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Müller-Riemenschneider F, Petrunoff N, Sia A, Ramiah A, Ng A, Han J, Wong M, Choo TB, Uijtdewilligen L. Prescribing Physical Activity in Parks to Improve Health and Wellbeing: Protocol of the Park Prescription Randomized Controlled Trial. Int J Environ Res Public Health 2018; 15:E1154. [PMID: 30720784 PMCID: PMC6025310 DOI: 10.3390/ijerph15061154] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 12/05/2022]
Abstract
Previous studies in primary care settings showed that brief advice prescribing physical activity for inactive patients could be an effective way to promote physical activity. Park prescription interventions confer health benefits associated with exposure to nature and increased physical activity by recommending park use specifically to increase physical activity in parks. The purpose of this trial is to evaluate the effectiveness of a park prescription intervention for increasing time spent in moderate-to-vigorous physical activity (MVPA) assessed by accelerometry. Middle-aged Singaporeans who were insufficiently active and who met health screening criteria were recruited via existing community health screening programs and allocated to one of two groups. Intervention participants received a prescription of physical activity in parks, an information pack, access to a weekly group exercise program in parks and telephone counselling (n = 80). Control participants received physical activity materials (n = 80). The primary outcome (mean difference between both groups in time spent in MVPA minutes per week measured by accelerometer) will be assessed at six months. Secondary outcomes include self-reported health behaviors, self-reported mental wellbeing and objectively-measured physical health. This is the first randomized controlled trial investigating the effectiveness of a park prescription intervention for increasing health-enhancing MVPA.
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Affiliation(s)
- Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
- Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre Berlin, Luisenstrasse 57, 10117 Berlin, Germany.
| | - Nick Petrunoff
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
| | - Angelia Sia
- Centre for Urban Greenery & Ecology, National Parks Board Singapore, 1E Cluny Rd., Singapore Botanic Gardens, Singapore 259569, Singapore.
| | - Anbumalar Ramiah
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore 768828, Singapore.
| | - Alwyn Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
| | - Jane Han
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore 768828, Singapore.
| | - Michael Wong
- Health for Life Centre, Khoo Teck Puat Hospital, Alexandra Health Pte Ltd. 90 Yishun Central, Singapore 768828, Singapore.
| | - Tai Bee Choo
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
| | - Léonie Uijtdewilligen
- Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, #10-01, Singapore 117549, Singapore.
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Tay MHW, Thamboo TP, Wu FMW, Zhaojin C, Choo TB, Ramaan L, Tiong HY. High R.E.N.A.L. Nephrometry scores are associated with pathologic upstaging of clinical T1 renal-cell carcinomas in radical nephrectomy specimens: implications for nephron-sparing surgery. J Endourol 2014; 28:1138-42. [PMID: 24810993 DOI: 10.1089/end.2014.0123] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND AND PURPOSE The R.E.N.A.L. Nephrometry Score (RNS) was developed to standardize the reporting of anatomic information of a renal mass. This study aimed to identify the association of preoperative clinical and tumor features assessed by the RNS with pathologic upstaging of clinical T1 renal-cell carcinomas (RCCs) in complete en bloc radical nephrectomy (RN) specimens. PATIENTS AND METHODS A review was performed for 65 consecutive patients (2005-2013) who underwent RNs for a unilateral clinical T1N0M0 RCC. The RNS was measured in all patients based on preoperative CT scans. Pathologic review was performed to identify patients with final pathologic upstaging. Associations were assessed with the Fisher exact test, Student t test, and Wilcoxon rank sum test. RESULTS Of the 65 patients (41 male, mean age 59 years), 4 (6%) patients were upstaged to pT2 and 16 (25%) were upstaged to pT3a and above in the final histologic evaluation. Upstaged patients were not significantly different from those without in terms of age, sex, race, surgical approach, side of surgery, Fuhrman grade, and histologic cell type. Independent tumor features associated with pathologic upstaging were (R) tumor diameter (P=0.021), and (L) central location within polar lines (P=0.010). Tumors that were upstaged had a higher median total RNS than those without (10 vs 9, P=0.010). Complex tumors, with RNS≥10, were associated with significantly increased risk of upstaging compared with low and intermediate complexity categories (RNS<10) (relative risk=2.56, 95% confidence interval 1.22-5.37, P=0.014). CONCLUSIONS A higher RNS was associated with an increased risk of upstaging in clinical T1 cancers, predominantly from perinephric or sinus fat invasion in RN pathologic specimens. This may have implications on the selection of surgical option for the clinical T1 renal mass.
