Monday, June 27, 2016

Singapore - Singapore offers guidance on cloud use for the private healthcare sector

The Infocomm Development Authority of Singapore (IDA) and Ministry of Health (MOH) recently mapped cloud security standards for the private healthcare sector.

This Multi-Tier Cloud Security (MTCS) Singapore Standard aims to bring clarity to the private healthcare sector on how cloud computing can be used and applied for their enterprises, as well as trust through transparency of cloud service providers (CSPs) via certification.

The mapping guidelines show that the base tier of the MTCS, Level 1, could be used to host publicly available information such as clinical standards and terminology systems. Meanwhile, the most stringent tier, Level 3, could be used to host clinical administrative support systems such as billing and admissions data.

"Singapore must continue to lay the foundations for innovative solutions to thrive and grow in a Smart Nation, and this means bringing clarity to industry sectors to aid in their adoption. We are encouraged that the healthcare sector can now look to adopting the cloud with the clarity which our Multi-Tier Cloud Security Standard brings," said IDA Assistant Chief Executive Khoong Hock Yun.

Besides the MTCS, IDA recently called for feedback on the possibility of a data certification framework.

The agency has been driving clarity in the data landscape through various guidelines and standards, and is looking into the potential for an expanded framework to further drive adoption and use of private datasets through clarity. One such potential use case could be in exploring how a "common tongue" could be achieved between dataset owners and potential buyers to better gauge datasets.

Nurdianah Md Nur

Read more…                 and       Microsoft MTCS Singapore

Singapore - Health warning issued against anti-itch herbal product

SINGAPORE: A health warning has been issued by Singapore authorities against an anti-itch herbal product after a woman who had taken the capsules developed Cushing’s syndrome, which causes rapid weight gain and a round “moon face”.

The consumer, who is in her 40s, had taken the Hai Leng Hai Beh Herbal Itch Removing Capsule (海龙海马止痒丸) capsules to relieve an itchy skin condition, the Health Sciences Authority (HSA) said in an advisory on Thursday (May 5).

Although the condition improved within a day of taking the capsules, she experienced rapid weight gain and her face became puffy after consuming the product for more than two months, HSA said.

She was later diagnosed with Cushing’s syndrome, which is characterised by a round or “moon face”, and upper body obesity with thin limbs. The doctor reported the case to HSA.

The product was found to contain undeclared "potent Western medicinal ingredients" dexamethasone, chlorpheniramine and paracetamol, although it was labelled “100% herbal”, HSA said.

“Dexamethasone is a potent steroid that is usually prescribed for inflammatory conditions and should only be used under strict medical supervision. Long-term unsupervised use of oral steroids can cause Cushing’s syndrome, increased blood glucose levels leading to diabetes, high blood pressure, cataracts, muscular and bone disorders and an increased risk of infections,” it said.

Although the consumer had purchased the product overseas, HSA warned that it does not rule out the possibility of the product being sold in Singapore.

Any sellers in Singapore should immediately stop the sale and distribution of the product immediately, it said. Offenders may face a fine of up to S$10,000 and up to two years’ jail if convicted.

Members of the public who have purchased or are consuming the capsules are advised to consult a doctor as soon as possible. They should not stop the use of the product immediately as the sudden discontinuation of steroids without proper medical supervision can cause withdrawal symptoms such as weakness, fatigue, confusion and low blood pressure, especially when it has been consumed for more than a few weeks, HSA said.


Singapore - Dengue cases in Singapore rise

The number of new dengue cases in Singapore rose to 244 with 15 new cases recorded last week, according to latest figures published by the National Environment Agency’s (NEA) on Wednesday.

Another 44 cases were reported between May 1 and 3, Channel News Asia reported.

A total of 7,370 dengue cases have been reported in Singapore since the start of the year. Four people have died of the disease.

The health ministry and NEA have warned that the number of dengue cases in Singapore may exceed 30,000 this year, higher than the record of 22,170 reported in 2013.

This is due to factors such as warmer conditions brought about by the El Nino weather phenomenon, faster breeding and maturation cycles of the Aedes mosquito population and a change in the main circulating dengue virus.

There are now 61 active dengue clusters in Singapore, including 12 classified as high-risk.

Singapore - Regional study to be done on economic, health and social impact of haze in 2015

SINGAPORE - The haze episode in 2015 went down in history as the worst on record, surpassing even the 1997 and 2013 crises. In a bid to assess the implications for South-east Asia, a regional study on its economic, health and social impacts will be conducted.

