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Foo CD, Tan YL, Shrestha P, Eh KX, Ang IYH, Nurjono M, Toh SA, Shiraz F. Exploring the dimensions of patient experience for community-based care programmes in a multi-ethnic Asian context. PLoS One 2020; 15:e0242610. [PMID: 33237953 PMCID: PMC7688169 DOI: 10.1371/journal.pone.0242610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/06/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of this study is to explore patients’ experiences with community-based care programmes (CCPs) and develop dimensions of patient experience salient to community-based care in Singapore. Most countries like Singapore are transforming its healthcare system from a hospital-centric model to a person-centered community-based care model to better manage the increasing chronic disease burden resulting from an ageing population. It is thus critical to understand the impact of hospital to community transitions from the patients’ perspective. The exploration of patient experience will guide the development of an instrument for the evaluation of CCPs for quality improvement purposes. Methods A qualitative exploratory study was conducted where face-to-face in-depth interviews were conducted using a purposive sampling method with patients enrolled in CCPs. In total, 64 participants aged between 41 to 94 years were recruited. A deductive framework was developed using the Picker Patient Experience instrument to guide our analysis. Inductive coding was also conducted which resulted in emergence of new themes. Results Our findings highlighted eight key themes of patient experience: i) ensuring care continuity, ii) involvement of family, iii) access to emotional support, vi) ensuring physical comfort, v) coordination of services between providers, vi) providing patient education, vii) importance of respect for patients, and viii) healthcare financing. Conclusion Our results demonstrated that patient experience is multi-faceted, and dimensions of patient experience vary according to healthcare settings. As most patient experience frameworks were developed based on a single care setting in western populations, our findings can inform the development of a culturally relevant instrument to measure patient experience of community-based care for a multi-ethnic Asian context.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Yan Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pami Shrestha
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health National University of Singapore, Singapore, Singapore
- Health Services Research, Changi General Hospital, Singapore Health Services, Singapore, Singapore
| | - Sue-Anne Toh
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
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Ha NHL, Chan I, Yap P, Nurjono M, Vrijhoef HJM, Nicholas SO, Wee SL. Mixed-method evaluation of CARITAS: a hospital-to-community model of integrated care for dementia. BMJ Open 2020; 10:e039017. [PMID: 33020104 PMCID: PMC7537438 DOI: 10.1136/bmjopen-2020-039017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The capability and capacity of the primary and community care (PCC) sector for dementia in Singapore may be enhanced through better integration. Through a partnership involving a tertiary hospital and PCC providers, an integrated dementia care network (CARITAS: comprehensive, accessible, responsive, individualised, transdisciplinary, accountable and seamless) was implemented. The study evaluated the process and extent of integration within CARITAS. DESIGN Triangulation mixed-methods design and analyses were employed to understand factors underpinning network mechanisms. SETTING The study was conducted at a tertiary hospital in the northern region of Singapore. PARTICIPANTS We recruited participants who were involved in the conceptualisation, design, development and implementation of the CARITAS Programme from a tertiary hospital and PCC providers. INTERVENTION We used the Rainbow Model of Integrated Care-Measurement Tool (RMIC-MT) to assess integration from managerial perspectives. RMIC-MT comprises eight dimensions that play interconnected roles on a macro-level, meso-level and micro-level. We administered RMIC-MT to healthcare providers and conducted in-depth interviews with key CARITAS stakeholders. PRIMARY AND SECONDARY OUTCOME MEASURES We assessed integration scores across eight dimensions of the RMIC-MT and factors underpinning network mechanisms. RESULTS Compared with other dimensions, functional integration (mechanisms by which information and management modalities are linked) achieved the lowest mean score of 55. Other dimensions (eg, clinical, professional and organisational integration) scored about 70. Presence of inspiring clinical leaders and tacit interdependencies among partners strengthened the network. However, the lack of structured documentation and a shared information-technology platform hindered functional integration. CONCLUSION CARITAS has reached maturity in micro-levels and meso-levels of integration, while macro-integration needs further development. Integration can be enhanced by assessing service gaps, increasing engagement with stakeholders and providing a shared communication system.
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Affiliation(s)
- Ngoc Huong Lien Ha
- Geriatric Education and Research Institute, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | - Ivana Chan
- Geriatric Education and Research Institute, Singapore
| | - Philip Yap
- Geriatric Education and Research Institute, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
| | | | - Hubertus J M Vrijhoef
- Panaxea B.V, Amsterdam, the Netherlands
- Department of Patient and Care, Maastricht University Medical Center, Amsterdam, the Netherlands
| | | | - Shiou-Liang Wee
- Geriatric Education and Research Institute, Singapore
- Health and Social Science Cluster, Singapore Institute of Technology, Singapore
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Nurjono M, Shrestha P, Ang IYH, Shiraz F, Eh KX, Toh SAES, Vrijhoef HJM. Shifting care from hospital to community, a strategy to integrate care in Singapore: process evaluation of implementation fidelity. BMC Health Serv Res 2020; 20:452. [PMID: 32448283 PMCID: PMC7245814 DOI: 10.1186/s12913-020-05263-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 04/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Accessibility to efficient and person-centered healthcare delivery drives healthcare transformation in many countries. In Singapore, specialist outpatient clinics (SOCs) are commonly congested due to increasing demands for chronic care. To improve this situation, the National University Health System (NUHS) Regional Health System (RHS) started an integrated care initiative,the Right-Site Care (RSC) program in 2014. Through collaborations between SOCs at the National University Hospital and primary and community care (PCC) clinics in the western region of the county, the program was designed to facilitate timely discharge and appropriate transition of patients, who no longer required specialist care, to the community. The aim of this study was to evaluate the implementation fidelity of the NUHS RHS RSC program using the modified Conceptual Framework for Implementation Fidelity (CFIF), at three distinct levels; providers, organizational, and system levels to explain outcomes of the program and to inform further development of (similar) programs. Methods A convergent parallel mixed methods study using the realist evaluation approach was used. Data were collected between 2016 and 2018 through non-participatory observations, reviews of medical records and program database, together with semi-structured interviews with healthcare providers. Triangulation of data streams was applied guided by the modified CFIF. Results Our findings showed four out of six program components were implemented with low level of fidelity, and 9112 suitable patients were referred to the program while 3032 (33.3%) declined to be enrolled. Moderating factors found to influence fidelity included: (i) complexity of program, (ii) evolving providers’ responsiveness, (iii) facilitation through synergistic partnership, training of PCC providers by specialists and supportive structures: care coordinators, guiding protocols, shared electronic medical record and shared pharmacy, (iv) lack of organization reinforcement, and (v) mismatch between program goals, healthcare financing and providers’ reimbursement. Conclusion Functional integration alone is insufficient for a successful right-site care program implementation. Improvement in relationships between providers, organizations, and patients are also warranted for further development of the program.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health National University of Singapore, National University Health System, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Pami Shrestha
