- S E G A L A_ M A C A M_ P E N Y A K I T -

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Number of new HFMD cases soars past epidemic levels
By Hoe Yeen Nie, Channel NewsAsia | Posted: 05 September 2008 2352 hrs


                                                                                       Veronica Tee

Dr Thoon Koh Cheng

SINGAPORE : The number of new hand, foot and mouth disease (HFMD) cases in Singapore has reached epidemic levels for the first time since June this year.

This comes at a time when kindergartens are gearing up for a spike in cases when the new school term begins on Monday.

But doctors said that often it is the lack of proper hygiene at home that helps spread the disease.

HFMD is a common childhood infection, which typically sees two peaks each year.

617 new cases were reported last week - breaking the epidemic threshold of 565 cases. But this is below the numbers seen in the previous seasonal epidemic between March and May, which saw 1,466 new cases a week at its height.

Experts differ on how much impact the September holidays will have on infection rates.

The Health Ministry said that the one-week break might provide some relief, but some doctors think the time away from school may be too short to have a large effect. Furthermore, childcare centres continue to operate as usual during this time.

But with classes due to reopen on Monday, the PAP Community Foundation kindergarten in Woodlands Avenue 6 is taking no chances. Aside from increasing the frequency of checks, it also teaches its kids to look out for ulcers and sores on the palms, soles and buttocks.

Veronica Tee, administrator, PCF Sembawang, said: "The children already know that when they do feel unwell during class time, they need to let the teacher know. And we have also put in an added measure recently - by doing another check mid-way during class."

During an outbreak, kindergartens and childcare centres will minimise outdoor excursions and intermingling between children of different age groups.

Cherie Hearts, which operates a chain of 30 childcare centres here, said that it will also rope in healthy adult volunteers to help take care of children should its centres have to shut down.

It said this would help ease the load of those working parents who have difficulty taking leave.

NTUC Childcare said it provides hand sanitisers for visitors throughout the year.

Hand hygiene is also stressed at all centres, but some doctors said that not enough is being done at home.

Dr Thoon Koh Cheng, Department of Paediatric Medicine, KK Women's and Children's Hospital, said: "Strict hand hygiene is probably still overlooked. People let down their guard when the child is well, and when the child becomes sick, people let down their guard again by allowing them to go back to childcare centres and kindergartens when they are just on the brink of recovery."

One factor that could account for the rise in cases is the weather. The theory goes that during rainy weather, people tend to stay indoors, and this makes it easier for viruses to spread. - CNA/ms

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Sep 9, 2008
Cancer clue cracked
Discovery of key gene's role in colorectal cancer will help the fight against the disease
By Judith Tan


Prof Ito and his team found that a certain gene in colorectyal cancer. Switching it back could slow down the disease, a top killer cancer among men here. -- ST PHOTO: SAMUEL HE

SINGAPORE scientists have discovered a genetic clue that could prevent the growth and development of colorectal cancer, the leading cause of cancer death here.

Led by Professor Yoshiaki Ito, the team found that when a gene, RUNX3, is disrupted, colorectal cancer can occur. RUNX3 is a gatekeeper gene which suppresses abnormal cell growth.

'For the first time, we found that inactivated RUNX3 occurs at the early stage of the cancer and is relatively easy to detect. This is significant as it is possible to reactivate the gene to slow down the cancerous growth,' said Prof Ito, a professor in medical oncology at the National University of Singapore's Yong Loo Lin School of Medicine, at a media conference yesterday.

In 2006, the team of 12 researchers found that the same gene plays a key role in gastric cancer. It is also present in other cancers of the bladder and breast.

The team, which has been studying RUNX3 for six years, comprises researchers from the medical school and the Agency for Science, Technology and Research's (A*Star) Institute of Molecular and Cell Biology (IMCB).

Their findings, published in the biomedical research journal Cancer Cell, move experts closer to identifying the right targets to develop therapeutic treatments in the fight against bowel cancer.

The medical school's dean, Professor John Wong, said: 'Prof Ito's research also lays the groundwork for a diagnostic kit for early detection.'

Understanding the causes of the disease also means a focused approach to treating it, instead of 'shotgun therapies', he added.

Colorectal cancer rates in Singapore are among the highest in the world. The disease has overtaken lung cancer as the top killer cancer among men, and is the second-highest cancer among women after breast cancer.

About 2,000 new cases are diagnosed each year.

The team's study of the gene in colon cancer involved both animal models and tissue samples from patients diagnosed with the cancer. The RUNX3 gene in all the human samples were 'switched off'.

Previous studies by research centres in Britain and the United States had found that flaws in another gatekeeper gene called adenomatous polyposis coli (APC) trigger development of most colorectal cancers.

Prof Ito's team showed that even when there is no flaw in the APC gene, cancer can still occur when the RUNX3 is not switched on.

Prof Ito said the good news is that changes to the RUNX3 gene seem to involve its function, and not its innate DNA sequence.

'This means its basic core remains intact, making it possible to be reactivated. We are now looking at how to do so and with which chemicals,' he said.

Until further advances, he said, the gold standard to detect the cancer is still colonoscopy, in which the entire large intestine can be examined through a scope.

The professor said that his team would study if the predisposition for the gene to be switched off is inherited.

He cautioned that it would be years before a diagnostic kit would be available for use by doctors.

juditht@sph.com.sg

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22 new cases of chikungunya fever reported
By Wong Siew Ying, Channel NewsAsia | Posted: 12 September 2008 1833 hrs

SINGAPORE : The Ministry of Health (MOH) said on Friday that 22 new cases of chikungunya fever have been reported. This brings the total number of cases to 200 as of Thursday.

