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PubMed2005

Epidemiology of burn injuries in Singapore from 1997 to 2003.

The Singapore General Hospital (SGH) Burn Centre receives more than 93% of burn cases occurring in Singapore. The Centre also received patients from the Southeast Asian region. The collection and analysis of burn epidemiology data in recent years from Singapore would provide insights into new prevention/management strategies in terms of population profile and economic activities. Data pertaining to burn patients admitted to SGH Burn Centre between January 1997 and December 2003 were studied retrospectively in terms of admissions' demographics, extent of burn (TBSA), causes of burns, length of hospital stay (LOS) and mortality. A total of 2019 burn patients were admitted with an annual admission of 288. This presented an incidence rate for burn injury (with admission) of 0.07 per 1000 general population. The male to female ratio is 2.2:1 and the mean age of admission is 32.5years. The mean extent of burn was 11.5% and patients with burn size 10% TBSA and less made up the majority of admissions at 70.7% while patients with burn size 30% TBSA and more made up 8.2%. The most common cause of burn injury is scald at 45.6% followed by flame at 35.2%. The overall mean LOS and mortality are 10.8days and 4.61%, respectively. An annual trend of falling mortality rate for admissions with burn size >30% TBSA was observed-60% in year 2000 to 30% in 2003. This is a result of massive early excision and grafting of severe burn patients. 17.6% of patients were children of 12years and below, showing a 11.9% reduction from previous study in the 80s. This is consistent with the city's demographics of falling fertility rate and improved living and social conditions. Occupational burn admissions account for 33.4% of total admissions, a reduction of 11.6% from a study in the early 90s. Occurrence of occupational flame burns decreased by 9.5% due to an improvement in fire prevention and management of the industrial sectors. However, chemical burns increased by 12.6% as the chemical sector in Singapore grew at a rate of 10% from year 1995 to 2000. Singapore has also derived much experience from the management of mass casualties resulting from SQ006 plane crash and bomb blasts in Bali as well as in Jakarta. In total, 315 victims were treated (4 from SQ006, 16 from Bali and 15 from Jakarta) with 1 mortality. The burns admissions in Singapore has a profile consistent with population demographics. Scald is the major cause of burns and most of these injuries are preventable. While the industries have made inroads into good fire prevention and management, management of chemical burns and other occupational hazards will continue to be scrutinized and advice given in terms of regulations, work processes and personal protective gears.

Adolescent↗
PubMed1999

Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore.

OBJECTIVE: To compare the frequency of reflux oesophagitis and hiatus hernia in dyspeptic patients in England with that in Singapore. DESIGN: Demographic, clinical and endoscopic findings in consecutive dyspeptic patients seen in England and Singapore by the same clinician were compared. The association of various factors with the occurrence of hiatus hernia and oesophagitis was analysed by logistic regression. SETTING: District general hospital in England and university hospital in Singapore. PARTICIPANTS: The English series comprised 212 consecutive patients, and 173 patients were seen in Singapore. RESULTS: Reflux oesophagitis and hiatus hernia were found in 52 (25%) and 50 (49%) of the English patients, and 12 (6%) and 7 (4%) of the Singapore patients, respectively (P<0.005 in each case). Race, body mass index and age were independently associated with hiatus hernia (odds ratios 3.07, 1.08 and 1.04, respectively). The risk factors for oesophagitis were race, sex, body mass index and age (odds ratios 4.04, 2.37, 1.11 and 1.02, respectively). If hiatus hernia was included in the analysis, the risk factors were hiatus hernia, sex, race and body mass index (odds ratios 20.10, 3.07, 2.81 and 1.09, respectively). CONCLUSIONS: Reflux oesophagitis and hiatus hernia are more common in English dyspeptic patients compared to those in Singapore. The most important risk factor for both oesophagitis and hiatus hernia is race.

Adult↗
PubMed1999

Incidence of eyelid cancers in Singapore from 1968 to 1995.

