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At least 1,243 records · Page 69Linked to original sources
PubMed2002

Dietary soy and increased risk of bladder cancer: the Singapore Chinese Health Study.

The association between soyfood consumption and subsequent bladder cancer risk was investigated in a population-based cohort study, the Singapore Chinese Health Study. As of December 31, 2000, 329,848 person-years of follow-up were accrued. Sixty-one histologically confirmed incident bladder cancer cases were identified. Information on soyfood consumption at baseline was obtained through in-person interviews using a validated dietary questionnaire. Relative risks and 95% confidence intervals were calculated using the Cox proportional hazard regression method. High intake of soyfood was statistically significantly related to an elevated risk of bladder cancer. Relative to the lowest quartile of energy-adjusted total soy intake (<36.9 g/1000 Kcal), the highest quartile of total soy intake (> or =92.5 g/1000 Kcal) was associated with a 2.3-fold increase in bladder cancer risk (95% confidence interval = 1.1-5.1) after adjustment for cigarette smoking and level of education. Similar results were obtained for intakes of soy protein and soy isoflavones. The soyfood-bladder cancer risk association did not differ significantly between men and women and was not explained by other dietary factors. The soy-cancer relationship became stronger when the analysis was restricted to subjects with longer (> or =3 years) duration of follow-up. To our knowledge, this is the first epidemiological report on the effect of dietary soy on bladder cancer risk.

Age Distribution↗
PubMed2002

Early unplanned readmission of elderly in Singapore: a retrospective study.

STUDY OBJECTIVE: To study the incidence and profile of elderly patients requiring early unplanned readmission within 15 days of discharge from a regional hospital and the predictive factors for readmission. PATIENTS: All patients (n = 150) aged 65 years old and above who were readmitted within 15 days into the hospital's geriatric unit in the western region of Singapore over a period of 10 months were retrospectively studied. METHODOLOGY: Demographic data, information on patients' medical problems and social environment were gathered from the patients' medical, nursing and therapist records. A control group (n = 103) consisting of patients not readmitted over 15 days were gathered over the same period. RESULTS: The percentage of readmission over the period between 1 January 1999 and 31 October 1999 was (150/1632) 9.2% (95% CI, 7.8% to 10.7%). There were a total of 150 patients with an equal number of male and female patients. The patients had a mean of 4 medical problems. Cardiovascular disease was noted in 73% (95% CI, 65.5% to 80.2%) of the patients during the index admissions. They were noted to be ambulatory and were staying with their own families. Half of the patients were discharged from the index admission with no adjustment to their previous care system. The majority of patients (68.7%; 95% CI, 59.9% to 75.4%) required readmission because of medical problems. Fifty per cent of the patients admitted for a new medical complaint were secondary to sepsis. Thirty per cent (95% CI, 22.8% to 38.0%) of the study population had both medical and social issues. The main predictive factors noted when compared to a control group of 103 patients (using a stepwise logistic regression model) were number of medical problems (P = 0.0128; OR = 1.4; 95% CI, 1.1 to 1.9) and number of previous admissions (P = 0.005; OR = 1.6; 95% CI, 1.2 to 2.3). CONCLUSION: Unplanned readmissions are relatively common in elderly patients. They cannot be entirely prevented in view of multiple chronic illnesses. Further studies, looking at early detection of medical problems and prevention of nosocomial infections are warranted to decrease the problem of readmissions for this group of elderly.

Age Factors↗
PubMed2002

A retrospective study on the characteristics of androgenetic alopecia among Asian races in the National Skin Centre, a tertiary dermatological referral centre in Singapore.

