Displaying publications 1 - 20 of 411 in total

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  1. Bartlett AW, Truong KH, Songtaweesin WN, Chokephaibulkit K, Hansudewechakul R, Ly PS, et al.
    AIDS, 2018 07 31;32(12):1689-1697.
    PMID: 29794827 DOI: 10.1097/QAD.0000000000001883
    OBJECTIVES: The aim of this study was to describe characteristics of perinatally HIV-infected adolescents (PHIVAs), factors associated with mortality, and outcomes at transition.

    DESIGN: Ongoing observational database collating clinical data on HIV-infected children and adolescents in Asia.

    METHODS: Data from 2001 to 2016 relating to adolescents (10-19 years) with perinatal HIV infection were analysed to describe characteristics at adolescent entry and transition and combination antiretroviral therapy (cART) regimens across adolescence. A competing risk regression analysis was used to determine characteristics at adolescent entry associated with mortality. Outcomes at transition were compared on the basis of age at cART initiation.

    RESULTS: Of 3448 PHIVA, 644 had reached transition. Median age at HIV diagnosis was 5.5 years, cART initiation 7.2 years and transition 17.9 years. At adolescent entry, 35.0% had CD4+ cell count less than 500 cells/μl and 51.1% had experienced a WHO stage III/IV clinical event. At transition, 38.9% had CD4+ cell count less than 500 copies/ml, and 53.4% had experienced a WHO stage III/IV clinical event. Mortality rate was 0.71 per 100 person-years, with HIV RNA ≥1000 copies/ml, CD4+ cell count less than 500 cells/μl, height-for-age or weight-for-age z-score less than -2, history of a WHO stage III/IV clinical event or hospitalization and at least second cART associated with mortality. For transitioning PHIVA, those who commenced cART age less than 5 years had better virologic and immunologic outcomes, though were more likely to be on at least second cART.

    CONCLUSION: Delayed HIV diagnosis and cART initiation resulted in considerable morbidity and poor immune status by adolescent entry. Durable first-line cART regimens to optimize disease control are key to minimizing mortality. Early cART initiation provides the best virologic and immunologic outcomes at transition.

    Matched MeSH terms: Longitudinal Studies
  2. Ong NH, Chua CL, Liew JWK, Wan Sulaiman WY, Chan YF, Sam IC, et al.
    Acta Trop, 2020 Aug;208:105472.
    PMID: 32389451 DOI: 10.1016/j.actatropica.2020.105472
    Zika virus (ZIKV) is a mosquito-borne flavivirus with global impact since 2015. Although ZIKV was first isolated from Aedes aegypti in Malaysia in 1965, not much is known about the competency of Malaysian Ae. aegypti to ZIKV. To date only 9 cases of ZIKV have been reported in Malaysia despite the abundance of mosquito vectors. This study aimed to determine the susceptibility of Ae. aegypti to ZIKV, and the impact of sequential infections in Ae. aegypti mosquitoes with DENV serotype 2 (DENV-2) followed by ZIKV. Field-caught urban Ae. aegypti were orally challenged with a Martinique strain of ZIKV, and midgut, head/thorax and saliva were collected at 3, 7 and 14 days post-infection (dpi). At 14 dpi, ZIKV-exposed mosquitoes had infection and dissemination rates of 59% (n=10/17) and 90% (n=9/10), respectively. Average titres of 3.9 and 4.4 log pfu infectious ZIKV were recovered in midgut and head/thorax, respectively. In sequential infection, prior exposure of Ae. aegypti to DENV did not affect the subsequent ZIKV infection in head/thorax albeit with a low sample size. In conclusion, Malaysian urban Ae. aegypti is susceptible to the contemporary Asian lineage of ZIKV. The established and continuous DENV circulation in Ae. aegypti did not suppress ZIKV emergence in Malaysia. Other factors contributing to low level of ZIKV circulation in Malaysia remain to be explored.
    Matched MeSH terms: Longitudinal Studies
  3. Schram A, Aisbett E, Townsend B, Labonté R, Baum F, Friel S
    Addiction, 2020 07;115(7):1277-1284.
    PMID: 31808205 DOI: 10.1111/add.14925
    BACKGROUND AND AIMS: Trade liberalization is hypothesized to increase the availability of imported alcoholic beverages in importing countries. This study provides the first longitudinal analysis of the impact of preferential trade agreements (PTAs) on alcohol imports.

