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PubMed2006

Clinical and laboratory findings of SARS in Singapore.

INTRODUCTION: Singapore was one of 29 countries worldwide affected by severe acute respiratory syndrome (SARS) in 2003. MATERIALS AND METHODS: There were 238 cases identified during the outbreak. We performed a retrospective analysis of the clinical and laboratory data of 234 patients admitted to Tan Tock Seng Hospital and Singapore General Hospital. RESULTS: The mean age of patients was 21 years, 31.6% of patients were males and 41.8% were healthcare workers. At presentation, the common symptoms were fever, myalgia, cough and headache; rhinorrhoea was uncommon. On admission, 21% had leukopenia, 18% had thrombocytopaenia, 29% had hyponatraemia, 31% had hypokalaemia, 21% had transaminitis. Polymerase chain reaction (PCR) testing of respiratory and stool samples provided the best yield at the end of the first week of illness. Thirty-two patients were initially not recognised as probable SARS and were reclassified when the serology test results were available. The chief reasons for not identifying these patients early were persistently normal chest X-rays (68.8%), very mild presentation (43.8%) and the presence of a concomitant illness (12.5%). Overall, 12% of the patients were probable SARS with atypical presentations. Overall mortality was 11.8%. CONCLUSION: Patients infected with the SARS coronavirus had a wide clinical presentation with non-specific symptoms.

Adolescent↗
PubMed2006

Teleradiology in Singapore--taking stock and looking ahead.

Teleradiology will have a significant impact on the delivery of healthcare and the practice of medicine. In order to ensure a positive outcome, the expected benefits, limitations and potential pitfalls of teleradiology must be carefully considered. For Singapore, teleradiology can be used to facilitate a quantum leap in the standards of radiological services. This can be achieved through the development of an integrated, nationwide, high-speed radiology network which will allow patients to have access to high-quality and responsive subspecialty radiology expertise located throughout the country. If judiciously implemented, teleradiology has the potential to propel Singapore radiology to an unprecedented level of professional quality and service delivery, and will provide the framework for sustainable radiological insourcing from other countries.

Communication↗
PubMed2006

Comparisons of the interactions of health care delivery and medico-legal practice between Australia and Singapore.

Australia and Singapore have similar standards of health care. The one major difference in the two health care systems is the cost to the patient at the point of care. The Medicare system in Australia provides partial to complete subsidy for health care delivery in the public hospitals. In Singapore, the patient has to bear the cost of their health care when needed, with some government subsidies. Studies in the variations between two health care systems, where the costs to the government and individuals are clearly dissimilar, but the health outcomes are similar, can be educational for health law specialists. The methods in which patients obtain recompense for their grievances can help both countries understand how to determine and improve standards of health care communication. Having worked in both systems, the relative values of each and their effects on medical litigation will be discussed.

Australia↗
PubMed2006

An e-learning portal for nurses in Singapore General Hospital.

Singapore General Hospital (SGH) pioneered e-learning systems in Singapore as a knowledge management initiative for nurses. This paradigm shift in nursing education is a proactive step taken to address the increasing sophistication of healthcare systems, expanding demand and perennial shortage of nursing talent. E-learning has been a success at SGH, through providing systematic sharing of knowledge and capture of experience, through both formal and informal online channels. It also made training more effective and less costly. Formal methods of knowledge sharing comprise online learning through interactive training modules and slides presentation with narration, while informal learning comprises of peer group discussion and journal review. Both elements have been essential in making e-learning a success and in creating a lifelong learning culture in SGH.

Education, Distance↗
PubMed2006

Travel characteristics and health practices among travellers at the travellers' health and vaccination clinic in Singapore.

INTRODUCTION: Singapore has a fast-growing travel industry, but few studies have been done on travel characteristics and travel health practices. This study describes the profile and healthseeking behaviour of travellers attending a travel health clinic in Singapore. MATERIALS AND METHODS: A cross-sectional survey was conducted on travellers attending the Traveller's Health and Vaccination Centre (THVC) between September and November 2002 using a standardised questionnaire. Information obtained included individual demographic and medical information, travel patterns, vaccination status and travel health practices. RESULTS: Four hundred and ninetyfive (74%) eligible travellers seen at THVC responded to the questionnaire. Their mean age was 36 years; 77% were professionals, managers, executives, and businessmen, students, and white collar workers. Asia was the main travel destination, and most travelled for leisure and resided in hotels or hostels. The median duration of travel was 16 days. Although >90% had previously travelled overseas, only 20% had previously sought pre-travel advice. Malays were significantly underrepresented (P < 0.01); and Caucasians and Eurasians were significantly more likely (P < 0.01) to have previously sought pre-travel advice compared with Chinese, Indians and Malays. Factors associated with seeking pre-travel advice included travel outside of Asia, especially Africa and South America. CONCLUSION: Singaporean travellers travel more often to cities rather than rural areas, compared with non-Asian travellers. Asia is the preferred destination, and travel outside of Asia is perceived as more risky and is associated with seeking pre-travel advice and vaccinations. Travel patterns and behaviours need to be taken into account when developing evidence-based travel medicine in Asia.

