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Sugianto R, Toh JY, Wong SF, Tint MT, Colega MT, Lee YS, Yap F, Shek LPC, Tan KH, Godfrey KM, Chong YS, Tai BC, Chong MFF. Dietary patterns of 5-year-old children and their correlates: findings from a multi-ethnic Asian cohort. Br J Nutr 2022; 127:763-772. [PMID: 33910654 PMCID: PMC7612427 DOI: 10.1017/s0007114521001434] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is limited data on the dietary patterns of 5-year-old children in Asia. The study examined childhood dietary patterns and their maternal and child correlates in a multi-ethnic Asian cohort. Based on caregiver-reported 1-month quantitative FFQ of 777 children from the Growing Up in Singapore Towards healthy Outcomes cohort, cluster analysis identified two mutually exclusive clusters. Children in the 'Unhealthy' cluster (43·9 %) consumed more fries, processed meat, biscuits and ice cream, and less fish, fruits and vegetables compared with those in the 'Healthy' cluster (56·1 %). Children with mothers of lower educational attainment had twice the odds of being assigned to the 'Unhealthy' cluster (adjusted OR (95 % CI) = 2·19 (95 % CI 1·49-3·24)). Children of Malay and Indian ethnicities had higher odds of being assigned to the 'Unhealthy' cluster (adjusted OR = 25·46 (95 % CI 15·40, 42·10) and 4·03 (95 % CI 2·68-6·06), respectively), relative to Chinese ethnicity. In conclusion, this study identified two dietary patterns in children, labelled as the 'Unhealthy' and 'Healthy' clusters. Mothers' educational attainment and ethnicity were two correlates that were associated with the children's assignments to the clusters. These findings can assist in informing health promotion programmes targeted at Asian children.
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Affiliation(s)
- R Sugianto
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - JY Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - SF Wong
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MT Tint
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MT Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - YS Lee
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital and National University Health System, Singapore
| | - F Yap
- Duke-NUS Medical School, Singapore
- KK Women’s and Children’s Hospital, Singapore
| | - LPC Shek
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital and National University Health System, Singapore
| | - KH Tan
- Duke-NUS Medical School, Singapore
- KK Women’s and Children’s Hospital, Singapore
| | - KM Godfrey
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - YS Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - BC Tai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - MFF Chong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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Koo CY, Tai BC, Chan KHD, Tan KK, Lee CH. P3499Predictors of major adverse cardiac and cerebrovascular events in patients newly diagnosed with colorectal carcinoma after surgical resection. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Y Koo
- National University Heart Centre, Cardiology, Singapore, Singapore
| | - B C Tai
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, Singapore
| | - K H D Chan
- National University Health System, General Surgery, Singapore, Singapore
| | - K K Tan
- National University Health System, General Surgery, Singapore, Singapore
| | - C H Lee
- National University Heart Centre, Cardiology, Singapore, Singapore
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Alperet DJ, Rebello SA, Khoo EYH, Tay Z, Seah SSY, Tai BC, Tai ES, Emady-Azar S, Chou CJ, Darimont C, van Dam RM. The effects of coffee consumption on insulin sensitivity and other risk factors for type 2 diabetes. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- DJ Alperet
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - SA Rebello
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
| | - EYH Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Z Tay
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - SSY Seah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - BC Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - ES Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - S Emady-Azar
- Nestlé Clinical Development Unit, Lausanne, Switzerland
| | - CJ Chou
- Microbiome and Metabolism, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | - C Darimont
- Nutrition & Health Research, Nestlé Research Center, Lausanne, Switzerland
| | - RM van Dam
- NUS Graduate School for Integrative Sciences and Engineering, National University of Singapore, Singapore, Singapore
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Liu JJ, Lim SC, Yeoh LY, Su C, Tai BC, Low S, Fun S, Tavintharan S, Chia KS, Tai ES, Sum CF. Ethnic disparities in risk of cardiovascular disease, end-stage renal disease and all-cause mortality: a prospective study among Asian people with Type 2 diabetes. Diabet Med 2016; 33:332-9. [PMID: 26514089 DOI: 10.1111/dme.13020] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Abstract
AIM To study prospectively the ethnic-specific risks of cardiovascular disease, end-stage renal disease and all-cause mortality in patients with Type 2 diabetes mellitus among native Asian subpopulations. METHODS A total of 2337 subjects with Type 2 diabetes (70% Chinese, 17% Malay and 13% Asian Indian) were followed for a median of 4.0 years. Time-to-event analysis was used to study the association of ethnicity with adverse outcomes. RESULTS Age- and gender-adjusted hazard ratios for cardiovascular disease in ethnic Malay and Asian Indian subjects were 2.01 (1.40-2.88; P<0.0001) and 1.60 (1.07-2.41; P=0.022) as compared with Chinese subjects. Adjustment for conventional cardiovascular disease risk factors, including HbA1c , blood pressure and lipid profile, slightly attenuated the hazards in Malay (1.82, 1.23-2.71; P=0.003) and Asian Indian subjects (1.47, 0.95-2.30; P=0.086); However, further adjustment for baseline renal function (estimated GFR) and albuminuria weakened the cardiovascular disease risks in Malay (1.48, 0.98-2.26; P=0.065) but strengthened that in Asian Indian subjects (1.81, 1.14-2.87; P=0.012). Competing-risk regression showed that the age- and gender-adjusted sub-distribution hazard ratio for end-stage renal disease was 1.87 (1.27-2.73; P=0.001) in Malay and 0.39 (0.18-0.83; P=0.015) in Asian Indian subjects. Notably, the difference in end-stage renal disease risk among the three ethnic groups was abolished after further adjustment for baseline estimated GFR and albuminuria. There was no significant difference in risk of all-cause mortality among the three ethnic groups. CONCLUSIONS Risks of cardiovascular and end-stage renal diseases in native Asian subjects with Type 2 diabetes vary substantially among different ethnic groups. Differences in prevalence of diabetic kidney disease may partially explain the ethnic disparities.