    DESIGN: Panel data comprising alcohol-product (n = 15) by importing country (n = 16) observations from 1988 to 2016 constructed from global databases. The relationship between PTA status, tariff level and alcohol imports were assessed using a log-linear model. Unobserved heterogeneity was addressed through a combination of differencing and product-year fixed-effects.

    SETTING: Australia and its 16 free trade partners (PTA year in parentheses), classified by low [ 50%: Chile (2009), China (2015), Japan (2015), Korea (2014), Laos (2010), New Zealand (1983, 2010), Philippines (2010), Singapore (2003, 2010) and United States (2005)] percentage of alcohol consumers in the population.

    MEASUREMENTS: Independent variables were the existence of a PTA with Australia and tariff (border tax) rate on Australian products. Outcomes were (log) Australian imports; and a binary indicator of any imports from Australia.

    FINDINGS: Introducing a PTA has been associated with a statistically significant increase in the share of Australian alcoholic beverage imports in its partner country's total alcoholic beverage import supply, mainly from trade in new alcoholic beverage categories (0.067, P 

    Matched MeSH terms: Longitudinal Studies
  4. Ling W, Liew G, Li Y, Hao Y, Pan H, Wang H, et al.
    Adv Mater, 2018 Jun;30(23):e1800917.
    PMID: 29633379 DOI: 10.1002/adma.201800917
    The combination of novel materials with flexible electronic technology may yield new concepts of flexible electronic devices that effectively detect various biological chemicals to facilitate understanding of biological processes and conduct health monitoring. This paper demonstrates single- or multichannel implantable flexible sensors that are surface modified with conductive metal-organic frameworks (MOFs) such as copper-MOF and cobalt-MOF with large surface area, high porosity, and tunable catalysis capability. The sensors can monitor important nutriments such as ascorbicacid, glycine, l-tryptophan (l-Trp), and glucose with detection resolutions of 14.97, 0.71, 4.14, and 54.60 × 10-6 m, respectively. In addition, they offer sensing capability even under extreme deformation and complex surrounding environment with continuous monitoring capability for 20 d due to minimized use of biological active chemicals. Experiments using live cells and animals indicate that the MOF-modified sensors are biologically safe to cells, and can detect l-Trp in blood and interstitial fluid. This work represents the first effort in integrating MOFs with flexible sensors to achieve highly specific and sensitive implantable electrochemical detection and may inspire appearance of more flexible electronic devices with enhanced capability in sensing, energy storage, and catalysis using various properties of MOFs.
    Matched MeSH terms: Longitudinal Studies
  5. Raman S, Kishen D, Hamidah K, Ang ES
    Adv Contracept, 1992 Jun;8(2):129-40.
    PMID: 1519495 DOI: 10.1007/BF01849750
    There have been changes in the national policy regarding population growth in Malaysia from 1982. This report studies the changes in contraceptive practice among the three racial groups in this country, i.e. Malays, Chinese and Indians, over a 5-year period with an interval of 10 years. This is a retrospective study based on the attendance at the same family planning clinic in an urban setting. The striking change noted is the change in the racial composition of contraceptive usage in the two study periods with a shift from the Chinese being predominant in 1975-1979 to Malays in 1985-1989. There was no change among the numbers of Indians using contraception. The results also reveal a significant trend of change for users of the pill and those undergoing sterilization. There were no significant changes in IUD, condom and injectable usage. The study demonstrates how national policies, level of education and rural urban migration can significantly alter contraceptive practice.
    Matched MeSH terms: Longitudinal Studies
  6. Thiruchelvam K, Byles J, Hasan SS, Egan N, Cavenagh D, Kairuz T
    Aging Clin Exp Res, 2021 Jul;33(7):1919-1928.
    PMID: 32909246 DOI: 10.1007/s40520-020-01693-y
    BACKGROUND: Older people use many medications, but combinations of medications used among the oldest old (≥ 80 years) are not commonly reported.

    AIMS: This study aimed to determine common combinations of medications used among women aged 77-96 years and to describe characteristics associated with these combinations.

    METHODS: A cohort study of older women enroled in the Australian Longitudinal Study on Women's Health over a 15-year period was used to determine combinations of medications using latent class analysis. Multinomial logistic regression was used to determine characteristics associated with these combinations.

