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PubMed1996

Measuring quality of life in different cultures: translation of the Functional Living Index for Cancer (FLIC) into Chinese and Malay in Singapore.

Quality-of-life assessment has become an accepted method of evaluation in clinical medicine. The technique is based on a patient's self-assessment of physical, psychological, and social function, as well as the effects of distressing physical symptoms. The most important aspect of quality-of-life assessment is that it brings into focus a patient-centred view of health outcome, which is broader than the physiologic measures which predominate in Western medicine. Strategies for the development and use of assessment questionnaires have evolved over the past 15 years, and numerous questionnaires have been created. Most originate in Western societies, with English as the most common language of development. Adapting such questionnaires for use in other language and cultural settings is an imprecise practice. Language translation and equivalent cultural meaning must both be addressed. This paper reports on the language translation process and results for the Functional Living Index for Cancer (FLIC) as translated into Chinese and Malay in Singapore. We employed a step-wise process beginning with translation/back translation, followed by structured pilot field trials and population sampling. Taped versions of the questionnaire were devised to meet illiteracy problems in the sample population. Paired comparisons of the Chinese and Malay versions of individual questions with their English counterparts show good correlations and similar means most of the time. Factor analysis on a population sample of 246 (112 Chinese, 35 Malay and 98 English speaking) with cancers of minimal, extensive or palliative extent is convergent with that obtained on a North American population. However, a separate analysis of the Chinese questionnaires showed some differences in factor pattern. Specific language and cultural translation difficulties are discussed. Of note is the predicted significant decrease in total FLIC scores with extent of disease within each of the language preference populations, which provides some evidence for the validity for each language version in the Singapore culture(s). Thus, the FLIC translations into Malay and Chinese in Singapore can be considered for use in local trials, subject to ongoing evaluation.

Activities of Daily Living↗
PubMed1996

Severe community-acquired pneumonia in Singapore.

BACKGROUND: There has been no previous study documenting the aetiology and prognosis of severe community-acquired pneumonia in Singapore. Patients with severe community-acquired pneumonia (SCAP) needing admission to a medical intensive care unit in Singapore were studied retrospectively. METHODS: All patients admitted to the medical intensive care unit at National University Hospital from June 1991 to February 1993 with a diagnosis of community-acquired pneumonia were entered into the study. All patients had blood cultures, sputum cultures, serologies for Legionella and mycoplasma drawn on admission. APACHE II scores were determined prospectively. RESULTS: Fifty-nine consecutive cases from June 1991 to February 1993 were identified with a mean age of 61 (SD 17) years. Nearly all the cases needed mechanical ventilation (90%) and overall mortality was 63%. An aetiological agent was identified in the majority of cases (68%), with Klebsiella pneumoniae being the most common agent (9 cases, 15%). Haemophilus influenzae and Streptococcus pneumoniae were identified in 8% (5 cases) and 5% (3 cases) of cases respectively. Pseudomonas pseudomallei was identified in 4 cases (7%) with a 100% mortality. Overall, gram-negative organisms were identified in 47% of cases. APACHE II was significantly higher in non-survivors. Age, creatinine levels, and the presence of bacteraemia were not prognostic features. CONCLUSION: SCAP in Singapore carries a high mortality with the predominance of gram-negative organisms. Empiric antibiotics should include gram-positive and gram-negative coverage with specific coverage for Pseudomonas pseudomallei.

Adolescent↗
PubMed1997

Burkholderia pseudomallei infection in the Singapore Armed Forces from 1987 to 1994--an epidemiological review.

Between 1987 and 1994, twenty-three cases of Burkholderia pseudomallei infection (melioidosis) were diagnosed in persons serving in the Singapore Armed Forces. There were four deaths resulting from complications of the infection. Unlike the situation in the general population, where the affected are mainly the elderly with underlying illness, the majority of cases in the Singapore Armed Forces were otherwise fit and healthy young servicemen. Serological surveys have shown the prevalence of the infection in Singapore to be 0.2% in the military as well as civilian population. As physical contact with soil is an unavoidable part of military training, military personnel continue to be at risk of exposure to this soil-related disease.

