Singapore School Children Research Articles

Snoring and atopic disease: a strong association.

The prevalence and factors associated with snoring and habitual snoring in Asian children are largely unknown. Our objectives were to evaluate the prevalence and factors associated with snoring and habitual snoring in preschool and primary school children in Singapore. A self-response questionnaire on snoring was administered to parents of children aged 4-7 years in randomly selected preschools and primary schools in Singapore. The overall response rate was 91.3% (nt = 11,114). Snoring and habitual snoring were reported in 28.1% and in 6.0% of the children, respectively. On multivariate logistic regression analysis, snoring was significantly associated with male gender, race, atopy (asthma, allergic rhinitis, or atopic dermatitis), maternal atopy (allergic rhinitis or atopic dermatitis), maternal smoking, and breastfeeding. Habitual snoring was significantly associated with obesity (odds ratio (OR), 3.75; 95% confidence interval (CI), 1.67-8.42), allergic rhinitis (OR, 2.90; 95% CI, 2.06-4.08), atopic dermatitis (OR, 1.80; 95% CI, 1.28-2.54), maternal smoking (OR, 2.22; 95% CI, 1.09-4.53), and breastfeeding (OR, 1.49; 95% CI, 1.11-1.98). Atopy was the strongest risk factor for habitual snoring, and the effect was cumulative. The odds ratio of a child with all three atopic diseases (asthma, allergic rhinitis, and atopic dermatitis) to have habitual snoring was 7.45 (95% CI, 3.48-15.97). In conclusion, snoring and habitual snoring are common in Asian children. Atopy is strongly associated with snoring and habitual snoring. We suggest that children who are significantly atopic receive additional attention during screening for snoring, habitual snoring, and other features of obstructive sleep apnea syndrome.

Anisometropia in Singapore school children

PurposeTo report the prevalence rates of anisometropia in a school population and determine the relative contribution of refractive power and axial length to the measured anisometropia. DesignPopulation-based cross-sectional study. MethodsAutorefraction, keratometry, and ultrasonography studies were made. Setting: Three schools, located on the eastern, northern, and western part of Singapore. Study Population: In all, 1,979 children aged 7 to 9 years were recruited for this study. The study sample included Chinese (n = 1,481), Malay (n = 324), and Asian Indian (n = 174) children; 720 subjects have myopia (spherical equivalent ≤ −0.5 diopters) in at least one eye. Main Outcome Measure: Anisometropia. ResultsThe prevalence rates of anisometropia, in terms of spherical equivalent (SE) difference of at least 1.5 diopters and 2.0 diopters were 1.57% (95% confidence interval [CI]: 1.1, 2.2) and 1.01% (95% CI: 0.6, 1.6), respectively. The prevalence rate of anisometropia (at least 2.0 diopters) among the children with at least one myopic eye was 2.4% (95% CI: 1.4, 3.8), whereas in those without any myopic eyes, the prevalence rate was only 0.2% (95% CI: 0.06, 0.8). The spherical equivalent difference between the right and left eyes was positively correlated with the difference in axial lengths (P < .001). The difference in corneal refractive power is not statistically different between the anisometropic and the nonanisometropic children. ConclusionsThe anisometropia prevalence rate in a childhood population with a relatively high prevalence of myopia was reported. The origin of the anisometropia is axial, and these results suggest that the differential rate of elongation between the two eyes of nonmyopic subjects results in anisometropia.

Sensitivity and specificity of visual acuity screening for refractive errors in school children.

To examine the optimal cutoff point for the use of the visual acuity test to screen for refractive errors in schoolchildren. In a sample of schoolchildren between 7 and 9 years old, visual acuity testing was performed using modified ETDRS charts monocularly without optical aids by trained personnel. Cycloplegic autorefraction was performed in each eye. The screening efficacy of using various cutoff points for referring children for further optometric/ ophthalmic assessment was studied. Myopia was defined as a spherical equivalent of at least -0.5 D, hyperopia a spherical equivalent of at least +2.0 D, and astigmatism a cylinder of at least -1.0 D in at least one eye. The sensitivity, specificity, and predictive values were calculated using each patient as a case; a receiver operator curve was plotted. A total of 1,028 children were tested. A satisfactory sensitivity/specificity profile was obtained using a referral criterion of visual acuity worse than or equal to 0.28 logarithm of the minimum angle of resolution in at least one eye. In this scenario, the sensitivity and specificity of this screening test were 72% (95% confidence interval [CI], 68 to 76) and 97% (95%CI, 95 to 98), respectively. The positive and negative predictive values were 96% (95%CI, 93 to 98) and 78% (95%CI, 75 to 82), respectively. The modified ETDRS visual acuity chart can be used to predict refractive errors in schoolchildren in Singapore in a sensitive and specific manner using a referral criterion of worse than or equal to 0.28 logarithm of the minimum angle of resolution.