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Farah Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Regional Health System Office, National University Health System, Singapore, Singapore
| | - Ke Xin Eh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Ee Shiow Toh
- Regional Health System Office, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastrich, Maastricht, the Netherlands.,Panaxea B.V., Amsterdam, the Netherlands
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Ang IYH, Ng SHX, Rahman N, Nurjono M, Tham TY, Toh SA, Wee HL. Right-Site Care Programme with a community-based family medicine clinic in Singapore: secondary data analysis of its impact on mortality and healthcare utilisation. BMJ Open 2019; 9:e030718. [PMID: 31892645 PMCID: PMC6955507 DOI: 10.1136/bmjopen-2019-030718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Stable patients with chronic conditions could be appropriately cared for at family medicine clinics (FMC) and discharged from hospital specialist outpatient clinics (SOCs). The Right-Site Care Programme with Frontier FMC emphasised care organised around patients in community rather than hospital-based providers, with one identifiable primary provider. This study evaluated impact of this programme on mortality and healthcare utilisation. DESIGN A retrospective study without randomisation using secondary data analysis of patients enrolled in the intervention matched 1:1 with unenrolled patients as controls. SETTING Programme was supported by the Ministry of Health in Singapore, a city-state nation in Southeast Asia with 5.6 million population. PARTICIPANTS Intervention group comprises patients enrolled from January to December 2014 (n=684) and control patients (n=684) with at least one SOC and no FMC attendance during same period. INTERVENTIONS Family physician in Frontier FMC managed patients in consultation with relevant specialist physicians or fully managed patients independently. Care teams in SOCs and FMC used a common electronic medical records system to facilitate care coordination and conducted regular multidisciplinary case conferences. PRIMARY OUTCOME MEASURES Deidentified linked healthcare administrative data for time period of January 2011 to December 2017 were extracted. Three-year postenrolment mortality rates and utilisation frequencies and charges for SOC, public primary care centres (polyclinic), emergency department attendances and emergency, non-day surgery inpatient and all-cause admissions were compared. RESULTS Intervention patients had lower mortality rate (HR=0.37, p<0.01). Among those with potential of postenrolment polyclinic attendance, intervention patients had lower frequencies (incidence rate ratio (IRR)=0.60, p<0.01) and charges (mean ratio (MR)=0.51, p<0.01). Among those with potential of postenrolment SOC attendance, intervention patients had higher frequencies (IRR=2.06, p<0.01) and charges (MR=1.86, p<0.01). CONCLUSIONS Intervention patients had better survival, probably because their chronic conditions were better managed with close monitoring, contributing to higher total outpatient attendance frequencies and charges.
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Affiliation(s)
- Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sheryl Hui-Xian Ng
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nabilah Rahman
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Tat Yean Tham
- Clinical Affairs Department, Frontier Healthcare Group, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Toh
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Faculty of Science, National University of Singapore, Singapore, Singapore
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Abdul Rashid NA, Nurjono M, Lee J. Clinical determinants of physical activity and sedentary behaviour in individuals with schizophrenia. Asian J Psychiatr 2019; 46:62-67. [PMID: 31627166 DOI: 10.1016/j.ajp.2019.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Modifiable lifestyle factors such as physical activity (PA) have ameliorative effects on commonly reported health conditions in schizophrenia like cardiovascular diseases and diabetes. Similarly, reduction in sedentary behaviour (SB) promotes better physical health. However, engaging individuals with schizophrenia in PA and less SB can be challenging because of symptoms of schizophrenia. The aims of the present study are (i) to examine the profiles of PA and SB in individuals with schizophrenia; and (ii) to identify their respective clinical determinants. METHOD 157 individuals with schizophrenia were recruited. PA and SB were examined via the Global Physical Activity Questionnaire (GPAQ). Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). Potential clinical predictors of PA and SB were identified via univariate regression analyses and subsequently included in the final multiple regression models for PA and SB respectively. RESULTS 63.7% met the WHO PA guidelines. Work-related activity was the largest domain specific contribution towards PA. Mean duration of SB was approximately 9 h and about 57.3% reported at least 8 h or more of SB daily. Positive symptom was associated with engagement in PA and reduced duration of SB. Negative symptom was associated with greater SB. CONCLUSION With emerging evidence of deleterious health effects of SB independent of PA, it is important to monitor SB in individuals with schizophrenia, particularly those presenting with negative symptoms. While the lack of treatment response for negative symptoms remains a challenge, effort should be made to reduce duration of SB.
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Affiliation(s)
| | | | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; North Region & Department of Psychosis, Institute of Mental Health, Singapore.
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Ang IYH, Tan CS, Nurjono M, Tan XQ, Koh GCH, Vrijhoef HJM, Tan S, Ng SE, Toh SA. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019; 9:e027220. [PMID: 31122989 PMCID: PMC6538026 DOI: 10.1136/bmjopen-2018-027220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model. DESIGN A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls. SETTING The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population. PARTICIPANTS Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients. INTERVENTIONS For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients' post-discharge. PRIMARY OUTCOME MEASURES One-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared. RESULTS Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges. CONCLUSIONS Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.
