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Epidemiological data suggest that traffic exposures can influence asthma and allergic symptoms among preschool children; however, there is no information on risk reduction via home air-conditioning (AC). The aim of this study is to evaluate the associations of self-reported traffic densities with asthma and allergic symptoms among preschool children and determine whether AC is an effect modifier. A cross-sectional study adopting an expanded and modified ISAAC--International Study of Asthma and Allergies in Childhood conducted on randomly selected 2994 children living in homes without any indoor risk factors. Specific information on demographics, indoor home risk factors, and traffic variables were obtained. Adjusted prevalence ratios (PR) and 95% confidence interval (CI) were determined by Cox proportional hazard regression model with assumption of a constant risk period controlled for covariates. We found dose-response significant relationships between validated self-reported traffic densities and asthma and rhinitis symptoms. Among children sleeping in non-air-conditioned homes, there were stronger associations between asthma and rhinitis symptoms studied. PRs for heavy traffic density were 2.06 for wheeze (95% CI 0.97-4.38), 2.89 for asthma (1.14-7.32), 1.73 for rhinitis (1.00-2.99), and 3.39 for rhinoconjunctivitis (1.24-9.27). There were no associations found for children sleeping in air-conditioned homes. Our results suggest that AC in the bedroom modifies the health effects of traffic among preschool children. This finding suggests that attention should also be paid to ventilation characteristics of the homes to remediate health-related traffic pollution problems.

P>Background Acrylates/methacrylates are volatile substances. There might be a gradual decrease in acrylate/methacrylate allergen content over time in patch test preparations but this has not yet been documented. Objectives To determine the allergen content of acrylates/methacrylates in patch test preparations over time under different storage conditions. Methods Five acrylate/methacrylate allergens [2-hydroxyethyl methacrylate (2-HEMA), methyl methacrylate (MMA), ethylene glycol dimethacrylate (EGDMA), triethylene glycol diacrylate (TREGDA) and 2-hydroxypropyl acrylate (2-HPA)] in syringes and IQ (TM) chambers (Chemotechnique Diagnostics, Vellinge, Sweden) were analysed using gel permeation chromatography and high-performance liquid chromatography to measure the allergen content over time in samples stored in the freezer, refrigerator and under room temperature. Results The concentration of allergens in syringes decreased with time. Those stored at room temperature had the fastest rate of decrease, followed by those in the refrigerator and freezer. In most cases, in syringes or IQ (TM) chambers under all storage conditions, the MMA decreased most rapidly, followed by 2-HPA, 2-HEMA, EGDMA and TREGDA. The allergens in the IQ (TM) chambers rapidly disappeared, with almost all samples reaching nondetectable levels by day 8. MMA was the first to reach a nondetectable level - at day 2. Conclusions Acrylate/methacrylate allergens are lost rapidly from IQ (TM) chambers especially if stored at room temperature. Allergens in syringes remain above 80% of their initial concentrations for longer periods compared with IQ (TM) chambers. In syringes and IQ (TM) chambers there is a slower rate of decrease in concentration when the storage temperature is lower. Allergens should be stored refrigerated, replaced regularly, and freshly applied on to test patches on the day of use. (Less)

On March 12, 2003, the World Health Organization issued a global health alert stating that a new, unrecognizable, flulike disease may spread to health care workers (HCWs). We now know this illness as severe acute respiratory syndrome (SARS). By August 2003, there were 8422 SARS cases and 916 deaths reported from 29 countries. SARS galvanized the world to the threat of emerging infectious diseases and provided a dress rehearsal for subsequent challenges such as H5N1 and H1N1 influenza. Among the insights gained were the following: SARS reminded us that health care work can be hazardous; the effects of SARS extended beyond the infection; general principles for prevention and control were effective against SARS; and SARS posed both a public health and an occupational health threat. Given these perspectives gained, we should be better prepared when faced with similar scenarios in the future.

Policymakers’ understanding of and ability to reduce health disparities are pivotal for health promotion worldwide. This study aimed to verify the behavioral pathways leading to oral health disparities. Oral examinations were conducted for 1782 randomly selected preschoolers (3-6 yrs), and 1576 (88.4%) participants were followed up after 12 months. Parents were surveyed on their knowledge (K), attitude (A), and practices (P) regarding their children’s oral health homecare (infant feeding, diet, and oral hygiene) and dental attendance. Structural equation modeling substantiated the links between specific KAs and corresponding practices, while generic KA did not affect practices. KAP pathways partly explained the ethnic and socio-economic disparities in oral health. Deprivation had a direct effect (not mediated by KA) on dental attendance, but not on oral health homecare. Ethnicity directly influenced oral health homecare practices, but not dental attendance. These behavioral pathways, furthering our understanding of health disparity, may have practical implications for health promotion and policy-making.

Despite the well-recognized importance of caries risk assessment, practical models remain to be established. This study was designed to develop biopsychosocial models for caries risk assessment in various settings. With a questionnaire, an oral examination, and biological (salivary, microbiological, and plaque pH) tests, a prospective study was conducted among 1782 children aged 3-6 years, with 1576 (88.4%) participants followed in 12 months. Multiple risk factors, indicators, and protective factors were identified. Various risk assessment models were constructed by the random selection of 50% of the cases and further validated in the remaining cases. For the prediction of a “one-year caries increment”, screening models without biological tests achieved a sensitivity/specificity of 82%/73%; with biological tests, full-blown models achieved the sensitivity/specificity of 90%/90%. For identification of a quarter of the children with high caries burden (baseline dmft > 2), a community-screening model requiring only a questionnaire reached a sensitivity/specificity of 82%/81%. These models are promising tools for cost-effective caries control and evidence-based treatment planning. Abbreviations: decayed, missing, filled teeth in primary dentition (dmft); receiver operation characteristics (ROC); relative risk (RR); confidence interval (CI); National Institutes of Health (NIH); World Health Organization (WHO); US Department of Health and Human Services (US/DHHS); American Academy of Pediatric Dentistry (AAPD).