This will allow affected countries to better understand the impact of transboundary haze and supplement existing estimates on the cost of the 2015 haze.

Details of the type of data that will be included in the study are still being worked out, Mr Masagos Zulkifli, Singapore's Minister for the Environment and Water Resources, told the media on Wednesday morning (May 4).

This is because different countries collect different types of data depending on their economies. Singapore, for instance, collects data on affected tourism while Indonesia collects data related to agriculture.

Mr Masagos noted that while there is no timeline yet for when the study will be completed, he hopes there will be some results in a year.

He was speaking during the press conference for the 18th Meeting of the Sub-regional Ministerial Steering Committee (MSC) on Transboundary Haze Pollution, which was held in the Marina Mandarin Hotel in Singapore on Wednesday morning.

Hosted by Singapore, the meeting was attended by environment ministry representatives from Malaysia, Thailand, Brunei Darussalam and Indonesia. Indonesia was represented by Mr Arief Yuwono, senior adviser to the Minister for Energy.

Smoke-belching forest and peatland fires that burn in Indonesia are the main cause of the haze experienced by Singapore and the region during the traditional dry season between June and October every year.

In 2015, the fires burned harder and for longer due mainly to the El Niño weather phenomenon, which is linked to prolonged hot and dry weather in this region. It resulted in prolonged haze that clouded the skies of Indonesia and its neighbours - causing illness and death, grounding flights and closing schools.

During Wednesday's meeting, the ministers noted that the effects of El Nino are expected to subside by the middle 2016, when the dry season typically begins. They also noted that La Nina conditions, a weather phenomenon associated with more rain this region, is expected to kick in by the third quarter of 2016.

While this could bring more rain to the parched, fire-prone landscape in Indonesia amid the dry season, Mr Masagos noted there could still be periods of dry spells in between bouts of rain. But the hope is that haze of last year's scale will not affect Singapore when June comes around.

Singapore - Struck by cancer: Should I tell my kids?

How does a parent who has just received a cancer diagnosis break the news to children? Eveline Gan finds out

Being told that you have cancer is a frightening experience.

Throw young children into the equation, and navigating the life-threatening illness often becomes more complex.

Parents who have been hit by the disease said one of their topmost concerns following their diagnosis is: "Should I tell the children?"

Mr Kelvin Choo, 50, chose not to share the news with his four children when he was battling advanced colon cancer in 2012 and 2013. As part of his treatment, the primary school teacher had surgery to remove 15cm of his large intestine and underwent chemotherapy.

His reason: At just two to seven years old then, his children were too young to understand the gravity of the situation.

"My wife and I just told them that I was not feeling too good and needed some time to recover," said Mr Choo.

Another parent, Janice (not her real name), kept her condition a secret until a few weeks before her death. In her 40s, she did so to protect her only child from the horrors of the disease, which could not be contained despite aggressive treatment. But when she called her 10-year-old son to her bedside in the last weeks of her life, he rejected her.

By then, she had physically deteriorated so much that she was a shadow of her former self, said Ms Jayne Leong, manager of psychosocial services at the Singapore Cancer Society (SCS), which provided home hospice support to Janice's family.

Nobody told the boy or prepared him for it. The dying mother wanted her son to be near her. "But to the child, witnessing his mother's physical change must have been frightening," said Ms Leong.

Despite parents' good intentions of protecting their children, counsellors said hiding the disease beneath a shroud of secrecy can backfire.

This is because children, even the really young, are able to observe what is happening around them, said Mr Travis Loh, principal medical social worker from the psychosocial oncology division at National Cancer Centre, Singapore (NCCS).

Ms Saryna Ong, another medical social worker from the psychosocial oncology division, said: "Children can recognise that something is not right when their parents are sick."

When children are not given the right information, they become more frightened. In addition, said Ms Leong, trust may be broken if the children hear about the diagnosis from another person other than the parent himself.

Sharing information about the illness early - in an age-appropriate manner - opens the door for communication between parent and children. It also addresses any misconceptions the children may develop when they are being kept in the dark, added Mr Loh.

Ms Leong said that parents who want to protect the children do not realise that the youngsters need help to make sense of reality.

A case in point is Janice's son. In his naive 10-year-old mind, he had blamed himself for his mother's cancer. "He thought his mother was very sick because he was naughty. Children may think their parent's illness is their fault, when not given information and assurance," said Ms Leong.


Senior enrolled nurse Zulfa Anas, 47, has seen first-hand the lasting regret secrecy can cause. She was diagnosed with a rare bone cancer in 2006 and has suffered two cancer relapses since then.

