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PubMed1980

Frequencies of Gm and Km allotypes in the population of Singapore, Sri Lanka and Punjabis in North India.

Serum samples from Sinhalese subjects, from Punjab and from Singapore have been studied. The Gm phenotypes found are very numerous and we can observe some similarities concerning the Gm gene frequencies between the Singapore Indians with the Indians of North India, and with the Sinhalese. In contrast, Gm gene frequencies found among Chinese and Malays from Singapore are quite different from those found among Indians of Singapore. Our results here are very similar to those obtained in Malaya studies.

China↗
PubMed1998

Suicides in Hong-Kong and Singapore: a tale of two cities.

Suicide statistics from Hong Kong and Singapore over the period 1984-1994 were studied. The suicide behaviours in Hong Kong and Singapore are remarkably similar. Suicide rates increased with age, with a sharp increase among the elderly which was about four to five times the average. A relatively low male:female ratio and low teenage suicide were also found. Jumping from a height was the commonest method of suicide. Nevertheless, a different time trend of the suicide rates was observed, with an upward and downward trend for Hong Kong and Singapore respectively. The cultural, social and economic aspects in understanding suicidal behaviour in Hong Kong and Singapore are also discussed.

Adolescent↗
PubMed1994

Aflatoxin exposure in Singapore: blood aflatoxin levels in normal subjects, hepatitis B virus carriers and primary hepatocellular carcinoma patients.

Blood screening conducted on Singaporeans over 1991-1992 showed exposure to predominantly aflatoxin B1 and to a lesser extent G1. The extent of exposure to B1 among three groups of residents in Singapore, namely normal subjects (n = 423), hepatitis B virus carriers (n = 302) and primary hepatocellular carcinoma (PHC) patients (n = 58) were extensive as reflected by the positive rates of 15.1, 0.7 and 1.7 per cent respectively. However, the degree of individual exposure to this toxin among the three groups was considered low as shown by the low respective mean blood levels of 5.4 +/- 3.2 (range 3.0-17), 7.7 (range 7.5-7.9) and 7.5 picogrammes per ml of blood. It is not immediately clear whether or not such low levels would precipitate an undesirable health effect. The higher positive rate seen in normal subjects as compared with the other groups could be due to differences in dietary intake of aflatoxin B1, differences in metabolic patterns or both. About 70 per cent of PHC patients studied were carriers. The degree of aflatoxin B1 exposure among normal subjects in Singapore was a factor of 22.1 times less than that in Japan, 40.9 times less than that in Indonesia and 51.3 times less than that in the Philippines. Similarly, the extent of exposure among hepatitis B carriers in Singapore was a factor of 8.2 times, 39.6 times and 24.2 times less than those in the other three Asiatic countries respectively. The results reflected stringent Government control over the quality of food stuff imported into this country. As Singapore imports almost all of its dietary needs from elsewhere, it can afford to be selective at a cost. Aflatoxin M1, a metabolite of B1, was most commonly encountered in the liver tissues of deceased (n = 154) who died of causes other than sickness or disease in 1992-93, consistent with our blood findings of prevalence of aflatoxin B1. High performance liquid chromatography (HPLC) with fluorescence detection using one of the aflatoxins G2 or B2 as an internal standard was used for the detection and quantification of aflatoxins. The use of an internal standard structurally and chemically similar to those required to be quantified minimizes errors in quantifications. This is because differences in the quenching of fluorescence between specimen extracts and spiked-standard extracts were internally standardized and compensated for. The presence of an internal standard also helped to locate aflatoxins of interest more accurately.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2004

Prevalence of Parkinson disease in Singapore: Chinese vs Malays vs Indians.

