WINNER AWARD OF EXCELLENCE APEX 2013 May/Jun 2014 HONOURABLE Issue 51 MENTION CONTENT MARKETING AWARDS Pioneer Perks What the Pioneer Generation Package means, health-wise

Smoke-free & Happy Kicking the habit means having more cash in hand to do as they please On the Road Travel tips to keeping well

when exercise is bad • apps cut waiting times • understanding x-rays 2007-0387-H Lifewise MAY-JUN issue 51 contents features

08 cover story OFF THE HOOK Everybody knows smoking is bad, yet smokers find it hard to quit. What are the ways to get help in kicking the habit?

12 GOING SMOKE-FREE Through sheer willpower or via medical intervention, these three individuals were able to stub out their cigarette addiction.

14 MODERN TALKING How Tan Tock Seng Hospital’s Speech Therapy Department helps patients regain the ability to speak and eat properly.

16 GAIN EMPLOYMENT, GAIN WEIGHT 8 A survey by employment portal JobsCentral finds that most workers put on the pounds when starting their careers.

18 SHOULD SUICIDE BE ILLEGAL? Criminalising it may not help at-risk persons in getting the care they need. 16 20

20 UP ALL NIGHT Tossing and turning past your bedtime? Some tips for getting a good night’s rest.

May - Jun 2014 lifewise 1 Lifewise maY-JUN issue 51 contents

23 In person A/Prof Daniel Fung and Dr Karen Ng share how they 28 effectively divide their time between work and play.

26 SUPPORTING A GENERATION Lifewise examines how the Pioneer Generation Package announced in the 2014 Budget benefits eligible seniors.

28 EN ROUTE TO GOOD HEALTH Going on a driving holiday? Read our tips on staying well on the road.

30 EXERCISING CAUTION Sometimes, working out can be bad for you.

32 EATING FOR A CENTURY Okinawa has the largest proportion of residents aged 100 or more. What is it they are eating over there? 32

regulars

EDITOR’S NOTE 03 NEWSROOM 04 ASK THE EXPERTS 34 Spotlight/NHG news 37 30 Spotlight/NHG directory 48

2 lifewise May - Jun 2014 On the cover: (from left) Olivia ng, Najadi abu Bakar and Guo Xinhui Stub it out for Photographer Ealbert Ho Art direction Don lee styling Sheh grooming Manisa Tan clothes Olivia: Camisole and knitted top by Uniqlo. health’s sake Pants by GAP. Najadi and xinhui: ALL Clothes BY Gap Everybody knows that smoking is bad but statistics indicate a recent rise in the number of regular smokers in Singapore. Initiatives like the Health Promotion Board’s I Quit campaign as well as international movements like World No Tobacco Day (which falls on 31 May) are well-publicised, but smokers National Healthcare Group still find it difficult to give up the habit. The first step to quitting — thereby potentially adding EDITORIAL years of healthy life — is to recognise the many downsides of Wong Fong Tze, Lim Phay-Ling, Eleanor Toh, Jason Chiew, Praveen Nayago, smoking. On the upside, there are many avenues to seek help Ng Si Jia, Audrey Wong, Shirlene Wong, Evon Teo if a smoker is trying to quit. In fact, within National Healthcare Group (NHG) institutions, help is available at Tan Tock Lifewise Advisory Panel Seng Hospital (TTSH), the Institute of Mental Health (IMH), A/Prof Lim Tock Han, A/Prof Thomas Lew, A/Prof Chua Hong Choon, National Skin Centre (NSC) and at National Healthcare Group A/Prof Chong Phui-Nah, Prof Roy Chan Polyclinics. Consultations are inexpensive — certainly less wallet-damaging than a lifetime spent buying cigarettes! So if you smoke or know someone who does, read about the

MediaCorp Pte Ltd quit-smoking options available on page 8. At TTSH too, there is something more specialised — EDITORIAL & DESIGN treatment for speech and swallowing problems. As you will Senior Editor Agatha Koh Brazil read on page 14, the Speech Therapy department diagnoses Supervising Editor Ronald Rajan Editor Amir Ali and treats a range of life-altering conditions. Art Directors Don Lee Speaking of life-altering, it seems our bodies undergo Samuel Ng significant changes once we enter the workforce. The majority Designer Carol Chan Writers Gene Khor of us put on weight, but which professions are most linked to Alex Ngai weight gain? Find out on page 16 as we present the findings Photographer Ealbert Ho of a survey by JobsCentral. Hong Chee Yan For many of the survey’s respondents, the duties of CONTRIBUTORS work have been detrimental. But for passionate doctors like Wanda Tan, Nirmala Sivanathan, Elisabeth Lee Associate Professor Daniel Fung of IMH, the line between Business Development work and play is blurred as he combines his love of video Senior Business games with his research (page 23). Meanwhile, Dr Karen Ng Relationship Manager Michele Kho (page 24) successfully divides her time between being a family physician, being there for her own family and setting For advertisement enquiries, please email: [email protected] aside time to exercise. And while most of us work out for health reasons, it For subscription enquiries, please email: seems there are reasons for some people not to exercise. [email protected] For them, exercise can be bad in that their blood pressure and cholesterol levels go up rather than down as a result of working out. Read about this and other ways exercise can be harmful on page 30. Every care has been taken in the production of this magazine, but National Healthcare Group (NHG), the But before you use that as an excuse, note that it is only publisher, editor and employees assume no responsibility for any errors, inaccuracies or omission arising thereof. a small minority who experience these effects. For most, Opinions expressed by contributors and advertisers are not necessarily those of NHG, the publisher or the editor. working out is just one of the many things we would be wise to include in our weekly schedules. After all, with the school The information produced is for reference and educational purposes only. As each person’s medical condition is holidays coming up, it might be a good idea to get into shape unique, you should not rely on the information contained in this magazine as a substitute for personal medical to best enjoy that road trip (see page 28 for driving holiday attention, diagnosis or hands-on treatment. If you are concerned about your health or that of your child, please tips) or family vacation! consult your family physician or healthcare professional.

Copyright © is held by the publishers. All rights reserved. Reproduction in whole or in part without permission is prohibited. Printed in Singapore by Times Printers, www.timesprinters.com. MCI (P) 056/11/2013. The Editorial Team

May - Jun 2014 lifewise 3 (newsroom) snippets from the healthcare world // calendar of events

ONCOLOGY Exercise Helps Ease Swelling Women who suffer from lymphoedema — swelling that can cause pain and loss of mobility following breast cancer treatment — should be encouraged to exercise, say experts from Britain’s National Institute for Health and Care Excellence (NICE). Some women are wary of exercise, believing that it can aggravate the swelling. One in five breast cancer patients develop lymphoedema following surgical or radiotherapy treatment. It occurs when the body’s lymphatic system becomes damaged and is unable to drain fluid normally, often resulting in pain and loss of mobility. The new advice from NICE says that exercise can actually help to reduce swelling by keeping joints supple and aiding lymph drainage. It adds that healthcare professionals should discuss with patients how regular movement can improve their quality of life as some might still be SOMNOLOGY afraid to exercise. LosE Sleep, LoSE BRAIN CELLS leep loss may be more serious than previously thought. It may result in a permanent loss of brain cells, say Sscientists from the University of Pennsylvania in the Sleep-Deprived United States. The new study, published in The Journal of lab mice lost Neuroscience, was conducted on lab mice and found that a prolonged lack of sleep led to 25 per cent of certain brain a quarter of cells dying. the brain cells The mice were kept awake to replicate the kind of sleep in a part of g es loss that is common in modern life, through night shifts or long hours in the office. The mice were put on three days of the brain stem ‘night shifts’ with only four to five hours sleep in 24 hours. The researchers said that if the effects are similar in O RB IS , Getty ima humans, it may be futile to try to catch up on missed sleep. But they added that more work needs to be done to find out

if sleep-deprived people are at risk of permanent damage. C p h otos:

4 lifewise May - Jun 2014 BACTERIOLOGY Another calendar reason MaY/Jun to enjoy chocolate Bacteria in our stomach ferments GP’s ASSISTANT COURSE chocolate into useful anti- inflammatory compounds that are — FOUNDATION Topics covered include: good for the heart, say researchers  An overview of healthcare from Louisiana State University in organisations in Singapore the United States.  The role of a General Practitioner’s Assistant The scientists, reporting their  Fundamental concepts of findings at a meeting of theA merican patient care Chemical Society, explained that  Basic communication skills microbes found in the gut such  Basic measurement skills (height, weight, tympanic as Bifidobacterium, feast on the and digital axillary temperature chocolate and release beneficial taking, BMI calculation and polyphenolic compounds in a waist circumference)  Fundamentals of infection process akin to fermentation. Several control in clinical settings studies have strongly suggested that  Basics on how medication works the long-term consumption of a diet and avoiding medication errors rich in plant-based polyphenolic DATE & TIME compounds offers protection against cancer, 22 and 23 May 2014, 1.30pm – 5pm cardiovascular disease, diabetes, osteoporosis Long-term consumption VENUE Primary Care Academy Learning and neurodegenerative diseases. could protect against Centre, Choa Chu Kang Polyclinic, The scientists also suggested that Lvl 3, 2 Teck Whye Lane, S(688846) adding fruit to chocolate could boost the cancer, cardiovascular FEE $192.60 (incl GST). Call 6496-6682 fermentation process. disease & osteoporosis or 6496-6683 to register.

NUTRITION Is Butter Really All Bad? esearchers from the British Heart Foundation have found Rthat there is no evidence CARE FOR THE ELDERLY COURSE to show that switching from The Primary Care Academy is offering a training programme “unhealthy” saturated fats (such conducted by experienced as butter and ghee) to “healthier” registered nurses to equip you polyunsaturated fats will cut your and your caregiver with the skills risk of heart disease. to care for the elderly. A Caregiver’s Training Grant The researchers looked at data is available. To be eligible for the from 72 studies with more than grant, the caregiver must: 600,000 participants. However,  Be looking after a person needing care, who is a Singapore citizen this is not an invitation to start or Singapore Permanent Resident. gorging on a fat-rich diet. Too much  Be the main caregiver; he or fat is still bad for you and trans fat she could be a family member (the artificial fat found in many or foreign domestic worker. processed foods and margarine DATE & TIME spreads) remains strongly and 25 Jun 2014, 10am – 5pm VENUE positively associated with the risk of Primary Care Academy Learning heart disease. These should continue Centre, Choa Chu Kang Polyclinic, to be regulated and avoided, say the Lvl 3, 2 Teck Whye Lane, S(688846) FEE study’s authors. $117.70 (incl GST). Call 6496-6682 or 6496-6683 to register.

May - Jun 2014 lifewise 5 CARDIOLOGY A New Hip For A Better Heart knee or hip joint replacement might lower your risk of a serious heart problem or A death by an astounding 37 per cent, a The most likely study of some 2,200 arthritic seniors has found. reason for this “When you look at the activity levels recommended by the American Heart lowered risk of Association, it’s not a lot of activity — only about heart problems 30 minutes a day — but a lot of people can’t do was the fact that OPHTHALMOLOGY this with arthritis,” said Dr Bheeshma Ravi, the lead researcher behind the study and a physician these elderly with the University of Toronto’s Division of patients were Losing An Eye Orthopaedic Surgery. more able to be He explained that while other factors could physically active For Colour also be contributing towards the lowered risk of heart problems or death, the most likely reason after going t’s as “inevitable as death and for this decline was the fact that these patients for knee or hip taxes” — you will start losing your were more able to be physically active after a replacement Iability to distinguish certain colours knee or hip replacement surgery. once you hit 70, as revealed by a new study published in the March issue of Optometry and Vision Science. But there is good news: this loss of colour vision does not seem to affect seniors in their day-to-day life and certain treatments can reverse the condition. Cataract surgery, for example, can make a major difference as it replaces lenses in the eyes, clearing away the yellowish film that affects colour vision. However, changes in colour vision could also be a sign of medical problems such as diabetes, warned Prof Michael Crognale, Director of Cognitive and Brain Sciences at the University of Nevada in the United States. “If you notice rapid changes in your colour vision, that should be a warning for you to get your blood sugar tested and see an ophthalmologist for possible retinal damage,” he told WebMD. And for those with good The good eyesight hoping news is, the to prevent it, loss of colour ophthalmologists say there is no vision does way to prevent not seem to age-related colour affect seniors vision loss. in their day- to-day life

6 lifewise May - Jun 2014 Photos: Corbis, getty images, shutterstock Indonesia T around theworld, withseven millionkilledby pollutionin2012. Organization reported that badairisafactor inone ineightdeaths complaining ofrespiratory andeye problems. T seriously affects thehealth ofpeopleintheregion, with many enveloped insmogcaused by forest fires inIndonesia.T and Malaysia, whichare routinely with neighbouringSingapore countries to fightfires inIndonesia. allows firefighters from ASEA N T the ASEAN A lawmakers have agreed to ratify that could beaboutto change. smothers theregion annually—but agreement to battle thehaze that of Southeast AsianNations (ASEA N) has yet to ratify a2002 Association Indonesia istheonlycountry that ransboundary Haze P THE HAZE o For Healthier Seniors Higher Self-Es or notthepersonfelt worthless. self-esteem was measured by whether study co-leader Sarah Liu.The seniors’ prevent healthproblems later inlife,” said well-being andphysical health,soraising ithelps people withahistory ofstress ordepression. between self-esteem andcortisol levels was especiallystrong in esteem decreased, cortisol levels increased, andvice-versa. The link and self-esteem. The study found that whentheparticipants’self- measured for theirlevels ofthestress hormonecortisol, depression followed 147 peopleaged60andolderfor four years. They were researchers from Concordia University inMontreal, Canada. High levels ofself-esteem mightresult inbetter healthfor seniors,say T Nearly 65percent ofIndonesian he issue isapointofcontention WELLNESS “Self-esteem isassociated withpsychological The study, publishedinthejournalPsychoneuroendocrinology, P utting OutFires greement on ollution which ollution which rawing Closer DrawingCloser teem he W orld Health orld Health

he haze

later life problems in prevent health helps to Self-esteem raising

Cure A Cure Could Be L S researcher on the two studies. Professorsaid Janet Treasure, the lead difference to how patients are treated,” beforepopulations we canmake a on more diverse trials larger need is along way“We off, however. from third disgust of parties. were less likely to affected be by signs patients receiving oxytocin of adose afterstudy patients, on the same Inthe second after oxytocin. of adose inanegative wayfood image and body anorexia were less likely to fixate on disorders.psychiatric atreatment as forsuggested arange of breastfeeding. already has It been and such bonding sex as moments of isreleased naturally Oxytocin during ANOREXIA ove ove calendar VENUE 17 and18Oct2014 (Fri&Sat) DATE &TIME shared at alater date. caregivers. More detailswillbe long-term care sectors, aswell as healthcare, intermediate and professionals inthesocialservices, needs. SMHC2014 targets helping meet thepopulation’s mentalhealth care that canbuildresilience and in developing amodelof integrated emphasise theneedfor collaboration T “Mental HealthandResilience —It Conference (SMHC)2014, themed T conference 2014 Singapore mentalhealth MA [email protected] or6389-2968. Emeliana at emeliana_mohamad_ imh.com.sg or6389-2831, or Contact Arthurat arthur_tm_lim@ ENQUIRIES Experts say a useable treatment say auseable Experts In the first study, with patients akes aWholeCommunity”, will he Singapore MentalHealth used to treat anorexia nervosa. to treatused anorexia nervosa. oxycontin could be hormone” tudies have found that the “love X A tria @Singapore EXPO

May - Jun 2014 lifewise

7 ( Quit it)

EVERYBODY KNOWS SMOKING IS BAD, YET SMOKERS FIND IT hard to quit. WHAT ARE THE WAYS to GET HELP TO kick THe habit?

