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At least 235 records · Page 13Linked to original sources
PubMed2006

Singapore familial adenomatous polyposis (FAP) patients with classical adenomatous polyposis but undetectable APC mutations have accelerated cancer progression.

OBJECTIVES: Germline mutation in adenomatous polyposis coli (APC) is detected in up to 80% of familial adenomatous polyposis (FAP) patients worldwide. In this study, we evaluated clinical features and APC mutations of Singapore FAP patients and contrasted genotype-phenotype correlation with Caucasians from other regions of the world and between FAP patients with and without detectable APC mutations. METHODS: We screened 242 members from 57 unrelated FAP families using a combination of cDNA protein truncation test, multiplex ligation-dependent probe amplification, and differential expression techniques. RESULTS: APC germline mutations were detected in 50 families. In contrast to Caucasians, fundic gland polyposis in Singapore patients was associated with APC mutations throughout the coding region and osteomas were also not confined to codon 767-1573. There was also no FAP-associated hepatoblastoma or medullablastoma. APC mutation-negative patients from four families with mixed (adenomatous/hyperplastic/atypical juvenile) polyps were subsequently reclassified as hereditary mixed polyposis syndrome (HMPS) patients. APC mutation-negative patients with classical adenomatous polyposis were negative for MYH, beta-catenin, and Axin 1 mutations. These patients had a significantly older age at diagnosis (P < 0.001) and more colorectal cancers (P= 0.017) than patients with APC mutations. CONCLUSIONS: We achieved a 94% (50/53) APC mutation detection rate via a combination of techniques, suggesting that the current detection rate is probably not exhaustive. Singapore patients have some features similar to and other features distinct from Caucasians. Furthermore, APC mutation-negative patients have accelerated cancer progression that merits closer surveillance.

Adenomatous Polyposis Coli↗
PubMed2005

Analysis of photodermatoses seen in a predominantly Asian population at a photodermatology clinic in Singapore.

BACKGROUND: The idiopathic photodermatoses have been reported to be rarer in tropical Singapore than in countries of higher latitude, with photoaggravated dermatoses and systemic phototoxicity making up most of the photodermatoses seen here. This study aims to reassess the spectrum of photodermatoses seen at the National Skin Centre, Singapore, compared with almost a decade ago, and analyse the clinical and photobiological characteristics, as compared with other countries. MATERIALS AND METHODS: We reviewed the clinical data of 141 patients phototested from January 2000 to December 2001, and analysed the epidemiological, clinical and photobiological features. RESULTS: Photosensitive dermatoses were diagnosed in 88% (124/141) of patients phototested. In those diagnosed with photodermatoses, polymorphic light eruption (PMLE) (28%) was the most common diagnosis, followed by photoaggravated dermatoses (26%), chronic actinic dermatitis (CAD) (15%), systemic phototoxicity (15%), solar urticaria (SU) (7%), actinic prurigo (AP) (5%) and photoallergic contact dermatitis (4%). Ethnic Indians appeared to be more predisposed to PMLE; AP was diagnosed only in ethnic Chinese. The other photodermatoses occurred proportionally in all racial groups. AP differed from that found in Caucasians, being of adult onset and persistent. Abnormal phototest results were obtained in all patients with CAD, SU and AP, but only in 56% and 49% of systemic phototoxicity and PMLE, respectively. CONCLUSION: Idiopathic photodermatoses are more commonly diagnosed in Singapore than a decade ago, while the incidence of systemic phototoxicity has remained stable. The spectrum of photodermatoses in our Asian population now approximates that seen in Caucasian cohorts.

Aged↗
PubMed1996

Ethnic variation of cord plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore.

In multiracial Singapore, the prevalence of coronary artery disease is highest in ethnic Indian and lowest in ethnic Chinese populations. Since susceptibility to coronary artery disease is closely associated with plasma lipid traits, we studied the cord blood lipid and apolipoprotein profiles of the three ethnic groups in Singapore to determine if ethnic differences in lipid profile are present at birth. The high-risk lipid traits of high LDL-cholesterol, triglycerides and apo B, low HDL-cholesterol and apo A-I were found to be highest in ethnic Indian and lowest in ethnic Chinese populations. This difference was concordant with the relative coronary mortality rates for their respective adult populations in Singapore.

