International Journal of Environmental Research and Public Health, 2021
Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish asso... more Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study 2016 was a population-level epidemiological survey, which determined the prevalence of physical disorders, psychiatric disorders, and suicidality. Questionnaires were used to determine socio-demographic information. A total of 6216 respondents were interviewed. Lifetime prevalence of suicidal ideation, planning, and attempts were 7.8%, 1.6%, and 1.6%, respectively. All components of suicidality were more likely in those with major depressive disorder, bipolar disorder, generalized anxiety disorder, alcohol use disorder, and chronic pain. Suicidal ideation and attempts were more likely in those with diabetes. Age above 65, being male, and a monthly household income of ≥ SGD 10,000 were associated with a lower likelihood of suicidal ideation. These f...
Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions o... more Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions of being an untreatable moral defect,1 often associated with antisocial behaviour, to its current acceptance as a treatable neurodevelopmental disorder that has a lifelong impact, it is one of the most prevalent childhood psychiatric disorders. A recent meta-analysis estimated the worldwide prevalence of ADHD to be 5.29%.2 A survey of 2400 children aged 6 to 12 years in Singapore showed that 4.9% had disruptive behaviour disorders by parent ratings.3 The importance of ADHD in modern society lies in its impact on academic, social and occupational development. A burden of disease study conducted by the Ministry of Health, Singapore placed ADHD as the third highest contributor of Disability Adjusted Life Years (DALYs) in the 10 to 16 age group.4 This burden is likely to be carried into adulthood and beyond. Yet in a survey of 48 family physicians in Singapore, knowledge about ADHD was found ...
International Journal of Environmental Research and Public Health, 2020
Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it i... more Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting ...
BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of... more BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental health problems and illnesses arising in healthcare workers (HCWs) from tertiary care settings during the COVID-19 pandemic is well-examined,1 the impact on GPs remains understudied.AimTo describe the prevalence and predictors of anxiety, burnout, depression, and post-traumatic stress disorder (PTSD) among GPs during the COVID-19 pandemic.Design & settingSurvey of GPs operating in Singapore primary care clinics.MethodGPs completed a survey that comprised of four validated psychometric instruments. Open-ended questions asked about responders’ challenges and their envisaged support. Data were analysed with multiple logistic regression with demographic data as covariates; concepts of grounded theory were used to analyse the qualitative responses.ResultsA to...
International Journal of Environmental Research and Public Health, 2021
Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general pra... more Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners attending a webinar on resiliency, hosted by the College of Family Physicians, Singapore, participated in the survey anonymously. Participants provided responses to questions relating to COVID-19 in the domains of Family and friends, Myself, Practice, and Community. Responses are categorized into LEARNING, FEAR, and GROWTH zones. The majority of the doctors reported to be in the GROWTH zone in relation to Family and friends (39%) and Myself (38%) as compared to Practice and Community, aOR = 4.5 (95% CI 3.4 to 5.9), p < 0.001. 34% of the participants reported being in the FEAR zone in relation to Family and friends, aOR = 8.0 (95% CI = 5.6 to 11.2), p < 0.001; at least 81% reported being in the LEARNING zone in relation to Practice and Community...
International Journal of Environmental Research and Public Health, 2020
This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric popul... more This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed b...
Introduction: Advances in experimental psychology have led to a better understanding of automatic... more Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not understand why some individuals have a greater magnitude of these biases, and why others have none. There has been little focus on elucidating individual differences and task parameters that affect the overall magnitude of the biases. In this opinion piece, we will attempt to identify these. We will then discuss both the research and clinical implications. Methods and Analysis: To identify the factors that modulated the magnitude of attentional biases across all the substance disorders (i.e., opioid use, cannabis use, and stimulant-use disorders), we performed a search using the bibliographic databases PubMed and MEDLINE. The search terminologies “attention bias” or “cognitive bias” or “approach bias” or “avoidance bias” were used when we looked for relev...
International Journal of Environmental Research and Public Health, 2020
Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, ther... more Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-...