Since 1986, the National Smoking Control Programme started by the Ministry of Health of Singapore has launched numerous awareness campaigns about the many health risks posed by smoking. As a result, most people would not dispute the fact that smoking is unhealthy — and yet, there are still so many smokers in our midst. The 2010 Singapore Mental Health Study, conducted by the Institute of Mental Health (IMH), found that 16 per cent of the population were regular smokers and 4.5 per cent of Singaporeans had a nicotine dependence. Furthermore, men are nearly five times more at risk of addiction than women. It would seem that despite the fact that smokers know their habit is unhealthy, they still find it too tough not to puff. Off the

by ALEX NGAI in consultation with MS GWEE XIAO LIN SENIOR PHARMACIST // INSTITUTE OF MENTAL HEALTH HOOKMS GRACE TIANG HUI YING SMOKING CESSATION PHARMACIST // TAN TOCK SENG HOSPITAL Ms Germaine Chua Senior Pharmacist // National Skin Centre Ms Sandra Xu Jia Lun Pharmacist // NHG Pharmacy

8 lifewise May - Jun 2014 Nicotine replacement therapies like nicotine gum reduce withdrawal symptoms.

Why So Hard To Quit? There are quit-smoking Cigarettes contain nicotine, a drug that is quickly absorbed via the lungs and can programmes available reach the brain as quickly as within seven seconds of inhalation of tobacco smoke. at TTSH, IMH, NSC Nicotine causes the release of hormones such as dopamine and serotonin, which are AND NHGP associated with pleasurable feelings and also with appetite suppression. This is the source of the addiction as smokers continue A Fix For Your ‘Fix’ to depend on smoking to receive these Nicotine replacement therapy (NRT) helps pleasurable effects. reduce nicotine withdrawal and craving When a smoker attempts to quit, he by supplying your body with nicotine. or she begins to experience withdrawal These may take the form of nicotine gum, symptoms. “During the quitting process, patches or inhalers. “The purpose of NRT the drop in nicotine level results in is to provide clean nicotine to a smoker constant cravings for cigarettes, which to relieve withdrawal symptoms without may give rise to irritability, anxiety absorption of the harmful chemicals and and difficulty concentrating,” says carcinogenic substances from smoking Ms Gwee Xiao Lin, Senior Pharmacist at but smokers can also receive nicotine tobacco,” says Ms Tiang Hui Ying, a the Institute of Mental Health (IMH). replacement therapy, cognitive-behavioural smoking cessation pharmacist at TTSH. Other physical symptoms that smokers therapy and even hypnosis. The bulk of the harmful health effects may experience while trying to quit include Many people think that quitting of smoking stems from the inhalation of a feeling of tiredness due to a reduction can be done through willpower alone, smoke from the cigarette which contains in the stimulating effects of nicotine; and that people who fail to quit smoking tar and other chemicals, rather than from headaches due to increased oxygen available do not really have the desire to stop. the nicotine. Using nicotine alternatives in the brain; coughing due to improved lung At the TTSH smoking cessation clinics, can therefore help to improve the health function to clear the built-up tar, dead cells however, the certified counsellors will of the smoker during the journey, as well and mucus accumulated from the cigarettes; conduct a thorough assessment of the as help break the habit of smoking. and a tingling sensation in the hands and patient, focusing on the areas below: According to health portal WebMD, feet due to improved blood circulation to nicotine replacement therapy also works the fingers and toes. 1 Personal smoking habit by lowering the dependence on nicotine, 2 Family smoking history as the alternatives tend to deliver less Help Me To Help You 3 Reasons for smoking The difficulty in leaving nicotine behind is the reason why so many smokers remain 4 Level of nicotine dependence addicted. The good news however is that 5 Measure of harmful carbon there is plenty of help for those smokers monoxide levels in the who have a genuine desire to quit. There lungs and bloodstream are smoking cessation programmes 6 Stage of readiness kp hoto ge s, istoc available at IMH, Tan Tock Seng Hospital to quit smoking (TTSH), the National Healthcare Group Polyclinics (NHGP) and National Skin 7 Motivation to quit smoking Centre (NSC), with a wide range of services that can be individualised to meet each Based on these factors, the counsellor

hotos: ge tty i m a p hotos: smoker’s needs. Counselling is the most will formulate an individualised strategy to common smoking cessation strategy, help the patient quit smoking.

May - Jun 2014 lifewise 9 ( Quit it)

in cognitive therapy, counsellors increase awareness of the problems associated with smoking

nicotine in a slower manner compared to cessation, a patient is asked to imagine smoking. They also help to remove the unpleasant outcomes from smoking. habit of lighting up a cigarette by replacing The hypnotherapist might suggest that it with something more innocuous like cigarette smoke smells like truck exhaust chewing on a piece of gum. fumes for example, or that smoking will leave the mouth feeling extremely Changing Your Mind Mind Over Matter parched. The desired outcome is that these Cognitive-behavioural therapy has seen Despite the common reaction to the idea undesirable images deter the patient from increasing popularity in recent years, of hypnosis, which is considered by some craving a cigarette. largely due to smoking-cessation guru to be a mere magician’s parlour trick, Allen Carr’s Easy Way to Stop Smoking, it is actually a method that has been How Badly Do You which has become a popular alternative. proven in smoking cessation in recent Want To Quit? In general, cognitive-behavioural therapy years. In fact, some 30 medical staff from In the end, smokers must have a strong works by changing and restructuring TTSH completed smoking cessation personal desire to quit smoking for any thought processes combined with hypnosis training in 2009 to add the smoking cessation method to be effective. implementing new learning behaviours. method to their repertoire. For those who wish to do it on their own, “Through this type of therapy, During hypnosis for smoking it is important for them to set a realistic counsellors attempt to increase the smoker’s awareness of the potential problems related to smoking; the consequences experienced and risks faced as a result of smoking; as well as to help STOP BURNING YOUR MONEY! about breast cancer. the patient to envision a better future and NOT ONLY WILL YOUR HEALTH IMPROVE Be savvy become increasingly motivated to achieve THE MOMENT YOU QUIT SMOKING, BUT the disease entails. it. The ultimate aim is to help smokers YOUR FINANCES WILL AS WELL. Here’s what think differently about their behaviour and to consider what might be gained through changing their behaviour,” says Ms Gwee.

Need help quitting? Time after TTSH last cigarette: Savings*: Call 6889-4345 1 month $360 — A suit from H&M or 6889-4343 or a month’s supply of organic vegetables 3 months $1,080 — A designer handbag IMH or a new top-of-the-range smartphone Call 6389-2077 6 months $2,160 — A brand-name racing bicycle with a carbon fork NHGP or about 30 sessions with a personal trainer Call 6355-3000 1 year $4,380 — Round-trip economy-class airline tickets for two from Singapore to New York NSC (with shopping money to spare) or a two-day top-of-the-range spa retreat Call 6350-8454 for two at an award-winning five-star resort 3 years $13,000 — Five per cent cash downpayment HPB QuitLine for a 4-room BTO flat Call 1800-438-2000 or a new motorcycle or sms 9463-3771 10 years $43,800 — Tuition fees for a four-year NUS Business degree or a second-hand car

Based on buying 1 packet of cigarettes, which costs $12, per day 10 lifewise May - Jun 2014 * photos: istockphoto An Immediate Improvement Time afterlastcigarette Skin C Furthermore, thepremature ageing (hair loss) andpsoriasis (painfulor Senior Pharmacist at theNational itchy skinlesions), amongothers. according to MsGermaineChua, 2 weeksto3months that canbecausedby smoking is irreversible —althoughthe numerous skinconditions, healing ofwounds should entre. T Smoking isafactor in speed upwhen you 1 to9months DID Y 20 minutes KNOW? quit smoking. 10 years 12 hours 15 years hese include alopecia hese includealopecia 5 years 1 year

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angry,” says Ms Tiang. may feel help whenthey also stressed or techniques orcourses anger-management hobby, anew up Relaxation or skill. sport smoking. This through be picking could for theand gratification time they achieve encouraged to substitute find to activities todeciding smoking. quit agoal date as toquit work towards when t a tes Cener “Smokers to who wish are quit s for Disea as20minutes after that last cigarette. you quitsmoking?Effects canbefelt assoon Want to know how quicklyyour bodyhealswhen smokers who repla se C Your riskofcoronaryheartdiseaseisbacktothatanon-smoker’s of themouth,throat,oesophagus,bladder,kidneyandpancreasdecreases Your lungcancerdeathrateishalfthatofasmoker’s,andyourriskcancers Your strokeriskisequivalenttoanon-smoker’s Your riskofcoronaryheartdiseaseishalfthatasmoker’s Coughing andshortnessofbreathdecreases Your heartattackriskbeginstodrop,lungfunctionimprove The carbonmonoxidelevelinyourblooddropstonormal Your heartratedrops Effect c ontrol andPrevention,2004 or find an turnt t ce t hey used t he gr a 6355-3000 or visit www.nhgp.com.sg6355-3000 or visit . the NHGPContact Call Centre at or Yishun. Toa Jurong, Hougang, Payoh, Woodlands Kang, Chu Choa Clementi, Batok, Bukit theone Polyclinics of Mo —Ang Kio, at phone the on or online appointment for smokers help quitting. whoseek recommend tailored cessation programes areThey trained evaluate,to motivate and Smoking consultant. Quit have acertified Pharmacy, says that allNHGpharmacies are recommended. appropriate strategies and treatment quit which counselling during sessions Smokers are allages. of offered personal for patients cessationsmoking services to NHGP, home canvisit which offers and $7.45forsession, sessions. follow-up charges $15.45inclinic fees for the first for example, cessation clinic at TTSH, cessation programmes. The smoking fromcan choose many different smoking ctivties t Interested parties can book an canbook Interested parties fromMs Sandra Xu,apharmacist NHG closer looking Those something for more alittle who need Those help o hypnosis, wish t a o tific Ma get y - Jun 2014 li fewise

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( QUIT QUOTES) Going Smok e-free Through sheer willpower Najadi Abu Bakar and medical consultation, 39, Logistics Manager MR Najadi Abu Bakar’s these three stubbed out their first step towards quitting smoking was with the realisation cigarette addiction. that nicotine is a drug, and that smoking is a Interviews BY ALEX NGAI AND GENE KHOR drug addiction. “I realised that after 28 years of smoking, I was basically a drug addict, and that I would need all the help I could get their best not to smoke in my presence. to stop smoking,” says the 39 year-old. I took up jogging, and my cousin would For someone who had been smoking join me in a show of solidarity.” since he was 11 years old, quitting was The support he received from his almost unimaginable. “My friends and family was equally important. “I would colleagues are heavy smokers, so smoking — and still — go running whenever I feel has been a part of my social life. I would find like smoking, and my wife was always excuses to go for a smoke, and even found very supportive. Most importantly, my I had better discussions with my boss over a two young daughters actually policed cigarette than in the meeting room,” he says. my quitting by putting up ‘No Smoking’ The situation was so bad that when posters and checking my breath to make Mr Najadi was hospitalised at Tan Tock sure that I did not relapse!” Seng Hospital (TTSH) for chest pains in When things became unbearable, November 2013, he persuaded a relative the professional counsellors from the to smuggle cigarettes to him so he could Smoking Cessation Clinic were there sneak a puff the night before he was to have to help. “Quitting is as much a a coronary angiography, a procedure where mental thing as it is a physical a special dye is injected into the arteries to thing, and it was not easy to highlight any blockages in blood flow. That communicate these problems cigarette was his last. “I was able to Having the counsellors to witness the angiography first-hand. The doctor report to gave me an added explained that the blood flow in my heart was sense of responsibility. slow due to congested arteries caused by their professionalism was smoking,” Mr Najadi key to my success says. “I held the belief that things like heart disease would not with others. Having the happen to me. But when you see for yourself counsellors to report to in the follow- the damage smoking does, it becomes a up sessions gave me an added sense of wake-up call. I did not want to die so young.” responsibility, and their professionalism The next day, Mr Najadi signed up for was key to my success,” Mr Najadi says. the Smoking Cessation Clinic at TTSH. Physically, he feels much better — He was determined to make a clean break, being less breathless means he can and opted to go cold turkey rather than try run longer distances. More importantly nicotine replacement therapy. “The support though, his conscience feels better, I got from my friends and colleagues was as he does not worry about setting very crucial in the early days. They tried a bad example for his daughters.

12 lifewise May - Jun 2014 Smok e-free GUO XINHUI 27, IN THE MEDIA INDUSTRY Curiosity led Ms Guo Xinhui to try her first puff at the age of 19. She asked a friend for a cigarette. “It was really unpleasant,” recalls Ms Guo. “I felt really nauseous, but I continued to smoke one or two cigarettes a day to see if I could learn to pick it up.” She was soon smoking half a pack a day. Over six years of smoking, quitting never really crossed her mind, as she didn’t if you take notice any adverse effects. It only occurred to Ms Guo to give up smoking in August 2012 when she was having braces put in care of your her mouth. “As the braces partially concealed parts of my teeth, I was concerned that smoking would result in uneven tar stains body, it’ll take once the metal was removed,” she explains. “If not for this, care of you I probably would not have thought about quitting.” Ms Guo tried going cold turkey. She felt miserable with constant mood swings and hunger pangs on top of the cravings to light up. But she stuck it out and a week later, the urges subsided and she began to feel better overall. “You honestly don’t know how badly addicted you are until you try quitting,” she says. “No matter how bad I felt, OLIVIA NG I wanted to prove to myself that I could 39, PROJECT COORDINATOR quit on my own. It’s also why I didn’t Ms Olivia Ng picked up the habit at 14, and like call the QuitLine or see a doctor for many teens who experiment with smoking, it was assistance in this journey.” because of peer pressure. “When you see your friends Since kicking the habit, doing it, you don’t want to be the odd one out,” she says. Ms Guo’s teeth haven’t been the “Although I did not enjoy it initially, it made me feel like I was only thing that have benefited. “I no part of an exclusive group.” From smoking five cigarettes a day, longer smell like an ashtray,” she says. Ms Ng was soon buying a pack every two days. “I’m relieved that the frequent urges She stopped smoking after becoming pregnant in 2000, but to smoke no longer have a hold soon after giving birth to her daughter Tiffany, Ms Ng began on me and disrupt my life. I’ve puffing away again. “I was running a logistics business with also saved more money from a partner, so it was very stressful juggling that with my new not buying cigarettes, which responsibilities as a mother,” she says. “Going out for a smoke means I don’t have to be so was an opportunity to take a break and ease the tension.” tight with my spending!” But as Tiffany grew older, she would display displeasure whenever her mother lit up. Wanting to set a good example, Ms Ng had her final cigarette in 2009. “Besides being good You honestly for health, I wanted to show Tiffany that you can accomplish don’t know how anything you put your mind to.” Ms Ng was lucky — she says she didn’t suffer any badly addicted you withdrawal symptoms, which in most ex-smokers includes irritability and strong cravings. But she did notice a big are until you improvement in her health — since quitting she’s nearly try quitting doubled her fitness and can swim at least 15 laps at a go. “I was prone to asthma attacks, but these happen far less often now,” she says. “It really goes to show that if you take care of your body, it will take care of you.”

