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Biomedical subjects

L G Goh

Publications and source records attributed to L G Goh.

At least 37 records · Page 2Linked to original sources
PubMed1997

Work stress and psychological well-being among the nursing profession in Singapore.

OBJECTIVE: To investigate the work stress of nursing and its relationship with the psychological well-being of the nurses. DESIGN: A survey research method was adopted in which a questionnaire was designed for data collection. SETTING: The study was conducted in the hospital setting. SUBJECTS: Nurses (N = 1,043) of different grades participated in this study on an anonymous and voluntary basis. MEASURES: A work stress measure (ie, the Nursing Stress Inventory) and GHQ-12 were incorporated in a questionnaire which also contained items on subject's background information. RESULTS: The eight areas of work stress identified were found to be negatively related to psychological well-being of the nurses, with stronger effects on anxiety and depression than sense of adequacy. CONCLUSION: Certain work stressors were more detrimental than those others. They may also exert differential effects on the affective and cognitive stress reactions.

Adult↗
PubMed1997

Future health issues and delivery needs of the elderly.

We have 6.9% of the population who are 65 years and older in June 1996. This figure will increase to 18.4% in 2030. In absolute numbers, the increase will be from 209,700 to 789,600 million in 2030. The majority of these however, will be ambulant and independent. Our important task in the health context is to help ageing persons maintain function and quality of life to achieve the maximum life-span potential. To achieve this, we need to focus on individual preventive efforts to develop the medical profession in the new medicine paradigm, to provide care and we need to develop at the societal level the well network, the activating network and the health & nursing care network as an integrated seamless service. We also need at a societal level, to invest in the determinants of good health and disability-free life, namely, financial independence, acceptance by the family and recognition of the elderly, as valued members of society.

Aged↗
PubMed1996

The advance directive--a review.

The advance directive is a document that enables a competent individual to specify the form of health care he would like to have, in the event that he is unable to make such decisions in the future. This review paper traces the development of the advance directive from 1967, when it was first proposed by Luis Kutner. The Karen Ann Quinlan case and the Nancy Cruzan case are cited as examples of the case for the advance directive. The argument is that advance directives assist doctors, patients, family members and other carers with the increasingly complex health care decision making. Reservations have been expressed about the anticipatory nature of the decision, possible conflict with personal and religious ethics and the risk of cost containment considerations being over-riding concerns. The advance directive in America has undergone changes since the California Natural Death Act 1976 was passed. In the 1980s, "terminal" included permanent unconsciousness and advanced dementia. The declarant was also given a wider choice of treatment procedures that they wish to be withheld. Proxy directives were also introduced. In the 1990s, the declarant is even allowed to request the use of life-prolonging procedures. When appropriately implemented, the advance directive can perform its intended functions of clarifying the patient's perspective on life, death and medical care. When it is vague in terminology or applied to patients with uncertain prognoses, it can cause confusion to the patient's carers; and when improperly used, it can become an instrument not of patient's preferences, but of economic purpose, family bias, or physician's values.

Advance Directives↗
PubMed1995

Child health surveillance: enlarging the role of the family doctor.

The family doctor looks after the family as a unit of care. This includes not only curative care but also disease prevention and health promotion. One of the areas is child health. He is in an ideal position to participate in child health surveillance as a member of the primary health care team. The tasks involved in child health surveillance include growth monitoring, monitoring of developmental progress, prevention of disease by immunisation, health education, nutrition education, developmental guidance and injury prevention. To meet the expanding role of the family doctor in child health surveillance, he needs adequate training and continuing education.

Adolescent↗
PubMed1994

Risks of asthma associated with occupations in a community-based case-control study.

