Economic burden of Parkinson's disease in Singapore

BACKGROUND

This study was carried out to evaluate the economic burden of Parkinson's disease (PD) and factors independently associated with individual components of total cost in Singapore.

METHODS

A consecutive sample of 195 patients with PD (mean age: 68.2, men: 51.8%) attending a tertiary neuroscience clinic were identified and interviewed using standardized questionnaires including a financial burden questionnaire, two Health Related Quality of Life (HRQoL) questionnaires and the Beck Depression Inventory questionnaire.

RESULTS

Annual total cost of PD from a societal perspective was SGD11345 (USD10129) per patient, with direct cost accounted for 38.5% and indirect cost 61.5%. The main cost components for direct medical cost, direct non-medical cost, and indirect cost was pharmacotherapy (50.4%), home care (76.1%), and productivity loss (97.9%), respectively. In multiple linear regression analysis, higher education, younger age and longer duration of PD were associated with higher total cost.

CONCLUSIONS

Parkinson's disease exerts a considerable burden on patients, health care system and society in Singapore. As productivity loss accounts for a large share of the economic burden imposed by PD, treatments and health care programmes with potential for returning patients to higher productivity are urgently needed.

First Report of Neofusicoccum parvum Causing Dieback Disease of Chinese Weeping Cypress in China

Cupressus funebris Endl. (Chinese weeping cypress) is native to southwestern and central China. In June 2008, blighted shoots of Chinese weeping cypress trees were observed in Yunnan Province (southwestern China). Symptomatic trees were located in an ornamental planting established approximately 8 to 12 years ago. Additional samples were collected from 11 locations in the provinces of Sichuan, Yunnan, Guizhou, and Chongqing. Disease symptoms included yellowing and wilting of leaves on several branches, followed by sudden death within 6 to 8 weeks. Cross sections on trunks and branches revealed darkened zones. Tissue from diseased samples was plated on potato dextrose agar (PDA) and incubated at 25°C. Fungal isolates developed copious, white, aerial mycelium that became dark gray after 4 to 6 days and formed black pycnidia after 25 days. Conidia were hyaline, ellipsoidal to fusiform, externally smooth, thin walled, nonseptate, and measured 12.5 to 18.5 × 4.0 to 6.5 μm. Identity was confirmed by analysis of the rDNA internal transcribed spacer region (ITSI-5.8S-ITS2) and the translation elongation factor 1-alpha (EF1-α). BLAST searches at GenBank showed a high identity with reference sequences (ITS: >99%; EF1-α: 100%). Representative sequences of both regions were deposited in GenBank (ITS: Accession No. FJ842960 and FJ842961; EF1-α: Accession No. GU811148). Morphological and molecular results confirmed this species as Neofusicoccum parvum, reported as the anamorph of Botryosphaeria parva. Pathogenicity tests were conducted by stem inoculation of 2-year-old C. funebris seedlings. Mycelial plugs (4 mm in diameter) of N. parvum from actively growing colonies were applied to same-size bark wounds on the middle point of the stems. Control seedlings were inoculated with sterile PDA plugs. Inoculated and control seedlings (five each) were kept in a greenhouse and watered as needed. After 5 weeks, all C. funebris seedlings showed leaf wilting and dark vascular stem tissue. N. parvum was reisolated from all inoculated, symptomatic tissues, fulfilling Koch's postulates; no symptoms were visible in the control seedlings. N. parvum has previously been reported to cause canker and dieback disease of avocado (3), mango (2), and magenta cherry (Syzygium paniculatum) (1). To our knowledge, this is the first report of N. parvum causing dieback of C. funebris in China. References: (1) R. C. Ploetz et al. Plant Pathol. 58:801, 2009. (2) B. Slippers et al. Mycologia 97:99, 2005. (3) T. Zea-Bonilla et al. Plant Dis. 91:1052, 2007.

