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Racial differences in perception of oral health and oral health behaviours in Singapore.

Knowledge of prevention can influence preventive dental behaviours. This study surveyed knowledge and preventive dental behaviours on the prevention of dental caries and gum disease among the adult population of the three major racial groups in Singapore. Respondents were asked to rate the importance of several preventive measures against dental caries and gum disease. Questions were also fielded on dental behaviours such as preventive visits to the dentist, toothbrushing and flossing. Results showed that there was a general lack of appreciation for the use of flossing, dental sealants and fluoride supplements. Although a majority of respondents thought that regular dental checkups would be essential for prevention, the proportion who actually saw the dentist for preventive care was significantly lower. Respondents provided inappropriate reasons for brushing their teeth. Differences in both preventive knowledge and preventive dental behaviours among racial groups were evident although these were attributed to differences in education and exposure to product information rather than to racial or cultural factors.

Adult↗

Enteropathogenic Escherichia coli as a cause of diarrhoea among children in Singapore.

Enteropathogenic Escherichia coli (EPEC) was isolated from 2.7% of 2983 children under 3 years of age with diarrhoea in Singapore. Of the nine serotypes identified, the most common were 0126:K71(B16), 086:K61(B7) and 0127:K63(B8). Infants were at the greatest risk of contracting gastroenteritis due to EPEC, and female children were slightly more susceptible than males. Antimicrobial susceptibility tests showed that the EPEC strains were generally resistant to ampicillin, streptomycin, tetracycline and triple sulpha, but highly sensitive to ceftriaxone and gentamicin.

Anti-Bacterial Agents↗

The first oocyte donation pregnancy home-bred and delivered in Singapore to illustrate a simplified oocyte donation programme--no more embryo freezing, synchronisation or disruption of social life.

The wait for an oocyte donor is highly unpredictable and stressful. The recipients may have to remain contactable at all times. Even when a donor is present, their reproductive cycles may not be in synchrony to enable gamete or embryo replacement, and embryo freezing is required for the transfer of embryos in the subsequent cycle. After the release of the Guidelines for Assisted Reproductive Technique by the Ministry of Health we have established a simplified oocyte donation programme with which the need for synchronisation, embryo freezing and the disruption to the recipient couple's social life are eliminated. To illustrate, we report the first report of oocyte donation pregnancy home bred and delivered in Singapore.

Adult↗

An epidemiological survey of respiratory morbidity among granite quarry workers in Singapore: radiological abnormalities.

This report presents baseline findings from the first of a series of epidemiological studies to evaluate inter alia the effects of control measures introduced in 1972-79 to reduce dust exposure in all quarries in Singapore. The prevalence of radiological abnormalities among 219 currently employed quarry workers were estimated according to a number of parameters of dust exposure. Large-sized chest x-ray films were read, independently and in random order, by a panel of three experienced readers, who were "blinded" to the personal particulars and exposure of the subjects, using standard chest x-ray films to record opacities according to the International Standard Classification of Radiographs of Pneumoconioses. Silicosis as defined by radiological small opacities (both rounded and irregular) of profusion 1/1 or greater as read by at least two readers were noted in 11 subjects. The prevalence of silicosis was 12.5% in highly exposed drilling and crushing workers, and 0.8% in maintenance and transportation workers with low level exposure to granite dust. Among those who were first exposed to granite dust after 1979, no cases of silicosis were noted in any quarry worker. It is concluded that reduction in dust exposure since 1979 has so far been successful in producing nil or negligible risks of silicosis among active quarry workers over ten years, but further follow-up studies are needed.

Adult↗

Prevalence of bacterial agents of diarrhoeal disease at the National University Hospital, Singapore and their resistance to antimicrobial agents.

Over a 50-month period, 4,508 stool specimens from patients with diarrhoea were bacteriologically examined at the National University Hospital, Singapore. Salmonella serotypes other than the typhoid and paratyphoid bacilli were the most common finding, being isolated in 10.8% of cases. Campylobacter jejuni was unexpectedly infrequent (1.9%); Aeromonas hydrophila was found in 1.8%. No other aerobic pathogen occurred in more than 1% of cases. Clostridium difficile was sought only when requested, and was isolated from 9.6% of cases tested. Testing for enteropathogenic Escherichia coli was limited to children under 1 year old. Gentamicin was active against the greatest number of aerobic isolates, followed by chloramphenicol and cotrimoxazole. The C. difficile isolates were all sensitive to metronidazole.