May - Jun 2014 lifewise 13 ( speak up)

MODERN TALKING With a combination of methods, speech therapists from Tan Tock Seng Hospital’s Speech Therapy Department are helping patients to eat or talk again. By Nirmala Sivanathan In Consultation With Ms Goh Cheng Jee Senior Speech Therapist // Speech Therapy Department // Tan Tock Seng Hospital

Imagine the frustration When Speech Stops of being unable to get a “There are two sub-categories of disorders mouthful of your favourite that can result in communication food past your throat, or being unable to difficulties,” says Ms Goh. “Speech disorders form the words to say something to a which affect our ability to pronounce or loved one. articulate, and language disorders.” “Frustration at being unable to do One example of a speech disorder is something as natural as eating or saying apraxia. Patients with apraxia struggle to something is one of the biggest challenges produce speech when they want to; they our patients face,” says Ms Goh Cheng Jee, struggle to talk even though the muscles Senior Speech Therapist in the Speech they need to perform the task are working Therapy Department at Tan Tock Seng properly. For example, these patients might Hospital (TTSH). “That is why early have difficulty putting syllables or words intervention is important — we need to together in the right order and end up reach out to the patient before he or she pronouncing words like ‘potato’ as ‘topato’. gets demotivated.” Another speech disorder is dysarthria, Speech therapists assess, diagnose in which the muscles for producing speech and treat patients who have difficulty have become weak or paralysed. Patients swallowing or communicating. with dysarthria are not able to make certain The department treats mainly adult sounds or words and might slur, mumble or damage to the brain, aphasia makes it hard patients whose conditions have arisen drool when speaking. for patients to read, or to write and say due to stroke or cancer, or those with Both disorders are the result of damage what they mean. degenerative diseases such as motor to the brain caused by brain tumors, cancers Frequently, patients might suffer more neuron disease or Parkinson’s Disease. and strokes. In addition, dysarthria may than one of these disorders at the same Patients are referred to the department also be the result of damage to the nerves time. For all communication difficulties, by TTSH itself, or by polyclinics and that supply the speech muscles, damage to the therapists at TTSH’s Speech Therapy community hospitals. the muscles themselves, or neuromuscular Department assess and diagnose the The department also collaborates with diseases such as cerebral palsy. patient using a combination of specialised the Ministry of Health to provide regular Language disorders such as aphasia tools and simple charts, and treatment is service to nursing homes around Singapore. also make speaking difficult. Caused by customised to individual needs.

14 lifewise May - jun 2014 A patient having problems writing, for Patients might have difficulty or pain when example, will be recommended a treatment swallowing and some might not be able to plan where he or she writes letters of the swallow at all. alphabet before progressing onto simple Therapy for swallowing difficulties phrases and sentences. And a patient who may be carried out with the use of Digital can’t talk clearly due to weak muscles will Swallowing Workstation (DSW). The be taught exercises to strengthen his or her DSW has a probe attached to the patient speech organs. that monitors in real-time how he or she “Because no two patients have the swallows, and can detect where the difficulty same problem, our treatment plans target a lies. It is important to catch and treat patient’s specific deficits,” says Ms Goh. Each swallowing problems early on as they can be course of treatment typically lasts six weeks potentially fatal, as swallowing difficulties and consists of weekly hour-long sessions. can lead to dehydration, malnutrition and in Patients are also given exercises to severe cases, pneumonia. Ther-app-y complete at home during the week and their Patients with swallowing difficulties are is at Hand goals are reviewed as they go along. assessed to find out what type of food or fluid consistency they are able to handle. For people having trouble Can’t Swallow “We also look at things such as whether speaking, there are plenty of Swallowing difficulties are frequently the their muscles are intact and how strong or smartphone apps* available on result of other conditions such as strokes, weak these muscles are,” says Ms Goh. the three major platforms. A search of the various app head or spinal cord injuries, or nervous For both language and swallowing stores yielded the following: system diseases such as Parkinson’s. difficulties, the speech therapists work as part of a team that includes various medical Apple iOS and allied health professionals. SpeechBox is a customisable In the case of swallowing difficulties, tool that helps mostly younger the speech therapists work with dietitians patients with apraxia and other to make food recommendations. The speech difficulties to practise speaking. therapist is also then able to put together an appropriate treatment plan. This involves Android teaching patients how to swallow safely as SpeechCompanion Speech well as exercises to strengthen the muscles Therapy has videos with speech used in swallowing. therapy exercises, and features a mirror function for patients Tech Talk to self-assess their progress. Speech therapists tap on innovations, Windows Phone both simple and advanced, to help Vox4All is an augmentative patients with communication and and alternative communication swallowing difficulties. Low-tech system which helps patients innovations include individualised young and old whenever communication charts that help patients communication is compromised. regain their ability to communicate. *please note that the apps listed have “With these customised charts, we not been tested by Lifewise. involve both the patient and their family members,” says Ms Goh. “Family members Senior Speech Therapist can help us understand exactly what Ms Goh uses machines to the patient needs to communicate for diagnose problems with daily life, which helps with their home- The department has also gone high- language and swallowing. based therapy.” tech. Dysarthria patients can use iPad applications which visually demonstrate how to perform swallowing or muscle- strengthening exercise regimens between Patients with Apraxia might have therapy sessions. Patients with trouble speaking can use difficulty putting words together and apps to ‘speak’ for them, with phrases such end up pronouncing words like ‘potato’ as “I am hungry”. There are also language

c k ang, shuttersto apps to treat aphasia which help patients as ‘topato’. Other patients might relearn their language and writing skills. Says Ms Goh, “We focus on a patient’s have pain while Swallowing or not strengths and use these to boost their weaknesses — this helps motivate them to photos: W ilson P photos: be able to swallow at all. engage in therapy.”

May - jun 2014 lifewise 15 ( JOBSCENTRAL Survey) GAIN employment

weightA survey by employment portal JobsCentral finds that most workers have put on the pounds since starting work. g es photo: Getty I ma photo:

16 lifewise May - Jun 2014 Workers put on Average Weight Average Weight Gain an average of Gained (kg) 62% by Years of Work Experience of workers have 20 3for everykg gained weight year of work since starting work 15 14.4 13.8 13.2 12.4 12.7 11.1 11.4 12.1 13.6 Top 3 jobs 12.3 11.8 10 9.4 10.6 with the… 6.5 8.8 Most weight gainers 5 Years of 76.2% Events Work Management 0 Experience 73.0% Analyst 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ 68.4% Finance Least weight gainers Largest surge in weight occurs in 53.6% Legal, Military/Uniform the first year of work and stabilises after10years of work 54.2% Risk Management, Education/Training 58.2% Writing/Editorial Workers blame their weight gain on… Lack of time or energy to exercise 76% Too much sitting all day long 63% Eating more due to stress 48% ‘Desserts’ is ‘stressed’ Slower metabolism from age 44% spelled backwards... Too much snacking or unhealthy food 35% Stress-eating can be due to cravings Consuming high-calorie food due to higher income 16% driven by high levels of the stress hormone Picking up bad eating habits from colleagues cortisol. A moderate amount of cortisol 11% is beneficial, but high levels over an Over reliance on personal transport 7% extended period can lead to health problems. It can also lead to cravings and result in junk food binges. weight gain Instead of eating when stressed — between snacking on healthier foods is not the both genders answer — we help stress-eaters identify their stressors to help them overcome it.” Weight-gainers Ms Pauline Xie make up… Senior Dietitian // Collaborative Care Unit // 64% of Women vs 60% of Men Clinical Services // National Healthcare Group Polyclinics Though… Gained an Gained an average of average of Overcoming stress-eating 9kg 14kg according to Ms Pauline Xie

There is more risk of obesity Identify Keep a Don’t eat the difference stress-eating mindlessly. with a sedentary lifestyle. between diary. Keep Keep a list When you sit for extended periods, the body’s physical and a log of your of alternatives metabolism slows down and fewer calories are burned. emotional food and to stress- Key flab-burning enzymes start to switch off. Your hunger. mood. eating. risk of heart disease is thus increased. The chance of contracting diabetes goes up. You’re more prone to Ask yourself, “Are Think back to events Avoid distractions depression — with less blood flow, fewer feel-good you really hungry?” that led up to the when eating and hormones reach the brain. If you crave specific binge. You might take the time to Even a 30-minute exercise regime every day is not foods or the urge notice a pattern of know what you are enough to combat the ill-effects of prolonged sitting comes on suddenly, bingeing during times consuming and how for eight to 10 hours daily. In a recent study, people you are unlikely to of unusual stress it is prepared. When who took more breaks from sitting had slimmer waists, be physically hungry or critical deadlines. cravings hit, think lower body mass indexes and healthier blood fat and — especially if the Once you identify of an alternative to blood sugar levels than those who sat the most.” eating is associated what these triggers eating — call a friend, Ms Samita Dayal with guilt and a are, you can slowly go for a short walk, or Physiotherapist // Collaborative Care Unit // lack of control. overcome them. take a shower to relax. Clinical Services // National Healthcare Group Polyclinics May - Jun 2014 lifewise 17 ( A DOC’S PERSPECTIVE)

As a psychiatrist, I have, every now and then, a patient who admits to making a recent suicide attempt. Such information invariably causes me a surge of anxiety. With the spectre of an actual suicide looming, I respond by carrying out as detailed an assessment as possible. Then, I do what I can to prevent it from happening. In my case, however, this almost never includes cautioning my patients that they have committed a crime. It doesn’t seem appropriate or even right. And just occasionally, I wonder — at the back of mind (poorly schooled in legal matters) — if I would be considered an accessory to a crime for not reporting it to the authorities. The Law Against Suicide Ensconced within Singapore’s Penal Code is Section 309, which makes an act of attempted suicide punishable with a year’s jail sentence, a fine, or both. This provision, which is a legacy of British colonial laws, has its roots in Christian theology. In the fourth century, St Augustine denounced suicide as a mortal sin. He did this apparently to staunch the wave of Christians who were killing themselves because of religious persecution. He justified his position by basing it on an interpretation of the sixth biblical commandment — thou shalt not kill. Killing oneself, St Augustine argued, was also killing the “image of God” Should since the Bible said that men were created in God’s image. This led to draconian laws against suicidal acts, reaching their peak in the Middle Ages when the corpse of one who committed suicide would be mutilated and his property confiscated by the state. SUICIDE With time, however, there was a gradual shift in public perceptions. Religion lost its predominant and central role in Western societies which became more be illegal? secularised. A more philosophical and intellectual view of suicide softened the hardline religious stance, and suicide was seen less as a sin and more a social or medical problem. CRIMINALISATION MAY NOT AID THOSE Many countries also began to decriminalise suicide. But there are still a AT RISK IN GETTING NECESSARY HELP. by Associate Professor Chong Siow Ann number of countries, including Malaysia Vice-Chairman Medical Board (Research) // Institute of Mental Health and Singapore, where attempted suicide is still a crime.

18 lifewise May - Jun 2014 Helplines Polemics Of The Law contemplating suicide, this law might  S amaritans There are a number of arguments in favour possibly make such a person even more Of Singapore of the law. An anti-suicide law might be seen resolute, encouraging him or her to resort Call 1800-221-4444 as a demonstration of a society’s emphasis to an even more lethal method. They also  S ’pore Association on the sanctity and inviolability of human noted that even if this law were abolished, for Mental Health Call 1800-283-7019 life. A less lofty but utilitarian reason is there is the extant Mental Health (Care and that a human life also has economic value: Treatment) Act, which would still empower  Care Corner Counselling Centre Governments have invested in their citizens the police to ensure that those who harm Call 1800-353-5800 through the provision of education, security themselves would receive medical treatment.  and other social goods. A suicide, therefore, (The person concerned, however, must, AWAR E Call 1800-774-5935 represents a loss of an investment. Suicide in the wording of this law, be “reported to might also be viewed as a selfish act that be of unsound mind” and “believed to be hurts loved ones. dangerous to himself or other persons by An attendant fear is that we might reason of unsoundness of mind”.) be led to that “slippery slope” towards For some who try to harm themselves, following abolition of the law as compared legalising euthanasia and assisted suicide. such acts might be impulsive. For others, with the five years prior). But, in a separate There are however specific laws in they might be an inchoate means of getting analysis where these two countries were Singapore that make abetting suicide a attention. Research in many countries has grouped with England, Wales, Ireland, Hong crime. Britain has decriminalised suicide found that over 90 per cent of those who Kong and Sweden, there was an increase and suicide attempts, but it is still an committed suicide suffered from mental in the average rate of all seven territories. offence to assist another person to die by illness at the time of their deaths. In fact, It was noted, however, that the rate was suicide. This situation regarding abetting major depression occurred in about 60 per already increasing in Sweden even before the prompted Britain’s Parliamentary Under- cent to 70 per cent of cases. Most, therefore, law was dismantled. Secretary of State for Justice to comment needed some form of help. The risk of legal This is not surprising. If anything, it on the “unusual nature of the offence”. sanction, it has been argued, may make it underscores the extreme complexity of It is something that carries “accessory even more daunting for suicidal individuals suicide. There are a myriad factors that push liability in respect of something that is not to receive the necessary assistance. people to take their own lives, including of itself criminal”. those that are unique to that person. There Early this year, Ms Corinna Lim, Helping The Suicidal is also that array of external and societal Executive Director of the Association of Very few cases of attempted suicide actually stressors that differ in time and place. They Women for Action and Research (Aware), reach the courts. If hospitalised, the people all interact in very complex ways. and Ms Porsche Poh, Executive Director concerned would most probably be referred Reducing suicide obviously requires more of Silver Ribbon Singapore, argued for the to a psychiatrist for an assessment. The than the law. It requires a concerted effort decriminalisation of attempted suicide police ask the psychiatrist for a report, of multiple initiatives involving all segments in Singapore. In an article on the Aware and most — as I have done on numerous of society, which is why some countries have website, they commented that while most occasions — invariably write a sympathetic a national suicide prevention plan. arrests for attempted suicide do not lead to assessment. The police then issue a warning “The moral test of government,” said criminal charges, the whole police procedure and no further action is taken. American statesman Hubert H Humphrey, is “traumatising” for the person concerned It is difficult to know for sure if this “is how that government treats those who and might “aggravate distress by adding a law has the desired deterrent effect — it are in the dawn of life, the children; those sense of grievance towards the legal system”. remains very much a postulate. Trend who are in the twilight of life, the elderly; And if someone were truly analyses of suicide rates in countries and those who are in the shadows of life, following decriminalisation have given the sick, the needy and the handicapped”. mixed results. There were no increases in Many of those who kill themselves, or Canada and New Zealand (in the five years attempt to do so, are either in the dawn, twilight or shadows of life. And that may be the nub of the matter. It is about how Reducing suicide obviously we as a society, with our intelligence, sensibilities and decency, respond to them requires more than the law. and to a law that has, perhaps, become It requires a concerted an anachronism. effort of multiple A/Prof Chong sits on the board of Silver g es, SH utterstock Ribbon Singapore, a non-profit organisation initiatives involving founded to foster a positive attitude towards all segments of society. mental health issues among the community. A/Prof Chong siow Ann, Vice-Chairman Medical Board This Article first appeared in the

photos: Getty ima photos: (Research), Institute of Mental Health 22 Feb 2014 edition of The Straits Times.

