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PubMed1993

Mental Health Service in Singapore.

The year 1928 marked the beginning of the mental health service in Singapore. From a large asylum which provided mainly custodial care the mentally ill were managed by a handful of expatriate medical pioneers and nurses. Drugs were limited and hospitalisations lasted years. The scene has changed tremendously over the last six decades. Today the Mental Health Service in Singapore is largely provided by the public sector with contributions from private and voluntary organisations. It provides a comprehensive and integrated programme consisting of both hospital-based and community-based treatment programmes with the objectives to promote good mental health for everyone as well as to provide the best possible treatment for those afflicted with mental illnesses of all types. With the rapid development of community-based mental healthcare, several changes have taken place to reflect this trend. Besides introducing a wide range of community support services and greater liaison with primary care givers, the need to educate medical students and doctors, members of the public, people involved in healthcare in the voluntary sector and others about mental health and illness has been recognised to be an important component in the delivery of good mental healthcare. As a step forward the National Mental Health Programme has been launched by the Ministry of Health in 1993 to further improve the mental health service that is currently available (Fig 1). The newly established Institute of Mental Health will serve as the education, training and research arm of the National Mental Health Programme. Together with the new Woodbridge Hospital, mental healthcare in the future will be professionally organised, coordinated and community-orientated.

Adolescent↗
PubMed1993

Excimer laser photorefractive keratectomy in Singapore--a new treatment modality for myopia.

BACKGROUND: Myopia is a national epidemic in Singapore. Photorefractive Keratectomy (PRK) for the treatment of myopia using the Argon Fluoride Excimer Laser commenced in January 1992 at the Singapore National Eye Centre. METHODS: An open, prospective, non randomised clinical trial to assess the efficacy, predictability, stability, and safety of PRK for the correction of myopia between -2.0 to -6.0 dioptres. RESULTS: One hundred and fifty-five eyes of one hundred and thirty-five patients underwent PRK between January and September 1992, of which thirty-one had completed at least six months of follow-up. Twenty-nine of the thirty-one patients (93.5%) achieved an unaided visual acuity of at least 6/12. Twenty-six patients (83.9%) were within 1 dioptre of emmetropia. There was an initial over-correction in all patients which regressed to a plateau at around three or four months. Corneal haze did not pose a significant problem. Three patients had ocular hypertension, and another developed a mild allergic reaction to the antibiotic-steroid ointment. CONCLUSIONS: Excimer Laser Photorefractive Keratectomy is a very effective, fairly predictable, stable and safe surgical method for the treatment of myopia.

Adult↗
PubMed1993

Trends in human immunodeficiency virus infection: epidemiology in Singapore.

The acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV) and recognised a decade ago, has reached pandemic proportions worldwide. By early 1992, the World Health Organisation estimates that at least 10 to 12 million people are infected with HIV globally. The majority of these infections are the result of heterosexual transmission. In South and South-east Asia, the AIDS pandemic is growing rapidly due to intravenous drug use and heterosexual transmission. Since 1985, the major route of HIV transmission in Singapore has been sexual. The transmission pattern, however, has changed from one that was predominantly homosexual or bisexual to one that is increasingly heterosexual from mid-1990. In addition, HIV infections among intravenous drug users, children and organ recipients who received transplantation overseas have also surfaced since 1990. It is estimated that there will be 400 cases of HIV infection in Singapore by the mid-1990s.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Main causes of pre-donation deferral of prospective blood donors in the Singapore Blood Transfusion Service.

A retrospective study of the main causes of pre-donation deferral of prospective blood donors in the Singapore Blood Transfusion Service was carried out. Computerised records of all pre-donation deferrals from 1 January 1988 to 31 December 1991 were studied. A total of 278,401 pre-donation screening interviews were carried out during this period. Forty thousand one hundred and sixty-three or 14.4% of these transactions resulted in deferral of prospective blood donors either temporarily or permanently. Analysis of the deferrals showed that the top ten defined causes were: recent ingestion of medication; influenza; low haemoglobin level; a raised blood pressure; recent sexual exposure in high-risk activity; being underweight; Hepatitis B carrier status; recent history of measles, chickenpox or other infections; tattoos, ear-piercing or acupuncture in the preceding six months; and presenting for a subsequent donation too soon. To protect blood donors and recipients, stringent donor screening criteria are necessary. Modifying physical criteria could lower deferral rates but must be preceded by studies to ensure that donors do not suffer ill-effects. Increased public education on common causes of donor deferral may also lower deferral rates by allowing prospective donors to "pre-screen" themselves. However, one-to-one medical screening and appropriate counselling are still the best means for accepting or deferring blood donors in the Singapore setting.