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Affiliation(s)
- Ian Yi Han Ang
- Regional Health System Planning Office, National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Planning Office, National University Health System, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea b.v., Amsterdam, The Netherlands
| | - Shermin Tan
- Department of Palliative Medicine and Community Transformation Office, Woodlands Health Campus, Singapore
| | - Shu Ee Ng
- National University Singapore Yong Loo Lin School of Medicine, Singapore
- University Medicine Cluster, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
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Nurjono M, Shrestha P, Ang IYH, Shiraz F, Yoong JSY, Toh SAES, Vrijhoef HJM. Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore. BMC Health Serv Res 2019; 19:177. [PMID: 30890134 PMCID: PMC6425607 DOI: 10.1186/s12913-019-3980-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/28/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To cope with rising demand for healthcare services in Singapore, Regional Health Systems (RHS) comprising of health and social care providers across care settings were set up to integrate service delivery. Tasked with providing care for the western region, in 2012, the National University Health System (NUHS) - RHS developed a transitional care program for elderly patients with complex healthcare needs who consumed high levels of hospital resources. Through needs assessment, development of personalized care plans and care coordination, the program aimed to: (i) improve quality of care, (ii) reduce hospital utilization, and (iii) reduce healthcare-related costs. In this study, recognizing the need for process evaluation in conjunction with outcome evaluation, we aim to evaluate the implementation fidelity of the NUHS-RHS transitional care program to explain the outcomes of the program and to inform further development of (similar) programs. METHODS Guided by the modified version of the Conceptual Framework for Implementation Fidelity (CFIF), adherence and moderating factors influencing implementation were assessed using non-participatory observations, reviews of medical records and program databases. RESULTS Most (10 out of 14) components of the program were found to be implemented with low or moderate level of fidelity. The frequency or duration of the program components were observed to vary based on the needs of users, availability of care coordinators (CC) and their confidence. Variation in fidelity was influenced predominantly by: (1) complexity of the program, (2) extent of facilitation through guiding protocols, (3) facilitation of program implementation through CCs' level of training and confidence, (4) evolving healthcare participant responsiveness, and (5) the context of suboptimal capability among community providers. CONCLUSION This is the first study to assess the context-specific implementation process of a transitional care program in the context of Southeast Asia. It provides important insights to facilitate further development and scaling up of transitional care programs within the NUHS-RHS and beyond. Our findings highlight the need for greater focus on engaging both healthcare providers and users, training CCs to equip them with the relevant skills required for their jobs, and building the capability of the community providers to implement such programs.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Pami Shrestha
- Regional Health System Planning Office, National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Planning Office, National University Health System, Singapore, Singapore
| | - Farah Shiraz
- Regional Health System Planning Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joanne Su-Yin Yoong
- Center for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - Sue-Anne Ee Shiow Toh
- Regional Health System Planning Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea B.V, Amsterdam, The Netherlands
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Ang MS, Nurjono M, Lee J. The effects of clinical illness severity and physical activity on health-related quality of life in schizophrenia. Qual Life Res 2019; 28:1509-1520. [PMID: 30805880 DOI: 10.1007/s11136-019-02126-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Quality of life is an important clinical outcome in individuals with schizophrenia. Illness severity and physical activity (PA) were independently reported to influence health-related quality of life (HRQoL) in people with schizophrenia. This study attempts to examine the intensity and types of PA and their impact on HRQoL, as well as the relative contributions of illness severity, PA, and sedentary behavior (SB) to HRQoL in people with schizophrenia. METHODS Demographic information was collected from 297 community-dwelling individuals with schizophrenia. Severity of illness was assessed on the Clinical Global Impression-Severity (CGI-S); PA and SB were assessed on the Global Physical Activity Questionnaire (GPAQ); HRQoL was assessed on the RAND-36. Regression analyses were conducted to examine the impact of different types and intensities of PA on HRQoL, and the relative impact of CGI-S, GPAQ-PA, and GPAQ-SB on HRQoL. RESULTS Most participants had low PA level, and travel is the main type of PA adopted. Leisure time, travel-related, work-related, moderate-, and vigorous-intensity PA were all not associated with HRQoL. Lower severity of illness was significantly associated with better physical (PHC), mental (MHC) and global (GHC) health composites of the RAND-36 (GHC: t = - 5.628, p < 0.001, PHC: t = - 4.026, p < 0.001, MHC: t = - 5.534, p < 0.001). Both PA and SB were not significantly associated with PHC, MHC, and GHC. CONCLUSION Severity of illness has a significant impact on HRQoL in people with schizophrenia. However, we found no evidence to support the association between physical activity and sedentary behavior with HRQoL.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore. .,North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Nurjono M, Shrestha P, Lee A, Lim XY, Shiraz F, Tan S, Wong SH, Foo KM, Wee T, Toh SA, Yoong J, Maria Vrijhoef HJ. Realist evaluation of a complex integrated care programme: protocol for a mixed methods study. BMJ Open 2018; 8:e017111. [PMID: 29500199 PMCID: PMC5855239 DOI: 10.1136/bmjopen-2017-017111] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The lack of understanding of how complex integrated care programmes achieve their outcomes due to the lack of acceptable methods leads to difficulties in the development, implementation, adaptation and scaling up of similar interventions. In this study, we evaluate an integrated care network, the National University Health System (NUHS) Regional Health System (RHS), consisting of acute hospitals, step down care, primary care providers, social services and community partners using a theory-driven realist evaluation approach. This study aims to examine how and for whom the NUHS-RHS works to improve healthcare utilisations, outcomes, care experiences and reduce healthcare costs. By using a realist approach that balances the needs of context-specific evaluation with international comparability, this study carries the potential to address current research gaps. METHODS AND ANALYSIS This evaluation will be conducted in three research phases: (1) development of initial programme theory (IPT) underlying the NUHS-RHS; (2) testing of programme theory using empirical data; and (3) refinement of IPT. IPT was elicited and developed through reviews of programme documents, informal discussions and in-depth interviews with relevant stakeholders. Then, a convergent parallel mixed method study will be conducted to assess context (C), mechanisms (M) and outcomes (O) to test the IPT. Findings will then be analysed according to the realist evaluation formula of CMO in which findings on the context, mechanisms will be used to explain the outcomes. Finally, based on findings gathered, IPT will be refined to highlight how to improve the NUHS-RHS by detailing what works (outcome), as well as how (mechanisms) and under what conditions (context). ETHICS AND DISSEMINATION The National Healthcare Group, Singapore, Domain Specific Review Board reviewed and approved this study protocol. Study results will be published in international peer-reviewed journals and presented at conferences and internally to NUHS-RHS and Ministry of Health, Singapore.
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Affiliation(s)
- Milawaty Nurjono
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Pami Shrestha
- Regional Health System Planning Office, National University Health System, Singapore
| | - Alice Lee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Xin Ya Lim
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Farah Shiraz
- Regional Health System Planning Office, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Shermin Tan
- Regional Health System Planning Office, National University Health System, Singapore
| | - Shing Hei Wong
- Regional Health System Planning Office, National University Health System, Singapore
| | - Kah Mun Foo
- Regional Health System Planning Office, National University Health System, Singapore
| | - Thomas Wee
- Regional Health System Planning Office, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
| | - Joanne Yoong
- Centre for Health Services Research and Policy Research, Saw Swee Hock School of Public Health, National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Center for Economic and Social Research, University of Southern California, California, USA
| | - Hubertus Johannes Maria Vrijhoef
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea B.V., Amsterdam, The Netherlands
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
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10
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Abstract
BACKGROUND There is a growing interest in the association between schizophrenia and the activation of inflammatory system with signs of acute phase (AP) response. Majority of such studies had focused on C-reactive protein (CRP). The aims of the present study were (i) to examine the gene expression profiles of other acute phase proteins (APP), namely haptoglobin (HP), alpha-1 antitrypsin (A1T), and alpha-2 macroglobulin (A2M) in patients with first episode psychosis (FEP) over a period of three months and (ii) to explore the association between APP levels and severity of symptoms. METHODS In this study, HP, A1T and A2M gene expression levels from whole blood were measured at recruitment, 1- and 3-month follow-up visits using quantitative PCR (qPCR) in 43 patients with FEP and in 57 healthy controls. Diagnoses was ascertained on the Structured Clinical Interview for DSM-IV-TR. Severity of symptoms in patients was assessed on the Positive and Negative Syndrome Scale (PANSS) and a previously validated 5-factor PANSS structure was applied in the subsequent analyses. RESULTS The FEP sample comprised of 28 (65.1%) individuals with schizophrenia, 12 (27.9%) with schizophreniform disorder and 3 (7%) with schizoaffective disorder. HP gene expression level was noted to be significantly higher in patients than controls at all three time points: recruitment (P=0.049), 1-month follow up (P=0.002) and 3-month follow up (P=0.005). PANSS positive, depression, and excitement symptom factors showed significant associations with HP (P=0.002), A1T (P=0.016) and A2M (P=0.034), respectively. These findings remained significant after controlling for age, gender, smoking status and accumulated chlorpromazine dosage. CONCLUSION The current study provides information on HP, A1T and A2M gene expression profiles in FEP patients and their associations with psychopathology. This provides support for the hypothesis that inflammation is related to schizophrenia and further encourages studies on immune-inflammatory markers to understand the relationship between inflammation and schizophrenia.
