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sep
oct
2014
a Bimonthly Publication of
Singapore General Hospital
and SingHealth ACADEMIC
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MCI (P) 173/05/2014
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05
More children are seeing the dentist
before turning two
08
Drinking coffee cuts the risk of dying from
some liver diseases
New injection
method for
overactive
parathyroid
glands
21
With the right posture, equipment and
attire, cyclists can enjoy the sport better
P3
26
能快速恢复
甲状旁腺功能
的新疗法
P27
An expectant mother’s moods can affect
her baby’s development
29
居家护理让病患省却了往返医院的奔波，
也减轻了医院的负担
02
singapore health
SEP– OCT 2014
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sep– oct 2014
singapore health
NEWS
03
Cut, mince and jab
A new technique that injects finely minced parathyroid gland tissue into the arm
of a kidney failure patient works better than implanting a bit of the gland
By Thava Rani
S
urgery to remove overactive
parathyroid glands in patients
with kidney failure was often followed up immediately with a small bit
of the gland being implanted into the
arm muscle. This was done to restore the
glands’ function, which could take nearly
nine months to recover.
But a team of surgeons from the
Singapore General Hospital (SGH) and
the National Cancer Centre Singapore
(NCCS) recently found through a retrospective study of 132 patients that injecting a solution containing finely minced
gland tissue into the upper arm got the
parathyroid function up and running
again more quickly. The glands’ function
was restored in just two months, the
study found.
“This new injection method promotes
faster recovery and can be performed
in nearly half the time that the conventional method requires,“ said Dr Jeremy
Ng, Consultant, General Surgery, SGH.
Unlike the previous method of cutting up
muscle to implant the gland, the injec-
(From left) Dr Gopal Iyer, Dr Jeremy Ng
and Associate Professor Lina Choong,
were involved in the study on the new
injection method which promotes
quicker recovery.
Small but
important
thyroid gland
parathyroid
glands
The tiny parathyroid glands, found behind the thyroid, can grow many times
their normal size in some advanced stage renal disease patients.
tion does not leave any scars, and there is
less risk of bleeding or infection.
“If the gland becomes overactive
again, surgeons can get to the injection
site more easily, without having to cut
through muscle again,” said Dr Gopal
Iyer, Senior Consultant, Department of
Surgical Oncology, NCCS.
The study involved 132 patients who
underwent surgery to remove their parathyroid glands between February 2005
and February 2012. The patients’ parathyroid function was restored by either
implantation or injection.
The study was published in Surgery,
a renowned international journal, in
January this year. The injection method,
which carries a lower risk of complications, has become the standard procedure for this condition at SGH. About 130
patients have undergone the procedure.
The tiny parathyroid glands that sit
near the thyroid glands in the neck serve
the very important function of maintaining the right balance of calcium and
phosphate levels in the blood. When this
balance goes out of whack, as is common
among those suffering from poor kidney
function, medication or even surgery is
needed to treat the condition.
“Patients with poor kidney function
have a problem with phosphate because
Implantation or injection?
What isHow longHow long beforescarring? risks
Done
it takes
parathyroid function
is restored Injection
Solution of finely minced
gland injected into fat
under the skin
Implantation
Gland pieces implanted 30min
9 months
4-5cm
into arm muscle
18min
2 months
None
None
Bleeding,
infection
Sometimes too small
to be detected even
by ultrasound,
parathyroid glands
• Are small pea-sized glands,
usually four, located just
behind the butterfly-shaped
thyroid glands in the neck
• Can grow 20-30 times their
normal size when stimulated
to keep producing a hormone
that deals with phosphate and
calcium imbalance
The glands’
Balancing act
• Parathyroid hormone is
released to control levels
of calcium (too low) and
phosphate (too high) in the
body; magnesium too
• Causes kidneys to excrete
excess phosphate in urine
• Causes release of calcium
from bones, calcium to be
absorbed, and stops kidneys
from getting rid of calcium
in urine
Calcium and phosphate
are important in
• Building and repairing bones
and teeth
• Helping nerves to function
• Making muscles contract
• Helping blood to clot
When there is Too
much phosphate
• Kidneys are not able to remove
excess phosphate in urine
effectively when prompted by
hormone
• Parathyroid glands keep
releasing hormone to try and
lower high phosphate level
• Continued discharge of
hormone causes side effects:
more calcium is released from
bones, resulting in slow loss
of support function; released
calcium clogs blood vessels
• Patients may experience bone
and joint pains, fractures and/
or cardiovascular problems
> Continued on page 4
( 华文版本请翻阅至27页 )
04
NEWS
singapore health
sep– oct 2014
> Continued from page 3
Cut, mince and jab
with people suffering from end-stage
renal failure, the signals cannot be
heard and the kidneys cannot get rid
of phosphate easily, leading to phosphate levels staying at elevated levels,
she said. When this occurs for a long
time, bone and cardiovascular diseases can occur.
Not everyone with kidney failure will
Measuring kidney deterioration
Kidney disease usually worsens slowly over a period of
years. There are five stages of kidney deterioration, each
requiring different tests and treatments, said Associate
Professor Lina Choong, Senior Consultant and Director of
Dialysis, Department of Renal Medicine, SGH.
develop overactive parathyroid glands;
an estimated one-third of kidney failure patients develop the condition
eventually. While the overactive glands
can be controlled through medication
and diet, about 5 per cent to 15 per
cent of patients will need to turn to
surgery as a last resort to address
the problem.
The stages are defined based on the glomerular filtration
rate (GFR), the best measure of kidney function. The GFR
is calculated using the results of a blood test along with
the patient’s age, race and gender. The higher the GFR, the
better the kidney’s function.
Stage I
Stage II
Stage III
Stage IV
Stage V
(end-stage)
GFR
> 90
GFR
60 – 89
GFR
30 – 59
GFR
15 – 29
GFR
< 15
PhotoS: alvinn lim
all food has some phosphate in it,” said
Associate Professor Lina Choong, Senior
Consultant and Director of Dialysis,
Department of Renal Medicine, SGH.
For people with kidneys that function normally, this excess phosphate
is excreted through the urine, and balance is regained quickly. But when the
kidney is not functioning normally, as
Dr Jeremy Ng (foreground) uses
an ultrasound scan to check Mr Ho
Peng Fun’s parathyroid glands. Mr
Ho underwent surgery to have his
parathyroid glands removed and the
gland function restored by the injection
method. The 65-year-old had bone
pain, a common symptom of overactive
glands in kidney failure patients.
(dialysis or kidney
transplant needed)
GFR 10090 80 7060 5040 3020 10
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Sep– oct 2014
singapore health
NEWS
05
Show me your teeth
The call to take very young children for dental check-ups seems to be getting heard
rect dental habits and dietary practices
set up a negative environment for baby
teeth, even before the first tooth erupts.
After evaluation, dentists will formulate a
plan with parents to lower this risk. This
is a cost-effective strategy for parents and
dentists to prevent problems with.
Consequently, the age recommendation was reduced to two years. But
even with this lowering of the age recommendation, many children were still
coming in with dental cavities. Decay
was spreading rampantly.
“We needed a change in strategy to
get ahead of this disease,” said Dr Chng.
The first dental visit
According to AAPD, the first dental visit
is now recommended at the time when
the first tooth erupts; no later than
age one. This is so that before children
develop decay (as many children did by
age two previously), parents will be able
to avoid the risk factors and keep their
children’s teeth decay-free.
Paediatric dentists at NDCS have
long adopted and supported this recommendation, setting up the first dedicated infant oral health programme
five years ago. However, inertia against
bringing children by age one was only
more recently overcome – the result of
public education by the PDU. Other outreach platforms include its Facebook
page, media interviews, and publication in newspapers and magazines.
The key element of a first visit
is dental risk assessement. Incor-
Photo: jasper yu
P
aediatric dentists at the National
Dental Centre Singapore (NDCS)
are happy because more infants
and very young children are coming in
for their first visit. Last year, the NDCS’
Paediatric Dentistry Unit (PDU) saw a 50
per cent increase in parents taking their
children there for their first dental visit
before their second birthday.
“This trend is very encouraging,” said
Dr Tabitha Chng, Senior Registrar, PDU.
“First Dental Visit By Age One” is a
proactive measure parents are taking
to maintain their children’s dental
health. Currently, the dental health of
children in Singapore is on the decline:
the number treated for Severe Early
Childhood Caries (SECC) before the age
of six doubled from about 500 in 2000 to
1,000 in 2011 and 2012.
The American Academy of Paediatric Dentistry (AAPD) revised its recommendations in the 1990s with regards to
the timing of a child’s first dental visit.
Historically, many parents used to take
their children to the dentist after the age
of three. However,
many had
succumbed
to SECC
by then.
According to Dr Tabitha Chng,
last year, the Paediatric
Dentistry Unit saw a 50 per cent
increase in parents taking their
children there for their first
dental visit before their second
birthday.
The ABCs of the
first dental visit
Assessment
Preventing future dental problems is the goal of an early first
visit. Parent-child dental risk
assessments include a detailed
interview with parents, an oral
examination for child and caregiver (e.g. parent), and discussions on the management of
dental injuries, dental habits (e.g.
thumb sucking) and choosing the
right tools for the child’s current
needs (e.g. toothpaste).
Be honest
Parents should not feel embarrassed to share their own dental
struggles or concerns with their
child. Paediatric dentists are
there to guide them.
Comfort
The number of children treated for Severe Early Childhood Caries before
the age of six doubled from about 500 in 2000 to 1,000 in 2011 and 2012.
The child’s comfort is important.
Pick appointment times when the
child is well-rested (e.g. avoid nap
times or feeding times). During
the examination, the paediatric
dentist will be able to guide the
parent to position the child in a
comfortable position that is safe
and secure.
Paediatric dentists at work
Dr Chng is part of a diverse team of paediatric dentists at NDCS. She obtained her
Masters of Science in Paediatric Dentistry
from the University of Toronto, Canada,
and is doubly board-certified in the
United States and Canada.
As a paediatric dentist, Dr Chng has
one main goal – to equip parents and
children with the right dental practices
and attitudes, so that children grow
into adults with good dental attitudes.
An understanding of child psychology,
patience, and most importantly sincerity,
is needed when treating children, she
said. “They are the best lie detectors and
can tell when you’re not sincere. Trust
needs to be earned.”
It warms my heart to
see parents take
ownership of their
child’s dental health
and commit to
cultivating good
dental habits. It gives
me a lot of satisfaction
to see a child’s dental
health improve, and the
smiles on a child and
his parents’ faces when
I tell them that their
efforts have paid off.
Dr Tabitha Chng, Senior Registrar, PDU, NDCS
Dr Chng is proud of the progress her
patients and their parents are making.
She said: “It warms my heart to see
parents take ownership of their child’s
dental health and commit to cultivating
good dental habits. It gives me a lot of
satisfaction to see a child’s dental health
improve, and the smiles on a child and his
parents’ faces when I tell them that their
efforts have paid off. These remind me of
why I chose to be a paediatric dentist.”
06
NEWS
singapore health
sep– oct 2014
East-West drug mix has
benefits, dangers
Doctors worried about the herbal medicines their patients take
with the Western medical drugs they prescribe are turning
to a traditional medicine information service for help
By Sol E Solomon
M
and experience, and less in the way of
documented trials. “So it’s hard to draw
a conclusion about whether a herb works,
or whether a result is due to something
else,” said Ms Lim.
To address this shortcoming, Ms Lim
and a group of like-minded SGH colleagues set up a traditional medicine
information service in October 2011 to
provide doctors, pharmacists and other
health care professionals with evidence-based information about traditional and alternative medicines.
Because we believe that
traditional medicines
do have their benefits,
we want patients to
benefit from both
traditional medicine
and Western medicine
(within safety limits).
Ms Lim Ching Hui, Senior Principal
Pharmacist, SGH
The others in her team are Dr Linn
Yeh Ching, Senior Consultant, Department of Haematology, SGH; Mr Ricky Ang
Seng Kok, Principal Pharmacist, Department of Oncology Pharmacy, National
Photo: Alvinn Lim
any patients regularly take traditional or herbal medicines without realising that such remedies
can have harmful effects or interact with
the conventional Western drugs prescribed by their doctors.
Yet, the use of such medicines is on
the rise.
While doctors and other medical professionals can and should play a role in
ensuring that folk or complementary
remedies are used safely, high-quality evidence about the efficacy, effects
and other pharmaceutical information
of these products must also be readily
available, said Ms Lim Ching Hui, Senior
Principal Pharmacist, Singapore General Hospital (SGH). “There is a gap in
current medical practice,” said Ms Lim.
“We know through our daily contact with
patients that many of them take complementary and alternative medicines, but
the reality is that many don’t or won’t tell
their doctors they are using such products. Doctors, on the other hand, may not
know how to advise their patients
because they don’t know enough about
these products.”
Much of the distrust that Western
medical professionals have about traditional medicines stems from the differences in practice. Cold, hard evidence
following years – sometimes decades – of
documented clinical observations and
tests is the cornerstone of conventional
Western medical practice. With traditional and herbal medicines, however,
the proof is in centuries’ worth of practice
(From left) Dr Linn Yeh Ching, Mr Ricky Ang Seng Kok, Ms Lim Ching Hui,
and Ms Fung Foon Yin are members of the team that set up a traditional
medicine information service to help health care professionals with queries
about herbs and traditional medicines.
