singapore health sep/oct

a Bimonthly PuBlication of SingaPore general hoSPital and Singhealth academic healthcare cluStermci (P) 173/05/2014

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More children are seeing the dentist before turning two

With the right posture, equipment and attire, cyclists can enjoy the sport better

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

An expectant mother’s moods can affect her baby’s development

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能快速恢复甲状旁腺功能的新疗法

p3

new injection method for overactive

parathyroid glands

08Drinking coffee cuts the risk of dying from some liver diseases

singapore health sep– oCt 201402

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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 para-thyroid glands between February 2005 and February 2012. The patients’ para-thyroid function was restored by either implantation or injection.

The study was published in Surgery, a renowned international journal, in

By Thava Rani

Cut, mince and jabA 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

NEWS 03

> Continued on page 4 (华文版本请翻阅至27页)

Sep– OCT 2014 SINGapOre healTh

SurGery to remove overactive parathyroid glands in patients with kidney failure was often fol-

lowed 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 retro-spective study of 132 patients that inject-ing 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 conven-tional method requires,“ said Dr Jeremy Ng, Consultant, General Surgery, SGh. unlike the previous method of cutting up muscle to implant the gland, the injec-

January this year. The injection method, which carries a lower risk of complica-tions, has become the standard proce-dure 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 main-taining 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

Small but importaNtSomEtimES 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

implantation or injection? What iS hoW loNg hoW loNg bEforE ScarriNg? riSkS doNE it takES parathyroid fuNctioN iS rEStorEd injection Solution of finely minced 18min 2 months None None gland injected into fat under the skin

implantation Gland pieces implanted 30min 9 months 4-5cm Bleeding, into arm muscle infection

The tiny parathyroid glands, found behind the thyroid, can grow many times their normal size in some advanced stage renal disease patients.

parathyroidglands

thyroid gland

(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.

04 NEWS

> Continued from page 3

Cut, mince and jab

singapore health sep– oct 2014

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.

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

gFr > 90

Stage III

gFr 30 – 59

Stage V (end-stage)

gFr < 15

(dialysis or kidney transplant needed)

Stage IV

gFr 15 – 29

Stage II

gFr 60 – 89

gFR 100 90 80 70 60 50 40 30 20 10 0

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 func-tion normally, this excess phosphate is excreted through the urine, and bal-ance is regained quickly. But when the kidney is not functioning normally, as

with people suffering from end-stage renal failure, the signals cannot be heard and the kidneys cannot get rid of phosphate easily, leading to phos-phate levels staying at elevated levels, she said. When this occurs for a long time, bone and cardiovascular dis-eases can occur.

not everyone with kidney failure will

pho

tos:

alv

inn

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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.

develop overactive parathyroid glands; an estimated one-third of kidney fail-ure 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.

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Show me your teethThe call to take very young children for dental check-ups seems to be getting heard

Consequently, the age recommenda-tion was reduced to two years. But even with this lowering of the age rec-ommendation, 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 visitAccording 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 rec-ommendation, setting up the first ded-icated 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 out-reach platforms include its Facebook page, media interviews, and publica-

tion in newspapers and magazines.The key element of a first visit

is dental risk assessement. Incor-

NEWS

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.

PHO

TO: j

ASPe

r yU

SeP– OCT 2014 SINgAPOre HeAlTH

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

The ABCs of the first dental visit

ASSESSmENT Preventing future dental prob-lems 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 care-giver (e.g. parent), and discus-sions 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 hoNESTParents should not feel embar-rassed to share their own dental struggles or concerns with their child. Paediatric dentists are there to guide them.

ComforTThe 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.

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.

Paediatric dentists at workDr Chng is part of a diverse team of paedi-atric 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.”

PAeDIATrIC 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 Paediat-ric Dentistry (AAPD) revised its recom-mendations 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, m a n y h a d succumbed to SeCC by then.

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.”

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.

Many patients regularly take tradi-tional or herbal medicines with-out realising that such remedies

can have harmful effects or interact with the conventional Western drugs pre-scribed by their doctors.

Yet, the use of such medicines is on the rise.

While doctors and other medical pro-fessionals can and should play a role in ensuring that folk or complementary remedies are used safely, high-qual-ity 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 Gen-eral 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 comple-mentary and alternative medicines, but the reality is that many don’t or won’t tell their doctors they are using such prod-ucts. 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 tradi-tional medicines stems from the differ-ences in practice. Cold, hard evidence following years – sometimes decades – of documented clinical observations and tests is the cornerstone of conventional Western medical practice. With tradi-tional and herbal medicines, however, the proof is in centuries’ worth of practice

East-West drug mix has benefits, dangersDoctors 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

PHo

To: A

Lvin

n L

iM

(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 narayanaswamy, Pharmacy Practice Manager, SGH; and Ms Fung Foon Yin, Traditional Medicine Resource Executive, Pharmacy Department, SGH. Ms Fung answers queries and does the literature searches.

