Epidemiology of acute hepatitis E in Singapore.

Objectives: We undertook an epidemiological review to determine the trend and characteristics of acute hepatitis E in Singapore over the last 12 years.

Methods: We analysed the epidemiological records of all laboratory-confirmed cases of acute hepatitis E maintained at the Communicable Diseases Division, Ministry of Health, from 2000 to 2011.

Results: A total of 540 laboratory-confirmed cases of acute hepatitis E was reported with more than half imported, mainly from India and Bangladesh.

Certification of poliomyelitis eradication in Singapore and the challenges ahead.

Introduction: This study reviewed the epidemiological trends of poliomyelitis from 1946 to 2010, and the impact of the national immunisation programme in raising the population herd immunity against poliovirus. We also traced the efforts Singapore has made to achieve certification of poliomyelitis eradication by the World Health Organisation.

Materials And Methods: Epidemiological data on all reported cases of poliomyelitis were obtained from the Communicable Diseases Division of the Ministry of Health as well as historical records.

Determinants of late-stage HIV disease at diagnosis in Singapore, 1996 to 2009.

Introduction: The delay in HIV diagnosis has been identified as a significant reason for late presentation to medical care. This research aims to elucidate the significant determinants of late-stage HIV infection in Singapore between 1996 and 2009, after the advent of highly active anti-retroviral therapies.

Materials And Methods: We included 3735 patients infected via sexual mode of transmission from the National HIV Registry diagnosed between 1996 and 2009.

Distribution of ankle--brachial index and the risk factors of peripheral artery disease in a multi-ethnic Asian population.

Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis and is associated with increased cardiovascular morbidity and mortality. We describe the prevalence and risk factors of PAD in a multi-ethnic Asian population (Chinese, Malays and Indians) in Singapore. The Singapore Prospective Study Program recruited 4132 individuals between 2004 and 2006 in which the ankle-brachial index (ABI) was measured using the Smartdop™ 20EX bi-directional blood flow detector.

Changing seroprevalence of hepatitis B virus markers of adults in Singapore.

Introduction: We presented the findings from 2 seroprevalence studies conducted 6 years apart, so as to determine changes in the hepatitis B surface antigen (HBsAg) positivity rate and immunity to hepatitis B virus (HBV) among Singapore residents aged 18 to 69 years, and to assess the impact of a 4-year catch-up hepatitis B immunisation programme for adolescents and young adults launched in 2001.

Materials And Methods: Two hepatitis B seroprevalence studies (HBSS) were conducted in 1999 and 2005 based on stored blood samples collected from 4698 participants aged 18 to 69 years during the national health survey (NHS) 1998 and from 3460 participants during the NHS 2004, respectively. Serology for HBsAg, hepatitis B e antigen (HBeAg) and antibody to HBsAg (anti-HBs) were tested by enzyme immunoassay in HBSS 1999 and electrochemiluminescence in HBSS 2005.

Polymorphisms identified through genome-wide association studies and their associations with type 2 diabetes in Chinese, Malays, and Asian-Indians in Singapore.

Context: Novel type 2 diabetes mellitus (T2DM) susceptibility loci, identified through genome-wide association studies (GWAS), have been replicated in many European and Japanese populations. However, the association in other East Asian populations is less well characterized.

Objective: To examine the effects of SNPs in CDKAL1, CDKN2A/B, IGF2BP2, HHEX, SLC30A8, PKN2, LOC387761, and KCNQ1 on risk of T2DM in Chinese, Malays, and Asian-Indians in Singapore.

Where the elderly die: the influence of socio-demographic factors and cause of death on people dying at home.

Introduction: The place of death of the elderly has implications on the overall healthcare delivery system. The aim of this study is to describe where deaths of elderly occur in Singapore and to determine the association of socio-demographic characteristics and the causes of death on dying at home.

