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PubMed1994

Sickness absence in a Singapore refinery, 1981-1992.

Sickness absence among the unionised staff of the largest petroleum refinery in Singapore was followed up from 1981 to 1992. The changes seen throughout these 12 years were related to national, organisational and personal factors. Initially because of increasing competitiveness in the industry, and later because of a national recession, manpower in the refinery was progressively reduced from 1981 to 1986. This however was not the main cause of the reduction in sickness absence rates from 8.4 working days in 1981 to 5.8 days in 1983. Organisational changes to medical leave entitlements and improved means of supervision of absence were responsible for the early fall in absence rates. Personal factors, such as the increasing age of the population, did not affect the amount of short-term absences, while shift work was associated with higher absences. From 1986 absence rates rose again, eventually to almost 1981 levels by 1992, a reflection of the tendency for sickness absence to increase with time, unless active measures are undertaken for its control.

Absenteeism↗
PubMed1994

Medical selection of military pilots: a Republic of Singapore Air Force perspective.

A comprehensive selection examination in the Republic of Singapore Air Force (RSAF) aims to minimise medical wastage of military pilots who have to function safely in the unnatural environment. Of the 8642 applicants examined, 657 (7.6%) were rejected for non-medical reasons before completion of medical examination. Of the remaining 7778, 58.7% passed the selection examination while 41.3% failed. Ophthalmological (34.3%), anthropometry (23.7%), and ENT (13.7%) conditions were the three major causes for failure (71.7%). Myopia and astigmatism accounted for 57.6% while squints accounted for 22.1% of the ophthalmological conditions. Amongst ENT conditions, 70.8% were for marked vasomotor rhinitis, sinusitis and nasal septum deviation with marked narrowing of one or both nasal passages, while 22.4% were for permanent abnormal hearing threshold shifts above the minimum standards.

Aerospace Medicine↗
PubMed1994

Health of female shiftworkers in Singapore.

More than 200,000 persons in Singapore work shifts. Over half of these shiftworkers are females. With the continued emphasis on capital-intensive industries and growing demand for "round-the-clock" services, shiftwork is increasingly an economic necessity for more and more industries and a way of life for many Singaporeans. It is generally accepted that about 20% of those who start shiftwork may find it difficult to continue in such work, usually for social rather than medical reasons. For those who continue on shiftwork, concerns have been raised regarding possible health effects, such as increased incidence of digestive disorders and ulcers, chronic fatigue and cardiovascular disorders. In the case of female shiftworkers, there is also the concern that the added responsibilities of looking after the home and young children may further aggravate sleep problems associated with shiftwork, thus adversely affecting their health. So far, our own studies of female electronics workers on 8-hour as well as 12-hour shift schedules indicate no serious long-term health effects. The study subjects had been employed in such work for at least over a year, some as long as 17 years and 6 years, respectively. Except for complaints of sleep problems and tiredness among some rotating shiftworkers, no significant differences in symptom prevalence, blood pressure or sickness absence were found between the shift and day workers. While the findings are reassuring, further studies may be needed to determine if preventive measures can be taken to minimise the common complaints of sleep problems and tiredness, particularly among rotating shiftworkers.

Electronics↗
PubMed1994

Pattern of skin diseases in the elderly seen at the National Skin Centre (Singapore) 1990.

A retrospective study was conducted at the National Skin Centre (Singapore) for the period 1st January 1990 to 31st December 1990 to determine the pattern of skin disorders in the elderly. A total of 2,571 patients aged 65 years and above were studied. This constituted 6.4% (2,571/39,941) of patients seen at the Centre for that year. 38.1% of the elderly patients were aged 75 years or older. The male to female ratio was 1.3 to 1. There were differences in the pattern of skin problems when compared with the young. Xerosis and asteatotic eczema were distinctly common in the elderly. The most common dermatosis in the elderly was eczema. Endogenous eczema (including seborrhoeic dermatitis, lichen simplex chronicus, hand/feet eczema, stasis eczema, generalised exfoliative dermatitis), exogenous eczema (ie contact dermatitis) and dermatitis (not otherwise specified) formed 35.3% (907/2,571) of the skin disorders encountered at the National Skin Centre. Eczema, fungal, viral infections and psoriasis were on the whole less common in the elderly compared with the general population. Common skin infestations and infections were scabies, viral warts, monilial and bacterial intertrigo and tinea corporis. Urticaria, alopecia, insect bite reactions and post-inflammatory pigmentation were uncommon referral problems in the elderly.

