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PubMed2005

Assessment of migraineurs referred to a specialist headache clinic in Singapore: diagnosis, treatment strategies, outcomes, knowledge of migraine treatments and satisfaction.

This study aimed to compare (i) migraineurs' diagnosis, treatment strategies and satisfaction when treated by community care physicians (CCPs) and at the specialist headache clinic; (ii) migraineurs' knowledge of migraine treatments and outcomes at baseline and at 3 months' interval. Thirty-eight patients were interviewed at baseline visit and 3 months after neurologist consultation, using a survey form which consisted of a series of self-designed questions, the MIDAS questionnaire and the SF-36 Health Survey. More patients were informed of the diagnosis of migraine by the neurologist than by CCPs. Compared with CCPs, the neurologist was more likely to employ preventive therapies, prescribe triptans and ask patients to keep a headache diary. Patients' number of days with headaches in the last 3 months, pain intensity, MIDAS score and five out of the eight SF-36 domain scores were significantly improved at the 3 months' interval (P<0.05) compared with baseline at the specialist headache clinic. More patients recognized migraine-specific therapies and reported satisfaction with treatment after the neurologist consultation. This is the first study detailing significant improvements in patients' clinical outcomes, knowledge of migraine treatments and satisfaction after consultation at a specialist headache clinic in Singapore.

Adult↗
PubMed1981

The pattern of hydatidiform moles in Singapore.

Hydatidiform mole is common in Singapore, and the the incidence of malignant trophoblastic neoplastic neoplasia is significantly higher than in Western countries. Within a 10-year period (1968-1977), 538 cases of hydatidiform mole were diagnosed. On retrospective study, 498 (92.6%) were considered to be complete and 40 (7.4%) partial. The ratios of complete to partial moles were similar for the major population groups. In the present study, only complete moles were found to give rise to persistent trophoblastic disease. The lack of such association in partial hydatidiform moles is in keeping with their known low malignant potential. Occasional abnormal post-evacuation hCG curves, however, are being described from other centres, and while the underlying pathology remains largely undocumented, partial moles have to be dealt with on an empirical basis in the light of the hCG follow-up levels.

Female↗
PubMedDate not supplied

Patch testing of Singapore children and adolescents: our experience over 18 years.

This is a retrospective epidemiologic study of allergic contact dermatitis in children and adolescents in Singapore who had undergone patch testing from January 1, 1986 to December 31, 2003. A total of 2,340 patients below the age of 21 years had undergone patch testing. Of these, 1,063 (583 girls, 480 boys) were positive to one or more allergens. The most common allergens were: nickel (40%), thimerosal (15%), colophony (9%), lanolin (8%), cobalt (8%), fragrance mix (5%), and neomycin (4%). Each of these allergens will be discussed individually. This is the first study with over 1000 patients on this subject from Asia.

Adolescent↗
PubMed2002

Emergency medical preparedness and response to a Singapore airliner crash.

A Singapore airline crash in 2000 was the first documented mass casualty incident (MCI) caused by an aircraft disaster in Taiwan. This report reviews the emergency medical preparedness of the airport and examines its effects on the medical response during this incident. The anticipated benefits from the new MCI plan and prior medical preparedness were not achieved during this disaster. Poor compliance with the new MCI plan by the airport authority was noted. Victims were not triaged and did not receive adequate field medical care. Structural problems with the MCI plan were also noted. Site medical teams responding from hospitals could not function as the plan had been designed. This article discusses factors causing the poor compliance, various problems, and related issues in medical response to the incident. As learned from this experience, a properly and practically designed MCI plan, good compliance of responders, and a strong support system of responding agencies are the most important factors for successful emergency response to any MCI.

Accidents, Aviation↗
PubMed1990

Prevalence of dental anxiety and fear in children in Singapore.

505 primary school children in Singapore aged 10-14 were surveyed regarding fear of the dentist. Sixty-eight children were classified as having high fear, giving a sex and race adjusted population prevalence rate of 177 fearful children per 1000 population. Females were 2.64 times more fearful than males. There were no significant racial differences in the prevalence rate. Children with high state anxiety are almost three times as likely to report dental fear as those with low state anxiety. Children with trait anxiety scores above the population mean were just as likely as those reporting below the mean to be fearful. Access to dental care is an important intervening variable in dental fear.