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Affiliation(s)
- Melissa H W Tay
- 1 Department of Urology, National University Health System , Singapore
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Koh GCH, Chen C, Cheong A, Choo TB, Pui CK, Phoon FN, Ming CK, Yeow TB, Petrella R, Thind A, Koh D, Seng CK. Trade-Offs between Effectiveness and Efficiency in Stroke Rehabilitation. Int J Stroke 2011; 7:606-14. [DOI: 10.1111/j.1747-4949.2011.00612.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Most stroke research has studied rehabilitation effectiveness and rehabilitation efficiency separately and not investigated the potential trade-offs between these two indices of rehabilitation. Aims To determine whether there is a trade-off between independent factors of rehabilitation effectiveness and rehabilitation efficiency. Methods Using a retrospective cohort study design, we studied all stroke patients ( n = 2810) from two sub-acute rehabilitation hospitals from 1996 to 2005, representing 87·5% of national bed-years during the same period. Results Independent predictors of poorer rehabilitation effectiveness and log rehabilitation efficiency were older age race-ethnicity caregiver availability ischemic stroke longer time to admission dementia admission Barthel Index score, and length of stay. Rehabilitation effectiveness was lower in females, and the gender differences were significantly lower in those aged ≥70 years (β −4·7 (95% confidence interval −7·4 to −2·0)). There were trade-offs between effectiveness and efficiency with respect to admission Barthel Index score and length of stay. An increase of 10 in admission Barthel Index score predicted an increase of 3·6% (95% confidence interval 3·2–4·0) in effectiveness but a decrease of 0·04 (95% confidence interval −0·05 to −0·02) in log efficiency (a reduction of efficiency by 1·0 per 30 days). An increase in log length of stay by 1 (length of stay of 2·7 days) predicted an increase of 8·0% (95% confidence interval 5·7–10·3) in effectiveness but a decrease of 0·82 (95% confidence interval −0·90 to −0·74) in log efficiency (equivalent to a reduction in efficiency by 2·3 per 30 days). For optimal rehabilitation effectiveness and rehabilitation efficiency, the admission Barthel Index score was 30–62 and length of stay was 37–41 days. Conclusions There are trade-offs between effectiveness and efficiency during inpatient sub-acute stroke rehabilitation with respect to admission functional status and length of stay.
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Affiliation(s)
- Gerald Choon-Huat Koh
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
- Centre for Health Services Research, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Cynthia Chen
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Angela Cheong
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Tai Bee Choo
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Choi Kwok Pui
- Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Fong Ngan Phoon
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Chan Kin Ming
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore, Singapore
| | - Tan Boon Yeow
- Medical Services, St Luke's Hospital, Singapore, Singapore
| | - Robert Petrella
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Amardeep Thind
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - David Koh
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Chia Kee Seng
- Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
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Abstract
The objective of this study was to investigate suicide trends in Singapore between 1955 and 2004. Suicide cases were identified from the Registry of Birth and Death, Singapore, and analyzed using Poisson regression. Overall, suicide rates in Singapore remained stable between 9.8-13.0/100,000 over the last 5 decades. Rates remain highest in elderly males, despite declines among the elderly and middle-aged males in recent years. Rates in ethnic Chinese and Indians were consistently higher than in Malays. While the rates among female Indians and Chinese have declined significantly between 1995 and 2004, some increase was noted in female Malays. Although there was no increase in overall suicide rates, risk within certain population segments has changed over time.