May - Jun 2014 lifewise 19 ( SLEEP DEBT)

UallP night Tossing and turning past your bedtime? Here’s how to get a good night’s rest. by GENE KHOR in consultation with Dr CHONG YAW KHIAN ENT CONSULTANT // SLEEP DISORDER CLINIC // DEPARTMENT OF OTORHINOLARYNGOLOGY // TAN TOCK SENG HOSPITAL AND Dr WONG MEI YIN PRINCIPAL PSYCHOLOGIST // COLLABORATIVE CARE UNIT // NATIONAL HEALTHCARE GROUP POLYCLINICS

20 lifewise May - Jun 2014 Insomnia can have a huge psychological impact and result After a long day, few things are more appealing than diving into in poor work performance. bed. So, you lay your head on your pillow, close your eyes and wait for sleep ... which It significantly decreases the never comes. Only after much tossing and turning and counting of sheep do you finally slip sufferer’s quality of life. into slumber. But by then, it’s too late and you’re left with only a few hours of shut-eye before you have to get up. In Singapore, acute insomnia is the more common If this sounds familiar, you are one of many people type. “This is likely to be due to our hectic, fast-moving who suffer from a sleep disorder. According to the lifestyle,” says Dr Chong. At the Sleep Disorder Clinic, Philips Index for Health and Well-being, a survey about 15 per cent of patients suffer from insomnia. conducted across 23 countries including Singapore by electronics manufacturer Philips and released in What Causes It? March 2011, 35 per cent of people felt that they did Is one bad night’s rest a sign of insomnia, or must it not get enough sleep. be a prolonged problem? According to the Diagnostic One of the most common sleep disorders is and Statistical Manual of Mental Disorders (DSM-5), insomnia, where the individual is unable to fall asleep a widely-used diagnostic handbook published by the or has difficulty in staying asleep. American Psychiatric Association, there are several Dr Chong Yaw Khian, Ear Nose and Throat criteria to diagnosing insomnia: Consultant at the Sleep Disorder Clinic at the Department of Otorhinolaryngology in Tan Tock £ Difficulty initiating and maintaining sleep — Seng Hospital, explains that insomnia sufferers are frequent awakening or problems returning at increased risk of developing hypertension and to sleep thereafter other heart diseases, as well as diabetes and obesity. £ The sleep problems cause significant distress “It can have a huge psychological impact on the or impairment at work/school or in individual and result in poor work performance, social situations memory loss, slow reaction time, irritability and a £ It occurs at least three times a week higher risk of depression and anxiety,” he says. “Studies £ It occurs for three months or more have also shown that insomniacs have a higher incidence £ Sleep problems happen despite having of road-related accidents. Insomnia significantly adequate opportunities for sleep decreases the sufferer’s overall quality of life.” £ The insomnia is not better explained by the Insomnia can be acute (lasting a few nights to a few presence of another sleep disorder or by weeks) or chronic (occurring three nights a week for a psychological effects of a medical substance ge s month or longer). It is common for insomnia to come and go, with periods of no sleep problems. The first step in dealing with insomnia is to People of all ages can be affected, recognise what causes it. There are two types of although those more likely to have insomnia. Primary insomnia is insomnia that it are people above the age of does not have any apparent contributing factors — hotos: G e tt y i m a p hotos: 60, those with a history of although sometimes life stress and emotional turmoil mental health disorders like can trigger it. depression, or those who Secondary insomnia, however, is brought about work late-night shifts or by a variety of external factors. According to Dr Wong who frequently travel Mei Yin, Principal Psychologist from the Collaborative across time zones, such Care Unit at National Healthcare Group Polyclinics, as airline crew. common causes include but are not limited to:

 Psychological stressors: Worrying about work, studies, health or family can keep the mind Avoid stimulation active at night and make it difficult to sleep. from streetlights or traffic noise Going through emotionally-trying events like — wear a mask or the death or illness of a loved one, a divorce, earplugs if needed. or job loss can also lead to insomnia.

May - Jun 2014 lifewise 21 ( SLEEP DEBT)

 Medical conditions: People with chronic pain, Snooze Solutions breathing difficulties or the need to urinate After identifying the cause of your insomnia with a frequently might develop insomnia. Other doctor’s help, treatment can be prescribed. But in many conditions that cause insomnia include having cases, Dr Chong says that beating insomnia, whether arthritis, cancer, lung disease, and having had primary or secondary, is simply a matter of practising heart failure and stroke. good sleep habits. For a better night’s rest, avoid:  Poor sleep habits: Insomnia can stem from having an irregular sleep schedule, doing things £ taking daytime naps that stimulate the brain just before bed, or being £ caffeine, nicotine, and in an uncomfortable sleep environment. alcohol late in the day Beating insomnia  Medication: Many prescription drugs can £ exercising within three to interfere with sleep like some antidepressants, fours of bedtime as it may is simply a matter heart and blood pressure medication, allergy stimulate you medication, stimulants and [steroid hormone] £ eating a heavy dinner of practising good corticosteroids. (although a light snack  Lifestyle factors: Eating heavily late in the before bedtime may help sleep habits. evening may cause physical discomfort before you fall asleep easier) Dr Chong Yaw Khian sleep. Drinking coffee, tea and other caffeinated £ stimulation from streetlights or drinks in the late afternoon or later can affect traffic noise — wear a mask or earplugs if needed sleep. Nicotine in tobacco products is another £ using your bed for anything other than sleep or sex stimulant that can cause insomnia. Alcohol is £ worrying about things at bedtime — make a a sedative that may help in falling asleep, but it to-do list before bed prevents deeper stages of sleep and often causes £ sleeping next to your mobile phone — and if awakening in the middle of the night. you must, silence it totally  Additional causes: Other possible reasons such as a change of environment or work schedule Dr Chong adds that practising a good sleep routine by which disrupt the body’s sleep cycle or sleeping going to bed and getting up at the same times every day, beside a partner who snores can cause insomnia. can help you avoid insomnia. LW

to Tan Tock Seng Hospital’s WHAT IS Dr Chong Yaw Khian. “One possible explanation for SLEEP APNOEA? John’s condition is that his airway collapses several Besides insomnia, which affects times while he sleeps, one’s ability to get to sleep or stay which causes him to stop asleep, other conditions can get in breathing,” says Dr Chong. the way of a restful slumber. “As a result, vital organs like One of these conditions is his brain and heart don’t obstructive sleep apnoea, in which receive enough oxygen, one’s airway is partially or completely which would lead to him blocked temporarily, affecting waking up and not feeling breathing. In some, this obstruction refreshed. If his condition can occur hundreds of times a night, continues without being according to health portal WebMD. addressed, it could lead to “Every night since August 2013, his smartphone and computer at increased risks of cardiac problems I’d wake up feeling like I hadn’t slept, least an hour before he went to bed, like heart attack and high blood even though I thought I’d had at least sometimes as early as 9pm. pressure, or stroke.” eight hours’ sleep,” says John (not However, his condition did not At the time of writing, John his real name), who is in his mid-30s. improve. “It really affected my was scheduled for an in-hospital “At first, I passed my constant fatigue social life — all I could think about level 1 sleep study during which off as a result of a hectic day at was going home to sleep,” he says. his entire sleep profile and work. But, as my daytime exhaustion “I didn’t want to hang out with my biophysical parameters are analysed. persisted, I changed my sleep habits girlfriend and friends — it was a chore Thereafter, he will be given an to try and improve my situation.” to remain focused and have a simple appointment to see Dr Chong at John started exercising regularly conversation with them.” the Sleep Disorder Clinic. Further and stopped going out late at In January this year, after seeking management of John’s condition will night. He also stopped checking medical advice, John was referred depend on his sleep study results.

22 lifewise May - Jun 2014 In Person

Plugged In ASSOCIATE PROFESSOR DANIEL FUNG, 47, CHAIRMAN, MEDICAL BOARD, INSTITUTE OF MENTAL HEALTH, on HOW HIS WORK AWAKENS THE CHILD IN HIM. Interview Alex Ngai

“I HAVE BEEN A TECHNOLOGY and science-fiction fan ever since I was a boy. I am from the same generation as Steve Jobs and Bill Gates, so computers were very exciting at the time. Not only did I join the computing club at school, I taught myself to code using BASIC, a programming language. It was thus a surprise to many that I pursued medicine instead of computing. But I felt that studying medicine would allow me to help more people — after all, technology is a big part of the medical field. Studying medicine allowed me to meet ELIZA. That is not the name of my wife — who is Joyce — but a virtual counselling programme! It was programmed to make simple conversation using a very early form of Artificial Intelligence, and meeting ELIZA was like coming face- to-face with something out of my favourite sci-fi novels. Some people think technology is very ‘cold’, a concept that is at odds with being a psychiatrist, who is basically a ‘doctor for your feelings’. Well, ELIZA was an early attempt at creating a virtual ‘friend’, and my favourite sci-fi author Isaac Asimov’s Foundation series is a story about using science and psychology to predict human behaviour. Personally, I’ve never felt the two to be different; rather, I believe them to be complementary. I have always felt that technology can be an important tool in helping to treat or prevent mental problems. Take video games, for instance. People do complain about violence in video games, but there are many games that are educational and condition the mind to cultivate positive behaviours. Video games today are a big part of many people’s lives, so instead of laying blame on violent games, it would be better to encourage the development of ‘good’ video games that can help people. I think the reason why my work is focused on treating behavioural problems in children is because there is still a child in me. I am a father of five. I love there are many games working with children, and I like to combine this with that are educational my other interests, which are finding new ways of using and condition the technology and video games to help people. mind to cultivate I play video games regularly and own several positive behaviours consoles at home. So, although some people think I am a workaholic, the truth is my work is something that I enjoy doing in my own personal time.” photo: wilson pang photo:

may - jun 2014 lifewise 23 may - jun 2014 lifewise 23 In Person

Relishing The Challenges Despite the demands of her job, weekends for the HEAD OF ANG MO KIO POLYCLINIC, 42 Year-Old DR KAREN NG, Are all about her family. Interview WANDA TAN

“My life is A constant juggling act, balancing work commitments with family responsibilities. I also have to split my time at work between various job demands. But despite the challenges, I wouldn’t trade any of it for the world. I first joined National Healthcare Group Polyclinics (NHGP) in 2000 as a family medicine trainee at Toa Payoh Polyclinic, and have been Head of Ang Mo Kio Polyclinic since November 2006. Most of my time is spent with patients. I spend about three half-days a week at the Family Physician Clinic and the rest of my time at the General Clinic. I also often have staff meetings as well as discussions with colleagues from other institutions. As a family physician, I see a wide spectrum of clinical cases, from neonatal jaundice and developmental progress checks for children, to acute problems like back pain and chronic conditions like diabetes. I also build long-term relationships with patients at the Family Physician Clinic which provides personalised care for those with chronic conditions like diabetes and hypertension. I also teach medical undergraduates, as well as Medical Officers on six-month rotations. Moving forward, I see the primary care landscape changing to meet Singapore’s ageing population. There is a greater focus now on prevention as patients are more aware about the importance of a healthy diet and regular screening. At NHGP, we have adopted a more collaborative approach and work with nurses and allied health professionals to provide multi-disciplinary, team-based care. We also exchange ideas with hospital consultants and specialists about improving patient care. Time management is probably my number one concern. At work, I divide my time between clinical sessions, teaching and running the polyclinic, as well as planning the training and development of staff. I also have to make time for my family so that my Despite the challenges husband and children — aged 12 and nine — are not of juggling work neglected. Luckily, I have strong family support. My commitments and family parents look after the kids during the week, and my lawyer husband loves spending time with the children on Saturday duty, I wouldn’t trade mornings while I work. I fill my weekends with fun family any of it for the world activities such as going to the park — being outdoors helps me recharge. I also swim on Sundays while my kids are having their swimming lessons.” photo: Kelvin Chia Kelvin photo:

24 lifewise May - Jun 2014 24 lifewise May - Jun 2014 Read Lifewise Learn about hea l th with advice o nline! from experts, and introduce Lifewise to your friends. Visit www.nhg.com.sg for our free archive of past issues.

Steve Zhu, 56, photographer “As a photographer, I find that the Dhany Osman, attractive pictures 33, sub-editor in Lifewise really “I find the interviews complement that Lifewise does the stories and very insightful, and, make them more at times, inspiring.” engaging.”

FAZLINA MANSOR, 32, civil servant “The topics of health and medicine could come across as rather dry if not approached sensitively, but I enjoy Lifewise because the stories are easy-to-read, informative and engaging.” VANESSA MANIAM, 50s, legal secretary ALBERT PANG, 20s, student “Lifewise is very informative “The diversity of topics makes Lifewise an and helpful, particularly at entertaining read. As a fitness buff, I enjoy my age. It is colourful and the Workout section most as it offers many attractive, and the design is well-researched suggestions on improving certainly eye-catching.” my exercise routines, such as knowing which sports accessories are useful.”

