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PubMed1999

Spontaneous subarachnoid haemorrhage and outcome--results from Tan Tock Seng Hospital, Singapore.

AIM OF STUDY: To ascertain the number of cases of spontaneous (aneurysmal) subarachnoid haemorrhage presenting to Tan Tock Seng Hospital, Singapore, over a one year period, the demographics of the patients involved, their treatment and their eventual outcome. METHOD: A retrospective study from June 1995 to June 1996. RESULTS: There were 62 patients admitted over this period with an average of 5 patients per month. Their ages ranged from 9 to 85 years with a mean of 54 years. All 62 patients underwent 4-vessel cerebral angiograms. Forty-three patients (69%) underwent clipping of their aneurysms. Twelve patients (19%) had negative angiograms. Four patients (6%) underwent coiling of their aneurysms via interventional neuroradiology techniques. Patients with subarachnoid haemorrhage of Grades 1 to 3 on the WFNS (World Federation of Neurological Surgeons) grading had a favourable outcome (Glasgow Outcome Score of 4 and 5) in 85% of the cases. The overall mortality rate for the operated group (all grades) was 11%. However for the group with good WFNS grading, namely the Grade 1 to 2 groups, there were no deaths. Twenty-four percent of patients developed clinically symptomatic vasospasm. Eighteen percent of patients required ventriculo-peritoneal shunting for hydrocephalus secondary to the subarachnoid haemorrhage. The overall management mortality (operated and non-operated cases) was 14% for proven aneurysmal and angiographically-negative spontaneous subarachnoid haemorrhage. These results are comparable to that of other reputable centers reported in the literature.

Adolescent↗
PubMed1999

A cross-sectional survey of physical activity among middle aged women in Singapore.

OBJECTIVES: To assess the extent to which middle-aged women in Singapore engage in physical activity of a level which would result in long-term health benefits, and to determine the factors associated with this. METHODS: We conducted a cross-sectional survey of women aged between 35 and 60 years residing in Marine Terrace. A standardised questionnaire incorporating a modified Seven-Day Recall Questionnaire was used to record the level and type of physical activity engaged in over the past week. Demographic information and factors promoting or discouraging sports and exercise were also elicited. The total energy expenditure for household, occupational and sports activities of moderate intensity and above was calculated using metabolic equivalents (METs) in kcal/kg/week. RESULTS: Of the 341 respondents, 50.7% reported engaging in at least moderate activity for 30 minutes or more every day during the past week, thus fulfilling the WHO recommendations on physical activity. Housework contributed significantly to the energy expenditure on these activities among our target population. After adjusting for age, body mass index and educational level, we found that housewives without domestic help were most likely to fulfill the WHO recommendations. Housewives or working women with domestic help were the two groups at highest risk of low physical activity. A lack of time was the reason most commonly cited for not engaging in sports or exercise. CONCLUSION: Studies assessing physical activity in relation to disease risk among women should include domestic work in addition to the traditional leisure-time activities. There is a scope for further efforts to improve the level of activity in this population, which could be facilitated by the support of health professionals, employers and family members.

Adult↗
PubMed1999

HealthLine--a telephone health information and promotion service in Singapore.

HealthLine is a toll-free telephone information service on healthy living. Provided by Singapore's Ministry of Health, it augments national health promotion programmes and simultaneously feels the pulse of the common health concerns of the population. The development of the telephone information service is described and the ease of the use of telecommunication in the provision of health information and promotion is highlighted in the paper.

Health Promotion↗
PubMed1999

Disseminated Penicillium marneffei infection: a report of five cases in Singapore.

Penicillium marneffei has emerged as an important opportunistic pathogen in HIV-infected patients in Southeast Asia. We report the first 5 cases of P. marneffei diagnosed in Singapore. All the patients were HIV-infected and were either Thai nationals or had frequently travelled to Thailand. Fever, weight loss, anaemia and papular skin lesions were common clinical manifestations in our patients, all of whom had the organism isolated from blood. Skin biopsy specimens showed histological evidence of P. marneffei in 2 patients. In 1 patient each, the organism grew in cultures of specimens from bone marrow and respiratory secretions. Amphotericin B therapy followed by itraconazole were used in 3 of our 5 patients and was associated with good clinical response and outcome.

AIDS-Related Opportunistic Infections↗
PubMed1999

Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma.

