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PubMed2002

Fluconazole susceptibility of Candida species in Singapore by disc diffusion test.

INTRODUCTION: Resistance of Candida species to fluconazole has been increasingly reported worldwide. To date, the prevalence of resistance to fluconazole in Singapore is unknown. The aim of this study was to use a newly described agar disc diffusion method to study levels of susceptibility of Candida species to fluconazole in several hospitals in Singapore. MATERIALS AND METHODS: Three hundred and ninety Candida isolates from clinical specimens collected from different sites were tested, of which 191 isolates (49.0%) were C. albicans, 69 (17.7%) were C. parapsilosis, 59 (15.1%) were C. glabrata, 51 (13.1%) were C. tropicalis and 4 (1.0%) were C. krusei. Susceptibility testing was performed using 25 micrograms fluconazole discs and standard Mueller-Hinton agar supplemented with 2% glucose and 0.5 microgram/mL of methylene blue. RESULTS: Overall, 381 (97.7%) isolates were susceptible, 6 (1.5%) were susceptible dose-dependent, and 3 (0.8%) were resistant to fluconazole. Of the individual species, 99.5% of C. albicans, 93.2% of C. glabrata, 0% of C. krusei, and 100% of C. parapsilosis, C. tropicalis and other Candida species were susceptible. CONCLUSION: The resistance of Candida species to fluconazole, as measured using a new disc diffusion method, is low in Singapore, with the exception of C. krusei. Fluconazole remains a useful agent for the treatment of candidiasis in this country.

Antifungal Agents↗
PubMed1994

Brain drain or links to the world: views on emigrants from Singapore.

"This article will present a general picture of emigration and emigrants from Singapore, with specific references to Australia where the data permit. The first section presents some flow data on the magnitudes of emigration from Singapore.... It is necessary to place this outflow against the background of the constraints imposed by the country's small size. This is discussed in the second section, together with the economic policies and strategies adopted to overcome these constraints. The third section documents the public debate on emigration and the responses to the 'problem.' This is followed in the last section by a prognosis for the future, particularly with regard to the implications for Australia. The article ends with a discussion of the relationship between emigration and nation building, using Singapore as a case study."

Asia↗
PubMed1995

Population movement in the Asia Pacific region: Singapore perspective.

"This article [is] structured to give some brief overview of the trends and characteristics of population movement in the Asia Pacific region. Wherever relevant, the implications of these regional and global trends for Singapore will be highlighted to offer a better appreciation of its case study. This will touch on Singapore's own experiences of outflow and inflow of people and its policies and philosophy on such movement. Noted are implications on labor policy arising from Singapore's strategy to become a capital exporter and anchor itself in economies like China."

Asia↗
PubMed2002

A study of the effectiveness of AIDS health education interventions among the adolescent population of Singapore.

AIM OF STUDY: This study aims to evaluate the effectiveness of existing AIDS health education interventions in Singapore amongst the adolescent population of Singapore. By identifying specific target groups that lack knowledge and information regarding HIV, it is hoped that suggestions may be provided towards increasing the effectiveness of these interventions. METHOD: A cross-sectional survey using a self-administered questionnaire of randomly selected adolescents between the ages of 13 and 19 years was performed to assess their knowledge of HIV and their opinions and awareness of HIV education in Singapore. RESULTS: A total of 400 adolescents of various backgrounds were surveyed. In general, the subjects surveyed possessed reasonably good knowledge about HIV/AIDS, with an average score of 77.4% (SD = 15.8%). However, the results also showed areas of knowledge deficiency and misconception prevalent among those surveyed. Subgroup analysis showed that adolescents from low-income families, relatively less academically successful schools and those of younger ages knew significantly less than other adolescents. In terms of the awareness of HIV/AIDS education and information, the percentage of the subjects who could recognise any of the three commonly issued pamphlets or poster or who knew of any telephone numbers to call to receive information on HIV and AIDS was low. Less than 40% of those surveyed felt that enough awareness was being created within the public regarding AIDS. CONCLUSION: It can be concluded that most adolescents surveyed felt that they are inadequately educated regarding HIV andAIDS. The results would certain target groups using the appropriate media in future educational intervention.

Adolescent↗
PubMed2003

Eating disorders in Singapore: a review.