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Affiliation(s)
- Jie Yin Yee
- Research Division, Institute of Mental Health, Singapore.
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wai Yee Ng
- Research Division, Institute of Mental Health, Singapore
| | - Stephanie Ruth Teo
- Neuroscience & Behavioural Disorders, Duke-NUS Medical School, Singapore
| | - Tih-Shih Lee
- Neuroscience & Behavioural Disorders, Duke-NUS Medical School, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of General Psychiatry 1, Institute of Mental Health, Singapore
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11
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Bautista MAC, Nurjono M, Lim YW, Dessers E, Vrijhoef HJ. Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties. Milbank Q 2017; 94:862-917. [PMID: 27995711 DOI: 10.1111/1468-0009.12233] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Policy Points: Investigations on systematic methodologies for measuring integrated care should coincide with the growing interest in this field of research. A systematic review of instruments provides insights into integrated care measurement, including setting the research agenda for validating available instruments and informing the decision to develop new ones. This study is the first systematic review of instruments measuring integrated care with an evidence synthesis of the measurement properties. We found 209 index instruments measuring different constructs related to integrated care; the strength of evidence on the adequacy of the majority of their measurement properties remained largely unassessed. CONTEXT Integrated care is an important strategy for increasing health system performance. Despite its growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. Our systematic review aims to provide evidence on the state of the art in measuring integrated care. METHODS Our comprehensive systematic review framework builds on the Rainbow Model for Integrated Care (RMIC). We searched MEDLINE/PubMed for published articles on the measurement properties of instruments measuring integrated care and identified eligible articles using a standard set of selection criteria. We assessed the methodological quality of every validation study reported using the COSMIN checklist and extracted data on study and instrument characteristics. We also evaluated the measurement properties of each examined instrument per validation study and provided a best evidence synthesis on the adequacy of measurement properties of the index instruments. FINDINGS From the 300 eligible articles, we assessed the methodological quality of 379 validation studies from which we identified 209 index instruments measuring integrated care constructs. The majority of studies reported on instruments measuring constructs related to care integration (33%) and patient-centered care (49%); fewer studies measured care continuity/comprehensive care (15%) and care coordination/case management (3%). We mapped 84% of the measured constructs to the clinical integration domain of the RMIC, with fewer constructs related to the domains of professional (3.7%), organizational (3.4%), and functional (0.5%) integration. Only 8% of the instruments were mapped to a combination of domains; none were mapped exclusively to the system or normative integration domains. The majority of instruments were administered to either patients (60%) or health care providers (20%). Of the measurement properties, responsiveness (4%), measurement error (7%), and criterion (12%) and cross-cultural validity (14%) were less commonly reported. We found <50% of the validation studies to be of good or excellent quality for any of the measurement properties. Only a minority of index instruments showed strong evidence of positive findings for internal consistency (15%), content validity (19%), and structural validity (7%); with moderate evidence of positive findings for internal consistency (14%) and construct validity (14%). CONCLUSIONS Our results suggest that the quality of measurement properties of instruments measuring integrated care is in need of improvement with the less-studied constructs and domains to become part of newly developed instruments.
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Affiliation(s)
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Yee Wei Lim
- Saw Swee Hock School of Public Health, National University of Singapore
| | - Ezra Dessers
- Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Hubertus Jm Vrijhoef
- Saw Swee Hock School of Public Health, National University of Singapore.,National University Health System, Singapore.,Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands.,Vrije Universiteit Brussels, Brussels, Belgium
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12
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Abstract
γ-Aminobutyric acid (GABA), the primary inhibitory neurotransmitter, has often been studied in relation to its role in the pathophysiology of schizophrenia. GABA is synthesized from glutamate by glutamic acid decarboxylase (GAD), derived from two genes, GAD1 and GAD2. GAD1 is expressed as both GAD67 and GAD25 mRNA transcripts with the former reported to have a lower expression level in schizophrenia compared to healthy controls and latter was reported to be predominantly expressed fetally, suggesting a role in developmental process. In this study, GAD67 and GAD25 mRNA levels were measured by quantitative PCR (qPCR) in peripheral blood of subjects with first-episode psychosis (FEP) and from healthy controls. We observed low GAD25 and GAD67 gene expression levels in human peripheral blood. There was no difference in GAD25 and GAD67 gene expression level, and GAD25/GAD67 ratio between patients with FEP and healthy controls. PANSS negative symptoms were associated with levels of GAD25 mRNA transcripts in patients with FEP. While the current study provides information on GAD25 and GAD67 mRNA transcript levels in whole blood of FEP patients, further correlation and validation work between brain regions, cerebrospinal fluid and peripheral blood expression profiling are required to provide a better understanding of GAD25 and GAD67.
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Affiliation(s)
- Jie Yin Yee
- Research Division, Institute of Mental Health, Singapore, Singapore
- * E-mail:
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Stephanie Ruth Teo
- Neuroscience & Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Tih-Shih Lee
- Neuroscience & Behavioural Disorders, Duke-NUS Medical School, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore
- Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore
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13
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Vrijhoef B, Tan S, Wong T, Nurjono M. ISQUA16-3108IMPROVEMENT SCIENCE TO EVALUATE PERSON-CENTRED AND INTEGRATED CARE: AN INTERNATIONAL COMPARISON. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Billings JL, Hare DJ, Nurjono M, Volitakis I, Cherny RA, Bush AI, Adlard PA, Finkelstein DI. Effects of Neonatal Iron Feeding and Chronic Clioquinol Administration on the Parkinsonian Human A53T Transgenic Mouse. ACS Chem Neurosci 2016; 7:360-6. [PMID: 26712118 DOI: 10.1021/acschemneuro.5b00305] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Increased nigral iron (Fe) is a cardinal feature of Parkinson's disease, as is the accumulation of aggregates comprising α-synuclein. We used wild-type mice and transgenic mice overexpressing the human A53T mutation to α-synuclein to examine the influence of increased Fe (days 10-17 postpartum) on the parkinsonian development phenotype of these animals (including abnormal nigral Fe levels and deficits in both cell numbers and locomotor activity), and to explore the impact of the Fe chelator clioquinol in the model. Both untreated and Fe-loaded A53T mice showed similar levels of nigral cell loss, though 5 months of clioquinol treatment was only able to prevent the loss in the non-Fe-loaded A53T group. Iron levels in the Fe-loaded A53T mice returned to normal at 8 months, though effects of dopamine denervation remained, demonstrated by limited locomotor activity and sustained neuron loss. These data suggest that Fe exposure during a critical developmental window, combined with the overexpression mutant α-synuclein, presents a disease phenotype resistant to intervention using clioquinol later in life.