May - Jun 2014 lifewise 25 ( silverglow)

HERE’S HOW THE PIONEER GENERATION PACKAGE — announced in the 2014 budget — WILL BENEFIT SENIORS. by ALEX NGAI Supporting aGENERATION With the release The Pioneer Generation will enjoy the following benefits for life: in February of the Singapore Budget Outpatient care for Financial Year 2014, the Pioneer Generation Package has become a hot topic. 50% discount off the net bill for subsidised services Lifewise takes a look at who benefits from the at Specialist Outpatient Clinics (SOC) and polyclinics. package and how it will affect them. These will be implemented from September 2014. Showing Appreciation SOC Services Subsidy Rates for Pioneer Generation: The Pioneer Generation Package is a show Monthly household Annual Value of Subsidy (with Subsidy for income per capita home (for those effect from Pioneer Generation, after of appreciation for the contributions without income) 1 Sep 2014)* further 50% discount Singaporeans aged 65 and above have made to the country. Citizens born in 1949 and Up to $1,100 Up to $13,000 70% 85% earlier and who received their citizenship by $1,101 to $1,800 $13,001 to $21,000 60% 80% 31 December 1986 qualify. The vast majority of the Pioneer Generation will automatically More than $1,800 More than $21,000 50% 75% receive their benefits and do not need to take *Current SOC subsidy is about 50% on average. any active steps to enjoy the benefits outlined in the package. Letters will be sent out in All members of the Pioneer The Pioneer Generation August 2014 to all eligible citizens to inform Generation will be placed on an them of the benefits they will receive. Disability Assistance enhanced Community Scheme will provide Healthcare Assist cash assistance of Scheme (CHAS), which provides subsidies $1,200 a year for outpatient and dental to help those treatments. Those already with moderate to on CHAS will enjoy severe functional additional subsidies. disabilities.

26 lifewise May - Jun 2014 Announced by the Prime Minister during the What Is 2013 National Day Rally, Medishield Life is meant to provide universal healthcare coverage to all Medishield Singapore residents for their lifetime. To be implemented in 2015, Medishield Life will provide Life? better coverage for large subsidised bills and provide assurance that all Singaporeans will be covered for life for subsidised bills, regardless of how their circumstances change. Benefits and payouts are designed to rise as Singaporeans grow older in order to offset increasing healthcare costs for common medical problems that come with old age. The target is to offset larger healthcare bills that may come with accidents or serious illnesses, bills that may not be affordable for a large portion of Singaporeans.

With all these measures which will be with those who are staying with parents, progressively introduced in the coming grandparents or great-grandparents months, a comprehensive package is receiving more relief. thus created which helps offset the cost The Pioneer Generation Package will of living and healthcare for our elderly. also include all Singaporeans aged 80 In addition, Singaporeans aged 55 and and above in 2014 in the Medishield Life above who do not qualify for the Pioneer scheme, with their premiums fully covered Generation Package will not be left out through premium subsidies and Medisave either. They will receive annual Medisave top-ups. Those aged between 65 and 80 top-ups of $100 to $200 over the next five will have about half of their Medishield years. Additionally, a Senior’s Bonus of Life premiums covered by the package. $100 to $250 will be given out in the form For A/Prof Chin, placing the whole of GST Vouchers. pioneer generation on the Medishield Life scheme is a strong statement by the GENERATIANNUAOL MedisaveN ‘Big Enough’ To government. “What can happen without Have An Impact a national health insurance is that there Top-ups of $200-$800 Associate Professor Chin Jing Jih, can be a lot of cherry-picking. People who paid out from August 2014. Director of the Institute of Geriatrics and are genetically unfortunate or people who Age in 2014 Annual Medisave Active Ageing and Divisional Chairman can’t afford premiums can be left out. (Year of birth) Top-Up (Integrative and Community Care) at “Having a national health insurance 65– 69 ( 1945-1949) $200 Tan Tock Seng Hospital believes that the model is a very powerful statement. package, for which $8 billion was set aside It says that this whole nation has a 70 –74 ( 1940-1944) $400 in the Budget, is large enough to impact certain solidarity and compact between the lives of older Singaporeans. “Many the healthy and unhealthy, those who 75–79 ( 1935-1939) $600 seniors in the pioneer group are concerned can afford and those who can’t afford,” 80+ ( 1934 and earlier) $800 that they will be a burden to their families. he said, further adding that the Pioneer Psychologically, the package has the great Generation Package is a message from effect of giving the comfort that there the government that “as long as you have special subsidies is a lot of backup,” A/Prof Chin said in contributed to the building of Singapore, for MediShield an interview with website Singapolitics. it doesn’t matter whether you are now “It also is a great relief to the children, financially successful or not, whether Life premiums grandchildren or relatives responsible for you live in a bungalow or you live in a The Pioneer Generation will the healthcare needs and costs of these HDB flat”.LW receive a special subsidy for senior citizens.” their MediShield Life premiums Family members and caretakers starting from 40% of their premium will be glad to hear that the Pioneer at age 65, rising to 60% of their Generation Package will also premium at age 90. The Pioneer introduce the Pioneer Generation Psychologically, the package Generation can expect an Disability Assistance Scheme, which average of at least 50% will provide cash assistance of $1,200 has the great effect of subsidy over their lifetime. 60% a year to help those with moderate to severe functional disabilities. On giving the comfort that top of that, parent and handicapped parent tax reliefs will be raised by there is a lot of backup. 40% up to $3,000 from 2015 onwards, A/Prof Chin Jing Jih 65 90 YEARS YEARS May - Jun 2014 lifewise 27 ( Lifespaces) En UTE O With THE open road R ahead of you, going on a road trip is arguably one of the to good most liberating vacation experiences out there. Although getting around by plane or train is usually quicker and perhaps more convenient, there is little to touch the relaxing feeling of cruising cross-country, health watching often-unfamiliar scenery whizz by, with friends or loved ones by your side. Going on a road trip? But driving long-distance can also be here's how to stay well. hazardous if you don’t follow some simple rules. So stay safe and healthy with the by WANDA TAN following tips. CK S : SH U TTE R STO photo

28 lifewise May - Jun 2014  STAY ACTIVE Slouching in your seat can also induce The longer the distance covered, the longer lethargy — besides promoting back pain — your movement remains limited in the car, so practise good posture by sitting straight raising the likelihood of developing deep with your head up, your shoulders square vein thrombosis (DVT). DVT is a blood and your back against the seat. clot that usually forms in the legs, and More importantly, a proper driving symptoms of this include cramp-like pain position is crucial for safety. The United and swelling in the affected limb. The danger States National Highway Transport Safety of DVT is that this clot can be dislodged and Administration outlines the following: If you travel through the blood to the lungs and are driving, sit as far back as possible while block the flow of blood to them, a condition still being able to fully depress all the pedals. called pulmonary embolism which is The steering wheel should be adjusted to potentially deadly. face your chest rather than up to your face. DVT is usually associated with air travel Recline the seat a little but keep enough but it can affect anyone who sits still for space between you and the steering wheel. periods of four or more hours, according to And always ensure you are buckled up in the  STAY NOURISHED online health portal WebMD. Move your car, no matter which seat you’re in. Road trips tend to go hand-in-hand with feet every now and then while in the car Get a good night’s sleep beforehand so convenience foods like potato chips and and drink enough fluids to maintain blood that you are well-rested for the drive ahead candy bars, and highway rest stops circulation. The Automobile Association — make sure you get the recommended six are often stocked with quick and easy of Singapore recommends that you stop to eight hours of sleep the night before. (but very greasy) food. every two hours for a break — which So before setting off, you  DON'T RESIST should pack nutritious, easy-to- THE URGE eat foods to munch on — just Whenever you stop to stretch, empty make sure to pull over at a rest your bladder as well. According to area to eat them. A good idea is the US National Institutes of Health, a to put fresh fruits and cut-up bladder holds about 500ml. When half vegetables such as apples and full, it triggers the urge to urinate. Don’t baby carrots in a sealed container, ignore the urge to wee — if you hold it and store it in a portable cooler in for too long, this may overstretch or for optimum freshness. Raisins, weaken bladder muscles over time, almonds and other dried fruits causing incontinence or a loss of and nuts also make good snacks. bladder control. And if you have to have crisps or Another consequence of urine crackers, choose those with the retention is urinary tract infection Health Promotion Board (HPB)’s (UTI). This occurs when bacteria Healthier Snack Symbol on their label, as is especially important for the driver who from the intestines enter the these come in small packages and are lower wouldn’t have the chance to move much. urethra, through which urine in saturated fat, sodium and sugar. Walk around and do stretching exercises to passes from the bladder and out Do not skip breakfast, no matter how loosen leg, shoulder and neck muscles which of the body. Urinary flow flushes early you start your journey. Otherwise, may have tensed up. bacteria out of your body. So, the your energy and concentration levels may In addition, driving for long periods of longer you hold your urine, the more time flag as the day progresses, and your driving time can become monotonous, so be wary bacteria has to multiply within the urinary ability will then be impeded. of mental fatigue as well. Keep your mind tract, worsening UTI symptoms such It is crucial to stay hydrated in order active by listening to music or talking to as a burning sensation when peeing and to oxygenate your body and remain alert, your travel companions. a frequent need to relieve yourself. LW so bring enough water along. HPB has also labelled some isotonic drinks, fruit juices and other beverages with the Healthier Choice Symbol, indicating that these have less sugar than the usual soft drinks. OUTDOOR CARE INSIDE THE CAR Caffeine-laden beverages like coffee You should be wary of overexposure to the sun on long daytime and tea may help you stay awake while drives, just as you would if you were outdoors — even more so driving, but when consumed in excess, if the car's windows are untinted. Sunburn is not only painful caffeine will increase your need to go to but also increases the risk of skin cancer later in life. To protect the bathroom — something to note if skin from harmful ultraviolet rays, apply some broad-spectrum you are on a route without convenient sunscreen — an SPF of 30 will do — on arms, nose toilet facilities. and other exposed skin areas, and reapply it often. HPB advises that caffeine intake Don’t forget to protect your eyes too with should be limited to two cups of coffee a good pair of sunglasses. In particular, polarised or four cups of tea per day. sunglasses have the added benefit of reducing sun glare, making driving safer and more enjoyable.

May - Jun 2014 lifewise 29 ( Workout)

But before you cancel that gym membership, it is important to note that another 10 per cent of the participants We might have all heard showed improved results in at least it before: exercise improves one measure of heart disease risk, with and prolongs life. But is this improvements ranging from 20 per cent always true? to 50 per cent. From causing muscular injury if not done right, to damaging the heart — in You’re Doing more ways than one — exercising can It Wrong occasionally have detrimental effects. There are countless ways to build muscle and lose fat, but these Heart Effects exercises would be for nought if According to a study released by scientific your training technique is wrong. journal PLOS ONE in May 2012, exercise If your form is incorrect, you will at can actually increase the risk of heart best not reap the full benefits of your disease in some people. As part of this workout or worse, suffer strains, sprains, research, 1,687 people were put through fractures or other injuries. For example, six rigorous exercise studies. Researchers were unable to explain why some 10 per cent of them showed increases in at least one measure of heart disease risk — blood pressure, insulin level or cholesterol. Exercising

CAUtennis elbow, an inflammationt of ithe on Sometimes, tendons at the elbow, occurs when you Too Much Of A don’t practise proper form in swinging Good Thing? working out can your arm in sports like tennis and golf. While exercising daily can help prevent It is always recommended that heart disease and lower your blood be bad for you. you talk to a doctor before starting or pressure, pushing your body to its limit by GENE KHOR intensifying an exercise regime. Your and beyond might do just the opposite. doctor may offer tips to help make it safer A review published by medical journal for you. For example, if you have a muscle Mayo Clinic Proceedings in June 2012 weakness in your hip, your doctor might showed that training for and competing teach you exercises to address the problem in extreme endurance events such as and prevent further injury. marathons and triathlons could cause The same goes for working out in a long-term damage to the heart. gym. You might pick up weight training In one study, the hearts of 12 per techniques from watching those around cent of outwardly healthy marathon you, but they themselves might be doing runners showed evidence of scarring it incorrectly. of the muscular tissue. It was also To ensure proper weightlifting form found that the rate of coronary heart and prevent injury, consult a qualified disease was significantly higher in trainer. Even if you are a seasoned gym marathon runners than in runners veteran, consider getting the advice of a who ran shorter distances. trainer to demonstrate proper technique So where should you draw the to you. line? The Health Promotion Board

30 lifewise May - Jun 2014 (HPB) of Singapore recommends at least 150 minutes of physical activity a week for improved overall health. Based on the Mayo Clinic review’s findings, lead author Dr James O’Keefe said that the recommended daily duration of exercise should be between 30 and 60 minutes a day. Anything beyond this would only lead to “diminishing returns”. Poor Dieting Exercising to get into shape is often complemented with a reduced caloric intake, as the key to fat loss is to burn more calories than are consumed. In this vein, some people overcompensate and end up under-eating in a bid to speed up the weight-loss process. But doing this could do more harm than good, even resulting in weight gain and diminished strength. According to the Mayo Clinic, if you reduce your calories too drastically, your body shuts metabolism down. Your body could even start marathoners have metabolising or converting muscle into energy in the absence a higher rate of of an adequate food supply. heart disease than If you are not sure how much food is too much or too little, non-marathon follow the guidelines set by HPB’s Healthy Diet Pyramid runners which outlines what a balanced diet should include. In a nutshell, have more rice and other carbohydrate alternatives like potatoes and bread, followed by fruits and vegetables, and then meats and other dairy products. Take in small amounts of fats, oils, sugar and salt. ck to ‘EXERCISE IS TEARING s: Sh u tt ers OUR MARRIAGE APART!’

p hoto Having the support of loved ones in your fitness quest can be an important factor in staying motivated. But on occasion, exercising can have an adverse effect on your love life. In 2011, the Wall Street Journal newspaper ran a story on “exercise widows” — women whose husbands spent more time who became athletic became attractive training for competitions than with to other men. As she was heavy-set their families. One of the husbands before, she had married her husband agreed that his behaviour was “selfish”. thinking that no one else would find A couples therapist quoted in her appealing. the story highlighted how many To avoid any of these situations, relationships were based on similar the article suggested that “the surest levels of attractiveness, so a shift in way for a marriage to accommodate that equation could destabilise the an intense exercise regimen is for both marriage. For example, one woman spouses to engage in it”.

May - Jun 2014 lifewise 31 ( eat well) Eating for a

CETheN Japanese T— in partUicular RY Okinawans — have historically possessed the longest lifespans. Here are some reasons why. by Alex Ngai And Amir Ali

Japanese people live longer than any other national population. According to World Bank figures, the average life expectancy there is 82.6 years. (The figure for Singapore, also above average in this regard, is 81.9.) In fact, Japan has topped the tally for the past 20 years. Within Japan, certain parts — far from the madding crowds — foster an extraordinarily long lifespan. For example, the southern prefecture of Okinawa, which is comprised of more than 100 islands, is historically known to have the highest proportion of centenarians in the world. The people there also had an average life expectancy that was — until 2013 — higher than the rest of the country. (It has since been dethroned in this regard by Nagano, and the bulk of the blame for this has been placed on modern changes to the Okinawan diet.) The islands have been the subject of the famous Okinawa Centenarian Study which aimed to find out why five times more Okinawans live past the age of 100 than residents of other Japanese prefectures. Unlike the rest of Japan, which is infamous for its strict rules and modern social pressures, Okinawans are known goya (Bitter gourd) for being much more laid-back. Being features heavily in located quite a distance away from the okinawan cuisine. main islands of Honshu, Kyushu, Shikoku

and Hokkaido — and being geographically es, S hutterstock Getty I m ag photos:

32 lifewise May - Jun 2014 older generations of the islanders lived longer due to their Eating for a largely-organic diet.