    RESULTS: The highest medication users during the study were for the cardiovascular (2003: 80.28%; 2017: 85.63%) and nervous (2003: 66.03%; 2017: 75.41%) systems. A 3-class latent model described medication use combinations: class 1: 'Cardiovascular & neurology anatomical group' (27.25%) included participants using medications of the cardiovascular and nervous systems in their later years; class 2: 'Multiple anatomical group' (16.49%) and class 3: 'Antiinfectives & multiple anatomical group' (56.27%). When compared to the reference class (class 1), the risk of participants being in class 3 was slightly higher than being in class 2 if they had > 4 general practitioner visits (RRR 2.37; 95% CI 2.08, 2.71), Department of Veterans Affairs' coverage (RRR 1.59; 95% CI 1.36, 1.86), ≥ 4 chronic diseases (RRR 3.16; 95% CI 2.56, 3.90) and were frail (RRR 1.47; 95% CI 1.27, 1.69).

    CONCLUSION: Identification of combinations of medication use may provide opportunities to develop multimorbidity guidelines and target medication reviews, and may help reduce medication load for older individuals.

    Matched MeSH terms: Longitudinal Studies
  7. Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T
    Aging Clin Exp Res, 2021 Sep;33(9):2499-2509.
    PMID: 33449339 DOI: 10.1007/s40520-020-01772-0
    BACKGROUND: Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women.

    AIMS: This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.

    METHODS: This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.

    RESULTS: Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03).

    CONCLUSION: Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.

    Matched MeSH terms: Longitudinal Studies
  8. Lua PL, Talib NS
    Altern Ther Health Med, 2013;19(4):28-42.
    PMID: 23981370
    Substance abuse has been prevalent in Malaysia for many years and currently represents one of the main concerns to its society. The limitations of conventional therapies have resulted in efforts to explore the potentia of complementary therapies in the management of drug addiction. The evidence for auricular acupuncture (AA) as a potential complementary therapy for drug addiction is still limited and inconclusive.
    Matched MeSH terms: Longitudinal Studies
  9. Mahalingam G, Samtani S, Lam BCP, Lipnicki DM, Lima-Costa MF, Blay SL, et al.
    Alzheimers Dement, 2023 Nov;19(11):5114-5128.
    PMID: 37102417 DOI: 10.1002/alz.13072
    INTRODUCTION: Previous meta-analyses have linked social connections and mild cognitive impairment, dementia, and mortality. However, these used aggregate data from North America and Europe and examined a limited number of social connection markers.

    METHODS: We used individual participant data (N = 39271, Mage  = 70.67 (40-102), 58.86% female, Meducation  = 8.43 years, Mfollow-up  = 3.22 years) from 13 longitudinal ageing studies. A two-stage meta-analysis of Cox regression models examined the association between social connection markers with our primary outcomes.

    RESULTS: We found associations between good social connections structure and quality and lower risk of incident mild cognitive impairment (MCI); between social structure and function and lower risk of incident dementia and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.

    DISCUSSION: Different aspects of social connections - structure, function, and quality - are associated with benefits for healthy aging internationally.

    HIGHLIGHTS: Social connection structure (being married/in a relationship, weekly community group engagement, weekly family/friend interactions) and quality (never lonely) were associated with lower risk of incident MCI. Social connection structure (monthly/weekly friend/family interactions) and function (having a confidante) were associated with lower risk of incident dementia. Social connection structure (living with others, yearly/monthly/weekly community group engagement) and function (having a confidante) were associated with lower risk of mortality. Evidence from 13 longitudinal cohort studies of ageing indicates that social connections are important targets for reducing risk of incident MCI, incident dementia, and mortality. Only in Asian cohorts, being married/in a relationship was associated with reduced risk of dementia, and having a confidante was associated with reduced risk of dementia and mortality.