Adolescent↗
PubMed1997

Advance directive: a study on the knowledge and attitudes among general practitioners in Singapore.

Recent calls for the Advance Directive (AD) to be implemented in Singapore have raised issues regarding the dearth of knowledge and attitude among local healthcare professionals. The present study aims to find out the attitudes and to assess the extent of knowledge regarding the AD among General Practitioners (GPs) in Singapore. This was a cross-sectional, descriptive survey with a sample size of 199 doctors randomly drawn from the Singapore Medical Council list, forming a sampling fraction of 16%. The response rate obtained was 78%. The results showed that while GPs generally supported the concept of the AD, their views were divided on the issue of legislation. They had a basic knowledge of the AD, such as the definition of the AD, that it could be revoked, and the continuity of care and pain relief even after withdrawal of life-sustaining measures. However, only half knew when it should be executed. Many GPs were concerned that the legislation of the AD would lead to the acceptance of euthanasia. They believed that they were in the best position to decide on the treatment of choice for their patients, although they would respect their patients' wishes.

Adult↗
PubMed1997

Plasma lipids and lipoprotein(a) levels in the Chinese from China and Singapore.

This study compared the influence of environmental factors on plasma lipid levels between the descendants of immigrant southern Han Chinese (Singapore Chinese, n = 275) and the native Chinese from southern China (n = 277). Their lipid profiles including lipoprotein (a) [Lp(a)] were measured and compared. The alpha level was set at 0.05 throughout the analysis. Body mass index (BMI), plasma total cholesterol (TC), low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDLC) and triglycerides (TG) levels were significantly elevated in the Singapore Chinese. Plasma Lp(a) however, was comparable in both groups for concentrations as well as frequency distributions. Since both groups were genetically identical, the similar Lp(a) level was in agreement with studies which reported that the apolipoprotein(a) [apo(a)] gene explained as much as 70% of the plasma Lp(a) variations in Chinese. No correlation of plasma Lp(a) level was observed with age and BMI while significant positive linear correlations were observed with TC and LDLC in the male subjects only. We concluded that environmental factors (possibly affluent lifestyle and westernised diet) have significantly influenced the lipid risk factor levels of the Singapore Chinese whereas Lp(a) levels, which are predominantly under genetic control, were not altered significantly.

Adult↗
PubMed1997

Hypercholesterolaemia and its treatment in Singapore with implications for screening.

The National University of Singapore Heart Study is a cross-sectional survey of the whole of Singapore from 1993 to 1995 with a random sample of 961 persons aged 30 to 69 years (response rate 71.2%). Serum lipids were measured enzymatically on an autoanalyser (Ektachem, kodak). Hypercholesterolaemia was diagnosed if the person was on lipid lowering drugs or had a serum cholesterol > or = 6.5 mmol/L (250 mg/dL). Results for the 40 to 64 age group are presented. The proportion and number in Singapore with hypercholesterolaemia were high, 23.7% and 186,544 persons respectively. However, they declined with the additional requirement of coronary heart disease (CHD) or risk factors (i.e. cigarette smoking, hypertension or diabetes mellitus), and were small if only hypercholesterolaemic persons with CHD were included, 1.6% and 13,126 persons respectively. For both genders, the proportions on drugs increased with the added options of CHD or risk factors, so that for persons with hypercholesterolaemia and CHD the proportion on drugs was very high i.e. 84.0%. However, 11.2% of persons with only hypercholesterolaemia (i.e. without CHD or other risk factors) had been prescribed drugs. The main conclusions were:1) The use of different criteria for the screening and treatment of hypercholesterolaemia would involve large differences in the number of Singaporeans on lipid lowering drugs and this should be considered when deciding policy and 2) Medical practitioners currently to some extent do consider the presence of CHD or other risk factors when prescribing lipid lowering drugs for hypercholesterolaemia.

