Upper Respiratory Tract Infection Trends in a Psychiatric Institute in Singapore.

OBJECTIVES: To compare the incidence of upper respiratory tract infection (URTI) between inpatients at the Institute of Mental Health in Singapore and the general population over 8 years to determine the effectiveness of our infection control strategies. METHODS: Data for cases of influenza and URTI at our institute between January 2012 and December 2019 were collected. National data were derived from weekly infectious disease bulletins that report daily averages of people attending polyclinics/surgeries with influenza and URTI. Interrupted time series analyses were used to determine the impact of infection prevention and control strategies on incidence. RESULTS: Over the 8 years, there were 1607 cases of URTI involving 182 clusters, equal to 3.16 cases per 10 000 patient-bed-days. 965 (60%) cases and 95 (52%) clusters occurred in long-stay wards, whereas 642 (40%) cases and 87 (48%) clusters occurred in acute wards. The median cluster size was 12 in the long-stay wards and 7 in the acute wards (p < 0.0001). The spikes in cases in June and December may be attributed to the increased staff and visitor mobility during school vacations in June and December. Strategies implemented during the study period did not significantly reduce the incidence of URTI. Previous strategies implemented in 2005 to meet accreditation standards are more likely to be contributors. CONCLUSION: Infection control strategies of our institute appear to be effective, because the incidence of URTI was lower in our institute than in the community. The similar incidence of URTI in acute and long-stay wards indicates that service-user turnover is not a contributor. Rather, staff and visitors are more likely to be the vector. The larger clusters in long-stay wards indicates a greater risk of transmission in such settings. Increased activity in our institute during school vacations may be associated with an increase in cases in June and December. It is difficult to determine if strategies implemented during the study period successfully reduce the incidence of URTI.

Omega-3 fatty acids in the management of autism spectrum disorders: findings from an open-label pilot study in Singapore.

The goal of this open-label trial was to examine the efficacy and safety of a 12-week omega-3 fatty acids supplementation among children suffering with Autism Spectrum Disorders (ASD). A total of 41 children and adolescents aged 7-18 years (36 boys, 5 girls; mean age = 11.66, s.d. = 3.05) diagnosed with ASD participated in the study. At post-treatment, participants showed significant improvements on all subscales of the Social Responsiveness Scale (P < 0.01) and the Social and Attention Problems syndrome scales of the Child Behavior Checklist (P < 0.05). Blood fatty acid levels were significantly correlated with changes in the core symptoms of ASD. Baseline levels of blood fatty acid levels were also predictive of response to the omega-3 treatment. Omega-3 fatty acids supplementation was well-tolerated and did not cause any serious side effects. Our findings lend some preliminary support for the use of omega-3 fatty acids supplementation in addressing ASD. Future randomized controlled trials of omega-3 fatty acids in ASD with blood fatty acid measurements with a larger sample and longer follow-up period is warranted.

Effects of cognitive-behavioural therapy on anxiety for children with high-functioning autistic spectrum disorders.

INTRODUCTION: Children with autistic spectrum disorders (ASD) often exhibit one or more comorbid disorders, including anxiety, disruptive behaviour, mental retardation, and depression. Various studies have documented the effectiveness of cognitive-behavioural therapy (CBT) in treating children with anxiety. Although studies have indicated a high prevalence of anxiety in individuals with ASD, there is a lack of systematic studies substantiating the effectiveness of cognitive-behavioural interventions among children with high-functioning autism. METHODS: This pilot study investigated the effects of a 16-session CBT programme on six high-functioning children diagnosed with ASD (mean age 11.50 years, standard deviation 0.84 years). These children were diagnosed with ASD or Asperger's syndrome by the DSM-IV criteria. Measures on levels of child's anxiety, parental and teacher stress were administered at pre- and post-treatment. RESULTS: Children showed lower levels of anxiety at post-treatment. Parents and teachers also reported lower levels of stress following the CBT programme. CONCLUSION: Findings from the present study provided some evidence of the effects of CBT for high-functioning autistic children in reducing anxiety, parental and teacher stress. Interpretation of the findings, recommendations for future research and implications of the present study are presented.