Blood Donors↗
PubMed1996

Premature myocardial infarction in Singapore--risk factor analysis and clinical features.

A retrospective analysis was carried out on all patients aged 40 years and below with acute myocardial infarction admitted to the coronary care unit (CCU) at the National University Hospital (NUH). We found that most came early direct to hospital, more than half of those eligible received thrombolysis and there was a low incidence of complications. Compared to the Singapore population, Indians in the group were over-represented. The most common coronary risk factor was smoking. A majority had elevated serum cholesterol level. These observations may provide some insight for the primary prevention of premature coronary artery disease in young people in Singapore.

Adult↗
PubMed1995

Prevalence of sexually transmitted diseases among commercial sex workers in Singapore from 1977 to 1993: the effects of screening measures.

This paper discusses the trend of sexually transmitted diseases (STDs) among commercial sex workers in Singapore. Various STD control measures were introduced in Singapore since 1976 to control STDs among commercial sex workers. Under a Medical Surveillance Scheme introduced in 1976, all commercial sex workers were encouraged to undergo regular STD screening and received treatment when found to be infected. As a result, the infection rates of various STDs among commercial sex workers have declined over the years. The infection rate for gonorrhoea has declined from 9% in 1977 to 1.7% in 1993. The chlamydia infection rate declined from 8% in 1992 to 4% in 1993. The human immunodeficiency virus (HIV) infection rate among commercial sex workers under the Medical Scheme was less than 0.1%. The STD infection rate of commercial sex workers who did not participate in the Medical Scheme was much higher than those enrolled in the Medical Scheme. Our findings indicated the effectiveness of the Medical Scheme in controlling STDs among commercial sex workers.

Chlamydia Infections↗
PubMed1995

Mass screening for diabetic retinopathy--a report on diabetic retinal screening in primary care clinics in Singapore.

INTRODUCTION: Mass screening for diabetic retinopathy is expensive and inaccessible if done by institutional ophthalmalogists. Most diabetics are seen in primary care. Hence it is logical to provide mass screening in primary care clinics. In Singapore, government polyclinics are ideal centres of screening as they are well organised and accessible to the community. SCREENING METHOD: An effective mass screening strategy must provide wide coverage, be low cost and have the ability to assess diabetic eyes accurately and quickly. Non-mydriatic fundal photography was used as the screening method. Mass coverage was achieved by rotating two cameras around six government polyclinics. Cost was reduced by training existing staff and organising the programme to provide a high turnover of screenees. The photographs were read by ophthalmologists in a government-owned hospital. Patients that required referral were referred to specialist eye clinics. RESULTS: A total of 13,296 patients were screened or rescreened during a period of 2 years (25 months). 2,911 patients or 21.8% of the total screened were found to have diabetic retinopathy. About half of these (10.8%) had sight threatening retinopathy. The most common sight threatening retinopathy was maculopathy (8.0%). Twenty-two percent of cases screened were referred. These include referral for other ocular conditions detected during the screening. CONCLUSION: Non-mydriatic fundal photography has proven to be both accessible and effective in screening diabetic eyes in urban Singapore and can be recommended for mass screening of diabetic eyes in the community.

Adult↗
PubMed1996

Review of published clinical trials conducted in Singapore from 1959 to 1994.

Trials are increasingly being used to evaluate the effectiveness of health care interventions. As has been recognised by those active in these activities, there is a need, not only to search for all published materials, but also to evaluate their quality and usefulness. This paper is an attempt to provide information and to examine the areas of focus and quality of information on all published clinical trials conducted in Singapore from 1959 to 1994. The searches were conducted using the MEDLINE CD-ROM for the period from 1966 to 1994 and manual search for the period before 1966. All published studies involving drugs or procedures (surgical techniques or instrumentation) on human subjects performed in Singapore were included in the study. Out of a total of 136 papers obtained, 90 fulfilled our criteria. There is an increase in the number of publications over the years especially in the last 10 years; with the biggest surge in the last 5 years. Most of the clinical trials were pharmacological intervention studies (57.8%) although there is a steady rise in non-pharmacological studies recently. As the number of clinical trials increases, coupled with the rising cost, it would be useful for the relevant authorities to consider setting up a registry to co-ordinate the trials that are being conducted.

