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The History of Surgery in Singapore is over a hundred years old. The major land marks are, the starting of the Medical School, the rapid development of health and hospital services after the war and the establishment and growth of major specialities and postgraduate education in the last 15 years. This paper traces the significant Scottish influence in the various stages of developmental history of Surgery in Singapore.
We studied the prevalence of diabetes mellitus in Singapore and compared it to the study conducted ten years previously. A rise in prevalence rates from 2.0% to 4.7% was demonstrated. Impaired glucose tolerance (IGT) was studied for the first time, and a prevalence rate of 0.9% was found. Findings on chronic complications of diabetes were also reported. A high frequency of coronary heart disease and hypertension were detected in both diabetic and IGT subjects. Obesity and hyperlipidaemia were identified as important risk factors. This study demonstrates the scope and impact of diabetes mellitus as a major healthcare problem in Singapore. Strategies directed at prevention and control of this disease needs to be implemented so as to check its rising trend.
Urinary borates calculated as boric acid were found to span 0 to 54 microgramme per ml urine for both Singaporean adults (population size: 507) and children (population size: 162). The normal dietary boron intake could account for the urinary boric acid levels observed. Of the hundred and fifty-three children who suffered from gastroenteritis in Singapore over the period from Jan to May 1989, two were found to have urinary boric acid exceeding 54 micrograms per ml urine. One of them was said to have consumed fish balls, bean curds and noodles prior to the onset of illness. These food items were among those likely to have added borates. Unfortunately, the dietary intake prior to the onset of illness of the other child was not recorded. Of the hundred and twelve adults affected by gastroenteritis in Dec 1988 in the Tiong Bahru area, one was found to have boric acid level of 117 micrograms per ml urine, indicative of added borates in the diet. The present study showed that borates related gastroenteritis incidents in Singapore over the time-period of our study at least, were few and far in between. With the on-going surveillance for the presence of added borates in both locally manufactured and imported food and the continued tight control over the importation and sale of borates, future incidents are likely to be minimal.
Over the last decade, admissions from respiratory infections have declined but there had been an increase in admissions from Bronchial Asthma in Singapore Government Hospitals. Better recognition by doctors and increased prevalence are important factors. However, mortality had remained low. Like other mortality studies, underestimation of the severity of asthma and undertreatment are the major contributing factors to asthma deaths in Singapore children. Therefore, better public education and continuing education of medical personnel may help to reduce deaths from asthma in children and adolescents.
Medical surveillance of workers exposed to a lead hazard is a common practice in many countries. In Singapore, legislation on periodic medical examinations for lead exposed workers in factories was introduced in 1985. This paper discusses the results of the laboratory tests in workers exposed to inorganic lead in 1987. The WHO recommended that the health-based limit for lead absorption be 40 micrograms/dL for adult male workers. Taking this level, we could divide the factories into a "higher risk" category and a "lower risk" one, the latter not having a single result of blood lead of 40 micrograms/dL or above. The former category included factories manufacturing PVC and lead storage batteries, with the highest level of 79.6 micrograms/dL found in PVC manufacture. Of the 3 main races in Singapore, the Chinese have the lowest blood lead levels after adjusting for the type of industry, age and duration of exposure to lead. Age was correlated with the duration of lead exposure. The higher blood lead levels in Malays and Indians may have been contributed to by eating habits (eating with hands). The higher prevalence of smoking among Malays may also be contributory. The results in this study, while reassuring that no worker was found with blood lead above 80 micrograms/dL, also indicated that workers in some factories were still exposed to a health risk.
This study examined key issues facing Singapore youth and whether social class status affected their perceptions of problems. The major problems reported by 220 high school aged youths included being pressured to keep up with schoolwork, worrying about the future, and needing help with schoolwork. A considerable degree of congruence was found in terms of how lower- and middle-class youths ranked their problems. Cm-square analysis, however, indicated that significantly larger numbers of lower-class youths considered the following issues problematic: arguing with parents, receiving enough sex education, feeling good about oneself, worrying about suitable work, worrying about the future, difficulty in accessing recreation facilities, and needing help with schoolwork. The path for Singapore youth growing into adulthood is one that reflects the stress and pressure of a dynamic, modern society with changing social and cultural values.