The aim of this study was to identify occupational risk groups which might usefully be targeted for occupational asthma surveillance and control, using a community-based case-control approach. Data on previous and current occupations held by subjects were analyzed for 787 adult patients with bronchial asthma and 1591 nonasthmatic patient controls, aged 20-54 years, belonging to the three major races (Chinese, Malays, and Indians) in five outpatient primary care polyclinics. Odds ratios (OR) and 95% confidence intervals (95% CI) of association were adjusted for sex, age, race, smoking, and clinical atopy. No associated risks of asthma were found for clerical or sales workers in general. Significantly reduced risks of association with asthma were found for professional, technical, administrative, and managerial occupations (OR, 0.62; 95% CI, 0.47-0.82). The associated risks of asthma were generally elevated for service workers (OR, 1.35; 95% CI, 1.04-1.74) and manufacturing production and related workers (OR, 1.49; 95% CI, 1.23-1.81). Among them, increased risks were observed for cleaners, particularly municipal cleaners and sweepers (OR, 1.91; 95% CI, 1.22-2.99), textile workers (OR, 5.83; 95% CI, 1.93-17.57), garment markers (OR, 1.61; 95% CI, 1.01-2.58), electrical and electronic production workers (OR, 1.36; 95% CI, 1.06-1.75), printers (OR, 2.24; 95% CI, 1.17-4.31), and construction/renovation workers (OR, 2.24; 95% CI, 1.30-3.85). The odds ratio of association of asthma with exposures in service and production-related occupations overall, relative to the "nonexposed" reference group of nonmanual professional/technical, administrative/managerial, clerical, and sales occupations, was estimated to be 1.72 (95% CI, 1.36-2.19); the estimated population attributable risk was 0.33 (95% CI, 0.22-0.44).

Adult↗
PubMed1994

Understanding asthma: patient survey.

Eight hundred and two adult patients attending five randomly selected polyclinics in Singapore were interviewed to assess their understanding of asthma. Knowledge of asthma mechanism and its medications was poor with a mean score of 1.4 (median: 1) out of a total score of 6. About a third knew that asthma is due to narrowing of airways and a quarter knew the action of bronchodilators. Only 4.4% (27) knew that steroids decrease airway swelling or inflammation. The best knowledge score was associated with subjects who had the highest education, who had a family history and who had been exposed to pamphlets and books. Incorrect use of prophylaxis was also evident with only one-third (37%) using steroid inhalers regularly as prescribed. Only half (54.5%) of those with no schooling used the correct inhaler technique. Doctors were a source of information for only 49.9% (400) of the patients and it was those with the highest education who were most likely to get information from the doctors. Pamphlets were a source of information for less than one-fifth (16.2%) of the subjects. Greater emphasis should be given to patient education by doctors to help patients understand asthma and its treatment. Important target groups are the older, lesser educated and the moderate or severe patients on steroid inhalers.

Adult↗
PubMed1994

Outpatient adult bronchial asthma in Singapore.

OBJECTIVES: To describe the clinical pattern and drug use in adult bronchial asthma seen in Government polyclinics (primary health care centres). DESIGN: A cross-sectional study using a structured questionnaire. SETTING: The five largest Government polyclinics in Singapore. SUBJECTS: Eight hundred and two subjects aged between 21-58 years drawn from the register of outpatient attendances. The response rate was 63%. RESULTS: The mean age of the study subjects was 37.4 years and the mean age of onset was 19.2 years. Thirty-three percent had onset of asthma under 10 years old. The most commonly reported trigger factors were cold drinks (67%), a change of temperature or humidity (65%), influenza or colds (65%), house dust (58%) and cigarette smoke (37%). In 27%, the work environment was a provoking factor. One-fifth had attacks every night or every day. About half of the patients had FEV1 under 80% of predicted. In the past year, 10% had 4 or more acute attacks requiring emergency attendance, 18% had one or more hospital admissions and 21% had sickness absence from asthma for one week or more. Of the 186 subjects who needed bronchodilators/inhalers 3 times or more a day, only 19.3% were on inhaled steroids. CONCLUSIONS: Considerable morbidity existed amongst outpatient asthmatics. Inhaled steroids appeared to be under-used.

Adult↗
PubMed1994

Lifestyle and behavioural risk factors associated with asthma morbidity in adults.

