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PubMed2006

Cancer screening in Singapore, with particular reference to breast, cervical and colorectal cancer screening.

Cancer is the leading cause of mortality in Singapore, accounting for 27.1% of deaths in 2004. The most common cancers are those of the lung, colon and rectum, liver, stomach, and prostate in men; and breast, colon and rectum, lung, ovary and cervix in women. Singapore has the highest age-adjusted breast cancer incidence in Asia. National population screening programmes have been implemented for breast and cervical cancer. BreastScreen Singapore (BSS), the first population-based nationwide mammographic breast-screening programme in Asia, was launched in 2002, incorporating international standards and practice guidelines. For improved quality assurance, two-view screening mammography is carried out. From January 2002 until March 2004, BSS conducted over 84,000 screens, with an overall recall rate of 9.5%, and an overall invasive cancer detection rate of 4.48 per 1000 screened. Close to 30% of the cancers diagnosed was ductal carcinoma in situ. Papanicolaou (Pap) smear screening for cervical cancer has been available opportunistically since 1964. The national CervicalScreen Singapore programme was launched in 2004, aiming to achieve coverage of 80% of targeted women by 2010. Colorectal cancer currently has the highest incidence of all cancers in Singapore. The health authorities advocate colorectal cancer screening for the average risk population, starting from age 50 years, but in the absence of a national screening programme, the reliance is on opportunistic screening.

Adult↗
PubMed1985

Singapore in international comparisons of birthweight and perinatal mortality.

The position of Singapore as regards birthweight distribution and perinatal mortality has been compared with six countries in the 1973 WHO study namely, Austria, Cuba, Hungary, Japan, New Zealand and Sweden. Birthweight distribution and perinatal mortality reflect both the social and health conditions of a population and the standards of obstetric and paediatric care, and seeing where a country ranks in the international comparison of them may play a role in the formulation of health policy for that country. Singapore was well placed for the proportion of very low birthweight babies (less than 1,500 grams), ranking 2nd for both live births (0.5%) and total births (0.7%). It was however not so well placed for proportion of low birthweight babies (less than 2,500 grams), ranking 5th for both live births (8.8%) and total births (9.2%). With regard to perinatal mortality Singapore at 20.0 per 1,000 total births ranked 4th and this improved to 3rd after standardizing for birthweight and in fact was little different from Hungary (1st) and Sweden (2nd). Given that standardization for birthweight largely removes the effect of "socioeconomic and demographic factors" so that remaining differences to a large extent reflect medical care, this indicates a relatively high standard of perinatal care in Singapore. The problems of interpretation, the implications of the findings and suggestions for improving birth statistics in Singapore are discussed.

Austria↗
PubMed1993

Third chapter of surgeons lecture: revolution in urology and its evolution in Singapore.

Urology has been an evolving specialty since the time of Hippocrates. The itinerant surgeon was known to go from town to town to remove bladder stones in the early middle ages. In this century, urologists had been at the forefront in pioneering minimally invasive surgery with the introduction of transurethral resection of the prostate more than 50 years ago in the United States. This could be considered the first revolution in urology and this has influenced the evolution of urology in Singapore. Transurethral surgery had proved to be far superior to open surgery for most lesions of the lower urinary tract. This technique was introduced to Singapore in the early 1970s by Dr N E Wong. Because of the need for special instruments, skill and training, there was a need for a Department of Urology. This was not to be until after the second revolution in urology. The second revolution saw the introduction of endoscopic surgery of the upper urinary tract and Extra-corporeal Shockwave Lithotripsy in the early 1980s. This had truly revolutionised the treatment of urinary stones and today almost 95% of patients can be treated with these non to minimally invasive techniques. These new modalities of treatment were rapidly introduced in Singapore in the mid 1980s. The need for the establishment of urology as a specialty was more urgently felt. The Singapore Urological Association was formed in February 1986 and in March 1987, a Division of Urology was formed at the Singapore General Hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Intravesical↗
PubMed1995

Delivering health information databases on World Wide Web at the National University of Singapore.