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Affiliation(s)
- J J Liu
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - S C Lim
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - L Y Yeoh
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - C Su
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - B C Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - S Low
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - S Fun
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
| | - S Tavintharan
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
| | - K S Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - E S Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C F Sum
- Diabetes Centre, Khoo Teck Puat Hospital, Singapore
- Department of Medicine, Khoo Teck Puat Hospital, Singapore
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Salunke AA, Chen Y, Chen X, Tan JH, Singh G, Tai BC, Khin LW, Puhaindran ME. Does pathological fracture affect the rate of local recurrence in patients with a giant cell tumour of bone?: a meta-analysis. Bone Joint J 2016; 97-B:1566-71. [PMID: 26530662 DOI: 10.1302/0301-620x.97b11.35326] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Indexed: 11/05/2022]
Abstract
We investigated whether the presence of a pathological fracture increased the risk of local recurrence in patients with a giant cell tumour (GCT) of bone. We also assessed if curettage is still an appropriate form of treatment in the presence of a pathological fracture. We conducted a comprehensive review and meta-analysis of papers which reported outcomes in patients with a GCT with and without a pathological fracture at presentation. We computed the odds ratio (OR) of local recurrence in those with and without a pathological fracture. We selected 19 eligible papers for final analysis. This included 3215 patients, of whom 580 (18.0%) had a pathological fracture. The pooled OR for local recurrence between patients with and without a pathological fracture was 1.05 (95% confidence interval (CI) 0.66 to 1.67, p = 0.854). Amongst the subgroup of patients who were treated with curettage, the pooled OR for local recurrence was 1.23 (95% CI 0.75 to 2.01, p = 0.417). A post hoc sample size calculation showed adequate power for both comparisons. There is no difference in local recurrence rates between patients who have a GCT of bone with and without a pathological fracture at the time of presentation. The presence of a pathological fracture should not preclude the decision to perform curettage as carefully selected patients who undergo curettage can have similar outcomes in terms of local recurrence to those without such a fracture.
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Affiliation(s)
- A A Salunke
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Y Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - X Chen
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - J H Tan
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - G Singh
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - B C Tai
- National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore 117549, Singapore
| | - L W Khin
- National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - M E Puhaindran
- National University Health System Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Tai BC, Chen ZJ, Machin D. Estimating sample size in the presence of competing risks – Cause-specific hazard or cumulative incidence approach? Stat Methods Med Res 2015; 27:114-125. [DOI: 10.1177/0962280215623107] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In designing randomised clinical trials involving competing risks endpoints, it is important to consider competing events to ensure appropriate determination of sample size. We conduct a simulation study to compare sample sizes obtained from the cause-specific hazard and cumulative incidence (CMI) approaches, by first assuming exponential event times. As the proportional subdistribution hazard assumption does not hold for the CMI exponential (CMIExponential) model, we further investigate the impact of violation of such an assumption by comparing the results obtained from the CMI exponential model with those of a CMI model assuming a Gompertz distribution (CMIGompertz) where the proportional assumption is tenable. The simulation suggests that the CMIExponential approach requires a considerably larger sample size when treatment reduces the hazards of both the main event, A, and the competing risk, B. When treatment has a beneficial effect on A but no effect on B, the sample sizes required by both methods are largely similar, especially for large reduction in the main risk. If treatment has a protective effect on A but adversely affects B, then the sample size required by CMIExponential is notably smaller than cause-specific hazard for small to moderate reduction in the main risk. Further, a smaller sample size is required for CMIGompertz as compared with CMIExponential. The choice between a cause-specific hazard or CMI model in competing risks outcomes has implications on the study design. This should be made on the basis of the clinical question of interest and the validity of the associated model assumption.
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Affiliation(s)
- BC Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - ZJ Chen
- Investigational Medicine Unit, National University Health System, Singapore
| | - D Machin
- Medical Statistics Unit, School of Health and Related Sciences, University of Sheffield, UK
- Department of Cancer Studies and Molecular Medicine, University of Leicester, UK
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Koh GCH, Tai BC, Ang LW, Heng D, Yuan JM, Koh WP. All-cause and cause-specific mortality after hip fracture among Chinese women and men: the Singapore Chinese Health Study. Osteoporos Int 2013; 24:1981-9. [PMID: 23224227 PMCID: PMC9244854 DOI: 10.1007/s00198-012-2183-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 06/24/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture. INTRODUCTION To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population. METHODS The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively. RESULTS Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35-1.86] for females and aHR = 1.64 [95 % CI, 1.30-2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery. CONCLUSIONS All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.
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Affiliation(s)
- G C-H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Block MD3, #03-20, 16 Medical Drive, 117597 Singapore, Singapore.
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Chen Y, Tai BC, Nayak D, Kumar N, Chua KH, Lim JW, Goy RWL, Wong HK. Blood loss in spinal tumour surgery and surgery for metastatic spinal disease: a meta-analysis. Bone Joint J 2013; 95-B:683-8. [PMID: 23632682 DOI: 10.1302/0301-620x.95b5.31270] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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] [Indexed: 11/05/2022]
Abstract
There is currently no consensus about the mean volume of blood lost during spinal tumour surgery and surgery for metastatic spinal disease. We conducted a systematic review of papers published in the English language between 31 January 1992 and 31 January 2012. Only papers that clearly presented blood loss data in spinal surgery for metastatic disease were included. The random effects model was used to obtain the pooled estimate of mean blood loss. We selected 18 papers, including six case series, ten retrospective reviews and two prospective studies. Altogether, there were 760 patients who had undergone spinal tumour surgery and surgery for metastatic spinal disease. The pooled estimate of peri-operative blood loss was 2180 ml (95% confidence interval 1805 to 2554) with catastrophic blood loss as high as 5000 ml, which is rare. Aside from two studies that reported large amounts of mean blood loss (> 5500 ml), the resulting funnel plot suggested an absence of publication bias. This was confirmed by Egger's test, which did not show any small-study effects (p = 0.119). However, there was strong evidence of heterogeneity between studies (I(2) = 90%; p < 0.001). Spinal surgery for metastatic disease is associated with significant blood loss and the possibility of catastrophic blood loss. There is a need to establish standardised methods of calculating and reporting this blood loss. Analysis should include assessment by area of the spine, primary pathology and nature of surgery so that the amount of blood loss can be predicted. Consideration should be given to autotransfusion in these patients.
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Affiliation(s)
- Y Chen
- National University Health System, Department of Orthopaedic Surgery, NUHS Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore
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Chai LYA, Netea MG, Tai BC, Khin LW, Vonk AG, Teo BW, Schlamm HT, Herbrecht R, Donnelly JP, Troke PF, Kullberg BJ. An elevated pro-inflammatory cytokine response is linked to development of amphotericin B-induced nephrotoxicity. J Antimicrob Chemother 2013; 68:1655-9. [DOI: 10.1093/jac/dkt055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Abstract
BACKGROUND Some epidemiological studies have reported that teachers may be at increased risk of non-Hodgkin's lymphoma (NHL), but results are inconsistent. AIMS To examine the possible association between occupation and risk of NHL in the Singapore population. METHODS A hospital-based interviewer-administered case-control study was carried out in five major hospitals in Singapore between April 2004 and December 2008. A complete occupational history, which included all jobs lasting over 1 year since graduation from school, was obtained for each participant. The Singapore Standard Occupational Classification was used for coding all occupations recorded. RESULTS Eight hundred and thirty controls and 465 NHL cases, comprising B-cell (n = 404, 87%) as well as T- and NK-cell (n = 61, 13%) neoplasms, were recruited. Having ever worked as a teacher was associated with a significantly higher risk of NHL (adjusted OR 2.04, 95% CI 1.12-3.72). Teachers who had taught for ≤10 years had a significantly higher risk of NHL (adjusted OR 2.44, 95% CI 1.11-5.34), but we did not observe an elevated risk for those who reported teaching for >10 years. Among the 31 teachers with NHL, 23% taught in upper secondary schools, with equal proportions (13%) teaching in primary and pre-primary schools, respectively. The remainder taught in other settings. CONCLUSIONS Teachers come into frequent contact with children and may consequently have higher rates of exposure to common infectious agents. Therefore, the hypothesis of an infective aetiology of NHL may be supported by our findings.
