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Process of care and prescribing practices for hypertension in public and private primary care clinics in Malaysia

Tong SF, Khoo EM, Nordin S, Teng CL, Lee VK, Zailinawati AH, et al.

Asia Pac J Public Health, 2012 Sep;24(5):764-75.
PMID: 21659332 DOI: 10.1177/1010539511402190

This study aimed to compare the process of care and the choice of antihypertensive medications used in both public and private primary care clinics in Malaysia. A cross-sectional survey was completed in 2008 on randomly selected 100 public health clinics and 114 private primary care clinics in Malaysia. A total of 4076 patient records, 3753 (92.1%) from public clinics and 323 (7.9%) from private clinics were analyzed. Less than 80% of the records documented the recommended clinical and laboratory assessments. The rates of documentation for smoking status, family history of premature death, retinal assessment, and urine albumin tests were lower in public clinics. Overall, 21% of the prescription practices were less than optimal. The process of care and the use of antihypertensive medications were not satisfactory in both settings.

Matched MeSH terms: China/ethnology
Prevalence of rubella susceptibility among pregnant mothers in a community-based antenatal clinic in Malaysia: a cross-sectional study

Cheong AT, Khoo EM

Asia Pac J Public Health, 2008;20(4):340-6.
PMID: 19124328 DOI: 10.1177/1010539508322698

INTRODUCTION: routine rubella antibody screening is not done for antenatal mothers in community health clinics in Malaysia. However, congenital rubella syndrome has persisted with its associated health burden.
OBJECTIVES: to determine the prevalence of rubella susceptibility among pregnant mothers and its associated risk factors.
METHODOLOGY: a cross-sectional study was carried out in the Petaling district, Selangor, Malaysia, where 500 pregnant mothers were recruited, and face-to-face interviews were conducted. Rubella IgG tests were performed.
RESULTS: the prevalence of rubella susceptibility among pregnant mothers was 11.4%. Using logistic regression, a history of not having received rubella vaccination or having unknown rubella vaccination status was found to be a significant predictor for mothers to be rubella susceptible (odds ratio = 2.691; 95% confidence interval = 1.539-4.207).
CONCLUSIONS: routine rubella IgG screening tests need to be offered to all antenatal mothers in view of the high prevalence found.
Study site: Antenatal clinics (klinik kesihatan), Petaling, Selangor, Malaysia

Matched MeSH terms: China/ethnology
Use of Alternative Medications for Menopause-Related Symptoms in Three Major Ethnic Groups of Ipoh, Perak, Malaysia

Ohn Mar S, Malhi F, Syed Rahim SH, Chua CT, Sidhu SS, Sandheep S

Asia Pac J Public Health, 2015 Nov;27(8 Suppl):19S-25S.
PMID: 25972428 DOI: 10.1177/1010539515586457

This cross-sectional study investigated the use of alternative medications to alleviate menopause-related symptoms among Malay, Chinese, and Indian women of Ipoh city. The prevalence, types, effectiveness, and associated factors were determined. The prevalence of alternative medication use was 41.4%. Evening primrose oil (EPO) was the most popular medication used (18.1%), followed by soy-based products (12.3%), green tea (6.8%), and gingko (5.8%). The medication was reported to be highly effective by 58.3% of soya bean diet users and 41.1% of EPO users. Significant variables associated with the use were Chinese or Indian ethnicity (P < .001), age between 50 and 54 years (P < .01), lower self-health rating (P < .05), education level of diploma or professional degree (P < .05), employment as professionals or entrepreneurs (P < .05), and the use of hormone replacement therapy (P < .05). Regression analysis showed that Chinese and Indians had significantly higher odds for the use than Malays (Chinese: odds ratio [OR] = 4.33, 95% confidence interval [CI] = 2.392-7.837; Indians: OR = 3.248, 95% CI = 1.586-6.654).

