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PubMed1991

Health care services for the elderly--a Singapore perspective.

Singapore is greying at a phenomenal pace as well as in a markedly disproportionate manner. By the year 2030, the elderly will comprise around 25% of the total population; at the same time the numbers of younger and economically active persons will decline. The reasons for this process are varied and its implications disturbing. An important consequences is the urgent need for careful and comprehensive planning to meet the elderly's needs. The needs are best addressed when the elderly are looked at as either being well or frail. A guiding principle is that most of them prefer and should remain within community (and not be institutionalised). Efficient and appropriate community services must be developed so as to support the elderly's stay in the community.

Aged↗
PubMed1991

Occupational asthma in Singapore--a review of cases from 1983 to 1990.

One of the newer occupational diseases in Singapore is occupational asthma. As on 31 December 1990 there were 35 confirmed cases of occupational asthma in the official statistics on occupational disease. We report in this paper our observations and experience based on these cases. The problem of under-reporting and the importance of early diagnosis are discussed.

Adolescent↗
PubMed1991

Singapore General Hospital's experience in corneal grafting.

This is a retrospective study of 56 corneal grafts that was done in the Singapore General Hospital (SGH) between 1980 and 1989. These cases were analysed and it was found that there was a male predominance of about 2:1. There was a rather even spread among the various age groups except for a slightly higher incidence in the 20-29 year age group. There was a drastic drop in the number of grafts done after the year 1987 and this was attributed to the reluctance to accept donor corneas from Sri Lanka as there was the danger of the AIDS transmission through the donor material. The most number of grafts were done for patients with infection as a cause for corneal opacities, followed closely by keratoconus. There was a high incidence of graft rejection as almost 20 out of the 56 developed rejection. However, the visual results proved to be good with 27 obtaining at least 6/12 vision post operatively. This article outlines the need for more stringent pre-operative evaluation of both the donor material as well as the host patient in order to reduce the incidence of graft rejection and, hence, increase the overall success rate.

Age Factors↗
PubMed1991

Serotype distribution and antimicrobial resistance of Shigella isolates in Singapore.

Serogrouping of 506 Shigella strains isolated in Singapore from 1986 to 1990 showed that Shigella flexneri (60.3%) was the most common, followed by S. sonnei (33.6%), S. boydii (3.2%) and S. dysenteriae (3%). Of the 23 Shigella serotypes identified, the predominant ones were S. flexneri types 2a and 1b, S. boydii types 1 and 5, and S. dysenteriae types 1 and 3. More than 80% of the Shigella species were resistant to at least one antimicrobial drug, and the incidence of multiresistance was particularly high in S. flexneri strains. Due to the high incidence of antimicrobial resistance, the susceptibility pattern of Shigella strains should be determined for treatment purposes.

Drug Resistance, Microbial↗
PubMed1991

Clinical profile of elderly urinary incontinence in Singapore: a community-based study.

The prevalence of urinary incontinence in the elderly aged 65 years and above was found to be 4.6% (42 out of a total of 919 respondents), in a community-based study in Singapore. Urinary incontinence was defined as leakage of urine on at least two occasions in the previous one month. The clinical profile of 30 out of the 42 (71%) subjects were studied. There was equal distribution of male and female subjects. Eighteen (60%) of the subjects were below 75 years of age. Twenty-five (83.3%) subjects had severe incontinence. Twenty-four (80%) had the incontinence for more than one year. Despite the high percentage of patients with severe incontinence, only nine (30%) used some form of aid. Incontinence in our very old (75 years and above) was not related to frailty or physical dependence. Seven of the subjects (23.3%) were found to have functional incontinence associated with cognitive impairment. These patients were unable to indicate their toilet needs. They also had associated physical disability as well as double incontinence, and their carers were under stress. Ten of the subjects had pure urge incontinence. Seven of them had an underlying central nervous system disorder, suggesting that destrusor hyperreflexia may be the underlying cause for urinary incontinence in this group. All except one in this group had more than one possible precipitating factor for their incontinence. Eleven subjects had symptoms suggestive of outlet obstruction, although only two were found to have proven outlet obstruction. None of the female subjects had pure stress incontinence.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed1991

Pacing experience with the atrial screw-in leads at the Singapore General Hospital.