Adult↗
PubMed1998

Isoflavonoid levels in spot urine are associated with frequency of dietary soy intake in a population-based sample of middle-aged and older Chinese in Singapore.

Soy products contain high amounts of isoflavonoids, which have been shown to exhibit possible cancer-protective properties. Chinese populations in Asia, in particular, have a high level of soy intake and a relatively low risk of hormone-dependent cancers. In this study, we assessed the distributions of dietary soy isoflavonoids (daidzein, genistein, and glycitein) and urinary soy isoflavonoids and their metabolites (daidzein, genistein, glycitein, equol, and O-desmethylangolensin) among 147 Singapore Chinese (76 men and 71 women) ages 45-74 years, who are participants of the Singapore Cohort Study on diet and cancer. Urinary values were measured from spot samples collected 10-20 months following recruitment, when usual dietary habits were assessed by a structured food frequency/portion size questionnaire administered in person. Dietary levels of daidzein and genistein were comparable within individuals and about seven times higher than the level of dietary glycitein. All three dietary isoflavonoids showed an approximately 3.5-fold difference between the 25th and 75th percentile values. Similarly, daidzein was the most abundant and glycitein the least abundant of the five isoflavonoid compounds in urine. There was a 4.9-fold difference between the 25th and 75th percentile values for the sum of the five urinary isoflavonoids. Among study subjects, there were statistically significant, dose-dependent associations between frequency of overall soy intake and levels of urinary daidzein (two-sided P = 0.03) and sum of urinary daidzein, genistein, and glycitein (two-sided P = 0.04). In contrast, there were no associations between frequency of overall soy intake and levels of the two daidzein metabolites (equol and O-desmethylangolensin) in urine (two-sided P = 0.85 and 0.34, respectively). We suggest that within the range of exposures experienced by Singapore Chinese, urinary level of daidzein or the sum of daidzein, genistein, and glycitein obtained from a spot sample can serve as a biomarker of current soy consumption in epidemiological studies of diet-disease associations.

Aged↗
PubMed1997

The Marei Ika Daigaku (Syonan Medical College) during the Japanese occupation of Singapore (1942-1945).

During the Japanese Occupation of Singapore (1942-1945), Singapore was renamed Syonan (or Syonanto). The Japanese Military Administration established The Medical College on 27 April 2603 (1943) and it was known as The Marei Ika Daigaku or Syonan Medical College. It was sited at the Tan Tock Seng Hospital (Hakua Byoin). The Ika Daigaku relocated to the General Hospital, Malacca in February 2604 (1944) where it functioned till the end of the Japanese Occupation in September 1945. About 200 students from Singapore, Malaya, Sumatra and Java attended the Syonan Medical College; the students were taught mainly Japanese language and culture.

Education, Medical↗
PubMed1998

Liver transplant in Singapore--coming of age.

BACKGROUND/AIM OF STUDY: Liver transplantation was first performed in 1967, and has become an accepted form of treatment worldwide for chronic liver diseases, acute liver failure and certain metabolic diseases. We document our experience in Singapore over the last 7 years since the first transplant was performed in 1990. METHOD: Retrospective study at National University Hospital, Singapore. RESULTS: Twenty-two operations (10 paediatric and 12 adults) have been performed with the last 17 having been performed in the last 17 months. Currently, there are 15 survivors (68%) since 1990, and percentage survival is even better if one considers the cases from the last 17 months when the majority of cases (17 transplants-77%) were performed (77% survival). The most common indication for transplant was biliary atresia for the paediatric group, while the adults were transplanted for hepatitis B and C cirrhosis, primary biliary cirrhosis, and fulminant liver failure. Tacrolimus is the main immunosuppression (10 patients), with the remaining 5 patients on cyclosporine. Various surgical techniques (living donor, graft reduction) have been employed successfully to provide a complete transplant service. Hospital and ICU stays are within normal limits and the hospital charges range from a low of S$30,000 to S$141,000. CONCLUSION: Liver transplantation has become a reality in Singapore with outcomes comparable to other transplant centres. The shortage of donors remains the greatest stumbling block for further expansion.