INTRODUCTION: Anorexia nervosa, bulimia and binge-eating disorder are the three best recognised eating disorders. Eating disorders have been reported to affect some 1 to 3% of adolescent females in the West. Increasing reports from Asia suggest that it is no longer possible to view these illnesses as 'Western' diseases. Eating disorders are the third most common serious medical disorder in female adolescents, after asthma and depression. It poses a tremendous burden for individuals, families and society. Historical and current studies on eating disorders in Singapore are reviewed, and discussed in the light of available regional and worldwide research. METHODS: Studies on anorexia nervosa and bulimia in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on eating disorders. RESULTS: Reports of eating disorders have increased over recent years in the local literature. The psychopathology of eating disorders in Singapore is very similar to that described in the Western literature, and in the two main current classification systems. Body dissatisfaction is prevalent among Singaporean Chinese schoolgirls and female undergraduates, with rates not dissimilar to the West. There is a link between 'Westernisation' (based on English being spoken as the main language at home) and body dissatisfaction.

Adolescent↗
PubMed2003

Sexually transmitted infections in Singapore teenagers.

INTRODUCTION: This is a review of sexual knowledge, behaviour and the extent of sexually transmitted infections (STI), including human immunodeficiency virus (HIV) infection, in Singapore adolescents. METHODS: Data were retrieved from relevant studies, reports and statistics concerning STI and HIV in Singapore. RESULTS: For many reasons, adolescents are at a higher risk of acquiring STI and HIV infections. Adolescents in Singapore are still relatively conservative in their sexual attitudes and behaviour. Most of those who had sex never used condoms. Fortunately, the incidence of STI and HIV infections among adolescents is relatively low. However, this may be changing, and there is a proportion of individuals who exhibit higher risk behaviours. CONCLUSIONS: In this age of rapidly changing morals and values, accurate information and skills need to be provided to young people to ensure that they are adequately prepared to protect themselves from acquiring STI/HIV infection.

Adolescent↗
PubMed2002

Prevalence of hearing disorders in Singapore military conscripts: a role for routine audiometry screening?

AIM: To determine the prevalence of hearing disorders in Singapore military conscripts and describe the profile of hearing loss and associated risk factors. METHODS: Population-based descriptive analysis of randomised cohort of 818 Singapore military conscripts presenting for medical examination, using self-administered questionnaire and pure tone audiometry performed for both ears. Main outcome measures are prevalence rate of hearing loss and relative risk of hearing loss by demographic factors and surrogates for noise exposure. RESULTS: Prevalence of hearing loss was 36.7 per 1,000 (95% CI 24.8, 51.9). Of 30 subjects with hearing loss, 19 (63.3%) had loss at high frequency, 7 (23.3%) at low frequency, and 4 (13.4%) in both ranges. Hearing loss was unilateral in 17 (56.7%) subjects and bilateral in 13 (43.3%). Relative risk of hearing loss did not differ by age group, education level, race or frequency of personal stereo use. Relative risk of hearing loss is higher in subjects with frequent discotheque visits compared to those who never do so (RR = 2.72, 95%CI 1.09, 6.76). CONCLUSION: The high prevalence of hearing loss in Singapore military conscripts points to the need for routine audiometry screening prior to enlistment. This will be useful in assigning military vocations, in clinical case management, and for assessing cases of noise-induced hearing loss attributable to military service.

Adolescent↗
PubMed2003

Malignant mesothelioma: experience at the Singapore General Hospital.

INTRODUCTION: Malignant mesothelioma is a rare occupational disease in Singapore. There have been few reports of this condition in Singapore. We aim to describe the clinical characteristics, management and outcomes in a case series of 16 patients diagnosed in a teaching hospital in Singapore. MATERIALS AND METHODS: A chart review of all cases of malignant mesothelioma diagnosed in our institution during the period 1996 to 2001 was conducted, with particular attention to the occupational history. RESULTS: There were 16 patients (15 male patients) with a median age of 61.5 (range, 46 to 78) years. Thirteen patients had malignant pleural mesothelioma (MPM) and 3 patients had mesothelioma of the periotoneum. Eleven of the patients with MPM (84.6%) presented with a pleural effusion and only 2 patients (15.4%) had chest pain. Initial pleural fluid cytology and closed pleural biopsies were negative in all patients who presented with a pleural effusion. Thoracoscopy confirmed the histologic diagnosis and allowed simultaneous talc pleurodesis in 9 patients. All patients had documented asbestos exposure, of which 14 (87.5%) were confirmed to be occupationally related. The median time from first exposure to symptoms was 33.5 (range, 16 to 53) years. The median survival was 6 months. Most of the patients (75%) received best supportive care alone. CONCLUSIONS: In our experience, malignant mesothelioma is an aggressive disease with a poor prognosis. It is strongly associated with asbestos exposure. Thoracoscopy is an invaluable diagnostic modality in the evaluation of a patient with occupational asbestos exposure and an undiagnosed pleural effusion.