    Matched MeSH terms: Longitudinal Studies
  10. Sakai S, Momose K, Yumoto T, Kato M, Inoue T
    Am J Bot, 1999 Jan;86(1):62-9.
    PMID: 21680346
    Pollination ecology of an emergent tree species, Shorea (section Mutica) parvifolia (Dipterocarpaceae), was studied using the canopy observation system in a lowland dipterocarp forest in Sarawak, Malaysia, during a general flowering period in 1996. Although the species has been reported to be pollinated by thrips in Peninsular Malaysia, our observations of flower visitors and pollination experiments indicated that beetles (Chrysomelidae and Curculionidae, Coleoptera) contributed to pollination of S. parvifolia in Sarawak. Beetles accounted for 74% of the flower visitors collected by net-sweeping, and 30% of the beetles carried pollen, while thrips accounted for 16% of the visitors, and 12% of the thrips carried pollen. The apical parts of the petals and pollen served as a reward for the beetles. Thrips stayed inside the flower almost continuously after arrival, and movements among flowers were rare. Fruit set was significantly increased by introduction of beetles to bagged flowers, but not by introduction of thrips. Hand-pollination experiments and comparison of fruit set in untreated, bagged, and open flowers suggested that S. parvifolia was mainly outbreeding.
    Matched MeSH terms: Longitudinal Studies
  11. Momose K, Yumoto T, Nagamitsu T, Kato M, Nagamasu H, Sakai S, et al.
    Am J Bot, 1998 Oct;85(10):1477-501.
    PMID: 21684899
    Flowerings and flower visitors were observed continuously in alowland dipterocarp forest in Sarawak, Malaysia, for 53 mo in1992-1996. Flower visitors of 270 plant species were observed orcollected, and pollinators were assessed by observing body contact tostigmas and anthers. We recognized 12 categories of pollination systems.Among them, plants pollinated by social bees included the largest numberof species (32%) and were followed by beetle-pollinated species(20%). Pollination systems were significantly related with somefloral characters (flowering time of day, reward, and floral shape), butnot with floral color. Based on the relationships between pollinatorsand floral characters, we described pollination syndromes found in alowland dipterocarp forest. The dominance of social bees and beetlesamong pollinators is discussed in relation to the general floweringobserved in dipterocarp forests of West Malesia. In spite of high plantspecies diversity and consequent low population densities of lowlanddipterocarp forests, long-distance-specific pollinators were uncommoncompared with theNeotropics.
    Matched MeSH terms: Longitudinal Studies
  12. Nepomnaschy PA, Welch K, McConnell D, Strassmann BI, England BG
    Am J Hum Biol, 2004 Sep-Oct;16(5):523-32.
    PMID: 15368600 DOI: 10.1002/ajhb.20057
    We report here on a longitudinal study of stress and women's reproduction in a small Kaqchikel Mayan community in rural Guatemala. Current understanding of the effects of stress on the reproductive axis in women is mostly derived from clinical studies of individual stressors. Little is known, however, about the cumulative effects of "real life" stress. Cortisol increases in response to a broad variety of individual stressors (Tilbrook et al., 2002). In this article, we evaluate the association between daily fluctuations in women's urinary cortisol and reproductive hormones: estrone conjugates (E(1)C), pregnandiol glucuronide (PdG), luteinizing hormone (LH), and follicle stimulating hormone (FSH). To assess the association between daily changes in cortisol levels and changes in the profiles of the reproductive hormones, we used a random coefficients model based on polynomial regression. The sample includes 92 menstrual cycles provided by 24 participants over a year-long prospective study. Increases in urinary cortisol levels were associated with significant increases in gonadotrophin and progestin levels during the follicular phase. Also, in a time window between days 4 and 10 after ovulation, increased cortisol levels were associated with significantly lower progestin levels. These results are significant because untimely increases in gonadotrophins and low midluteal progesterone levels have previously been reported to impinge on the ovulatory and luteinization processes and to reduce the chances of successful implantation (Ferin, 1999; Baird et al., 1999). Future research should consider the possibility that stress may affect fecundability and implantation without necessarily causing amenorrhoea or oligomenorrhoea.
    Matched MeSH terms: Longitudinal Studies
  13. Kanamori T, Kuze N, Bernard H, Malim TP, Kohshima S
    Am J Primatol, 2010 Sep;72(9):820-40.
    PMID: 20653008 DOI: 10.1002/ajp.20848
    We observed the diet and activity of Bornean orangutans (Pongo pygmaeus morio) in the primary lowland dipterocarp forests of Danum Valley, Sabah, Malaysia, during 2005-2007, including two mast fruitings. We collected 1,785 hr of focal data on 26 orangutans. We identified 1,466 samples of their food plants and conducted a fallen fruit census to monitor fruit availability in the study area. Their activity budget was 47.2% feeding, 34.4% resting, and 16.9% traveling. Fruits accounted for the largest part (60.9%) of feeding time, especially during mast fruiting periods (64.0-100%), although the percentages of leaves (22.2%) and bark (12.3%) were higher than those reported for P. abelii and P. pygmaeus wurmbii. Although 119 genera and 160 plant species were consumed by focal animals, only 9 genera accounted for more than 3% of feeding time (total: 67.8% for 9 genera). In particular, the focal orangutans fed intensively on Ficus and Spatholobus during most of the study period, especially in periods of fruit shortage. The percentage of fruit feeding changed markedly from 11.7 to 100% across different months of the year, and was positively correlated with the amount of fallen fruit. When fruit feeding and availability decreased, orangutans fed primarily on leaves of Spatholobus and Ficus, and the bark of Spatholobus and dipterocarp. The percentage of time devoted to feeding during mast fruitings, when the orangutans foraged almost exclusively on fruits, was lower than during seasons when the orangutan diet included leaves and bark as well as fruits. Resting increased as feeding decreased in the late stage of each fruiting season, suggesting that the orangutans adopted an energy-minimizing strategy to survive the periods of fruit shortage by using energy stored during the fruit season.