Aeromonas hydrophila↗

Giant cell arteritis (temporal arteritis, cranial arteritis) and a case from Singapore.

Giant cell arteritis as the underlying cause of blindness in the elderly is common in the West but is not seen except on rare occasions in South East Asia. We describe an 86-year-old Chinese man from Singapore who presented with a central retinal artery occlusion. Biopsy of a prominent superficial temporal artery established the underlying cause to be giant cell arteritis which was also the eventual cause of death as the condition resulted in rupture of a dissecting aneurysm of the aorta. Giant cell arteritis should be considered in all cases of ischaemic eye disease in the elderly. The importance of early diagnosis lies in the very high incidence of second eye involvement within days or at most weeks in untreated patients. A high index of suspicion is required for diagnosis of this condition which is likely under-diagnosed in our local context.

Aged↗

After-hour home care service provided by a hospice in Singapore.

A home care Hospice programme was set up to provide care to the patients with advanced diseases and their families in Singapore. After office-hour, the service is managed by a doctor on weekdays, with the assistance of a nurse during daytime on Saturdays, Sundays and public holidays. The doctor on-call made an average of 3.1 phone calls and 1.3 visits each weekday evening. Over the weekends and public holidays, there were a mean of 16.7 phone calls and 6 visits each day. More than half of the visits (50.3%) were made for certification of death. The commonest symptoms that prompted visits were dyspnoea (20%) and pain (12.2%). The busiest period during weekdays was between 6.00 pm and 11.00 pm, when our doctors did most of their visits. The workload of the hospice home care service is likely to increase and resources such as family health physicians can be explored to help to meet this increasing demand. This can be achieved through the provision of comprehensive training and easy accessibility to medical records which are kept with patients.

After-Hours Care↗

Localised outbreak of Falciparum malaria in Singapore.

Malaria is primarily an imported disease in Singapore. Local outbreaks are uncommon. We describe a localised outbreak of three patients with Falciparum malaria, which we believe to be locally acquired. There was one fatality due to severe disease and late presentation. Malaria should be considered as a cause of febrile illness as the likelihood of cure depends on early detection and treatment.

Adult↗

Validity and reliability of the EQ-5D self-report questionnaire in Chinese-speaking patients with rheumatic diseases in Singapore.

OBJECTIVE: We assessed the psychometric properties of a Singaporean Chinese version of the EQ-5D, a health-related quality of life (HRQoL) instrument. MATERIALS AND METHODS: Consecutive outpatients with rheumatic diseases seen for routine follow-up consultations at the National University Hospital, Singapore were interviewed twice within 2 weeks using a standardised questionnaire containing the EQ-5D, the Short-Form 36 Health Survey (SF-36), the Learned Helplessness Subscale, a pain Visual Analogue Scale (VAS) and assessing demographic and psychosocial characteristics. To assess the validity of the EQ-5D, 13 hypotheses relating the EQ-5D self-classifier (5 dimensions) or visual analogue scale (EQ-VAS) to SF-36 scores or other variables were examined using the Mann-Whitney U test, Kruskal-Wallis or Spearman's correlation coefficient. Test-retest reliability was assessed using Cohen's kappa. RESULTS: Forty-eight subjects were studied (osteoarthritis: 16; rheumatoid arthritis: 22; systemic lupus erythematosus: 8; spondyloarthropathy: 2; female: 93.8%; mean age: 56.4 years). Seven of 13 a-priori hypotheses relating EQ-5D to external variables were fulfilled, supporting the validity of the EQ-5D. For example, subjects reporting moderate or extreme problems for EQ-5D dimensions generally had lower median SF-36 scores than those without such problems. Cohen's kappa for test-retest reliability of the self-classifier ranged from 0.41 to 1.00 (n = 42; median interval: 7 days, interquartile range: 7 to 11 days). CONCLUSIONS: The Singaporean Chinese EQ-5D self-classifier appears to be a valid measure of HRQoL in Singaporeans with rheumatic diseases; however, the reliability of the EQ-VAS requires further investigation. These data provide a basis for further studies of the Singaporean Chinese EQ-5D.