MOH said half of the 22 new cases were imported and the victims had a history of travel to Malaysia.

Among the other 11 local cases, two belonged to a new cluster at Seletar Farmway. MOH said two retirees in their 60s developed symptoms on September 6, and one of them was subsequently hospitalised.

Seven new cases were also found in existing clusters like Kranji Way, Sungei Kadut and Mandai Estate.

The two remaining cases were reported at Crawford Lane and Mei Ling Street.

The National Environment Agency continues to conduct checks in those areas to eradicate mosquito breeding sites.

MOH has advised people who develop symptoms of chikungunya - which include fever, joint pain and rashes - to consult their doctors immediately. - CNA/ms

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Sep 12, 2008
'Diet' wards off strokes, cancer
PARIS - THE so-called Mediterranean diet cuts the risk of heart disease, cancer and neurodegenerative conditions such as Alzheimer's, according to research released on Friday.

Piecemeal evidence over the last three decades has shown that a diet rich in grains, fruit, vegetables and olive oil but stingy on meat and dairy - washed down with a modest daily dose of wine - promotes health.

But a meta-study published in the British Medical Journal is the first to sift through all this data in an attempt to quantify the overall benefits.

'Our findings support a simple recommendation: eat in a more Mediterranean way because it reduces the incidence of chronic disease,' the lead researcher, Francesco Sofi of the University of Florence, told AFP by phone.

Pouring over a dozen scientific surveys conducted since 1966 and involving more than 1.5 million people, Dr Sofi and a team of researchers in Italy created a scale of one to nine corresponding to different food groups.

Someone who consumed all the healthiest foodstuffs and largely avoided the harmful ones - a theoretically-perfect Mediterranean diet - would score a perfect nine, he explained.

The study found that a bump of two points anywhere in the scale - moving, say, from zero to two, or from six to eight - corresponded to a 'significant reduction in overall mortality', Dr Sofi said.

When broken down by disease, such a shift in dietary habits lowered the risk of death from cardiovascular disease by nine percent and from cancer by six per cent.

The study also evaluated a recent set of findings on the impact of diet on neurodegenerative disease, and concluded that going Mediterranean decreased the incidence of Alzheimer's and Parkinson's by 13 per cent.

These results are 'clinically relevant for public health', and suggest that getting one's daily calorie intake from these food groups could play an important role in preventing major chronic diseases, Dr Sofi said.

Despite growing evidence of its benefits, some specialists up to now have been reluctant to fully endorse the Mediterranean way.

'We need more studies to find out whether the diet itself or other lifestyle factors account for the lower deaths from heart disease,' the American Heart Association says on its website.

Ironically, most of the more than dozen countries ringing the Mediterranean Sea are slowly abandoning their traditional foods in favour of more meat, saturated fats and processed foods, according to the UN's Food and Agriculture Organisation (FAO).

'The European diet has become too fat, too salty and too sweet,' Mr Josef Schmidhuber, an economist at the FAO, said earlier this month in a statement.

The traditional balance of foods found in southern Europe and Northern Africa 'is declining into a moribund state', he said.

Historically, more than half the fat calories in a Mediterranean diet come from monounsaturated fats - mainly olive oil - that do not raise blood cholesterol levels the way saturated fats do.

Dr Sofi hopes that his scoring system might help people improve their eating habits.

'Adherence to the score could be a good way to measure the quality of a diet,' he said.

He is currently doing more research on what the optimum quantity of each food group would be for a balanced diet.

'Then we would be in a position to recommend eating a specific amount of, say, fish or fruits,' he said. -- AFP

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Bilberries to protect eyes

>IT is shown that about 40 per cent of diabetes sufferers would be at risk of going blind. This is because diabetes damages the fine blood vessels in the retina, which is a light-sensitive tissue that helps us to see.

Damage to the retina due to high blood sugar level is called diabetic retinopathy and usually affects both eyes.

There are four stages to this condition; the initial stage is when the tiny blood vessels supplying the retina start to swell. As the disease progresses some of these blood vessels become blocked. If diabetes is not well managed, this will affect more blood vessels which cause the retina to be deprived of nutrients and blood supply.

The deprivation stimulates the body to actually grow new blood vessels to try to meet the retina?s needs.

At this stage, it is relatively advanced and the growth of new blood vessel is referred to as proliferative retinopathy. These new blood vessels grow along the retina and on to the gel-filled surface of the eye.

While the new growth should be a solution, it actually increases the risk of blindness as these fragile, abnormal blood vessels are easily damaged resulting in blood leaks that cause blurring and loss of vision. Due to this potential risk of vision loss, it advisable that people with diabetes get a thorough eye examination yearly.

Diet plays a crucial role in managing blood sugar and reducing the risk of diabetic complications.

In a previous issue of Archives of Ophthalmology, a study involving periodic data collection of food intake in 77,562 women and 40,866 men over an average period of 15 years shows that a diet high in fruits and vegetables decreases the risk of eye disease.

It is found that flavonoids, a group of antioxidants found in many fruits, vegetables, grains, legumes, and particularly abundant in berries help to reduce free radical damage to tissue and aid in tissue repair.

Among the berries, bilberries have been used traditionally since 1945 for diabetic neuropathy in France.

It seems that the flavonoids in bilberries identified as anthocyanidins increase circulation in the fine blood vessels of the eyes as well as help strengthen blood vessel walls. Blood vessel walls are composed of collagen that maintains their integrity.

