Undergraduate occupational health teaching in medical schools--not enough of a good thing?
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Education, Medical, Undergraduate↗
Biomedical subjects
T C Aw
Publications and source records attributed to T C Aw.
Guidance on standards of health for clinical health care workers.
Judgements about the health of clinical health care workers in relation to fitness to practice are made by a variety of doctors. These guidelines have been written to assist with such judgements and to facilitate equitable decision making in matters of employment.
Delivery of Health Care↗
Serum lipids, serum insulin, plasma fibrinogen and aerobic capacity in obese and non-obese Singaporean boys.
OBJECTIVES: To compare blood lipids, lipoproteins, apoproteins, fibrinogen, insulin and aerobic capacity in obese and non-obese Chinese Singaporean boys. To examine relationships between blood metabolites, body composition and aerobic capacity in these groups. DESIGN: Cross-sectional. SUBJECTS: Forty Chinese Singaporean boys aged 13-15 y. Classified as obese (n=20) or non-obese (n=20) based on adiposity (fat mass/fat free mass): >0.60=obese, <0.40=non-obese. MEASUREMENTS: Body composition (dual energy X-ray absorptiometry), waist circumference, peak oxygen consumption (VO(2) peak), serum concentrations of total cholesterol, triacylglycerol, high density lipoprotein cholesterol (HDL-C), total cholesterol/HDL-C, apoproteins AI and B, lipoprotein(a), insulin and glucose. Plasma concentration of fibrinogen. RESULTS: Obese boys had significantly (P<0.01) higher (mean+/-s.d.) concentrations of serum triacylglycerol (1.51+/-0.65 vs 1.04+/-0.34 mmol/l), serum insulin (24.1+/-11.5 vs 12.3+/-4.45 mU/l) and plasma fibrinogen (4.01+/-0.54 vs 3.35+/-0.76 g/l) than non-obese boys. Within the non-obese group plasma fibrinogen concentration was significantly related to percentage body fat (r=0.546, P<0.05). VO(2) peak relative to body mass (ml/kg/min or ml/kg(-0.67)/min) was significantly (P<0.001) lower in obese compared to non-obese boys but absolute VO(2) peak (l/min), adjusted for fat-free mass via analysis of covariance, was higher in obese than non-obese boys (P<0.01). Partial correlations revealed that none of the blood metabolites were significantly related to VO(2) peak independent of body fatness. CONCLUSIONS: Obesity was related to elevated concentrations of serum triacylglycerol, serum insulin and plasma fibrinogen in Chinese Singaporean boys. These elevated concentrations did not appear to be associated with a lower aerobic capacity (independent of body fatness) in the obese.
Absorptiometry, Photon↗
Occupational health research priorities in Malaysia: a Delphi study.
OBJECTIVES: As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia. METHODS: Participation was sought from government ministries, industry, and professional organisations, and university departments with an interest in occupational and public health. Two rounds of questionnaires resulted in a final list of priorities, with noticeable differences between participants depending on whether they worked in industry or were from government organisations. RESULTS: The participation rate of 71% (55 of 78) was obtained for the first questionnaire and 76% (72 of 95) for the second questionnaire. The participants identified occupational health problems for specific groups and industries as the top research priority area (ranked as top priority by 25% of participants). Ministry of Health participants placed emphasis on healthcare workers (52% ranking it as top priority), whereas those from industry identified construction and plantation workers as groups, which should be accorded the highest priority. Evaluation of research and services was given a low priority. CONCLUSIONS: The priorities for occupational health determined with the Delphi approach showed differences between Malaysia, a developing country, and findings from similar European studies. This may be expected, as differences exist in stages of economic development, types of industries, occupational activities, and cultural attitudes to occupational health and safety. Chemical poisonings and workplace accidents were accorded a high priority. By contrast with findings from western countries, workplace psychosocial problems and musculoskeletal injuries were deemed less important. There also seemed to be greater emphasis on adopting interventions for identified problems based on experience in other countries rather than the need to evaluate local occupational health provisions.
Delphi Technique↗
Occupational methaemoglobinaemia.
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Enzyme Inhibitors↗
An international comparison of the involvement of epidemiology in the most frequently cited publications in the field of clinical medicine.