This is a retrospective study of atrial screw-in leads implanted at the Singapore General Hospital from January 1988 to August 1990. There were 21 (13 female and 8 male) consecutive patients, with age ranging from 17 to 79 years (mean 55 years). Thirteen patients had sick sinus syndrome and the remaining eight patients had high grade AV block. Eleven patients had AAI, six had DDD and four had DDDR pacing modes respectively. Three different models of unipolar screw-in leads were used. Eight patients had Medtronic Model 6957, seven had Medtronic Model 4057 and six had Siemens-Pacesetter Model 1007 pacing leads implanted. At the time of implant, the measured P wave amplitudes ranged from 1 to 4.8 mV (2.5 +/- 1.1 mV) and the pacing thresholds ranged from 0.5 to 2.3 volts (1.21 +/- 0.51 volts). There were no acute complications at the time of implant. On follow-up ranging from one month to two years, two patients had inadequate sensing in the atrium and one patient had high pacing threshold. There were no lead dislodgement. In conclusion, these screw-in leads can be safely used in the atrium with acceptable pacing characteristics.

Adolescent↗
PubMed1991

Community-acquired legionellosis in Singapore.

Patients admitted to hospital with chest infections were examined serologically to see if these were due to Legionella pneumophila. Each of the 219 samples of serum collected from 177 patients was examined by two standard tests. The tests, which generally agreed, identified three individuals (1.7% of the group) who had sufficient antibody to suggest that they were suffering from current legionellosis. Serological evidence of previous infection was discovered (with differing degrees of certainty) in 26 (14.7%) of the others. The study showed that legionellosis is endemic in Singapore, and so must be taken into account in the differential diagnosis of cases of pneumonia.

Adult↗
PubMed1991

Normal standard of pubertal development in Singapore school children.

A cross sectional study of the pubertal status of normal school children in Singapore was performed in 1987. The results of the data analysis are presented as an update from the last survey performed in 1977. The norms of pubertal development in boys and girls are thus defined.

Adolescent↗
PubMed1991

Toxoplasmosis in Singapore.

The present paper reports research done in the following areas in the Parasitology Unit of the Department of Microbiology, National University of Singapore: determination of anti-Toxoplasma gondii antibodies in different IgG subclasses; immunoblot analysis of the antibody response to T. gondii and identification of key reactive epitopes; production and characterization of monoclonal antibodies to T. gondii; and the development of an IgM capture ELISA. IgG1 is the dominant subclass involved in the humoral response to T. gondii. IgG3 and IgG4 may be produced at low but significant levels. IgG2 production was not apparent. Immunoblot analysis of the positive sera revealed that the major antigens recognized by IgG and IgM antibodies were of MW 22, 35 and 67 kDa. Many of the bands observed in blots with positive sera were also present in blots with negative sera. The 22 kDa band was seen in majority of positive sera and was generally absent in negative sera. Anti-Toxoplasma sera also revealed IgA antibodies. Immunoblot analysis of the antigen revealed a 14 kDa band that reacted with all IgA positive sera. From a panel of monoclonals produced against T. gondii, one monoclonal, 5F3 (A) was selected for development of a monoclonal based IgM capture ELISA for detection of antibodies to 22 kDa and 41 kDa epitopes of T. gondii.

Animals↗
PubMed1991

Mortality among psychiatric inpatients in Singapore.

This study examines the Standardized Mortality Ratio (SMR) by age, sex and cause of death among psychiatric inpatients in Singapore. Mortality in mentally ill inpatients was found to be 2.79 times that of the general population. The SMR decreased with age and the SMR for those 70 years and above was lower than that reported in the literature. The mortality ratio was most accentuated in the younger patients, especially in the female. Excess mortality was observed in both the natural as well as the unnatural causes of death. Among the natural causes of death, infection and pneumonia showed high excess in mortality. In the unnatural causes of death, suicide was predominant.