AIM: To describe the epidemiological characteristics of patients with eyelid malignancies seen in all hospitals in Singapore from 1968 to 1995. METHOD: The Singapore Cancer Registry has been collecting epidemiological data of all cancers seen in Singapore since 1968. The data of all cases of Singapore residents with eyelid cancers diagnosed from 1968 to 1995 (ICD-9, sites 172.1 and 173.1) were retrieved for analysis. RESULTS: There were 162 male patients (49.8%) and 163 females (50.2%). The median age at diagnosis was 63 years in males and 66 years in females. The average annual age standardised incidence rate among male Singapore residents was 6.5 per million and 5.5 per million among female Singapore residents. Between 1993 and 1995, the average annual rate for females was 6.8 per million, compared with 3.1 per million between 1968 and 1972. The most common cancer was basal cell carcinoma (84.0%), followed by sebaceous adenocarcinoma (10.2%) and squamous cell carcinoma (3.4%). CONCLUSION: The annual age standardised incidence for male residents has remained relatively stable. The incidence for female residents has shown a steady increase over the past 28 years. The incidence for males is generally higher than that for females. These expanded epidemiological characteristics may serve to provide a foundation to monitor future disease patterns and to promote further research into the aetiology of these cancers.

Adolescent↗
PubMed1999

Conducting clinical trials in Singapore.

All clinical trials in Singapore will now have to conform to the Medicines (Clinical Trials) Amended Regulations 1998 and the Singapore Good Clinical Practice (GCP) Guidelines 1998. The Medical Clinical Research Committee (MCRC) has been established to oversee the conduct of clinical drug trials in Singapore and together with the legislations in place, these will ensure that clinical trials conducted in Singapore are properly controlled and the well-being of trial subjects are safe guarded. All clinical drug trials require a Clinical Trial Certificate from the MCRC before the trial can proceed. The hospital ethics committee (EC) vets the application for a trial certificate before it is sent to MCRC. The drug company sponsoring the trial has to indemnify the trial investigators and the hospital for negligence arising from the trial. The MCRC, apart from ensuring the safety of trial subjects, has to provide continuing review of the clinical trial and monitors adverse events in the course of the trial. The EC will conduct continuing review of clinical trials. When a non-drug clinical trial is carried out, the EC will ensure that the proposed protocol addresses ethical concerns and meets regulatory requirements for such trials. There is great potential for pharmaceutical Research & Development (R&D) in Singapore. We must develop our skills and infrastructure in clinical trials to enable Singapore to be a regional hub for R&D of drugs in Asia.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Pacemaker implantation in Singapore in 1997.

INTRODUCTION: Previous reports on pacemaker implantation in Singapore have been from a single institution and hence may not accurately reflect the practice in Singapore. As part of the World survey on pacemaker implantation, a survey of all pacemaker implantations in Singapore in 1997 was performed. METHOD: Information was obtained from the pacemaker manufacturers and a survey form was sent to all doctors involved in pacemaker implantation. RESULT: In 1997, 206 pacemakers were implanted or replaced in Singapore. This gives a pacemaker rate of 69 per million. For new implants only, there were 61 implants per million. More detailed information regarding the patient and implantation was obtained in 160 (78%) patients. The mean age of the patients was 68.5 +/- 14.4 years (range 2-97 years). There were 142 (89%) new implants and 18 (11%) replacements. 62.5% of the patients were females. Seventy-nine percent of the patients were older than 60 years old and 17.5% were older than 80 years. Seventy-five percent of the pacemakers were single chamber pacemakers. Twenty-five percent were dual chamber pacemakers. Only 1.4% of the pacemakers used epi-myocardial leads and all these were in children. Heart block was the most common indication for pacing and consisted of 52.8% of the patients while 43.0% of patients were implanted for the sick sinus syndrome. CONCLUSION: Pacemaker implantation in Singapore in 1997 was 69 per million. Heart block remains the most common indication for implant and single chamber pacing is still the most commonly used mode of pacing. The majority of the implants were in persons older than 60 years. With an increasing ageing population in Singapore, the implant rate for pacemakers will be expected to increase significantly.

Adolescent↗
PubMed2004

2001 survey on primary medical care in Singapore.

