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Beta-thalassemia mutations in Singapore--a strategy for prenatal diagnosis.

The strategy for early prenatal diagnosis of beta-thalassemia in Singapore by direct detection of the mutant beta-globin gene requires the spectrum of mutations producing the disorder in this population to be characterized. We analyzed 134 beta-thalassemia alleles from Singapore by specific oligonucleotide hybridization after DNA amplification, using a nonradioactive enhanced chemiluminescence detection system. The mutations were identified in 90% of the alleles using five oligonucleotide probes for the following mutations: codons 41/42 (deletion-TCTT), IVS II nt 654 (C-->T), codon 17 (A-->T), IVS I nt 5 (G-->C), and -28 TATA box (A-->G). Together with the strategy of direct sequencing, a total of 97% of the mutations were identified. In the Chinese subpopulation, 97% of the mutations were detected by the oligonucleotide probes. Using just four oligonucleotide probes would identify 96% of the mutations, and 76% of the mutations were accounted for by codon 41/42 (-TCTT) and IVS II nt 654 (C-->T) mutations. Thus in this subpopulation early prenatal diagnosis would be possible in virtually all the affected families.

Alleles↗

Quality control in colonoscopy: a Singapore perspective.

For quality control purposes, a computer based auditing system for colonoscopy has been developed in the Department of Colorectal Surgery, Singapore General Hospital, Singapore. The first year's experience was reviewed to determine both workload patterns and the individual operators' performances. Colonoscopic completion rates, both as raw data and cusum transformations, were used as indices of quality control. The mean colonoscopic completion rate for the Unit was 97.0% and, when temporal trends were analysed by cusum, all operators consistently met or exceeded the minimum target completion rate of 90%.

Colonoscopy↗

Treatment of primary liver cancer in Singapore. A review of 3200 cases seen between January 1, 1977, and July 31, 1987.

Between January 1977 and July 1987, 3200 patients with hepatocellular carcinoma (HCC) were studied in Singapore. HCC formed 90% of primary liver cancers seen in Singapore and is the second most common fatal malignancy seen in men in the country. Extensive clinical and basic research has defined certain treatment strategies. Of importance is the prompt detection of early nodular tumours, which can be resected. Resection, 'targetting' with anticancer drugs and, in selected cases, synchronised direct hepatic irradiation with adriamycin, used as a radiosensitiser, have been promising treatment methods. Biological modifiers, such as interferons and interleukins, offer potential for the future. Preliminary pilot studies suggest that interferons may prevent the development of HCC, but more studies are required. Similarly, selective localisation of anticancer agents with radio-isotopical agents opens opportunities for treatment.

Antineoplastic Agents↗

Acute glomerulonephritis--changing patterns in Singapore children.

This study compared the pattern of acute glomerulonephritis (AGN), a disease known to be influenced by socioeconomic and environmental factors, in children 12 years and under, for the years 1971 and 1985. All children admitted to the four major paediatric departments with haematuria and at least two of the following (oedema, hypertension or oliguria) had an initial diagnosis of AGN. A sample population from one unit from 1980 to 1984 showed that over 70% of these children had evidence of a post-streptococcal aetiology. In 1971, 411 children were admitted with AGN, as compared with only 58 in 1985. The age-sex-race standardized rates for 1971 and 1985 were 0.632 and 0.023/1,000 children 12 years and under, respectively (P less than 0.001). The mean age of presentation was lower in 1971. Over this period, Singapore saw a threefold rise in the gross national product, accompanied by rapid urbanization. On analysis of the housing pattern, only 31% of the children lived in high-rise apartments in 1971, in contrast with 86% in 1985 (P less than 0.001). The majority of non-apartment dwellers had homes in rural districts. From an epidemiological perspective, factors which could have led to the highly significant decline in prevalence of AGN in Singapore children included improvement in the socioeconomic status and health care system, and urbanization of the country.

Acute Disease↗

Aging trends--Singapore.