Matched MeSH terms: China/ethnology
Some enzyme polymorphisms in Malaysian mothers and their newborn

Yip MY, Dhaliwal SS, Yong HS

Hum Hered, 1979;29(1):5-9.
PMID: 761922

Four red cell enzyme systems were studied in Malaysian mothers and their newborn belonging to three racial groups, the Malays, Indians and Chinese. No significant heterogeneity was observed in the distribution of phosphoglucomutase (PGM1), adenosine deaminase (ADA), 6-phosphogluconate dehydrogenase (6PGD) and acid phosphatase (AP) phenotypes between mothers and their newborn of the three groups. Pooled mother and child acid phosphatase data show a significant heterogeneity between the Malays and Chinese, and between the Malays and Indians. This is comparable to previous studies conducted. For the placental phosphoglucomutase (PGM3) system, a significant heterogeneity was observed between the Chinese and Malays only. No significant heterogeneity was detected in the distribution of PGM1, ADA and 6PGD phenotypes among Malays, Chinese and Indians.

Matched MeSH terms: China/ethnology
T cell receptor beta chain RFLP in Chinese, Indians and Malays from Singapore

Tan JA, Tay JS, Aziz NB, Saha N

Hum Hered, 1996 Jul-Aug;46(4):236-8.
PMID: 8807327

Restriction fragment length polymorphism (RFLP) of the gene encoding the beta chain of the human T cell receptor (TcR) was studied in three ethnic groups in Singapore by Southern blotting. Polymorphism in the beta chain gene was identified in BglII-digested DNA samples using a 770-bp TcR beta cDNA clone containing the joining and constant region segments. The TcR beta/BglII polymorphism was studied in 136 Chinese, 93 Indian and 88 Malay samples. The frequency of the less frequent allele (TcR beta*2) in all the ethnic groups was significantly lower (0.15-0.29, p < 0.01) than that in the Caucasians (0.46). Indians had a significantly lower frequency of this allele (0.15) than the Chinese (0.29) and Malays (0.26).

Matched MeSH terms: China/ethnology
Linkage disequilibrium between two loci (5' untranslated exon 1 and intron 5-DdeI) of the antithrombin III gene in three ethnic groups in Singapore

Liu Y, Saha N, Low PS, Tay JS

Hum Hered, 1995 Jul-Aug;45(4):192-8.
PMID: 7558050

The distribution of two common DNA polymorphisms (5' untranslated exon 1 and intron 5-DdeI) of the antithrombin III (ATIII) gene was studied in three ethnic groups in Singapore: 251 Chinese, 221 Dravidian Indians and 102 Malays. The polymorphisms were identified by the polymerase chain reaction and size fractionation in agarose gels. The 5' untranslated to exon 1 polymorphism is a length polymorphism while the intron 5 polymorphism is a restriction site (DdeI) polymorphism. The frequency of the short fragment (S) of the 5' to exon 1 length polymorphism of the ATIII gene was found to be 0.37 in the Chinese, 0.54 in the Malays and 0.65 in the Dravidian Indians. For the Chinese, this was significantly lower compared to the Caucasians and Indians (p < 0.0001) and the Malays (p < 0.01). On the other hand, the frequencies of DdeI+ did not vary significantly among these three populations (p > 0.05). The distribution of different genotypes at these two loci of the ATIII gene was in Hardy-Weinberg equilibrium in all three ethnic groups. A strong linkage disequilibrium between these two polymorphisms was observed in all the ethnic groups and the estimated correlation coefficient (delta) was 0.42 in the Chinese (p < 0.001), 0.61 in the Dravidian Indians (p < 0.001) and 0.43 in the Malays (p < 0.001). The frequencies of haplotype S+, L+ and L- were, respectively, 0.37, 0.40 and 0.23 in the Chinese, 0.65, 0.18 and 0.16 in the Dravidian Indians and 0.54, 0.37 and 0.09 in the Malays.(ABSTRACT TRUNCATED AT 250 WORDS)

Matched MeSH terms: China/ethnology
Diabetes mellitus abolishes ethnic differences in cardiovascular risk factors: lessons from a multi-ethnic population

Tan CE, Emmanuel SC, Tan BY, Tai ES, Chew SK

Atherosclerosis, 2001 Mar;155(1):179-86.
PMID: 11223440 DOI: 10.1016/s0021-9150(00)00534-7

AIMS: To compare cardiovascular risk factors in diabetic subjects of different ethnic groups, and between new and known diabetic subjects, in the Singapore National Health Survey '92.