INTRODUCTION: The 2001 survey on primary medical care was undertaken to compare updated primary healthcare practices such as workload and working hours in the public and private sectors; determine private and public sector market shares in primary medical care provision; and gather the biographical profile and morbidity profile of patients seeking primary medical care from both sectors in Singapore. This is the third survey in its series, the earlier two having been carried out in 1988 and 1993, respectively. METHODS: The survey questionnaire was sent out to all the 1480 family doctors in private primary health outpatient practice, the 89 community-based paediatricians in the private sector who were registered with the Singapore Medical Council and also to all 152 family doctors working in the public sector primary medical care clinics. The latter comprised the polyclinics under the two health clusters in Singapore, namely the Singapore Health Services and National Healthcare Group, and to a very much smaller extent, the School Health Service's (SHS) outpatient clinics. The survey was conducted on 21 August 2001, and repeated on 25 September 2001 to enable those who had not responded to the original survey date to participate. Subjects consisted of all outpatients who sought treatment at the private family practice clinics (including the clinics of the community-based paediatricians), and the public sector primary medical care clinics, on the survey day. RESULTS: The response rate from the family doctors in private practice was 36 percent. Owing to the structured administrative organisation of the polyclinics and SHS outpatient clinics, all returns were completed and submitted to the respective headquarters. Response from the community-based paediatricians was poor, so their findings were omitted in the survey analysis. The survey showed that the average daily patient-load of a family doctor in private practice was 33 patients per day, which was lower than the 40 patients a day recorded in 1993. The average working hours of each of these private practitioners was 7.6 hours per day. Family doctors in public sector primary medical care clinics were responsible for 16.6 percent of the patient-load for primary medical care in Singapore while the remaining 83.4 percent was provided by family doctors in private practice. Singaporeans made approximately 4.4 visits to a family doctor in 2001, which was lower than the 5.0 visits ascertained in 1993. Chronic medical conditions seen by family doctors as a whole, increased from 29.2 percent in 1993 to 34.3 percent in 2001. Upper respiratory tract infections and hypertension were the two leading disease conditions seen at both private and public sector primary medical care clinics in 2001. The load of hypertension managed at primary medical care clinics had notably increased. CONCLUSION: The public sector share of outpatient load at 17 percent in 2001 is well within the 25 percent level set in the Government's 1993 White Paper on Affordable Healthcare. The private sector remains the main provider of primary medical care in Singapore, serving 83 percent of the population. The average workload for each family doctor in private practice had dropped from 40 to 33 patients a day between 1993 and 2001. There had been a notable growth in family doctors working in the private sector over this period. Both sectors saw an increase in the chronic disease load that they managed.

Adolescent↗
PubMed1987

Trends and ethnic variation in incidence and mortality from cancers of the colon and rectum in Singapore, 1968 to 1982.

Data collected by the population-based Singapore Cancer Registry show rapidly increasing incidence for both cancer of the colon (annual average of 3-6%) and rectum (annual average of 3-5%) over the period 1968 to 1982. The cancer incidence rates were generally highest among the Chinese in whom the latest age-adjusted rates (1978-82) for colon were 14.3 per 100,000 in males and 14.9 in females, and for rectum 12.5 in males and 10.0 in females. The rates were intermediate for Indians and lowest in Malays. In both sexes, foreign-born Singapore Chinese (mostly born in China) had significantly lower risks for colon cancer compared to local-born Chinese (RR 0.71 in males, RR 0.72 in females, both p less than 0.05). There were no discernible differences between the two groups for rectal cancer. Internationally, Singapore's incidence rates for both sites rank roughly midway between the lows of Asia and Eastern Europe and the highs of Western Europe, North America and New Zealand. Among Chinese populations worldwide, the Singapore rates are also intermediate between the low rates in Shanghai and the high rates in Hawaii and California. The rates among Singapore Indians are generally higher than those in Bombay, Madras and Bangalore. These findings strongly suggest the importance of environmental lifestyle related risk factors among which, on current knowledge, dietary intakes feature prominently. The per capita food availability in Singapore especially in meat and animal fat, has also increased markedly over the last two decades.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic Neoplasms↗
PubMed2001

Cataract extraction rates among Chinese, Malays, and Indians in Singapore: a population-based analysis.