Adolescent↗
PubMed1998

A review of the role of stroke units in the modern day management of stroke--implications for stroke care in Singapore.

Among the strategies to combat stroke, an important cause of mortality and morbidity in Singapore, is the establishment of stroke units. Stroke units are characterised by a geographical co-location of stroke patients or care by a mobile multidisciplinary stroke team of specialists; the provision of 24-hour CT scanning, laboratory, monitoring, neurology and neuroradiology services, and availability of neurosurgical and angiography services is recommended. Stroke intensive care units are expensive to run and do not reduce mortality-however, they may have a role for the aggressive management of carefully selected patients. Non-intensive stroke and rehabilitation units have been shown to reduce mortality, morbidity, institutionalisation, and even length of stay and healthcare costs. They facilitate better utilisation of resources, audit, teaching and clinical research. As the number of stroke patients in Singapore is expected to rise, with minor reorganisation, all Singapore hospitals should be able to establish their own stroke units.

Cerebrovascular Disorders↗
PubMed1998

Serum ferritin and iron status in the general population of Singapore, 1993 to 1995.

The National University of Singapore Heart Study is a cross-sectional survey of cardiovascular risk factors in persons aged 30 to 69 years from the general population of Singapore, with 957 persons having measurements of serum ferritin. For males aged 30 to 69 years, mean serum ferritin concentrations were highest in Chinese (236 micrograms/L), followed by Malays (175 micrograms/L) and then Indians (132 micrograms/L). For females aged 30 to 49 years (pre-menopausal), mean levels were higher in Chinese (61 micrograms/L) and Malays (55 micrograms/L) than Indians (30 micrograms/L), and likewise for the 50 to 69 years age group (post-menopausal) where the mean values were 144 micrograms/L for Chinese, 141 micrograms/L for Malays, and 85 micrograms/L for Indians. The proportions with iron deficiency (serum ferritin < 12 micrograms/L) were low in males aged 30 to 69 years (1.9%) and in females aged 50 to 69 years (2.6%), but fairly high in females aged 30 to 49 years and was highest in Indians (23.0%), followed by Malays (15.6%), and then Chinese (7.8%). The much lower ferritin in Indians is maybe partly due to their more vegetarian diet and binding of dietary iron by phytates, but other mechanisms probably exist. Only 0.4% of males and no females had serum ferritin > or = 1000 micrograms/L. Levels of serum ferritin were somewhat higher than that reported in the USA. The overall iron status in Singapore seems to be satisfactory, although pre-menopausal females (especially Indians) have a fairly high rate of iron deficiency and these females need to be identified and treated with iron supplementation.

Adult↗
PubMedDate not supplied

Utilization of healthcare resources for asthma in Singapore: demographic features and trends.

This study examined the healthcare utilization patterns for asthma in Singapore, a tropical island city-state, between 1986 and 1993. Asthma was ranked fifth among principal conditions with the highest number of discharges in Singapore (2.4 discharges per 1,000 population per annum). Among the 0-14 year-olds, asthma was ranked second, only after accidents and injuries, as the condition with the highest number of discharges (5.2 per 1,000). It was estimated that there were approximately 20,000 accident and emergency (A & E) room visits for asthma per annum (7.0 visits per 1,000 population per annum). There were, however, no significant changes in the number of hospitalized or emergency room cases for asthma over the period of analysis. In the primary healthcare setting, asthma ranked 6th among the leading conditions seen by the general practitioners and government polyclinics (15 visits per 100 population per annum). Among under 15 year olds, asthma (37 visits per 100 age-adjusted population per annum) ranked as the second leading condition behind upper respiratory tract infections. This study has shown that asthma causes a significant amount of morbidity in the Singapore community.

Adolescent↗
PubMed2002

Medical savings accounts: a core feature of Singapore's health care system.