A multiple regression approach to study optical components of myopia in Singapore school children.

Previous studies on the optical components of childhood myopia adjusted only for age and gender or reported only the change of individual components with time. We perform a study to assess the association of the optical components of the eye contributing to the degree of myopia by building a statistical model which can better assess the individual effects of each optical component. Children 6-12 years old with myopia of -1 to -6 D were used in this study. Autokeratometry was performed to determine the mean corneal power in two perpendicular meridia. Ultrasonography was used to determine the vitreous chamber depth (VCD). Ultrasonography and Scheimflug biometry were used to determine lens thickness (LT) and anterior chamber depth. A stepwise multiple linear regression was used to determine statistically significant independent variables that explain the variation in the mean spherical equivalent of the left eye. The independent variables investigated were anterior chamber length, LT, VCD, mean corneal power, age and gender. The first regression model used measurements of anterior chamber depth and LT from ultrasonography, while the second model used measurements from Scheimflug photography. Statistical significance was set at p < 0.05. Both statistical models have the same significant independent variables - VCD, LT and gender, with similar estimates. In both models, VCD was found to have the strongest partial association with mean spherical equivalent, followed by gender and LT. A more myopic refractive error was associated with (1) a longer eye, (2) an increased LT, and (3) female gender. Myopia was associated with a longer vitreous chamber. This remained the primary determinant of myopia in Chinese children after consideration of other optical components. The effect of gender and LT on myopia requires further study. These results are in agreement with multiple regression analyses in Singapore adults.

Effects of Cooperative Learning on Elementary School Children in Singapore

(2002). Effects of Cooperative Learning on Elementary School Children in Singapore. Asia Pacific Journal of Education: Vol. 22, No. 1, pp. 3-15.

The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children.

Atopic dermatitis is a common disease that appears to be increasing in frequency during recent decades. Most of the studies are based on the Western population, and there are few data in the Asian population. To determine the prevalence and descriptive epidemiology of atopic dermatitis among school children in the general community in Singapore. This is a questionnaire study of 12 323 students done over a 1-year period, comprising 7 year olds (4605), 12 year olds (3940) and 16 year olds (3778) from 19 primary and 17 secondary schools randomly selected in Singapore. All children had a complete cutaneous examination. The diagnosis of atopic dermatitis was based on the U.K. Working Party diagnostic criteria. The questionnaire was translated into Chinese and both the English and Chinese versions were issued simultaneously to the students. The 1-year period prevalence of atopic dermatitis was 20.8%. Atopic dermatitis was present in 22.7% of 7 year olds, 17.9% of 12 year olds and 21.5% of 16 year olds. The overall sex ratio was equal. There were slightly more boys with atopic dermatitis among the younger children (6 and 12 year olds, 1.18 : 1 and 1.19 : 1, respectively) but more girls were affected (1.57 : 1) among the 16 year olds. Atopic dermatitis was more common among the Chinese (21.6%) and Malays (19.8%) compared with the Indians (16%) and other races (14%). The onset of the disease occurred before the age of 10 years in 49.5% of the 16 year olds. "Pure" atopic dermatitis without concomitant respiratory allergies was noted in 788 respondents (30.7%); 1775 (69.3%) suffered from a "mixed" type, with 34.3% having allergic rhinitis, 9.5% having asthma and 25.5% having both asthma and allergic rhinitis. More boys had atopic dermatitis and concomitant respiratory allergies whereas more girls were affected with "pure" atopic dermatitis alone (1.4 : 1). At least one first-degree family member with atopy was noted in 1435 children (56%): atopic dermatitis (70%), asthma (62%) and allergic rhinitis (68%). Among siblings with one parent with atopic dermatitis, 37% had either a father or a mother with atopic dermatitis. Common aggravating factors reported included exercise, heat and sweating, grass intolerance, thick clothing and stress. Pityriasis alba was noted in 25% of the study population, keratosis pilaris in 13% and ichthyosis vulgaris in 8%. Most respondents had mild to moderate atopic dermatitis that could be controlled with a fairly simple regimen of moisturizers, topical steroids, antihistamines and antibiotics. The high prevalence of atopic dermatitis in Singapore is similar to that observed in developed countries, suggesting that environmental factors may be important in determining the expression of the disease.

