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PubMed1997

Fear of flying--a Singapore perspective.

Fear of flying is a term commonly used in the Aviation Medicine community. However, heterogeneous conditions which can present with fear of flying, demand that a more stringent and systematic approach be made in one's management of the aviator with fear of flying (FOF). Cases of FOF between 1974 and 1995 presented to the Civil Aviation Medical Board and the Aeromedical Centre of the Republic of Singapore Air Force were studied for their psychopathology, psychodynamics, diagnoses, motivation for treatment, type of treatment and response to treatment, and their eventual outcome in relation of flying. 53.3% of 15 cases had Adult Situational Reaction, 26.7% had phobia of flying, 6.6% had Adjustment Disorder, 6.7% had Anxiety Depressive Disorder and 6.7% had Transient Psychosis. All cases of Adjustment Disorder were returned to flying, compared with 25% of Adult Situational Reaction, 66.7% of Phobia of Flying and none of the aircrew suffering from Transient Psychosis. Fear of flying is thus a complex phenomenon, where there is interaction of elements of mental health, neurotic roots, real and imaginary threats and life events affecting eventually the flyer's willingness to fly.

Adaptation, Psychological↗
PubMed1997

The periodic medical examination in the Republic of Singapore Air Force--a review.

Aeromedical Examinations (AMEs) have been done in the Republic of Singapore Air Force (RSAF) since its beginning for licensing and monitoring health status of essential personnel. The rapid progress in scientific advances and medical costs of recent years prompted a re-evaluation of the AME as a preventive tool, both in accident prevention and health promotion. A retrospective cohort study of 233 males spanning the time they joined the Air Force until 1990 was done and a descriptive analysis of the cohort with the incidence rate of cases picked up during this period was used as an indicator of usefulness of the AME. In the follow-up period of 2997 person-years, a small number of cases were picked up which resulted in two pilots being grounded permanently. Most procedures were found to be useful to varying extent except the routine chest X-rays which was found to be ineffective. Trends of biodata resulting from serial examinations are useful in planning and evaluation of intervention and health education programme, but only if the baseline measurements are accurate, hence quality control at all stages is important. The AME can be an effective tool for prevention if designed appropriately. Screening tests included must be scientific and the logic for selecting tests must be convincing. Most importantly, it is suggested that a clear and detailed medical history is the most useful component for early detection of problems. This is facilitated by a strong bond and rapport between doctors and subjects to ensure that the information is forthcoming and honest.

Adult↗
PubMed1997

Two-year follow-up of a behavioural weight control programme for adolescents in Singapore: predictors of long-term weight loss.

We followed up 112 obese adolescents enrolled in a weight control programme at a polytechnic institute in Singapore for two years. The programme used behavioural and environmental strategies to help students make sustained changes in their diet and physical activity pattern. Of these 112 students, 71.4% lost weight compared to 60% in a comparison group of 86 obese students not in the programme. About one-third (29.5%) had achieved normal weight [body mass index (BMI) < 25] with a mean weight loss of 3.3 kg among boys and 2.3 kg among girls. A stepwise multiple linear regression to determine the best combination of variables predictive of weight loss found three variables to be significantly associated with long-term weight loss: percent of weight loss in the initial 8-week intervention period; increase in exercise or physical activity following intervention, and income. These 3 variables accounted jointly for 59.5% of the variance in weight loss in males and 48% of weight loss in females. We recommend intensive efforts during the initial intervention phase to help students lose weight and strategies that can help students incorporate exercise or increased physical activity in their daily routine.

Adolescent↗
PubMed1997

Retinoblastoma in Singapore: 1976 to 1995.

