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The negative impact of stunting and severe underweight on cognitive neurodevelopment of children is well documented; however, the effect of overweight/obesity is still unclear. The 2018 Global Nutrition Report reported that stunting and overweight concurrently affect 189 million children worldwide. As existing reviews discuss undernutrition and overweight/obesity separately, this scoping review aims to document the impact of mild/moderate and severe underweight, stunting, and overweight/obesity among children aged 0–60 months on their cognitive neurodevelopmental trajectories. Twenty-six articles were analysed to extract significant information from literature retrieved from PubMed and Cochrane databases published from 1 January 2009 to 31 October 2019. Length gain is associated with cognitive neurodevelopment in normo-nourished and stunted children aged under 24 months. Among stunted children, it seems that cognitive and neurodevelopmental deficits can potentially be recovered before 8 years of age, particularly in those whose nutritional status has improved. The impact of overweight/obesity on cognitive neurodevelopment appears to be limited to attention, gross motor skills and executive control. Parental education level, birth weight/length, breastfeeding duration, and sanitation level are some identifiable factors that modify the impact of undernutrition and overweight/obesity on cognitive and neurodevelopment. In conclusion, underweight, stunting and overweight/obesity have a significant impact on cognitive neurodevelopment. Multidimensional approaches with various stakeholders should address all issues simultaneously, such as improving sanitation levels, assuring parental job security and adequate social welfare, and providing access to adequate nutrients for catch-up growth among underweight or stunted children and to affordable healthy foods for those who are overweight/obese and from low socio-economic status.
Intensity in adolescent romantic relationships was examined as a long-term predictor of higher adult blood pressure in a community sample followed from age 17 to 31 years. Romantic intensity in adolescence – measured via the amount of time spent alone with a partner and the duration of the relationship – was predicted by parents’ psychologically controlling behavior and was in turn found to predict higher resting adult systolic and diastolic blood pressure even after accounting for relevant covariates. The prediction to adult blood pressure was partially mediated via conflict in nonromantic adult friendships and intensity in adult romantic relationships. Even after accounting for these mediators, however, a direct path from adolescent romantic intensity to higher adult blood pressure remained. Neither family income in adolescence nor trait measures of personality assessed in adulthood accounted for these findings. The results of this study are interpreted both as providing further support for the view that adolescent social relationship qualities have substantial long-term implications for adult health, as well as suggesting a potential physiological mechanism by which adolescent relationships may be linked to adult health outcomes.
Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 severe acute respiratory syndrome coronavirus 2 positive cases and 564 controls, accounting for the time course of illness using generalised multivariate logistic regression. Significant symptoms included abdominal pain, cough, diarrhoea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5 and 37.9 °C and temperature above 38 °C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, leave-one-out cross-validation confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. External validation datasets reported similar result. Our study provides a tool to discern COVID-19 patients from controls using symptoms and day from illness onset with good predictive performance. It could be considered as a framework to complement laboratory testing in order to differentiate COVID-19 from other patients presenting with acute symptoms in outpatient care.
This chapter examines the life and contributions of Singapore's Chief Justice Chan Sek Keong as a towering judge. Chan’s imprint on Singapore public law goes beyond his jurisprudential contributions and extends to fostering a mindset shift that has led to a reformed image of public law litigation as a professional and legitimate endeavour, and not simply a political and politicised activity. In presenting Chan as a towering judge, we conceptualise ‘towering’ as a relative and contextualised idea. Chan towers not only because he is one of the best legal minds in Singapore, and is more committed and diligent than most, but also because he was able to navigate what would be considered a limited policy space in a dominant-party state. Accordingly, although his jurisprudence may be described as minimalist in some quarters, we present his judicial minimalism not as judicial conservatism but as judicial courage.
In 1988, Malaysia’s Constitution was amended to separate the Syariah and civil jurisdictions of the courts. Henceforth, matters involving Syariah (Islamic religious law) would only be litigated in the Syariah courts and not the civil courts. This move proved problematic especially since the Federal Constitution regulates all fundamental rights and liberties – including the right to religious freedom – while religion is regulated by the constituent states. State legislatures are thus empowered to create and punish offences against precepts of Islam. This chapter analyses how common law principles of administrative law have been applied and developed in Malaysia by studying their interaction with the administration of Syariah law. More specifically, it asks: How do the civil courts exercise its powers of judicial review in cases involving Syariah and the exercise of powers by both secular and religious authorities in such cases? It traces the patterns of judicial application and assessment of key administrative law principles such as natural justice, reasonableness, and proportionality and argues that while English precedents continue to be cited, these same precedents are often jettisoned and modified when it conflicts with the political power and primacy of Islamic law.
Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups.
In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment.
Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other).
The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.
It is important to understand the temporal trend of the paediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load to estimate the transmission potential of children in schools and communities. We determined the differences in SARS-CoV-2 viral load dynamics between nasopharyngeal samples of infected asymptomatic and symptomatic children. Serial cycle threshold values of SARS-CoV-2 from the nasopharynx of a cohort of infected children were collected for analysis. Among 17 infected children, 10 (58.8%) were symptomatic. Symptomatic children, when compared to asymptomatic children, had higher viral loads (mean cycle threshold on day 7 of illness 28.6 vs. 36.7, P = 0.02). Peak SARS-CoV-2 viral loads occurred around day 2 of illness in infected children. Although we were unable to directly demonstrate infectivity, the detection of significant amount of virus in the upper airway of asymptomatic children suggest that they have the potential to shed and transmit SARS-CoV-2. Our study highlights the importance of contact tracing and screening for SARS-CoV-2 in children with epidemiological risk factors regardless of their symptom status, in order to improve containment of the virus in the community, including educational settings.
IFRS 17 Insurance Contracts is a new accounting standard currently expected to come into force on 1 January 2023. It supersedes IFRS 4 Insurance Contracts. IFRS 17 establishes key principles that entities must apply in all aspects of the accounting of insurance contracts. In doing so, the Standard aims to increase the usefulness, comparability, transparency and quality of financial statements.
A fundamental concept introduced by IFRS 17 is the contractual service margin (CSM). This represents the unearned profit that an entity expects to earn as it provides services. However, as a principles-based standard, IFRS 17 results in entities having to apply significant judgement when determining the inputs, assumptions and techniques it uses to determine the CSM at each reporting period.
In general, the Standard resolves broad categories of mismatches which arise under IFRS 4. Notable examples include mismatches between assets recorded at current market value and liabilities calculated using fixed discount rates as well as inconsistencies in the timing of profit recognition over the duration of an insurance contract. However, there are requirements of IFRS 17 that may create economic or accounting mismatches of its own. For example, new mismatches could arise between the measurement of underlying contracts and the corresponding reinsurance held. Additionally, mismatches can still arise between the measurement of liabilities and the assets that support the liabilities.
This paper explores the technical, operational and commercial issues that arise across these and other areas focusing on the CSM. As a standard that is still very much in its infancy, and for which wider consensus on topics is yet to be achieved, this paper aims to provide readers with a deeper understanding of the issues and opportunities that accompany it.
There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition.
Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman’s correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition.
Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition.
The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.
An acute gastroenteritis (AGE) outbreak caused by a norovirus occurred at a hospital in Shanghai, China, was studied for molecular epidemiology, host susceptibility and serological roles. Rectal and environmental swabs, paired serum samples and saliva specimens were collected. Pathogens were detected by real-time polymerase chain reaction and DNA sequencing. Histo-blood group antigens (HBGA) phenotypes of saliva samples and their binding to norovirus protruding proteins were determined by enzyme-linked immunosorbent assay. The HBGA-binding interfaces and the surrounding region were analysed by the MegAlign program of DNAstar 7.1. Twenty-seven individuals in two care units were attacked with AGE at attack rates of 9.02 and 11.68%. Eighteen (78.2%) symptomatic and five (38.4%) asymptomatic individuals were GII.6/b norovirus positive. Saliva-based HBGA phenotyping showed that all symptomatic and asymptomatic cases belonged to A, B, AB or O secretors. Only four (16.7%) out of the 24 tested serum samples showed low blockade activity against HBGA-norovirus binding at the acute phase, whereas 11 (45.8%) samples at the convalescence stage showed seroconversion of such blockade. Specific blockade antibody in the population played an essential role in this norovirus epidemic. A wide HBGA-binding spectrum of GII.6 supports a need for continuous health attention and surveillance in different settings.
This study estimates the incubation period of COVID-19 among locally transmitted cases, and its association with age to better inform public health measures in containing COVID-19. Epidemiological data of all PCR-confirmed COVID-19 cases from all restructured hospitals in Singapore were collected between 23 January 2020 and 2 April 2020. Activity mapping and detailed epidemiological investigation were conducted by trained personnel. Positive cases without clear exposure to another positive case were excluded from the analysis. One hundred and sixty-four cases (15.6% of patients) met the inclusion criteria during the defined period. The crude median incubation period was 5 days (range 1–12 days) and median age was 42 years (range 5–79 years). The median incubation period among those 70 years and older was significantly longer than those younger than 70 years (8 vis-à-vis 5 days, P = 0.040). Incubation period was negatively correlated with day of illness in both groups. These findings support current policies of 14-day quarantine periods for close contacts of confirmed cases and 28 days for monitoring infections in known clusters. An elderly person who may have a longer incubation period than a younger counterpart may benefit from earlier and proactive testing, especially after exposure to a positive case.