Adolescent↗
PubMed1991

Maintenance haemodialysis in Singapore.

The chronic haemodialysis programme of the Singapore General Hospital started in 1968 as a hospital-based fully nurse-assisted programme. This has since expanded to include Self Dialysis and Home Dialysis programmes. Data of 425 patients who entered the dialysis programmes was analysed retrospectively. The major cause of end stage renal failure was chronic glomerulonephritis (52%). Almost half of the patients in the haemodialysis programme were patients on self-dialysis (49%). There were 157 withdrawals and 116 deaths. Survival has improved tremendously with the use of treated water for dialysis from 1981. The 5 year survival in an earlier group of patients dialysed with untreated water was 48% compared with 81% in a late group dialysed with treated water (p less than 0.001). The pattern of complications has also changed with a lower incidence of dialysis osteomalacia, hypertension, hepatitis and eradication of dialysis dementia.

Acute Kidney Injury↗
PubMed1991

Cigarette smoking among school children in Singapore. Part II--Development of the smoking habit.

The second in this series on smoking among school children in Singapore aims to define the characteristics of young smokers. Results show that of respondents who had ever smoked, the median age of experimentation with smoking was 12 years. This was seen among boys as well as girls. The median age at which current smokers went on to smoke regularly was 14 years, approximately two years after trying their first cigarette. Friends and parents were the main sources of the first cigarette for all categories of smokers, whether they be ex smokers, experimenters or current smokers. Among the reasons as to why current smokers smoked, the leading two were "to relax" (46.4%) and "out of sheer curiosity" (22.3%). Boys tend more to smoke with friends of the same sex (40.6%) whilst girls preferred mixed company (45.5%) when they smoked. Fathers played a major role in the development and continuation of smoking among those who had ever smoked before--52.0% of boys and 51.6% of girls currently smoking reported that their fathers smoked as well.

Adolescent↗
PubMed1991

Prevention of heat disorders in the Singapore Armed Forces--1984-1989.

A review of the incidence of heat disorders in the Singapore Armed Forces was done in relation to the preventive and corrective measures applied. Data was compiled and analysed from records kept by the SAF Medical Services. A thorough review was made into all the preventive measures carried out thus far and the effectiveness was evaluated. There was a rise in the incidence of heat strokes from eight cases in 1984 to a peak of 46 cases in 1986. Subsequently, aggressive measures were adopted and the incidence fell significantly in 1988 and 1989. The main strategy involved a comprehensive health education programme, regulations, active surveillance and aggressive treatment. However, the incidence has not fallen to the pre-1984 levels. Therefore, a strict vigilance must be constantly maintained to prevent further mortality and morbidity.

Heat Exhaustion↗
PubMed1991

Typhoid fever in Singapore: a review of 370 cases.

The medical records of 370 patients treated for typhoid fever between 1986 and 1988 at the Communicable Disease Centre, Singapore, were reviewed. The disease was generally mild. There was no mortality. Fever was found in 98.4% of patients on admission and diarrhoea in 21%. Cough was predominantly a symptom of children and occurred in 7.1% of patients aged below 15 years. Other symptoms were uncommon. Hepatomegaly was found in 71% and splenomegaly in 47%. Leucopenia was not a helpful diagnostic marker. Chloramphenicol was the drug of choice. The relapse rate was 5.4% and the convalescent and temporary carrier rates 11.6%. The risk of developing the carrier state was significantly higher among patients who were afebrile on admission compared with those who were febrile (P less than 0.001); it was also higher in patients treated with ampicillin as compared to those treated with chloramphenicol (P less than 0.001, chi 2 = 22.7, odds ratio = 5.25, 95% confidence limits: 2.46 and 11.29). The role of ampicillin as a first line treatment for acute typhoid fever may need further re-evaluation.