In 1984 Singapore adopted a system of Medisave accounts, individually owned accounts used to pay for many of the health care expenditures that in Germany would normally be covered by the obligatory or private health insurance. The fact that people are spending their own money rather than that of a third-party insurer has helped to curtail Singapore's health care costs, which were about 2.6% of gross domestic product in 1999 (Germany: 10.5%). Even with these low expenditures, the income of Singapore physicians is about the same in relation to average wages as physician income in Germany or the United States, and patients have easy access to such technology as computerised axial tomography, organ transplants and bypass surgery.

Journal Article↗
PubMed1993

Respiratory symptoms and lung function effects of domestic exposure to tobacco smoke and cooking by gas in non-smoking women in Singapore.

STUDY OBJECTIVES: To investigate the effects of passive exposure to tobacco smoke and gas cooking at home on respiratory symptoms and lung function of non-smoking women. SETTING: Evidence on the effects of passive smoking and exposure to nitrogen dioxide from gas cooking on the respiratory health of adults is limited and variable. Over 97% of women in Singapore do not smoke, and a principal source of indoor air pollution for housewives is passive smoking and gas cooking. DESIGN: This was a cross sectional (prevalence) study of a population based sample of 2868 adults aged 20 to 74 years in Singapore. A structured questionnaire administered by trained interviewers was used to collect data on passive smoking, gas cooking, respiratory symptoms, and other relevant variables. Passive smoking was defined as exposure to cigarette smoke from one or more members of the household who had ever smoked. Gas cooking was defined in terms of the weekly frequency of gas cooking, as well as the frequency with which the respondent's kitchen was filled with heavy cooking fumes (rarely, occasionally, often). Forced expiratory volume in one second (FEV1) was measured by using a portable Micro-spirometer. Multivariate analyses were used to estimate relative odds of association for respiratory symptoms and FEV1 effect, with adjustment for potential confounding variables. PARTICIPANTS: Of a total of 1438 women in the sample, 1282 women who had never smoked provided questionnaire data and 1008 women provided acceptable readings of FEV1 for analysis. MAIN RESULTS: Passive smoking was significantly associated with greater relative odds of usual or chronic cough and phlegm, wheezing, and breathlessness on exertion, as well as lower FEV1. Greater relative odds of respiratory symptoms were also associated with the weekly frequency of gas cooking, although these results were statistically insignificant. Chronic cough and phlegm and breathlessness on exertion, however, were significantly associated with the frequency with which the kitchen was filled with heavy cooking fumes. A lower FEV1 was found in women who cooked frequently (more than thrice a week). CONCLUSION: Domestic exposure to cigarette smoke and gas cooking is associated with increased risks of respiratory symptoms and impairment of lung function in non-smoking women in Singapore.

Adult↗
PubMed2005

SARS transmission pattern in Singapore reassessed by viral sequence variation analysis.

BACKGROUND: Epidemiological investigations of infectious disease are mainly dependent on indirect contact information and only occasionally assisted by characterization of pathogen sequence variation from clinical isolates. Direct sequence analysis of the pathogen, particularly at a population level, is generally thought to be too cumbersome, technically difficult, and expensive. We present here a novel application of mass spectrometry (MS)-based technology in characterizing viral sequence variations that overcomes these problems, and we apply it retrospectively to the severe acute respiratory syndrome (SARS) outbreak in Singapore. METHODS AND FINDINGS: The success rate of the MS-based analysis for detecting SARS coronavirus (SARS-CoV) sequence variations was determined to be 95% with 75 copies of viral RNA per reaction, which is sufficient to directly analyze both clinical and cultured samples. Analysis of 13 SARS-CoV isolates from the different stages of the Singapore outbreak identified nine sequence variations that could define the molecular relationship between them and pointed to a new, previously unidentified, primary route of introduction of SARS-CoV into the Singapore population. Our direct determination of viral sequence variation from a clinical sample also clarified an unresolved epidemiological link regarding the acquisition of SARS in a German patient. We were also able to detect heterogeneous viral sequences in primary lung tissues, suggesting a possible coevolution of quasispecies of virus within a single host. CONCLUSION: This study has further demonstrated the importance of improving clinical and epidemiological studies of pathogen transmission through the use of genetic analysis and has revealed the MS-based analysis to be a sensitive and accurate method for characterizing SARS-CoV genetic variations in clinical samples. We suggest that this approach should be used routinely during outbreaks of a wide variety of agents, in order to allow the most effective control.