Saliva eosinophil cationic protein (ECP) is higher in asthmatic adults than in healthy ones. However, its relationship with asthma severity, other atopic conditions and allergic sensitization have not been reported. Saliva collection is painless, readily acceptable to children and parents, and can be a potentially useful body fluid to measure asthma biomarkers. We recruited 102 physician-diagnosed young asthmatic subjects from outpatient clinics with change in FEV(1) > or = 12% with inhaled salbutamol and collected data on asthma severity, concurrent allergic rhinitis (AR) and atopic dermatitis (AD), and medication used (bronchodilator and corticosteroid). We measured whole saliva and serum ECP and performed skin prick tests (SPT) for three dust mites (Dermatophagoides pteronyssisinus, Dermatophagoides farinae and Blomia tropicalis) and two cockroaches (Periplaneta americana and Blatella germanica). Median salivary ECP was 84.6 microg/l (inter-quartile range [IQR]: 40.9-147.9) and median serum ECP was 14.7 microg/l (IQR: 6.4-32.1). Serum ECP was only higher in children whose sleep was disturbed by asthma in the past year than those who were not (geometric mean [GM]: 18.9 vs. 11.1 microg/l, relative mean difference [RMD]: 1.71 [95%CI: 1.09-2.69]). Serum ECP was increased among asthmatic children on inhaled corticosteroid than those not using them (GM: 15.6 vs. 8.1 microg/l, RMD: 1.93 [95%CI: 1.11-3.39]). Salivary ECP was not associated with asthma severity, concurrence of atopic conditions, medications used, or any SPT parameter. Saliva ECP did not correlate with serum ECP (r(s) = 0.032, p = 0.790). Salivary and serum ECP did not correlate with wheal size for any skin prick test.

UNLABELLED Although vacuum cleaning is recommended to reduce allergen levels and improve asthma and allergic rhinitis symptoms, some studies suggest it may increase allergen load in homes. We conducted a cross-sectional study to determine if home floor vacuuming was associated with sensitization to dust-mites and cockroaches, and serum eosinophil cationic protein (ECP), a biomarker for atopy, in 102 physician-diagnosed spirometry-confirmed asthmatics. We collected data on floor type, floor cleaning method and frequency, asthma severity, allergy medications used, serum ECP and skin prick tests (SPT) to three dust-mites [Dermatophagoides pteronyssisinus (Der p), Dermatophagoides farinae (Der f) and Blomia tropicalis (Blo t)] and two cockroaches [Periplanata americana (Per a) and Blatella germanica (Bla g)]. Those who vacuumed had increased sensitization to three dust-mites [adjusted ORs (95%CI) = Der p: 26.6 (1.8-405.2); Der f: 44.8 (3.2-620.9); Blo t: 14.1 (1.8-108.1)] but not to cockroaches, adjusted for cleaning frequency and other methods of floor cleaning. Subjects who vacuumed their floor had higher levels of serum ECP than those who did not [adjusted median difference (95%CI): 9.4 (1.1-17.7)], adjusted for use of nasal corticosteroids among those with allergic rhinitis. Vacuuming is associated with increased sensitization to dust-mite allergens and higher serum ECP. PRACTICAL IMPLICATIONS We found an association between floor vacuuming and increased sensitization to dust-mite allergens and higher levels of an atopy biomarker. Current recommendations to use vacuuming to control allergen exposure and allergic conditions may need to be reconsidered until further studies are performed.

The study of the biological underpinnings of behavior is in its nascent stages in the field of management. We study how the hormone testosterone (T) is related to status and collective efficacy in a group. We assessed salivary testosterone of 579 individuals in 92 teams. We find that T does not predict status within the group. We also tested the effects of a mismatch between T and status in the group on the collective efficacy of the group. Using a novel slope-as-predictor multilevel structural equation model, we find that the greater the mismatch between T and status in the group (i.e., the more negative the within-group correlation among T and status), the lower is the collective efficacy of the group. We discuss the implications of our findings for the study of the biological underpinnings of group behavior in organizations.

Background The incidence rates of skin cancers in Caucasian populations are increasing. There is little information on skin cancer trends in Asians, who have distinctly different skin types. Objective We sought to study skin cancer incidence rates and time trends among the 3 Asian ethnic groups in Singapore. Methods We analyzed skin cancer data from the Singapore Cancer Registry from 1968 to 2006 using the Poisson regression model. Results There were 4044 reported cases of basal cell carcinoma, 2064 of squamous cell carcinoma, and 415 of melanoma. Overall skin cancer incidence rates increased from 2.9/100,000 in 1968 to 1972 to 8.4/100,000 in 1998 to 2002, declining to 7.4/100,000 in 2003 to 2006. Among older persons (≥60 years), basal cell carcinoma rates increased the most, by 18.9/100,000 in Chinese, 6.0/100,000 in Malays, and 4.1/100,000 in Indians from 1968 to 1972 to 2003 to 2006. Squamous cell carcinoma rates among those aged 60 years and older increased by 2.3/100,000 in Chinese and by 1/100,000 in Malays and Indians. Melanoma rates were constant for all 3 races. Skin cancer rates among the fairer-skinned Chinese were approximately 3 times higher than in Malays and Indians, who generally have darker complexions. Limitations Although appropriate population denominators were used, lack of data from 2007 could have affected the results for the last time period, which comprised 4 instead of 5 years. Conclusion Incidence rates of skin cancer in Singapore increased from 1968 to 2006, especially among older Chinese

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. Key words: Duty of care, Mesothelioma, Occupational asthma, Standard of care, Tort

OBJECTIVE: The goal was to assess personal and environmental factors associated with premarital sex among adolescents. METHODS: We conducted a case-control study. Between 2006 and 2008, we recruited 500 adolescents who reported having engaged in voluntary sex for most recent sex. Five hundred control subjects were matched for age, gender, and ethnicity. RESULTS: Independently significant factors for premarital sex among boys were pornography viewing (adjusted odds ratio [OR]: 5.82 [95% confidence interval [CI]: 2.34–14.43]), lack of confidence to resist peer pressure (OR: 3.84 [95% CI: 2.27–6.50]), perception that more than one half of their friends had engaged in sex (OR: 3.37 [95% CI: 1.92–5.92]), permissiveness regarding premarital sex (OR: 3.41 [95% CI: 2.10–5.55]), involvement in gang activities (OR: 3.45 [95% CI: 1.66–7.15]), drinking (OR: 1.77 [95% CI: 1.07–2.94]), smoking (OR: 1.91 [95% CI: 1.14–3.20]), and living in low-cost housing (OR: 3.25 [95% CI: 1.64–6.43]). For girls, additional factors were previous sexual abuse (OR: 7.81 [95% CI: 2.50–24.41]) and dropping out of school (OR: 2.72 [95% CI: 1.32–5.61]), and stronger associations were found for lack of confidence to resist peer pressure (OR: 5.56 [95% CI: 2.94–10.53]) and permissiveness regarding premarital sex (OR: 6.25 [95% CI: 3.30–11.83]). Exposure to persons with HIV/AIDS or sexually transmitted infections in the media was negatively associated with sex for boys (OR: 0.27 [95% CI: 0.16–0.45]) and girls (OR: 0.24 [95% CI: 0.13–0.47]). CONCLUSION: Sex education programs for adolescents must address social, media, and pornographic influences and incorporate skills to negotiate sexual abstinence.