Familial clustering and myopia progression in Singapore school children

BACKGROUND. Familial factors may be related to the progression of myopia in children. A cohort study was conducted to determine the relationship between familial factors and myopia progression in children. METHODS. From a larger clinical trial (n = 311), 153 Singapore children aged 6–12 years were recruited to participate in a cohort study of the risk factors for myopia progression. An in-person interview was conducted whereby information on the history of myopia in first-degree relatives was obtained. Other information collected included housing type, parental education and income. Cycloplegic refractive error as measured by subjective refraction and autorefraction were ascertained every six months. The average length of follow-up was 28 months. RESULTS. The adjusted mean rate of progression of myopia was -0.60 (95% confidence interval -0.66, -0.55) diopters per year. The average rate of progression of myopia for children with a parental history of myopia was -0.63 (95% confidence interval -0.69, -0.56) diopters per year compared to -0.42 (95% confidence interval -0.57, -0.27) diopters per year for children whose parents were not myopic. The different measures of family history of myopia were related to rate of change in refractive error and refractive error in the final visit. There was no association between close work and myopia progression. CONCLUSIONS. A positive family history is related to the progression of myopia and final refractive error in Singapore children, thus supporting evidence that hereditary factors may play an important role in myopia progression.

Obstructive sleep apnea syndrome in obese Singapore children.

We set out to determine the prevalence of obstructive sleep apnea syndrome (OSAS) among obese Singapore school children and identify risk factors for OSAS. This study was designed as a prospective study in three phases. Parents completed a questionnaire with regards to sleep and daytime symptoms in Phase 1. Children suspected to have OSAS based on the questionnaire and all with a percent ideal body weight (IBW) >/=180 were called for clinic visits in Phase 2. All whose percent IBW >/=180 and those in whom the physicians strongly suspected OSAS were subjected to a polysomnogram in phase 3. The children were recruited from the School Health Nutritional Clinic for obese children. The investigations were carried out at Tan Tock Seng Hospital. In all, 3,671 children were screened with the questionnaire. Of these, 146 were selected to undergo polysomnography. Twenty-six had abnormal sleep studies with apnea/hypoxia indices (AHIs) >5/hr. The significant clinical feature which correlated with OSAS was sleep sitting up (P = 0.005). The risk is higher in morbidly obese (IBW >/=180), with a prevalence of 13.3% (8/60), than in less obese children (IBW <180). One in eight (12.5%) of these children was asymptomatic and would have been missed based on the questionnaire. Presence of adenotonsillar hypertrophy led to increased risk of OSAS. The prevalence of OSAS was 0.7% (26/3,671) among the obese schoolchildren in Singapore, which is similar to the prevalence reported by others. Using discriminant analysis, the estimated prevalence increased to 5.7%. In the morbidly obese (IBW >/=180), the prevalence rate is higher at 13.3%.

Under-recognition of childhood asthma in Singapore: evidence from a questionnaire survey.

In a recent study on the prevalence of childhood asthma and allergies using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires, 6238 Singapore school children in two age-groups, 6-7 years (n = 2030) and 12-15 years (n = 4208), were evaluated. Of the 1856 children who reported asthma-like symptoms (wheezing, exercise-wheezing, persistent nocturnal cough), 919 (49%) had not been diagnosed asthmatic. Of these undiagnosed children, 731 (39%) reported current symptoms of asthma. Under-recognition of asthma was more prevalent among those with persistent nocturnal cough and mild symptoms. In addition, the discordance between wheezing in the last 12 months and a diagnosis of asthma was significantly higher among the younger age-group (6-7 years), but exercise-induced wheezing was less recognized as a symptom of asthma among the older age-group (12-15 years). This study has shown that there is a substantial degree of under-recognition of asthma among school children in Singapore.