OBJECTIVE: To investigate the prevalence of Parkinson disease (PD) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians. METHODS: A three-phase community-based survey among a disproportionate random sample of 15,000 individuals (9,000 Chinese, 3,000 Malays, 3,000 Indians) aged 50 years and above who live in central Singapore was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a validated 10-question questionnaire. In phase 2, medical specialists examined participants who screened positive to any of the questions. Participants suspected to have PD had their diagnosis confirmed in phase 3 by a movement disorders specialist. RESULTS: The participation rate was 67% among 22,279 eligible individuals. Forty-six participants with PD were identified of which 16 were newly diagnosed cases. The prevalence rate of PD for those aged 50 and above in Singapore was 0.30% (95% CI: 0.22 to 0.41), age-adjusted to US 1970 census. The prevalence rates increased significantly with age. The age-adjusted prevalence rates among Chinese (0.33%, 95% CI: 0.22 to 0.48), Malays (0.29%, 95% CI: 0.13 to 0.67), and Indians (0.28%, 95% CI: 0.12 to 0.67) were the same (p = 1.0). CONCLUSIONS: The prevalence of PD in Singapore was comparable to that of Western countries. Race-specific rates were also similar to previously reported rates and similar among the three races. Environmental factors may be more important than racially determined genetic factors in the development of PD.

Aged↗
PubMed2006

Migration psychosis and homicide in Singapore: a five year study.

Psychiatric research into violent offences, particularly murder, have been scant in the South East Asian region, with the last major review of homicides in Singapore and their association with psychiatric disorders being as far back as 1985. This study seeks to update the psychiatric community on individuals charged with murder in Singapore from 1997 to 2001 and particularly to further investigate the phenomenon of 'migration psychosis' in relation to foreigners in this sample who have committed homicide. One hundred and ten individuals in Singapore were charged with murder between 1997 and 2001. Socio-demographic data, psychiatric diagnoses, offence and victim profiles and court outcomes were obtained. The group consisting of offenders who were Singapore citizens or permanent residents was compared with those offenders who were foreigners. Analysis was done using the statistical package, SPSS. The proportion of foreigners in this study who committed homicide is significantly higher than the proportion of citizens/permanent residents in the general population. Foreigners who commit homicide also appear to (i) suffer from the more serious psychiatric illnesses of mood and psychotic disorders compared with locals, (ii) be less likely to have a known history of violence or a past forensic history and (iii) be more likely to be new to psychiatric services compared with the local homicide offenders. Compared with locals, foreigners appear to have a higher risk for committing homicide. Yet, they are less likely to appear early enough before mental health services. Some form of basic education to employers of foreigners as well as to the foreigners themselves on the early signs of mental illness is recommended.

Adolescent↗
PubMed2006

The A-SACT (Achievement in Singapore of Cholesterol Targets) study in patients with coronary heart disease.

BACKGROUND: Cardiovascular disease remains a leading cause of death worldwide, with hypercholesterolemia being a major risk factor. Evidence-based consensus guidelines have recommended consideration of increasingly stringent cholesterol-lowering goals, yet most patients do not meet these targets. Coronary heart disease (CHD) event and mortality rates and mean serum cholesterol levels have declined in Singapore in recent years; however, certain groups remain at elevated risk. OBJECTIVE: To determine (i) proportions of patients with CHD in Singapore who achieved goals for serum low-density lipoprotein-cholesterol (LDL-C); and (ii) factors influencing goal attainment. METHODS: A historical cohort study was conducted using records from the Singapore Cardiac Databank, a national registry of CHD patients. Serum LDL-C goal attainment was assessed in 5174 survivors of acute myocardial infarction or coronary revascularization (i.e. coronary artery bypass graft surgery or percutaneous coronary interventions), of whom 3811 (73.7%) were at very high risk. RESULTS: At baseline, the mean patient age was 60.3 years, mean serum value of total cholesterol was 228 mg/dL, and mean LDL-C was 163 mg/dL. Of all CHD patients, approximately 70% did not achieve a serum LDL-C target of <100 mg/dL. Most patients receiving HMG-CoA reductase inhibitor (statin) regimens were treated initially with low- to medium-equipotency regimens and were never titrated to stronger regimens. The vast majority (approximately 94%) of patients at very high risk did not achieve the stringent serum LDL-C target of <70 mg/dL. Patients receiving higher potency statins were significantly more likely to achieve LDL-C goals, whereas those with higher baseline LDL-C levels or Malaysian ethnicity were less likely to achieve LDL-C goals. CONCLUSIONS: Most CHD patients in the large group of Singapore residents with CHD in the present study did not achieve recommended LDL-C targets. A more effective disease-management approach, including patient education concerning lifestyle modification (e.g. diet, physical activity), efforts to enhance medication adherence, and more effective, well tolerated therapies such as high-equipotency or high-dose statins and statin combination regimens, may be needed to improve achievement of consensus cholesterol targets. This is the first study of cholesterol goal attainment in a large group of Southeast Asians and serves as a baseline for future evaluations in Asian populations.