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Affiliation(s)
- S E Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Engman M, Bystrom B, Varghese S, Lalitkumar PGL, Gemzell-Danielsson K, Romeu C, Urries A, Lierta M, Sanchez Rubio J, Sanz B, Perez I, Casis L, Salerno A, Nazzaro A, Di Iorio L, Bonassisa P, Van Os L, Vink-Ranti CQJ, de Haan-Cramer JH, Rijnders PM, Jansen CAM, Nazzaro A, Salerno A, Marino S, Granato C, Pastore E, Brandes M, Hamilton CJCM, de Bruin JP, Bots RSGM, Nelen WLDM, Kremer JAM, Szkodziak P, Wozniak S, Czuczwar P, Paszkowski T, Wozniak S, Szkodziak P, Czuczwar P, Paszkowski T, Agirregoitia N, Peralta L, Mendoza R, Exposito A, Matorras R, Agirregoitia E, Chuderland D, Ben-Ami I, Kaplan-Kraicer R, Grossman H, Satchi- Fainaro R, Eldar-Boock A, Ron-El R, Shalgi R, Custers IM, Scholten I, Moolenaar LM, Flierman PA, Dessel TJHM, Gerards MH, Cox T, Janssen CAH, van der Veen F, Mol BWJ, Wathlet S, Adriaenssens T, Verheyen G, Coucke W, Smitz J, Feliciani E, Ferraretti AP, Paesano C, Pellizzaro E, Magli MC, Gianaroli L, Hernandez J, Rodriguez-Fuentes A, Garcia-Guzman R, Palumbo A, Radunovic N, Tosic T, Djukic S, Lockwood JC, Adriaenssens T, Wathlet S, Van Landuyt L, Verheyen G, Coucke W, Smitz J, Karayalcin R, Ozcan SARP, Ozyer S, Gurlek B, Kale I, Moraloglu O, Batioglu S, Chaudhury K, Narendra Babu K, Mamata Joshi V, Srivastava S, Chakravarty BN, Viardot-Foucault V, Prasath EB, Tai BC, Chan JKY, Loh SF, Cordeiro I, Leal F, Soares AP, Nunes J, Sousa S, Aguiar A, Carvalho M, Calhaz-Jorge C, Karkanaki A, Piouk A, Katsikis I, Mousatat T, Koiou E, Daskalopoulos GN, Panidis D, Tolikas A, Tsakos E, Gerou S, Prapas Y, Loufopoulos A, Abanto E, Barrenetxea G, Agirregoikoa J, Anarte C, De Pablo JL, Burgos J, Komarovsky D, Friedler S, Gidoni Y, Ben-ami I, Strassburger D, Bern O, Kasterstein E E, Komsky A, Maslansky B, Ron-El R, Raziel A, Fuentes A, Argandona F, Gabler F, Galleguillos A, Torres A, Palomino WA, Gonzalez-Fernandez R, Pena O, Hernandez J, Palumbo A, Avila J, Talebi Chahvar S, Biondini V, Battistoni S, Giannubilo S, Tranquilli AL, Stensen MH, Tanbo T, Storeng R, Abyholm T, Fedorcsak P, Johnson SR, Foster L, Ellis J, Choi JR, Joo JK, Son JB, Lee KS, Helmgaard L, Klein BM, Arce JC, Sanhueza P, Donoso P, Salinas R, Enriquez R, Saez V, Carrasco I, Rios M, Gonzalez P, Macklon N, Guo M, Richardson M, Wilson P, Chian RC, Eapen A, Hrehorcak M, Campbell S, Nargund G, Oron G, Fisch B, Ao A, Freidman O, Zhang XY, Ben-Haroush A, Abir R, Hantisteanu S, Ellenbogen A, Hallak M, Michaeli M, Fainaru O, Maman E, Yong G, Kedem A, Yeruahlmi G, Konopnicki S, Cohen B, Dor J, Hourvitz A, Moshin V, Croitor M, Hotineanu A, Ciorap Z, Rasohin E, Aleyasin A, Agha Hosseini M, Mahdavi A, Safdarian L, Fallahi P, Mohajeri MR, Abbasi M, Esfahani F, Elnashar A, Badawy A, Totongy M, Mohamed H, Mustafa F, Seidman DS, Tadir Y, Goldchmit C, Gilboa Y, Siton A, Mashiach R, Rabinovici J, Yerushalmi GM, Inoue O, Kuji N, Fukunaga T, Ogawa S, Sugawara K, Yamada M, Hamatani T, Hanabusa H, Yoshimura Y, Kato S, Casarini L, La Marca A, Lispi M, Longobardi S, Pignatti E, Simoni M, Halpern G, Braga DPAF, Figueira RCS, Setti AS, Iaconelli Jr. A, Borges Jr. E, Vingris L, Setti AS, Braga DPAF, Figueira RCS, Iaconelli Jr. A, Pasqualotto FF, Borges Jr. E, Collado-Fernandez E, Harris SE, Cotterill M, Elder K, Picton HM, Serra V, Garrido N, Casanova C, Lara C, Remohi J, Bellver J, Steiner HP, Kim CH, You RM, Nah HY, Kang HJ, Kim S, Chae HD, Kang BM, Reig Viader R, Brieno Enriquez MA, Toran N, Cabero L, Giulotto E, Garcia Caldes M, Ruiz-Herrera A, Brieno-Enriquez M, Reig-Viader R, Toran N, Cabero L, Martinez F, Garcia-Caldes M, Velthut A, Zilmer M, Zilmer K, Haller T. Kaart E, Karro H, Salumets A, Bromfield JJ, Sheldon IM, Rezacova J, Madar J, Cuchalova L, Fiserova A, Shao R, Billig H. POSTER VIEWING SESSION - FEMALE (IN) FERTILITY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koh GCH, Shek LP, Kee J, Tai BC, Wee A, Ng V, Koh D. An association between floor vacuuming and dust-mite and serum eosinophil cationic protein in young asthmatics. Indoor Air 2009; 19:468-473. [PMID: 19682104 DOI: 10.1111/j.1600-0668.2009.00610.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED Although vacuum cleaning is recommended to reduce allergen levels and improve asthma and allergic rhinitis symptoms, some studies suggest it may increase allergen load in homes. We conducted a cross-sectional study to determine if home floor vacuuming was associated with sensitization to dust-mites and cockroaches, and serum eosinophil cationic protein (ECP), a biomarker for atopy, in 102 physician-diagnosed spirometry-confirmed asthmatics. We collected data on floor type, floor cleaning method and frequency, asthma severity, allergy medications used, serum ECP and skin prick tests (SPT) to three dust-mites [Dermatophagoides pteronyssisinus (Der p), Dermatophagoides farinae (Der f) and Blomia tropicalis (Blo t)] and two cockroaches [Periplanata americana (Per a) and Blatella germanica (Bla g)]. Those who vacuumed had increased sensitization to three dust-mites [adjusted ORs (95%CI) = Der p: 26.6 (1.8-405.2); Der f: 44.8 (3.2-620.9); Blo t: 14.1 (1.8-108.1)] but not to cockroaches, adjusted for cleaning frequency and other methods of floor cleaning. Subjects who vacuumed their floor had higher levels of serum ECP than those who did not [adjusted median difference (95%CI): 9.4 (1.1-17.7)], adjusted for use of nasal corticosteroids among those with allergic rhinitis. Vacuuming is associated with increased sensitization to dust-mite allergens and higher serum ECP. PRACTICAL IMPLICATIONS We found an association between floor vacuuming and increased sensitization to dust-mite allergens and higher levels of an atopy biomarker. Current recommendations to use vacuuming to control allergen exposure and allergic conditions may need to be reconsidered until further studies are performed.