"Three major inter-related issues have emerged concerning population aging in Singapore. The first two concerns are whether aging will increase dependency on the state for welfare and financial assistance and whether traditional family caring structures will survive and provide the care deemed necessary in the future. The third concern focuses on the potential impact of population aging on Singapore's future economic growth and development....A national policy on elderly persons has been formulated since 1989 and focuses on four main areas: employment of elderly people in the workforce; attitudes towards elderly people; community care; and residential care."

Adult↗

Developmental profile of 200 male and 100 female transsexuals in Singapore.

Two hundred male and 100 female transsexuals compared with 100 male and 80 female heterosexuals were studied in Singapore. Transsexuals started their psychosexual development earlier than controls. Transsexual feelings started in childhood. Male transsexuals went through a homosexual phase followed by a transvestite phase, before they became transsexual. Female transsexuals did not go through distinct phases. Cross-dressing was one of the early signs of transsexualism and started earlier in females. None of the transsexuals were married, in contrast to reports showing that up to 50% of Caucasian transsexuals had been married. Cultural differences may explain the contrasts between Singapore transsexuals and patients from Western countries.

Adolescent↗

Substance abuse in schizophrenia. A Singapore perspective.

BACKGROUND: Most of the information on the prevalence and patterns of substance abuse in patients with schizophrenia has been from studies conducted in North America and Europe and data from Asian countries are conspicuously lacking. This study was undertaken with the aim to identify the prevalence and patterns of substance abuse among patients with first-episode schizophrenia in the city-state of Singapore. METHODS: All new patients with a diagnosis of first-episode schizophrenia or schizophreniform disorder who were seen in one calendar year in the only state mental institute in Singapore and its affiliated outpatient clinics were evaluated for a lifetime history of substance use. RESULTS: In a sample of 272 patients, 201 (73.6 %) were abstainers, 43 (15.8 %) had "mild" substance use and 28 (10.3 %) had "heavy" use patterns. Alcohol was the most frequently abused substance. The substance users were more likely to be males and were more likely to have a criminal record than abstainers. CONCLUSIONS: To our knowledge, this is the first study that examines the co-morbidity of substance abuse in schizophrenia in an Asian population. Our findings once again highlight the fact that patients with schizophrenia are at a high risk for substance abuse.

Adult↗

Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population.

BACKGROUND: There has been a relative lack of epidemiological data on generalised anxiety disorder (GAD) in Southeast Asia. A previous study reported a lifetime prevalence of 1.5% and highlighted low preference for seeking professional help and consultation by persons suspected to be suffering from mental health problems. The present study is part of a National Mental Health survey of adults conducted from February 2003-March 2004 specifically assessing anxiety and depression in Singapore. In this paper we report on prevalence, co-morbidity and risk factors associated with GAD. METHODS: We interviewed 2,847 households from an ethnically stratified random sample of adults aged 20-59 years who were Singapore citizens or permanent residents. The General Health Questionnaire and Schedule for Clinical Assessment of Neuropsychiatry were administered, which generated Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses of GAD. We assessed socio-demographic correlates, life events, medical and other psychiatric co-morbidities related to GAD. RESULTS: Lifetime prevalence of GAD was 3.3%, current prevalence is 3.0%. Female to male ratio is 3.6:1. GAD was significantly associated (p<0.001) with the presence of other psychiatric co-morbidities, including major depressive disorder, dysthymia, panic disorder, agoraphobia and social phobia. Prevalence increased in older individuals, with the odds of association greatest in subjects with three or more co-morbid medical conditions [adjusted odds ratio (OR) 3.66]. Those who had experienced one or more threatening life events showed increased odds of association with GAD. Chinese ethnicity, the divorced and persons from both the upper and the lowest socio-economic status had highest odds of association with GAD. CONCLUSIONS: We challenge established notions that GAD tends to be a disorder of the socially disadvantaged. Life events are important as precipitating factors in GAD, and uniquely different types of events appear to affect both extremes of social classes. High co-morbidity associations with current GAD are grounds for concern. This may suggest failure to seek treatment, hence giving rise to an increase in severity of the primary condition.

