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PubMed1984

Factors contributing to a reduction of twin perinatal mortality in Singapore.

A total of 204 cases of twin pregnancy occurred between 1970 and 1972 have been compared with 102 cases occurred between 1976 and 1978. During the interval of time, specialised care was instituted for the early diagnosis and management of twins. The incidence of twin pregnancy in Singapore decreased from 1:131 to 1:141 pregnancies. With a background of improved socioeconomic conditions and obstetric care, there has been a dramatic decline in perinatal mortality from 76.4 to 29 per 1000. In undiagnosed cases, the perinatal mortality of the first vs the second twin in the earlier group was 64.4 vs 93.6 per 1000. No such difference was observed in the later period, with the average birthweights of twins being significantly higher. The principles of our antenatal supervision, antenatal tocography , and management are presented and the value of early diagnosis, bedrest, and tocolytic therapy discussed. The reduced perinatal mortality and morbidity gives evidence of an improvement in prematurity and augmented intrauterine growth.

Adult↗
PubMed1990

Attitudes towards contraceptive implants and injectables among present and former users in Singapore.

In a comparison of present and past users of contraceptive implants (Norplant) or injectables (DMPA) and discontinuers of Norplant or DMPA, information concerning the women's knowledge and perception of, and attitude to, implants and injectable contraceptives, was studied. The long duration of action (5 years) of implants was perceived positively by all groups as compared to the shorter 3-month duration of injectables, though this was seen as an advantage over the pill. It appears that the Norplant system has potential for wider use in Singapore in the future.

Adult↗
PubMed1993

Premature childbirth: social and behavioural risks in Singapore.

The associations of social and behavioural factors on preterm birth in Singapore were studied using hospital maternity records of 20,723 consecutive singleton births between January 1986 and November 1991. The overall proportion of preterm births was 3.6%, the rates for the Chinese, Malay and Indian groups being 3.2%, 3.8% and 4.9% respectively. Teenage mothers were at a higher risk of preterm labour compared to women aged 20-29 years. The incidence of preterm labour decreased with increasing educational status. Preterm births were six times more likely in women who had no antenatal care. Women who had three or more previous births were at a higher risk, while those who had one or two previous births were at a lower risk compared to women who had none.

Adult↗
PubMed1995

Ethnicity and obstetric performance in Singapore.

The influence of ethnicity on obstetric performance in Singapore was assessed by retrospective analysis of all deliveries in the National University Hospital over a 7-year period. Malay mothers were younger, shorter, less educated, of higher parity, were more likely to have had no antenatal care, and had the highest incidence of premature labour. However, mothers of Indian origin had the smallest babies, the highest incidence of low birth weight and significantly higher perinatal mortality rates. Chinese mothers fared better than their Malay and Indian counterparts in all parameters assessed. The ethnic origin of the mother has an important bearing on perinatal performance. This emphasises the importance of designing appropriate strategies to improve perinatal health in the different ethnic groups.

Adult↗
PubMed1995

The future of stapedectomy--the Singapore problem.

Concern has been expressed in the recent literature regarding the problem of a dwindling number of stapedectomy cases and an increasing number of surgeons trained to do this operation. In Singapore, the problem is made worse by the very low incidence of this disease in its main ethnic groups of Chinese and Malays who together make up more than 90 per cent of the population. We report here an audit of 47 ears that underwent stapedectomy in a teaching hospital over a six-year period. The hearing results for consultants and surgical trainees were compared. Closure of the air-bone gap to within 10 dB was obtained in 64 per cent of Consultants' cases and 68 per cent of trainees' cases. These results fall short of the 90 to 95 per cent figure reported by experts in this procedure and only comparable to the less satisfactory results of several series recorded by residents in North America. We conclude that the unsatisfactory results arise from the small number of surgical cases available for each surgeon to improve and maintain his skills in a technically demanding procedure. It is proposed that such cases be directed to those pursuing otology as a subspecialty rather than all otolaryngologists in general.

Clinical Competence↗
PubMed2001

Seasonality of suicide in Singapore: data from the equator.

BACKGROUND: Studies in the northern and southern hemispheres consistently identify seasonal patterns in suicidal deaths. In many such studies, bimodal yearly peaks have been described for females as against unimodal ones for males. The current study examines the monthly variation in suicidal deaths in Singapore to determine if any seasonal patterns exist in an equatorial region. METHODS: Monthly suicidal death data over the decade 1989-98 were examined for the whole sample and for gender- and age-specific subgroups. Both von Mises' distribution and harmonic analysis techniques were used to interpret the data. RESULTS: Among the 2013 male and 1382 female suicides, there was minimal variation in patterning of suicidal deaths. We found a weak suggestion of a later peak for the females in mid-May as opposed to mid-February for the males, and the peaks for those less than 25 years of age were 5-6 months later than for the older age groups. The magnitude of all peaks was, however, very small suggesting chance variation. The harmonic analyses confirmed that patterning was 'randomly' rather than 'seasonally' determined. CONCLUSION: In an equatorial region, there was no evidence of any 'seasonal' patterning of suicidal deaths.

