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  1. Fulltext Validity, feasibility and acceptability of time trade-off and standard gamble assessments in health valuation studies: a study in a multiethnic Asian population in Singapore
    Wee HL, Li SC, Xie F, Zhang XH, Luo N, Feeny D, et al.
    Value Health, 2008 Mar;11 Suppl 1:S3-10.
    PMID: 18387064 DOI: 10.1111/j.1524-4733.2008.00361.x
    OBJECTIVES: To assess the validity, feasibility and acceptability of standard gamble (SG) and time trade-off (TTO) assessments in a multiethnic Asian population.
    METHODS: Through in-depth interviews performed among Chinese, Malay, and Indian Singaporeans (education >or= 6 years), we assessed validity of SG/TTO methods for eliciting health preferences by hypothesizing that 1) SG/TTO scores for three hypothetical health states (HS) would exhibit ranked order (decreasing scores with worse HS); and 2) more subjects would rate the most severe HS as worse than dead. Subjects also evaluated feasibility and acceptability of SG/TTO using a 10-point visual analog scale (VAS) and open-ended questions. Ratings were compared using Kruskal-Wallis, Wilcoxon signed-rank tests or tests of proportions.
    RESULTS: VALIDITY: In 62 subjects (90% response rate), as hypothesized, SG and TTO scores exhibited ranked order with increasing HS severity (SG: 0.85, 0.08, -19.00; TTO: 0.85, 0.00, -0.18). More subjects rated the most severe HS as worse than dead (SG: 8%, 39%, 59%; TTO: 8%, 45% and 62%).
    FEASIBILITY: Subjects felt SG and TTO were easy to understand (median VAS scores: 8.0 vs. 8.0, P = 0.87) and to complete (8.0 vs. 8.0, P = 0.84). Acceptability: SG and TTO were well accepted, with TTO less so than SG (median [interquartile range] offensiveness: 2.0 [0, 4.0] vs. 2.0 [0, 3.0], P = 0.045). Overall, subjects did not have a clear preference for SG/TTO (50% vs. 45%, P = 0.70).
    CONCLUSIONS: This study suggests the validity, feasibility and acceptability of SG and TTO for population-based HS valuation studies in a multiethnic Asian population.
    Matched MeSH terms: Singapore
  2. Ethnic differences in the frequency of subtypes of childhood acute lymphoblastic leukemia: results of the Malaysia-Singapore Leukemia Study Group
    Ariffin H, Chen SP, Kwok CS, Quah TC, Lin HP, Yeoh AE
    J Pediatr Hematol Oncol, 2007 Jan;29(1):27-31.
    PMID: 17230064
    Childhood acute lymphoblastic leukemia (ALL) is clinically heterogeneous with prognostically and biologically distinct subtypes. Although racial differences in frequency of different types of childhood ALL have been reported, many are confounded by selected or limited population samples. The Malaysia-Singapore (MA-SPORE) Leukemia Study Group provided a unique platform for the study of the frequency of major subgroups of childhood ALL in a large cohort of unselected multiethnic Asian children. Screening for the prognostically important chromosome abnormalities (TEL-AML1, BCR-ABL, E2A-PBX1, and MLL) using multiplex reverse-transcription polymerase chain reaction was performed on 299 consecutive patients with ALL at 3 study centers (236 de novo, 63 at relapse), with the ethnic composition predominantly Chinese (51.8%) and Malay (34.8%). Reverse-transcription polymerase chain reaction was successful in 278 (93%) of cases screened. The commonest fusion transcript was TEL-AML1 (19.1%) followed by BCR-ABL (7.8%), MLL rearrangements (4.2%), and E2A-PBX1 (3.1%). Chinese have a significantly lower frequency of TEL-AML1 (13.3% in de novo patients) compared with Malays (22.2%) and Indians (21.7%) (P=0.04). Malays have a lower frequency of T-ALL (6.2%) compared with the Chinese and Indians (9.8%). Both Malays (7.4%) and Chinese (5.0%) have significantly higher frequency of BCR-ABL compared with the Indian population (P<0.05) despite a similar median age at presentation. Our study suggests that there are indeed significant and important racial differences in the frequency of subtypes of childhood ALL. Comprehensive subgrouping of childhood ALL may reveal interesting population frequency differences of the various subtypes, their risk factors and hopefully, its etiology.