Retinal arteriolar narrowing is a marker of microvascular damage from elevated blood pressure. Between August 2004 and June 2006, the authors examined the association between retinal vascular diameter and chronic kidney disease in a population-based cohort of 3,280 community-dwelling adults of Malay ethnicity aged 40-80 years living in Singapore. Chronic kidney disease was defined as 1) an estimated glomerular filtration rate (eGFR) of60 mL/minute/1.73 m(2) from serum creatinine or 2) the presence of micro/macroalbuminuria defined as urinary albumin:creatinine ratios ofor = 17 mg/g for men andor = 25 mg/g for women. Retinal arteriolar and venular diameters were measured and summarized as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). Individuals with reduced CRAE were more likely to have chronic kidney disease than those with increased CRAE. After controlling for age, gender, education, smoking, diabetes, hypertension, body mass index, and total and high density lipoprotein cholesterol, the authors found the odds ratio comparing the smallest with the largest CRAE quartile to be 1.42 (95% confidence interval: 1.03, 1.96; P(trend) = 0.02) for eGFR of60 mL/minute/1.73 m(2) and 1.80 (95% confidence interval: 1.11, 2.91; P(trend) = 0.01) for micro/macroalbuminuria. Retinopathy was also found to be positively associated with both eGFR and micro/macroalbuminuria. Retinal venular diameter was not associated with chronic kidney disease. These data suggest that retinal arteriolar narrowing is associated with chronic kidney disease, independent of diabetes and hypertension.

Background: No studies to specifically determine the prevalence of contact allergy to acrylates/methacrylates in patch tested populations have been published. Objectives: To determine the prevalence of acrylate/methacrylate allergy in all patients tested to the baseline patch test series. Methods: Five acrylate/methacrylate allergens (2-hydroxyethyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate, triethylene glycol diacrylate, and 2-hydroxypropyl acrylate) were included in the baseline series for at least 2 years in Malmo and Singapore. Results: Thirty-eight patients in total had reacted to acrylate/methacrylate allergens in the baseline series during the study period in both populations. In Malmo, there were 26 (1.4%) patients with positive patch tests to acrylate/methacrylate allergens, 14 of whom had relevant reactions. In Singapore, there were 12 (1.0%) patients with positive patch tests to acrylate/methacrylate allergens, but only 1 had relevant reactions. If we had not added acrylate/methacrylate allergens to the baseline series, we would not have patch tested 13/26 (50%) of the positive reactors in Malmo and 11/12 (92%) of the positive reactors in Singapore. The overall proportion of missed positive reactors would have been 24/38 (63%). Conclusions: The prevalence of acrylate/methacrylate allergy in our patch tested dermatitis populations is 1.4% in Malmo and 1.0% in Singapore.

The involvement of chronic inflammation in albuminuria and renal function was investigated in a cross-sectional study of 320 type 2 diabetic Chinese patients from the Singapore Diabetes Cohort Study. Plasma levels of TNF-α and its two cellular receptors and of IL-6 and C-reactive protein (CRP) were measured. A composite TNF-α score was extracted using principal component analysis. Multiple linear regression analysis was implemented to evaluate the relationship between log e (ln) albumin:creatinine ratio (ACR) and estimated GFR (eGFR) with the inflammatory variables and other clinical covariates. A Bonferroni correction was applied based on the total number of variables entered into regression analyses. ln ACR was significantly associated with TNF-α score independently of eGFR even after a Bonferroni correction. TNF-α score was also significantly associated with eGFR independently of ln ACR even after correction for multiple testing. These findings were similar when the individual molecules of the TNF-α system were analysed separately instead of using the composite TNF-α score. No association was observed for IL-6 and CRP with either renal trait. Diabetes duration was a significant predictor for ln ACR but not eGFR. Conversely, age was significantly associated with eGFR but not ln ACR. Activation of the TNF-α system may potentially exert independent effects on ln ACR and eGFR in type 2 diabetes. Because of the study design, one may also consider the possibility that changes in these renal traits may conversely be responsible for such an inflammatory response.

11 healthy adult graduate students were studied on two separate occasions 2 wk. apart at the same time of day. Self-rating of perceived stress and serial measurements of salivary alpha-amylase levels were performed at T1 = 15 min. before, T2 = 1 min. before, T3= 1 min. after, and T4= 15 min. after an event. The events were a highly stressful master's degree oral examination on the first occasion and 15 min. of typing on a computer on the second occasion as a control activity. A kinetic assay was used to estimate salivary alpha-amylase activity. Students rated higher stress on the oral examination day, and their salivary alpha-amylase activity was higher during the oral examination period than on the second less stressful control day.

This paper argues that while there was a large leadership turnover at the 10th Vietnamese Communist Party Congress in April 2006, the wait continues for younger leaders to emerge. The congress showed increased intraparty democracy. The willingness to go beyond regional distribution of power in the selection of top leaders was remarkable.

