COVID-19 and Return-To-Work for the Construction Sector: Lessons From Singapore

Singapore’s construction sector employs more than 450,000 workers. During the height of the COVID-19 pandemic in Singapore from April to June 2020, migrant workers were disproportionately affected, including many working in the construction sector. Shared accommodation and construction worksites emerged as nexuses for COVID-19 transmission. Official government resources, including COVID-19 epidemiological data, 43 advisories and 19 circulars by Singapore’s Ministries of Health and Manpower, were reviewed over 8 month period from March to October 2020. From a peak COVID-19 incidence of 1,424.6/100,000 workers in May 2020, the incidence declined to 3.7/100,000 workers by October 2020. Multilevel safe management measures were implemented to enable the phased reopening of construction worksites from July 2020. Using the Swiss cheese risk management model, the authors described the various governmental, industry, supervisory and worker-specific interventions to prevent, detect and contain COVID-19 for safe resumption of work for the construction sector.

COVID-19 and Return-To-Work for the Construction Sector: Lessons From Singapore

Singapore’s construction sector employs more than 450,000 workers. During the height of the COVID-19 pandemic in Singapore from April to June 2020, migrant workers were disproportionately affected, including many working in the construction sector. Shared accommodation and construction worksites emerged as nexuses for COVID-19 transmission. Official government resources, including COVID-19 epidemiological data, 43 advisories and 19 circulars by Singapore’s Ministries of Health and Manpower, were reviewed over 8 month period from March to October 2020. From a peak COVID-19 incidence of 1,424.6/100,000 workers in May 2020, the incidence declined to 3.7/100,000 workers by October 2020. Multilevel safe management measures were implemented to enable the phased reopening of construction worksites from July 2020. Using the Swiss cheese risk management model, the authors described the various governmental, industry, supervisory and worker-specific interventions to prevent, detect and contain COVID-19 for safe resumption of work for the construction sector.

Occupationally Acquired Plasmodium knowlesi Malaria in Brunei Darussalam

Simian malaria is a zoonotic disease caused by Plasmodium knowlesi infection. The common natural reservoir of the parasite is the macaque monkey and the vector is the Anopheles mosquito. Human cases of P. knowlesi infection has been reported in all South East Asian countries in the last decade, and it is currently the most common type of malaria seen in Malaysia and Brunei. Between 2007–2017, 73 cases of P. knowlesi infection were notified and confirmed to the Ministry of Health in Brunei. Of these, 15 cases (21%) were documented as work-related, and 28 other cases (38%) were classified as probably related to work (due to incomplete history). The occupations of those with probable and confirmed work related infections were border patrol officers, Armed Forces and security personnel, Department of Forestry officers, boatmen and researchers. The remaining cases classified as most likely not related to work were possibly acquired via peri-domestic transmission. The risk of this zoonotic infection extends to tourists and overseas visitors who have to travel to the jungle in the course of their work. It can be minimised with the recommended use of prophylaxis for those going on duty into the jungles, application of mosquito/insect repellants, and use of repellant impregnated uniforms and bed nets in jungle camp sites.

Dietary Habits and Lifestyle Practices among University Students in Universiti Brunei Darussalam

Background: Young adults are at risk of developing obesity, especially when transitioninginto university life as they become responsible for their daily eating and lifestyles. This studyestimates the prevalence of overweight/obesity and explores the eating patterns and lifestylepractices of university students.Methods: A cross-sectional study was conducted at Universiti Brunei Darussalam (UBD).A total of 303 students participated. Data was collected from January to April 2016. Self-designedquestionnaires comprised questions pertaining to current weight, self-reported height data,information on eating habits, exercise and knowledge of the food pyramid. The collected datawere used to compare and contrast eating habits and lifestyle practices among overweight/obesestudents with those of non-overweight/obese students.Results: The prevalence of overweight/obesity was 28.8% (95% CI: 24.0%, 34.0%). Themajority ate regular daily meals, but more than half skipped breakfast. Frequent snacking, friedfood consumption at least three times per week and low intake of daily fruits and vegetableswere common. The frequency of visits to fast food restaurants was significantly higher in theoverweight/obese. 25.4% of the students exercised at least three times per week. Almost allstudents are aware of balanced nutrition and the food pyramid.Conclusions: Most university students had poor eating habits, although the majority hadgood nutrition knowledge. By way of recommendation, the university is encouraged to provide amulti-disciplinary team specialising in health promotion that includes nutrition and physicalactivity programmes to increase the awareness among the university students.