Cultural adaptation and validation of a questionnaire for use in hepatitis B patients

Health-related quality of life (HRQoL) is an important aspect of the overall management of hepatitis B virus (HBV) infection. The major challenge is to find a valid and reliable disease-specific HRQoL instrument designed specifically for measuring health status in hepatitis B patient. Consequently, this study was undertaken to adapt culturally the Hepatitis Quality of Life Questionnaire (HQLQ) and assess its suitability for use in English-speaking hepatitis B virus-infected (HBV) patients in Singapore. Two patient focus groups were conducted to facilitate the cultural adaptation of the HQLQ. Reliability was assessed using Cronbach's alpha coefficients and intraclass correlation coefficients. Item-to-scale correlation was assessed using Spearman's rank correlations (rho) between scale scores and their constituent items. Convergent and divergent construct validities were tested in three and two a priori hypotheses, respectively, and the correlations were assessed using Spearman's rank correlation coefficients (rho). The culturally adapted questionnaire was tested in 298 HBV patients. The test-retest reliability was supported with 10 of the 12 scales showing acceptable correlation coefficients (i.e. alpha>0.7). Item-to-scale correlations were good with most items highly correlated with their hypothesized scales. Convergent and divergent construct validities were supported by the presence of hypothesized correlations between the HQLQ and the EQ-5D domains (eight of 10 sub-hypotheses for convergent construct validity and all hypotheses for divergent construct validity were fulfilled). In conclusion, our results showed that the culturally adapted HQLQ has good validity and reliability, making it a potentially useful outcome measure in the evaluation of HBV patients in Singapore.

How big is the financial burden of hepatitis B to society? A cost-of-illness study of hepatitis B infection in Singapore

Hepatitis B virus (HBV) infection is the most common cause of chronic viral liver disease in Singapore. Nevertheless, very little data exist on the financial burden of HBV infection to the society as a whole. The aim of this study was therefore to assess the direct and indirect cost of HBV infection in a cost-of-illness analysis. The combined data from the direct and indirect cost with the estimated prevalence for different disease stages of HBV infection would represent the annual financial burden of HBV infection to the Singaporean society as a whole. The estimated total annual cost of chronic HBV infection and its associated complications in Singapore was US$279 million (range US$34-941 million when allowing various assumptions as tested by the sensitivity analyses), with 58% or US$161 million attributable to direct cost. Based on the base-case estimation, total direct cost alone is equivalent to 12% of the national healthcare expenditure for 2003. The total cost incurred by chronic hepatitis B patients represents the biggest cost component, followed by decompensated cirrhosis (DC) patients. The ratio of direct to indirect costs based on the base-case estimation increased with disease severity, with the highest ratio obtained for the post-liver transplants (40.2:1), followed by hepatocellular carcinoma (7.4:1) and DC patients (2.7:1). The results of this study suggest that the management of HBV infection poses more than a medical challenge as it is a sizeable economic burden from both the payer and societal perspectives.

Ultrasonography is a sensitive tool for monitoring localized scleroderma

OBJECTIVE

To examine the usefulness of ultrasonography (USG) for monitoring paediatric localized scleroderma (LS).

METHODS

A retrospective chart review of six paediatric patients who had USG of their LS.

RESULTS

USG detected several abnormalities in active lesions including increased blood flow, increased echogenicity and loss of subcutaneous fat. USG findings corresponded with clinical assessment, and documented regeneration of subcutaneous fat and reduction in lesion size during treatment. In one patient, USG was more sensitive than magnetic resonance evaluation.

CONCLUSION

USG was found to be a sensitive tool for assessing the activity and extent of LS lesions in paediatric patients. Further studies are needed to assess its general applicability for monitoring these patients.

Meaning of health-related quality of life among children and adolescents in an Asian country: a focus group approach

AIMS

We aimed to evaluate the extent to which HRQoL instruments developed based on the Western notion of health is applicable to Asian children and adolescents by assessing their conceptualization of QoL. A secondary objective is to evaluate the necessity of developing age- or gender-specific HRQoL instruments.

METHODS

We explored the meaning of general and health-related QoL through focus group discussions in Singapore, a multi-ethnic Asian society. Two investigators independently analysed the data. They extracted major and sub-themes related to both general and health-related QoL. The agreement between the analyses was compared and disagreement was resolved through discussion.

RESULTS

Thirty-two subjects (children: 50.0%, female: 50.0%) participated. There were few disagreements. Meanings of general and health-related QoL could be grouped under three broad themes: (1) physical, (2) psychological and (3) social health, consistent with the current definition of HRQoL. We found that Singaporean and Western children/adolescents share a remarkably similar notion of general and health-related QoL. Compared to adolescents, children were more likely to report positive emotions, be less mindful of others' opinions and had less varied social activities.