OBJECTIVE: To describe the rates of cataract extraction among Chinese, Malays, and Indians in an urban population in Asia. DESIGN: Population-based incidence study using data from a medical savings fund. STUDY POPULATION: Chinese, Malay, and Indian residents in Singapore. METHODS: Data on all cataract operations performed for "senile cataract" (International Classification of Diseases, Ninth Revision, Clinical Modification code 366.1) between 1991 and 1996 were retrieved from Medisave, a population-wide, government-administered medical savings fund. The Singapore census was used as a denominator to allow an estimation of age, sex, and race-specific annual rates of cataract surgery. RESULTS: Between 1991 and 1996, 61 210 cataract operations for "senile cataract" were performed on Singapore residents, which is equivalent to an average rate of 356.4 cataract operations per 100 000 persons per year (95% confidence interval [CI], 353.6-359.2). The average rate was highest for Indians (age-sex adjusted rate of 396.5 per 100 000/year), followed by Chinese (371.2 per 100 000/year), and lowest for Malays (237.2 per 100 000/year). Women had higher rates of cataract extraction than men (age-adjusted relative risk, 1.14; 95% CI, 1.11-1.17), with this pattern consistent across the 3 racial groups. The rate of cataract extraction increased by an average of 40 operations per 100 000/year (95% CI, 28.6-52.8) between 1991 and 1996. Overall, the proportion of cataract extraction without concurrent intraocular lens implantation was low (n = 762, 1.2%), but rates still decreased by an average of 0.8 per 100 000 per year (95% CI, 0.03-1.5) during the 6 years. CONCLUSIONS: The rate of cataract extraction in Singapore is consistent with rates seen in developed countries in the West. Racial variation in rates suggests varying predisposition to cataract development and/or threshold for cataract surgery between Chinese, Malay, and Indian populations in Singapore.

Adult↗
PubMed2001

Population-based cancer survival in Singapore, 1968 to 1992: an overview.

The Singapore Cancer Registry has provided comprehensive population-based incidence data since 1968. This paper describes the population-based survival analysis of the registry data. All invasive primary cancers diagnosed from January 1, 1968 to December 31, 1992 were passively followed up until December 31, 1997. Only 5.8% were lost to follow-up. Cumulative and observed survival rates were calculated using Hakulinen's method. Overall 5-year relative survival rates have increased dramatically over the 25-year period in both genders. Significant increases are seen with nasopharynx, stomach and colo-rectum cancers, non-Hodgkin's lymphoma, leukemias and cancers of the testis, cervix, ovaries and breast. When compared with the Surveillance, Epidemiology and End Results (SEER) rates in the United States, the 5-year relative survival rates in Singapore are generally lower. However, the rate of change between the two countries is fairly similar. On the average, the rates are 10 to 15 years behind the SEER rates and 5 to 10 years behind Finland, Switzerland and Japan, but they are close to the UK rates. The age-standardized 5-year survival rate for Singapore is higher for most sites compared with other developing countries like Qidong (China), Madras (India), Bombay (India) and Chiang Mai (Thailand). The 25-year trend in cancer survival in Singapore showed two extreme groups: those showing no change and those showing significant improvements. Reducing the incidence of cancers belonging to the first group remains the only viable mode of cancer control. For cancers in the second group, improvement in survival is due to a combination of successful early detection measures and effective treatment services in Singapore.

Age Factors↗
PubMed2003

Hemagglutinin-neuraminidase sequence and phylogenetic analyses of mumps virus isolates from a vaccinated population in Singapore.