The objectivity, validity and credibility of research in clinical medicine can be enhanced by the appropriate involvement of epidemiology. However, the overall contribution of epidemiology to clinical research, either as a methodology or as a resource for research, has been poorly quantified. We therefore assessed the involvement of epidemiology in influential publications in the field of clinical medicine, and made an international comparison on a quantitative basis. The 500 most frequently cited papers published during 1981-96 in the field of clinical medicine in the US, the UK, and Japan were compared in terms of epidemiological involvement using predetermined criteria. The three criteria were based on the indexing of relevant MeSH keywords, publication types, or the departmental affiliations of the authors. For all three criteria, the proportion of clinical papers with epidemiological involvement was the highest in the US, followed by the UK, whereas it was the lowest in Japan. The difference was almost four-fold between the US and Japan. There was also an increasing trend of epidemiological involvement in publications of clinical medicine over the years, which was more apparent in the US than in either the UK or Japan. These findings may reflect inter-country differences in resources as well as in the stance towards evidence-based health sciences.
Bibliometrics↗
Urine laminin and kallikrein, markers of tubulointerstitial damage in experimental protein overload on pre-existing renal damage.
We studied the response of urinary protein overload on preexisting tubulointerstitial nephritis (TIN), which was induced in male Sprague Dawley rats by hexachloro-1,3-butadiene (HCBD). Five days after the development of TIN, puromycin aminonucleoside (PAN) was administered to induce urinary protein overload. Urinary laminin and kallikrein were measured. Urine specimens were collected daily for 14 days and on day 21; and tissue specimens were collected on days 1, 4, 7, 10, 14 and 21. Urinalysis was correlated with the renal pathology at the light microscopic level. Laminin excretion was increased on day 4; one day before total protein, indicating damage to the basement membrane. Kallikrein levels also fell early indicating distal tubular damage. There is clear evidence that urine protein overload in a previously damaged kidney with tubulointerstitial injury leads to accelerated and more severe renal damage. Laminin and kallikrein are early and sensitive markers of renal injury.
Animals↗
Current trends, examples of regulations and practical approaches to occupational health services in the United Kingdom.
Occupational health services in the United Kingdom are evolving from the traditional approach using doctor and nurses to provide clinical care at the worksite for any medical ailment, to multidisciplinary occupational health practitioners focussing on the prevention of ill-health from workplace factors. Nevertheless, there continues to be an artificial divide between safety departments and occupational health departments within the same organisation. Many occupational health services focus on the need to comply with the requirements of health and safety legislation. In the UK, these include the Health and Safety at Work, etc. Act of 1974, the Control of Substances Hazardous to Health, the 1994 regulations, and a newer legislation based on the European Union Directives. A practical approach to providing occupational health cover has been the development of occupational health departments within the public healthcare sector, private occupational health service providers, and independent consultants. These are some similarities between the UK situation and other countries in the models used for providing occupational health care. The appropriate model for any country would depend on their perceived needs, resources, industries and hazards.
Facility Regulation and Control↗
Notification of occupational and work-related diseases and poisonings in Malaysia, 1997-1998.
In 1997, the Ministry of Health Malaysia introduced a surveillance programme for occupational and work-related diseases including poisonings for cases seen in government health facilities. Between June 1997 and November 1998, there were 36 cases of respiratory disease and 95 cases of poisoning by chemicals and pesticides notified while skin diseases were 108 cases. Respiratory diseases reported were predominantly occupational asthma (25%), pneumoconiosis (17%) and infections (39%). The commonest reported skin disease was contact dermatitis (87%). The commonest causes of occupational poisonings were paraquat (19%), organo-phosphates (16%), agro-chemicals excluding pesticides (15%) and gases (10%). The number of cases reported is still relatively few compared to data from other countries, suggesting that there is still considerable under reporting.
Adult↗
Differential diagnosis of Hb EE and Hb E-beta(0)-thalassemia by protein and DNA analyses.
DNA analysis was used to confirm the Hb EE genotype and to differentiate from the possible genotype of Hb E-beta(0)-thalassemia in two Malay patients. The first patient was a 13-year-old Malay girl, whose parents were available for family studies. The second patient was a 69-year-old Malay woman with no living family members. The presence of Hb E in both propositi was confirmed by: (1) its characteristic electrophoretic mobilities on alkaline/acid gels; (2) its chromatographic properties on anion/cation exchangers, and (3) its mildly insoluble properties. However, differential diagnosis of Hb EE and Hb E-beta(0)-thalassemia was challenging in these two cases. In the former, this was because of the possible interactions of the parents' phenotypes; i.e., the mother had a similar phenotype. In the latter, it was due to the lack of any living family members for family studies. In this communication, we present the protein and DNA analyses, including data on the use of the restriction enzyme Mnl I, for the definitive diagnosis of the Hb EE genotype in the propositi of these two Malay families.