CENTURY SWEET POTATOES MEAT AND SEAWEED With the islands unsuitable for rice Okinawans traditionally eat meat — farming, sweet potatoes have long been pork in particular — more than fish. the staple food. White rice which was Their dishes, including meat dishes, popular elsewhere in Japan, only started often feature another staple food, becoming popular in Okinawa after seaweed. Seaweed or kelp — such as those World War II. of the varieties mozoku and kombu — are Sweet potatoes are rich in nearly calorie-free but have many health potassium, Vitamin A and fibre. A 100g benefits. Kombu for example, has iodine serving of sweet potatoes provides which is needed by the body to produce almost 10 per cent of the recommended hormones. Okinawa is one of the largest daily potassium intake, 12 per cent consumers of kombu in Japan. LW Seaweed is another of the recommended daily fibre staple of their diet. intake and almost 300 per cent of the recommended daily Vitamin A intake. closer to Taipei than Tokyo, Okinawa Furthermore, the purple sweet potatoes has a different cuisine from that of found in Okinawa are high in flavonoids its cousins to the north-east. So in and carotenoids which, as antioxidants, NO LONGER combination with genetic factors and can prevent cancer and heart disease, as a quiet island lifestyle, diet has played well as boost the immune system. LONGEST-LIVED a big part in Okinawa cultivating so American military forces many centenarians. BITTER GOURD built bases that operated in One of the signature dishes in Okinawan Okinawa from 1945 to 1972, ORGANIC FOOD cuisine is chanpuru, which means so fast food and processed The homes of older Okinawans ‘something mixed’. The dish usually food have become more traditionally have a small garden plot contains tofu stir-fried with small and more popular there. for growing vegetables, a tradition based slices of meat or fish, eggs and goya, In fact, the American on the humble, self-sufficient lifestyle commonly known as bitter gourd, which influence has been so of the islanders of the 19th and early- is considered to be one of the major pervasive that the formerly 20th centuries. Owing to their decades- contributors to the long lives of the longest-lived prefecture in long diet of largely organically-grown Okinawan centenarians. Japan now holds the dubious foods, older generations of Okinawans Goya contains polypeptide-P and honour of being the prefecture simply live longer than those of today. charantin, two nutrients that help to with the highest obesity rate. Okinawan centenarians eat up to eight reduce blood sugar and is used in the A study published in servings of vegetables and two servings treatment of type 2 diabetes. It is also the Asia-Pacific Journal of of fruits daily. rich in carotene, lutein and zeaxanthin, Public Health shows that nutrients that help slow between 1988 and 1998, the ageing and prevent consumption of vegetables in Bitter gourd is rich in cancer. Goya is very Okinawa dropped by almost popular among the older 20 per cent. carotene, lutein and generation but increasingly Incidentally, during this shunned by younger same period, the mortality zeaxanthin which help slow Okinawans, something rate in Okinawa due to heart that some say has led to disease increased by almost ageing and prevent cancer poorer health among the 10 per cent. current generation.

May - Jun 2014 lifewise 33 ask the ( & ) experts Q Ayour medical questions answered

Q2) Going Giddy

I am a man in my mid-40s. I suffer from occasional bouts of vertigo, which I find worrying as I often have to drive myself to meetings. Are there lasting effects of vertigo, even if I no longer feel dizzy? For example, if I have an attack in the evening, should I refrain from driving the next day?

Vertigo — or the hallucination of movement — is a common symptom due to a disorder of the balance (vestibular) system but can occasionally be due to a brain disorder. The two common vestibular conditions that are accompanied by recurrent bouts of vertigo are BPPV (Benign Paroxysmal Positional Q1) Given the Cold Shoulder Vertigo) and Meniere’s Disease. With BPPV, the attacks of vertigo normally do not last more My mother, who is in her late 50s, has difficulty than a minute and are provoked by changes in position; usually lying moving her right arm and has trouble carrying out down and turning the head to one routine tasks due to severe pain in her shoulder. particular direction. I’ve heard of people having ‘frozen shoulder’. With Meniere’s, the vertigo What are the symptoms of this and can simple tends to last longer, for up to several exercises help to ease it? hours, and can be associated with a reduction in hearing, tinnitus and a feeling of ear ‘fullness’. Patients with The two possible reasons for shoulder pain could be pain radiating from the neck or frequent and unpredictable vertigo pain originating within the shoulder itself. “Frozen shoulder” is a condition associated may need to be cautious about with stiffness and pain in the shoulder joint, which begins gradually and worsens over driving. An accurate diagnosis is time. Simple range-of-motion exercises within the pain-free range will help her maintain vital as the natural histories of both the shoulder’s range of motion. If the pain has been there for more than two months, conditions are completely different, a hot towel application to the shoulder can be helpful in alleviating some pain. I would as are the treatments. A consult with recommend that your mother consult a doctor for an accurate diagnosis. If necessary, the an ENT specialist is recommended. doctor will then refer your mother to a physiotherapist for the relevant exercises and advice. Dr Ho Eu Chin Ms Richa Goel Consultant // General ENT Clinic // Physiotherapist // Collaborative Care Unit // National healthcare group polyclinics Tan Tock Seng Hospital photos: shutterstock photos:

34 lifewise MAY - JUN 2014 is to help you learn about the anxiety and provide you with strategies and skills to manage and reduce the anxiety. Other treatment options include self-help, medication and psychodynamic psychotherapy. Although not the first choice of treatment, medication does have a role in some cases of social anxiety disorder, particularly where the disorder becomes complicated by other diagnoses like depression.

Dr Diana Ruth Andrea Barron Consultant // Psychiatry of learning disabilities // Institute of Mental Health, and Dr Alex Su Senior Consultant and Chief of Department of General Psychiatry // Head, Emergency Services // Institute of Mental Health

Q4) Weighty Issue Q3) Social Stress I’m overweight — I am male, 1.7m tall and weigh 95kg — and at my last checkup From a young age, I have had trouble it was discovered that I have borderline adapting to social situations — I haven’t high blood pressure, and low ‘good’ made many friends throughout school, cholesterol. I read that these are signs of because I become terrified around Metabolic Syndrome, which is a precursor groups of people. I believe I have to kidney stones. What can I do to prevent Social Anxiety Disorder. I am 19 and in these painful crystals from forming? polytechnic, so I hope to find a way to get through it. How do I manage my anxiety? Is medication the answer? Metabolic Syndrome is a cluster of factors that increase your risk for cardiovascular diseases (including heart disease and stroke) and diabetes. The diagnosis of Social Anxiety Disorder is based on These factors are as follows: the persistent fear or anxiety of social situations where £ Central obesity — having a waistline of more than an individual is expected to ‘perform’ in some way. 80 cm (in females) and more than 90 cm (in males) For example, meeting new people, eating or drinking £ A high triglyceride level (1.7 mmol/L or more) in front of other people, or speaking in public. The £ A low HDL (good) cholesterol of 1.0 mmol/L or less individual affected by this disorder fears that they may in men and 1.3 mmol/L or less in women say or do something humiliating or embarrassing, £ Blood pressure of 130/85 or more, or being which leads them to avoid many such situations. on treatment for high blood pressure Social Anxiety Disorder is actually one of the (established Hypertension) most common anxiety disorders. More than one in 10 £ Fasting blood glucose of 6.1 mmol/l more or adults will experience it at some point in their lives. on treatment for diabetes This disorder can have a terrible impact on a person’s quality of life and can limit the person’s ability to make A person might have one of these risk factors, friends or perform at work and can place the individual but they tend to occur together. To be diagnosed with at risk from other disorders like depression and Metabolic Syndrome, you must have at least three substance abuse. metabolic risk factors. Despite being so common and causing so much In a recent study, there has been shown to be suffering, only about half of the people with this an association between kidney stones disease disorder ever seek treatment and frequently this with metabolic syndrome. The best way diagnosis can be missed. to prevent this is to minimise your The chances of recovery with appropriate metabolic risk factors at the very treatment are good. The first choice of treatment start. These can be done by getting is psychotherapy in the form of Cognitive more exercise and losing weight. Behavioural Therapy that has been specifically Dr Teh Tiong developed for the treatment of Social Anxiety Resident Physician and Deputy Disorder. This therapy usually requires at Head // Hougang Polyclinic // least 14 individual sessions over a period of National Healthcare up to four months. The aim of the therapy Group Polyclinics

may - jun 2014 lifewise 35 and hypertensive heart disease are preventable. As coronary artery disease accounts for the majority of SCD cases, it would be good to control the Q5) Sudden Death risk factors for coronary artery disease. These include exercising regularly, quitting smoking, avoiding I have recently read about seemingly drinking too much alcohol, adopting a healthy diet healthy people dying suddenly, as well as the effective treatment of hypertension, especially after competitive sporting hypercholesterolemia and diabetes mellitus. events. Why does this happen? Dr Chia Pow-Li Consultant // Department of Cardiology // Tan Tock Seng Hospital Sudden cardiac death (SCD) refers to the sudden cessation of cardiac activity so that the victim becomes unresponsive, with no normal breathing and no signs of circulation. Despite advances Q6) in the treatment of heart disease, the Scratching outcome of patients experiencing SCD remains poor — most do not survive the that Itch journey to the hospital. SCD usually occurs in people with some I am a man in my late 30s. I was form of underlying structural heart disease, recently diagnosed with shingles. most notably coronary artery disease which accounts I have read that shingles is not for up to 70 per cent of cases. Other forms of structural contagious, but should I avoid heart disease, both acquired and hereditary, account for making contact with people? approximately 10 per cent. Some examples include left ventricular hypertrophy secondary to hypertension, hypertrophic cardiomyopathy and congenital anomalies Shingles is caused by the Varicella Zoster virus, of the coronary arteries. Some 10 per cent of cases the virus that causes chickenpox. It is much less can be attributed to primary electrical diseases of the contagious than chickenpox, but if you have fresh heart such as Brugada syndrome, long QT syndrome or lesions or blisters you could still transmit the virus to Wolff-Parkinson-White syndrome. others. You should keep away from pregnant women Most importantly, 10 to 20 per cent of SCD cases and infants while you are having blisters, particularly cannot be explained even with post-mortem autopsy. if the infant is under one month of age. Among these causes of SCDs, coronary artery disease Dr Pan Jiun Yit Consultant Dermatologist // National Skin Centre

ask the Sexperts

Erectile dysfunction could be due to either psychological factors such as lethargy and anxiety, or physical factors such as an issue with the nerve supply, problems with arterial blood inflow and venous blood outflow. More often than not, it is caused by a combination of factors. When a man binges on alcohol, it leads to dilatation of blood vessels, including the penile veins. Research has shown that alcohol can temporarily lead to “leaky veins” within the penis, resulting in a poor or complete lack of erection. Furthermore, the intoxicated state may lead to lethargy and drowsiness which affects arousal. Long-term alcohol consumption has not been shown conclusively to cause erectile dysfunction, provided the amount consumed does not exceed that recommended by the Health Promotion Drunk in love Board, which is not more than three standard I’m a man in my late 20s. After a night of drinks a day for men. However, long-term drinking drinking, I have trouble making love to my has adverse effects on other organs. partner. Why do men get erectile dysfunction after drinking too much alcohol, and are there Dr Simon Chong long-term ramifications to heavy drinking? Consultant // Department of Urology // And how much alcohol is too much? Tan Tock Seng Hospital photos: shutterstock photos:

36 lifewise MAY - JUN 2014 CORPORATE NEWS + CALENDAR OF EVENTS + FORUMS Prof Roy Chan steps down as Director, NSC A/Prof Tan Suat Hoon takes over the reins of the national skin centre.

n 1 April 2014, after 10 years of service, Professor Roy Chan stepped down as Director of the National Skin Centre (NSC), Oand was replaced by Associate Professor Tan Suat Hoon. Since his appointment in 2004, Prof Chan saw through a number of excellent programmes, including the adoption of Electronic Medical Records in NSC (see page 42). Under his directorship, the Mandalay Clinic in NSC firmly established itself as the pre-eminent national and regional leader in dermato-surgery and demato-laser therapy. Above: A/Prof Tan Transmitted Infections Control Programme and Suat Hoon took over We have enhanced our programmes from Prof Roy Chan a Professor in the Department of Epidemiology on 1 April, 2014. and Public Health at the National University of to train clinician researchers, Singapore’s Yong Loo Lin School of Medicine, among recruit research manpower and other positions. In 1988, Prof Chan founded the non-governmental organisation Action For Aids, encourage clinicians to devote more and he remains its president. time and energy in research. A/Prof Tan Suat Hoon has been groomed Prof Roy Chan, in the official announcement on 26 Sept 2013 for leadership roles within NSC and has been its on the setting up of the Skin Research Institute of Singapore Deputy Director since 2004. Following her appointment, A/Prof Tan said, NSC also developed and introduced several “NSC has achieved its status as a centre of excellence initiatives to monitor, evaluate and enhance service in clinical care and education in Singapore and the and clinical quality, and to promote patient safety. region in the last 25 years, supported by visionary As a result of these initiatives, the Centre became the leadership, people architecture and the organisational first Ambulatory Care Centre in Asia to receive Joint capacity and capabilities. Research will be one aspect Commission International (JCI) Accreditation in 2007. of long-term value creation for our patients, doctors Through the years, Prof Chan built on subspecialty and staff to make us a world-class institution. development for tertiary dermatology care and led “We will continue to invest in people, systems and NSC to introduce more new subspecialty clinics such infrastructure, even as we plan the new NSC building as the Wound Clinic, Eczema Clinic and Acne Clinic, and facilities which will be ready in five years’ time.” which together form the cornerstone of NSC’s success as a Dermatology Centre. NSC has achieved its status as Besides providing specialised care to the patients, these clinics have impressed global experts. These a centre of excellence supported subspecialty clinics also make NSC an attractive by visionary leadership, people training centre for medical staff from around Asia and the Middle East. architecture and organisational Apart from his former Directorship of NSC, capacity and capabilities.

