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PubMed1993

Seroepidemiology of hepatitis A and hepatitis B virus infection in a Gurkha community in Singapore.

The overall prevalence of hepatitis A virus (HAV) infection among the Gurkhas and their families stationed in Singapore was 83.2%, with antibody to HAV detected in 67 (38.1%) of 176 children under 5 years of age, 121 (76.6%) of 158 children between 5 and 14 years, and 600 (97.9%) of 613 older children and adults over age 15 years. Children born in Singapore (102/223 or 45.7%) had a significantly lower crude prevalence than those born in Nepal (85/110 or 77.3%) (P < 0.000001). The age-adjusted difference in prevalence was also statistically significant (P < 0.001). Susceptible children had a high risk of acquiring HAV infection when they travelled to Nepal. As for hepatitis B virus (HBV) infection, the prevalence of hepatitis B surface antigen (HBsAg) was 2.8%, with a higher rate in males (20/560 or 3.6%) than in females (6/384 or 1.6%). The highest HBsAg prevalence (4/26 or 15.4%) was in young adult Gurkhas 15-19 years of age. No significant difference in the crude prevalence of HBV markers was noted between children born in Singapore (45/224 or 20.1%) and those born in Nepal (19/107 or 17.8%). Even after age adjustment, the difference remained insignificant. The prevalence of HBV markers of children of seropositive parents (27/156 or 17.3%) was not significantly higher than that of seronegative parents (19/131 or 14.5%). Married men had a significantly higher age-adjusted prevalence of infection than unmarried men (45.4% and 32.4%, respectively; P < 0.05). Seropositivity of one spouse was significantly correlated with the seropositivity of the other (P < 0.05), suggesting a role for heterosexual transmission of HBV infection.

Adolescent↗
PubMed1989

Lactase deficiency in Singapore-born and Canadian-born Chinese.

Seventy-three of 77 adult Singapore-born Chinese (95%) and 48 of 49 Canadian-born adult Chinese (98%) were demonstrated to be lactase deficient using the lactose breath hydrogen test. The similar prevalence of lactase deficiency in the Singapore- and the Canadian-born Chinese despite a larger estimated amount of daily milk ingestion in the Canadian-born Chinese (430 ml vs 157 ml) supports the concept that lactase deficiency, which is transmitted genetically, does not have an adaptable component related to the quantity of lactose ingested. When the lactose breath hydrogen test performed with a dose of 0.5 g/kg of lactose was compared with the test using a standard dose of 50 g of lactose, there was very little loss of sensitivity. In spite of the presence of lactase deficiency, only 32% of the Singapore subjects and 23% of the Canadian subjects had gastrointestinal symptoms when milk was ingested in the daily diet. Peak breath H2 was higher in females than males, but the difference was more significant in the Canadian cohort.

Adolescent↗
PubMed2005

Stress among family caregivers of older persons in Singapore.

It is projected that, in the 21st century, the majority of the world's older people will be living in Asia. After Japan, Singapore is the most rapidly aging country in Asia. With an increasing life expectancy, many older persons will require health and instrumental care during later life stages. In Singapore, close to 95% of older people co-reside with family members, highlighting the importance of community support for family caregivers. Using a study of 61 principal family caregivers in Singapore, this article highlights the nature of and relationship between caregivers' stress and gender, patients' activities of daily living (ADL) and instrumental ADL dependency, and caregivers' attitudes. Findings from the study suggest that female caregivers tended to be more stressed than male caregivers. Results also showed a significant inverse relationship between the level of stress experienced by caregivers and the ADL and instrumental ADL dependency of patients. Caregivers looking after patients suffering from dementia, Parkinson's disease, and hypertension were more likely to be stressed than those caring for persons with stroke, depression, and other illnesses. This article concludes by describing some implications of this research for social worker practice and for informal as well as formal support programs for family caregivers.

Activities of Daily Living↗
PubMed2005

Ethnic differences in quality of life in adolescents among Chinese, Malay and Indians in Singapore.

