Mental disorders: employment and work productivity in Singapore

Aim

To examine the association between mental disorders and work disability in the adult resident population in Singapore.

Method

Data are from the Singapore Mental Health Study, which was a household survey of a nationally representative sample. The main instrument used was the Composite International Diagnostic Interview (CIDI). Employment-related information was collected using the modified employment module of the CIDI.

Results

A total of 6,429 respondents were included in the analysis, 71 % (n = 4,594) were employed, 24.5 % (n = 1,522) were economically inactive and 4.5 % (n = 313) were unemployed. Among the employed, 2.3 % had a 12-month prevalence of at least one mental disorder, while 5.3 % of the unemployed had at least one mental disorder. The average number of work loss days (absenteeism) per capita among those with a mental disorder was 0.5 per month that is equivalent to an annualized national projection of approximately 0.3 million productivity days. The average work-cutback days (presenteeism) were 0.4 days among this group. Of the mentally ill in the workforce, a high proportion (86.5 %) did not ever seek help for problems related to mental health.

Conclusion

Our findings provide information on the significant consequences of mental disorders on the workforce in terms of lost work productivity, which could pave the way for a more rational allocation of scarce resources.     

A Qualitative Exploration of the Views of Policymakers and Policy Advisors on the Impact of Mental Health Stigma on the Development and Implementation of Mental Health Policy in Singapore

Few studies have examined the views of policy makers regarding the impact of mental health stigma on the development and implementation of mental health policies. This study aimed to address this knowledge gap by exploring policymakers’ and policy advisors’ perspectives regarding the impact of mental health stigma on the development and implementation of mental health programmes, strategies, and services in Singapore. In all 13 participants were recruited for the study comprising practicing policymakers, senior staff of organisations involved in implementing the various mental health programmes, and policy advisors. Data was collected through semi-structured interviews, which were transcribed verbatim and analysed using reflexive thematic analysis. Data analysis revealed three superordinate themes related to challenges experienced by the policymakers/advisors when dealing with mental health policy and implementation of programmes. These themes included stigma as a barrier to mental health treatment, community-level barriers to mental health recovery, and mental health being a neglected need. Policymakers/advisors demonstrated an in-depth and nuanced understanding of the barriers (consequent to stigma) to mental healthcare delivery and access. Policymakers/advisors were able to associate the themes related to the stigma towards mental illness with help-seeking barriers based on personal experiences, knowledge, and insight gained through the implementation of mental health programmes and initiatives.

     

Donor selection in pediatric kidney transplantation using DR and DQ eplet mismatching: A new histocompatibility paradigm

It is now appreciated that more HLA‐DR mismatching at the time of the first renal transplant is associated with higher degrees of sensitization, lower rates and longer times to retransplantation, and worse graft outcomes in children who are subsequently retransplanted. As such, our pediatric renal transplant program preferentially uses 0 or 1 HLA‐DR–mismatched kidneys and reserves 2 DR‐mismatched kidneys for recipients with an eminent need for a kidney. Based on a new HLA class II epitope matching strategy that is designed to minimize dnDSA production to DR and DQ antigens, we evaluated the prevalence of DR and DQ eplet mismatching for dd offers made to our pediatric wait‐listed candidates. Each candidate/dd pair were HLA‐DR (β1 and β3 and/or β5) and DQ (α1 and β1) allele typed by rSSO and were then evaluated for eplet mismatches by the HLAMatchmaker program. We evaluated 78 offers made to 16 children on our UNOS waiting list from 27 consecutive dd from 4/14/14 to 3/23/15. The data show that 40% (8/20) of the 1 DR‐mismatched dd offers and 64% (37/58) of the 2 DR‐mismatched offers were in the high‐risk category for both DR and DQ dnDSA development. Whereas only 15% (3/20) of the 1 DR‐mismatched offers and 5% (3/58) of the 2 DR‐mismatched offers were in the low‐risk category for both DR and DQ dnDSA development, 55% and 33% of the 1 DR‐ and 2 DR‐mismatched offers, respectively, had a favorable DQ eplet mismatch threshold. In summary, HLA class II eplet mismatching is common in potential pediatric transplant recipient/donor pairs. Additional study will be necessary to validate the DR and DQ eplet threshold levels in children and to determine whether eplet mismatching strategies in donor selection result in improved transplant outcome and decreased dnDSA production.     

Linear furanocoumarin protects rat myocardium against lipidperoxidation and membrane damage during experimental myocardial injury.

The antioxidant activity and the membrane effects of linear furanocoumarin marmesinin isolated from Aegle marmelose was evaluated during experimental myocardial injury. Isoproterenol (150 mg kg(-1) intraperitonially twice at an interval of 24 h) caused increase in the levels of serum marker enzymes via creatinekinase (CK), creatinekinase-MB (CK-MB) isoenzyme, lactatedehydrogenase (LDH) and lactatedehydrogenase isoenzyme (LDH1). It also produced electrocardiographic changes such as increased heart rate, reduced R amplitude and ST elevation. Marmesinin at a dose of 200 mg kg(-1), when administered orally, demonstrated a decrease in serum enzyme levels and restored the electrocardiographic changes towards normalcy. Myocardial injury was accompanied by the disintegration of lipidperoxides and the impairment of natural scavengers. Marmesinin oral treatment for 2 days before and during isoproterenol administration decreased the effect of lipidperoxidation. It was also shown to have a membrane stabilizing action by inhibiting the release of beta-glucuronidase from the subcellular fractions. Thus, linear furanocoumarin marmesinin could have the protective effect against the damage caused by experimental myocardial injury.     

Clinical spotlight review for the management of choledocholithiasis

Choledocholithiasis is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis. A systematic English literature search was conducted in PubMed to determine the appropriate management strategies for choledocholithiasis. The following clinical spotlight review is meant to critically review the available evidence and provide recommendations for the work-up, investigations as well as the endoscopic, surgical and percutaneous techniques in the management of choledocholithiasis.     

Synthesis and pharmacological evaluation of novel 1-(piperidin-4-yl)-1H-benzo[d]imidazol-2(3H)-one derivatives as potential antimicrobial agents

Novel compounds of biological interest were synthesized by in situ reduction of Schiff’s base of 5,6-dimethoxy indanone and 1-(piperidin-4-yl)-1H-benzo[d]imidazol-2(3H)-one in the presence of Ti(OiPr)₄ and NaBH₃CN. Further alkylation using different alkyl/aryl halides in the presence of NaH in DMF gave a series of novel compounds. A formation of newly synthesized compounds was confirmed on the basis of their spectral and elemental analysis. Further these compounds were screened for their antimicrobial activity and found to have promising antibacterial and antifungal activity.