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Affiliation(s)
- Jessica L. Billings
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Dominic J. Hare
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
- Elemental
Bio-imaging Facility, University of Technology Sydney, Broadway, New South Wales 2007, Australia
| | - Milawaty Nurjono
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Irene Volitakis
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Robert A. Cherny
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Ashley I. Bush
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Paul A. Adlard
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - David I. Finkelstein
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
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15
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Finkelstein DI, Hare DJ, Billings JL, Sedjahtera A, Nurjono M, Arthofer E, George S, Culvenor JG, Bush AI, Adlard PA. Clioquinol Improves Cognitive, Motor Function, and Microanatomy of the Alpha-Synuclein hA53T Transgenic Mice. ACS Chem Neurosci 2016; 7:119-29. [PMID: 26481462 DOI: 10.1021/acschemneuro.5b00253] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The abnormal accumulation of alpha-synuclein (α-syn) has been linked to a number of neurodegenerative disorders, the most noteworthy of which is Parkinson's disease. Alpha-synuclein itself is not toxic and fulfills various physiological roles in the central nervous system. However, specific types of aggregates have been shown to be toxic, and metals have been linked to the assembly of these toxic aggregates. In this paper, we have characterized a transgenic mouse that overexpresses the A53T mutation of human α-syn, specifically assessing cognition, motor performance, and subtle anatomical markers that have all been observed in synucleinopathies in humans. We hypothesized that treatment with the moderate-affinity metal chelator, clioquinol (CQ), would reduce the interaction between metals and α-syn to subsequently improve the phenotype of the A53T animal model. We showed that CQ prevents an iron-synuclein interaction, the formation of urea-soluble α-syn aggregates, α-syn-related substantia nigra pars compacta cell loss, reduction in dendritic spine density of hippocampal and caudate putamen medium spiny neurons, and the decline in motor and cognitive function. In conclusion, our data suggests that CQ is capable of mitigating the pathological metal/α-syn interactions, suggesting that the modulation of metal ions warrants further study as a therapeutic approach for the synucleinopathies.
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Affiliation(s)
- David I. Finkelstein
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Dominic J. Hare
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
- Elemental
Bio-imaging Facility, University of Technology Sydney, Broadway, New South Wales 2007, Australia
- Senator
Frank R. Lautenberg Environmental Science Laboratory, Icahn School of Medicine at Mount Sinai, New York, New York 10029, United States
| | - Jessica L. Billings
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Amelia Sedjahtera
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Milawaty Nurjono
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Elisa Arthofer
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
- Department
of Physiology and Pharmacology, Karolinska Institut, Stockholm SE-171 77, Sweden
| | - Sonia George
- School
of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Janetta G. Culvenor
- School
of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Ashley I. Bush
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Paul A. Adlard
- The
Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
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16
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Neelamekam S, Nurjono M, Lee J. Regulation of interleukin-6 and leptin in schizophrenia patients: a preliminary analysis. Clin Psychopharmacol Neurosci 2014; 12:209-14. [PMID: 25598824 PMCID: PMC4293166 DOI: 10.9758/cpn.2014.12.3.209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/04/2014] [Accepted: 08/11/2014] [Indexed: 12/29/2022]
Abstract
Objective Immune-inflammatory mediators play a pivotal role in brain signaling and have been increasingly associated with the pathophysiology of schizophrenia. Many studies have indicated an increased level of immune-inflammatory interleukin-6 (IL-6) in schizophrenia. IL-6 is a well-known chief stimulator of inflammation. Of late leptin has also been implicated in the inflammatory pathway of schizophrenia. In this study we measured and compared serum levels of IL-6 and leptin in patients with schizophrenia to healthy controls, and investigated the relationship between IL-6 and leptin. Methods Serum IL-6 and leptin were determined in 20 patients diagnosed with schizophrenia and in 19 healthy controls matched by gender, age and body mass index (BMI) using commercial Bioplex assays. Results Using Mann-Whitney U-test, significantly increased IL-6 levels were found in the patients but there was no significant difference in leptin levels though a trend towards higher leptin was observed in the patients. Spearman correlations did not show any correlation between IL-6 and clinical variables except antipsychotic dosage. Leptin significantly correlated with gender and BMI. A large effect size correlation was observed between IL-6 and leptin in the patients but not in the controls. Multiple regression analysis performed on patients, after adjusting for gender and BMI, revealed there was no significant association between IL-6 and leptin. Conclusion IL-6 and leptin levels may reflect the chronic inflammatory state associated with schizophrenia but further evaluation is required. Also, it is important to consider the confounding effects of obesity in any examination of relationships between groups with regard to cytokines and adipokines.
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Affiliation(s)
| | | | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore. ; Department of General Psychiatry 1, Institute of Mental Health, Singapore. ; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
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17
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Renjan V, Nurjono M, Lee J. Serum brain-derived neurotrophic factor (BDNF) and its association with remission status in Chinese patients with schizophrenia. Psychiatry Res 2014; 220:193-6. [PMID: 25174850 DOI: 10.1016/j.psychres.2014.07.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/30/2014] [Accepted: 07/31/2014] [Indexed: 11/17/2022]
Abstract
The neurotrophin, brain-derived neurotrophic factor (BDNF), characterises a probable neurobiochemical explanation of maldevelopments in schizophrenia and is a candidate biomarker of the illness. A paucity of studies examining neurobiochemical predictors of remission in schizophrenia exists. In this study, we seek to examine if serum BDNF level is associated with remission status in a sample of Chinese patients with schizophrenia. This study did not find a significant relationship between serum BDNF and remission in patients with schizophrenia. Identification of a suitable biomarker for diagnosis, management, and prognostic outcome is crucial and warrants further study.