International Journal of Environmental Research and Public Health, 2018
The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of al... more The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of alcohol and drugs applications on the commercial stores. Content analyses and reviews of applications to date have demonstrated that most of these applications are for entertainment or information purposes. More recent content analyses have identified common behavioural change techniques in substance applications. Nevertheless, there remain several limitations of existing content analyses and reviews of applications. There is an increasing prevalence of other substance-related disorders, such as that of stimulants and opioids, but the existing content analyses are limited to an analysis of alcohol and cannabis applications. Only two of the content analyses performed to date have attempted to identify applications that have their basis on a theoretical approach, based on the identification of behavioural change techniques or motivational techniques. There is a need to identify applications on the commercial stores that replicate conventional psychological interventions, or at least provide elements of conventional psychological interventions using behavioural change techniques that are integrated into the application. Further evaluative research could be done on these applications to determine if they are efficacious before using them for patient care. To address the limitation that existing content analyses have only focused on reviews of alcohol and cannabis applications, we propose for there to be updated content analyses for alcohol and cannabis, and new content analyses for other substances of abuse (such as opioids and stimulants). We like to suggest that future reviews consider keywords such as abstinence or recovery, and ones that relate to psychological therapies, such as self-determination or attention bias retraining, as commercial applications that have an underlying psychological basis might be categorised differently, under different keyword terms. We have evidence of how a better search strategy identifies previously unrecognised applications for attentional bias modification.
International Journal of Environmental Research and Public Health, 2019
Advances in experimental psychology have provided evidence for the presence of attentional and ap... more Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders—that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified ...
International Journal of Environmental Research and Public Health, 2018
Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances ar... more Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that automatic attention biases might be responsible for relapse. Prior reviews have provided evidence for the presence of these biases in addictive disorders and the effectiveness of bias modification. However, the prior studies are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have failed to adopt a systematic approach in evidence synthesis. Objectives: The primary aim of this current systematic review is to synthesise the current evidence for attention biases amongst opioid use, cannabis use, and stimulant use disorders. The secondary aim is to determine the efficacy of attention bias modification interventions and other addictions related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Six randomised trials were identified. The evidence synthesized from these trials have provided strong evidence that attentional biases are present in opioid and stimulant use disorders. Evidence synthesis for other secondary outcome measures could not be performed given the heterogeneity in the measures reported and the limited number of trials. The risk of bias assessment for the included trials revealed a high risk of selection and attrition bias. Conclusions: This review demonstrates the potential need for interventions targeting attention biases in opiate and cocaine use disorders.
Infection control and hospital epidemiology, Jan 9, 2018
OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevan... more OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.SETTINGA 2,000-bed tertiary-care psychiatric hospital.METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)-based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1-C3). Clu...
International journal of environmental research and public health, Jan 4, 2018
Research on attentional bias modification has increased since 2014. A recent meta-analysis demons... more Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological trials that have appeared to date have produced mixed results, which has clinical implications. Developments in Internet and mobile technologies have transformed how attention bias modification is currently being achieved. There remains great potential for further research that examines the efficacy of technology-aided attention bias interventions.
Singapore is a young island city-state in Southeast Asia with a diverse population of approximate... more Singapore is a young island city-state in Southeast Asia with a diverse population of approximately 5.7 million (https://www.singstat.gov.sg/modules/ infographics/population). Ethnic Chinese constitute approximately 76% of the residents, followed by ethnic Malays (13.6%), Indians (9.4%), and others (3.4%). Its relatively brief history as an independent state has been characterized by considerable economical and capital growth, four official languages (English, Mandarin, Malay, and Tamil; English is the official language of business, administration, and school instruction), an internationally strong and competitive educational system, as well as governmental and community visions of Singapore as an inclusive society (Lee 2004). It is within this context that this paper seeks to present and summarize the history and current development of services, education, and other initiatives for individuals with autism spectrum disorder (ASD) and their families. Legal Issues/Mandates for Service Singapore signed the UN Convention on the Rights of Persons with Disabilities in November 2012 and ratified it in August 2013. Service development and provisions for individuals with disabilities in Singapore have been guided by national-level committees and advisory groups. The Enabling Masterplans (EMs) for the disability sector (EM 2007-2011, EM 2012-2016, and EM 2017-2021) are comprehensive disability-specific policy documents designed to chart the development of programs and services for people with disabilities in the public sector and aimed to enhance the integration of persons with
Annals of the Academy of Medicine, Singapore, 2003
To provide a review of adolescent mental health service utilisation in a child and adolescent men... more To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.
