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A survey was conducted among Singapore Dental Association (SDA) members to determine the demand for a fee schedule, the nature of the schedule, and the possible methods of implementing it. The survey revealed that the majority wanted a fee schedule and wanted it enforced. It was commonly perceived that a fee schedule would help to raise the standards of dentistry.
Norplant contraceptive implants are silastic implants containing levonorgestrel. This study describes our experience with 100 acceptors of NORPLANT implants in Singapore. No pregnancies occurred during the first year of use. The majority found the method's ease of use to be the most attractive feature. Disruption of menstrual rhythm appeared to be the least liked feature. However the incidence of these menstrual irregularities appeared to diminish with time. Implant users have tolerated this early disruption of their menstrual rhythm well and the continuation rate at the end of the year was 97%. Thus it appears that Norplant is a safe, effective and acceptable method of contraception.
A voluntary immunization programme to prevent perinatal transmission of hepatitis B virus (HBV) infection in Singapore was implemented on 1 October 1985 as an integral component of the national childhood immunization programme. Up to April 1988, a total of 68,845 mothers who attended government maternal and child health clinics were screened for the disease. Of these, 2432 (3.5%) were positive for hepatitis B surface antigen (HBsAg) and 904 (1.3%) for hepatitis B e antigen (HBeAg). Virtually all the babies born to carrier mothers completed the full immunization schedule; and in addition, those of HBeAg-positive mothers were given a dose of hepatitis B immunoglobulin at birth. The hepatitis B immunization programme was extended on 1 September 1987 to cover all newborns. About 90% of the 15,943 babies delivered in government institutions from September 1987 to April 1988 were immunized at birth, with the subsequent doses being administered at maternal and child health clinics at 4-6 weeks and 5 months later. More than 85% of the children given the full course of plasma-derived and yeast-derived hepatitis B vaccine from birth continued to have protective antibody to HBV two years after immunization. The programme is being closely monitored to assess the duration of immunity and the need for booster doses, while seronegative adults are also being encouraged to be vaccinated.
The frequency and correctness of respirators were studied in 5 granite quarries in Singapore involving 201 workers. The overall prevalence of usage of correct respirators was 45.8%. 10.4% of the workers were found to be using the wrong respiratory protective devices. Age, years of exposure and types of occupations were found to affect the usage of respirators. Some common reasons given by workers for not wearing the respirators were 'breathing difficulty', 'hot & sweaty', and 'respirator smells after a while'.
In this survey for the presence of the feline leukaemia virus (FeLV) in the Singapore domestic cat population, the sera of two different groups of unvaccinated mainly short haired cats which were over 6 months old were sampled. The FeLV enzyme-linked immunoadsorbent assay (ELISA) diagnostic test kit was used to detect the presence of the FeLV group specific (gs) antigens in the blood of cats. Of the 345 clinically healthy cats surveyed, 34 sera (9.9%) were found to be positive and of the group of 123 cats with clinical signs such as chronic wasting, marked by anaemia, anorexia and lethargy, 33 sera (26.8%) were found to be positive. From the time of diagnosis of a viraemia, 70% of cats will die within 20 months. The results are therefore indicative that annually a small proportion of cats in the local environment will die from a FeLV infection. This survey reflects the natural distribution of an infectious oncovirus in a susceptible host population which is unaffected by any control programme to interfere with the normal sequence of events of host virus interactions.
The aims of this study are to determine for the 3 main ethnic groups in Singapore: a) the ABO phenotype distribution in 1987 b) the A, B and O gene frequencies c) the proportion of A and B group individuals who are homozygous using (i) temporal studies (trial & error) (ii) the derived A and B gene frequencies This paper presents the method of study and the results obtained using a sample of 39,019 blood donors in 1987. The opportunity has also been taken to compare the data derived in this study with that quoted in 2 previous studies.