Salivary leptin concentrations in Bruneian secondary school children

Objective: To investigate the association between leptin levels and body mass index in Bruneian secondary school students. Methods: The body mass index of Bruneian secondary school students (aged 11-18 years) was determined before collecting their saliva using the passive drool technique. Salivary leptin concentration was determined by ELISA. Results: Correlation and partial correlation (controlled for age) analyses showed no significant differences between the levels of salivary leptin of normal weight and overweight students. Conclusions: No significant increase in the salivary leptin concentration was observed in overweight compared with normal weight Bruneian secondary school students.

Incidence of needlestick injuries among medical students after implementation of preventive training

<p><b>INTRODUCTION</b>Structured training for the prevention of needlestick injuries (NSIs) among medical students was implemented in Singapore in 1998. In this study, we determined the incidence of NSIs and the knowledge and practice of managing and reporting NSIs among first-year clinical students in a medical school in Singapore, as well as the adequacy of the training provided for these students, 14 years after preventive training was instituted.</p><p><b>METHODS</b>All third-year medical students (n = 257) from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore, who had completed their first clinical year posting were enrolled in this cross-sectional study. A self-administered questionnaire was answered by the students one month after completion of their last clinical posting. Students who repeated their first clinical year were excluded from the study.</p><p><b>RESULTS</b>237 students completed the questionnaire. However, 9 of these students were excluded because they repeated their first clinical year. The response rate was 91.9%. Although 8 (3.5%) students reported one NSI each, only 2 (25.0%) of these 8 students reported the incident to the relevant authority. Among the students surveyed, 65.8% reported using gloves at all times during venepuncture procedures, 48.7% felt that improvements could be made to the current reporting system and procedures, and 53.2% felt that the training provided before commencement of clinical posting could be enhanced.</p><p><b>CONCLUSION</b>There was a decrease in the incidence of NSIs among medical undergraduates in their first clinical year when compared to the incidences reported in earlier studies conducted in the same centre (35.1% in 1993 and 5.3% in 2004). The current reporting system could use a more user-friendly platform, and training on NSIs could be improved to focus more on real-life procedures and incident reporting.</p>

Socio-demographic and clinical profile of admissions to community hospitals in Singapore from 1996 to 2005: a descriptive study

<p><b>INTRODUCTION</b>Little data is available on community hospital admissions. We examined the differences between community hospitals and the annual trends in sociodemographic characteristics of all patient admissions in Singaporean community hospitals over a 10- year period from 1996 to 2005.</p><p><b>MATERIALS AND METHODS</b>Data were manually extracted from medical records of 4 community hospitals existent in Singapore from 1996 to 2005. Nineteen thousand and three hundred and sixty patient records were examined. Chisquare test was used for univariate analysis of categorical variables by type of community hospitals. For annual trends, test for linear by linear association was used. ANOVA was used to generate beta coefficients for continuous variables.</p><p><b>RESULTS</b>Mean age of all patient admissions has increased from 72.8 years in 1996 to 74.8 years in 2005. The majority was Chinese (88.4%), and female (58.1%) and admissions were mainly for rehabilitation (88.0%). Almost one third had foreign domestic workers as primary caregivers and most (73.5%) were discharged to their own home. There were significant differences in socio-demographic profile of admissions between hospitals with one hospital having more patients with poor social support. Over the 10-year period, the geometric mean length of stay decreased from 29.7 days (95% CI, 6.4 to 138.0) to 26.7 days (95% CI, 7.5 to 94.2), and both mean admission and discharge Barthel Index scores increased from 41.0 (SD = 24.9) and 51.8 (SD = 30.0), respectively in 1996 to 48.4 (SD = 24.5) and 64.2 (SD = 27.3) respectively in 2005.</p><p><b>CONCLUSION</b>There are significant differences in socio-demographic characteristics and clinical profile of admissions between various community hospitals and across time. Understanding these differences and trends in admission profiles may help in projecting future healthcare service needs.</p>