OBJECTIVE: To study the characteristics and psychosocial impact of androgenetic alopecia among Asian races. METHODOLOGY: A retrospective telephone interview study of patients managed for androgenetic alopecia in 1997 in a tertiary dermatological referral centre in Singapore. RESULTS: Two hundred and fifty-six patients (111 females and 145 males) were included in the study. Their mean age at presentation was 33.7 years. There were no significant statistical mean age differences among the different races (Chinese, Malay and Indian). The mean duration of disease before consultation was 31.2 months; 33.2 months for males and 28.9 months for females (ns). Almost all patients (96.4%) were socially embarrassed and "unhappy" about their androgenetic alopecia. Most (90.5%) sought treatment for "cosmetic" reason. Slightly more males sought treatment for cosmetic reason than female (P = 0.01). 7.5% were worried about an underlying systemic disease as a cause of their alopecia. A positive family history of androgenetic alopecia was recorded in 58.9% (151/256). Male patients tend to have higher proportion of having a father or male sibling with similar problem, whereas female patients tend to have higher proportion of having a mother or females sibling with androgenetic alopecia. The predominant balding patterns for males were a combination of frontal, bi-temporal recession and vertex thinning (43%, 45% and 55%, respectively). Whereas in females, the predominant presentation was vertex thinning (60%) and, infrequently, frontal and bi-temporal thinning (19% and 15%, respectively). Diffuse pattern was also more predominant in females (28%) compared to males (10%). CONCLUSIONS: Most patients presented in their thirties with females presenting earlier than males and almost all patients presented for treatment for cosmetic reasons. Patients are generally unhappy about their appearance as a result of their alopecia. A strong positive family history appears to suggest that the disorder may be acquired through an autosomal dominant trait. Male patients tend to have a father or male sibling with similar condition and female patients tend to have a mother or female sibling with similar condition.

Adaptation, Psychological↗
PubMed2002

Aseptic meningitis in children--the Singapore experience.

OBJECTIVE: To study the incidence, aetiology, clinical characteristics and management of paediatric aseptic meningitis in a paediatric hospital in Singapore. MATERIALS AND METHODS: Patients with cerebrospinal fluid (CSF) pleocytosis, a negative Gram stain and bacterial culture were reviewed retrospectively from 1 January to 31 December 2000. Eighty-seven patients who fulfilled the criteria for aseptic meningitis and without neurological deficits were studied. In addition, reverse transcriptase polymerase chain reaction (RT-PCR) using pan enterovirus primers was subsequently performed on 73 of these CSF specimens which were available for storage. RESULTS: The incidence of aseptic meningitis was approximately 37 cases per 10,000 admissions. Non-polio enteroviruses were isolated from 29 of 64 (45.3%) CSF and 38 of 52 (73.1%) stool samples. RT-PCR was positive in 43 (58.9%) of the archived CSF specimens. The aetiologies of the remaining cases were mostly unidentified. Their ages ranged from 5 days to 12 years (median, 2 months). All patients except 1 had fever. Vomiting or poor feeding occurred in 44.7%, cough or running nose in 35.3%, irritability was observed in 35.3%, seizures in 7.1%, a rash in 10.6% and diarrhoea in 5.9%. All patients recovered without sequelae. The median CSF white cell count was 212 cells/mm3 (range, 7 to 12,000). The median glucose concentration was 2.7 mmol/L (range, 1.6 to 4.4). The median CSF/blood glucose ratio was 0.52 (range, 0.23 to 0.73). Median length of stay was 7 days (range, 4 to 17). Eighty-four patients (96.6%) received antibiotics for a median of 5.5 days (range, 2 to 14). CONCLUSION: Enteroviruses were the most common aetiologic agent identified. A method of early diagnosis using RT-PCR for enteroviruses is necessary to reduce the current duration of antibiotic usage and to decrease the length of hospital stay.

Age Distribution↗
PubMed2002

Medical support for the North East Line Mass Rapid Transit project by the Republic of Singapore Navy's Naval Medicine Hyperbaric Centre.

Naval Medicine Hyperbaric Centre (NMHC) was approached by the Land Transport Authority (LTA) to provide medical support for the North Eastern Line MRT Project. The medical support provided by NMHC focused on providing training, audits and ensuring that safety and health infrastructure were in place even before the commencement of compressed air tunnelling. The extensive use of the EPBM (Earth Pressure Balance Machine) tunnelling machines for the first time in Singapore necessitated a reassessment of the medical support system and paradigm that was based primarily on the older form of tunnelling. The survey results showed that human exposure to compressed air works with the use of EPBM was minimal and no decompression illness was reported. However, there was still a total of 28 cases of barotrauma that were reported which were mainly from the tunnels dug using the open face compressed air tunnelling method. As such, medical providers should still exercise careful planning for the medical support of compressed air works.

Atmospheric Pressure↗
PubMed2003

Five-year review of adolescent mental health usage in Singapore.