METHODS: Disproportionate stratified sampling followed by systematic sampling were used in 3568 (total) respondents of whom 2743 were non-diabetics, 179 newly diagnosed diabetics and 150 known diabetics. Amongst the diabetics, there were 185 Chinese, 66 Malays and 78 Asian Indians. Diagnosis of diabetes mellitus (DM) was based on the 2 h glucose alone, after a 75 g oral glucose tolerance test. Blood pressure (BP), lipid profile, glucose, insulin and anthropometric indices were obtained from all subjects.

RESULTS: Subjects with diabetes (new and known) exhibited significantly higher triglyceride (TG), lower high density lipoprotein cholesterol (HDL-C) and low density lipoprotein (LDL)/apolipoprotein B (apo B) ratio (LDL size) compared with normoglycaemic subjects. They were more obese (generalised and central) and had higher systolic and diastolic BP. There was no difference in lipid risk factors between the two groups with diabetes although those with new diabetes were more obese whilst those with known diabetes had higher fasting glucose. Amongst subjects with diabetes, there were no significant differences between ethnic groups in TG, HDL-C, LDL/apo B ratio, or waist to hip ratio (WHR). Female Malays with diabetes had higher total cholesterol and were more obese whilst male Asian Indians with diabetes had higher fasting insulin.

CONCLUSION: Asian Indians had lower HDL-C and LDL/apo B ratio than Chinese or Malays amongst normoglycaemic subjects. However, these differences between ethnic groups were not seen in subjects with DM.

Matched MeSH terms: China/ethnology
HPV vaccination is highly effective and cost-effective for cervical cancer prevention in women living with HIV in China: A cost-effectiveness analysis

Liu H, Zou M, Shen M, Kamarulzaman A, Chen S, Li J, et al.

Int J Cancer, 2025 Mar 15;156(6):1225-1235.
PMID: 39551969 DOI: 10.1002/ijc.35242

The presence of human immunodeficiency virus (HIV) infection increases the risk of acquiring human papillomavirus (HPV) infection and developing HPV-related adversities. We aimed to estimate the cost-effectiveness of HPV vaccination for women living with HIV in a Chinese setting. A decision-analysis Markov model was developed to estimate the cost-effectiveness of 36 HPV vaccination strategies for women living with HIV aged 18-45 years, from the healthcare system perspective. With the status quo, not vaccinating women living with HIV would lead to 51.99% (51,985/100,000) HIV-related deaths; 35.10% (35,098/100,000) would develop genital warts, 0.36% (355/100,000) develop cervical cancer, and among which 63.66% (226/355) die from cervical cancer over their lifetime (1,601,457 person-years). With a willingness to pay (WTP) threshold of three times gross domestic product (GDP), Gardasil 4 vaccination for all women living with HIV aged 18-45 years was the most cost-effective strategy (ICER = US $32,766/QALY gained). This strategy would reduce genital warts by 35.52% (12,467/35,098), cervical cancers by 12.96% (46/355), and cervical cancer deaths by 12.39% (28/226) over the lifetime of the cohort. If the future domestic Cecolin 9 vaccine is priced at 60% of Gardasil 9, vaccinating all women living with HIV aged 18-45 years with Cecolin 9 would be the most cost-effective strategy (ICER = US $30,493/QALY gained). Improving adherence to antiretroviral therapy for HIV may substantially improve the cost-effectiveness of both Gardasil 4 and Cecolin 9 vaccination.

Matched MeSH terms: China/epidemiology
Refractory seizures in a young army cohort