Aged↗
PubMed1992

The Singapore Polyposis Registry.

The Singapore Polyposis Registry was established in 1989 in Singapore General Hospital. The aim is to provide a central registry service to all doctors in Singapore to facilitate in identification, surveillance and management of families and individuals at high risk of getting colorectal cancer from FAP (Familial Adenomatous Polyposis) and HNPCC (Hereditary Non-polyposis Colorectal Cancer). Both have an autosomal dominant inheritance that gives rise to colorectal cancer at any early age if untreated. They account for 5-6% of all colorectal cancers. Sixteen FAP families with 139 members have been evaluated. Fifty-eight members are affected and 81 are at risk or unaffected. Those who have been screened positive have a much lower risk of cancer (13%) compared with those who presented with the disease (89%) and death from colorectal cancer in the corresponding groups were nil and 58%. Eight HNPCC families with 36 affected and 170 at-risk members have been registered. Colonoscopic surveillance have just started: one case of Dukes' A cancer in a 26 year-old patient, and two cases with polyps have been diagnosed. Advances in molecular genetics and the identification of APC (Adenomatous Polyposis Coli) gene in the FAP locus of Chromosome 5 have made it possible to diagnose FAP genetically. This has important impact on management in terms of prenatal diagnosis and dietary and chemoprevention programmes in addition to surgical intervention.

Adenomatous Polyposis Coli↗
PubMed1992

Surgery for brain metastases in Singapore.

The best possible treatment for a single metastasis to the brain is complete surgical excision followed by whole brain irradiation. A survey was done to determine the proportion of patients with brain metastases who had surgical excision of the lesion. The number of patients with a preoperative diagnosis of cerebral metastases who underwent surgical excision in Tan Tock Seng Hospital from 1985 to 1989 was obtained from the operation records. An average of 11 surgical excisions were done for cerebral metastases annually. To estimate the number of cases of single brain metastases seen annually in Singapore, figures of cases of cancer of the lungs, breast and colorectum from 1978 to 1982 were obtained from the Singapore Cancer Registry. Based on a conservative estimate that 20% of these cancers metastasize to the brain, that 50% are single metastasis and of these, half are suitable surgical candidates, our calculations show that there are at least 67 cases of surgically excisable single brain metastasis in Singapore annually. This means that more than 84% of patients with a single brain metastasis are not getting the best possible treatment. The reasons may be due to patients' fear of operation and to lack of awareness among physicians on advances in the management of brain metastases. Patient education and physician update on recent advances in treatment will allow patients to obtain the best possible treatment.

Biopsy↗
PubMed2003

Chlamydia pneumoniae IgG seropositivity and clinical history of ischemic heart disease in Singapore.

There is still substantial uncertainty concerning the association between Chlamydia pneumoniae and ischemic heart disease. This may partly be explained by the adjustment for potential confounders in different population studies. This is the first study in Singapore to look at the association of C. pneumoniae seropositivity with ischemic heart disease in a multivariate analysis. A random sample of 714 persons aged between 35 and 69 years was selected from the participants of the Singapore National Health Survey conducted in 1998. Data on clinical measurements and conditions were collected using biochemical tests and interviewer-based questionnaires. Ischemic heart disease was defined by the Rose questionnaire and included history suggestive of angina and/or myocardial infarction. Immunoglobulin G antibodies for C. pneumoniae were detected using an indirect microimmunofluorescence test, and seropositivity was defined as IgG titers > or = 1:16. There were no statistically significant differences in the prevalence rates of seropositivity to C. pneumoniae among the three ethnic groups, that is, Chinese (80.4%), Malays (74.0%), and Asian Indians (73.2%). There was no association between seropositivity and ischemic heart disease after adjustment for age alone (OR 1.00, 95% CI 0.54-1.83) or for age, sex, and other risk factors of atherosclerosis (OR 0.99, 95% CI 0.53-1.84). C. pneumoniae Immunoglobulin G seropositivity was not associated with an increased risk of ischemic heart disease as defined by the Rose angina questionnaire in Singapore.

Adult↗
PubMed2003

Prescribing psychoactive medications in nursing homes: current practice in Singapore.