Clinical Trials as Topic↗
PubMed1996

Laparoscopic hernia repair in Singapore--views from a cross-section of surgeons.

Laparoscopic cholecystectomy was introduced into Singapore in 1990, and has since replaced conventional cholecystectomy as the treatment of choice for gallstone disease in most situations. In contrast, laparoscopic hernia repair introduced two years later in the same wave of enthusiasm, was received with scepticism and much less acceptance. A survey of 27 general surgeons in three large institutions in Singapore was performed to analyse this observation. The majority of surgeons felt that laparoscopic hernia repair (i) had limited applications, mainly for bilateral and recurrent hernias, (ii) was not completely established as a technique, requiring refinement in the procedure, (iii) was costly, and (iv) did not have objective evidence of long-term benefits over conventional hernia repair.

Cross-Sectional Studies↗
PubMed1996

A recent case of congenital malaria in Singapore.

We report a case of congenital malaria in a 2-month-old baby girl, born in Singapore of a Singaporean mother, who presented with fever for one week, gross hepatosplenomegaly and anaemia (haemoglobin 5.6 g/dL) and thrombocytopenia. Peripheral blood films showed Plasmodium vivax. There was no local transmission at that time, but the mother had spent the first 6 months of her pregnancy in Pakistan, where she had been treated for prolonged fever at 4 months amenorrhoea with ibuprofen alone. The mother and 2 siblings were asymptomatic and repeatedly tested negative on blood films for malaria parasites, but the mother tested positive for antibodies to Plasmodium on the Fluorescent Antibody Test. The child was treated with oral chloroquine and made an uneventful recovery. We postulate that this is believed to be the first recent case of congenital malaria in Singapore since it was declared malaria free in 1982. The diagnosis should be considered in babies of mothers who have travelled to places where malaria is endemic, as maternal infection may be unrecognised, and the child may be asymptomatic at birth.

Antimalarials↗
PubMed1996

Early prenatal diagnosis of beta-thalassaemia in Singapore.

beta-thalassaemia is one of the commonest autosomal recessive genetic diseases in the Singapore population. In the homozygous form, it results in a severe anaemia, requiring monthly transfusion for survival. Because of the less than satisfactory treatment available for the condition, prenatal diagnosis has always been an option for couples at-risk. The available method was globin chain analysis of foetal blood, obtained at 18 to 20 weeks of gestation. Affected pregnancies would then be diagnosed and require termination in the mid to late trimester. A relatively newer technique, chorionic villus sampling (CVS), allows foetal material to be obtained in the first trimester. However, analysis of the foetal tissue requires direct gene studies to be performed. The aim of this study was to evaluate the feasibility of this analysis in couples at-risk for beta-thalassaemia in Singapore. Sixteen couples who were at-risk for a child with beta-thalassaemia major were offered prenatal diagnosis. All of them opted for CVS as compared to foetal blood sampling. The mutations in the beta-globin gene in these couples at-risk were identified. Direct gene analysis was then performed on the foetal sample, using a variety of molecular techniques. These included reverse dot-blot hybridisation, allele-specific oligonucleotide hybridisation, restriction enzyme digests and direct analysis of amplified products. DNA profiling was done for each case to exclude definitively the possibility of maternal tissue contaminating the foetal sample. The results in all these cases were unequivocal. The procedure of CVS itself was uneventful in these 16 couples. Procedural-associated foetal loss was nil. Prenatal diagnosis in the first trimester allows early termination of an affected pregnancy with significantly less maternal morbidity and prenatal anxiety. It also results in greater patient acceptability of the procedure and plays a key role in the prevention of this devastating genetic disease.

Chorionic Villi Sampling↗
PubMed1997

Incidence of retinopathy of prematurity in Singapore.