CONCLUSION

The results suggest that currently available instruments are potentially useful for Singaporean children/adolescents. We also found that age-specific HRQoL instruments are necessary.

Suspended aggregates as an immobilization mode for high-density perfusion culture of HEK 293 cells in a stirred tank bioreactor

Cells of the human embryonic kidney cell line (HEK 293) grown in repeated suspension and perfusion systems were characterized and described. Cell aggregates that formed immediately after the HEK 293 cells were inoculated in stirred vessels in serum-containing Dulbecco's modified Eagle's medium (D-MEM)/F-12 medium. The mean diameter of the cell aggregates reflecting the aggregate size increased with culture time, shifting from 63 to 239 mum after 1 and 8 days of culture in spinner flasks, respectively. No significant differences in cell performance were observed between HEK 293 cell populations grown as suspended aggregates and those grown as anchored monolayers. Replacing the D-MEM/F-12 with CD 293 medium caused the compact spherical cell aggregates to dissociate into single cells and small irregular aggregates without any apparent effect on cell performance. Moreover, the spherical cell aggregates could reform from individual cells and small aggregates when exposed to the serum-containing D-MEM/F-12 dominant medium. Perfusion culture of HEK 293 cells grown as suspended aggregates in a 7.5-l stirred tank bioreactor for 17 days resulted in a maximum viable cell density of 1.2 x 10(7) cells ml(-1). These results demonstrate the feasibility and proof-of-concept for using aggregates as an immobilization system in large-scale stirred bioreactors because a small-scale culture can be used as easily as the inoculum for larger bioreactors.

Are they being used safely? A retrospective cross-sectional tertiary health care survey of selective serotonin reuptake inhibitors prescribing practice in Singapore

OBJECTIVES

To determine the prescribing pattern of the SSRIs and to evaluate the safety of current utilization of SSRIs associated with concomitant psychotropic medications in Singapore.

METHODS

The average prescribed daily dose (PDD) for each SSRI was calculated and compared with the defined daily dose (DDD). Pearson's chi2 test, one-way analysis of covariance (ANCOVA) and multinomial logistic regression were performed to examine the impacts of variables such as age, gender, patient type and concomitant psychotropic medications on the utilization of SSRIs. Safety issues were discussed by examining the potential metabolic drug interactions between the SSRIs and concomitant psychotropic medications.

RESULTS

The most frequently prescribed SSRI was fluoxetine and the PDDs were slightly more than the DDDs for all these SSRIs except fluvoxamine. The SSRIs were mainly prescribed to the patients who were younger, female and outpatients. Psychotropics were more likely concomitantly used with fluvoxamine, sertraline and paroxetine, relative to fluoxetine.

CONCLUSION

The prescribing pattern of SSRIs in a tertiary health center in Singapore is generally consistent with the accepted practices, although some safety concerns in terms of metabolic drug interactions were raised. This study provides useful baseline information for further in-depth studies for SSRIs usage both locally and for international comparison.

Advice-giving on self-medication: perspectives of community pharmacists and consumers in Singapore

BACKGROUND

In Singapore, community pharmacists provide an advice-giving service to consumers who seek self-medication for minor ailments management. This service has not been studied formally from the perspectives of pharmacists and consumers.

OBJECTIVES

The study aimed to identify (i) the approach taken by pharmacists in providing advice for self-medication and (ii) consumers' behaviour in self-treatment and their perception of the advice-giving role of the community pharmacist.

METHOD

The pharmacists and consumers were surveyed independently using two structured questionnaires.

RESULTS AND DISCUSSION

All community pharmacists who participated in the survey were confident in providing advice on self-medication. However, none of them recorded the consultations and only 17.5% of them had documented their general physician referrals. Most consumers (66.3%) would self-medicate and only consult a professional when the desired outcome was not achieved. Less than 10% of consumers would approach the pharmacists as the first option for advice. More than half of the pharmacists felt that the advice they rendered deserved a fee whereas only 28.4% of the consumers were willing to pay. Both parties thought the fee should not be more than S5 dollars (US3 dollars).

CONCLUSION

Generally, there is congruence in the perspectives on self-medication between the advice-giving pharmacist and the consumer. The consumers still lack awareness that pharmacists can help them to self-medicate more safely and effectively. Therefore, more effort in public education is warranted. The current state of poor documentation of the advisory function of community pharmacists should be improved.