During 1999-2000, a sustained mumps outbreak in the highly vaccinated population in Singapore was attributed to vaccine failure associated with the Rubini vaccine strain. To explain this phenomenon, the complete nucleotide and amino acid sequences of the hemagglutinin-neuraminidase (HN) gene of eight mumps virus isolates from patients with parotitis in Singapore were determined and compared with those of known vaccine strains. Phylogenetic trees constructed on the basis of HN nucleotide and amino acid sequences showed that the Singapore mumps virus isolates were more closely related to the Urabe strain and belonged to a different cluster from the Rubini and Jeryl-Lynn strains. The Rubini vaccine showed only approximately 93% nucleotide and approximately 96% amino acid sequence similarity to Urabe and Singapore isolates. Compared with the vaccine strains, six of the eight isolates lacked the extracellular glycosylation site at residues 400-402. Other significant amino acid disparities (e.g., at residue 354) may also affect the antigenic properties of the HN protein. These findings suggest that the evolution and adaptation of the currently circulating mumps virus strains in the community has led to the emergence of genetically distinct viral strains. The low vaccine efficacy of the Rubini strain represents a major reason for the recent mumps resurgence and failure of mumps immunization in Singapore.

Amino Acid Sequence↗
PubMed2006

Cultural influences on occupational therapy practice in Singapore: a pilot study.

Over the past decades, numerous occupational therapy frameworks have been published and adopted in the West but there is little discussion of their applicability to Singapore. The purpose of this study was to examine the relevance and applicability of occupational therapy frameworks in Singapore. Data were gathered from nine highly experienced occupational therapists. Audio-taped semi-structured interviews were used to collect data. Qualitative methods were used in identifying five themes--independence, applicability of client-centred practice, concepts of occupation/activity, client's areas of concern, and application of occupational therapy models to practice. The themes were discussed in the context of three broad areas: (1) the potential discrepancy between occupational therapy's philosophical base and clients' values, (2) mismatch between the occupational therapists' prescription of activity and the meaning of activities to clients, and (3) the potential conflict between the occupational therapy approach and the corporate culture in Singapore. One of the important results from the study was that in Singapore culture, clients generally did not believe that achieving independence was important and they expected to be taken care of by their families. Further research with a larger sample is necessary to explore how culture and societal values impact on occupational therapy practice in Singapore.

Culture↗
PubMed1995

Radical surgery for gastric cancer in Singapore.

This study was conducted to define the pattern and results of gastric cancer surgery in Singapore by reviewing the epidemiological data from the Singapore Cancer Registry together with a review of a personal series of 182 patients operated on over a 14 1/2-year period. As in Japan and the West, the incidence of gastric cancer is decreasing in Singapore; it was 2.3% per year for men and 1.5% for women in the period 1968-1982. Nevertheless, the disease is still common and the respective age-standardized rates among the ethnic Chinese in Singapore of 37.3 and 15.4 per 100,000 per year remain higher than in the West but are only about half the rate observed in Japan. These rates in Singapore Chinese are also higher than those seen in the Chinese-Americans in the United States, but are lower than those of the Chinese of Shanghai, which suggests that lifestyle and diet influence the incidence of gastric cancer. In the series of 182 patients, gastric adenocarcinoma occurred in the antrum or body or the whole stomach in 78.5% and in the cardia in 21.5%. Presentation was late: stage I, 10%; stage II, 7.7%; stage III, 28%; and stage IV, 54.3%. Surgical resection was performed whenever technically possible (146 patients, 80%). In 86 patients, all macroscopic tumors were excised by a radical resection approximating the R2 type of resection, with only one operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2006

Lichens as bioindicators of atmospheric heavy metal pollution in Singapore.

Lichens have been used as bioindicators in various atmospheric pollution assessments in several countries. This study presents the first data on levels of heavy metals (As, Cd, Cu, Ni, Pb, and Zn) in lichens at different locations in Singapore, Southeast Asia. Singapore is a fully industrialised island nation, with a prevailing tropical climate and a population of 4 million people within a confined land area of less than 700 km2. The ubiquitous lichen species, Dirinaria picta was collected from six sample sites across Singapore and analysed for heavy metals using inductively coupled plasma mass spectrometry (ICPMS). No significant relationship existed between metal levels in lichen and soil, indicating that accumulated metals in lichen are primarily derived from the atmosphere. Peak concentrations of zinc (83.55 microg g(-1)), copper (45.13 microg g(-1)) and lead (16.59 microg g(-1)) in lichens were found at Sembawang, Jurong and the National University of Singapore campus which are locations associated with heavy petroleum and shipping industries, and road traffic respectively. The mean heavy metal levels of lichen samples in Singapore were found to be at the upper range of values reported in the literature for temperate countries.