THE EFFECTS OF TWO EXERCISE INTENSITIES ON CARDIORESPIRATORY FUNCTION IN CHILDREN IN SINGAPORE

958 This study investigated the effects of two exercise intensities on˙VO2max and determined the required exercise intensity to improve cardiorespiratory function in primary school children in Singapore. Thirty four children aged 10-11 years, were randomly assigned into group I (n=17) and group II (n=17) with exercise intensities at 70% of HRmax and 60% of HRmax, respectively. The training program was over 8 weeks. Subjects exercised on a cycle ergometer, 3 times a week, 30 minutes per session. ˙VO2max was measured before and after 8 weeks of training. There was a significant increase in ˙VO2max in group I, but the increase in˙VO2max in group II was not significant. TableTableThe result of this study shows that an intensity of 70% of HRmax is required for an exercise program of 3 times a week and 30 minutes per session for improving cardiorespiratory function in children in Singapore. Exercise at 60% of HRmax may help to maintain health status in children in Singapore.

The Singapore Youth Coronary Risk and Physical Activity Study.

The purpose of this study was to examine coronary risk factors and physical activity patterns of primary and secondary school children in Singapore. Children 6-18 yr (730 boys, 849 girls) were evaluated for anthropometry, percent body fat, resting blood pressure, fasting plasma lipids and lipoproteins and glucose. A physical activity and leisure pursuits self-reported survey was used to group children into five categories ranging from "inactive" to "vigorous" activity. The self-reported questionnaire also recorded individual responses to exercise behaviors, leisure activities, and participation in organized games and sports. Body weight, body mass index (BMI; kg x m[-2]), and percent body fat were compared by age and gender. The blood analysis showed no significant differences in boys' and girls' plasma lipid and lipoprotein concentrations. Physical activity was significantly correlated with total cholesterol (rs = -0.13, P = 0.018) and triglycerides (rs = -0.18, P = 0.001) for boys and between physical activity with body fat (rs = -0.22, P = 0.0001) and BMI (rs = -0.16, P = 0.01) for girls. Height, weight, BMI, percent body fat, and blood pressure were greater for each age to 14 yr, after which there was less recorded body fat for boys. Girls' body fat remained about the same after 14 yr. Comparing by gender and age, significant differences were found between physical activity groups and total cholesterol and body fat. Although few children were at risk for heart disease, this study provides baseline coronary risk and physical activity data for further longitudinal analysis in this population.

Prevalence and severity of asthma, rhinitis, and eczema in Singapore schoolchildren.

This study was part of an international effort to evaluate the epidemiology of asthma and allergic diseases around the world. The aim was to assess the prevalence and severity of these disorders in Singapore schoolchildren. The international study of asthma and allergies in childhood (ISAAC) written questionnaire was administered to 6238 schoolchildren. The respondents were parents of a 6-7 year cohort (n = 2030), and schoolchildren aged 12-15 years (n = 4208). The overall cumulative and 12 month prevalence of wheezing were 22% and 12%, respectively. The prevalence of doctor diagnosed asthma was 20%. Rhinitis was reported by 44% and chronic rashes by 12%. Multiple logistic regression analysis showed that a higher prevalence of wheezing and rhinitis was associated with males, and subjects of higher socioeconomic status (based on type of housing and total family income). More severe asthma related symptoms were present in Malays and Indians than in the Chinese. Allergic disorders are common in Singapore and prevalence is comparable to some populations in the West. Demographic and socioeconomic factors appear to influence the prevalence and severity of these disorders.

The Physical Activity of Singapore Primary School Children as Estimated by Heart Rate Monitoring

Physical activity patterns of Singapore school children aged 9–10 years were assessed by continuous heart rate monitoring. Fifty boys and 64 girls were monitored for three 14-hour periods during normal school days. In addition, 43 boys and 53 girls were monitored for 14 hours on a Saturday. Only 13 children (11.4%) experienced a daily 10-min period of continuous activity at a heart rate ≥140 bpm. Twenty percent of the boys and more than 50% of the girls never achieved a single 10-minute period ≥140 bpm. Boys achieved more periods of moderately intense activity (p &lt; .01) than girls on weekdays. Lean girls were more active (p &lt; .05) than the obese girls during weekdays. No differences were detected between activity levels on weekdays or on Saturday. The results indicate that Singapore school children in general rarely experience the quantity or quality of physical activity needed for maintenance and development of cardiovascular health and cardiopulmonary fitness.

