Chia Ks

Cancer survival in Africa, Asia, and Central America: a population-based study

BACKGROUNDnPopulation-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions.nnnMETHODSnSurvival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined.nnnFINDINGSnFor cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76-82% for breast cancer, 63-79% for cervical cancer, 71-78% for bladder cancer, and 44-60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services.nnnINTERPRETATIONnThe wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources.nnnFUNDINGnAssociation for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA).

Angiotensin-I converting enzyme insertion/deletion polymorphism and its association with diabetic nephropathy: a meta-analysis of studies reported between 1994 and 2004 and comprising 14,727 subjects

Aims/hypothesisThe ACE insertion/deletion polymorphism has been examined for association with diabetic nephropathy over the past decade with conflicting results. To clarify this situation, we conducted a comprehensive meta-analysis encompassing all relevant studies that were published between 1994 and 2004 and investigated this potential genetic association.MethodsA total of 14,727 subjects from 47 studies was included in this meta-analysis. Cases (n=8,663) were type 1 or 2 diabetic subjects with incipient (microalbuminuria) or advanced diabetic nephropathy (proteinuria, chronic renal failure, end-stage renal disease). Control subjects (n=6,064) were predominantly normoalbuminuric.ResultsNo obvious publication bias was detected. Using a minimal-case definition based on incipient diabetic nephropathy, subjects with the II genotype had a 22% lower risk of diabetic nephropathy than carriers of the D allele (pooled odds ratio [OR]=0.78, 95% CI=0.69–0.88). While there was a reduced risk of diabetic nephropathy associated with the II genotype among Caucasians with either type 1 or type 2 diabetes, the association was most marked among type 2 diabetic Asians (Chinese, Japanese, Koreans) (OR=0.65, 95% CI=0. 51–0.83). This OR is significantly different from the OR of 0.90 (95% CI= 0.78–1.04) that was obtained for type 2 diabetic Caucasians (p=0.019). Using a stricter case definition based on advanced diabetic nephropathy, a comparable risk reduction of 24–32% was observed among the three subgroups, although statistical significance was reached only among Asians.Conclusions/interpretationThe results of our meta-analysis support a genetic association of the ACE Ins/Del polymorphism with diabetic nephropathy. These findings may have implications for the management of diabetic nephropathy using ACE inhibitors especially among type 2 diabetic Asians.

Basal cell carcinoma, squamous cell carcinoma and melanoma of the skin: analysis of the Singapore Cancer Registry data 1968–97

Summary Backgroundu2003There has been an alarming recent increase in skin cancer incidence among fair‐skinned populations. Information from Asian populations is less readily available.

Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore

Aims/hypothesisThe aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups.MethodsRegistry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2xa0years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression.ResultsDiabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77–7.12) in Asian Indians and 3.07 (95% CI 1.86–5.06) in Chinese (pu2009=u20090.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk.Conclusions/interpretationAsian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.

The relation between birth size and the results of refractive error and biometry measurements in children

Aim: To examine the association of birth parameters with biometry and refraction in Singapore Chinese schoolchildren. Methods: Chinese children aged 7–9 years (nu200a=u200a1413) from three schools in Singapore were recruited. Birth parameter information on birth weight, head circumference, length at birth, and gestational age were obtained from standard hospital records. Cycloplegic autorefraction, keratometry and biometry measures (axial length, vitreous chamber depth, lens thickness, and anterior chamber depth) were obtained. Results: Across the normal birthweight range (2.0–4.9 kg), children with birth weights ⩾4.0 kg had longer axial lengths (adjusted mean 23.65 mm versus 23.16 mm), compared with children with birth weights <2.5 kg, after controlling for age, sex, school, height, parental myopia, and gestational age. For every 1 cm increment in head circumference at birth, the axial length was longer by 0.05 mm. For every 1 cm increment in birth length, the axial length was longer by 0.02 mm in multivariate analysis. Additional week increases in gestational age till 46 weeks resulted in axial lengths that were longer by 0.04 mm, controlling for age, sex, school, parental myopia, and height. Children with larger birth weights, head circumferences, birth lengths, or gestational ages had deeper vitreous chambers and larger corneal curvature radii; however, there were no significant associations with refraction. Conclusions: Children who were born heavier, had larger head sizes or lengths at birth, or who were born more mature had longer axial lengths, and deeper vitreous chambers; but there were no differences in refraction at ages 7–9 years, possibly because of the observed compensatory flattening of the cornea.