We studied the association between morbidity and personal lifestyle/behavioural factors that predispose to exposure to known environmental precipitants of asthma, in a group of asthmatics (n = 787) in primary-care clinics. Clinical severity of asthma was determined by questions regarding the frequency of daytime or nocturnal attacks, the number of visits to primary care or hospital emergency departments for treatment of acute attacks, and the number of hospitalizations, as well as the amount of sick leave in the past year. Questions concerning risk factors included ethnicity, clinical atopic status (current rhinitis/eczema), smoking, occupation, keeping of pets, rugs and carpets, use of brooms, burning of mosquito coils or incense, and outdoor air pollution, as well as the patient's knowledge of asthma care. The most significant independent predictors of asthma morbidity, identified from multivariate logistic regression analyses, were current keeping of either pets or rugs/carpets (OR 1.49; 95% CI 1.12-1.99), and current high-risk occupations (OR 0.59, 95% CI 0.40-0.89). A multiplicity of interacting factors and behavioural responses appear to influence the effects of allergens and other environmental precipitants on asthma morbidity in patients.

Adult↗
PubMed1993

Calculating the GP consultation fee in Singapore: towards a rational costing approach.

PURPOSES: The General Practitioner (GP) consultation fee in Singapore, unlike that of his specialist colleague, has been left very much undefined over the years. There is a need for an objective way of calculating the GP consultation fee. METHOD: A proposed method of calculating the GP consultation fee based on the model of estimating the total cost of producing the service plus the doctor's remuneration is described. Known prevailing costs were used in the computation. This model allows us to work out the cost to the patient by dividing the total cost of producing the service by the number of patients (referred to as patient encounter load) seen by each duration of consultation--4, 6, 10, 15 and 30 minutes. Different monthly remuneration levels for the doctor were used to compute the different consultation fees that would result for each of the duration of consultations. RESULTS: Using this method of calculation, for a doctor with a desired monthly remuneration of $7000, and seeing a patient every 6 minutes over a 150-hour month, the consultation fee is $13.00. This drops to $11.00 if the doctor receives a remuneration of $4000 per month. Using the same parameters, a 15 minute consultation will cost the patient $30.00 and $25.00 respectively. CONCLUSION: This method can be used to derive a consultation fee for services requiring different durations and varying remuneration brackets for the doctor.

Capital Financing↗
PubMed1992

Sudden unexplained death syndrome. A review and update.

Sudden unexplained death syndrome (SUDS) among young healthy Thai construction workers in Singapore has been given much publicity recently. From May 1982 to July 1990, 226 SUDS were reported among them. In this article we review and compare studies on SUDS in the United States and South-east Asia. So far, studies to identify the causal factors have been inconclusive and they cannot explain the male preponderance and occurrence of death during sleep. Current hypotheses about the cause of SUDS have included stress, genetic factors, dietary deficiency (particularly thiamine), potassium deficiency, melioidosis and sleep disorders. The following areas are suggested for further research: epidemiological investigations on SUDS at its source; in-depth case studies of families with and without SUDS; role of dietary factors, biochemical studies with respect to thiamine, pyruvate and potassium metabolism in the victims and susceptibles; and histopathological studies of cases and controls.

Adolescent↗
PubMed1992

Routine immunisation against chickenpox. Is it time?

Natural varicella in healthy children is normally not a severe illness. Nevertheless, the need to be away from school such as during an important examination, or from work, may be inopportune. It is therefore attractive to be able to prevent chickenpox. Such a proposition became a reality in 1974 with the development of a live attenuated varicella vaccine (the Oka strain). This has since been used in leukaemic children and children with other malignancies, and found to be safe and effective. Some of these children were immunised without complete suspension of anticancer therapy. The vaccine has also been used on healthy children and adults, mainly in Japan and North America. The results too indicated the vaccine to be safe and immunogenic, with minimal side effects. It has been shown to confer protection even if given within 3 days of exposure. The occurrence of zoster appears to be no higher than in natural infection. The vaccine has so far been shown to be protective up to 10 years post-immunisation. It appears safe enough to offer the vaccine routinely to those who are at risk of infection. One dose of vaccine given subcutaneously is usually sufficient for healthy children, but two doses are needed for immunocompromised children and adults.