Annals of the Academy of Medicine, Singapore, 1999
The aims of this paper were: to study the profile of trichotillomania cases referred to a child g... more The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a descriptive, retrospective study of all cases of trichotillomania presenting to the clinic between January 1996 and January 1998. There were 7 cases seen in a 2-year period which is less than 1% of new cases seen at the clinic. The female to male ratio was 1.33:1 with a mean age of 9.3 years. All cases met the DSM-IV criteria for trichotillomania. All 6 pulled their hair in tufts with 1 who was almost hairless. Associated problems included tics, nail-biting, anxiety and shortness of temper. Treatments included behavioural treatment, stress management, parental education and counselling as well as medications. Two improved and were discharged, with 3 still undergoing treatment and 2 defaulted follow-up. The 7 cases seen in Singapore are similar in clinical feat...
Background: The origins of mental disorders arise often in childhood. Early life is a period of u... more Background: The origins of mental disorders arise often in childhood. Early life is a period of unique sensitivity with long lasting effects on mental health. However, the mechanisms for these effects remain unclear. Objective: This thesis describes a variety of studies using a developmental framework to promote greater understanding of the influence of nature (genotypes) and nurture (e.g., environmental risk and protective factors) on outcomes later in childhood. Method: The aim of this thesis is to investigate gene and environmental influences on behavioural, emotional, and cognitive outcomes in different samples from the Netherlands and Singapore, most derived from the general population. We assessed early life influences from a neurobiological, social, and a psychological perspective by using a biopsychosocial framework. Results: Our studies support the hypothesis that all experiences during life, including early experiences in utero, will influence the expression of genes and in the end the mental health of individuals. However, genotypes influencing stress responses are found to be ''plastic,'' which implies that they can be modulated by environmental experiences during life. In line with this, patterns of resilience are found to be contextdependent too. Conclusions: The model of ''epigenetic programming'' suggests the predictive power of the environment in utero and early childhood on mental health later in life. This association is probably determined by a neurodevelopmental pathway with individual differences in neural and endocrine responses to stress.
C linic a l P r a c tic e G ui d e lin e s 58 1.1 Objectives and scope of guideline These guideli... more C linic a l P r a c tic e G ui d e lin e s 58 1.1 Objectives and scope of guideline These guidelines are intended to assist primary care physicians and other healthcare professionals in the management of infertility. This includes increasing awareness and educating about the scale of fertility problems, recognising the various causes of infertility, natural fecundity, and success rates of in vitro fertilisation (IVF) treatment in relation to female age. These guidelines also seek to establish clear referral criteria to guide primary care physicians. 1.2 Target group The primary target group of these guidelines are primary care physicians. Nevertheless, these guidelines would also benefit all healthcare professionals involved in the management of infertility. 1.3 Guideline development These guidelines have been produced by a committee appointed by the Ministry of Health and the Academy of Medicine, Singapore, with representation from gynaecologists, fertility specialists, urologists and family physicians. They were developed using the best available current evidence and expert opinion. 1.4 Review of guidelines Evidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review three years after publication, or if new evidence appears that requires substantive changes to the recommendations. E XECUTIVE SUMMARY OF RECOMMENDATIONS Details of the recommendations listed can be found in the main text as the pages indicated. Definition and causes of infertility People who have not conceived after one year of regular unprotected sexual intercourse should be offered further clinical investigation, including semen analysis and/or assessment of ovulation (pg 20). GPP Basic measures to optimise fertility potential Preconceptual counselling in those with advanced age should include a discussion of the increased risks of aneuploidy, spontaneous abortion and obstetric complications (such as delivery by Caesarean section and gestational diabetes) associated with increasing maternal age (pg 21). Grade D, Level 3 In women with advanced maternal age (> 35 years), consultation with a reproductive specialist should be considered after six months of unsuccessful efforts to conceive (pg 22).