    Matched MeSH terms: Singapore
  3. Interethnic variability of warfarin maintenance requirement is explained by VKORC1 genotype in an Asian population
    Lee SC, Ng SS, Oldenburg J, Chong PY, Rost S, Guo JY, et al.
    Clin. Pharmacol. Ther., 2006 Mar;79(3):197-205.
    PMID: 16513444
    Chinese and Malay subjects have been reported to require less maintenance warfarin than Indians that could not be accounted for by cytochrome P450 (CYP) 2C9 variants. Vitamin K epoxide reductase complex 1 (VKORC1) is the target enzyme of warfarin, and VKORC1 intronic variants and haplotypes have recently been shown to influence VKORC1 activity and warfarin requirements.
    Matched MeSH terms: Singapore
  4. Cardiovascular responses to stress in Singapore and India
    Kaur D, Bishop GD
    Int J Psychophysiol, 2013 Feb;87(2):130-40.
    PMID: 23206971 DOI: 10.1016/j.ijpsycho.2012.11.011
    Epidemiological studies have shown significant ethnic differences in coronary heart disease death rates with South Asians showing significantly greater coronary heart disease mortality than other groups.
    Matched MeSH terms: Singapore
  5. Association of ethnicity and acute kidney injury after cardiac surgery in a South East Asian population
    Chew ST, Mar WM, Ti LK
    Br J Anaesth, 2013 Mar;110(3):397-401.
    PMID: 23171723 DOI: 10.1093/bja/aes415
    BACKGROUND: Postoperative acute kidney injury (AKI) is a frequent and serious complication after cardiac surgery. Clinical factors alone have failed to accurately predict the incidence of AKI after cardiac surgery. Ethnicity has been shown to be a predictor of AKI in the Western population. We tested the hypothesis that ethnicity is an independent predictor of AKI in patients undergoing cardiac surgery in a South East Asian population.

    METHODS: A total of 1756 consecutive patients undergoing cardiac surgery were prospectively recruited. Among them, data of 1639 patients met the criteria for analysis. There were 1182 Chinese, 195 Indian, and 262 Malay patients. The main outcome was postoperative AKI, defined as a 25% or greater increase in preoperative to a maximum postoperative serum creatinine level within 3 days after surgery.

    RESULTS: Five hundred and seventy-nine patients (35.3%) developed AKI after cardiac surgery. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery with Indians and Malays having a higher risk of developing AKI when compared with Chinese patients (odds ratio: Indian vs Chinese 1.44, Malay vs Chinese 1.51).

    CONCLUSIONS: Indians and Malays have a higher risk of developing AKI after cardiac surgery than Chinese in a South East Asian population. Ethnicity was shown to be an independent predictor of AKI after cardiac surgery.

    Matched MeSH terms: Singapore
  6. The impact of diabetes mellitus and other chronic medical conditions on health-related Quality of Life: is the whole greater than the sum of its parts?
    Wee HL, Cheung YB, Li SC, Fong KY, Thumboo J
    Health Qual Life Outcomes, 2005;3:2.
    PMID: 15644146
    Diabetes mellitus (DM) is an important public health concern, the impact of which is increased by the high prevalence of co-existing chronic medical conditions among subjects with DM. The aims of this study were therefore to (1) evaluate the impact of DM and co-existing chronic medical conditions on health-related quality of life (HRQoL) (which could be additive, synergistic or subtractive); (2) to determine the extent to which the SF-6D (a single-index preference measure) captures the multidimensional information provided by the SF-36 (a profile measure).
