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PubMed1996

Abortion trends in Singapore: a 25-year review.

STUDY OBJECTIVE: Abortion legislation in Singapore has gone through dramatic changes in the past 25 years. In this paper, we studied the effect of abortion legislation on abortion trends in Singapore. SETTING AND PARTICIPANTS: The Ministry of Health, Singapore, collects data on all abortions performed in Singapore. These data have been analyzed and are presented in this paper. RESULTS: The liberalization of abortion legislation resulted in a dramatic increase in the number of abortions performed beginning in 1974. The rate peaked at 23,512 abortions in 1985, and in fact, 35% of all pregnancies were terminated in 1985. The introduction of mandatory abortion counseling in 1986 resulted in a decline in the number of abortions to 16,476 in 1993 with only 24.6% of pregnancies being terminated. The teenage abortion rate was 0.2 per 1000 female teenagers under 20 years of age in 1970. With the liberalization of abortions, the rate reached a peak of 13.7 per 1000 female teenagers in 1985. In 1993, the teenage abortion rate was 9.5%. The proportion of nulliparous women seeking abortion has increased phenomenally from 0.5% in 1976 to 40.6% in 1993. Close to 95% of the women seeking abortions in 1993 did so for social reasons, 3.7% for medical reasons, and 2.0% for failed contraception (Table 3). CONCLUSION: Mandatory abortion counseling and a change in the government policy which now encourages Singaporeans to have more children if they can afford it, have resulted in a decrease in the number of abortions being performed. The problems of teenage abortions, nulliparous abortions, and repeated abortions need to be further addressed.

Abortion, Legal↗
PubMed2005

Serological evidence for the co-circulation of multiple dengue virus serotypes in Singapore.

We did a seroepidemiological study to determine the circulating dengue virus serotypes and the extent to which the Singapore population has been exposed to multiple dengue virus serotypes, using the plaque reduction neutralization assay (PRNT). Of 164 enrolled subjects aged between 18-30 years, 49 subjects (29.8%) were PRNT positive for at least one dengue serotype. The seroprevalence was 39 (23.8%) for dengue virus serotype 1, 37 (22.6%) for type 2, 43 (26.2%) for type 3, and 30 (18.3%) for type 4. Of the 49 subjects with PRNT-positive dengue virus results, 28 (57.1%) were positive to all four virus serotypes, seven (14.3%) to three serotypes, two (4%) to two serotypes, and 12 (24.5%) to a single serotype. All four dengue virus serotypes circulate in Singapore, and a substantial proportion of the adult population in Singapore had exposure to more than one dengue virus serotype. In spite of multiple circulating types, the rate of dengue haemorrhagic fever is low in Singapore.

Adolescent↗
PubMed2001

Retinal detachment in Chinese, Malay and Indian residents in Singapore: a comparative study on risk factors, clinical presentation and surgical outcomes.

PURPOSE: To evaluate the risk factors, clinical presentation and surgical outcomes of retinal detachment (RD) among Chinese, Malay and Indian residents in Singapore. METHODS: A retrospective descriptive study from January 1995 to December 1998. All RD operations performed at a tertiary ophthalmic center in Singapore were initially identified from a computerized audit database. Case records data of all Malay and Indian patients as well as a 10% randomized sample of Chinese patients were retrieved and analyzed. Tractional and exudative RD's were excluded. RESULTS: Of the Singapore residents who had a RD operation over the 4-year period, 597 (89.6%) were Chinese, 47 (7.1%) were Malays and 22 (3.3%) were Indians. The age (mean: 46.1 +/- 15.5 years), gender distribution (70.5% males) and presenting visual acuities were similar in the 3 races. The most common site of the retinal break(s) was the superotemporal retina (44.9%), followed by the inferotemporal retina (15.3%). Chinese patients were more likely to have multiple or indeterminate breaks (p = 0.09) and macula-on RD (p = 0.04), compared to Malays and Indians. The distribution of known risk factors (myopia, lattice degeneration, prior cataract surgery and prior ocular trauma) was similar between the three races. The majority of patients required a scleral buckling operation either in isolation (71.3%), or in combination with vitrectomy (19.4%), and only 10 (7.8%) had vitrectomies without buckles. At 6 months postoperatively, anatomical success (defined as an attached retina on ocular examination) and functional success (defined as visual acuities of 6/60 or better) were achieved in 108 (94.7%) and 62 patients (54.4%), respectively, with no significant racial variation seen. The overall rate of redetachment after the initial operation was low (9.3%). CONCLUSION: Variation in risk factors, clinical presentations and postoperative outcomes of retinal detachment appears to be minimal among Chinese, Malays and Indians in Singapore.