Adult↗

Diagnosis and treatment of mental disorders: a survey of Singapore mental health professionals.

BACKGROUND: A series of surveys of mental health literacy have been undertaken in Australia, involving members of the general public as well as general practitioners and mental health professionals, whereby respondents consider vignettes of depression and of schizophrenia, offer a diagnosis and rate a series of possible interventions for their judged helpfulness. A similar survey was undertaken in Singapore and is reported in this paper. METHODS: The survey was undertaken at a large state psychiatric hospital with staff (psychiatrists, allied health professionals, psychiatrically and generally trained nursing staff) rating a vignette of mania, in addition to the vignettes derived in Australia for depression and schizophrenia, and with the Australian intervention options extended somewhat to respect Singapore facilities. RESULTS: Responses of those in the four professional groups were compared. The psychiatrists were highly accurate in generating diagnoses, other staff somewhat less so for diagnosing depression (with a percentage instead choosing a diagnosis of stress) and mania (with a percentage instead diagnosing a schizophrenic condition). Reported helpfulness ratings identified those interventions judged consensually as likely to be helpful or harmful, as well as establishing some differences across the four professional groups. CONCLUSIONS: The consensus decisions of helpful treatments for depression and schizophrenia revealed very similar findings to judgements made by Australian professionals. The treated outcome of schizophrenia was judged as somewhat worse than that for mania and depression. While non-medical staff differed from psychiatrists in judging the comparative utility of some drug interventions and lifestyle issues, there was clear evidence of a relatively dominant 'medical model' to recommended treatments, while traditional healing practices and services were rated as distinctly unhelpful.

Adult↗

Hip fracture incidence rates in Singapore 1991-1998.

In this population-based study, we determined the incidence rates of hip fracture among Singapore residents aged 50 years and above. Information was obtained from a centralized database system which captured admissions with the primary diagnosis of a closed hip fracture (ICD-9 codes 820, 820.0, 820.2 and 820.8, n = 12,927) from all health care establishments in the country from 1991 to 1998 inclusive. After removing duplicates, hospital transfers, readmissions and non-acute care admissions, the total number of hip fractures was 9406. Based on the national population census 1990 (n = 464,100) and yearly population estimates, the age-adjusted hip fracture rates for 1991-1998 (per 100,000) were 152 in men and 402 in women. This was 1.5 and over 5 times higher than corresponding rates in the 1960s. From 1991 to 1998, these hip fracture rates tended to increase by 0.7% annually in men and by 1.2% annually in women. Among the three major racial groups, in men, the Chinese had significantly higher age-adjusted hip fracture rates (per 100,000): 168 (95% confidence interval (CI) 158-178) compared with 128 (95% CI 105-152) for Indians and 71 (95% CI 54-88) for Malays. A similar pattern occurred in women: 410 (95% CI 395-425), for Chinese compared with 361 (95% CI 290-432) for Indians and 264 (95% CI 225-303) for Malays. Since the 1960s, the main increases in hip fracture rates have been seen in the Chinese and Malays, with the rates in Indians appearing to decrease. Hip fracture incidence rates in Singapore have risen rapidly over the past 30-40 years, particularly in women, and are now among the highest in Asia. Significant racial differences in hip fracture rates occur within the same community. Time trends in hip fracture rates differed between races.

Age Distribution↗

Sympathetic ophthalmia in Singapore: new trends in an old disease.

