variations of SSN provides an anatomical database of SSN in the Indian context. This database will be of use in surgical procedures, as the information can be used to ensure adequate access to and complete decompression of the suprascapular nerve. 

Keywords: scapula, suprascapular nerve entrapment, suprascapular notch
Singapore Med J 2014; 55(1): 41-44; http://dx.doi.org/10.11622/smedj.2014009

REFERENCES

Thwin SS, Fazlin Z, Than M
Correspondence: Dr San San Thwin, santhwin@yahoo.com

ABSTRACT
INTRODUCTION Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain’s syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain’s tenosynovitis.
METHODS Routine dissection of ten upper limbs was performed to determine the variations in the tendons of the anatomical snuffbox of the wrist. 
RESULTS In all the dissected upper limbs, the APL tendon of the first extensor compartment was found to have several (3–14) tendon slips. The insertion of the APL tendon slips in all upper limbs were at the base of the first metacarpal bone, trapezium and fascia of the opponens pollicis muscle; however, in seven specimens, they were also found to be attached to the fleshy belly of the abductor pollicis brevis muscle. In two specimens, double tendons of the extensor pollicis longus located in the third extensor compartment were inserted into the capsule of the proximal interphalangeal joints before being joined to the extensor expansion. In two other specimens, the first extensor compartment had two osseofibrous tunnels divided by a septum that separated the APL tendon from the extensor pollicis brevis tendon.
CONCLUSION Multiple variations were found in the anatomical snuffbox region of the dissected upper limbs. Knowledge of these variations would be useful in interventional radiology and orthopaedic surgery.

Keywords: abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, tendon
Singapore Med J 2014; 55(1): 37-40; http://dx.doi.org/10.11622/smedj.2013216

REFERENCES

Supakthanasiri P, Klaewsongkram J, Chantaphakul H
Correspondence: Dr Hiroshi Chantaphakul, hchantaphakul@gmail.com

ABSTRACT
INTRODUCTION Healthy individuals may be exposed and sensitised to allergens, and have a positive response to a skin prick test despite being asymptomatic. The objectives of this study were to evaluate the prevalence of atopic sensitisation and identify the reactivity of healthy volunteers to common aeroallergens.
METHODS Healthy volunteers with no known allergic symptoms were recruited in this study. All volunteers were scheduled to undergo a skin prick test with 16 common aeroallergens that were previously identified among atopic patients. 
RESULTS A total of 100 volunteers (mean age 28 years) were enrolled in this study. 42 volunteers had positive skin prick tests for at least one allergen. The median number of sensitised allergen was 2 (range 1–7). Volunteers with positive skin tests (n = 42) were younger than those with negative skin tests (n = 58) (mean age 25.5 vs. 29.2 years; p < 0.05). The group with positive skin tests also had a higher proportion of males (57.1% vs. 31.0%; p < 0.01) and firstdegree relatives with a history of atopic diseases (31.0% vs. 10.3%; p < 0.05). The most common sensitised allergens in these healthy asymptomatic volunteers were mite (n = 33), house dust (n = 23) and American cockroach (n = 20).
CONCLUSION In this study, up to 42% of healthy volunteers, particularly those with a family history of atopy, were sensitised to allergens. Reactivity of the skin test without allergic symptoms, however, does not indicate allergic disease. Therefore, the skin test should only be indicated in atopic symptomatic individuals.

Keywords: allergic rhinitis, allergy, asthma, prick test, sensitivity
Singapore Med J 2014; 55(1): 34-36; http://dx.doi.org/10.11622/smedj.2014007

REFERENCES

López-Muñoz F, Sim K, Shen WW, Huelves L, Moreno R, Molina JD, Rubio G, Noriega C, Pérez-Nieto MA, Álamo C
Correspondence: Prof Francisco López-Muñoz, francisco.lopez.munoz@gmail.com

ABSTRACT
INTRODUCTION A bibliometric study was carried out to ascertain the volume and impact of scientific literature published on second-generation antipsychotic drugs (SGAs) in Singapore from 1997 to 2011.
METHODS A search of the EMBASE and MEDLINE databases was performed to identify articles originating from Singapore that included the descriptors ‘atypic* antipsychotic*’, ‘second-generation antipsychotic*’, ‘clozapine’, ‘risperidone’, ‘olanzapine’, ‘ziprasidone’, ‘quetiapine’, ‘sertindole’, ‘aripiprazole’, ‘paliperidone’, ‘amisulpride’, ‘zotepine’, ‘asenapine’, ‘iloperidone’, ‘lurasidone’, ‘perospirone’ and ‘blonanserin’ in the article titles. Certain bibliometric indicators of production and dispersion (e.g. Price’s Law on the increase of scientific literature, and Bradford’s Law) were applied, and the participation index of various countries was calculated. The bibliometric data was also correlated with some social and health data from Singapore, such as the total per capita expenditure on health and gross domestic expenditure on research and development. 
RESULTS From 1997 to 2011, a total of 51 articles on SGAs in Singapore were published. Our results suggested non-fulfilment of Price’s Law (r = 0.0648 after exponential adjustment vs. r = 0.2140 after linear adjustment). The most widely studied drugs were clozapine (21 articles), risperidone (16 articles) and olanzapine (8 articles). Division into Bradford zones yielded a nucleus occupied by the Journal of Clinical Psychopharmacology (6 articles) and the Singapore Medical Journal(4 articles). The analysed material was published in a total of 30 journals, with the majority from six journals. Four of these six journals have an impact factor greater than 2.
CONCLUSION Publications on SGAs in Singapore are still too few to confirm an exponential growth of scientific literature.

