STUDY OBJECTIVE:The aim of the study was to analyse differences in mortality from the main cardiovascular diseases (ischaemic heart disease, hypertensive disease, and cerebrovascular disease) among Chinese, Malays, and Indians in Singapore.
DESIGN: The study was a survey using national death registration data in Singapore for the five years 1980 to 1984. The underlying cause of death, coded according to the ninth revision of the International Classification of Diseases, was taken for the analyses.
SETTING: The study was confined to the independent island state of Singapore, population 2.53 million (Chinese 76.5%, Malays 14.8%, Indians 6.4%, Others 2.3%). Death registration is thought to be complete.
SUBJECTS: All registered deaths in the age range 30-69 years during the study period were analysed by ethnic group.
MEASUREMENT AND MAIN RESULTS: Indians had higher mortality from ischaemic heart disease than the other ethnic groups in both sexes, with age-standardised relative risks of Indian v Chinese (males 3.8, females 3.4), Indian v Malay (males 1.9, females 1.6), and Malay v Chinese (males 2.0, females 2.2). The excess mortality in Indians declined with age. For hypertensive disease Malays had the highest mortality, with age-standardised relative risks of Malay v Chinese (males 3.4, females 4.4), Malay v Indian (males 2.0, females 2.5), and Indian v Chinese (males 1.6, females 1.6). For cerebrovascular disease there was little ethnic difference except for lower rates in Chinese females, with age-standardised relative risks of Malay v Chinese (males 1.1, females 1.9), Malay v Indian (males 1.0, females 1.1), and Indian v Chinese (males 1.1, females 1.7).
CONCLUSIONS: There are significant differences in mortality from the three main cardiovascular diseases in the different ethnic groups in Singapore.
In Singapore, cancer incidence is documented separately for the different Chinese dialect groups, as a means of providing a possible insight into environmental or genetic factors which may be involved in the aetiological process. Thus, it would be useful to determine whether or not the Chinese population in Singapore still comprises distinct dialect groups. In view of this, an investigation into the dialect group of the parents of 792 hospital in-patients (cases and controls) was carried out. It was found that the vast majority of patients (94.2%), most of whom were born before 1940, had parents of the same dialect group. The percentages of within-dialect marriages were only slightly less for offspring born in Singapore or Malaysia as opposed to China, and decreases with time were small. Thus in 1985-87 Chinese cancer patients and controls in Singapore, of the ages represented in this study may indeed be classified according to their father's dialect and this is likely to be the case for at least the next decade or so. This finding will be of use to cancer epidemiologists as well as others studying Chinese dialect group variations in disease patterns.
Two hundred and twenty-five hair samples (150 Chinese, 44 Malays and 31 Indians) from healthy residents not occupationally exposed to mercury were analyzed by cold vapour atomic absorption spectrophotometry to determine their total, inorganic and organic mercury levels. The arithmetic means of total mercury levels in hair were 6.1, 5.2 and 5.4 ppm for the Chinese, Malays and Indians, respectively. Factors contributing to the amount of mercury in hair, including consumption of fish and marine products, use of traditional ethnic medicines, artificial hair waving, age, sex and ethnicity were analyzed. Fish consumption, sex and ethnicity are factors found to contribute significantly (p less than 0.05) to mercury levels in hair.
In a study of suicide in Singapore in 1980 there were 230 cases and the suicide rate for the general population was 9.5 per 100,000. The age-specific rates increased steeply after 50 years and there was a male preponderance especially in the age group 60 years and over. Comparing the three major ethnic groups in Singapore, the highest rate was seen in the Indians and Chinese, whereas the Malays had the lowest. Amongst the suicides there were 59 (25.7%) with mental illness, mainly schizophrenia, and they were of a younger age group, 20-39 years. The commonest method of suicide was jumping from high-rise flats.
Mitochondrial malic enzyme (EC 1.1.1.40; MEM) was examined by starch-gel electrophoresis on post-mortem brain samples from 453 unrelated subjects of either sex comprising 161 Chinese, 150 Indians and 113 Malays and 29 from other racial groups. The estimated gene frequencies of MEM1 were found to be 0.7111, 0.6100 and 0.6769 in Chinese, Indians and Malays, respectively. No significant deviation from the Hardy-Weinberg equilibrium was observed in Chinese and Malays. However, there was a significant deviation with a deficiency of heterozygotes among Indians. MES did not show any polymorphism.
The forfeiture of the proceeds of drug-related offences does not seem to have received much attention as yet from British Commonwealth countries. Whereas in some of these countries specific legislation exists in relation to forfeiture, in many other countries the act of forfeiture falls within the purview of general criminal law. Forfeiture presupposes enquiry and search, two procedures which involve integral aspects of present-day human rights law, and which seem to be impeded at almost every stage of the process concluding in forfeiture. Time and the procedure for execution of judgments seem to be two significant factors in the successful enforcement of forfeiture judgments. Unfortunately, given the present practice of maintaining inviolability of bank secrecy, effective enforcement of forfeiture judgments is not possible. Perhaps an international convention may offer some assistance in the successful implementation of a forfeiture judgment, especially where the ill-gotten gains have been transferred to a foreign jurisdiction.