BACKGROUND: Sympathetic ophthalmia (SO) is an uncommon uveitic condition that occurs after injury to the uvea of one eye and may occur after accidental ocular trauma or ocular surgery. We sought to investigate the common causes of SO in Singapore and the demographic profile as well as the final visual acuity after treatment in these patients. METHODS: This was a retrospective, non-comparative case series in which patients with SO were identified from the Singapore National Eye Centre uveitis database in the period between 1993 and 2003. The patients' case records were examined for a history of ocular trauma or surgery and subsequent development of bilateral or contralateral uveitis consistent with SO or histopathological evidence of SO in enucleated eyes. The medical records of these patients were reviewed for details of the inciting event, presentation, treatment, and visual acuity. RESULTS: A total of ten patients (six men and four women) were diagnosed with SO in the period of study. SO occurred after accidental trauma in three patients and following ocular surgery in seven. Vitreoretinal surgery was responsible for four of these cases, and diode laser cyclophotoablation for another two, whereas neodymium:yttrium-aluminium-garnet (Nd:YAG) laser cyclotherapy was the cause in the last patient. Overall, six of ten patients underwent at least one vitreoretinal procedure. Four of the patients had a final visual acuity of 6/15 or better, whereas five had a visual acuity of 6/30 or worse. Good final visual acuity appeared to be associated with early initiation of immunosuppressive therapy. CONCLUSION: In this series, ocular surgery, especially vitreoretinal surgery, had overtaken non-surgical trauma as the major cause of SO. A good outcome was possible in most cases if an early diagnosis was made and immunosuppressive treatment started promptly.

Adult↗

Experiencing leisure in later life: a study of retirees and activity in Singapore.

In a society faced with rapid aging and extended life expectancy, older persons in Singapore are just beginning to see retirement as a new era in their lives that can be quite different from the later life experiences of their own parents. Presenting an ethnographic case study of one of the first retiree activity centers in Singapore, this article will examine (a) how older persons cope with retirement, social, and cultural norms, and (b) the strategies older adults adopt in order to stay relevant in a fast-paced society. The ethnographic study shows that extrafamilial social support and opportunities for new experiences in learning and leisure contribute significantly to positive and active living in old age. Although the discussion of aging in Asia usually focuses on the problems of health, finances, and caregiving, the present study suggests the need for policy makers to pay equal attention to issues such as activity participation in old age. Participation in leisure activities may act as a preventive measure to delay the onset of aging-related problems, while at the same time enhancing life satisfaction among seniors.

Adaptation, Psychological↗

Pregnancy outcome in unmarried teenage nulligravidae in Singapore.

Singapore, like other newly industralized countries, has seen a dramatic transformation in the social standards of its population in a particularly short space of time. Unfortunately, this period of development has been accompanied by an escalation in the number of pregnancies to unmarried teenage girls. This paper examines the obstetric and social implications of 150 such pregnancies in younger and older teenagers. Poor intrauterine growth in the younger teenager appears to be the most important adverse obstetric outcome in that mean birthweight was significantly reduced (2738 g compared to 3054 g; P less than 0.02). We believe this to be an important explanation for the five-fold increase in perinatal mortality seen in this group of mothers. Unlike some other reports, we found no significant increase in the incidence of cephalopelvic disproportion, anemia or pregnancy induced hypertension in these mothers. The social implications of teenage pregnancy in Singapore are also examined and recommendations made for methods to curb the problem.

Adolescent↗

A tuberculosis treatment survey in Singapore: results at five-years.

A National Tuberculosis Treatment Survey was instituted in the Republic of Singapore in 1969 with the aim of evaluating the Tuberculosis Treatment Services in Singapore. This five-year follow-up study of the 1969 survey was based on the assessment of the first 1000 consecutive patients who were registered for treatment during the year. Two hundred and forty-six cases were excluded for various reasons, leaving 754 cases for analysis. At the end of 5 years, only 2 (0.3%) were culture positive, 677 (89.8%) were culture negative, 48 cases (6.4%) had died from tuberculosis and 27 cases (3.6%) were lost. The most notable factor which influenced bacteriological positivity was lack of co-operation leading to interruption of chemotherapy. It is concluded that with an efficient organisation highly satisfactory results can be achieved by routine treatment services and prolonged observation of adequately treated patient is not necessary.

Adult↗

The health belief model and preventive health behaviour in Singapore.