    Matched MeSH terms: Singapore
  7. Bone mineral density and hip axis length in Singapore's multiracial population
    Goh JC, Low SL, Das De S, DasDe S
    J Clin Densitom, 2004;7(4):406-12.
    PMID: 15618601
    Ethnic differences in bone density and hip geometry are known to exist, even within the same population. A recent study in Singapore showed that there were significant racial differences in hip fracture rates, with Chinese having the highest incidence of hip fractures. The aim of this study was to compare the bone mineral density (BMD) and hip axis length in Chinese, Malay, and Indian women. A total of 1575 women aged 20-59 yr were recruited, of which 77.6% (1222) were Chinese, 7.7% (122) Malays, and 14.7% (231) Indians. There was no significant difference in peak BMD of both lumbar spine and femoral neck among the three ethnic groups. However, in the older age group (50-59 yr), both Chinese and Malay women had significantly lower femoral neck BMD compared to Indian women. There was no significant loss in BMD of the lumbar spine between the second and fifth decades in all the three races. Between the second and fifth decade, Chinese and Malay women had significant bone loss in the femoral neck of 6.6% and 8.2%, respectively, whereas Indian women did not show any significant bone loss. Chinese women had significantly longer hip axis length compared to either Malay or Indian women (9.87 +/- 0.52 cm vs 9.67 +/- 0.49 cm; p < 0.005; and 9.69 +/- 0.55 cm, p < 0.05, respectively). The initial findings suggest racial differences in bone density and hip geometry exist in the local community. Future research should include prospective, longitudinal studies to determine the age-related bone loss in these three racial groups. It is also important to investigate the differences of spine and hip fracture rates and their relationship with bone density and hip axis length.
    Matched MeSH terms: Singapore
  8. Late-onset marrow aplasia due to imatinib in newly diagnosed chronic phase chronic myeloid leukaemia
    Chng WJ, Tan LH
    Leuk. Res., 2005 Jun;29(6):719-20.
    PMID: 15863215
    Matched MeSH terms: Singapore
  9. Validation of the medical outcomes study family and marital functioning measures in SLE patients in Singapore
    Thumboo J, Fong KY, Chan SP, Leong KH, Feng PH, Thio ST, et al.
    Lupus, 1999;8(7):514-20.
    PMID: 10483028 DOI: 10.1191/096120399678840747
    OBJECTIVE: To validate the Medical Outcomes Study Family and Marital Functioning Measures (FMM and MFM) in a multi-ethnic, urban Asian population in Singapore.
    METHODS: English speaking Chinese, Malay or Indian SLE patients (n=120) completed a self-administered questionnaire containing the FFM and MFM at baseline, after 2 weeks and after 6 months. Lupus activity, disease-related damage and quality of life were assessed using the British Isles Lupus Assessment Group (BILAG), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index and SF-36 Health Survey respectively. Scale psychometric properties were assessed through factor analysis, Cronbach's alpha, quantifying test-retest differences and known-groups construct validity.
    RESULTS: Factor analysis of scores obtained at baseline and after 6 months identified 3 factors corresponding to the FFM (1 factor) and the MFM (2 factors). Both scales showed acceptable internal consistency, with Cronbach's alpha of 0.95 for the FFM and 0.70 for the MFM. Mean (s.d.) test-retest differences were -0.31 (3.82) points for the FFM and -0.70 (4.26) points for the MFM. Eleven out of 13 a priori hypotheses relating both the FFM and MFM to demographic, disease and quality of life variables were confirmed, supporting the construct validity of these scales.
    CONCLUSION: The FFM and MFM are valid and reliable measures of family and marital functioning in a multi-ethnic cohort of Asian SLE patients in Singapore.
