MyMedR

Prevalence and risk factors of retinal arteriolar emboli: the Singapore Malay Eye Study

Cheung N, Lim L, Wang JJ, Islam FM, Mitchell P, Saw SM, et al.

Am J Ophthalmol, 2008 Oct;146(4):620-4.

PMID: 18639861 DOI: 10.1016/j.ajo.2008.05.033

To examine the prevalence and risk factors of retinal arteriolar emboli, a risk predictor of stroke, in an Asian population.

Determinants of the optic cup to disc ratio in an Asian population: the Singapore Malay Eye Study (SiMES)

Amerasinghe N, Wong TY, Wong WL, Mitchell P, Shen SY, Loon SC, et al.

Arch. Ophthalmol., 2008 Aug;126(8):1101-8.

PMID: 18695105 DOI: 10.1001/archopht.126.8.1101

To describe the distribution and determinants of the optic cup to disc ratio (CDR) in Malay adults in Singapore.

Prevalence of Parkinson disease in Singapore: Chinese vs Malays vs Indians

Tan LC, Venketasubramanian N, Hong CY, Sahadevan S, Chin JJ, Krishnamoorthy ES, et al.

Neurology, 2004 Jun 08;62(11):1999-2004.

PMID: 15184604

OBJECTIVE: To investigate the prevalence of Parkinson disease (PD) in Singapore and compare the rates between Singaporean Chinese, Malays, and Indians.

METHODS: A three-phase community-based survey among a disproportionate random sample of 15,000 individuals (9,000 Chinese, 3,000 Malays, 3,000 Indians) aged 50 years and above who live in central Singapore was conducted. In phase 1, trained interviewers conducted a door-to-door survey using a validated 10-question questionnaire. In phase 2, medical specialists examined participants who screened positive to any of the questions. Participants suspected to have PD had their diagnosis confirmed in phase 3 by a movement disorders specialist.

RESULTS: The participation rate was 67% among 22,279 eligible individuals. Forty-six participants with PD were identified of which 16 were newly diagnosed cases. The prevalence rate of PD for those aged 50 and above in Singapore was 0.30% (95% CI: 0.22 to 0.41), age-adjusted to US 1970 census. The prevalence rates increased significantly with age. The age-adjusted prevalence rates among Chinese (0.33%, 95% CI: 0.22 to 0.48), Malays (0.29%, 95% CI: 0.13 to 0.67), and Indians (0.28%, 95% CI: 0.12 to 0.67) were the same (p = 1.0).

CONCLUSIONS: The prevalence of PD in Singapore was comparable to that of Western countries. Race-specific rates were also similar to previously reported rates and similar among the three races. Environmental factors may be more important than racially determined genetic factors in the development of PD.

Fulltext The Effects of Different Outdoor Environments, Sunglasses and Hats on Light Levels: Implications for Myopia Prevention

Lanca C, Teo A, Vivagandan A, Htoon HM, Najjar RP, Spiegel DP, et al.

Transl Vis Sci Technol, 2019 Jul;8(4):7.

PMID: 31360613 DOI: 10.1167/tvst.8.4.7

Purpose: Lack of outdoor time is a known risk factor for myopia. Knowledge of the light levels reaching the eye and exposure settings, including sun-protective measures, is essential for outdoor programs and myopia. We evaluated the impact of sun-protective strategies (hat and sunglasses) on maintaining high illuminance levels to prevent myopia.

Methods: A child-sized mannequin head was developed to measure light illuminance levels with and without sun-protective equipment, across a wide range of environments in Singapore, outdoors (open park, under a tree, street) and indoors (under a fluorescent illumination with window, under white LED-based lighting without window). A comparison was made between indoor and outdoor light levels that are experienced while children are involved in day-to-day activities.

Results: Outdoor light levels were much higher (11,080-18,176 lux) than indoors (112-156 lux). The higher lux levels protective of myopia (>1000 lux) were measured at the tree shade (5556-7876 lux) and with hat (4112-8156 lux). Sunglasses showed lux levels between 1792 and 6800 lux. Although with sunglasses readings were lower than tree shade and hat, light levels were still 11 to 43 times higher than indoors.

Conclusions: Recommendations on spending time outdoors for myopia prevention with adequate sun protection should be provided while partaking in outdoor activities, including protection under shaded areas, wearing a hat or sunglasses, sunscreen, and adequate hydration.

Translational Relevance: Light levels outdoors were higher than indoors and above the threshold illuminance for myopia prevention even with adequate sun-protective measures.