Anticholesteremic Agents↗
PubMed1999

Prevalence of diabetes and ethnic differences in cardiovascular risk factors. The 1992 Singapore National Health Survey.

OBJECTIVE: The purpose of the 1992 Singapore National Health Survey was to determine the current distribution of major noncommunicable diseases and their risk factors, including the prevalence of diabetes and dyslipidemia, in Singapore. RESEARCH DESIGN AND METHODS: A combination of disproportionate stratified sampling and systematic sampling were used to select the sample for the survey. The final number of respondents was 3,568, giving a response rate of 72.6%. All subjects fasted for 10 h and were given a 75-g glucose load, except those known to have diabetes. Blood was taken before and 2 h after the glucose load. Diagnosis of diabetes was based on 2-h glucose alone. RESULTS: The age-standardized prevalence of diabetes in Singapore residents aged 18-69 years was 8.4%, with more than half (58.5%) previously undiagnosed. Prevalence of diabetes was high across all three ethnic groups. The prevalence of impaired glucose tolerance was 16.1%, that of hypertension was 6.5%, and 19.0% were regular smokers. The total cholesterol (mean +/- SD) of nondiabetic Singaporeans was 5.18 +/- 1.02 mmol/l; 47.9% had cholesterol > 5.2 mmol/l, while 15.4% had levels > 6.3 mmol/l. Mean LDL cholesterol was 3.31 +/- 0.89 mmol/l; HDL cholesterol was 1.30 +/- 0.32 mmol/l, and triglyceride was 1.23 +/- 0.82 mmol/l. CONCLUSIONS: Prevalence of diabetes was high across all three ethnic groups. Ethnic differences in prevalence of diabetes, insulin resistance, central obesity, hypertension, smoking, and lipid profile could explain the differential coronary heart disease rates in the three major ethnic groups in Singapore.

Adolescent↗
PubMed1989

Beverage alcohol spending in Singapore: a potential development constraint?

World Health Organization sponsored studies identify Singapore as a low-level-drinking country where beverage alcohol consumption is not growing at a rapid pace. However, data for Singapore do show that from 1978 through 1986, consumer spending on beverage alcohol was on the rise, although not alarmingly. Growing spending on beverage alcohol could signal a challenge to Singapore's continuing economic development when viewed in the context of the country's emerging labor shortage and its development strategy. Beverage alcohol could become a problem due to the upward trend in spending on drinking, the emergence of a labor shortage, and the need for the largest possible pool of highly skilled workers to sustain Singapore's growth and development. Government might, therefore, look into spending on alcohol as diligently as it focuses on the consumption of tobacco and narcotics.

Alcoholic Beverages↗
PubMed2006

Dengue prevention and 35 years of vector control in Singapore.

After a 15-year period of low incidence, dengue has reemerged in Singapore in the past decade. We identify potential causes of this resurgence. A combination of lowered herd immunity, virus transmission outside the home, an increase in the age of infection, and the adoption of a case-reactive approach to vector control contribute to the increased dengue incidence. Singapore's experience with dengue indicates that prevention efforts may not be sustainable. For renewed success, Singapore needs to return to a vector control program that is based on carefully collected entomologic and epidemiologic data. Singapore's taking on a leadership role in strengthening disease surveillance and control in Southeast Asia may also be useful in reducing virus importation.

Aedes↗
PubMed1999

The changing pattern of glomerulonephritis in Singapore over the past two decades.