Bilberry anthocyanidins are shown to possess collagen-stabilising action and smooth muscle-relaxing activity which works favourably in the tissues of the retina.

Bilberries can be eaten fresh though they are rather sour but more commonly they are found in jams. In order to enjoy the benefits of this fruit, it is advised that one consumes at least two cups of fresh bilberries a day.

With modern technology, bilberries are now available in supplements and a good product should deliver 25 per cent anthocyanidins. Some supplements may have added other herbs to enhance the effectiveness of bilberries and these include eyebright and lycium.

Apart from anthocyanidins, nutrients required for eye health are vitamin A, beta carotene, C, E, lutein, zeaxanthin, and zinc.

Food sources of lutein and zeaxanthin include egg yolks, kale, spinach, romaine lettuce, broccoli, zucchini, red peppers and Brussels sprouts.

Fatty acids such as docosahexaenoic acid (DHA) from tuna oil are also important as DHA is naturally concentrated in the retina of the eye require for healthy retinal function.

The writer is a pharmacist who is actively involved in the dissemination of information on natural healthcare and holistic therapies. For more information, she can be contacted at csyam@streamyx.com

This story was first published in the New Straits Times on Aug 25, 2008.

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A chance to see near things clearly again
Joanne Chiew

THOSE with presbyopia might now find a new and permanent solution to their condition - if they want to participate in a global clinical trial that is being conducted in Singapore.

Presbyopia usually affects those 40 years old and above, and is commonly referred to in Mandarin as 'lau hua yan' as the eye loses the ability to focus on near objects with age. The crystalline lens in the eye loses elasticity over time, making focusing difficult.

The Singapore National Eye Centre (SNEC) now offers what appears to be the only effective treatment so far for the condition - the AcuFocus Corneal Inlay (ACI). Results so far have shown it to be effective with high patient satisfaction, says Chan Wing Kwong, senior consultant and head of Refractive Surgery at SNEC.

The current solution is Lasik, which does not provide satisfactory results and frequently causes distortions in vision.

Dr Chan describes ACI as 'revolutionary and ground-breaking'.

The technique uses a simple optical phenomenon - the 'pin-hole effect'. A doughnut-shaped disc is implanted under the cornea of the eye to create a smaller aperture for light to enter the eye, thereby increasing the depth of field of vision.

The procedure does not involve tissue removal and takes a total of five minutes. Improvement in vision is immediate.

In fact, Dr Chan notes that visual quality continues improving over time, as the patient adjusts to the implant. Also, it need only be done in the dominant eye as the other one will adapt.

Twenty-four patients who have had the implant for three months already can now read words 1mm high, better than what they saw with reading glasses.

Some side-effects include dimmer vision and slightly narrower visual field. Slight deterioration of far vision also occurs. But it is difficult for the patient to observe these changes, Dr Chan said.

The treatment is expected to be commercially available in Singapore by 2009.

It is estimated to cost between S$1,300 and S$1,900 per eye, comparable to the cost of Lasik, although patients can't use Medisave to pay for it as yet.

SNEC is the only trial centre for the ACI in Asia. It has 35 patients so far and is looking to enrol more.

Those interested in joining the trial can call 6322 4500 or 6322 4501.

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Singapura : 16 September 2008         

KINI BOLEH LANTIK INDIVIDU URUSKAN EHWAL JIKA SAKIT MENTAL

WARGA Singapura kini berkuasa melantik individu yang mereka percayai untuk menguruskan ehwal mereka sekiranya mereka hilang keupayaan mental.

Ini setelah Rang Keupayaan Mental diluluskan Parlimen semalam.

Akta itu akan berkuatkuasa apabila Pejabat Pelindung Awam ditubuhkan dan Kod Amalan siap dalam setahun ini.

Ketika membentangkan rang itu semalam, Menteri Pembangunan Masyarakat, Belia dan Sukan, Dr Vivian Balakrishnan, berkata dengan masyarakat semakin menua, kes orang yang menghidapi demensia akan meningkat.

'Akta ini membolehkan individu Singapura melantik orang yang dipercayai membuat keputusan bagi pihak mereka jika mereka hilang keupayaan mental pada masa hadapan.

'Akta itu juga membolehkan ibu bapa seorang individu cacat intelek memohon mahkamah melantik orang yang dipercayai sebagai penolong untuk membuat keputusan bagi anak mereka apabila mereka meninggal dunia,' katanya.

Ini boleh dilakukan menerusi mekanisme berkanun baru yang dipanggil Kuasa Wakil Berpanjangan (LPA) (Lasting Power of Attorney). Ia membolehkan individu melantik wakil atau 'donee' membuat keputusan berkaitan perihal hartanah dan kewangannya serta kebajikan peribadi dan penjagaan kesihatan, apabila beliau hilang keupayaan mental.

Wakil yang dilantik itu boleh merupakan ahli keluarga, saudara atau rakan yang dipercayai.

Sebuah Kod Amalan akan menjadi panduan bagi penjaga utama dan profesional penjagaan.

jadi, mana2 rakyat singapura yg rasa akan sakit mental, pandai2lah buat persediaan sekarang

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More youths contract sexually-transmitted infections
By Hoe Yeen Nie, Channel NewsAsia | Posted: 15 September 2008 2250 hrs

SINGAPORE: The number of sexually-transmitted infections (STIs) among youths in Singapore has nearly doubled in the past ten years.

Latest figures by the Ministry of Health (MOH) showed that 418 of every 100,000 people aged 15 to 24 had contracted a sexually-transmitted infection, compared to 213 in 1998.

