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PubMed2006

Influenza-associated deaths in tropical Singapore.

We used a regression model to examine the impact of influenza on death rates in tropical Singapore for the period 1996-2003. Influenza A (H3N2) was the predominant circulating influenza virus subtype, with consistently significant and robust effect on mortality rates. Influenza was associated with an annual death rate from all causes, from underlying pneumonia and influenza, and from underlying circulatory and respiratory conditions of 14.8 (95% confidence interval 9.8-19.8), 2.9 (1.0-5.0), and 11.9 (8.3-15.7) per 100,000 person-years, respectively. These results are comparable with observations in the United States and subtropical Hong Kong. An estimated 6.5% of underlying pneumonia and influenza deaths were attributable to influenza. The proportion of influenza-associated deaths was 11.3 times higher in persons age >65 years than in the general population. Our findings support the need for influenza surveillance and annual influenza vaccination for at-risk populations in tropical countries.

Adult↗
PubMed1999

Chinese characters: semantic and phonetic regularity norms for China, Singapore, and Taiwan.

Cognitive models of language processing in English are founded on norms for word properties, but their universality is now being explored across different writing scripts and subject groups. Although Chinese characters are popular for this comparative work, their salient properties remain ill defined or poorly controlled. We describe how norms for semantic and phonetic regularity in Mandarin can be calibrated on a regional basis. The rating data that we present from China, Singapore, and Taiwan also illustrate why the diversity of both oral and written forms of Chinese should be considered in future empirical work.

China↗
PubMed2006

Caring for dying patients and those facing death in an acute-care hospital in Singapore: a nurse's perspective.

Nurses are at the forefront of caring for dying patients in hospices, nursing homes, acute-care hospitals, and patients' homes. This study was conducted to explore the emotional and practical experience as well as attitudes of nurses caring for the dying and the deceased in an acute-care hospital in Singapore. The authors explored differences in opinion among the various ethnic groups (Malay, Chinese, Indian, Filipino) that make up the nurse population in this particular hospital. A structured questionnaire was self-administered by the participants to explore nurses' views, opinions, and experiences in caring for dying patients from a quantitative aspect. It specifically addressed attitudinal, ethical, and communicational issues involved in caring for dying patients. Where applicable, a Likert scale ranging from Always to Never or from Strongly Agree to Strongly Disagree was used. One hundred and eighty of 246 questionnaires were returned (73%). Most respondents never or only occasionally felt uncomfortable caring for dying patients, and felt it reminded them of their own mortality, made them treasure life more, and made them ask questions about life and death. In this descriptive study, some difference in attitudes and views among the various ethnic groups was observed.

Adult↗
PubMed2000

Fall incidence in a state psychiatric hospital in Singapore.

The results of a retrospective study of fall incidence during a 1-year period in a psychiatric hospital in Singapore are reported, involving 309 patients who fell one or more times during their stay. The profile of inpatients involved in falls was identified. Data were derived from standard incident forms completed whenever patients had a fall. A total of 348 falls were identified for the 1-year period. Results revealed higher fall rates in younger male epileptic patients; elderly female patients, age 70 and older with depression or dementia; individuals with concomitant medical conditions; and patients taking three types of medication. The majority of falls occurred when the activity level was high in the ward. Young epileptic patients and elderly depressed patients were prone to repeated falls. These results have the potential to assist in identifying patients at high risk and in designing and implementing strategies to prevent such incidents.

Accidental Falls↗
PubMed2006

Mutational hotspot in exon 20 of PIK3CA in breast cancer among Singapore Chinese.