    Matched MeSH terms: Longitudinal Studies
  14. Ng SM, Narayanaswamy R
    Anal Chim Acta, 2011 Oct 10;703(2):226-33.
    PMID: 21889638 DOI: 10.1016/j.aca.2011.07.032
    Despite the increasing number of usage of molecularly imprinted polymers (MIPs) in optical sensor application, the correlation between the analytical signals and the binding isotherms has yet to be fully understood. This work investigates the relationship between the signals generated from MIPs sensors to its respective binding affinity variables generated using binding isotherm models. Two different systems based on the imprinting of metal ion and organic compound have been selected for the study, which employed reflectance and fluorescence sensing schemes, respectively. Batch binding analysis using the standard binding isotherm models was employed to evaluate the affinity of the binding sites. Evaluation using the discrete bi-Langmuir isotherm model found both the MIPs studied have generally two classes of binding sites that was of low and high affinities, while the continuous Freundlich isotherm model has successfully generated a distribution of affinities within the investigated analytical window. When the MIPs were incorporated as sensing receptors, the changes in the analytical signal due to different analyte concentrations were found to have direct correlation with the binding isotherm variables. Further data analyses based on this observation have generated robust models representing the analytical performance of the optical sensors. The best constructed model describing the sensing trend for each of the sensor has been tested and demonstrated to give accurate prediction of concentration for a series of spiked analytes.
    Matched MeSH terms: Longitudinal Studies
  15. Ma CH, Huang PY, Chang YC, Pan YJ, Azra MN, Chen LL, et al.
    Animals (Basel), 2021 Feb 02;11(2).
    PMID: 33540637 DOI: 10.3390/ani11020370
    Cannibalism is a major problem in lobster and crab aquaculture. Reducing the aggressive characteristics of lobsters and crabs can improve survival during the culturing process. In this study, juvenile scalloped spiny lobsters (Panulirus homarus) and crucifix crabs (Charybdis feriatus) were both cultured under different shelter and live prey conditions. Groups with shelter (seaweed and cotton filter) showed a better survival rate than the control group (no shelter; p < 0.05) for both Pa. homarus and Char. feriatus. Co-culturing with live prey (Litopenaeus vannamei) significantly benefited the juveniles of Pa. homarus and visibly increased the survival of juvenile Char. feriatus. Although providing shelter is currently the main method for reducing agonistic behavior, it must be continually altered as the lobsters and crabs grow. Live prey can grow and attract lobsters and crabs to hunt them, and live prey can be supplemented at any time. They can also be used as an additional source of income during the harvest season.
    Matched MeSH terms: Longitudinal Studies
  16. Ten DCY, Jani R, Hashim NH, Saaban S, Abu Hashim AK, Abdullah MT
    Animals (Basel), 2021 Apr 06;11(4).
    PMID: 33917373 DOI: 10.3390/ani11041032
    The critically endangered Malayan tiger (Panthera tigris jacksoni), with an estimated population of less than 200 individuals left in isolated rainforest habitats in Malaysia, is in an intermediate population crash leading to extinction in the next decade. The population has decreased significantly by illegal poaching, environmental perturbation, roadkill, and being captured during human-wildlife conflicts. Forty-five or more individuals were extracted from the wild (four animals captured due to conflict, one death due to canine distemper, one roadkilled, and 39 poached) in the 12 years between 2008-2019. The Malayan tigers are the first wildlife species to test positive for COVID-19 and are subject to the Canine Distemper Virus. These anthropogenic disturbances (poaching and human-tiger conflict) and environmental perturbation (decreasing habitat coverage and quality) have long been identified as impending extinction factors. Roadkill and infectious diseases have emerged recently as new confounding factors threatening Malayan tiger extinction in the near future. Peninsular Malaysia has an existing Malayan tiger conservation management plan; however, to enhance the protection and conservation of Malayan tigers from potential extinction, the authority should reassess the existing legislation, regulation, and management plan and realign them to prevent further population decline, and to better enable preparedness and readiness for the ongoing pandemic and future threats.
    Matched MeSH terms: Longitudinal Studies
  17. Idris IB, Barlow J, Dolan A
    Ann Glob Health, 2019 03 07;85(1).
    PMID: 30873768 DOI: 10.5334/aogh.2336
    BACKGROUND: Emotional and behavioral problems (EBD) or mental health problems in children and adolescents are an important public health issue, but there has been no evaluation to date of the extent of such problems in near-developed countries. This study evaluated the prevalence and stability of EBD among children in Malaysia.

