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PubMed1999

Labor force status transitions at older ages in the Philippines, Singapore, Taiwan, and Thailand, 1970-1990.

While there is considerable evidence of a trend toward earlier retirement in the United States and Europe, trends in rapidly growing economies in other parts of the world have not been closely examined. This paper traces the labor force participation rates of older men and women in four Asian countries, the Philippines, Singapore, Taiwan, and Thailand, over the period of 1970 to 1990. Aggregate census data are used to calculate net transitions into and out of the labor force so as to permit the analysis of differences by country and cohort as well as change over time. Results show that, although men exhibit a general trend toward earlier net labor force exit, labor force participation rates at older ages remain high. Older women are found to be increasingly engaged in economic activity, especially in Singapore and Taiwan.

Journal Article↗

PubMed2003

Opposing effects of dietary n-3 and n-6 fatty acids on mammary carcinogenesis: The Singapore Chinese Health Study.

We investigated the effects of individual fatty acids on breast cancer in a prospective study of 35,298 Singapore Chinese women aged 45-74 years, who were enrolled during April 1993 to December 1998 (The Singapore Chinese Health Study). At recruitment, each study subject was administered, in-person, a validated, semiquantitative food frequency questionnaire consisting of 165 food and beverage items. As of December 31, 2000, 314 incident cases of breast cancer had occurred. We used the Cox regression methods to examine individual fatty acids in relation to breast cancer risk, with adjustment for age at baseline interview, year of interview, dialect group, level of education, daily alcohol drinking, number of live births, age when menstrual periods became regular, and family history of breast cancer. Consumption of saturated, monounsaturated or polyunsaturated fat overall was unrelated to risk. On the other hand, high levels of dietary n-3 fatty acids from fish/shellfish (marine n-3 fatty acids) were significantly associated with reduced risk. Relative to the lowest quartile of intake, individuals in the higher three quartiles exhibited a 26% reduction in risk (relative risk (RR)=0.74, 95% confidence interval (CI)=0.58, 0.94)); RRs were similar across the top three quartiles of intake (0.75, 0.75, 0.72, respectively). Overall, there was no association between n-6 fatty acids and breast cancer risk. However, among subjects who consumed low levels of marine n-3 fatty acids (lowest quartile of intake), a statistically significant increase in risk was observed in individuals belonging to the highest vs the lowest quartile of n-6 fatty acid consumption (RR=1.87, 95% CI=1.06-3.27); the corresponding RR for advanced breast cancer was 2.45 (95% CI=1.20-4.97, P for trend=0.01). To our knowledge, these are the first prospective findings linking the intake of marine n-3 fatty acids to breast cancer protection.

Aged↗

PubMed2002

Ductal carcinoma in situ of the breast in Singapore: recent trends and clinical implications.

BACKGROUND: Breast ductal carcinoma in-situ (DCIS) is increasingly being diagnosed as a result of screening mammography and better pathological recognition. With this and the rising breast cancer incidence in Singapore, DCIS is poised to become a bigger part of surgical practice. Principles of screening, diagnosis and management of DCIS have also been rapidly evolving. Against this background, a clinicopathological audit of recent cases of DCIS in our centre was performed. METHODS: Thirty-eight cases of DCIS diagnosed in the period 1997-2000 were retrospectively analysed. Histological examination and immunohistochemical studies for oestrogen and progesterone receptor expression were performed. RESULTS: In the present study, DCIS was most common in the group of patients who were <50 years (58%) as compared to an American series' where the corresponding group were > or =60 years (36%). Compared to a previous local study a decade ago, the present series showed that: (i) DCIS constituted a higher proportion of all breast cancers (6.4% vs 3.7%); (ii) a larger proportion of patients had disease detected by mammography (47% vs 10%); (iii) conservative breast excision was the only definitive surgery in 39% of cases (vs approximately 30%); and (iv) the mean size of lesions is smaller (13.5 mm vs 24.4 mm). Histologically, 26% of tumours were high grade, 71% had necrosis while 32% were oestrogen receptor (ER) and progesterone receptor (PR) negative. High grade tumours were associated with the presence of necrosis (P = 0.018), ER negativity (P = 0.015) and PR negativity (P = 0.001). CONCLUSIONS: This study reveals interesting trends of DCIS in Singapore. The sizeable proportion of hormone receptor-negative tumours may have implications for the hormonal adjuvant therapy of DCIS.