A survey was conducted to study certain characteristics of geriatric patients admitted to two medical departments in Singapore. The aim was to create awareness as well as to provide a better understanding of these elderly as more and more doctors would have to attend to them. Our results show that about 27% of admissions were geriatric patients. The typical geriatric patient in this study was about 75 years old (mean age 74.6 years) and was likely to present with breathlessness due to heart disease or pneumonia. The overall duration of stay in hospital was 10 days and only about 6% of the patients had "discharge" problems needing assistance from the Medical Social Worker. About one in five patients died in hospital, usually from pneumonia or ischaemic heart disease.
The suicide rate in Singapore has remained at 9-11 per 100,000 over the past decade. Comparing the age specific suicide rate, elderly people (60 years and above) have a much higher rate (21.3 per 1000,000) than the young (5 per 100,000). The data also indicate that elderly men are more prone to kill themselves than elderly women. Risk factors in elderly suicide and preventive measures are discussed.
The mission of the Singapore Government Dental Service is to prevent dental diseases and promote dental health, and to develop excellence in dentistry. The history and organisation of the Dental Service are recounted together with the development of the Hospital Dental Service, School Dental Service, Community Dental Service, Training Department and Dental Health Education. Information on the development of a new dental centre with the objective of achieving dental excellence is provided.
Before setting up the first Senior Citizens' Health Care Centre (SCHCC), a survey was done to establish the health and morbidity profiles of older adults in the community and their health care needs. Community volunteers personally interviewed 1,697 persons aged 55 years and above, living in three areas in Singapore. The response rate was 75%. The respondents' general characteristics, the prevalence rate of chronic diseases, their functional and mobility status, utilisation of the health services and how the chronic diseases affected their activities of daily living (ADL) were studied. Among the respondents, 2.1% required nursing care, 4.2% were unable to climb stairs, and 23.3% were on long-term medications. As compared to the younger age groups, those 75 years and above reported more difficulties with mobility (semi-ambulant 6.5%, bedridden 1.8%), more needed assistance in ADL (bathing 4.8%, toiletting 4.7%, dressing 3.0%, and feeding 2.4%) and a higher percentage required nursing care (3.6%). Services that would benefit the frail elderly are reported in this paper.
This is a descriptive study to establish the profile of 120 consecutive patients seeking relief from symptoms and dysfunction of the masticatory system at the Dental Clinic, Singapore General Hospital from February 1988-September 1988. The mean age of the patients was 29.4 years and females outnumber males by 2:1. The patients complained of TMJ clicking (66%), TMJ pain (55%), painful chewing (47%), headaches (42%), painful opening (37%), jaw locking (33%), and jaw muscle pain (23%). The possible etiological factors were recorded: macrotrauma (27%), stressful episodes (24%), unilateral mastication (53%), clenching (28%), grinding (26%) and excessive chewing habits (10%). Unilateral chewing was significantly associated with pain on opening (p less than 0.05) and joint pain (p less than 0.05). A statistical relationship was found between night grinding and laterotrusive wear of teeth (p less than 0.001). There was evidence that tension headache reported by TMD sufferers was related to temporalis muscle/tendon dysfunction (p less than 0.001).
The progress and development of microbiology services in Singapore during the last two decades are described. Rapid diagnosis, quality control, automation, nosocomial infections and national and international studies are some of the topics highlighted in this paper.
A survey conducted in September 1987 among medical doctors and dental surgeons in Singapore found that most respondents expressed personal reservations and inadequacies in dealing with AIDS/HIV-positive patients and homosexuals. They were also concerned about exposure of their staff to AIDS patients and their likely reactions towards treating these patients. The risk of contagion with AIDS was a major deterrent expressed. The majority of the health professionals had no experience in the management of AIDS related conditions. Although many indicated interest in training, only less than half were willing to undergo what they perceived as the more effective clinically based training themselves.