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Affiliation(s)
- G C H Koh
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Ng DPK, Fukushima M, Tai BC, Koh D, Leong H, Imura H, Lim XL. Reduced GFR and albuminuria in Chinese type 2 diabetes mellitus patients are both independently associated with activation of the TNF-alpha system. Diabetologia 2008; 51:2318-24. [PMID: 18839132 DOI: 10.1007/s00125-008-1162-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 04/02/2008] [Accepted: 08/05/2008] [Indexed: 11/30/2022]
Abstract
AIMS/HYPOTHESIS The involvement of chronic inflammation in albuminuria and renal function was investigated in a cross-sectional study of 320 type 2 diabetic Chinese patients from the Singapore Diabetes Cohort Study. METHODS Plasma levels of TNF-alpha and its two cellular receptors and of IL-6 and C-reactive protein (CRP) were measured. A composite TNF-alpha score was extracted using principal component analysis. Multiple linear regression analysis was implemented to evaluate the relationship between log( e ) (ln) albumin:creatinine ratio (ACR) and estimated GFR (eGFR) with the inflammatory variables and other clinical covariates. A Bonferroni correction was applied based on the total number of variables entered into regression analyses. RESULTS ln ACR was significantly associated with TNF-alpha score independently of eGFR even after a Bonferroni correction. TNF-alpha score was also significantly associated with eGFR independently of ln ACR even after correction for multiple testing. These findings were similar when the individual molecules of the TNF-alpha system were analysed separately instead of using the composite TNF-alpha score. No association was observed for IL-6 and CRP with either renal trait. Diabetes duration was a significant predictor for ln ACR but not eGFR. Conversely, age was significantly associated with eGFR but not ln ACR. CONCLUSIONS/INTERPRETATION Activation of the TNF-alpha system may potentially exert independent effects on ln ACR and eGFR in type 2 diabetes. Because of the study design, one may also consider the possibility that changes in these renal traits may conversely be responsible for such an inflammatory response.
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Affiliation(s)
- D P K Ng
- Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 16 Medical Drive MD3, Singapore, 117597, Singapore.
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Thng CH, Hartono S, Koh TS, Rumpel H, Ong AB, Sukri N, Tai BC, Soo RA, Humerickhouse R, Goh BC. Dynamic contrast enhanced MRI (DCE MRI) for Phase I anti-angiogenic trial: Comparison of the transfer constant (Ktrans) to blood flow and permeability derived by a distributed parameter model. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Soong R, Shah N, Salto-Tellez M, Tai BC, Soo RA, Han HC, Ng SS, Tan WL, Zeps N, Joseph D, Diasio RB, Iacopetta B. Prognostic significance of thymidylate synthase, dihydropyrimidine dehydrogenase and thymidine phosphorylase protein expression in colorectal cancer patients treated with or without 5-fluorouracil-based chemotherapy. Ann Oncol 2008; 19:915-9. [PMID: 18245778 DOI: 10.1093/annonc/mdm599] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low tumour expression levels of thymidylate synthase (TS), dihydropyrimidine dehydrogenase (DPD) and thymidine phosphorylase (TP) have been linked with improved outcome for colorectal cancer (CRC) patients treated with 5-fluorouracil (5-FU). It is unclear whether this occurs because such tumours have better prognosis or they are more sensitive to 5-FU treatment. PATIENTS AND METHODS Associations between TS, DPD and TP levels, determined by tissue microarrays and immunohistochemistry, and survival was evaluated in 945 CRC patients according to treatment status. RESULTS Low TS and DPD expression associated with worse prognosis in stage II [hazard ratio (HR) = 1.69, 95% confidence interval (CI) (1.09-2.63) and HR = 1.92 (95% CI 1.23-2.94), respectively] and stage III CRC patients treated by surgery alone [HR = 1.39 (95% CI 0.92-2.13) and HR = 1.49 (95% CI 1.02-2.17), respectively]. Low TS, DPD and TP associated with trends for better outcome in stage III patients treated with 5-FU [HR = 0.81 (95% CI 0.49-1.33), HR = 0.70 (95% CI 0.42-1.15) and HR = 0.66 (95% CI 0.39-1.12), respectively]. CONCLUSION Low TS and DPD expression are prognostic for worse outcome in CRC patients treated by surgery alone, whereas low TS, DPD and TP expression are prognostic for better outcome in patients treated with 5-FU chemotherapy. These results provide indirect evidence that low TS, DPD and TP protein expression are predictive of good response to 5-FU chemotherapy.
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Affiliation(s)
- R Soong
- Oncology Research Institute, National University of Singapore, Singapore.