Adolescent↗
PubMed1992

A computerised out-patient medical records programme based on the Summary Time-Oriented Record (STOR) System.

Advances in microcomputer hardware and software technology have made computerised outpatient medical records practical. We have developed a programme based on the Summary Time-Oriented Record (STOR) system which complements existing paper-based record keeping. The elements of the Problem Oriented Medical Record (POMR) System are displayed in two windows within one screen, namely, the SOAP (Subjective information, Objective information, Assessments and Plans) elements in the Reason For Encounter (RFE) window and the problem list with outcomes in the Problem List (PL) window. Context sensitive child windows display details of plans of management in the RFE window and clinical notes in the PL window. The benefits of such innovations to clinical decision making and practice based research and its medico-legal implications are discussed.

Humans↗
PubMed1992

Choices and preferences in asthma management.

We conducted a questionnaire survey of the management of asthma among doctors in Singapore to determine the trend and range of prescribing habits. Standardised questionnaires were sent to 3,153 medical practitioners registered with the Singapore Medical Council. The overall response rate was 25.3% (797 out of 3,153 doctors). The data were grouped and analysed according to one of 4 respondent-defined groups: (1) non-specialist general practitioners (NS-GP); (2) non-specialists (house officers, medical officers and specialist-in-training) who worked in MOH hospitals (NSMOH); (3) chest specialists; (4) non-respiratory specialists. Patients tended to underestimate the severity of their disease. Inhaled or nebulised beta-agonist was the treatment of choice for acute severe asthma in adults and children for all 4 groups of respondents. In the maintenance treatment for chronic asthma, inhaled and oral beta-agonists and oral theophylline were the mainstay of treatment for adults and children. Nocturnal asthma was similarly treated. The use of inhaled steroids was variably conservative and was reserved for situations where bronchodilators proved inadequate.

Asthma↗
PubMed1991

Knowledge and concerns of newly diagnosed NIDDM patients in Singapore.

This paper describes the findings of a questionnaire survey of the knowledge and concern of 152 newly diagnosed NIDDM patients presenting at the Government Polyclinic (primary health care centre). This study is part of a project on outpatient diabetic care in Singapore. It was found that 23.7% of the subjects had no education and 51.3% had only primary school education. More than eighty percent of the subjects understood the importance of diet control and weight control in their condition. More than half of the subjects, 61% of males and 52.7% of females were aware that diabetes could not be cured and that once diabetes is controlled, that medication cannot be stopped and that one must still take the medication even if one feels well. Less than 30% knew about the interpretation of blood and urine sugar findings. The two major concerns amongst the subjects were complications and the need for long-term medication. These findings will be incorporated into the next phase of the project where a health education programme for NIDDM patients will be developed and evaluated.

Adult↗
PubMed1991

Using role-play to teach consultation skills--the Singapore experience.

Role-play by students has been adopted as a teaching method for learning consultational skills during a primary health care posting for fourth year medical students in the National University of Singapore. This article describes the construction of the framework used, and reports on its evaluation by both the students and their teachers. The overall response to the session by the students was positive. Suggestions were then solicited to make refinements to enhance its efficacy as a teaching tool.

Communication↗
PubMed1991

The value of the girl child in Singapore.

Son preference exists in many countries in Asia. In countries like Pakistan, Bangladesh and Nepal, such preference has been shown to result in excess female mortality. In Singapore, there is also son preference but excess female mortality is not seen because of several factors: Government's policy of equal educational opportunities for boys and girls since World War II, the protection of women's rights through the Women's Charter, the family planning message that "Boy or Girl, two is enough", urbanisation and industrialisation. Singapore is seeing increasing participation of women in the workforce, not only as clerks and factory operators but also as decision makers in middle and senior management positions. In this modern age, the girl child should be given as much value as the boy child. Only when such an egalitarian attitude towards the girl child exists would she be able to develop into her full potential to be an asset to her country. Government policies to promote the well-being, protect the rights, and to improve the lot of the girl child appear necessary in countries where son preference leads to excess mortality of girls from sex discrimination in nutrition and/or health care.

Child↗