Adult↗
PubMed1997

Clinical and microbial spectrum of fungal keratitis in Singapore: a 5-year retrospective study.

BACKGROUND: The epidemiology of fungal keratitis varies geographically, but commonly occurs in warm, tropical climates. To determine the microbial and clinical characteristics of this disease in Singapore, we conducted a 5-year hospital-based retrospective study. METHODS: A retrospective review of culture-positive fungal keratitis at the Singapore National Eye Center and Singapore General Hospital, from January 1991 to December 1995. RESULTS: Twenty-nine consecutive cases of culture-positive fungal keratitis were seen over the study period. The mean age of the cases was 41 years and 23 were males. Amongst the varied occupations, 9 were construction workers. The most common cultured organisms were Fusarium sp. (52%) and Aspergillus flavus (17%). More than half had a history of ocular trauma prior to the development of keratitis, while a quarter had antecedent topical corticosteroid therapy. In contrast, only 2 patients were contact-lens wearers. Despite medical therapy, 10 patients eventually required therapeutic penetrating keratoplasties; of these, 6 were caused by Fusarium species. CONCLUSION: Fusarium is the commonest cultured organism in fungal keratitis in Singapore and is associated with significant ocular morbidity.

Adult↗
PubMed2000

Epidemiology of occupational skin disease in Singapore 1989-1998.

This is an epidemiologic study of occupational skin disease in Singapore. All patients diagnosed with occupational dermatoses in the National Skin Centre, Singapore, over the 10-year period 1989-1998 were studied retrospectively. Irritant contact dermatitis was found to be more common than allergic contact dermatitis. The major sources of occupational dermatitis in Singapore were the metal/engineering, building/construction, electrical/electronics and transport industries. The main irritants were detergents/wet work, solvent and oil/grease. The main allergens were chromate, rubber chemicals and nickel. We concluded that the main sources of occupational skin disease and main allergens in Singapore had remained the same compared to a similar study of occupational skin diseases in 1984-85. Weak irritants are still the predominant causes of occupational irritant contact dermatitis, though the main irritants have changed compared to the previous study, where cutting fluids, cement and solvent were the most common irritants.

Adolescent↗
PubMed1999

A prospective study of the clinical features, manometric findings, incidence and prevalence of achalasia in Singapore.

BACKGROUND: This study aimed to describe the clinical features, manometric findings, prevalence and incidence of achalasia in Singapore. METHODS: A total of 615 new patients referred for oesophageal manometry between 1989 and 1996 were examined prospectively. Twenty-four men and 25 women fulfilled the manometric and clinical criteria for achalasia. RESULTS: Their median age of onset of symptoms was 37 years (range 15-71) and 37% first developed symptoms after the age of 50 years. The presenting symptoms were dysphagia (100%), regurgitation (80%), weight loss (67%) and chest discomfort (33%). Five patients (10%) had a history of benign (mostly autoimmune) thyroid disorders. Endoscopy was reported as normal in 10/43 patients (23%) and achalasia was suggested in only 31 (72%) of 43 barium examinations. Lower oesophageal sphincter (LOS) dysfunction was present in 82% of cases. Using data from medical records and from a survey of gastroenterologists and surgeons in Singapore, the prevalence (in 1996) and incidence of achalasia in Singapore were estimated to be 1.8 per 100000, and 0.3 per 100000 per year, respectively. The incidence was significantly lower in Malays than Chinese or Indians. The age-specific incidence of achalasia for both genders followed a bimodal distribution with the larger peak in the sixth decade. No cases of oesophageal carcinoma were identified among these patients. CONCLUSION: Achalasia is an uncommon condition in Singapore. The clinical and manometric features were similar to those described in Western countries.

