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PubMed1988

A survey of household food purchases and dietary habits in relation to affluence among Singapore Chinese.

A survey of 40 Singapore Chinese households was performed, obtaining information on major perishable foods purchased for home consumption in the previous week, extent of home consumption (eating in), household dietary habits and housing type, the last as a measure of affluence. Eating out was very common: nine (23 per cent) households ate less than 50 per cent of meals at home. Excluding these nine households, consumption and habits were compared between more affluent and less affluent households. The more affluent households purchased more red meat/offal (P = 0.001), poultry (P = 0.002), vegetables other than green leafy (P = 0.04), fruit (P = 0.007) and eggs (P = 0.04); they also differed significantly in various dietary habits. Significant differences were also observed between English-speaking and Chinese-speaking households. The results suggest that increasing affluence may have brought about substantial dietary change in Singapore, thus meriting further study of the role of diet in changing disease patterns in Singapore.

Acculturation↗
PubMed1987

Geriatric medicine in Singapore: quo vadis?

In this review article, the demography of Singapore and future needs for medical care for the elderly are discussed. Tracing the history of the development of the specialty in UK, the following conclusions can be drawn: Home visits for assessment by specialists can avoid many unnecessary hospital admissions by using existing community services. Elderly people fare badly in acute sectors of hospitals. Elderly people respond to, and need, rehabilitation. The elderly are poor reporters of illness. There have been, and still are, misunderstandings between general physicians and physicians in geriatric medicine as to their roles and the future of the specialty. The role of geriatric medicine versus general medicine is defined. The possibilities for the future role of geriatric medicine in Singapore are discussed. The present use of medical services by the elderly and financial implications are reviewed. Suggestions are made for research into a comprehensive type of medical care for the elderly in Singapore.

Aged↗
PubMed1979

Suicide of the young in Singapore.

This is a study of 137 cases of young suicide aged below 29 occurring in Singapore from years 1969-1976--a period of 8 years. The pattern of young suicide among the different sexes and ethnic groups in Singapore, the suicide letters and the methods of suicide were analysed, studied and discussed. Where pertinent, case histories were illustrated. Suicide in the young in Singapore as in other countries poses as an important psycho-social and medical problem.

Adolescent↗
PubMed1979

Suicide of the elderly in Singapore.

This is a study based on data from all Coroners' case-files (Years 1969-1976) and a 'psychological post-mortem' study of all suicides for the year 1974--57 cases comprising of 39 males and 18 females. The trend of aged suicide in Singapore, the demographic data of the aged suicide population, the methods used by the aged suicide and the causative factors associated with suicide in aged are recorded, analysed and discussed. Reactions of the surviving relatives are also described. The unique features particular to the aged suicide in Singapore are noted and explained. Suicide of the aged in Singapore is mainly a study of the aged Chinese suicide.

Aged↗
PubMed1984

Imported communicable diseases in Singapore.

Most communicable diseases in Singapore have been brought under control and some eliminated. In recent years, an increasing proportion of the reported cases turned out to be imported. Between the period 1977 and 1982, 96% of malaria, 44% of paratyphoid, 32% of typhoid, 20% of leprosy, 11% of acute viral hepatitis, 7% of dengue fever/dengue haemorrhagic fever and 7% of cholera were imported. About 10% of the notified tuberculosis cases were non-residents while all the sporadic cases of poliomyelitis (except in 1977) and diphtheria (except in 1982) were contracted outside Singapore. The majority of the infections originated from Southeast Asia and the Indian subcontinent. The main groups of population with imported infections were local residents who travelled to the endemic areas without taking adequate preventive measures, foreign contract workers, and foreign seeking medical treatment in Singapore. Whether or not these imported cases would spread the infection to others in the community and cause epidemics depend on the virulence of the pathogen introduced, the susceptibility of the population and the environmental conditions which favour transmission of infection. Measures taken to reduce the risk of transmission include provision of a high standard of environmental sanitation, epidemiological surveillance to detect and eliminate the focus of infection; maintenance of a high level of herd immunity through immunisation; health education of the medical practitioners and of the public on the need for personal prophylaxis when travelling overseas; and screening of foreign contract workers and returning residents in special situations.

Adolescent↗
PubMed1984

The fading links between tradition and oral health in Singapore.