The National University of Singapore (NUS) is one of the first medical schools in Asia to exploit the use of the World Wide Web on the Internet for the delivery of health information databases. Its WWW server was established in 1993 by the NUS Biocomputing Research and User Support (BRUS) technology group in collaboration with the Computer Resource Planning committee of the Faculty of Medicine. As a result of the early recognition of the powerful platform on which health information services can be delivered worldwide, the NUS effort has been accredited with a number of Internet firsts in the area of health informatics. The following are some of the NUS achievements: NUS-NCI CancerNet on the Web. The NUS developed and implemented the first WWW version of the popular CancerNet database offered by the National Cancer Institute, NIH, USA. Health Info-Com Network Medical Newsletter. The NUS developed and implemented the first WWW version of the medical newsletter, MEDNEWS which is edited by Dr. David Dodell, USA. It is now mirrored by the University of Pennsylvania in the United States and De Montfort University, U.K. Poisons Information Database. This first WWW implementation of a database on known plant, snake and other animal toxins with directories of antivenoms, toxinologists and poisons control centers around the world is offered by the NUS Venom and Toxin Research Group. HistoNet. This is a large collection of histology specimens from the NUS Department of Anatomy. MEDISTAT. This is the first WWW implementation of a Health and Population Statistical Database which contains information for Singapore, selected Asian countries and aggregate data for world regions. The Singapore Biotechnology Database. This database features companies and organizations involved in biotechnology and related activities in Singapore. Efforts are continuing to offer more value-added health information databases on the NUS WWW server and to link the server with other top-class information centers worldwide. Our mission is to identify the National University of Singapore as a global health information hub on the Internet.

Computer Communication Networks↗
PubMed1998

Serum selenium in the general population of Singapore, 1993 to 1995.

Selenium is a trace element which plays a vital role in many metabolic functions and in particular is an integral part of the antioxidant enzyme glutathione peroxidase. It may be involved in the prevention of a number of diseases including cardiovascular diseases and cancer, which are the main causes of death in Singapore with ethnic differences. The National University of Singapore Heart Study measured cardiovascular risk factors, including serum selenium, in a random of the general population aged 30 to 69 years from 1993 to 1995. Mean serum selenium was higher in Chinese (males 126 and females 119 micrograms/L) and Malays (males 122 and females 122 micrograms/L) than Indians (males 117 and females 115 micrograms/L). These levels (with an estimated mean of 122 micrograms/L in Singapore) are lower than those in the USA but higher than those in Western Europe. The proportions with serum selenium < 80 micrograms/L (classified as low values) were low, though highest in Indians (males 1.2% and females 1.2%), then Chinese (males 0.6% and females 1.3%) and then Malays (males 0.0% and females 0.0%), but the differences were not statistically significant. The overall estimate for the prevalence of low selenium in Singapore was 0.8%. It is concluded that levels of serum selenium in Singapore are satisfactory and no action with regard to dietary supplementation is needed. Serum selenium levels are slightly lower in Indians than in Chinese and Malays (probably due to a more vegetarian diet) and this may make a small contribution to Indians' higher rates of coronary heart disease compared to Chinese and Malays.

Adult↗
PubMed2000

A comparative mental health literacy survey of psychiatrists and other mental health professionals in Singapore.

OBJECTIVE: The objectives of this study are, first, to replicate and extend an Australian approach to assessing mental health literacy by studying a sample of Singapore mental health professionals, and to focus on differences between judgements made by the psychiatrists in comparison with the other mental health professionals. Second, to compare the psychiatrists' judgements with those of Australian psychiatrists. METHOD: The Australian questionnaire, assessing responses in relation to vignettes of major depression and to schizophrenia was extended by adding a third vignette of mania, and by the addition of several region-specific response options. Nearly 500 questionnaires were distributed to representative staff (psychiatrists, nurses and allied health) of a large psychiatric institution in Singapore, with a response rate of 81%. Psychiatrists' judgements were compared with all other hospital staff, and with Australian psychiatrists' judgements. RESULTS: The two principal contrast groups (Singapore psychiatrists and other Singapore mental health professionals) differed slightly in terms of diagnostic accuracy. The psychiatrists differed in favouring a more professionally focused model of intervention, while both professional groups viewed traditional healers and their practices as distinctly unhelpful. Direct comparison of psychiatrist ratings generated in Singapore and in Australia revealed quite similar response profiles. CONCLUSIONS: In addition to generating data of some intrinsic importance, comparison with Australian survey data allows the potential impact of regional and cultural differences, as well as of varying psychiatric practices, to be identified. Responses identified more similarities than differences in the judgements of the psychiatrists from the two countries.