: C H EE YAN Ph oto Prof Chan is Head of Singapore’s National Sexually A/Prof Tan SuaT Hoon

May - Jun 2014 lifewise 37 The launch was an uplifting affair, reflecting the inspirational stories contained within the book Our Shared Stories. NHG Stories From the Heart The National Healthcare Group launches a book that celebrates the ‘4P7R’ group-wide culture which is aimed at building a common language.

ince 2012, the National Healthcare Group £ We give ideas, learn, develop, improve (NHG)’s culture-building “4 Principles and continuously and share results. 7 Simple Rules” (4P7R) programme has £ Work within guidelines and standard Sbeen adopted across the group. 4P7R is procedures. a set of foundational principles and rules that £ Solve the problem or take responsibility for guides NHG in its vision, mission and values. handing over to the next step. Understanding and applying 4P7R helps staff £ Give feedback to the step before. members as individuals, teams and units to achieve a higher level of performance and strive towards On 28 March 2014, patients, visitors and NHG the goal of being a Regional Healthcare System. staff gathered at the TTSH atrium for the official launch of the 4P7R book, titled Our Shared Stories. The 4 Principles are: Same Same Yet Different. Our Shared Future. Over £ Patient-centred care the six months leading up to the launch, NHG £ Systems thinking encouraged staff members to tell their stories in £ Learning organisation order to encapsulate the culture of care and improve £ Staff engagement productivity, both of which are among the aims of 4P7R. The result is a compilation of some 50 stories, And the 7 Simple Rules (below) are aimed at helping quotes, poems and drawings, laid out over 160 to achieve these Principles. uniquely-designed pages by an in-house design team. £ Healthcare originates from what patients need Each staff member received a copy. and value. Speaking at the book launch, Group CEO £ We care and protect patients and ourselves. Professor Chee Yam Cheng said, “For us to be an £ As a system with partners, it is the system’s effective Regional Health System, we must be able results that count. to speak one common language in our delivery of

38 lifewise May - Jun 2014 patient outcomes and quality of care. “Embracing 4P7R will bring us to the next level of performance, quality and care. It helps us to focus on what is important for the whole system to function NHG Group CEO effectively and as one that is well-coordinated and Ms Goh Bee Hong, who was suffering respiratory Professor Chee seamless.” Prof Chee was addressing the crowd problems. Continued A/Prof Abisheganaden, Yam Cheng at the launch of the book made up of staff members, senior management of “My patients, especially Bee Hong, remind me organised by NHG NHG institutions, and the Culture Building Steering that we heal, not just to eliminate disease but Group Corporate Committee, which is chaired by Professor Low Cheng to help them regain their lives.” Communications with the Hock, Emeritus Consultant; and co-chaired by Besides being an opportunity to hear these 4P7R Secretariat. Associate Professor Lim Tock Han, Deputy Group CEO inspiring stories, the book launch was a time for (Education and Research). celebration. NHG staff put up joint performances of song medleys that interspersed the two-hour Inspired By Patients Themselves event watched by a 200-strong audience including One of the inspiring stories contained within patients and volunteers. Our Shared Stories came from Associate Professor To keep the narrative going, staff could also pen John Abisheganaden, Senior Consultant of Respiratory their thoughts throughout the pages of the book. and Critical Care Medicine at Tan Tock Seng Hospital Said Prof Chee, “I hope that the book will inspire (TTSH). He wrote, “As a clinician, we sometimes you to continue learning from one another in this focus too much on fighting the disease, and forget journey. As you do, remember that you can create about the person behind the patient.” He referred to your own stories by penning your thoughts in the the perseverance and tenacity shown by a patient, pages provided.”

Above and right: Senior The book is full of uplifting management staff singing along while Prof Chee plays the piano. stories from nHG staff. Top right: A/Prof Lim Tock Han, Deputy Group CEO (Education Their accounts seek to encapsulate & Research), NHG; Co-Chair, Culture Building Steering Committee, speaking to the crowd. the culture of care and improve productivity, both of which are among the aims of 4P7R.

May - Jun 2014 lifewise 39 sessions which were grouped into four different HIGHLIGHTING THE tracks — Institutional Review Board (IRB)/Ethics Review Board, Quality Management & Quality Improvement in Research, Industry & Clinical HUMAN ELEMENT Research Professionals, and Hot Topics in Research THE ISSUE OF HUMAN RESEARCH SUBJECT PROTECTION Ethics. Fundamental issues such as IRB frameworks tOOK CENTRESTAGE AT THE THIRD ASIA PACIFIC RESEARCH and review tools, IRB education, audits, legislation and legal requirements were explored in detail, ETHICS CONFERENCE (APREC) 2014. as were controversial topics like the researching of vulnerable populations and institutional conflicts of interest. onducting research on human subjects is The delegates, who hailed from various sectors of understandably one of the most sensitive the scientific community, are responsible for ensuring and controversial aspects of scientific the safety and welfare of research volunteers. They Cstudies. Bringing together experts in included not just clinical research professionals but research ethics to share their knowledge and best also representatives of regulatory agencies, scientific practices in human research protection, the National and academic agencies, IRBs and pharmaceutical Healthcare Group (NHG) and the United States- companies. In addition, four regional and world based non-profit organisation Public Responsibility leaders in bioethics and public health policy were in Medicine and Research (PRIM&R) co-organised invited to give keynote speeches — notably, the biennial Asia Pacific Research Ethics Conference Professor Nancy Kass from the Johns Hopkins (APREC) in Singapore. Held every other year since Bloomberg School of Public Health in the US. 2010, the third APREC took place from 26 to 28 March During the opening ceremony, NHG Group CEO 2014 at the Grand Copthorne Waterfront Hotel. Professor Chee Yam Cheng mentioned the strides Some 50 speakers and 400 participants from that NHG’s Office of Human Research Protection more than a dozen countries across Europe, Africa, Programme has made to ensure high-quality ethical North America, the Middle East and Asia-Pacific research. “We have achieved successful accreditation attended the conference. In line with the theme of twice by the Association for the Accreditation of ‘Research Ethics: Harmonising Global Principles with Human Research Protection Programs (AAHRPP) Asia Pacific Practices’, they examined the need to in 2007 and 2010, and we look forward to the third harmonise global research ethics principles with the successful re-accreditation in 2015,” he said. unique and diverse cultures and practices of the In his speech, Prof Chee said that he was confident Asia-Pacific region. of an exciting and enriching exchange of ideas and Associate Professor Chin Jing Jih, Divisional best practices over the next two days, given the Chairman of Integrative & Community Care at diverse mix of backgrounds and expertise. He urged Tan Tock Seng Hospital as well as APREC 2014 everyone to participate actively and apply what they Organising Committee Chairman, said in his welcome learned from APREC in their respective communities. address, “Our theme for APREC 2014 reflects our Distinguished guest Prof Nancy Kass recognition of the diverse research principles and (below) of the Johns the need to apply the global practices in the local Hopkins Bloomberg Asia-Pacific context.” School of Public Health in the US spoke to the The event comprised a day of pre-conference Opening APREC gathered crowd. 2014 was NHG PRIM&R workshops and two days of conference Group CEO Prof Chee Yam Cheng (far left). A/Prof Chin Jing Jih (left) also gave a welcome address.

40 lifewise May - Jun 2014 Upon arrival at the polyclinic, patients who have made online appointments register themselves at self-service kiosks. They are then assigned to a consultation room where they wait to be attended to. mobile smartphone app cuts waiting times Patients welcome NHGP’s Enhanced Appointment System.

isiting a polyclinic may sometimes be Patients with chronic conditions are encouraged off-putting due to waiting times and to come by appointment. Acute patients receive large crowds. As these clinics are open to treatment on a first-come first-served basis, while Vwalk-in patients, the patient volume can walk-in patients who are very ill and who require be unpredictable and thus overwhelming at times. urgent care are given priority. In the middle of 2012, National Healthcare Group Polyclinics (NHGP) introduced an Enhanced A Positive Response Appointment System across its nine clinics. Under NHGP receives about 500 appointment calls per the system, patients can easily book a consultation day — more than 10,000 calls are put through to appointment via NHGP’s Contact Centre or by using the NHGP Contact Centre each month — and as a mobile smartphone app. reported in the media, patients are certainly taking The upshot of this has been that, for many to the revised system. Patient Aminah Almoner patients, waiting times have been slashed. In addition, told Channel NewsAsia that she called to make an patients can leave feedback via the app as well as get appointment, and was told it would be at 11am that information on NHGP’s various services. very day. She asked if she had to make her way down immediately that morning to wait to be seen, and was How It Works instead told by the nurse, “No need, you just need After having made an appointment via the NHGP to come at your appointed time.” In Mdm Aminah’s Contact Centre or mobile app, patients register words, “It was settled very, very fast.” themselves at self-service kiosks upon arrival at the NHGP’s Director of Operations Mr Ang Chee polyclinic. At that point, they are then assigned to a Chiang said, “One of the good things about the system consultation room where they wait to be attended to. is it spreads the load throughout the day evenly, so that Walk-in patients are given an appointment time, we don’t see a very crowded clinic waiting area.” which is printed on their respective queue tickets. This gives them the option of leaving the clinic to rest The NHGP Contact Centre can be reached on or run errands. 6355-3000. The mobile smartphone app can be They can then return nearer to their allotted time, downloaded from the Apple App Store and Google

k : Sh utterstoc Ph oto meaning less time spent in the clinic waiting area. Play Store; search ‘miHealthcare’ to get the app.

May - Jun 2014 lifewise 41 Healthcare In The Digital Age The National Skin Centre has been recognised for its wide adoption of electronic medical records.

eing so sensitive and private, medical records require appropriately secure handling and storage. This Bis ever-more effectively done in this age of operations. And finally, a mobile system will be information, and for the past decade, the National developed to enable doctors to track urgent lab tests Skin Centre (NSC) has been keeping medical records and review patient records while on the move, so that digitally. NSC’s electronic medical records (EMR) the response to the patient’s needs will be improved. system was rolled out on 20 March 2004 after a three- “We hope to continually enhance our EMR year development phase. Since then, $3.9 million system to improve our patient care, patient safety, has been spent on the total development and improve our staff healthcare productivity in the enhancement of the system. best way possible so that our patients will get the One of the benefits of going digital is the ease best medical care and enjoy a blissful, healthy life.”, of retrieval of these records, which can significantly said Professor Goh Chee Leok, Senior Consultant improve the patient experience. Another benefit Dermatologist and Chairman of NSC’s Medical and was the freeing-up of 630 square metres — nearly Healthcare Informatics Committee who spearheaded 7,000 square feet — of space, which was converted and oversaw the project in 1998. from a records office into clinic space. More importantly to patients, turning paper records A First In The Region into 1s and 0s has proven to be a great time-saver, as it All this constant development hasn’t gone unnoticed has made online appointment booking possible. Patients — NSC’s EMR system has recently achieved a can make appointments online, and are reminded of significant recognition. In February 2014, HIMSS their appointment via text message and email. At the (Healthcare Information and Management Systems hospital, self-registration kiosks cut registration waiting Society) Analytics Asia Pacific announced that NSC time. And, with their records available to the doctor at — a member of the National Healthcare Group — the click of a mouse, waiting times are further reduced has achieved Stage 6 of the Primary Care Electronic — in the past, physical records had to be retrieved. Medical Record Adoption Model (PC-EMRAM). This Finally, EMR improves patient safety as it identifies makes it the first medical centre in the Asia-Pacific patients who have special needs. region to achieve such an advanced level of electronic medical record adoption in outpatient care. Constant Fine-Tuning HIMSS Analytics Asia Pacific is part of HIMSS Technology moves so fast that development and WorldWide, a global enterprise that collects and refinement are occasionally necessary. Recent distributes information on IT within healthcare enhancements to NSC’s EMR system include the institutions. The PC-EMRAM evaluation model introduction of an Electronic Consent system which creates a framework for institutions to discuss ways reduces paperwork. Also, a Patient Health Portal to improve their key IT systems to achieve better Integration system enables patients to check and access and improve the quality, efficiency and safety securely share their own medical records, including of care for patients. PC-EMRAM is measured on in appointments, diagnoses, lab results, procedures stages numbering 1 to 7, with 7 being the highest and prescriptions. level of electronic record-keeping. Down the road, patients’ photographs will be NSC’s Stage 6 rating means that the institution’s included in their EMR to ensure their safety. Analytics EMR system allows for advanced clinical decision will be used more extensively, with collective data used support, proactive care management and population

more in the planning and management of hospital health management. k : Sh utterstoc Ph oto

42 lifewise May - Jun 2014 FFDM is commonly used in hospitals. Now, however, National Healthcare Group Diagnostics offers the first FFDM unit to be used in a primary care setting, at National Healthcare Group Polyclinics. Dr TYrone Goh, Executive Director, National Healthcare Group Diagnostics

Keep abreast with full-field digital In FFDM, the digital processor is mammography incorporated into the machine, no longer An efficient new system makes it possible for more requiring the use of a cassette containing the patients to undergo screening. imaging plate and a separate CR processor. FFDM uses digital receptors to examine breast tissue and tests have shown that digital ver the years, traditional film mammography is as effective as the old mammography has been largely methods. The amount of radiation patients replaced by a digital processing system are exposed to is the same as before, which is Ocalled computed radiography (CR), in to say well within safe levels. And although which special imaging plates are used. These plates the price of FFDM used to be two to three were housed in cassettes inserted into the CR times that of conventional machines, the cost processor to generate a digital image. CR has now has now come down to close to that of the been supplanted by a system called full-field digital conventional system. mammography (FFDM). These days, FFDM is commonly used in hospitals. Now, however, National Healthcare Group Diagnostics (NHGD) offers the first FFDM unit to be used in a primary care setting, at National Healthcare Group Polyclinics. With FFDM, the process for patients remains the same as before, in that they are required to place their breast on a machine to be compressed and scanned. However, there is significant time saving for them in that once the patient is settled in, capturing the image is nearly instantaneous. Newer machines even have sensors built into them to sense whether or not the breast is undergoing enough compression for optimum image quality. Full-field digital Because of the faster processing, FFDM has mammography has a higher patient throughput compared to before. moved the game on by There are plans to eventually replace all current being more efficient, enabling higher CR mammogram systems once they reach the patient throughput. end of their lifespan.