BACKGROUND: Health-related quality of life in adolescents and ethnic and cultural differences are not well characterized. We used the Quality of Life Questionnaire for Adolescents (QOLQA) to examine ethnic differences in reported QOL scores among Chinese, Malay and Indian ethnicities in Singapore. METHODS: The 70-item QOLQA measuring five QOL domains (physical, psychological, independence, social and environmental) was administered to a random sample of 1363 school-children aged 10-15 years, representative of the ethnic composition of Singapore adolescents (Chinese 72%, Malays 20% and Indians 8%). RESULTS: Indians reported the highest overall QOL (mean 3.71 +/- SD 0.54) compared to Chinese (3.59 +/- 0.43), p < 0.05, and Malays (3.58 +/- 0.44), p < 0.05. In particular, Indians had significantly higher psychological QOL scores (3.73 +/- 0.61) compared to Chinese (3.55 +/- 0.54), p < 0.01. On the other hand, Chinese scored highest on physical and independence domains (3.97 +/- 0.54), p < 0.01 compared to Malays (3.82 +/- 0.55). There were no statistically significant gender differences in QOL scores. QOL declined significantly from age 10 to 15 for overall score, psychological, physical (p < 0.01) and environmental (p < 0.05). Lower socio-economic status and the self-report of a significant health problem were significantly associated with lower overall QOL and most domains. These ethnic differences persisted after adjusting for differences in socio-economic and health status. Psychometric properties and known group construct validity appeared to be similar across different ethnic groups, but compared to Chinese (r = 0.39) or Malays (r = 0.39), Indians showed a higher correlation of psychological scores with physical score (r = 0.59) and with other domain scores. CONCLUSION: Significant ethnic differences in reported adolescent quality of life among Chinese, Malays and Indians in Singapore that are independent of socioeconomic and health status suggest important cultural differences.

Adolescent↗
PubMed2006

A longitudinal study of advanced practice nursing in singapore.

This longitudinal study of the first cohort of APN interns provides information on aspects of the practice and on the development of their role from Singapore perspective. The APN role is a new one in Singapore, providing an opportune time to pioneer and define advanced practice nursing for the future. Longitudinal surveys will be conducted annually among this first cohort for 5 years to identify changes in role development over time. These results will be compared against those obtained from subsequent cohorts of APN interns in Singapore. Continued research into the role of the APN is needed to enhance role acceptance and development, and to ensure that the benefits of having APNs are attained.

Adult↗
PubMed2006

Polybrominated diphenyl ethers in house dust in Singapore.

The use of polybrominated diphenyl ethers (PBDEs) as flame retardants in Singapore is not strictly regulated; therefore these compounds can be readily found in furniture, electronic devices, and building materials. This study was the first of its kind to be conducted in Singapore to measure concentrations of PBDEs in house dust. Samples were collected from 31 homes in various locations across the island-state of Singapore, and a total eight PBDEs congeners were measured. PBDEs were detected in all 31 dust samples and the number of BDE congener detected per home ranged between 3 and 8. The most abundant BDE congeners found were BDE 47, 99 and 209, with a median value of 20 ng g(-1) dust, 24 ng g(-1) dust and 1000 ng g(-1) dust, respectively. BDE 209 contributed 88% to the median of all the congeners, and BDE 47 and 99 contributed 1.8% and 3.5%, respectively. Different congener profiles were observed between this and studies conducted elsewhere, which is consistent with the use of different commercial PBDE around the world. No significant correlations between PBDE dust levels and residential characteristics (number of TVs and computers, floor area or flooring material) were observed. The daily intake of PBDEs via the inhalation pathway was estimated. House dust may be regarded as the most important exposure route of PBDEs for children.

Dust↗
PubMed2026

A comparative systematic review of pharmacist education systems and pharmacy service quality in ASEAN-5: Indonesia, Malaysia, Thailand, the Philippines, and Singapore.

