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PubMed1980

Smoking and blood pressure among adults in Singapore.

In a nationwide survey of blood pressures in Singapore, the prevalence of current smoking was estimated at about 27% for all persons aged 20 years and above. There is male predominance of 5:1, with the peak age among them at 40-49 years. The majority are cigarette smokers; with mean daily consumption at 16.1 for males and 10.7 for females. The study has shown no significant differences in mean systolic and diastolic blood pressures between cigarette smokers and non-smokers at every age-group from 20 to 69 years. There is also no higher prevalence of hypertension among smokers. These findings confirm various other epidemiological studies, especially those in the West where smoking is at a much higher level. Smoking as a risk factor in ischaemic heart distance cannot, therefore, be attributed to its long-term effects on the blood pressure. It is also not likely to be a cause of essential hypertension.

Adult↗
PubMed1981

Surgical management of rheumatic heart disease in Singapore.

Over the last three decades there has been a world-wide decline in the incidence and severity of rheumatic fever and rheumatic heart disease, but the death rate in Singapore from chronic rheumatic heart disease has risen from 3.6 per 100,000 population in 1966 to 4.4 per 100,000 in 1977. Valvular lesions from rheumatic heart disease are very common, and between 1967 to 1979, 715 surgical procedures were performed for rheumatic valvular disease, and of these, 654 procedures involved the mitral valve which was most commonly affected by the disease process. Since many of the patients were female and in the child-bearing age, conservative procedures on the mitral valve were performed whenever possible. Mitral valvotomy for mitral stenosis relieved symptoms effectively; and for restenosis of the mitral valve, more than half of the patients underwent a second valvotomy with functional improvement. Mitral valve replacement was reserved for the severely distorted valve, sometimes calcified, and where there was stenosis associated with incompetence. Between 1971 to 1979, 162 mitral valves were replaced and actuarial studies showed 80% survival five years after surgery. 30 aortic and mitral valve replacements were performed in this same period with an operative mortality of 16.7%. Only 75 aortic valves were replaced for rheumatic valvular disease and 14 of these also had associated mitral and triscuspid valve disease. The prosthetic valves commonly used for replacement were the Starr-Edwards non-cloth covered valves, models 6120 and 1260. All patients that had valve replacements were treated with long-term anticoagulation with Warfarin. The incidence of thromboembolism was low, being 8% for mitral valve replacement and the majority of these episodes occurred in the first three months after surgery.

Adolescent↗
PubMed1993

Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population of Singapore.

Prevalence of antibodies to HCV is studied among a blood donor population in Singapore and its relationship to surrogate markers was examined. Sequential serum samples from 4,091 blood donors were tested for the presence of anti-HCV using the second generation immunoassay (Abbott). 275 random serum samples were tested for anti-HBc and ALT. All the samples positive for anti-HCV were also tested for anti-HBc and ALT. Only 22 of the 4,091 donor samples (0.54%) were repeatedly reactive for anti-HCV. Of the 275 random samples tested, 43 samples (15.6%) were positive for anti-HBc and 24 (8.7%) had ALT levels more than 45 IU/l. None of these 67 samples were positive for anti-HCV. Only 3 of the 22 anti-HCV positive samples (13.6%) were positive for anti-HBc and only 6 samples (27.2%) had ALT level more than 45 IU/l. The prevalence of anti-HCV among the donors is only 0.54% which is much lower than the prevalence of HBV. An important finding is that about 60% of the donors positive for anti-HCV had no detectable surrogate markers. Exclusion of blood donors positive for anti-HBc, if implemented in an area where the prevalence of HBV infection is relatively high will result in the loss of blood donors estimated to be 15.6% and the use of raised ALT will result in a further loss of 6.1% of the blood donors.

Adolescent↗
PubMed1995

Seroprevalence of antibodies against hepatitis A (anti-HAV) in Singapore: the NFDD experience.

At the 4th National Foundation for Digestive Disease (NFDD) Day in 1991 where public lectures on prevention of hepatitis and early detection of hepatocellular carcinoma were given, screening of sera obtained from 364 registrants for antibodies to Hepatitis A (IgG) was undertaken. The overall sero-prevalence rate was 50%, with 55% for males and 46% for females with antibodies for HAV. None of the subjects below 20 years old had antibodies to HAV. This rose to 16% for those 21-30 years old and 92% for those above 61 years. This study shows that in Singapore, prevalence of anti-HAV antibodies rise with age and is approaching the low endemicity pattern that is seen in developed countries.