Australia↗
PubMed2001

Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire.

This report describes the development and validation/calibration of a structured food frequency questionnaire for use in a large-scale cohort study of diet and health in Chinese men and women aged 45-74 years in Singapore, the development of a food composition database for analysis of the dietary data, and the results of the dietary validation/calibration study. The present calibration study comparing estimated intakes from 24-hour recalls with those from the food frequency questionnaires revealed correlations of 0.24-0.79 for energy and nutrients among the Singapore Chinese, which are comparable to the correlation coefficients reported in calibration studies of other populations. We also report on the nutritional profiles of Singapore Chinese on the basis of results of 1,880 24-hour dietary recalls conducted on 1,022 (425 men and 597 women) cohort subjects. Comparisons with age-adjusted corresponding values for US whites and blacks show distinct differences in dietary intakes between the Singapore and US populations. The Singapore cohort will be followed prospectively to identify dietary associations with cancer risk and other health outcomes.

Aged↗
PubMed1997

Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey.

OBJECTIVES: To determine the incidence of acute primary angle-closure glaucoma (APACG) in Singapore and to identify demographic and meteorological risk factors. DESIGN: A prospective, island-wide incidence study. SETTING: All government and private ophthalmological practices in Singapore, from March 1, 1995, to February 29, 1996. METHODS: New cases of APACG were identified by all ophthalmologists in Singapore during a 1-year period. Demographic and clinical details were recorded. RESULTS: One hundred eighty-nine people (208 eyes) were seen with APACG for the first time during the 1-year period. These new cases represent an incidence of 12.2 per 100,000 per year (95% confidence interval, 10.5-13.9) in those aged 30 years and older. Major risk factors identified were female sex (relative risk, 2.4), Chinese ethnic origin (relative risk, 2.8), and age of 60 years or older (relative risk, 9.1). Half of those affected were seen 3 days or more after the onset of symptoms. Attacks were more frequent on hotter days. There also was a relationship between the number of attacks per day and the mean number of sunspots and mean solar radio flux during the previous 30 days. CONCLUSIONS: There is a high incidence of APACG in Singapore, with elderly women being the highest risk group. Chinese Singaporeans are at higher risk than other ethnic groups (Malay and Indian). There is often a substantial delay before these patients consult a physician. The onset of APACG seems to be associated with meteorological factors.

Acute Disease↗
PubMed2006

Singapore Human Mutation/Polymorphism Database: a country-specific database for mutations and polymorphisms in inherited disorders and candidate gene association studies.

There is a need for country/population-specific databases because the existence of population-specific mutations for single gene disorders is well documented, and there is also good evidence for ethnic differences in the frequencies of genetic variations involved in complex disorders. Thus the Singapore Human Mutation/Polymorphism Database (SHMPD) was created to provide clinicians and scientists access to a central genetic database for the Singapore population. The data catalogued in the database include mutations identified in Singapore for Mendelian diseases, and frequencies of polymorphisms that have been investigated in either healthy controls or samples associated with specific phenotypes. Data from journal articles identified by searches in PubMed and other online resources, and via personal communications with researchers were compiled and assembled into a single database. Genes are categorized alphabetically and are also searchable by name and disease. The information provided for each variant of the gene includes the protein encoded, phenotype association, gender, size, and ethnic origin of the sample, as well as the reported genotype and allele frequencies, and direct links to the corresponding abstracts on PubMed. Our database will facilitate molecular diagnosis of Mendelian disorders and improve study designs for complex traits. It will be useful not only for researchers in Singapore, but also for those in countries with similar ethnic backgrounds, such as China, Taiwan, Hong Kong, Indonesia, and Malaysia.

Alleles↗
PubMed2005

Profound changes in breast cancer incidence may reflect changes into a Westernized lifestyle: a comparative population-based study in Singapore and Sweden.

