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PubMed1987

Epidemiological aspects of an outbreak of dengue fever/dengue haemorrhagic fever in Singapore.

A nation-wide outbreak of 260 cases of DF/DHF with 1 death occurred in Singapore from Apr-Sept 1986. The outbreak originated from 3 separate foci of transmission at the western, south-eastern and north-eastern parts of the island and then spread to other dengue receptive urban and suburban areas. The morbidity rate was highest in young male Chinese adults between 15 and 24 years of age. The outbreak was rapidly brought under control through destruction of adult Aedes mosquitoes, surveys and source reduction of larval breeding habitats, health education and to a certain extent law enforcement. The Aedes population was high in the main foci of transmission although the overall house index was only 1.1. Other factors which could have precipitated the outbreak included waning herd immunity of the human population and continuous introduction of dengue virus into the country.

Aedes↗
PubMed1987

Management of colorectal adenoma: a Singapore experience.

The racial distribution and pathology of 115 colorectal polyps from 72 patients were analysed. There were 88 (77%) adenomas. 90.9% of these were from Chinese and none from Malay patients. 79% were found in the sigmoid colon and rectum. The racial and site distributions of adenomas reflect the patterns of carcinoma seen in Singapore. The management of adenoma was discussed. Annual surveillance for high-risk and three yearly surveillance of low-risk patients up to an arbitrary age of 75 years is recommended.

Adenoma↗
PubMed1987

Clinico-pathological prognostic factors of large bowel cancer in Singapore: a multivariate analysis.

Clinical and pathological data from 219 cases of large bowel cancer were analysed using the Cox regression model to evaluate their effects on survival. Clinical variables such as sex, change in bowel habit, bleeding per rectum, tumour site, size and duration of symptoms had no significant influence on survival. Individually, age, abdominal distension, Dukes' stage and tumour grade had significant influence on survival. When considered together, Dukes' stage was the only variable selected. Therefore Dukes' stage is the most important prognostic factor in colorectal cancer. The distribution of patients was 25, 18, 26 and 31 percent for Dukes' A, B, C and D respectively. The probabilities of survival at five years were 71, 55, 36 and 16 percent for the respective Duke's stages. These data show that the clinical and pathological variables of patients with colorectal cancer in Singapore and the factors significantly associated with survival are similar to those in western countries.

Adult↗
PubMed1987

Advanced colorectal carcinoma--5 year survival of 76 cases treated at the Department of Therapeutic Radiology, Singapore General Hospital.

The results of 76 cases of advanced colorectal carcinoma treated at the Department of Therapeutic Radiology, Singapore General Hospital, from 1977 to 1978, are presented. All cases had "Curative" Surgery and were given adjuvant radiotherapy or chemotherapy or both. All were adenocarcinoma and had lymph node involvement as well as tumour infiltration through the bowel wall. 44 cases of rectal carcinoma were given radiotherapy to the pelvis followed by I/V 5-fluorouracil for at least one year. 32 cases of colon cancer were given I/V 5-fluorouracil for at least one year. 20 of these cases had cancer of the sigmoid colon and were given pelvic irradiation as well. The five year actuarial survival rates were 27.8% for rectal cancer and 24.3% for colon cancer.

Actuarial Analysis↗
PubMed1987

Some aspects of breast cancer in Singapore--a review of 306 cases.

A retrospective study of 306 cases of carcinoma breast in Singaporean patients managed at the University Department of Surgery, Singapore General Hospital was made, based on all available case notes, pathology report forms, operation record books, Cancer Registry Notification Forms, and data obtained from the Registry of Births and Deaths. These cases had their initial histological diagnosis made between 1970 to 1978. Basic data like age distribution, sex distribution and racial distribution of our cases are presented. Aspects of breast cancer like stage at time of diagnosis and 5- and 10-year survival figures are also presented. The crude five-year survival for all 306 cases was 56% and the crude 10-year survival for 223 cases was 22%. Survival for small lesions (T1, or less than 2 cm) was 90% at five years and 68% at ten years, a rate comparable with most centres in the world.