    METHODS: This research comprises a longitudinal population-based study that measured the prevalence and 6-month stability of EBD in children aged seven to eight years and thirteen to fourteen years attending public schools in Malaysia based on parents, teachers and children's (aged 13 to 14 years) report of the Strengths and Difficulties Questionnaire (SDQ) at baseline and 6 months later.

    FINDINGS: The prevalence of EBD in Malaysian school children was 9.3% for teacher-report, 8.5% for parent-report and 3.9% for child-report. There was no significance difference in the prevalence of emotional and behavioral problems over six-months for all informants, except for teacher-report Emotional and Conduct problems scores which increased significantly and child-report Total Difficulties and Emotional problems scores which decreased significantly (p < 0.05).

    CONCLUSIONS: This study shows that the prevalence of EBD among Malaysian children is almost similar to the Western countries and stable over a 6-month period. These findings suggest the need for policy makers in near-developed countries to provide services aimed at preventing EBD and treating children identified as having such problems.

    Matched MeSH terms: Longitudinal Studies
  18. Soh SE, Chong YS, Kwek K, Saw SM, Meaney MJ, Gluckman PD, et al.
    Ann Nutr Metab, 2014;64(3-4):218-25.
    PMID: 25300263 DOI: 10.1159/000365023
    BACKGROUND: The dramatic emergence of noncommunicable diseases (NCD) in Asia, albeit with ethnic variation, has coincided with the rapid socioeconomic and nutritional transition taking place in the region, with the prevalence of diabetes rising 5-fold in Singapore in less than 4 decades. The Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study recruited 1,247 expectant mothers of Chinese, Malay, or Indian ethnicity in their first trimester, with detailed longitudinal tracking--through the antenatal period, birth, and the child's first 4 years of life--to examine the potential roles of fetal, developmental, and epigenetic factors in early pathways to metabolic and neurodevelopmental outcomes.

    KEY MESSAGES: A number of findings with a translational and clinical focus have already emerged. In the mothers, we found that changes and differences in food consumption varied across ethnic groups, with persistence of traditional beliefs, during pregnancy and the postpartum period. During pregnancy, higher maternal glucose levels, even in the absence of gestational diabetes mellitus, had graded relations with infant adiposity. Relations between maternal emotional health and birth outcomes and neurodevelopment have been identified. Genotype (25%) and in particular gene × environment interactions (75%) shape interindividual variations in the DNA methylome at birth. The complex effects of fixed genetic variations and different in utero environments can influence the epigenetic status at birth and the later-life phenotype.

    CONCLUSIONS: The richness of the clinical data in 3 ethnicities, the extent of the biospecimen collection, and the extensive infancy and preschool follow-up have allowed us to study the biological pathways that link fetal development to health outcomes. In the coming years, more sophisticated analyses of epigenotype-phenotype relationships will become possible as the children grow and develop. Our studies will lead to the development of clinical and population-based interventions to reduce the burden of NCD.

