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PubMed1985

Drug preventive education and rehabilitation programmes in Singapore.

The drug situation in Singapore is considered to be under control now because of the successful adoption of its two-pronged strategy of both supply and demand reduction. This paper only discusses the latter which is carried out through preventive education, treatment and rehabilitation, and aftercare services. Drug preventive education and publicity aimed at the public and the students are mainly done by the Singapore Anti-Narcotics Association (SANA). How various methods and ways have been organized to heighten the awareness of the dangers of drug abuse is discussed. Drug abusers perceived as patients are sent directly, when arrested, to Drug Rehabilitation Centres for treatment and rehabilitation. Discussion is concentrated on both the 5-stage programme and the day release scheme. Also included in the paper is the aftercare service provided to the ex-drug addicts after completing the programme or the scheme by the SANA's voluntary aftercare officers either from the religious/secular groups or at the constituency level.

Adult↗
PubMed2001

Epidemiology of autism in Singapore: findings of the first autism survey.

The report describes the results of a survey conducted on 176 parents of children with autism in Singapore. The ages of the children ranged from 3 to 12 years. The survey focused on the child's background, behaviour problems and skill profile, the home and school situation as well as the linguistic and social background. It was noted that the Singapore population confirms the international distribution regarding a predominance of boys over girls and a low incidence of birth complications. A positive trend noted was the fact that 60% of the children were diagnosed before the age of 3 years. Discussion focuses on possible risk factors and psychosocial adversities for autism such as a high frequency of caregivers who are foreign maids, the use of multiple languages and the high level of punitive educational practices. The possible influence of psychosocial deprivation on child development is discussed.

Autistic Disorder↗
PubMed1993

Industry and radiology in Singapore.

Singapore is an ideal educational and commercial hub because of its its central location within Asia, its excellent communication and transportation network, and its ability to remain in the forefront of technology where medical equipment and radiology are concerned. Technologists well trained and fluent in more than one language with an excellent command of English ensures that they benefit from their training stints overseas. From the manufacturer's vantage point, the training center at NUH remains a highly developed center of excellence in Asia, functioning as a shop window for potential clients. Catering to both technologists and radiologists, the center represents the manufacturer's contribution to growth and continued up-grading of the standards in Southeast Asia. We hope that this experiment, the only concrete attempt by any manufacturer in contributing to the radiologic community in Singapore and Southeast Asia, will continue to grow and to develop and become a channel for industry to continue such contributions. One important question that must be addressed is whether all equipment must be purchased from this one manufacturer. There is no such arrangement, and whatever equipment is needed is purchased from any source, depending on budgetary constraints and other restrictions. We believe that training and contributing to the growth, understanding, and application of all modalities in radiology should be worldwide, but organized regionally. In planning training programs, companies must look beyond their countries of origin and rely more heavily on input from their local, regional, and national offices. We hope that the program we have established will serve as a model that can be used elsewhere.

Hospitals, University↗
PubMed2002

Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state.

BACKGROUND: Ulcerative colitis (UC) is rare in Asia. Singapore is an ethnically heterogeneous city-state with a population made up of Chinese (77%), Indians (7.5%), and Malays (14%). This study describes and compares the characteristics of Chinese, Malay, and Indian patients with UC. STUDY: Retrospective chart review was performed of 235 patients seen in the largest tertiary care hospital in Singapore between 1971 and June 2000. RESULTS: There were 169 (72%) Chinese, 24 (10%) Malays, and 42 (18%) Indians with UC. Male-to-female ratio was 1.8:1 (150:85). Most patients in all three races presented between the ages of 20 and 39 years. No bimodal peak in the age at presentation was seen. The median period from onset of symptoms to diagnosis was 1 month in all three races. More Malay (57%) and Indian (55%) patients had colitis extending proximal to splenic flexure at presentation compared with Chinese (32%) patients (p = 0.04). There were more Indian patients (29%) with severe disease at onset compared with Chinese (12%) and Malay (22%) patients (p = 0.035). Thirty-one percent of patients had only one episode of colitis, 12% were steroid dependent, and 4% were steroid refractory. Proctocolectomy was needed in 31 (18.3%) Chinese, 3 (12.5%) Malay, and 4 (9.5%) Indian patients. Extraintestinal manifestations were found in 6% of the Chinese, 12% of Malay patients, and 14% of Indian patients. The most common extraintestinal manifestation was arthritis, present in 6.4% of patients. CONCLUSION: There were more Indians with UC than expected in this population. Whereas Indian and Malay patients have more extensive and severe disease at presentation than Chinese patients, this does not predict for more refractory disease or a greater need for surgery.