There were at least 56 local and 42 foreign patients seen in Singapore between 1976 and 1995 inclusively. The local incidence rate is 1 in 15789 live-births, and there appears to be no predilection for sex and race. Ninety-eight per cent presented before the age of five with the average age at diagnosis being 18 months. Bilateral cases were diagnosed earlier than unilateral cases. At least 17% are hereditary, with only 2 of these with positive family histories. Of the 41 patients studied for presenting complaints, 82.9% had leukocoria, 19.5% had strabismus and 12.2% had decreased visual acuity. The main mode of treatment was enucleation alone in unilateral disease; in bilateral cases, the main mode was enucleation of the more badly affected eye together with radiotherapy and cryotherapy of the fellow eye. Ninety per cent of all patients who underwent treatment have had enucleation done. Four patients defaulted treatment--with counselling of the parents of these patients, this number could be reduced or at least kept low. Patients with early diagnosis and treatment are more likely to survive. Eight of the 56 patients died. However, with better treatment modalities, the prognosis for both life and vision have, in recent years, improved significantly.

Age Distribution↗
PubMed1997

Prevalence rates of major and minor electrocardiogram abnormalities in the Singapore general population.

A cross-sectional survey on the general population was carried out in Singapore, with each of the 2143 persons (Chinese, Malays and Indians) aged 18 to 69 years having a 12-lead resting electrocardiogram (ECG). The tracings were coded according to the Minnesota Code with major abnormalities being Q wave changes (1-1 and 1-2), complete atrio-ventricular (A-V) block (6-1), and left bundle branch block (7-1) and minor abnormalities being lesser Q wave changes (1-3), ST depression of at least 1 mm (4-1), and T wave inversion of at least 1 mm (5-1 and 5-2). In all age groups the prevalence rates of any major abnormality were higher in males than females. In the age-adjusted 18-69 age group the prevalence rates in males and females were 2.0% and 0.5% respectively (P = 0.001). The prevalence rates of any minor abnormality (without any major abnormality) were higher in females than males in all age groups and in the age-adjusted 18-69 age group the prevalence rates in males and females were 3.5% and 5.4% respectively (P = 0.027). The prevalence rates of any minor abnormality (without any major abnormality) in the 18-29 age group in males and females were 2.2% and 4.7% respectively, indicating that these proportions of the population have minor abnormalities as a normal physiological variant. It is estimated in the 50-69 age group that 33.8% of males and 50.0% of females with any minor abnormality (without any major abnormality) have these changes as a normal physiological variant.

Adult↗
PubMed1997

Primary monosymptomatic nocturnal enuresis in Singapore--parental perspectives in an Asian community.

Primary monosymptomatic nocturnal enuresis (PMNE) is often not openly discussed in Asian societies. We report the parental view of PMNE in Singapore, its impact on patients and their families and the traditional beliefs and its influence on subsequent management. A screening questionnaire was used in evaluating 30 children enrolled in a clinical trial on the use of oral Desmopressin for the treatment of PMNE. Primary monosymptomatic nocturnal enuresis was familial in 56.7% of patients. Fifty per cent of them were previously unevaluated. Earlier remedial attempts included bedtime fluid restriction and voiding (100%), incentive measures (43.3%), traditional practices (26.7%), punishment (20%), drugs (16.7%), psychotherapy (100%) and bladder training (3.3%). Perceived causes of PMNE were maturational delay (50%), deep sleep (50%), familial (43.3%), behavioural problems (43.3%) and excessive fluid intake (26.7%). Reasons for seeking treatment included restricted outdoor activities (90%), parental fatigue (86.7%), disrupted sleep for the household (46.7%) and fear of underlying pathology (26.7%). Perceived adverse effects on patients included social stigma (83.3%), disrupted sleep (33.3%) and impaired school performance (13.3%). Primary monosymptomatic nocturnal enuresis can thus be a chronic distressing problem in Asian communities.

Adolescent↗
PubMed1996

In vitro activity of cefoperazone-sulbactam: Singapore experience.

In vitro activity of commonly used antimicrobial agents against consecutively isolated 521 strains of Gram negative bacilli causing serious infections in the National University Hospital, Singapore were tested in parallel with cefoperazone-sulbactam combination. With the combination complete resistance of 2% and intermediate resistance of 5% were noted among the 521 strains tested. Resistance to imipenem was low (5%) but resistance against other antimicrobial agents varied from 12% (amikacin) to 80% (ampicillin). In vitro data demonstrated a possible future role for cefoperazone-sulbactam in the treatment of sepsis caused by Gram negative bacilli in our hospital.