Childhood myopia and parental smoking

Aim: To examine the relation between exposure to passive parental smoke and myopia in Chinese children in Singapore. Methods: 1334 Chinese children from three schools in Singapore were recruited, all of whom were participants in the Singapore Cohort study Of the Risk factors for Myopia (SCORM). Information on whether the father or mother smoked, number of years smoked, and the number of cigarettes smoked per day during the child’s lifetime were derived. These data were correlated with contemporaneously obtained data available in SCORM. The children’s cycloplegic autorefraction, corneal curvature radius, and biometry measures were compared with reported parental smoking history. Results: There were 434 fathers (33.3%) and 23 mothers (1.7%) who smoked during their child’s lifetime. There were no significant trends observed between paternal smoking and refractive error or axial length. After controlling for age, sex, school, mother’s education, and mother’s myopia, children with mothers who had ever smoked during their lifetime had more “positive” refractions (adjusted mean −0.28 D v −1.38 D) compared with children whose mother did not smoke (pu200a=u200a0.012). Conclusions: The study found no consistent evidence of association between parental smoking and refractive error. There was a suggestion that children whose mothers smoked cigarettes had more hyperopic refractions, but the absence of a relation with paternal smoking and the small number of mothers who smoked in this sample preclude definite conclusions about a link between passive smoking exposure and myopia.

Population-based cancer survival in Singapore, 1968 to 1992: An overview

The Singapore Cancer Registry has provided comprehensive population‐based incidence data since 1968. This paper describes the population‐based survival analysis of the registry data. All invasive primary cancers diagnosed from January 1, 1968 to December 31, 1992 were passively followed up until December 31, 1997. Only 5.8% were lost to follow‐up. Cumulative and observed survival rates were calculated using Hakulinens method. Overall 5‐year relative survival rates have increased dramatically over the 25‐year period in both genders. Significant increases are seen with nasopharynx, stomach and colo‐rectum cancers, non‐Hodgkins lymphoma, leukemias and cancers of the testis, cervix, ovaries and breast. When compared with the Surveillance, Epidemiology and End Results (SEER) rates in the United States, the 5‐year relative survival rates in Singapore are generally lower. However, the rate of change between the two countries is fairly similar. On the average, the rates are 10 to 15 years behind the SEER rates and 5 to 10 years behind Finland, Switzerland and Japan, but they are close to the UK rates. The age‐standardized 5‐year survival rate for Singapore is higher for most sites compared with other developing countries like Qidong (China), Madras (India), Bombay (India) and Chiang Mai (Thailand). The 25‐year trend in cancer survival in Singapore showed two extreme groups: those showing no change and those showing significant improvements. Reducing the incidence of cancers belonging to the first group remains the only viable mode of cancer control. For cancers in the second group, improvement in survival is due to a combination of successful early detection measures and effective treatment services in Singapore.

Ethnic disparities in risk of cardiovascular disease, end-stage renal disease and all-cause mortality: a prospective study among Asian people with Type 2 diabetes.

To study prospectively the ethnic‐specific risks of cardiovascular disease, end‐stage renal disease and all‐cause mortality in patients with Type 2 diabetes mellitus among native Asian subpopulations.