Scholars studying Singapore have given it many labels ranging from a dictatorship and one-party state to an illiberal democracy. In 2015, Mark Tushnet, in a much-discussed article published in the Cornell Law Review, used Singapore as the quintessential prototype of what he calls “authoritarian constitutionalism.” This chapter critically examines and unpacks Tushnet’s model of “authoritarian constitutionalism” and argues that this categorization is neither accurate nor useful. The author argues that Tushnet’s construction of this model is based on flawed premises and variables and that from the perspective of comparative constitutional law, this kind of model-making is unhelpful for scholars seeking to understand the true nature of how constitutions work in different societies.
The psychiatric reactions relating to Human Immunodeficiency Virus (HIV) infection cover the whole range of mental illnesses and psychosocial problems. This poses a challenge to both physicians and psychiatrists and is of immense relevance due to the rising number of HIV patients in Singapore.
To retrospectively examine the psychiatric disorders and related factors associated with HIV infected patients in a general hospital in Singapore.
To review and describe the psychiatric disorders and related factors associated with HIV patients under the care of Tan Tock Seng Hospital and Communicable Disease Centre in Singapore.
A 2-years retrospective descriptive study was performed on all HIV patients who were referred to the Department of Psychological Medicine of Tan Tock Seng Hospital for psychiatric assessment and this includes both inpatient and outpatient referrals. The data for inpatient referrals was obtained through the interdepartmental referral registry and relevant case notes. The data for outpatient referrals was obtained through the attendance and relevant case notes of the HIV psychiatric clinic. The data was collated and analyzed.
Mood disorders were the most common psychiatric disorders diagnosed and antidepressants were the most commonly used psychotropic drugs. Most patients were followed up on an outpatient basis for continuation of treatment.
Many HIV infected patients may have concomitant psychiatric disorders. Clinicians may need to actively identify patients at risk and initiate early psychiatric consult to ensure appropriate care for these treatable disorders.
The air transport industry has seen a rapid growth since the early 1900s. Serving more than 180 cities in over 50 countries, Changi International Airport in Singapore has established itself as a major aviation hub in the Asia Pacific region, with an annual handling capacity of more than 44 million passengers. In recent years, it has been observed that a number of passengers are found to be in a mentally disturbed state at the Changi International Airport. Some of whom are unable to continue in their journey and have to be admitted for further evaluation. The purpose of this descriptive study was to examine the occurrence and the presentation of mental disorders requiring admission at an international airport.
A retrospective study was performed including patients who had been referred for psychiatric observation by the Changi International Airport to a tertiary hospital nearest the airport. The patients were studied in respect to the circumstance of admission, clinical presentation, management and how they continued on their journey.
Most of the patients admitted had a history of a major mental illness, such as schizophrenia and bipolar disorder. In-flight emergencies and serious incidents caused by psychiatric patients were fortunately uncommon.
As air travel becomes more prevalent, it is conceivable that there will be an increasing number of psychiatric patients taking a flight. Although most patients are able to travel uneventfully, there are still a small number of patients who have to be detained and stabilised at a hospital.
Electroconvulsive therapy (ECT) involves the administration of a variable frequency electrical stimulus shock via electrodes applied to the scalp to induce a seizure for therapeutic purposes. In 2001, the American Psychiatric Association (APA) task force on ECT concluded that convincing data exists to support use for major depression, bipolar depression and mania, schizophrenia, and schizoaffective and schizophreniform disorders. However, the National Institute for Clinical Excellence in the UK (NICE 2003) does not recommend that ECT be used as a long-term treatment to prevent recurrence of depressive illness, and that it recommends that ECT should not be used in the general management of schizophrenia.
To review and describe the practice of ECT in the largest psychiatric hospital in Singapore.
This was a retrospective descriptive study performed on all patients who were administered electroconvulsive therapy at the Institute of Mental Health in Singapore during the 2-year study period of 1st July 2005 – 30th June 2007. Data was collected from existing medical records on the demographics, indications, frequency and the complications of the patients given ECT. The frequency of missed fits was also determined as measuring the number of missed-fits provided one way of assessing an ECT clinic's efficiency.