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Affiliation(s)
- Vidhya Renjan
- Research Division, Institute of Mental Health, Singapore
| | | | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of General Psychiatry 1, Institute of Mental Health, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
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18
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Abayomi O, Amato D, Bailey C, Bitanihirwe B, Bowen L, Burshtein S, Cullen A, Fusté M, Herrmann AP, Khodaie B, Kilian S, Lang QA, Manning EE, Massuda R, Nurjono M, Sadiq S, Sanchez-Gutierrez T, Sheinbaum T, Shivakumar V, Simon N, Spiteri-Staines A, Sirijit S, Toftdahl NG, Wadehra S, Wang Y, Wigton R, Wright S, Yagoda S, Zaytseva Y, O'Shea A, DeLisi LE. The 4th Schizophrenia International Research Society Conference, 5-9 April 2014, Florence, Italy: a summary of topics and trends. Schizophr Res 2014; 159:e1-22. [PMID: 25306204 PMCID: PMC4394607 DOI: 10.1016/j.schres.2014.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/07/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
The 4th Schizophrenia International Research Society Conference was held in Florence, Italy, April 5-9, 2014 and this year had as its emphasis, "Fostering Collaboration in Schizophrenia Research". Student travel awardees served as rapporteurs for each oral session, summarized the important contributions of each session and then each report was integrated into a final summary of data discussed at the entire conference by topic. It is hoped that by combining data from different presentations, patterns of interest will emerge and thus lead to new progress for the future. In addition, the following report provides an overview of the conference for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Olukayode Abayomi
- Ladoke Akintola University of Technology Teaching Hospital, PMB 4007, Ogbomoso, Oyo, Nigeria
| | - Davide Amato
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Ulmenweg 19, 91054 Erlangen, Germany
| | - Candace Bailey
- University of Texas Medical Branch, School of Medicine, 215 Mechanic Street, Apt. M206, Galveston77550, TX, United States
| | - Byron Bitanihirwe
- Laboratory of System and Cell Biology of Neurodegeneration, University of Zurich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Lynneice Bowen
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States
| | | | - Alexis Cullen
- Health Services and Population Research Department, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - Ana P Herrmann
- Pharmacology Department, Basic Health Sciences Institute, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | | | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Qortni A Lang
- Howard University College of Medicine, 520 W Street, Washington, DC 20059, United States
| | - Elizabeth E Manning
- The Florey Institute of Neuroscience and Mental Health, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, VIC, Australia
| | - Raffael Massuda
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350 Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Sarosh Sadiq
- Government College University, 170-S, 19/B, College Road, New Samanabad, Lahore, Pakistan
| | - Teresa Sanchez-Gutierrez
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43 28009, Madrid, Spain
| | - Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Edifici B, 08193 Bellaterra, Barcelona, Spain
| | | | - Nicholas Simon
- Department of Neuroscience, A210 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Anneliese Spiteri-Staines
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville 3052, Victoria, Australia
| | - Suttajit Sirijit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nanna Gilliam Toftdahl
- Mental Health Centre Copenhagen, Bispebjerg Bakke 23, Entrance 13A, 3rd floor, DK-2400, Copenhagen NV, Denmark
| | - Sunali Wadehra
- Wayne State University School of Medicine, 469 West Hancock, Detroit 48201, MI, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China
| | - Rebekah Wigton
- Cognition and Schizophrenia Imaging Laboratory, Institute of Psychiatry, King's College, 16 De Crespigny Park Rd, Denmark Hill, London SE5 8AF, UK
| | - Susan Wright
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Neuroimaging Research Program, P.O. Box 21247, Baltimore, MD 21228, United States
| | - Sergey Yagoda
- Department of Psychiatry, Psychotherapy and Medical Psychology of Stavropol State Medical University, 28b Aivazovsky str, Stavropol 355007, Russia
| | - Yuliya Zaytseva
- Moscow Research Institute of Psychiatry, Russian Federation/Prague Psychiatric Centre affiliated with 3rd Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Anne O'Shea
- Harvard Medical School, Brockton, MA 02301, United States. anne_o'
| | - Lynn E DeLisi
- Department of Psychiatry, Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, United States; VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, United States.
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19
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Nurjono M, Tay YH, Lee J. The relationship between serum brain-derived neurotrophic factor (BDNF) and cardiometabolic indices in schizophrenia. Schizophr Res 2014; 157:244-8. [PMID: 24934904 DOI: 10.1016/j.schres.2014.05.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 04/25/2014] [Accepted: 05/17/2014] [Indexed: 01/09/2023]
Abstract
Brain derived neurotrophic factor (BDNF), which has been implicated in the pathogenesis of schizophrenia, has been recently shown to be involved in the regulation of metabolism and energy homeostasis. This study seeks to examine the relationship between BDNF, metabolic indices and cardiovascular (CVD) risk in patients with schizophrenia. Medical histories, demographic information and anthropometric measurements were collected and analyzed from 61 participants with schizophrenia. Fasting glucose and lipids were measured in a central laboratory, and serum BDNF was analyzed using commercially available enzyme-linked immunosorbent assay (ELISA). The 10-year CVD risk for each participant was computed using the Framingham risk score (FRS). Linear regressions were performed to examine the relationships between serum BDNF with body mass index (BMI), blood pressure (BP), triglycerides (TG), total cholesterol, high-density lipoprotein cholesterol (HDL-C) and glucose. To examine the relationship between serum BDNF and FRS, serum BDNF was categorized into quartiles, and a multiple regression was performed. After adjusting for age, gender and current smoking status, diastolic BP (dBP) (p=0.045) and TG (p=0.015) were found to be significantly associated with serum BDNF. Participants in the highest quartile of serum BDNF had a 3.3 times increase in FRS over those in the lowest quartile. Our findings support the possible regulatory role of BDNF in metabolism and cardiovascular homeostasis among patients with schizophrenia similar to that observed among the non-mentally ill. Serum BDNF not only present itself as a candidate biomarker of schizophrenia but also might be a viable marker of metabolic co-morbidities associated with schizophrenia.
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Affiliation(s)
- Milawaty Nurjono
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Yi Hang Tay
- Ministry of Health Holdings, Singapore, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore, Singapore; Department of General Psychiatry 1, Institute of Mental Health, Singapore, Singapore; Duke-NUS Graduate Medical School, Singapore, Singapore.
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20
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Tay YH, Nurjono M, Lee J. Increased Framingham 10-year CVD risk in Chinese patients with schizophrenia. Schizophr Res 2013; 147:187-192. [PMID: 23590873 DOI: 10.1016/j.schres.2013.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/06/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
UNLABELLED BACKGROUND & HYPOTHESIS: Schizophrenia is associated with increased mortality rates, which has been attributed to the greater incidence of cardiovascular disease (CVD) events. The Framingham risk score (FRS) is a widely-used age- and gender-specific algorithm to estimate 10-year CVD risk and vascular age. The main aim of this study was to determine the cardiovascular risk profile in schizophrenia and examine the effect of metabolic syndrome (MetS) as a predictor of CVD risk. We hypothesized that patients with schizophrenia have an increased 10-year CVD risk. METHODS 83 Chinese patients with schizophrenia and 243 Chinese community controls were recruited. Their medical and smoking histories were obtained, and anthropometric parameters measured. All subjects provided fasted venous blood samples for lipid and glucose measurements. 10-year CVD risk and the difference between vascular and actual age (VAdiff) for each participant were computed using the FRS and compared between patients and controls. RESULTS Schizophrenia patients had a higher mean 10-year CVD risk of 4.6%, as compared with 3.1% in controls, and a greater VAdiff of 4.6 years vs. 0.6 years. Both smoking and MetS contributed significantly to the 10-year CVD risk in patients with schizophrenia, with smoking having a greater effect than MetS on this risk. CONCLUSION This study found a significantly elevated mean 10-year CVD risk and VAdiff in patients with schizophrenia compared with controls. Findings point towards the importance of smoking cessation and screening for MetS to decrease the excess CVD risk in patients with schizophrenia.
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Affiliation(s)
- Yi Hang Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Jimmy Lee
- Research Division, Institute of Mental Health, Singapore; Department of General Psychiatry 1, Institute of Mental Health, Singapore; Office of Clinical Sciences, Duke-NUS Graduate Medical School, National University of Singapore, Singapore.