Breast cancer incidence in Sweden has always been approximately twice as high as in Singapore. In recent years, this difference is limited to postmenopausal women. The aim of this study was to explore the reasons behind these differences through the use of age-period-cohort modeling. This population-based study included all breast cancer cases reported to the Swedish and the Singapore cancer registries from 1968 to 1997, with a total of 135,581 Swedish and 10,716 Singaporean women. Poisson regression using age-period and age-cohort models was used to determine the effects of age at diagnosis, calendar period and birth cohort. Incidence rate ratios were used to summarize these effects. An age-cohort model provided the best fit to the data in both countries, indicating that changes over lifetime, rather than recent differences in medical surveillance, might account for the observed differences in these 2 populations. The changes over birth cohort were much greater among Singaporean women. The relative effect of age was very similar in the 2 countries. Analyses show that age and cohort effects may explain the differences in trends of female breast cancer incidence between Sweden and Singapore. The larger cohort effect seen in Singaporean women may be attributed to more rapid changes in reproduction and lifestyle patterns than that of Swedish women during the period studied. The incidence of breast cancer in postmenopausal women in Singapore will probably continue to rise in the coming decades to match the current Swedish rates.

Adult↗
PubMedDate not supplied

Strategies adopted and lessons learnt during the severe acute respiratory syndrome crisis in Singapore.

In Singapore, the military was actively involved in the containment of the outbreak of severe acute respiratory syndrome (SARS) last year. The outbreak started in February 2003 with three Singapore travellers to Hong Kong. At that time, nothing was known about the aetiological agent of the atypical pneumonia that was termed SARS. Unfortunately one of the travellers was a super-spreader, defined as a person with high efficiency for virus transmission, and was responsible for the expansion of the national outbreak. Not only was the Singapore military involved in contact tracing of personnel and enforcement of home quarantine, military-affiliated research institutes were also involved in providing diagnostic support. This review reconstructs the events that took place during the SARS outbreak, focusing on the special support arising from complementing the military-affiliated laboratory with the public health laboratory. A description of the diagnostic findings is provided in chronological order. The review ends with lessons Singapore learnt from the SARS crisis, stressing the importance of national preparedness for future outbreaks.

Communicable Diseases, Emerging↗
PubMed1998

Occupational health in Singapore.

Singapore, a newly industrializing country in Southeast Asia, has a resident population of 3 million and a work force of 1.75 million. Most workers are employed in the manufacturing, services, and commerce sectors. Agricultural and mining activities are negligible. In 1996 the infant mortality rate was 3.8 per 1,000 live births and the life expectancy at birth was 77 years. In 1996 the total industrial accident rate was 2.7 per million man-hours worked and the severity rate was 353 industrial man-days lost per million man-hours worked. The shipbuilding and construction industries had the most frequent and most severe accidents. In the same year, 1,521 cases of occupational disease were notified to, and confirmed by, the Ministry of Labor. The majority of cases involved noise-induced hearing loss. There is substantial underreporting of cases. New cases that are expected to appear will be work-related illnesses such as musculoskeletal or psychosocial disorders. The principal occupational health legislation in Singapore is the Factories Act. Although it selectively targets workers at highest risk of developing occupational illness, its main limitation is the exclusion of nonfactory workers, who comprise 63% of the working population. Labor regulations are enforced by the Ministry of Labor. Workmen's compensation paid in 1995 amounted to S $46.6 million (U.S. $1=S $1.75). Education and training in occupational health is provided by employer federations, employee unions, and various government agencies. Occupational health is taught to medical students during their undergraduate training. Postgraduate-diploma and Masters programs in occupational medicine are also available. About 600 doctors in Singapore have some form of postgraduate training in occupational health. Health care for workers is offered either through the private sector or through government clinics and hospitals. Although Singapore has made great strides in protecting and promoting the health of its workers, it must constantly strive to strengthen its commitment to occupational health and safety. New problems in the next century must be anticipated and solutions, implemented. Improved training and development of health professionals is needed such that they be better prepared to deliver optimal occupational health care. Finally, labor legislation must be appropriate and responsive to protect the health of all workers.

Accidents, Occupational↗
PubMed2006

Persistent organic pollutants in moss as bioindicators of atmospheric pollution in Singapore.