Every theoretical model in the social sciences confronts a common challenge: to maintain its explanatory power in different cultural contexts. This is, of course, only one of many challenges faced in theory building. But, this discussion shall focus only on the possibility of a cultural bias. More specifically, the aim of this paper is to discuss some of the findings from a test of the Health Belief Model (HBM) in a multi-ethnic society, Singapore. The HBM is a theoretical framework frequently used in the analysis of health-related behaviour. The discussion will be divided into four sections. The first section will present briefly the components of the HBM. The second section will summarize the procedure used to conduct the empirical test of the HBM. And the third and final sections shall deal with the comparison of preventive health behaviour among three ethnic subpopulations in Singapore, highlighting the main findings of the test of the HBM.

Alcohol Drinking↗

Dental care of institutionalized elderly in Singapore.

Previous studies have identified considerable barriers to dental care and unmet dental needs among institutionalized elderly. This study examined physical and financial arrangements for dental care of institutionalized elderly in Singapore. Chief administrators of the 68 homes for the elderly in Singapore were interviewed. Results showed that 48 homes (70.7%) assumed responsibility for arranging dental care and providing access to treatment facilities for its ambulant residents while only 33 homes (48.5%) had similar arrangements for semi- and non-ambulant residents. Four of the homes (5.9%) reported having in-house dental facilities while the rest arranged for its residents to be treated either in public dental facilities (44.2%) or in private dental offices (20.6%). Type of sponsorship of the homes and ambulatory status were closely associated with the type of arrangement for dental care. Over 64.6% of homes (44) required residents to be fully responsible for the costs of their dental care. The availability of subsidies for residents' dental costs was found to be associated with the type of sponsorship and type of arrangement for care. Lack of physical access and financial constraints were found to be potential problems in the utilization of dental services in this population group.

Aged↗

Molecular diagnosis of genital HPV DNA types by polymerase chain reaction and sensitivity-standardized filter in situ hybridization in randomly sampled cohorts of Singapore women.

Infection of the cervix uteri with various types of human papillomaviruses is generally considered a necessary factor in the etiology of cancer of the cervix uteri. In many human populations throughout the world, approximately 90% of cervical carcinomas are found to harbour HPV genomes, as judged by Southern blot hybridization, while only a few percent of the cervical smears of asymptomatic individuals contain viral DNA, as assessed by filter in situ hybridization. To obtain corresponding epidemiological data from Singapore, we analysed two groups of 740 and 130 individuals by filter in situ hybridization, and found 4.1% and 6.9% of them to be HPV positive, with HPV 16 and HPV 31 being the predominant types. In consideration of the limitations of filter in situ hybridization, namely low sensitivity and a tendency to suggest false positives due to contaminants, including blood, we analysed the cervical smears of two further groups of 52 and 50 individuals by the polymerase chain reaction for infection by HPV 16 and HPV 18 respectively. With this test, 61% and 14% of the cervical smears proved to be HPV 16 and HPV 18 DNA positive respectively. We conclude that in Singapore, if not worldwide, the majority of the population the population is infected by genital HPV types, suggesting that factors other than HPV infection are ultimately rate-limiting in cervical carcinogenesis.

Adolescent↗

Use of quarantine in the control of SARS in Singapore.

BACKGROUND: A total of 238 cases of the severe acute respiratory syndrome (SARS) occurred in Singapore between February 25 and May 11, 2003. Control relied on empirical methods to detect early and isolate all cases and quarantine those who were exposed to prevent spread in the community. METHODS: On April 28, 2003, the Infectious Diseases Act was amended in Parliament to strengthen the legal provisions for serving the Home Quarantine Order (HQO). In mounting large-scale quarantine operations, a framework for contact tracing, serving quarantine orders, surveillance, enforcement, health education, transport, and financial support was developed and urgently put in place. RESULTS: A total of 7863 contacts of SARS cases were served with an HQO, giving a ratio of 38 contacts per case. Most of those served complied well with quarantine; 26 (0.03%) who broke quarantine were penalized. CONCLUSION: Singapore's experience underscored the importance of being prepared to respond to challenges with extraordinary measures. With emerging diseases, health authorities need to rethink the value of quarantine to reduce opportunities for spread from potential reservoirs of infection.

Contact Tracing↗