Maternal adiposity and blood pressure in pregnancy: varying relations by ethnicity and gestational diabetes

Lim WY, Kwek K, Chong YS, Lee YS, Yap F, Chan YH, et al.

J Hypertens, 2014 Apr;32(4):857-64.

PMID: 24390251 DOI: 10.1097/HJH.0000000000000096

OBJECTIVE: Greater maternal adiposity is a potentially modifiable risk factor for elevated blood pressure during pregnancy; however, the association has been little studied in Asian populations, and no study has evaluated potential differences in the adiposity-blood pressure relation between ethnic groups or interaction with gestational diabetes.

METHODS: We performed a cross-sectional evaluation of a Singapore mother-offspring cohort comprising 799 pregnant Chinese, Malay and Indian women. Data on body weight, height, skinfold thickness and glycaemia (oral glucose tolerance test) were collected during the 2nd trimester; peripheral SBP and DBP were measured using an oscillometric device and central pressures by noninvasive radial applanation tonometry. The associations between adiposity measures BMI and sum of skinfold thickness and blood pressure outcomes were examined by linear regression with adjustment for potential confounders.

RESULTS: Higher maternal BMI was associated with elevated peripheral and central pressures: the increases in pressure (mmHg) for each kg/m(2) increase in BMI were 1.19 (95% confidence interval, 1.03-1.36) for peripheral SBP, 0.76 (0.63-0.89) for peripheral DBP, 1.02 (0.87-1.17) for central systolic pressure and 0.26 (0.16-0.37) for central pulse pressure. The associations were generally stronger in Chinese women (P-interaction = 0.03 for central pulse pressure) and individuals with gestational diabetes (P-interaction = 0.03 for DBP and P-interaction = 0.046 for central systolic pressure). Similar patterns of results were found when using skinfold thickness as the measure of adiposity.

CONCLUSION: Maternal adiposity is associated with higher peripheral and central blood pressures during pregnancy. Stronger associations in Chinese women and individuals with gestational diabetes warrant further investigation.

Fulltext Development of the FitSight Fitness Tracker to Increase Time Outdoors to Prevent Myopia

Verkicharla PK, Ramamurthy D, Nguyen QD, Zhang X, Pu SH, Malhotra R, et al.

Transl Vis Sci Technol, 2017 Jun;6(3):20.

PMID: 28660095 DOI: 10.1167/tvst.6.3.20

PURPOSE: To develop a fitness tracker (FitSight) to encourage children to increase time spent outdoors. To evaluate the wear pattern for this tracker and outdoor time pattern by estimating light illumination levels among children.

METHODS: The development of the FitSight fitness tracker involved the designing of two components: (1) the smartwatch with custom-made FitSight watch application (app) to log the instant light illuminance levels the wearer is exposed to, and (2) a companion smartphone app that synchronizes the time outdoors recorded by the smartwatch to smartphone via Bluetooth communication. Smartwatch wear patterns and tracker-recorded daily light illuminance levels data were gathered over 7 days from 23 Singapore children (mean ± standard deviation age: 9.2 ± 1.4 years). Feedback about the tracker was obtained from 14 parents using a three-level rating scale: very poor/poor/good.

RESULTS: Of the 14 parents, 93% rated the complete "FitSight fitness tracker" as good and 64% rated its wearability as good. While 61% of 23 children wore the watch on all study days (i.e., 0 nonwear days), 26% had 1 nonwear day, and 4.5% children each had 3, 4, and 5 nonwear days, respectively. On average, children spent approximately 1 hour in light levels greater than 1000 lux on weekdays and 1.3 hours on weekends (60 ± 46 vs. 79 ± 53 minutes, P = 0.19). Mean number of outdoor "spurts" (light illuminance levels >1000 lux) per day was 8 ± 3 spurts with spurt duration of 34 ± 32 minutes.

CONCLUSION: The FitSight tracker with its novel features may motivate children to increase time outdoors and play an important role in supplementing community outdoor programs to prevent myopia.

TRANSLATIONAL RELEVANCE: If the developed noninvasive, wearable, smartwatch-based fitness tracker, FitSight, promotes daytime outdoor activity among children, it will be beneficial in addressing the epidemic of myopia.

Retinal vascular caliber, blood pressure, and cardiovascular risk factors in an Asian population: the Singapore Malay Eye Study

Sun C, Liew G, Wang JJ, Mitchell P, Saw SM, Aung T, et al.

Invest Ophthalmol Vis Sci, 2008 May;49(5):1784-90.