Funded by the Ministry of Health, the service covers all traditional remedies including traditional Chinese, Ayurvedic and Malay/indonesian Jamu medicines, as well as health supplements.

“Because we believe that traditional medicines do have their benefits, we want patients to benefit from both tra-ditional medicine and Western medicine (within safety limits),” said Ms Lim. For instance, ginger, a traditional herbal cure for nausea and vomiting, can help allevi-ate the side effects that a patient under-going chemotherapy may get. Acupunc-ture can also help with such symptoms, said Ms Lim, noting that patients have stopped treatment when the side effects of chemotherapy became too severe to bear. “Reducing the side effects of the chemotherapy helped them to continue with their treatment,” she said.

The traditional medicine information service receives two to three queries a week. Ms Fung trawls through medical reference books, medical journals, case reports, and Chinese medical databases to find the information needed. The pro-cess can take anywhere from one to two hours to several days.

The team analysed the 216 queries the service received between october 2011 and April 2013, and found that 77 per cent related to the safety of traditional or herbal medical products. Published infor-mation was available for 82 per cent of these queries. And of these, 115 enquirers provided feedback about whether they encouraged or discouraged the use of the product in question.

out of 15 cases for which no risk was indicated, eight (53 per cent) of the health care professionals allowed the use of the product in question. The remaining 47 per cent took a cautious stance and discouraged their use, said Ms Lim, who was the lead investigator of the survey.

Ms Lim added that those who gave the go-ahead to their patients did so because they continued monitoring their patients’ conditions, or the drug had already been used for a while by the patient with no reported problems.

The queries came from pharmacists (77 per cent) and doctors (20 per cent). not surprisingly, safety issues predomi-nated, such as concerns with drug inter-actions (56 per cent) and adverse reac-tions (22 per cent). The findings were summarised in a poster and presented at last year’s SGH Annual Scientific Meeting, Annual Singapore Pharmacy Congress (where it was the 2nd runner-up in the Competitive Poster category), and other overseas conferences.

Ms Lim said that her team is working on another project to build up a data-base of treatments on cancer, diabetes and hypertension with Thong Chai Med-ical institution. The effects – both posi-tive and negative – of using both West-ern and traditional Chinese treatments for cancer, diabetes or hypertension will be studied carefully and documented.

“Hopefully, we will be able to develop a database of findings to share with both Western and traditional Chinese doc-tors,” said Ms Lim.

if the group is able to secure a grant for the project, the study will begin at the end of this year. The team is also looking to set up a database on warfa-rin, a common blood-thinning drug, and its interactions. When that is completed, they will continue and set up databases of other medications.

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

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 col-leagues set up a traditional medicine information service in october 2011 to provide doctors, pharmacists and other health care professionals with evi-dence-based information about tradi-tional and alternative medicines.

The others in her team are Dr Linn Yeh Ching, Senior Consultant, Depart-ment of Haematology, SGH; Mr Ricky Ang Seng Kok, Principal Pharmacist, Depart-ment of oncology Pharmacy, national

06 NEWS SinGAPoRE HEALTH SEP– oCT 2014

07sep– oct 2014 singapore health

08 NEWS singapore health sep– oct 2014

By DesmonD ng

the jury may still be out on whether coffee is good or bad for health. But a new study has given the bev-

erage a thumbs-up – at least for the ben-efits it has for some liver diseases.

the study by singapore general hospital (sgh) and Duke-nUs gradu-ate 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 chi-nese in singapore by 66 per cent. cir-rhosis is scarring of the liver and can be due to viral hepatitis B or c, or non-viral causes such as heavy drinking, autoim-mune disease and fatty liver disease.

according to Dr george goh, consul-tant, Department of gastroenterology and hepatology, sgh, the benefits of coffee reported in earlier international studies on several aspects of liver dis-ease 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-vi-ral hepatitis-related cirrhosis by 66 per cent.”

coffee has more than a thousand compounds, and it is difficult to iden-tify 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 com-pounds such as polyphenols, melanoi-dins, cafestol and kahweol have antiox-idant and anti-inflammatory properties that are beneficial for the liver.”

the study found that other caf-feine-containing beverages like green tea and black tea had no significant effects on cirrhosis mortality. Drink-ing fruit juices or soft drinks also didn’t affect the risk of dying from cirrhosis. another finding of the study, unsur-prisingly, 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,

Good brewDrinking at least two cups of coffee a day lowers the risk of dying from some types of liver cirrhosis

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 con-flicting results on the effect of coffee in Western and asian-based studies of death from liver cirrhosis. our find-ing 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 world-wide appeal in its use as a therapeutic option in liver disease, particularly in chronic liver diseases such as non-alco-holic 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 treat-ment option,” he said.

the study was published in February in Hepatology, the international publica-tion for original, peer-reviewed articles concerning all aspects of liver struc-ture, function and disease, and was pre-sented orally in the outstanding clinical research award category of the sgh 20th annual scientific Meeting.