Anti-Bacterial Agents↗
PubMed1997

A two-year experience of an acute pain service in Singapore.

The first anaesthesia-based acute pain service in Singapore is described. The benefits, risks and resource implications of such a service during its first two years are reviewed. One thousand two hundred and sixty-eight (1,268) post-operative patients were treated with either patient-controlled analgesia (310 patients) or epidural opioid analgesia (958 patients). Retrospective analysis of the data revealed good patient satisfaction with a low incidence of potentially life threatening side-effects: more than 79% of patients reported satisfaction with pain control while only 0.2% of patients receiving epidural opioid analgesia experienced clinically significant respiratory depression. There were no reports of respiratory depression in the patient-controlled analgesia group. The authors conclude that the provision of an acute pain service in the local context was safe and resulted in excellent post-operative patient satisfaction.

Acute Disease↗
PubMed1997

Smoking in the Singapore Armed Forces.

The Singapore Armed Forces has, since 1986, established a comprehensive smoking control programme which combines health education, counselling and administrative measures aimed at discouraging non-smokers from smoking, and encouraging smokers to quit the habit. The prevalence of regular smoking decreased from 28.6% in 1987 to 20.7% in 1993. The latest, 1993 survey as in past surveys covered 3,545 respondents, made up of regulars (32.0%), NSF (62.2%) and NUSAF (5.6%). The 1993 survey revealed that the majority of smokers (88.9%) in the SAF who consist primarily of 18 to 20-year-olds, had started smoking before enlistment. Most acquired the habit on their own (49.8%) or through influences outside the SAF (40.3%). Very few smokers became smokers through the influence of fellow soldiers (4.9%). The majority (87.7%) of smokers readily agreed that smoking is harmful, but this is not translated into practice. Health education efforts need to focus more on bringing about positive attitudinal and behavioural changes, rather than merely give information and advice. The young age of smoking onset (mean age of 14.3 years) In the SAF population surveyed points to the need to focus preventive efforts further upstream than hitherto emphasised.

Humans↗
PubMed1997

Percutaneous transluminal coronary angioplasty in Singapore General Hospital in 1995: a medical audit.

BACKGROUND: There are few reports which describe the outcomes of unselected groups of patients undergoing percutaneous transluminal coronary angioplasty (PTCA) locally. This study has undertaken to audit the outcome of patients undergoing elective PTCA at Singapore General Hospital. METHODS: Procedural data and acute outcomes were recorded prospectively in all patients undergoing PTCA over a 12 month period. A retrospective casenotes review of all patients were carried by independent observers to determine out-of-lab complications. RESULTS: Seven hundred and eight-two patients underwent PTCA in 1995. Acute angiographic success rate was 90.9% and early clinical success rate was 89% ie excluding death, coronary bypass surgery and non fatal myocardial infarction. There were only two deaths in the series (0.26%). CONCLUSION: The audit confirms the importance of a high volume PTCA cases to achieve excellent results. The data serve as a useful background for future comparison of outcomes.

Aged↗
PubMed1996

A severe case of hemorrhagic fever with renal syndrome in Singapore.

The incidence of human hantavirus infection in Singapore is low. Hitherto, only 2 cases of hemorrhagic fever with renal syndrome (HFRS) have been reported. A third case is reported here of a ragman who had the classical manifestations of HFRS, confirmed by serology. In addition, his condition was complicated by liver dysfunction and neurological disturbance. After a protracted stay, the patient was finally discharged from hospital 5 months after the onset of his severe illness.

Aged↗
PubMed1997

Cognitive testing of elderly Chinese from selected community clubs in Singapore.