Adolescent↗
A man with osteoblastic metastasis and hypocalcaemia.
We report a case of an 80-year-old man with osteoblastic metastases from advanced carcinoma of the prostate presenting with a grand mal seizure resulting from severe hypocalcaemia. He had low serum phosphate and ionised calcium levels, elevated serum skeletal alkaline phosphatase and intact parathormone levels. 99mTc radioisotope bone scan revealed a "super bone scan" suggestive of osteomalacia. The serum 1, 25-dihydroxycholecalciferol level was unexpectedly elevated. The biochemical abnormalities persisted despite high dose calcium replacement, but improved with supraphysiological doses of 1,25 (OH)2 vitamin D3 (Rocaltrol) therapy. We hypothesise that the hypocalcaemia in this patient was due to vitamin D resistance secondary to a humoral factor secreted by the tumour.
Aged↗
Age-related reference intervals for free and total prostate-specific antigen in a Singaporean population.
Cancer of the prostate is the sixth most frequently found cancer in Singapore. Prostate-specific antigen (PSA) is the most clinically useful tumour marker available today for the diagnosis and management of prostate cancer. To enhance the value of PSA as a screening test we developed age-specific intervals for our ethnic population. The measurement of free PSA was included in the study to calculate the free:total ratio which enhances the differential diagnosis of prostate cancer from benign prostatic hyperplasia or prostatitis. The total PSA upper limits of 10-year intervals, beginning at 30-years-old, were 1.4, 1.7, 2.3, 4.0, 6.3 and 6.6 microg/l. Free PSA cut-off limits were 0.4, 0.5, 0.5, 1.0, 1.5 and 1.6 microg/l. The free:total ratio of PSA was not age dependent. Abbott AxSym standardised their calibration material for both free and total PSA assays with the Stanford 90:10 reference material. This laboratory has implemented these age-specific reference intervals and are currently following up their pick-up rate in the detection of prostate cancer.
Adult↗
Serum lipoprotein(A) profiles in a Singaporean population.
Lipoprotein(a) [Lp(a)] is formed when apolipoprotein(a) is linked to low density lipoprotein (LDL)-cholesterol via a single disulfide bond. It is an independent risk factor for myocardial infarction and raised concentrations are associated with an increased risk of developing coronary artery disease. Singapore has a multi-racial population of 77% Chinese, 14% Malays and 7% Indians. Studies have shown that the Indians have significantly higher standardised mortality ratios (SMR) compared to the Chinese and the Malays. We measured serum Lp(a) concentrations in 803 healthy individuals recruited from the Multiphasic Health Screening Programme, using the Macra Lp(a) sandwich enzyme immunoassay kit (Strategics Diagnostics, Delaware, USA). Lp(a) concentrations were skewed in all three groups. Our population mean was 9.0 mg/dl, with 50th, 75th and 95th percentile values of 10.2, 19.8 and 43.1 mg/dl, respectively, which are lower than values reported from Caucasian populations (15.0, 29.0 and 60.0 mg/dl, respectively). Males had lower Lp(a) concentrations than females (P < 0.05). The Indian group had significantly higher concentrations (median 12.3 mg/dl) compared to their Chinese (median 9.6 mg/dl) and Malay (median 8.4 mg/dl) counterparts (P < 0.05). This could partly account for the higher SMR seen in the Indian population in Singapore. As serum Lp(a) concentrations are method- and population-dependent, we recommend that laboratories determine their own reference ranges by their method to avoid misclassification of the coronary heart disease (CHD) risk of patients.
Adolescent↗
An alternative to journal-based impact factors.
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Bias↗
Apolipoprotein B 5'-Ins/Del and 3'-VNTR polymorphisms in Chinese, malay and Indian singaporeans.