Adult↗
PubMed1994

Prevalence of hepatitis A virus infection among sewage workers in Singapore.

To determine whether or not occupational exposure to sewage is associated with a higher seroprevalence of hepatitis A virus (HAV) infection, 600 sewage workers in Singapore were tested for total (IgG and IgM) antibody to HAV by enzyme immunoassay. Using logistic regression with stepwise procedure, the adjusted seroprevalence of sewage workers was 2.2 times higher than that of another non-occupationally exposed population group. Seroprevalence was significantly correlated with age and educational levels, the association being independent of the occupational association. The epidemiological data in the study show that sewage workers have an increased occupational risk of acquiring HAV infection and should be protected by active immunization.

Adult↗
PubMed2002

An outbreak of multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium, DT104L linked to dried anchovy in Singapore.

Multidrug-resistant Salmonella enterica subsp. enterica serotype Typhimurium DT104L was first reported in Singapore from mid-July to mid-October 2000. Salmonella strains isolated from clinical laboratories were submitted to a reference laboratory for serotyping, phage-typing and pulsed-field gel electrophoresis (PFGE) using XbaI restriction endonuclease. An epidemiological investigation was conducted to determine the source of infection and mode of transmission using a structured questionnaire. A total of 33 cases involving mainly infants and toddlers were detected in the 3-month long outbreak. The outbreak strain was of the R-type ACGSTSu, i.e. resistant to ampicillin, chloramphenicol, gentamicin, streptomycin, tetracycline and sulphonamide. PFGE showed all isolates had an indistinguishable pattern, indicating a common source of infection. Consumption of imported dried anchovy was found to be the vehicle of transmission after adjusting for all confounding variables in the case-control study using stepwise logistic regression (OR 25.6; 95% CI 3.9-167.9; P = 0.001). Imported dried seafood should be properly processed, packed, labelled, and thoroughly cooked to prevent transmission of multidrug-resistant S. Typhimurium.

Adolescent↗
PubMed2002

A survey of Nipah virus infection among various risk groups in Singapore.

Following the Nipah virus (NV) outbreak in March 1999 in Singapore, a serological survey was undertaken to screen individuals potentially exposed to NV. Blood samples were tested for NV IgM, IgG and neutralizing antibodies. Twenty-two (1.5%) of 1469 people tested had antibodies suggesting NV infection. Although 12 of the 22 infected people (54.6%) were symptomatic, the remaining 10 (45.4%) were clinically well and had no past history of compatible pulmonary or neurological disease. Clinical and serological findings suggested three people had been infected with NV before the outbreak was recognized. All those who were infected were male abattoir workers. None of the people who had contact with horses, and no healthcare workers exposed to infected patients and their specimens had detectable antibodies. This study provides evidence that NV causes asymptomatic infection. All of the antibody positive individuals had direct contact with pigs and there was no evidence of human to human transmission.

Abattoirs↗
PubMed2004

Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore.

Between 1 and 22 March 2003, a nosocomial outbreak of Severe Acute Respiratory Syndrome (SARS) occurred at the Communicable Disease Centre in Tan Tock Seng Hospital, Singapore, the national treatment and isolation facility for patients with SARS. A case-control study with 36 cases and 50 controls was conducted of factors associated with the transmission of SARS within the hospital. In univariate analysis, contact with respiratory secretions elevated the odds ratio to 6.9 (95 % CI 1.4-34.6, P= 0.02). Protection was conferred by hand washing (OR 0.06, 95% CI 0.007-0.5, P=0.03) and wearing of N95 masks (OR 0.1, 95% CI 0.03-0.4, P=0.001). Use of gloves and gowns had no effect. Multivariate analysis confirmed the strong role of contact with respiratory secretions (adjusted OR 21.8, 95 % CI 1.7 274.8, P=0.017). Both hand washing (adjusted OR 0.07, 95 % CI 0.008-0.66, P=0.02) and wearing of N95 masks (adjusted OR 0.1, 95% CI 0.02-0.86, P=0.04) remained strongly protective but gowns and gloves had no effect.

Adult↗
PubMed1995

Ethnicity and elderly suicide in Singapore.