In the last five years, the number of females infected have outnumbered males. 479 females contracted STIs last year compared to 362 males.

A Students' Health Survey, which was last conducted in 2006, also found that students as young as Secondary 3 and 4 have had sexual intercourse. And of these, 24 per cent were sexually active, having sex at least five times within 12 months.

Health Minister Khaw Boon Wan released these figures in Parliament on Monday in response to a written question from MP for Hong Kah GRC, Zaqy Mohamad.

Mr Khaw added that the National University of Singapore is conducting a survey to study the correlation factors, including the socio-economic and educational backgrounds.

He said there are programmes to address the rising trend, including working with youth organisations.

The Health Promotion Board also runs sexually-transmitted infections and AIDS awareness programmes. These are targeted at Secondary 3 students, covering issues such as abstinence and condom use. - CNA/vm

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18 new cases of chikungunya fever reported
By Wong Siew Ying, Channel NewsAsia | Posted: 17 September 2008 1845 hrs


A worker fumigates in the drainage to prevent mosquitoes breeding

SINGAPORE : The Ministry of Health (MOH) said 18 new cases of chikungunya fever have been reported, bringing the total number of cases to 218 as of September 17.

Most of the patients have since recovered, except for a few recent cases who are still hospitalised.

Of the 18 new cases, 5 are imported as the victims had a history of travel to Malaysia.

Among the remaining 13 local cases, 9 were found in two new clusters.

One cluster was at Bah Soon Pah Road where 7 construction workers developed symptoms between September 6 and 14, and were admitted to hospital.

A couple in their 60s came down with chikungunya fever in the second new cluster Bang Kit Road.

MOH said the other 4 cases were linked to existing clusters in Lim Chu Kang and Sungei Kadut.

The National Environment Agency continues to conduct checks in those areas to eradicate mosquito breeding sites.

MOH advises persons who develop symptoms of chikungunya - which include fever, joint pain and rashes - to consult their doctors immediately. - CNA /ls

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Singapura : 26 September 2008        
  
CHIKUNGUNYA: LAGI 6 KES IMPORT, 7 SETEMPAT DIKESAN

LAGI 13 kes demam chikungunya dikesan di sini, menjadikan jumlah keseluruhan 231 sepanjang tahun ini.

Menurut kenyataan bersama Kementerian Kesihatan (MOH) dan Agensi Sekitaran Kebangsaan (NEA) semalam, enam daripada 13 kes baru itu adalah kes yang diimport.

Pesakit dalam kes yang diimport didapati telah mengunjungi kawasan penularan penyakit itu di Johor.

Enam daripada tujuh kes setempat pula dikaitkan dengan kelompok di Lim Chu Kang, Sungei Kadut, Bah Soon Pah Road dan Mandai Estate.

Satu lagi ialah kes berasingan di St Martin's Drive yang melibatkan seorang peniaga berusia 55 tahun.

Beliau, yang tinggal di situ, menghidapi tanda-tanda penyakit itu pada 16 September.

Beliau telah pulih dan anggota keluarganya tidak dijangkiti.

Pegawai NEA telah mengadakan pemeriksaan di kawasan tersebut namun sejauh ini tidak mengesan sebarang tempat pembiakan nyamuk.

NEA akan terus memeriksa kawasan tersebut.

Orang ramai dinasihatkan supaya mengambil langkah menghalang pembiakan nyamuk.

Mereka yang mengalami tandatanda chikungunya, seperti demam, sakit sendi, menggigil dan rasa mual, dinasihatkan berjumpa doktor.

Tanda-tanda itu biasanya berakhir dalam tempoh 10 hari.

Sejauh ini belum ada ubat bagi penyakit itu, yang biasanya hilang secara sendiri, dan ia jarang membawa maut.

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Contraception awareness among teenagers severely lacking
By Pearl Forss, Chanel NewsAsia | Posted: 27 September 2008 0640 hrs



SINGAPORE : September 27 is World Contraception Day and some health groups in Singapore are taking the opportunity to call for improved education on the choices and usage of contraception, in light of increasing rates of sexually transmitted infections among teenagers.

It has been eight years since schools started teaching about sex and contraception but it seems students are still woefully ignorant.

In a survey of 240 youths aged 15 to 20, it was found that 30 per cent thought washing the genitals after sex could prevent pregnancy while 15 per cent believed urinating will do the same.

16 percent believed that exercising vigorously after sex will help shed off sperm, thus preventing pregnancy.

The survey, conducted by pharmaceutical company Bayer Schering Pharma and with doctors advising on the study, found that about 1 in 4 youths engage in sexual activity and about half of them are not using contraceptives.

Said Dr Janet Lee, a general practitioner at Temasek Medical Centre: "I do see teenagers with unwanted pregnancies, and a lot of times, they do not even realise that they are pregnant because it never occurred to them they can be pregnant through unprotected sex.

"Their mindset is that it will not happen to me... I think we need to educate youths about the importance of abstinence, and also educating them about condom use and contraceptive pills so as to prevent unwanted pregnancies."

Teenagers account for about 12 percent of abortion numbers every year, and the number of teenagers with sexually transmitted infections has also doubled in the last decade.

The Ministry of Education has made it compulsory for all schools to have a sexuality education programme, but it seems the message is still not getting through to all teenagers.

Some said it's because teachers gloss over sexuality education. Others feel teenagers may be too embarrassed to ask questions about sex in class.