Microarray analysis of multiple candidate genes and associated plasma proteins for nephropathy secondary to type 2 diabetes among Chinese individuals

Aims/hypothesisEvolving research suggests that common and rare alleles jointly constitute the genetic landscape of complex disease. We studied the association between 43 pathway-related candidate genes with ‘intermediate phenotype’ (i.e. corresponding plasma protein) and diabetic nephropathy in a customised microarray of 1,536 SNPs.MethodsIn this case–control study of type 2 diabetic Chinese individuals with and without diabetic nephropathy, cases (nu2009=u2009545) were defined on the basis of a spot urinary albumin/creatinine ratio (ACR)u2009>u2009113xa0mg/mmol; the value for controls (nu2009=u2009503) was ACRu2009<u20093.3xa0mg/mmol. Genotyping was performed using Illumina GoldenGate assay.ResultsNo single nucleotide polymorphism (SNP) remained significant in single locus analysis after correction for multiple testing. Therefore, we explored the best ∼1% SNPs. Of these 13 SNPs, four clustered to a 5′ end NADPH oxidase homologue 4 (NOX4) haplotype (GGCC frequencyu2009=u20090.776) with estimated OR for diabetic nephropathy of 2.05 (95% CI 1.04–4.06) (heterozygous) and 2.48 (1.27–4.83) (homozygous) (pu2009=u20090.0055). The haplotype was correlated with plasma Cu/Zn superoxide dismutase (SOD) concentration, suggesting increased oxidative burden. Endothelin-1 SNP (rs1476046G>A, frequencyu2009=u20090.252) was correlated with plasma C-terminal pro-endothelin-1 concentrations with an estimated OR for diabetic nephropathy of (heterozygous) 1.26 (0.96–1.66) and (homozygous) 1.87 (1.13–3.12) (pu2009=u20090.0072). Nitric oxide synthase 1 (NOS1) 5′ haplotype (TGTC frequencyu2009=u20090.38) also revealed a suggestive association with diabetic nephropathy: heterozygous 1.26 (0.95–1.67), homozygous 1.57 (1.04–2.35) (pu2009=u20090.0073). A rare NADPH oxidase homologue 1 (NOX1)-coding non-synonymous SNP (Arg315His, frequencyu2009=u20090.006) was found exclusively among cases.Conclusions/interpretationOur preliminary observations suggest that common haplotypes from NOX4 and endothelin-1 SNP correlated with plasma Cu/Zn SOD and C-terminal pro-endothelin-1 concentrations, respectively, and might have conferred diabetic nephropathy susceptibility. Common NOS1 and rare NOX1 variants also revealed a suggestive association with diabetic nephropathy. Future studies to validate our observation are needed.

Occupational health in national development

Part 1 Occupational health issues in national development: occupational health and national development, J. Jeyaratnam environment concerns of industrialization - eastern European experience, G. Unguary transfer of technology - issues and solutions, J. LaDou and J. Jeyaratnam risk assessment, E. Smith role of occupational health legislation, W.H. Phoon and H.S. Lee setting of environmental standards, J. Indulski occupational health services for small-scale industries, D. Koh acute pesticide poisoning, J. Jeyaratnam making pesticides safer, W. Tordoir occupational health services for agricultural workers, K. Husman risk of hepatitis and AIDS among health professionals, S.K. Chew occupational health services for health care workers, J.F. Cailard health concerns of women at work, D. Koh and S.E. Chia health problems of office workers, C.N. Ong stress among office workers, L.K. Tay executive health screening, S.M. Lee and K. Koh occupational cancers and cancer prevention strategies, K.S. Chia role of a cancer registry in the prevention of cancer, H.P. Lee health promotion at the workplace, D. Koh et al. Part 2 Developing national health plans for the working population: primary health care approach in occupational health services, S.L. Ling and J. Jeyaratnam systems approach in national health planning, K.H. Phua evaluation of current status of occupational health services, K. Kurrpa identification of national occupational health needs, J. Rantanen manpower and organizational needs, J. Jeyaratnam evaluation of occupational health services, K.H. Phua and J.F Cailard examples of national occupational health services, V. Bencko et al role of international agencies in national occupational health services, L.S. Wang.