Validation of the English version of the KINDL generic children's health-related quality of life instrument for an Asian population--results from a pilot test

OBJECTIVES

To evaluate the psychometric properties of the KINDL questionnaire in an Asian population.

METHODS

Consecutive patients with diabetes mellitus (DM) and healthy subjects were recruited to complete the English KINDL questionnaire. The inclusion criteria for patients were age 8-16 years, English-speaking, diagnosed with DM and absence of co-morbid conditions.

RESULTS

Thirty children with DM (mean age: 10.7 +/- 1.35 years; 11 M) and 39 healthy subjects (mean age: 10.6 +/- 1.23 years, 17M) completed the child version whereas 31 adolescents with DM (mean age: 14.5 +/- 1.48 years; 15M) and 32 healthy subjects (mean age: 14.3 +/- 0.87 years, 16M) completed the adolescent version. Overall, children with DM reported better HRQoL than healthy children. Although this appeared counter-intuitive, several explanations are possible: (1) the development of resilience to the disease over time, (2) our subjects are well-managed, (3) response shift, (4) the provision of high quality medical care, (5) compared to normal children, diabetic subjects and their family pay greater attention to health issues. The reliability coefficients were (overall, scales): KINDL-Kid DM (0.79, 0.44-0.65), KINDL-Kid Healthy (0.71,0.60-0.80), KINDL-Kiddo DM (0.77, 0.37-0.74) and KINDL-Kiddo Healthy (0.84, 0.21-0.79).

CONCLUSIONS

The KINDL questionnaire appeared promising for use in Asian children. However, further validation in a sample more representative of the general population is required.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-c30): validation of English version in Singapore

OBJECTIVE

This study aimed to validate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, English version 3.0) in Singaporean cancer patients.

METHODS

In a cross-sectional study, a heterogeneous sample of cancer patients (n = 57) self-administered a questionnaire containing the QLQ-C30, the Short Form 36 Health Survey (SF-36) and assessing health and sociodemographic status. Construct validity was assessed by testing a priori hypotheses that QLQ-C30 scales would be moderately or strongly correlated with SF-36 scales measuring similar dimensions of health-related quality of life (HRQoL) and that subjects reporting mild symptoms would have better HRQoL scores than those reporting severe symptoms. Internal consistency reliability was assessed using Cronbach's alpha.

RESULTS

Strength of Spearman's correlations between the QLQ-C30 and SF-36 scales assessing similar dimensions of HRQoL ranged from 0.35 to 0.67. Subjects with mild symptoms had better scores than those with severe symptoms for all six QLQ-C30 HRQoL scales (p < 0.05 for five scales, Mann-Whitney U tests). Cronbach's alpha ranged from 0.19 for the cognitive functioning scale to 0.91 for the global QoL scale.

CONCLUSION

This study provides preliminary evidence for the validity and reliability of the EORTC QLQ-C30 in English-speaking Singaporean cancer patients.

An evaluation of antimicrobial prophylaxis in paediatric surgery and its financial implication

OBJECTIVE

To assess the appropriateness of use of antimicrobial prophylaxis in paediatric surgery in Singapore.

METHODS

A prospective evaluation of the use of antimicrobial prophylaxis in paediatric patients undergoing surgery in KK Hospital, Singapore was carried out from September and December 2001. Process measures for the study included adherence to local or international guidelines, choice and dose of antimicrobial agent and timing and duration of prophylaxis. Outcome measures included surgical site and other related infections. A cost analysis was also performed to look at the extra expenditure due to any excessive use of antimicrobials.

RESULTS

A total of 171 patients with a mean age of 5.7 years (SD=4.5) were included in the study. Among the 117 (68.4%) elective and 54 (31.6%) emergency procedures, 22 cases (12.8%) were fully compliant with the guidelines. The most frequently encountered non-compliance types were unnecessary prolongation of prophylaxis (54.4%), inappropriate choice of antibiotics (42.7%) and overdose of antibiotics (26.3%). The estimated extra cost to patients for the study period was Sing$13,879.41 (US 8164.36).

CONCLUSION

The results showed a significantly high level of inappropriate use of antimicrobial prophylaxis in paediatric surgery in Singapore. However, when the individual factors such as appropriate choice of antibiotics, appropriate timing and duration were considered, the situation was very similar to the results obtained from overseas studies.