"It is not just enough for the schools to be teaching, or for the VWOs to come in. They (teenagers) need to be guided to the right sources of information, and parents can also play a part to be more open, to encourage their teenagers to approach them if they have questions about sex. But I think this will take time, as we are still a pretty conservative society," said Joanne Tan, spokesperson for the Singapore Planned Parenthood Association. - CNA /ls

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Sep 29, 2008
Hota: donors to get paid
It's not unethical to pay costs incurred by donor, notes Health Minister
By Salma Khalik, Health Correspondent


Mr Khaw said he returned home even more convinced that something had to be done to regulate organ trading, in particular, to cut out the middlemen. -- ST PHOTO: NG SOR LUAN

CHANGES to the Human Organ Transplant Act (Hota), expected early next year, will include compensation to those who donate their kidneys to save the lives of people they do not know.

Health Minister Khaw Boon Wan said this yesterday when he sought to refine the ethical debate over organ trading to placate those who are against money changing hands for body parts.

Ethicists are against commercialisation, he noted, but even ethicists in the United States with its 'highly ethical framework' think that altruistic donors should be reimbursed.

'Ethicists have no problems with reimbursing the donor provided that...he or she is fully informed of the risks, possibility of complications and what will happen to him for the rest of his life.'

Mr Khaw, who was in Manila last week to meet organ donors, said he returned home even more convinced that something had to be done to regulate organ trading, in particular, to cut out the middlemen.

The donors he met had no clue what they were getting themselves into. 'We cannot leave this problem to the black market,' he said.

His remarks following the opening of Woodlands Polyclinic are a sea change from his earlier stance a few months ago which had seemed to preclude any kind of organ trading whatsoever.

But Mr Khaw has been shifting his stance gradually, as debate grew following a high-profile court case involving retailer Tang Wee Sung's attempt to buy a kidney from an Indonesian.

The problem is acute, with over 1,000 more people each year suffering from kidney failure and needing transplants. Last year, 46 people received a cadaveric kidney - after a wait of almost nine years.

Desperation is driving some to illegal methods, despite the risks of running foul of the law and health complications. Every year, 20 to 30 Singaporeans go abroad for an illegal kidney transplant.

Hota, which allows for cadaveric and living-related organ transplants, will be amended early next year to lift the current 60 age cap.

It will also allow for paired matching, where relatives of patients who are not good matches can donate their organs to another patient who also has a family member who is willing to donate a kidney.

The minister drew a distinction between inducement - 'You're poor, I'm rich, I'll give you $1 million for your kidney' - and reimbursement.

'I think if we stick to the reimbursement side of the equation, we'll remain ethical,' he said.

Central to Mr Khaw's plan is the welfare of the donor. The Filipinos he met had been 'short-changed', he said, with just $3,000 to $4,000 paid to them for a kidney.

But what about follow-up treatment and checkups? What if their own kidney failed? The money would scarcely see them into the future.

He said he has asked his ministry officials to compute what additional medical expenses donors might incur as a result of giving up one kidney.

'Putting a dollar value to that is not unethical,' he said, suggesting that the amount would likely be in the tens of thousands of dollars, since it has to last the donor the rest of his life.

Mr Khaw said that there will be roles for various parties. He sees hospitals taking on the job of making sure that donors know the risk they face.

The ministry will audit to ensure that there is no 'hanky-panky', and also to link donors with recipients.

Those able to afford it should reimburse the donors themselves, since they are the beneficiaries. Voluntary welfare organisations like the National Kidney Foundation (NKF) could help poorer recipients raise funds for such reimbursements.

The minister has already met with NKF officials regarding a possible role for the charity.

Mrs Eunice Tay, NKF's chief executive officer, said that details are still sketchy, but the foundation is likely to set up a fund to pay for post-operative treatments for poor donors.

Mr Khaw made it clear that this proposal is but a complement to the living related and cadaveric transplants.

But prevention or the management of diabetes is still the best safeguard. Diabetes causes over half of the almost 1,000 or so kidney failures here a year.

He said: 'Once kidneys fail, the options are all lousy, whether it is dialysis or transplant.'

salma@sph.com.sg

NEED FOR REGULATION

'I think we should look into the legislation with a view to better regulate such activities to cut out exploitation and unscrupulous middlemen. And we can do it in a way that is totally within the ethical framework.'
Health Minister Khaw Boon Wan

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Three people contracted dengue virus via blood transmission
By Ali Smith, Channel NewsAsia | Posted: 02 October 2008 2241 hrs


Residents in Singapore donate blood

SINGAPORE : Three people contracted the dengue virus after receiving infected blood from a donor in Singapore.

The infected blood came from a 52-year-old repeat donor who gave blood on July 15 last year.

The Health Sciences Authority (HSA) said this is the first local case of dengue fever transmission via blood. The other reported case of transfusion transmitted dengue was from Hong Kong.

There are currently no licensed kits available in the market to screen donated blood for dengue. But HSA said it is taking precautionary measures to address the safety of the national blood supply.

For example, there is a strict screening process in place for the recruitment of blood donors.

In addition, the HSA is conducting a study with National University of Singapore laboratories to explore ways to test for dengue in donated blood.

The HSA assures the public that it has a quality system in place to keep risks at a minimum. - CNA /ls

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44% of Singapore parents believe their babies have sleep problem
By Greta Georges, Channel NewsAsia | Posted: 02 October 2008 2010 hrs



SINGAPORE: An international study has found that 44 per cent of Singapore parents believe their babies have a sleep problem, while in Caucasian countries, less than one quarter feel the same way.