Adolescent↗
PubMed2001

Autoimmune hepatitis in Singapore: a rare syndrome affecting middle-aged women.

BACKGROUND AND AIM: The prevalence of autoimmune hepatitis in Singapore is unknown. Over a period of 7 years, 24 cases were diagnosed in a district general hospital in Singapore (Toa Payoh Hospital) by using the scoring system proposed by the International Autoimmune Hepatitis Group in 1993. The aims of our study were to determine the prevalence of autoimmune hepatitis in Singapore, and to investigate the characteristics and prognosis in the mainly Chinese population. METHODS: The case records of all 24 patients were reviewed, and the following parameters were recorded: age at presentation, sex, symptoms and signs at presentation, past exposure to hepatotoxic drugs, alcohol intake, blood transfusion laboratory and histological tests used to determine autoimmune hepatitis, response to treatment, complications, and survival. RESULTS: The mean age of patients was 57 years old. There was a female-male ratio of 11:1. Forty-two percent of the patients were cirrhotic at presentation. The prevalence of autoimmune hepatitis was four per 100 000, with no significant difference between Chinese, Malay and Indian patients (Odds ratio of 0.38 by the chi-squared test). Eighty-nine percent of the patients responded to treatment with the induction of prednisolone, but the relapse rate was 61%. Treatment failure occurred in one patient. The mortality rate during the 7 years of follow up was 21%, and all were caused by complications of cirrhosis. The survival at 5 years was 71%, with a standard error of 0.13. CONCLUSION: Autoimmune hepatitis in Singapore is mainly a disease in older women. The response to steroid treatment is good, with a 5-year survival rate of 71%.

Anti-Inflammatory Agents↗
PubMed2006

The tick Ixodes granulatus infests Rattus rattus populating a small island offshore of Singapore.

The ixodid tick Ixodes granulosus Supino 1897 was found infesting Rattus rattus in Semakau island, one of the small offshore islands fringing Singapore to the south. None of the examined R. rattus from the other islands fringing Singapore, or from Singapore island were found infested. Ixodes granulatus occurs, however, on Singapore island on Rattus annandalei, resident of undisturbed forested habitats. We speculate that invading black rats in Semakau replaced autochthonous sylvatic rodent population and contracted their associate tick population.

Animals↗
PubMed2003

Population-based survival for cervical cancer in Singapore, 1968-1992.

OBJECTIVE: The aim of this study was to describe the cervical cancer survival rates in Singapore during the period of 1968 through 1992 using population-based data. STUDY DESIGN: A review of cases with cervical cancer diagnosed between 1968 and 1992 from Singapore Cancer Registry was conducted. Information on vital status at December 31, 1997, was available for 3531 cases. Cumulative observed and relative survival rates were computed by using Hakulinen's method. RESULTS: Survival in cervical cancer in Singapore has improved over the 25-year period. The overall 5-year age-standardized relative survival (ASRS) for all patients increased from 45% in 1968-1972 to 65% in 1988-92. Poorer survival rates were observed in elderly patients and Malays. CONCLUSION: The improvement in survival of cervical cancer is likely to be attributed to the rapid national development of Singapore, resulting in the improvements in health services infrastructure and accessibility, as well as to the impact of widely available cytology-based screening resulting in early detection.