The recent identification of somatic mutations in the catalytic region of PIK3 (PIK3CA) in breast cancer and demonstration of their oncogenic function has implicated PIK3CA in mammary carcinogenesis. To investigate possible ethnic differences in patterns of PIK3CA mutations in Singaporean Chinese breast cancer and to characterize these in a panel of cell lines, we sequenced exons 9 and 20 in 80 primary tumors, 19 breast cancer cell lines and 7 normal human mammary epithelial cells (HMECs). Searching for novel hotspots of mutation, we sequenced additional exons (1, 2, 6, 7, 14 and 18) in 20 primary tumors and 6 breast cancer cell lines. We detected 33 point mutations in 31 of 80 (39%) breast cancers, and 11 mutations in 10 of 19 (53%) breast cancer cell lines. No mutations were detected in normal breast tissue adjacent to the tumor, or in the 6 normal HMECs. The exon 20 A3140G (H1047R) substitution was identified most frequently (22/31, 71%) and showed a significant association with patient age (p = 0.043) and stage of the disease (p = 0.025), but not with ER/PR status or histological grade of the tumor. The incidence of point mutations in PIK3CA, the A3140G substitution in particular, in Singapore breast cancers are among the most frequent reported to date for any gene in breast cancer. The results suggest that mutation of PIK3CA might contribute to development of early stage breast cancer and could provide a potent target for early diagnosis and therapy.

Asian People↗
PubMed1999

Outbreak of Hendra-like virus--Malaysia and Singapore, 1998-1999.

During September 29, 1998-April 4, 1999, 229 cases of febrile encephalitis (111 [48%] fatal) were reported to the Malaysian Ministry of Health (MOH). During March 13-19, 1999, nine cases of similar encephalitic illnesses (one fatal) and two cases of respiratory illness occurred among abattoir workers in Singapore. Tissue culture isolation identified a previously unknown infectious agent from ill patients. This report summarizes the preliminary epidemiologic and laboratory investigations of these cases, which indicate that a previously unrecognized paramyxovirus related to, but distinct from, the Australian Hendra virus is associated with this outbreak.

Abattoirs↗
PubMed1979

Keeping disease at bay: Singapore.

The welfare state has arrived and is thriving in Singapore. Mark McCarthy, a senior lecturer in community medicine at University College Hospital Medical School, London, who visited the country recently, gives his impressions of the progress being made in health services, where the emphasis is on prevention.

Delivery of Health Care↗
PubMed1998

Integration of bioInformatics tools at the National University of Singapore (NUS).

In the past decade "Big Science" such as the Genome Project has generated an enormous amount of data in the life sciences. Concurrently, the synergy of this project with existing research has quickened the pace of biological discovery. But the major drawback that is beginning to be felt worldwide is the primitive level of organisation in the data accumulated. Without a proper framework or knowledge scaffold to hang and interconnect the various bits of data and information, the national knowledge-to-data ratio is declining rapidly. We are trying to serve a solution to this enigma by providing a World Wide Web (WWW) interface to Biosoftware and at the same time have come up with a database integration tool that can query heterogeneous, geographically scattered and disparate databases simultaneously. In this report we will talk about BioInformatics in general with specific reference to BioInformatics Centre (BIC) at the National University of Singapore.

Computational Biology↗
PubMed1998

Collaboration over the Internet--the Melbourne-Singapore way.

The University of Melbourne and The National University of Singapore have established a joint WWW page under the auspices of the Cyberspace Hospital to facilitate inter-regional collaboration and discussion about best practice in research, teaching and clinical activities in general and family practice. Information about each of the two departments are available as well as an electronic forum over the WWW (URL is http:/(/)ch.nus.sg/fammed). Seminal papers on research, teaching and clinical practice are discussed and summarised after critique from GPs from both regions. A paper is discussed every 8 weeks: 1 week to post the paper plus a critique, 6 weeks for discussion, and 1 week to sum up and post the summary. It is planned to progress to audio- and video-conferencing and to widen the participant groups. The process of and difficulties with establishing, maintaining and running the electronic forum is described. Results of the discussions, comments from participants and strategies for the future will be presented as well as a demonstration of the electronic forum.

Australia↗
PubMed1999

A clinical study of 100 new admissions to an adolescent psychiatric inpatient unit in Singapore.

