A cross-sectional study on reference ranges of normal oral temperatures among students in Singapore

<p><b>INTRODUCTION</b>During the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, all schools in Singapore implemented twice-daily temperature monitoring for students to curtail the spread of the disease. Students were not allowed to attend school if their temperature readings were >37.8 degrees C for students < or =12 years old, or > or =37.5 degrees C for students >12 years old. These values had been arbitrarily determined with professional inputs. The aim of this study is to determine the reference ranges of normal oral temperatures of students in Singapore and recommend the cut-off values for febrile patients. This may be used in another similar outbreak of an infectious disease with fever.</p><p><b>MATERIALS AND METHODS</b>Four co-ed primary schools and 4 co-ed secondary schools were selected for this study. Four thousand and two hundred primary 1 to secondary 3 students responded (96.8%) and participated in this cross-sectional study. The mean ages of the students in the lowest (primary 1) and highest educational levels (secondary 3) were 7.4 years old and 15.3 years old, respectively. Twelve oral temperature readings per student (i.e. measurements taken 4 times a day in 3 consecutive days) were collected. Forty-six thousand seven hundred and eighty-three (92.8%) out of 50,400 temperature readings were used for the analysis as missing data were excluded. A quantile regression model was applied to estimate reference ranges of normal oral temperatures for students with adjustment for potential confounding factors.</p><p><b>RESULTS</b>The age-specific reference ranges of normal oral temperature from this study for students < or =12 years old and >12 years old were 35.7 degrees C to 37.7 degrees C and 35.6 degrees C to 37.4 degrees C, respectively. Temperatures of 37.8 degrees C and 37.5 degrees C are therefore recommended as the oral temperature cut-offs for those < or =12 years old and >12 years old, respectively.</p><p><b>CONCLUSION</b>This study has provided empirical data on normal oral temperature cut-offs which could be used during temperature screening in schools.</p>

Sleep disorders in children: the Singapore perspective

This review article summarises the current available literature on sleep patterns and sleep problems in Singapore children. Co-sleeping is a culturally dependent practice and its prevalence in Singapore has been determined to be 73%. Co-sleeping is not associated with significant sleep problems in Singapore children. Snoring and habitual snoring occur in 28.1% and 6.0% of Singapore children, respectively. Habitual snoring in Singapore children was significantly associated with obesity, allergic rhinitis, atopic dermatitis, maternal smoking and breastfeeding. Atopy was the strongest risk factor for habitual snoring in Singapore, and the effect was cumulative. Children attending psychiatric services in Singapore may also have sleep disorders, the highest prevalence being in children with attention deficit hyperactivity disorder. The knowledge on childhood sleep disorders (including obstructive sleep apnoea) amongst the public, patients, parents and future doctors in Singapore are inadequate and there is an urgent need for increased education in this area given the importance of good sleep in children. There is also a need to change parental attitudes about sleep disorders and encourage early medical consultation.