    Matched MeSH terms: Longitudinal Studies
  19. Heng DM, Lee J, Chew SK, Tan BY, Hughes K, Chia KS
    Ann Acad Med Singap, 2000 Mar;29(2):231-6.
    PMID: 10895345
    INTRODUCTION: This is the first prospective cohort study in Singapore to describe the incidence of ischaemic heart disease (IHD) and stroke among Chinese, Malays and Asian Indians.

    MATERIALS AND METHODS: The Singapore Cardiovascular Cohort Study is a longitudinal follow-up study on a general population cohort of 5920 persons drawn from 3 previous cross-sectional surveys. Morbidity and mortality from IHD and stroke were ascertained by record linkage using a unique identification number with the death registry, Singapore Myocardial Infarct Registry and in-patient discharge databases.

    RESULTS: There were 193 first IHD events and 97 first strokes during 52,806 person-years of observation. The overall incidence of IHD was 3.8/1000 person-years and that of stroke was 1.8/1000 person-years. In both males and females, Indians had the highest IHD incidence, followed by Malays and then Chinese. For males after adjusting for age, Indians were 2.78 times (95% CI 1.86, 4.17; P < 0.0001) and 2.28 times (95% CI 1.34, 3.88; P = 0.002) more likely to get IHD than Chinese and Malays respectively. For females after adjusting for age, Indians were 1.97 times (95% CI 1.07, 3.63; P = 0.03) and 1.37 times (95% CI 0.67, 2.80; P = 0.39) more likely to get IHD than Chinese and Malays respectively. For stroke, male Chinese and Indians had higher incidence than Malays (though not statistically significant). However, in females, Malays had the highest incidence of stroke, being 2.57 times (95% CI 1.31, 5.05; P = 0.008) more likely to get stroke than Chinese after adjustment for age.

    CONCLUSIONS: This prospective study of both mortality and morbidity has confirmed the higher risk of IHD in Indians. It has also found that Malay females have a higher incidence of stroke, which deserves further study because of its potential public health importance.

    Matched MeSH terms: Longitudinal Studies
  20. Liu S, Liu JJ, Gurung RL, Chan C, Yeo D, Ang K, et al.
    Ann Acad Med Singap, 2019 Jul;48(7):217-223.
    PMID: 31495867
    INTRODUCTION: The risk for diabetes progression varies greatly in individuals with type 2 diabetes mellitus (T2DM). We aimed to study the clinical determinants of diabetes progression in multiethnic Asians with T2DM.

    MATERIALS AND METHODS: A total of 2057 outpatients with T2DM from a secondary-level Singapore hospital were recruited for the study. Diabetes progression was defined as transition from non-insulin use to requiring sustained insulin treatment or glycated haemoglobin (HbA1c) ≥8.5% when treated with 2 or more oral hypoglycaemic medications. Multivariable logistic regression (LR) was used to study the clinical and biochemical variables that were independently associated with diabetes progression. Forward LR was then used to select variables for a parsimonious model.

    RESULTS: A total of 940 participants with no insulin use or indication for insulin treatment were analysed. In 3.2 ± 0.4 (mean ± SD) years' follow-up, 163 (17%) participants experienced diabetes progression. Multivariable LR revealed that age at T2DM diagnosis (odds ratio [95% confidence interval], 0.96 [0.94-0.98]), Malay ethnicity (1.94 [1.19-3.19]), baseline HbA1c (2.22 [1.80-2.72]), body mass index (0.96 [0.92-1.00]) and number of oral glucose-lowering medications (1.87 [1.39-2.51]) were independently associated with diabetes progression. Area under receiver operating characteristic curve of the parsimonious model selected by forward LR (age at T2DM diagnosis, Malay ethnicity, HbA1c and number of glucose-lowering medication) was 0.76 (95% CI, 0.72-0.80).

    CONCLUSION: Young age at T2DM diagnosis, high baseline HbA1c and Malay ethnicity are independent determinants of diabetes progression in Asians with T2DM. Further mechanistic studies are needed to elucidate the pathophysiology underpinning progressive loss of glycaemic control in patients with T2DM.
    Matched MeSH terms: Longitudinal Studies
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