Adult↗

PubMed2003

Parental occupations and other risk factors associated with nonchromosomal single, chromosomal single, and multiple birth defects: a population-based study in Singapore from 1994 to 1998.

OBJECTIVE: The purpose of this study was to evaluate the association between the prevalence of birth defects among maternal and paternal occupation groups in Singapore for live births between January 1, 1994, and December 31, 1998, and to determine whether there are certain demographic risk factors and maternal and/or paternal occupation groups that are associated with an increased risk for birth defects versus chromosomal single birth defect, nonchromosomal single birth defect, and multiple birth defects. STUDY DESIGN: This was a retrospective study. Information on live births (Singapore National Registry of Births and Deaths) and birth defect cases (National Birth Defects Register) were studied. Other information included the mother's date of birth, ethnic group, highest educational qualification, and the occupation of the mother and the father. Cox regression analysis was used to determine whether certain demographic and occupational factors were associated with the three groups of birth defects. RESULTS: Of a total of 237,755 live births, there were 3276 birth defect cases (nonchromosomal single birth defect, 1869 cases; chromosomal single birth defect, 197 cases; and multiple birth defects, 1210 cases). Increased risks for all types of birth defects were observed with advancing gestational age. Occurrence of nonchromosomal single birth defect and multiple birth defects were significantly higher for multiple births compared to singleton births. Significant associations were found with the use of "legislators, senior officers, and managers" as reference: Maternal occupation of "cleaners, laborers, and related workers" with chromosomal single birth defect anomalies (adjusted risk ratio, 4.86; 95% CI, 1.07-22.14); paternal occupation of "plant and machine operators and assemblers" (adjusted risk ratio, 1.50; 95% CI, 1.14-1.98) with nonchromosomal single birth defect; "production craftsmen and related workers" and "cleaners and laborers and related workers" with nonchromosomal single birth defect (adjusted risk ratio, 1.42; 95% CI, 1.10-1.82; and adjusted risk ratio, 1.43; 95% CI, 1.07-1.91 respectively); and multiple birth defects (adjusted risk ratio, 1.42; 95% CI, 1.03-1.94; and adjusted risk ratio, 1.47; 95% CI, 1.03-2.09, respectively). CONCLUSION: Maternal delivery age is an important risk factor for all birth defects. Mothers and fathers who work as "cleaners and laborers and related workers" appear to have a higher risk of giving birth to children with chromosomal single birth defect and nonchromosomal single birth defect and multiple birth defects, respectively. Further in-depth study would be needed to confirm these observations.

Abnormalities, Multiple↗

PubMed2003

The clinical predictors of sleepiness correlated with the multiple sleep latency test in an Asian Singapore population.

STUDY OBJECTIVES: To explore the clinical predictors of sleepiness as objectively determined by the Multiple Sleep Latency Test with the Epworth Sleepiness Scale, age, body mass index, and overnight polysomnographic parameters at a tertiary referral center Sleep Disorders Unit. DESIGN: Retrospective, consecutive case series review. SETTING: A multidisciplinary sleep disorders unit in Singapore General Hospital, a tertiary-care university-affiliated hospital. PATIENTS: 72 consecutive patients evaluated for sleep disorders with overnight polysomnograms and Multiple Sleep Latency Tests between March 2002 and September 2002. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Mean sleep latency on the Multiple Sleep Latency Test was 9.0 +/- 4.4 minutes, and mean Epworth Sleepiness Scale score was 10.8 +/- 5.8. On univariate analysis, mean sleep latency on the Multiple Sleep Latency Test showed a significant negative correlation with the Epworth Sleepiness Scale score, apnea-hypopnea index, body mass index, arousal index, and time spent below 90% oxygen saturation during overnight polysomnography. After performing multiple linear regression, only Epworth Sleepiness Scale score and apnea-hypopnea index remained significantly correlated (P = .039 and P = .008, respectively). An Epworth Sleepiness Scale score of 8 or above predicted a mean sleep latency on the Multiple Sleep Latency Test of less than 10 minutes with a sensitivity of 73.9% and specificity of 50.0%. CONCLUSIONS: The Epworth Sleepiness Scale and apnea-hypopnea index are useful predictors of sleepiness in our Asian Singapore population.

Adult↗

PubMed2001

Myopia and night lighting in children in Singapore.