Adolescent↗
PubMed1996

Prevalence of dental fluorosis in children in Singapore.

Prevalence and severity of dental fluorosis was assessed in 1739 Singaporean children aged 9, 12 and 16 yr in three different ethnic groups. All subjects had resided since birth in Singapore, which has a tropical climate. The water supply was fluoridated in 1957 at a level of 0.7 ppm. In this sample, mouth prevalence was 82.6%, tooth prevalence was 66.9%, the community fluorosis index was at 1.96; 9.2% of children had severe fluorosis and 26.2% had moderate fluorosis. There were no significant gender or racial differences. Prevalences were higher than those reported in most other studies. Due to differences in indices used and methodology, comparisons could not be made directly with other studies.

Adolescent↗
PubMed1996

A survey of reasons for extraction of permanent teeth in Singapore.

A survey was carried out to determine the reasons for tooth extractions of permanent teeth in Singapore. Data were obtained from 52 dentists practising general dentistry over a period of 12 months. At the end of the 12-month period, data were collected from 1276 patients, from whom a total 272 teeth were extracted. In this population group, the results showed that the percentage of teeth extracted due to periodontal reasons and caries were about the same, that is 35.8% and 35.4%, respectively. There was an increase in teeth extracted due to periodontal reasons with age. In patients above 40 yr, an average of 76% of teeth were lost due to periodontal reasons. An average of 26.7% of teeth were lost due to periodontal reasons in patients under 40 yr old. However, the trend for loss of teeth due to caries is reversed. Posterior teeth were more frequently extract compared to anterior teeth. Third molars accounted for 24.7% of all extractions carried out, whilst central incisors were 8.0% of all extractions. Molars were often lost due to caries and lower anterior teeth were most frequently lost due to periodontal reasons. The results of this study did not demonstrate one predominant reason for extraction. Both caries and periodontal reasons were equally common causes of tooth extraction.

Adolescent↗
PubMed1989

Contact sensitivity to topical antimicrobials (I). Epidemiology in Singapore.

18% (571/3145) of patients attending a contact dermatitis clinic in Singapore had contact sensitivity to one or more topical antimicrobials. The rates in males and females were similar. The rate for patients under 50 years old was 16% and for those over 50 years old 30% (p less than 0.0001). There were no significant differences in the rates among Chinese, Malays, Indians and other races. The antimicrobials proflavine, neomycin and clioquinol were the commonest sensitizers.

Adolescent↗
PubMed1991

Tussockosis: an outbreak of dermatitis caused by tussock moths in Singapore.

An outbreak of acute pruritic rash occurred in March 1990 among 141 residents of a high-rise public housing estate in Bukit Panjang, Singapore. The typical rash consisted of urticarial lesions distributed over the limbs and trunk. The outbreak was associated with a transient increase in tussock moths in the residential estate following an unusual, short dry spell. The aetiology was established when patch tests with crude moth material produced similar eruptions in 5 out of 7 adult volunteers between 40 min and 12 h. Pharmacological experiments with an aqueous extract of moth hairs in isolated guinea pig ileum elicited a response similar to that induced by histamine.

Adolescent↗
PubMed1992

Changing trends in the epidemiology of contact dermatitis in Singapore.

All patients seen in the Contact Dermatitis Clinic of the National Skin Centre, Singapore (and the former Middle Road Hospital) between January 1986 and December 1990 were analysed retrospectively. 5557 patients comprising 2634 (47.4%) males and 2923 (52.6%) females were patch tested. 3154 (56.8%) patients had 1 or more positive reactions. The majority of the patients were Chinese (78.0%), followed by Malays (11.5%), Indians (8.1%) and other minority races (2.4%). The majority of positive reactions belonged to the 21-40 age group. The incidence of positivity decreased after 60 years. The commonest allergens responsible were nickel (17.7%), fragrance (13.3%), neomycin (6.9%), colophony (6.6%) and proflavine (6.5%). Both neomycin and proflavine were commonly used as over-the-counter medicaments. Compared to an earlier report in 1988, there were differences in the incidence of contact sensitivity to some allergens. Potassium dichromate, which used to be a common allergen, was less common. Some allergens (carba-mix, naphthyl-mix, caine-mix and PCMX) have been removed from our standard series as they were uncommon causes of contact allergy. Thimerosal and Amerchol L-101 were added in their place.

