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PubMed1998

Doctors' and lawyers' perspectives of child abuse and neglect in Singapore.

AIM OF STUDY: To investigate the Singaporean doctor's and lawyer's definition of child abuse and neglect, their attitudes towards reporting and their manner of handling suspected cases. METHODS: A self-addressed questionnaire survey was carried out in a population of hospital doctors, family physicians and lawyers. A total of 368 respondents participated in the survey. RESULTS: Most respondents had similar parenting attitudes. The majority felt that child abuse occurred sporadically but 25% of family physicians felt it seldom occurred. Thirty-eight per cent of family physicians had a personal definition of child abuse compared to less than a third of hospital doctors. There was a high consensus among all 3 groups concerning 21 behaviours studied. In all 3 groups, more than 80% agreed that having sex, burning child, tying child and not protecting the child from sexual advances were both unacceptable and abusive. More than 80% of respondents felt that some form of compulsory reporting is necessary in Singapore. Doctors preferred to refer cases of physical abuse to the hospital while lawyers preferred the police. All agreed that sexual abuse is a matter for the police. Respondents were more likely to act in cases of physical abuse and sexual abuse than for cases of emotional abuse and neglect. CONCLUSIONS: There is a need to formalise definitions of child abuse in our society. More education and training in the understanding and handling of child abuse by doctors and lawyers may be necessary.

Adult↗
PubMed1998

Development of software tools at BioInformatics Centre (BIC) at the National University of Singapore (NUS).

There is burgeoning volume of information and data arising from the rapid research and unprecedented progress in molecular biology. This has been particularly affected by the Human Genome Project which is trying to completely sequence three billion nucleotides of the human genome (1),(1a). Other genome sequencing projects are also contributing substantially to this exponential growth in the number of DNA nucleotides and proteins sequenced. The number of journals, reports and research papers and tools required for the analysis of these sequences has also increased. For this the life sciences today needs tools in information technology and computation to prevent degeneration of this data into an inchoate accretion of unconnected facts and figures. The recently formed BioInformatics Centre (BIC) at the National University of Singapore (NUS) provides access to various commonly used computational tools available over the World Wide Web (WWW)--using a uniform interface and easy access. We have also come up with a new database tool. BioKleisli, which allows you to interact with various geographically scattered, heterogeneous, structurally complex and constantly evolving data sources. This paper summarises the importance of network access and database integration to biomedical research and gives a glimpse of current research conducted at BIC.

Animals↗
PubMed1998

The efficacy and safety of mivacurium in children in Singapore.

AIM: The aim of this study was to evaluate the clinical use of mivacurium, a short-acting, non-depolarising muscle relaxant, in the paediatric population in Singapore. METHODS: Twenty children between the ages of 2 and 12 years were given mivacurium to maintain neuromuscular blockade during nitrous oxide-halothane anaesthesia. Reversal from neuromuscular blockade was spontaneous. The onset, ease of intubation after different doses of mivacurium, and the ease of reversal were evaluated. RESULTS: Different intubating doses of mivacurium did not result in significantly different times of onset. The mean recovery index (25% to 75% recovery) was 4.1 minutes. There were no adverse reactions. CONCLUSIONS: Mivacurium provided rapid and efficacious onset of neuromuscular blockade in the local paediatric population. Rapid spontaneous recovery obviated the need for reversal agents.

Child↗
PubMed1998

Surgical treatment of thyroid cancer: the Singapore General Hospital experience.

Patients with differentiated thyroid cancers generally have a good prognosis. This should be considered when deciding the extent of surgical resection. Radical surgery, however, may be appropriate in the control of locally advanced disease. An audit of 149 cases of thyroid cancer treated in the Department of General Surgery, Singapore General Hospital between October 1988 and June 1994 is presented. Particular attention is drawn to eight patients who underwent radical surgery. There were 111 (74.5%) women and 38 (25.5%) men. The median age was 45 years (range 12 to 83 years) and 80.5% of the cancers were papillary carcinomas, 14.8% follicular, 2.7% medullary and 2.0% anaplastic. Total or near-total thyroidectomy was the most common procedure for primary disease in about 75% of patients. Eight patients (5.4%) underwent radical surgery-four laryngectomy, one pharyngectomy and three median sternotomy-for tumour clearance. Morbidity included: wound complications in 2%; hypocalcaemia, transient in 16.8% and permanent in 3.4%; and hoarseness of voice in 8.1% with 4.7% having proved recurrent laryngeal nerve palsy. All three patients with anaplastic thyroid cancer died within 3 months. Of the eight who underwent radical surgery, three (37.5%) are alive and disease-free at median follow-up of 20 months. In a correctly selected group of patients with locally invasive differentiated thyroid cancer, aggressive surgery is appropriate, with acceptable morbidity and mortality.