Medical examinations for fitness to work are undertaken by the specialist and the non-specialist 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. Key words: Duty of care, Economic loss, Personal injury, Physical harm, Standard of care, Tort

Background: Systematic reviews on the effects of problem-based learning have been limited to knowledge competency either during medical school or postgraduate training. We conducted a systematic review of evidence of the effects that problem-based learning during medical school had on physician competencies after graduation. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Databases, and the tables of contents of 5 major medical education journals from earliest available date through Oct. 31, 2006. We included studies in our review if they met the following criteria: problem-based learning was a teaching method in medical school, physician competencies were assessed after graduation and a control group of graduates of traditional curricula was used. We developed a scoring system to assess the quality of the studies, categorized competencies into 8 thematic dimensions and used a second system to determine the level of evidence for each competency assessed. Results: Our search yielded 102 articles, of which 15 met inclusion criteria after full text review. Only 13 studies entered final systematic analysis because 2 studies reported their findings in 2 articles. According to self-assessments, 8 of 37 competencies had strong evidence in support of problem-based learning. Observed assessments had 7 competencies with strong evidence. In both groups, most of these competencies were in the social and cognitive dimensions. Only 4 competencies had moderate to strong levels of evidence in support of problem-based learning for both self-and observed assessments: coping with uncertainty (strong), appreciation of legal and ethical aspects of health care (strong), communication skills (moderate and strong respectively) and self-directed continuing learning (moderate). Interpretation: Problem-based learning during medical school has positive effects on physician competency after graduation, mainly in social and cognitive dimensions.

This study explores the relationship between competitiveness and stress. In Experiment 1, we examine the response of cortisol, the primary stress hormone, during both piece-rate and tournament tasks. We find that the more competitive tournament task induces a higher cortisol response than the less competitive piece-rate task. Moreover, more competitively inclined subjects exhibit higher stress responses induced by the tasks. In Experiment 2, we manipulate stress using the Trier Social Stress Test and find that induced stress does not significantly affect competitiveness. Taken together, our findings suggest a tendency for people who are competitively disposed to have high stress response.

Existing literature has shown that home dampness increases indoor mold burden and is associated with increased allergic symptoms among young children in temperate environments. There is no report of any studies of similar nature in the tropics where conditions are characterized typically by high temperatures and humidity with rainfall throughout the year. To evaluate if there are associations between the prevalence of current asthma and allergic symptoms in young children (age 1.5-6 yr) with dampness and indoor mold in children's bedrooms in a tropical environment. A cross-sectional study adopting an expanded and modified ISAAC- International Study on Asthma and Allergies in Children - questionnaire for the evaluation of asthma and allergies was conducted on 6794 children (4759 responded - 70%) attending 120 randomly selected daycare centers. Specific information on demographics, home dampness, and the visible presence of indoor molds were obtained. The prevalence ratios (PR) and 95% confidence interval (CI) were determined by Cox proportional hazard regression model with assumption of a constant risk period as recommended for cross-sectional studies. The calculated PRs were controlled for age, gender, ethnicity, socio-economic status, type of housing, maternal and paternal atopy, respiratory infections, environmental tobacco smoke (ETS) exposure, and food allergy. After adjusting for potential confounding effects, home dampness was observed to be significantly associated with current symptoms of rhinoconjunctivitis (adjusted PR 1.53, 95% CI: 1.00-2.33). The visible presence of mold was significantly associated with current symptoms of rhinitis (PR 1.55, 95% CI: 1.16-2.07) and rhinoconjunctivitis (PR 2.38, 95% CI: 1.51-3.75). Indoor dampness and mold in children's bedroom are important risk factors associated with allergic symptoms in young children in Singapore.

The Chapter of Public Health and Occupational Physicians was formed in 1980, 23 years after the founding of the Academy of Medicine in Singapore. From a modest beginning with 12 foundation Fellows, the Chapter has provided professional leadership and continuing education in public health and occupational medicine. It has organised numerous talks, conferences, seminars and symposia, and a very successful series of annual scientific meetings. The content of these activities reflect the concerns and developments of public health and occupational medicine in Singapore throughout the last quarter century. Fellows of the Chapter serve on national specialist training committees and on academic programme committees of both specialities. The Chapter also provides recommendations to the Academy on specialist qualification and training. With an active current membership of 100 Fellows, which is still growing, the Chapter is poised to further raise the professional standards and practice of public health and occupational medicine in Singapore. Key words: Academy of Medicine Singapore, Occupational Medicine, Public Health

Introduction: 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. Materials and Methods: 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 ≤21 years) employed by a large acute care tertiary hospital. Results: The uptake rates among frontline caregivers – doctors >50%, nurses >65% and ancillary staff >70% – markedly exceeded many of our international counterparts’ results. Conclusion: 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. Key words: Avian, Flu, Pandemic, Season

Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.

Objective The Global Physical Activity Questionnaire (GPAQ) was originally designed to be interviewer-administered by the World Health Organization in assessing physical activity. The main aim of this study was to compare the psychometric properties of a self-administered GPAQ with the original interviewer-administered approach. Additionally, this study explored whether using different accelerometry-based physical activity bout definitions might affect the questionnaire’s validity. Methods A total of 110 participants were recruited and randomly allocated to an interviewer- (n = 56) or a self-administered (n = 54) group for test-retest reliability, of which 108 participants who met the wear time criteria were included in the validity study. Reliability was assessed by administration of questionnaires twice with a one-week interval. Criterion validity was assessed by comparing against seven-day accelerometer measures. Two definitions for accelerometry-data scoring were employed: (1) total-min of activity, and (2) 10-min bout. Results Participants had similar baseline characteristics in both administration groups and no significant difference was found between the two formats in terms of validity (correlations between the GPAQ and accelerometer). For validity, the GPAQ demonstrated fair-to-moderate correlations for moderate-to-vigorous physical activity (MVPA) for self-administration (rs = 0.30) and interviewer-administration (rs = 0.46). Findings were similar when considering 10-min activity bouts in the accelerometer analysis for MVPA (rs = 0.29 vs. 0.42 for self vs. interviewer). Within each mode of administration, the strongest correlations were observed for vigorous-intensity activity. However, Bland-Altman plots illustrated bias toward overestimation for higher levels of MVPA, vigorous- and moderate-intensity activities, and underestimation for lower levels of these measures. Reliability for MVPA revealed moderate correlations (rs = 0.61 vs. 0.63 for self vs. interviewer). Conclusions Our findings showed comparability between both self- and interviewer-administration modes of the GPAQ. The GPAQ in general but especially the self-administered version may offer a relatively inexpensive method for measuring physical activity of various types and at different domains. However, there may be bias in the GPAQ measurements depending on the overall physical activity. It is advisable to incorporate accelerometers in future studies, particularly when measuring different intensities of physical activity.