Materials And Methods: Data of 10,399 Singapore resident decedents aged 65 years and above in 2006 were obtained from the national Registry of Births and Deaths.

Seroepidemiology of dengue virus infection among adults in Singapore.

Introduction: To determine the seroepidemiology of dengue virus infection in a representative sample of the adult resident population aged 18 years old to 74 years old in Singapore and to estimate the proportion of asymptomatic dengue infection during the 2004 epidemic.

Materials And Methods: The study was based on 4152 stored blood samples collected between September and December 2004 from participants aged 18 years old to 74 years old during the 2004 National Health Survey. Sera were tested for IgG and IgM antibodies using a commercial test kit (PanBio Capture/Indirect ELISA).

Association between glucokinase regulatory protein (GCKR) and apolipoprotein A5 (APOA5) gene polymorphisms and triacylglycerol concentrations in fasting, postprandial, and fenofibrate-treated states.

Background: Hypertriglyceridemia is a risk factor for cardiovascular disease. Variation in the apolipoprotein A5 (APOA5) and glucokinase regulatory protein (GCKR) genes has been associated with fasting plasma triacylglycerol.

Objective: We investigated the combined effects of the GCKR rs780094C-->T, APOA5 -1131T-->C, and APOA5 56C-->G single nucleotide polymorphisms (SNPs) on fasting triacylglycerol in several independent populations and the response to a high-fat meal and fenofibrate interventions.

A family history of type 2 diabetes is associated with glucose intolerance and obesity-related traits with evidence of excess maternal transmission for obesity-related traits in a South East Asian population.

Aim: To evaluate family history (FH) of type 2 diabetes (T2DM) as a risk factor for impaired fasting glucose (IFG), impaired glucose tolerance (IGT), T2DM and related metabolic traits in South East Asia and to compare the effects of a paternal versus maternal history.

Methods: We studied 4717 men and women (68% Chinese, 18% Malays and 14% Asian Indians) living in Singapore. FH was considered positive if at least one first degree relative had T2DM.

FTO variants are associated with obesity in the Chinese and Malay populations in Singapore.

Objective: Association between genetic variants at the FTO locus and obesity has been consistently observed in populations of European ancestry and inconsistently in non-Europeans. The aim of this study was to examine the effects of FTO variants on obesity and type 2 diabetes in Southeast Asian populations.

Research Design And Methods: We examined associations between nine previously reported FTO single nucleotide polymorphisms (SNPs) with obesity, type 2 diabetes, and related traits in 4,298 participants (2,919 Chinese, 785 Malays, and 594 Asian Indians) from the 1998 Singapore National Health Survey (NHS98) and 2,996 Malays from the Singapore Malay Eye Study (SiMES).

Influence of pre-hypertension on all-cause and cardiovascular mortality: the Singapore Cardiovascular Cohort Study.

Background: The effect of "pre-hypertension" (pre-HTN) itself, and in combination with other cardiovascular disease (CVD) risk factors in relation to mortality has not been assessed in Asian populations.

Methods: From three cross-sectional studies conducted in Singapore (baseline 1982-1995), 5830 persons were grouped into normotensive (NT), pre-HTN or hypertensive (HTN). Follow-up (median 12.

A systematic review of the effectiveness of Tai Chi on fall reduction among the elderly.

Falls among the elderly is a major public health concern. There has been recent extensive research on the effects of Tai Chi in fall prevention among the elderly. As such, we undertook a systematic review to look for evidence on the effect of this intervention.

The metabolic syndrome and mortality: the Singapore Cardiovascular Cohort Study.

Objective: This study assesses the effect of the metabolic syndrome on all-cause and cardiovascular disease (CVD) mortality in healthy Chinese, Malays and Asian Indians in Singapore. The utility of the metabolic syndrome is also compared with the Framingham risk score for prediction of mortality.

Methods: Healthy participants (n = 5699) were grouped by the presence or absence of the metabolic syndrome, and followed up (mean 14.

