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Fulltext Family influence on current smoking habits among secondary school children in Kota Bharu, Kelantan

Shamsuddin K, Haris MA

Singapore Med J, 2000 Apr;41(4):167-71.
PMID: 11063181

Objectives: To measure the prevalence of cigarette smoking among male secondary school children and assess their family influence especially that of their fathers' smoking habits on their current smoking habits.
Methodology: A cross-sectional study was carried out in Kota Bharu, Kelantan in April 1997 where 460 male form four students, aged 15-16 years were randomly selected from six secondary schools. Data on smoking habits, sociodemographic profile and family characteristics particularly parents and siblings' smoking habits, perceived parental supervision and communication were collected through self-administered questionnaires.
Results: The prevalence of cigarette smoking among male secondary school children was 33.2%. Crude analysis shows family factors, fathers' and siblings' smoking habits, and lack of parental supervision were significantly associated with the students' current smoking habit. Among students who smoked compared to non-smokers, father's smoking habit gives a crude Odds Ratio = 1.8, 95% C.I. 1.08 - 3.16. Further analysis shows that the effect of their father's smoking habit on the student's current smoking habit is still significant after controlling for other familial and non-familial factors including parental supervision, academic performance, reported influence of cigarette advertisement, having friends who smoked and the student's poor knowledge of the ill-effects of smoking and other factors (Odds Ratio = 1.9, 95% C.I 1.05 - 3.32). In conclusion, family factors especially the father's smoking habit is an important factor that influences a student's current smoking habit and the presence of negative role models within the home need to be seriously considered in any cigarette smoking prevention programs among secondary school adolescents.
Keywords: smoking, male students, adolescents, family influence, father’s smoking habit

Matched MeSH terms: Singapore/epidemiology
Fulltext Endemic typhus in Singapore--a re-emerging infectious disease?

Ong AK, Tambyah PA, Ooi S, Kumarasinghe G, Chow C

Singapore Med J, 2001 Dec;42(12):549-52.
PMID: 11989574

Singapore is a modern urban city and endemic typhus is thought to be a disease of the past. This may be due to lack of specific serological testing as indirect immunoperoxidase testing using specific rickettsial antigens (U.S. Army Medical Research Unit, Institute of Medical Research, Kuala Lumpur, Malaysia) has only recently become available. In the last fourteen months, twenty-one cases of endemic typhus were diagnosed in patients hospitalised for acute febrile illnesses at the National University Hospital. We conducted a case control study to define the clinical and laboratory features of endemic typhus in Singapore.

Matched MeSH terms: Singapore/epidemiology
Fulltext The Nipah virus outbreak--a reminder

Tambyah PA

Singapore Med J, 1999 May;40(5):329-30.
PMID: 10489488
Matched MeSH terms: Singapore/epidemiology
Fulltext Cystic fibrosis in Malay children--a report of three cases

Norzila MZ, Azizi BH

Singapore Med J, 1996 Jun;37(3):273-4.
PMID: 8942227

Cystic fibrosis (CF) is a rare disease among Asians. Three Malay children with CF presenting with recurrent pulmonary symptoms, malabsorption and failure to thrive are reported. Problems in their management include availability of pancreatic enzymes, compliance to medications and climate factors.

Matched MeSH terms: Singapore/epidemiology
Fulltext Breast cancer--a comparative study between Malaysian and Singaporean women

Yip CH, Ng EH

Singapore Med J, 1996 Jun;37(3):264-7.
PMID: 8942224

Breast cancer is the leading cause of cancer deaths in Malaysian and Singaporean women. A study done to compare the epidemiology of the disease, as well as to compare the rate of conservative surgery between Malaysian and Singaporean women was carried out. The results show that the median age at presentation was the same in both countries, and the incidence was lower among the Malays. However, there was a significant difference in the stage at presentation and the tumour size; Singaporean women presented at earlier stages and with smaller tumours compared to Malaysian women. This led to a lower rate of conservation surgery in Malaysian women.