Moss samples were collected from the island of Singapore and analysed for a range of organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs). Although all compounds analysed have been banned from use in Singapore, they were detected in all samples collected. Among the hexachlorocyclohexanes (HCH), beta-HCH was the most dominant isomer, while trans-chlorane was found to be the most dominant cyclodiene pesticide. High levels (79.12 ng g(-1)) of PCBs were detected in mosses collected from a nearby island due to active accumulation of pollutants associated with boat emissions. Significant spatial variations in the levels of organic pollutants in Singapore were largely absent, indicating that air masses moving over the island deposit OCPs and PCBs in a uniform pattern. A comparison of moss pollutant levels with available data from Czech Republic showed that dichlorodiphenyldichloroethylene (p,p'-DDE), dichlorodiphenyltrichloroethane (p,p'-DDT) and PCB levels in Singapore are the highest. The presence of these compounds suggests that they are still used in the region and are environmentally recalcitrant.

Air Pollutants↗
PubMed2006

Outpatient parenteral antibiotic therapy in Singapore.

Outpatient parenteral antibiotic therapy (OPAT) remains in its infancy in Singapore, with the first patients enrolled 4 years ago. Singapore's three largest hospitals, with over 3000 inpatient beds, now have designated and approved OPAT services. This study reviews the demographic, clinical and cost data of all patients enrolled in 2005 to facilitate benchmarking between services in Singapore and abroad and also to identify common needs for further development. In 2005, 225 OPAT enrollments in 208 different patients resulted in 4050 days of OPAT care. Orthopaedic diagnoses constituted 40% of admissions. Vancomycin was the most frequently used antibiotic (34%). The re-admission rate was 8.9%, but complications of OPAT care were only occasionally implicated. An estimated $207,200 was saved by patients despite there being significant financial disincentives to subsidised patients. OPAT is a safe, cost-efficient system that is becoming increasingly accepted in Singapore by patients, clinicians and management. Our three services have evolved independently into very similar practices. There is potential for further innovation, including outreach and carer-delivered dosing. However, major financial disincentives require review.

Adolescent↗
PubMed2001

The prevalence and risk factors for pterygium in an adult Chinese population in Singapore: the Tanjong Pagar survey.

PURPOSE: To determine the prevalence and risk factors for pterygium in the Chinese population of Singapore. METHODS: A population-based survey was conducted in Singapore, an island located 1 degree north of the equator with a stable tropical climate. A disproportionate, stratified, clustered, random sampling procedure was used to select the names of 2000 Chinese people aged 40 to 79 years from the 1996 electoral register in the Tanjong Pagar district of Singapore. Selected subjects underwent a comprehensive interview and ocular examination. Pterygium was diagnosed and graded clinically as grade 1 (transparent), 2 (intermediate), and 3 (opaque). Risks factors associated with pterygium and grade 3 pterygium were evaluated with logistic regression models. RESULTS: From a total of 1717 eligible subjects, 1232 (71.8%) were examined. There were 120 people with either unilateral (n = 70) or bilateral (n = 50) pterygium, equivalent to an overall prevalence of 6.9% (95% confidence interval [CI], 5.2, 8.8) in the Chinese population aged 40 and older. The prevalence increased linearly with age (chi-square test of trend P <.001) and was higher among men than women (age-adjusted odds ratio [OR], 4.2; 95% CI, 2.5, 6.9). Men aged 70 and above had the highest overall prevalence of 25.4% (95% CI, 18.2, 19.4), but pterygium was not seen in women aged 40 to -49 years. In multivariate analysis, ptergyium was independently associated with increasing age (OR, 7.8; 95% CI, 3.2, 18.8 for persons 70 to 81 years, compared with 40 to 49 years), male sex (OR, 5.1; 95% CI, 2.9, 9.3) and certain occupations; factory workers, production workers and machine operators (OR, 3.1; 95% CI, 1.5, 6.3), as well as laborers and agricultural workers (OR, 3.3; 95% CI, 1.6, 7.0) had higher risks, compared with professionals and office workers. Grade 3 pterygium (n = 36) was also independently associated with male sex (OR, 11.6; 95% CI, 3.5, 38.6) and similar occupations but was not related to age. CONCLUSIONS: The prevalence of pterygium in Singapore is 7% among Chinese aged 40 years and older. Independent associations with increasing age, male sex, and occupations linked to outdoor work and other exposures suggest a multifactorial cause of this condition.