Adult↗
PubMed2002

Prevalence rates and epidemiological risk factors for astigmatism in Singapore school children.

PURPOSE: This study examined the prevalence rate of astigmatism and its epidemiological risk factors in Singapore school children. METHODS: In a study of school children aged 7 to 9 years old in two schools in Singapore in 1999, a detailed questionnaire was administered to parents regarding reading or close-work habits, past history of close-work, family history, and socioeconomic factors. Cycloplegic refraction was performed five times in each eye. Defining astigmatism as worse than or equal to 0.5, 0.75, and 1 D cylinder in the right eye, the prevalence of astigmatism was calculated. RESULTS: The study population consisted of 1028 children. The prevalence rate of astigmatism (worse than or equal to 1 D cylinder) was 19.2% (95% confidence interval, 16.8 to 21.6). This was not different between genders, ethnic groups, or age (p > 0.05). With-the-rule astigmatism was more common than against-the-rule astigmatism. The prevalence of astigmatism and myopia was 9.8% (95% confidence interval, 8.0 to 11.6). A high AC/A ratio was associated (p = 0.003) with astigmatism, even after exclusion of myopic children. On vectorial analysis, J0 and J45 were associated with the number of hours of playing video games, whereas J45 was also associated with computer use. Only J45 was associated to male gender, a high AC/A ratio, and a family history of myopia. CONCLUSIONS: The prevalence rate of astigmatism (> or = 1 D) was 19%. Playing video games and computer use may be associated with astigmatism severity, although the presence of astigmatism (> or = 1 D) was not associated with any nearwork factors. A family history of myopia was associated with oblique astigmatism severity. A high AC/A ratio is associated with astigmatism, and this requires further investigation.

Astigmatism↗
PubMed2005

Utility values in Singapore Chinese adults with primary open-angle and primary angle-closure glaucoma.

PURPOSE: To evaluate utility values in Chinese glaucoma patients. PATIENT AND METHODS: Singapore Chinese residents (n = 213) with primary open-angle glaucoma or primary angle-closure glaucoma were recruited from a single tertiary ophthalmic center. Standard face-to-face interviews were conducted to ask about utility values (time trade-off and standard gamble for both death and blindness). Ocular information, including current visual acuity, intraocular pressure, visual field defect, and cup-disc ratio were also obtained. RESULTS: The mean time trade-off utility value was 0.88 (95% confidence interval 0.85, 0.91), and standard gamble for death and blindness were 0.94 (95% confidence interval 0.93, 0.96) and 0.95 (95% confidence interval 0.93, 0.97), respectively. Only 35.7% of patients were willing to trade time, and 34.3% willing to risk blindness in return for perfect vision. Both primary angle-closure glaucoma and primary open-angle glaucoma patients had similar utility values. After adjusting for age, gender, language spoken, educational level, and diagnosis, patients with better eye visual field PSD > 10 were 2.52 times (95% confidence interval 1.13, 5.61) more willing to trade time. In a multivariate model, the odds ratio of willingness to risk blindness for a complete hypothetical glaucoma cure was 9.88 (95% confidence interval 1.65, 59.23) for patients who had only visited an ophthalmologist 15 years or more ago, and 0.53 (95% confidence interval 0.27, 1.02) for patients who had previous trabeculectomy. CONCLUSION: Most Chinese glaucoma patients in Singapore are not willing to trade time or risk blindness. Patients with worse visual fields in the better-seeing eye are more willing to trade time; whereas patients who have not seen an ophthalmologist for at least 15 years or who had no history of a previous trabeculectomy are more willing to risk blindness.

