Sharon Wee

The Prevalence, Symptom Characteristics, and Impact of Irritable Bowel Syndrome in an Asian Urban Community

OBJECTIVE:To study the epidemiology, symptom characteristics and impact of IBS in an urban Asian population.METHODS:A validated bowel symptom questionnaire was administered at face-to-face interviews to a random sample of 3,000 households in Singapore.RESULTS:The response rate was 78.2% (n = 2,276, 1,143 males and 1,133 females). The age, sex, and racial distribution of our respondents were similar to the general population and there was no significant difference between respondents and nonrespondents by type of household. The prevalence of IBS was 11.0%, 10.4%, and 8.6% by Manning (>1 criteria), Rome I and Rome II criteria, respectively. There was a higher prevalence of IBS in those <50 years of age (9.7%vs 5.8% 50 or > years, p = 0.002), with more than 6 years of education (9.8%vs 5.9% 6 year or <, p = 0.002) and living in landed property (16.8%vs 8.2% living in apartments and public housing, p = 0.008). There was no striking preponderance of female IBS subjects. Chronic constipation was a more common bowel disturbance than chronic diarrhea among our IBS subjects (51.0%vs 12.8%).CONCLUSIONS:The prevalence and impact of IBS in our Asian urban society are greater than previously appreciated. We believe that our results provide a useful window to the future trends of gastrointestinal diseases for health and education authorities in developing Asian countries to look into.

Deep whole-genome sequencing of 100 southeast Asian Malays.

Whole-genome sequencing across multiple samples in a population provides an unprecedented opportunity for comprehensively characterizing the polymorphic variants in the population. Although the 1000 Genomes Project (1KGP) has offered brief insights into the value of population-level sequencing, the low coverage has compromised the ability to confidently detect rare and low-frequency variants. In addition, the composition of populations in the 1KGP is not complete, despite the fact that the study design has been extended to more than 2,500 samples from more than 20 population groups. The Malays are one of the Austronesian groups predominantly present in Southeast Asia and Oceania, and the Singapore Sequencing Malay Project (SSMP) aims to perform deep whole-genome sequencing of 100 healthy Malays. By sequencing at a minimum of 30× coverage, we have illustrated the higher sensitivity at detecting low-frequency and rare variants and the ability to investigate the presence of hotspots of functional mutations. Compared to the low-pass sequencing in the 1KGP, the deeper coverage allows more functional variants to be identified for each person. A comparison of the fidelity of genotype imputation of Malays indicated that a population-specific reference panel, such as the SSMP, outperforms a cosmopolitan panel with larger number of individuals for common SNPs. For lower-frequency (<5%) markers, a larger number of individuals might have to be whole-genome sequenced so that the accuracy currently afforded by the 1KGP can be achieved. The SSMP data are expected to be the benchmark for evaluating the value of deep population-level sequencing versus low-pass sequencing, especially in populations that are poorly represented in population-genetics studies.

Correlates of leisure-time physical activity in an elderly population in Singapore.

OBJECTIVES This study assessed correlates of leisure-time physical activity among the elderly in Singapore. METHODS A cross-sectional household survey was conducted in 1998 with 2494 subjects 60 years and older. RESULTS Regular leisure-time physical activity was practiced by 47.0% of men and 38.5% of women. It was significantly correlated with family support, proportion of family members exercising, awareness of benefits of exercise, and healthy dietary habits. Other significant but negative correlates were smoking and barriers to exercise, such as lack of time and poor health. CONCLUSIONS Exercise programs for the elderly should aim at helping them overcome barriers to exercise, informing them of the benefits of exercise, and involving their families.

Sociodemographic and lifestyle factors associated with constipation in an elderly Asian community.

Objective:We surveyed elderly individuals in an Asian community to determine the prevalence of constipation and its association with sociodemographic and lifestyle factors. This information will be used to plan a health promotion program for the elderly.Methods:A random sample of 2807 residents aged ≥ 60 yr in Singapore were interviewed in their homes, using a standardized questionnaire. The response rate was 87.4%n = 2454.Results:The overall age- and gender-adjusted prevalence rate of functional constipation was 11.6 per 100 persons (95% confidence interval [CI], 11.4–11.7). There were no gender or ethnic differences in constipation rates. Increased rates of constipation were significantly associated with advancing age. We found a significant dose-response relationship of increased constipation rates with decreased intake of rice, increased intake of Chinese tea, and number of chronic illnesses and medications, after controlling for potential confounders. Constipation was also significantly associated with lower intake of fruits and vegetables, but no dose-response gradient was seen.Conclusions:Patients taking many medications should be monitored for constipation and given advice to avoid constipating factors. Further studies are needed to establish the causal-effect relationship of rice and Chinese tea with constipation.

Determinants of inconsistent condom use with female sex workers among men attending the STD clinic in Singapore.