Singapore is an island republic of 616 km2. Four main ethnic groups make up its population of 2.4 million; these are the Chinese, Malays, Indians and others. Singapore's successful housing, industrialization and modernization programmes have caused tremendous changes in the lifestyles and expectations of the people. This very success has rendered some traditional customs impractical and irrelevant. Older Indians and Malay women still chew betel-nut. During the Hindu Thaipusam ceremony a traditional practice of dental interest is the piercing of devotees' cheeks and tongues with slivers of silver. There is no pain, bleeding or permanent tissue damage. The Chinese pick their teeth, crack melon seeds and scrape their tongues every morning. They also drink large quantities of unsweetened tea. Yet they remain caries-prone. Singaporeans have recently adopted the practice of eating at all hours of the day and night. This may have a bearing on their future caries state. Singapore has two categories of dental practitioner: the graduate and the registered but unqualified dentist who is invariably of Chinese descent. The swaged metal crown over sound and diseased tooth structure is frequently the unfortunate trademark of the latter. Often abscesses and cysts develop beneath these crowns. Successful dental health programmes have produced a DMFT of 2.8 in 12-year-old children, which betters the DMF target of 3.0 set by WHO for the year 2000. The progressive outlook of Singaporeans may eventually reduce further the number of traditional practices which are harmful to oral health.

Adolescent↗
PubMed1982

The history of dialysis in Singapore.

The last 20 years has been seen the birth of nephrology in Singapore, starting from a single machine in a side room of a ward to a fully fledged unit with a satellite centre. Renal transplantation and hemodialysis have been accepted as a form of therapy for renal failure in Singapore. The spin off from the creation of dialysis units has been improvement in overall renal care particularly in cases of acute renal failure. It has also generated an atmosphere for research into renal diseases and has helped to promote the image of Singapore as a medical centre par excellence in Southeast Asia.

Hemodialysis Units, Hospital↗
PubMed1982

Postgraduate medical education in Singapore.

The history of postgraduate medical education in Singapore is chronicled. Four phases have been discerned; phase I from 1910--1936 when only one local doctor obtained a higher postgraduate qualification; phase 2 from 1946--1960 when 40 qualified; phase 3 from 1960--1970 when 86 qualified. The School of Postgraduate Medical Studies was established in 1970 and in phase 4 from 1970--1981, 391 postgraduates were trained and qualified. This last phase has enabled the National University of Singapore and the Academy of Medicine to provide sufficient expertise in both the private and public sectors. The problem of continuing medical education in Singapore is discussed.

Education, Medical, Continuing↗
PubMed1982

The development of critical care medicine in Singapore.

The development of critical care medicine in Singapore is similar to that in other countries. The fact that intensive care work was not centralised meant that anaesthetists had to attend to patients who were to be found all over a large hospital. Moreover, up to 1967, there was only one ventilator in the Singapore General Hospital although this was commonly used. When open-heart surgery was restarted in 1967, the need for intensive care in the post-operative patients became obvious and a post-basic intensive care nursing course was subsequently started. The quest for an area to centralise intensive care also stepped up and as space in certain wards were generously given toward this cause, intensive care further developed. With the opening of the new Singapore General Hospital, critical care medicine is certainly ready to move toward an even more sophisticated standard.

Critical Care↗
PubMed1981

A dynamic model of tuberculosis epidemiology for Singapore.

An epidemiological model was used to estimate the size of the tuberculosis problem in Singapore from 1975 to 2025. It was shown that even without any control activities after 1979 there would be a reduction of the tuberculosis indices in the country. If the present control programme was pursued unchanged, a reduction of the tuberculosis problem by 10.0% and 14.5% would be expected in 2000 and 2025 respectively. Tuberculosis would be expected to remain a major public health problem over the next fifty years. In Singapore's context increased case finding and treatment of bacteriologically positive cases of tuberculosis would be the most effective ways of further reducing the tuberculosis problem over the next fifty years. Practical methods of implementing this were suggested. Reduced BCG coverage of infants was not expected to increase the tuberculosis problem to any significant extent over this period. Treatment relapse rates were shown not to be a sensitive variable that would affect the tuberculosis problem in Singapore.

Adolescent↗
PubMed1978

Variations in nasopharyngeal cancer incidence among specific Chinese communities (dialect groups) in Singapore.

A total of 729 cases of NPC (93.6% confirmed histologically) were diagnosed among the Singapore Chinese population during a five-year period (1968--1972). Age-standardized incidence rates for the total Chinese population were 18.4 per 100,000 per year for males and 7.0 for females; the respective rates for the specific Chinese communities were 14.1 and 4.7 for Hokkien, 18.3 and 6.2 for Teochew, 29.1 and 11.0 for Cantonese, 14.2 and 3.3 for Hainanese, 12.6 and 4.8 for Hakka and 12.2 and 6.0 for the other dialect groups. It is evident that all of the Chinese communities in Singapore have high risks for NPC; only the Cantonese have risks significantly higher than that for the rest of the Chinese population. NPC incidence rates for males and females of the other major racial groups in Singapore were 4.7 and 0.6 for Malays and 0.9 and 0.0 for Indians, respectively.