May - Jun 2014 lifewise 43 44

X- U undergoes stringent checks for checks stringent safety every year.”undergoes and allourequipment radiation islow-dose National Healthcare “Medical Group Diagnostics, at Yong, Radiographer Senior Says Ms Chia Li radiationof emittedby clinical machines. these harboured afear that radiation cancer. cancause disaster inJapan have —people nuclear2011 Fukushima reactor inthe wake the of particularly — And hazardous. people, some X-rays. generatedclear image by a get to must remain inorder still perfectly machine where the they of front shadows, patients are stationed in into cast that agown not does radiographers are health professionals allied a radiographer, the patient isinsafe as hands, anX-raygetting under clinical conditions by background radiation. More importantly, when the naturally-occurring amount of three days’ achest X-raygetting isalmost equivalent to to radiation when amount of isexposed aperson and eating bananas. smoking travel, radiation arelow-level airplane cigarette common sourcesour tabletop ovens. Other of radiation, and we don’t live inconstant fear of microwave as ordinary isasource cooking of and harmless as and something cosmic.Infact, from natural various sources, terrestrial both “background” radiation with isfilled Earth The Radiation IsAllroundU I diagnostic exams. radiation during unhealthy dosof worry aboutreceiving Patients neednot lifewse May - Jun 2014 one, too — after changing one, too —after changing the X-ray. adaunting canbe It point: athave some undergone is a procedureus t that many of But there is no need to worry about the levels about thereBut to isno need worry clinical and to sounds It It istherefore toIt note that the important nderstandin R ays

doses, and their effectnegligible. is thus doses, X-ray proceduresDiagnostic infact much use lower change inthe body.a chemical and biological of ionising effects radiation,which may produce anatomy technology. and imaging years trainingwith of inthe human areas both of 1 T for safetyand peace mind: of numerous procedures inplace and standards put Patients anX-ray getting are protected by Making ItS

he X-Ray Process g all ourequipmentudergoestrige correct examination. correct to ensure the isundergoingthe individual the patient by identifying The processbegins In addition, the three-dayon the figure isbased Medical radiationislow-doead

cheks forafetyevery year. Senior RadiographeMsChiaLYOng afe ForPatients

Photo: Shutterstock 2 For a female patient, a check is done first to How much radiation are you exposed to? ensure that she is not pregnant. This is done through the 28-day rule: if the patient has missed her period, she would be deemed pregnant unless proven otherwise. The X-ray procedure 500mSv would then be delayed until her menstruation resumes. 3 Clear instructions from the radiographer are given to minimise the patient’s exposure to radiation — getting it right in as few attempts as possible avoids repeated exposure. 400mSv Slight decrease in 4 Radiographers adopt the ALARA principle — blood cell count, however, it will As Low As Reasonably Achievable — during return to normal the procedure. It is important that the patient’s after a few days received dosage is kept low, and this is better achieved with the individual’s preparation and co-operation. Radiographers are committed to the Recommended Maximum radiation limit for radiation safe application of radiography, producing high- detected in an hour at workers every quality images with minimum exposure Fukushima plant on five years to radiation. 14/3/2011, three days 5 Radiographers collimate the X-ray — that is to after the disaster say, they focus the machine’s rays — only on the area of interest. That is to say, the radiation is targeted at a specific body part. Annual dose 100mSv Workplace Safety for smoking 1 The X-ray room is lined with a 2mm-thick 1.5 packets of cigarettes/day lead-equivalent to contain radiation within Annual the room. background 2 The door of the room is also lead-lined and has radiation received a radiation warning sign to easily identify the purpose of the room. 3 A warning light is activated during 3.6mSv radiation exposure. 4 Prior to the use of a new radiation facility 3.0mSv and as part of the accreditation of it, officers from the National Environment Agency’s Radiation Mammogram One-way Protection and Nuclear Science Department flight from conduct tests to ensure the radiation level outside Singapore to the room housing the radiation source does not Frankfurt exceed a certain level (10µSv/hr).

Safety for Radiographers 0.4mSv 1 Radiography workers wear radiation tags to monitor the amount they are exposed to. For them, 0.39mSv the limit on the effective dose to the whole body is 20mSv a year averaged over defined periods of five Dental years, with the further provision that the effective X-ray 0.1mSv dose shall not exceed 50mSv in any one year. If the dose report indicates that the worker has received an excessive dose, he or she will be sent 0.02mSv Chest by the employer for a medical checkup including a X-ray full examination. The worker will also be taken off Eating a 0.0001mSv radiation work for an appropriate amount of time. banana 2 To protect themselves at work, radiographers stand behind the lead shielding during Contributed by radiographers of Tan Tock Seng Hospital Reference: Mettler et al (2008) Effective Doses in Radiology radiation exposure. and Diagnostic Nuclear Medicine: A Catalog, Radiology

May - Jun 2014 lifewise 45 eat the “Healthy Plate Way”, and how to create quick GST meals — Great, Simple, Tasty — in Doing Good a practical way. The team’s aim was to educate their colleagues on what a healthy plate of food With Food should look like, as well as to encourage self- NHGP dietitians coached preparation of meals. The NHGP dietitians hosted a surprise their colleagues on do-it-yourself meal-making session, coaching healthy eating as part their colleagues to prepare pasta salad, which of Dietitians’ Day 2014. participants could enjoy at teatime or bring home to enjoy. There was also a talk and cooking demonstration, as well as hands-on activities using readily-available healthy foods such as ietetics — the application of canned fish, corn, peas, beans and vegetables nutrition in relation to personal to create a balanced meal. Recipes were further well-being — is an important part of the given out to promote healthy living. Dmanagement of chronic conditions. And Participants also received goodie bags which across the National Healthcare Group Polyclinics included some of the food items sponsored by (NHGP), a team of dietitians is on-hand to Ayam Brand and S&W Fine Foods. assess patients based on their individual dietary Besides being fun for all, the event received needs or restrictions. Based on this personalised a lot of positive feedback. According to Senior information — in light of a patient’s weight Dietitian Ms Lynette Goh, participants had problems, or diabetes, hypertension or high enthusiastic comments such as, “The pasta cholesterol, for example — these allied health salad was excellent!” and “Knowing how to professionals provide dietary advice to help divide portions on a plate is useful.” They were patients manage their chronic conditions. also delighted to receive a specially-designed Earlier this year, on 12 March, the team of “I Love Great, Simple, Tasty Meals” apron. NHGP dietitians celebrated Dietitians’ Day, a time of fun and celebration for them and Dietetics — the application of their colleagues. This year’s theme was how to nutrition in relation to personal well-being — is an important part of the management of conditions like diabetes or high cholesterol.

NHGP dietitians hosted a surprise do-it-yourself meal-making session, coaching their colleagues to prepare a healthy salad.

46 lifewise May - Jun 2014 Photo: Shutterstock at TTSH out for less forbasictuberculosiestsfromApril1. Singaporeans ndPermnentReidentsopay T flat fee A flat fee T 1,560 in2012to 1,420in2013. casesfirsttime infive new of dropped from years. The number to patients.” some can becomeabarrier “As TBtreatment expenses medical sixmonths, lasts typically reduced over the entire treatment added, outpatient It regimen. the flat out-of-pocketof substantially patients’ be fee, will costs separately.charged centand PRs, a25per reduction. Investigative tests were consultation, Singaporeans with receiving cent a50per discount 2014. on 1April on 24 March 2014—World TB Day fees —the new took effect the down overallbring treatment cost for Announced patients. tests. Thisintroduction of will the new structure fee laboratory a flat thatfee covers consultation, basicinvestigation and Singaporeans and $15for Permanent Residents(PRs) —are tuberculosis treatment. outpatient The —$10 charges for Tuberculosis the down chargesfor brought Control has Unit, observed. being to healthcare toreport institutions take their medication while MOH has also reported a decline in new TB cases for TBcases innew adecline the MOH reported also has of Health (MOH)said introductionthatwith Ministry The Previously, $32 and $120for patients paid between Tan Tock which the ishome of Hospital Seng (TTSH), B treat regimented affair regimented that obliges patients to regularly required treatment medication isunpleasant, isa the of some problems. respiratory As serious cause that can disease isanairborne uberculosis (TB) p ent ment atient

Ar Resear b Rec Resear IMH four-year tiningfellowshipwrd. Asst ProfMythilySubramnigets as a ‘first’ of its kind of kind its researchof be funded.”to a ‘first’ as in the area considered such, canbe it gambling. of As research researchers the best of andsome work with to develop my inqualitative skills opportunity researchgives inSingapore. me the Thisfunding acommonaddictions, which not isalso field for researchers inclinical research. Myfocus ison which isdifferent from that employed by most qualitative, ismainly “My research methodology understanding gambling among older adults. research areas. inthese Her isfocused on PhD addiction, and to she hopes do more health services is inthe area psychosis of and research. Her research interest studies and health services involved inepidemiological institution. local in research at a graduate degree a or inpursuing research training in overseas biostatisticians professionals and health science and talented outstanding clinicians, award supports award from PhD MOH. for This her part-time a four-year NMRCResearch Training fellowship Research Mental the Institute of of Health, Division Professor Subramaniam, Director the Mythily of biomedical research inSingapore. of trends and priorities in mind the longer-term programmes rolled outby MOH while keeping T On receivingOn the award, said, Prof Mythily Asst iscurrently Prof Mythily Asst Recently, NMRCawarded Assistant Adjunct y M leads and runs various research various funding leads and runs Health of (MOH). NMRC the Ministry of (NMRC) isthe biomedical research arm he National Medical Research Council m

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lifewse 47

NHG College or nutritional advice. Tel: 6340-2362 / NHG Pharmacy also Fax: 6340-3275 provides comprehensive directory www.nhg.com.sg/college We’ve made it easy for you to contact or locate us. The unit develops medicationmanagement healthcare professionals to services to Intermediate their maximum potential Long Term Care so that they will provide facilities (ILTCs) such and Communicable quality, cost-effective and as nursing homes. National Diseases. It covers 27 National Healthcare safe evidence-based care Under the ConviDose™ Healthcare Group clinical specialties, Group Polyclinics to patients. programme, medication Corporate Office including cardiology, Contact centre: 6355-3000 is conveniently packed www.nhgp.com.sg 3 Fusionopolis Link geriatric medicine, into individual sachets National Healthcare #03-08, Nexus @ infectious diseases, for patients according Group Polyclinics (NHGP) one-north rheumatology, allergy NHG Diagnostics to the stipulated forms NHG's primary Call centre: 6275-6443 Singapore 138543 and immunology, quantity and time healthcare arm. NHGP's (6-ASK-NHGD) / Tel: 6496-6000 / diagnostic radiology, the pills need to be nine polyclinics serve a Fax: 6496-6625 Fax: 6496-6870 emergency medicine, consumed. significant proportion www.diagnostics.nhg.com.sg www.nhg.com.sg gastroenterology, of the population in the National Healthcare The National Healthcare otorhinolaryngology, central, northern and Group Diagnostics (NHG Group (NHG) is a leader orthopaedic surgery, Primary western parts of Singapore. Diagnostics) is a business in public healthcare in ophthalmology and NHGP's one-stop health division of NHG. Care Academy Singapore, providing general surgery. centres provide treatment It is the leading provider Tel: 6496-6681 / care through our for acute medical in primary healthcare Fax: 6496-6669 integrated network conditions, management of for one-stop imaging www.pca.sg of nine primary care Institute of chronic diseases, women- and laboratory services The Primary Care polyclinics, acute and-child health services that is accessible, cost Academy (PCA), a care hospital, national Mental Health Buangkok Green Medical and dental care. NHGP effective, seamless, member of NHG, was specialty centres and Park, 10 Buangkok View also enhances the field of timely and accurate. NHG set up to meet the business divisions. Singapore 539747 family medicine through Diagnostics supports professional training NHG’s vision of “Adding Tel: 6389-2000 / research and teaching. polyclinics, community needs of primary health­ Years of Healthy Life” Fax: 6385-1050 NHGP has also been hospitals, nursing homes, care professionals in is more than just www.imh.com.sg awarded the prestigious general practitioners and Singapore and the about healing the Specialist mental health Joint Commission the community at large region. PCA aims sick. It encompasses services are provided International (JCI) via its extensive network to be a platform for the more difficult but to meet the special accreditation under the in Singapore, Indonesia sharing of expertise and more rewarding task of needs of children and Primary Care Standards. and Vietnam. Its services capacity building among preventing illness and adolescents, adults and Through the Family are available in static and community healthcare preserving health and the elderly. There are sub- Medicine Academy and mobile centres. Mobile leaders and practitioners quality of life. specialty clinics such as the NHG Family Medicine services include general in and around ASEAN. As the Regional Health the Neuro-Behavioural Residency Programme, X-ray, mammogram, System (RHS) for Clinic, Psychogeriatric NHGP plays an integral role ultrasound, bone mineral Central Singapore, it is Clinic, Mood Disorder in the delivery of primary densitometry, and medical vital for NHG to partner Johns Hopkins Unit and an Addiction care training at medical courier. It also provides and collaborate with Medicine Department. undergraduate and post- tele-radiology service, Singapore other stakeholders, The treatment at IMH graduate levels. laboratory and radiology International community advisers, integrates evidence-based management, and volunteer welfare Medical Centre therapies, supported by ang mo kio polyclinic professional consultancy organisations and 11 Jalan Tan Tock Seng the departments of Clinical Blk 723 Ang Mo Kio Ave 8 services in setting up others in this Care Tel: 6880-2222 / Psychology, Nursing, #01-4136 Fax: 6458-5664 of imaging centres and Network together Fax: 6880-2233 Occupational Therapy and bukit batok polyclinic clinical laboratories. with our patients, their www.imc.jhmi.edu Medical Social Work, to 50 Bukit Batok West Ave 3 families and caregivers Johns Hopkins provide holistic care for Fax: 6566-2208 to deliver integrated Singapore International patients. IMH also provides choa chu kang polyclinic healthcare services NHG Pharmacy Medical Centre a 24-hour Psychiatric 2 Teck Whye Crescent and programmes that Tel: 6340-2300 (JHSIMC) is a licensed Emergency Service. Fax: 6765-0851 help in “Adding Years clementi polyclinic Fill your prescription online: 30-bed medical of Healthy Life” to Blk 451 Clementi Ave 3 www.pharmacy.nhg.com.sg oncology facility all concerned. #02-307 Fax: 6775-7594 NHG Pharmacy manages located in Singapore, a National hougang polyclinic the dispensary and retail joint venture between 89 Hougang Ave 4 pharmacies at all nine the NHG and Johns Skin Centre Fax: 6386-3783 NHG Polyclinics. Services Hopkins Medicine Tan Tock Seng 1 Mandalay Road jurong polyclinic include Smoking International (JHMI). It Hospital Tel: 6253-4455 / 190 Jurong East Ave 1 Cessation Clinics, is the only fully-branded Fax: 6253-3225 11 Jalan Tan Tock Seng Fax: 6562-0244 pharmacist-led Anti- Johns Hopkins facility www.nsc.gov.sg Tel: 6256-6011 / toa payoh polyclinic Coagulation Clinics and outside the United The centre has a team of Fax: 6252-7282 2003 Toa Payoh Lor 8 Hypertension-Diabetes- States, providing trained dermatologists to www.ttsh.com.sg Fax: 6259-4731 Lipidemia Clinics, where inpatient and outpatient treat patients with various The second largest woodlands polyclinic pharmacists monitor and medical oncology care, skin problems. To serve acute care general 10 Woodlands St 31 help patients optimise medical intensive care, patients better, there are hospital in Singapore Fax: 6367-4964 their medication. laboratory services, sub-specialty clinics for with specialty centres yishun polyclinic Patients may also hospital and retail the different skin disorders in Endoscopy, Foot 30A Yishun Central 1 consult our pharmacists pharmacy, general and laser surgeries. Fax: 6852-1637 Care & Limb Design, for treatment of minor internal medicine and Rehabilitation Medicine ailments or for travel health screenings.

48 lifewise May - Jun 2014

NHG IS THE REGIONAL HEALTH SYSTEM FOR CENTRAL SINGAPORE