Loh NK, Lee WL, Yew WW, Tjia TL

Ann Acad Med Singap, 1997 Jul;26(4):471-4.
PMID: 9395813

This survey covered male Singapore citizens born in 1974 who were medically screened at the age of 18 years before enlistment for compulsory military service. Suspected epileptics were referred to government hospitals for further management. Out of 20,542 men, there were 121 epileptics, giving a cumulative incidence of 5 per 1000 by age 18 years. We had information on 106 (87%) of these individuals and were able to interview them and review their hospital records. Seventy-three of the 106 (69%) epileptics had generalised seizures while 14 (13%) had refractory seizures. There was no statistically significant racial bias amongst these epileptics. Unprovoked afebrile seizures occurred early in these patients, half of whom had seizures onset before 7 years of age. Nine refractory epileptics had a history of febrile seizures, 4 of which were complex febrile seizures. Magnetic resonance imaging identified mesial temporal sclerosis in 2 patients and a hypothalamic lesion in 1 patient. Computed tomographic scans revealed focal cortical atrophy in 2 patients. Nine other patients had normal imaging studies. Nine out of 14 (64%) patients with refractory epilepsy had partial seizures; 4 (29%) had generalised seizures and 1 (7%) was unclassified. This is in contrast to the distribution of the entire cohort of epileptics studied. Two out of 9 patients with refractory partial seizures (gelastic epilepsy and mesial temporal sclerosis) had undergone surgery while 6 of the other 7 patients refused to consider surgery.

Matched MeSH terms: China/ethnology
Plasma vitamins A, C and E in the general population of Singapore, 1993 to 1995

Hughes K, New AL, Lee BL, Ong CN

Ann Acad Med Singap, 1998 Mar;27(2):149-53.
PMID: 9663300

The National University of Singapore Heart Study measured cardiovascular risk factors, including selected plasma vitamins, on a random sample of the general population aged 30 to 69 years. Plasma vitamins A and E were normal and similar by ethnic group. Mean plasma vitamin A levels were: Chinese (males 0.68 and females 0.52 mg/L), Malays (males 0.67 and females 0.54 mg/L), and Indians (males 0.66 and females 0.51 mg/L). Mean plasma vitamin E levels were: Chinese (males 12.6 and females 12.6 mg/L), Malays (males 13.6 and females 13.3 mg/L), and Indians (males 12.9 and females 12.8 mg/L). No person had plasma vitamin A deficiency (< 0.01 mg/L) and only 0.1% had vitamin E deficiency (< 5.0 mg/L). In contrast, plasma vitamin C was on the low side and higher in Chinese than Malays and Indians. Mean plasma vitamin C levels were: Chinese (males 6.3 and females 8.4 mg/L), Malays (males 5.1 and females 6.4 mg/L), and Indians (males 5.7 and females 6.9 mg/L). Likewise, the proportions with plasma vitamin C deficiency (< 2.0 mg/L) were lower in Chinese (males 14.4 and females 0.7%), than Malays (males 19.7 and females 7.2%), and Indians (males 17.8 and females 11.0%). Relatively low levels of plasma vitamin C may contribute to the high rates of coronary heart disease and cancer in Singapore. In particular, lower plasma vitamin C in Malays and Indians than Chinese may contribute to their higher rates of coronary heart disease. However, plasma vitamin C does not seem to be involved in the higher rates of cancer in Chinese than Malays and Indians. The findings suggest a relatively low intake of fresh fruits and a higher intake is recommended. Also, food sources of vitamin C may be destroyed by the high cooking temperatures of local cuisines, especially the Malay and Indian ones.

Matched MeSH terms: China/ethnology
Clinical presentation and disease associations of gout: a hospital-based study of 100 patients in Singapore

Koh WH, Seah A, Chai P

Ann Acad Med Singap, 1998 Jan;27(1):7-10.
PMID: 9588267

The aim of this retrospective study was to characterise the clinical presentation and disease associations of Oriental patients with gout seen in our hospital over a six-month period. One hundred patients comprising of 77 males and 23 females [89% Chinese, 7% Malays, 2% Indians and 2% others; mean age was 50.9 years (range 18 to 82 years), mean age at onset of disease was 43.7 years (range 16 to 78 years)] were studied. The disease was familial in 18% and 44% of patients had a history of alcohol ingestion. Co-morbid conditions included hypertension (36%), hyperlipidaemia (25%), renal failure (17%), ischaemic heart disease (13%), diabetes mellitus (4%), systemic lupus erythematosus (3%), psoriasis (2%) and ankylosing spondylitis (1%). The majority of patients (68%) had at least one associated disease. At the onset of disease, the joints commonly involved were the ankles (39%) and knees (27%) whilst the first metatarsophalangeal (MTP) joint was affected in only 26% of cases. Polyarticular onset was uncommon (n = 6). The precipitating factors reported by the patients included food (n = 23), alcohol (n = 12), drugs (n = 4), trauma (n = 3) and surgery (n = 2). Eleven patients had a history of renal calculi and 15% had tophaceous gout. Majority of patients (71%) had been treated with urate-lowering drugs (allopurinol). We concluded that gout in Singapore predominantly affects middle-aged men who often have an accompanying illness.