Adolescent↗
PubMed1991

Stroke rehabilitation of elderly patients in Singapore.

A retrospective study of 100 elderly stroke patients admitted to a rehabilitation centre in Singapore was done to study the characteristics of the patients and the factors associated with the outcome. The mean age of the patients was 72.7 +/- 5.4 years with an equal sex ratio. There was a predominance of Chinese. Two or more concomitant diseases were present in 43% of the patients with a markedly high prevalence of hypertension. Majority had unilateral motor deficit, and cerebral infarcts were seen in 66% of the scans done. Altogether 79% of the patients improved on their level of self-care in activities of daily living (ADL) while 60% showed improvement in their level of mobility. Patients with good prognosis were those who were assessed to be at least partially independent in ADL prior to rehabilitation and those who showed improvement in the motor power of their affected limbs during rehabilitation. Those with dense hemiplegia at the outset were likely to remain dependent. Age, sex, delay in rehabilitation, duration of rehabilitation, presence of dysphasia and sides of deficit had no bearing on the outcome.

Activities of Daily Living↗
PubMed1990

Peripheral fibroma/fibrous epulis with and without calcifications. A clinical evaluation of 204 cases in Singapore.

Peripheral fibroma/fibrous epulis accounts for the great majority of localised gingival swellings as was substantiated by various reports in the literature. A study was undertaken to investigate the clinical features of a series of 204 localised fibrous gingival swellings received by the Histopathology Laboratory, Department of Oral Surgery, National University of Singapore. The female patients were more affected than the male patients and the lesions occurred predominantly among the Chinese. The lesions were mainly pedunculated and most commonly occurred in anterior maxilla. The recurrence rate was about 10.3%. In conclusion the results obtained in this study were overall in agreement with those of other authors.

Adolescent↗
PubMed1990

Preimmunisation hepatitis B screening in Singapore--a viewpoint from private sector clinics.

Blood samples from 1,600 persons who sought immunisation against hepatitis B in private clinics in Singapore in 1988-1989 were screened for two viral markers. Of that total, 4.81% were positive for HBsAg and 17.31% had anti-HBs levels greater than 10 mIU/ml, indicating that about 22.12% of the general population would not benefit from immunisation. Preimmunisation screening will identify persons not requiring the hepatitis B vaccine and thus, avoid wastage. When immunisation has already been performed without screening, recall for post-immunisation screening should be considered in order to detect the infectious hepatitis B carriers. Data in this study indicates that at this point in time, it is important to immunise adolescents and adults, in addition to neonates and children.

Ambulatory Care Facilities↗
PubMed1990

Awareness and acceptance of hepatitis B vaccination in Clementi, Singapore.

Hepatitis B Virus infection, a public health problem in Singapore, can be effectively controlled by vaccination. This paper reports on a study conducted in 1988/89 to ascertain the awareness and uptake rate of Hepatitis B vaccination. A list of children born between November 1986 and May 1987 in the catchmen zone of the Clementi Maternal and Child Health (MCH) Clinic was obtained. Out of a total of 257 children, 226 (87.9%) responded to our study in May 1988 which was part of a larger community health survey carried out by a group of medical students. The vaccination uptake rate was 23%. The awareness of the parents on Hepatitis B virus infection and vaccination was assessed using a standardised questionnaire. About two-thirds were aware of the main modes of Hepatitis B transmission, 46.5% were aware of the long-term consequences of Hepatitis B infection and 6.6% thought that the vaccine was not safe from serious side effects. A follow-up survey of the respondents was carried out in August 1989. The Hepatitis B vaccination uptake had increased to 48.3%. The immunisation status showed a correlation with the ethnic group, father's occupation and awareness score of respondents. The more than two-fold increase in uptake rate can be attributed to a reduction in the cost of Hepatitis B vaccination and a vigorous nation-wide education programme during the preceding year.

Asian People↗