International Journal of Environmental Research and Public Health, 2021
Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish asso... more Suicidality encompasses suicidal ideation, plans, and attempts. This paper aims to establish associations between suicidality and sociodemographic variables, physical disorders, and psychiatric disorders. The Singapore Mental Health Study 2016 was a population-level epidemiological survey, which determined the prevalence of physical disorders, psychiatric disorders, and suicidality. Questionnaires were used to determine socio-demographic information. A total of 6216 respondents were interviewed. Lifetime prevalence of suicidal ideation, planning, and attempts were 7.8%, 1.6%, and 1.6%, respectively. All components of suicidality were more likely in those with major depressive disorder, bipolar disorder, generalized anxiety disorder, alcohol use disorder, and chronic pain. Suicidal ideation and attempts were more likely in those with diabetes. Age above 65, being male, and a monthly household income of ≥ SGD 10,000 were associated with a lower likelihood of suicidal ideation. These f...
Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions o... more Attention Defi cit Hyperactivity Disorder (ADHD) is a modern day paradox. From its descriptions of being an untreatable moral defect,1 often associated with antisocial behaviour, to its current acceptance as a treatable neurodevelopmental disorder that has a lifelong impact, it is one of the most prevalent childhood psychiatric disorders. A recent meta-analysis estimated the worldwide prevalence of ADHD to be 5.29%.2 A survey of 2400 children aged 6 to 12 years in Singapore showed that 4.9% had disruptive behaviour disorders by parent ratings.3 The importance of ADHD in modern society lies in its impact on academic, social and occupational development. A burden of disease study conducted by the Ministry of Health, Singapore placed ADHD as the third highest contributor of Disability Adjusted Life Years (DALYs) in the 10 to 16 age group.4 This burden is likely to be carried into adulthood and beyond. Yet in a survey of 48 family physicians in Singapore, knowledge about ADHD was found ...
International Journal of Environmental Research and Public Health, 2020
Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it i... more Whilst cognitive bias modification was initially used in the treatment of anxiety disorders, it is also currently being used for the treatment of other psychopathologies. In fact, cognitive bias modification has been especially well-investigated amongst children and adolescents. A recent review suggests some evidence for the modification of interpretative biases amongst children with neurodevelopment disorders. There have since been other studies reporting of the existence of other cognitive biases, such as emotional biases, amongst individuals with attention deficit hyperactivity disorder (ADHD). This perspective article will discuss the epidemiology of ADHD and the nature of emotional biases that are present amongst individuals with ADHD. This perspective article also reviewed some of the studies that have assessed and modified emotional biases in individuals with ADHD. A total of three studies have been identified from the published literature that provide evidence for targeting ...
BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of... more BackgroundCOVID-19 has stressed healthcare systems and workers worldwide. GPs, as first points of contact between suspected cases and the healthcare system, have assumed frontline roles in this crisis. While the prevalence of mental health problems and illnesses arising in healthcare workers (HCWs) from tertiary care settings during the COVID-19 pandemic is well-examined,1 the impact on GPs remains understudied.AimTo describe the prevalence and predictors of anxiety, burnout, depression, and post-traumatic stress disorder (PTSD) among GPs during the COVID-19 pandemic.Design & settingSurvey of GPs operating in Singapore primary care clinics.MethodGPs completed a survey that comprised of four validated psychometric instruments. Open-ended questions asked about responders’ challenges and their envisaged support. Data were analysed with multiple logistic regression with demographic data as covariates; concepts of grounded theory were used to analyse the qualitative responses.ResultsA to...
International Journal of Environmental Research and Public Health, 2021
Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general pra... more Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners attending a webinar on resiliency, hosted by the College of Family Physicians, Singapore, participated in the survey anonymously. Participants provided responses to questions relating to COVID-19 in the domains of Family and friends, Myself, Practice, and Community. Responses are categorized into LEARNING, FEAR, and GROWTH zones. The majority of the doctors reported to be in the GROWTH zone in relation to Family and friends (39%) and Myself (38%) as compared to Practice and Community, aOR = 4.5 (95% CI 3.4 to 5.9), p < 0.001. 34% of the participants reported being in the FEAR zone in relation to Family and friends, aOR = 8.0 (95% CI = 5.6 to 11.2), p < 0.001; at least 81% reported being in the LEARNING zone in relation to Practice and Community...