Emotional and behavioural problems in Singaporean children based on parent, teacher and child reports.

INTRODUCTION: This study aims to determine the prevalence of emotional and behavioural problems in a community sample of Singaporean children aged 6-12 years, and its agreement according to parent, teacher and child reports. METHODS: The Child Behaviour Checklist (CBCL), Teacher Rating Form (TRF) and child report questionnaires for depression and anxiety were administered to a community sample of primary school children. 60 percent of the children sampled (n = 2,139) agreed to participate. Parents of a sub-sample of 203 children underwent a structured clinical interview. RESULTS: Higher prevalence of emotional and behavioural problems was identified by CBCL (12.5 percent) than by TRF (2.5 percent). According to parent reports, higher rates of internalising problems (12.2 percent) compared to externalising problems (4.9 percent), were found. Parent-teacher agreement was higher for externalising problems than for internalising problems. Correlations between child-reported depression and anxiety, and parent and teacher reports were low to moderate, but were better for parent reports than for teacher reports. CONCLUSION: The prevalence rates of emotional and behavioural problems in Singaporean children based on CBCL ratings are comparable to those in the West, but the low response rate and exclusion of children with special needs limit the generalisability of our findings. Singaporean children have higher rates of internalising problems compared to externalising problems, while Western children have higher rates of externalising problems compared to internalising problems.

Five-year review of adolescent mental health usage in Singapore.

INTRODUCTION: To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. MATERIALS AND METHODS: Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. RESULTS: Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. CONCLUSIONS: There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.

A clinical study of seven cases of trichotillomania in Singapore.

The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a descriptive, retrospective study of all cases of trichotillomania presenting to the clinic between January 1996 and January 1998. There were 7 cases seen in a 2-year period which is less than 1% of new cases seen at the clinic. The female to male ratio was 1.33:1 with a mean age of 9.3 years. All cases met the DSM-IV criteria for trichotillomania. All 6 pulled their hair in tufts with 1 who was almost hairless. Associated problems included tics, nail-biting, anxiety and shortness of temper. Treatments included behavioural treatment, stress management, parental education and counselling as well as medications. Two improved and were discharged, with 3 still undergoing treatment and 2 defaulted follow-up. The 7 cases seen in Singapore are similar in clinical features to cases found overseas. A behavioural approach with reduction of environmental stress is most effective. Drugs were less effective. More systematic studies need to be done.

A clinical study of 100 new admissions to an adolescent psychiatric inpatient unit in Singapore.

BACKGROUND: Psychiatric inpatient services for children and adolescents in Singapore began in 1982 when Woodbridge Hospital started the Child and Adolescent Inpatient Unit. To date, this is the only unit with specialised facilities and staff in the management of young patients. Admissions were mainly based on a need for custodial management of acute major behavioural disturbances. Patients were discharged for outpatient treatment once these behaviours subsided. METHODS: This is a retrospective clinical study of 100 consecutive new patients admitted from April 1993 to August 1994. RESULTS: Majority of admissions (92%) were adolescents above age 12, who were either attending secondary or vocational school. Most came from nuclear families. Forty-eight percent of referrals were intradepartmental. Ten percent were from general hospitals with 16% as self referrals. Psychoses accounted for the diagnosis in 43%, schizophrenia being the main type. Neurosis and adjustment disorders formed the other main diagnoses. All patients received individual and family treatment. Liaison with schools was required in a third of the cases. Sixty-one percent received pharmacological treatment. Ninety-one percent were discharged home after a stay of less than 3 months. Majority returned to school upon discharge from the hospital. CONCLUSION: The main criteria for admission in this unit, located in an adult psychiatric hospital, is that of custody of young patients with disturbed and unmanageable behaviour. This provides additional stigma for the admissions of young patients with minor psychiatric problems and interferes with comprehensive care including admission required for some adolescents with psychiatric problems.

Dental caries status of preschool children in Hong Kong.