Amylopectinosis disease isolated to the heart with normal glycogen branching enzyme activity and gene sequence

We report a 17-month-old female patient with a rare cause of cardiomyopathy secondary to accumulation of amylopectin-like material (fibrillar glycogen) isolated to the heart. Evidence of amylopectinosis isolated to cardiac myocytes in this patient was demonstrated by histology and electron microscopy. Glycogen content, glycogen branching enzyme (GBE) activity, as well as phosphofructokinase enzyme activities measured in liver, skeletal muscle, fibroblasts and ex-transplanted heart tissue were all in the normal to lower normal ranges. Normal skeletal muscle and liver tissue histology and GBE activity, normal GBE activity in skin fibroblasts, plus normal GBE gene sequence in this patient exclude the classical branching enzyme deficiency (type IV GSD). We believe that this is an as yet uncharacterized and novel phenotype of GSD associated with cardiomyopathy, in which there is an imbalance in the regulation of glycogen metabolism limited to the heart.

Validity and reliability of the Chinese (Singapore) version of the Parkinson’s Disease Questionnaire (PDQ-39)

OBJECTIVE

The purpose of the study was to validate the Chinese (Singapore) version of the Parkinson's Disease Questionnaire (PDQ-39CSV) and its briefer version (PDQ-8CSV).

METHODS

A convenience sample of Chinese-speaking Singaporeans with Parkinson's disease (PD) (n = 63) completed a questionnaire containing the PDQ-39CSV and the Chinese (Singapore) EQ-5D. A subgroup also participated in a retest and/or a focus group discussion. A priori hypotheses were tested by examining correlations between PDQ-39CSV, PDQ-8CSV and EQ-5D scores and using principal component factor analysis. Reliability was assessed using Cronbach's alpha and intra-class correlation coefficients (ICC).

RESULTS

Thirty-two PDQ-39CSV items correlated satisfactorily with their hypothesized dimensions (Spearman's p > or = 0.4). Factor analysis yielded a component on which all 8 PDQ-39CSV dimensions were substantially loaded (loading range: 0.53-0.89). As hypothesized, the PDQ-39CSV and PDQ-8CSV summary indices were highly correlated (Pearson's r:0.95, ICC:0.94); correlations between related PDQ and EQ-5D scores were generally strong (Spearman's p: 0.38-0.76, p < 0.001 for all). Cronbach's alpha values ranged from 0.64 to 0.90 and ICC values from 0.66 to 0.86.

CONCLUSION

This study provides preliminary evidence supporting validity and reliability of both the PDQ-39CSV and its briefer version.

A retrospective drug utilization evaluation of vancomycin usage in paediatric patients

OBJECTIVE

To evaluate the appropriateness of use of vancomycin in paediatric patients at KK Women's and Children's Hospital, the major paediatric hospital in Singapore to identify potential problems in prescribing practices that may necessitate intervention to optimize vancomycin usage.

METHODS

A retrospective drug utilization evaluation was performed for paediatric patients who received intravenous vancomycin from 1 June 1998 to 31 June 1999. The outcome measures were consistency of vancomycin indication with recommended guidelines, dosing regimens, microbiological data, monitoring of serum drug levels, renal function, clinical outcomes and adverse drug reactions (ADRs).

RESULTS

A total of 96 cases was available for evaluation. Sixty-two (64.6%) courses of vancomycin were consistent with guidelines for indication of therapy. Eighty-six (89.6%) of the dosing regimen were consistent. All infusion times that were recorded (56.3%) were consistent with criteria. Of the patients treated with vancomycin for more than 1 day, peak and/or trough serum vancomycin levels were ordered for 70 cases. Of the 56 cases with paired levels ordered, 46 cases had at least one level that fell outside the therapeutic range. Nineteen (19.8%) cases of ADRs were documented. Fifty-eight (60.4%) cases received concurrent nephrotoxic drugs. However, a substantial portion of vancomycin courses were apparently not prescribed for appropriate indications, and there was poor recording of vancomycin administration information and sampling time.

CONCLUSION

The majority of dosing regimens of vancomycin was consistent with guideline criteria. The most evident problem was the sub-optimal use of the monitoring of vancomycin serum levels. The information derived from this study may be used as a for further study and for the development of strategies for optimize vancomycin usage.