Analysis of Variance↗
PubMed2006

Correlations in refractive errors between siblings in the Singapore Cohort Study of Risk factors for Myopia.

BACKGROUND: The prevalence of myopia in parts of South East Asia has risen dramatically over the past 1-2 generations, suggesting that environmental factors may be particularly important determinants of refractive development in these populations. AIM: To assess the contribution of familial factors (shared genes and/or shared family environment) to refractive error and ocular component dimensions of school-aged children in Singapore. METHODS: Data were available for 315 children who had one or more siblings also participating in the Singapore Cohort Study of the Risk factors for Myopia (SCORM). Refractive error and ocular biometric parameters were measured under cycloplegia at baseline when children were 7-9 years, and at yearly follow-up sessions for the next 3 years, using consistent clinical procedures. The time children spent performing a variety of nearwork-related tasks was obtained from questionnaires. Familial influences were assessed by calculating between-sibling correlations. RESULTS: After adjusting for age and sex, the between-sibling correlation in refractive error was 0.447 (95% CI 0.314 to 0.564), suggesting that familial factors account for 63-100% of the variation in the cohort. The between-sibling correlation for 1-year change in refractive error was similarly high, at 0.420 (95% CI 0.282 to 0.543). All ocular component dimensions were correlated significantly between siblings, especially for corneal curvature and vitreous chamber depth--the major structural determinants of refraction. The amount of time siblings spent engaged in nearwork tasks (reading, watching TV, playing video games, computing) and in outdoor activities was also highly correlated between siblings (p<0.001). CONCLUSION: Shared genes and/or shared environment are important factors in the refractive development of children in Singapore. Because the time spent in nearwork tasks is highly correlated between siblings, epidemiological studies will benefit from precise, quantitative measures of refractive error in parents and more distant relatives in order to begin to dissociate genetic and environmental sources of variation.

Biometry↗
PubMed2000

Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore.

AIM: To estimate the rates of hospital admissions for primary angle closure glaucoma (PACG) in Chinese, Malays, and Indians in Singapore METHODS: A population-wide hospital discharge database in Singapore was used to identify all hospital admissions with a primary discharge diagnosis of PACG (International Classification of Disease-CM code: 365.2). The Singapore census was used for denominator data. RESULTS: Between 1993 and 1997 there were 894 hospital admissions for PACG. The mean annual rate of PACG admissions was 11.1 per 100 000 (95% confidence interval (CI), 10.4, 11.8) among people aged 30 years and over. The annual rate was highest for Chinese (age and sex adjusted rate: 12.2 per 100 000), which was twice that of Malays (6.0 per 100 000) and Indians (6.3 per 100 000). Females had two times higher rates than males in all three races (age adjusted relative risk: 2.0, 95% CI: 1.7, 2.3). CONCLUSION: Malay and Indian people had identical rates of hospital admissions for PACG, which were only half the rates compared with Chinese.

Adult↗
PubMed2004

Outbreak of severe acute respiratory syndrome in a tertiary hospital in Singapore, linked to an index patient with atypical presentation: epidemiological study.

OBJECTIVE: To describe an outbreak of severe acute respiratory syndrome (SARS) in a tertiary hospital in Singapore, linked to an index patient with atypical presentation, and the lessons learnt from it. DESIGN: Descriptive study. SETTING: A tertiary hospital in Singapore. PARTICIPANTS: Patients, healthcare workers, and visitors who contracted SARS in Singapore General Hospital. MAIN OUTCOME MEASURES: Probable SARS as defined by the World Health Organization. RESULTS: The index patient presented with gastrointestinal bleeding, initially without changes to his chest radiograph. Altogether 24 healthcare workers, 15 patients, and 12 family members and visitors were infected. The incubation period ranged from three to eight days. Only 13 patients were isolated on their dates of onset. CONCLUSIONS: Atypical presentation of SARS infection must be taken into consideration when managing patients with a history of contact with SARS patients. The main gap in the containment strategy in this outbreak was the failure to identify the index patient as someone who had been discharged from a ward in another hospital that managed probable SARS cases. Strict infection control measures, a good surveillance system, early introduction of isolation procedures, and vigilant healthcare professionals are essential for controlling outbreaks.