The allele frequencies for the apolipoprotein B (apo B) 5'-Ins/Del and 3'-VNTR polymorphisms varied significantly (p < 0.01) among Singaporeans of Chinese, Malay and Indian descent. We calculated the unbiased expected heterozygosities for the 5'-Ins/Del polymorphism as 0.3357, 0.1984 and 0.2418, and for the 3'-VNTR as 0.5980, 0.5260 and 0.6749, respectively, in the Chinese, Malays and Indians. Compared to heterozygosities reported for other populations, the Singaporeans differed from most Caucasians in having significantly lower values but were closely related to other non-Caucasians. Thirteen alleles, with a bimodal distribution, were observed at the 3'-VNTR polymorphic locus; the alleles occurring most frequently among the Chinese and Malays were of 35 or 53 repeats, and among the Indians, of 37 or 47 repeats. The Del allele was associated with elevated serum cholesterol (p = 0.023), LDL-cholesterol (LDL-C) (p = 0.001) in the Chinese, and apo B (p = 0.007) in the Indians. Likewise, the larger 3'-VNTR alleles (> 41 repeats) were associated with raised cholesterol (p = 0.018), LDL-C (p = 0.025), and triglyceride (p = 0.001) in the Chinese. The two polymorphisms were not in significant linkage disequilibrium (D = -0.0029, p = 0.494) in the three ethnic groups.
Adult↗
Serum IGF-binding protein-6 and prostate specific antigen in breast cancer.
OBJECTIVE: Recent studies have demonstrated the presence of the IGF-binding proteins (IGFBPs) and prostate specific antigen (PSA), an IGFBP protease. in human breast tissue. We sought to investigate the differences in serum IGFs, IGFBP-1, -3 and -6, and PSA between patients with surgically proven breast cancer and patients with benign breast disease. DESIGN AND METHODS: Concentrations of IGFs, IGFBP-1, -3 and -6, and PSA were determined in the sera from 57 patients with breast cancer (CA), and 46 women with benign breast disease (BBD) using immunoassays for IGFs and IGFBPs and an ultrasensitive ELISA for PSA. RESULTS: The mean (+/- S.E.M.) serum IGFBP-6 level in the CA group, 127 (16) ng/ml, was statistically significantly lower than in the BBD group, 157 (10) ng/ml (P = 0.016). Patients with CA had an elevated geometric mean serum PSA level of 0.018 (range: 0.0015-0.107) ng/ml, compared with 0.007 (range: 0.0015-0.019) ng/ml in women with BBD (P = 0.025). Mean serum IGFBP-1 concentrations were significantly lower in the CA group, 16 (2) ng/ml, versus 37 (4) ng/ml in the BBD group (P = 0.001). Mean serum IGFBP-3 concentrations were also lower in the CA group versus the BBD group, at 1981 (65) ng/ml, versus 2603 (140) ng/ml (P = 0.002) respectively. In the CA group, statistically significant correlations between PSA and IGFBP-6 (r = 0.413; P = 0.001), and between PSA and IGFBP-1 (r = -0.329; P = 0.021) were seen. Differences in IGF-I and -II between the two groups were not statistically significant. CONCLUSION: Lower serum concentrations of IGFBP-6, -3 and -1, but higher PSA concentrations were seen in the breast cancer group, and collectively these would suggest that there is an increase in bioavailable IGF-I in breast cancer.
Breast Neoplasms↗
Technical evaluation of thyroid assays on the Vitros ECi.
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Humans↗
Comparison of the qualified occupational physician systems in the United Kingdom and Japan.
The British educational system of occupational medicine was compared to the Japanese system. Furthermore, a comparison was carried out between the certified occupational physician (COP) recognized by the Japan Society for Occupational Health in Japan and the Associateship of the Faculty of Occupational Medicine (AFOM) by the Faculty of Occupational Medicine (FOM) which is a part of the Royal College of Physicians in the United Kingdom. Judging from the comparison of the minimum total training period, the clinical training period, the occupational health training period, the method of examination and the success rate between COP and AFOM, it is suggested that the British system of occupational physicians may be better as a training system for occupational medicine and may regard occupational clinical training as more important than the Japanese system does. A comparison of a Diploma in Occupational Medicine (Dip Occ Med) approved by the FOM and the certification of occupational physicians by the Japan Medical Association has shown that the former has an examination but there is no test system in the latter. It should be discussed whether an examination system for the certification of occupational physicians should be introduced into the Japanese system in the near future.
Education, Medical, Continuing↗