Cleft lip and palate is the most common congenital abnormality seen in the Department of Plastic Surgery, Singapore General Hospital. A total of 461 operative cases seen over a period of 5 years (1977 to 1981) is analysed. There is a relatively high incidence in the Singapore population of 2.0 per 1000 live births. In both cleft lip and cleft palate deformities, there is no significant difference in the sex distribution. The cleft patterns show that 78% of the cases are unilateral clefts, 53% are left sided, 25% are right sided and 22% of the cases are bilateral clefts.
Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.
Forty-five Asian patients (Indians 35, Chinese 8, Malay 2) with histologically proven lichen planus were studied by immunofluorescence. The most characteristic feature, seen in 93% of the cases, was shaggy deposition of fibrinogen along the basement membrane. Immunoglobulin deposition along the basement membrane was notably, absent. Colloid bodies were observed in 87% of the cases. Fibrinogen was the most common immunoreactant, and its presence in colloid bodies was always associated with fibrinogen deposition along the basement membrane zone. Colloid bodies also contained a variety of other immunoreactants. However, staining for IgM was noted to be the most intense. The combination of shaggy deposition of fibrinogen along the basement membrane, in the absence of immunoglobulins, and the presence of colloid bodies around the basement membrane zone, is highly characteristic of lichen planus. The pattern of immunofluorescence among Asians with lichen planus, conforms to that observed in other races. There did not appear to be any difference in the immunofluorescence staining with pattern in the three racial groups studied.
Possession-trance is a common culture-bound syndrome in Singapore. The characteristic features as seen in 36 young men of the three different ethnic communities are described. At follow-up four to five years later, none of the 26 who could be contacted showed any evidence of mental illness. The psychopathology of the possession-trance is discussed.
The concentrations of non-haem iron, ferritin and ferritin-iron were measured in the livers of 137 adults and children collected at necropsy. The concentrations of non-haem and ferritin iron were found to be 146.6 +/- 95.2 micrograms/g and 61.6 +/- 32.4 micrograms/g, respectively, in males and 108.0 +/- 61.7 micrograms/g and 60.6 +/- 26.4 micrograms/g, respectively, in females. The values for males in Singapore were lower than those reported in developed Western countries. No correlation was observed between storage iron and age, or ferritin concentration and age. Concentrations of non-haem iron and ferritin were similar for persons dying from accident and coronary heart disease. The non-haem iron concentration in Chinese (187.9 +/- 101.0 micrograms/g) was significantly greater than that in Indians (103.1 +/- 65.8 micrograms/g), while the ferritin concentration in Chinese (6.18 +/- 2.37 mg/g) was significantly greater than either Malays (3.81 +/- 1.8 mg/g) or Indians (3.52 +/- 1.6 mg/g). A significant positive correlation was observed between the non-haem iron and ferritin and also ferritin-iron in Chinese males (r values of 0.678 and 0.598, respectively) and Indian males (r values of 0.576 and 0.612, respectively). However, the correlation between these indices was not significant in the case of Malay males. In premenopausal women the non-haem iron correlated well with ferritin (r = 0.737) and ferritin iron (r = 0.826) while the correlation was lacking in postmenopausal women.
Most in vivo body composition methods rely on assumptions that may vary among different population groups as well as within the same population group. The assumptions are based on in vitro body composition (carcass) analyses. The majority of body composition studies were performed on Caucasians and much of the information on validity methods and assumptions were available only for this ethnic group. It is assumed that these assumptions are also valid for other ethnic groups. However, if apparent differences across ethnic groups in body composition 'constants' and body composition 'rules' are not taken into account, biased information on body composition will be the result. This in turn may lead to misclassification of obesity or underweight at an individual as well as a population level. There is a need for more cross-ethnic population studies on body composition. Those studies should be carried out carefully, with adequate methodology and standardization for the obtained information to be valuable.
A series of 31 consecutive parotidectomies was evaluated. FNAC could differentiate tumour from non tumour in 72.8% of cases. For actual histology, FNAC was correct in 66.6%. Frozen section was correct in differentiating between benign, malignant and inflammatory conditions in all cases. Eighty-eight percent of frozen section histology concurred with final histology. The immediate postoperative period had 13 cases of facial nerve dysfunction, but only 3 cases had residual weakness. The branch most commonly affected was the mandibular branch (92.3%). Two patients had Frey's syndrome and one had a traumatic neuroma. FNAC and CT scans improve preoperative planning, providing histological evidence and the extent of the lesion.