Aged↗
PubMed1994

Five cases of high-level aminoglycoside resistant enterococcal septicaemia in Singapore.

Five clinical cases of enterococcal septicaemia were studied retrospectively including determination of high-level aminoglycoside resistance (HLAR) to gentamicin, streptomycin and kanamycin. This is the first study of its kind in Singapore. The clinical features and risk factors for this illness were analysed and found to be very similar to enterococcal bacteremia in general. It is important to carry out tests to detect HLAR so that unnecessary aminoglycoside toxicity can be prevented or to decide on the appropriate aminoglycoside to combine with a cell wall-active agent in severe enterococcal sepsis.

Aged↗
PubMed1994

Outpatient adult bronchial asthma in Singapore.

OBJECTIVES: To describe the clinical pattern and drug use in adult bronchial asthma seen in Government polyclinics (primary health care centres). DESIGN: A cross-sectional study using a structured questionnaire. SETTING: The five largest Government polyclinics in Singapore. SUBJECTS: Eight hundred and two subjects aged between 21-58 years drawn from the register of outpatient attendances. The response rate was 63%. RESULTS: The mean age of the study subjects was 37.4 years and the mean age of onset was 19.2 years. Thirty-three percent had onset of asthma under 10 years old. The most commonly reported trigger factors were cold drinks (67%), a change of temperature or humidity (65%), influenza or colds (65%), house dust (58%) and cigarette smoke (37%). In 27%, the work environment was a provoking factor. One-fifth had attacks every night or every day. About half of the patients had FEV1 under 80% of predicted. In the past year, 10% had 4 or more acute attacks requiring emergency attendance, 18% had one or more hospital admissions and 21% had sickness absence from asthma for one week or more. Of the 186 subjects who needed bronchodilators/inhalers 3 times or more a day, only 19.3% were on inhaled steroids. CONCLUSIONS: Considerable morbidity existed amongst outpatient asthmatics. Inhaled steroids appeared to be under-used.

Adult↗
PubMed1994

A prevalence study of chronic rhinitis among residents in Telok Blangah Town, Singapore.

A community-based questionnaire survey on a random sample of 562 persons aged seven to 81 years residing in the flatted housing estate of Telok Blangah, Singapore, was studied to determine the prevalence of chronic rhinitis, its associated risk factors and severity of the symptomatology. Chronic rhinitis was defined as the presence of nasal obstruction or clear, watery discharge together with any or both of the following: tearing eyes or sneezing, for a period of more than one month. The overall prevalence was 32.5% with Chinese having the highest ethnic specific rate of 33.9% followed by Indians (27.1%) and Malays (25.4%). The age-specific prevalence rates showed a clear downward trend with increasing age (P < 0.0001). Among the risk factors studied, family history of atopy ranked the highest followed by personal history of atopy and age group (< 30 years and 30 years or more). Most of the chronic rhinitis' symptoms (79%) were graded as not severe.

Adolescent↗
PubMed1994

Smoking restrictions in private workplaces in Singapore.

This survey aims to determine the number and profile of private workplaces in Singapore which have a smoking restriction policy. The response rate was 43%. Of the companies which responded, 59% had some form of smoking restriction. Private companies are more likely to have a smoking restriction policy: (a) where smoking poses inherent fire risks, such as those dealing with inflammable chemicals or gases; (b) where smoking poses inherent detrimental effects to the quality of the products, such as those dealing with precision electronic microcomponents, where a smoke-free and dust-free environment is essential; (c) are larger companies; and (d) have strong management support in initiating and enforcing smoking restriction. Future programmes should give more emphasis to the service industries such as construction, insurance, banking and finance, and smaller companies (with fewer than 100 employees). They should involve the management who play an important role in implementing smoking restriction at their workplace.

Air Conditioning↗
PubMed1994

An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Singapore: a 20-month study of clinical characteristics and control.