Stress-management interventions have been integrated into treatments for people with mental disorders. Nevertheless, most studies on these interventions have been conducted on patients with schizophrenia in Western countries, and limited studies have used objective measurements of stress. We developed a group-based, four-session stress-management (S-Manage) program for people with mental disorders, consisting of two major components: psychoeducation and relaxation practice. This single-group, pretest–posttest, quasi-experimental study was undertaken to test the initial effects and determine the effect sizes of the program. A convenience sample of 55 inpatients were recruited from a mental health ward at a tertiary hospital in Singapore. Self-report questionnaires and physiological measures of stress (skin temperature and salivary immunoglobulin A [SIgA]) were used for data collection. Data were analyzed by descriptive statistics and repeated-measures analysis of variance. Most participants were Singaporean, female, single, and employed. Diagnoses included schizophrenia, depression, bipolar disorder, anxiety disorder, and mixed diagnoses. All received standard care provided by the hospital. Participants had significant reductions in objective stress, measured by skin temperature (effect size = 0.54) and SIgA (effect size = 0.16), and subjective stress (effect size = 0.16) as well as improved psychological health (effect size = 0.40) in response to the intervention. This study provides preliminary evidence to support the positive effects of the S-Manage program on people with mental disorders. Future studies should further test the efficacy of the program using more rigorous methods such as randomized controlled trial and multicenter study.

HapMap samples are currently being genotyped using different high throughput protocols at various international genome centres. To determine if there are any differences between SNP genotypes that may be related to these protocols, we analysed an initial set A consisting of 2,200 SNPs (100 SNPs from each autosome) typed in 90 HapMap CEU samples. Although SNP composition in terms of percentage of transitions and transversions was similar across protocols, one (termed "PI") yielded a high prevalence (39.9%) of mono-morphic SNPs (i.e. those with heterozygosity = 0) which was generally double that observed for the other protocols (corrected P-value (Pc) 0 and

Background Saliva is a potentially useful but untapped source of genomic DNA for genetic epidemiological studies. However, current commercial methods are mainly concerned with DNA extraction and do not address important issues concerning saliva preservation and storage. As such, we evaluated how various saliva storage conditions affected DNA yield and quality obtained using a new commercially available method that proposes to integrate these aspects in a single kit. Methods The conditions involved the extraction of the DNA immediately after saliva collection (condition 1) or when stored at air-conditioned room temperature (20 °C) for 1 month (condition 2) and 6 months (condition 3) as well as at − 80 °C for 6 months (condition 4). The effect of incorporating an additional incubation of saliva samples at 30 °C for 2 weeks was also examined. Results Overall average DNA yield from 2 ml of saliva was 35.5 μg (8.5–85.2 μg). DNA yield was unaffected by incubation of saliva at 30 °C but DNA yield under condition 3 was significantly higher compared to conditions 1 and 2. OD 260 / 280 values were acceptable and comparable across all conditions. Differences in storage conditions did not impact DNA quality in real time PCR experiments and genotyping fidelity remained undiminished. Conclusion Saliva is a viable alternative source of human genomic DNA for genetic epidemiological studies and that this new commercial method and possibly other related techniques can be effective means towards this end.

Emergency infection control measures are essential in hospitals. Although Japan was spared from the 2003 epidemic of severe acute respiratory syndrome (SARS), hospitals were placed on high alert. The actual preparedness level of hospitals can be determined by examining individual perceptions among the hospital healthcare workers (HCWs). The objective of this study was to assess the level of preparedness of emergency infection control measures in Japan and to quantify the differences in preparedness across institutions and disciplines. From July to September 2003, a questionnaire survey concerning the perceptions of risks and countermeasures and knowledge about SARS was distributed at seven tertiary hospitals. Disciplines were categorized as emergency room (ER)/intensive care unit (ICU), surgical, medical, and "others". Of the 9978 questionnaires administered, 6929 valid responses were received and analyzed. After adjusting for age, sex, and job category, specific institutional measures (I-scores) were found to be more indicative of the level of preparedness across institutions and disciplines than were measures of overall effectiveness (E-scores) or knowledge of preventive measures (K-scores). In particular, the difference in I-scores was much more substantial across institutions than across disciplines. Across disciplines, surgical ranked lower than ER/ICU or medical. In conclusion, substantial differences in emergency infection control measures, as perceived by HCWs, exists among hospitals in Japan, with the differences across institutions exceeding those across disciplines. To achieve a higher level of preparedness for infectious diseases, institutions should designate and implement effective emergency infection control measures.

Aims: To assess the longitudinal changes in biometric parameters and associated factors in young myopic children aged 7–9 years followed prospectively in Singapore. Methods: Children aged 7–9 years from three Singapore schools were invited to participate in the SCORM (Singapore Cohort study Of the Risk factors for Myopia) study. Yearly eye examinations involving biometry measures were performed in the schools. Only myopic children (n = 543) with 3 year follow up data were included in this analysis. Results: The 3 year increases in axial length, anterior chamber depth, lens thickness, vitreous chamber depth, and corneal curvature were 0.89 mm, −0.02 mm, −0.01 mm, 0.92 mm, and 0.01 mm, respectively. Children who were younger, female, and who had a parental history of myopia were more likely to have greater increases in axial length. After adjustment for school, age, sex, race, parental myopia and reading in books per week, the age (p

Purpose To describe the prevalence of cataract in adults in rural Sumatra, Indonesia. Design Population-based cross-sectional study. Participants A random sample of all adults aged 21 years or older living in 3 rural villages in central Sumatra was assessed. Nine hundred nineteen of 1089 (84.4%) eligible adults participated. Methods A team of 7 ophthalmologists examined the anterior segment of both eyes using a portable slit lamp after pupil dilatation. Lens opacity was graded according to the Lens Opacities Classification System III (LOCS III). A structured questionnaire was used to collect data on education level and income. Main Outcome Measures Cataract was defined as either a LOCS III nuclear region score of ≥4.0, cortical ≥4.0, or posterior subcapsular (PSC) cataract ≥2.0, in either eye. Results Two hundred one (21.9%) of 919 subjects were found to have cataract. The age-adjusted prevalence rate of cataract (including cataract surgery) was 23.0% (95% confidence interval, 20.8–25.2). The most common type of cataract for both genders (adjusted for age) was mixed (13%) followed by nuclear only (5.7%), and cortical only (4%). The prevalence rate of any cataract for adults aged 21 to 29 was 1.1%, increasing to 82.8% for those aged older than 60 years. Similar trends with age were noted for nuclear, cortical, and PSC cataract. Women had higher prevalence rates than men for all types of cataract except cortical. There was a trend of increasing prevalence of all types of cataract with decreasing education ( P Conclusions Cataract prevalence in adults aged 21 years and older in rural Indonesia is among the highest reported in Southeast Asia. Despite this, there are inadequate resources available to manage this treatable disease. Allocation of resources to tackle the present burden of cataract would likely have large personal, social, and economic benefits.

Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism.We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics.From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%).During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.

Objective: We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. Study: A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. Results: Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. Conclusion: There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.

Background: Singapore was affected by an outbreak of severe acute respiratory syndrome (SARS) from 25 February to 31 May 2003, with 238 probable cases and 33 deaths. Aims: To study usage of personal protective equipment (PPE) among three groups of healthcare workers (HCWs: doctors, nurses, and administrative staff), to determine if the appropriate PPE were used by the different groups and to examine the factors that may determine inappropriate use. Methods: A self-administered questionnaire survey of 14 554 HCWs in nine healthcare settings, which included tertiary care hospitals, community hospitals, and polyclinics, was carried out in May–July 2003. Only doctors, nurses, and clerical staff were selected for subsequent analysis. Results: A total of 10 236 valid questionnaires were returned (70.3% response); 873 doctors, 4404 nurses, and 921 clerical staff were studied. A total of 32.5% of doctors, 48.7% of nurses, and 77.1% of the administrative staff agreed that paper and/or surgical masks were "useful in protecting from contracting SARS". Among this group, 23.6% of doctors and 42.3% of nurses reported working with SARS patients. The view that a paper and/or surgical mask was adequate protection against SARS was held by 33.3% of doctors and 55.9% of nurses working at the A&E unit, 30.5% of doctors and 49.4% of nurses from medical wards, and 27.5% of doctors and 37.1% of nurses from intensive care units. Factors which predicted for agreement that paper and/or surgical masks were protective against SARS, included HCW's job title, reported contact with SARS patients, area of work, and Impact Events Scale scores. Conclusion: A variety of factors determine appropriate use of personal protective equipment by HCWs in the face of a major SARS outbreak.

The ACE insertion/deletion polymorphism has been examined for association with diabetic nephropathy over the past decade with conflicting results. To clarify this situation, we conducted a comprehensive meta-analysis encompassing all relevant studies that were published between 1994 and 2004 and investigated this potential genetic association.A total of 14,727 subjects from 47 studies was included in this meta-analysis. Cases (n=8,663) were type 1 or 2 diabetic subjects with incipient (microalbuminuria) or advanced diabetic nephropathy (proteinuria, chronic renal failure, end-stage renal disease). Control subjects (n=6,064) were predominantly normoalbuminuric.No obvious publication bias was detected. Using a minimal-case definition based on incipient diabetic nephropathy, subjects with the II genotype had a 22% lower risk of diabetic nephropathy than carriers of the D allele (pooled odds ratio [OR]=0.78, 95% CI=0.69-0.88). While there was a reduced risk of diabetic nephropathy associated with the II genotype among Caucasians with either type 1 or type 2 diabetes, the association was most marked among type 2 diabetic Asians (Chinese, Japanese, Koreans) (OR=0.65, 95% CI=0. 51-0.83). This OR is significantly different from the OR of 0.90 (95% CI= 0.78-1.04) that was obtained for type 2 diabetic Caucasians (p=0.019). Using a stricter case definition based on advanced diabetic nephropathy, a comparable risk reduction of 24-32% was observed among the three subgroups, although statistical significance was reached only among Asians.The results of our meta-analysis support a genetic association of the ACE Ins/Del polymorphism with diabetic nephropathy. These findings may have implications for the management of diabetic nephropathy using ACE inhibitors especially among type 2 diabetic Asians.

OBJECTIVES A survey was conducted to measure psychological stress in hospital workers and measure factors that may have mediated acute traumatic responses. METHODS A self-report survey was completed by 1557 healthcare workers at three Toronto hospitals in May and June 2003. Psychological stress was measured with the Impact of Event Scale. Scales representing attitudes to the outbreak were derived by factor analysis of 76 items probing attitudes to severe acute respiratory syndrome. The association of Impact of Event Scale scores to job role and contact with severe acute respiratory syndrome patients was tested by analysis of variance. Between-group differences in attitudinal scales were tested by multivariate analysis of variance. Attitudinal scales were tested as factors mediating the association of severe acute respiratory syndrome patient contact and job role with total Impact of Event Scale by linear regression. RESULTS Higher Impact of Event Scale scores are found in nurses and healthcare workers having contact with patients with severe acute respiratory syndrome. The relationship of these groups to the Impact of Event Scale score is mediated by three factors: health fear, social isolation, and job stress. CONCLUSIONS Although distress in response to the severe acute respiratory syndrome outbreak is greater in nurses and those who care for patients with severe acute respiratory syndrome, these relationships are explained by mediating variables that may be available for interventions to reduce stress in future outbreaks. In particular, the data suggest that the targets of intervention should include job stress, social isolation, and health fear.