Adult↗
PubMed1999

A study of the sensitization rate to sesquiterpene lactone mix in Singapore.

We report a study of the sensitization rate to sesquiterpene lactone (SL) mix at the National Skin Centre, Singapore. This is a retrospective review of 1256 patients who were patch tested to SL mix (0.1%) from January 1995 to December 1997. 18 out of 1256 patients (1.43%) reacted positively to SL mix. Their ages ranged from 13 to 58 years (average 33.8 years). There were 15 Chinese, 2 Indian and 1 Malay patients. There was a female preponderance, with a female: male ratio of 3.5:1. The most common clinical presentation were dermatitis of the hands (8; 44%), face (5; 28%), and generalized involvement (5; 28%). After extensive evaluation, only 2 patients had a positive patch test reaction that was of current clinical relevance. 13 patients had concomitant sensitization to other allergens. The 3 commonest concomitant allergens were nickel, balsam of Peru and fragrance mix. In our series, SL allergy is observed to be more common in females and the mean age is lower compared to the classical Compositae dermatitis. The sensitization rate is comparable to other studies, although the clinical relevance is only 11%.

Adolescent↗
PubMed2006

Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome--a descriptive study in Singapore.

Severe acute respiratory syndrome (SARS) was first recognized in February 2003. It is the first severe and readily transmissible new disease to emerge in the 21st century. Healthcare workers in affected countries were exposed to the regular use of personal protective equipment (PPE) such as the N95 mask, gloves, and gowns. Our aim was to study the prevalence of adverse skin reactions to PPE among healthcare workers in Singapore during the SARS outbreak. Healthcare staff in the National Skin Centre and Tan Tock Seng Hospital were surveyed using questionnaires. Of those asked to participate, 322 (94.7%) agreed. 14.3% of the respondents were doctors, 73.0% nurses, and 12.7% other ancillary staff. Mean age of respondents was 32.4 years, with the majority being women (85.7%) and Chinese (53.7%). 109 (35.5%) of the 307 staff who used masks regularly reported acne (59.6%), facial itch (51.4%), and rash (35.8%) from N95 mask use. 64 (21.4%) of the 299 who used gloves regularly reported dry skin (73.4%), itch (56.3%), and rash (37.5%). The use of PPE is associated with high rates of adverse skin reactions. There is a need to find suitable alternatives for affected staff and to encourage awareness among staff of the role of dermatologists in their care.

Adult↗
PubMed2004

Solar urticaria in Singapore: an uncommon photodermatosis seen in a tertiary dermatology center over a 10-year period.

BACKGROUND: Solar urticaria is an uncommon photodermatosis, characterized by the appearance of pruritic wheals after sun exposure. In this study, we examine the photobiological characteristics of solar urticaria in the heterogeneous group of Singaporean patients. METHODS: The photobiological features of all patients treated for solar urticaria at a tertiary dermatology center in Singapore over a 10-year period were retrospectively examined. RESULTS: A total of 19 patients were diagnosed to have solar urticaria from 1993 to 2002. The mean age at diagnosis was 26 years, with a racial distribution of 17 (90%) Chinese, one (5%) Malay, and one (5%) Indian. Fifteen (79%) patients were males and four (21%) were females. The face/neck (47%) and arms/forearms (58%) were most often affected. Six (32%) patients had a history of atopy and two (11%) had dermographism. Fifteen (79%) patients had Fitzpatrick's skin type IV, three (16%) had skin type III and one (5%) patient had skin type V. The mean exposure time to wheal formation was 23 min. The action spectra of solar urticaria were visible light for 12 (63%) patients, ultraviolet (UV) A for one (5%), visible light and UVA for five (27%), and natural sunlight for one (5%) patient. All patients reported partial improvement with a combination of antihistamines and sunscreens as the main modality of treatment. CONCLUSIONS: Our data suggest that solar urticaria is an uncommon photodermatosis and a rare form of urticaria. Wheals were mostly elicited by visible light and/or UVA. A combination of antihistamines and sunscreens provided a useful form of therapy for patients with solar urticaria.

Adult↗
PubMed1995

Traumatic dental injuries at the Accident and Emergency Department of Singapore General Hospital.