INTRODUCTION: To provide a review of adolescent mental health service utilisation in a child and adolescent mental health outpatient clinic in Singapore. MATERIALS AND METHODS: Data from all new adolescent cases seen over a 5-year period in the Child Guidance Clinic were analysed. A review of services provided is also included. RESULTS: Adolescent mental health usage has been on an increase with a rise in the number of cases diagnosed with depression. There has also been an increase in the number of forensic cases seen in the department. CONCLUSIONS: There is a growing demand for adolescent mental health services. As the demands and stresses on today's youth increase, there is likely to be a continued increase in the demand for such services. The challenge in the future is to provide adolescent mental health services in cost-effective packages that will meet the needs as well as stay financially viable.

Adolescent↗
PubMed2003

Training incidents in armored vehicles in the Singapore Armed Forces.

Training in armored vehicles presents occupational hazards. Since the inception of armored units in the Singapore Armed Forces in 1969, there has been no scientific study of the demographics of the trauma patterns. A review of existing literature also indicated a paucity of data on this subject. This article qualified and quantified the proportion of trauma during peacetime armored vehicle training during a 5-year period. Most of the 100 documented incidences of injuries occurred on the head and body limbs. Many injuries were caused by minor lacerations, abrasions, and crush injuries. Although fractures accounted for 24%, 65% of the total injury count could be classified as "minor." A diurnal pattern of injuries was noted in the study. The injury patterns could be used to analyze morbidity and mortality trends and facilitate subsequent evaluation of efficacy of affirmative action. New challenges facing further research in training injuries were also discussed.

Accidents↗
PubMed1992

Knowledge about developmental screening in mothers attending a maternal and child health clinic in Singapore.

A study of knowledge about Developmental Screening in mothers was done among 200 Singapore mothers attending a Maternal and Child Health Clinic from February to March 1990. They were requested to answer a set of questions pertaining to their knowledge on the Developmental Screening session and their reason for attending the session. They were also asked whether they had attended any health education talks given by the nurses in the clinic. Seventy-three out of 200 (36.9%) knew what the appointment given was for. Mothers with secondary education were almost three times and mothers with tertiary education were five-and-a-half times more likely to possess the correct knowledge than a mother with primary education. Wives of husbands from Social Classes I and II were more knowledgeable (83% and 54%) than those in lower social classes (32% and 25%). Mothers with older children were more knowledgeable than those with children age six weeks. Mothers of one child four-and-a-half years old were more knowledgeable than those with one child age six weeks. Twelve out of 27 (44%) of mothers of one child age six weeks did not know what Developmental Screening was about whereas all mothers with four-and-a-half year old children knew what Developmental Screening was about. Only 88 (44%) mothers had attended health education talks. There was no discernible difference in knowledge of Developmental Screening between those mothers who attended talks and those who did not (35% vs 40%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Neonatology in Singapore: the way we were, the way forward.

Singapore has a maternity hospital since 1924, but for many decades the newborns could only receive basic care. Neonatal and perinatal mortality rates were high. Marked improvement in neonatal care began from the 1980s when many neonatal departments were set up to provide intensive care. Improved socioeconomic status, better healthcare facilities, effective infection control, immunisation programmes and availability of potent antibiotics contributed to the decline of perinatal and neonatal mortality. Following the implementation of the glucose-6-phosphate dehydrogenase (G6PD) deficiency screening programme, severe neonatal jaundice and kernicterus were largely reduced. Exchange blood transfusions initiated in the 1960s and phototherapy in the 1970s had saved many babies. Kernicterus is almost not seen now. With more neonatal-trained staff, organised resuscitation teams, advances in respiratory management and better monitoring equipment, more babies have survived. Closer cooperation between obstetricians and neonatologists was a great leap forward towards perinatal medicine. Physicians should endeavour to reduce the incidence and prevalence of birth defects and metabolic errors. Perinatal asphyxia should be promptly detected and managed effectively, including neuroprotective strategies. There should be markers to predict the outcome of asphyxiated babies for decision-making. Neonatologists should be mindful of safe introduction of new technologies and rapid diagnostic techniques for infections, including group B streptococcal screening and chemoprophylaxis when required. Other current issues include prevention of major morbidities, preservation of brain function, improved neurodevelopmental outcome of premature babies, use of blood substitutes, optimal nutrition, fetal surgery, evidence-based medicine, better information systems, avoidance of medication errors, adequate sedation and pain relief of the baby, and the use of nitric oxide. One should bear in mind the need to enhance the neonatal intensive care environment, improve non-invasive monitoring and minimise invasive procedures. Physicians should prioritise neonatal care for their country and utilise less costly neonatal care. Ethical issues in neonatology that arise following advancement in neonatal care deserve attention. Advances in life sciences, such as the completion of the human genome project, cloning of tissues and organs, human stem cell research and technology, gene therapy, deoxyribonucleic acid vaccines and nanomedicine, should benefit neonatology.