Adolescent↗
PubMed1998

Audit of 2431 admissions to the Surgical Intensive Care Unit, Singapore General Hospital.

A prospective analysis of 2431 patients admitted to the Surgical Intensive Care Unit (SICU) of Singapore General Hospital was conducted between January 1994 and June 1997. All patients were followed up until hospital discharge. This ongoing project serves as both audit and quality assurance in the SICU. The mean APACHE II score of patients was 12.67 +/- 8.36 and the mean age was 59.17 +/- 17.82 years. There were 157 re-admissions, giving a re-admission rate of 6.46%. Mortality rate for re-admitted patients was 48.4%. One hundred and four (4%) patients stayed in the SICU for more than 2 weeks. Thirty (29%) died before the SICU discharge. SICU mortality was 9.46%, hospital mortality was 10.86% and standardised mortality ratio was 1.95. Computerised tools that analyse ICU utilisation patterns and outcomes have the potential to better target resources and so lower hospital costs, reducing futile medical care by selecting patients for appropriate expensive ICU care.

APACHE↗
PubMed1998

Characterization of clinical isolates of Helicobacter pylori in Singapore.

Of the 69 Helicobacter pylori isolates analysed, 31 strains (45%) showed resistance to metronidazole, one strain (1.4%) was resistant to amoxicillin while two strains (2.9%) were resistant to clarithromycin. It was found that metronidazole resistance rates increased in Singapore from 20% to 62% between late 1995 and early 1997. By biotyping using API ZYM, a total of 80% (55/69) strains were characterized as biotype II, while the remaining 20% (14/69) strains belonged to biotype III. Interestingly, 71% (10/14) of biotype III were resistant to metronidazole compared with 38% (21/55) of biotype II. DNA profiles generated by random amplified polymorphic DNA from 69 isolates showed highly diversified DNA fingerprints allowing effective discrimination among strains. Of the 60 H. pylori isolates from peptic ulcer patients, it was found that cagA and vacA occurred in 80% (48/60) and 82% (49/60) isolates, respectively.

Amoxicillin↗
PubMed1998

Self-perception of health among elderly community dwellers in Singapore.

Majority (90.5%) of the elderly living in the community in Singapore had a positive (satisfactory to good) perception of their health. This study found that age (70 years or older), recent hospitalisation, regular medical follow-up, hearing impairment, presence of chronic medical conditions (like musculo-skeletal problems, hypertension, ischaemic heart disease and chronic obstructive lung disease), impairment in activities of daily living, history of falls, those on regular medications and those with financial difficulties all adversely influenced perception of health. Those able to participate in regular outdoor leisure activities have a positive influence. Factors that did not significantly influence perception of health were gender, health-promoting activities, work, poor eyesight, cognitive impairment, urinary incontinence, diabetes, history of stroke and the ability to use public transport.

Activities of Daily Living↗
PubMed1998

Childhood leukaemia: towards an integrated psychosocial intervention programme in Singapore.

A hospital-based behavioural intervention programme was developed for families of children with newly diagnosed or relapsed Acute Lymphoblastic Leukaemia (ALL). The programme's aim was to enhance the families' ability to cope with the emotionally distressing aspects of the illness and the medical treatment. Eight children and 10 parents participated in the programme for 12 weeks. The children received individual therapeutic play sessions and computer-assisted distraction activities, while the parents participated in a structured support group. The subjects were evaluated before, immediately after, and 6 months post-intervention, using both self-administered questionnaires and clinical observation by the psychosocial intervention team and the hospital staff. Findings indicated positive changes on the coping and the hopelessness measures, and an overall benefit for both parents and children. The hospital team reported better compliance and co-operation with treatment procedures by the children and their parents. The study concludes with an assessment of the benefits and feasibility of integrating a psychosocial programme into paediatric oncology services in Singapore.

Adaptation, Psychological↗
PubMed1998

One hundred and seventy cases of childhood-onset rheumatological disease in Singapore.