ChroNiC hEpatitiS B aNd NoN-alCoholiC fatty livEr diSEaSE form the majority of the chronic liver diseases seen at sgh clinics

360,000,000 people worldwide have chronic hepatitis B infections;

a significant proportion of them are in Asia

2 billion people worldwide have been infected with the hepatitis B virus

2.9%or about 1 in 35 adults in Singapore are hepatitis B carriers

Up to

12% of chronic hepatitis B patients develop

cirrhosis annually

liver cirrhosis, which can lead to the development of liver cancer, is the 16th leading cause of death

in singapore

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

16th4th3rd

Study recruited older Chinese living in Singaporethe data of 63,275 ethnic chinese living in singapore were used for the Coffee reduces risk of mortality from non- viral 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.

*Figures from World health organization, Ministry of health


E

MDI287 SHLS Singapore health 345x260 Sep Oct FA.indd 1 29/7/14 11:00 AM

Professor Wong Tien Yin is the new Medical Director of the Singapore National Eye Centre.

SNEC and will continue his research at Singapore Eye Research Institute (SERI).

Prof Wong has a strong track re cord in re s earch with many research breakthroughs, published papers, and patents for eye imag-ing software and related technol-ogy. His local and international awards include the Singapore Translational Research Investigator Award, the National Clinical Scien-tist Award, the President’s Science Award and the 2013 Eisenhower Fel-lowship Award. As Medical Director of SNEC, Prof Wong will continue to elevate the Centre’s service and reputation in the field of ophthal-mology. He also serves as Group Director, Research, SingHealth.

Singapore national eye Centre (SneC)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 concur-rent role of Academic Chair, Sing-Health 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 trans-plantation, refractive surgery and myopia treatments in the interna-tional arena. Prof Tan will remain a tenured Professor in Ophthalmol-ogy and senior faculty member of

national Heart Centre Singapore (nHCS) Professor Koh Tian Hai, Medical Direc-tor 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 oper-ating 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 Profes-sor with Duke-NUS Graduate Medical School and Clinical Associate Pro-fessor 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 Outstand-ing Clinician Award in 2013. In his new role, Prof Chua will continue to advance NHCS’ standing as a national specialist centre for cardiovascular treatment.

Associate Professor Poon Choy Yoke is the new Director of the National Dental Centre Singapore.

10 NEWS SINGAPORE HEALTH SEP– OCT 2014

Professor Terrance Chua is the new Medical Director of the National Heart 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 Duke-NUS Oral Health Academic Clinical Program.

Under Prof Kwa, NDCS developed into a specialist oral health care centre, offering multi-disciplinary care to patients with dento-facial and cleft deformities, facial pain and sleep dis-orders, or in need of complex oral rehabilitation. NDCS is Asia’s first Joint Commission International-accred-ited oral health care institution, and the Centre collaborates with interna-tional 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 Sur-gery, 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 con-tinue to provide leadership and vision to strengthen NDCS’ reputation for excellence in clinical services, educa-tion and research.

Three SingHealth institutions recently had leadership changes

Changes at the helm By celine lim

C

M

Y

CM

MY

CY

CMY

K

Sengkang Health’s logo, launched in July, was developed with input from staff and residents from Sengkang and Punggol.

NEWS 11sep– oct 2014 singapore health

The new logo represents collaboration between the patient, the community and the health care professional towards better health

sengkang health has launched its logo, vision and mission state-ments, keeping in mind the

people it will serve when sengkang general and community hospitals open in 2018.

the logo, launched in July, was devel-oped with input from staff and residents from sengkang and punggol. they were asked to pick one of five designs. the majority picked the design that sengkang health ultimately chose.

one resident described the design as touching. “it looks as if three staff mem-bers are standing with their hands wide open to welcome patients.” another, who chose the same design, said: “it looks like people holding hands in partnership, cooperating as a community, helping each other heal and living a healthy life.”

professor christopher cheng, pro-tem

Residents, staff help pick hospitals’ new logo

ceo of sengkang health, said: “the new logo represents collaboration between the patient, the community and the health care professional towards better health. the right hand symbolises us reaching out towards healthier futures and the north-east community we will be serving.”

he said the organisation’s vision, “healthy living. Fulfilling life”, and mission, “Better health together”, will be achieved through “holistic, informed and reassuring care in partnership with the community”.

to bring the message home, sengkang health is engaging the community early. it will be holding a sporting challenge to encourage families to stay healthy together during the september holidays.

For more details on the september event, Millennia Kids challenge 2014, refer to the event calendar on page 20.

Distributes and provides supplies to healthcare professionalsNo. 190 Clemenceau Ave #03-33 Singapore • Shopping Centre S(239924) Phone: (65) 6468-4948 • Email: [email protected]

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500 mg of glucosamine per capsule • Glucosamine hydrochloride

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Normal collagen fibresArthritic collagen fibres

Genacol® Plus has no SODIUM or POTASSIUM.

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GenacolSODIUM or POTASSIUM.

IMPORTANT NOTE:

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Collagen acts as a main catalyst for growth and repairs almost every tissue in the body.