AIM: To examine the role of night time lighting and myopia in children in Singapore METHODS: A cross sectional study was conducted on 1001 children in two Singapore schools. Cycloplegic refraction and A-scan biometry measurements were made in both eyes. A detailed questionnaire was completed by the parents to obtain information on night time lighting, near work activity, educational and demographic factors. RESULTS: There was no difference in myopia prevalence rates in children exposed to night time light (33.1%) compared with children who slept in the dark (31.4%) before age 2. In addition, vitreous chamber depth was not related to night light (p = 0.58) before age 2. These results remained even after controlling for near work. CONCLUSION: Myopia is not associated with night light in Asian populations.

Anterior Chamber↗

PubMed1986

Purulent penile ulcers of patients in Singapore.

In 80 patients with painful purulent penile ulcers who attended the outpatient service of Middle Road Hospital in Singapore, Haemophilus ducreyi was isolated from 18 (22%), herpes simplex virus type 2 from nine (11%), and Neisseria gonorrhoeae from eight (10%). Primary pathogens were not isolated from 45 (57%) men. Painful purulent penile ulcers were more common in uncircumcised men, and patients had often acquired the disease after sexual intercourse with prostitutes in Singapore.

Adolescent↗

PubMed2003

Correlates of habitual walking and sports/leisure-time physical activity in older persons in Singapore: interaction effects between educational attainment and gender.

INTRODUCTION: We examined for demographic and psychosocial correlates on the participation of habitual walking and sports/leisure-time physical activity (LTPA) among older persons in Singapore. MATERIALS AND METHODS: In an observational study, 177 Chinese, community/urban-dwelling, ambulant, non-disabled participants > or = 50 years old were recruited from a health promotion programme. The main outcome measures were self-reported participation in habitual walking and sports/LTPA. Variables examined include highest educational attainment, demographic and health characteristics, social contact and health knowledge. Interaction between gender and educational attainment was also examined. RESULTS: The mean age of participants was 62.5 +/- 7.8 years. The effects of educational level were significant on habitual walking (P = 0.02), while that of age, self-rated health and interaction between gender and educational level were significant for sports/LTPA (P = 0.012, P = 0.002 and P = 0.019, respectively). Men with higher education had a higher self-reported sport/LTPA, while in women; those with lower education attainment had a higher participation. CONCLUSION: Unlike findings from Western developed nations, previous studies done in Japan and Singapore found that educational level and health behaviours may not be positively associated. In this study, there is a negative correlation between educational attainment and participation in habitual walking and sports/LTPA, especially among older Singaporean women.

Aged↗

PubMed1991

Serodiagnosis of melioidosis in Singapore by the indirect haemagglutination test.

Melioidosis is endemic in Singapore, with diagnosis dependent upon both bacteriological culture and serodiagnosis. Using the polysaccharide (melioidin)-sensitized turkey red cells in the indirect haemagglutination test (IHAT), 20 (100%) of the Pseudomonas pseudomallei culture-positive cases were detectable by the IHAT with titles ranging from 1:16 to 1:32, 768. Eight of these patients who died within a few days after the IHAT was performed had titres ranging from 1:16 to 1:1028. Five culture-negative patients, with clinical symptoms suggestive of melioidosis infection and who responded to treatment with ceftazidime, showed IHA titres between 1:64 and 1:8,192. One hundred and twenty one sera from patients with pneumonia, abscesses, or diabetes mellitus were IHAT negative. The IHAT showed good specificity since negative titres were seen in tests using sera from 2 patients with culture-positive Pseudomonas aeruginosa and 4 patients positive for Legionella. IHAT negative results were obtained from tests of 50 normal blood donors and 50 sewerage workers. Of 683 national servicemen tested, 5 (0.73%) had IHAT titres ranging from 1:16 to 1:128. Unlike hyperendemic areas such as Thailand where interpretation of IHAT is seriously hampered by IHA titres found in one-third to half of the population, serodiagnosis of melioidosis by the sensitive IHAT may be employed in Singapore as a routine procedure since background IHA titres are low.

Hemagglutination Tests↗

PubMed1983

[Field experiences with the 6-month Singapore therapy in the treatment of open lung tuberculosis in Cambodian refugees].