One hundred and seventy patients with rheumatological disease diagnosed before their 16th birthday and still on follow up were studied retrospectively. They were seen within the last 3 years at KK Women's and Children's Hospital, Tan Tock Seng Hospital, National Skin Centre or Singapore General Hospital. Of these, 89 were still less than 16 years old at the time of study. The majority had systemic lupus erythematosus (51.8%). Many were on long-term follow-up for persistent disease, including renal manifestations (47.7%), neurological manifestations (26.1%) and haemolytic anaemia (15.9%). Photosensitivity and malar rash were more common than in Western studies while arthritis was less common. Anti-phospholipid antibodies were found in children complicated by myocardial infarction, pulmonary hypertension, Raynaud's phenomenon, cerebral and gut lupus. Children with juvenile chronic arthritis comprised 28.8% and juvenile dermatomyositis 10%. The male predominance and lack of uveitis in children with pauciarticular JCA were striking. Rarer conditions included polyarteritis nodosa, scleroderma, rheumatic fever with arthritis, polychondritis and Behcet's disease. Many diseases may first present with a rheumatological complaint. This review of features of local children highlights similarities and differences with Western data. It also provides information for planning long-term care, multidisciplinary clinics, group physiotherapy sessions, educational programmes and support groups.

Adolescent↗
PubMed1998

Studying the mental health of a nation: a preliminary report on a population survey in Singapore.

AIM: A Singapore Mental Health Survey was designed to study the prevalence and pattern of psychiatric morbidity of the general population. Community surveys reveal the true pattern of mental disorders, free from any self-selection into, or referral within the health care system. METHODS: A cross-sectional survey design was used to estimate the point prevalence of minor psychiatric morbidity (MPM) in an area-probability sample drawn from different regions. Disproportionate quota sampling yielded approximately equal numbers of Chinese, Malays and Indians for inter-ethnic comparison. The General Health Questionnaire, 28-item version (GHQ-28) measured psychoemotional symptoms in 3,020 subjects aged between 13-65 years. The GHQ-28 was validated against ICD-10 psychiatric diagnoses derived from structured psychiatric interview with the Composite International Diagnostic Interview (CIDI). RESULTS: The optimal cut-off point for the GHQ-28 was determined to be 4/5 for Chinese, and 5/6 for Malays and Indians. Using the validated ethnic-specific cut-offs, MPM rate for Chinese was 17.4%, Malays 15.1% and Indians 17.8%. The population MPM prevalence rate was estimated to be 16.6% after standardisation with population census data. Specific types of ICD-10 psychiatric disorders which give rise to MPM were mainly anxiety and depressive disorders. Twelve percent of individuals with MPM had at least one ICD-10 disorder in the previous year. CONCLUSION: Two-staged methodology is an efficient, cost-effective approach to study population prevalence of mental illness. Screening instruments utilised should be validated specifically for the culture and setting. Information from population surveys of psychiatric morbidity are important for the planning of mental health services for the country.

Adolescent↗
PubMed1998

The economics of breastfeeding in Singapore.

A study of 340 mothers was conducted in Kandang Kerbau Hospital on September 1992 to determine if it were more economical for households to breastfeed or bottle-feed an infant for the first three months. Two economic models, a low cost model and a high cost model, were adopted incorporating a mathematical expression from Almroth's work in 1979. The savings in a mother's gross income for the period ranged from 3% to 9% for the low cost model and from 8% to 21% for the high cost model. From the household perspective, two components contributed to the economic savings of breastfeeding over artificial feeding: the cost of goods consumed and the time taken to feed the baby. It was noted that the time taken to artificially feed is longer than the time taken to breastfeed an infant. The results of this study provided more concrete basis for policy makers and advocates of breastfeeding to promote breastfeeding in Singapore. The amount of savings from breastfeeding could be considered for the health care system from the public perspective.

Breast Feeding↗
PubMed1998

Prolonged ambulatory oesophageal pH and pressure recording in healthy adults in Singapore.

BACKGROUND/AIM OF STUDY: Data on prolonged ambulatory oesophageal pH and pressure monitoring in normal subjects in the East are limited. This study aimed to define the normal characteristics of ambulatory oesophageal pH and motility among healthy adults in Singapore. METHOD: Prolonged ambulatory oesophageal pH and pressure recording was performed on 10 healthy volunteers using a one-channel pH probe, a two channel pressure probe, a portable digital data recorder and a computerised data analysis system. The median (range) number of episodes with pH < 4 and the percentage of total time with pH < 4 were 24% (4%-56%) and 3.0% (0.2%-4.0%) respectively. They were greater in the upright than supine positions. RESULTS: The median percentages of peristaltic and simultaneous contractions were 65.8%-80.5% and 10.6%-12.7% respectively. The frequency, amplitude and duration of peristaltic contractions were greater during mealtimes than between meals in the upright position. CONCLUSION: This study provides the first data on prolonged ambulatory oesophageal pH and manometry in healthy Singaporean adults.