Adolescent↗
PubMed2006

A brief history of psychiatry in Singapore.

The development of psychiatric services in Singapore during the last 150 years can be divided into four distinct, albeit overlapping, phases: (1) the origins of the Lunatic Asylum; (2) the interruption caused by the Japanese Occupation, and the post-war years; (3) the training of local psychiatrists and mental health professionals; and (4) the development of general hospital psychiatry and community mental health services. Early psychiatry in Singapore was essentially British psychiatry as an outpost but modified by local conditions. Modern psychiatry in Singapore has its roots in Singapore's colonial past and is strongly influenced by Western psychiatry. It has come a long way since its humble beginnings when the first mental hospital was established in 1841.

Colonialism↗
PubMed1998

Trends in cerebrovascular disease mortality in Singapore: 1970-1994.

BACKGROUND: Cerebrovascular disease has been the third leading cause of death in Singapore for the last 25 years. This study was carried out to examine recent trends in cerebrovascular disease mortality in Singapore, and to study corresponding changes in stroke risk factors in our population. METHODS: The Registry of Births and Deaths, Singapore, publishes annual reports on births and deaths. The cause of death is coded using the International Classification of Diseases Revisions 8 (1969-1978) and 9 (1979 onwards). Data for this study were obtained using rubrics 430-438. Death rates were age- and sex-standardized to the World Standard Population, and separately for males and females. Cerebrovascular disease risk factor patterns were derived from national epidemiological health surveys conducted from 1970 and 1994. RESULTS: The absolute number of deaths annually from cerebrovascular disease rose from 1041 in 1970 to 1692 in 1994. Crude death rates remained stable at 50-60 per 100000, accounting for 10-12% of all deaths. Standardized death rates showed a distinct fall from 99 per 100000 in 1976 to 59 per 100000 in 1994, 101 to 60 per 100000 in males and 95 to 57 per 100000 in females. National health surveys have shown a fall in the prevalence of undetected hypertension, smoking and hyperlipidaemia; the prevalence of obesity was unchanged, while that of diabetes mellitus rose over the same period. The mortality trends found in this study are unlikely to be due to changing fashions in coding or inadequate data collection. CONCLUSION: As in many countries in the world, cerebrovascular disease mortality in Singapore has fallen over the last 25 years; this may in part be related to the decline in stroke risk factors in our population.

Age Distribution↗
PubMed2002

Prevalence of birth defects and parental work in Singapore live births from 1994 to 1998: a population-based study.

The aims of the study were to assess the prevalence of birth defects (BDs) among different occupational groups and non-working parents, and to identify possible risk factors associated with BDs in Singapore live births born between 1 January 1994 and 31 December 1998. To do this, information on live births (from the Singapore National Registry of Births and Deaths) and BD cases [from the National Birth Defects Register (NBDR)] was obtained from 1 January 1994 to 31 December 1998. There were a total of 237 755 live births in Singapore between 1 January 1994 and 31 December 1998. Over the same period, 3293 cases of BDs were reported to the NBDR, giving an overall rate of 13.9 per 1000 live births. A downward trend with time was noted. Of the live born with BDs in this series, 36.7% presented with multiple anomalies. The overall occurrence of malformation (per 1000 live births) among working versus non-working mothers was 13.4 versus 14.2, respectively, and 13.8 for working fathers compared with 16.8 for non-working fathers. Parents in the occupational group 'Legislators, Senior Officers & Managers' had the lowest prevalence rates of congenital anomalies (9.4 per 1000 for mothers and 10.3 per 1000 for fathers), while the 'Agricultural & Fishery Workers' had the highest rates (40.0 per 1000 for mothers and 23.4 per 1000 for fathers). However, the very small number of workers in this latter group makes the rate unreliable. The prevalence of BDs in Singapore is comparable to those in other countries. Parental work per se is not correlated with BDs.

Adult↗
PubMed2007

Asthma fatalities at the Emergency Department of the Singapore General Hospital.

