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Fulltext BCG programme in the Republic of Singapore

Chew CH, Hu PY

Singapore Med J, 1974 Dec;15(4):241-5.
PMID: 4549136

Mass BCG Vaccination is an effective and an inexpensive method of tuberculosis control. In Singapore, a nation wide BCG Vaccination programme was implemented in 1957, and from 1957 to 1972, i.e. a 16 year period, over 1 million vaccinations had been performed: 680,098 for infants, 512,797 for school students, 49,417 for contacts of tuberculosis patients and 7,775 for other special groups. The coverage of newborn infants has been over 90% from 1967 to 1972. In 1972, it was estimated that 90% of primary school children and 75% of secondary school students have been covered with BCG vaccinations. Although no controlled studies have been done in Singapore, it is observed from our analysis that the BCG programme has contributed in no small measure to the decline in tuberculosis incidence and mortality rates. Thus for 1972, the tuberculosis incidence rates per 100,000 were 5 for the BCG vaccinated group and 37 for the non-vaccinated group of primary school students, and 34 and 127 for the corresponding groups of secondary school students. In 1956, the death rate per 100,000 of respiratory tuberculosis was 4 and that of non-respiratory tuberculosis was 23 for children aged 4 and below, and the corresponding rates were 0.5 and 6.7 for those aged 5 to 9, and 0.8 and 3.7 for the group aged 10 to 14. In 1971 there were no tuberculosis deaths in children under 10 years of age, and the death rates for the age group 10-14 were 0.3 per 100,000 for either form of 241 tuberculosis.
Fulltext Impact of COVID-19 pandemic on consumer behavioural intention to purchase green products

Hu P, Bhuiyan MA, Rahman MK, Hossain MM, Akter S

PLoS One, 2022;17(10):e0275541.
PMID: 36260619 DOI: 10.1371/journal.pone.0275541

This study examined the fear of COVID-19 pandemic and its impact on consumer behavioural intention to purchase green products. The data was collected from consumers of Malaysia in hypermarkets. A total of 491 respondents were analyzed using the partial least square technique. The results indicated that the fear of the COVID-19 epidemic has a significant impact on health concerns, social media information, intolerance of uncertainty, and personal relevance, which in turn affect consumers' behavioural intention to purchase green products. With a serial mediating effect the results identified that fear of COVID-19 epidemic is associated with behavioural intention to purchase the green product. The findings of this study are crucial for understanding the swings in the green product purchase behaviour due to the ongoing uncertainty of COVID-19 crisis.
Early course of inflammatory bowel disease in a population-based inception cohort study from 8 countries in Asia and Australia

Ng SC, Zeng Z, Niewiadomski O, Tang W, Bell S, Kamm MA, et al.

Gastroenterology, 2016 Jan;150(1):86-95.e3; quiz e13-4.
PMID: 26385074 DOI: 10.1053/j.gastro.2015.09.005

BACKGROUND & AIMS: The incidence of inflammatory bowel disease (IBD) is increasing in Asia, but little is known about disease progression in this region. The Asia-Pacific Crohn's and Colitis Epidemiology Study was initiated in 2011, enrolling subjects from 8 countries in Asia (China, Hong Kong, Indonesia, Sri Lanka, Macau, Malaysia, Singapore, and Thailand) and Australia. We present data from this ongoing study.
METHODS: We collected data on 413 patients diagnosed with IBD (222 with ulcerative colitis [UC], 181 with Crohn's disease [CD], 10 with IBD unclassified; median age, 37 y) from 2011 through 2013. We analyzed the disease course and severity and mortality. Risks for medical and surgical therapies were assessed using Kaplan-Meier analysis.
RESULTS: The cumulative probability that CD would change from inflammatory to stricturing or penetrating disease was 19.6%. The cumulative probabilities for use of immunosuppressants or anti-tumor necrosis factor agents were 58.9% and 12.0% for patients with CD, and 12.7% and 0.9% for patients with UC, respectively. Perianal CD was associated with an increased risk of anti-tumor necrosis factor therapy within 1 year of its diagnosis (hazard ratio, 2.97; 95% confidence interval, 1.09-8.09). The cumulative probabilities for surgery 1 year after diagnosis were 9.1% for patients with CD and 0.9% for patients with UC. Patients with CD and penetrating disease had a 7-fold increase for risk of surgery, compared with patients with inflammatory disease (hazard ratio, 7.67; 95% confidence interval, 3.93-14.96). The overall mortality for patients with IBD was 0.7%.
CONCLUSIONS: In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia was comparable with that of the West. Patients with CD frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery in Asia. Increasing our understanding of IBD progression in different populations can help optimize therapy and improve outcomes.
KEYWORDS: ACCESS; Natural History; Risk Factor; Treatment
Sofosbuvir-velpatasvir for treatment of chronic hepatitis C virus infection in Asia: a single-arm, open-label, phase 3 trial

Wei L, Lim SG, Xie Q, Văn KN, Piratvisuth T, Huang Y, et al.