Cancer Centre Singapore; Ms Shyamala
Out of 15 cases for which no risk
Narayanaswamy, Pharmacy Practice was indicated, eight (53 per cent) of the
Manager, SGH; and Ms Fung Foon Yin, health care professionals allowed the use
Traditional Medicine Resource Executive, of the product in question. The remaining
Pharmacy Department, SGH. Ms Fung 47 per cent took a cautious stance and
answers queries and does the literature discouraged their use, said Ms Lim, who
searches.
was the lead investigator of the survey.
Funded by the Ministry of Health, the
Ms Lim added that those who gave the
service covers all traditional remedies go-ahead to their patients did so because
including traditional Chinese, Ayurvedic they continued monitoring their patients’
and Malay/Indonesian Jamu medicines, conditions, or the drug had already been
as well as health supplements.
used for a while by the patient with no
“Because we believe that traditional reported problems.
medicines do have their benefits, we
The queries came from pharmacists
want patients to benefit from both tra- (77 per cent) and doctors (20 per cent).
ditional medicine and Western medicine Not surprisingly, safety issues predomi(within safety limits),” said Ms Lim. For nated, such as concerns with drug interinstance, ginger, a traditional herbal cure actions (56 per cent) and adverse reacfor nausea and vomiting, can help allevi- tions (22 per cent). The findings were
ate the side effects that a patient under- summarised in a poster and presented at
going chemotherapy may get. Acupunc- last year’s SGH Annual Scientific Meeting,
ture can also help with such symptoms, Annual Singapore Pharmacy Congress
said Ms Lim, noting that patients have (where it was the 2nd runner-up in the
stopped treatment when the side effects Competitive Poster category), and other
of chemotherapy became too severe to overseas conferences.
bear. “Reducing the side effects of the
Ms Lim said that her team is working
chemotherapy helped them to continue on another project to build up a datawith their treatment,” she said.
base of treatments on cancer, diabetes
The traditional medicine information and hypertension with Thong Chai Medservice receives two to three queries a ical Institution. The effects – both posiweek. Ms Fung trawls through medical tive and negative – of using both Westreference books, medical journals, case ern and traditional Chinese treatments
reports, and Chinese medical databases for cancer, diabetes or hypertension will
to find the information needed. The pro- be studied carefully and documented.
cess can take anywhere from one to two “Hopefully, we will be able to develop a
hours to several days.
database of findings to share with both
The team analysed the 216 queries Western and traditional Chinese docthe service received between October tors,” said Ms Lim.
2011 and April 2013, and found that 77 per
If the group is able to secure a grant
cent related to the safety of traditional or for the project, the study will begin at
herbal medical products. Published infor- the end of this year. The team is also
mation was available for 82 per cent of looking to set up a database on warfathese queries. And of these, 115 enquirers rin, a common blood-thinning drug, and
provided feedback about whether they its interactions. When that is completed,
encouraged or discouraged the use of the they will continue and set up databases of
product in question.
other medications.
sep– oct 2014
singapore health
07
08
NEWS
singapore health
sep– oct 2014
Good brew
Drinking at least two cups of coffee
a day lowers the risk of dying from
some types of liver cirrhosis
Study recruited
older Chinese living
in Singapore
By Desmond Ng
T
he jury may still be out on whether
coffee is good or bad for health.
But a new study has given the beverage a thumbs-up – at least for the benefits it has for some liver diseases.
The study by Singapore General
Hospital (SGH) and Duke-NUS Graduate Medical School doctors found that
drinking at least two cups of coffee a day
lowered the risk of dying from non-viral
hepatitis-related cirrhosis among Chinese in Singapore by 66 per cent. Cirrhosis is scarring of the liver and can be
due to viral hepatitis B or C, or non-viral
causes such as heavy drinking, autoimmune disease and fatty liver disease.
According to Dr George Goh, Consultant, Department of Gastroenterology
and Hepatology, SGH, the benefits of
coffee reported in earlier international
studies on several aspects of liver disease have been inconsistent. But the
SGH-Duke-NUS study was able to show
for the first time “that it is the non-viral
hepatitis cirrhosis group, rather than the
viral hepatitis group, that benefits from
drinking coffee,” Dr Goh said.
“Coffee did not affect mortality
from viral hepatitis-related cirrhosis,
but drinking two or more cups of coffee
per day reduced mortality from non-viral hepatitis-related cirrhosis by 66
per cent.”
Coffee has more than a thousand
compounds, and it is difficult to identify the actual active component that
reduces the risk of dying from cirrhosis,
said Dr Goh, one of the investigators
of the study. “From our data, we know
that it is not caffeine, which is one of the
more prominent compounds that come
to mind when talking about coffee. We
postulate that several of its other compounds such as polyphenols, melanoidins, cafestol and kahweol have antioxidant and anti-inflammatory properties
that are beneficial for the liver.”
The study found that other caffeine-containing beverages like green
tea and black tea had no significant
effects on cirrhosis mortality. Drinking fruit juices or soft drinks also didn’t
affect the risk of dying from cirrhosis.
Another finding of the study, unsurprisingly, was that respondents who
drank at least 20g of ethanol (alcohol)
every day had a greater risk of dying
from cirrhosis than non-drinkers.
The study was based on data from
an earlier research study cohort by
Associate Professor Koh Woon Puay of
Duke-NUS Graduate Medical School.
Together with Associate Professor
Chow Wan Cheng, Senior Consultant,
The data of 63,275 ethnic Chinese
living in Singapore were used for the
Coffee reduces risk of mortality from nonviral hepatitis-related cirrhosis among
Chinese in Singapore study to find out if
drinking coffee, alcohol, black tea, green
tea and soft drinks affected the risk of
dying from cirrhosis.
The subjects, between 45 and 74
years of age, were surveyed for an earlier
study, and had provided information on
their diets, lifestyle choices, and medical
histories during in-person interviews
conducted between 1993 and 1998.
They were followed for an average
of nearly 15 years, during which 14,928
or 24 per cent died at the average
age of 67. Of this number, 114 died of
liver cirrhosis.
Chronic hepatitis
B and nonalcoholic fatty
liver disease
form the majority of the
chronic liver diseases seen
at SGH clinics
2.9%
or about 1 in 35 adults
in Singapore are
hepatitis B carriers
360,000,000
people worldwide have chronic hepatitis B infections;
a significant proportion of them are in Asia
3rd
4th
16th
Liver cancer occurs
more often in men
than women and is
the 3rd highest
cause of male
cancer mortality in
Singapore
Liver cancer
accounts for 7.5
per cent of all
cancer incidences
– the 4th highest –
among Singapore
residents
Liver cirrhosis,
which can lead to
the development
of liver cancer, is
the 16th leading
cause of death
in Singapore
Up to
12%
of chronic hepatitis
B patients develop
cirrhosis annually
2 billion
people worldwide have been infected
with the hepatitis B virus
*Figures from World Health Organization, Ministry of Health
Department of Gastroenterology and
Hepatology, SGH, the investigators then
collaborated by identifying the cases
and conducting the analysis together,
said Prof Koh.
The finding from their study, said
Prof Koh, “resolves the seemingly conflicting results on the effect of coffee
in Western and Asian-based studies
of death from liver cirrhosis. Our finding suggests that while the benefit
of coffee may be less apparent in the
Asian population where chronic viral
hepatitis B predominates currently,
this may change as the incidence of
non-viral hepatitis-related cirrhosis is
expected to increase in these regions,
accompanying the increasing affluence
and westernised lifestyles of their
younger populations.”
Coffee is widely consumed globally
and is universally accepted as a lifestyle
choice, rather than a “pharmacological
drug”, said Dr Goh. Hence, it has worldwide appeal in its use as a therapeutic
option in liver disease, particularly in
chronic liver diseases such as non-alcoholic fatty liver disease where treatment
options are limited.
“However, there remains a lot more
research that is required before we can
confidently ‘prescribe’ coffee as a treatment option,” he said.
The study was published in February
in Hepatology, the international publication for original, peer-reviewed articles
concerning all aspects of liver structure, function and disease, and was presented orally in the Outstanding Clinical
Research Award category of the SGH
20th Annual Scientific Meeting.
sep– oct 2014
singapore health
09
E
MDI287 SHLS Singapore health 345x260 Sep Oct FA.indd 1
29/7/14 11:00 AM
10
NEWS
singapore health
sep– oct 2014
Singapore National Eye
Centre (SNEC)
Professor Wong Tien Yin is the new
Medical Director of the Singapore
National Eye Centre.
On Aug 1, 2014, Professor Donald
Tan, Medical Director of SNEC since
2008, passed the leadership baton
to Professor Wong Tien Yin. Prof
Wong will also take on the concurrent role of Academic Chair, SingHealth Duke-NUS Ophthalmology
Academic Clinical Program.
During his six years at the helm,
Prof Tan steered SNEC to global
leadership in ophthalmology. His
work has led to major innovations
in corneal and stem cell transplantation, refractive surgery and
myopia treatments in the international arena. Prof Tan will remain a
tenured Professor in Ophthalmology and senior faculty member of
SNEC and will continue his research
at Singapore Eye Research Institute
(SERI).
Prof Wong has a strong track
r e co r d in r e s ear ch wit h many
research breakthroughs, published
papers, and patents for eye imaging software and related technolog y. His local and international
awards include t h e Singap ore
Translational Research Investigator
Award, the National Clinical Scientist Award, the President’s Science
Award and the 2013 Eisenhower Fellowship Award. As Medical Director
of SNEC, Prof Wong will continue
to elevate the Centre’s service and
reputation in the field of ophthalmology. He also ser ves as Group
Director, Research, SingHealth.
Changes at the helm
Three SingHealth institutions recently had leadership changes
By celine lim
C
M
Professor Terrance Chua is the
new Medical Director of the
National Heart Centre Singapore.
Associate Professor Poon Choy Yoke
is the new Director of the National
Dental Centre Singapore.
National Dental Centre
Singapore (NDCS)
Associate Professor Kwa Chong Teck
has been succeeded by Associate
Professor Poon Choy Yoke as Director
of NDCS. Prof Poon has also been
appointed Academic Chair of the
newly-established SingHealth DukeNUS Oral Health Academic Clinical
Program.
Under Prof Kwa, NDCS developed
into a specialist oral health care centre,
offering multi-disciplinar y care to
patients with dento-facial and cleft
deformities, facial pain and sleep disorders, or in need of complex oral
rehabilitation. NDCS is Asia’s first Joint
Commission International-accredited oral health care institution, and
the Centre collaborates with international universities and educational
institutes to further dental education
and research. Prof Kwa was appointed
Senior Advisor of NDCS on Aug 1, 2014.
Prof Poon, formerly Direc tor,
Department of Oral & Maxillofacial Surgery, has played a key role in pushing
the frontiers of dental research and
education at NDCS. In her new role as
Director of NDCS, Prof Poon will continue to provide leadership and vision
to strengthen NDCS’ reputation for
excellence in clinical services, education and research.
Y
CM
MY
CY
CMY
K
National Heart Centre
Singapore (NHCS)
Professor Koh Tian Hai, Medical Director of NHCS, has been succeeded by
Professor Terrance Chua, who has also
taken on the position of Academic Chair,
SingHealth Duke-NUS Cardiovascular
Academic Clinical Program.
Prof Koh led NHCS to become a
global leader in cardiovascular care,
research and training. From a speciality
centre with 650 staff members, NHCS’
staff strength has more than doubled,
with expanded services including operating theatres and a short-stay unit in a
new 12-storey building. Under Prof Koh,
NHCS also pioneered complex cardiac
therapies, boosted medical fellowship
training, and has become a place where
research flourishes. Prof Koh has been
appointed to the SingHealth Board
of Advisors and is now Senior Advisor
of NHCS.
Prof Chua, a cardiologist with an
interest in imaging, is Adjunct Professor with Duke-NUS Graduate Medical
School and Clinical Associate Professor with the Yong Loo Lin School
of Medicine at the National University
of Singapore. He is dedicated to patient
care and committed to teaching and
research, with a particular research
interest in imaging and heart disease.
He received the National Outstanding Clinician Award in 2013. In his new
role, Prof Chua will continue to advance
NHCS’ standing as a national specialist
centre for cardiovascular treatment.
sep– oct 2014
singapore health
NEWS
11
Residents, staff help pick
hospitals’ new logo
The new logo represents collaboration between the patient, the community and the health
care professional towards better health
S
engkang Health has launched its CEO of Sengkang Health, said: “The new
logo, vision and mission state- logo represents collaboration between
ments, keeping in mind the the patient, the community and the health
people it will serve when Sengkang care professional towards better health.
General and Community Hospitals open The right hand symbolises us reaching out
in 2018.
towards healthier futures and the northThe logo, launched in July, was devel- east community we will be serving.”
oped with input from staff and residents
He said the organisation’s vision,
from Sengkang and Punggol. They were “Healthy Living. Fulfilling Life”, and mission,
asked to pick one of five designs. The “Better Health Together”, will be achieved
majority picked the design that Sengkang through “holistic, informed and reassuring
Health ultimately chose.
care in partnership with the community”.