Adult↗
PubMed2006

Nonsteroidal anti-inflammatory drug use is a significant cause of peptic ulcer disease in a tertiary hospital in Singapore: a prospective study.

BACKGROUND: Peptic ulcers due to nonsteroidal anti-inflammatory drug (NSAID) use may have contributed to the static prevalence of ulcer disease in Asia. GOAL: We aimed to determine the current etiology of peptic ulcer disease in Singapore. STUDY: Consecutive patients undergoing esophagogastroduodenoscopy who had not been exposed to antibiotics, or antiulcer therapy within the past 6 months, and in whom peptic ulcers were found, were prospectively studied. Before endoscopy, patients were interviewed regarding the use of NSAID or aspirin. During endoscopy, antral biopsies were obtained for urease test and histology. Serum thromboxane B2 levels were compared with those of healthy volunteers. RESULTS: Peptic ulcers were detected in 600 patients during a 2-year period. The ulcers were negative for Helicobacter pylori in 212 patients (35.3%) and these H. pylori negative ulcers were related to NSAID use in 68.9% of cases. On the basis of serum thromboxane B2 levels, 30.8% of the patients with non-H. pylori non-NSAID were considered to have consumed NSAID. CONCLUSIONS: H. pylori negative peptic ulcer makes up a significant proportion of peptic ulcer in Singapore. Most of these ulcers were related to NSAID use. Serum thromboxane profile suggested surreptitious NSAID use in many of the non-H. pylori and apparently non-NSAID patients.

Adult↗
PubMed2005

Risk perception and impact of Severe Acute Respiratory Syndrome (SARS) on work and personal lives of healthcare workers in Singapore: what can we learn?

INTRODUCTION: Healthcare workers (HCWs) were at the frontline during the battle against Severe Acute Respiratory Syndrome (SARS). Understanding their fears and anxieties may hold lessons for handling future outbreaks, including acts of bioterrorism. METHOD: We measured risk perception and impact on personal and work life of 15,025 HCWs from 9 major healthcare institutions during the SARS epidemic in Singapore using a self-administered questionnaire and Impact of Events Scale and analyzed the results with bivariate and multivariate statistics. RESULTS: From 10,511 valid questionnaires (70% response), we found that although the majority (76%) perceived a great personal risk of falling ill with SARS, they (69.5%) also accepted the risk as part of their job. Clinical staff (doctors and nurses), staff in daily contact with SARS patients, and staff from SARS-affected institutions expressed significantly higher levels of anxiety. More than half reported increased work stress (56%) and work load (53%). Many experienced social stigmatization (49%) and ostracism by family members (31%), but most (77%) felt appreciated by society. Most felt that the personal protective measures implemented were effective (96%) and that the institutional policies and protocols were clear (93%) and timely (90%). CONCLUSION: During epidemics, healthcare institutions have a duty to protect HCWs and help them cope with their personal fears and the very stressful work situation. Singapore's experience shows that simple protective measures based on sound epidemiological principles, when implemented in a timely manner, go a long way to reassure HCWs.

Adaptation, Psychological↗
PubMed2005

Managing knowledge integration in a national health-care crisis: lessons learned from combating SARS in Singapore.

The outbreak of Severe Acute Respiratory Syndrome is the first severe and readily transmissible disease to emerge in the 21st century. Often one new infection meant tracing of several people to monitor their health conditions as well. In Singapore, several agencies coordinated their efforts to quickly bring the outbreak under control. The current breed of health-care information systems (HCIS) was not sufficient to handle new information-sharing needs during the crisis. In this paper, we take a look at the measures taken during the crisis in Singapore through a knowledge integration perspective. This perspective reveals interesting implications for HCIS.