An analysis of all cases presenting with contact lens related complications to the Department of Ophthalmology, Singapore General Hospital, was undertaken over a period of one year (October 1987 to September 1988). A total of 147 patients were seen with contact lens related problems. The overall incidence of patients with contact lens related problems was 0.8% of all referrals to the Department of Ophthalmology during this period. This survey was done in a prospective manner and an analysis with regard to age, sex distribution, presenting complaints, sterilisation technique and diagnoses was done. The study showed a significantly higher incidence of serious sight-threatening complications in extended wear lens wearers. Hard contact lens and Hard Gas Permeable lens wearers had no serious complications seen. There was a significant number of young adults choosing to wear the extended wear contact lens for the convenience of not having to clean their lenses daily even though they had a higher risk of a sight-threatening complication. Interviews with the patients also showed a universally poor knowledge of contact lens hygiene.
The purpose of this retrospective study is to delineate: a) The ethnic group specific distribution patterns of the various Lewis phenotypes in our population in Singapore. b) The occurrence rates of the various anti-Lewis antibodies in our population. The approximate frequencies of the Lewis A-B-, Lewis A-B+ and Lewis A + B- phenotypes in the blood-donor population were estimated to be about 10%, 48% and 42% respectively. It was evident that frequency of the Lewis A-B- phenotype was highest among the Malays, being almost 3 times more frequent than it was among the Chinese (P less than 0.01). The anti-Lewis antibodies were noted to be the commonest irregular antibodies seen in our blood donor population, with an occurrence rate of about 127 per 100,000. Likewise, from 1982 to 1987, the anti-Lewis antibodies were also noted to be the most frequently encountered antibodies in our patient population, accounting for nearly 60% of all cases. Although the Malays comprised only about 15% of the Singaporean population, they accounted for as much as 42.9% of all patients with anti-Lewis antibodies. Similarly, out of all 76 blood donors in 1987 with anti-Lewis antibodies, 50% were found to be Malays although they comprised only 14.28% of the donor population. It was also interesting to note that a sizeable proportion of all patients with anti-Lewis antibodies were pregnant women with or without obstetric complications.
Over a period of seven months, 87 samples of water collected from 48 air-conditioning cooling-towers on 15 sites in Singapore yielded 19 strains of Legionella. Legionellas were found in 7 of the 15 sites. The strains isolated fell into 7 species, serogroups or subgroups of the genus Legionella. Only 11% of them belonged to the more pathogenic Pontiac subgroup of Legionella pneumophila serogroup 1.
Protein C is an important physiological inhibitor of coagulation. A deficiency of this protein is a recognised cause of recurrent venous thromboembolism. The assay for protein C was not locally available until recently. Our investigation of a young Malay woman who had sustained two previous pulmonary emboli led us to identify the first family in Singapore with this familial disorder. The definitive diagnosis of symptomatic protein C deficiency justifies longterm anticoagulant therapy in two members of this family. We now systematically screen all young adults who present with the first episode of deep venous thrombosis or pulmonary embolism irrespective of whether the event is spontaneous or seemingly precipitated.
As Singapore is a densely populated island, and also a major air and sea port, the importation and dissemination of viral infections is facilitated. Respiratory viral infections have the highest prevalence rates, influenza and respiratory syncytial virus (RSV) being the most important ones. Seasonal variation occurs with influenza, RSV and parainfluenza virus type 1 infections. The age distribution and clinical picture associated with infections due to the various respiratory viruses are similar to those reported in other countries. Carrier rates for hepatitis B are high, but differ in the three major ethnic groups, vertical transmission from infected mothers being an important mode of transmission. Outbreaks of hepatitis A have been associated with the consumption of inadequately cooked shellfish. Cytomegalovirus and Epstein-Barr virus infections are acquired early in life and herpes simplex, more slowly. Genital herpes is increasing in incidence. Coxsackievirus A24 and enterovirus 70 have caused major epidemics of acute haemorrhagic conjunctivitis at 5-10 year intervals. Outbreaks of hand, foot and mouth disease due to coxsackievirus A16 have also occurred. With the declining incidence of dengue haemorrhagic fever, the percentage of susceptible individuals in children under 10 years, has increased markedly. Epidemics of rubella which occurred during the past decade, together with immunisation, have increased herd immunity to this virus.