A population based survey has measured levels of physical activity by questionnaire in persons aged 18 to 69 years in Singapore. Levels of physical activity were classified into high, medium and low based on activity in leisure and at work. The only ethnic difference was that for males a higher proportion were classified as "high" activity in Malays (24.8%) than Chinese (16.0%) and Indians (18.1%). For the overall 18 to 69 age group, it was found that for males, the proportions in the "low" category were Chinese 80%, Malays 70% and Indians 75% while for females it was 95% in all three ethnic groups. As physical activity of sufficient intensity is important in disease prevention and health promotion, more needs to be done on educating the public in Singapore about the benefits of regular exercise.
A population based survey has measured alcohol consumption by questionnaire in persons aged 18 to 69 years in Singapore. The majority were "occasional/none" drinkers, being males (Chinese 87%, Malays 99% and Indians 80%) and females (Chinese 98%, Malays 100% and Indians 100%). "Heavy" consumption was uncommon in males (Chinese 0.6%, Malays 0% and Indians 1.3%) and absent in females, while "heavy/moderate" drinking was males (Chinese 5.7%, Malays 0.5% and Indians 3.8%) and females (Chinese 0.3%, Malays 0% and Indians 0%). For males, "light" drinking was highest in Indians (15.9%), then Chinese (7.8%) and then Malays (0.5%). This survey indicates that alcohol consumption is not yet a major public health problem in Singapore.
This study describes the occurrence of anaemia (haemoglobin level below 12.5 g/dl) amongst National Service (NS) Registrants in Singapore. A total of 32,320 subjects were screened and the prevalence of anaemia was 0.51%. The Indians had the highest prevalence compared to the other races. The commonest cause of anaemia was haemoglobinopathy. Though alpha-thalassaemia is the commonest form of haemoglobinopathy in Singapore, we found that beta-thalassaemia was the commonest form of haemoglobinopathy in anaemic subjects. In the Chinese and Malay races, the commonest cause of anaemia was haemoglobinopathy. For the Indian and Other races, it was iron deficiency. Of all the subjects with haemoglobinopathy, 86.2% did not have a family history of anaemia. Iron deficiency occurred in about a third of the anaemic subjects. The prevalence was highest in the low income groups and the Indian and Other races. But with higher standards of living, blood loss may be a more important cause for iron deficiency than poor nutrition.
Percutaneous transluminal coronary angioplasty (PTCA) is an increasingly important technique for the treatment of patients with coronary artery disease. One hundred cases of PTCA were performed in Singapore General Hospital between 1985 to September 1988. 87% were males and 13% were females. The mean age of these patients were 55 +/- 9 SD years (range from 28 to 79 years). 85% had angina pectoris, 43% had a previous myocardial infarction and 12% received intravenous streptokinase previously. One hundred and twenty-nine lesions were dilated. 51% of the cases had single, 40% had double and 9% triple vessel disease. 83% had single, 16% double and 1% triple vessel dilatation. The distribution of the cases by vessel location was 64% for LAD, 19% for RCA and 17% for CX. Overall lesion success was 86%, with an increment in the success rate from 76% in 1987 to 89% in 1988. Similarly, the clinical success rate was 86% for the whole group; it increased from 74% to 90% from 1987 to 1988. The mean diameter stenosis was decreased from 86 +/- 14% SD predilatation to 28 +/- 28% SD postdilatation (p less than 0.005). The mean transtenotic gradient was reduced from 60 +/- 17 mmHg SD predilatation to 18 +/- 11 mmHg SD postdilatation (p less than 0.005). There were 14 failures (14%), the majority of which were due to inability transversing the lesion with a guide wire or balloon catheter. Fourteen complications (14%) occurred in these 100 cases of PTCA. 3% required emergent/semiemergent surgical revascularization. There was no mortality. PTCA is now an established mode of therapy for coronary artery disease in Singapore General Hospital.
Based on data collected by the population-based Singapore Cancer Registry over the period 1968 to 1982, baseline epidemiological characteristics and incidence trends of primary liver cancer were described. This will facilitate the interpretation of future trends, especially in the light of new interventions such as hepatitis B immunisation. The primary liver cancer incidence is four times higher in males than in females, with the incidence peaked in the seventh decade. The incidence rate was higher in the Chinese than in Malays and Indians and marginally higher among foreign born than Singapore born Chinese. A general declining trend in liver cancer incidence was especially notable in the local born Chinese. Misclassification of metastatic carcinomas in the earlier years of cancer registration may have contributed to the initial higher incidence. Definitive decrease in incidence as a result of hepatitis immunisation will only be seen in another two to three decades.
