METHODS: Healthy young adult volunteers between the ages of 18-30 years were consecutively recruited from June 2012 to May 2014 at the University of Malaya Medical Centre (UMMC), Kuala Lumpur. Serum samples from all the participants were tested for anti-gliadin antibody immunoglobulin A/immunoglobulin G (IgA/IgG) and anti-tissue transglutaminase antibody (tTG) IgA/IgG. Samples positive for both anti-gliadin and anti-tTG were further validated for anti-human endomysial IgA antibodies (EmA). Serological diagnosis of CD was made when anti-gliadin, anti-tTG and anti-EmA were positive.
RESULTS: 562 qualified participants with mean age 24 ± 2.4 years old were recruited into our study. CD was found in 7 participants where most of them were asymptomatic and unaware of their CD status. The median of anti-gliadin and anti-tTG IgA/IgG value was 38.2 U/ml (interquartile range, 28.3-60.4 U/ml) and 49.2 U/ml (interquartile range, 41.1-65.9 U/ml), respectively. Seroprevalence of CD antibodies was 1.9% (6 out of 324) in female while only 0.4% (1 out of 238) in male. Seroprevalence among Malay was 0.8% (2 of 236), Chinese was 1.7% (3 of 177) and Indian was 1.3% (2 of 149). Overall, seroprevalence of CD antibodies in healthy asymptomatic adults in the Malaysian population was 1.25% (95% CI, 0.78%-1.72%). No significant relationship was discovered between CD and H. pylori infection.
CONCLUSIONS: The seroprevalence of CD antibodies in healthy young adults in the Malaysian population was 1.25% (1 in 100). CD is underdiagnosed and it could be a much greater problem in Malaysia than previously thought.
RESULTS: No significant difference in plasma propranolol (mean +/- SEM) levels was seen between races six hours after the last dose (Malays, 59.7 +/- 8.8 ng/ml, Indians, 67.6 +/- 19.3 ng/ml, Chinese, 58.4 +/- 7.9 ng/ml). Chinese were least sensitive to the bradycardic and hypotensive effects of propranolol at rest and exercise. Indians and Malays had significant reduction of supine systolic blood pressure with propranolol but not Chinese. Comparison of percentage reductions of systolic blood pressure at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.022). Similarly, comparison of percentage reductions of heart rate at supine, sitting and exercise by repeated measure analysis showed the Malays to have significantly higher change compared to the Chinese (p = 0.040). Average change in potassium concentrations at peak exercise and recovery showed the Indians to have significantly higher increase in potassium levels with propranolol compared to the Malays (p = 0.038). However, no significant interethnic difference was seen in the reduction of glucose levels at rest, peak exercise or recovery. Also, no significant interethnic difference was seen in reduction of FEV1 values.
CONCLUSION: We, therefore, conclude that ethnic differences in response to blockade of beta-receptors exist among racial groups in Malaysia. These differences were seen at similar plasma drug levels between races suggesting ethnic differences in drug sensitivity, rather than differences in drug disposition.
METHODS: Recurrent abdominal pain was defined as at least three episodes of abdominal pain, severe enough to affect a child's activities over a period longer than 3 months. A health-care consulter was defined as a child who had been brought to see a doctor regarding recurrent abdominal pain at least once in the past year. Children aged between 9 and 15 years were randomly chosen from schools in the city of Petaling Jaya, given questionnaires to fill in and interviewed to determine whether they fulfilled the above criteria for having symptoms of recurrent abdominal pain and for being a consulter. Bivariate analysis and multiple logistic regression analysis were performed on the data obtained.
RESULTS: One hundred and forty-three (9.61%) children fulfilled the criteria for recurrent abdominal pain out of a total of 1488 schoolchildren interviewed. There were 65 (45.5%) consulters and 78 (54.5%) non-consulters. Among the consulters, the male to female ratio was 1:1.4, while among the non-consulters, the ratio was 1:1.1. On bivariate analysis, the Chinese had a significantly lower likelihood to consult a doctor (P = 0.02), while the other two races did not show any increase in consultation (Malays, P = 0.08; Indians, P = 0.21). Among those with severe pain, there was a significantly higher prevalence of consulters (P < 0.01). Furthermore, those whose sleep was interrupted by abdominal pain were more likely to consult (P < 0.01). Children who had consulted a doctor were more likely to be missing school because of abdominal pain (P < 0.01). Following multiple logistic regression analysis, ethnicity was no longer a significant predictor.
CONCLUSIONS: Approximately 45.5% of schoolchildren with recurrent abdominal pain in an urban setting were brought to see a doctor. Predictors of recent health-care consultation were school absence, pain severity and interruption of sleep caused by abdominal pain.
METHODS: Male subjects included in this study were drawn from those undergoing routine annual medical examinations offered by their employers. Venous blood was obtained from these patients after an overnight fast and from which genomic DNA was extracted. Genotyping was carried out by polymerase chain reaction (PCR) followed by digestion with restriction enzyme NciI. Personal and family medical history of the subjects were also taken.
RESULTS: The genotype distribution of the individuals studied was in accordance to a population at Hardy Weinberg equilibrium. The frequency of the PI(A2) allele was 0.1, 0.01 and 0.01 in the Indians, Malays and Chinese, respectively. The differences in frequencies of the PI(A2) variant are significant among different ethnic groups (P<0.001 for Indians vs. Chinese and Indians vs. Malays).
CONCLUSIONS: We observed a significantly higher frequency of the PI(A2) allele among Indians relative to the Chinese and Malays in Singapore. The effect of this genotype may partially explain the higher rate of ischaemic heart disease seen among Indians compared to the Chinese and Malay ethnic groups.
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.
METHODS: Age-standardized mortality rates were calculated for 16 amenable causes of death in Singapore for six 5-year periods (1965-1969,..., 1990-1994), and for each of the three main ethnic groups for three periods (1989-1991, 1992-1994, 1995- 1997). Amenable mortality rates were divided into those which can be reduced by timely therapeutic care for 'treatable' conditions (e.g. asthma and appendicitis), or by primary preventive measures for 'preventable' conditions (e.g. lung cancer and motor vehicle injury).
RESULTS: Amenable mortality was higher in males (age-standardized rate 109.7 per 100 000 population) than in females (age-standardized rate 60.7 per 100 000 population). Amenable mortality declined by 1.77% a year in males and 1.72% a year in females. By comparison, the average yearly decline in non-amenable mortality was 0.91% in males and 1.17% in females. The decline in amenable mortality was largely due to 'treatable' causes rather than a decline in mortality due to 'preventable' causes of death. Amenable mortality was lowest for Chinese and highest for Malays. Over the recent 9-year period from 1989 to 1997, amenable mortality declined more in Chinese than in Malays and Indians. However, Indian females showed by far the sharpest decline, whereas Indian males, by contrast, showed an increase in amenable mortality, due to both treatable and preventable causes.
CONCLUSIONS: In line with findings from European countries, amenable mortality in Singapore declined more than non-amenable mortality. There were more significant gains in mortality outcomes from medical care interventions than from primary preventive policy measures. Gender and ethnic differences in amenable mortality were also observed, highlighting issues of socioeconomic equities to be addressed in the financing and delivery of health care.