BACKGROUND: Bronchial asthma is one of the most common chronic diseases in Singapore and the prevalence is increasing. Despite this, the worldwide mortality rate from asthma has been noted to be low at an average of 2.0 per 100,000 people in developed countries such as the United States. Risk factors for fatal asthma attacks that have been described include excessive use of short acting beta-agonists, errors in clinical judgement, poor compliance, psychosocial disorders, use of three or more groups of asthma medication and indicators of asthma severity. AIM: We aim to study the incidence of asthma deaths occurring in the emergency department of a tertiary care hospital in Singapore. METHODS: Of the total number of patients at the Department of Emergency Medicine in Singapore General Hospital from January 1999 to June 2005, eight fatalities were attributed to exacerbation of bronchial asthma. The characteristics of these patients are described. RESULTS: A low incidence of asthma-related deaths is found in Singapore.

Adult↗
PubMed1997

Regionalization, economic restructuring and labour migration in Singapore.

"This paper documents the impact of economic development on changes in employment and labour migration in Singapore. High export-led growth and the relaxation of immigration policies in the late 1960s enabled employment of substantial numbers of unskilled foreign labour in manufacturing, construction and domestic service sectors....Economic development in the 1990s, characterized by the regionalization drive which relocates relatively resource-intensive operations of Singapore-based companies overseas, has led to increased retrenchments and a moderation of demand for foreign workers. The upgrading of remaining production operations in Singapore is expected to increase demand for workers with higher skill levels. Emigration of highly educated and skilled professionals from Singapore became a national concern in the late 1980s. However, with regionalization, the new challenge in the 1990s has become one of encouraging Singaporeans to temporarily take up overseas positions." (SUMMARY IN FRE AND SPA)

Asia↗
PubMed2005

A study of natural rubber latex allergens in gloves used by healthcare workers in Singapore.

BACKGROUND: Allergy to natural rubber latex (NRL) proteins is a well-recognized health problem among subjects using protective gloves and products made of NRL. There is currently no information on NRL allergen levels in gloves used in Singapore. OBJECTIVES: This study aims to quantify the amount of specific allergens (Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02) found in rubber gloves used in Singapore. It also aims to determine if these levels are above thresholds that may cause NRL allergy. It also compares the levels of these specific allergens in gloves used for different purposes, namely gloves used for examination purposes or for surgical procedures. METHODS: Forty-nine rubber gloves were obtained from major hospitals and healthcare departments in Singapore and were analysed for their NRL allergen levels. FITkit, based on the enzyme immunometric assay technique, was used to determine the specific allergen levels of Hev b 1, Hev b 3, Hev b 5 and Hev b 6.02 in the gloves. RESULTS: Examination gloves had higher NRL allergen content compared with surgical gloves, and powdered gloves had higher allergen content compared with nonpowdered gloves. Among the various allergens, Hev b 5 and Hev b 6.02 were present in larger quantities than Hev b 1 and Hev b 3. Only two of 19 (11%) surgical gloves had the sum of the four allergens (Hev b 1, Hev b 3, Hev b 5, Hev b 6.02) in excess of 1 microg g(-1), which is believed to be a clinically relevant threshold. Among the examination gloves, 25 of 30 (83%) exceeded this level. CONCLUSIONS: This study shows that NRL allergen levels are present in the majority of examination gloves used by healthcare workers in Singapore at levels high enough to cause NRL allergy among sensitized persons. The information can serve as evidence for a possible requirement for manufacturers to produce gloves with low NRL allergen levels and to state the allergen level in gloves in the product information.

Allergens↗
PubMed2006

Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan.