Matched MeSH terms: China/ethnology
Ankylosing spondylitis in Singapore: a study of 150 patients and a local update

Koh WH, Boey ML

Ann Acad Med Singap, 1998 Jan;27(1):3-6.
PMID: 9588266

This paper presents the results of a clinical study of 150 patients in Singapore with ankylosing spondylitis (AS) and reviews recent developments locally with regards to the disease. The patients were predominantly males (ratio 7:1) and Chinese (n = 147). The onset of disease is usually in the early twenties and there was a mean delay of 6.3 years before diagnosis was made. Peripheral joint involvement is common but apart from uveitis (17%), extra-articular manifestations are rare. AS patients have abnormal lipid profiles and lower bone mineral density compared to healthy controls. HLA*B2704 is the predominant subtype in our Chinese patients whilst HLA*B2706 was found only in healthy controls. Intensive group physiotherapy is beneficial for patients with spondyloarthropathy.

Matched MeSH terms: China/ethnology
Incidence of ischaemic heart disease and stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study

Heng DM, Lee J, Chew SK, Tan BY, Hughes K, Chia KS

Ann Acad Med Singap, 2000 Mar;29(2):231-6.
PMID: 10895345

INTRODUCTION: This is the first prospective cohort study in Singapore to describe the incidence of ischaemic heart disease (IHD) and stroke among Chinese, Malays and Asian Indians.
MATERIALS AND METHODS: The Singapore Cardiovascular Cohort Study is a longitudinal follow-up study on a general population cohort of 5920 persons drawn from 3 previous cross-sectional surveys. Morbidity and mortality from IHD and stroke were ascertained by record linkage using a unique identification number with the death registry, Singapore Myocardial Infarct Registry and in-patient discharge databases.
RESULTS: There were 193 first IHD events and 97 first strokes during 52,806 person-years of observation. The overall incidence of IHD was 3.8/1000 person-years and that of stroke was 1.8/1000 person-years. In both males and females, Indians had the highest IHD incidence, followed by Malays and then Chinese. For males after adjusting for age, Indians were 2.78 times (95% CI 1.86, 4.17; P < 0.0001) and 2.28 times (95% CI 1.34, 3.88; P = 0.002) more likely to get IHD than Chinese and Malays respectively. For females after adjusting for age, Indians were 1.97 times (95% CI 1.07, 3.63; P = 0.03) and 1.37 times (95% CI 0.67, 2.80; P = 0.39) more likely to get IHD than Chinese and Malays respectively. For stroke, male Chinese and Indians had higher incidence than Malays (though not statistically significant). However, in females, Malays had the highest incidence of stroke, being 2.57 times (95% CI 1.31, 5.05; P = 0.008) more likely to get stroke than Chinese after adjustment for age.
CONCLUSIONS: This prospective study of both mortality and morbidity has confirmed the higher risk of IHD in Indians. It has also found that Malay females have a higher incidence of stroke, which deserves further study because of its potential public health importance.

Matched MeSH terms: China/ethnology
Activated protein C resistance: a study among 60 thromboembolic patients in the Singapore population

Lim LC, Tan HH, Lee LH, Tien SL, Abdul Ghafar A

Ann Acad Med Singap, 1999 Mar;28(2):252-5.
PMID: 10497677

Resistance to activated protein C (APC-R) is the commonest inherited cause of thrombosis among Caucasians. Few studies have been carried out on its prevalence in Asians. We conducted a prospective study on 60 patients with thromboembolism to determine its prevalence in our local population. The Factor V Leiden (VaQ506) mutation associated with this condition was detected by amplification of the Factor V gene by polymerase chain reaction (PCR) and digestion of the fragment with Mnl I. Three patients were found to be heterozygous for this mutation. None of the 3 patients had other concomitant hypercoagulable states. In addition, we studied the prevalence of this condition in Malays which was found to be 0.5%. Our study suggests that the incidence of APC-R is much lower here compared to the West.