BACKGROUND: Psychiatric inpatient services for children and adolescents in Singapore began in 1982 when Woodbridge Hospital started the Child and Adolescent Inpatient Unit. To date, this is the only unit with specialised facilities and staff in the management of young patients. Admissions were mainly based on a need for custodial management of acute major behavioural disturbances. Patients were discharged for outpatient treatment once these behaviours subsided. METHODS: This is a retrospective clinical study of 100 consecutive new patients admitted from April 1993 to August 1994. RESULTS: Majority of admissions (92%) were adolescents above age 12, who were either attending secondary or vocational school. Most came from nuclear families. Forty-eight percent of referrals were intradepartmental. Ten percent were from general hospitals with 16% as self referrals. Psychoses accounted for the diagnosis in 43%, schizophrenia being the main type. Neurosis and adjustment disorders formed the other main diagnoses. All patients received individual and family treatment. Liaison with schools was required in a third of the cases. Sixty-one percent received pharmacological treatment. Ninety-one percent were discharged home after a stay of less than 3 months. Majority returned to school upon discharge from the hospital. CONCLUSION: The main criteria for admission in this unit, located in an adult psychiatric hospital, is that of custody of young patients with disturbed and unmanageable behaviour. This provides additional stigma for the admissions of young patients with minor psychiatric problems and interferes with comprehensive care including admission required for some adolescents with psychiatric problems.

Adolescent↗
PubMed1999

Standard oesophageal manometry in healthy adults in Singapore.

Data on oesophageal manometry in normal subjects in the East are limited. The aim of this study was to define standard oesophageal pressure values in a group of healthy adults in Singapore. Standard oesophageal manometry was performed on 26 asymptomatic volunteers (12 males and 14 females, aged 19 to 34 years) using the water-perfused capillary system and stationary pull-through technique. Median (range) lower oesophageal sphincter pressure, distal oesophageal contractile amplitude, distal oesophageal contractile duration and distal oesophageal contractile velocity were 13.6 (8.0 to 32.0) mmHg, 93.0 (41.0 to 143.0) mmHg, 3.8 (3.2 to 5.3) s and 3.6 (2.2 to 4.6) cm/s respectively. They were similar in males and females except for distal oesophageal contractile velocity which was higher in males than females [4.0 (3.1 to 4.6) cm/s versus 3.2 (2.2 to 4.4) cm/s, P < 0.01]. They were also generally in line with published normal values from Western countries. The present study helps to establish standards for normal manometric findings, at least among the young adults, in this part of the world.

Adult↗
PubMed1999

Extent and appropriateness of emergency department services usage by foreign workers in Singapore.

The objective of this study was to determine the extent and appropriateness of emergency department services usage by foreign workers. A prospective questionnaire survey of foreign workers who attended the Emergency Department (ED) of Tan Tock Seng Hospital was conducted from 30 December 1996 to 29 January 1997. A foreign worker was defined as a non-citizen, non-permanent resident working in Singapore, excluding students and tourists. Demographic and clinical data were collected. During the study period, 7409 patients above the age of 15 attended the ED of which 1174 (15.8%) were foreign workers. Forty-seven per cent of these foreign workers could not speak English, of whom 48.2% did not come with any English-speaking companion. Most of their ED visits were on weekdays and during office hours. Of the foreign workers, 43.1% were classified as non-emergency by ED doctors compared to 6.7% of other ED patients (P < 0.01). Trauma-related complaints accounted for 43.4% while febrile and minor infectious illnesses accounted for 26.7% of foreign workers' complaints. Admissions from ED into the hospital were 17.1% for foreign workers and 28.3% (P < 0.01) for other patients. Language barrier and lack of information on types of health care services available could have led to the high proportion of inappropriate use of ED services by foreign workers. Most of their complaints were minor injuries and illnesses which could be managed by non-ED health care providers. Care provided across a language barrier raises ethical and medico-legal questions. A multi-agency approach involving the Manpower and Health Ministries, employer and foreign worker representatives is needed to eliminate language barrier and help these workers to use health care services appropriately.

Adolescent↗
PubMed1999

Preliminary results of heart-beating and non-heart-beating donor kidney transplants--the Singapore experience.