Artificial Intelligence↗
PubMed1976

T3 toxicosis and its relation to the iodide status in Singapore.

Baseline thyroid function tests (including total serum thyroxine iodide-T4I, total serum tri-iodothyronine T3 as well as T3 Sephadex Uptake Studies (T3U)) were determined in 82 normal Asian subjects. In addition, another group of normal volunteers (39) were assessed as regard serum and 24-hour urinary iodide levels to gauge the iodide status of the community; the results were comparable to that of goitre-free regions of the world. Having established the range of values of normal thyroid function tests, 103 consecutive clinically thyrotoxic patients (both new and relapsed cases) were similarly studied in an attempt to elucidate the magnitude of the problem of T3 toxicosis, and its relation to the iodide status in Singapore. Only three clinically hyperthyroid patients were foudn to have normal PBI T3 levels. A detailed analysis and discussion of the data is presented. It is concluded that T3 toxicosis is a rarity in Singapore.

Adult↗
PubMed2004

Horizontal and vertical dispersal of dengue vector mosquitoes, Aedes aegypti and Aedes albopictus, in Singapore.

To study the dispersal of dengue vector mosquitoes in Singapore, females of Aedes aegypti (L.) and Aedes albopictus (Skuse) (Diptera: Culicidae) were fed blood containing rubidium (Rb), which was detectable in their eggs by means of Graphite Furnace Atomic Absorption Spectrophotometry (GFAAS). Laboratory calibration of the Rb reading, for a range of egg numbers from Rb-fed females, indicated a reasonably linear relationship and an unequivocal distinction between results with zero and one marked egg. Rb-marked female Aedes mosquitoes aged 3-5 days were released in semi-rural and urbanized parts of Singapore, with an array of ovitraps extending to a radius of 320 m from the release point. Subsequently, Rb-marked Aedes eggs were detected throughout the array, with similar distributions on each of the 4 days after release. More Rb was detected nearer the release point. However, when correction was made for the greater areas of zones further from the release point (and therefore presumably existence of more alternative oviposition sites), there were no significant differences in the numbers of marked eggs per ovitrap in the zones nearer or further from the release points. It is concluded that females of both these Aedes (Stegomyia) species could disperse easily and quickly throughout areas of radius 320 m in search of oviposition sites. This contrasts with the general belief that Ae. aegypti seldom flies more than 50 m and that control operations can safely be based on such an assumption. Releases on level 12 of a 21-storey apartment block, with ovitraps on each storey, showed similar easy and rapid dispersal to the top and bottom of the block.

Aedes↗
PubMed1989

Cross-cultural study of alcohol behaviour among Singapore college students.

To test the hypothesis that Singapore Indian college students would experience higher rates of drinking problem behaviour than their Chinese counterparts, the Engs and Hanson questionnaire was administered to 767 Chinese and 185 Indian undergraduate students. The significant differences in drinking problems found between Indian and Chinese students were interpreted as reflected a higher level of anomie among the Indians in terms of their drinking norms. Singapore Indian students' alcohol-related problem behaviours, however, are considerably less than those found in college students from western countries.

Alcohol Drinking↗
PubMedDate not supplied

An assessment of the cognitive abilities of multiply handicapped children: adaptations of the Uzgiris and Hunt scales and their use with children in Britain and Singapore.