The Acquired Immunodeficiency Syndrome (AIDS) is caused by a retrovirus, the Human Immunodeficiency Virus (HIV). As at 30 April 1988, there were 22 infected individuals in Singapore, of which 4 had AIDS. A comprehensive retrospective study was carried out to establish the clinico-epidemiological features of the disease and its transmission in Singapore. The infected patients have been related mainly to sexual transmission through sexual contact (homosexual, bisexual or heterosexual) with men and women from countries where HIV infection is more prevalent. The majority of the infected were homosexual males in the age range 20-39 years. There was one case of transfusion-associated AIDS and another was infected through heterosexual transmission. The local pattern is consistent with the Western pattern (Pattern 1), with the notable absence of intravenous drug abusers, paediatric cases or infected haemophiliacs.
The standard tuberculin test used by all Singapore government hospitals and institutions is the intradermal Mantoux test using 1 TU of PPD RT23 with Tween 80, and read 72 hours later. There is almost 100% BCG coverage in Singapore children for many years, and therefore the tuberculin skin reaction must be interpreted with special consideration. Taking 8 mm and above as positive, six month old infants vaccinated at birth gave a positive rate of 42% and a mean reaction size of 5.89 mm. The reaction appeared to wane rapidly and among 6 year old school children the positive rate dropped to 12% and the mean size to 2.38 mm. By the age of 11 years, the children showed a positive rate of 36% and a mean size of 6.27 mm. A further increase is observed in 15 year old children, the positive rate being 88% and mean size 13.28 mm. Among tuberculosis contacts, the positive rate and mean size of the tuberculin reaction are generally higher, especially in the younger age groups. Tuberculosis patients above 15 years old were observed to be practically all positive reactors with a mean size of at least 16 mm.
Age-standardised death rates, for ages 35-64 years in both sexes, from ischaemic heart disease, cerebrovascular disease, and hypertensive disease for Chinese, Malays, and Indians in Singapore (1980-84) have been compared with those in England and Wales, USA and Japan (1982). For ischaemic heart disease Indians have the highest mortality, then Malays, with Chinese less than the Western countries but more than Japan. For cerebrovascular disease the Malays have highest mortality, then Indians, then Chinese, followed by Japan, England and Wales, and USA in that order. For hypertensive disease it is again Malays, then Indians, then Chinese, but followed by the different order of USA, England and Wales, and Japan. The differences are discussed in the light of declining trends in mortality from these disease in Singapore over the preceding 25 years. The special problems of ischaemic heart disease in Indians and hypertension and it's sequelae in Malays are highlighted.
The history of postgraduate medical education in Singapore is described culminating in the award of the local higher qualification - the master of Medicine, equivalent to the higher qualifications awarded by the Royal Colleges in UK and Australasia. Initially, in 1971, the M.Med. in Internal Medicine, Paediatrics, Obstetrics and Gynaecology and Surgery and the M.Sc. in Public Health and Occupational Medicine were awarded and since then, the M.Med. in Anaesthesia and Psychiatry were also awarded. At present, the courses leading to the Examinations are well attended not only by local postgraduates but also by doctors from overseas. The number of postgraduates certified over the various period in Singapore is documented.
Colorectal cancer is the second most common cancer in Singapore: it forms 11.9% of all cancers registered by the Singapore Cancer Registry compared with 18.4%, 10.4% and 8% for lung, stomach and liver respectively. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer. Arguments are presented for a colorectal cancer screening programme. To succeed it is necessary to appreciate the short-comings of testing for faecal occult blood, to evaluate and adopt new screening tests and to establish a well organised programme.
The pattern of corneal disorders in Singapore is different from that seen in the western countries, and in the developing countries. Dendritic corneal ulceration, keratoconus and corneal dystrophy are relatively uncommon. Bullous Keratopathy, however, is on the increase, due mainly to the increasing number of cataract operations done and to the use of intraocular implants. Other major corneal disorders in Singapore are Exposure Keratitis and Neurotrophic Keratitis. The management of the various corneal disorders are discussed. Prevention is possible especially in those disorders due to iatrogenic factors. Constant vigilance and care are called for to prevent unnecessary surgical trauma and corneal blindness.
The resistant level of the houseflies to the seven kinds of insecticides, Malathion, Sumithion, Baytex, Diazinon, DDVP, DDT and Chrysron, was examined on the 3 strains collected in Singapore. It was found that most housefly colonies in Singapore showed a higher susceptibility to those insecticides than that of the Takatsuki strain of Japan, especially to DDT. However, the resistant level to Malathion was remarkably higher than that of the Takatsuki strain. The synergists, piperonyl butoxide, Safroxane and S-421, mixed with Malathion were effective for lowering the resistant level of the Malathion-resistant strain.