Adult↗
PubMed1998

A retrospective epidemiology study of contact eczema among the elderly attending a tertiary dermatology referral centre in Singapore.

AIM: The aim of this study was to examine the epidemiology of contact eczema in the elderly patients attending a skin clinic in Singapore. METHODOLOGY: This is a retrospective study on patients attending our skin clinic at the National Skin Centre. All patients older than 49 years old attending our Contact and Occupational Dermatoses Clinic between 1990 and 1993 were included in the study. The prevalence of contact eczema among different age groups (50-59 years, 60-69 years, and 70-79 years) were compared. Diagnosis of contact dermatitis was based on the clinical history, physical examination and relevant patch test reactions. Demographic data of the patients were collected and analysed. Chi-square test was used for statistical analysis. RESULTS: Two hundred and one patients who were older than 49 years old, were included in the study. There was no significant difference in the prevalence of personal history of atopy among the 3 age groups. There was no significant difference in the racial distribution of the 3 age groups. The proportion of patients who were occupationally active decreased with age (50% vs 23% vs 0% respectively). There was no significant difference in the proportion of patients with positive patch test reactions in the 3 age groups although the proportion appears to increase with age (68% vs 75% vs 75% respectively). Similarly, the proportion of patients with allergic contact dermatitis was slightly higher in the older age group although the difference was not statistically significant among the 3 age groups (32% vs 45% vs 39% respectively). The face (54%) and hands (31%) were the commonest sites of eczema in the younger age group (50-59 years age group) whereas the lower limbs (41%) and the upper limbs (33.3%) were the commonest sites of eczema in the older patients (70-79 years age group). Nickel allergy was significantly more common in the younger age group (23% vs 17% vs 14% respectively). Medicament allergy (clioquinol-mix) and medicament related allergens e.g. balsam of Peru and fragrance-mix and para-phenylenediamine were slightly more prevalent in the older patients. CONCLUSIONS: The findings appear to indicate that the prevalence of allergic contact dermatitis is higher in older patients and that contact dermatitis tends to occur on the extremities in older patients than younger patients.

Aged↗
PubMed1994

A prospective study of ingested foreign bodies in Singapore.

OBJECTIVE: To evaluate the following: the symptoms, physical signs, investigation, and treatment of impacted foreign bodies (FBs); the dimensions of FBs according to site of impaction; and epidemiology, risk factors, and complications of FB ingestion. DESIGN: Prospective analysis of 397 patients with a history of FB ingestion. SETTING: Department of Otolaryngology, Tan Tock Seng Hospital, Singapore, a referral center with institutional practice. PATIENTS: Of the 397 patients treated between May and December 1991, ingested FBs were found in 197 patients. INTERVENTION: Foreign bodies were removed with forceps under direct or indirect vision; if this was impossible, removal was done endoscopically. RESULTS: Dysphagia, positive laryngeal rub, and drinking water tests had high sensitivity and specificity for esophageal FBs. Large and rigid FBs of various shapes tend to lodge in piriform fossae and esophagus and might cause complications if not removed early. The risk factors of FB ingestion were use of dentures and Chinese method of cooking and eating. The complication rate of impacted FBs was 5.1% and increased with the delay in seeking treatment. Flexible esophagoscope was found to be as effective as rigid esophagoscope in retrieving esophageal FBs. Lesions simulating impacted FBs were found in nine patients. In 162 patients in whom no FB was found, the symptoms resolved spontaneously within 16 days. CONCLUSION: Dysphagia, positive laryngeal rub, and drinking water tests are indicative of impacted FBs that must be removed early to prevent complications. Ability to use both rigid and flexible esophagoscopes is advantageous in FB retrieval.

Adolescent↗
PubMed2000

Sperm-mediated gene transfer studies on zebrafish in Singapore.

This paper describes the work conducted in the Department of Biological Sciences, National University of Singapore; on sperm-mediated gene transfer in zebrafish. This study began by carrying out direct interaction experiments of pUSVCAT reporter DNA with spermatozoa. Other constructs, including pXGH5, pMTL, pRSVL and pGEM-luc, were subsequently used. The different constructs were taken up by sperm cells with comparable efficiencies. In general, no reporter gene expression, Mendelian inheritance, or evidence of genomic integration of the foreign sequences were obtained. However, transmission of the reporter DNA through generations was observed. DNA uptake by sperm cells was shown using FISH and was enhanced by electroporation. The potential use of more recent approaches, such as REMI and ICSI are explored. Future research directions are discussed.