BACKGROUND: The objective of the current study was to describe the survival of nasopharyngeal carcinoma (NPC) patients in Singapore, verify the prognostic value of the revised 1997 TNM staging system, and develop a multivariate prognostic model for NPC. In addition, the authors also examined the prognostic value of characteristics of lymph node spread and parapharyngeal involvement. METHODS: A prospectively maintained database containing clinical and computed tomography scan data was used to reclassify 677 NPC patients treated between 1992 and 1994 according to the new staging system. Records were linked with the death registry to ascertain the patient's vital status and date of death. Overall and stage specific survival were analyzed using the Kaplan-Meier method and the log rank test. Univariate and multivariate Cox proportional hazards regression analysis were used to obtain prognostic models. RESULTS: Two hundred seventy-four deaths (40.5%) occurred. The 5-year survival rate was 56.6% (95% confidence interval [95% CI], 52.3%, 60.7%). The stage specific 5-year survival rates were: Stage I, 88%; Stage IIA, 75%; Stage IIB, 74%; Stage III, 60%; Stage IVA, 35%; and Stage IVB, 28%. TNM stage was found to be a statistically significant prognostic factor (P < 0.0001). Cranial nerve (hazard ratio [HR]: 2.77), orbit (HR: 5.71), and intracranial involvement (HR: 2.46) conferred a particularly bad prognosis in univariate analysis. Independently significant prognostic factors were age; lymph node status; and paraoropharyngeal, cranial nerve, orbit, and nasal involvement. Among lymph node positive patients, independently significant prognostic lymph node characteristics were Ho level and laterality. Although parapharyngeal involvement appeared to be prognostically unimportant, paraoropharyngeal involvement distinguished a subgroup with a poorer prognosis (HR: 1.84; 95% CI, 1.45, 2.34; P < 0.0001). Lateral spread to the medial infratemporal fossa and beyond also was found to confer a poorer prognosis. CONCLUSIONS: The results of the current study show that the revised 1997 TNM staging system is prognostically useful. Subdivision into paraoropharyngeal involvement and using the medial infratemporal fossa to delineate prognostically significant lateral spread should be considered in future revisions.

Adolescent↗
PubMed1999

Perceived need for community geriatric services: a survey at a regional hospital in Singapore in an inpatient setting.

Our primary aim was to study the need for community services as perceived by the elderly and their relatives. A secondary objective was to determine the predictive factors of need for these services. This is a survey of 115 consecutive non-institutionalised patients admitted to a hospital geriatric department and their relatives. Twenty-seven elderly patients without cognitive impairment and 115 relatives were interviewed as to their need for community services after discharge. Services most needed by patients were: 24-hour medical helpline (33%), emergency alarm system (19%), social helpline (14%) and day care centre (13%). Services most needed by relatives were: 24-hour medical helpline (70%), emergency alarm system (40%), home visits by doctors (40%), respite care (35%), day care centre (35%) and transport service (33%). There were low levels of need for home help service, meal delivery service and the befriender service. Important predictive factors of need were: low ECAQ (Elderly Cognitive Assessment Questionnaire) score, low Barthel score, and absence of a carer. The development of community geriatric services in Singapore should be guided by the perceived needs of the elderly and their relatives/care-givers. This study is limited by its hospital-based perspective and small numbers. We recommend that further community-based studies be carried out to complement our study and extend our findings.

Activities of Daily Living↗
PubMed1996

Oral health of Singapore adults.

In a study conducted by the Dental Division of the Ministry of Health in 1992, 3157 Singapore adults aged 20 to 65 years and over were interviewed on their knowledge, attitude and practice of dental care and given an examination. About 66% indicated they required dental treatment. Utilisation of dental services was low with 39% visiting the dentist at least once in 2 years. About 72% brushed their teeth morning and night. The dental examination showed that 79.2% had calculus, 92% needed prophylaxis and oral hygiene instruction and only 0.2% needed complex periodontal treatment. A large proportion (96.6%) of the sample was dentate. The mean DMFT was 10.7 and the mean number of decayed root for the dentate population was 0.2. The age-group 65 years and over had the highest percentage (63.6%) of persons wearing dentures and the age group 50-54 years had the highest percentage (54.2%) requiring dentures. This study has shown that oral health promotion for home and professional care should be stressed to the adult population, particularly the older age groups.