A study of over 1,000 local infants shows their average bedtime is at 9.38pm, compared to those in predominantly Caucasian countries, who sleep at 8.51pm.

But Singapore babies are early risers - waking up at 6am, earlier than babies anywhere else.

This means they get 40 minutes less sleep a day than their Caucasian counterparts, after factoring in daytime naps.

Paediatrics professor from the School of Medicine at the University of Pennsylvania, Dr Jodi Mindell, suggests three golden rules.

She said, "We want parents to be putting their babies to bed early, we want them having a bedtime routine and we want them to help their babies fall asleep independently."

And this means not rocking or nursing babies to sleep, even when they wake up at night, so they will learn to fall asleep on their own.

Dr Mindell said, "We found that 3 out of 4 babies in Singapore are sleeping in their parents' room, though not all are sleeping in their parents' bed. Those babies who fall asleep independently, no matter in their parents' bed or a separate room, are going to sleep better at night."

Dr Mindell is the leader of a global study by the Asia Pacific Paediatric Sleep Alliance and Johnson & Johnson.

Sleep is a natural biological need and is especially important for babies in their formative first years, and babies may get cranky, irritable and accident prone if they do not get enough sleep.

Establishing a bedtime routine goes a long way, say experts.

Bathing, massaging or reading and cuddling can help babies stay 20 per cent longer in continuous sleep and help cut babies' night awakenings by half.

- CNA/yt

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Breast cancer is now top cancer-killer in Singapore
By Margaret Perry, Channel NewsAsia | Posted: 04 October 2008 2115 hrs


Breast cancer screening

SINGAPORE: Breast cancer has overtaken lung and colorectal cancers as the top cancer-killer in Singapore.

So this year's Breast Cancer Awareness Month hopes to encourage more women to go for screening.

Regular exercise and a healthy diet can help prevent breast cancer. But Singapore's increasingly affluent and sedentary lifestyle, plus more screening, has resulted in a 25 per cent increase in breast cancer cases over the past 10 years.

Previously, women died from breast cancer without being aware they had it.

Some 1,300 women are diagnosed with the disease every year, and 313 women die from breast cancer every year. Early detection saves lives, but only 41 per cent of women go for screening.

"Please get a mammogram. It's subsidised, it's available, it's accessible," urged Dr Vivian Balakrishnan, Minister for Community Development, Youth and Sports.

"I know it's not the most comfortable thing in life, but it makes a difference and it can save mums, it can save wives, it can save our sisters," he added.

Walks, talks and special offers for screening at hospitals are available during October for Breast Cancer Awareness Month.

Doctors recommend women aged between 40 and 49 to go for a mammogram once a year, and for women aged 50 to 69 to go for screening once every two years. This is the only way to bring down the death rate.

Subsidised mammograms are available throughout the year at all 15 polyclinics and on the mammogram bus.

A subsidised mammogram through the BreastScreen Singapore scheme costs S$50 for Singapore citizens and S$75 for Permanent Residents. A mammogram in a private hospital costs about S$110-S$150.

The number of women dying from breast cancer has remained stable over recent years, but the disease has become the top cancer-killer because death rates from lung and colorectal cancer have declined.

One of Singapore's grand old architectural dames is supporting the screening drive. The Arts House at Old Parliament is being lit up in pink over the next two weeks in support of breast cancer awareness and to remind women to go for mammograms.

- CNA/ir

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Spine under strain

Don't take that pain in the waist lightly. It could mean a slipped disc, which more Singaporeans are now prone to, said traditional Chinese medicine (TCM) practitioner Lim Choon Huat.

The chairman and founder of Chien Chi Tow Healthcare, a TCM health-care group, said a slipped disc is a painful condition in which one of the discs connecting the bones of the vertebral column - or spine - becomes displaced and presses on a nerve.

He cautioned against taking slight pain lightly as it could become a bigger problem. It is important to seek early treatment for a slipped disc or the nervous system may be affected, causing numbness and pain in the lower legs.

Incontinence - lack of bowel and urinary control - could occur too.

Chien Chi Tow offers three treatment options for slipped disc. The first is tui na (traditional Chinese massage), which relaxes the muscles around the affected area. Tui na applied to the affected joints around the area also reduces stiffness.

Next, the affected area is repeatedly massaged to encourage blood flow and improve circulation. Accupressure points will also be massaged to reduce pain.

In TCM practice, it is believed hundreds of accupressure points along specific interconnected channels, known as meridians, carry the body's vital energy or qi. Pain can be caused by blockage of qi and massaging the accupressure points will help to clear the blockage.

Mr Lim said he also stretches the muscles, especially those in the legs, as they are usually more stiff.

The third treatment option involves pinpointing the affected area in the vertebral column so that it can be realigned to its correct position. Protruding discs can cause pain in the feet and thighs too.

Recovery speed depends on how bad the problem is, age and posture habits.

Recommending these options as an alternative to surgery, he said: "We have patients who choose tui na over surgery. Some of them have been pain free for over 10 years."

For inquiries on TCM treatment at Chien Chi Tow, call 6293-3933.

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Health authorities monitoring botox use after deaths overseas
By Greta Georges, Channel NewsAsia | Posted: 12 October 2008 2325 hrs


botox treatment

SINGAPORE: There have been no local deaths associated with the use of botulinum toxin or botox, says Singapore's Health Sciences Authority.

Still, the agency is keeping a close watch for any severe reactions to the neurotoxin protein here.

This comes after watchdogs in Europe and the United States warned of dangerous side effects, including death.