The aim of this study was to describe the psychometric performance of cognitively normal elderly Chinese on selected psychological tests. One hundred and fifty-five community-living, cognitively intact elderly Chinese, stratified according to age and gender were administered a selected neuropsychological assessment battery which comprised the Abbreviated Mental Test (AMT), the Chinese Mini-Mental Status (CMMS), the Short Blessed Test (SBT), the Word-List Immediate Memory (WL-i), the Word-List Delayed Memory (WL-d), the Word-List Recognition Memory (WL-r), the Set Test (ST), the modified Boston Naming Test (BNT), the Constructional Praxis Test (CPT), the Block Design Test (BDT) and the Object Assembly Test (OAT). The local median scores (ranges) of the above tests were as follows-AMT: 9 (6-10); CMMS: 25 (16-28); SBT: 2 (0-10); WL-i: 17 (8-27); WL-d: 5 (0-10); WL-r: 9 (1-10); ST: 13 (6-25); BNT: 14 (10-15); CPT: 1 (0-3); BDT: 19 (0-42); OAT: 20 (3-33). These results can assist in the clinical identification of cognitive abnormalities amongst the elderly Chinese in Singapore. Future work will attempt to adjust these overall scores for variables such as the subjects' education and age.

Aged↗
PubMed1997

An institutional outbreak of Salmonella enteritidis in Singapore.

A large outbreak of food poisoning occurred in Singapore in March 1995 when a total of 188 inmates in an institution was taken ill. Salmonella enteritidis was isolated from the stool cultures of 35 inmates (16 symptomatic and 19 asymptomatic). All the isolates were of the serotype profile 0:1, 9, 12 and H:g, m (antigen phase I); all were sensitive to ampicillin, ceftriaxone, chloramphenicol, co-trimoxazole and ciprofloxacin. Plasmid profile analysis and restriction enzyme fragmentation patterns (REFPs), as generated with EcoRI and HindIII, of a 60 kb plasmid obtained from these isolates were all identical, confirming that the outbreak resulted from a single source of infection. Stratified statistical analysis of food-specific attack rates strongly implicated imported canned luncheon pork consumed by the inmates on 26 March 95 as the single most probable cause of the food poisoning [p < 10(6), Mantel-Haenszel weighted odds ratio (OR) = 14.33; 95% confidence interval (CI) = 6.20-33.15]. The median incubation period of this outbreak was 19.3 hours and the median duration of illness was three days. The outbreak was rapidly brought under control through prompt implementation of epidemic control measures which comprised active search for diarrheal cases, rectal swabbing of asymptomatic inmates, isolation of those found to be infected, and maintenance of a high standard of personal, food and environmental hygiene.

Disease Outbreaks↗
PubMed1997

Occupational skin disease in workers from the electronics industry in Singapore.

Of 149 workers from the electronics industry with occupational dermatoses seen at the Joint Occupational Dermatoses Clinic at the National Skin Centre, Singapore, 51.0% (76) were diagnosed to have irritant contact dermatitis, 40.9% (61) had allergic contact dermatitis, and 8.1% (12) had noncontact dermatitis. More than half of the patients were younger than 30 years of age. Common irritants were soldering flux, oils and coolants, solvents, and acids/alkalis. The most common allergens were nickel and resins, followed by rubber chemicals and the constituents of flux. Of the noncontact dermatitis, 8 were caused by occupationally relevant exacerbation of endogenous eczema, whereas there was one case each of miliaria, frictional dermatitis, and fatal toxic epidermal necrolysis caused by trichloroethylene allergy.

Adult↗
PubMed1997

Sickness absence in private sector establishments in Singapore.

AIM: A study was conducted in June 1995 to determine the current level of sickness absence in Singapore. METHOD: The questionnaire survey was part of a larger labour market survey conducted quarterly by the Ministry of Labour, and covered 3,553 private sector establishments employing 25 or more employees. RESULTS: Overall, 14.4% of the 628,477 employees took sick leave, while the percentage of working days lost due to sick leave, excluding maternity leave, was 1.1%. An average of 3.2 days of medical leave were taken per person per year. Industry specific characteristics seemed to have more influence on sickness absence than establishment size, employee's sex and occupation (viz, professional versus clerical versus production staff), number of hours worked and overtime work. Over 60% of the establishments, particularly larger companies and those in manufacturing, implemented measures to control sickness absence, most commonly counselling, disciplinary procedures and attendance allowance or bonus. Over 13% monitored sickness absence using computerised records. CONCLUSION: Comparing with overseas sickness absence (lost time) rates, the rates observed in this study do not appear high.