PMID: 18436813 DOI: 10.1167/iovs.07-1450

To describe the relationship of retinal vascular caliber with cardiovascular risk factors in an Asian population.

Ethnic differences in Singapore's dementia prevalence: the stroke, Parkinson's disease, epilepsy, and dementia in Singapore study

Sahadevan S, Saw SM, Gao W, Tan LC, Chin JJ, Hong CY, et al.

J Am Geriatr Soc, 2008 Nov;56(11):2061-8.

PMID: 19016940 DOI: 10.1111/j.1532-5415.2008.01992.x

To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians.

Prevalence of stroke among Chinese, Malay, and Indian Singaporeans: a community-based tri-racial cross-sectional survey

Venketasubramanian N, Tan LC, Sahadevan S, Chin JJ, Krishnamoorthy ES, Hong CY, et al.

Stroke, 2005 Mar;36(3):551-6.

PMID: 15692124

Stroke prevalence data among mixed Asian populations are lacking. Prevalence rates of stroke were studied among Singaporeans aged > or =50 years of Chinese, Malay, and Indian origin.

Impact of glaucoma severity and laterality on vision-specific functioning: the Singapore Malay eye study

Chan EW, Chiang PP, Wong TY, Saw SM, Loon SC, Aung T, et al.

Invest Ophthalmol Vis Sci, 2013 Feb;54(2):1169-75.

PMID: 23341009 DOI: 10.1167/iovs.12-10258

We determined the impact of glaucoma severity and laterality on vision-specific functioning (VF) in an Asian population.

The age of menopause and the menopause transition in a multiracial population: a nation-wide Singapore study

Loh FH, Khin LW, Saw SM, Lee JJ, Gu K

Maturitas, 2005 Nov-Dec;52(3-4):169-80.

PMID: 16257608

To describe the prevalence of menopausal symptoms, define the mean age of menopause, and determine contributory factors, which influence the experience of symptoms among Singaporean women of different racial groups.

Fulltext Risk factors for hip fracture in Asian men and women: the Asian osteoporosis study

Lau EM, Suriwongpaisal P, Lee JK, Das De S, Festin MR, Saw SM, et al.

J. Bone Miner. Res., 2001 Mar;16(3):572-80.

PMID: 11277276 DOI: 10.1359/jbmr.2001.16.3.572

The objectives of the Asian Osteoporosis Study (AOS) were to determine risk factors for hip fracture in men and women in four Asian countries, that is, Singapore, Malaysia, Thailand, and the Philippines. A total of 451 men and 725 women (aged 50 years and over) with hip fractures were compared with an equal number of community controls. A standardized questionnaire was administered by interview. The following relative risks (RRs) were found in women and men by multiple logistic regression: dietary calcium intake < 498 mg/day, 2.0 for women (95% CI, 1.5-2.8) and 1.5 for men (95% CI, 1.0-2.2); no load bearing activity in the immediate past, 2.0 for women (95% CI, 1.4-2.7) and 3.4 for men (95% CI, 2.3-5.1); no vigorous sport activities in young adulthood, 7.2 for women (95% CI, 4.0-13.0) and 2.4 for men (95% CI, 1.6-3.6); cigarette smoking, 1.5 for men (95% CI, 1.0-2.1); alcohol consumption 7 days a week, 2.9 for women (95% CI, 1.0-8.6) and 1.9 for men (95% CI, 1.1-3.2); fell twice or more in the last 12 months, 3.0 for women (95% CI, 1.8-4.8) and 3.4 for men (95% CI, 1.8-6.6); a history of fractures after 50 years of age, 1.8 for women (95% CI, 1.1-2.9) and 3.0 for men (95% CI, 1.6-5.6); a history of stroke, 3.8 for women (95% CI, 2.0-7.1) and 3.6 for men (95% CI, 1.8-7.1); use of sedatives, 2.5 for women (95% CI, 1.0-6.3) and 3.0 for men (95% CI, 1.0-9.7); and use of thyroid drugs, 7.1 for women (95% CI, 2.0-25.9) and 11.8 for men (95% CI, 1.3-106.0). Women who were 1.56 m or taller had an RR of 2.0 (95% CI, 1.3-3.0) for hip fracture and men who were 1.69 m or taller had an RR of 1.9 (95% CI, 1.2-3.1) for hip fracture. Based on these findings, primary preventive programs for hip fracture could be planned in Asia.

Hip fracture incidence rates in Singapore 1991-1998

Koh LK, Saw SM, Lee JJ, Leong KH, Lee J, National Working Committee on Osteoporosis

Osteoporos Int, 2001;12(4):311-8.