Aged↗
PubMed1996

Hepatitis B virus infection in Singapore.

Although Singapore is in an endemic region for hepatitis B infection, the hepatitis B carriage rate of 5-6% is relatively low. The highest positivity rates for hepatitis B surface antigen (HBsAg) are found in the paediatric age group, with another peak in 40-49 year olds. Studies suggest that, although perinatal transmission is an important route of infection, most children acquire the virus through horizontal transmission between family members. Viral replication continues at a high rate in young carriers and tends to slow down with increasing age. Up to 50% of hepatitis B carriers in Singapore have chronic hepatitis, shown by raised serum ALT values and liver histology, and about 10% are infected with the precore mutant virus. About 20% of carriers have cirrhosis. Among patients with HCC, up to 75% are HBsAg positive, of whom 45% are still viraemic. Mass vaccination against hepatitis B was introduced into Singapore on a voluntary basis in 1983, with compulsory vaccination of babies born to HBeAg positive mothers since 1985. The number of cases of acute hepatitis B has fallen by 60% between 1989 and 1995 although the problems of the longterm complications of chronic hepatitis B still need to be tackled.

Age Factors↗
PubMed1990

Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. II. Differences in risk factor levels.

STUDY OBJECTIVE: The aim of the study was to examine cardiovascular risk factors to see how these might explain differences in cardiovascular disease mortality among Chinese, Malays, and Indians in the Republic of Singapore. DESIGN: The study was a population based cross sectional survey. Stratified systematic sampling of census districts, reticulated units, and houses was used. The proportions of Malay and Indian households were increased to improve statistical efficiency, since about 75% of the population is Chinese. SETTING: Subjects were recruited from all parts of the Republic of Singapore. SUBJECTS: 2143 subjects aged 18 to 69 years were recruited (representing 60.3% of persons approached). There were no differences in response rate between the sexes and ethnic groups. MEASUREMENTS AND MAIN RESULTS: Data on cardiovascular risk factors were collected by questionnaire. Measurements were made of blood pressure, serum cholesterol, low and high density lipoprotein cholesterol, fasting triglycerides and plasma glucose. In males the age adjusted cigarette smoking rate was higher in Malays (53.3%) than in Chinese (37.4%) or Indians (44.5%). In both sexes, Malays had higher age adjusted mean systolic blood pressure: males 124.6 mm Hg v 121.2 mm Hg (Chinese) and 121.2 mm Hg (Indians); females 122.8 mm Hg v 117.3 mm Hg (Chinese) and 118.4 mm Hg (Indians). Serum cholesterol, low density lipoprotein cholesterol and triglyceride showed no ethnic differences. Mean high density lipoprotein cholesterol in males (age adjusted) was lower in Indians (0.69 mmol/litre) than in Chinese (0.87 mmol/litre) and Malays (0.82 mmol/litre); in females the mean value of 0.95 mmol/litre in Indians was lower than in Chinese (1.05 mmol/litre) and Malays (1.03 mmol/litre). Rank prevalence of diabetes for males was Indians (highest), Malays and then Chinese; for females it was Malays, Indians, Chinese. CONCLUSIONS: The higher mortality from ischaemic heart disease found in Indians in Singapore cannot be explained by the major risk factors of cigarette smoking, blood pressure and serum cholesterol; lower high density lipoprotein cholesterol and higher rates of diabetes may be part of the explanation. The higher systolic blood pressures in Malays may explain their higher hypertensive disease mortality.