A mother of two boys aged 12 and nine, she said: "My friend did not tell her teenage sons she had cervical cancer until it was too late. At her wake, her children were so angry that they were not informed about her illness earlier.

"They also had a lot of regrets about not spending more time with their mum."

NCCS' Ms Ong said giving children appropriate and timely updates on their parents' disease helps minimise the shock they may experience if bad news is broken to them suddenly.

For that reason, Madam Zulfa has openly shared and involved her sons in her cancer journey.

She has even informed them who will take care of them, in the event that she dies.

"I don't want my kids to blame me or feel lost if I'm no longer around," she said. She is currently on maintenance treatment, in stable condition, but the doctor has not given her the all-clear.

Similarly, being upfront about her illness was a necessity for Madam Sandar Myint, 45, who is battling stage three breast cancer. Her three children are aged 14, nine and five.

Her husband, Mr Nay Myo Hun, 38, said: "They realised very early on that their mother was seriously sick when we took them along to the hospital for her treatments because no one else could care for them."

The illness has also affected the couple's finances. They had to explain why they could not afford many things when the new school term started. "I felt embarrassed telling the kids about our financial struggles, but it was necessary for them to understand," said Mr Nay Myo Hun.

While it may not always be possible, maintaining normalcy in your child's schedules will help him feel more secure.

Despite having no domestic help at home, Mr Choo and his wife, a 42-year-old insurance agent, tried to stick to their children's regular routines as much as possible.

They formed a tag team, working out a schedule to manage the children's routines, their work and his treatments.

"The only setback was not being able to take them out during my treatments," Mr Choo said.

But they made up for it by watching movies or playing educational games together at home. Mr Choo is currently cancer-free and does not need further treatment.

He eventually told his children about his brush with cancer, when the topic of death came up after his father died from prostate cancer last year.

"They are now older and at an age where they would ask many questions. We explained what cancer is, and they have also found out more information about the condition through the media," he said.

While telling your children about your illness is important, so is offering them ample support.

But for parents struggling to cope with their disease, that can be a huge challenge, said counsellors.

Ms Leong advises parents to rope in professional help - available at SCS and all restructured hospitals with a team of medical social workers - if they are unable or do not know how to do this.

They should also watch for changes in their children's behaviour - it may affect their academic performance, regular activities and mood.

"The ways children cope with difficulties in their lives can be very different from that of adults. They do not necessarily always verbally share their feelings and struggles," she said.

Hence, Mr Loh added, engaging them through non-verbal means, such as through play and art, can be more effective at times.

SCS and NCCS currently have support programmes in place to help children cope. About 100 children have gone through NCCS' art therapy and bereavement programmes.

Its medical social workers also provide counselling and psychosocial support to children affected by their parent's illness.

At SCS, the Help the Children and Youth programme has educational financial assistance schemes, free home tuition, and activities such as camps and family engagement programmes.

Through these day trips and activities, the family is brought together and experience what life was probably like before cancer.

Said Ms Leong: "Very often, families affected by cancer focus on the treatment plan and forget the need to have fun too."

Madam Zulfa and Mr Nay Myo Hun said sharing information with their little ones has its silver lining.

Mr Nay Myo Hun said his oldest child seems to have "grown up".

"He has become more understanding and proactive. Previously, he left all the household chores to his mother but, now, he helps out at mealtimes. He has also been working harder in school," he said.

Madam Zulfa said her illness has drawn the family closer.

"Every day, the children, especially my older boy, still tell me they love me very much before I leave for work," she said.

"Through this cancer journey, we have learnt to really treasure the time we have together as a family."

Singapore - Know which cancers to screen for and when

Q. I am 41 years old. Is it necessary for me to go for cancer screening even though I am feeling very well?

A. Cancer is one of the top two medical killers in Singapore. The best chance of surviving cancer is by detecting the condition early.

With advances in medical technology and knowledge, a lot of cancers are now treatable and potentially curable if the condition is discovered early.

Therefore, early detection of cancer by cancer screening is extremely important.

Checking for cancer (or for conditions that may lead to cancer) in people who have no symptoms is called screening. Screening can help doctors find and treat some types of cancer early.

However, not all types of cancer have effective screening tests and some tests are only for people with specific genetic risks.

The recommended screening tests that are effective in detecting cancer early, where effective treatments are available for the cancers are:

Mammography for breast cancer
Colonoscopy for bowel cancer
PAP smear tests for cervical cancer.