Methicillin resistant Staphylococcus aureus (MRSA) is a major infection control problem in many countries. There have been many reports of outbreaks in neonatal nurseries including, in our part of the world, Australia, Hong Kong and Malaysia. A recent outbreak of MRSA in the neonatal intensive care unit in the Kandang Kerbau Hospital, Singapore, presented us with the opportunity to study the clinical characteristics of the outbreak and the effects of infection control measures. Neonates admitted to the neonatal intensive care unit were studied over a 20-month period. They were all screened for nasal colonisation on admission and weekly thereafter. Infections were documented. Over this period there were altogether 2,576 admissions of which 85 infants had nasal colonisation with MRSA (3.3%) and 28 developed infections (1%). Although the majority of infants colonised by MRSA suffered no ill effects, 3 had septicaemia and 2 had septicaemia with osteomyelitis. There were no deaths. Standard infection control measures with barrier nursing and the use of mupirocin nasal ointment were ineffective, and control was achieved only after strict cohorting together with the use of mupirocin was instituted. This was done without additional costs to the department and without additional nurses or doctors.

Cross Infection↗
PubMed1994

The Beri-Beri Hospital, Singapore (1907-1925).

The high incidence of Beri-beri in the 1890s and 1900s coupled with the ignorance of its causation led to many forms of treatment, culminating in the establishment of a "specialised hospital" in Singapore. However, the "anti-beri-beri" factor in unpolished rice soon made this hospital redundant.

Beriberi↗
PubMed1994

The community psychiatric nurse in Singapore.

The Community Psychiatric Nursing Service in Singapore began on 1st November 1988 in recognition of the need for continuous supervision of a group of psychiatric patients following discharge from hospital. The Community Psychiatric Nurse is able to provide mental health nursing care in a community setting. Her multiple roles are described. The various problems encountered and how she tackles them are discussed. The challenges posed and the future prospects are briefly addressed.

Combined Modality Therapy↗
PubMed1994

A survey of symptoms in hospice patients in Singapore.

A descriptive study was done on patients referred to a hospice home care service in Singapore. The demographic profile, type of disease, presenting symptoms and performance status were noted. Particular attention was paid to the incidence of pain and types of analgesics used. The patients referred were representative of the population at large, as was their incidence of cancer. Eastern Cooperative Oncology Group (ECOG) performance status was poor (ECOG 3 or 4) in 93 (93%) of the patients referred, indicative of the lateness of referral in many cases. The number of symptoms per patient averaged 5.8, and pattern of symptoms were similar to those of comparable groups of patients in other parts of the world. Pain was present in 82 (82%) patients and controlled only in 22 (22%) of these at presentation. Strong opioids had been prescribed for 51 (51%) patients. In these, oral morphine mixture was incorrectly prescribed in 17 (47%) out of 36 cases. Education in palliative care is needed so that patients are referred to palliative care services appropriately. Though there is some indication of improvement, medical education in pain management continues to be necessary, particularly in the correct prescription of morphine.

Adolescent↗
PubMed1993

The development of DNA profiling database in an HAE III based RFLP system for Chinese, Malays, and Indians in Singapore.

Deoxyribonucleic acid (DNA) restriction fragment length polymorphism (RFLP) profiles were obtained for blood specimens from the three population groups--Chinese, Malays and Indians--in Singapore. The population databases were collected from Hae III digested high molecular weight DNA hybridized with four variable number of tandem repeats (VNTR) loci--D2S44, D10S28, D4S139 and D1S7. The data were analyzed statistically using the fixed bin system. Comparison of ratio of bin frequencies of these population data with published data on whites, blacks, and hispanics shows that the alleleic distribution at these loci is not seriously different among the six groups. This has important implications to the statistical significance of forensic DNA applications.

Alleles↗
PubMed1993

Pulmonary function in healthy Chinese, Malay and Indian adults in Singapore.

Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEFR), single-breath diffusion capacity measurements (effective alveolar volume (VA), carbon monoxide transfer factor (DLCO) and transfer coefficient (KCO)) were determined in 452 healthy Singaporean adults (277 males and 175 females) aged 20-70 years. The ratio of Chinese, Malay and Indian subjects was 5:2:3 in both sexes. Age, height and weight in the males were all significantly correlated with FEV1, FVC, DLCO, VA and PEFR. However, for females, only age and height were significantly correlated with the studied lung function parameters. Significant ethnic differences were observed for most of the pulmonary functions (except KCO and PEFR) among the Chinese, Malays and Indians for both males and females. The predicted FEV1 and FVC values (specific age and height) for both sexes were highest among the Chinese followed by the Malays than Indians, in that order. Regression equations, with age and height as independent variables, were derived for males and females in each ethnic group to predict normal pulmonary function for the Singapore Chinese, Malay and Indian populations. The predicted values of various pulmonary function measurements obtained from these regression equations for subjects of specified age (30 years) and height (165 cm for men, 155 cm for women) were compared with those reported in other studies. Differences were observed among the different races.

Adult↗
PubMed1993

Three year results of radial keratotomy surgery at the National University Hospital, Singapore.

This paper presents the three year results of radial keratotomy (RK) surgery on 51 of the first 59 consecutive eyes at the National University Hospital in Singapore. Before surgery, uncorrected visual acuity was worse than 6/24 in all eyes with 33.3% worse than 6/60. The average pre-operative spherical equivalent (SE) was -4.56 Dioptres(D). Three years after surgery the mean SE was -0.66D, a change of 3.9D; and 72.5% of eyes were within 1D of emmetropia. 70.6% had uncorrected visual acuity of at least 6/12 with no eyes having worse than 6/60 visual acuity. Analysis based on levels of pre-operative myopia showed that the best visual and refractive results were obtained in patients with SE of -6D or less. None of the patients were troubled by complications such as glare, fluctuating vision, irritation and discomfort three years after surgery. Our results indicate that RK surgery is safe and effective through the three years and more following surgery.

Adult↗
PubMed1993

Calculating the GP consultation fee in Singapore: towards a rational costing approach.

PURPOSES: The General Practitioner (GP) consultation fee in Singapore, unlike that of his specialist colleague, has been left very much undefined over the years. There is a need for an objective way of calculating the GP consultation fee. METHOD: A proposed method of calculating the GP consultation fee based on the model of estimating the total cost of producing the service plus the doctor's remuneration is described. Known prevailing costs were used in the computation. This model allows us to work out the cost to the patient by dividing the total cost of producing the service by the number of patients (referred to as patient encounter load) seen by each duration of consultation--4, 6, 10, 15 and 30 minutes. Different monthly remuneration levels for the doctor were used to compute the different consultation fees that would result for each of the duration of consultations. RESULTS: Using this method of calculation, for a doctor with a desired monthly remuneration of $7000, and seeing a patient every 6 minutes over a 150-hour month, the consultation fee is $13.00. This drops to $11.00 if the doctor receives a remuneration of $4000 per month. Using the same parameters, a 15 minute consultation will cost the patient $30.00 and $25.00 respectively. CONCLUSION: This method can be used to derive a consultation fee for services requiring different durations and varying remuneration brackets for the doctor.

Capital Financing↗
PubMed1994

Laparoscopic cholecystectomy: the Singapore experience.

A questionnaire survey was conducted in April 1992, 2 years after the first laparoscopic cholecystitis (LC) was performed in Singapore. The aim was to evaluate the safety and efficacy of this new procedure. Twenty surgeons performed 1,066 LC, of which 93% were done electively, mainly for biliary colic and chronic cholecystitis. Acutely inflamed gallbladders accounted for 6.5% of cases. Fifty-seven (5.4%) patients had to be converted to open surgery, 108 (10.1%) patients required preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis, and 57 (5.4%) intraoperative cholangiograms were done. Common bile duct injuries occurred in 10 (0.9%) patients, of which six (0.6%) were transections. Seven (0.6%) patients developed bile leakage. Minor complications occurred in another 10 (0.9%) patients. There was one (0.09%) death.

Biliary Tract Diseases↗
PubMed1993

Epidemiology of epilepsy in Singapore.

Though epilepsy is recognised as a major medical and social problem in Singapore, there is no epidemiological survey to realise the size of the problem. We studied this problem from data collected from hospitals, school health clinics and from military statistics. The prevalence varied in the three sample populations studied. The most accurate data for prevalence study were obtained in army recruits. A life-time prevalence of 3.8 per 1000 was noted. The prevalence variation with age, sex and races is discussed. The mortality from epilepsy was 0.5 per 100,000. The types of epilepsies and the treatment patterns are discussed.

Adolescent↗