The purpose of this retrospective study was to determine the occurrence and the type of after office-hours traumatic dental injuries managed by the Dental Unit of the Accident and Emergency Department at the Singapore General Hospital. During a 2-year period (from August 1990 to July 1992), 461 trauma patients (314 males, 147 females) sustained injuries to 968 teeth. The distribution in different races of Chinese: Malay: Indian: others was 7.3: 1.3: 0.9: 0.5. The predominant age groups were 2-3 years, 3-4 years and 17-18 years; 71.3% of the teeth sustained luxation type injuries, the remaining 28.7% had fractures, 45.3% of the cohort had concomitant soft tissues injuries, while 13.7% had associated facial bone fractures. Teenager traumas were more common during school vacations. It is concluded that thorough standardized documentation is imperative to obtain baseline information on dental trauma. This could facilitate future preventive measures, education and research.

Adolescent↗
PubMed1997

An evaluation of after-office-hour dental trauma in Singapore.

The purpose of this study was to assess the post-traumatic sequelae and treatment outcome and the corresponding prognostic factors at the initial emergency visit. Over a 5-year period, the authors collected case records from 129 dental trauma patients. These patients had been referred subsequent to receiving emergency treatment after office hours at the Accident and Emergency Department of Singapore General Hospital. After the exclusion of 31 cases with concomitant fracture of maxilla and/or mandible and cases with insufficient documentation, the final study sample consisted of 98 patients (41 males, 57 females) who had sustained injuries to 264 permanent teeth. The main cause of dental trauma was falls (56%), and the main type of injuries was periodontal tissue injuries with or without concomitant injuries to hard tissue, including root fracture (73%). For the final evaluation, teeth with insufficient recall period were excluded before univariate and multivariate stepwise logistic regression analysis. It was found that for 100 teeth with luxation type of injuries, the presence of concomitant hard tissue injuries retained prognostic significance for pulpal outcome (p < 0.001) after adjusting for severity of luxation, while the severity of luxation was the only significant factor for periodontal outcome (p < 0.001). For 34 avulsed teeth, the stage of root development was the major factor associated with the pulpal outcome (p = 0.003), while extra-alveolar storage media were found to be significantly related to the periodontal outcome (p < 0.001). For 72 teeth with hard tissue injuries, first-visit interval played a significant role in the outcome (p = 0.03). Although the sample size in the root fracture group was too small for such statistical analysis, the results indicated that patient education on dental trauma was an important factor. Thorough standardized documentation was also recommended to facilitate optimal follow-up management and future research as well as medico-legal purposes.

Adolescent↗
PubMed1997

Declining prevalence of dental caries in school children in Singapore.

OBJECTIVE: Dental health surveys of school children in Singapore from past decades were reviewed to document reductions in prevalence of dental caries. MATERIALS AND METHODS: Surveys were carried out in schools by the Dental Division, Ministry of Health in 1970, 1979, 1984, 1989 and 1994. A sample size of approximately 5000 school children representing 1.2% of the school population aged 6 to 18 years old was examined in each survey. RESULTS: Survey data showed an increase in the proportion of children free of caries in the permanent dentition from 30% in 1970 to 58.7% in 1994. The DMFT index for 6 to 18 year old children has dropped from 2.98 in 1970, 2.61 in 1979, 1.97 in 1984, 1.61 in 1989 to 1.05 in 1994. CONCLUSION: Fluoridation of public water supplies together with the adoption of preventive dental health programmes by the State and professional bodies is credited as the major factor in caries reduction.

Adolescent↗
PubMed1992

Medical care for institutionalised elderly people in Singapore.

This study examined physical and financial arrangements for medical care of institutionalised elderly people in Singapore. Chief administrators of all long-term care facilities were interviewed on the existing arrangements for medical care of their residents. Results showed that 66 out of a total of 68 (97%) homes arranged medical care for residents. Of those, 29 homes offered on-site medical care with alternative arrangements when the in-house facilities were not operating. While government-owned homes would pay for all medical costs incurred by their residents, over 48% of voluntary homes and 87% of commercial homes required residents to be financially responsible for their care. The availability of financial support given to residents for payment of medical care was found to be associated with the type of sponsorship of the homes. While there was adequate physical access to medical care, the lack of financial support would pose a potential barrier to use of medical care for institutionalised elderly people.

Aged↗
PubMed1998

Trigeminal neuralgia. A retrospective survey of a sample of patients in Singapore and Malaysia.

This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in the present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in the general population.

Adult↗