Adult↗
PubMed2000

The changing demography of diabetes mellitus in Singapore.

Diabetes mellitus has been on the rise in Singapore, while Singaporeans are becoming more affluent, our lifestyles are more sedentary and our population is ageing rapidly. The prevalence of diabetes mellitus rose from 2% in 1975 to 4.7% in 1984, 8.6% in 1992 and 9.0% of adults 18-69 years old in 1998. Malay and Indian women and Indian men were at higher risk, with 14.3, 14.9 and 16.7% prevalence rates, respectively. A further 15% of the adult population have impaired glucose tolerance (IGT). Diabetes was a factor in 39.7% of strokes and in 9.3% of all deaths in Singapore, and is the sixth most common cause of death. In the Diabcare Singapore 1998 Study, 91% of participants were diagnosed with Type 2 diabetes, with mean BMI of 25.1+/-4.4 kg/m(2). The incidence of Type 1 diabetes in childhood is 2.46 per 100000 children 0-12 years of age, while Type 2 diabetes in childhood is an emerging problem. The prevalence of obesity (BMI >30 kg/m(2)) among persons aged 18-69 years rose to 6% in 1998, up from 5.1% in 1992. The prevalence of obesity was highest among the Malays (16.2%) followed by the Indians (12.2%) and the Chinese (3.8%). About 12% of schoolchildren are obese. Increased efforts must be made to change lifestyle and eating patterns in our society, reduce childhood obesity and encourage adults to make lifelong sports and exercise part of the Singaporean way of life. Singapore has one of the world's fastest ageing populations, and even now, 32.4% of Singaporeans 60-69 years of age have diabetes. We should consider screening for diabetes in obese schoolchildren and seek to improve quality of care for people with diabetes, including enlisting the aid of community organisations to improve access to diabetes education, monitoring, support and complications screening services.

Adolescent↗
PubMed2002

Visual function and outcomes after cataract surgery in a Singapore population.

PURPOSE: To identify the predictors of visual outcomes (visual acuity and visual function) in cataract surgery patients in Singapore and compare the visual outcomes of phacoemulsification and extracapsular cataract extraction (ECCE). SETTING: Singapore National Eye Center, Singapore, Republic of Singapore. METHODS: The visual function was measured by the VF-14 and visual acuity in the operated and the better eye in 460 systematically sampled cataract surgery patients preoperatively and 3 months after surgery. Several patient- and surgery-related predictive factors were recorded. RESULTS: After cataract surgery, 85.1% of patients reported improved visual acuity in the operated eye and 77.6% reported improved visual function. Patients with poorer visual acuity and visual function at baseline reported greater improvements in visual acuity and visual function. Patients who had phacoemulsification had better final visual function (P =.006) and better final visual acuity (P <.001) scores. In multiple linear regression models, final visual function was better in patients without preexisting eye disease and with better baseline visual function, and final visual acuity in the operated eye was better in patients who were younger, were better educated, had no preexisting conditions or postoperative complications, and had a better baseline visual acuity. CONCLUSIONS: Patients with poorer baseline visual acuity or who had no preexisting eye disease reported more improvement in visual acuity in the operated eye. Several factors including no preexisting eye disease were associated with better final visual acuity and visual function scores.

Aged↗
PubMed2002

The practice and challenges of solid waste management in Singapore.

This paper presents an overview of the current solid waste management situation in Singapore and provides a brief discussion of the future challenges. Singapore is a small island city-state with a large population, warm climate and high humidity. Over the past two to three decades, rapid industrialization and economic development have caused a tremendous increase in solid waste generation. The yearly disposed solid waste increased from 0.74 million tonnes in 1972 to 2.80 million tonnes in 2000. Solid waste management in Singapore has traditionally been undertaken by the Ministry of Environment (ENV), with the participation of some private sectors in recent years. The hierarchy of solid waste management in Singapore is waste minimization (reduce, reuse and recycle or so-called 3 Rs), followed by incineration and landfill. As land is extremely scarce and only one newly constructed offshore landfill site is available, solid waste incineration has been identified as the most preferred disposal method. Waste minimization, the utilization of incineration ashes, industrial waste management are regarded to be the major challenges in the future.

Economics↗