Imaging cells and tissues with refractive index radiology

Can individual cells, including live cells, be imaged using hard x rays? Common wisdom until now required sophisticated staining techniques for this task. We show instead that individual cells and cell details can be detected in culture solution and tissues with no staining and no other contrast-enhancing preparation. The sample examined can be much thicker than for many other microscopy techniques without sacrificing the capability to resolve cells. The key factor in our approach is the use of a coherent synchrotron source and of contrast mechanisms based on the refractive index. The first successful tests were conducted on a variety of cell systems including skin and internal leaf cells, mouse neurons, rabbit fibroblast cells, and human tumor cells.

Interaction of GM2 activator protein with glycosphingolipids

GM2 activator protein is a protein cofactor that stimulates the hydrolysis of the GalNAc and the NeuAc in GM2 by beta-hexosaminidase A and sialidase, respectively. To understand the mechanism of action of GM2 activator, the interaction of this protein with GM2 and/or beta-hexosaminidase A has been the subject of interest since the purified GM2 activator became available. Numerous techniques including ultracentrifugation, isoelectric a focusing, polyacrylamide gel electrophoresis, gel filtration, thin layer chromatogram overlay, and fluorescence dequenching assay have been used to investigate the binding and the affinity of GM2 activator to various glycosphingolipids. It has been generally accepted that GM2 activator must have a very weak binding with the enzyme, because they can be easily separated from each other by gel filtration. Therefore, the interaction of GM2 and GM2 activator has been the focus for most of he study. Although preferential association of GM2 activator with GM2 was detected by some methods, GM2 activator was found also to bind other glycosphingolipids. Isolation of the specific complex that consists of only GM2 activator and GM2 from incubation mixture containing the activator protein and mixed glycosphingolipids has not been successfully carried out. Ultracentrifugation and gel-filtration are the mildest methods for the isolation of the complexes. However, these methods do not separate the complexes formed by specific interaction from that formed by non-specific association. In fluorescence dequenching assay, the attempt to isolate the complex of R18 lipid probe with GM2 activator was also not successful. Since GM2 activator and glycosphingolipids contain hydrophobic domains in their molecules, the non-specific hydrophobic interactions between the two components can greatly interfere with the isolation of true functional complexes. Among the reported methods, thin layer chromatography overlay and the assay based on the inhibition of fluorescence dequenching by various glycosphingolipids are more informative than the others on the binding between GM2 activator and the carbohydrate head groups of glycosphingolipids.

Validity and reliability of the EQ-5D self-report questionnaire in Chinese-speaking patients with rheumatic diseases in Singapore

OBJECTIVE

We assessed the psychometric properties of a Singaporean Chinese version of the EQ-5D, a health-related quality of life (HRQoL) instrument.

MATERIALS AND METHODS

Consecutive outpatients with rheumatic diseases seen for routine follow-up consultations at the National University Hospital, Singapore were interviewed twice within 2 weeks using a standardised questionnaire containing the EQ-5D, the Short-Form 36 Health Survey (SF-36), the Learned Helplessness Subscale, a pain Visual Analogue Scale (VAS) and assessing demographic and psychosocial characteristics. To assess the validity of the EQ-5D, 13 hypotheses relating the EQ-5D self-classifier (5 dimensions) or visual analogue scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann-Whitney U test, Kruskal-Wallis or Spearman's correlation coefficient. Test-retest reliability was assessed using Cohen's kappa.

RESULTS

Forty-eight subjects were studied (osteoarthritis: 16; rheumatoid arthritis: 22; systemic lupus erythematosus: 8; spondyloarthropathy: 2; female: 93.8%; mean age: 56.4 years). Seven of 13 a-priori hypotheses relating EQ-5D to external variables were fulfilled, supporting the validity of the EQ-5D. For example, subjects reporting moderate or extreme problems for EQ-5D dimensions generally had lower median SF-36 scores than those without such problems. Cohen's kappa for test-retest reliability of the self-classifier ranged from 0.41 to 1.00 (n = 42; median interval: 7 days, interquartile range: 7 to 11 days).

CONCLUSIONS

The Singaporean Chinese EQ-5D self-classifier appears to be a valid measure of HRQoL in Singaporeans with rheumatic diseases; however, the reliability of the EQ-VAS requires further investigation. These data provide a basis for further studies of the Singaporean Chinese EQ-5D.

Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore

Validity and reliability of a Singaporean English EQ-5D self-report questionnaire (EQ-5D) were evaluated among consecutive outpatients with rheumatic diseases attending a tertiary referral hospital in Singapore (a multi-ethnic, urban Asian country). Subjects were interviewed twice within a 2-week period using a standardized questionnaire containing the EQ-5D, Short Form 36 Health Survey (SF-36) and assessing demographic and psychosocial characteristics. To assess validity of the EQ-5D, 13 hypotheses relating responses to EQ-5D dimension/Visual Analogue Scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann-Whitney test, Kruskal-Wallis test, or Spearman's correlation coefficient. Test-retest reliability was assessed using Cohen's kappa. Sixty-six subjects were studied (osteoarthritis: 9, rheumatoid arthritis: 26, systemic lupus erythematosus: 23, spondyloarthropathy: 8; female: 72.7%; mean age: 44.3 years). Ten of 13 a-priori hypotheses relating EQ-5D responses to external variables were fulfilled, supporting the validity of the EQ-SD. Cohen's kappa for test-retest reliability (n = 52) ranged from 0.29 to 0.61. The Singaporean English EQ-5D appears to be valid in measuring quality of life in Singaporeans with rheumatic diseases; however, its reliability requires further investigation. These data provide a basis for further studies assessing the validity of the EQ-5D in Singapore.

Evaluation of the hepatic and renal-protective effects of Ganoderma lucidum in mice

The antioxidative effect of hot water extract of the mushroom Ganoderma lucidum on ethanol-induced free radical generation had been studied. In order to further investigate the hepatic and renal protective mechanism of Ganoderma lucidum, rates of lipid peroxidation were determined. The hot water extract of Ganoderma lucidum dose-dependently exhibited antioxidative effect on mouse liver and kidney lipid peroxidation; our results indicated that hepatic and renal homogenates have a higher malonic dialdehyde level in an ethanol administered group than in the Ganoderma lucidum treated group. It was concluded that the hepatic and renal protective mechanism of Ganoderma lucidum, might be due at least in part to its prominent superoxide scavenging effect. Ganoderma extract could protect the liver and kidney from superoxide induced hepatic and renal damages.

A study of the effectiveness of AIDS health education interventions among the adolescent population of Singapore

AIM OF STUDY

This study aims to evaluate the effectiveness of existing AIDS health education interventions in Singapore amongst the adolescent population of Singapore. By identifying specific target groups that lack knowledge and information regarding HIV, it is hoped that suggestions may be provided towards increasing the effectiveness of these interventions.

METHOD

A cross-sectional survey using a self-administered questionnaire of randomly selected adolescents between the ages of 13 and 19 years was performed to assess their knowledge of HIV and their opinions and awareness of HIV education in Singapore.

RESULTS

A total of 400 adolescents of various backgrounds were surveyed. In general, the subjects surveyed possessed reasonably good knowledge about HIV/AIDS, with an average score of 77.4% (SD = 15.8%). However, the results also showed areas of knowledge deficiency and misconception prevalent among those surveyed. Subgroup analysis showed that adolescents from low-income families, relatively less academically successful schools and those of younger ages knew significantly less than other adolescents. In terms of the awareness of HIV/AIDS education and information, the percentage of the subjects who could recognise any of the three commonly issued pamphlets or poster or who knew of any telephone numbers to call to receive information on HIV and AIDS was low. Less than 40% of those surveyed felt that enough awareness was being created within the public regarding AIDS.

CONCLUSION

It can be concluded that most adolescents surveyed felt that they are inadequately educated regarding HIV andAIDS. The results would certain target groups using the appropriate media in future educational intervention.

Public awareness of diabetes mellitus in Singapore

INTRODUCTION

Much effort has been devoted to educating the public about diabetes. However, the impact of such efforts has yet to be formally evaluated.

OBJECTIVES

To identify areas of knowledge that might require additional educational efforts.

METHODOLOGY

A cross-sectional survey was conducted to evaluate the general public's knowledge of diabetes. The respondents were required to answer 45 questions from a pre-tested questionnaire divided into five main sections, namely, general knowledge, risk factors, symptoms and complications, treatment and management, monitoring and other miscellaneous questions. A point was awarded for each correct response and zero for wrong or unsure responses. The maximum total score was 41. The miscellaneous questions were not scored.