Approach to hand dermatitis in primary care

Hand dermatitis is commonly seen in primary care, although it is often underdiagnosed. Exogenous causes should always be considered and a detailed environmental and occupational history taken, especially in patients presenting in adulthood. Although not life-threatening, the condition may have significant impact on the patient's quality of life and employment. Refractory cases or those suspected to be due to exogenous workplace agents may need to be referred for further investigation. Hand dermatitis can be treated effectively using pharmacotherapy and prevented by minimising subsequent exposure to irritants and allergens. Occupational skin disorders, once diagnosed, should be notified to the relevant authorities, i.e. the Ministry of Manpower in Singapore.

Diabetes Management and Hypoglycemia in Safety Sensitive Jobs

The majority of people diagnosed with diabetes mellitus are in the working age group in developing countries. The interrelationship of diabetes and work, that is, diabetes affecting work and work affecting diabetes, becomes an important issue for these people. Therapeutic options for the diabetic worker have been developed, and currently include various insulins, insulin sensitizers and secretagogues, incretin mimetics and enhancers, and alpha glucosidase inhibitors. Hypoglycemia and hypoglycaemic unawareness are important and unwanted treatment side effects. The risk they pose with respect to cognitive impairment can have safety implications. The understanding of the therapeutic options in the management of diabetic workers, blood glucose awareness training, and self-monitoring blood glucose will help to mitigate this risk. Employment decisions must also take into account the extent to which the jobs performed by the worker are safety sensitive. A risk assessment matrix, based on the extent to which a job is considered safety sensitive and based on the severity of the hypoglycaemia, may assist in determining one's fitness to work. Support at the workplace, such as a provision of healthy food options and arrangements for affected workers will be helpful for such workers. Arrangements include permission to carry and consume emergency sugar, flexible meal times, self-monitoring blood glucose when required, storage/disposal facilities for medicine such as insulin and needles, time off for medical appointments, and structured self-help programs.

Diabetes Management and Hyperglycemia in Safety Sensitive Jobs

The chronic and acute effects of hyperglycemia affecting cognition and work are as important as those of hypoglycemia. Its impact, considering that majority of diabetic patients fail to reach therapeutic targets, would be potentially significant. Self monitoring of blood glucose, recognition of body cues and management interventions should be geared not only towards avoidance of disabling hypoglycemia, but also towards unwanted hyperglycemia. Over the long term, chronic hyperglycemia is a risk for cognitive decline. Acute episodes of hyperglycemia, above 15 mmol/L have also been shown to affect cognitive motor tasks. Maintaining blood sugar to avoid hyperglycemia in diabetic workers will help promote safety at work.

Preventive Measures to Eliminate Asbestos-Related Diseases in Singapore

The incidence of asbestos-related diseases (ARD) has increased in the last four decades. In view of the historical use of asbestos in Singapore since the country started banning it in phases in 1989 and the long latency of the disease, the incidence of ARD can be expected to increase further. As occupational exposure to asbestos still occurs, preventive measures to eliminate ARD continue to be required to protect the health of both workers and the public from asbestos exposure. The majority of occupational exposures to asbestos at present occur during the removal of old buildings. Preventive measures have been utilized by different government ministries and agencies in eliminating ARD in Singapore over the past 40 years. These measures have included the enforcement of legislation, substitution with safer materials, and engineering controls during asbestos removal as well as improvements in personal hygiene and the use of personal protective equipment. The existing Workman's Compensation System for ARD should be further refined, given that is currently stipulates that claims for asbestosis and malignant mesothelioma be made within 36 and 12 months after ceasing employment.