Renal transplantation is the ideal renal replacement therapy for treatment of end stage kidney failure but its limitation is the constant shortage of cadaveric donors. While the traditional source of cadaveric kidneys is procurement from heart-beating donors, organ procurement from non-heart-beating donors (NHBD) would help in coping with the rising demand for organs. However various important legal, logistic and technical constraints have limited the implementation of such a procurement programme. Nevertheless, prolonged warm ischaemic times in procuring kidneys from NHB donors may affect the viability of these organs and adversely affect overall outcome after transplant. Fifty-three consecutive patients who underwent renal allotransplantation (Tx) between January and December 1994 at the Singapore General Hospital were retrospectively reviewed. Outcomes after renal transplantation among 25 heart-beating donor (HBD) and 28 NHBD were compared. Despite significant differences in donor age (23.7 +/- 11.0 and 34.1 +/- 7.9, P = 0.001), first warm (0 and 22.2 +/- 9.0 minutes) and cold ischaemic times (12.8 +/- 6.7 and 5.2 +/- 5.0 hours, P = 0.001) between the HBD and NHBD groups, the two-year patient and graft survivals were very similar in both groups (100% versus 98% and 98% versus 96%). The incidence of delayed graft function (DF) was also comparable between the HBD (41%) and the NHBD (50%) Tx. These results suggest that NHBD is a viable source for kidney transplants and comparable patient and graft survivals can be achieved if the first warm and cold ischaemic times are kept to the minimum.

Adolescent↗
PubMed1999

Current indications for open stone surgery in Singapore.

A 3-year retrospective study (January 1995 to December 1997) of all treatment modalities for urinary stone disease done in the Department of Urology, Singapore General Hospital was documented, and open stone surgery identified. Patient's characteristics, stone burden, surgical factors, indications and outcome were reviewed for each patient. Of the 2651 procedures performed for urinary stone disease, the majority had extracorporeal shockwave lithotripsy [78% (n = 2075)], while 11% (n = 298) had percutaneous nephrostolithotomy and 9% (n = 228) ureteroscopy. Open stone surgery rate was 2% (n = 50) which included 16 anatrophic nephrolithotomies, 5 pyelolithotomies, 18 ureterolithotomies and 11 nephrectomies. There were 28 males and 22 females varying in age from 26 to 63 years (mean 48 years). The most common indications for open stone surgery were complex stone burden [38% (n = 19)], failure of minimally invasive modalities [16% (n = 8)], non-functioning kidneys [20% (n = 10)], concurrent open surgery [8% (n = 4)], co-morbid medical condition [4% (n = 2)], patient preference for open procedure [8% (n = 4)], anatomic abnormality [4% (n = 2)] and obesity [2% (n = 1)]. Stone free rate of 90% was achieved, morbidity of 8% (n = 4) mostly wound infections and a pneumothorax. Majority of patients with urinary tract calculi can be treated with less invasive modalities. Complex stone burden, failure of less invasive modalities, non-functioning kidney, concurrent open surgery, co-morbid medical problems, patients' preference, anatomic abnormality and obesity are factors to be considered in a small cohort of patients who may still benefit from treatment using open surgical technique.

Adult↗
PubMed1999

Use of ligase chain reaction and polymerase chain reaction on urine specimens to detect Chlamydia trachomatis infections in a sexually transmitted diseases clinic in Singapore.

This study was done to assess the specificity and sensitivity of the DNA amplification assays of ligase chain reaction (LCR) and polymerase chain reaction (PCR) on urine specimens to detect Chlamydia trachomatis infections in both male and female patients seen at a sexually transmitted diseases (STD) clinic in Singapore, compared with other diagnostic methods currently in use. A total of 100 patients were selected; 50 male patients diagnosed with non-gonococcal urethritis based on symptoms and a positive Gram-stained urethral smear and 50 female asymptomatic sex workers were assessed. Automated assays using LCR and PCR were used, and compared to enzyme immunoassays, chlamydial cell cultures and PCR of urethral and endocervical swab specimens. In male patients, LCR and PCR of urine specimens had sensitivities of 100%, compared to 87.0% for PCR of urethral swab specimen, 82.6% for enzyme immunoassay (EIA) and 91.3% for cell cultures. In female patients, LCR and PCR of urine samples achieved sensitivities of 77.8% and 88.9% respectively, compared with 55.6% for PCR of endocervical swab specimens, 22.2% for EIA and 66.7% for cell cultures. LCR and PCR of urine samples provided higher sensitivity compared to cell cultures, EIA and PCR of urethral and endocervical swab specimens. The use of LCR and PCR on urine as a non-invasive means of detecting chlamydial infections is viable, and may have a role to play in population-based screening programmes.