Background/objectives: Female sex workers and their male clients have been identified as risk groups for the transmission of STDs and HIV. Behavioural interventions targeting clients need to address inconsistent condom use among them. The aim of the study is to assess the sociodemographic, behavioural, and psychological factors associated with inconsistent condom use among clients of sex workers. Methods: 229 male patients attending the STD clinic in Singapore who reported paying for sex in the previous 6 months were interviewed. Response rate was 91%. Results: Overall, 45% used condoms inconsistently; these clients were more likely to have poor STD knowledge, visit sex workers five or more times in the past 6 months, have lower self efficacy, less favourable social norms for condom use, and more likely to forget condom use when intoxicated (alcohol impaired decision making). Conclusions: Behavioural interventions for clients need to improve STD/HIV transmission knowledge and focus on improving client’s self efficacy in using condoms.

Sexually transmitted diseases and condom use among female freelance and brothel-based sex workers in singapore

BACKGROUND AND OBJECTIVES Most studies in Asia exclude freelance female sex workers because of difficulties in access and the illegality of their work. Data are lacking on their risk behaviors. GOAL To compare sexually transmitted disease (STD) rates, condom use, and health screening behavior between freelance and brothel-based sex workers in Singapore. STUDY DESIGN This is a cross-sectional survey of 111 free-lance sex workers arrested from November 1996 to March 1997 for illicit prostitution and 333 randomly selected brothel-based sex workers. All were tested for STDs. RESULTS STDs were significantly more prevalent among freelance than brothel-based sex workers (34.8% vs. 24.0%). Inconsistent condom use was significantly higher among freelance than brothel-based sex workers and was significantly associated with younger age, decreasing number of clients, and perception of non-condom use among peers. CONCLUSION Educational programs to promote condom use should target freelance sex workers and their clients.

Concerns over participation in genetic research among Malay- Muslims, Chinese and Indians in Singapore: a focus group study

Objective: This study was aimed at exploring and comparing peoples’ concerns over donation of blood specimens for genetic research across three ethnic groups in Singapore: Malay-Muslims, Chinese and Indians. Methods: We conducted 12 focus group sessions among 98 participants with 7–10 in each group. Results: Concerns over donation of blood specimens for genetic research were diverse, with all ethnic groups expressing anxiety about breach of confidentiality, finding out that they have a disease and misuse of research for cloning. Other concerns included fear of pain, blood and needle pricks and misconceptions of adverse health effects such as weight gain from donating blood specimens. Malay-Muslims were generally concerned about the selection process, potential racial discrimination, and religious beliefs regarding blood storage while Chinese and Indians were concerned about giving blood to strangers and being inconvenienced by participating in research. Conclusion: Programmes to promote community participation in genetic research should address the diverse ethnic concerns, design ethnic-sensitive messages and involve the community.

A comparative study of condom use and self-reported sexually transmitted infections between foreign Asian and local clients of sex workers in Singapore.

Objective: We conducted a survey to compare condom use and its associated factors between foreign Asian and local clients of female sex workers in Singapore. Study: A survey was conducted between 2001 and 2002 on a random sample of 810 clients (677 foreign Asian workers and 133 locals) recruited from the streets and outside the brothels in Singapore. Results: Foreign clients were more likely than locals to be inconsistent condom users with sex workers. Clients from China reported the highest percentage of inconsistent condom use (29.2%) and sexually transmitted infections (16.7%) compared with 8.3% (P < 0.003) and 2.3% (P < 0.005), respectively, among locals. On multivariate analysis, inconsistent condom use among foreign clients increased significantly with the number of freelance sex workers. The reverse trend was found for local clients. Conclusion: There is a need to design separate condom-promotion programs for foreign Asian and local clients of sex workers in Singapore.

Sex Workers’ Perspectives on Condom Use for Oral Sex with Clients: A Qualitative Study

The authors conducted in-depth interviews with 46 female brothel-based sex workers to explore their perceived barriers and approaches in getting clients to use condoms for oral sex. Reasons given by sex workers for not using condoms for oral sex as compared to vaginal sex included self-perception of low vulnerability to AIDS and sexually transmitted infections, misconceptions on transmission of the HIV virus, lack of negotiation skills, lack of support from brothel keepers and peers, and unpleasant taste and smell of condoms. Some sex workers could get all their clients to use condoms for oral sex by using negotiation skills, including the positive approach, the fear approach, the emotional appeal approach, and the assertive approach. Findings from this study would help design more appropriate messages and improve negotiation skills of sex workers to increase consistent condom use for oral sex.

A prospective study on condom slippage and breakage among female brothel-based sex workers in Singapore.

Background: Concerns about the effectiveness of condoms in preventing sexually transmitted diseases have been raised. Data are lacking on condom failure and its associated factors among sex workers in Southeast Asia. Goal: To assess factors associated with condom breakage and slippage. Study Design: A prospective study on condom breakage and slippage over a 1‐day period was conducted among 219 female brothel‐based sex workers in Singapore in 1997. Results: Condom breakage and slippage rates among 1,885 episodes of condom use were 1.2% (95% CI, 0.7‐1.8) and 2.1% (95% CI, 1.2‐3.0), respectively. After adjusting for intracluster effects and confounders, condom breakage and slippage were significantly associated with duration of sex work and spontaneity of clients to use condoms. Conclusion: Condom use among sex workers should be promoted in view of the low failure rates. Strategies to reduce condom breakage and slippage should be directed at sex workers with increased risk of condom failure.