One resident described the design as
To bring the message home, Sengkang
touching. “It looks as if three staff mem- Health is engaging the community early.
bers are standing with their hands wide It will be holding a sporting challenge
open to welcome patients.” Another, who to encourage families to stay healthy
chose the same design, said: “It looks together during the September holidays.
like people holding hands in partnership,
cooperating as a community, helping For more details on the September event,
each other heal and living a healthy life.”
Millennia Kids Challenge 2014, refer to the
Professor Christopher Cheng, Pro-Tem event calendar on page 20.
Sengkang Health’s logo, launched in July, was developed with input from staff and
residents from Sengkang and Punggol.
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12
people
singapore health
sep– oct 2014
Celebrating passion
By Jessica Leow and
Chua Hwee Leng
Here, take the hot seat!
Dr Hwang Siew Wai, Clinic Director,
SingHealth Polyclinics Bukit Merah Outstanding Clinician Award
Dr Hwang Siew Wai is quite used to the
hot seat – the clinician’s chair – and he
believes in giving medical students a
taste of it, early.
His “hot seat” sessions involve getting them – postgraduates from Yong
Loo Lin School of Medicine and DukeNUS who are assigned to SingHealth
Polyclinics - Bukit Merah – to lead consultations while he keeps a watching
brief. “We allow them to play the role of
the doctor. They really enjoy it, because
for the first time, they feel like they are
being real doctors.”
While they get vital hands-on experience from this, Dr Hwang said that
he learns much from experiences too.
In fact, it was his own experience as a
patient that inspired him to become
a doctor.
When I was five, I was
hospitalised with
dengue haemorrhagic
fever. The doctors
and nurses were very
good, and that
inspired me to want
to help others.
even before they see a doctor, they can
go for screening,” said Dr Hwang. As a
result of the success of this, the initiative was spread and improved upon
across the other SingHealth Polyclinics.
Dr Hwang said patients may be
unaware they have complications from
diabetes as the symptoms are silent.
“Diabetes can affect the nerves, and
once this happens patients may not feel
any pain or sensation.”
The foot test screens for nerve
damage and patients also learn about
proper foot care to reduce the risk of
infection. The eye test detects changes
in the eyes, such as small bleeds, so the
doctor can refer patients to a specialist.
Dr Hwang was also behind a clinic
project to increase the number of
patients with chronic lung infections
being vaccinated against influenza. At
Bukit Merah Polyclinic, the numbers
increased from 10 per cent to 50 per
cent over six months in 2013.
“Convincing patients to have the
injection, which protects them against
pneumonia and death from infection,
is more challenging than getting them
to do the diabetes tests. Checking the
eyes and feet is easy, but patients don’t
want a jab because it’s painful,” he said.
“These projects help us to look after
patients even better. And if they’re successful here, we can share them with
other polyclinics.”
Photo: Jasper Yu
Dedication and strength of purpose underpin the passion of these four health care professionals,
winners of the 2014 SingHealth GCEO Excellence Award
Loving the challenge
Mdm Maliga Riaki Chinniah,
Senior Staff Nurse, Cardiothoracic
Surgery Intensive Care Unit,
National Heart Centre Singapore
Outstanding Nurse Award
As a young girl, one of eight siblings,
she applied to become a nurse to
lighten her parents’ financial load. After
40 years on the job, Mdm Maliga Riaki
Chinniah, now a Senior Staff Nurse
(Clinical), has no regrets and would do
it all over again.
“When I was five, I was hospitalised
with dengue haemorrhagic fever,” he
said. “The doctors and nurses were very
good, and that inspired me to want to
help others. As a doctor now, I have the
rare opportunity to really make a difference in peoples’ lives.”
This latest award joins a long list that
Dr Hwang already has. And it is not his
first award for excellence. As head of
Bukit Merah Polyclinic since 2008, Dr
Hwang has spearheaded many initiatives which have since been adopted
by other polyclinics. Among them are
increasing the rates of diabetic foot
screening and diabetic retinal photography done for patients with diabetes.
“At the registration counter, via a
computer alert system, we identify diabetic patients who need these tests. So,
Photo: Alvinn lim
Dr Hwang Siew Wai, Clinic Director,
SingHealth Polyclinics - Bukit Merah Working at the Cardiothoracic Surgery Intensive Care Unit, National Heart
Centre Singapore (NHCS), she said nursing suits her personality. She is naturally composed, caring, alert, a fervent
time manager, and constantly looks for
better ways of doing things. Over the
years, her work has not only given her
a lot of satisfaction but also won her an
array of awards, including this year’s
Outstanding Nurse Award.
An Intensive Care Unit (ICU) nurse
since 1985 – first in Tan Tock Seng Hospital, then Singapore General Hospital and now NHCS – her confidence is
apparent, but this has not always been
the case. “When I first started, I was
nervous when I encountered sudden
changes in a patient’s condition without doctors around. Now, having been
in the ICU for so long, issues like blood
pressure falling have become everyday
issues that we can manage with confidence,” she said.
Mdm Maliga was part of the team
who cared for Singapore’s first heart
transplant patient in 1990, and for many
others since then.
During the course of her work, she
also takes time to find out if the patients’
families are facing any difficulties, and
when needed, refers them to a medical social worker. In fact, Mdm Maliga
has been so engrossed in her job that
she has not taken a single day of medical leave in the 23 years after her last
maternity leave. This was despite wearing many hats – nurse, mother, housekeeper, children’s tutor and volunteer,
just to name a few. A mother of three,
Mdm Maliga managed without domestic help when her children were younger
– by doing the night shift for many years
and strictly managing her time during
the day. She even volunteered in the
hospital’s outreach efforts then, and is
doing more of that, since her children
are now grown up.
sep– oct 2014
Mdm Koay Saw Lan runs a huge kitchen.
The Senior Manager of Singapore General Hospital’s (SGH) Department of Food
Services oversees a dedicated catering
team that prepares meals for some 1,300
patients each day.
It isn’t just the sheer number of meals.
For a large hospital with patients suffering from many different serious medical
conditions, the kitchen needs to concoct
vast permutations of meals: carbohydrate control for diabetics, low cholesterol and low salt for cardiac patients,
soft food for stroke patients with difficulty swallowing, nourishing confinement dishes for new mothers, and halal
meals for Muslims are some of the special-requirement “cuisines” that are prepared alongside more regular fare.
The logistics of preparing over a thousand meals three times a day can be a
nightmare. But the many changes that
Mdm Koay made over the years have
led to a smooth running kitchen. Hot
meals are served hot, while desserts are
refreshingly cool – and on time. Above
all, the meals are also healthy, nutritious
and appetising.
“When I first joined the public health
sector more than 30 years ago, dietitians
had to be involved in the operational
aspects of food preparation.
And because soft foods weren’t readily available like they are now, we had
to show kitchen staff how to puree and
strain food for patients on soft diets, for
instance,” said Mdm Koay, a trained dieti-
Keeping it real
Associate Professor Deidre Anne
De Silva, Senior Consultant,
Department of Neurology,
Singapore General Hospital
Outstanding Clinician
Researcher Award
Clinical research can be isolating and
detached from reality. But for Associate
Professor Deidre Anne De Silva, Senior
Consultant, Department of Neurology
(SGH Campus), National Neuroscience
Institute, having regular patient contact
through clinic and other consultations
helps make her efforts to improve treatments and care relevant.
“I get to know the issues that they, as
well as our health care system, face. I can
then identify the problems on the ground,
and this makes the research real,” said
Prof De Silva.
Without that ongoing contact with
patients, research work can become “just
science”, said Prof De Silva.
Her unwavering dedication to making
a difference in patients’ lives helped Prof
De Silva clinch a SingHealth GCEO Excellence Award 2014 in the Outstanding Clinician Researcher category.
Often, as a researcher, she is plug-
tian who previously headed SGH’s Dietetics and Nutrition Services Department.
Under Mdm Koay, professional cooks
and kitchen staff were brought in, while
technology was introduced to automate mundane kitchen operations like
meal ordering.
“It was a huge challenge to make these
changes in the 1990s, but we persevered
and saw the automation project to fruition,” she said.
To make sure her dietitians reach
their full potential, she encourages
them to advance professionally. They
underwent further education and training under programmes like the Ministry
of Health’s Health Manpower Development Plan. They undertook research
and participated in scientific meetings,
as well as patient seminars to teach participants about eating the right foods to
enhance recovery.
at SGH. They give expert advice on diet
to patients with gastrointestinal, eating
and renal disorders, and serious burns.
Among the many changes Mdm Koay
has made to improve patients’ comfort is
the introduction of an Asian menu to add
variety to hospital meals. “When you are
in bed with nothing much to do, you look
forward to your meals,” she said, adding
that there is no reason for patients to
miss their chicken rice and nasi goreng.
Patients can look forward to their
meals by checking the colourful pictorial menus on the hospital’s in-house
TV channel.
13
It was another first in Singapore hospitals when she and her team of dietitians and chefs launched a special snack
alternative for patients on therapeutic
diets, instead of just biscuits, for afternoon tea.
The energetic Mdm Koay may have
been lauded this year, but she isn’t resting on her laurels.
Next on her plate is the design and
set-up of the kitchens for the planned
SingHealth community hospital and
Sengkang Health, the new general
hospital for residents in the northeast
of Singapore.
When you are in (a
hospital) bed with
nothing much to do,
you look forward to
your meals.
Mdm Koay Saw Lan, Senior Manager,
Department of Food Services, SGH
Indeed, Mdm Koay has played a critical part in changing the general perception of dietitians. They are no longer
seen as people who merely offer advice
on weight loss, but as key partners
with other health care professionals in
offering patients multi-disciplinary care
ging away in her own “little cave” and
not always sure if she’s on the right path.
Receiving the award, she said, is “a nice
boost to the research work that my team
and I are doing, and an affirmation that
we are on the right track.”
She works with other researchers,
notably fellow neurologist, Associate Professor Chang Hui Meng, stroke research
coordinators and research fellows whom
she mentors.
Research is no bed of roses, said Prof
De Silva. Behind every paper published
or grant received are the many long
hours and failures that a researcher goes
through. Still, the disappointment of
not getting a grant is a small thing when
compared to the reality of sick patients.
Photo: Jasper Yu
Mdm Koay Saw Lan,
Senior Manager, Department of
Food Services, Singapore General
Hospital
Outstanding Ancillary Staff Award
people
Photo: zaphs zhang
creating great meals
singapore health
“At the end of my career, I hope to say that
my research has added to the evolution
of stroke care,’’ said the neurologist, who
describes herself as a 100 per cent clinician. “It will take many steps to get there,
but if I had contributed in some way, that
would be good.”
It was patient contact that first got
Prof De Silva interested in stroke neurology. While on ward rounds as a first-year
registrar, she observed that young Indian
patients outnumbered Chinese patients.
“I asked my mentor, Associate Professor Wong Meng Cheong (the former Head
of the Department of Neurology) if Indian
stroke patients were generally younger
than Chinese patients, expecting him to
provide me with the answer.”
Instead, Assoc Prof Wong told her to
“go and find out”, she said.
Her curiosity was piqued, and with
guidance and support from her teacher,
she delved into the subject, subsequently co-publishing a paper with her
mentor on the findings.
Stroke neurology is more than an
area of medical interest for Prof De Silva.
As President of the Singapore National
Stroke Association, she is always pushing for greater public awareness of the
disease and greater support for stroke
survivors and their caregivers.
14
singapore health
sep– oct 2014
sep– oct 2014
singapore health
Money
15
An extra helping hand
Mrs Jenny Thang can hold a day job knowing that her husband, a stroke patient, is well cared for at home
L
ooking at Ms Jamiati Tolan’s petite
figure, you may not think the
28-year-old Indonesian domestic
helper has the strength to move bedridden Mr Robert Thang from his bed to a
wheelchair. Mr Thang, 62, weighs 68kg.
But with proper caregiving techniques picked up from nurses at Ang Mo
Kio Community Hospital, Ms Tolan – or
Jamie to her employers – has been able
to do it expertly without injuring herself
over the last four years.
“Even I have difficulty moving him,
but Jamie is able to do it, as she has the
skills. She has really been a great help,”
said Mrs Jenny Thang.
“Not only does she look after my
husband, she helps to watch over my
eldest daughter who has special needs.
She also takes care of the cooking and
household chores.”
Thanks to the government’s Foreign Domestic Worker Grant which provides a monthly payout of $120, the
Thangs have been able to defray part
of the cost of hiring Ms Tolan. The grant
gives Mrs Thang, 58, peace of mind and
allows her to continue working even
after her husband’s illness to support
her family of five. She is an administrative assistant.
To qualify for the grant, the foreign
domestic worker in question needs to
be trained. Ms Tolan attended the Effective Caregiving For Foreign Domestic Workers course at Hua Mei Training Academy, which is under the Tsao
Foundation. The Thang family tapped
on a training fee subsidy – the $200
Caregivers Training Grant – to help pay
for Ms Tolan’s training.
Programme of Integrated Comprehensive Care (EPICC) centre in Tiong Bahru,
using transport provided by the centre.
It was there that she picked up physiotherapy techniques and other caregiving tips from other caregivers. “Everybody in the family is very good to me.
Madam gives me a lot of freedom. When
Sir gets frustrated and scolds me, I can
go for a jog. Someday, I may want to
work in a nursing home,” Ms Tolan said.