Screening tests for other cancers are available, but these are recommended only for people who are at high risk of developing that group of cancer, such as computed tomography scans for smokers, who have a higher risk of developing lung cancer.

Anyone who is above the age of 50 should go for bowel cancer screening.

Some people who are at high risk, such as those with a strong family history of the cancer or a history of polyps, may need to have bowel screening tests done at an earlier age.

Colonoscopy involves a doctor examining the whole of the inside of your bowel with a long flexible tube. Colonoscopy allows direct visualisation of the bowel wall and allows a biopsy to be taken if abnormalities are seen.

Breast cancer screening is recommended for all women above the age of 40. Some people who are at high risk, such as those who have a strong family history of breast cancer, may need to have breast screening tests done at an earlier age.

Mammography involves a radiographer who helps you to position one breast at a time between two small flat plates on the X-ray machine. The plates then press your breast firmly between them for a few moments, to take an X-ray. The compression of the breast helps to give a clear picture.

All sexually active women above the age of 21 should go for a cervical cancer screening test. The screening test involves a doctor taking a small sample of cells from the surface of your cervix.

This is done by putting an instrument called a speculum inside your vagina, then scraping the cervix with a small soft brush. The sample is sent to a laboratory where a pathologist analyses the cells and reports abnormal ones.

Dr Sue Lo

Senior consultant medical oncologist at The Harley Street Heart & Cancer Centre

Singapore - Dementia costs Singapore $1.4b a year

Dementia and its accompanying woes cost the country $1.4 billion every year, making it among the biggest drains on the healthcare system here.

This alarming figure, uncovered for the first time by local and international researchers, underscores the need to prevent the debilitating disease from taking hold in greying Singapore, say experts.

"Part of trying to define the scale of the problem is finding out dementia's economic cost," said Professor Chong Siow Ann, vice-chairman of the Institute of Mental Health's medical board (research), who was involved in the study.

"That then gives us an idea where we might want to intervene."

He and 13 others, from IMH, Changi General Hospital, the Ministry of Health and King's College London analysed the social care costs - such as care provided by family members and maids - and healthcare costs of 2,565 people, the majority of them aged 60 to 74. About one in 10 of them had dementia - consistent with the national average.

What the researchers found: For every person with dementia, he, his family and society paid $10,245 more in health and social care costs in 2013 than those without the condition.

As a country, Singapore shouldered the burden of $532 million that year, to care for people with the brain disease marked by memory disorders, personality changes and impaired reasoning. Taking into account social factors and other health problems dementia patients tend to suffer from such as depression and hypertension, the cost triples to $27,331 per person.

The study offers an important benchmark for the illness, said the researchers, who are calling in particular for more help for caregivers.

Said Dr Chia Shi-Lu, who chairs the Government Parliamentary Committee for Health: "Such studies do provide grist to the policy mill and are useful to either start or bookend discussions about resource allocations for specific medical issues, in this case dementia."

Last month, the Government declared war on diabetes, which cost more than $1 billion in 2010 - a figure expected to soar beyond $2.5 billion by 2050. The estimated cost per working-age person due to diabetes was $7,678 in 2010, and is expected to go up to $10,596 by 2050.

As at 2013, the annual cost of dementia, at $10,245 per patient, already closes in on the 2050 mark for diabetes, experts pointed out.

The price tag is expected to grow exponentially as the country ages. There were about 40,000 dementia patients here last year and this is projected to reach 53,000 by 2020, and 187,000 by 2050.

Notably, the study found that over three-quarters of the money spent on dementia patients comprises social care such as income lost when caregivers take time off work, while the rest is due to healthcare costs, including hospital admissions and doctor visits.

Associate Professor Phua Kai Hong of the Lee Kuan Yew School of Public Policy at the National University of Singapore said there is still a lack of professional outpatient care here such as rehabilitation services or care for a patient's daily needs.

"If you look at Singapore, most care is absorbed by the family or at most shows up as the cost of hiring a maid," Prof Phua said. Placing the burden squarely on these two groups would result in poor care for Singapore's elderly and heavy stress on caregivers, he warned.

Dr Jeremy Lim, a partner in global consulting firm Oliver Wyman, said there is a need to be creative in finding solutions. This includes changing the subsidy model to recognise the high social costs and give more subsidies not just for medicine and institutional care, but also in areas such as transport and elderly-friendly infrastructure for homes, for instance. "More of the same, meaning more of today's care model, will doom us to failure," he said.

Samantha Boh