PMID: 11420781

In this population-based study, we determined the incidence rates of hip fracture among Singapore residents aged 50 years and above. Information was obtained from a centralized database system which captured admissions with the primary diagnosis of a closed hip fracture (ICD-9 codes 820, 820.0, 820.2 and 820.8, n = 12,927) from all health care establishments in the country from 1991 to 1998 inclusive. After removing duplicates, hospital transfers, readmissions and non-acute care admissions, the total number of hip fractures was 9406. Based on the national population census 1990 (n = 464,100) and yearly population estimates, the age-adjusted hip fracture rates for 1991-1998 (per 100,000) were 152 in men and 402 in women. This was 1.5 and over 5 times higher than corresponding rates in the 1960s. From 1991 to 1998, these hip fracture rates tended to increase by 0.7% annually in men and by 1.2% annually in women. Among the three major racial groups, in men, the Chinese had significantly higher age-adjusted hip fracture rates (per 100,000): 168 (95% confidence interval (CI) 158-178) compared with 128 (95% CI 105-152) for Indians and 71 (95% CI 54-88) for Malays. A similar pattern occurred in women: 410 (95% CI 395-425), for Chinese compared with 361 (95% CI 290-432) for Indians and 264 (95% CI 225-303) for Malays. Since the 1960s, the main increases in hip fracture rates have been seen in the Chinese and Malays, with the rates in Indians appearing to decrease. Hip fracture incidence rates in Singapore have risen rapidly over the past 30-40 years, particularly in women, and are now among the highest in Asia. Significant racial differences in hip fracture rates occur within the same community. Time trends in hip fracture rates differed between races.

Does education explain ethnic differences in myopia prevalence? A population-based study of young adult males in Singapore

Wu HM, Seet B, Yap EP, Saw SM, Lim TH, Chia KS

Optom Vis Sci, 2001 Apr;78(4):234-9.

PMID: 11349931

PURPOSE: To study interethnic variation in myopia prevalence and severity in young adult males in Singapore and to determine whether these variations are related to differences in education level.

METHODS: A population-based survey of refractive errors in a cohort of 15,095 military conscripts between July 1996 and June 1997 using noncycloplegic autorefraction and a standard questionnaire. Prevalence rates of myopia (

The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS)

Lau EM, Lee JK, Suriwongpaisal P, Saw SM, Das De S, Khir A, et al.

Osteoporos Int, 2001;12(3):239-43.

PMID: 11315243 DOI: 10.1007/s001980170135

The Asian Osteoporosis Study (AOS) is the first multicenter study to document and compare the incidence of hip fracture in four Asian countries. Hosital discharge data for the year 1997 were obtained for the Hong Kong SAR, Singapore, Malaysia and Thailand (Chiang Mai). The number of patients who were 50 years of age and older and who were discharged with a diagnosis of hip fracture (ICD9 820) was enumerated. The age-specific incidence rates were deduced and were directly adjusted to the US white population in 1989. The age-adjusted rates for men and women (per 100,000) are as follows: Hong Kong, 180 and 459; Singapore, 164 and 442; Malaysia, 88 and 218; Thailand, 114 and 289; compared with US White rates of 187 in men and 535 in women, published in 1989. We conclude that there is moderate variation in the incidence of hip fracture among Asian countries. The rates were highest in urbanized countries. With rapid economic development in Asia, hip fracture will prove to be a major public health challenge.

Association of raised liver transaminases with physical inactivity, increased waist-hip ratio, and other metabolic morbidities in severely obese children

Lee YS, Kek BL, Poh LK, Saw SM, Loke KY

J Pediatr Gastroenterol Nutr, 2008 Aug;47(2):172-8.

PMID: 18664869 DOI: 10.1097/MPG.0b013e318162a0e5

To identify factors associated with raised alanine transaminase, aspartate transaminase, and gamma-glutaryl transferase in severely obese children

Prevalence and risk factors of ocular trauma in an urban south-east Asian population: the Singapore Malay Eye Study

Loon SC, Tay WT, Saw SM, Wang JJ, Wong TY

Clin Exp Ophthalmol, 2009 May;37(4):362-7.

PMID: 19594562 DOI: 10.1111/j.1442-9071.2009.02035.x

To describe the prevalence and risk factors of ocular trauma in an urban Asian population.

Ethnicity-specific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore

Saw SM, Goh PP, Cheng A, Shankar A, Tan DT, Ellwein LB