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Thng CH, Koh TS, Rumpel H, Khoo JB, Ong AB, Sukri N, Tai BC, Soo RA, Humerickhouse R, Goh BC. Dynamic contrast enhanced MRI (DCE MRI) for assessment of effects of anti-angiogenic therapy: Comparison of the transfer constant (Ktrans) to blood flow and permeability derived by a distributed parameters model. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14109 Background: Transfer constant (Ktrans) and IAUC60 normalized with arterial input function are commonly used dynamic contrast enhanced magnetic resonance imaging (DCE MRI) parameters. The distributed parameters model (DP) is a DCE MRI model that enables derivation of blood flow and capillary permeability-surface area product (PS). We aim to study the distributed parameters model as an alternative method of angiogenesis assessment and correlate the above parameters to drug exposure and patient outcome in a Phase I anti- angiogenic trial. Methods: Fifteen evaluable patients from an on-going Phase I trial (ABT 869) with 3 dose escalations formed the study population. Pharmacokinetic study was performed on Day 1 and the area under the concentration time curve extrapolated to infinity (AUCinfinity) was used as an indicator of drug exposure. All patients underwent DCE MRI at baseline, Day 3 and Day 15 with temporal resolution of 4 seconds. Gadolinium concentrations were estimated using a dual flip angle method. Patients demonstrating progressive disease in first 2 evaluation scans (cycle 2 or 4) based on RECIST criteria were considered progressors and all other patients non-progressors. Receiver operating curve (ROC) analysis was performed. Correlation with AUCinfinity was analyzed. Results: There is good correlation (Spearman’s coefficient -0.67, p = 0.008) between AUCinfinity and DP derived PS and less strong correlation with normalized IAUC60 (Spearman’s coefficient -0.57, p = 0.03). There is no correlation for Ktrans (Spearman’s coefficient 0.04). ROC analysis for predicting progressors versus non-progressors showed a higher ROC area for PS compared to Ktrans (0.83 versus 0.47, p = 0.037). Normalized IAUC60 showed a slightly lower area compared to PS (0.77 versus 0.83) but the difference is not significant (p = 0.58). Conclusions: PS derived from DP model shows better correlation with drug exposure and may predict patient outcome better than Ktrans. [Table: see text]
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Affiliation(s)
- C. H. Thng
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - T. S. Koh
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - H. Rumpel
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - J. B. Khoo
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - A. B. Ong
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - N. Sukri
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - B. C. Tai
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - R. A. Soo
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - R. Humerickhouse
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
| | - B. C. Goh
- National Cancer Centre, Singapore, Singapore, Singapore; Nanyang Technological University, Singapore, Singapore; Singapore General Hospital, Singapore, Singapore; National University Hospital, Singapore, Singapore; National University of Singapore, Singapore, Singapore; Abbott Laboratories, Abbott Park, IL
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Yeo KK, Tai BC, Heng D, Lee JMJ, Ma S, Hughes K, Chew SK, Chia KS, Tai ES. Ethnicity modifies the association between diabetes mellitus and ischaemic heart disease in Chinese, Malays and Asian Indians living in Singapore. Diabetologia 2006; 49:2866-73. [PMID: 17021918 DOI: 10.1007/s00125-006-0469-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [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: 05/30/2006] [Accepted: 08/14/2006] [Indexed: 01/23/2023]
Abstract
AIMS/HYPOTHESIS The aim of the study was to determine whether the risk of ischaemic heart disease (IHD) associated with diabetes mellitus differs between ethnic groups. METHODS Registry linkage was used to identify IHD events in 5707 Chinese, Malay and Asian Indian participants from three cross-sectional studies conducted in Singapore between the years 1984 and 1995. The study provided a median of 10.2 years of follow-up with 240 IHD events experienced. We assessed the interaction between diabetes mellitus and ethnicity in relation to the risk of IHD events using Cox proportional hazards regression. RESULTS Diabetes mellitus was more common in Asian Indians. Furthermore, diabetes mellitus was associated with a greater risk of IHD in Asian Indians. The hazard ratio when comparing diabetes mellitus with non-diabetes mellitus was 6.41 (95% CI 5.77-7.12) in Asian Indians and 3.07 (95% CI 1.86-5.06) in Chinese (p = 0.009 for interaction). Differences in the levels of established IHD risk factors among diabetics from the three ethnic groups did not appear to explain the differences in IHD risk. CONCLUSIONS/INTERPRETATION Asian Indians are more susceptible to the development of diabetes mellitus than Chinese and Malays. When Asian Indians do develop diabetes mellitus, the risk of IHD is higher than for Chinese and Malays. Consequently, the prevention of diabetes mellitus amongst this ethnic group is particularly important for the prevention of IHD in Asia, especially given the size of the population at risk. Elucidation of the reasons for these ethnic differences may help us understand the pathogenesis of IHD in those with diabetes mellitus.
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Affiliation(s)
- K K Yeo
- Department of Endocrinology, Singapore General Hospital, Block 6 level 6, Room B35, Outram Road, Singapore, Singapore
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Lee YM, Fernandez M, Da Costa M, Lee KH, Sutedja DS, Tai BC, Tan KC, Isaac J, Prabhakaran K, Lim SG. MELD may not be the better system for organ allocation in liver transplantation patients in Singapore. Singapore Med J 2006; 47:592-4. [PMID: 16810430] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The Model for End-Stage Liver Disease (MELD) score is a good predictor of mortality on the liver transplant waiting list and is the current system of organ allocation in the USA. However, a higher MELD may be associated with poorer outcome post-liver transplantation. The aim of this study was to determine if MELD should be implemented as the system for organ allocation for liver transplantation in Singapore. METHODS There were 46 adult patients who underwent primary liver transplantation at the National University Hospital, Singapore from January 1996 to December 2002. We applied the MELD score to patients who were transplanted and looked for a correlation with survival post-transplant. Patients were followed-up until the most recent visit or death. Survival analysis was performed using Cox regression and Kaplan-Meier method. RESULTS The mean age at transplant was 52.7 (SD 2.34) years. The majority of the patients transplanted had Hepatitis B (43 percent). The median MELD score at transplantation was 17 (7-42) and the median Child's score was 11 (6-15). There was a significant correlation between pre-transplant MELD and survival at six months (p-value is 0.037, 95 percent confidence interval [CI] is 1.004-1.13) but not at one year (p-value is 0.065, 95 percent CI is 0.99-1.12). There were no differences in the pre-transplant MELD (odds-ratio [OR] 1, 95 percent CI 0.9-1) as well as survival for patients with and without Hepatitis B (OR 0.72, 95 percent CI 0.22-2.35). CONCLUSION MELD allows livers to be allocated to the patients with the greatest medical urgency but its influence on post-transplant survival should be further clarified so that post-transplant survival is not compromised.