The doctor in claims for work injuries and ill health--legal pitfalls

Occupational health work is currently undertaken by the specialist and the non-specialist physician alike. The work scope can vary from medical assessments of individual workers to health risk assessment at the workplace. The scope of the latter will include evaluation of exposures, hazards, risks and its management to control these risks. Much of the case law governing legal disputes over industrial safety and health have involved the employers. Over the years, the actions brought forth by workers have resulted in a formidable volume of case law based on statutes and on the common law of negligence in tort. Disputes over the assessment of workers' health or workplace health risks to the extent that it is a failure to discharge a reasonable standard of care, may result in the doctor being a defendant. Measures to prevent these legal pitfalls include communication with employers about the causative link of the illness suffered to workplace factors and the clarity of contractual obligations undertaken with regard to workplace health risk assessment.

Concerns, perceived impact and preparedness in an avian influenza pandemic--a comparative study between healthcare workers in primary and tertiary care

<p><b>INTRODUCTION</b>With the potential threat of an avian influenza (AI) pandemic, healthcare workers (HCWs) are expected to play important roles, and they encounter significant stress levels from an expected increase in workload. We compared the concerns, perceived impact and preparedness for an AI pandemic between HCWs working in public primary care clinics and a tertiary healthcare setting.</p><p><b>MATERIALS AND METHODS</b>An anonymous, self-administered questionnaire was given to 2459 HCWs working at 18 public polyclinics (PCs) and a tertiary hospital (TH) in Singapore from March to June 2006. The questionnaire assessed work-related and non-work-related concerns, perceived impact on personal life and work as well as workplace preparedness.</p><p><b>RESULTS</b>We obtained responses from 986 PC and 873 TH HCWs (response rate: 74.6% and 76.7%). The majority in both groups were concerned about the high AI risk from their occupation (82.7%) and falling ill with AI (75.9%). 71.9% accepted the risk but 25.5% felt that they should not be looking after AI patients with 15.0% consider resigning. HCWs also felt that people would avoid them (63.5%) and their families (54.1%) during a pandemic. The majority expected an increased workload and to feel more stressed at work. For preparedness, 74.2% felt personally prepared and 83.7% felt that their workplaces were prepared for an outbreak. TH HCWs were more likely to be involved in infection-control activities but the perception of infection-control preparedness in both groups was high (>80.0%).</p><p><b>CONCLUSIONS</b>HCWs in both public primary and tertiary healthcare settings felt prepared, personally and in their workplaces, for a pandemic. Their main concerns were risks of falling ill from exposure and the possibility of social ostracism of themselves and their families. Preparedness levels appeared high in the majority of HCWs. However, concerns of HCWs could affect their overall effectiveness in a pandemic and should be addressed by incorporating strategies to manage them in pandemic planning.</p>

Bridging the gap between occupational medicine and family medicine

Family medicine and occupational medicine share close similarities in their focus on disease prevention and health promotion. The opportunities for mutual learning and collaboration in patient care abound, with far-reaching implications on the standard of patient care that can be offered. Unfortunately, a gap exists between family medicine and occupational medicine in dayto- day practice as well as in continuing medical education. It is important that we actively seek to bridge this gap. The workforce constitutes a significant part of the population and thus the patient load of a typical primary healthcare practice. Moreover, with an ageing population and rising retirement age, we can expect that there will be an increasing number of health issues to be addressed among older working people. Both occupational and non-occupational factors are important in determining an individual's health. Thus, family physicians need to adequately understand occupational medicine and vice versa.

Fitness to work: legal pitfalls

Medical examinations for fitness to work are undertaken by the specialist and the nonspecialist occupational physicians alike. An assessment done negligently in such a capacity will expose physicians to legal risks, even if they are not specialist occupational physicians. This is not unlike negligent care given in the traditional therapeutic care setting. Much of the case law governing legal disputes in medical fitness to work assessments depend on the kind of loss that is at stake, that is, whether it is one resulting in economic loss, as in loss of an employment opportunity, or one resulting in personal injury, such as when the doctor negligently fails to diagnose or to communicate a serious medical finding. In the latter, the courts are more likely to find for the injured claimants. One of the ways for doctors to reduce their risk in this area is to establish with prospective employers and employees the ground rules when conducting medical fitness to work examinations.