Matched MeSH terms: Singapore/epidemiology
Fulltext Education and myopia in 110,236 young Singaporean males

Au Eong KG, Tay TH, Lim MK

Singapore Med J, 1993 Dec;34(6):489-92.
PMID: 8153707

Computerised data of 110,236 Singaporean males aged 15 to 25 (mean 17.75) years who underwent compulsory medical examination from April 1987 to January 1992 were used to estimate the prevalence and severity of myopia among young Chinese, Malay, Indian and Eurasian Singaporean males with different educational levels. The prevalence and severity of myopia amongst the groups with different educational levels were compared. These groups were fairly well-matched for important known confounding factors such as age, sex, race and degree of urbanisation of place of residence. Our data showed a positive association between educational attainment and both the prevalence and severity of myopia. Both the prevalence of myopia and the proportion of myopes with severe myopia were in general higher among those with more years of formal education.

Matched MeSH terms: Singapore/epidemiology
Fulltext Prevalence of simian malaria parasites in macaques of Singapore

Li MI, Mailepessov D, Vythilingam I, Lee V, Lam P, Ng LC, et al.

PLoS Negl Trop Dis, 2021 Jan;15(1):e0009110.
PMID: 33493205 DOI: 10.1371/journal.pntd.0009110

Plasmodium knowlesi is a simian malaria parasite currently recognized as the fifth causative agent of human malaria. Recently, naturally acquired P. cynomolgi infection in humans was also detected in Southeast Asia. The main reservoir of both parasites is the long-tailed and pig-tailed macaques, which are indigenous in this region. Due to increased urbanization and changes in land use, there has been greater proximity and interaction between the long-tailed macaques and the general population in Singapore. As such, this study aims to determine the prevalence of simian malaria parasites in local macaques to assess the risk of zoonosis to the general human population. Screening for the presence of malaria parasites was conducted on blood samples from 660 peridomestic macaques collected between Jan 2008 and Mar 2017, and 379 wild macaques collected between Mar 2009 and Mar 2017, using a Pan-Plasmodium-genus specific PCR. Positive samples were then screened using a simian Plasmodium species-specific nested PCR assay to identify the species of parasites (P. knowlesi, P. coatneyi, P. fieldi, P. cynomolgi, and P. inui) present. All the peridomestic macaques sampled were tested negative for malaria, while 80.5% of the 379 wild macaques were infected. All five simian Plasmodium species were detected; P. cynomolgi being the most prevalent (71.5%), followed by P. knowlesi (47.5%), P. inui (42.0%), P. fieldi (32.5%), and P. coatneyi (28.5%). Co-infection with multiple species of Plasmodium parasites was also observed. The study revealed that Singapore's wild long-tailed macaques are natural hosts of the five simian malaria parasite species, while no malaria was detected in all peridomestic macaques tested. Therefore, the risk of simian malaria transmission to the general human population is concluded to be low. However, this can be better demonstrated with the incrimination of the vectors of simian malaria parasites in Singapore.

Matched MeSH terms: Singapore/epidemiology
Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore

Wong TY, Foster PJ, Seah SK, Chew PT

Br J Ophthalmol, 2000 Sep;84(9):990-2.
PMID: 10966951

AIM: To estimate the rates of hospital admissions for primary angle closure glaucoma (PACG) in Chinese, Malays, and Indians in Singapore
METHODS: A population-wide hospital discharge database in Singapore was used to identify all hospital admissions with a primary discharge diagnosis of PACG (International Classification of Disease-CM code: 365.2). The Singapore census was used for denominator data.
RESULTS: Between 1993 and 1997 there were 894 hospital admissions for PACG. The mean annual rate of PACG admissions was 11.1 per 100 000 (95% confidence interval (CI), 10.4, 11.8) among people aged 30 years and over. The annual rate was highest for Chinese (age and sex adjusted rate: 12.2 per 100 000), which was twice that of Malays (6.0 per 100 000) and Indians (6.3 per 100 000). Females had two times higher rates than males in all three races (age adjusted relative risk: 2.0, 95% CI: 1.7, 2.3).
CONCLUSION: Malay and Indian people had identical rates of hospital admissions for PACG, which were only half the rates compared with Chinese.

Matched MeSH terms: Singapore/epidemiology
Fulltext Projection of dengue fever transmissibility under climate change in South and Southeast Asian countries

Wang Y, Li C, Zhao S, Wei Y, Li K, Jiang X, et al.