BACKGROUND: The global transition toward patient-centered pharmaceutical care has exposed structural disparities in ASEAN pharmacy workforce training and deployment. This review examines four research questions: how pharmacy education systems and accreditation standards differ across Indonesia, Malaysia, Thailand, the Philippines, and Singapore (collectively, the ASEAN-5); the extent to which pre-registration education influences clinical service scope and professional confidence; how education reform and regulatory change have shaped pharmacist clinical roles; and what barriers and enablers exist for regional qualification harmonization. METHODS: A systematic literature review following PRISMA 2020 was conducted. Searches of PubMed/MEDLINE and Scopus, supplemented by grey literature, were completed in May 2026. Of 78 unique records screened, 46 studies published between 2005 and 2026 met inclusion criteria. Quality appraisal used an adapted Mixed Methods Appraisal Tool; synthesis employed narrative thematic analysis. RESULTS: The five countries represent four structurally distinct pharmacy education architectures: Thailand's standardized six-year Doctor of Pharmacy with dual specialization tracks; four-year Bachelor of Pharmacy programmes in Malaysia and the Philippines with institutional variation; Indonesia's clinically underdeveloped system despite rapid expansion; and Singapore's four-year Bachelor of Pharmacy followed by a nationally mandated one-year pre-registration pathway. Evidence links deeper clinical training to broader practice scope, higher confidence, and improved patient outcomes. Reform produced uneven results: Thailand's PharmD transition improved clinical recognition but exposed deployment paradoxes; Singapore achieved the strongest training-to-practice alignment; Indonesia's health insurance reforms were not absorbed by an underprepared workforce; the Philippines lacks a national competency framework. No binding mutual recognition arrangement was identified; divergent qualification structures, incompatible accreditation systems, and an asymmetric evidence base remain the primary barriers. DISCUSSION: These findings indicate that clinical service scope is bounded less by national policy ambition than by the depth and clinical orientation of the pre-registration education that precedes it, and that credentialing reforms which outpace a health system's capacity to absorb new clinical roles, or the reverse, do not by themselves translate into expanded practice. CONCLUSIONS: Pharmacy education across the ASEAN-5 remains nationally distinct and clinically uneven. Clinical service scope is directly bounded by pre-registration education quality. No country has fully closed the education-practice gap. Regional harmonization requires national-level educational reform as a prerequisite.

Humans↗
PubMed2005

Complementary and alternative medicine use in multiracial Singapore.

OBJECTIVE: To determine the prevalence of complementary and alternative medicine (CAM) use in Singapore, the factors influencing CAM use, and the attitudes, beliefs and perceptions of the general population towards CAM. DESIGN: An interviewer-administered questionnaire survey in a housing estate with demographic and socioeconomic characteristics closely matching that of Singapore. RESULTS: 76% (95% C.I. 73.9-77.9%) used CAM over a 12-month period. Females were 2.1 times (95% C.I. 1.3-3.4) more likely than males to use CAM. Chinese (84%) were the most frequent users, followed by Malays (69%) and Indians (69%), with adjusted odds ratios of 0.4 (95% C.I. 0.2-0.7) for Malays and 0.4 (95% C.I. 0.2-0.8) for Indians. Traditional Chinese Medicine (88%) was the most widely used form of CAM, followed by Traditional Malay (Jamu) Medicine (8%) and Traditional Indian (Ayuverdic) Medicine (3%). Similar to western studies, CAM was more likely to be used for maintenance of health than for treatment of illness. Different from western studies, CAM use was not independently associated with household income, marital status, age and education. Seventy-four percent did not discuss their use of CAM with their western-trained doctors. CONCLUSIONS: The high prevalence of CAM use in multi-racial Singapore suggests the same may be true in other Asian countries. Western-trained doctors need to understand CAM better and communicate more with their patients regarding CAM use. The lack of a scientific evidence base for most forms of CAM notwithstanding, its ubiquitous use worldwide is something that governments and the medical profession cannot afford to ignore.

Adult↗
PubMed2005

Regulatory control of Chinese Proprietary Medicines in Singapore.

In Singapore, there has been a growing public interest in traditional Chinese medicine (TCM), which plays an important role in the healthcare system. With effect from 1 September 1999, the control on Chinese Proprietary Medicines (CPM) was implemented in three phases over a span of 3 years. Under the CPM regulatory framework, CPM importers, wholesalers, manufacturers and re-packers must be licensed and CPM products assessed and listed by the health authority before they are allowed for sale. Product assessment is based on the criteria of safety and quality which include limits of toxic heavy metals and microbial contents. During the 3-year CPM listing exercise, irregularities were detected, including intrinsic toxicity, adulteration, substitution, contamination, misidentification, non-traditional and/or inappropriate usage, incorrect preparation, inappropriate labelling, exaggerated claims and/or advertising. The full implementation of CPM control by September 2001 saw the listing of 7943 CPM products and brought about an improvement in the quality and safety of CPM in Singapore as well as the removal of sub-standard, fake/imitation and adulterated products. The standards of practices by local CPM dealers have also been raised. These improvements have, in turn, increased the level of public confidence in CPM products in Singapore.