Adult↗
PubMed1995

Mortality analyses of the 1990 Singapore population: I. General life tables.

General life tables for the 1990 Singapore resident population are given in this paper. Analyses were carried out separately for males and females for all ethnic groups as well as for Chinese, Malays and Indians. Average fractions of the last age interval lived were used to give a more precise derivation of the life table death rates from their corresponding age-specific death rates. The results show that in 1990, Singapore males had achieved a life expectancy at birth of 73.7 years while the females had attained a level of 78.6 years. These levels were comparable to those of many developed countries. Other interesting features include higher differentials in the life expectancies between sexes among the Chinese and the Indians taking over the Malays for second placing in terms of life expectancy at birth for both sexes. As a result, the Indians registered a 12% gain in life expectancy at birth for males for the decade 1980 to 1990, compared to only 7.1% for Chinese and 4.4% for Malays as well as nearly 10% for females compared to only 6.2% for Chinese and 6.3% for Malays. A subsequent paper will highlight the results of multiple-decrement life table analyses which will summarise the mortality of the 1990 Singapore resident population for various component causes of death rather than for all causes combined.

Adolescent↗
PubMed1994

Anaesthesia in institutional practice in Singapore.

Documentation of the early development of anaesthesia in Singapore is scanty. Before World War II the anaesthetic agents used were mainly chloroform, ether and ethyl-chloride. They were usually administered by the surgeons themselves or by apothecaries under the supervision of the operating surgeon. After World War II, anaesthetists were sent from the United Kingdom to be in charge of all anaesthetics administered in Singapore. From 1956 to 1971, local doctors were sent to the United Kingdom for training and to obtain the specialist degree FFARCS. From 1968 onwards, the Faculty of Anaesthetists of the Royal Australasian College of Surgeons held examinations in Singapore for candidates appearing for FFARACS. This continued until our M Med Anaesthesia examinations, which began in 1974, were well established. The number of specialists has increased over the years. With the decentralisation of the anaesthetic departments in the various hospitals in 1975, and the recent restructuring of Government hospitals, many changes have taken place in the anaesthetic scene. The long-awaited University Department of Anaesthesia was eventually established in 1985. Keeping pace with progress made in the various surgical disciplines, and in other fields of medicine, the duties of anaesthetists in institutional practice have increased enormously. They have extended beyond the operating theatre.

Anesthesia Department, Hospital↗
PubMed1994

Current logistics of acute burn care in Singapore.

OBJECTIVE: To study logistic requirements in acute burn care in Singapore and to correlate statistics on fire, unnatural deaths and burns. DESIGN: Fire data (from Singapore Fire Safety Bureau), mortality data (from Institute of Science & Forensic Medicine) and burn data (from Burns Centre, Singapore General Hospital) were studied. SETTING: Severe burn victims often require prolonged treatment. Useful data was obtained in a 1,500-bed restructured government hospital. PARTICIPANTS: All reported and investigated fire incidents, coroner enquiries of unnatural deaths and admitted burn patients. INTERVENTION: General burn data obtained retrospectively from 398 burn admissions in 1988 and logistic burn data from 41 patients requiring fluid replacement regime. RESULTS: Fire data showed one burn admission in every 12 fires (398/4718), one burn death in every 314 fires (15/4174) or 55 unnatural deaths (15/828). Mortality data showed 15 burn deaths, two prior to admission, 7/13 admitted died of suicidal injuries and mortality rate was 3.3% (national annual average is 1.9%). General burn data showed adults 76% and children 24%, 3:1 male predominance; scalds (46%), fire (32%), explosions (11%) and others (11%). Seventy-eight patients (adults 58, children 20) required fluid resuscitation. Logistic burn data (average burn 35%, 28 partial thickness and 13 full thickness burns) were: ALOS 19.5 days, 2.4 major operations per patient (range 2-7), 56 minor procedures and 2.9 L blood transfusion per patient (those who were operated required 3.8 L and those not operated, 1 L per patient). Blood investigations increased with severity and pattern of injury, Acinetobacter species was commonest microorganisms, antibiotics were used in 66% of patients and commonest burn dressings were tullegra (T/G), followed by T/G with silverzine. CONCLUSION: Data presented useful for correlation of fire, mortality and burn statistics, resource allocation and new burn facility establishment.