What is glucosamine hydrochloride?

Glucosamine hydrochloride is abiochemical product naturally present in bone cartilage. This substance allows to slow down the degradation of the cartilage and increases the lubricating ef-fect of the synovial fluid, which is the joint liquid that is secreted by the organism that protects the cartilage from mechanical stress.

Here, take tHe Hot seat!Dr Hwang siew Wai, Clinic Director, singHealth Polyclinics - Bukit Merah Outstanding Clinician Award

singapore health sep– oct 201412 PeoPle

Celebrating passionDedication and strength of purpose underpin the passion of these four health care professionals, winners of the 2014 SingHealth GCEO Excellence Award

By Jessica Leow and chua hwee Leng

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.Dr Hwang Siew wai, CliniC DireCtor, SingHealtH PolyCliniCS - Bukit MeraH

even before they see a doctor, they can go for screening,” said Dr hwang. as a result of the success of this, the initia-tive 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 suc-cessful here, we can share them with other polyclinics.”

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loving tHe CHallengeMdm Maliga riaki Chinniah, senior staff nurse, Cardiothoracic surgery intensive Care Unit, national Heart Centre singapore Outstanding Nurse Award

“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 differ-ence 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 initia-tives which have since been adopted by other polyclinics. among them are increasing the rates of diabetic foot screening and diabetic retinal photog-raphy done for patients with diabetes.

“at the registration counter, via a computer alert system, we identify dia-betic patients who need these tests. so,

Working at the cardiothoracic sur-gery intensive care unit, national heart centre singapore (nhcs), she said nurs-ing suits her personality. she is natu-rally 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 hos-pital, then singapore general hospi-tal 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 with-out 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 confi-dence,” 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 medi-cal social worker. in fact, Mdm Maliga has been so engrossed in her job that she has not taken a single day of med-ical leave in the 23 years after her last maternity leave. this was despite wear-ing many hats – nurse, mother, house-keeper, children’s tutor and volunteer, just to name a few. a mother of three, Mdm Maliga managed without domes-tic 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.

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.

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 get-ting them – postgraduates from Yong loo lin school of Medicine and Duke-nus who are assigned to singhealth polyclinics - Bukit Merah – to lead con-sultations 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 expe-rience 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.

people 13sep– oct 2014 singapore health

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

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creating great mealsmdm Koay saw lan,senior manager, Department of Food services, singapore general HospitalOutstanding Ancillary Staff AwardMdm Koay saw lan runs a huge kitchen. the senior Manager of singapore gen-eral 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 suffer-ing from many different serious medical conditions, the kitchen needs to concoct vast permutations of meals: carbohy-drate control for diabetics, low choles-terol and low salt for cardiac patients, soft food for stroke patients with diffi-culty swallowing, nourishing confine-ment dishes for new mothers, and halal meals for Muslims are some of the spe-cial-requirement “cuisines” that are pre-pared alongside more regular fare.

the logistics of preparing over a thou-sand 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 read-ily 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-

tian who previously headed sgh’s Dietet-ics and nutrition services Department.

under Mdm Koay, professional cooks and kitchen staff were brought in, while technology was introduced to auto-mate 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 frui-tion,” she said.

to make sure her dietitians reach their full potential, she encourages them to advance professionally. they underwent further education and train-ing under programmes like the Ministry of health’s health Manpower Develop-ment plan. they undertook research and participated in scientific meetings, as well as patient seminars to teach par-ticipants about eating the right foods to enhance recovery.

Keeping it realassociate professor Deidre anne De silva, senior consultant, Department of neurology, singapore general HospitalOutstanding Clinician Researcher Award

“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 clini-cian. “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 neurol-ogy. While on ward rounds as a first-year registrar, she observed that young indian patients outnumbered chinese patients.

“i asked my mentor, associate profes-sor 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, subse-quently 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 push-ing for greater public awareness of the disease and greater support for stroke survivors and their caregivers.

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 picto-rial menus on the hospital’s in-house tV channel.

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.

it was another first in singapore hos-pitals when she and her team of dieti-tians and chefs launched a special snack alternative for patients on therapeutic diets, instead of just biscuits, for after-noon tea.

the energetic Mdm Koay may have been lauded this year, but she isn’t rest-ing 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.

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 pro-fessor chang hui Meng, stroke research

indeed, Mdm Koay has played a crit-ical part in changing the general per-ception 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

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 treat-ments 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 excel-lence award 2014 in the outstanding cli-nician researcher category.

often, as a researcher, she is plug-

15Moneysep– oct 2014 singapore health

An extra helping handMrs Jenny Thang can hold a day job knowing that her husband, a stroke patient, is well cared for at home

looking at Ms Jamiati tolan’s petite f igure, you may not think the 28-year-old indonesian domestic

helper has the strength to move bedrid-den Mr robert thang from his bed to a wheelchair. Mr thang, 62, weighs 68kg.