Drug Labeling↗
PubMed2004

SARS in Singapore: surveillance strategies in a globalising city.

Public health measures employed to fight against the spread of SARS need to be guided by biomedical knowledge as well as an understanding of the social science aspects of the disease. Using Singapore as a case study, we explore how the state constructs the disease and implements measures targeted at creating a ring of defense around the island and using surveillance to monitor and prevent its spread. While there is support, there is also resentment among some Singaporeans who complain that their right to privacy has been invaded and that over surveillance may have actually occurred. Marginalisation and discrimination have not only affected the local population but in this open economy which is striving to achieve global city status, businesses, tourism, foreign talent, foreign contract workers and foreign students studying in Singapore have also been negatively affected. While Singapore has been applauded by WHO and used as an example of quick and effective response, a holistic approach to the management of infectious disease must address the social implications of strategies that are drawn from medical knowledge alone because it impinges on the social lives of people and how people interact with each other under stressful circumstances.

Adult↗
PubMed2005

The relationship of hostility, negative affect and ethnicity to cardiovascular responses: an ambulatory study in Singapore.

This study tested the hypotheses that ambulatory heart rate and blood pressure would be higher for individuals high but not low in hostility when they experienced negative affect or social stress and that this interaction would be stronger for Indians compared with other Singapore ethnic groups. Ambulatory blood pressure monitoring was done on 108 male Singapore patrol officers as they went about their daily duties. After each BP measurement participants completed a computerized questionnaire including items on emotional experience. Individuals high in hostility showed higher systolic blood pressure when reporting negative affect whereas this was not true for those low in hostility. Ethnic differences were obtained such that Indians showed an increase in mean arterial pressure when angered whereas MAP was negatively related to anger for Malays and unrelated for Chinese. Also a three-way interaction between ethnicity, hostility, and social stress indicated that hostility and social stress interacted in their effects on DBP for Indian participants but not for Chinese or Malays. Finally, a three-way interaction was obtained between ethnicity, hostility and negative affect for heart rate in which heart rate increased with increasing levels of negative affect for Chinese high in hostility and Malays low in hostility but decreased with increasing negative affect for all other participants. These data are consistent with higher CHD rates among individuals high in hostility and also provide additional evidence on ethnic differences in cardiovascular reactivity in Singapore.

Adult↗
PubMed2005

Determination and occurrence of polybrominated diphenyl ethers in maternal adipose tissue from inhabitants of Singapore.

Polybrominated diphenyl ethers (PBDEs), as a specific group of brominated flame retardants (BFR), are used in a variety of consumer products including electronics and household furnishings. In recent years, a marked increase in the levels of PBDEs in human biological tissues and fluids, especially breast milk, has been reported in several countries. However, few data are available from countries in the Asia-pacific region, including Singapore. This study presents a validated method procedure and the first available data of the concentrations of PBDE congeners: PBDE-47 (2,2,4,4-Tetrabromodiphenyl ether), PBDE-99 (2,2',4,4',5-Pentabromodiphenyl ether), PBDE-100 (2,2',4,4',6-Pentabromodiphenyl ether), PBDE-153 (2,2',4,4',5,5'-Hexabromodiphenyl ether), PBDE-154 (2,2',4,4',5,6'-Hexabromodiphenyl ether) in maternal adipose tissue collected from inhabitants of Singapore. Microwave-assisted extraction (MAE) of PBDEs spiked adipose tissues coupled with GC-MS analysis achieved comparable recoveries to a conventional Soxhlet Extraction (SE) procedure of between 70 and 130%. MAE also yielded comparable precision data (variance less than 13%) relative to the SE procedure. Spiked Carbon-13 PBDE congeners were also used as surrogates for MAE quality assurance and confirmed the efficiency of the procedure. PBDE congeners were detected in all of 16 maternal adipose tissues collected in Singapore, where levels were comparable to available data from Belgium.