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Affiliation(s)
- Y M Lee
- Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore
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Ho TF, Tai BC, Lee EL, Cheng S, Liow PH. Prevalence and profile of females at risk of eating disorders in Singapore. Singapore Med J 2006; 47:499-503. [PMID: 16752018] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION The objective of this study was to assess the prevalence of young females at risk of developing eating disorders (ED) and the associated socio-demographical variables. METHODS A set of self-administered questionnaires consisting of an Eating Attitude Test (EAT), an Eating Disorder Inventory (EDI) and a socio-demographical questionnaire was administered to 4,461 young females. Based on scores for EAT and/or EDI-drive for thinness (EDI-DT) subscale, subjects were categorised into either "normal" (NM) or "at risk" (AR) of ED. RESULTS Mean age of the subjects was 16.7 years (range 12-26 years). The ethnic composition was 78.8 percent Chinese, 11.7 percent Malay, 6.6 percent Indian and 3 percent other ethnic groups. Prevalence of AR was 7.4 percent (95 percent confidence interval [CI] 6.7-8.2 percent). Mean EAT and EDI-DT scores for AR were significantly higher than that of NM (EAT: mean difference is 22.1, 95 percent CI 20.7-23.4, p-value is less than 0.0001; EDI-DT: mean difference is 10.9, 95 percent CI 10.5-11.4, p-value is less than 0.0001). Female Malays constituted a significantly larger proportion of AR (20.6 percent) as compared to NM (10.9 percent). AR females are more likely to use Malay as a spoken language at home (prevalence rate ratio 1.70, p-value is 0.001) and to be better educated with completion of General Certificate of Education (GCE) "O" levels. However, the parents of AR females are likely to be less well educated (below GCE "A" levels). CONCLUSION The prevalence of females at risk of developing ED is 7.4 percent. Malay ethnic group, using Malay language at home and the educational levels of both the subjects and their parents appear to be associated with an increased risk for development of ED.
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Affiliation(s)
- T F Ho
- Department of Physiology, National University of Singapore, 2 Medical Drive, Block MD 9, Singapore 117597.
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Ng DPK, Tai BC, Koh D, Tan KW, Chia KS. Angiotensin-I converting enzyme insertion/deletion polymorphism and its association with diabetic nephropathy: a meta-analysis of studies reported between 1994 and 2004 and comprising 14,727 subjects. Diabetologia 2005; 48:1008-16. [PMID: 15830182 DOI: 10.1007/s00125-005-1726-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [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: 07/22/2004] [Accepted: 12/19/2004] [Indexed: 02/03/2023]
Abstract
AIMS/HYPOTHESIS The ACE insertion/deletion polymorphism has been examined for association with diabetic nephropathy over the past decade with conflicting results. To clarify this situation, we conducted a comprehensive meta-analysis encompassing all relevant studies that were published between 1994 and 2004 and investigated this potential genetic association. METHODS A total of 14,727 subjects from 47 studies was included in this meta-analysis. Cases (n=8,663) were type 1 or 2 diabetic subjects with incipient (microalbuminuria) or advanced diabetic nephropathy (proteinuria, chronic renal failure, end-stage renal disease). Control subjects (n=6,064) were predominantly normoalbuminuric. RESULTS No obvious publication bias was detected. Using a minimal-case definition based on incipient diabetic nephropathy, subjects with the II genotype had a 22% lower risk of diabetic nephropathy than carriers of the D allele (pooled odds ratio [OR]=0.78, 95% CI=0.69-0.88). While there was a reduced risk of diabetic nephropathy associated with the II genotype among Caucasians with either type 1 or type 2 diabetes, the association was most marked among type 2 diabetic Asians (Chinese, Japanese, Koreans) (OR=0.65, 95% CI=0. 51-0.83). This OR is significantly different from the OR of 0.90 (95% CI= 0.78-1.04) that was obtained for type 2 diabetic Caucasians (p=0.019). Using a stricter case definition based on advanced diabetic nephropathy, a comparable risk reduction of 24-32% was observed among the three subgroups, although statistical significance was reached only among Asians. CONCLUSIONS/INTERPRETATION The results of our meta-analysis support a genetic association of the ACE Ins/Del polymorphism with diabetic nephropathy. These findings may have implications for the management of diabetic nephropathy using ACE inhibitors especially among type 2 diabetic Asians.
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Affiliation(s)
- D P K Ng
- Department of Community, Occupational and Family Medicine, Faculty of Medicine (MD3), National University of Singapore, 16 Medical Drive, Singapore 117597, Singapore.
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Lee YM, Fernandes M, Da Costa M, Lee KH, Sutedja D, Tai BC, Tan KC, Isaac J, Prabhakaran K, Lim SG. The MELD score may help to determine optimum time for liver transplantation. Transplant Proc 2005; 36:3057-9. [PMID: 15686693 DOI: 10.1016/j.transproceed.2004.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The model for end-stage liver disease (MELD) score is a good predictor of mortality on the waiting list and short-term survival post liver transplantation. AIM Our aim was to determine if there is a pretransplant MELD score beyond which liver transplantation is prohibitive. PATIENTS AND METHODS Forty-six adult patients underwent primary liver transplantation from January 1996 to December 2002. Patients followed to the most recent visit or death underwent survival analysis using Cox regression and Kaplan Meier methods. RESULTS There was a significant correlation between the pretransplant MELD score and survival at 6 months posttransplant (P=.037 95% CI: 1.004-1.13). Patients with pretransplant MELD score greater than or equal to 32 showed significantly greater mortality compared with those less than 32 (HR 9.18, 95%CI=1.16-72.44). CONCLUSION Pretransplant MELD may help to determine the optimum time for liver transplantation.
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Affiliation(s)
- Y M Lee
- Department of Medicine, National University Hospital, Singapore.
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Wee J, Tan EH, Tai BC, Wong HB, Leong SS, Tan T, Chua ET, Lee KM, Yang E, Machin D. Phase III randomized trial of radiotherapy versus concurrent chemo-radiotherapy followed by adjuvant chemotherapy in patients with AJCC/UICC (1997) stage 3 and 4 nasopharyngeal cancer of the endemic variety. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Wee
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - E. H. Tan
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - B. C. Tai
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - H. B. Wong
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - S. S. Leong
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - T. Tan
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - E. T. Chua
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - K. M. Lee
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - E. Yang
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
| | - D. Machin
- National Cancer Center, Singapore, Singapore; Clinical Trials & Epidemiology Research Unit, Singapore, Singapore
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Abstract
BACKGROUND Immunosuppressive therapy is reportedly ineffective in adults with acute myocarditis. AIMS To systematically review the impact of immunosuppressive therapy on the outcome of acute myocarditis in children. METHODS A literature search for articles published from 1984 to 2003 was conducted with the following keywords: myocarditis, dilated cardiomyopathy, and immunosuppression. The relevant studies were systematically reviewed and comparison of treatment effect was made by calculating the odds ratio (OR) and confidence interval (CI) using the exact method based on the exact discrete reference distribution. RESULTS Of the 1470 articles found, only nine studies were eligible. The odds for improvement with immunosuppression was between 4.33 (95% CI 0.52 to 52.23) and 2.7 (95% CI 0.59 to 14.21). Addition of a second immunosuppressive agent to prednisolone only proved effective in one randomised controlled trial (OR 0.09, 95% CI 0.01 to 0.52). Heterogeneity of these studies precluded pooled odds ratio. CONCLUSION Current data suggest that immunosuppressive therapy does not significantly improve outcomes in children with acute myocarditis and there is insufficient evidence for its routine use. However, statistical power to detect a significant difference in the treatment effect may be limited because of the small number of subjects. This, together with problems of diagnosis, varying treatment practices, and a relative lack of evidence based guidelines would support efforts for a large multicentre, randomised controlled trial to better define the role of immunosuppression in acute myocarditis.