Activities of Daily Living↗

Hand, foot and mouth disease in Singapore: a comparison of fatal and non-fatal cases.

AIM: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD-related deaths and after the epidemic, another three HFMD-related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. METHODS: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n = 7) and non-fatal controls (n = 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n = 4) and non-fatal controls (n = 63) were also compared. RESULTS: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non-fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right-sided pneumonia, Haemophilus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin-related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p = 0.0006), raised total white cell count (p = 0.0128), vomiting (p = 0.0116) and absence of mouth ulcers (p = 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis. CONCLUSION: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.

Child↗

HLA in Singapore Chinese with rheumatoid arthritis.

The HLA-A, B, C, DR and DQ antigens were determined in 50 Singapore Chinese patients with rheumatoid arthritis (RA). There was a significant increase in the prevalence of HLA-Bw46, DRw53 and DQ3 in patients with RA. The linkage disequilibrium between Bw46 and DRw53 explains this association. This major histocompatibility complex association differs from the HLA-DR4 link in Caucasian populations and suggests that RA is an immunogenetically heterogeneous disease.

Adult↗

The development of geriatric psychiatry services in Singapore.

Singapore is ageing rapidly and the need to develop a comprehensive range of psychiatric services for the elderly is urgent. To cater to the increase in the number of elderly with mental health problems, a multi-pronged, collaborative approach to developing services is necessary. Over the last decade, the development of such services has been initiated by the Department of Geriatric Psychiatry, Woodbridge Hospital and Institute of Mental Health, and effected through dynamic elderly networks consisting of health, social and voluntary organisations. This has facilitated the integration of psychogeriatric services within the overall framework of elderly services. With the establishment of the Integrated Framework of Healthcare of the Elderly by the Ministry of Health in 2000, the importance and effectiveness of building partnerships in service provision have been demonstrated. The challenge for the future is to attract and retain geriatric-trained healthcare professionals, enhance their training in the early diagnosis and management of psychiatric disorders in the elderly, improve the support of family caregivers and expand the range of quality psychogeriatric services.

Aged↗

Acute interstitial nephritis in Singapore: a report of five cases.

Interstitial nephritis is an uncommon cause of acute renal failure. Reported incidence varies widely in the literature and may depend on several factors i.e. geographical location, diagnostic criteria, dietary, environmental factors and therapeutic practices. This is a retrospective study of biopsy proven interstitial nephritis in National University Hospital Singapore. We report five cases out of a total of 349 biopsies carried out during a five-year period between September 1997 and August 2002. Four patients presented acutely with fever and or cough. In four patients, there was exposure to traditional Chinese medications and/or drugs. Renal failure in four out of the five patients progressed rapidly, three of whom required dialysis. One patient was treated with steroids. Renal function recovered in all patients with one patient who had significant residual renal impairment after one month.

Acute Disease↗

Pattern of third molar impaction in a Singapore Chinese population: a retrospective radiographic survey.

One thousand orthopantomograms (OPGs) of patients 20-40 years old were examined. Where impacted third molars were present, the angle and depth of impaction were recorded. Results were analysed using the Pearson chi2 test. 68.6% of OPGs showed at least one impacted third molar. The frequency was three-fold higher in the mandible (1024/1079=90%) than in the maxilla (306/1077=28%), with a significantly higher frequency (P<0.05) in females (56%) than males (44%). The mesioangular impaction was the most common, and 80% of all impacted third molars were partially buried in bone. Of the 429 bilateral occurrence of impacted third molars, 423 were in the mandible. It was concluded that the frequency of impacted third molars in the Singapore Chinese population studied was generally two to three times that reported in races of the Caucasian stock. There was also double the frequency of impacted third molars when compared to a previous study in a Chinese population published in 1932 with females being more frequently affected than males.

Adult↗