Absenteeism↗
PubMed1997

A nationwide outbreak of coconut-associated paratyphoid A fever in Singapore.

A large outbreak of 167 cases of paratyphoid A was reported in Singapore during the period 15 February to 4 May 1996. Cases were distributed all over the country and no specific food establishment was implicated. The attack rate was highest among the Indian ethnic group between the ages of 25 and 34 years. A case-control study showed that consumption of a variety of food items in which imported deshelled coconut was used as an ingredient was statistically significantly associated with the illness (P < 0.001). As soon as the vehicle of transmission was suspected, the import of deshelled coconut was banned. No further cases were reported four weeks after the ban. The outbreak highlighted the need to maintain a high degree of vigilance against the introduction of infectious diseases through imported food.

Adolescent↗
PubMed1997

Drug-resistant tuberculosis in Singapore, 1995 to 1996.

Singapore's tuberculosis incidence of 49 to 57 per 100,000 population for 1987 to 1996 presents a picture that is intermediate between developed and developing countries. The proportion of drug-resistant isolates has remained stable at 4.3% to 5.5% from 1992 to 1996 despite rising HIV rates. From 1995 to 1996, of the 199 consecutive drug-resistant isolates at the Central Tuberculosis Laboratory, 66% were mono-resistant, 22% dual-resistant and 12% resistant to more than two drugs. Isoniazid resistance was most prevalent, being found in 72% of isolates, followed by streptomycin resistance in 45%. Resistance to isoniazid and streptomycin (21%) was more common than to isoniazid and rifampicin, i.e. multidrug resistance (MDR) (14%). The small numbers indicated by the low overall prevalence of resistance and the predominance of single-drug resistance support the current initial choice of the standard short course with its three-drug initial phase. Of the 170 cases with matching National Tuberculosis Registry data, 72% of drug-resistant cases represented initial and 28% acquired resistance; testifying to the effectiveness of present day treatment regimens in suppressing resistance when compliance is assured. Case-control analysis using 244 drug-sensitive controls randomly selected from notifications in 1995 to 1996 showed an odds ratio for drug-resistance between subjects with a previous history and no previous history of tuberculosis of 2.47 (95% CI 1.40 to 4.37; P = 0.0007). With each increment in the number of episodes of tuberculosis experienced, there was a trend of resistance to progressively more drugs (P = 0.000004). This association remained even when a logistic regression model including all predictor variables was fitted. No associations were found with age, history of contact with tuberculosis, cavitary disease and, most notably, with human immunodeficiency virus infection. This study reaffirms that a history of previous tuberculosis should increase clinicians' index of suspicion for drug resistance, the urgency with which culture and sensitivity results are sought and the vigour with which patients are followed-up and compliance monitored.

AIDS-Related Opportunistic Infections↗
PubMed1997

Clinical characteristics and natural history of human immunodeficiency virus infected patients seen at a general hospital in Singapore.

The number of patients with human immunodeficiency virus (HIV) infection in Singapore has risen over the years. A considerable proportion of them present with acquired immunodeficiency syndrome (AIDS). In this study, we document the clinical characteristics and natural history of a consecutive series of 50 patients who were found to have HIV infection when they were seen at a tertiary care hospital. The majority were in the 30 to 49 age group and the most common mode of acquisition was heterosexual contact. The patients presented with a variety of symptoms to 11 different clinical departments. Fifty-eight per cent of the patients had AIDS-defining illnesses at presentation, with Pneumocystis carinii pneumonia being the most common. On follow-up, the most frequently occurring opportunistic infection that developed was Cytomegalovirus retinitis. Most patients had multiple subsequent admissions--for both AIDS-defining and non AIDS-defining conditions. The median CD4 count of the cohort at presentation was 72/mm3. The median survival was 399 and 822 days in those who had and those who did not have an AIDS-defining illness at presentation, respectively. Mortality was most commonly attributed to pneumonia. HIV infection has protean manifestations and patients may present to various specialty departments; hence, doctors need to be aware of the spectrum of disease in order to make a diagnosis.

AIDS-Related Opportunistic Infections↗