International Journal of Environmental Research and Public Health, 2020
This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric popul... more This study aims to understand (a) the prevalence and correlates of smoking in a psychiatric population, (b) factors that encourage smoking cessation, and (c) awareness towards cessation programmes. This study captured data (n = 380) through a modified version of the Global Adult Tobacco Survey (GATS). A descriptive analysis of the data was performed. The prevalence of smoking was 39.5% (n = 150) and 52.3% of the smokers were dependent on nicotine. More than half of the smokers had made at least one attempt to quit in the past 12 months and 56% reported no immediate plans to quit smoking. The awareness towards institutional smoking cessation programmes was fair (44%), with 49.7% of smokers having indicated that they were willing to use the service upon referral. Smokers endorsed that increasing the cost of cigarettes, restricting availability, and increasing knowledge of health harms could encourage smoking cessation. Past smokers reported that self-determination/willpower followed b...
Introduction: Advances in experimental psychology have led to a better understanding of automatic... more Introduction: Advances in experimental psychology have led to a better understanding of automatic, unconscious processes, referred to as attentional biases. Despite the growing evidence from meta-analytical studies, we still do not understand why some individuals have a greater magnitude of these biases, and why others have none. There has been little focus on elucidating individual differences and task parameters that affect the overall magnitude of the biases. In this opinion piece, we will attempt to identify these. We will then discuss both the research and clinical implications. Methods and Analysis: To identify the factors that modulated the magnitude of attentional biases across all the substance disorders (i.e., opioid use, cannabis use, and stimulant-use disorders), we performed a search using the bibliographic databases PubMed and MEDLINE. The search terminologies “attention bias” or “cognitive bias” or “approach bias” or “avoidance bias” were used when we looked for relev...
International Journal of Environmental Research and Public Health, 2020
Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, ther... more Introduction: Globally, there is an epidemic of opioid use disorders. Locally, in Singapore, there is an increase in the number of individuals abusing opioids. The advances in experimental psychology have highlighted the need to modify unconscious, automatic biases. These automatic, unconscious biases result in individuals having preferential attention to substance-related cues in their natural environment, thus leading to a slip or relapse back into their underlying addictive disorders. Prior studies have demonstrated not only the presence of robust attentional biases amongst individuals with opioid use disorder, even when maintained on methadone; and the effectiveness of bias modification amongst these individuals. There remains limited evaluation of attention bias modification amongst a treatment-seeking cohort of Asian individuals. The objective of this pilot is to ensure that the methods of the planned definitive randomized trial could be conducted. Methods and Analysis: A non-...
International Journal of Environmental Research and Public Health, 2018
The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of al... more The advances in Mobile Health (M-health) technologies has led to an increase in the numbers of alcohol and drugs applications on the commercial stores. Content analyses and reviews of applications to date have demonstrated that most of these applications are for entertainment or information purposes. More recent content analyses have identified common behavioural change techniques in substance applications. Nevertheless, there remain several limitations of existing content analyses and reviews of applications. There is an increasing prevalence of other substance-related disorders, such as that of stimulants and opioids, but the existing content analyses are limited to an analysis of alcohol and cannabis applications. Only two of the content analyses performed to date have attempted to identify applications that have their basis on a theoretical approach, based on the identification of behavioural change techniques or motivational techniques. There is a need to identify applications on the commercial stores that replicate conventional psychological interventions, or at least provide elements of conventional psychological interventions using behavioural change techniques that are integrated into the application. Further evaluative research could be done on these applications to determine if they are efficacious before using them for patient care. To address the limitation that existing content analyses have only focused on reviews of alcohol and cannabis applications, we propose for there to be updated content analyses for alcohol and cannabis, and new content analyses for other substances of abuse (such as opioids and stimulants). We like to suggest that future reviews consider keywords such as abstinence or recovery, and ones that relate to psychological therapies, such as self-determination or attention bias retraining, as commercial applications that have an underlying psychological basis might be categorised differently, under different keyword terms. We have evidence of how a better search strategy identifies previously unrecognised applications for attentional bias modification.