    Matched MeSH terms: Singapore
  10. Fulltext Clinical efficacy and safety of sildenafil citrate (Viagra) in a multi-racial population in Singapore: A retrospective study of 1520 patients
    Lim PH, Li MK, Ng FC, Chia SJ, Consigliere D, Gooren L, et al.
    Int J Urol, 2002 Jun;9(6):308-15.
    PMID: 12110094 DOI: 10.1046/j.1442-2042.2002.00425.x
    Sildenafil citrate (Viagra), a selective inhibitor of cGMP-specific phosphodiesterase type-5, has been used as an oral therapeutic drug for erectile dysfunction. The present paper is a clinical study of the success rate and side-effects of the use of sildenafil in a multi-racial population in Singapore.
    Matched MeSH terms: Singapore
  11. Fulltext Transient hyperthyroidism of hyperemesis gravidarum
    Tan JYL, Loh KC, Yeo GSH, Chee YC
    BJOG, 2002 Jun;109(6):683-8.
    PMID: 12118648
    OBJECTIVE: To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum.
    DESIGN: Prospective observational study.
    SETTING: Hospital inpatient gynaecological ward.
    POPULATION: Women admitted with hyperemesis gravidarum and found to have hyperthyroidism.
    METHODS: Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation.
    MAIN OUTCOME MEASURES: Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes).
    RESULTS: Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile.
    CONCLUSIONS: In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.
    Matched MeSH terms: Singapore
  12. Fulltext Avoidable hospitalisation rates in Singapore, 1991-1998: assessing trends and inequities of quality in primary care
    Niti M, Ng TP
    J Epidemiol Community Health, 2003 Jan;57(1):17-22.
    PMID: 12490643
    STUDY OBJECTIVES: To assess avoidable hospitalisation as an indicator of quality of primary care by examining trends and gender and ethnic variations.
    DESIGN AND SETTING: Aggregated nationwide data in Singapore from 1991 to1998 were analysed for hospitalisations for chronic diseases that are avoidable by timely, appropriate, and effective primary care: asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension (avoidable hospitalisations).
    MAIN RESULTS: Of a total of 1 479 494 hospitalisations, 6.7% were for ambulatory care sensitive conditions (ACSC). The annual rate of avoidable hospitalisation was 29.4 per 10 000 population. Women had lower rates of avoidable hospitalisations than men (22.4 versus 29.5 per 10 000), as well as for total hospitalisations (496.2 versus 515.5 per 10 000). Adjusted for total hospitalisation, men were 1.3 times more likely than women to be hospitalised for ACSC. With similar adjustments for baseline utilisation, Indian and Malays had 1.7 and 1.8 times higher rates of avoidable hospitalisations than Chinese. Avoidable hospitalisation decline was -9.1% overall; greater in men (-11.8%) than in women (-5.3%); greater for Chinese (-15.8%), than Malays (-1.1%) and Indians (increase of +4.3%).
    CONCLUSION: Gender and ethnic differences and declining trends in avoidable hospitalisation demonstrated in this study suggest that avoidable hospitalisation rates are a sensitive indicator for assessing quality of primary ambulatory care.
    Matched MeSH terms: Singapore
  13. Ethnic variation of cord plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore
    Low PS, Saha N, Tay JS, Hong S
    Acta Paediatr, 1996 Dec;85(12):1476-82.
    PMID: 9001661
    In multiracial Singapore, the prevalence of coronary artery disease is highest in ethnic Indian and lowest in ethnic Chinese populations. Since susceptibility to coronary artery disease is closely associated with plasma lipid traits, we studied the cord blood lipid and apolipoprotein profiles of the three ethnic groups in Singapore to determine if ethnic differences in lipid profile are present at birth. The high-risk lipid traits of high LDL-cholesterol, triglycerides and apo B, low HDL-cholesterol and apo A-I were found to be highest in ethnic Indian and lowest in ethnic Chinese populations. This difference was concordant with the relative coronary mortality rates for their respective adult populations in Singapore.