Lancet Gastroenterol Hepatol, 2019 02;4(2):127-134.
PMID: 30555048 DOI: 10.1016/S2468-1253(18)30343-1

BACKGROUND: Treatment with combined sofosbuvir and velpatasvir has resulted in high sustained virological response rates in patients chronically infected with hepatitis C virus (HCV) with genotypes 1-6 in clinical trials and real-world settings, but its efficacy and safety has not been assessed in Asia, a region with diverse HCV genotypes.
METHODS: In this single-arm, open-label, phase 3 trial, we recruited patients from 38 sites across China, Thailand, Vietnam, Singapore, and Malaysia, who were chronically infected with HCV genotypes 1-6, and were HCV treatment-naive or treatment-experienced, either without cirrhosis or with compensated cirrhosis. Patients self-administered a combined sofosbuvir (400 mg) and velpatasvir (100 mg) tablet once daily for 12 weeks. The primary efficacy endpoint was sustained virological response, defined as HCV RNA less than 15 IU/mL at 12 weeks after completion of treatment (SVR12), assessed in all patients who received at least one dose of study drug. The primary safety endpoint was the proportion of adverse events leading to premature discontinuation of study drug. This trial is registered with ClinicalTrials.gov, number NCT02671500, and is completed.
FINDINGS: Between April 14, 2016, and June 30, 2017, 375 patients were enrolled in the study, of whom 374 completed the full treatment course and one discontinued treatment. Overall, 362 (97% [95% CI 94-98]) of 375 patients achieved SVR12. Among 42 patients with HCV genotype 3b, all of whom had baseline resistance-associated substitutions in NS5A, 25 (89% [95% CI 72-98]) of 28 patients without cirrhosis and seven (50% [23-77]) of 14 patients with cirrhosis achieved SVR12. The most common adverse events were upper respiratory tract infection (36 [10%] patients) and headache (18 [5%] patients). There were no discontinuations due to adverse events. Serious adverse events were reported in three (1%) patients, none of which was judged to be related to sofosbuvir-velpatasvir treatment.
INTERPRETATION: Consistent with data from other phase 3 studies, single-tablet sofosbuvir-velpatasvir for 12 weeks is an efficacious and safe treatment for Asian patients with chronic HCV infection, but might have lower efficacy in those infected with HCV genotype 3b and with cirrhosis.
FUNDING: Gilead Sciences.
Need for approval from others and face concerns as predictors of interpersonal conflict outcome in 29 cultural groups

Lun VM, Smith PB, Grigoryan L, Torres C, Papastylianou A, Lopukhova OG, et al.

Int J Psychol, 2023 Jan 27.
PMID: 36707726 DOI: 10.1002/ijop.12895

The extent to which culture moderates the effects of need for approval from others on a person's handling of interpersonal conflict was investigated. Students from 24 nations rated how they handled a recent interpersonal conflict, using measures derived from face-negotiation theory. Samples varied in the extent to which they were perceived as characterised by the cultural logics of dignity, honour, or face. It was hypothesised that the emphasis on harmony within face cultures would reduce the relevance of need for approval from others to face-negotiation concerns. Respondents rated their need for approval from others and how much they sought to preserve their own face and the face of the other party during the conflict. Need for approval was associated with concerns for both self-face and other-face. However, as predicted, the association between need for approval from others and concern for self-face was weaker where face logic was prevalent. Favourable conflict outcome was positively related to other-face and negatively related to self-face and to need for approval from others, but there were no significant interactions related to prevailing cultural logics. The results illustrate how particular face-threatening factors can moderate the distinctive face-concerns earlier found to characterise individualistic and collectivistic cultural groups.
Environmental risk factors in inflammatory bowel disease: a population-based case-control study in Asia-Pacific

Ng SC, Tang W, Leong RW, Chen M, Ko Y, Studd C, et al.