International Journal of Environmental Research and Public Health, 2019
Advances in experimental psychology have provided evidence for the presence of attentional and ap... more Advances in experimental psychology have provided evidence for the presence of attentional and approach biases in individuals with substance use disorders. Traditionally, reaction time tasks, such as the Stroop or the Visual Probe Task, are commonly used in the assessment of attention biases. The Visual Probe Task has been criticized for its poor reliability, and other research has highlighted that variations remain in the paradigms adopted. However, a gap remains in the published literature, as there have not been any prior studies that have reviewed stimulus timings for different substance use disorders. Such a review is pertinent, as the nature of the task might affect its effectiveness. The aim of this paper was in comparing the different methods used in the Visual Probe Task, by focusing on tasks that have been used for the most highly prevalent substance disorders—that of opiate use, cannabis use and stimulant use disorders. A total of eight published articles were identified ...
International Journal of Environmental Research and Public Health, 2018
Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances ar... more Background: Opiates, cannabis, and amphetamines are highly abused, and use of these substances are prevalent disorders. Psychological interventions are crucial given that they help individuals maintain abstinence following a lapse or relapse into substance use. Advances in experimental psychology have suggested that automatic attention biases might be responsible for relapse. Prior reviews have provided evidence for the presence of these biases in addictive disorders and the effectiveness of bias modification. However, the prior studies are limited, as they failed to include trials involving participants with these prevalent addictive disorders or have failed to adopt a systematic approach in evidence synthesis. Objectives: The primary aim of this current systematic review is to synthesise the current evidence for attention biases amongst opioid use, cannabis use, and stimulant use disorders. The secondary aim is to determine the efficacy of attention bias modification interventions and other addictions related outcomes. Methods: A search was conducted from November 2017 to January 2018 on PubMed, MEDLINE, Embase, PsycINFO, Science Direct, Cochrane Central, and Scopus. The selection process of the articles was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A qualitative synthesis was undertaken. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Six randomised trials were identified. The evidence synthesized from these trials have provided strong evidence that attentional biases are present in opioid and stimulant use disorders. Evidence synthesis for other secondary outcome measures could not be performed given the heterogeneity in the measures reported and the limited number of trials. The risk of bias assessment for the included trials revealed a high risk of selection and attrition bias. Conclusions: This review demonstrates the potential need for interventions targeting attention biases in opiate and cocaine use disorders.
Infection control and hospital epidemiology, Jan 9, 2018
OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevan... more OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.SETTINGA 2,000-bed tertiary-care psychiatric hospital.METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)-based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1-C3). Clu...
International journal of environmental research and public health, Jan 4, 2018
Research on attentional bias modification has increased since 2014. A recent meta-analysis demons... more Research on attentional bias modification has increased since 2014. A recent meta-analysis demonstrates evidence for bias modification for substance disorders, including alcohol and tobacco use disorders. Several pharmacological trials have shown that pharmacological agents can attenuate and modify such attentional bias. The pharmacological trials that have appeared to date have produced mixed results, which has clinical implications. Developments in Internet and mobile technologies have transformed how attention bias modification is currently being achieved. There remains great potential for further research that examines the efficacy of technology-aided attention bias interventions.
Singapore is a young island city-state in Southeast Asia with a diverse population of approximate... more Singapore is a young island city-state in Southeast Asia with a diverse population of approximately 5.7 million (https://www.singstat.gov.sg/modules/ infographics/population). Ethnic Chinese constitute approximately 76% of the residents, followed by ethnic Malays (13.6%), Indians (9.4%), and others (3.4%). Its relatively brief history as an independent state has been characterized by considerable economical and capital growth, four official languages (English, Mandarin, Malay, and Tamil; English is the official language of business, administration, and school instruction), an internationally strong and competitive educational system, as well as governmental and community visions of Singapore as an inclusive society (Lee 2004). It is within this context that this paper seeks to present and summarize the history and current development of services, education, and other initiatives for individuals with autism spectrum disorder (ASD) and their families. Legal Issues/Mandates for Service Singapore signed the UN Convention on the Rights of Persons with Disabilities in November 2012 and ratified it in August 2013. Service development and provisions for individuals with disabilities in Singapore have been guided by national-level committees and advisory groups. The Enabling Masterplans (EMs) for the disability sector (EM 2007-2011, EM 2012-2016, and EM 2017-2021) are comprehensive disability-specific policy documents designed to chart the development of programs and services for people with disabilities in the public sector and aimed to enhance the integration of persons with
Annals of the Academy of Medicine, Singapore, 2003
To provide a review of adolescent mental health service utilisation in a child and adolescent men... more To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.