Background: Saliva is a potentially useful source of genomic DNA for genetic studies since it can be collected in a painless and non-invasive manner. We sought to determine whether different storage conditions of saliva samples impact our ability to extract genomic DNA that is of sufficient quality for use in the polymerase chain reaction (PCR). Methods: Saliva was collected from healthy volunteers and 2-ml aliquots subjected to different storage conditions: S1—washing of saliva using phosphate-buffered saline (PBS) and extraction of DNA on the same day of collection; S2—washing and centrifugation to yield a pellet, which was stored at−70 °C for 1 week prior to DNA extraction; S3—storage of whole saliva at 4 °C for 7 days, followed by washing and extraction of DNA; S4—storage at 4 °C for 7 days, followed by washing and pellet formation. The pellet was stored at −70 °C for 1 month before extraction of the DNA; S5—storage at−70 °C for 1 month, followed by washing and extraction of DNA. DNA yield and purity was determined by spectrophotometry at 260 and 280 nm. Twenty nanograms of genomic DNA was used for the polymerase chain reaction, and the resulting PCR band was captured by digital photography and quantified. Results: The amounts of DNA extracted from 2 ml of saliva varied widely under the different storage conditions, while purity of the DNA extraction, based on OD260/280 ratios, was good and comparable. PCR resulted in the presence of a single specific product of the correct size from all samples regardless of saliva storage conditions. Quantification of PCR bands showed significant differences between the various storage conditions (P

Aim: To examine the association of birth parameters with biometry and refraction in Singapore Chinese schoolchildren. Methods: Chinese children aged 7–9 years (n = 1413) from three schools in Singapore were recruited. Birth parameter information on birth weight, head circumference, length at birth, and gestational age were obtained from standard hospital records. Cycloplegic autorefraction, keratometry and biometry measures (axial length, vitreous chamber depth, lens thickness, and anterior chamber depth) were obtained. Results: Across the normal birthweight range (2.0–4.9 kg), children with birth weights ⩾4.0 kg had longer axial lengths (adjusted mean 23.65 mm versus 23.16 mm), compared with children with birth weights Conclusions: Children who were born heavier, had larger head sizes or lengths at birth, or who were born more mature had longer axial lengths, and deeper vitreous chambers; but there were no differences in refraction at ages 7–9 years, possibly because of the observed compensatory flattening of the cornea.

Spotlight on a diverse industry The electronics industry employs millions of workers throughout the world and plays a significant role in the structure of the world’s economy. Many multinational electronics industries retain their capital intensive operations in home countries, but locate their labour intensive operations in newly industrialising countries, because of the lower cost of labour and attractive financial and infrastructural incentives offered. In many developing and newly industrialising countries, the industry is a major contributor to employment and national economic growth. The electronics industry is diverse with a wide spectrum of processes. Its sectors include semiconductor wafer fabrication, manufacture of printed circuit boards, the assembly of semiconductor devices and printed circuit boards, and assembly of the final electronic products. There are also many supporting industries that produce materials and components necessary to make the final product. These include those which manufacture metal and plastic parts, electrical parts such as storage media for hard disks, precision motors to run drives, transformers, switches, liquid crystal displays, and other electronic components. In general, the processes in the electronics industry can be viewed as a series of work leading to the final product (table 1): View this table: Table 1 Work processes in the electronics industry

In the drama of negotiation of state boundaries, the role of local administrators as mediators is indispensable. They mediate between state demands for more discipline and societal demands for more liberties. Their ability and willingness to enforce determines the extent of state power. They are a particular type of elites chosen by the state to administer; yet often they have an irrational and morally corrupt relationship with their subjects. The questions that arise then are: When do the local administrators decide to or not to enforce the rules? What considerations do they hold in the face of contradicting demands for their loyalties? This paper seeks answers to the above questions by examining state enforcement of its construction rules in Hanoi after 1975, in which the ward, a level of local administrators in the urban administration landscape, plays an important role in holding up (or letting down) the fences. I will examine the irrationality of the housing regime that led to widespread offences against construction rules, and then show why and how local administrators may or may not enforce rules. This paper comprises two parts. The first part outlines the nature and history of the housing regime in Vietnam and the situation of state provision of housing to the people. These provide the context in which illegal construction arises. Part Two looks at illegal construction in Hanoi chronologically, and focuses on important episodes. The theme that runs through this paper is the role of local administrators in the reality of illegal construction.

A definition of surveillance is as follows: “surveillance (ser-vâ1lens) noun. 1. Close observation of a person or group, especially one under suspicion. 2. The act of observing or the condition of being observed” ( The American Heritage Dictionary of the English Language , 3rd edition, Houghton Mifflin Company, 1992). The term “surveillance” is derived from the French word meaning “to watch over”. In public health, surveillance was originally developed as part of efforts to control infectious diseases, but the principles of surveillance can potentially be applied to other problems such as chronic diseases (for example, cancer and coronary heart disease), social problems (for example, drug addiction), and the threat of bioterrorism.1 Surveillance is a core activity in the practice of occupational health. Two broad groups of surveillance are commonly performed—hazard surveillance and health surveillance. While the focus of the former is hazards at the workplace, the latter type of surveillance pertains to the health of a person of group of workers. Both have important roles in occupational health practice and are complementary. The focus of this paper will be on chemical and biological exposures and related diseases. In many countries, occupational health concerns include psychosocial and ergonomic issues in the work environment and related problems and adverse health outcomes. These issues will not be addressed in detail in this paper, but surveillance programmes for such concerns have been developed, for instance, in Nordic countries. Hazard surveillance has been defined as “the process of assessing the distribution of, and the secular trends in, use and exposure levels of hazards responsible for disease and injury”.2 For this type of surveillance to be considered, a clear “exposure–health outcome” relation must already have been established. The surveillance of hazards should result in action to reduce exposure in workplaces where indicated. This …

SummaryBackground There has been an alarming recent increase in skin cancer incidence among fair-skinned populations. Information from Asian populations is less readily available. Objectives This study examines time trends and ethnic differences of skin cancers among Asians in Singapore. Methods Data from 1968 to 1997 was obtained from the Singapore Cancer Registry, a population-based registry. Age-standardized incidence rates (ASRs) and age-adjusted average annual percentage change, using the Poisson regression model, were calculated. Results A total of 2650 basal cell carcinomas (BCCs), 1407 squamous cell carcinomas (SCCs) and 281 melanomas were reported. There was an overall increase of skin cancer from 6·0 per 100 000 person years (1968–72) to 8·9 per 100 000 person years (1993–97). BCC incidence increased 3% annually, melanoma remained constant, and SCC decreased 0·9% annually. BCC ASRs were highest among Chinese, then Malays and Indians. A similar pattern was noted for SCC and melanomas. Conclusions The incidence rates of skin cancer increased in Singapore during the period 1968–97. Fairer-skinned Chinese had a higher incidence of skin cancer.