Gender, ethnicity, health behaviour & self-rated health in Singapore.

Background: Self-rated health and the factors that influence it have never been described in Singapore before. This paper presents a descriptive study of self-rated health in a nationally representative cross-sectional survey of 6236 persons.

Methods: As part of the National Health Surveillance Survey 2001, 6236 subjects aged 18 years and above were interviewed in the homes of participants by trained interviewers.

Impact of sex, metabolic syndrome, and diabetes mellitus on cardiovascular events.

Although cardiovascular events occur more frequently among patients with metabolic syndrome (MS) or diabetes mellitus (DM), the impact of gender is unclear. We aimed to determine the relation of MS and DM on cardiovascular events between men and women. The National Health Survey of 1992 provided information on outcomes for 3,414 Singaporeans aged 18 to 69 years without cardiovascular diseases.

Risk factors for contact lens-related fusarium keratitis: a case-control study in Singapore.

Objective: To evaluate the specific contact lens-related or other factors that may contribute to the outbreak of Fusarium keratitis.

Methods: A case-control study was conducted of Fusarium keratitis in contact lens users in Singapore from March 1, 2005, to May 31, 2006, and included 61 patients with Fusarium keratitis and 188 population-based and 179 hospital-based control subjects. Interviewers asked about contact lens solution use and other risk factors.

Trends in alcohol consumption in Singapore 1992 2004.

Aims: To present trends in alcohol consumption between 1992 and 2004 in Singapore.

Methods: Alcohol consumption data were derived from national health surveys conducted in 1992, 1998 and 2004. Age-adjusted prevalence of frequent (drinking 1-4 days a week), regular (drinking more than 4 days a week) and binge (having five or more drinks during a drinking session at least once in the month) drinking by gender and age group for the three surveys were compared.

Should central obesity be an optional or essential component of the metabolic syndrome? Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study.

Objective: The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD).

Research Design And Methods: From the population-based cohort study (baseline 1992-1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.

The impact of central obesity as a prerequisite for the diagnosis of metabolic syndrome.

Objective: To compare the prevalence of metabolic syndrome (MS) defined according to the American Heart Association (AHA)/National Heart Lung and Blood Institute (NHLBI) and the International Diabetes Federation (IDF) and to determine the effect of the presence of central obesity on the phenotype (insulin resistance and other cardiovascular risk factors) associated with MS.

Research Methods And Procedures: We studied 4723 Chinese, Malays, and Asian Indians living in Singapore. Each individual was categorized according to the five criteria for MS as defined by the AHA/NHLBI and the IDF.

Societal learning in epidemics: intervention effectiveness during the 2003 SARS outbreak in Singapore.

Background: Rapid response to outbreaks of emerging infectious diseases is impeded by uncertain diagnoses and delayed communication. Understanding the effect of inefficient response is a potentially important contribution of epidemic theory. To develop this understanding we studied societal learning during emerging outbreaks wherein patient removal accelerates as information is gathered and disseminated.

Epidemiology and control of SARS in Singapore.

Severe acute respiratory syndrome (SARS) was imported into Singapore in late February 2003 by a local resident who returned from a holiday in Hong Kong and started an outbreak in the hospital where she was admitted on 1 March 2003. The disease subsequently spread to 4 other healthcare institutions and a vegetable wholesale centre. During the period between March and May 2003, 238 probable SARS cases, including 8 imported cases and 33 deaths, were reported.

A 24-year review on the epidemiology and control of measles in Singapore, 1981-2004.

The objective of our paper is to review the epidemiology of measles in Singapore and the impact of the measles vaccination program on the control of measles. Our review will form the basis for a critical appraisal of our future measles control program. We analyzed the trend of reported measles cases in relationship to measles vaccination coverage from 1981 to 2004 using routine measles notifications and measles vaccination data submitted to the Ministry of Health and the National Immunization Registry, respectively.