History, 20th Century↗
PubMed2003

Determinants of circulating insulin-like growth factor I and insulin-like growth factor binding protein 3 concentrations in a cohort of Singapore men and women.

Variation in the circulating concentrations of the insulin-like growth factor (IGF) system has been implicated in the etiology of chronic diseases including cancer (prostate, breast, colon, and lung), heart disease, type 2 diabetes, and osteoporosis. We searched for sociodemographic, anthropometric, reproductive, lifestyle, and dietary determinants of IGF-I and insulin-like growth factor binding protein (IGFBP) -3 serum concentrations. Serum samples were collected in a Singapore Chinese cohort with a mean age of 61 years. Subject information was assessed during an in-person interview. Radioimmunometrically measured IGF-I and IGFBP-3 concentrations were available for 312 men and 326 postmenopausal women ages 50 years or older. Mean IGF-I concentrations were 144 ng/ml and 121 ng/ml for men and women, respectively (gender difference, P < 0.0001), and mean IGFBP-3 concentrations were 3710 ng/ml and 4147 ng/ml for men and women, respectively (gender difference, P < 0.0001). IGF-I and IGFBP-3 decreased with age (P for trend <0.0001); the age-related decrease in the IGF-I:IGFBP-3 molar ratio was stronger in women than men. IGF-I concentrations were higher among physically inactive subjects and among women with an early age at menarche. Consumption of saturated fat was found to decrease, and intake of omega-3 polyunsaturated fatty acids and of dietary fiber was found to increase circulating IGFBP-3 concentrations. Intake of calcium from food and supplement was associated positively with circulating IGF-I, IGFBP-3, and molar ratio. Intake of soy was associated positively with IGF-I and molar ratio concentrations, but only in men. The results of this study lend additional support to the hypothesis that circulating IGF-I concentrations increase the risk of prostate, bladder, colorectal, and breast cancer.

Age Factors↗
PubMed1992

Epidemiology and management of respiratory burns in National Burns Centre, Singapore.

Respiratory burns constitute one of the two leading causes of burns mortality today, the other being infection. When cutaneous burns are complicated by co-existent respiratory or inhalational injury, the mortality remains high in most reported series. We began our prospective study of respiratory burns in 1982 as a multi-disciplinary team effort involving respiratory physicians, anaesthetists and our burns physicians. Between 1982 until February 1990, we treated a total of 240 patients with respiratory burns. During the same period, a total of 4041 patients were admitted to our Burns Centre at Singapore General Hospital. Respiratory burns cases therefore constituted 5.4% of the total burns admissions. In our series, there were 44 deaths out of 240 patients, giving an overall mortality of 18.3%. The average size of burns in the patients who died was 57.4% BSA in Group A patients, 65.0% BSA in Group B and 57.7% BSA in Group C. Our management protocol has gradually evolved over the eight years of the study. Systemic antibiotics and steroids are no longer used routinely. Fiberoptic bronchoscopy is done early in the ward as a bedside procedure once a patient is clinically assessed to have suffered a respiratory burns and repeat bronchoscopic examination done when deemed necessary. An aggressive regime of respiratory support measures with early intubation and PEEP ventilation is recommended.

Adolescent↗
PubMed1992

Epidemiology of burns in Singapore children--an 11-year study of 2288 patients.