Air Pollution↗
PubMed1999

A population-based study on the incidence of severe ocular trauma in Singapore.

PURPOSE: To define the epidemiology of severe ocular trauma in Singapore. METHODS: A population-based incidence study involving all Singapore citizens and residents. Two government-administered databases were used to capture information on severe ocular trauma in Singapore. The national hospital discharge database provided information on incident episodes of hospitalized ocular injury, defined as any ocular injury requiring hospitalization. The national medical savings database provided information on incident episodes of open globe injury, defined as any open globe injury requiring acute ophthalmic surgery. The 1990 Singapore Census was used as denominator data. RESULTS: From 1991 to 1996, the overall annual incidence rate of hospitalized ocular injury was 12.6 per 100,000, and the annual incidence rate of open globe injury was 3.7 per 100,000. Nearly 15% of open globe injury was associated with an intraocular foreign body. Although a 20% decline in the rate of hospitalization over this 6-year period was observed, no distinct time trend in the rate of open globe injury was seen. Men had fourfold higher rates of injury than women. A bimodal age pattern of ocular injury was observed, with a peak in injury rates in young adults and another in people over 70 years. Racial variation in rates of injury was seen in men but not in women (with Indian men having twice the risks than either Chinese or Malay men). CONCLUSIONS: Severe ocular trauma in Singapore varied with age (highest in young adults and elderly), gender, and race (highest in Indian men), suggesting demographic-specific differences in exposure to high-risk injury settings.

Adolescent↗
PubMed2002

Prevalence of lens opacity in Chinese residents of Singapore: the tanjong pagar survey.

OBJECTIVE: To determine the prevalence of lens opacity among Chinese residents of Singapore. DESIGN: Population-based, cross-sectional survey. PARTICIPANTS: Chinese men and women aged 40 years or more in Singapore. METHODS: A stratified, clustered, random sampling method, with more weights given to the older age groups, was used to initially select 2000 Chinese persons aged 40 to 79 years from the 1996 electoral register in the Tanjong Pagar district in Singapore. Eligible subjects (n = 1717) were invited for a comprehensive ocular examination at a centralized clinic, after which nonrespondents were examined in their homes with portable instruments. MAIN OUTCOME MEASURES: Lens opacity, as determined clinically at the slit lamp using a modification of the Lens Opacity Classification System III. Prevalence rates were age adjusted to the 1997 Singapore census population. RESULTS: Of the 1232 persons examined (71.8%), 1206 (70.2%) provided lens data for this analysis. The age-adjusted prevalence of any cataract surgery was 5.1% (95% confidence interval [CI], 3.6, 6.5), with similar rates between men and women. The age-adjusted prevalence of specific types of lens opacity was 22.6% (95% CI, 19.8, 25.4) for any nuclear opacity, 23.9% (95% CI, 21.0, 26.8) for any cortical opacity, and 7.0% (95% CI, 5.3, 8.8) for any posterior subcapsular opacity. The overall age-adjusted prevalence of any cataract or cataract surgery was 34.7% (95% CI, 31.5, 38.0), increasing from 7.0% in those 40 to 49 years and to 94.3% in those 70 years and older (P < 0.001, test for trend for age). When the prevalence of distinct types of lens opacity in an eye was considered, the most common was mixed (age-adjusted prevalence, 11.5%, based on right eye data), followed by nuclear only (9.7%), cortical only (8.3%), and posterior subcapsular only (0.6%). For all cataract types, the prevalence was similar in men and women and was higher in persons examined at their homes than in those examined at the study clinic. CONCLUSIONS: These population-based data suggest that cataract is common among adult Chinese residents in Singapore, despite ready access to cataract surgical services. Persons accepting the offer of free eye examinations were less likely to have cataract than those who did not take up this offer.