AIM: To assess the prescribing practice, use and potential adverse effects of psychoactive medications in Singapore nursing homes. METHOD: From a list of existing 24 voluntary welfare organisation (VWO) run nursing homes, four homes with the largest bed capacity were selected from the eastern zone of Singapore. When contacted, two homes agreed to participate in the study. Medical records of all residents aged 65 years and above were reviewed to obtain demographic information, clinical diagnoses and medication orders. Two geriatricians and one psychogeriatrician reviewed the psychoactive medications used in these nursing homes. RESULT: A Total of 384 residents were enrolled in the study. Mean age of the participants was 79.1 years (65-107); 60.7% were female and 92.4% were Chinese. Dementia was documented for 131 (34.1%) residents, depression for 50 (13%) residents. Residents were on an average of 5.2 (0-14) medications. A total of 309 psychoactive medications were prescribed for the residents. Fifty-nine (63%) antipsychotics, 42 (65%) Benzodiazepines, 65 (61%) antidepressants, 10 (77%) others sedatives and 31 (100%) anticonvulsants were deemed inappropriate. Lack of documented indication, potential adverse drug reaction, drug-drug interaction and therapeutic duplication were the most common medication related problems observed in this study. CONCLUSION: Majority of the nursing home residents were on psychoactive medications. Residents with dementia were more likely to be on psychoactive medications. Statistically significant association was observed between the use of inappropriate psychoactive medications and the diagnosis of dementia. Better documentation of clinical diagnoses and indications, and regular medication review for potential adverse drug reactions would improve the quality of care in Singapore nursing homes.

Aged↗
PubMed2004

Importation of seven cases of an unusual helminthic infection into Singapore and assessment of the risk of local transmission.

Singapore remains vulnerable to the introduction of infectious diseases from other countries due to the high traffic of migrant labour and other visitors. We describe seven cases of migrant workers from West Africa who entered Singapore carrying loaisis, a helminthic infection. The clinical presentation, treatment using single dose ivermectin, potential for transmission, and the need for screening of this infection in Singapore are discussed.

Adult↗
PubMed2004

Behcet's disease: experience in a tertiary rheumatology centre in Singapore and a review of the literature.

INTRODUCTION: The only reported study on Behcet's disease (BD) in Singapore found that only 15% of 34 BD patients managed at a tertiary dermatology centre had arthritis and 6% had eye complications with no other systemic manifestations. The aim of our study was to characterise the clinical manifestations and outcome of patients with BD at a tertiary rheumatology centre in Singapore. MATERIALS AND METHODS: The International Study Group (ISG) and the O'Duffy (OD) criteria were used. The demographics, manifestations and outcome of our patients with BD were recorded. RESULTS: Thirty-seven patients were included in our study. Twenty-three (62.2%) satisfied both ISG and OD criteria. Fourteen (37.8%) did not fulfil the ISG criteria but fulfilled the OD criteria and of these 6 were the incomplete form and 8 the complete form. The male to female ratio was 1:1.1. The mean age of onset of disease was 32.7 years (range, 15 to 58 years). The commonest presentations were recurrent oral ulcers (37, 100%), genital ulcers (24, 64.9%), joint (21, 56.8%) and cutaneous manifestations (18, 48.6%). The most common systemic manifestations were arthritis (16, 43.2%), gastrointestinal manifestations (15, 40.5%) and uveitis (13, 35.1%). There were 2 cases of Neuro Behcet's and 2 cases of venous thrombosis. Visual impairment from uveitis was the commonest cause of morbidity. There were no deaths in our series of BD. CONCLUSION: BD is a relatively rare rheumatologic condition in Singapore. However, because its systemic complications are not rare, early diagnosis and prompt treatment are essential.

Adolescent↗
PubMed2004

Post-SARS psychological morbidity and stigma among general practitioners and traditional Chinese medicine practitioners in Singapore.

INTRODUCTION: The severe acute respiratory syndrome (SARS) outbreak has been unique in recent history in its rapidity of transmission, its concentration in healthcare settings, and the large number of healthcare workers who have been infected. This study aims to examine the psychological impact of SARS on general practitioners (GPs) and traditional Chinese medicine (TCM) practitioners in Singapore. MATERIALS AND METHODS: Two months after the SARS outbreak, all the GPs and TCM practitioners in Singapore were mailed a set of self-reported questionnaires, which included the General Health Questionnaire (GHQ), the Impact of Event Scale-R (IES-R), and a questionnaire to measure the perception of stigma. RESULTS: A total of 721 (29%) GPs and 329 (22%) TCM practitioners responded to the survey. Significantly more GPs had worked in SARS affected facilities and had been directly involved in the care of patients with SARS than the TCM practitioners (P <0.001). Those GPs who were directly involved in the care of patients with SARS were significantly more likely to be GHQ case as compared to those not involved in the care of patients with SARS (P = 0.02; OR = 2.9; 95% CI, 1.3-6.3). The mean score of the GHQ somatic, anxiety and social dysfunction subscales were significantly higher in GPs as compared to TCM Practitioners (P <0.001). The GHQ total score as well as the subscales was significantly correlated with the IES-R and stigma subscales (P <0.05). CONCLUSION: The fear, uncertainty and stigma caused by SARS are associated with psychological distress among some of the primary healthcare providers in Singapore.