A retrospective review of 2288 children (12 years and below) admitted to the Burns Centre, Singapore General Hospital over an eleven year period (1978-1988) was made. Annual admissions from 1978-85 ranged from 208-290 cases annually (32-38% of all admissions). Between 1986 to 1988 annual admissions ranged from 73-104 cases annually (22-28% of all admissions). There was a reduction of number as well as proportion of children admitted. The main reasons for this change in trend were due to the successful nationwide campaign on fire and home accident prevention, change in admission policy and introduction of newer dressings to treat smaller burns. Boys accounted for 62% admissions. Toddlers between the age of one to two were most vulnerable (26% admission) and children under three years of age accounted for 50% admissions. Eighty-five percent of burns admitted were 10% or less. Length of stay ranged 8-12 days. The commonest cause of injury was scalds (90%) and flame burns (6%). Flame was responsible for the death of six children and scalds of three children. There were nine deaths in this series giving a mortality of 0.4%. Children mortality contributed to 5.6% of total mortality seen in our burns centre. Age per se did not contribute to a higher mortality. There was a definite correlation of mortality to extent of burns. Only one child died from burns of less than 40%. Case mortality in the 40-60% burns group was around 20% and it increased sharply when extent of burns reached or exceeded 70%. Burns in children exhibit anatomical, physiological, surgical, rehabilitative and psychological differences when compared to adults.

Burns↗
PubMed1992

Clinical aspects of a successful embryo cryopreservation programme from IVF cycles in Singapore General Hospital.

An analysis in November 1991 showed a successful cryopreservation programme between May 1989 and October 1991 in Singapore General Hospital. This programme has resulted in 9.1% more pregnancies in addition to those from conventional in-vitro fertilisation (IVF) methods, increasing pregnancy rates during the same period, from 27.8% per IVF cycle to 36.9% per cycle. The current policy is to transfer 3 fresh embryos in the IVF cycle and freeze the remainder using a modified Testart's method. Clinical factors that influence the success rate include the number of embryos transferred, stage of development of embryos and genital tract infections. Age of patient and grade of embryos did not seem to have affected pregnancy rates. Patients with anovulatory cycles enjoy similar pregnancy rates using a regulated cycle regime for frozen-thawed embryo transfer.

Adult↗
PubMed1992

Rheumatoid arthritis in Singapore: carpal predominance and lower incidence of erosive changes.

Radiographs of the hand and wrists in 33 patients with a diagnosis of classic or definite rheumatoid arthritis were reviewed. The mean duration of disease was about five years. A scoring system for quantitative analysis was used to assess the presence and severity of erosions, joint space narrowing and deviation of joint alignment. No radiological abnormality was seen in 30% of patients while in another 30%, only minor radiological changes were seen. Moderate to severe radiological abnormality was seen in only 40% and in this group of patients all showed more severe disease in the wrists than in the finger joints. Erosions in the fingers were only seen in 21% of patients and erosions in the wrists were present in 57%. Previous reports have indicated that disease in the wrists can be more severe than the hands in up to 60% while the incidence of erosions can be expected to range from 40% at 3 months to 95% at 10 years. Although the sample size in this study is small, the findings suggest that the radiological pattern of rheumatoid in the hands in Singapore is quite different from that classically described in temperate countries as the incidence of erosions appears lower while disease in the wrists can be expected to be more severe than in the fingers in almost all cases. The usual radiological criteria used to aid diagnosis of the disease may not be applicable.

Adult↗
PubMed1992

Pattern of dermatophyte infection in Singapore.

Dermatophyte infection is the fourth commonest skin disorder seen in the National Skin Centre in Singapore. A prospective study was carried out from June 1990 to March 1991 to determine the epidemiology and pattern of dermatophyte infections seen in this centre. Two hundred patients who had a clinical diagnosis of dermatophyte infection and confirmed by direct microscopy were included into the study. Cultures for dermatophyte were done on Sabouraud's dextrose agar with chloramphenicol and cycloheximide. There were 148 male and 52 female patients, of whom 146 (73%) had a positive culture from one or more sites. One hundred and thirty-nine (95.2%) patients had dermatophyte infection while the remaining seven (4.8%) patients had non-dermatophyte infection. The sites involved were the groin (92 patients), feet (52 patients), trunk (26 patients), hands (18 patients), face (9 patients), legs (9 patients), scalp (8 patients) and axilla (7 patients). The commonest dermatophyte isolated was Trichophyton rubrum (81/139). It was also the commonest organism isolated in all the sites except the scalp. The other dermatophytes grown were, in order of frequency, Trichophyton interdigitale (21/139), Epidermophyton floccosum (19/139), Trichophyton mentagrophytes (9/139), Microsporum ferrigineum (4/139), Microsporum canis (4/139) and Microsporum gypseum (1/139). Scalp infections occurred in children and were due either to Microsporum canis or Microsporum ferrigineum. The organisms isolated in our study were either ubiquitous or common in the Asia-Pacific region indicating that certain dermatophytes are more prevalent in certain geographical regions.