Adult↗
PubMed1999

Record and around the world flights through Singapore by women.

Women's efforts to fly as military pilots during World War I were unsuccessful. However, their numbers and achievements increased and, in 1929, they formed the Ninety-Nines and held the first Women's Air Derby, where male pilots escorted them and mechanics were available. In May 1930, England's Amy Johnson became the first woman to fly solo from England to Australia. She was flying for the Air Transport Auxiliary in England when she was killed in an aircraft accident in 1941. New Zealander Jean Batten set new records over the same course in May 1934, from England to New Zealand in Oct. 1936 and from Australia to England in Oct. 1937. Routes were typically via Singapore as were round-the-world efforts by Amelia Earhart (1937), Joan Merriam Smith (1964), Sheila Scott (1966), and Ann Pellegreno (1967). Accounts frequently mention severe weather including monsoon storms. Adequacy of flight planning has been questioned for some. Jerrie Mock, the first woman to fly around the world alone, in 1964, was asked by Saigon Radio if she had a man aboard. Further successes and independence for women in aviation have been slow, but steady.

Aerospace Medicine↗
PubMed1999

Psychiatric survey of offenders under criminal commitment in Singapore.

AIM OF STUDY: The study examined the demographic characteristic, pattern of psychiatric morbidity in offenders committed by Singapore courts and the effects of psychiatric recommendations on the disposal of these offenders. METHODS: A retrospective case-note study was done on all offenders committed by the courts from January 1987 to December 1988 to Woodbridge Hospital. A 23-item questionnaire was used to collect data from the offenders. RESULTS: There were 187 offenders in the study, 165 males and 22 females. The typical offender was Chinese, male, unemployed and suffered from schizophrenia. 63.1% of the offenders required treatment after commitment. 13.9% had no psychiatric disorder. At the end of commitment, charges were dropped in 25% of cases. Theft was the most common offense and this was followed by sexual offences (molestation, outrage of modesty, exhibitionism). Offenders with schizophrenia were more likely than the others to have committed violent offences. CONCLUSION: A large proportion of offenders were unwell at the time of the offence, the majority were suffering from schizophrenia. 13.9% had no psychiatric illness and charges were dropped in 25% indicating that the legal process could be further improved by providing additional psychiatric input to the courts so that offenders who exhibit abnormal or deviant behaviour may be appropriately dealt with.

Adolescent↗
PubMed1999

A retrospective study on the clinical presentation and treatment outcome of melasma in a tertiary dermatological referral centre in Singapore.

BACKGROUND: This is a retrospective study on the epidemiology of 205 patients with melasma seen in a tertiary dermatological referral centre in Singapore. PATIENTS: The mean age of the 205 patients with melasma was 42.3 years with a female preponderance of 21:1 female to male ratio. There were proportionally more Chinese with melasma than the other races compared to the racial distribution of patients attending our clinic. Ninety percent of our patients had skin type III or IV. The mean age of onset of melasma was 37.6 years. Most sought treatment only 5 years after the appearance of their melasma. Forty-six percent of melasma were light brown, the majority of which were distributed on the malar areas (89%). More than 2/3 had epidermal melasma. Eighty-eight percent had mild localised melasma (occurring on < 20% of the total facial area). Only 26.8% of our patients reported sun exposure, 25 (12.1%) reported pregnancy and 27 (13.1%) reported oral contraceptives as precipitating factors. A positive family history of melasma was observed in 21 (10.2%) patients. Sunscreen forms the backbone in the treatment of melasma in our patients. Most patients were prescribed a sunscreen together with hydroquinone containing bleaching cream (54%) as first line treatment. Patients with epidermal type of melasma responded slightly better to treatment than those with dermal type of melasma (28% experienced > 25% reduction in pigmentation compared to 16% respectively (n.s.)). CONCLUSION: Overall, 53% of our patients experienced some reduction of pigmentation with 28% experiencing > 25% reduction and 7% experiencing > 75% reduction. In 40%, the pigmentation remained stable with treatment. Treatment of melasma remains an enigma. More studies need to be undertaken to improve treatment response to alleviate the psychosocial impact melasma has on the patient.

Adult↗