Adolescent↗
PubMed1995

Diagnosis of deep vein thrombosis by Duplex Doppler ultrasound imaging at the Singapore General Hospital.

Deep vein thrombosis (DVT) of the lower extremity is the major cause of pulmonary embolism and chronic venous obstruction disease of the legs. However, the clinical diagnosis of leg vein thrombosis is notoriously difficult. Venography, using iodine containing contrast materials, has been the most reliable older method for diagnosing thrombosis. It is relatively more invasive, requires exposure to radiation and is not free of risks. Doppler ultrasonography has been shown to be highly sensitive and specific in the diagnosis of obstruction of flow in veins. We present 25 patients studied at Singapore General Hospital (SGH) with Doppler for the presumptive clinical diagnosis of DVT. Thirteen were found to have complete or partial obstruction of leg veins and 12 showed normal veins. These 12 patients were thus spared the risk and expense of long term anticoagulation. In experienced hands, Duplex Doppler ultrasonograph is an excellent diagnostic modality for the diagnosis or exclusion of significant deep vein thrombosis of the legs. It can be carried out safely and reliably in the very sick, in patients with renal failure, diabetics and the pregnant.

Hospitals, General↗
PubMed1995

Risk factors for birth defects in Singapore: a case control study.

To explore possible risk factors for birth defects, a matched case-control study was carried out at Kandang Kerbau Hospital in Singapore from January 1986 to December 1988. Cases and controls were selected from livebirths born in that hospital during that period. Cases were babies who were clinically detected as having defects at birth and the diagnosis reconfirmed at 6 weeks post partum. Each case was matched to a control by maternal age, ethnic background of mother, the same class of maternity ward and time of delivery. Five hundred and seventy-two matched pairs were accrued for the study. The parents of both cases and controls were interviewed at 6 weeks post partum. Information on the medical and birth history of both mother and baby was obtained from medical records. Using conditional logistic regression analysis to adjust for potential confounders, the strongest risk factors for birth defects were family history of birth defects (OR 3.3; 95% CI 1.8-6.4) and parents having a previous abnormal baby (OR 2.4; 95% CI 1.1-5.3). Other notable risk factors included drug history during pregnancy (OR 1.2; 95% CI 0.8-2.0), the ingestion of traditional medicine during pregnancy (OR 1.4; 95% CI 1.0-2.0), injuries or accidents during pregnancy (OR 2.2; 95% CI 1.5-3.2) and maternal diabetes mellitus (OR 1.3, 95% CI 0.3-7.1). Mothers in professional occupations (OR 1.4, 95% CI 0.7-2.6) and those in production occupation (OR 1.2, 95% CI 0.9-1.7) had an increased risk for birth defects compared to housewives.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1995

Hybridizing the health care plans of Hawaii, Oregon, and Singapore.

Universal coverage requires costcontainment. Working models of health care coverage from Hawaii, Oregon, and Singapore address different aspects of cost-containment. Hybridizing the three produces the following system: A percentage of an individual's salary is mandatorily set aside in an individual medical account. Using these savings, the individual purchases catastrophic medical insurance with a managed care organization. Residual funds are used as a deductible or co-payment and to purchase additional medical services as desired. Enough funds should accumulate during an individual's working life to enable continued coverage after retirement. The basic health care package needs to be limited and is defined by a systematic and rational process based on cost-benefit analysis and democratic consensus regarding priorities and coverage. Medicaid recipients get the same basic package from managed care organizations as that available to the rest of the population; low wage earners receive sliding-scale subsidies from the government. Co-payments and deductibles remain in place except for beneficial preventive services.

Bioethics↗
PubMed1995

Oro-facial pain distribution in the Singapore Armed Forces: a pilot study.

The purpose of the study was to obtain information on the pain distribution in 140 consecutive patients referred to a Singapore Armed Forces (SAF) Temporomandibular Disorders (TMD) and Craniofacial pain clinic from January 1992 to April 1994 via questionnaire, oral history and clinical examination. A cross-sectional study of 130 patients in the general military population was also done to serve as a control and to obtain initial data on the prevalence of signs and symptoms of TMD in the SAF. The control was age and sex matched with the TMD patient sample. The data showed that the "TMD patient" infrequently presented with temporomandibular joint pain alone. Neck pain, shoulder pain, ear ache and headaches were found quite frequently in addition to masticatory muscle tenderness and should be checked for in any TMD patient. Initial findings support the recommendation that the routine palpation of the styloid regions be included in any clinical screening protocol for patients presenting with head, neck and oro-facial pains. A history of macrotrauma and parafunctional habits were also important. Interesting observations relating to the TMD patients in the SAF are briefly described and discussed and there is a need to further explore the correlation between certain SAF vocations and TMD.