A vial of about 100 units of botulinum toxin can be used to relax the spastic leg muscles of a child with cerebral palsy.

While Dr Ong Hian Tat said some young patients have stopped treatments since the warning from the US Food and Drug Administration, it generally has not affected the way he practises.

"What we have done is that we have re-explained to the parents again what the caution is all about, who these cases that had complications were - they were severe cases and non-ambulant - and the complications and general doses are much higher than what we have been using," said Dr Ong, a senior consultant paediatrician at NUH Children's Medical Institute.

In addition, Dr Ong now gives out a botox fact sheet to children's parents.

This describes the possible adverse side effects such as speech disorders, breathing problems and difficulties in swallowing or holding up the head.

He also records where the injection has been administered and parents are advised to seek immediate medical attention if any worrying symptoms occur.

Dr Ong pointed out that the complaints in the US were mainly severe cases of children suffering from cerebral palsy and were being treated for leg spasticity.

To treat a 15-kilogramme child with cerebral palsy for stiffness in the calf, a doctor would use one vial of botox of about 100 units.

However, if more sets of muscles need to be treated, doctors here would wait for three to six months to do the next injection, to avoid complications from a higher dose of botox in a single sitting.

In aesthetic procedures for adults, botox doses are small.

Only 12 units are used to treat frown lines, compared to about 100 for a young child's spastic leg muscle.

Dr Allan Kok, an aesthetic doctor, said: "Out of 17 million patients who have done botox since 2002....only 108 reported adverse effects and 16 deaths so far (according to the American Academy of facial aesthetics surgeons). And as far as the 16 deaths were concerned, all injected botox for medical reasons."

In the US, patients and their families have sued doctors and major botox-maker Allergan for allegedly causing them life-threatening injuries and deaths.

Dr Kok feels that while confidence in botox might have fallen in the US, it has not affected his practice here.

And that has not put Singapore patients off one bit.

Dr Kok is seeing more women asking for the procedure, with some returning for more.

- CNA/ir

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Get rid of toxins

>By Yam Cher Seng

TOXINS are poisonous substances that are chemically unstable in the body. They are an accumulation of normal body by-products that haven't been eliminated. We can divide toxins into two forms: endogenous and exogenous.

Endogenous toxins are waste products created in the process of normal body functions.

If they are not eliminated adequately, they will remain in the body. Uric acid, a by-product of protein metabolism, is one example.

Exogenous toxins are those that are not normally found in the body such as environmental pollutants (as in haze), food additives, chemicals, heavy metals and pesticides.
Body fat tends to be a storage depot for fat-soluble toxins.

You may consider the possibility of toxicity if you experience fatigue, swelling under the eyes and prostate gland, cysts, oedema, skin disorders, headache, joint pain, allergies, constipation and a coated tongue.

Organs of elimination are the liver, kidneys, large intestines and the skin. The main focus of natural detoxification involves the liver.

Herbalists the world over have held milk thistle in high regard for centuries. It is traditionally used for liver disorders.

This herb contains a group of silymarins, in which silybin is the most active.

Silybin exerts antioxidant and liver-protective properties and its bioavailability is five times higher than free silymarin.

Silybin has been found to stabilise cell membranes, thus preventing toxic chemicals from entering the cell and exporting toxins out of the cell before damage ensues.

It acts as a free radical scavenger and protects glutathione (a natural antioxidant enzyme) from being depleted.

Glutathione is responsible for detoxifying a wide range of chemicals. Increasing the glutathione content of the liver means the organ has an increased capacity for detoxification.

Silybin also increases the glutathione content of the liver by 35 per cent in healthy subjects and by over 50 per cent in experimental rats, and increases the level of the important antioxidant enzyme, superoxide dismutase, in cell cultures.

Perhaps the most interesting effect of milk thistle on the liver is its ability to stimulate protein synthesis. This results in an increase in the production of new liver cells to replace the damaged old ones.

Regular bowel movement is important to detoxify the body. Taking care of your diet is an important step in ensuring a healthy digestive system.

Increase your intake of vegetables and fruits. Many people find relief in merely reducing refined carbohydrates such as white flour, white sugar, white bread, noodles and white rice and increasing fibre intake.

According to the American Dietetic Association, we should take about 25 to 35 grammes of fibre daily.

It is beneficial in regulating bowel movements and adding bulk to the faeces.

Regular bowel movements are essential in aiding the body in eliminating toxins, and thus improve intestinal and liver health.

You may achieve this by consuming a variety of vegetables, fruits and whole grains.

Fresh fruits and vegetables have always been used by natural therapists to help cleanse and restore the body to good health.

Fresh juices have a distinct advantage over just plain water. Juices contain water, vitamins, minerals and other phyto-nutrients that cleanse, nurture and strengthen the body.

Best fruit juices include apple, grapefruit, grape, lemon, lime, papaya, pear, pineapple, strawberry and suitable vegetable juices are beetroot, carrot, celery, cucumber, gotu kola (pegaga) and watercress.

Maintaining a healthy lifestyle such as exercising regularly, avoiding both smoking and excessive alcohol consumption, and managing stress wisely are important in ensuring good liver health.

- The writer is a pharmacist who is actively involved in the dissemination of information on natural healthcare and holistic therapies. For more information, she can be contacted at csyam@streamyx.com

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Using Medisave abroad
By Salma Khalik, Health Correspondent & April Chong

SINGAPOREANS may be allowed to use their Medisave to pay for treatment overseas, but only if it is done through a local hospital.