This study reviews the pattern of glomerulonephritis (GN) in Singapore over the past 2 decades. In the earlier decade the pattern was typical of most Asian countries with mesangial proliferative GN (Mes GN) (56%) as the most common form of primary GN including the nephrotic syndrome (40%). In the 2nd decade the pattern undergoes a change. Though Mes GN is the commonest primary GN (42%), the commonest form of nephrotic syndrome is now minimal change disease (30%) with Mes GN decreasing to 25% among all primary nephrotic syndromes. Both minimal change and focal global sclerosis account for 50% of steroid/cyclophosphamide responsive GN today. Membranous GN though still uncommon, has increased from 3% (1st decade) to 6% (2nd decade) (p < 0.01). IgA nephritis is still the commonest primary GN occurring in Singapore (42% of all primary GN in the 1st decade and 45% in the 2nd decade). The present pattern of GN in Singapore, though, still predominantly Asian with the preponderance of mesangial proliferative GN with a relatively low incidence of membranous GN contrasts with the pattern in the West where membranous GN is the commonest form of primary GN. Even the incidence of FSGS has not increased as in the West where there is a rising incidence. The underlying basis for most GN in Singapore as in other Asian countries and elsewhere is antigen-driven: infective antigen as well as food or other allergens.

Adolescent↗
PubMed2000

Attitudes and beliefs of Singapore health care professionals concerning HIV/AIDS.

AIM OF STUDY: This study examines the beliefs and attitudes of Singapore doctors, dentists, and nurses concerning HIV/AIDS and persons living with HIV/AIDS (PWAs). METHOD: A mail survey was done of all doctors and dentists in Singapore as well as a random sample of 1,500 nurses from the Singapore Nursing Board Register. RESULTS: The results showed that respondents held accurate beliefs concerning transmission of HIV via sex and needle sharing but a significant proportion also expressed belief in transmission via everyday social contact. Respondents were aware of universal precautions when treating persons with HIV/AIDS but tended to be overly cautious in low/no risk situations. A substantial proportion of respondents indicated little or no knowledge or experience with AIDS-related conditions and the majority believed that most health care professionals are unprepared to care for PWAs. Further, there was evidence of substantial stigmatisation and fear of treating PWAs, both of which were significantly and negatively correlated with accuracy of beliefs about HIV transmission and universal precautions. CONCLUSION: These results point to important misconceptions about HIV/AIDS held by Singapore health care professionals as well as stigma towards and fear of treating PWAs. These are areas that need to be addressed through better professional education concerning HIV/ AIDS. This education needs to address both the factual misconceptions about HIV/AIDS as well as the stigma associated with this disease and the fears that health care professionals have of treating PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Overview of legislation and tobacco control in Singapore.

Legislative measures against smoking in Singapore began in the early 1970s, and can be said to have been the start of a comprehensive smoking control programme. With the launch of the National Smoking Control Programme (NSCP) in 1986, a National Smoking Control Coordinating Committee was set up to look into legislation and fiscal measures. To further increase the dimension and impact of the programme, a Civic Committee on Smoking Control was formed in 1996. This committee also looks into and recommends legislative measures. The NSCP is an ongoing programme that aims to reduce smoking rates through a combination of strategies, including education, establishment of no-smoking areas and increasing taxation and legislative measures. Existing legislation is regularly and systematically reviewed and revised, and new laws are recommended to strengthen our smoking control efforts. Concurrently, penalties and ways to improve enforcement of the legislation are also updated. The legislative measures that have been implemented in Singapore over the years include prohibition of tobacco advertising and promotion, restrictions on the sale of tobacco products, licensing of sales outlets, use of health warnings on cigarette packets, controlling and labelling of tar and nicotine contents, restriction of smoking in public places and prohibition of smoking in public by the under-eighteens. Several factors have helped make legislative measures work in Singapore. These include political will and support, starting legislation early, comprehensive legislative measures, enforcement measures and continuous review. To sustain these efforts, Singapore needs to continue to stay abreast of world-wide measures on smoking control.

Advertising↗
PubMed2002

Clinical update on deep vein thrombosis in Singapore.