Capsular serotypes, magA, and rmpA have been documented in high prevalence for Klebsiella pneumoniae liver abscess. To investigate the regional difference and the correlation of capsular serotype, magA, and rmpA with virulence, 73 isolates were collected in Singapore and Taiwan. Capsular serotypes were determined by countercurrent immunoelectrophoresis, the presence of magA and rmpA was determined by PCR, and virulence was determined by phagocytosis and mouse inoculation. Isolates from Singapore were similar to those from Taiwan in genomic heterogeneity, prevalence of serotype, and the presence of magA and rmpA. The most common serotype was K1 (34/73; 46.6%), followed by K2 (15/73; 20.5%). magA was restricted to serotype K1. All K1 or K2 isolates and 66.7% (16/24) of isolates that were neither serotype K1 nor serotype K2 (non-K1/K2) carried rmpA. Serotype K1 or K2 isolates demonstrated significantly more phagocytic resistance and virulence than did rmpA-positive and -negative groups of non-K1/K2 isolates. In the non-K1/K2 group, the virulence profiles of rmpA-positive strains from Taiwan and Singapore were different by phagocytosis assay and in the mouse model, indicating that factors other than rmpA contributed to virulence. The characteristics of K. pneumoniae liver abscess in Singapore and Taiwan are similar. Capsular serotype K1 or K2 plays a more important role than magA and rmpA in determining virulence in K. pneumoniae liver abscess.

Animals↗
PubMed1985

Comparison of birthweight and infant mortality between Singapore and England and Wales, 1980.

For 1980 Singapore was found to have overall a more favourable birthweight distribution than England and Wales. The proportion of very low birthweight babies (less than 1500 g) and heavy babies (3500 g and over) was 0.4% and 18.5% in Singapore and 0.7% and 34.9% in England and Wales for live births, and 0.6% and 18.5% against 0.9% and 34.7% for total births. However, for low birthweight (less than 2500 g) Singapore with 7.5% in live births and 7.9% in total births had higher rates than England and Wales (6.7% and 7.2%). While infant mortality rates were very similar, Singapore had a somewhat higher neonatal mortality rate but a considerably lower postneonatal mortality rate than England and Wales. The effects on mortality of standardising for birthweight are examined. The problems of interpretation and the implications of the findings are discussed.

Birth Weight↗
PubMed1990

Cardiovascular diseases in Chinese, Malays, and Indians in Singapore. I. Differences in mortality.

STUDY OBJECTIVE: The aim of the study was to analyse differences in mortality from the main cardiovascular diseases (ischaemic heart disease, hypertensive disease, and cerebrovascular disease) among Chinese, Malays, and Indians in Singapore. DESIGN: The study was a survey using national death registration data in Singapore for the five years 1980 to 1984. The underlying cause of death, coded according to the ninth revision of the International Classification of Diseases, was taken for the analyses. SETTING: The study was confined to the independent island state of Singapore, population 2.53 million (Chinese 76.5%, Malays 14.8%, Indians 6.4%, Others 2.3%). Death registration is thought to be complete. SUBJECTS: All registered deaths in the age range 30-69 years during the study period were analysed by ethnic group. MEASUREMENT AND MAIN RESULTS: Indians had higher mortality from ischaemic heart disease than the other ethnic groups in both sexes, with age-standardised relative risks of Indian v Chinese (males 3.8, females 3.4), Indian v Malay (males 1.9, females 1.6), and Malay v Chinese (males 2.0, females 2.2). The excess mortality in Indians declined with age. For hypertensive disease Malays had the highest mortality, with age-standardised relative risks of Malay v Chinese (males 3.4, females 4.4), Malay v Indian (males 2.0, females 2.5), and Indian v Chinese (males 1.6, females 1.6). For cerebrovascular disease there was little ethnic difference except for lower rates in Chinese females, with age-standardised relative risks of Malay v Chinese (males 1.1, females 1.9), Malay v Indian (males 1.0, females 1.1), and Indian v Chinese (males 1.1, females 1.7). CONCLUSIONS: There are significant differences in mortality from the three main cardiovascular diseases in the different ethnic groups in Singapore.

Adult↗