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Nurjono M, Lee J. Waist Circumference is a Potential Indicator of Metabolic Syndrome in Singaporean Chinese. Ann Acad Med Singap 2013. [DOI: 10.47102/annals-acadmedsg.v42n5p241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Metabolic Syndrome (MetS) is associated with cardiovascular morbidity and mortality. Studies proposed that waist circumference (WC) and body mass index (BMI) are good indicators of MetS. In this study, we examined and compared the predictive utility of clinical measures such as WC, blood pressure and BMI and determined the cut off points in which these measures are most reliable in identifying MetS in Singaporean Chinese. Materials and Methods: Two hundred and forty-four subjects aged between 21 and 50 years of Chinese ethnicity were recruited into the study. Sociodemographic, height, weight and blood pressure information were obtained. High-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and glucose levels were evaluated. Presence of MetS was examined according to American Heart Association (AHA)/National Heart, Lung and Blood Institute (NHLBI) guidelines. Predictive utility of BP, WC and BMI was examined using receiver operating curve and discriminant indices were determined accordingly. Results: Forty-one (16.8%) subjects were identified to have MetS. Our analysis revealed that waist circumference was most accurate in identifying MetS (area under the curve (AUC) = 0.88, 95% confidence interval (CI), 0.83 to 0.93, P 92.5 cm in males and >86.5 cm in females were found to be most sensitive and specific in discriminating MetS. Conclusion: Our finding has immediate and significant clinical implications as WC can be easily obtained. However, as the study included only Singaporean Chinese, findings cannot be generalised for other ethnic groups.
Key words: Chinese, Metabolic syndrome, Waist circumference
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Affiliation(s)
| | - Jimmy Lee
- Institute of Mental Health, Singapore
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Nurjono M, Lee J. Predictive utility of blood pressure, waist circumference and body mass index for metabolic syndrome in patients with schizophrenia in Singapore. Early Interv Psychiatry 2013; 7:205-9. [PMID: 22747854 DOI: 10.1111/j.1751-7893.2012.00384.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 05/04/2012] [Indexed: 01/01/2023]
Abstract
AIMS This study aims to examine and compare the predictive utility of blood pressure (BP), waist circumference (WC) and body mass index (BMI), and to determine optimal cut-off values in prediction of metabolic syndrome (MetS) in patients with chronic schizophrenia. METHODS About 100 patients with chronic schizophrenia were recruited. BMI and BP were measured and laboratory tests to evaluate patients' high-density lipoprotein cholesterol, triglycerides and glucose levels were performed. Presence of MetS was examined according to AHA/NHLBI guidelines. Predictive utility of BP, WC and BMI was examined using receiver operating curve and discriminant indices were determined accordingly. RESULTS Forty-six (46%) patients were identified to have MetS. BMI of ≥23 kg m(-2) was most accurate (AUC = 0.83, P < 0.001), with sensitivity of 93.5%, specificity of 48.1%, positive predictive value of 60.6% and negative predictive value of 92.9% in identifying MetS. CONCLUSION This finding has immediate and significant clinical implications in the local population with schizophrenia.
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Affiliation(s)
- Milawaty Nurjono
- Research Division, Institute of Mental Health, Singapore, Singapore
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Nurjono M, Lee J. Waist circumference is a potential indicator of metabolic syndrome in Singaporean Chinese. Ann Acad Med Singap 2013; 42:241-245. [PMID: 23771112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Metabolic Syndrome (MetS) is associated with cardiovascular morbidity and mortality. Studies proposed that waist circumference (WC) and body mass index (BMI) are good indicators of MetS. In this study, we examined and compared the predictive utility of clinical measures such as WC, blood pressure and BMI and determined the cutoff points in which these measures are most reliable in identifying MetS in Singaporean Chinese. MATERIALS AND METHODS Two hundred and forty-four subjects aged between 21 and 50 years of Chinese ethnicity were recruited into the study. Sociodemographic, height, weight and blood pressure information were obtained. High-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and glucose levels were evaluated. Presence of MetS was examined according to American Heart Association (AHA)/National Heart, Lung and Blood Institute (NHLBI) guidelines. Predictive utility of BP, WC and BMI was examined using receiver operating curve and discriminant indices were determined accordingly. RESULTS Forty-one (16.8%) subjects were identified to have MetS. Our analysis revealed that waist circumference was most accurate in identifying MetS (area under the curve (AUC) = 0.88, 95% confidence interval (CI), 0.83 to 0.93, P <0.001) followed by BMI (AUC = 0.84, 95% CI, 0.77 to 0.91, P = 0.035), systolic BP (AUC = 0.83, 95% CI, 0.76 to 0.90, P = 0.036) and diastolic BP (AUC = 0.80, 95% CI, 0.71 to 0.88, P = 0.042). Waist circumference cut-off values of >92.5 cm in males and >86.5 cm in females were found to be most sensitive and specific in discriminating MetS. CONCLUSION Our finding has immediate and significant clinical implications as WC can be easily obtained. However, as the study included only Singaporean Chinese, findings cannot be generalised for other ethnic groups.
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Lee J, Nurjono M, Wong A, Salim A. Prevalence of Metabolic Syndrome Among Patients with Schizophrenia in Singapore. Ann Acad Med Singap 2012. [DOI: 10.47102/annals-acadmedsg.v41n10p457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction: Schizophrenia has been associated with an increased risk of cardio-metabolic morbidity and mortality. Metabolic syndrome (MetS), a reliable predictor of cardiovascular-related morbidity and mortality, has also been shown to be more prevalent in patients with schizophrenia. In this study, we investigated the prevalence of MetS in a sample of patients with schizophrenia in Singapore, and the potential risk factors associated with it. Materials & Methods: One hundred patients with schizophrenia and 300 community controls were recruited. All subjects provided a fasted sample of venous blood to measure high-density lipoprotein cholesterol (HDL-C), triglycerides and glucose levels. Weight, height and waist circumference were measured. Presence of MetS was assessed according to the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) guidelines. Results: The prevalence of MetS in patients with schizophrenia was 46.0%. The adjusted odds ratio (OR) for MetS among patients was 2.79 (CI, 1.50 to 5.20, P = 0.001) when compared with controls. Increasing body mass index (BMI) was identified to be significantly associated with the prevalence of MetS. Conclusion: This study found a high prevalence of MetS in Singapore patients with schizophrenia, and that BMI might be a risk factor in the development of MetS. This information is clinically relevant as BMI is routinely measured in psychiatric practice today, and could be used to monitor for development of MetS in schizophrenia.