Matched MeSH terms: China/ethnology
A study of joint mobility in a normal population

Seow CC, Chow PK, Khong KS

Ann Acad Med Singap, 1999 Mar;28(2):231-6.
PMID: 10497673

Joint hypermobility is a clinical entity that has been little studied in Southeast Asia in contrast to the many studies that have been conducted in the West. A pioneer study was conducted in Singapore involving 306 subjects from the three major races i.e. Chinese, Malays and Indians. Their ages ranged from 15 to 39 years. The objective was to ascertain the joint mobility profile in a study sample representative of the Singapore population and the prevalence of joint hypermobility amongst normal individuals. Joint mobility was assessed using criteria according to Carter and Wilkinson modified by Beighton et al. The distribution of the three major races in the study sample was based on the 1990 census of the Singapore population. The prevalence of joint hypermobility was found to be 17%. The results showed that joint mobility decreases with age and that females had consistently higher degree of joint mobility compared to males throughout the age group. Among the racial groups, Malays had the highest degree of joint mobility followed by Indians and Chinese.

Matched MeSH terms: China/ethnology
Measuring health-related quality of life in Singapore: normal values for the English and Chinese SF-36 Health Survey

Thumboo J, Chan SP, Machin D, Soh CH, Feng PH, Boey ML, et al.

Ann Acad Med Singap, 2002 May;31(3):366-74.
PMID: 12061299

OBJECTIVE: To determine norms for assessing Health-related Quality of Life (HRQOL) in Singapore using the Short Form 36 Health Survey (SF-36).
MATERIALS AND METHODS: Mean SF-36 scores were calculated for 24 population subgroups (categorised by age, gender, ethnicity and questionnaire language) and for subjects with self-reported co-morbid conditions using data from a community-based survey in Singapore.
RESULTS: The English and Chinese SF-36 was completed by 4122 and 1381 subjects, respectively, 58% (n = 3188) of whom had self-reported co-morbid conditions. SF-36 scores varied in subgroups differing in age, gender and ethnicity. In general, subjects with self-reported co-morbid conditions had lower SF-36 scores than those without these conditions, the magnitude of which exceeded 20 points in several instances. A method for calculation of SF-36 scores adjusted for age, gender, ethnicity and questionnaire language is described.
CONCLUSION: We present norms for English and Chinese SF-36 versions in Singapore and describe potential uses for these data in assessing HRQOL in Singapore.

Matched MeSH terms: China/ethnology
Prevalence and determinants of cervical cancer screening: a community-based study in Singapore

Seow A, Lee HP

Ann Acad Med Singap, 1994 May;23(3):342-7.
PMID: 7944247

A cross-sectional survey of 568 married women aged 21-65 years in the Pasir Panjang Constituency was conducted to determine the prevalence of cervical cancer screening in the community and the factors affecting acceptance of this screening test. Results show that 309 (54.4%) of the respondents had ever had a Pap smear. The women who reported having had a smear were more likely to be below 45 years of age (prevalence ratio 1.47, 95% confidence interval 1.15 to 1.88), Chinese and of a higher socioeconomic status (1.68, 1.33 to 2.12). They were also more likely to have married at a later age (1.68, 1.21 to 2.31) than women who had not had a smear. Age and socioeconomic status remained independent predictors on multivariate analysis. The findings suggest that an important task of public health practitioners is to increase the uptake of screening among older and socially disadvantaged women who are known to be at the highest risk of cervical cancer. In addition, strategies to encourage younger women to continue regular attendance at screening clinics beyond their childbearing years will be important for the future.

Matched MeSH terms: China/ethnology
Measuring quality of life in different cultures: translation of the Functional Living Index for Cancer (FLIC) into Chinese and Malay in Singapore

Goh CR, Lee KS, Tan TC, Wang TL, Tan CH, Wong J, et al.