Although the idea of using Medisave for foreign treatment has been raised before, this is the first time Health Minister Khaw Boon Wan has suggested how it might work.

He said: 'Hospitals here with branches or formal relationships with reputable hospitals in the region, may find it sensible to outsource some of their routine in-patient or day surgery services to the foreign hospitals, through referring some of their patients there for lower-cost elective surgery.'

Speaking at the Institution of Engineers' dinner and dance last night, he said such a move 'will give our patients more choices and also raise the competitive pressure on our hospitals here'.

'Both outcomes will benefit patients,' he said adding: 'Provided standard of care is comparable, should not the patients be offered such an option?'

If it comes to pass, private hospitals stand to benefit, as some already have branches abroad. The restructured hospitals would have to make formal arrangements with hospitals abroad if they want to do likewise for their patients.

A total knee replacement, for example, costs a private patient about $16,000 here, but about $10,000 at Gleneagles in Penang - including the cost of flying there.

But with Medisave now covering about $5,000 of the bill for a four-day hospital stay here, there is little difference in out-of-pocket expenditure. This changes if the same amount of Medisave is allowed for the surgery in Penang.

Mr Khaw told The Straits Times that he is even open to the idea of subsidised patients going abroad for treatment.

Going overseas can be inconvenient, he said, but patients can be encouraged to get routine things like X-rays done elsewhere 'provided standards are preserved and cost is lower'.

The Parkway Group, which has hospitals in Penang and Kuala Lumpur, was thrilled.

Its president of Singapore operations, Dr Goh Jin Hian, called it 'a fantastic opportunity for us all to examine the benefits medical tourism can provide'.

He said the group can help patients pick a suitable health facility 'with well respected, highly trained' doctors who have solid track records.

'We can ensure smooth sharing of medical information for post-procedure follow-up in Singapore,' he said.

The spokesman for Thomson Medical, on the other hand, feared the move would lead to an outflow of patients, countering Singapore's promotion as a medical hub.

The group's first foreign link will be the management of a hospital in Binh Duong province in Vietnam when it opens next year.

Of 13 people interviewed, most would take up the offer if they were assured of the quality of care overseas, coupled with substantial savings. Mr Jacky Kho, 40, who runs a printing business, said: 'I don't think I will go over unless the savings are really significant, at least a few thousand dollars.'

But teacher June Chiong, 55, was not tempted. 'I will worry about follow-ups, even if I can do them here,' she said, adding that it would be 'too troublesome', especially the return trip after surgery.

Several people also asked if they could draw on MediShield to cover part of their overseas treatment. Said Madam Ang Guat Hoh, 61, a clerk: 'I will only go for major surgery abroad if there's medical insurance for it.'

When this question was posed to the minister, he said it might not necessarily apply to MediShield, the national medical insurance paid for with Medisave.

'While one policy change may inspire another to also follow suit, it is something for the insurers to think about. We should not assume that one must automatically follow the other,' he said.

But he added: 'The underlying motivation to get value for money is common.'

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S$50m funding boost for dengue, diabetes research
By Hoe Yeen Nie, Channel NewsAsia | Posted: 19 October 2008 2200 hrs


A worker fumigates the drainage to prevent mosquitoes breeding

SINGAPORE: Research into dengue and diabetes will get a S$50 million boost in funding.

The next few years will also see the expansion of Singapore's clinical research infrastructure.

Dengue fever is a growing problem worldwide.

In Singapore, dengue outbreaks have become increasingly severe, despite mosquito control. The largest outbreak was in 2005, which saw 15,000 reported cases and 25 deaths.

With the new grant, researchers hope to build on current efforts to understand and better manage the disease, and in particular, how it affects adults.

Communicable Diseases Centre's clinical director, Professor Leo Yee Sin, said: "There are also many other countries beginning to see that the age group being infected with dengue is getting older. But somehow Singapore is moving ahead of them, we have much older individuals infected with dengue."

Another area of attention is diabetes.

Associate Professor Chong Yap Seng from the National University Hospital's Department of Obstetrics & Gynaecology, said: "Singaporeans seem to be getting diabetes at much lower levels of obesity.....that's something unusual about the Asian form of diabetes."

Professor Chong explained: "In America, the prevalence of diabetes is about 6%; in Singapore, it's 8%. But obesity is about 20%, 25% in the United States; in Singapore, it's only about 8%, 9%."

Studies have also shown that there are clear differences among ethnic groups that are not fully explained by genetics alone.

Yet, Professor Chong said that although the majority of diabetics in the world are Asian, much of the research is done in the West.

His team hopes to study how obesity, early childhood nutrition and genes affect the incidence of the disease in the region.

Research into dengue and diabetes will each receive S$25 million over five years, under a push (called the Biomedical Sciences Initiative) to bolster Singapore's capabilities in translational and clinical research.

The funding comes under the Translational and Clinical Research (TCR) Flagship Programme, which also supported studies into cancer, neurosciences and eye diseases.

According to an international panel of experts, as more countries embark on clinical research, it is necessary for countries like Singapore to find niche areas on which they can focus their resources.

"One of the things you have to do is to make sure that there is one or two, or a small number of areas in which you can support in a competitive way. That is, you can bring enough resources there, to make a big signal," said Dr Sydney Brenner from The Salk Institute for Biological Studies.

The next few years will also see the doubling of research space (and the hiring of up to 50% more research staff) at the Kent Ridge and Outram medical clusters.

There will also be a partnership with the United States' Duke University of Medicine to develop the Singapore Clinical Research Institute.

- CNA/ir