The study was done to investigate the incidence and severity of retinopathy of prematurity (ROP) in Singapore over a one-year period. Its relation to factors like birth weight, gestational age are also explored so as to identify high risk groups and provide guidelines for the implementation of a screening programme in Singapore. At the various government restructured hospitals from Dec 1993 to Nov 1994, 34.4% (72 out of 209) of babies, with birth weights less than 1250 g or gestational ages less than 32 weeks, developed ROP. The incidence of ROP correlated significantly with low birth weight, early gestational age, multiple births; the severity correlated with low birth weight and multiple births. There was a notably higher proportion of Malays in the study population (premature babies) than all the live births of the same period. From the results, an optimal screening programme should include babies weighing less than 1250 g or of gestation earlier than 32 weeks. A first examination at 33 weeks of post-menstrual age is suggested.

Female↗
PubMed1997

Eye diseases in the elderly in Singapore.

OBJECTIVE: The study was conducted to determine the prevalence rates of blindness and visual impairment in those aged 60 years and above in Singapore and to determine the pickup rate of undiagnosed eye diseases through an active screening programme. METHOD: A random frame of 3,000 elderly persons aged 60 years and above was obtained from the Ministry of Home Affairs in Singapore. They were invited by mail to attend eye screening at Hougang Senior Citizens' Health Care Centre. The eye screening was in two parts: the first part by a trained registered nurse or therapy aide and the second part by the ophthalmologist. For each respondent, autorefraction, tonometry, retinal photography and visual field analysis were done. Examination criteria and disease classification were modelled after the Framingham Eye Study. RESULTS: 574 subjects attended the screening, giving a response rate of 22.2%. The prevalence rates for blindness and visual impairment in the elderly screened were 3.0% and 15.2% respectively. The prevalence rates for cataract, age-related macular degeneration, glaucoma and diabetic retinopathy were 78.6%, 27.0%, 5.7% and 5.1% respectively. For every person known to have cataract, 2 were unknown; for every person with age-related macular degeneration, 154 were unknown. None of the 29 persons with diabetic retinopathy was diagnosed previously. CONCLUSION: Almost 1 in 5 of the elderly screened had some degree of visual disability. The rates of visual impairment and blindness were similar to those reported in other studies and indicate a significant burden of visually impairing diseases in the community.

Aged↗
PubMed1997

Initial construct cross-cultural validation of the Short Form 36 for quality of life assessment of systemic lupus erythematosus patients in Singapore.

The objective of this study was to determine if the Short Form 36 (SF-36) Health Survey Questionnaire measures differences in quality of life between lupus patients and healthy controls in Singapore. A cross-sectional pilot study was conducted on consecutive English-speaking, female Chinese lupus patients seen at a Rheumatology unit. Healthy volunteers were recruited as controls during the same time period. All subjects completed the United Kingdom version of the SF-36. Lupus disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) index and converted to a global score. Lupus-related damage was measured using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACRDI). The main outcomes measured were the mean SF-36 scale scores for lupus patients and healthy controls. Thirty-six lupus patients and 76 controls were included in the study. All subjects were English-speaking, Chinese female between 21 and 53 years of age. The mean age of patients and controls was 31.9 and 29.0 years respectively. Lupus patients had lower mean scale scores than controls for physical functioning (73.0 versus 89.7, P < 0.0027), bodily pain (71.0 versus 81.4, P < 0.027), physical role functioning (55.7 versus 89.5, P < 0.0001) and general health (47.4 versus 51.8, P < 0.05). Mean scale scores for vitality, social and emotional role function and mental health were similar in both groups. Ten patients had active disease (BILAG global scores of 3 to 14) and 13 patients had lupus-related damage (Damage Index scores of 1 to 7). These preliminary data suggest that the SF-36 Health Survey may be able to measure differences in quality of life between lupus patients and healthy controls in Singapore.

Adult↗
PubMed1997

Prevalence and distribution of indoor allergens in Singapore.