    Matched MeSH terms: Singapore
  14. Maxillary arch and central incisor dimensions of an ethnic Chinese population in relation to complete denture prosthodontics
    Keng SB, Foong KW
    Int Dent J, 1996 Apr;46(2):103-7.
    PMID: 8930682
    In the absence of pre-extraction records, investigators have used various methods to aid in the selection and placement of artificial teeth for complete dentures. Natural tooth position and size provide the dentist with an optimal guide. A study was conducted on a group of ethnic Chinese subjects where direct measurements were made of the arch size and width of the maxillary central incisor on stone casts. The anterior arch width represented by the inter-canine cusp tip distance was 35.74 +/- 2.17mm. The mesiodistal diameter of the maxillary central incisor was 8.85 +/- 0.59mm with a range of 7.60mm to 11.20mm. The results of this study was discussed against other findings on the Caucasian, Nigerian and Malay groups. The significance of artificial tooth selection for dentures was highlighted in relation to the results obtained from the study for the group of Chinese and other races.
    Matched MeSH terms: Singapore
  15. Fulltext Central obesity, insulin resistance, syndrome X, lipoprotein(a), and cardiovascular risk in Indians, Malays, and Chinese in Singapore
    Hughes K, Aw TC, Kuperan P, Choo M
    J Epidemiol Community Health, 1997 Aug;51(4):394-9.
    PMID: 9328546
    STUDY OBJECTIVE: To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is at least partly explained by central obesity, insulin resistance, and syndrome X (including possible components).
    DESIGN: Cross sectional study of the general population.
    SETTING: Singapore.
    PARTICIPANTS: Random sample of 961 men and women (Indians, Malays, and Chinese) aged 30 to 69 years.
    MAIN RESULTS: Fasting serum insulin concentration was correlated directly and strongly with body mass index (BMI), waist-hip ratio (WHR), and abdominal diameter. The fasting insulin concentration was correlated inversely with HDL cholesterol and directly with the fasting triglyceride concentration, blood pressures, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA), but it was not correlated with LDL cholesterol, apolipoproteins B and A1, lipoprotein(a), (Lp(a)), fibrinogen, factor VIIc, or prothrombin fragment (F)1 + 2. This indicates that the former but not the latter are part of syndrome X. While Malays had the highest BMI, Indians had a higher WHR (men 0.93 and women 0.84) than Malays (men 0.91 and women 0.82) and Chinese (men 0.91 and women 0.82). In addition, Indians had higher fasting insulin values and more glucose intolerance than Malays and Chinese. Indians had lower HDL cholesterol, and higher PAI-1, tPA, and Lp(a), but not higher LDL cholesterol, fasting triglyceride, blood pressures, fibrinogen, factor VIIc, or prothrombin F1 + 2.
    CONCLUSIONS: Indians are more prone than Malays or Chinese to central obesity with insulin resistance and glucose intolerance and there are no apparent environmental reasons for this in Singapore. As a consequence, Indians develop some but not all of the features of syndrome X. They also have higher Lp(a) values. All this puts Indians at increased risk of atherosclerosis and thrombosis and must be at least part of the explanation for their higher rates of CHD.
    Matched MeSH terms: Singapore
  16. Glutathione S transferase-theta (GSTT1) genetic polymorphism among Chinese, Malays and Indians in Singapore
    Lee EJ, Wong JY, Yeoh PN, Gong NH
    Pharmacogenetics, 1995 Oct;5(5):332-4.
    PMID: 8563775
    Glutathione S-transferase-theta (GSTT1) is subject to a genetic polymorphism where approximately 50% of a Caucasian population are homozygous for the null allele. Because of the possible association of the polymorphism with increased cancer risk in individuals, we genotyped by polymerase chain reaction 187 normal Chinese, 167 normal Malays and 152 normal Indians from Singapore and Malaysia. The proportion of Chinese, Malays and Indians with the null genotype were 58%, 38% and 16% respectively and mirrored previously reported frequencies of the GSTM1 null genotype in these populations. The frequency of the combined GSTM1 and GSTT1 null genotypes among Chinese, Malays and Indians were 37%, 22% and 5% respectively. The similarity with predicted frequencies indicated no interaction between the two genetic polymorphisms.