In the cosmopolitan city of Singapore the annual suicide rates in the general population from 1985 to 1991 remained fairly constant, with a mean of 15.3 per 100,000. It was highest among Indians (19.5 per 100,000), followed by Chinese (16.2 per 100,000) and Malays (2.3 per 100,000). The suicide rates were higher in elderly people (aged 65 years and over) than in younger age groups (10 to 64 years) and in males than in females. For the elderly, the mean annual suicide rate for this period was 52.0 per 100,000. However, it was highest among Chinese, with 59.3 per 100,000, followed by Indians at 33.9 per 100,000, and, again, lowest among Malays, with 3.0 per 100,000. Possible sociocultural factors are proposed to account for differences in suicide rates among these ethnic groups.

Aged↗
PubMed1995

Prevalence of dementia among elderly Chinese and Malay residents of Singapore.

This is a comparative study of the prevalence of dementia among elderly Chinese and Malay persons living in the community in Singapore. The subjects, aged 65 years and over, were all living in public housing estates. Two hundred elderly Chinese and 149 elderly Malay persons were interviewed. They were first screened for any cognitive deficit with the Elderly Cognitive Assessment Questionnaire (ECAQ). All those who scored 5 or fewer points on the ECAQ were then assessed with the Geriatric Mental State schedule. The results showed an overall dementia prevalence of 4.0% among the Malay elderly and 2.5% among the Chinese elderly. The rate of dementia of the Alzheimer's type was 1.8% for Chinese women and 1.5% for Malay women; for multi-infarct dementia the rate for Malay women was 4.4% and for Chinese women 0.9%. For Chinese and Malay men, the prevalence of Alzheimer's disease and multi-infarct dementia was quite similar (1.1% and 1.2%).

Aged↗
PubMed2000

Meningiomas in Singapore: demographic and biological characteristics.

We sought to determine the relative incidence of meningiomas compared to other central nervous system tumours in an Asian surgical series, as well as the demographic and biological characteristics of these meningiomas. A review of 655 consecutive cases of central nervous system tumours from 583 patients representing the last five years admissions to one hospital in Singapore was undertaken. A total of 33 malignant/atypical tumours from 19 patients and 196 benign meningiomas from 187 patients were identified. Twenty malignant/atypical and 20 benign tumours were selected at random and subjected to histochemical and immunohistochemical analysis using antibodies directed against p53, bax and 3'-DNA hydroxy groups (TUNEL). Meningiomas comprised some 35.2% of all central nervous system tumours with malignant/atypical meningiomas representing 9.2% of meningiomas. Histochemically, necrosis was the predominant finding. However, peri-necrotic areas displayed p53 positivity in 10% of cases and bax positivity in 25% of cases. Apoptotic cells were detected in the peri-necrotic areas in 90% of benign and 75% of malignant/atypical meningiomas. Meningiomas represent the predominant form of central nervous system tumour in the Singaporean population, and aberration of p53 expression is not associated with tumour formation or progression. There was a slight but non-significant reduction in apoptosis in the progression from benign to malignant meningioma, suggesting that in contrast to many other tumour types disruption of cellular apoptosis is not a predominant driving force in Asian meningioma tumourigenesis.

Apoptosis↗
PubMed2001

Identification and molecular characterisation of the complete genome of a Singapore isolate of hepatitis C virus: sequence comparison with other strains and phylogenetic analysis.

The complete genomic sequence of a Singapore isolate of the hepatitis C virus (HCV) was obtained from serum of an individual chronically infected with HCV. Nine overlapping cDNA clones covering the entire viral genome was amplified by reverse-transcription-polymerase chain reaction (RT-PCR), This isolate (HCV-S1) comprised 9,609 nucleotides (nt), including 341 nt of the complete 5' untranslated region (5' UTR), a single open reading frame of 3,011 amino acids (aa) and 235 nt of the complete 3' UTR. Its genotype was identified as type lb from analyses of its sequences in the 5' UTR, NS3 and NS5B regions. When compared against nine reported HCV isolates, the overall aa homology of HCV-SI was closest with an Australian strain, HCV-A (94%) and a Japanese strain, HCV-JT (93.9%). Phylogenetic analysis revealed that it was most closely related to the Taiwan strain, HCV-TW and another Japanese strain, HCV-K1-R1.

5' Untranslated Regions↗
PubMed1998

Doctors, patients, and perceived job image: an empirical study of stress and nurses in Singapore.

This study examined the relationships among three potential sources of stress, namely, demands from patients/relatives, demands from doctors, and perceived job image, and several work-related outcomes, namely, job satisfaction, organizational commitment, intention to quit, and job-induced tension. Respondents consist of nurses from two tertiary-care hospitals in Singapore. Findings of this study suggest that demands from patients/relatives, doctors, and perceived job image were significantly associated with nurses' job satisfaction, organizational commitment and job-induced tension. While demands from patients/relatives and perceived job image were significantly associated with intention to quit, the relationship between demands from doctors and nurses' intention to quit failed to reach statistical significance. Implications of the findings are discussed.