Blood Transfusion↗
PubMed1994

Burns mass disasters in Singapore--a three decade review with implications for future planning.

OBJECTIVE: The main objective of this paper is to review three decades (1962-1991) of data relating to burns mass disasters in Singapore. DESIGN: Records of the Burns Centre, Singapore General Hospital were reviewed retrospectively. Only patients admitted were analysed in three separate groups in relation to the cause of the burns mass casualties and place of occurrence. SETTING: Patient selection was based on O'ya's criteria of burns mass disaster and were grouped into separate decades: Group A (1962-71), Group B (1972-81) and Group C (1982-91). INTERVENTION: Data collected will provide useful information on high risk sources, patterns and trends of burns mass disasters in Singapore. MAIN OUTCOME MEASURE: The data will provide the facts and will have implications for future planning and organisation of burn treatment facilities. RESULTS: There were 17 burns mass casualties and 257 patients admitted. The largest single admission was 76 in 1978. Group A had four, Group B had two and Group C had eleven disasters. Explosions (66%) and fires (30%) were the main causes of burns. The predominant place of occurrence in Group A patients was outdoor injuries (78%), Group B was work environment (100%) and Group C was evenly spread out: work environment (55%), indoors (36%) and outdoor (9%). Shipyards and fires were the largest sources of burns mass disasters. Other potential sources identified include hazardous materials, petrochemical industries, aviation industries, mass rapid transit train system, high rise fires, shopping complexes and imported disasters. CONCLUSION: The recommendation is to plan and reorganise burn treatment facilities. This is to cope with existing pattern, frequency and projected patterns of burn mass disasters which have occurred in other highly urbanised and populated countries.

Burns↗
PubMed1993

Quality assurance in medicine: research and evaluation activities towards quality control in Singapore.

Quality assurance and medical audit requires a good Health Management Information System (HMIS) to support it. In Singapore, there is a well developed HMIS built on the routine reporting of utilisation and activity statistics from public sector and private sector hospitals, government clinics and support services. In addition, there is a computerised national surveillance system for disease monitoring, which includes the disease condition, operations done and the physician and surgeon responsible for managing any inpatient or day case admitted into any hospital in Singapore. This forms the basis for the computerised national health system known as Medinet. Supplementing this are ad hoc surveys on quality of service, medical audit studies and supplementary information systems such as the Births and Deaths registration system and the Census of Population. Such a well developed HMIS greatly facilitates medical audit in Singapore. Indicators for audit can be generated from existing health databases, which point to areas requiring further inquiry and investigation. The use of a unique National Registration Identity Card (NRIC) for every Singaporean enables healthcare utilisation at all levels to be linked, further enhancing the capability for medical audit here.

Databases, Factual↗
PubMed1995

Blood aflatoxin levels in patients with hepatocellular carcinoma in Singapore.

Aflatoxin (AF), a highly potent hepatocarcinogen, is strongly implicated in the pathogenesis of human hepatocellular carcinoma (HCC). In this study, our aim was to determine if this carcinogen is associated with cases of HCC in Singapore. Blood levels of the naturally-occurring AFs--B1, B2, G1 and G2--were assayed in 56 cases of HCC. AF was detected in only 2/56 (3.6%) cases of HCC, one each of AF-B1 and AF-G1. In contrast, in a similar survey done in Singapore on normal subjects, AF was positive in 64/423 (15.1%) cases. The low frequency of AF detection in our patients suggests that HCC in Singapore is not associated with significant chronic exposure to AF.

Adult↗
PubMed1995

Tetanus in Singapore: report of three cases.

Three cases of tetanus in Singapore are presented. One local resident had cephalic tetanus most likely secondary to otitis media and the other two, residents from surrounding Asean countries, had generalised tetanus. The portal of entry was a puncture wound on the foot in one patient and the ear in another. No portal of entry was identified in one patient. All three patients required tracheostomy, ventilatory support and intensive care management for periods ranging from 11 to 22 days. One patient died from complications of nosocomial septicaemia and one patient required prolonged rehabilitation. There was a questionable history of tetanus immunization in the Singapore resident whereas the other two patients who were foreigners had never received any immunization. Tetanus is an uncommon but important disease in Singapore. In spite of the availability of intensive care management, it continues to be a disease with significant morbidity and mortality. Early recognition and treatment of the disease are critical factors in determining the prognosis. This is a disease that may be largely prevented by adequate immunization.

Abdominal Pain↗