But with proper caregiving tech-niques 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 For-eign Domestic Worker grant which pro-vides 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 administra-tive assistant.

to qualify for the grant, the foreign domestic worker in question needs to be trained. Ms tolan attended the effec-tive caregiving For Foreign Domes-tic Workers course at hua Mei train-ing 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 comprehen-sive care (epicc) centre in tiong Bahru, using transport provided by the centre.

it was there that she picked up phys-iotherapy techniques and other caregiv-ing tips from other caregivers. “every-body 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-year-old son recently started work as a finance executive while her youngest son is a full-time polytechnic student.

this article is adapted from an extra caregiv-ing hand in Nextstep (issue 8), the agency for integrated care’s quarterly newsletter. Visit silverpages.sg for more information on long-term care and caregiving.

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

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:

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.

1 You need to be a family member staying with your

loved one at the same address shown on both your nrics.

2You 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.

3the 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.

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

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HealtH XcHange Our experts answer all your questions about health

16 singapore health sep– oct 2014

Please visit our website listed above to see the topics for discussion in Sep-Oct 2014.

These articles are from www.healthxchange.com.sg, Singapore’s first interactive health and lifestyle portal.

Early cataracts?Recently, I went for an eye examina-tion 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 pre-vent 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

Getting plastic surgery overseasI am thinking of getting plastic sur-gery 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/gov-ernment 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 plas-tic surgeons’ website (plasticsur-gery.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 proce-dure, 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 sur-geon 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 pro-cedure. 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

those who smoke or have had pro-longed exposure to UV light, may be predisposed to its earlier onset. pos-sible causes include constant rub-bing 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-sighted-ness 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. eventu-ally, you should con-sider 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

TEXT BY NG Hui Hui

wo r l d s i g h t day

With childhood myopia on the rise, this “myopic generation” will face more eye

problems in their adult and twilight years

Sources: Ministry of Health, Health Promotion Board, Singapore National Eye Centre, National University of Singapore

Common eye problems (adUlts)

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.

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 low-

dose atropine is effective in slowing myopia progression.

DON O Tl O s es i g h TO f e y ec a r e e v e N

a s y O u a g e

60%

60%

of all eye infection cases are associated with contaminated

contact lenses

of patients who have had diabetes for 15 years or more have some blood

vessel damage in their eyes

50%

of people aged 60 and above have some form of

cataract

80%age-related

macular degeneration

is a major cause of blindness in those over

50 years old

Common eye problems (elderly)

Cloudy vision Eye pain

eye Care

Surgical procedures can slow or halt the progression of age-related macular degeneration.

Presbyopia or lao hua can be corrected with special spectacle lenses called bifocals.

the prevalence of myopia in singapore is one of the highest

in the world.

of children are myopic by age 12.

17SEP– OCT 2014 SiNGaPOrE HEalTH UpClose

I donated blood for the first time about a year ago when the Health Sci-ences 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

When you are next at SGH and want to donate blood, you can go to the blood bank at HSA on Outram Road. The HSA’s other 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.

Can I donate blood at SGH?

your say18

Ms Roslina Rahim, Senior Enrolled Nurse, was excellent when I visited a clinic at the National Neuroscience Insti-tute. She was patient, friendly and effi-cient. I had been referred to the wrong specialist by my general practitioner’s clinic. However, Ms Rahim helped to arrange another appointment at the cor-rect one, even trying to get an appoint-ment for me on that very day. I could see that it was a busy morning at the

Trib

uTes

SinGApORe HeAlTH Sep– OCT 2014

a bout your h e a lth experience and win a prize for best letter

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

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.

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.

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 Con-sultant, 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 Solzhavala-van Govindasamy, Principal Enrolled Nurse, SGH. He was very friendly, help-ful and professional. I really appreci-ate 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, Lacta-tion Consultant, gave me her mobile number and said I could call her any-time if I had issues with breastfeed-ing. 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,

AICSAyS

My friend’s mother became bed-ridden after suffering a stroke. She needs to be tube-fed and is on dia-pers. Milk feeds and adult diapers are expensive. Is there a financial scheme to help them pay for these items?

The Seniors’ Mobility and enabling Fund (SMF) has a category of subsidised

consumables for frail seniors to help defray the costs of medical consum-ables 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-

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 consumablesOther 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.

Financial help for the elderly sick

SGHSAyS

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 moti-vate them to breastfeed. My sincere compliments to her.- Ms Seema D

My husband and I would like to com-mend 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 Singa-pore (NHCS). The team is very profes-sional 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, Con-sultant, Department of Cardiothoracic Surgery, NHCS for your caring, atten-tion and advice during my husband’s recovery in ICU. Keep up the good work. Thank you.- A grateful patient

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singapore health sep– oCt 201420 FYI

Source: Medical News Today

Love out Loud: Enabling Families through CommunicationDate nov 9, sunday tIme 9am-12.30pmVenue KK Women’s and Children’s hospital, Women’s tower, level 1, auditorium, Conference, seminar and patient education roomsFees $5 to $8 per person for workshops. plays are free of chargeRegIstRatIon 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.