Gut, 2015 Jul;64(7):1063-71.
PMID: 25217388 DOI: 10.1136/gutjnl-2014-307410

The rising incidence of inflammatory bowel disease in Asia supports the importance of environmental risk factors in disease aetiology. This prospective population-based case-control study in Asia-Pacific examined risk factors prior to patients developing IBD.
Population Density and Risk of Inflammatory Bowel Disease: A Prospective Population-Based Study in 13 Countries or Regions in Asia-Pacific

Ng SC, Kaplan GG, Tang W, Banerjee R, Adigopula B, Underwood FE, et al.

Am J Gastroenterol, 2019 01;114(1):107-115.
PMID: 30177785 DOI: 10.1038/s41395-018-0233-2

INTRODUCTION: Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region.
METHODS: Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude.
RESULTS: We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval.
CONCLUSIONS: Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.
Fulltext GestaltMatcher Database - A global reference for facial phenotypic variability in rare human diseases

Lesmann H, Hustinx A, Moosa S, Klinkhammer H, Marchi E, Caro P, et al.

Res Sq, 2024 Jun 10.
PMID: 38903062 DOI: 10.21203/rs.3.rs-4438861/v1

The most important factor that complicates the work of dysmorphologists is the significant phenotypic variability of the human face. Next-Generation Phenotyping (NGP) tools that assist clinicians with recognizing characteristic syndromic patterns are particularly challenged when confronted with patients from populations different from their training data. To that end, we systematically analyzed the impact of genetic ancestry on facial dysmorphism. For that purpose, we established the GestaltMatcher Database (GMDB) as a reference dataset for medical images of patients with rare genetic disorders from around the world. We collected 10,980 frontal facial images - more than a quarter previously unpublished - from 8,346 patients, representing 581 rare disorders. Although the predominant ancestry is still European (67%), data from underrepresented populations have been increased considerably via global collaborations (19% Asian and 7% African). This includes previously unpublished reports for more than 40% of the African patients. The NGP analysis on this diverse dataset revealed characteristic performance differences depending on the composition of training and test sets corresponding to genetic relatedness. For clinical use of NGP, incorporating non-European patients resulted in a profound enhancement of GestaltMatcher performance. The top-5 accuracy rate increased by +11.29%. Importantly, this improvement in delineating the correct disorder from a facial portrait was achieved without decreasing the performance on European patients. By design, GMDB complies with the FAIR principles by rendering the curated medical data findable, accessible, interoperable, and reusable. This means GMDB can also serve as data for training and benchmarking. In summary, our study on facial dysmorphism on a global sample revealed a considerable cross ancestral phenotypic variability confounding NGP that should be counteracted by international efforts for increasing data diversity. GMDB will serve as a vital reference database for clinicians and a transparent training set for advancing NGP technology.
Fulltext GestaltMatcher Database - A global reference for facial phenotypic variability in rare human diseases

Lesmann H, Hustinx A, Moosa S, Klinkhammer H, Marchi E, Caro P, et al.

medRxiv, 2024 May 21.
PMID: 37503210 DOI: 10.1101/2023.06.06.23290887

The most important factor that complicates the work of dysmorphologists is the significant phenotypic variability of the human face. Next-Generation Phenotyping (NGP) tools that assist clinicians with recognizing characteristic syndromic patterns are particularly challenged when confronted with patients from populations different from their training data. To that end, we systematically analyzed the impact of genetic ancestry on facial dysmorphism. For that purpose, we established the GestaltMatcher Database (GMDB) as a reference dataset for medical images of patients with rare genetic disorders from around the world. We collected 10,980 frontal facial images - more than a quarter previously unpublished - from 8,346 patients, representing 581 rare disorders. Although the predominant ancestry is still European (67%), data from underrepresented populations have been increased considerably via global collaborations (19% Asian and 7% African). This includes previously unpublished reports for more than 40% of the African patients. The NGP analysis on this diverse dataset revealed characteristic performance differences depending on the composition of training and test sets corresponding to genetic relatedness. For clinical use of NGP, incorporating non-European patients resulted in a profound enhancement of GestaltMatcher performance. The top-5 accuracy rate increased by +11.29%. Importantly, this improvement in delineating the correct disorder from a facial portrait was achieved without decreasing the performance on European patients. By design, GMDB complies with the FAIR principles by rendering the curated medical data findable, accessible, interoperable, and reusable. This means GMDB can also serve as data for training and benchmarking. In summary, our study on facial dysmorphism on a global sample revealed a considerable cross ancestral phenotypic variability confounding NGP that should be counteracted by international efforts for increasing data diversity. GMDB will serve as a vital reference database for clinicians and a transparent training set for advancing NGP technology.