Adult↗
PubMed2004

Economic burden of varicella in Singapore--a cost benefit estimate of implementation of a routine varicella vaccination.

Varicella is a common childhood illness that can result in significant morbidity and mortality. As early as 1995, recommendations for routine varicella vaccination have been published, but have not been universally implemented, with cost of vaccination as a major reason. Though available from 1996, the vaccine has yet to be routinely implemented in Singapore. We set out to assess the economic burden of varicella and the cost-benefit of adding a varicella vaccine to the existing immunization schedule in Singapore. In this study, using data from 1994--1995 the direct cost estimates were based on all levels of medical care; inpatient care, emergency room visits, primary health care and medication. Indirect costs were estimated from the cost of time lost by patients and their families attending to medical needs, as well as loss of productivity due to absenteeism. The cost of a vaccination program targeted at 15-month old infants receiving concomitant measles-mumps-rubella immunization was also assessed. The cost-benefit ratio was then estimated. The total cost of varicella in Singapore was estimated to be US$11.8 million per annum. The loss of productivity accounted for a large proportion of the total cost as a lot of parents took leave when their children were ill. The estimates of total cost represent approximately US$188 per varicella case per year. In comparison, the cost of a vaccination program was found to be US$3.3 million per annum. The cost per case averted was US$104. From a societal point of view, for every dollar invested in a vaccination program, we would save about US$2 dollars.

Acyclovir↗
PubMed2005

Knowledge, attitude and practices of childhood injuries and their prevention by primary caregivers in Singapore.

INTRODUCTION: Childhood injuries are the leading cause of death for children between 5 to 14 years of age in Singapore. There have been no studies done on primary caregivers' knowledge, attitude and practices on childhood injuries and its prevention in Singapore. Thus there is a need to conduct this type of study in order to develop appropriate educational programmes. METHODS: A cross-sectional nationwide study with a two-stage stratified random sampling was conducted to obtain a representative sample of the Singapore population. Families that had children younger than 15 years of age were selected for the study. Parents and caregivers were interviewed at their homes. RESULTS: The primary caregivers had good knowledge of road safety but poor knowledge on home safety and first aid. The higher the education of the mother, the more likely it is that she would possess the correct knowledge and practice on childhood injuries and its prevention. The media plays an important role on information on child safety of the caregivers. Only 38 percent said they obtained information from doctors and other health personnel. CONCLUSION: There is a need to educate parents and caregivers on home safety and first aid. Doctors and nurses should take a more active role in giving advice on child safety.

Accident Prevention↗
PubMed2005

Anorexia nervosa in Singapore: an eight-year retrospective study.

INTRODUCTION: Information regarding the clinical features of patients with anorexia nervosa in Singapore is rare and there have not been any large studies published to date. The aims of this paper were to study the clinical characteristics and features of patients with anorexia nervosa in Singapore, and to compare the clinical features of the early versus the classical later-onset cases. METHODS: 126 cases presenting to the Child Guidance Clinic and the Eating Disorder Clinic at the Institute of Mental Health between 1994 and 2002 were identified and studied retrospectively. All presented with anorexia nervosa or had a past history of it. Subjects were further classified into early-onset (younger than 14 years) or classical later-onset (14 years and older), and a comparison was done between the two groups. RESULTS: The large majority were female students with a mean presenting age of 17.6 years. 65.1 percent were of the restricting subtype. 84.1 percent were Chinese, 7.9 percent were Indians and 4.8 percent were Malays. Mean presenting body mass index (BMI) was 15.56. Depression was the most common co-morbid condition affecting 25.4 percent of the sample. The number of new cases increased significantly from six in 1994 to 24 in 2002 (p-value equals 0.002). Commonest precipitating factors were comments from others, school and work stress. 11.1 percent were previously members of trim and fit club in school. 42.7 percent of late-onset cases compared to 16.2 percent of the early-onset were of the binge-purge type (p-value equals to 0.005) and had a higher presenting BMI (15.91 +/- 2.90 versus 14.74 +/- 2.14, p-value equals 0.003). CONCLUSION: The clinical characteristics of patients with anorexia nervosa in Singapore are similar to that reported in western literature. The Malay population appears to be under-represented. There was a significant increase in numbers presenting over the last two years. The early-onset cases tend to be of the restrictive-type and had a lower presenting BMI than the later-onset group.

Adolescent↗