The family sees her as a godsend.
“Jamie basically took over my role in the
family, allowing me to play my part as
the breadwinner. In fact, she is just like a
daughter to me,” said Mrs Thang, who has
three children aged 25 to 35. Her 26-yearold son recently started work as a finance
executive while her youngest son is a fulltime polytechnic student.
With Ms Jamiati Tolan (left) taking care of stroke patient Robert Thang at home,
his wife, Mrs Jenny Thang (right), can continue to work as an administrative
assistant to support their family of five.
The Foreign
domestic
worker grant
...is a monthly grant of $120
given to families who need a
foreign domestic worker to care
for their loved ones who have
at least moderate disability. To
apply for the grant:
1
You need to be a family
member staying with your
loved one at the same address
shown on both your NRICs.
2
She has really been a
great help. Not only
does she look after my
husband, she helps to
watch over my eldest
daughter who has
special needs. She also
takes care of the
cooking and
household chores.
Mrs Jenny Thang
Mr Thang, who had been a cook in
a five-star hotel, spent three months
at the Ang Mo Kio Community Hospital
following his initial stroke treatment.
Ms Tolan then came into the picture and
began looking after him at home.
She now accompanies him thrice
a week to the Hua Mei Elder-centred
This article is adapted from An Extra Caregiving Hand in Nextstep (Issue 8), the Agency for
Integrated Care’s quarterly newsletter. Visit
silverpages.sg for more information on longterm care and caregiving.
You must be a Singaporean.
Your loved one being cared
for must also be a Singaporean
if he is below the age of 65. If
he is above 65, he can be a
Singaporean or Permanent
Resident.
3
The person being cared for
must have at least moderate
disability, requiring permanent
assistance in at least three
activities necessary for daily
living. These include dressing,
eating, taking a bath or shower,
toileting, moving from bed to
wheelchair, and moving about
on a level floor without help.
4
The foreign domestic worker
will need to attend caregiver
training courses.
5
Your monthly household
income per person must not
exceed $2,600. For households
without income, the annual
value of the property must be
less than $13,000.
Visit silverpages.sg/fdwg/
for more information on the
eligibility criteria and how to
apply for the grant.
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16
singapore health
sep– oct 2014
Health Xchange
Early cataracts?
Our experts answer all your questions about health
Recently, I went for an eye examination to check if I qualify for LASIK, but
was told that I have early cataracts.
What causes cataracts in people
under 45 years old and how do I prevent them from getting worse?
Cataracts usually affect people above
60, but it is not uncommon to see
younger sufferers too. Cataracts may
develop earlier in patients on steroid
medication. People with diabetes, or
those who smoke or have had prolonged exposure to UV light, may be
predisposed to its earlier onset. Possible causes include constant rubbing of the eyes due to allergies and
previous eye trauma. Other patients
may be born with a congenital form
of cataract. Staying healthy, having
a balanced diet, not smoking and
reducing UV light exposure may delay
the worsening of cataracts. Wearing
glasses for short- and long-sightedness is still the most trusted way to
correct your vision for now.
Having LASIK when you
already have a cataract
is a waste of resources
as cataract surgery can
be refractive in nature
nowadays. Eventually, you should consider cataract surgery
when your corrected
eyesight is no longer
adequate for daily
functioning.
Dr Daphne Han, Consultant,
Cataract & Comprehensive
Ophthalmology Service,
Singapore National Eye Centre
Getting plastic
surgery overseas
I am thinking of getting plastic surgery done overseas. What should
I consider and how do I pick a good
surgeon?
The same considerations apply when
looking for a plastic surgeon either
locally or overseas. You should:
Check that the surgeon is certified
by the relevant regulatory/government bodies in his country of
practice. In Singapore, all plastic
surgeons need to be accredited by
the Ministry of Health, and a list of
plastic surgeons can be found on
the Singapore Association of Plastic Surgeons’ website (plasticsurgery.org.sg).
Find out from reliable sources like
your primary care doctor and/or
existing patients of the surgeon
in mind about the procedure and/or
the surgeon.
Check that the surgeon has facilities
that are fully equipped for the procedure, as well as for any emergency.
Find out about the surgeon’s follow-up
care procedure as good surgical care
does not end with surgery. Note that
follow-up visits with an overseas surgeon can be inconvenient and costly,
especially if complications arise and
revisionary care is needed.
Meet the surgeon at least once or
twice in person before committing to
the procedure so he can address any
queries and concerns about the procedure. It is important to have good
communication and rapport with the
surgeon of your choice.
Dr Leo Kah Woon, Consultant, Department of Plastic,
Reconstructive and Aesthetic Surgery, Singapore
General Hospital
These articles are from www.healthxchange.com.sg,
Singapore’s first interactive health and lifestyle portal.
Please visit our website listed above
to see the topics for discussion in
Sep-Oct 2014.
SEP– OCT 2014
singapore health
upclose
17
wo r l d s i g h t day
The prevalence of
myopia in Singapore
is one of the highest
in the world.
50%
of children are
myopic by age 12.
Common eye
problems (KIDS)
Blurred vision
Squinting
eye Care
Spectacles or
contact lenses
that help to refocus light
rays onto the retina are
the most common ways
of correcting myopia.
Surgical
procedures like
LASIK can correct or
improve myopia in adults.
LASIK is generally only
performed on adults
after their myopia has
fully stabilised.
Clinical trials have
shown that lowdose atropine is effective
in slowing myopia
progression.
DO
NOT
lose
sight
o f
e y e
c a r e
a
s
y
o
of people aged 60 and
above have some form of
cataract
u
a
g
e
With childhood myopia on the rise, this
“myopic generation” will face more eye
problems in their adult and
twilight years
Cloudy vision
Eye pain
eye care
Surgical procedures can slow
or halt the progression of agerelated macular degeneration.
Presbyopia or lao hua can be
corrected with special spectacle
lenses called bifocals.
TEXT BY NG Hui HUI
Eye infections
Blurred vision
eye care
Eye infections
can be treated
with antibiotic eyedrops
and ointment.
Laser treatment
is used to
seal or remove leaking
blood vessels in those
diagnosed with diabetic
retinopathy.
60%
of all eye infection
cases are associated
with contaminated
contact lenses
e v e n
Common eye
problems (elderly)
80%
Common eye
problems
(ADULTS)
60%
of patients who have had
diabetes for 15 years or
more have some blood
vessel damage in
their eyes
Age-related
macular
degeneration
is a major cause of
blindness in
those over
50
years old
Sources: Ministry of Health, Health Promotion Board, Singapore National Eye Centre, National University of Singapore
18
your say
singapore health
SEP– OCT 2014
Can I donate blood at SGH?
I donated blood for the first time about a year ago when the Health Sciences Authority (HSA) held a mobile blood drive at our office building.
That was also the last time, even though I received many reminders to
donate again. The places for blood donation are inconvenient for me to
travel to. Can I donate blood at the Singapore General Hospital (SGH) as I
accompany my elderly mother there for treatment quite frequently?
Ms May Tan
you are next at SGH and want to donate blood, you can
SGH When
go to the blood bank at HSA on Outram Road. The HSA’s other
says
blood banks are at Woodlands Civic Centre and Dhoby Ghaut
MRT station. You can also check donorweb.org/singapore-bloodmobiles
for a schedule of HSA’s mobile blood drive locations. More information
about donating blood can be found on the HSA website at www.hsa.gov.sg/
publish/hsaportal/en/health_services/blood_donation.html.
This letter wins a bottle of Heritage® American Ginseng (60 capsules). The product, worth
$92.40, is sponsored by HST Medical, Singapore.
tributes
Ms Roslina Rahim, Senior Enrolled
Nurse, was excellent when I visited a
clinic at the National Neuroscience Institute. She was patient, friendly and efficient. I had been referred to the wrong
specialist by my general practitioner’s
clinic. However, Ms Rahim helped to
arrange another appointment at the correct one, even trying to get an appointment for me on that very day. I could
see that it was a busy morning at the
clinic, but she stayed calm and cheerful
throughout. I truly appreciate the help
she gave me.
- N Yong
My elderly sister was born with Down’s
Syndrome and has been bedridden for
several years because of various other
illnesses. She was admitted to Singapore
General Hospital (SGH) earlier this year
and was diagnosed with several other
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Financial help for the elderly sick
My friend’s mother became bedridden after suffering a stroke. She
needs to be tube-fed and is on diapers. Milk feeds and adult diapers
are expensive. Is there a financial
scheme to help them pay for these
items?
Seniors’ Mobility and
AIC The
Enabling Fund (SMF) has
says
a category of subsidised
consumables for frail seniors to help
defray the costs of medical consumables such as diapers, milk feeds,
catheters, nasal tubing and wound
dressings. If she is currently receiving
home care services or enrolled in the
Singapore Programme for Integrated
Care for the Elderly (SPICE), she can
approach a nurse or centre man-
conditions. We were told that one of
these was life-threatening and she
was given early treatment. She has
since been discharged and is on the
mend. I was very worried about the
bill and her condition, and am very
grateful that government subsidies
took care of a substantial portion of
the bill. I would also like to thank SGH,
especially Associate Professor Tan Ban
Hock, Senior Consultant and Head,
Department of Infectious Diseases,
and Dr Lim Chin Siah, Associate Consultant, Department of Emergency
Medicine.
- Mr HC Low
On my recent visit to SGH’s Clinic H
to have my surgical wound dressed,
I was attended to by Mr Solzhavalavan Govindasamy, Principal Enrolled
Nurse, SGH. He was very friendly, helpful and professional. I really appreciate his help.
- Ms Siti ZS
My second child was delivered at
KK Women’s and Children’s Hospital
(KKH) on Feb 27, 2013. A few days after
I was discharged from the hospital,
Ms Sharon Lee, Nurse Clinician, Lactation Consultant, gave me her mobile
number and said I could call her anytime if I had issues with breastfeeding. I suffered a blocked duct due to
breastfeeding once and called her.
She promptly made an appointment
for me and advised me on what to do.
She even called me at the end of the
day to ensure I was all right. Recently,
ager to apply. The eligibility criteria
include:
Age 60 and above
Must be a Singapore citizen
Requires a high level of care
Monthly household income per
person is $1,800 and less
Not receiving any other subsidy for
similar consumables
Other than consumables, SMF
also provides subsidies for assistive
devices to help the elderly move
around their homes. It also provides
subsidies for transport between
home and Ministry of Health-funded
day rehabilitation centres, dialysis
centres or dementia day care centres.
For more information about SMF
and how to apply for assistance, visit
silverpages.sg/SMF.
my sister also had a blocked duct and
an infection. I suggested she call Ms
Lee. Even though my sister is not a KKH
patient, Ms Lee was very willing to give
her advice. It’s very inspiring to have
nurses like Ms Lee who is ever willing to
help patients, and encourage and motivate them to breastfeed. My sincere
compliments to her.
- Ms Seema D
My husband and I would like to commend Ms Jennifer Shim Poh Shwan,
Dietitian, Department of Dietetics,
SGH, for her professionalism and
patience. She took much time to
explain clearly the dietary plan she
drew up for my husband. We certainly
look forward to our next appointment
with her.
- Ms SQ Lai
I would like to thank Dr Jack Tan, Ms
Lim Zhiyu, Ms Kelly Cheong, Ms Joey
Wong, Ms Christine Ramos, Ms Asmah
Ibrahim, Ms Noraini, Ms Nurhidayu
Hatbar, Dr Gayathri, Ms Devi Nadarajan
from the National Heart Centre Singapore (NHCS). The team is very professional and knowledgeable in their areas
of work. They are courteous, attentive
and go all the way to meet a patient’s
needs. Thank you Dr Soon Jia Lin, Consultant, Department of Cardiothoracic
Surgery, NHCS for your caring, attention and advice during my husband’s
recovery in ICU. Keep up the good work.
Thank you.
- A grateful patient
SCIENCE
科学
a b o u t yo u r h e a lth
experience and win a
prize for best letter
NATURE
Letters must include your full name, address and
phone number. Singapore Health reserves the right to
edit letters and not all letters will be published. Write to
[email protected] or The Editor, Singapore Health,
Singapore General Hospital, Communications
Department, Outram Road, Singapore 169608, or
talk to us on Facebook.
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UMI NO SHIZUKU
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* This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, cure or prevent any disease.
The winner will receive a set of L-Glutathione Skin Plus
(two bottles containing 60 tablets each). The products,
worth $76 each bottle, is sponsored by VitaHealth Asia
Pacific (S) Pte Ltd.
sep– oct 2014
singapore health
19
20
FYI
singapore health
SEP– OCT 2014
▲
Cynicism
event Calendar
Date Sep 6, Saturday
Time 8am-12pm
Venue: Sengkang Sports & Recreation Centre
Registration Log on to sengkanghealth.com.sg
linked to dementia
for more information or to register
Celebrate active and healthy living with
Sengkang Health. Sign up for the Parent and
Child Obstacle Course or participate in the
5km Community Cycling event to receive a
goodie bag. Check out the health screening and
physiotherapy booths at the event too.