Adolescent↗
PubMed1999

Temporal trends and ethnic variations in asthma mortality in Singapore, 1976-1995.

BACKGROUND: A study was undertaken to examine temporal trends and ethnic differences in the asthma mortality rate in Singapore. METHODS: Asthma mortality rates in Singapore were estimated from vital data for the years from 1976 to 1995. Trends in sex and age specific (5-14, 15-34, 35-59, 60+ years) rates were obtained for four periods (1976-80, 1981-85, 1986-90, 1991-95) and for Chinese, Malay, and Indian subjects for the years when these data were available (1989-95). RESULTS: An increase in asthma mortality was observed in children aged 5-14 years from 0.21 per 100,000 person years in 1976-80 to 0.72 per 100,000 person years in 1991-95. No increases were noted in the other age groups but a small decrease was observed in the 1991-95 period for the 35-59 year age group. Marked ethnic differences in mortality rates were observed. In the group aged 5-34 years the asthma mortality rates were 0.5 per 100,000 in Chinese subjects, 1.3 per 100,000 in Indians, and 2.5 per 100,000 in Malay subjects. Similar 2-4 fold differences were observed in all other age groups. CONCLUSIONS: Apart from genetic factors, environmental exposures and medical care factors which influence asthma prevalence and severity are most likely to be the causes of the observed temporal trends and ethnic differences in the asthma mortality rate in Singapore, but further studies are needed to elucidate these more fully.

Adolescent↗
PubMed2006

Cross-cultural validation of expressed emotion in caregivers of Chinese patients with first episode psychosis in Singapore: a qualitative study.

BACKGROUND: The concept of Expressed Emotion (EE; Brown et al., 1972), a measure of criticism, over-involvement and hostility in families, has been shown to be a robust predictor of relapse in schizophrenia (Parker & Hadzi-Pavlovic, 1990). Recent criticism of using Western instruments in Asian countries has led to more stringent procedures for validation of scales. AIMS: The first aim was to establish that the concept of Expressed Emotion exists in Singapore. The second aim was to examine the Level of Expressed Emotion (LEE; Cole & Kazarian, 1988, Gerlsma & Hale, 1997) scale to ascertain the conceptual and construct operationalisation of this instrument in this culture. METHODS: This was a qualitative study. The concept of EE was examined using a Singaporean population; 10 patient-caregiver pairs were recruited and interviewed using a semi-structured interview format. Regarding the LEE, small focus-group interviews were conducted with a cross-section of Singaporeans to gain their views on the concepts in the scale and the relevance of the items in this culture. RESULTS: The interviews were analysed in light of attitudes found to discriminate between high and low EE families (Leff & Vaughn, 1985). A clear distinction between high and low EE groups was found. With regard to the LEE, the data from the focus groups, for the most part, supported the cross-cultural conceptual and operational equivalence of the scale and suggestions for additional items were made. CONCLUSION: There is support for the existence of EE among families in Singapore, and the LEE was found, for the most part, to be applicable in Singapore, with the addition of several emic items.

Adult↗
PubMed1999

The Sports Challenge international programme for identified 'at risk' children and adolescents: a Singapore study.

The current world wide phenomena of youth suicide which became a major issue for countries in the early nineties, is still growing exponentially. The Sports Challenge program was initiated in 1992 in Western Australia to identify 'at risk' children and adolescents who display: a low sense of basic trust, a sense of shame and doubt, a sense of inferiority and a sense of identity confusion with common characteristics of low self esteem. The subsequent program is based on a strong statistical paradigm encompassing current and historical information with reliable and objective evaluation measures. To this end, since 1992, Sports Challenge has been recognised as a 'World Best Practice' in redressing the issue of 'at risk' children and adolescents. The program now operates in over 150 schools and communities throughout Australia and 24 schools and Detention Centres in Singapore. This paper will allow a window into the development of the program and the successful transfer of the project into Singapore. The Singapore study which began in 1996 has revealed the success of the Sports Challenge program cross culturally with improvement in self esteem and self concept of 'at risk' groups in the range of 18% to 44%.