OBJECTIVE: To describe the dental caries status of preschool children in Hong Kong and factors which affect their caries status. DESIGN: 658 preschool children aged 4 to 6 years from six randomly selected kindergartens in Hong Kong were surveyed in December 1997. A questionnaire to investigate possible explanatory variables for caries status was completed by their parents. Dental caries was diagnosed according to the criteria recommended by the World Health Organization (1997). RESULT: Caries experience as measured by the mean number of decayed, missing and filled primary teeth (dmft) of the 4-, 5-, and 6-year-old children were found to be 0.9, 1.8, and 3.3 respectively. Overall, 61% of the children had a zero dmft score. Children born in Mainland China had a higher mean dmft score (4.6) than those born in Hong Kong (1.4). Statistically significant correlations were found between the children's dental caries status and their oral health practices as well as their socio-economic background. Parents' education level, dental knowledge and attitudes were also associated with the children's dental caries experience. CONCLUSION: In general, the caries status of Hong Kong Chinese preschool children was similar to that of children in industrialised countries and was better than that of children in the nearby areas. However, special dental programmes should be made available to children from lower socio-economic classes and new immigrants from Mainland China because they are the high risk groups for caries in Hong Kong.

Doctors' and lawyers' perspectives of child abuse and neglect in Singapore.

AIM OF STUDY: To investigate the Singaporean doctor's and lawyer's definition of child abuse and neglect, their attitudes towards reporting and their manner of handling suspected cases. METHODS: A self-addressed questionnaire survey was carried out in a population of hospital doctors, family physicians and lawyers. A total of 368 respondents participated in the survey. RESULTS: Most respondents had similar parenting attitudes. The majority felt that child abuse occurred sporadically but 25% of family physicians felt it seldom occurred. Thirty-eight per cent of family physicians had a personal definition of child abuse compared to less than a third of hospital doctors. There was a high consensus among all 3 groups concerning 21 behaviours studied. In all 3 groups, more than 80% agreed that having sex, burning child, tying child and not protecting the child from sexual advances were both unacceptable and abusive. More than 80% of respondents felt that some form of compulsory reporting is necessary in Singapore. Doctors preferred to refer cases of physical abuse to the hospital while lawyers preferred the police. All agreed that sexual abuse is a matter for the police. Respondents were more likely to act in cases of physical abuse and sexual abuse than for cases of emotional abuse and neglect. CONCLUSIONS: There is a need to formalise definitions of child abuse in our society. More education and training in the understanding and handling of child abuse by doctors and lawyers may be necessary.

Dental hygienists in Hong Kong: present and future status.

PURPOSE: This study assessed the current employment status of dental hygienists practicing in Hong Kong, investigated factors affecting their employment, evaluated the satisfaction of local dental hygienists and their employers, and explored the career prospects of dental hygienists in Hong Kong. METHODS: All registered dental hygienists (n = 64), all dentists who employed dental hygienists (n = 25), and a systematic sample of dentists who did not employ dental hygienists (n = 278) were surveyed in June 1994 concerning employment situation, salaries, job satisfaction, and opinions on future prospects for dental hygienists. RESULTS: Response rates were 86% for dental hygienists (n = 55), 88% for employers (n = 22), and 63% for dentists at large (n = 175). Among the dental hygienists, 87% still were employed as dental hygienists, and both the dental hygienists and their employers agreed that the employment situation was satisfactory; however, several dental hygienists were considered to be working below their level of qualification. Major reasons for dentists not to employ a dental hygienist were having only one operatory and having an inadequate number of patients. In general, employers expressed satisfaction with the performance of the dental hygienists. Major reasons for employing a dental hygienist were that a dental hygienist would add professional and economical benefit to their clinic. Few dentists would support expanded duties for dental hygienists. CONCLUSIONS: In Hong Kong, dental hygienists and their employers comprise a small group with limited impact on oral healthcare services. Dental hygienists' perceptions of their future roles and ambitions are higher than those of their employers. To further the development of dental services in Hong Kong and meet documented oral healthcare needs in the population, greater utilization of dental hygienists should be promoted.