BACKGROUND AND AIMS: Immediate hypersensitivity to indoor allergens is known to be associated with allergic asthma. This study evaluated the prevalence and distribution of six indoor allergens in 956 dust samples obtained from homes, childcare centres, schools, and a hospital in tropical Singapore. Seasonality of mite allergens was also assessed. METHODS: The major allergens of the Dermatophagoides spp. dust mites, Der p 1 and Der f 1; major cat and dog allergens, Can f 1 (dog) and Fel d 1 (cat); and cockroach, Bla g 1, were measured by specific enzyme immunoassays. Allergen levels of the storage mite, Blomia tropicalis (Blo t), were measured by a fluorescent allergosorbent test (FAST) inhibition assay. RESULTS: Our results showed that homes had significantly higher concentrations and prevalence of allergens compared with the other locations, except for Bla g 1, where higher mean levels were found in schools. Within the homes, the highest concentrations of mite allergens were found in mattresses (geometric mean: 1.2 microg/g dust Der p 1; 2717 Allergen Units per gram dust [AU/g] Blo t), and carpets (1.5 microg/g Der p 1; 1620 AU/g Blo t), whilst Bla g 1 was mainly concentrated in the storerooms (geometric mean = 3.5 units/g) and kitchens (geometric mean = 5.1 units/g). The major cat and dog allergens were well distributed and not confined to homes with pets. Their highest levels were found in dust of soft furnishings, carpets and mattresses. There was an absence of significant seasonal variation in Der p 1, Der f 1 and Blo t levels in the homes over a 1 year period. CONCLUSION: The results indicate that compared with public places, the home consitutes a major reservior of indoor allergens. Allergens of the storage mite, B. tropicalis, should be considered as a major allergenic component of dust in Singapore.

Air Pollution, Indoor↗
PubMed1977

A component analysis of recent fertility decline in singapore.

To aid in achieving demographic goals, since 1968 the government of Singapore has passed a series of laws designed to limit family size. Policies were instituted in 1968 to discourage couples from having more than three children; policies introduced in 1973 discouraged having more than two. Trends in fertility rates and in the numbers of abortions and sterilizations in recent years are consistent with the intent of these social policies. Decline in third and subsequent births was the most important factor in fertility decline after 1972, and the numbers of abortions and sterilizations undergone by higher parity women have increased substantially sin"e 1970. Although other factors have affected fertility in Singapore, the data suggest that the disincentives have played a role in continued fertility decline in recent years.

Abortion, Legal↗
PubMed1997

An epidemiological study of developmental dysplasia of the hip in infants in Singapore.

The incidence of congenital dislocation of the hip (CDH) in Singapore and Malaysia has been reported as being lower than in the West. In our hospital, we have seen an increasing number of congenital hip dislocation as well as dysplastic hips. We undertook a prospective study from December 1989 to December 1994 of 20,000 live births. The neonates were all screened by a consultant neonatologist and the findings were confirmed by a consultant paediatric orthopaedic surgeon. All babies had plain X-rays at 3 months and an acetabular index (AI) of 30 degrees or more was considered dysplastic. All babies with positive signs were followed up for 1 year and again had radiographs taken at 1 year. Comparison of plain X-rays and ultrasound assessment in a subgroup of 130 neonates showed that 64% of patients with AI > 20 degrees had hip dysplasia by ultrasonographic (alpha angle < 60 degrees) The incidence of dysplastic hips was 16.8 per 1000 live births. The overall incidence of neonates with dislocated hips was 4.7 per 1000 live births. The Malays were most affected with an incidence of 5.4 per 1000 live births. The incidence of developmental dysplasia of the hip in Singapore is higher than previously reported, with the Malays having the highest incidence. A significant number of babies with clicking hips have radiological evidence of acetabular dysplasia (AI > 30 degrees). One-third of the babies' hips were still dysplastic at 1 year of age. A well-organised screening programme with experienced examiners has proved to be useful in making early and accurate clinical diagnosis.

Female↗
PubMed1997

A knowledge, attitudes, beliefs and practices (KABP) survey on HIV infection and AIDS among doctors and dental surgeons in Singapore.

An anonymous postal questionnaire survey studying the knowledge, attitudes, beliefs and practices on human immunodeficiency virus (HIV) infection was conducted among all registered medical and dental practitioners in Singapore in 1996. In all, 1523 replies were received, yielding a response rate of 29.3%. The level of knowledge regarding transmission and prevention was generally good, although there were a number who believed that HIV could be transmitted by the respiratory and oral routes. However, knowledge regarding diagnosis and medical management was unsatisfactory. Although a large majority felt they had the ethical obligation to treat HIV patients, only half of them indicated their willingness to do so if they were given the choice. The majority (62.3%) supported the idea of routine preoperative HIV testing for patients, but fewer (40%) supported mandatory HIV testing for health care workers. Dentists seemed more sensitive to issues involving transmission in the workplace, and 95% of them practised universal precautions. Continuing medical education on HIV infection is required to improve and maintain the level of knowledge and competency of doctors and dentists in Singapore.

Acquired Immunodeficiency Syndrome↗