Adolescent↗
PubMedDate not supplied

Health information management in Singapore.

This paper provides an overview of health information management practices in Singapore, based on personal observation and interviews with health information managers in five Singaporean hospitals. In Singapore borrowing a medical record often requires a formal request and a permanent tracer is maintained for each record. Medical officers generally have more responsibility than in Australia for coding, which is completed within three days of discharge. A Singapore-wide centralised patient database has been developed which is an important source of information about patient drug allergies. Record design and assembly, release of information and centralised registries are also described.

Abstracting and Indexing↗
PubMed1987

Suicide following parasuicide in Singapore.

Suicide was attempted by 1641 people (502 males and 1139 females) in Singapore during 1980. Eleven of these committed suicide during the following three years, giving a suicide rate of 0.67%. Of the eleven suicides, five had schizophrenia and three depression. The risk of suicide in the year following attempted suicide is lower in Singapore (0.5%) than in Britain (1.6%). High risk factors for the Singapore patients were being Chinese, being male, and having a mental illness.

Adolescent↗
PubMed2001

Medical savings accounts in Singapore: a critical inquiry.

With the United States currently experimenting with medical savings accounts (MSAs), it is appropriate to revisit the Singapore experience, where the practice has been in place for a decade and half. Singapore runs a modern, effective health system at a fraction of the cost of most systems operating in the developed West. Although MSAs contribute to the framework of a cultural rhetoric of personal responsibility for health care, this article argues that the heart of the Singapore system of health funding, with its financial discipline, is government control of inputs and outputs and strict rationing of health services according to wealth.

Cost Control↗
PubMed2006

Cost and cost-effectiveness of antiretroviral therapy for HIV infection in Singapore.

The objective of this study was to determine the cost and cost-effectiveness of antiretroviral therapy (ART) in Singapore. The use and cost of HIV services was calculated for patients managed at the national HIV referral centre in Singapore between 1996 and 2001 from a hospital perspective. Three groups of patients were compared by Centers for Disease Control and Prevention (CDC) stage of HIV infection: those who had never received ART; those who had received only dual therapy; and those who had only received highly active antiretroviral therapy (HAART). Hospital charges were used to estimate the average hospital inpatient and outpatient care costs. Life years gained (LYG) were calculated for different stages of HIV infection and the incremental costs per LYG were calculated comparing those on dual ART and HAART with those who did not receive ART. Patients on ART progressed less rapidly across all CDC stages. For CDC stage A, the incremental cost per LYG was 17,007 dollars (Singaporean dollar) (interquartile range [IQR] 7963-25,113 dollars ) and 22,511 dollars (IQR 11,299-33,724 dollars) for those on dual therapy and HAART, respectively. The incremental cost per LYG in stage B was 10,868 dollars (IQR 4506-17,239 dollars) and 21,094 dollars (IQR 7774-34,431 dollars) for patients on dual therapy and HAART, respectively, while the incremental cost per LYG for stage C patients was 9,848 dollars (IQR 5256-14,419 dollars ) and 16,513 dollars (IQR 8677-24,337 dollars) for dual therapy and HAART, respectively. Dual ART therapy and HAART were cost-effective interventions in Singapore. Cost-effectiveness is likely to improve if drug prices continue to decrease.

Adult↗
PubMed2003

Fatal pulmonary thromboembolism in Singapore: has anything changed?