The particular situation of a refugee camp with transit character, as represented by "holding Centre Khao-I-Dang" (KID) for Cambodian refugees in Thailand, had to be taken into consideration when determining the therapy plan for the disease that is epidemiologically most important, smear-positive pulmonary tuberculosis. Under Singapore conditions daily administration of isoniazid (H) and rifampicin (R) for 6 months combined with a 2-month intensive phase of streptomycin (S) and pyrazinamide (Z) daily proved highly effective. The large-scale transfers in KID in February and March 1981 led to consistent administration of this therapy plan, which is recommended by the WHO. By the end of September 1981 61 patients aged 15 years and over had entered the "Thai/Swiss Red Cross TB Programme". Criterion for entrance was the presence in sputum of acid-fast bacilli in the Ziehl-Neelsen stain. The routine examinations consisted of three microscopic sputum examinations per month, a sputum culture and a chest x-ray before commencement of therapy, followed by a chest x-ray at the end of the intensive phase and at the end of therapy. Efficacy and side effects of the 6-month therapy in our collective were similar to those of the Singapore study.

Adolescent↗

PubMed1984

Cardiopulmonary resuscitation at the Singapore General Hospital.

Effective use of Cardiopulmonary Resuscitation (CPR) saves lives both in and out of hospitals. Yet, in Singapore, this practical skill is rarely taught even within the medical community. Observations from a CPR pilot training programme at the Singapore General Hospital expose this glaring deficiency in our health system. Urgent remedial measures are needed.

Education, Continuing↗

PubMed2001

The status of diabetes mellitus in primary care institution and restructured hospitals in Singapore.

The Diabcare-Asia Singapore 1998 project was carried out using data from 22 centres collected on paper forms to provide an overview of diabetes management and metabolic control status in 1697 diabetic patients from both primary health care clinic (PHC) (67%) and restructured hospital (RH) (33%) settings. PHC patients were on average older than RH patients (61.3 +/- 11.2 years vs 51.5 +/- 17.7 years), and had a shorter duration of diagnosed diabetes (9.2 +/- 6.8 years vs 12.0 +/- 8.5 years). The mean body mass index (BMI) for PHC patients was 25.5 +/- 4.4 kg/m2 vs 24.5 +/- 4.2 kg/m2 for RH patients. Proportionately more PHC than RH patients were overweight (BMI >25 kg/m2) (49% vs 42%). Patients with type I diabetes constituted 3.5% of PHC vs 18.1% of the RH cohort. HbA1c information was available for 92.5% of RH vs 69% of PHC patients. HbA1c measurements were <1% above ULN in 50% of PHC vs 37% of RH patients, while FBG was >7.8 mmol/l in >61% of all patients. Proteinuria (>500 mg/24 hrs) was reported in 13% of PHC vs 26% of RH patients tested. Microalbuminuria (20-300 mg/l) was noted in 36% of 171 RH patients tested. Oral hypoglycaemic agents were used as sole therapy in 83.5% of PHC vs 43% of RH patients. Eye, feet, renal and severe late complications were more commonly reported by RH than PHC patients. There is a variation in the patient profiles and care between PHC and RH patients.

Diabetes Complications↗

PubMedDate not supplied

Kidneys for transplant--"opting out" law in Singapore.

This paper is about the legislative attempt in Singapore to obtain more cadaver kidneys for transplants. It is a brief account of the major features of the bill which has become law since this note was written. The bill and the law are identical in this case.

Accidents↗

PubMed1993

Containment of AIDS in Singapore--legal and policy implications.

Law has an important supportive role in containing the spread of AIDS. This essay hopes to show the ways in which law can help and ways in which it cannot. There is a discussion of the relevant laws of Singapore including the Infectious Diseases (Amendment) Act, 1992. Areas where possible future legislation may be considered are also pointed out.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The prevalence of glaucoma in Chinese residents of Singapore: a cross-sectional population survey of the Tanjong Pagar district.

BACKGROUND: Data on prevalence of glaucoma in East Asia are scarce. OBJECTIVE: To determine the prevalence and clinical characteristics of glaucoma in adult Chinese Singaporeans. METHODS: A group of 2000 Chinese people, aged 40 to 79 years, were selected from the electoral register of Tanjong Pagar district in Singapore using a disproportionate, stratified, clustered, random-sampling procedure. Glaucoma was diagnosed in people with an excavated optic neuropathy and a reproducible visual field defect or on the basis of severe structural disc abnormality alone, if reliable field results could not be obtained. The diagnosis was also made in blind subjects with raised intraocular pressure or previous glaucoma surgery. RESULTS: Of 1717 eligible subjects, 1232 were examined, with a response rate of 71.8%. There were 45 cases of glaucoma: 27 were men and 18 were women. The main diagnoses were primary open-angle glaucoma (n = 22 [49%]), primary angle-closure glaucoma (n = 14 [31%]), and secondary glaucoma (n = 7 [16%]). It was not possible to determine the mechanism in 2 (4%). CONCLUSIONS: The age-standardized prevalence of glaucoma was 3.2% (95% confidence interval, 2.3-4.1) in the population 40 years and older. Glaucoma was the leading cause of blindness. Primary angle-closure glaucoma and secondary glaucoma were the most visually destructive forms of the disease. Our findings suggest current projections of glaucoma prevalence among ethnic Chinese are a substantial underestimate. Arch Ophthalmol. 2000;118:1105-1111