Millennia Kids Challenge 2014Date sep 6, saturdaytIme 8am-12pm Venue: sengkang sports & recreation CentreRegIstRatIon log on to sengkanghealth.com.sg 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.

Run For Hope 2014Date nov 16, sunday tIme 7amVenue the promontory @ Marina BayFees $55 (adult); $32 (5-18 years old). early registrants will enjoy discountsRegIstRatIon Closes on oct 26, sunday. log on to runforhope.sg for more information or to sign up

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.

event Calendar

Visit www.singhealth.com.sg/events or the websites of respective institutions for any changes, more information, and other listings.

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Source: BBC News

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.

Supercooling to preserve transplant

Being cynical or distrustful increases one’s risk of developing dementia, according to a study by Dr anna-Malia 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.

Cynicism linked to dementia

Contest1. 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.

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

1. Abdul Razak Haja Mohideen 2. Aw Hui Yee 3. Valerie Chong Lih Wen 4. Ong Kim Siong 5. Yoon Tai Yaw

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.

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.

Call it a “scenic walk”

Source: Cornell University

Here’s tHe bad news: long-dis-tance cycling can be bad for sex. but the good news is that cor-

rect 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

sep– oct 2014 singapore HealtH 21

YOUR GUIDE TO BETTER LIVING

> Continued on page 22

With the right posture, equipment and attire, avid cyclists can enjoy their sport more comfortably and successfully. By Sol E Solomon

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 dys-function happens,” she said.

a serious cyclist, said Ms liang, should see a sports medicine specialist for an assessment of his level of fitness

RIDING afTER DaRk some cyclists prefer to ride or train at night. it can be as enjoy-able as day cycling, but they need to exercise greater caution.

For night riding, it is manda-tory 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, pedes-trians and other vehicles, and make sure they are aware of your presence.

be wary of approaching vehi-cles as their headlights can dazzle.

and general health condition, and have his bicycle checked out.

getting the basics right is impor tant for someone who intends to train seriously for the sport as it involves many hours of intense riding.

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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.

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.Ms Liang Zhiqi, senior Physiothera-Pist, sgh

at sgH, for instance, its phys-iotherapists can help people who have suffered musculoskeletal inju-ries 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 ser-vice’s physiotherapists costs between $100 and $150 for each session, and is by appointment only. patients need a referral from a singapore- registered doctor.

the patient first undergoes an interview followed by a physical

source: singapore sports council’s Safe Cycling Guide


> 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 bicy-cle is just as important as building up stamina and strength.

the exercises they are taught help build posture awareness, con-trol and endurance, develop flexibil-ity and strength for power and endur-ance, 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 strengthening their backs. Merely cycling to improve endurance without working on flexibility in areas like the spine, hip and knees can lead to injury.

l i ke w i s e , w e e ke n d w a r r i o r s (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 over-use injuries in the form of neck and back pain, and tingling numbness in the hands. a problem may start with a sen-sation of mild discomfort which gets more and more uncomfortable. even-tually, 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 accommo-dates to the bike, if such pains per-sist 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.

Ms liang Zhiqi, senior physiotherapist, singapore general hospital, explains the correct posture to adopt when cycling.

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 sur-prisingly, 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 measure-ments 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.

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).

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.

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.

Pedalling: Keep centre of knee-cap 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.

GET iT RiGHT!

train smart, Ms liang tells cyclists. “get your posture right, work out any problem in position or cycling technique. that way, you might see a huge improve-ment in your performance without additional hard work, pain or risk of injury.”

Doing some weight or power stretching exercises and pos-ture work will also improve a cyclist’s performance on a bicycle, she added.

this is because the more com-fortable and more stable one is on a bicycle, the more efficiently the energy that he produces will go into pushing the bike forward.

Easy listening

Not oNly the old lose their heariNgthe elderly: Hearing loss is an expected part of growing old, espe-cially after reaching 60 years of age. Hearing impairment gets progres-sively worse over time, and if not addressed, it can lead to social iso-lation, depression or miscommuni-cation 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 indi-vidual only realising that he is suffer-ing 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 portable players, an SGH-Te-masek 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.

Hearing aids now come with many advanced features that stream sounds as near to normal hearing as possible. By Thava Rani

SeP– OCT 2014 SinGaPOre HealTH 23

colour and design. The computer chip circuitry has also become more sophis-ticated. 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 fea-tures 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 over-come 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 pref-erences. 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 wire-less technology standard for exchanging data over short distances from fixed and mobile devices; it is expand-ing the world of the hearing impaired. With Bluetooth streaming, a device can wirelessly

connect to mobile phones, tablets, MP3 players and even television. FM-compat-ible 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 hear-ing 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.

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.

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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

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With technological advances, many hearing devices have improved capabilities and features.

One downside of sophisticated hearing aids is the frequency of battery replacement. Their high-tech 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. Fea-tures 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.

an “invisible” hearing aid placed inside the ear canal, worn 24 hours a day, and which requires mainte-

nance only every few months. a surgically implanted hearing aid system with no external components and whose batter-ies need replacing only every few years.

