Political Discourse and Aging in a Neoliberal Singapore: Models of Citizenship, Older Adults and Policy Initiatives

Singapore now faces one of the fastest aging populations in the world, leading the country's political leaders to fear the implications of population aging for the country's economic viability. We analyzed National Day Rally speeches from 2011 to 2015 by Prime Minister Lee Hsien Loong to examine how policymakers conceptualized the challenges related to its aging population. Findings point to the government's manifest and latent emphasis on its economic viability when developing social policies to address the well-being of its aging population. Its approaches to welfare provision are informed by a neoliberalist agenda that requires its citizens to exercise personal responsibility and self-reliance, and to rely on their family and community for mutual assistance. Despite its highly interventionist approach, the government is clear about its residual role in the provision of safety nets. A neoliberalist reconceptualization of citizenship serves to restrict older citizen's claims to basic social assistance.

Burnout in staff working at the Mathari psychiatric hospital

OBJECTIVE

As there are no data on burnout in staff in Kenyan psychiatric hospitals, this study sought to document the level of burnout among the staff at the Mathari Psychiatric Hospital.

METHOD

This was a cross sectional descriptive study of staff working at Mathari Psychiatric Hospital. The hospital staff completed self-administered questionnaires on socio-demographic characteristics and work environment and the Maslach Burnout Inventory - Human Services and General Survey. Analysis of the data was undertaken using the Statistical Package for the Social Sciences (SPSS) version 11.5.

RESULTS

Ninety-five percent of the respondents reported low to high emotional exhaustion while 87.8% reported depersonalization. Low accomplishment was reported by only 38.6% while 61.4% reported average to high personal accomplishment. Several work- and non-work-related factors including young age, number of own children, number of years worked, heavy workload and low morale were positively associated with various syndromes of burnout. Relationships at work, with family and society were generally rated as average. The staff made recommendations on how to improve the social support system and work performance.

CONCLUSION

High levels of burnout were reported. These should be addressed at individual, collective and institutional levels.

Perceived economic and behavioural effects of the mentally ill on their relatives in Kenya: a case study of the Mathari Hospital

OBJECTIVE

There is no documented evidence in Kenya on relatives' perceptions of economic and behavioural effects of the mentally ill patients and their coping mechanisms. To document what relatives of mentally ill patients perceive to be the economic effects of the patients on the family and how they are affected by and cope with the disturbed behaviours of the patients.

METHOD

This was a cross-sectional descriptive study conducted at the Mathari Psychiatric Hospital. Informed consent was obtained from both the relatives and the patients admitted at the hospital. Data on socio-demographic and economic profiles were obtained from the patients and their relatives. The relatives were interviewed using a structured questionnaire to determine what they perceived to be the economic effects of the mental illness, how the various disturbed behaviours of the mentally ill affected them, and how they coped. The data were analysed using SPSS version 11.5 and results are presented in narratives and tables.

RESULTS

One hundred and seventy-five relatives and 107 patients were recruited and interviewed. The patients were younger and better educated but economically less well off than their relatives. The relatives perceived that the mentally ill patients caused financial constraints and that various disturbed behaviours, particularly, verbal and physical aggression and refusal of the patient to take medicine or go to hospital, affected the family in different ways. Different coping mechanisms were used, depending on whether or not the behaviours were intrusive.

CONCLUSION

Mentally ill patients adversely affect their families in diverse ways. There is need for appropriate policy to address the needs of families with mentally ill patients at the family and community levels. However, these must be evidence-based and this calls for further research.

Obsessive-compulsive (oc) symptoms in psychiatric in-patients at Mathari hospital, Kenya

OBJECTIVE

To document the prevalence of obsessive-compulsive disorders (OCD) among patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya.

METHOD

This was a descriptive cross-sectional study conducted at the Mathari Hospital.

RESULTS

Out of 691 patients interviewed, 84 (12.2%) had symptoms which met the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) criteria for OCD, which started early in life. The clinicians had not recognized the OC symptoms/disorder. There were high co-morbidities between OCD and other Structured Clinical Interview for DSM-IV (SCID) core syndromes as well as psychotic symptoms often associated with schizophrenia.