▲
Being cynical or distrustful increases one’s risk of
developing dementia, according to a study by Dr AnnaMalia Tolppanen of the University of Eastern Finland. Tests
for dementia and a questionnaire to assess cynicism
levels were given to 1,449 people (average age 71). After
adjusting for factors that could affect dementia risk such
as hypertension, the study found that individuals with high
levels of cynical distrust were three times more likely to
develop dementia than those with low levels.
to preserve transplant
Source: BBC News
Source: Cornell University
contest
1.How long does it take for
parathyroid function to
be restored using the new
injection technique?
2. Which story in this issue did
you find the most informative?
Closing date: Oct 1, 2014
Send in your answers and stand to win a Kyäni SunriseTM
30-pack, worth $83.75, sponsored by Kyäni Singapore Pte. Ltd.
Hospital, Women’s Tower, Level 1,
Auditorium, Conference, Seminar and Patient
Education Rooms
Fees $5 to $8 per person for workshops. Plays
are free of charge
Registration Call 6394-5038 to register
An interactive play and six workshops promote
positive communication between different
members of the family, and provide parenting
tips and strategies to build children’s resilience.
Conducted in English.
▲
A technique that supercools rat livers was
able to preserve the organs for days before
transplants, a team of US researchers have
found. The technique combines chilling
the organ and pumping nutrients and
oxygen through its blood vessels. Further
experiments will be needed to see if the
technology can be scaled up from preserving
a 10g rat liver to a 1.5kg human liver. If the
technique works on human organs, it has the
potential to transform organ donation.
Call it a “scenic walk”
Think of your next run as a well-deserved break, and
you will eat less afterwards. Think of it as exercise or a
workout, and you will eat more after to reward yourself,
according to two studies by Cornell University’s Food
and Brand Lab. In the first study, 56 adults were led on
a 2km walk and were either told it was for exercise or a
scenic walk. Those who believed they had been exercising
ate 35 per cent more chocolate pudding after the walk
than those who believed they had been on a scenic walk.
In the second study, 46 adults were given mid-afternoon
snacks after a similar walk. Those who thought they
had been on an exercise walk ate 206 more calories of
M&M’s – 124 per cent more than those who had been
told they were on a scenic walk.
Love out Loud: Enabling Families
through Communication
Date Nov 9, Sunday
Time 9am-12.30pm
Venue KK Women’s and Children’s
Source: Medical News Today
Supercooling
Millennia Kids Challenge 2014
Run For Hope 2014
Date Nov 16, Sunday
Time 7am
Venue The Promontory @ Marina Bay
Fees $55 (adult); $32 (5-18 years old). Early
registrants will enjoy discounts
Registration Closes on Oct 26, Sunday. Log on
to runforhope.sg for more information or to
sign up
Include your name, age, gender, address and telephone number.
Winners will be notified via phone or e-mail. Incomplete or
multiple entries will not be considered.
E-mail [email protected] Post The Editor, Singapore Health,
Singapore General Hospital, Communications Department,
#13-01 Surbana One, Blk 168, Jalan Bukit Merah, Singapore 150168
Winners of Contest 29: Each will receive a bottle of Spirulina
100% Extra 10% Deep Ocean Water (750 tablets) worth $59,
sponsored by IMI Lifestyle Products Pte. Ltd., and a Buddie the
Badger plush toy. Prizes must be claimed by Oct 1, 2014.
1. Abdul Razak Haja Mohideen 2. Aw Hui Yee 3. Valerie Chong Lih
Wen 4. Ong Kim Siong 5. Yoon Tai Yaw
An annual run organised by Four Seasons Hotel
Singapore, Regent Singapore and the National
Cancer Centre Singapore to raise awareness
and support for cancer research, Run For Hope
maintains its tradition as a non-competitive
leisure run. Be part of the 15,000 who are
running together for a worthy cause.
Visit www.singhealth.com.sg/events or the
websites of respective institutions for any
changes, more information, and other listings.
sep– oct 2014
singapore health
21
YOUR GUIDE TO BETTER LIVING
Sit right for
a great ride
With the right posture, equipment
and attire, avid cyclists can enjoy
their sport more comfortably and
successfully. By Sol E Solomon
H
ere’s the bad news: long-distance cycling can be bad for sex.
But the good news is that correct posture or a change of saddle can
quickly reverse the erectile dysfunction
that can occur when cyclists ride their
bicycles for too long, use the wrong
saddle, have the wrong posture or wear
overly tight bike shorts.
Before erectile dysfunction actually
occurs – and it can last as long as a
week – a cyclist might feel pain, tingling
or numbness in the groin and penis as
pressure is concentrated on that part
of the body, said Ms Liang Zhiqi, Senior
Physiotherapist, Singapore General
Hospital (SGH). “But not many cyclists
talk openly about such symptoms, so
they might not know there is a problem
till something more serious like dysfunction happens,” she said.
A serious cyclist, said Ms Liang,
should see a sports medicine specialist
for an assessment of his level of fitness
and general health condition, and
have his bicycle checked out.
Getting the basic s right is
impor tant for someone who
intends to train seriously for the
sport as it involves many hours of
intense riding.
Get your posture
right, work out
any problem in
position or cycling
technique. That way,
you might see a
huge improvement
in your performance
without additional
hard work, pain or
risk of injury.
photos: jasper yu
Ms Liang Zhiqi, Senior Physiotherapist, SGH
According to Ms Liang Zhiqi, Senior Physiotherapist, a serious cyclist should
see a sports medicine specialist for an assessment of his level of fitness and
general health condition, and have his bicycle checked out.
At SGH, for instance, its physiotherapists can help people who
have suffered musculoskeletal injuries sustained from cycling. Patients
are taught to prevent injuries that
might occur from overtraining or
improper training, and how to reach
their individual peak performance
as quickly and safely as possible.
Consultation by the cycling service’s physiotherapists costs between
$100 and $150 for each session, and
is by appointment only. Patients
need a referral from a Singaporeregistered doctor.
The patient first undergoes an
interview followed by a physical
Riding after
dark
Some cyclists prefer to ride or
train at night. It can be as enjoyable as day cycling, but they need
to exercise greater caution.
For night riding, it is mandatory to have a lamp at the front
of the bicycle that emits white
light and another at the rear to
emit flickering red light.
Wear light-coloured clothes,
especially with reflective
panels, for high visibility.
Reflective anklets, tape and
stickers made of cloth or
plastic that can be attached to
bikes, helmets and riders are
highly recommended.
Be alert and ride defensively.
Watch out for joggers, pedestrians and other vehicles, and
make sure they are aware of
your presence.
Be wary of approaching vehicles as their headlights can
dazzle.
Source: Singapore Sports Council’s Safe
Cycling Guide
> Continued on page 22
22
singapore health
sep– oct 2014
> Continued from page 21
Sit right for a great ride
examination by a physiotherapist. With
a better understanding of the patient's
condition, the physiotherapist can then
tailor adjustments and exercises based
on detailed assessments both on and
off his bicycle.
Many cyclists are not aware that the
way they position themselves on a bicycle is just as important as building up
stamina and strength.
The exercises they are taught
help build posture awareness, control and endurance, develop flexibility and strength for power and endurance, and give them postural control
for stability. Mirrors are used to show
multi-angle views of the cyclists on
a bicycle.
Most of Ms Liang’s patients are men
in their 40s returning to the sport after
their children have grown up, or new
cyclists. “Filled with enthusiasm, they
are suddenly training a lot longer, faster
and harder,” she said.
She also sees many recreational
cyclists who might spend five to six
days a week cycling, easily doing
300km in that time, but who don’t
spend time – enough or at all – stretch-
ing or streng thening their backs.
Merely cycling to improve endurance
without working on flexibility in areas
like the spine, hip and knees can lead
to injury.
Likewise, weekend warriors
(so-called because they sit in the office
all day during the week but go all out
and push themselves over the weekend)
risk injuring themselves if they don’t
build up an exercise regime.
They may begin to suffer from overuse injuries in the form of neck and
back pain, and tingling numbness in the
hands. A problem may start with a sensation of mild discomfort which gets
more and more uncomfortable. Eventually, the problem persists even when
not cycling.
Although it is common for a cyclist
to get aches and pains in the beginning
as the body adjusts and accommodates to the bike, if such pains persist after a few weeks, he should seek
medical help, said Ms Liang.
Triathlon bikes are among the
most uncomfortable because they are
designed to be aerodynamic, said Ms
Liang, an avid cyclist herself.
GET it RIGHt!
Ms Liang Zhiqi, Senior Physiotherapist, Singapore General Hospital,
explains the correct posture to adopt when cycling.
Lower back: Do not overarch or
slouch. This avoids excessive strain
on the lower back and excessive
pressure on the perineum region
(the area that is in contact with
the saddle).
Trunk: Head is held at shoulder
height, not below the shoulders.
The neck is not overly arched and
the chin is tucked in slightly. The
shoulders are relaxed, and the
upper back is held in a strong
stable position.
Arms: Elbow is relaxed or slightly
bent, not fully straightened, to help
absorb the impact when the bicycle
rolls over bumps on the road. This
prevents excessive impact on the
shoulders and neck.
Pedalling: Keep centre of kneecap pointing forward (towards
the middle toe). Avoid turning the
knee inward (towards the bicycle
toptube) or outwards (away from
bicycle). This will prevent excessive
strain on the knee joint.
As these bicycles are all about
speed and performance, they are
designed for the cyclist to assume
a very low and crouched position
in order to cut wind drag. Not surprisingly, this position requires
the cyclist to have tight muscle
control, good posture, strength
and endurance.
Some bicycle shops can fit a
bike to a person’s body measurements with the aim of getting the
cyclist into the best aerodynamic
position, she said. But they don’t
necessarily check posture, riding
technique or whether the cyclist is
strong or flexible enough to hold
that position over a long time.
Train smar t, Ms Liang tells
cyclists. “Get your posture right,
work out any problem in position
or cycling technique. That way,
you might see a huge improvement in your performance without
additional hard work, pain or risk
of injury.”
Doing some weight or power
stretching exercises and posture work will also improve a
cyclist’s performance on a bicycle,
she added.
This is because the more comfortable and more stable one is on
a bicycle, the more efficiently the
energy that he produces will go
into pushing the bike forward.
sep– oct 2014
Easy listening
photos: Darren chang
Hearing aids now come with many advanced
features that stream sounds as near to normal
hearing as possible. By Thava Rani
According to Mr Gopal Krishna, one of
the biggest challenges faced by hearing
aid wearers is their inability to tune in to
a desired sound and tune out the rest of
the noise.
A
n “invisible” hearing aid placed
inside the ear canal, worn 24 hours
a day, and which requires maintenance only every few months. A surgically
implanted hearing aid system with no
external components and whose batteries need replacing only every few years.
Science fiction? Not at all. These hightech hearing aids do exist, although they
may only be available elsewhere. But with
significant advances in technology in the
last five years, many hearing devices sold
in Singapore now have improved capabilities and features that can be adjusted
to their wearers’ needs, said Mr Gopal
Krishna, Senior Manager, ENT Centre, Singapore General Hospital (SGH).
“Gone are the days
of big, bulky hearing
aids. Now they are
getting not only
smaller but
also trendier
in terms of
colour and design. The computer chip
circuitry has also become more sophisticated. This means better processing
speed and a lot more natural and clearer
sound quality,” Mr Gopal said.
All hearing aids have a microphone,
an amplifier and a receiver. The very
basic analogue models work much like
mini loudspeakers by merely making
sounds louder.
But digital devices come with features that let wearers do more – from
manual volume control in the more
basic models to enhancements that
stream sounds as near to normal
hearing as possible in the very high
end models.
“One of the biggest challenges faced
by wearers is their inability to tune in to
a desired sound and tune out the rest of
the noise – the louder the ambient noise,
the more difficult it is to pick out a single
voice,” said Mr Gopal.
“It’s not likely we’ll be able to overcome this fully, but some of the newer
models have as many as 48 channels
which can help filter out much of the
background noise and enhance speech
understanding,” he added.
These high-tech hearing aids have
adjustment controls to personalise preferences. Some devices have directional
microphones, an enhancement that lets
a user listen to only sounds from the
front, for instance.
Then there is Bluetooth, a wireless technology standard for
exchanging data over short
distances from fixed and
mobile devices; it is expanding the world of the hearing
impaired. With Bluetooth
streaming, a device
can wirelessly
connect to mobile phones, tablets, MP3
players and even television. FM-compatible hearing aids are particularly useful
in noisy classrooms or lecture theatres.
The speaker wears a transmitter and the
signals are wirelessly picked up by the
wearer’s device.
Hearing aids are sold singly. But
hearing impairment often affects both
ears, so wearers need to buy two hearing aids. Basic devices tend to work
independently, much like listening to
two different programmes at the same
time. But with the more sophisticated
devices, two pieces of equipment can
be synchronised to work together to
improve listening comfort.
Gone are the days of
big, bulky hearing aids.
Now they are getting
not only smaller but
also trendier in terms
of colour and design.
Mr Gopal Krishna, Senior Manager, ENT
Centre, SGH
Advances in technology help not
only wearers, but also health care professionals in getting newly-diagnosed
users adjusted to their devices. One
of the bigger recent breakthroughs is
data-logging. This feature keeps track
of usage history, environment variations
and user preferences.
“Now, I’m able to understand a patient’s lifestyle
by looking at how he has
been using the device,
and I can then make
adjustments to suit his
needs,” said Mr Gopal.