Educational achievement is measured by many forms of assessment. The assessment of some children, and disabled children, has elicited much concern and debate. In particular, problems have arisen with test design, construction, administration and recording. In the West, legislation and public opinion have drawn attention to the need to provide more suitable measuring instruments. The purpose of this paper is to illustrate the use of an adapted assessment procedure for monitoring educational achievement and progress. A study is discussed where the major aim is to use situations which are both stimulating and which most closely resembled the children's natural settings, in order to elicit communication and language skills. The study is being carried out in Singapore with a group of multiply handicapped children. The adaptations to the administration of the test enable the examiner to note the behaviour as it occurs rather than look for expected behaviours. It is possible then to record behaviours at a later stage. The results of the study show that it is possible to elicit the required responses from a group of children who are diagnosed as multiply handicapped and whose competencies are difficult to assess. In the original research in Britain, with a large group of multiply handicapped children, there was evidence of reliability, validity and ordinality in the children's responses. Analysis of these children's scores showed patterns of responses inconsistent with a popular view of development. This paper describes the Singapore study and the original study upon which it is based.

Child↗
PubMed2005

Sensitization to dust mites in children with allergic rhinitis in Singapore: does it matter if you scratch while you sneeze?

BACKGROUND: Previously published data established Blomia tropicalis, as the major source of allergic sensitization in asthmatic children in tropical Singapore. Objective To define the prevalence, clinical characteristics and risk factors of species-specific mite sensitization in paediatric allergic rhinitis (AR) patients in this unique environment. METHODS: We performed a prospective evaluation of newly diagnosed AR patients, from 1 May 2003 to 30 April 2004, from the otolaryngology and allergy outpatient clinics of the Kendang Kerbau Children's Hospital in Singapore. Patients included in the study showed evidence of sensitization to at least one respiratory allergen source and completed a detailed questionnaire. Relative risk of sensitization and associated risk factors were calculated using logistic regression analysis with the forward stepwise model. Multivariate regression analysis was performed to adjust for confounding interactions. Continuous values were compared using anova, SPSS 9.0 for Windows (SPSS Inc., 1999). RESULTS: One hundred and seventy-five patients were included, 119 (68%) males, 142 (81%) Chinese, age mean 7.9 years (range 2-16). Sixty-eight patients (39%) reported a concomitant diagnosis and/or clinical complaints of bronchial asthma and 84 (48%) of atopic dermatitis. Skin prick test results were positive for traditional house dust mites (Dermatophagoides pteronyssinus. and D. farinae mix) in 85% of patients and for B. tropicalis in 62%. Overall mite sensitization was 98%, household pets 10%, moulds 9% and food proteins 12%. By far the single most significant factor associated with Dermatophagoides sensitization in this group was the presence of allergic eczema (odds ratio (OR) 31.8%, 95% confidence interval (CI) 3.6-285, P=0.002). Allergic eczema was negatively associated with B. tropicalis sensitization (OR 0.26%, 95% CI 0.14-0.5). CONCLUSIONS: Children with AR and concomitant atopic dermatitis show a preferential sensitization to the Dermatophagoides mites. In our population, B. tropicalis sensitization is more prominent in children with pure respiratory allergy.

Adolescent↗
PubMed2005

Cutaneous sarcoidosis in Asians: a report of 25 patients from Singapore.

Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin involving multiple organ systems. There has been no report so far to describe the epidemiological pattern of cutaneous involvement in sarcoidosis in South-East Asia with diverse ethnic groups. A retrospective study examining the clinicopathological features of all patients diagnosed with sarcoidosis at a tertiary dermatology centre in Singapore from 1980 to 2003 was conducted. Cutaneous sarcoidosis was diagnosed in 25 patients: 13 were Indian, 11 were Chinese and one was Eurasian. Cutaneous manifestations included papules, nodules, plaques and scarring alopecia. Extracutaneous involvement of lymph nodes (four patients), lungs (eight patients) and eyes (two patients) was seen. Eight patients had abnormal chest radiographic findings. Histopathological examination of skin lesions revealed noncaseating, epithelioid granulomatous infiltration in the dermis without evidence of mycobacterial infection, deep fungal infection or polarizable birefringent material. Treatment modalities included corticosteroids, hydroxychloroquine, isotretinoin, methotrexate and surgical excision. Five patients had complete resolution of the cutaneous lesions. Cutaneous sarcoidosis is rare in Asia and indeed in Singapore. Extracutaneous involvement is not uncommon and a thorough clinical evaluation should be undertaken.