CONCLUSION

OC symptoms are common in psychiatric patients admitted at Mathari Hospital although such symptoms were clinically undetected and therefore not managed. The high co-morbidities between OCD, other psychiatric disorders and other psychiatric symptoms pose clinical challenges in differentiating between psychotic symptoms perceived by the patients to have an external locus and OC symptoms perceived to have an internal locus. A more systematic clinical procedure for assessing all DSM-IV symptoms should be adapted as standard quality control practice in all patients, particularly those with psychotic symptoms.

High grade superficial (G3t1) transitional cell carcinoma of the bladder treated with intravesical Bacillus Calmette-Guerin (BCG)

OBJECTIVES

Immunotherapy with Bacillus Calmette Guerin (BCG) has been widely used recently as primary option for treatment of high grade superficial (G3T1) carcinoma of the bladder. We describe our long term experience of therapy of G3T1 bladder cancer.

METHODS

From January 1982 to December 2000, 785 patients were diagnosed with superficial bladder cancer. All patients underwent preoperative CT scan and transurethral resection of the bladder. Eighty-six patients (11%) had histological high grade superficial bladder cancer infiltrating the lamina propria. This group was treated with the following schedule of BCG Pasteur strain plus maintenance. Four cycles BCG, 6 instillations per cycle, first cycle weekly x 6, second cycle every 2 weeks x 6, third cycle monthly x 6, fourth cycle (maintenance) every 3 months x 6 instillations.

RESULTS

The median follow-up is 91 months (30-197 months). The overall recurrence rate was 35% (30/86). The median time to recurrence was 29 months (5-128 months). Of these patients, 12 (14%) had progression at a median follow-up of 16 months (range 8-58 months). Cystectomy was needed in 8 (9%) patients. Death due to disease occurred in 5/86 (6%) patients. One patient died due to adenocarcinoma at the ureterosigmoidostomy site. Sixty-four (74%) patients are alive at a median follow-up of 71 months (range 28-197 months). Sixty patients (70%) are alive with an intact bladder.

CONCLUSIONS

Treatment with BCG is a feasible conservative therapy for patients with primary G3T1 transitional bladder cancer. Long term results of BCG treatment are excellent. Cystectomy shouldn't be considered first line treatment for high grade superficial carcinoma of the bladder.

Buccal mucosa urethroplasty in the treatment of bulbar urethral strictures

OBJECTIVES

To report our 8-year experience with buccal mucosa onlay urethroplasty with the dorsal approach in the treatment of bulbar urethral strictures. The buccal mucosal graft is widely used as an effective option for urethral reconstruction.

METHODS

Since June 1994, we have treated 65 patients with bulbar urethral strictures with buccal mucosa urethroplasty. A free graft of buccal mucosa was used as a ventral onlay in 9 patients and as a dorsal onlay in the remaining 56 patients. The bulbar urethra was isolated from the corpora. Endoscopic urethrotomy was performed dorsally. The graft was obtained from the lower lip and sutured to the urethra and corpora cavernosa. A transurethral grooved catheter and suprapubic drainage was maintained for 7 and 14 days, respectively.

RESULTS

The median follow-up was 41 months (range 6 to 94). The overall recurrence rate was 3% (2 of 65). One recurrence occurred in a ventral onlay patient and one in a dorsal onlay patient. Minor complications occurred in 9 patients (14%).

CONCLUSIONS

Buccal mucosa dorsal onlay urethroplasty is an excellent option for the treatment of bulbar urethral strictures.

Non-Hodgkin's lymphoma: a case report of a secondary bladder involvement

Bladder secondary involvement rate in non-Hodgkin's lymphoma (NHL) reaches 13%. Nevertheless, clinical evidence of such an involvement is very rare (less than 0.5%). We report a case of a NHL arising from the Peyer's plaques of the gut and involving secondly the bladder. The onset symptomatology was urologic. Pathophysiology and clinical features of secondary bladder lymphoma are discussed.

Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patients

BACKGROUND

It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs.

METHODS

The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated.

RESULTS

Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P < 0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P < 0.001); however, the prevalence of diagnostic (> 400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P < 0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. "Asymptomatic" cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a "toxic syndrome" dominated the clinical picture of the noncirrhotic patients.

CONCLUSIONS

Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha-fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

Etiologic factors and clinical presentation of hepatocellular carcinoma. Differences between cirrhotic and noncirrhotic Italian patients

BACKGROUND

It is not known whether the prevalence of hepatocarcinogenic factors differs between cirrhotic and noncirrhotic patients with hepatocellular carcinoma (HCC) or whether the clinical presentation of HCC in these two groups differs.

METHODS

The prevalence of the putative etiologic factors of HCC and its clinical presentation in 373 patients with cirrhosis and 102 without cirrhosis seen from 1981 to 1992 were evaluated.

RESULTS

Hepatitis C virus infection (76 vs. 48%, P = 0.003) and both current (22.5 vs. 10%, P = 0.007) and past (50.5 vs. 34.5%, P = 0.045) hepatitis B virus infections were more common in cirrhotic than in noncirrhotic patients with HCC. The absence of exposure to both viruses was much less frequent in the former (7 vs. 40%, P < 0.001). Heavy alcohol intake prevailed in patients with cirrhosis (30 vs. 16.5%, P = 0.01). Alpha-fetoprotein elevation was more common in cirrhotic patients (63% vs. 31%, P < 0.001); however, the prevalence of diagnostic (> 400 ng/ml) levels did not differ significantly (24 vs. 17%) between the two groups. Extrahepatic extension of HCC was more common in noncirrhotic patients (20.5 vs. 6.5%, P < 0.001) and its independent predictors were poor cancer differentiation and absence of cirrhosis. "Asymptomatic" cancers were more frequently encountered with cirrhosis. Abdominal pain was the most common presenting symptom in both groups. Signs of hepatic decompensation prevailed in cirrhotic patients, whereas a "toxic syndrome" dominated the clinical picture of the noncirrhotic patients.

CONCLUSIONS

Hepatitis viruses are associated more with carcinogenesis of the cirrhotic than of the noncirrhotic liver. Alpha-fetoprotein is not a sensitive neoplastic marker, particularly in noncirrhotic patients. In the latter, HCC appears more advanced at diagnosis and symptoms of neoplastic toxicity are prominent.

The production of antibodies to pentosanpolysulfate (ELMIRON, SP-54)

Pentosanpolysulfate (PPS) represents the product obtained after sulfation of xylan and is composed of beta 1----4-D-xylopyranose residues sulfated at C2 and C3. Studies have shown that this compound can often be effective in relieving the symptoms of interstitial cystitis (IC). In order to elucidate the mode of action of PPS in IC, a sensitive and reliable assay was needed. To this end we prepared an immunogenic form of PPS by coupling it to methylated bovine serum albumin (MBSA). This complex was used to immunize NZW rabbits (1 mg, IM). Four of five animals responded with anti-PPS antibodies, three of which had high titer (greater than 1/2000) as measured by an enzyme-linked immunosorbent assay (ELISA). All sera were routinely absorbed with an MBSA-Sepharose immunoadsorbent to remove anti-MBSA antibodies. ELISA inhibition tests were used to determine the sensitivity and specificity of the sera. At least 50 ng/ml of PPS could be routinely detected by this assay. A number of naturally occurring proteoglycans, polysaccharides, monosaccharides and disaccharides were examined for reactivity with the antibodies but only heparin was an effective inhibitor. Absorption with heparin immunoadsorbents reduced, but did not eliminate, the ability of heparin to inhibit anti-PPS binding. This activity could be destroyed by treatment with heparinase without affecting PPS inhibition. Normal urine did not affect the ELISA or ELISA inhibition tests and thus allowed the determination of PPS levels in IC patient urines. Initial analysis of seven IC patients receiving oral PPS revealed urine concentration of 0.8-16.0 micrograms/ml. No inhibition could be detected in pre-treatment urine samples.