Adult↗
PubMed1987

Surveillance of food poisoning and other food-borne diseases in Singapore.

The more important food-borne diseases in Singapore are food poisoning, enteric fever, cholera and hepatitis A. Bacterial food poisoning caused by Staphylococcus aureus, Salmonella and Vibrio parahaemolyticus is prevalent, but chemical poisoning due to ingestion of toxic plants and animals is uncommon. Enteric fevers have been brought under control. An increasing proportion of the cases reported in recent years were imported from Southeast Asia and the Indian subcontinent. Cholera continues to be introduced into the country with sporadic cases reported from time to time. Hepatitis A remains an important food-borne disease involving predominantly the adolescents and young adults. Consumption of raw and partially-cooked cockles has been associated with both sporadic transmission and periodic outbreaks of hepatitis A. Prevention and control strategies implemented include surveillance and outbreak investigation, food control and legislation, health education and maintenance of a high standard of environmental sanitation.

Cholera↗
PubMed1987

Epidemiology of syphilis in Singapore over three decades (1955-1986).

The overall incidence of syphilis in the last three decades has decreased from 93.3 cases per 100,000 population in 1955 to 42.5 in 1986 amidst fluctuations in between. The decrease from 1955 to 1965 might be related to the widespread use of penicillins. The increase from 1965 to 1973 could be attributed to the influx of tourists and the use of Singapore as a rest and recreation centre during the Vietnam war period; better reporting system; and waning herd immunity as a result of disappearance of yaws. The introduction of the Medical Scheme and better contact tracing methods might account for the drop from 1974 to 1979. In the last 7 years, there was some fluctuations in the overall incidence, but the incidence of early infectious syphilis rose from 10 per 100,000 in 1979 to 29 in 1986 with the greatest increase in the female patients with early latent syphilis. Female prostitutes contributed a substantial proportion of all the cases of early infectious cases, accounting for 32% of all the cases in 1984. Moreover, female prostitutes were cited as the main source of contact, 46% in a local study. The incidence rate of congenital syphilis remained low over the last three decades, averaging 0.36 per 1000 live births. Both early and late syphilis occurred most commonly in the 20-29-year-old age group. The male to female ratio changed from 3.5 in 1976 to one in 1986 for early infectious syphilis while the ratio for late syphilis was 0.7 in 1976 and 1 in 1986. The closing of the gap reflects better clinic acceptance by both sexes, good contact tracing and better public health education.

Adolescent↗
PubMed1987

Histoid leprosy in Singapore.

Histoid leprosy is a rare variant of lepromatous leprosy. This is the first documented case of histoid leprosy in Singapore. The patient was diagnosed as borderline leprosy in 1973, remained untreated and progressed to lepromatous leprosy. The characteristic histoid lesions were firm pruriginous nodules on the dorsum of his feet. The histology showed a pseudocapsulated tumour with fibroblasts and histiocytes filled with lepra bacilli. Electron microscopy showed fibroblasts, macrophages with bacilli and plasmacytoid cells with active endoplasmic reticulum. He was found to be dapsone-resistant and the lesions cleared with clorphazimine. Immunological defects were not detected.

Aged↗
PubMed1987

Scholastic attainment and employment of drug users in Singapore.

A study of the educational and employment aspects of drug use, which was carried out in 1980 in Singapore, included 100 drug users randomly selected from those who had been, because of drug addiction, registered for treatment and rehabilitation by some major voluntary organizations dealing with drug abuse problems, and 100 non-users individually matched for sex, approximate age, ethnic group, education and neighbourhood. The respondents were interviewed on the basis of a questionnaire designed to collect data for this study. Data on 11 items of the questionnaire were available in official records which were used to check the truthfulness of the responses of the drug users. The agreement between the two sources of data ranged from 83 to 100 per cent. The drug users were found to have significantly lower levels of educational attainment and poorer scholastic results than the non-users. Similarly, significantly more drug users than non-users had a lower career status, higher instability in employment and greater job dissatisfaction. The author suggests that educational and vocational guidance, counselling service, welfare schemes and in-service training should cater to this group of people.