Adolescent↗
PubMed1999

A 5-year survey of oral biopsies in an oral surgical unit in Singapore: 1993-1997.

A survey of oral biopsies performed in an oral surgical centre in Singapore from 1993 to 1997 was carried out to determine the relative frequency of oral pathologies encountered. A total of 2057 reports were reviewed, of which 1986 separate diagnoses were counted. The great majority of patients were Asian. The 20 most common diagnoses were: fibrous epulis (10.3%), periapical granuloma (8.8%), mucocele (8.6%), radicular cyst (7.6%), lichen planus (5.7%), mucosal inflammation (3.6%), squamous cell carcinoma (3.5%), granulation tissue (3.3%), fibrous hyperplasia (3.1%), keratosis (3.1%), pyogenic granuloma (2.6%), keratocyst (2.4%), osteomyelitis (2.3%), dentigerous cyst (2.3%), dental follicle (1.9%), non-specific ulcer (1.8%), ameloblastoma (1.8%), papilloma (1.5%), odontoma (1.5%) and residual cyst (1.3%). Oral malignancies accounted for 5.2% of all diagnoses, with squamous cell carcinoma (67.0% of malignancies) as the most common malignancy. Odontogenic cysts made up 14.9% of all specimens, with radicular cysts (50.7% of odontogenic cysts) being most common. Non-odontogenic cysts comprised 0.5% of all biopsies. Odontogenic tumours accounted for 5.0% of all diagnoses, with ameloblastoma as the most common tumour (35.0%). Similar surveys in the literature were reviewed. The relative frequency of some conditions appear to be higher than in other studies, including squamous cell carcinoma, odontogenic keratocysts and ameloblastomas.

Biopsy↗
PubMed2000

The prevalence and pattern of contact lens use in a Singapore community.

PURPOSE: We conducted a cross-sectional survey to determine the prevalence, socio-demographic patterns, and characteristics of contact lens use in an electoral community in Singapore. METHODS: One thousand eight hundred fifteen persons aged between 12-55 years from 768 households were surveyed using a standardized pre-tested questionnaire. RESULTS: The percentage of contact lens wearers in the survey populations was 9.0%. Forty-two percent of surveyed individuals were myopes, 21.8% of whom wore contact lenses. Contact lens wearers tended to be young Chinese females with higher level education and incomes. Most wore monthly disposable or daily wear soft contact lenses. Convenience and cosmesis were the main reasons cited for contact lens wear. Optometrists, who prescribed the bulk of contact lenses, were also the most influential in determining consumers' choice of lenses. CONCLUSION: Information gathered in this population-based survey may be used to facilitate national eye-care planning and provide a baseline for comparison with rates of lens wear found in other countries and in future surveys.

Adolescent↗
PubMed1999

The legality of slimming advertisements in Singapore.

Governments in newly affluent countries like Singapore perceive a growing obesity problem, which in turn attracts the attention of numerous suppliers of slimming aids of dubious value. Advertisements relating to these appear in many cases to breach the Sale of Food Act and the Medicines Act. Under these provisions, oral and transdermal slimming aids which are not prescription drugs or on the General Sales List must have a permit if they are to be advertised, which is granted if the authorities are satisfied as to the existence of evidence for efficacy. If perceived to be harmful, however, a product can be banned and if the associated advertisement is misleading it will attract a financial penalty. Slimming aids formally excluded (like herbal preparations) can be brought under the Act by executive order and banned from sale. That this formidable array of controls is rarely applied is due to the voluntary regulatory machinery of an advertising standards authority, a non-governmental body with a parallel in many other countries. However it has limited resources. It is suggested that either the executive or the advertising authority or both could adopt more rigorous criteria for the application of the law in the interests of the public.

Advertising↗
PubMed1999

Adult asthma prevalence, morbidity and mortality and their relationships with environmental and medical care factors in Singapore.

We have conducted a series of studies on adult asthma in Singapore that describe the prevalence, morbidity and mortality and their relationships with environmental and medical care factors. There was no evidence of a temporal increase of mortality from 1976 to 1995 for adults. The prevalence rate of asthma is 2.4% in men and 2.0% in women. There is considerable morbidity among asthmatics, corticosteroids are under-used, and patients' knowledge and self-management skills is poor. Increased morbidity is significantly associated with current keeping of pets, current smoking, and the patients' knowledge and self-management skills. Occupational exposure contributes up to a third of asthma morbidity. Malays and Indians have higher rates of asthma mortality and morbidity than Chinese. They have greater exposures to airborne allergens from keeping rugs or carpets, and pets. Malays experience the most morbidity from asthma, but make less use of health services, and receive less medical attention, than Indians or Chinese.