Adolescent↗
PubMed1992

T-cell lymphoma in Singapore: pathology, clinical findings and association with HTLV-1 antibodies.

Of 128 cases of malignant lymphomas studied in Singapore between 1986 and 1988, 28 were identified as peripheral T-cell lymphomas. Sera from two of the 128 cases were positive for HTLV-1 antibodies and both cases had the clinical and pathological features of adult T-cell leukaemia/lymphoma. The pathological and clinical features of the 28 cases of peripheral T-cell lymphoma are presented in detail. Survival data indicated no significant difference between the low grade and high grade histological types. Three of the patients had previous or concomitant malignancies. The percentage of T-cell lymphomas associated with HTLV-1 infection in Singapore is low compared to those areas in which HTLV-1 is endemic.

Adolescent↗
PubMed1988

Epidemiology of contact allergy in Singapore.

The prevalence of contact allergy in 2471 patients patch tested in Singapore was 49.2% (571/1160) in women and 49.8% (653/1311) in men (sex difference not significant). The rate appeared to increase with age (43.7% in those less than 20 years, 50.6% between 20 and 49 years, and 63.1% in those greater than 49 years). There was no significant difference in the prevalence of contact allergy among the major races (Chinese, Malay, and Indian) of Singapore. Contact allergies in 16.8% (96/571) of women and 38.9% (254/653) of men (p less than 0.001) were occupational. Nickel, fragrance mix, proflavine, and chromate were common sensitizers. The male:female prevalence of nickel allergy was 1:2 (sex difference p less than 0.001) and for chromate was 7:1 (sex difference p less than 0.001). Chromate sensitivity was occupational in 87.7% (121/138) of men and 47.1% (8/17) of women (sex difference p less than 0.001). Proflavine, neomycin, and clioquinol were the more common medicament sensitizers.

Adolescent↗
PubMed1994

In vitro evaluation of griseofulvin, ketoconazole, and itraconazole against various dermatophytes in Singapore.

BACKGROUND: Superficial cutaneous fungal infection, principally dermatophytosis, is an extremely common skin disease. Various in vitro test systems have been developed in recent years to determine the antifungal activity of various drugs. The minimum inhibitory concentration (MIC) obtained may give an indication of the in vivo potency of the drugs. METHODS: One hundred patients (69 men and 31 women) with a clinical diagnosis of dermatophytosis were entered into the study. Direct microscopy and culture were done on all patients. The MICS were determined using the broth dilution method. RESULTS: The age range was 1-76 years. The most common diagnosis was tinea corporis (36%), followed by tinea cruris (22%), and tinea pedis (19%). The most common fungus isolated was T. rubrum (58%), followed by E. floccosum (14%), and T. mentagrophytes (10%). The majority of the isolates was sensitive to the three drugs tested (griseofulvin, ketoconazole, and itraconazole). Of the isolates, 82% were sensitive to griseofulvin, 78% to ketoconazole, and 81% to itraconazole, all at a concentration of < 0.25 micrograms/mL. For T. rubrum, there were four isolates that had an MIC of > or = 64 micrograms/mL to griseofulvin, seven isolates and nine isolates with an MIC > or = 64 micrograms/mL to ketoconazole and itraconazole, respectively. T. interdigitale was relatively resistant to the three drugs in vitro with four of seven isolates having an MIC > or = 4 micrograms/mL with griseofulvin, one of seven isolate with an MIC > or = 64 micrograms/mL with ketoconazole, and three of seven isolates with an MIC > or = 32 micrograms/mL with itraconazole. CONCLUSIONS: The in vitro antifungal activity of griseofulvin, ketoconazole, and itraconazole are similar against dermatophytes in Singapore. Griseofulvin may be given as the first-line drug for treating such infections in Singapore.

Adolescent↗