A previous study of fatal pulmonary thromboembolism (PE) during a five-year period (1989-1993) in Singapore found a low post-mortem prevalence of fatal PE (1.05%). The present study investigated cases of fatal PE among 10,097 coroner's post-mortems conducted between 1994 and 1998 at the Centre for Forensic Medicine, Health Sciences Authority, Singapore, and compared the results with the previous study. There were 130 cases of fatal PE, representing a post-mortem prevalence of 1.29%. This is comparable to the previous study but is lower than most other published series from other countries. There was a shift towards younger subjects, with the modal age group being 40 to 49 years, compared with 70 to 79 years previously. A large proportion of subjects had risk factors for PE, with 42.3%, 23.8% and 11.5% having had a history of surgery, trauma or malignancy respectively. After the onset of immobility or trauma, 50% of subjects developed PE in the first seven days and 76.8% in the first two weeks. PE was not suspected as the cause of death in 74.6% of cases under medical care. The incidence of fatal PE in Singapore remains low. However, a large proportion of cases continue to be unsuspected as the cause of death. It would appear that, on the whole, a correct clinical diagnosis of fatal pulmonary thromboembolism remains largely elusive.

Adolescent↗
PubMed2003

Clustering of sex hormone disruptors in Singapore's marine environment.

Abnormal sexual differentiation and other reproductive abnormalities in marine animals indicate the presence in seawater of endocrine-disrupting compounds (EDCs) that perturb the function of the sex hormone signaling pathways. However, most studies to date have reported on EDC effects in freshwater and sewage samples, and there is a paucity of bioassay data on the effects of EDCs in marine waters. Our aims in this study were to devise robust methodologies suitable for extracting potential EDCs and to measure their summated effects on activities of androgen receptors (ARs) and estrogen receptors (ER-alpha and ER-beta) in marine samples from Singapore's coastal waters. In this study, we examined the ability of C18, hydrophilic and lipophilic balance, and diol cartridges to extract potential EDCs from seawater samples. Extracts from C18 cartridges exhibited the highest sex hormone bioactivities in reporter gene assays based on a human cell line expressing AR, ER-alpha, and ER-beta. Examination of extracts from 20 coastal locations showed high androgenic and estrogenic agonist activities in confined clusters closest to the main island of Singapore. Sex hormone activity declined rapidly in clusters farther from the main coastline and in more open waters. Unexpectedly, surface and mid-depth samples from the confined high-activity clusters, in the presence of hormone, exhibited AR and ER-alpha activities that were 200-900% higher than those observed for the cognate hormone alone. This enhanced sex hormone activity suggests that analyses of complex seawater mixtures may uncover unusual bioactivities that may not be obvious by studying individual compounds. Our data present a "snapshot" of the sex hormone disruptor activity in Singapore's marine environment and indicate that C18 extraction for EDCs used in conjunction with reporter gene bioassays represents a robust and sensitive methodology for measuring summated androgenic and estrogenic activities in seawater.

Animals↗
PubMed2004

Androgenic and estrogenic response of green mussel extracts from Singapore's coastal environment using a human cell-based bioassay.

In the last decade, evidence of endocrine disruption in biota exposed to environmental pollutants has raised serious concern. Human cell-based bioassays have been developed to evaluate induced androgenic and estrogenic activities of chemical compounds. However, bioassays have been sparsely applied to environmental samples. In this study we present data on sex hormone activities in the green mussel, Perna viridis, in Singapore's coastal waters. P.viridis is a common bioindicator of marine contamination, and this study is a follow-up to an earlier investigation that reported the presence of sex hormone activities in seawater samples from Singapore's coastal environment. Specimens were collected from eight locations around the Singapore coastline and analyzed for persistent organic pollutants (POPs) and heavy metals. Tissue extracts were then screened for activities on androgen receptors (ARs) and estrogen receptors (ER-alpha and ER-beta) using a reporter gene bioassay based on a HeLa human cell line. Mussel extracts alone did not exhibit AR activity, but in the presence of the reference androgenic hormone dihydrotestosterone (DHT), activities were up to 340% higher than those observed for DHT alone. Peak activities were observed in locations adjacent to industrial and shipping activities. Estrogenic activities of the mussel extract both alone and in the presence of reference hormone were positive. Correlations were statistically investigated between sex hormone activities, levels of pollutants in the mussel tissues, and various biological parameters (specimen size, sex ratio, lipid and moisture content). Significant correlations exist between AR activities, in the presence of DHT, and total concentration of POPs (r= 0.725, p < 0.05).

Animals↗