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Affiliation(s)
- C P P Hia
- Department of Paediatrics, National University of Singapore, National University Hospital, Singapore
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Tan SB, Machin D, Cheung YB, Chung YFA, Tai BC, Machin D. Following a trial that stopped early: what next for adjuvant hepatic intra-arterial iodine-131 lipiodol in resectable hepatocellular carcinoma? J Clin Oncol 2002; 20:1709. [PMID: 11896125 DOI: 10.1200/jco.2002.20.6.1709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Foo KF, Tan EH, Leong SS, Wee JTS, Tan T, Fong KW, Koh L, Tai BC, Lian LG, Machin D. Gemcitabine in metastatic nasopharyngeal carcinoma of the undifferentiated type. Ann Oncol 2002; 13:150-6. [PMID: 11865813 DOI: 10.1093/annonc/mdf002] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We conducted two parallel phase II trials in chemonaïve and previously treated patients with metastatic nasopharyngeal carcinoma (NPC) to evaluate the tumour response, progression-free and overall survival, and toxicity of gemcitabine. PATIENTS AND METHODS Gemcitabine 1250 mg/m2 was given on days 1 and 8 of a 21-day cycle. Patients with an Eastern Cooperative Oncology Group performance status <2, adequate renal, hepatic and bone marrow function, and radiologically measurable NPC were eligible. RESULTS Twenty-five chemonaïve and 27 previously treated patients were enrolled. The overall response rate was 28% [95% confidence interval (CI) 14% to 48%] for the chemonaïve and 48% (95% CI 31% to 66%) for previously treated patients. Toxicities greater than or equal to grade 3 occurred in 15 (60%) chemonaïve and 13 (48%) previously treated patients. Neutropenia was uncommon in chemonaïve patients, but occurred in 37% of previously treated patients. The median time to progression was 3.6 months (range 0.9-7.9) for chemonaïve and 5.1 months (0.9-13.1) for previously treated patients. Median overall survival time was 7.2 months (1.4-15.6) and 10.5 months (2.4-15.0) for chemonaïve and previously treated patients, respectively. CONCLUSIONS Gemcitabine has moderate activity in NPC with minimal toxicity, and is also an effective salvage agent for patients who have failed or progressed after treatment with other agents.
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Affiliation(s)
- K F Foo
- Department of Medical Oncology, National Cancer Centre, Singapore, Singapore
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Tai BC, Peregoudov A, Machin D. A competing risk approach to the analysis of trials of alternative intra-uterine devices (IUDs) for fertility regulation. Stat Med 2001; 20:3589-600. [PMID: 11746339 DOI: 10.1002/sim.1079] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The methods of survival analysis have had a profound influence on the way that studies concerned with the safety and efficacy of intra-uterine devices (IUDs) for fertility control have been designed, conducted, analysed and reported. For example, the Kaplan-Meier technique has been used to summarize the results of controlled clinical trials of alternative devices and the logrank test used to make any comparisons. A particular feature of IUD studies is the large number of possible causes of failure (reasons for discontinuation of the device). These lead to considerations of competing risks, where in this framework, the discontinuations are considered as competing causes of contraceptive failure. In this context, we compare the net and crude probability estimates of discontinuation rates using continuous time and argue for the routine use of the latter. We use data from a randomized multi-centre trialon the long-term safety and efficacy of two IUDs, TCu220C and TCu380A, for illustration.
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Affiliation(s)
- B C Tai
- NMRC Clinical Trials and Epidemiology Research Unit, 10 College Road, Singapore 169851.
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Tang CL, Eu KW, Tai BC, Soh JG, MacHin D, Seow-Choen F. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg 2001; 88:801-7. [PMID: 11412248 DOI: 10.1046/j.1365-2168.2001.01781.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic surgery is believed to produce an attenuated metabolic stress response and to have a less dampening effect on the immune response than open surgery. To date, the effect has not been studied in a randomized clinical trial of colorectal cancer. METHODS The study was a two-armed randomized prospective trial conducted in parallel with the UK Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial comparing laparoscopically assisted colorectal surgery for left-sided tumours with conventional open surgery. Systemic immunity was assessed by determining the T- and B-cell counts, the CD4 : CD8 ratio, the natural killer cell counts, the immunoglobulin (Ig) G, IgM and IgA levels, and C3 and C4 levels. The white cell phagocytic activity (nitroblue tetrazolium test) was studied before operation and on the third postoperative day. RESULTS A total of 236 patients were randomized in the immune study between 11 March 1997 and 14 August 1999; 161 had complete preoperative and postoperative assays for the analysis of results. There was no difference in mean response between the two surgical groups for each of the immune parameters studied. The unadjusted difference for the primary endpoint, T-cell count, 3 days after operation was - 1.6 per cent (95 per cent confidence interval - 5.0 to 1.8 per cent). CONCLUSION There is no difference in the systemic immune response in patients having laparoscopically assisted colectomy compared with those undergoing conventional open surgery for colorectal cancer.
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Affiliation(s)
- C L Tang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
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Abstract
In failure time studies involving a chronic disease such as cancer, several competing causes of mortality may be operating. Commonly, the conventional statistical technique of Kaplan-Meier, which is only meaningfully interpreted by assuming independence of failure types and the censoring mechanism, is employed in clinical research involving competing risks data. Some authors have advocated the use of a cause-specific cumulative incidence function which takes into account the existence of other events within a competing risks framework, without making any assumption about independence. Lunn and McNeil have proposed an approach based on an extension of the Cox proportional hazards regression, which enables direct comparisons between failure types. We have extended this approach to estimate cause-specific cumulative incidence. As it is often not easy to follow competing risks methodology in the literature, this paper sets out systematically the assumptions made and the steps taken to implement four different methods of analysing competing risks data using cumulative incidence rates or the Kaplan-Meier estimates of cause-specific failure probabilities. The data obtained from a randomized trial of patients with osteosarcoma were used to compare these four approaches. As illustrated using the osteosarcoma data, the estimates of the classical Kaplan-Meier methods have larger numerical values than the cause-specific cumulative incidence. On the other hand, estimates of the cause-specific cumulative incidence rates from the conventional method and the modified Cox method are highly comparable.