Venous thromboembolism (VTE) is thought to be a rare occurrence in Asian patients. The clinical features of VTE are elusive and the disease often unsuspected. Objective testing such as the duplex ultrasound scans and pulmonary imaging are necessary as clinical diagnosis alone is inaccurate. Fatality can occur in untreated patients not suspected of the disease as shown by our post-mortem studies. Indeed VTE is one of the leading causes of maternal mortality in Singapore. There is a rising trend in the incidence of VTE in Asia. Initial studies found an incidence of about 3 per 10,000 hospital admissions in Hong Kong and Malaysia in 1988 and 1990, respectively; rising to 8 and 15.8 per 10,000 hospital admissions in Singapore 1992 and 2000, respectively. The major risk factors for developing deep vein thrombosis (DVT) in our patients are immobilisation, surgery and malignancy. While Factor V Leiden mutation and mutation at position 20,210 in the prothrombin gene are found to be extremely rare in Chinese, the rest of the thrombophilia has not been formally studied. Studies in Singapore reported rates of 3% to 7% of DVT after general surgery, 9.7% after hip surgery and 14% after total knee replacement surgery. It is difficult to compare with studies from other centres because of differences in patient selection and diagnostic criteria. Studies in Singapore showed that the use of prophylactic low molecular weight heparin completely abolished the occurrence of DVT for patients undergoing total knee replacement and colorectal surgery without an increase in bleeding complications. In conclusion, VTE is not an uncommon problem here. Major acquired risk factors do not differ from the Caucasian populations. VTE is a preventable disease and a better understanding of its epidemiology, patient-risk factors and biological factors will allow better management of this condition.

Asian People↗
PubMed2002

Height and its relationship to refraction and biometry parameters in Singapore Chinese children.

PURPOSE: To examine the association between the anthropometric measurements of height, weight, body mass index (BMI) and refraction and other ocular parameters in Singapore Chinese children. METHODS: In a cross-sectional study of 1449 Chinese schoolchildren, aged 7 to 9 years, from three Singapore schools, height and weight were measured according to standard protocol, and BMI was calculated. Refractive error and corneal curvature measures were determined by autorefraction in eyes under cycloplegia. Axial length, vitreous chamber depth, lens thickness, and anterior chamber depth were measured using A-scan biometry ultrasonography. RESULTS: In comparison with the children with height in the first quartile for a given age and gender, the eyeball length in children in the fourth quartile was 0.46 mm longer, the vitreous chamber depth 0.46 mm deeper, the corneal radius of curvature 0.10 mm greater (i.e., flatter), refraction more negative by 0.47 D (-0.76 D versus -0.29 D), and axial length-to-corneal curvature radius (AL-CR) ratio higher, after analyses controlling for age, gender, parental myopia, reading, school, and weight. The associations of height with refractive error and AL-CR ratio were significant in girls but not in boys. Heavier and more obese children had refractions that were more hyperopic (P = 0.01, P = 0.08), after analyses controlling for age, gender, parental myopia, reading, and school (height was also controlled for if weight was evaluated). This association was present in boys but not in girls. CONCLUSIONS: Controlling for age, gender, parental myopia, reading, school, and weight showed that taller Singapore Chinese children had eyes with longer axial lengths, deeper vitreous chambers, flatter corneas, and refractions that tended toward myopia. In multivariate analysis, eyes in children who were heavier or who had a higher BMI tended to have refractions that were more hyperopic, and eyes in heavier children had shorter vitreous chambers. Differences between the present results and a recent report in Singapore adults suggest either a cohort effect or a potential influence of systemic endocrine or metabolic factors during childhood on refractive development.

Biometry↗
PubMed2002

Birth prevalence of Down syndrome in Singapore from 1993 to 1998.