Science fiction? not at all. These high-tech 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 capa-bilities and features that can be adjusted to their wearers’ needs, said Mr Gopal Krishna, Senior Manager, enT Centre, Sin-gapore General Hospital (SGH).

“Gone are the days of big, bulky hearing aids. now they are getting not only s ma lle r b u t also trendier in terms of

advances in technology help not only wearers, but also health care pro-fessionals 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 under-stand 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 sep– oCt 201424

Older people are more susceptible to falls and should actively reduce their risk of a tumble. By Lediati Tan

Watch your step

The elderly can reduce their risk of falls if they and caregivers are more aware of the dangers.

F 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, any-where. “the elderly tend to fall at home or in the community while going about their daily activ-ities.” Causes include clutter, slippery floors and loose cords in the home.

elderly people with mobility issues due to muscle weak-ness, or poor balance or coordination are at risk. also vulnerable are those with chronic medical conditions like cataracts, arthri-tis, 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 sed-atives that can cause unsteadiness or affect balance, vision and alertness. adding to the problem are poor light-ing, poorly designed steps and stairways, and chairs and beds of unsuitable height.

Injuries from falls Ms nor diana said that it is important to seek medical atten-tion 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, hospitalisa-tion 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, 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 partic-ipants can also learn simple exercises to strengthen their muscles. get more information on the classes by enquir-ing at the polyclinics, or look under education and training at shp’s web-site 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.

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serious falls may cause social and psy-chological problems. For instance, long-term hospitalisation may be a financial burden and also make patients lose social contact. they may also feel frus-trated, and lose self-esteem and confi-dence from not being able to carry out their daily activities independently. a severe fall may make them fearful of another fall, or distressed or embar-rassed 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 extend-ing your knee, as well as heel and toe raises to strengthen muscles. speak to your doctor before start-ing 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, espe-cially in dimly lit areas.

• Concentrate on walking. don’t use your mobile phone or be distracted while walking.

• don’t rush. walk slowly and care-fully, 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 appro-priate one for you.

Reduce the RIsk Of fAlls

source: Changi general hospital’s Your Guide To Falls Prevention

sep– oct 2014 singapore health 25

Parents can boost their children’s immunity by ensuring they get all the recommended childhood vaccinations. By Desmond Ng

That bug at school

Ask the doctor Dr ng chung Wai, Family physician and chairperson (infection control & infectious Diseases Workgroup), singhealth polyclinics, answers questions about immunity.

Q does being exposed to a few germs build up children’s

immunity?

a 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 vac-cine than by getting diphtheria.

Q can making the environment and children super clean actu-

ally make them more susceptible to germs?

a this is the hygiene hypothesis which postulates that an “over-

ly-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 super-clean does not make them more susceptible to germs.”

Q Are there differences in the levels of immunity at differ-

ent ages and why?

a 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, par-ticularly affect children aged below two. an immature immune system also may not respond adequately to a vaccine, which works by stimulat-ing 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 Is there any way to prevent illnesses such as the common

cold and measles?

a Vaccines can prevent childhood diseases such as mumps, mea-

sles, 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 pre-pare vaccines in time.

*the schedule of recommended childhood vac-cinations can be found at the health promo-tion Board’s website: hpb.gov.sg/hopportal/health-article/630

GoinG to school and childcare exposes a child to larGe numbers of other children, which in turn, increases the likelihood of exposure to Germs.Dr Ng ChuNg Wai, Family PhysiCiaN aND ChairPersoN (iNFeCtioN CoNtrol & iN-FeCtious Diseases WorkgrouP), shP

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Many parents notice that once their children start attending daycare or nursery school,

they begin to fall sick. Why is this so? studies show that attending day-care centres increases the risk of common colds and ear infections in children between three and five, said Dr ng chung Wai, Family physician and chairperson (infec-tion control & infec tious Dis-eases Workgroup), singhealth polyclinics (shp). “going to school and childcare exposes a child to large numbers of other children, which in turn, increases the likelihood of expo-sure to germs,” he said.

infections include the common cold as well as hFMD, sinusitis, infectious diarrhoea, chickenpox and influenza. While the common cold tends to be mild, influenza can lead to severe complications such as pneumonia, encephalitis (brain infection), myocarditis (heart muscle infection) and even death, said Dr ng.

he said that parents can play an important role in reducing the risk of infections. “if a child is unwell, stay-ing home will reduce the chance of spreading germs. this may mean that working parents need to make alternative arrangements like having a grandparent or child-sitter look after the child. older children can be

taught good habits such as hand-washing, and cough etiquette (e.g. coughing or sneezing into a tissue).”

ensure that children develop antibod-ies which protect them against these infections, but also reduce the likeli-hood of the infections occurring in the population, further reducing the pos-sibility of a child catching the infection from another child. this is what we call ʻherd immunity’.”