Annals of the Academy of Medicine, Singapore, 1999
The aims of this paper were: to study the profile of trichotillomania cases referred to a child g... more The aims of this paper were: to study the profile of trichotillomania cases referred to a child guidance clinic in Singapore, to identify potential risk factors and to study the management and outcome of these cases. This is a descriptive, retrospective study of all cases of trichotillomania presenting to the clinic between January 1996 and January 1998. There were 7 cases seen in a 2-year period which is less than 1% of new cases seen at the clinic. The female to male ratio was 1.33:1 with a mean age of 9.3 years. All cases met the DSM-IV criteria for trichotillomania. All 6 pulled their hair in tufts with 1 who was almost hairless. Associated problems included tics, nail-biting, anxiety and shortness of temper. Treatments included behavioural treatment, stress management, parental education and counselling as well as medications. Two improved and were discharged, with 3 still undergoing treatment and 2 defaulted follow-up. The 7 cases seen in Singapore are similar in clinical feat...
Background: The origins of mental disorders arise often in childhood. Early life is a period of u... more Background: The origins of mental disorders arise often in childhood. Early life is a period of unique sensitivity with long lasting effects on mental health. However, the mechanisms for these effects remain unclear. Objective: This thesis describes a variety of studies using a developmental framework to promote greater understanding of the influence of nature (genotypes) and nurture (e.g., environmental risk and protective factors) on outcomes later in childhood. Method: The aim of this thesis is to investigate gene and environmental influences on behavioural, emotional, and cognitive outcomes in different samples from the Netherlands and Singapore, most derived from the general population. We assessed early life influences from a neurobiological, social, and a psychological perspective by using a biopsychosocial framework. Results: Our studies support the hypothesis that all experiences during life, including early experiences in utero, will influence the expression of genes and in the end the mental health of individuals. However, genotypes influencing stress responses are found to be ''plastic,'' which implies that they can be modulated by environmental experiences during life. In line with this, patterns of resilience are found to be contextdependent too. Conclusions: The model of ''epigenetic programming'' suggests the predictive power of the environment in utero and early childhood on mental health later in life. This association is probably determined by a neurodevelopmental pathway with individual differences in neural and endocrine responses to stress.
C linic a l P r a c tic e G ui d e lin e s 58 1.1 Objectives and scope of guideline These guideli... more C linic a l P r a c tic e G ui d e lin e s 58 1.1 Objectives and scope of guideline These guidelines are intended to assist primary care physicians and other healthcare professionals in the management of infertility. This includes increasing awareness and educating about the scale of fertility problems, recognising the various causes of infertility, natural fecundity, and success rates of in vitro fertilisation (IVF) treatment in relation to female age. These guidelines also seek to establish clear referral criteria to guide primary care physicians. 1.2 Target group The primary target group of these guidelines are primary care physicians. Nevertheless, these guidelines would also benefit all healthcare professionals involved in the management of infertility. 1.3 Guideline development These guidelines have been produced by a committee appointed by the Ministry of Health and the Academy of Medicine, Singapore, with representation from gynaecologists, fertility specialists, urologists and family physicians. They were developed using the best available current evidence and expert opinion. 1.4 Review of guidelines Evidence-based clinical practice guidelines are only as current as the evidence that supports them. Users must keep in mind that new evidence could supersede recommendations in these guidelines. The workgroup advises that these guidelines be scheduled for review three years after publication, or if new evidence appears that requires substantive changes to the recommendations. E XECUTIVE SUMMARY OF RECOMMENDATIONS Details of the recommendations listed can be found in the main text as the pages indicated. Definition and causes of infertility People who have not conceived after one year of regular unprotected sexual intercourse should be offered further clinical investigation, including semen analysis and/or assessment of ovulation (pg 20). GPP Basic measures to optimise fertility potential Preconceptual counselling in those with advanced age should include a discussion of the increased risks of aneuploidy, spontaneous abortion and obstetric complications (such as delivery by Caesarean section and gestational diabetes) associated with increasing maternal age (pg 21). Grade D, Level 3 In women with advanced maternal age (> 35 years), consultation with a reproductive specialist should be considered after six months of unsuccessful efforts to conceive (pg 22).
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