Adolescent↗
PubMed2003

Non-consensual double reading in the Singapore Breast Screening Project: benefits and limitations.

INTRODUCTION: The aims of this study were to assess the efficacy of non-consensual double reading (against single reading) in the Singapore Breast Screening Project (SBSP) and to compare the benefits (increase in cancer detection) and limitations (increase in recall and biopsy) with published data. MATERIALS AND METHODS: The data from the SBSP was retrospectively analysed and the recommendations of the first and second readers were evaluated separately with regards to rate of recall, biopsy and cancer detection. The mean second screener contribution (MSSC) was also calculated for double reading. RESULTS: In the SBSP, double reading detected 7 additional cancers (5.2% of cancers detected) compared with single reading and the MSCC was 5.5%. Double reading also resulted in 632 additional recalls, with a decrease in the positive predictive value (PPV) of cancer in the recalled women from 8.2% for single reading to 6.1% for double reading. An additional 30 biopsies were performed with double reading which represented a small decrease in PPV (41% compared to 42.9% for single reading). CONCLUSION: In the SBSP, non-consensual double reading (compared to single reading) resulted in a modest increase in cancer detection (MSSC, 5.5%) with a modest decrease in PPV of recall (2.1%) and biopsy (1.9%). These findings were consistent with that of published data and non-consensual double reading is thus recommended.

Adult↗
PubMed2003

Cervical cytology: an audit in a Singapore teaching hospital.

OBJECTIVES: To describe the cervical cytology diagnoses and cyto-histological correlation in the Department of Pathology, National University of Singapore in 1997 and to compare the data with international figures. METHODS: A database search of all cervical cytology cases diagnosed in the department in 1997 as well as follow-up biopsies was carried out. The data was then critically analysed. RESULTS: 10,207 cases were reviewed. 96% of the cases had a diagnosis of "negative". Under 1% of cases were labelled as "inadequate". "Atypia" was diagnosed in 1% and dysplasia and/or malignancy was diagnosed in 1%. These figures correlate well with international data. Of the dysplasia cases, 78% were followed by biopsy. Of the high-grade dysplasia cases that were biopsied, 97% of the biopsy diagnoses were within the acceptable concordance range with the cytology diagnoses and in only 3% was there a significant discrepancy. Of the cases diagnosed as atypia, 39% were subsequently biopsied at the same institution as the next procedure and only one showed high grade dysplasia. A total of six cases showed a significant discrepancy between the cervical cytology result and the subsequent biopsy diagnosis and these were reviewed to elucidate the reasons for the discrepancies. CONCLUSION: The cervical cytology service is of a high diagnostic standard. A subset of patients is probably being prematurely biopsied and may benefit from having a repeat smear instead. Specific clinical protocols regarding subsequent therapy following cytology results and closer cyto-histological correlation are two main areas where the cytology service can be improved.

Biopsy↗
PubMed1977

Sterilization failures in Singapore: an examination of ligation techniques and failure rates.

The University Department of Obstetrics and Gynecology, Kandang Kerbau Hospital in Singapore, initiated a study in early 1974 of failure rates for various methods of sterilization and the factors responsible for the failures. During the period January 1974 to March 1976, 51 cases of first pregnancy following ligation were discovered. Cumulative failure rates at 24 months were 0.34 per 100 women for abdominal sterilization, 1.67 for culdoscopic, 3.12 for vaginal, and 4.49 for laparoscopic procedures. Findings for 35 patients who underwent religation showed that recanalization and the establishment of a fistulous opening caused the majority of failures. Clearly, more effective methods of tubal occlusion in sterilization are needed.

Abdomen↗