Keywords: atypical antipsychotics, bibliometry, schizophrenia, second-generation antipsychotics, Singapore
Singapore Med J 2014; 55(1): 24-33; http://dx.doi.org/10.11622/smedj.2014006

REFERENCES

Lim HJ, Lee H, Ti LK
Correspondence: Dr Lim Hsien Jer, hsienjer@gmail.com

ABSTRACT
INTRODUCTION To avoid the risk of pulmonary aspiration, fasting before anaesthesia is important. We postulated that the rate of noncompliance with fasting would be high in patients who were admitted on the day of surgery. Therefore, we surveyed patients in our institution to determine the rate of fasting compliance. We also examined patients’ knowledge on preoperative fasting, as well as their perception of and attitudes toward preoperative fasting.
METHODS Patients scheduled for ‘day surgery’ or ‘same day admission surgery’ under general or regional anaesthesia were surveyed over a four-week period. The patients were asked to answer an eighteen-point questionnaire on demographics, preoperative fasting and attitudes toward fasting. 
RESULTS A total of 130 patients were surveyed. 128 patients fasted before surgery, 111 patients knew that they needed to fast for at least six hours before surgery, and 121 patients believed that preoperative fasting was important, with 103 believing that preoperative fasting was necessary to avoid perioperative complications. However, patient understanding was poor, with only 44.6% of patients knowing the reason for fasting, and 10.8% of patients thinking that preoperative fasting did not include abstinence from beverages and sweets. When patients who did and did not know the reason for fasting were compared, we did not find any significant differences in age, gender or educational status.
CONCLUSION Despite the patients’ poor understanding of the reason for fasting, they were highly compliant with preoperative fasting. This is likely a result of their perception that fasting was important. However, poor understanding of the reason for fasting may lead to unintentional noncompliance.

Keywords: anaesthesia, compliance, fasting, knowledge, preoperative
Singapore Med J 2014; 55(1): 18-23; http://dx.doi.org/10.11622/smedj.2014005

REFERENCES

Sonkar GK, Singh S, Sonkar SK, Singh U, Singh RG
Correspondence: Dr Gyanendra Kumar Sonkar, gettwinklestar@rediffmail.com

ABSTRACT
INTRODUCTION Renal transplant rejection involves both immunological and non-immunological factors. The objective of the present study was to investigate the association between immunological factors, such as serum interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α), and non-immunological parameters, such as age, serum creatinine (SCr), creatinine clearance (CrCl) and dyslipidaemia, in renal transplant recipients (RTRs). 
METHODS This study included 90 RTRs and 90 healthy controls. Biochemical parameters, including serum IL-6 and TNF-α, were estimated using standard protocols. CrCl was calculated using the Cockroft-Gault equation, and the type of rejection was confirmed on biopsy. Student’s t-test and univariate and multivariate analyses were performed using the Statistical Package for the Social Sciences for Windows version 15.
RESULTS The mean levels of serum IL-6 and TNF-αwere significantly higher in RTRs than in the control group (p < 0.001). These parameters were also found to be significantly different between the transplant rejection (TR) and transplant stable (TS) groups (p < 0.001). CrCl was significantly decreased in the TR group when compared to the TS group (p < 0.001). The two cytokines, IL-6 and TNF-α, correlated significantly with all metabolic parameters, such as SCr, CrCl and dyslipidaemia. Multiple regression analysis showed that TNF-αand CrCl were the strongest predictors of IL-6. 
CONCLUSION We conclude that immunological factors, as well as non-immunological factors such as CrCl, SCr and dyslipidaemia, play important roles in the pathogenesis of graft rejection and renal graft dysfunction.

Keywords: creatinine clearance, interleukin 6, renal transplant recipients, total cholesterol, tumour necrosis factor alpha
Singapore Med J 2013; 54(9): 511-515; http://dx.doi.org/10.11622/smedj.2013174

REFERENCES