Home and Parental Influences on the Achievement of Lower Primary School Children in Singapore

Abstract This study investigated the effects of home environment and parental involvement in the achievement of pupils in the lower primary classes in nine schools found in four zones in Singapore. In total, 3,759 pupils and their parents participated in the study. The study was designed to answer four main questions relating to the effects of the home environment (SES, time engaged in television viewing, reading, school work and ethnicity of parents) and parental involvement in the children's school work and in other school matters. The findings indicated that significant differences in achievement were found for all combinations of SES categories and between most ethnic groups. A higher percentage of high-achieving pupils spent more time on television viewing, reading and school work. Parents of high-achieving children were more anxious about maximising every opportunity for their children including those not directly related to school work.

Education and the pattern of language use among ethnic Chinese school children in Singapore

Article Education and the pattern of language use among ethnic Chinese school children in Singapore was published on January 1, 1989 in the journal International Journal of the Sociology of Language (volume 1989, issue 80).

Dermatoglyphs in children with mitral valve prolapse.

The dermatoglyphs of 50 Singapore school children with mitral valve prolapse (MVP) were studied, with special reference to the frequency of digital arches. The MVP was diagnosed clinically and substantiated...

Idiopathic scoliosis. Prevalence and ethnic distribution in Singapore schoolchildren.

Routine examination for spinal deformity as part of a school health screening programme was introduced in Singapore in 1981. The three different ethnic groups included in the study provided figures for the prevalence of idiopathic scoliosis in an Asian population. A three-tier system of examination was used and a total of 110744 children in three age groups were studied. In those aged 6 to 7 years the prevalence was 0.12%. The prevalence in those aged 11 to 12 years was 1.7% for girls and 0.4% for boys, a ratio of 3.2 to 1. In girls aged 16 to 17 years the prevalence was 3.1%. In the latter two age groups there was a significantly higher prevalence in Chinese girls as compared with Malay and Indian girls. The optimal age for school screening seemed to be 11 to 12 years, but repeated examinations may be worthwhile.

The Development and Acquisition of Concepts in Primary School Children in Singapore

Introduction What follows is an account which summarises a study that took 18 months to complete and which examined concept development and acquisition in a sample of Singapore primary schoolchildren. For more details the reader is to refer to Thomas, Lee, Fam, (1984a). The broad aim of the study was to obtain baseline information on children's cognitive development mainly through the application of Piagetian tasks.

A Study of the Effect of Birth Interval on the Development of 9-year-old Schoolchildren in Singapore

The effect of birth interval on some physical and mental aspects of 9-year old children was studied in Singapore between September 1974 and July 1975. Birth interval falls into 2 main categories -- B1, the interval preceding the birth of the index child and B2, the interval following the birth of the child. It was hypothesized that the shorter the interval B1 the lower the vocabulary score and general attainment of the index child would be and the shorter the interval B2 the lesser the physical growth of the index child would be. A significant difference was found in the Mill Hill vocabulary score, Raven's Progressive Matrices score, as well as height and weight for children born with varying birth intervals. Children with shorter B1 intervals do score lower than those with longer B1 intervals, there being a gradual improvement as B1 progresses from less than 12 months to over 24 months. The relationship is linear. The effect of B2 is less marked and is inconsistent. The most striking correlation is between B1 and vocabulary score, B1 accounting for about 39% of the variation in the Mill Hill test. B2 does not have as great an effect as expected on height and weight, but it was significant at the 5% level for height. B1 is again more important. In both height and weight, neither birth interval is as important as in the verbal and perception tests. Neither family size nor language spoken at home affect the vocabulary score to any significant extent. Income does have an association with all 4 major variables considered and is 2nd in importance to B1 as a predictor variable in the cases of vocabulary score and Raven's score.