The main indications for electroconvulsive therapy at the Institute of Mental Health in Singapore were patients with Schizophrenia or Schizoaffective Disorders with poor response to medications, followed by patients with mood disorders. The rate of complications of ECT and the frequency of missed-fits were found to be low.
One of the major challenges in Asia is the impact of diseases in the aging population. Dementia is a common and disabling disorder in the elderly which has gained growing public health relevance. The Asian populations in developing countries have been known to report a lower prevalence of dementia, partially influenced by their cultural background and traditional societal roles for the elderly. We aim to investigate how living in a developed country with a strong Asian cultural background, influence perceptions on dementia.
We invited in-patients of a tertiary hospital, with no previously diagnosed cognitive impairment, to complete an anonymous, self-filled questionnaire about their perceptions of dementia, societal trends and the current role of elderly in Singapore.
Majority of respondents had strong traditional values and felt a duty of care for elderly within their family. Societal norms still suggests that our elderly would more likely give up position of authority and property for younger members of the family. Our elderly also became significantly less active in society after retirement.
With the rapid development of our society and trend towards nuclear families, the resultant possibility of higher carer stress and pressure for residential placement facilities are likely to grow.
The Lasting Power of Attorney (LPA), under the Mental Capacity Act 2008, came into effect in Singapore on March 2010. as more people become aware of the LPA and the demand for making one rises, it is imperative for healthcare professionals to be knowledgeable about it, in order to provide sound and timely advice to the public.
This study aims to assess the Knowledge, Attitudes and Practices of doctors and medical social workers (MSWs) in Tan Tock Seng Hospital, Singapore, with regards to the making of an LPA.
209 structured questionnaires were distributed and analyzed across seven medical and surgical disciplines between January-April 2011.
Only 8.89% of surgeons, 29.3% of physicians and 29.2% of MSWs have ever encountered an LPA before. 51% of respondents felt that they knew little or nothing at all about the LPA. Only 67% knew the difference between an LPA and an Advanced Medical Directive (AMD). Only 26% were aware of the information sources available for the making of an LPA.
The results of the study revealed limited knowledge and inconsistent attitudes. This resulted in misconceptions, leading to non-standard practices amongst doctors and medical social workers surveyed with regards to the LPA document, in Singapore. It is crucial to address and rectify this deficiency in knowledge. Hopefully in time, this will translate to better practices and the public would be more comfortable approaching their doctors for advice regarding creating a Lasting Power of Attorney for themselves and their loved ones.
Studies have shown the Clock Drawing Test (CDT) to be useful as a screening test between normal, elderly populations and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's dementia
(AD) and other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other dementias.
A review was conducted using MEDLINE, PsycINFO and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or Alzheimer's Disease or Dementia with Lewy Bodies (DLB) or Vascular Dementia (VaD) or Semantic Dementia.
20 studies were selected. In most of the studies included, no significant differences were found in CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. Frontotemporal dementia (FTD) patients consistently scored higher in the CDT than AD patients. Qualitative analyses of the type of errors seem to suggest a difference between AD and the other types of dementias.
Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.
Schizophrenia is associated with an increased risk of sudden cardiac death, traditionally attributed to prolonged QTc interval and cardiovascular risk factors such as metabolic syndrome. However, defective ion channels are also implicated in schizophrenia. This applies as well for Brugada syndrome (BrS), a rare hereditary cardiac disorder associated with an increased risk of cardiac arrhythmias, which can been provoked by various drugs, including psychotropic.
To screen whether an increased prevalence of suspect Brugada ECG is present in patients with recent onset schizophrenia.
273 subjects with recent onset schizophrenia admitted between 2006 and 2012 and 306 healthy controls, underwent an ECG. All persons who had an ECG suspect for BrS were asked to undergo a provocation test to diagnose/exclude BrS. We checked whether patients had deceased during follow-up.
20/273 patients (7.3%) and 5/306 healthy controls (1.6%) showed an ECG suspect for BrS, with a Relative risk (RR) of 4.8 (p<0.001). Thus far 12 provocation tests have been performed, confirming BrS in three patients (1.1%). Ten patients had deceased during follow-up, of which two due to sudden cardiac death. Patients and controls didn’t differ significantly on average QTc interval.
Conclusion: This study shows that a considerable subset of patients with recent onset schizophrenia have an ECG suspect of Brugada Syndrome, confirming results in a population with chronic schizophrenia (Blom 2014). This may imply that there is a common pathophysiologic mechanism involved in both disorders. Screening for Brugada Syndrome in schizophrenia is relevant to prevent sudden cardiac death.