Adult↗
PubMed2006

The epidemiology of paediatric intussusception in Singapore: 1997 to 2004.

INTRODUCTION: The world's first rotavirus vaccine, Rotashield or RRV-TV, was registered in the US in 1998, but withdrawn within a year because of an observed association with intussusception (IS). Surveillance for IS has consequently become important in safety monitoring of new-generation rotavirus vaccines during development. Post-marketing surveillance is also important, and requires the availability of local baseline epidemiology data on IS. MATERIALS AND METHODS: An eight-year study of IS in children under 2 years of age in Singapore was performed by retrospective review of admissions to KK Women's and Children's Hospital, the main paediatric hospital, from 1997 to 2001, followed by prospective surveillance of all hospitals from 2001 to 2004, using the case definition of the Brighton Collaboration Intussusception Working Group. RESULTS: The average IS incidence was 60 per 100,000 in under-ones, and 32 per 100,000 in under-twos, with a downward trend between 1999 and 2004. Ninety-two per cent of subjects were aged below one year, with 51% aged 6 months to 11 months. The mean age at which IS occurred increased from 6.4 months to 12.5 months over the study period. The male-to-female ratio was 1.3:1. No trend in IS numbers was observed over different months of the year. CONCLUSION: IS in Singapore shows no seasonality, but has demonstrated a trend of decreasing incidence in recent years. While highest in the first year of life, the risk of IS is increasing in the second year of life. Males have a slightly higher risk.

Child, Preschool↗
PubMed2006

Rates of posterior capsule rupture during cataract surgery among different races in Singapore.

INTRODUCTION: The aim of this study was to determine if racial differences exist in the rate of posterior capsule rupture (PCR) during cataract surgery in Singapore. MATERIALS AND METHODS: All intraoperative complications during cataract surgery were prospectively reported as part of a clinical audit programme. A retrospective review of all patients who sustained a PCR during cataract surgery between July 1995 and December 1998 was performed. RESULTS: Of 8230 consecutive eyes which underwent cataract surgery, 6951 (84.5%) were Chinese, 597 (7.3%) were Malay, 524 (6.4%) were Indian, and 158 (1.9%) were of other races. The overall incidence of PCR was 1.9%. The PCR rates were 1.8% [125 of 6951; 95% confidence interval (CI), 1.49 to 2.11] in Chinese, 2.0% (12 of 597; 95% CI, 1.01 to 3.57) in Malay, 2.7% (14 of 524; 95% CI, 1.13 to 3.56) in Indian, and 2.5% (4 of 158; 95% CI, 0.00 to 4.98) in other races. There was no statistical difference between the PCR rates (P = 0.62, chi-square test). CONCLUSION: Racial differences in Singapore do not have an effect on the rates of PCR during cataract surgery.

Adult↗
PubMedDate not supplied

Three decades of tuberculosis in Singapore.

Tuberculosis (TB) mortality for the period 1955-1959 to 1985-1989 declined 87% from 72 to 9 per 100,000 in males, and 90% from 31 to 3 per 100,000 in females. The mean annual rate of decline of mortality was 6.8%. Older persons had a lower 4.2-5.2% decline annually compared to 14.1-16.0% in the 0-4 year age group. The incidence of TB declined 80% from 438 to 88 per 100,000 in males, and 71% from 152 to 43 per 100,000 in females over the period 1960-64 to 1985-89. The mean annual rate of decline in incidence was 5.9%. The lowest decline was observed in the children below 15 years (2.8-3.2%) and elderly persons 65 years and above (2.3-5.5%). Birth cohorts of 1945-49 and earlier had progressively higher mortality risks, but declining morbidity risks as they advanced with age. Singapore has overcome the early phase of the TB epidemic as evidenced by its relatively low rates among children and females and the low rates of extra-pulmonary TB and meningitis. The high incidence rates in old people are the residue of even higher rates experienced by this cohort of persons who experienced higher risks of infection in their early lives. At the prevailing rates of decline under the present conditions and control measures, TB will not be eliminated in Singapore over the next 50 years.

Adolescent↗
PubMedDate not supplied

Organs for transplantation. The Singapore experience.

Singapore's Human Organ Transplant Act presumes that competent adults consent to donate their kidneys in the event of a fatal accident, unless they have refused in writing. No family consent is required. What can other countries wishing to implement a presumed-consent model of organ donation learn from Singapore's experience?

Cultural Diversity↗
PubMed1991

Organ procurement in Singapore.

Kidney transplantation, an accepted therapeutic intervention for patients with end stage kidney failure, was pioneered in Singapore on 8 July 1970 by the University Departments of Surgery and Medicine, University of Singapore. Up to 1987, an average of 4.7 cadaveric kidney transplants were performed annually. The introduction of Sandimmune (cyclosporine) in 1985 significantly increased graft survival and consequently created a demand for more cadaveric kidneys for transplantation. The rate of cadaveric kidney transplants escalated to 31.3 kidney transplants annually for the period 1988 to 1990. This increase can be attributed both to the appointment of full time transplant coordinators beginning April 1986 and the implementation of the Human Organ Transplant Act in July 1987. The Human Organ Transplant Act accounted for more than half of all kidneys procured for transplantation (55/94) for the period 1988 to 1990.