Sudden hearing
loss in people in
their 20s and 30s
may be due to
trauma or viral
infections.
singapore health
23
One downside of sophisticated
hearing aids is the frequency of
battery replacement. Their hightech features are energy guzzlers.
Luckily, rechargeable batteries
address this issue.
The list of advancements to
improve the quality of life of the
hearing impaired is growing. Features to subdue the noise of rattling
plates or even keyboard typing –
technology seems to have taken
care of it all.
With technology advancing so
rapidly, earrings or spectacles that
double up as hearing aids may not
be so far-fetched after all.
With technological advances,
many hearing devices have
improved capabilities and features.
Not only the old
lose their hearing
The elderly: Hearing loss is an
expected part of growing old, especially after reaching 60 years of age.
Hearing impairment gets progressively worse over time, and if not
addressed, it can lead to social isolation, depression or miscommunication for the elderly.
Adults: Sudden hearing loss in
people in their 20s and 30s may be
due to trauma or viral infections.
But if the loss is gradual, it is likely to
have started at birth, with the individual only realising that he is suffering from impairment later in life.
Young adults/teenagers: One
in six young people are at risk of
losing their hearing simply from
listening to loud music on their
por table players, an SGH-Temasek Polytechnic study found.
The study did not take into account
other sources of loud music (e.g.
television, rock concerts, etc), so
more young people may actually be
at risk.
Infants/babies: Genetics is the
biggest cause of hearing loss in
newborns. Contributing factors
include complications during
pregnancy or birth, such as low
birth weight or exposure to certain
medications/infections while in
the womb.
24
singapore health
SEP– OCT 2014
Watch your step
Older people are more susceptible to falls and should actively reduce their risk of a tumble. By Lediati Tan
F
Injuries from falls
Ms Nor Diana said that it is
important to seek medical attention after a fall.
Injuries vary from mild abrasions
and fractures to severe injuries that
cause death. Those with superficial
abrasions can be seen as outpatients in
polyclinics or by a general practitioner.
More serious injuries such as a fracture
may require total bed rest, hospitalisation or surgery.
Falls can cause pain, discomfort,
reduced mobility and inability to carry
out daily tasks for long periods. More
The elderly can reduce their risk
of falls if they and caregivers are
more aware of the dangers.
photo: vernon wong
The elderly can reduce their risk of
falls if they and caregivers are more
aware of the dangers, said Ms Nor
Diana.
Making improvements such as
removing clutter, installing better
lighting in the home, not rushing
for the bus, and paying attention to
uneven ground can help.
SHP holds regular free classes on
reducing the risk of falls where participants can also learn simple exercises
to strengthen their muscles. Get more
information on the classes by enquiring at the polyclinics, or look under
Education and Training at SHP’s website at polyclinic.singhealth.com.sg.
According to Senior Staff Nurse Nor
Diana Togeman (left), the elderly
can exercise regularly to maintain
muscle strength and improve joint
mobility and balance to reduce their
risk of falls.
Reduce the Risk of Falls
photo: Blue Jean Images/Corbis
alls in those aged 65 and
above must not be taken
lightly. Injuries in older
people may be more serious
than in the young.
Ms Nor Diana Togeman,
Senior Staff Nurse, SingHealth
Polyclinics (SHP) - Geylang,
said research shows that
once people fall, they
are more susceptible to
recurrent falls.
She said falls can
happen to anyone, anywhere. “The elderly tend
to fall at home or in the
community while going
about their daily activities.” Causes include
clutter, slippery floors
and loose cords in the
home.
Elderly people
with mobility issues
due to muscle weakness, or poor balance
or coordination are at
risk. Also vulnerable
are those with chronic
medical conditions
like cataracts, arthritis, Parkinson’s disease
or osteoporosis that
affect vision, muscle
strength and reflexes.
Other risk factors
include lack of exercise,
poor diet, alcohol, and
medicines such as sedatives that can cause
unsteadiness or affect
balance, vision and
alertness. Adding to the
problem are poor lighting, poorly designed
steps and stairways,
and chairs and beds of
unsuitable height.
serious falls may cause social and psychological problems. For instance, longterm hospitalisation may be a financial
burden and also make patients lose
social contact. They may also feel frustrated, and lose self-esteem and confidence from not being able to carry out
their daily activities independently. A
severe fall may make them fearful of
another fall, or distressed or embarrassed about their injuries, especially if
they need a walking aid.
Personal care:
• Check your eyesight regularly.
• Exercise regularly to maintain
muscle strength and improve joint
mobility and balance. Take walks or
do simple exercises such as extending your knee, as well as heel and
toe raises to strengthen muscles.
Speak to your doctor before starting any exercise.
• Ask your doctor to review your
medication as some can cause
drowsiness or dizziness.
• Reduce alcohol
intake, stop
smoking and eat
a balanced diet
to reduce your
risk of falls and
osteoporosis.
At home:
• Store commonly used items within
easy reach, at chest or waist level.
• Don’t stand on stools or chairs to
reach high shelves.
• Use a night light. If you wear glasses
or use a walking aid, place them
next to you when you go to bed.
• Don’t get up too quickly when
sitting or lying down.
• Put non-slip mats
on the toilet
or bathroom
floors. Remove
loose rugs or mats
that tend to slide.
• Install hand rails or grab bars in
the toilet and bathroom.
• Be extra cautious in high-risk areas
such as the toilet and kitchen.
• Remove excess clutter from the
floor, and tidy up cords and wires.
Outdoors:
• Pay attention to your environment.
Look out for uneven steps, especially in dimly lit areas.
• Concentrate on walking. Don’t use
your mobile phone or be distracted
while walking.
• Don’t rush. Walk slowly and carefully, especially when the floor is
wet.
• Wear flat shoes with rubber or
non-skid soles; check the soles for
wear and tear and change them
regularly.
• Talk to a doctor or physiotherapist
if you think you need a walking aid
so they can recommend an appropriate one for you.
Source: Changi General Hospital’s Your Guide To Falls Prevention
sep– oct 2014
singapore health
25
Ask the doctor
Dr Ng Chung Wai, Family Physician
and Chairperson (Infection Control
& Infectious Diseases Workgroup),
SingHealth Polyclinics, answers
questions about immunity.
Q
A
photos: vernon wong
Does being exposed to a few
germs build up children’s
immunity?
While getting an actual infection
may make a child immune to
subsequent infections by the same
germ, this is not always the case. For
example, a child can get diphtheria
more than once. The infections may
result in complications that cause
permanent damage, so it is safer to
be protected by the diphtheria vaccine than by getting diphtheria.
Parents can play an important role in reducing the risk of infections in their children. For instance, they can teach older
children good habits such as hand-washing, and cough etiquette (e.g. coughing or sneezing into a tissue).
That bug at school
Parents can boost their children’s immunity by ensuring they get all the
recommended childhood vaccinations. By Desmond Ng
M
any parents notice that once taught good habits such as handtheir children start attending washing, and cough etiquette (e.g.
daycare or nursery school, coughing or sneezing into a tissue).”
they begin to fall sick. Why is this so?
Studies show that attending daycare centres increases the risk of
common colds and ear infections
in children between three and
five, said Dr Ng Chung Wai, Family Going to school and
Physician and Chairperson (Infec- childcare exposes a
tion Control & Infec tious Diseases Workgroup), SingHealth child to large
Polyclinics (SHP). “Going to school numbers of other
and childcare exposes a child to large children, which in
numbers of other children, which in
turn, increases the likelihood of expo- turn, increases the
sure to germs,” he said.
likelihood of
Infections include the common exposure to germs.
cold as well as HFMD, sinusitis,
infectious diarrhoea, chickenpox Dr Ng Chung Wai, Family Physician and
Chairperson (Infection Control & Inand influenza. While the common fectious
Diseases Workgroup), SHP
cold tends to be mild, influenza can
lead to severe complications such
as pneumonia, encephalitis (brain
infection), myocarditis (heart muscle
But it is not always easy for workinfection) and even death, said Dr Ng. ing parents to make alternative arrHe said that parents can play an angements. Thankfully, hygiene
important role in reducing the risk of standards in some centres are good.
infections. “If a child is unwell, stay- Temperatures are checked twice a
ing home will reduce the chance of day and children with fever are
spreading germs. This may mean turned away.
that working parents need to make
Dr Ng said parents can boost their
alternative arrangements like having children’s immunity by ensuring they
a grandparent or child-sitter look get all the recommended vaccinaafter the child. Older children can be tions. “Childhood vaccines* not only
ensure that children develop antibodies which protect them against these
infections, but also reduce the likelihood of the infections occurring in the
population, further reducing the possibility of a child catching the infection
from another child. This is what we
call ʻherd immunity’.”
*The schedule of recommended childhood vaccinations can be found at the Health Promotion Board’s website: hpb.gov.sg/HOPPortal/
health-article/630
Q
Can making the environment
and children super clean actually make them more susceptible
to germs?
This is the Hygiene Hypothesis
which postulates that an “overly-clean environment” and the lack
of exposure to germs predisposes a
child to developing allergic diseases
such as hay fever and asthma, not
so much a susceptibility to germs.
There are several major issues
with the hypothesis. For example,
studies suggest that improving
hygiene is not necessarily linked to
an increase in asthma in children.
So the answer is: “No, making the
environment and children superclean does not make them more
susceptible to germs.”
A
Q
A
Are there differences in the
levels of immunity at different ages and why?
The immune system is not yet
mature in a very young child, so
those under one year old are more
susceptible to infections. Some
infections, such as blood infections
by the pneumococcus bacteria, particularly affect children aged below
two. An immature immune system
also may not respond adequately to
a vaccine, which works by stimulating the immune system to produce
antibodies. For this reason, vaccines
should not be administered before
the recommended age. They are
ineffective if given to a child earlier
than the recommended age.
Q
A
According to Dr Ng Chung Wai,
studies show that attending
daycare centres increases the risk of
common colds and ear infections in
children between three and five.
Is there any way to prevent
illnesses such as the common
cold and measles?
Vaccines can prevent childhood
diseases such as mumps, measles, German measles, diphtheria,
chickenpox and pneumococcus
infections. Unfortunately there are
no vaccines for some infections
such as the common cold. They are
caused by germs which mutate so
rapidly that we are unable to prepare vaccines in time.
26
singapore health
sep– oct 2014
Mind your moods
A mother’s moods while pregnant can affect her baby’s
development. By Chua Hwee Leng
w
hen a pregnant woman is
severely stressed, anxious
or depressed, she is not the
only one suffering. Her unborn child is
affected too.
According to the preliminary findings
of a landmark local study, such babies
have less developed limbic systems in
their brains (networks linked to things
such as memor y, stress regulation,
emotional reactions and decision-making). The more depressed a mother is,
the more her baby is affected. He may
be shorter at birth, and as he develops,
he may be more distracted, and have
poorer memory.
Researchers studied the mental and
emotional states of 1,200 mothers and
scanned their babies’ brains at a week
old as well as later in life. The study is a
sub-study of the Growing Up in Singapore Towards Healthy Outcomes (GUSTO)
study, and a joint effort of KK Women’s and Children’s Hospital (KKH), the
National University Health System, and
the Singapore Institute for Clinical Sciences, the Agency for Science, Technology and Research.
Explaining how babies might be
affected in the womb, Dr Helen Chen,
Head and Senior Consultant, Department of Psychological Medicine, KKH,
said that while an unborn baby may not
sense his mother’s distress, stress hormones can cross the placenta and influence the baby’s structural brain development. “The baby is then primed to
live in a state of high stress, and there
are studies which suggest that infants of
anxious mums are more temperamental
or difficult to settle.”
Doctors here find the study results
impactful, as they now have local data
to use in their practice, where previously
they relied on research in other populations. “As clinicians, these findings help
us educate women about the need for
intervention if they suffer from depression
Studies suggest that infants of anxious
mums are more temperamental or
difficult to settle.
or anxiety during pregnancy, as there can
be a real impact on their babies.”
Dr Chen said early intervention and
treatment are extremely important. “I
have seen women who have aborted a
much wanted and planned pregnancy
because they couldn’t cope with the
antenatal depression and anxiety.”
Societal pressures on
working women
demand that they
continue to perform.
But pregnancy is, in
itself, demanding
psychologically and
physically, so this is a
time of vulnerability.
Dr Helen Chen, Head and Senior Consultant, Department of Psychological
medicine, kkh
Although some studies indicate that
babies are more impacted if the mother
is depressed in the last trimester than
in earlier ones, doctors here are more
concerned about the duration of the
emotional disturbance. “If a mother
is depressed or anxious persistently
and for a long time, rather than
transiently, it will probably impact
her baby more, as physiological
changes associated with her mental
state can have a prolonged effect on
foetal growth.”
If the depression continues after
delivery, most of these mothers have difficulty caring for their babies, who in turn
are hard to settle, awake frequently and
have feeding difficulties.
Understanding needed
“The most worrying cases are women
with unplanned pregnancies who struggle to cope. Some reject their babies or
give up caring for them. Some severely
anxious ones have irrational fears of not
being able to care for their babies, or
of dropping them, because they are so
distressed. These women need special
intervention to address the mother-infant bonding problem, apart from treatment for their depression and anxiety.”