PLoS Negl Trop Dis, 2024 Apr;18(4):e0012158.
PMID: 38683870 DOI: 10.1371/journal.pntd.0012158

Vector-borne infectious disease such as dengue fever (DF) has spread rapidly due to more suitable living environments. Considering the limited studies investigating the disease spread under climate change in South and Southeast Asia, this study aimed to project the DF transmission potential in 30 locations across four South and Southeast Asian countries. In this study, weekly DF incidence data, daily mean temperature, and rainfall data in 30 locations in Singapore, Sri Lanka, Malaysia, and Thailand from 2012 to 2020 were collected. The effects of temperature and rainfall on the time-varying reproduction number (Rt) of DF transmission were examined using generalized additive models. Projections of location-specific Rt from 2030s to 2090s were determined using projected temperature and rainfall under three Shared Socioeconomic Pathways (SSP126, SSP245, and SSP585), and the peak DF transmissibility and epidemic duration in the future were estimated. According to the results, the projected changes in the peak Rt and epidemic duration varied across locations, and the most significant change was observed under middle-to-high greenhouse gas emission scenarios. Under SSP585, the country-specific peak Rt was projected to decrease from 1.63 (95% confidence interval: 1.39-1.91), 2.60 (1.89-3.57), and 1.41 (1.22-1.64) in 2030s to 1.22 (0.98-1.51), 2.09 (1.26-3.47), and 1.37 (0.83-2.27) in 2090s in Singapore, Thailand, and Malaysia, respectively. Yet, the peak Rt in Sri Lanka changed slightly from 2030s to 2090s under SSP585. The epidemic duration in Singapore and Malaysia was projected to decline under SSP585. In conclusion, the change of peak DF transmission potential and disease outbreak duration would vary across locations, particularly under middle-to-high greenhouse gas emission scenarios. Interventions should be considered to slow down global warming as well as the potential increase in DF transmissibility in some locations of South and Southeast Asia.

Matched MeSH terms: Singapore/epidemiology
Distribution of PON1 polymorphisms PON1Q192R and PON1L55M among Chinese, Malay and Indian males in Singapore and possible susceptibility to organophosphate exposure

Chia SE, Mohamed Ali S, Yap PH, Gan L, Ong YB, Chia KS

Neurotoxicology, 2009 Mar;30(2):214-9.
PMID: 19135476 DOI: 10.1016/j.neuro.2008.12.004

Organophosphate (OP)-containing pesticides are widely used worldwide for domestic and industrial purposes. Studies on acute and chronic exposure to OPs have revealed numerous health effects attributed mainly to acetylcholinesterase (AChE) inhibition. The enzyme human serum paraoxonase (PON1) is involved in the detoxification of OP compounds. PON1 polymorphisms have been shown to affect susceptibility to OP exposure. We studied the effect of OP exposure on pest control workers and assessed the distribution of two common PON1 polymorphisms in our local population. The exposed group consisted of 103 workers from various pest control companies under the Singapore Pest Management Association while the 91 unexposed workers were from a lead stabilizer factory. For all workers, the mean age was 36.9 (20-70) years and the ethnic distribution was 38.1% Chinese, 44.3% Malay and 17.5% Indian. The mean+/-S.D. exposure duration among the pesticide workers was 10.4+/-8.4 years. The mean+/-S.D. RBC cholinesterase level was 18436.2+/-2078U/L and 18079.6+/-1576U/L for the exposed and unexposed groups, respectively (p=0.216). The mean+/-S.D. serum pseudocholinesterase was 11028.4+/-2867.4U/L and 9433.6+/-2022.6U/L in the exposed and unexposed groups, respectively (p<0.0001). Mean paraoxonase activity was similar among Chinese and Malays (266.5 and 266.3U/L, respectively) whereas that of the Indians was significantly lower (165.6U/L). Our study showed that cholinesterase levels among the exposed were not lower than those in the unexposed group. PON1 polymorphisms differed among ethnic groups, implying that ethnicity could be an important surrogate for identifying susceptible groups in case of OP exposure. Although OP poisoning is rare among occupationally exposed workers in Singapore, this information is useful for other developing countries that have large populations of Chinese, Malays and Indians where OP exposure could be very high especially in agricultural settings.

Matched MeSH terms: Singapore/ethnology; Singapore/epidemiology
Epidemiology and characteristics of the dengue outbreak in Guangdong, Southern China, in 2014

Huang L, Luo X, Shao J, Yan H, Qiu Y, Ke P, et al.