RESULTS

A total of 1337 subjects were interviewed. The mean score obtained by the respondents was 66.1% of the maximum possible total score (i.e. 27.1 points out of 41). The "correct answer" percentages for the individual questions from each section ranges from 22 to 83% (General knowledge), 31 to 91% (Risk factors), 48 to 81% (Symptoms and complications), 35 to 87% (Treatment and management), and 58 to 93% (Monitoring of condition).With respect to the source of medical information, health care professionals did not feature prominently (20.7%).

CONCLUSION

The public as represented by the samples in this survey is generally well informed about diabetes except for a few areas. Analysis of these areas would have a significant implication for future public education programme. Health care professionals should be more proactive in disseminating health information about diabetes to the public.

Cloning and characterization of a DEAD box RNA helicase from the viable seedlings of aged mung bean

Seeds stored under adverse conditions will reduce the viability of germination as a result of induced aging. We have established a procedure to induce accelerated aging for studying the process of aging in mung bean (Vigna radiata) seeds at the molecular level. A full-length cDNA was isolated from acceleratedly aged mung bean seedlings. The cDNA, VrRH1 (Vigna radiata RNA helicase 1), contains an open reading frame of 2139 bp encoding a protein of 713 amino acids. VrRHI has seven highly conserved motifs including the DEAD box as in the case of other plant RNA helicases. VrRHI was sub-cloned into an expression vector pET-28b (+), over-expressed in Escherichia coli BL 21 and purified by a Ni2+-agarose column. The expressed protein showed double-stranded RNA unwinding and ATPase activities. Either ATP or dATP is required for the unwinding activity, indicating that VrRHI is an ATP/dATP-dependent RNA helicase. Northern blot analysis showed the presence of mRNAs hybridized with a full-length cDNA fragment of VrRHI (VrRH transcripts) in mung bean seeds that were imbibed for 16 to 32 h after accelerated aging treatment. The amount of these mRNAs reached a maximum in 24 h imbibed seeds after the treatment. The accumulation of VrRH transcripts was shown to lead to the appearance of 25S and 18S rRNAs in the imbibed aging mung bean seeds. The results suggest that VrRHI may play a role in the viability of mung bean seeds.

Degradation of G(M1) and G(M2) by mammalian sialidases

In mammalian tissues, the pathway known for the catabolism of G(M1) [Galbeta3GalNAcbeta4(Neu5Acalpha3)Galbeta4GlcCer; where Cer is ceramide] is the conversion of this ganglioside into G(M2) [GalNAcbeta4(Neu5Acalpha3)Galbeta4GlcbetaCer] by beta-galactosidase followed by the conversion of G(M2) into G(M3) (Neu5Acalpha3Galbeta4GlcbetaCer) by beta-N-acetylhexosaminidase A (Hex A). However, the question of whether or not G(M1) and G(M2) can also be respectively converted into asialo-G(M1) (Galbeta3GalNAcbeta4Galbeta4GlcCer; G(A1)) and asialo-G(M2) (GalNAcbeta4Galbeta4GlcbetaCer, G(A2)) by mammalian sialidases has not been resolved. This is due to the fact that sialidases purified from mammalian tissues always contained detergents that interfered with the in vitro hydrolysis of G(M1) and G(M2) in the presence of an activator protein. The mouse model of human type B Tay-Sachs disease created by the disruption of the Hexa gene showed no neurological abnormalities, with milder clinical symptoms than the human counterpart, and the accumulation of G(M2) in the brains of affected mice was only limited to certain regions [Sango, Yamanaka, Hoffmann, Okuda, Grinberg, Westphal, McDonald, Crawley, Sandhoff, Suzuki and Proia (1995) Nat. Genet. 11, 170-176]. These results suggest the possible presence of an alternative catabolic pathway (the G(A2) pathway) in mouse to convert G(M2) into G(A2) by sialidase. To show the existence of this pathway, we have used recombinant mammalian cytosolic sialidase and membrane-associated sialidase to study the desialylation of G(M1) and G(M2). We found that the mouse membrane-bound sialidase was able to convert G(M1) and G(M2) into their respective asialo-derivatives in the presence of human or mouse G(M2) activator protein. The cytosolic sialidase did not exhibit this activity. Our results suggest that, in vivo, the stable NeuAc of G(M1) and G(M2) may be removed by the mammalian membrane-associated sialidase in the presence of G(M2) activator protein. They also support the presence of the G(A2) pathway for the catabolism of G(M2) in mouse.