But it is not always easy for work-ing parents to make alternative arrangements. thankfully, hygiene standards in some centres are good. temperatures are checked twice a day and children with fever are turned away.

Dr ng said parents can boost their children’s immunity by ensuring they get all the recommended vaccina-tions. “childhood vaccines* not only

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).

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.


A mother’s moods while pregnant can affect her baby’s development. By Chua Hwee Leng

Mind your moodsw 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 memory, stress regulation, emotional reactions and decision-mak-ing). 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 singa-pore towards healthy outcomes (gUsto) study, and a joint effort of KK wom-en’s and children’s hospital (KKh), the national University health system, and the singapore institute for clinical sci-ences, the agency for science, technol-ogy and research.

explaining how babies might be affected in the womb, Dr helen chen, head and senior consultant, Depart-ment of psychological Medicine, KKh, said that while an unborn baby may not sense his mother’s distress, stress hor-mones can cross the placenta and influ-ence the baby’s structural brain devel-opment. “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 popula-tions. “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 Con-Sultant, 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 dif-ficulty 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 strug-gle 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-in-fant bonding problem, apart from treat-ment 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 psy-chological intervention. this does not just involve pregnancy-safe medication alone. there is also therapy and sup-portive counselling.

if mothers are carrying guilt about their moods affecting their babies’ devel-opment, 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 psycholo-gists to offer help at both outpatient clin-ics 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 preg-nant women. she said although there is

currently no local data, clinical observa-tions suggest that women in high-pres-sure jobs with long hours and tight time-lines 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 physi-cally, so this is a time of vulnerability.

“i hope that through more public edu-cation, our community can understand the need to address maternal mental health issues, and that employers, super-visors and colleagues will be supportive of pregnant women. we need them to nur-ture 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 communi-cation, refer to the event calendar on page 20.

During pregnancy, a mother should let go of guilt, and focus on keeping well for her child and building a strong family unit.

原文 Thava Rani

为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。

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

27新闻新加坡中央医院与新加坡保健服务集团的双月刊 2014年9–10月刊

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(thyro id )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。

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

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

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风险所需的时间部位的疤痕

以往的植入方式把一部分的腺体 30分钟 9个月 4-5厘米出血或受感染植入手臂肌肉内

新的注射方式在皮下脂肪层注射含有细细 18分钟 2个月没有没有剁碎的腺体组织的溶液

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。

甲状旁腺

甲状腺

Pho

to: a

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im

(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。

28 新闻 2014年9– 10月刊

防患乳癌意识月

降低患病风险

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）

及早检查

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。

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。 40+

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。 1 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。

原文 Denyse yeo

症状如果您出现任何以下症状，请立即去看医生：

感觉乳房里有无痛的肿块

乳头周围出现持久性

的皮疹

乳头出血或流出

异常分泌物

乳头内陷乳房皮肤肿胀、增厚、凹陷或起皱

资料来源：卫生部和保健促进局

提高警觉预防乳癌

在新加坡女性之中，乳癌是最常见的癌症。每年，大约有

名女性被诊断患上乳癌。

1,600乳癌占女性癌症的

20%18%乳癌是最主要导致女性死亡的癌症，占癌症死亡率的

250,000名女性已接受过新加坡乳房检验计划（BreastScreen Singapore）的检查。

在过去十年内（2002-2012），将近

图：

联合

早报

何炳

耀摄

文杨萌

居家护理

近几年来，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30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。

让病患省却了往返医院的奔波，也减轻了医院的负担

29健康2014年9– 10月刊

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。

居家护理须八面玲珑

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 it 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 te 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。

卫生部3C强化居家护理服务

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。

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

原文首次刊登于早报星期天2014年3月30日

卫生部津贴家庭人均月入居家护理服务居家复健服务

0–$700 80% $97$701–$1100 75% $91$1101–$1600 60% $73$1601–$1800 50% $61$1801–$2600 30% $36>$2601 0 0

*适用于新加坡公民，永久居民津贴较少资料来源：卫生部

30 焦点 2014年9– 10月刊

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

原文 Thava Rani

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。

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

及时注射疫苗保护孩子免受肝炎病毒感染并非难事

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。

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。

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。

一般上不需要重复注射疫苗

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。

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。

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

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

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

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。

肝炎须知

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

绝大多数的感染病例是毫无症状的

注射疫苗！ 1 2 3

31新闻2014年9–10月刊

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？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

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

Singapore Health is the official publication of Singapore General Hospital and SingHealth Group, the largest health care group in Singapore. Published bimonthly in a handy tabloid size, the newspaper aims to raise the health literacy level of Singaporeans. Singapore Health is available at Singapore General Hospital, KK Women’s and Children’s Hospital, Changi General Hospital, national speciality centres, and polyclinics under the SingHealth umbrella. It is also available at high-traffic points within the CBD area.

Singapore Health ensures your message gets across to your target audience.

Wide circulation that reaches over 200,000 readers Available at strategic locations

Contains authoritative health care news and information

For advertising enquiries, e-mail Lin Mi’er at [email protected]

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