Objectives To establish the prevalence of voice disorder using the Malay-Voice Handicap Index 10 (Malay-VHI-10) and to study the determinants, quality of life, depression, anxiety and stress associated with voice disorder among secondary school teachers in Peninsular Malaysia. Methods This study was divided into two phases. Phase I tested the reliability of the Malay-VHI-10 while Phase II was a cross-sectional study with two-stage sampling. In Phase II, a self-administered questionnaire was used to collect socio-demographic and teaching characteristics, depression, anxiety and stress scale (Malay version of DASS-21); and health-related quality of life (Malay version of SF12-v2). Complex sample analysis was conducted using multivariate Poisson regression with robust variance. Results In Phase I, the Spearman correlation coefficient and Cronbach alpha for total VHI-10 score was 0.72 (p < 0.001) and 0.77 respectively; showing good correlation and internal consistency. The ICCs ranged from 0.65 to 0.78 showing fair to good reliability and demonstrating the subscales to be reliable and stable. A total of 6039 teachers participated in Phase II. They were primarily Malays, females, married, had completed tertiary education and aged between 30 to 50 years. A total of 10.4% (95% CI 7.1, 14.9) of the teachers had voice disorder (VHI-10 score > 11). Compared to Malays, a greater proportion of ethnic Chinese teachers reported voice disorder while ethnic Indian teachers were less likely to report this problem. There was a higher prevalence ratio (PR) of voice disorder among single or divorced/widowed teachers. Teachers with voice disorder were more likely to report higher rates of absenteeism (PR: 1.70, 95% CI 1.33, 2.19), lower quality of life with lower SF12-v2 physical (0.98, 95% CI 0.96, 0.99) and mental (0.97, 95% CI 0.96, 0.98) component summary scales; and higher anxiety levels (1.04, 95% CI 1.02, 1.06). Conclusions The Malay-VHI-10 is valid and reliable. Voice disorder was associated with increased absenteeism, marginally associated with reduced health-related quality of life as well as increased anxiety among teachers.

The relationship between cancer and inflammation is a complex but intimate one. Decades of work has shown to us that cancer progression is influenced by a multitude of factors, including genetic, environmental, and immunological factors. We often overlook that cancer progression is also a pathological consequence of a dysregulated inflammatory control in the body. A current emerging topic in cancer research is the role of inflammasomes in carcinogenesis. The inflammasome is a multicomplex protein platform that when activated results in the release of proinflammatory cytokines, such as interleukin (IL)-1β. There is increasing evidence suggesting that IL-1β plays a pivotal role in cancer progression. This short review proposes the possibility of using IL-1β as a potential cancer progression biomarker and discusses the use of saliva as a model biological fluid for measuring physiological IL-1β levels in the body.

Aims: To assess and compare the self perceived work related stress among emergency department (ED) and general ward (GW) nurses, and to investigate its relation with salivary IgA and lysozyme. Methods: One hundred and thirty two of 208 (63.5%) registered female ED and GW nurses participated in the study. A modified mental health professional stress scale (PSS) was used to measure self perceived stress. ELISA methods were used to determine the salivary IgA and lysozyme levels. Results: On PSS, ED nurses had higher scores (mean 1.51) than GW nurses (1.30). The scores of PSS subscales such as organisational structure and processes (OS), lack of resources (RES), and conflict with other professionals (COF) were higher in ED than in GW nurses. ED nurses had lower secretion rates of IgA (geometric mean (GM) 49.1 μg/min) and lysozyme (GM 20.0 μg/min) than GW nurses (68.2 μg/min, 30.5 μg/min). Significant correlations were observed between PSS and log IgA and lysozyme secretion rates. OS, RES, and COF were correlated with log IgA and lysozyme levels. Conclusion: ED nurses, who reported a higher level of professional stress, showed significantly lower secretion rates of salivary IgA and lysozyme compared to GW nurses. Salivary IgA and lysozyme were inversely correlated with self perceived work related stress. As these salivary biomarkers are reflective of the mucosal immunity, results support the inverse relation between stress and mucosal immunity.

Aim: To determine the prevalence and identify associated risk factors for dry eye syndrome in a population in Sumatra, Indonesia. Methods: A one stage cluster sampling procedure was conducted to randomly select 100 households in each of the five rural villages and one provincial town of the Riau province, Indonesia, from April to June 2001. Interviewers collected demographic, lifestyle, and medical data from 1058 participants aged 21 years or over. Symptoms of dry eye were assessed using a six item validated questionnaire. Presence of one or more of the six dry eye symptoms often or all the time was analysed. Presence of pterygium was documented. Results: Prevalence of one or more of the six dry eye symptoms often or all the time adjusted for age was 27.5% (95% confidence interval (CI) 24.8 to 30.2). After adjusting for all significant variables, independent risk factors for dry eye were pterygium (p

Low condom use for oral sex among female brothel-based workers in Singapore has led to a rise in pharyngeal gonorrhea. The goal of the study was to evaluate a program promoting the use of condoms for oral sex. The authors used the time-series design to compare condom and pharyngeal gonorrhea trends before and after program intervention in 1996 and the pretest-posttest matched control group design to determine the impact of brothel interventions on sex workers. Results showed that consistent oral condom use increased significantly from 42.2% in 1996 to 89.9% in 2000 with a corresponding decline in pharyngeal gonorrhea (in comparison with no significant changes before intervention). Among sex workers in brothels with interventions there was a 10.8% absolute increase in condom use compared with an 11.7% decrease in condom use in the control group. The gonorrhea incidence rate was also significantly much lower in the intervention group than in the control group (adjusted risk ratio: 0.22; 95% confidence interval: 0.06-0.78). In conclusion the intervention increased oral condom use with a decline in the incidence of pharyngeal gonorrhea. (authors)

The global occupational medicine fraternity lost one of its leading lights when Professor Tar-Ching Aw passed away suddenly and unexpectedly on 18 July 2017. He is survived by his wife Foong Kwai, sons Yuen and Gene, and two grandsons. Tar-Ching, or ‘Ching’ was born on 17 July 1948 in the then British colony of Malaya. He had an idyllic childhood in the rural state of Kelantan before going to the capital city of Kuala Lumpur for his high school and enrolling for medical studies in the University of Malaya. He qualified in Medicine in 1971 and this was followed by degrees in Public Health from the University of Singapore in 1974, Occupational Medicine (with distinction) from the University of London in 1975 and a PhD from the Faculty of Medicine, University of London in 1980. He was board certified in occupational medicine in the USA in 1985. He had …