Animals↗
PubMed1985

Correlation of steroid receptors with histologic differentiation in mammary carcinoma. A Singapore experience.

Cancer of the breast is the most common tumor in females in Singapore, with the rate of 20.7 per 100,000 per year (1977 estimate), which is predicted to increase to 29.8 per 100,000 women per year by 1995. A detailed histopathologic review of 50 primary breast cancer tumors analyzed for estrogen receptor (ER) level was carried out and a variety of morphologic features correlated with ER results to identify any factors that will improve the management and prognosis for breast cancer. Cytosol was incubated with 3H-estradiol in the presence and absence of cold diethylstilbestrol, and bound and free hormone were separated by Dextran-coated charcoal method. Tumors binding more than 5 fmol/mg cytosol protein were classified as ER-positive. Progesterone receptor (PR) level was analyzed in some specimens with the use of a similar method. Most of the patients were Chinese (90%). Three patients were Malays, one was Indian, and one was European in this series. Results indicated that there was strong correlation between ER level, age, and histologic grade of the tumors. No correlation existed between absence or presence of lymph node metastases and ER. Although there was a trend for ER-positive tumors to have a low-grade lymphocytic infiltration, the difference was not statistically significant.

Adult↗
PubMed1992

Long-term survival following treatment of hepatocellular carcinoma in Singapore: evaluation of Wellferon in the prophylaxis of high-risk pre-cancerous conditions.

The present paper reviews several studies performed between 1977 and 1986 in Singapore on the 10-year survival outcome of treatment for stage I and II hepatocellular carcinoma (HCC). Of 801 HCC patients evaluated, only 2 survivors (0.3%) remained in complete remission for 13 and 14 years, respectively. One had received four weekly cycles of prednisolone, Adriamycin, vincristine and 5-fluorouracil for an inoperable HCC with a 10-cm diameter, and the other had received localised synchronised hepatic irradiation and Adriamycin. As follow-up, the use of localised hepatic irradiation consisting of 131I-labeled (30 mCi) iodised oil in lipiodol infused via the hepatic artery appeared to benefit patients with small residual tumours but did not affect larger tumours measuring 2 cm in diameter. Prophylactic, intermittent long-term administration of lymphoblastoid interferon-alpha (Wellferon) was carried out in pre-cancerous, high-risk hepatitis B surface antigen (HBsAg)-positive patients with cirrhosis, in immediate male relatives of liver cancer patients, and in persons who had undergone hepatic resection. In the untreated group, 10/162 (6%) cirrhotics, 3/18 (17%) male family members, and 6/10 (60%) post-resection cases developed single or multiple HCCs within 1 year of screening done at 3-month intervals on the basis of alpha-fetoprotein (AFP) levels and real-time hepatic ultrasonography. In contrast, none of the Wellferon-treated group consisting of 518 cirrhotic patients, 82 male relatives of HCC patients and 20 post-resection cases developed HCC. Two HBsAg-positive individuals who had not been treated with interferon (IFN) developed hepatic nodules which that showed dysplasia, AFP elevation and chromosomal changes. These studies demonstrate the poor results of late diagnosis and show that early intervention and prophylaxis with Wellferon can reduce the incidence of HCC in high-risk persons. In addition, transhepatic chemoembolisation and liver resection are suitable methods for treating small HCCs (single or multiple) that are detected by screening. However, some of these early-detected HCCs remain highly malignant. Prophylactic treatment of pre-cancerous conditions appears to be a better option as a long-term programme for HCC.

Adult↗
PubMed1993

Nucleotide sequence of a Singapore isolate of zucchini yellow mosaic virus coat protein gene revealed an altered DAG motif.

A cDNA clone of zucchini yellow mosaic virus (ZYMV) RNA was mapped to the 3' terminal region. The nucleotide sequence revealed a single open reading frame of 1035 nucleotides followed by a 3' noncoding region of 215 nucleotides. The putative protease cleavage site for the release of coat protein (CP) was deduced to be between Glu-Ser (at amino acid position 66-67), which would result in a protein of 279 amino acids. This non-aphid-transmissible Singapore isolate of ZYMV showed a change of DAG to GAG triplet near the N-terminal of the CP. The CP gene was expressed as a protein fused to the beta-galactosidase in Escherichia coli and as an unfused protein in Saccharomyces cerevisiae.

Amino Acid Sequence↗