Adipose Tissue↗
PubMed2004

Validity and reliability of the PDQ-39 and the PDQ-8 in English-speaking Parkinson's disease patients in Singapore.

The purpose of the study was to assess the validity and reliability of the Parkinson's disease questionnaire (PDQ-39, UK English version) as well as its briefer version (the PDQ-8) among Asian patients with Parkinson's disease (PD) in Singapore. Eighty-eight patients recruited from movement disorder clinics or patient support groups completed the PDQ-39 and EQ-5D, a generic health related quality of life questionnaire previously validated for use in Singapore. PDQ-39 items showed good convergent and discriminant validity. Construct validation against the EQ-5D showed strong correlation between these scales as hypothesised (Spearman's rho: 0.53-0.71, P<0.001 for all). Factor analysis yielded a component on which all eight PDQ-39 dimensions were substantially loaded (loading range: 0.50-0.79). The PDQ-39 also demonstrated acceptable internal consistency (Cronbach's alpha: 0.59-0.94) and test-retest reliability (intra-class correlation coefficient:0.67-0.87, n=68). Six of eight PDQ-8 items showed the strongest correlation with their PDQ-39 dimensions as hypothesised. PDQ-39 and PDQ-8 summary indexes were highly correlated (Pearson's r=0.96, ICC=0.95), and both were strongly correlated with the EQ-5D utility index and EQ-5D visual analogue scale (P<0.001). We conclude that the PDQ-39 and PDQ-8 are valid and reliable disease-specific HRQoL instruments for PD in Singapore.

Adult↗
PubMed2006

The development and regulation of occupational exposure limits in Singapore.

Singapore is an island republic in South East Asia with a workforce of about 2.1 million including 0.7 million employed in the manufacturing industry. Singapore's industry is diversified and the main growth sectors include microelectronics, chemical, petrochemical, pharmaceutical, and biomedical sectors. Exposure to chemical hazards is one of the main occupational health problems in the manufacturing sectors. The main roles of government in the protection of workers against safety and health hazards are to set standards and provide a proper infrastructure for industry to self-regulate. The occupation safety and health laws must provide adequate protection of workforce but must not disadvantage local industry in this globally competitive economy. To ensure a level playing field, Singapore's occupational exposure standards are benchmarked against those established in the developed countries. These standards are reviewed regularly to ensure they are realistic and relevant in tandem with worldwide trends. Industry and stakeholders are consulted before any new standards are introduced. In enforcing the laws relating to exposure standards, legal and administrative procedures are followed to ensure fairness and to prevent abuse.

Environmental Monitoring↗
PubMed2002

Organotin and Irgarol-1051 contamination in Singapore coastal waters.

The seas surrounding Singapore are principally utilized by the shipping industry but are now also increasingly used for a variety of other purposes, including desalination for supplies of drinking water and intensive aquaculture of food fish. While stringent environmental pollution standards are in place for industrial effluents, there is currently no legislative control over pollution from anti-fouling paints in Singapore. In this study, the concentrations of toxic antifouling agents tributyltin (TBT), triphenyltin (TPhT) and Irgarol-1051 (2-methylthio-4-tert-butylamino-6-cyclopropylamino-s-triazine) were determined from seawater obtained from 26 locations along and off the coast of Singapore in October and November 2000. These compounds were isolated by liquid-liquid extraction derivatized under controlled microwave heating and quantified by gas chromatography-mass spectrometry. TBT concentrations in seawater ranged between 0.43 and 3.20 microg 1(-1) with a mean value of 1.40 +/- 0.60 micro 1(-1). The mean values of DBT and MBT were 1.07 +/- 0.80 microg 11(-1) and 0.34 +/- 0.50 microg 1(-1) respectively, while TPhT concentrations of up to 0.40 microg 1(-1) were found. Monophenyltin and diphenyltin were not detected in all samples analysed. Irgarol-1051 was found to be present at concentrations of between 3.02 microg 1(-1) and 4.20 microg 1(-1) in seawater with a mean value of 2.00 +/- 1.20 microg 1(-1).