OBJECTIVE: To examine the livebirth prevalence rate of Down Syndrome in Singapore from 1993 to 1998. DESIGN: Index cases for the National Birth Defects Register were obtained from all neonatal nurseries in Singapore, all hospital discharge summaries, cytogenetic and pathology reports from all pathology laboratories in Singapore and from the compulsory reporting of all termination of pregnancy cases and stillbirths delivered. SETTING: Information for the Register was obtained from case notes retrieved from the medical record offices, antenatal clinics, cytogenetic laboratories, pathology departments and the Registry of Births and Deaths. SUBJECTS: All foetuses with Trisomy 21 diagnosed prenatally together with livebirths and stillbirths with Down Syndrome diagnosed at or after birth were identified from the Registry database. MAIN OUTCOME MEASURES: Prevalence of Down Syndrome RESULTS: From 1993 to 1998, there were 295 Down Syndrome livebirths, four stillbirths and 197 Down Syndrome foetuses aborted. There has been an increasing number of Down Syndrome foetuses diagnosed antenatally ending in termination and this is accompanied by a falling trend in the Down Syndrome livebirth rate in the same years from 1.17 to 0.89 per 1000 total live births. This is despite an expected increase in Down Syndrome livebirth rate obtained by modelling maternal Down Syndrome age-related risks on the maternal age distribution over the years. CONCLUSIONS: The livebirth prevalence of Down Syndrome in Singapore has fallen over the years from 1.17/1000 livebirths in 1993 to 0.89/1000 livebirths in 1998 due to antenatal diagnosis and selective termination.

Abortion, Induced↗
PubMed2002

Measuring health-related quality of life in Singapore: normal values for the English and Chinese SF-36 Health Survey.

OBJECTIVE: To determine norms for assessing Health-related Quality of Life (HRQOL) in Singapore using the Short Form 36 Health Survey (SF-36). MATERIALS AND METHODS: Mean SF-36 scores were calculated for 24 population subgroups (categorised by age, gender, ethnicity and questionnaire language) and for subjects with self-reported co-morbid conditions using data from a community-based survey in Singapore. RESULTS: The English and Chinese SF-36 was completed by 4122 and 1381 subjects, respectively, 58% (n = 3188) of whom had self-reported co-morbid conditions. SF-36 scores varied in subgroups differing in age, gender and ethnicity. In general, subjects with self-reported co-morbid conditions had lower SF-36 scores than those without these conditions, the magnitude of which exceeded 20 points in several instances. A method for calculation of SF-36 scores adjusted for age, gender, ethnicity and questionnaire language is described. CONCLUSION: We present norms for English and Chinese SF-36 versions in Singapore and describe potential uses for these data in assessing HRQOL in Singapore.

Adult↗
PubMed2002

History of the orthopaedic specialty in Singapore.

The Orthopaedic specialty service in Singapore began in 1952 with the appointment of J A P Cameron to the chair of Orthopaedics at the University of Malaya and the simultaneous establishment of the Department of Orthopaedic Surgery at the General Hospital, Singapore. A second department--a government department of orthopaedic surgery was established in 1959, under the headship of Mr D W C Gawne also at the General Hospital, Singapore to cater to the increasing workload. Although orthopaedic services were already available at Alexandra Hospital, Tan Tock Seng Hospital and Toa Payoh Hospital from as early as 1974, the formal establishment of a Department of Orthopaedic Surgery in these hospitals took place only in 1977. The pioneering local orthopaedic surgeons--Mr W G S Fung, Mr K H Yeoh, and Mr V K Pillay--joined the orthopaedic service in 1961. In 1967, Prof Pillay and Mr Fung took the leadership role at the University Orthopaedic Department and Government Orthopaedic Department, General Hospital, Singapore, respectively. Subspecialty services in orthopaedic surgery began in the late 1970s, and currently, at least 7 subspecialties have developed to divisional status at one or more hospitals. In 2001, there were 92 registered Orthopaedic specialists and just over a third were in private practice.

Emergency Service, Hospital↗
PubMed2002

History of the Singapore Orthopaedic Association.

Since emerging from the shadows of General Surgery, the specialty of Orthopaedic Surgery in Singapore has grown from strength to strength. The year 2002 commemorates 50 years of orthopaedic specialty practice in Singapore. It also celebrates the 34th birthday of the Singapore Orthopaedic Association and coincides with the 25th Annual Scientific Meeting. The Singapore Orthopaedic Association, from its humble beginnings, has grown into a credible organisation that aims to fulfill the academic aspirations of its members as well as serve as a bridge to other related organisations abroad. Apart from its academic activities, it also aims to broaden the bond of friendship with other orthopaedic organisations.

History, 20th Century↗