Adolescent↗
PubMed1986

Paediatric liver disorders in Singapore.

The liver in an infant or child is as liable to the same pathologies afflicting the adult liver but with certain differences in prevalence and causes. Genetic disorders are more likely to present in the paediatric age group where many involve metabolic processes such as galactosemia, phenylketonuria, glycogen storage disease and others. Many of these present in the newborn period. However, neoplasms and hamartomas also present in the newborn period, such as congenital neuroblastoma with an enormously enlarged liver, hepatoblastoma and haemangioma. The latter may present with intractable cardiac failure as a result of considerable shunting of blood. Acquired liver lesions often present in the newborn period or early infancy and this includes hepatitis and biliary atresia. The difficulties in the differentiation of the two lesions will be discussed together with the management of biliary atresia. As the child grows older, Reyes encephalopathy with microvesicular fat in the liver is not uncommon. The pathophysiology of Reyes encephalopathy as seen locally will be described. The choledochal cyst with direct (Caroli's disease) or indirect effect on the liver will be described. Problems of childhood portal hypertension as well as congenital hepatic fibrosis will be described. Hemosiderosis of the liver is chiefly seen in homozygous beta-thalassaemia patients who have been kept alive with repeated blood transfusions. Amoebic and pyogenic hepatitis, fatty liver due to protein malnutrition, biliary ascariasis, etc, which are common in tropical and subtropical countries are rarely seen now in Singapore children.

Adolescent↗
PubMed1986

Isolation of Chlamydia trachomatis in Singapore.

With the introduction of the culture method for isolating Chlamydia trachomatis in Singapore, several studies have been carried out to define its prevalence in different patient populations. The organism was isolated from a variety of clinical conditions. In certain clinical settings it appears to be even more prevalent than the gonococcus. Over 10% of the prostitutes are carriers, and they are probably the major transmitters. A control programme is needed to reduce the infective reservoir.

Chlamydia Infections↗
PubMed1986

Legionnaires' disease--report of Singapore's first local case.

A previously healthy 27 year-old male plumber presented with six days of fever, nausea, vomiting, malaise and headache. The subsequent development of cough, dyspnoea and pleuritic pain coincided with the simultaneous development of progressive bilateral cavitary pneumonia with pleural effusion. Leucocytosis, thrombocytopenia, hyponatraemia, hypoalbuminaemia, hypophosphataemia and hypoxaemia were the main laboratory abnormalities. Clinical suspicion of Legionnaires' disease was confirmed by the presence of serum antibody to Legionella pneumophila (titre 1:512) by an indirect fluorescent antibody test. Treatment with erythromycin and rifampicin resulted in clinical recovery with minimal residual bilateral pleural effusion six months after presentation. This patient is the first to acquire Legionnaires' disease in Singapore.

Adult↗
PubMed1987

Glucose dehydrogenase polymorphism among ethnic groups of Singapore--with report of two additional alleles (GDH4 and GDH5).

Placental glucose dehydrogenase (GDH; E.C.1.1.1.47) polymorphism was studied in 254 Chinese, 104 Malays, and 47 Indians from Singapore using isoelectric focusing. There is suggestive evidence of two additional anodal alleles (GDH4 and GDH5) in addition to the three alleles described in earlier studies. Altogether, 14 phenotypes have been observed in the present investigation, compared with six phenotypes described in earlier studies. It appears that placental GDH is controlled by five codominant autosomal alleles producing 15 possible phenotypes. The gene frequencies of GDH1, GDH2, and GDH3 in these ethnic groups are significantly different from those reported in Caucasians. There were slight differences in the gene frequencies between the three ethnic groups, with those of Indians being nearer to the frequency in Caucasians. In general, the distribution of GDH phenotypes was at Hardy-Weinberg equilibrium in all three ethnic groups studied.

Alleles↗
PubMed1986

Differentiated thyroid carcinoma--long term survival at the Singapore General Hospital.