Adolescent↗
PubMed1994

House dust mite allergen levels in a Singapore hospital.

House dust mite allergens constitute one of the most important allergens in house dust. In this study, the levels of two common dust mite allergens, Der p I and Der f I, in a general hospital in Singapore were evaluated. Our results showed that these allergens were detected in 42/74 (or 57%) of the dust samples. Der p I was found to be the predominant allergen detected (p < 0.001). The allergen levels were, however, low with only 1/74 having a Der p I concentration above 2 micrograms g-1 dust. None of the samples had Der f I concentrations above this level. Of the various niches studied (mattresses, pillows, sofas, carpets, blinds and floors), the blinds and floors had the lowest concentration of allergen (p < 0.05). These low levels in the hospital compared to homes were attributed to the vigorous cleaning schedule in the hospital, the use of plastic to encased mattresses and pillows, vinyl covered sofas and vinyl lined floors. These practices may be adopted in the home as a means to reduce mite allergen exposure.

Air Conditioning↗
PubMed1995

Review of results of ankle fracture fixation in Alexandra Hospital (Singapore) between January 1987-April 1990.

In 67 consecutive cases of ankle fracture treated operatively in Alexandra Hospital in Singapore, 35 ankles (53.7%) were available for review of the post-operative results. Thirteen fractures were of AO type A, 13 were type B and 9 type C. These patients had a minimum follow-up period of 16 months. They were assessed subjectively with a questionnaire and objectively by measuring the ankle movements. Good or excellent subjective results were obtained in 71% of the patients, while functional ankle scores were good or excellent in 88.5% of cases. Some restriction of ankle motion was present in 33.9% of patients. Difficulty in squatting was the most common complaint.

Adolescent↗
PubMed1995

Stapedectomy at the Singapore General Hospital--use of functional hearing analysis.

The results of stapedectomy surgery performed in Singapore General Hospital covering a period of over two years are reviewed. The diagnostic importance of selected clinical features and investigative procedures in otosclerosis is studied. The post-operative hearing status of twenty-six cases of primary stapedectomy is analysed using traditional audiometric and modern functional methods. Seventeen patients (65.4%) achieved closure of air-bone gap to less than 10 dB while the overall mean hearing gain was 28.6 dB. Using the Glasgow Plot parameter, 73.1% showed significant benefit from surgery, whilst the corresponding figure using the Belfast Rule of Thumb assessment technique was 57.7%. The validity of the foregoing evaluation techniques is compared. Different operative techniques, including variations in fenestra size and method of oval window seal showed statistically similar results. The scarcity of stapedectomy cases poses problems in the training of future specialists.

Acoustic Impedance Tests↗
PubMed1995

The aetiology of postmenopausal bleeding--a study of 163 consecutive cases in Singapore.

OBJECTIVE: To study the aetiology and pattern of Postmenopausal Bleeding (PMB) in the local population. DESIGN: A retrospective study SUBJECTS: 163 consecutive patients who presented with postmenopausal bleeding (PMB) SETTING: Kandang Kerbau Hospital, Singapore RESULTS: Malignant causes were found in 42 (25.7%) patients. Cervical carcinoma was the most common malignancy (12.9% of the patients) followed by endometrial carcinoma (11%). Important benign causes are cervicitis (12.9%), atrophic vaginitis (12.3%) and cervical polyp (6.7%). Other benign causes include endometrial hyperplasia (3.1%), urethral caruncle (2.5%) and estrogen replacement therapy (1.8%). CONCLUSION: PMB is a symptom of varied aetiologies. The associated incidence of malignancy is high and a thorough diagnostic evaluation is mandatory.

Adult↗
PubMed1995

The 'Rastelli' operation--results at the Singapore General Hospital.