Adolescent↗
PubMed1999

Factors associated with increased respiratory symptoms among asthmatic children in Singapore.

Asthma is a common cause of childhood morbidity. The objective of the present study was to evaluate the factors associated with increased asthma morbidity among asthmatic children in Singapore. A cohort of primary school children (n = 6,404, aged 6-13 years) were evaluated using the American Thoracic Society and the Division of Lung Diseases of the National Heart, Lung and Blood Institute, USA (ATS-DLD) respiratory questionnaire. A total of 2,222 of 6,404 children (34.8%) was found to have reported symptoms of wheezing. Of these, 899/2,222 (40.5%) reported symptoms of "increased asthma morbidity". This was associated with the younger age group, male sex and higher socio-economic status. In addition, concurrent or past allergies were strongly associated with increased asthma morbidity, while premature birth and a history of prior childhood respiratory illnesses and Infections were predictive of greater asthma morbidity. No association was found between increased morbidity and presence of domestic pets, parental smoking, childcare attendance, and the season of birth.

Adolescent↗
PubMed1999

Quality of life of patients with perennial allergic rhinitis: preliminary validation of the Rhinoconjunctivitis Quality of Life Questionnaire in Singapore.

Though sufferers of perennial allergic rhinitis do not die from their ailment, they endure years of chronic nose disease that Interferes with many important aspects of their lives. A rhinitis-specific instrument to gauge the quality of life of patients with this disease was published in 1991. Here, we validated the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) for use in English-speaking patients with perennial allergic rhinitis. We established that the RQLQ distinguishes between patients and control, demonstrates internal consistency and is sensitive to change. This study suggests that the RQLQ can be used to assess the quality of life of patients with perennial allergic rhinitis in Singapore.

Adolescent↗
PubMed1999

Primary non-compliance in a Singapore polyclinic.

AIM OF STUDY: To determine the rate of patients not collecting their medication despite being given a prescription (primary non-compliance) in a Singapore polyclinic; to compare the results with similar studies done abroad and to identify the characteristics of patients most likely to be non-compliant. METHODS: Out of 500 prescriptions issued consecutively by the author, those that were not presented to the pharmacy for collection of medication were identified. The case sheets of these patients were then retrieved for further analysis. FINDINGS: The primary non-compliance rate in this study was 4.0%. Patients who were less than 30 years old or who consulted for an acute complaint were significantly more likely to be non-compliant. While the overall non-compliance rate was similar to that of studies done in the UK, the number of non-compliant patients with chronic illnesses was markedly lower in the local population.

Adolescent↗
PubMed1999

Benign cephalic histiocytosis in Singapore--a review of 8 cases.

AIM OF STUDY: Benign cephalic histiocytosis (BCH) is a rare, benign, self-healing papular eruption that affects mainly children. The aim of this study was to characterise our Singapore children affected by this condition and to review some of the recent literature on non-Langerhans cell histiocytoses. METHODOLOGY: The case records of all cases of BCH seen between January 1990 and December 1996 in our centre were retrieved and analysed. Further details not available in the case records were obtained via a telephone interview with the patients or their parents. RESULTS: A total of 8 cases were seen. There was no sex preponderance or ethnic predilection. The average age of onset was 29 months. All patients began with small brownish papules on the face and sometimes the upper trunk, and most of the lesions regressed in less than 84 months. CONCLUSION: BCH is a benign non-Langerhans cell histiocytosis in which spontaneous resolution is the rule. A small skin punch biopsy is simple, diagnostic and helpful in its management. The management of BCE is expectant and reassurance is sufficient. However the regression and resolution of the lesions may take up to several years.

Age of Onset↗
PubMed2000

End-of-life issues--preferences and choices of a group of elderly Chinese subjects attending a day care centre in Singapore.