Eur J Clin Microbiol Infect Dis, 2016 Feb;35(2):269-77.
PMID: 26700953 DOI: 10.1007/s10096-015-2540-5

Dengue is a rapidly spreading mosquito-borne disease caused by the dengue virus (DENV) and has emerged as a severe public health problem around the world. Guangdong, one of the southern Chinese provinces, experienced a serious outbreak of dengue in 2014, which was believed to be the worst dengue epidemic in China over the last 20 years. To better understand the epidemic, we collected the epidemiological data of the outbreak and analyzed 14,594 clinically suspected dengue patients from 25 hospitals in Guangdong. Dengue cases were then laboratory-confirmed by the detection of DENV non-structural protein 1 (NS1) antigen and/or DENV RNA. Afterwards, clinical manifestations of dengue patients were analyzed and 93 laboratory-positive serum specimens were chosen for the DENV serotyping and molecular analysis. Our data showed that the 2014 dengue outbreak in Guangdong had spread to 20 cities and more than 45 thousand people suffered from dengue fever. Of 14,594 participants, 11,387 were definitively diagnosed. Most manifested with a typical non-severe clinical course, and 1.96 % developed to severe dengue. The strains isolated successfully from the serum samples were identified as DENV-1. Genetic analyses revealed that the strains were classified into genotypes I and V of DENV-1, and the dengue epidemic of Guangdong in 2014 was caused by indigenous cases and imported cases from the neighboring Southeast Asian countries of Malaysia and Singapore. Overall, our study is informative and significant to the 2014 dengue outbreak in Guangdong and will provide crucial implications for dengue prevention and control in China and elsewhere.

Matched MeSH terms: Singapore
Fulltext Susuk - black magic exposed "white" by dental radiographs

F AT, Mohammed F

J Clin Diagn Res, 2014 Jul;8(7):ZD03-4.
PMID: 25177646 DOI: 10.7860/JCDR/2014/8671.4546

Susuk or charm needles are a facial cum body art widely practiced among women of Malaysia, Brunei, Singapore, Thailand and Indonesia. These are small, needle-shaped metallic talismans inserted subcutaneously in different parts of the body. The concealed art of susuk was "exposed" by routine radiographic examination in the oral and maxillofacial region. This paper reports two such cases of unusual incidental radiographic finding in dental radiographs which were taken on a routine basis as part of the diagnostic work up. This article will also primarily enlighten the importance of radiographs in detecting such charm needles as the wearer keeps the body art a "hidden secret" thereby avoiding misdiagnosis.

Matched MeSH terms: Singapore
Fulltext Insecticide resistance and its underlying mechanisms in field populations of Aedes aegypti adults (Diptera: Culicidae) in Singapore

Koou SY, Chong CS, Vythilingam I, Lee CY, Ng LC

Parasit Vectors, 2014;7:471.
PMID: 25301032 DOI: 10.1186/s13071-014-0471-0

In Singapore, dose-response bioassays of Aedes aegypti (L.) adults have been conducted, but the mechanisms underlying resistance to insecticides remain unclear. In this study, we evaluated insecticide resistance and its underlying mechanism in field populations of Ae. aegypti adults.

Matched MeSH terms: Singapore
The energy cost of water independence: the case of Singapore

Vincent L, Michel L, Catherine C, Pauline R

Water Sci Technol, 2014;70(5):787-94.
PMID: 25225924 DOI: 10.2166/wst.2014.290

Finding alternative resources to secure or increase water availability is a key issue in most urban areas. This makes the research of alternative and local water resources of increasing importance. In the context of political tension with its main water provider (Malaysia), Singapore has been implementing a comprehensive water policy for some decades, which relies on water demand management and local water resource mobilisation in order to reach water self-sufficiency by 2060. The production of water from alternative resources through seawater desalination or water reclamation implies energy consumptive technologies such as reverse osmosis. In the context of increasing energy costs and high primary energy dependency, this water self-sufficiency objective is likely to be an important challenge for Singapore. The aim of this paper is to quantify the long-term impact of Singapore's water policy on the national electricity bill and to investigate the impact of Singapore's projects to reduce its water energy footprint. We estimate that 2.0% of the Singaporean electricity demand is already dedicated to water and wastewater treatment processes. If its water-energy footprint dramatically increases in the coming decades, ambitious research projects may buffer the energy cost of water self-sufficiency.