Reconstruction of the right ventricular outflow tract in patients with right ventricle-pulmonary artery discontinuity with a valved conduit is well established. The aim of this study was to review our results at the Singapore General Hospital. Between October 1989 and May 1993, 13 patients underwent the 'Rastelli' operation. The mean age at definitive repair was 68 months. Ten patients had pulmonary atresia with ventricular septal defect, two patients truncus arteriosus (one patient each with type 3 and type 2) and one patient had tetralogy of Fallot with absent pulmonary valve syndrome. In 12 patients cryo-preserved pulmonary artery homografts with a mean diameter of 21mm (19-23mm) were used, and a 11mm composite Hancock dacron valved conduit in one patient. There were no operative deaths. The mean duration of follow-up is 37 months (23-48 months). All patients were well and in NYHA class I on recent follow-up. On echocardiographic assessment 12 patients had trivial or no gradient across the right ventricular outflow tract, while one patient had a gradient of 25mmHg. The "Rastelli" operation can be undertaken with low mortality and morbidity and early results are encouraging.

Blood Vessel Prosthesis↗
PubMed1994

Susceptibility of Singapore Chinese schoolgirls to anorexia nervosa--Part I (Psychological factors).

Of 656 GCE "O" level Chinese Singapore schoolgirls, it was found that 56% perceived themselves as being too fat, and 38% had been teased about being overweight. On the Eating Disorders Inventory (EDI), 15 (2%) had a score at the anorectic range. Compared to a group of American undergraduates, Singaporean subjects had no significant difference on the drive for thinness scores, but had significantly higher scores on bulimia, ineffectiveness, body dissatisfaction, interpersonal distress and greater maturity fears. In a population which appears to be susceptible to anorexia nervosa, possible reasons for the low incidence of this disorder is discussed.

Adolescent↗
PubMed1994

Comparing the changing suicide rate in Singapore with the rates in England/Wales and the USA, 1950-1985.

Whereas marriage and birth rates were significantly associated with the time-series annual suicide rate from 1950 to 1985 in England and Wales and birth rates were associated with the annual suicide rate in the USA, neither variable was significantly associated with the annual suicide rate in Singapore. It seems that different theories of suicide may have to be proposed in order to account for the societal suicide rate in Asian nations.

Birth Rate↗
PubMed1994

Multidrug-resistant typhoid fever in Singapore.

A study was conducted to determine the clinical and epidemiological characteristics of multidrug-resistant (MDR) typhoid fever in Singapore. Twenty-one of 121 patients with typhoid fever had MDR typhoid fever after recent travel to the Indian subcontinent. Fifty patients with drug susceptible typhoid fever were also analysed for comparison. Nineteen of the MDR S. typhi isolates had resistance to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole (TMP-SMX) while the remainder had resistance to ampicillin and TMP-SMX. The predominant presenting symptoms were fever and diarrhoea. Eleven patients with MDR typhoid fever were treated with oral ciprofloxacin and nine with intravenous ceftriaxone. The patients with MDR typhoid fever had a longer duration of fever defervescence (8 +/- 5 days) compared to those with drug-susceptible typhoid fever (5.7 +/- 4.16 days) (p < 0.01). Eighteen patients were cured and one patient defaulted treatment. Two patients relapsed within two months of treatment. The study showed that 17.4% of patients with typhoid fever had imported MDR S. typhi after recent travel to the Indian subcontinent where MDR typhoid fever is prevalent.

Adult↗
PubMed1994

Susceptibility of Singapore Chinese schoolgirls to anorexia nervosa--part II. (family factors).

It was found that of a group of 656 GCE 'O' level Chinese Singapore schoolgirls in schools of good academic standing, where pressure was expected to be high, 15 (6%) had high drive for thinness (DT) scores. The families of these latter girls were not perceived to be significantly more enmeshed or rigid than those with low DT scores, and other family functioning was also not significantly different.

Adaptation, Psychological↗
PubMed1994

Control of dengue vectors in Singapore.

Singapore has a well-established system for the surveillance, research and control of Aedes aegypti and Aedes albopictus. Control of these vectors comes under the jurisdiction of the Environmental Public Health Division of the Ministry of the Environment. The strategy for Aedes control is an integrated approach incorporating case detection, source reduction, health education and law enforcement. This is done through the Quarantine & Epidemiology Department (dengue surveillance and research), Vector Control & Research Department (Aedes surveillance, control and research), Environmental Health Department (environmental sanitation and hygiene) and Public Education Department (health education on dengue prevention and control). Despite its success in reducing the Aedes population to a house index of around 1%, the incidence of dengue fever/dengue haemorrhagic fever has increased sharply during the last 5 years. The Ministry realises that the dengue problem can only be tackled on a regional basis and it is with this objective in mind that the Institute of Environmental Epidemiology has been formed to collaborate with other international agencies in operational research and training projects.

Aedes↗