    Matched MeSH terms: Singapore
  17. Migration and development: a critical relationship
    Appleyard RT
    Asian Pac Migr J, 1992;1(1):1-18.
    PMID: 12317235
    "Wide income differentials, the threat of increased illegal immigration from developing countries, and sub-replacement fertility in the developed countries are some reasons for the recent reassessment of the relationship between migration and development.... The model presented in this article proposes different roles for permanent immigrants, contract workers, professional transients, illegal migrants and others according to the stages of modernization of the sending and receiving countries. The model was found consistent with the experiences of Mauritius, Seychelles, Singapore and, to a lesser extent, Malaysia."
    Matched MeSH terms: Singapore
  18. Respect redefined: focus group insights from Singapore
    Mehta K
    Int J Aging Hum Dev, 1997;44(3):205-19.
    PMID: 9248879
    This article re-examines the meaning of the concept of respect within the context of a fast modernizing Asian multicultural society-Singapore. Two key findings emerge. First, the meaning of respect both from the perspective of the aged and the middle-aged generation has shifted from obedience to courteous behavior. Second, in the majority of focus groups members concurred that the degree of respect accorded to elders has in general decreased. The focus group methodology was used in this research. Bearing in mind the limited sample size (88 participants) these findings alert us to the need for social scientists to monitor perceptual shifts in meaning of concepts critical in the sphere of interpersonal relationships. The findings throw light on the subjective views of intergenerational relations within the family as well as the community. As such, they would be valuable to counselors, social workers, and family therapists.
    Matched MeSH terms: Singapore
  19. Analysis of the D1S80 locus by amplified fragment length polymorphism technique in the Chinese, Malays and Indians in Singapore
    Chuah SY, Tan WF, Yap KH, Tai HE, Chow ST
    Forensic Sci Int, 1994 Oct 21;68(3):169-80.
    PMID: 7982636
    The distributions of the D1S80 alleles and genotypes in the Chinese, Malays and Indians in Singapore were determined by amplified fragment length polymorphism (AMP-FLP) analysis. The distributions of the observed genotypes for the three races conformed to Hardy-Weinberg expectations. The system was applied to 19 families whose paternity had been established by restriction fragment length polymorphism (RFLP) analysis. In all cases, Mendelian inheritance of the alleles at the D1S80 locus could be demonstrated. D1S80 typing on DNA recovered by differential extraction of forensic specimens which included vaginal swabs, urethral swabs and seminal stains yielded consistent results.
    Matched MeSH terms: Singapore
  20. Racial differences in perception of oral health and oral health behaviours in Singapore
    Soh G
    Int Dent J, 1992 Aug;42(4):234-40.
    PMID: 1399041
    Knowledge of prevention can influence preventive dental behaviours. This study surveyed knowledge and preventive dental behaviours on the prevention of dental caries and gum disease among the adult population of the three major racial groups in Singapore. Respondents were asked to rate the importance of several preventive measures against dental caries and gum disease. Questions were also fielded on dental behaviours such as preventive visits to the dentist, toothbrushing and flossing. Results showed that there was a general lack of appreciation for the use of flossing, dental sealants and fluoride supplements. Although a majority of respondents thought that regular dental checkups would be essential for prevention, the proportion who actually saw the dentist for preventive care was significantly lower. Respondents provided inappropriate reasons for brushing their teeth. Differences in both preventive knowledge and preventive dental behaviours among racial groups were evident although these were attributed to differences in education and exposure to product information rather than to racial or cultural factors.
    Matched MeSH terms: Singapore
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