Environmental Monitoring↗
PubMed2001

Epidemiology of West syndrome in Singapore.

The incidence of West syndrome (WS) was determined by a search of reports of electroencephalograms (EEG) recorded in 1998 and 1999 in all public hospitals in Singapore. Amongst records of patients born in 1998, nine were found with EEG features of hypsarrhythmia or modified hypsarrhythmia with onset of seizures between January 1,1998 and December 31, 1999. The medical records of these patients were reviewed. The population of children born in 1998 was 43,664. In 1998 and 1999, 67% of all hospital admissions for patients 2 years or younger in Singapore were in public hospitals. The cumulative incidence of WS in Singapore corrected for the percentage of hospital admissions to public hospitals was 3.1/10,000 live births. The corrected cumulative incidences in Chinese, Malays and Indians were 2.7, 3.1 and 3.3 per 10,000, respectively. Three cases were idiopathic; three were due to congenital structural lesions of the brain; one each had periventricular leucomalacia, intracranial hemorrhage and severe intrauterine growth retardation. None of the patients were normal at follow up. The three patients with idiopathic WS had mild global developmental delay and the other six cases had cerebral palsy and severe mental retardation. With the best modern medical treatment, possibly only two of the nine cases of WS may have been prevented.

Asian People↗
PubMed2006

A survey on the knowledge and attitudes of anaesthesia providers in the United States of America, United Kingdom and Singapore on visual experiences during cataract surgery.

BACKGROUND AND OBJECTIVE: To assess the knowledge, beliefs and attitudes of anaesthesia providers on the patients' possible intraoperative visual experiences during cataract surgery under local anaesthesia. METHODS: Anaesthesia providers from the Ophthalmic Anaesthesia Society (USA); British Ophthalmic Anaesthesia Society (UK); Alexandra Hospital, National University Hospital, Tan Tock Seng Hospital, Singapore General Hospital and Changi General Hospital (Singapore) were surveyed using a structured questionnaire. RESULTS: A total of 146 anaesthesiologists (81.6%), 10 ophthalmologists (5.6%) and 23 nurse anaesthetists (12.8%) responded to the survey. Most respondents believed that patients would experience light perception and many also felt that patients might encounter other visual sensations such as movements, flashes, colours, surgical instruments, hands/fingers and the surgeon during the surgery. A significantly higher proportion of anaesthesia providers with previous experience of monitoring patients under topical anaesthesia believed that patients might experience the various visual sensations compared to those who have not previously monitored. For both topical and regional anaesthesia, anaesthesia providers who routinely counsel their patients are (1) more likely to believe that preoperative counselling helps or (2) were previously told by patients that they could see intraoperatively and/or that they were frightened by their visual sensations. These findings were statistically significant. CONCLUSIONS: The majority of anaesthesia providers in the USA, UK and Singapore are aware that patients may experience a variety of visual sensations during cataract surgery under regional or topical anaesthesia. Those who have previously managed patients undergoing cataract surgery under topical anaesthesia are more likely to believe this compared to those who have not.

Administration, Topical↗
PubMed2000

Risk factors for the development of pterygium in Singapore: a hospital-based case-control study.

PURPOSE: A hospital-based case-control study, designed to evaluate the risk factors for the development of pterygium in Singapore. METHODS: Sixty-one cases and 125 controls were interviewed at the Singapore National Eye Centre. Information on present and past (5 and 10 years ago) exposure to sunlight on weekdays and weekends, sociodemographic data, behavior lifestyle and family history of eye disease was collected. RESULTS: Patients with pterygia were mostly males, smoked and drank alcohol more often, had lower combined family incomes and were more likely to have a family history of eye disease. The adjusted odds ratios for the development of pterygia were 1.27 (95 percent confidence interval 1.06 to 1.54) and 1.31 (95 percent confidence interval 1.09 to 1.57) for participants who had spent more time in the sun five and ten years ago respectively. CONCLUSIONS: Pterygium is an important public health problem in Singapore and its development is related to the amount of sunlight exposure.

Adult↗