Matched MeSH terms: Singapore
Fulltext Predicting survival of de novo metastatic breast cancer in Asian women: systematic review and validation study

Miao H, Hartman M, Bhoo-Pathy N, Lee SC, Taib NA, Tan EY, et al.

PLoS One, 2014;9(4):e93755.
PMID: 24695692 DOI: 10.1371/journal.pone.0093755

BACKGROUND: In Asia, up to 25% of breast cancer patients present with distant metastases at diagnosis. Given the heterogeneous survival probabilities of de novo metastatic breast cancer, individual outcome prediction is challenging. The aim of the study is to identify existing prognostic models for patients with de novo metastatic breast cancer and validate them in Asia.
MATERIALS AND METHODS: We performed a systematic review to identify prediction models for metastatic breast cancer. Models were validated in 642 women with de novo metastatic breast cancer registered between 2000 and 2010 in the Singapore Malaysia Hospital Based Breast Cancer Registry. Survival curves for low, intermediate and high-risk groups according to each prognostic score were compared by log-rank test and discrimination of the models was assessed by concordance statistic (C-statistic).
RESULTS: We identified 16 prediction models, seven of which were for patients with brain metastases only. Performance status, estrogen receptor status, metastatic site(s) and disease-free interval were the most common predictors. We were able to validate nine prediction models. The capacity of the models to discriminate between poor and good survivors varied from poor to fair with C-statistics ranging from 0.50 (95% CI, 0.48-0.53) to 0.63 (95% CI, 0.60-0.66).
CONCLUSION: The discriminatory performance of existing prediction models for de novo metastatic breast cancer in Asia is modest. Development of an Asian-specific prediction model is needed to improve prognostication and guide decision making.

Matched MeSH terms: Singapore
Silver lining of Singapore's haze

Carrasco LR

Science, 2013 Jul 26;341(6144):342-3.
PMID: 23888020 DOI: 10.1126/science.341.6144.342-b
Matched MeSH terms: Singapore
Fulltext Recruitment constraints in Singapore's fluted giant clam (Tridacna squamosa) population--a dispersal model approach

Neo ML, Erftemeijer PL, van Beek JK, van Maren DS, Teo SL, Todd PA

PLoS One, 2013;8(3):e58819.
PMID: 23555597 DOI: 10.1371/journal.pone.0058819

Recruitment constraints on Singapore's dwindling fluted giant clam, Tridacna squamosa, population were studied by modelling fertilisation, larval transport, and settlement using real-time hydrodynamic forcing combined with knowledge of spawning characteristics, larval development, behaviour, and settlement cues. Larval transport was simulated using a finite-volume advection-diffusion model coupled to a three-dimensional hydrodynamic model. Three recruitment constraint hypotheses were tested: 1) there is limited connectivity between Singapore's reefs and other reefs in the region, 2) there is limited exchange within Singapore's Southern Islands, and 3) there exist low-density constraints to fertilisation efficacy (component Allee effects). Results showed that connectivity among giant clam populations was primarily determined by residual hydrodynamic flows and spawning time, with greatest chances of successful settlement occurring when spawning and subsequent larval dispersal coincided with the period of lowest residual flow. Simulations suggested poor larval transport from reefs located along the Peninsular Malaysia to Singapore, probably due to strong surface currents between the Andaman Sea and South China Sea combined with a major land barrier disrupting larval movement among reefs. The model, however, predicted offshore coral reefs to the southeast of Singapore (Bintan and Batam) may represent a significant source of larvae. Larval exchange within Singapore's Southern Islands varied substantially depending on the locations of source and sink reefs as well as spawning time; but all simulations resulted in low settler densities (2.1-68.6 settled individuals per 10,000 m(2)). Poor fertilisation rates predicted by the model indicate that the low density and scattered distribution of the remaining T. squamosa in Singapore are likely to significantly inhibit any natural recovery of local stocks.

Matched MeSH terms: Singapore
Occupational rehabilitation in Singapore and Malaysia

Chan KF, Tan CW, Yeo DS, Tan HS, Tan FL, Tan EW, et al.