Dr Chen advises mothers to be
mindful of their emotional state and
if they have distressing symptoms, to
speak to their obstetrician or general
practitioner who can refer them for psychological intervention. This does not
just involve pregnancy-safe medication
alone. There is also therapy and supportive counselling.
During pregnancy,
a mother should
let go of guilt, and
focus on keeping
well for her child
and building a
strong family unit.
If mothers are carrying guilt about
their moods affecting their babies’ development, they should let go of the guilt
and focus on what they can do to help
now, Dr Chen said. “And that is keeping
well for her child, and building a strong
family unit. Fathers definitely have a big
role in this too!”
Many women are uncomfortable
about seeking psychological help, but
KKH’s Women’s Mental Wellness Service
has counsellors and case managers who
work with psychiatrists and psychologists to offer help at both outpatient clinics and inpatient wards. The hospital’s
Department of Psychological Medicine is
also raising awareness of the importance
of a healthy family system to ensure the
psychological and emotional well-being
of women and their children.
Dr Chen sees the need for society to
be more understanding towards pregnant women. She said although there is
currently no local data, clinical observations suggest that women in high-pressure jobs with long hours and tight timelines face more challenges, and may be
more vulnerable.
“Societal pressures on working
women demand that they continue
to perform. But pregnancy is, in itself,
demanding psychologically and physically, so this is a time of vulnerability.
“I hope that through more public education, our community can understand
the need to address maternal mental
health issues, and that employers, supervisors and colleagues will be supportive of
pregnant women. We need them to nurture well the next generation, on whom
we will also depend on collectively as
a nation!”
For more details on a related event, Love Out
Loud: Enabling Families Through Communication, refer to the event calendar on page 20.
2014 年9– 10月刊
新加坡中央医院与新加坡保健服务集团的双月刊
新闻
27
注射碎片，加快康复效率
新的注射方式能更有效地解决其中一种肾衰竭的并发症
原文 Thava Rani
为
Photo: alvinn lim
了让甲 状 旁腺 恢 复 功 能，肾
衰竭 病人在切除过 度活跃的
甲 状旁腺 后，经常 得 马上将
一小部分的甲状旁腺重新植 入手臂肌
肉里。整个恢复过程需要将近九个月的
时间。
不过，新加坡中央医院和新加坡国立
癌症中心的一支外科医生团队，从一项
针对132名病人回顾性的研究中发现，
将细细剁碎的腺体组织与溶液混合注射
在上臂，短短的两个月内甲状旁腺功能
便恢复了。
“比传统治疗程序，新的注射方式
既快捷又能缩短复原期，”新加坡中央
医院普外科顾问医生吴颂辉说。据他补
充，新的注射方式无需像之前的方法需
切开肌肉植入腺体，这不只降低了出血
或受感染风险，也不会在上臂留下任何
疤痕。
“此外，要是甲状旁腺再次变得过
度活跃，外科医生将能够更容易地处理
注射部位，无需重新切开肌肉，”新加
坡国立癌症中心肿瘤外科高级顾问医生
Gopal Iyer说。
参与研究的132名病人分别在2005
年2月至2012年2月期间，接受了甲状旁
腺移除手术，然后通过 植 入或注 射方
式，恢复甲状旁腺功能。
(左起) Gopal Iyer医生，吴颂辉医生和
钟慧玲副教授有份参于一项有关快速
恢复甲状旁腺的功能新疗法的研究。
体积小、功能大
体积很小，连超声波有时也
难以检测出来
• 通常有四个，每个小如 豌
豆 ，位 于 颈 部 的 蝴 蝶 状
甲状腺后
• 当受到刺激时，可从正常大
小增大20-30 倍，以不断
产生荷尔蒙去处理磷酸盐
和钙质的平衡失调
甲状腺
甲状旁腺
对于一些末期肾功能衰竭病人，他们甲状腺后面的微小甲状旁腺可增长到
比正常的大几倍。
研究结果于今年1月被刊登在国际知
名期刊《外科》上。这种能够减低并发
症风险的注射方式现已成为新加坡中
央医院在治疗这类病症的标准程序。至
今，已有约130名病人接受了注射疗程。
位于 颈部甲状 腺 ( t hy r o i d )附 近 的
甲状旁腺(parathyroid)，体积虽然很小，
但肩负的却是非常重要的功能；为血液
中的钙质和磷取得最 佳平 衡。若失去
这个平衡，病人就得需要服药或接受手
术治疗，这是常见于肾功能衰竭的病人
身上。
“由于所有食物都含有一些磷酸盐，
因此肾功能衰竭的病人都需要面对处理
磷酸盐的问题，”新加坡中央医院肾科
高级顾问医生钟慧玲副教授说。
她说，肾功能 正常的人在排尿时会
把多余的磷酸盐排出，快速地恢复血液
成分的平衡。然而，当肾功能失常时，比
如末期肾功能衰竭病人所面对的情况，
人体将无法处理平衡失调的信号，肾脏
也难以简单地去除多余的磷酸盐，导致
磷酸盐含量持续保持在过高的水平。如
果这种情况持续很久，很可能会导致骨
骼和心血管疾病。
不是每个肾衰竭病人都会出现甲状
旁腺过度活跃的问题。据估计，有大约
三分之一的肾功能衰竭病人最终将有可
能出现这种情况。虽然病人可通过药物
和饮食控制过度活跃的腺体，不过大约
百分之五至十五的病人最后在无计可施
之下，都需要接受手术以解决问题。
植入和注射治疗方式的对比
技术上说明
程序时间 恢复甲状旁腺功能
植入或注射
所需的时间
风险
部位的疤痕
以往的植入方式
把一部分的腺体
植入手臂肌肉内
30分钟
9个月
4-5厘米
出血或受感染
新的注射方式
在皮下脂肪层注射含有细细
剁碎的腺体组织的溶液
18分钟
2个月
没有
没有
平衡功能
• 释放甲状旁腺荷尔蒙，控
制人体内过低的钙质水平
和过高的磷酸 盐（和镁）
水平
• 促使肾脏通过排尿排出多
余的磷酸盐
• 促 使 骨 骼 吸 收 和 释 放 钙
质，阻 止肾脏通过排尿排
出钙质
钙质和磷酸盐对以下功能是
不可或缺的成分
• 建造与修补骨骼和牙齿
• 促进神经功能
• 使肌肉收缩
• 促进血液凝固
当磷酸盐水平过高
• 当荷尔蒙产生时，肾脏 无
法通过排尿，有效 地去除
多余的磷酸盐
• 甲 状 旁 腺 不 断 释 放 荷 尔
蒙 ，以 尝 试 降 低 过 高 的
磷酸盐水平
• 持 续 释 放 的 荷 尔 蒙 会 造
成副 作用：骨骼释放 更多
的钙质，导致骨骼慢慢失
去支撑的功能；被释放的
钙质堵塞血管
• 病人可能会经历骨痛和关
节疼痛或骨折，以及心血管
问题
28
新闻
2014 年9– 10月刊
防 患 乳 癌 意 识 月
提高警觉
预防乳癌
原文 Denyse Yeo
乳癌是最主要导致女性死亡
的癌症，占癌症死亡率的
18%
20% 1,600
症状
如果您出现任何以下症状，请立即去看医生：
在新加坡女性之中，乳癌是最
常见的癌症。每年，大约有
乳癌占女性癌症的
感觉乳房
里有无痛
的肿块
乳头周围
出现持久性
的皮疹
名女性被诊断患上乳癌。
250,000
在过去十年内（2002-2012），将近
乳头出血
或流出
异常分泌物
乳头内陷
及早检查
女性乳房肿块并不罕见，但在
每10个肿块之中，只有一个是
因为癌症而形成的。这意味着
90%的乳房肿块都是良性的。
资料来源：卫生部和保健促进局
名女性已接受过新加坡乳房检验计划
（BreastScreen Singapore）的检查。
乳房皮肤
肿胀、增厚、
凹陷或起皱
降低患病
风险
拥有乳癌家
族病史的女
性可能面对
较高的风险。
如果您的母亲
和/或姐妹在
更年期前患上
乳癌，您应该
与您的医生或
乳腺专科医生
详谈。
+
40
1
女性患上乳癌的
风险会随着年龄
增加。大部分被
诊断患上乳癌的
女性都年届40
岁及以上。其他
的致病因素包括
较迟出现更年期、
完全没有生育或
儿女不多、正在
接受荷尔蒙替代
疗法和体重增加。
维持健康的生
活方式。定时
运动，保持健康的
体重。多一点进食
水果、蔬菜和全麦
食品，少一点进食
肥腻的食物。减少
喝酒，马上戒烟。
2
在每次月经来
潮后的第三至
第五天，自我检查
乳房，养成习惯。
3
定期接受乳房X
光检验。如果您
的年龄介于40-49岁，
您应该每年接受一
次乳房X光检验，直
到50岁为止。50岁后，
您应该每隔两年接
受一次检验。
接受检验
您可以在以下机构参与全国性的新加坡乳房检验计划：
新加坡保健服务集团（电话: 6536-6000）、Radiologic
Clinic（电话: 6533-2721）和国立健保集团诊断服务
（电话: 6275-6443/ 6-ASK-NHGD）
2014 年9– 10月刊
健康
29
居家护理
让病患省却了往返医院的奔波，也减轻了医院的负担
文 杨萌
近
职总乐龄合作社家务
助理黄金春为八旬病
患冲凉和按摩身体，
让卧床不起的病患获
得片刻舒坦。
图：联合早报何炳耀摄
几年来，居家护理（home
care）已成为本地医疗界
的热门话题。他们上门提
供 治疗的 模式 既让 病患省 却了往
返 医 院 的 奔 波，也 减 轻了医 院 的
负担。
居家护理领域依工作性质有所区
别。业者中，有的专注提供居家医疗
（home medical）和居家护理（home
nursing），有的专提供居家看护或家
务助理（home help）。同时提供医疗
和非医疗服务的业者不多。
一般上，家务助理负责为病患冲
凉、按摩、喂药、量体温血压，工作
也包括煮饭和陪同病患去医院。这
份工作看起来不难，但一点也不简
单。除了耐心，还得心细和不怕脏。
所以虽然市场上有需求，但要找到
合适的人选并不容易。
本地提供居家护理的志愿福利
团体大 约有15家，私 人公司3 0多
家。志愿福利团体照顾的年长者多
来自低收入家庭，他们多由医院或
社区服务机构转介，本地人可获得
高达80%卫生部津贴。属于中高收
入者则可私人家务助理业者。在津
贴之前的收费约每小时$20，但实际
收费还须视业者和具体服务而定。
低收入家庭即便是获得高额津
贴，也未必能负担家务助理每天上
门，因此会要求家务助理每周探访一
至三次，这也就意味着老人家一个
星期也就冲凉几次。那些需要长期
服务的，可选择配套，比如50个小时
的配套，以每小时$18来算是$900。
卫生部津贴
家庭人均月入
0–$700 $701–$1100 $1101–$1600 $1601–$1800 $1801–$2600 >$2601 居家护理服务 80%
75% 60% 50% 30% 0
居家复健服务
$97
$91
$73
$61
$36
0
*适用于新加坡公民，永久居民津贴较少
资料来源：卫生部
居家护理服务和收费
服务名称
服务内容
费用（津贴前）
居家医疗