The results of 48 cases of differentiated thyroid carcinoma treated at the Singapore General Hospital in the 5-year period 1977 to 1981 are presented. The peak incidence was in the 4th decade of life. Surgery, radiotherapy, radioactive iodine and hormones were the treatment modalities that were combined. 25% of the patients received radiotherapy while 74% were given at least one dose of radioactive iodine. The overall 5-year and 9-year actuarial (uncorrected) survival rates were 94.5% and 82.2% respectively. The 4 patients who died were in the older age group while younger patients had a good prognosis.

Adenocarcinoma↗
PubMed1987

Reactions to death and dying by doctors, medical students and nurses in Singapore 1985-86.

Questionnaires concerning their own death were given to groups of general practitioners, final year medical students, 2nd year medical students, post-basic nurses, nurses working with the home nursing foundation and religious nursing sisters. The results of the questionnaire indicate that the majority wish to die at home with their families present, and would like spiritual advice. The majority of the respondents believe in a life after death. Although a minority fear death, most feared a prolonged dying process, troubling others and a painful death. Most want to be told if they are terminally ill, want to help prepare their families for matters after their death and wish to discuss their death with their relatives. For those who are actively involved in the care of the dying in Singapore, the questionnaire was extended to include their opinions on their own experience in the care of the dying. The majority were not satisfied with the level of care given. Further support for the professional carers in the form of multidisciplinary seminars, and the formation of a hospice movement was deemed necessary by the majority. The greatest indication of problems in satisfying the needs of the dying patient and the family is in the desire to legislate euthanasia by 23% of doctors and 38% of nurses.

Attitude of Health Personnel↗
PubMed1987

Ageing: socio-economic implications for health care in Singapore.

In planning for the health of the population, especially of the aged, demographic variables which interact with social and economic factors must all be considered to assess their impact on the health services. Demographic trends such as the dependency ratio, sex ratio, marital status and family formation would also have a bearing on the care of the elderly at home. Trends in labour force participation and the extent of financial security among the elderly can therefore affect policy implications concerning public subsidy of health care and social services. As health needs are expected to rise in relation to the increasing proportion of the elderly as well as the survival of the older population itself, hence the urgency for innovative approaches to the organization and financing of health care. The aged accounts for a major share of the utilization and expenditure for hospitalization and medical services and yet have inadequate coverage. In Singapore, the Medisave Scheme was implemented to impose compulsory savings for medical care and to promote family support for the elderly. Pressures can be expected to emphasize the development of cost-effective programmes for the aged, such as community-based primary care, disease prevention and health promotion.

Aged↗
PubMed1987

Projecting the demand for institutional care by the aged in Singapore in the year 2000.

One of the areas of concern in a rapidly ageing population is the anticipated increase in demand for institutional care by the aged. This paper reports a procedure used for projecting such type of demand by the aged population in Singapore for the year 2000. The procedure involves two fundamental processes: estimating the present demand for such services and projecting the demand at some future time-frame (year 2000) using the baseline information and making assumptions about the influence of demographic, health and socio-economic factors altering demand. Estimation of present demand is made using a model that generally classifies aged persons in the population by functional status and residential status. Projection of future demand for institutional care is done using a 3 X 3 matrix of projection models. Three principal models (representing low, medium and high projections) are used to represent varying degrees of expected change in disease load among the aged population. Three sub-models are, in turn, used to fine-tune each principal model to reflect possible changes in the demand for institutional and hospital care within each functional status group.

Aged↗
PubMed1987

Eye diseases in the elderly in Singapore.

Ocular disorders in the elderly have become more important because of increased longevity and the demand for good vision. Many serious ocular conditions are age-related and they include cataract, glaucoma, diabetic retinopathy and other retinal conditions. The most important ocular disorder is cataract which fortunately is curable with excellent results when a posterior chamber implant is inserted. Angle closure glaucoma is common in the elderly Singapore Chinese and can be effectively treated with microscopic peripheral iridectomy or trabeculectomy. Blindness from diabetic retinopathy can be prevented with argon laser photocoagulation. In most cases blindness is preventable with early diagnosis e.g. in glaucoma and diabetic retinopathy. Severe visual loss in the elderly requires careful explanation and compassion by doctors and social workers.

Aged↗