Ann Acad Med Singap, 1996 May;25(3):323-34.
PMID: 8876896

Quality-of-life assessment has become an accepted method of evaluation in clinical medicine. The technique is based on a patient's self-assessment of physical, psychological, and social function, as well as the effects of distressing physical symptoms. The most important aspect of quality-of-life assessment is that it brings into focus a patient-centred view of health outcome, which is broader than the physiologic measures which predominate in Western medicine. Strategies for the development and use of assessment questionnaires have evolved over the past 15 years, and numerous questionnaires have been created. Most originate in Western societies, with English as the most common language of development. Adapting such questionnaires for use in other language and cultural settings is an imprecise practice. Language translation and equivalent cultural meaning must both be addressed. This paper reports on the language translation process and results for the Functional Living Index for Cancer (FLIC) as translated into Chinese and Malay in Singapore. We employed a step-wise process beginning with translation/back translation, followed by structured pilot field trials and population sampling. Taped versions of the questionnaire were devised to meet illiteracy problems in the sample population. Paired comparisons of the Chinese and Malay versions of individual questions with their English counterparts show good correlations and similar means most of the time. Factor analysis on a population sample of 246 (112 Chinese, 35 Malay and 98 English speaking) with cancers of minimal, extensive or palliative extent is convergent with that obtained on a North American population. However, a separate analysis of the Chinese questionnaires showed some differences in factor pattern. Specific language and cultural translation difficulties are discussed. Of note is the predicted significant decrease in total FLIC scores with extent of disease within each of the language preference populations, which provides some evidence for the validity for each language version in the Singapore culture(s). Thus, the FLIC translations into Malay and Chinese in Singapore can be considered for use in local trials, subject to ongoing evaluation.

Matched MeSH terms: China/ethnology
Hepatitis B surveillance in Singapore

Goh KT

Ann Acad Med Singap, 1980 Apr;9(2):136-41.
PMID: 6775577

257 cases of acute hepatitis B were reported between January 1977 and June 1979. This constituted about one-third of all reported acute viral hepatitis cases in Singapore. The mean annual morbidity and mortality rates per 100,000 was 4.4 and 0.12 respectively. The case-fatality rate was 2.7%. The age-specific morbidity rates were high in the 15-24 and 25-34 years age groups, while the ethnic specific morbidity rate was highest in Indians. The male to female ratio was 4.6: 1. Cases were concentrated in urban and suburban areas with high population density. Three outbreaks, one traced to contaminated needles and syringes, one to contaminated tattoo neeedles, and amongst close contacts, were described. Although parenteral procedures were associated with hepatitis B infection (p < 0.005), non-parenteral or inapparent parenteral mode of transmission probably contributes to a significant extent in the transmission of hepatitis B in Singapore. Studies to determine the role of perinatal transmission, and of vectors, in maintaining the endemicity of the disease, were suggested.

Matched MeSH terms: China/ethnology
Findings among 100 type 2 diabetics in a clinic in Penang, Malaysia, 1983-84

Merriman A, Ross I

Ann Acad Med Singap, 1985 Apr;14(2):277-85.
PMID: 4037686

A Specialist Clinic was commenced in August 1983, from the Medical School at Universiti Sains Malaysia, Penang, Malaysia to assess: 1) the present control and 2) the incidence of complications in a diabetic population already receiving primary health care at Penang General Hospital. The ethnic groups among the diabetics were Chinese (39%), Malays (26%) and Indian (35%). There was a greater percentage of Indians than would be expected from the ethnic distribution of the population of Penang. The results of the first 100 (43 males and 57 females) non-insulin dependent diabetic patients are reviewed. The mean age was 54 years, 41% had relatives with diabetes, and all were taking oral agents. The diet comprehension and compliance were poor. 65% of the group, 54% of males and 75% of females were obese. The mean blood glucose was 11 m.mols/l (fasting) and 12.8 m.mols/1 (2 hours post prandial). The complications seen in the 100 diabetics were: albuminurea 41, skin infection 37, cataracts 35, hypertension 32, peripheral sensory neuropathy 32, retinopathy 22, ischaemic heart disease 19, autonomic neuropathy 10, impaired renal function 4 (urea or creatinine elevated), foot ulcer 2 and gangrene 1. Urinalysis for glucose at the Clinic showed very little correlation with blood glucose at the same time. Nine out of 43 males admitted to impotence on questioning. Comparisons of findings in Penang were made with recent studies in Singapore and Hong Kong.

Matched MeSH terms: China/ethnology

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