J Occup Rehabil, 2011 Mar;21 Suppl 1:S69-76.
PMID: 21328063 DOI: 10.1007/s10926-011-9289-1

INTRODUCTION: Asia is the new and favored magnet of economic attention and foreign investments after it made an almost uneventful rebound from the depths of financial crisis of 2008/2009. Not many Western observers fully understand the diversity that is Asia other than perhaps its 2 growing economic giants of China and India. Indeed many smaller countries like Singapore and Malaysia in South East Asia along with Australia and Hong Kong (a Special Administrative Region within China) look to symbiotic relationships with these two economic giants. The purpose of this discussion paper is to examine the current issues related to the development and provision of occupational rehabilitation services in Singapore and Malaysia with a forward-looking view of how Asia's different developing societies could potentially benefit from better alignment of occupational rehabilitation practices and sharing of expertise through international collaboration and dialogue platforms.
METHODS: Seven therapists and one physician who are frequently involved in occupational rehabilitation services in their home countries critically reviewed the current issues in Singapore and Malaysia which included analysis of the prevalence and cost of occupational injury; overview of workers' compensation system; current practices, obstacles, and challenges in providing occupational rehabilitation and return to work practices. They also offered opinions about how to improve the occupational rehabilitation programs of their two home countries.
CONCLUSION: Even though Malaysia and Singapore are two different countries, in many ways their current provision of occupational rehabilitation services and the problems they face with are very similar. There is a lot of room for systemic improvements that require government support and action. Most prominently, the training of more healthcare professionals in the assessment and rehabilitation of the injured worker should be encouraged. There could be better liaison between the many stakeholders and more funding made available to develop resources and to jump start strategic programs. As these two countries are witnessing rapid economic growth, more resources should be allocated to establish holistic care of the injured workers emphasizing early interventions and prevention of chronic disabilities.

Matched MeSH terms: Singapore
Re-emergence of Chikungunya virus in South-east Asia: virological evidence from Sri Lanka and Singapore

Hapuarachchi HC, Bandara KB, Sumanadasa SD, Hapugoda MD, Lai YL, Lee KS, et al.

J Gen Virol, 2010 Apr;91(Pt 4):1067-76.
PMID: 19955565 DOI: 10.1099/vir.0.015743-0

Chikungunya fever swept across many South and South-east Asian countries, following extensive outbreaks in the Indian Ocean Islands in 2005. However, molecular epidemiological data to explain the recent spread and evolution of Chikungunya virus (CHIKV) in the Asian region are still limited. This study describes the genetic Characteristics and evolutionary relationships of CHIKV strains that emerged in Sri Lanka and Singapore during 2006-2008. The viruses isolated in Singapore also included those imported from the Maldives (n=1), India (n=2) and Malaysia (n=31). All analysed strains belonged to the East, Central and South African (ECSA) lineage and were evolutionarily more related to Indian than to Indian Ocean Islands strains. Unique genetic characteristics revealed five genetically distinct subpopulations of CHIKV in Sri Lanka and Singapore, which were likely to have emerged through multiple, independent introductions. The evolutionary network based on E1 gene sequences indicated the acquisition of an alanine to valine 226 substitution (E1-A226V) by virus strains of the Indian sublineage as a key evolutionary event that contributed to the transmission and spatial distribution of CHIKV in the region. The E1-A226V substitution was found in 95.7 % (133/139) of analysed isolates in 2008, highlighting the widespread establishment of mutated CHIKV strains in Sri Lanka, Singapore and Malaysia. As the E1-A226V substitution is known to enhance the transmissibility of CHIKV by Aedes albopictus mosquitoes, this observation has important implications for the design of vector control strategies to fight the virus in regions at risk of chikungunya fever.

Matched MeSH terms: Singapore
Fulltext Wandering humeral head mimicking a breast mass

Tan GJS, Tan AGS, Peh WCG

Med J Malaysia, 2008 Jun;63(2):164-5.
PMID: 18942311

A 74-year-old woman was incidentally found to have a left breast mass. The mass could not be adequately compressed to be visualized on mammography. Ultrasonography showed a heavily-calcified rounded mass in the left axillary tail of the left breast. Chest radiograph confirmed that the mass was a migrated humeral head. Remotely-displaced fracture-dislocations of the humeral head are very rare and to our knowledge, displacement into the breast, clinically mimicking a breast mass, has not been previously described.

Matched MeSH terms: Singapore

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