医疗团队定期上门提供治疗
每次$130–$200
居家护理
护士上门清洗伤口和拆除伤口
缝线、换食管和尿管、打针、
包装药物等
每次$80以上
居家复健
专业物理或职能治疗师上门
提供复健服务
每次$100–$150
家务助理
陪伴病患、做些简单运动、
冲凉、准备餐食和陪同病患
看病等
每小时$2.70–$30，视
具体内容和业者而定
看护者
喘息护理
家务助理上门提供数小时照顾
每小时约$20
看护者
训练
教导看护者（亲人或女佣）每
年可获培训津贴在家照顾年
长病患
最高$200
部分资料来源：
“新加坡乐银页”(Singapore Silver Pages)，silverpages.sg
卫生部3C强化居家护理服务
卫生部新财政年的重点计划之一，
是从3C下手强化居家护理服务。
第一个C是强化能（capacity）。
比如，卫生部鼓励医院提供更多医
疗 延 续 服 务（t r an s i t io nal c ar e
programmes），安排医疗人员短期
上门照料 病患，减少病患再次住院
概率 。另外，卫 生部也会资助更多
团体提供长期的居家护理服务。目
前每 年 有 5 4 0 0人 接 受 居家医 护服
务，1100人接受家务助理服务，到了
2020年，这两个群体估计会分别增
加至一万人和7500人。
第二个C是提高服务的多元性和
完整性（comprehensiveness），比
如两家医院去年推出短期看护者服
务（Interim Caregiver Service），在
病患出院两周内安排专人每天上门
提供长达12小时看护服务，今年底
所有重组医院和社区医院都将提供
这一服务。另外，规模还在初期阶段
的居家复健（home rehabilitation）
也将获得卫生部津贴（见表）。
卫 生部也 将调 整 对居家护理 业
者的资助方式。目前，卫生部主要是
以每小时或每次服务给予资助，今
后则计划以“人头计算”（capitated
funding），根据业者为年长者设计
的一整个护理配套来拨款。
业者对此普遍表示欢迎。触爱的
萧树耀说，这意味着业者长期财务
资助有了保障。曹氏的黄卫众医生
说，这解决了一些业者为了获得更多
资助而盲目增加年长者探访次数的
问题。但他认为，卫生部 在衡 量各
居家护理计划时应采用更全面的标
准，比如看护者压力、病患疼 痛是
否减轻等。
第 三 个 C 是 协 助 看 护 者
（c a r e g i v e r），卫 生 部 打 算 通 过
试 点 推 出 周 末 喘 息 看 护（r e s p i t e
care），让需要在周末出外办事或休
息的看护者暂时将年长者交给日间
托管中心。卫生部将在今年第三季
度成立看护者一站式热线中心。看
护者只需拨 打一个 号码，便有专人
回答有关转介护理服务和申请津贴
等问题。
居家护理须八面玲珑
居家护理的护理人员必须有“八面玲
珑、左右逢源”的本领。
曹氏 基金属下华美中心医药总 监
黄卫众医生解释，在医院里，医生直接
开药、吩咐病患去做检查，最多问问在
家里由谁照顾，但一旦到了病患家，尤
其是那些家徒四壁的病患，医护人员也
才发现，原来病患不是不肯吃药或不肯
好起来，而是有种种的障碍摆在他们
面前。
他说：
“你给糖尿病人开胰岛素，但
他家里连冰箱都没有，怎么存放胰岛
素？一些病患的问题不是生病本身，而
是生活孤立无助，这个生命的问题比
他的健康还重要，他一个人一整天坐在
椅子上，他觉得生命已无意义，还要健
康来干吗？”
从事居家护理13年，黄卫众医生除
了看病，还得亲自抹地、洗脏被单和清
理满屋的臭虫，但同时，满足感也无可
比拟，因为他可以走进病患的生活，帮
助一些原本已放弃自己的病患重新振
作、健康起来。
他强调，从事居家护理需要的技能
远大于专业技术，最需要知道社区里
有什么资源、如何处理情绪问题、如
何和病患家属合作。
“这都需要八面 玲珑、左右逢 源的
技巧，就连该不该把病患转介给专科
医生都要仔细想过，因为这名病患可
能连门都出不了，出门要安排什么交
通，是不是真的有必要，还有没有更
好的办法？”
因此，各机构越来越重视员工的培
训，比如职总乐龄的家务助理在物理
治疗师的教导下，学习基本的物理治疗
技巧，当物理治疗师不在时，家务助理
也能帮老人家做简单伸展动作。
负责职总乐龄居家服务的助理总
经理冯时韵说，家务助理还学习如何
辨认失智症及适合失智症患者做的游
戏。随着训练和技能的完善，这些助
理还可能朝管理方面发展。
触爱四年前推出看护者热线，护理
协调员除了给看护者推介服务，还能
给他们建议，减少看护者压力，省去他
们四处敲门求助的烦恼。
原文首次刊登于早报星期天2014年3月30日
30
焦点
2014 年9– 10月刊
及时注射疫苗
汤医生说：
“受感染的母亲通过生
产过程将病毒传染给孩子，是孩童感
染B型或C型肝炎最常见的方式。其他
传播方式包括跟受感染、同住的家庭
成员有亲密接触，或被沾有受感染的
血液的器具或物品割伤，如通过纹身、
在耳朵或身体其他部位打洞、针灸、
共用使用注射针等。在较为罕见的情
况，被感染者咬也能造成被咬的人受
感染。”
保护孩子免受肝炎病毒感染并非难事
原文 Thava Rani
您
是否知道，几乎所有受B型肝
炎病毒感染的婴儿与孩童都
不会出现迹象或症状？也就
是说，他们有可能会在不知情的情况下
将病毒传染给其他孩童。
然而，许多人仍对肝炎一知半解，并
不知道这种疾病的种类与个别的传播
方式。
应当心蚶和针
卫生条件差，是传染A型肝炎的主要原
因。此病毒存在于受感染者的粪便中。
病患在出现症状前的两三周前传染性
极高，所以家属如果接触不干净的食物
或液体，此病毒便很容易传播。
食用生的或没有完全煮熟的蚶也是
感染肝炎的常见方式，不过，此方式在
孩童中较少见。
竹脚妇幼医院儿科传染病高级顾问
医生兼部门主任汤国正说：
“贝类食物
是肝炎的病因之一。在较落后国家里，
人们常将粪便倒入河流与沟渠中，粪便
进而流入贝类繁殖的海里。”
另一方面，B型肝炎的传播方式跟人
体免疫缺陷病毒（HIV）的传播方式是相
同的，既是通过受感染的血液或其他体
液如精液或阴道分泌液等。然而，B型
肝炎的传染可能性比人体免疫缺陷病
毒的传染可能性高出50至100倍。
同样的，C型肝炎也是通过与受感染
的血液直接接触而传播的，但较少通
过其他体液传播。
注射疫苗！
保护您的孩子
若要预防孩子感染A型肝炎，最好的方
法就是确保他们严格遵守卫生习惯，如
在家里经常洗手。
当您到卫生水平较低的国家时，饮
食方面最好多加小心。
汤医生警告说：
“没有煮滚、煮熟或
去皮的食物就别吃。在饮料方面也必须
小心，尤其是冰冻饮料。用来制作饮料
的水也许是干净卫生的，但冰块可能已
受污染。”
确保孩子们免受感染的最佳保障是
对B型肝炎有免疫。如果有家庭成员是
带菌者，那您就得在住家内采取额外预
防措施。包括确保他们无法取得尖利
1
2
新加坡所有婴儿在全国性计划
下都接受B型肝炎疫苗注射
疫苗共有3剂，分别在刚出
世时、一个月大时及5至6个
月大时注射。
的物品如使用过的针或剃须刀，和避
免与伤口有直接接触。孩子们也不应
吃接触过他人口的任何食物。母乳喂
养是安全的。那些会接触到C型肝炎
感染者的孩童，也应在住家内采取类
似预防措施。
通过疫苗注射能有效预防A型和B
型肝炎，然而目前C型肝炎并没有预防
疫苗。自1985年起，B型肝炎疫苗注射
是全国儿童免疫计划的其中一项疫苗
注射，有效度高达95%。
汤医生说：
“注射疫苗不但对接受
注射的孩童有利，也有助于降低他们
在社区中将病毒传染给他人的风险，
尤其是 对那些不能 接受疫苗注 射的
人。更大的利益是，注射疫苗能提供
‘增强’保护，这远比直接保护来得有
效。通过注射疫苗，我们能根除此疾
病，而并非只是控制它。”
“注射疫苗能直接降低B型肝炎长
期感染的风险，进而降低患上肝硬化
和肝癌的长期风险。”
目前，为孩童注射A型肝炎疫苗并
非 常规，只有 当孩 童 需 要 到 此 疾 病
较为普 遍的国家时才需要 接受疫苗
注射。
3
一般上不需要重复注射疫苗
某些孩童不宜接受注射
对前一剂疫苗产生危及生命的
过敏反应的孩童。
对任何疫苗成分（如酵母）有
已知过敏反应的孩童。
首两剂疫苗提供迅速保护作
用，第3剂疫苗则让保护期
限尽可能延长。
在许多孩童当中，疫苗的保护期
相信可长达至少25年，而在一
些孩童当中则是终身的。
孩童在成年后若有染病风险，如
跟受感染的人接触过、需要接受
输血或进行高风险性性交，则应
再次接受检测与注射。
肝炎须知
肝炎指的是肝脏发炎，而肝脏发炎可能是由病毒感染造成，或因接触到有毒物质、酒精或药物而
引起的。虽然A型、B型及C型这三种肝炎很相似，但是导致个别肝炎的病毒却是不同的。
B型或C型肝炎
能通过沾留在针
头或刀片上的受
感染的血液传
播。A型肝炎则
很容易通过食用
未经烹煮或没有
完全煮熟的贝类
或不卫生的食
物，如已剥了皮
的香蕉而传播。
A型肝炎
B型肝炎
C型肝炎
由什么造成
A型肝炎病毒（HAV）
B型肝炎病毒（HBV）
C型肝炎病毒（HCV）
症状
疲劳、食欲不振、发烧、恶心、呕吐、腹部疼痛、体重下降、关节疼痛、
眼球与皮肤发黄（黄疸病）、尿液呈深色、粪便呈灰白色
孩童
小于6岁，一般上不会出
现明显症状，感染黄疸
病的人数只有约10%
年龄较大的孩童
出现更为严重的症状，感
染黄疸病的人数超过70%
并发症
在没有并发症的情况下，
康复过程一般历时数周
绝大多数的感染病例是毫无症状的
90%的孩童可能成为
慢性B型肝炎带菌者。
在这些孩童当中，其
肝炎恶化成慢性肝硬
化，可能导致肝脏衰
竭，甚至是肝癌的人
数可高达三分之一
恶化成慢性肝硬化或
肝癌的人数约为15%
至20%，尽管这个恶
化过程在孩童中可能
历时数十年
2014 年9– 10月刊
新闻
31
专家解答
烟霾使哮喘病加剧
最近的烟霾使我的哮喘病病情恶
化，经常发作。我该怎么做？
在哮喘病发作时，患者的呼吸道会收
窄，导致呼吸困难。如果没有适当地
控制病情，让呼吸道受到环境的触发
因素所刺激，病情很容易就会发作。
要减少哮喘病发作，就必须控制好病
情。因此，患者可能需要服用适量的控
制性药物。
哮喘病的吸入性药物可被分为两大
种类：
控制性药物：治疗肺炎，同时降 低
肺部对于触发因素，如烟霾这种环
境污染物的敏感度，从而减轻敏感
反应。 缓解性药物：在哮喘病发作时，舒
缓并扩张已收缩的气管。
在阴霾笼罩时，病情一般受到控制
的哮喘病患者可能会觉得病情转坏，
并需要服用控制性药物。至于已在服
药的患者，则可能需要医生调整药物
剂量。 所有的哮喘病患者都应该有一份列
明指示的哮喘病控制行动计划：识别
早期症状，以便采取适当的措施，预防
发作程度恶化；发作时需要采取的步
骤；以及如何辨别发作程度是否严重
到需要紧急救护治疗。
无 论病 情 是 否已受
到 良 好 的 控 制，所 有
哮喘病患者都应该
随 身携带一 个吸 入
器，预防哮喘病随时
发作。
新加坡保健服务
集团综合诊疗所
家庭内科顾问
医生黄忠伟
我患上抑郁症了吗？
我经常感到情绪低落，对任何东
西都不感兴趣。这是不是抑郁症
的征兆？月经来潮之前感到忧郁消
沉是正常的吗？ 月经来潮的前两周，有些妇女可能会
感到情绪低落是因为黄体酮（一种会
导致情绪消沉的荷尔蒙）一直在体内
不断地增加所引起，又或者因为月经
而必须避免进行某些活动，例如游泳/
水上运动、穿紧身或浅色衣服，甚至性
行为，而感到沮丧。
至于抑郁症，它主要的症状是情绪
低落和意志消沉，或对任何东西失去
兴趣和无法透过任何事物感到欢愉。
其他症状还包括：
失眠（尤其是在凌晨醒来） 食欲不振和消瘦（或爆食和发胖）
无法集中精神或健忘
失去正能量或动力、无精打采（或
容易激动和焦躁不安）
意志消极、过度内疚、绝望感，以及
有自杀倾向。
但 如果以 上症 状 连 续出现 超 过两
周，并引起重大的痛苦或影响个人的日
常生活能力时，那可能就是抑郁症了。
竹脚妇幼医院心理医学科主管及高级顾问
医生陳瑜
近视可以治疗吗？
我其中一名孩子患有近视。请问有
什么方法治疗吗？如何预防近视度
继续加深？另外，我也开始限制小
儿子使用电脑和电子产品的时间。
我是否过度反应了？
眼镜或隐形眼镜和使用阿托品滴眼剂
（Atropine Eye Drop）。眼镜和隐形眼
镜的治疗效果因人而异，一般 成功率
从零至30%不等。如果选用隐形眼镜
来治疗，家长必须加倍小心护理，以确
保孩子的眼睛不会受到感染和威胁到
视力健康。
阿托品滴眼剂是一种能够减缓近视
恶化的有效药剂，控制效率可达50%
至80%。不过，不同浓度的滴眼剂可能
会造成瞳孔放大和近距离视力模糊。
副作用较轻的较低浓度滴眼剂去年
上市，给使用者更多样化的选择。如果
你希望知道自己的孩子是否适合接受
以上治疗，请咨询你的医生。
新加坡全国眼科中心及竹脚妇幼医院幼儿
眼科与斜视治疗组高级顾问医生谢玮玲
遗传和环境因素会导致近视。如果你
有近 视，你孩子患 上近 视的几率会更
高。此外，我们目前的生活模式也过份
偏重于室内工作和近距离聚精会神。
为了减轻以上因素，保健促进局推
行了一个 计 划，支持 孩子多到户外活
动，避免长时间留在室内。你也应该限
制孩子玩电脑游戏和看电视的时间，并
让他多到户外玩耍。
如 果 近 视 持 续 加 深，我 们 可 以 通
过其他方法来控制它，例如配戴特制
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32
2014 年9– 10月刊
Ivy
Extra Special
ct EA
575