Cadaver↗
PubMed1991

Renal transplantation in Singapore--a brief historical perspective.

Renal transplantation in Singapore has been practised for the last 20 years. It was prompted by the extreme shortage of haemodialysis facilities in 1970. Because of the scarcity of cadaver kidneys, a living related programme was commenced in 1976. Since then, both programmes have run parallel. The renal transplantation programme has been influenced by such factors as importation of cadaver kidneys from abroad and living non-related transplantation programme in neighbouring countries. The great beneficial effects of Cyclosporin A (CyA), was evident in the results from 1986 onwards. It has been necessary to modify and expand the legislative rules to encourage and broaden kidney transplantation in Singapore.

Cadaver↗
PubMed1991

The value of the girl child in Singapore.

Son preference exists in many countries in Asia. In countries like Pakistan, Bangladesh and Nepal, such preference has been shown to result in excess female mortality. In Singapore, there is also son preference but excess female mortality is not seen because of several factors: Government's policy of equal educational opportunities for boys and girls since World War II, the protection of women's rights through the Women's Charter, the family planning message that "Boy or Girl, two is enough", urbanisation and industrialisation. Singapore is seeing increasing participation of women in the workforce, not only as clerks and factory operators but also as decision makers in middle and senior management positions. In this modern age, the girl child should be given as much value as the boy child. Only when such an egalitarian attitude towards the girl child exists would she be able to develop into her full potential to be an asset to her country. Government policies to promote the well-being, protect the rights, and to improve the lot of the girl child appear necessary in countries where son preference leads to excess mortality of girls from sex discrimination in nutrition and/or health care.

Child↗
PubMed1991

Current status of food-borne parasitic zoonoses in Singapore.

Parasitic infections adopt a rather low profile in the highly urbanized setting in Singapore. Very few food-borne parasitic infections are encountered. Apart from a few reports of infections with Clonorchis/Opisthorchis, Taenia spp. and hydatid disease, there are no other citations of such helminthic infections. Seroprevalence surveys have shown the presence of toxoplasmosis in local meat animals (sheep, pigs and cattle) and Toxoplasma strains have been isolated from the pig, tree shrew (Tupaia glis), slow loris (Nycticebus coucang) and guinea pigs. Human toxoplasmosis is prevalent in Singapore. Anti-Toxoplasma antibodies are found in the normal population as well as in clinical cases (cervical lymphadenopathy, ocular disease and congenital toxoplasmosis). Carcasses/organs from meat animals (sheep, pigs, cattle) slaughtered at local abattoirs were examined for parasites. The main parasites found were Ascaris suum, Dictyocaulus, Metastrongylus, Cysticercus ovis, Fasciola hepatica and Sarcocystis spp. Pigs were also examined for trichinosis and, thus far, these have all been negative.

Animals↗
PubMed1991

Human immunodeficiency virus infection in Singapore--containment strategies.

The worldwide occurrence of the Acquired Immunodeficiency Syndrome (AIDS) since its advent in the United States in 1981 has resulted in a global dilemma on how best to reduce transmission of the Human Immunodeficiency Virus (HIV). In Singapore, a national AIDS programme was established in 1985 to control the spread of the disease in the country. The programme included health care delivery, education of health care workers and the community, surveillance and counselling of individuals with high risk behaviours, as well as protection of the nation's blood supply. This paper examines the global response to the HIV pandemic and containment strategies appropriate to Singapore based on established epidemiological data.

AIDS Serodiagnosis↗
PubMed1991

Schistosomiasis in Singapore--a case report.

Schistosomiasis although endemic in the Far East, has not been reported in Singapore. We describe an 83 year-old lady with Schistosoma japonicum infection presenting with bloody diarrhoea. We discuss its diagnosis and postulate the mode of transmission of this infection in urban Singapore.

Aged↗
PubMed1990

AIDS-CMV retinitis: Singapore's first cases.

Since April 1988, four cases of AIDS-CMV retinitis were diagnosed in Singapore. Two patients were given intravenous ganciclovir. Clinical response was good but recurrent episodes of breakthrough infection occurred in one patient despite maintenance therapy. Another patient was started on intravenous foscarnet. The fourth patient succumbed to systemic AIDs-related infection before therapy could be started. AIDS-CMV retinitis is a new disease entity in Singapore. With increasing number of AIDS patients, more cases can be expected in the near future. Early treatment and long term maintenance therapy is essential for preserving sight.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pathology of the 5 most common cancers in Singapore.

Cancers in Singapore are on the rise in recent years. The five most frequent cancers in Singapore are lung, stomach, liver, colo-rectum and nasopharynx in males, and breast, uterine cervix, stomach, lung and colo-rectum in females. This article briefly reviews the pathology of these common cancers with emphasis on local patterns and recent developments.

Breast Neoplasms↗
PubMed1990

Neonatology in Singapore.

A short account of the history of Neonatology in Singapore is given. Current practice and results of management of neonates are highlighted and future directions for neonatology in Singapore outlined. Brief mention is made of 2 common controversies in neonatal practice.

History, 20th Century↗