Adult↗
PubMed2006

Alternative solutions to the current situation of oocyte donation in Singapore.

The rising incidence of age-related female infertility in Singapore, coupled with the prohibition on commercialized oocyte donation and egg sharing, has resulted in a severe shortage of donor oocytes. Infertile women are routinely encouraged by fertility doctors here to seek their close relatives and friends as prospective oocyte donors, which does not alleviate the shortage. A number of alternative solutions are discussed. The use of substantial financial remuneration to encourage oocyte donation is rejected as being legally, ethically and morally incompatible with present day Singaporean society. Egg sharing in return for subsidized fertility may have a strong case for ethical justification, but implementation would need amendment of the current legislation in Singapore. Cross- and mirror-exchange oocyte donations face less of a legal challenge in Singapore and also have a strong case for ethical justification. However, special consideration must be given to the unique socio-cultural values of Singaporean society, i.e. traditional Chinese culture. Finally, if no changes are made to restrictive regulations governing oocyte donation in Singapore, and shortage of donor oocytes still persists, then reproductive tourism abroad may be the solution for some patients; referrals by local fertility doctors are unlikely to be allowed in Singapore.

Humans↗
PubMed2003

Differences in body composition between Singapore Chinese, Beijing Chinese and Dutch children.

OBJECTIVES: To compare the relationship between body mass index (BMI) and body fat percentage (BF%) in children of different ethnic background. DESIGN: Cross-sectional observational study. SETTINGS: The study was performed in three different locations, Singapore, Beijing and Wageningen (The Netherlands). SUBJECTS: In each centre 25 boys and 25 girls, aged 7-12 y, were selected. They were matched on age, sex and body height. METHODS: Body weight and body height was measured following standardized procedures. The body mass index (BMI) was calculated as weight/height squared (kg/m(2)). Body fat was measured by densitometry in Beijing and Wageningen and by dual energy X-ray absorptiometry (DXA) in Singapore. The DXA measurements in Singapore were validated against densitometry. RESULTS: There were no significant differences in BF% or BMI within each gender group across the three study sites. However, after controlling for (non-significant) differences in age and BF%, the Singapore children had a lower (mean+/-s.e.) BMI (15.6+/-0.3) than the Beijing 17.6+/-0.3) and Wageningen (16.9+/-0.3) children. For the same BMI, age and sex the Singapore children had a significant higher BF% (24.6+/-0.7) than the Beijing (19.2+/-0.8) and Wageningen (20.3+/-0.7) children. CONCLUSIONS: The study strongly suggests that the relationship between BF% and BMI (or weight and height) is different among children of different ethnic background. Consequently growth charts and BMI cut-off points for underweight, overweight and obesity in children may have to be ethnic-specific.

Absorptiometry, Photon↗
PubMed1999

Geographical comparison of the prevalence of childhood asthma and allergies in Singapore.

A previous study suggested that differences in the prevalence of respiratory illnesses such as asthma in school children in different regions of Singapore were not due to the influence of air pollution or environmental factors but possibly to cultural and socio-economic factors. The effects of socio-economic or demographic variables were, however, not shown in that study. In this study, we set out to discover whether regional differences in the prevalence of atopic diseases such as asthma, rhinitis and eczema in Singapore school children could be explained by different demographic profiles. The prevalence of asthma and allergies were evaluated in 6238 Singapore school children in two age groups (6-7 years [n = 2030] and 12-15 years [n = 4208]). They were from four regions, based on residential post codes. Demographic and socio-economic data were also obtained. The questionnaire of the International Study on Asthma and Allergies in Childhood (ISAAC) was used. The data showed that children residing in the northern regions of Singapore had a significantly lower prevalence of asthma and rhinitis than those in other regions. When controlled for demographic influences (age, sex and race) and socio-economic factors (type of housing), however, the differences between these regions were reduced. No geographical difference in the prevalence of eczema was observed. Thus, geographical differences in the prevalence of asthma and rhinitis in Singapore could in part be explained by demographic and socio-economic differences in the population.

Adolescent↗