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Affiliation(s)
- B C Tai
- National Medical Research Council, Clinical Trials & Epidemiology Research Unit, 10 College Road, Singapore 169851.
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Chong YS, Chua S, El-Refaey H, Choo WL, Chanrachakul B, Tai BC, Rodeck C, Arulkumaran S. Postpartum intrauterine pressure studies of the uterotonic effect of oral misoprostol and intramuscular syntometrine. BJOG 2001; 108:41-7. [PMID: 11213003 DOI: 10.1111/j.1471-0528.2001.00014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the effect of oral misoprostol in dosages varying from 200 microg to 800 microg on postpartum uterine contractility and to establish their side effects. DESIGN A prospective descriptive study. PARTICIPANTS Fifty-seven women who delivered vaginally after spontaneous labours not requiring augmentation. METHODS Within 5 minutes of delivery of the placenta, a calibrated Gaeltec catheter with an intrauterine pressure transducer at its tip was inserted transcervically into the uterine cavity. Cumulative uterine activity was recorded for 30 minutes in each woman before administering the oral misoprostol tablets and continued for a further 90 minutes after its administration. Thus each woman acted as her own control regarding changes in uterine contractility. Uterine activity was recorded on a Sonicaid Meridian fetal monitor, which measures active contraction area automatically. The incidence of side effects was also recorded. RESULTS There was no statistical difference (P = 0.887) in the adjusted mean difference in cumulative uterine activity following all the doses of oral misoprostol, compared with intramuscular syntometrine, the largest difference being seen in oral misoprostol 200 microg (adjusted mean difference -2282 kPas s, 95% CI -7954 to 3390 kPas s). The mean onset of action of oral misoprostol (6.1, SD 2.1 min) was significantly slower than that of intramuscular syntometrine (3.2, SD 1.5 min; P = 0.002), but their durations of action were similar (P = 0.637). In the misoprostol group the commonest side effects were shivering (36%) and a rise in body temperature above 38 degrees C (40%). In the syntometrine group, the most commonly observed side effect was moderate uterine pain (nine out of ten women) and a rise in diastolic blood pressure of 20 mmHg (two out of ten women). CONCLUSION The results of this study show that oral misoprostol has a definite uterotonic effect on the postpartum uterus. At doses of 200 microg to 400 microg, oral misoprostol has a similar uterotonic effect to intramuscular syntometrine. Higher doses of oral misoprostol are associated with significantly more side effects.
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Affiliation(s)
- Y S Chong
- Department of Obstetrics and Gynaecology, National University of Singapore, Singapore
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Tai BC, Seldrup J. A review of software for data management, design and analysis of clinical trials. Ann Acad Med Singap 2000; 29:576-81. [PMID: 11126691] [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: 02/18/2023]
Abstract
In clinical trials, subjects are usually entered one at a time, and their responses to treatment monitored sequentially. Regular monitoring of trial progress in the early stages is crucial for accurate reporting of the final results. This paper discusses in detail the principles of quality data management in clinical trials, with specific reference to three clinical data management systems namely, CLINTRIAL, ORACLE CLINICAL and MACRO. All three systems have the essential features for monitoring and processing quality clinical trials data. In terms of functionality, there appears to be no significant advantage of one system over the other. However, to reap the full benefits of sophisticated systems such as these, a good support network and comprehensive training programmes are essential since their day-to-day use demands a high level of technical competence. Basic considerations pertinent to the success of a clinical trial involve not only logistics and data management. Issues relating to the study design are also of primary concern. In this respect, we briefly describe some sample size packages, NQUERY, PEST, POWER, POWER AND PRECISION and SAMPSIZE. Finally, a brief comparison is made with regards to some distinct features of three commonly used statistical packages, namely SPSS, SAS and STATA.
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Affiliation(s)
- B C Tai
- National Medical Research Council, Clinical Trials & Epidemiology Research Unit, 10 College Road, Singapore 169851
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Tai BC, Lee J. Sample size and power calculations for comparing two independent proportions in a 'negative' trial. Psychiatry Res 1998; 80:197-200. [PMID: 9754699 DOI: 10.1016/s0165-1781(98)00067-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Statistical methods for evaluating the adequacy of sample size and power cater mainly to the testing for treatment difference in a 'positive' trial. In biomedical research, the trial can sometimes be postulated as 'negative' to demonstrate that the different treatment groups are statistically equivalent. Herein we describe a computer program to determine the adequacy of sample size and power for comparing two independent proportions in a 'negative' trial. The program is written in MicroSoft QuickBasic Version 4.5, and its executable file is suitable for use as a stand-alone program on a microcomputer.
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Affiliation(s)
- B C Tai
- National Medical Research Council, Clinical Trials and Epidemiology Research Unit, Singapore, Singapore.
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Abstract
A common practice for determining whether a sample proportion is statistically different from a specified population proportion is using the exact probability procedure. However, it produces overly conservative confidence intervals and p-values. A stand-alone executable program is written for applying alternative approaches based on the mid-P and bootstrap methods.
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Affiliation(s)
- B C Tai
- National Medical Research Council, Singapore General Hospital, Singapore
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Li SH, Chiang CN, Tai BC, Marschke CK, Hawks RL. Quantitative versus qualitative urinalysis for benzoylecgonine in clinical trials for the assessment of cocaine use. Psychopharmacol Bull 1995; 31:671-679. [PMID: 8851639] [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: 05/22/2023]
Abstract
Urinalysis of benzoylecgonine (BE) concentrations is a primary outcome measure for evaluating medications for treating cocaine addiction. Using simulated BE data from a set of simple clinical models, the advantages of quantitative versus qualitative urinalysis were evaluated, as well as the advantages of once-weekly versus thrice-weekly sampling schedules. A 60 percent reduction in cocaine use, either in daily amount or in weekly frequency, was considered clinically significant. Quantitative urinalysis can detect reductions in both amount and frequency, whereas qualitative urinalysis can detect only a decrease in frequency. For quantitative urinalysis, changes are more easily detected when urine is collected three times a week than when it is collected once a week. For qualitative urinalysis, the majority rule analysis for a thrice-weekly sampling schedule yields an artificially high estimate of the percentage of positive samples, whereas a once-weekly schedule gives a highly variable estimate.
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Affiliation(s)
- S H Li
- National Institute on Drug Abuse, NIH, Rockville, MD 20857, USA
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