Adult↗

PubMed1996

Survival of childhood leukemia in Singapore.

The objective of this study was to evaluate the treatment outcome of children with acute leukemias at a university hospital in Singapore. Between January 1988 and January 1994, 66 children were treated, comprising 13 cases of acute myeloid leukemia (AML) and 53 acute lymphoblastic leukemia (ALL). The 2-year disease-free survival (DFS) was computed according to the Kaplan-Meier method. The results showed that the survival of AML was poor, with a 2-year DFS of only 30%. The major cause of death for AML was leukemia and leukemia-related complications, such as hemorrhage and severe infections. In contrast, a 62% 2-year DFS was achieved for ALL. It was found that marked hepatosplenomegaly (enlarged liver and/or spleen > or = 10 cm below the costal margin) at presentation correlated with a significance shortened survival in our patients with ALL. The major cause for treatment failure in ALL was recurrence of disease. We conclude that the DFS for our patients with ALL at 2 years was fair. The treatment results for AML were poor, but the numbers are too small to make any definite conclusions.

Acute Kidney Injury↗

PubMed1987

Intestinal and diffuse carcinoma of the stomach among the ethnic and dialect groups in Singapore.

This study attempts to determine the relative prevalence of intestinal-type and diffuse-type carcinomas (using a modified Lauren classification of gastric carcinomas) and to evaluate its significance in relation to the difference in stomach cancer risks among the different ethnic and Chinese dialect groups in Singapore. Of the 648 cases of primary adenocarcinoma of the stomach studied, 405 (62.5%) were of the intestinal type, 206 (31.8%) of the diffuse type, and 37 (5.7%) of the mixed type. Men had higher proportions of intestinal-type carcinoma than women. The intestinal-diffuse carcinoma ratio increased progressively with age. Although the relative intestinal-diffuse carcinoma ratios in women appeared to reflect the relative incidence rates of stomach cancer of the different ethnic and dialect groups, the ratios in men were inconsistent. Indian men had a higher intestinal-diffuse carcinoma ratio than Chinese men despite a lower incidence of stomach cancer. Hokkien men had the highest incidence of stomach cancer and the lowest intestinal-diffuse carcinoma ratio among the Chinese dialect groups. The use of the ratio as an indicator of relative risks for gastric cancer between populations of different genetic makeup is inconsistent and unreliable.

Adenocarcinoma↗

PubMed2000

Pathologic-radiologic correlations in screen-detected ductal carcinoma in situ of the breast: findings of the Singapore breast screening project.

Mammography detected 34 (25%) cases of ductal carcinoma in situ (DCIS) of the breast out of a total of 135 cancers diagnosed in 28, 231 participating women during the Singapore breast screening project. Radiologic findings in these 34 women with DCIS were calcifications only in 25 (74%); mass only in 2 (6%); and mass with calcifications in the remaining 7 (20%) cases. Calcifications were classified mammographically as powderish in 2 (6%), crushed stone-like in 16 (50%) and casting in 14 (44%) cases. Pathologic assessment revealed 11 (32%) cases with pure comedo, 16 (47%) mixed, 3 (9%) cribriform, 2 (6%) papillary, 1 (3%) micropapillary and 1 (3%) solid patterns. Histologic nuclear grade was low in 6 (18%), intermediate in 9 (26%) and high in 19 (56%). Necrosis was observed in 26 (77%) cases and absent in the rest. Pathologic-radiologic correlations yielded a significant association between the mammographic and pathologic lesional size, with the degree of agreement improved when there was histologic necrosis. A trend for radiologic crushed stone-like and casting-type calcifications to be associated with DCIS with necrosis and of higher nuclear grade was noted. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 231-236 (2000).

Aged↗