A cross-sectional study of primary-care physicians in Singapore on their concerns and preparedness for an avian influenza outbreak

<p><b>INTRODUCTION</b>During an avian influenza (AI) pandemic, primary-care physicians (PCPs) are expected to play key roles in the prevention and control of the disease. Different groups of PCPs could have different concerns and preparedness level. We assessed the concerns, perceived impact and preparedness for an outbreak among PCPs in Singapore.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional survey of PCPs working in private practice (n=200) and public clinics (n=205) from March to June 2006 with an anonymous self-administered questionnaire on concerns (12- items), perceived impact (10 items) and preparedness (10 items) for an outbreak.</p><p><b>RESULTS</b>Two hundred and eighty-five PCPs responded - 149 (response rate: 72.7%) public and 136 (response rate: 67.3%) private. The majority were concerned about risk to their health from their occupation (95.0%) and falling ill with AI (89.7%). Most (82.5%) accepted the risk and only 33 (11.8%) would consider stopping work. For perceived impact, most felt that people would avoid them (69.6%) and their families (54.1%). The majority (81.3%) expected an increased workload and feeling more stressed at work (86.9%). For preparedness, 78.7% felt personally prepared for an outbreak. Public PCPs were more likely to be involved in infection-control activities and felt that their workplaces were prepared.</p><p><b>CONCLUSIONS</b>Most PCPs felt personally prepared for an outbreak but were concerned about their exposure to AI and falling ill. Other concerns included social ostracism for themselves and their families. Public PCPs appeared to have a higher level of preparation. Addressing concerns and improving level of preparedness are crucial to strengthen the primary-care response for any AI outbreak.</p>

Predictors of vancomycin-resistant enterococcus (VRE) carriage in the first major VRE outbreak in Singapore

<p><b>INTRODUCTION</b>Until recently, vancomycin-resistant enterococcus (VRE) infection or colonisation was a rare occurrence in Singapore. The first major VRE outbreak involving a 1500-bed tertiary care institution in March 2005 presented major challenges in infection control and came at high costs. This study evaluates the predictors of VRE carriage based on patients' clinical and demographic profiles.</p><p><b>MATERIALS AND METHODS</b>Study patients were selected from the hospital inpatient census population during the VRE outbreak (aged 16 years or more). Clinical information from 84 cases and 377 controls were analysed.</p><p><b>RESULTS</b>Significant predictors of VRE carriage included: age>65 years Odds ratio (OR), 1.98; 95% CI (confidence interval), 1.14 to 3.43); female gender (OR, 2.15; 95% CI, 1.27 to 3.65); history of diabetes mellitus (OR, 1.94; 95% CI, 1.14 to 3.30), and staying in a crowded communal ward (OR, 2.75; 95% CI, 1.60 to 4.74). Each additional day of recent hospital stay also posed increased risk (OR, 1.03; 95% CI, 1.01 to 1.04).</p><p><b>CONCLUSION</b>Elderly diabetic females with prolonged hospitalisation in crowded communal wards formed the profile that significantly predicted VRE carriage in this major hospital-wide outbreak of VRE in Singapore. It is imperative that active VRE surveillance and appropriate infection control measures be maintained in these wards to prevent future VRE outbreaks.</p>

High coverage of influenza vaccination among healthcare workers can be achieved during heightened awareness of impending threat

<p><b>INTRODUCTION</b>As preparation against a possible avian flu pandemic, international and local health authorities have recommended seasonal influenza vaccination for all healthcare workers at geographical risk. This strategy not only reduces "background noise", but also chance of genetic shifts in avian influenza viruses when co-infection occurs. We evaluate the response of healthcare workers, stratified by professional groups, to a non-compulsory annual vaccination call, and make international comparisons with countries not at geographical risk.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional study was performed over the window period for vaccination for the 2004 to 2005 influenza season (northern hemisphere winter). The study population included all adult healthcare workers (aged < or =21 years) employed by a large acute care tertiary hospital.</p><p><b>RESULTS</b>The uptake rates among frontline caregivers--doctors >50%, nurses >65% and ancillary staff >70%--markedly exceeded many of our international counterparts results.</p><p><b>CONCLUSION</b>Given its close proximity in time and space to the avian flu pandemic threat, Singapore healthcare workers responded seriously and positively to calls for preventive measures. Other factors, such as the removal of financial, physical and mental barriers, may have played important facilitative roles as well.</p>