DNA, Viral↗
PubMed2003

Youth suicide and parasuicide in Singapore.

INTRODUCTION: Suicide and parasuicide rates are important markers of the health of a nation. Suicide is a common cause of mortality in youth and parasuicide has its peak prevalence in adolescence and early adulthood. Both pose a tremendous burden to individuals, families and society. Historical and current studies on suicide and parasuicide in Singapore are reviewed and discussed in the light of available worldwide research. METHODS: Studies on suicide and parasuicide in Singapore were identified through a MEDLINE search (from 1979). Information from these studies were supplemented with relevant local monographs on suicide and parasuicide. RESULTS: Suicide is extremely rare in children under 10 years of age. Rates rise in the 10 to 14 years age group and increase markedly in the 15 to 19 years age group. The male to female ratio is about 2:1 for youths 10 to 14 years old and 1:1 for the 15 to 19 years age group. The historical preponderance of female suicide is much less clearly seen in recent years. Jumping from a height is the commonest method used, and mental illness and recent life stress are common causative factors. A peak in suicides in the young was found for June and October, and a trough for November and December. Parasuicide is extremely rare in children under 10 years of age. There was a peak in the months of October and November in the student population, corresponding to the examination months. Youths of Indian ethnicity were over-represented. CONCLUSIONS: Preventing suicide and parasuicide is of paramount importance, given the severe burden of such acts on individuals, families and society. Current studies on youth suicide in Singapore and a national study on parasuicide are urgently needed to increase our understanding of these phenomena.

Adolescent↗
PubMed1991

A review of 58 patients in Singapore with significantly high anti-Toxoplasma serotitres.

Over a 42-month period, 58 patients presenting at the Singapore General Hospital were identified to have IgG anti-Toxoplasma serotitres of 1:1024 or higher by the indirect immunofluorescence test. This retrospective study examines the clinical presentation and management of these 58 patients. About 60% of these 58 patients had presented with lymphadenopathy, 20% with ocular symptoms and 14% with bad obstetric history. Almost all patients with IgG anti-Toxoplasma serotitres exceeding 1:1024 had presented with lymphadenopathy (with a modal titre of 1:4096). In contrast, most of the patients who presented with ocular symptoms or bad obstetric history had lower modal titres. The majority of patients who had presented with lymphadenopathy were Chinese, aged 21 to 35. Typically, they presented with a painless, mobile, solitary cervical node of three to four weeks duration as the only symptom, had biopsies where the histopathology was suggestive of toxoplasmosis, received no treatment and experienced no sequelae. The study concludes that: acute toxoplasmosis is common in Singapore and presents typically as asymptomatic cervical lymphadenopathy in a young Chinese; the incidence of congenital infection is also believed to be high, based on the number of cases presenting with fetal wastage and the prevalence of ocular toxoplasmosis; pigs in Singapore may constitute an important reservoir for the transmission of this disease to man.

Adult↗
PubMed2004

Organ transplantation in Singapore: history, problems, and policies.

The article explores the rules and criteria used for the allocation of donor organs in Singapore. Organs are extremely scarce, so hard decisions have to be made about who receives them. Based on an analysis of documents and interviews done with local program directors, both the admission to a waiting list for transplant and the final recipient selection are covered. The observed practices appear remarkably similar to those predominant in several Western countries until recently, when they had to be modified there following public criticism. It remains to be seen whether Singapore can sustain its much stricter standards in the future.

Ethical Theory↗