Adult↗
PubMed2003

Therapy related hospital admission in patients on polypharmacy in Singapore: a pilot study.

OBJECTIVE: To estimate the incidence of drug-related problems (DRPs)-associated hospital admission, and its correlation to polypharmacy and age. METHOD: A retrospective, cross-sectional study in in-patients on polypharmacy in Singapore. Significant differences (P < 0.05) between number of medications taken and age of patients were tested with the chi-square test. RESULTS: The study population consisted of 347 patients (aged 16-97) on a mean of 7.4 +/- 2.1 medications. 10.8% of the study population had DRPs on admission: 71.9% of which were dominant reasons for admission, and DRPs contributed partly in the remaining cases. These DRPs were mostly avoidable, and can be broadly classified into non-compliance, adverse drug reactions, require synergistic therapy, inappropriate dose and untreated condition. 52% of these cases were made up of geriatric patients. No statistical difference was found between patients on polypharmacy and those on major polypharmacy (10 and more drugs) in having a DRP. CONCLUSION: In this study, DRPs contributing to hospital admission appeared to be avoidable. Geriatrics were more susceptible to DRPs and future efforts are required in managing medications prescribed for these patients to reduce such incidences.

Adolescent↗
PubMed1999

Association of ambient air-pollution levels with acute asthma exacerbation among children in Singapore.

BACKGROUND: Air-pollution levels have been shown to be associated with increased morbidity of respiratory diseases. METHODS: Data for ambient air-pollutant levels, meteorologic factors, and hospitalization or emergency room (ER) visits for acute asthma in Singapore children over a 5-year period (1990-4) were obtained and analyzed for associations by time-series methods. RESULTS: Throughout this period, the annual mean and 24-h mean levels for sulfur dioxide (SO2), nitrogen dioxide (NO2), and total suspended particles (TSP) and maximum 1-h daily average for ozone were generally within the air-quality guidelines established by the World Health Organization (WHO). However, positive correlation between levels of each of these pollutants and daily ER visits for asthma was observed in children aged 3-12 years, but not among adolescents and young adults (13-21 years old). The association with SO2 and TSP persisted after standardization for meteorologic and temporal variables. An adjusted increase in 2.9 ER visits for every 20 microg/m3 increase in atmospheric SO2 levels, lagged by 1 day, was observed on days when levels were above 68 microg/m3. With TSP, an adjusted increase of 5.80 ER visits for every 20 microg/m3 increase in its daily atmospheric levels, lagged by 1 day, was observed on days with levels above 73 microg/m3. Similar results were also obtained after controlling for autocorrelation by time-series analysis. CONCLUSIONS: These associations were observed even though the overall levels of all pollutants were generally within the air-quality guidelines established by the WHO. These findings suggest that asthmatic children are susceptible to increased levels of air pollutants, particularly SO2 and TSP, although the ambient levels are generally within "acceptable" ranges.

Acute Disease↗
PubMed2001

Genetic susceptibility to asthma and atopy among Chinese in Singapore--linkage to markers on chromosome 5q31-33.

BACKGROUND: Asthma and atopy are complex genetic traits, influenced by the interaction of multiple genes and environmental factors. Linkage of these traits to chromosome 5q31-33 has been shown in other populations, but has not been well studied in the Chinese. We studied linkage between asthma and atopy with markers on chromosome 5q31-33 in the Singapore Chinese. This region contains many candidate genes, including the cytokine gene cluster. METHODS: We recruited 88 Chinese families with at least two affected offspring, totaling 373 subjects, with 125 and 119 sib-pairs for atopy and asthma, respectively. All individuals were genotyped with 19 polymorphic microsatellite markers spanning a distance of 41 cM along chromosome 5q31-33. Affected sib-pair and multipoint linkage analysis was performed. RESULTS: There was evidence for linkage of the asthma and atopy phenotypes with three markers, D5S2110, D5S2011, and D5S412 (P values of 0.001 to 0.00001). Multipoint analysis further substantiated this (nonparametric linkage scores of 1.8-2.9). These findings suggest that susceptibility genes for asthma and atopy are found in this region in the Chinese. CONCLUSION: This study has shown linkage of atopy and asthma to chromosome 5q31-33 in a heterogeneous Chinese population. These findings further substantiate the notion that chromosome 5q31-33 contains "universally" important susceptibility genes for these traits.

Adolescent↗