Key words: Mental illness, Obesity, Smoking
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Affiliation(s)
- Jimmy Lee
- Institute of Mental Health, Singapore
| | | | | | - Agus Salim
- Saw Swee Hock School of Public Health, National University of Singapore
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Lee J, Nurjono M, Wong A, Salim A. Prevalence of metabolic syndrome among patients with schizophrenia in Singapore. Ann Acad Med Singap 2012; 41:457-462. [PMID: 23138143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Schizophrenia has been associated with an increased risk of cardiometabolic morbidity and mortality. Metabolic syndrome (MetS), a reliable predictor of cardiovascular-related morbidity and mortality, has also been shown to be more prevalent in patients with schizophrenia. In this study, we investigated the prevalence of MetS in a sample of patients with schizophrenia in Singapore, and the potential risk factors associated with it. MATERIALS & METHODS One hundred patients with schizophrenia and 300 community controls were recruited. All subjects provided a fasted sample of venous blood to measure high-density lipoprotein cholesterol (HDL-C), triglycerides and glucose levels. Weight, height and waist circumference were measured. Presence of MetS was assessed according to the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) guidelines. RESULTS The prevalence of MetS in patients with schizophrenia was 46.0%. The adjusted odds ratio (OR) for MetS among patients was 2.79 (CI, 1.50 to 5.20, P = 0.001) when compared with controls. Increasing body mass index (BMI) was identifi ed to be signifi cantly associated with the prevalence of MetS. CONCLUSION This study found a high prevalence of MetS in Singapore patients with schizophrenia, and that BMI might be a risk factor in the development of MetS. This information is clinically relevant as BMI is routinely measured in psychiatric practice today, and could be used to monitor for development of MetS in schizophrenia.
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Affiliation(s)
- Jimmy Lee
- Research Division, Institute of Mental Health, Singapore 539747.
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Nurjono M, Lee J, Chong SA. A Review of Brain-derived Neurotrophic Factor as a Candidate Biomarker in Schizophrenia. Clin Psychopharmacol Neurosci 2012; 10:61-70. [PMID: 23431036 PMCID: PMC3569148 DOI: 10.9758/cpn.2012.10.2.61] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 04/26/2012] [Indexed: 12/21/2022]
Abstract
Brain-derived neurotrophic factor (BDNF), a neurotrophin known to be responsible for development, regeneration, survival and maintenance of neurons has been implicated in the pathophysiology of schizophrenia. This review seeks to complement previous reviews on biological roles of BDNF and summarizes evidence on the involvement of BDNF in the pathophysiology of schizophrenia with an emphasis on clinical relevance. The expressions of BDNF were altered in patients with schizophrenia and were found to be correlated with psychotic symptomatology. Antipsychotics appeared to have differential effects on expression of BDNF but did not restore BDNF expression of patients with schizophrenia to normal levels. In addition, evidence suggests that BDNF is involved in the major neurotransmitter systems and is associated with disruptions in brain structure, neurodevelopmental process, cognitive function, metabolic and immune systems commonly associated with schizophrenia. Besides that, BDNF has been demonstrated to be tightly regulated with estrogen which has also been previously implicated in schizophrenia. Evidence gathered in this review confirms the relevance of BDNF in the pathophysiology of schizophrenia and the potential utility of BDNF as a suitable biomarker for diagnostic and prognostic purposes for disease outcome and other co-morbidities. However, further investigations are warranted to examine the specificity of BDNF in schizophrenia compared to other neurodegenerative disorders and other neuropsychiatric illness. Longitudinal prospective studies will also be of added advantage for evaluation of prognostic utility of BDNF in schizophrenia.
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Affiliation(s)
- Milawaty Nurjono
- Research Division, Institute of Mental Health/Woodbridge Hospital, Singapore
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Hung L, Roberts B, Wilkins S, George J, Pham C, Lim S, Crouch P, Nurjono M, Gunawan L, Critch N, Sherratt N, Cherny R, Bush A, Masters C, Culvenor J, Cappai R, White A, Donnelly P, Villemagne V, Finkelstein D, Barnham K. P2.097 A reactive nitrogen species scavenger is neuroprotective in multiple Parkinson's disease animal models. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70448-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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George J, Wilkins S, Critch N, Gunawan L, Cortes M, Liu X, Laughton K, Nurjono M, Volitakis I, Huggins P, Parsons J, McNaughton M, Adlard P, Masters C, Cappai R, Barnham K, Gautier E, Bush A, Cherny R, Finkelstein D. P1.050 Novel neuroprotective agents for the treatment of Parkinson's disease. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Crouch PJ, Hung LW, Adlard PA, Cortes M, Lal V, Filiz G, Perez KA, Nurjono M, Caragounis A, Du T, Laughton K, Volitakis I, Bush AI, Li QX, Masters CL, Cappai R, Cherny RA, Donnelly PS, White AR, Barnham KJ. Increasing Cu bioavailability inhibits Abeta oligomers and tau phosphorylation. Proc Natl Acad Sci U S A 2009; 106:381-6. [PMID: 19122148 PMCID: PMC2626711 DOI: 10.1073/pnas.0809057106] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Indexed: 11/18/2022] Open
Abstract
Cognitive decline in Alzheimer's disease (AD) involves pathological accumulation of synaptotoxic amyloid-beta (Abeta) oligomers and hyperphosphorylated tau. Because recent evidence indicates that glycogen synthase kinase 3beta (GSK3beta) activity regulates these neurotoxic pathways, we developed an AD therapeutic strategy to target GSK3beta. The strategy involves the use of copper-bis(thiosemicarbazonoto) complexes to increase intracellular copper bioavailability and inhibit GSK3beta through activation of an Akt signaling pathway. Our lead compound Cu(II)(gtsm) significantly inhibited GSK3beta in the brains of APP/PS1 transgenic AD model mice. Cu(II)(gtsm) also decreased the abundance of Abeta trimers and phosphorylated tau, and restored performance of AD mice in the Y-maze test to levels expected for cognitively normal animals. Improvement in the Y-maze correlated directly with decreased Abeta trimer levels. This study demonstrates that increasing intracellular copper bioavailability can restore cognitive function by inhibiting the accumulation of neurotoxic Abeta trimers and phosphorylated tau.
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Affiliation(s)
- Peter J. Crouch
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Lin Wai Hung
- Department of Pathology
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victorial, 3010, Australia; and
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Paul A. Adlard
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Mikhalina Cortes
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Varsha Lal
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Gulay Filiz
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Keyla A. Perez
- Department of Pathology
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victorial, 3010, Australia; and
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Milawaty Nurjono
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Aphrodite Caragounis
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Tai Du
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Katrina Laughton
- Department of Pathology
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Irene Volitakis
- Department of Pathology
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Ashley I. Bush
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Qiao-Xin Li
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Colin L. Masters
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Roberto Cappai
- Department of Pathology
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victorial, 3010, Australia; and
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Robert A. Cherny
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Paul S. Donnelly
- School of Chemistry, and
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victorial, 3010, Australia; and
| | - Anthony R. White
- Department of Pathology
- Centre for Neuroscience
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
| | - Kevin J. Barnham
- Department of Pathology
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victorial, 3010, Australia; and
- Mental Health Research Institute of Victoria, Parkville, Victoria 3052, Australia
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