INTRODUCTION: This was an exploratory study that was intended to provide a descriptive analysis of the choices and preferences of a group of elderly Chinese subjects attending a day care centre in Singapore with regard to end-of-life issues. MATERIALS AND METHODS: A semi-structured one-to-one interview was conducted to collect data from the subjects. Qualitative techniques were used to analyse the data. RESULTS: Forty-three subjects were interviewed. The median age was 71 years. There were more women than men (58.1% vs. 41.9%). The predominant religion was Buddhism/Taoism. 83.7% and 76.7% of the subjects preferred to be told of the diagnosis and prognosis of a terminal illness, respectively. The person most preferred to reveal the diagnosis was the attending doctor (60.5%). About 83.7% of the subjects have never heard of the Advanced Medical Directive Act, while 37.2% agreed that making an advanced directive would be necessary. Twenty-three (53.5%) would choose the doctor, while 15 (34.9%) would choose a family member as a surrogate decision-maker. Twenty-two (51.2%) thought that euthanasia should be allowed, while 15 (34.9%) disagreed. With regard to supportive measures at the end of life, 67.4% wanted cardiopulmonary resuscitation, 62.8% wanted artificial ventilation, 55.8% wanted nasogastric feeding, 65.1% wanted intravenous hydration and 41.9% wanted renal dialysis. CONCLUSION: There is a need for closer communication between older persons and their carers with regard to end-of-life care. The attending doctor appears to have an important role in this respect.

Advance Directives↗
PubMed2000

Results of surgical resection of oesophageal carcinoma in Singapore.

INTRODUCTION: The 5-year survival rate after resection of oesophageal cancer is still poor, reported to be between 5% to 34% in the literatures. We conducted this retrospective study to determine the prognostic factors and long-term survival rate for surgical resection of oesophageal carcinoma in Singapore. MATERIALS AND METHODS: Sixty-seven consecutive patients who underwent surgical resection of oesophageal carcinoma from January 1989 to December 1996 were reviewed. RESULTS: Majority of the patients were Chinese (94%), males (81%) with a history of dysphagia (96%), cigarette smoking (84%) and alcohol ingestion (58%). The median age at surgery was 63.6 (range 29 to 81) years. Sixty-four patients had squamous cell carcinoma of the oesophagus and 3 patients had adenocarcinoma. The lower one-third of the oesophagus was the most common site (48.6%) followed by the middle third (46%). Postoperative complications included pneumonia (43.3%), vocal cord paralysis/paresis (19.4%) and anastomotic leakage (17.9%). Thirty-day postoperative mortality was 7.5%. There was an almost equal number of patients undergoing transhiatal (34 patients) and transthoracic approach (33 patients). There was no significant difference in postoperative complications and survival outcome for both approaches. The median survival was 15.3 months after surgery. Tumour features such as depth of involvement and TNM stage were useful in predicting survival (P < 0.05, log-rank test). CONCLUSIONS: We conclude that the poor outcome of surgical resection (5-year survival rate was 18% by Kaplan-Meier survival plots) was mainly attributed to late presentation (80% patients had T3 or T4 tumour).

Adenocarcinoma↗
PubMed2000

Survival of colorectal cancer patients in Singapore by anatomic subsite: a population-based study.

INTRODUCTION: Studies of the prognostic value of anatomic subsite in colorectal cancer survival have yielded conflicting results. Two explanations for possible differences in survival patterns between proximal and distal lesions in the colorectum are biological difference between subsites and the presence of more early-stage lesions in distal than in proximal large bowel. MATERIALS AND METHODS: A total of 435 cases with proximal lesions and an equal number with distal lesions diagnosed between 1990 and 1992 were randomly selected from the Singapore Cancer Registry. Information on vital status at 31 December 1996 were obtained by computerised matching with data from the National Registry of Births and Deaths. RESULTS: Persons with proximal cancers in our study population did not present at a later stage than persons with distal cancer, local lesions (Dukes' Stage A + B) being 45.5% and 45.1%, respectively. Our analysis showed no significant differences in survival between subsites on a stage-for-stage basis. The 5-year survival rates were 42% and 44% for proximal and distal lesions, respectively (median survival times 3.98 and 4.27 years). Stage at diagnosis was the strongest predictor of survival. Among proximal lesions, 5-year survival rates were 57%, 36% and 12% for local, regional and metastatic lesions, respectively. The corresponding figures for the distal group were 65%, 37% and 10%. Age at diagnosis had a significant influence on survival. CONCLUSIONS: Our results, based on population-based figures on survival of colorectal cancer patients where the impact of screening has not been large, do not support an independent influence of anatomic subsite in predicting survival of colorectal cancer.

Adult↗