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Sng J, Koh D, Siong WC, Choo TB. Skin cancer trends among Asians living in Singapore from 1968 to 2006. J Am Acad Dermatol 2009; 61:426-32. [DOI: 10.1016/j.jaad.2009.03.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 03/02/2009] [Accepted: 03/21/2009] [Indexed: 10/20/2022]
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Soo RA, Wang LZ, Ng SS, Chong PY, Yong WP, Lee SC, Liu JJ, Choo TB, Tham LS, Lee HS, Goh BC, Soong R. Distribution of gemcitabine pathway genotypes in ethnic Asians and their association with outcome in non-small cell lung cancer patients. Lung Cancer 2008; 63:121-7. [PMID: 18538445 DOI: 10.1016/j.lungcan.2008.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 04/18/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Pharmacogenetics suggests variants of genes involved in gemcitabine pharmacology could be useful markers for predicting inter-ethnic and inter-patient outcomes from treatment with the agent. Here, we have characterized the distribution of variants of genes involved in gemcitabine pharmacology in ethnic Asian populations and their association with non-small cell lung cancer (NSCLC) patient outcome. METHODS All genes involved in gemcitabine transport, metabolism and activity were screened for suitable variants for analysis using publications and public databases. By pyrosequencing, the frequency of qualifying variants was characterized from germline DNA of 94 healthy Asian donors and 53 NSCLC patients receiving gemcitabine-based chemotherapy. RESULTS Significant differences in genotype distribution between Caucasians and Asians were seen at 10/25 (45%) variant loci. In NSCLC patients, CDA+435 C>T variants were associated with response (p=0.026) and time to progression (p=0.016) and SLC28A1+1561 G>A variants were associated with neutropenia (p=0.030) and thrombocytopenia nadir (p=0.037). CONCLUSIONS Many genotypes in gemcitabine pharmacology vary in their frequency between Caucasians and Asians. CDA+435, and SLC28A1+1561 are worthy of further investigation as potential indicators of patient outcome after gemcitabine treatment.
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Affiliation(s)
- Ross A Soo
- Department of Haematology-Oncology, National University of Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
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Ong G, Yap M, Li FL, Choo TB. Impact of working status on breastfeeding in Singapore: evidence from the National Breastfeeding Survey 2001. Eur J Public Health 2005; 15:424-30. [PMID: 16030134 DOI: 10.1093/eurpub/cki030] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [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] Open
Abstract
BACKGROUND This study uses data from the 2001 Singapore National Breastfeeding Survey to examine factors, including working status, associated with breastfeeding duration. METHODS All women who delivered in the eight hospitals with obstetric services in Singapore from 1 April to 31 May 2001 were invited to participate in a survey on infant feeding and nutrition at 2 and 6 months postpartum. A total of 2149 respondents were interviewed for variables that were known or suspected to be associated with breastfeeding initiation and duration. Cox proportional hazards model was used to determine the associated effect of working status on breastfeeding duration. Kaplan-Meier estimate and survival curves were compared between working and non-working mothers. RESULTS Working status had no effect on initiation of breastfeeding, but had an effect on breastfeeding duration. The median breastfeeding duration for non-working and working mothers was 9 weeks and 8 weeks, respectively. This difference was significant by log rank test [hazard ratio (HR) = 1.27, 95% confidence interval (CI) 1.14-1.41, P value <0.001]. About 31% of non-working mothers breastfed for up to 6 months as compared to 20% of working mothers. Working mothers were more likely to stop breastfeeding than non-working mothers (HR = 1.61, 95% CI 1.43-1.85, P value = 0.001) after adjusting for potential confounders. The most important reason for working mothers stopping breastfeeding between 2 and 6 months was attributable to work. CONCLUSION More breastfeeding-friendly initiatives need to be put in place at workplaces to encourage working mothers to continue breastfeeding upon returning to work.
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Affiliation(s)
- Gary Ong
- Epidemiology and Disease Control Division, Ministry of Health, Singapore.
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Chua T, Yin LC, Thiang TH, Choo TB, Ping DZ, Leng LY. Accuracy of the automated assessment of left ventricular function with gated perfusion SPECT in the presence of perfusion defects and left ventricular dysfunction: correlation with equilibrium radionuclide ventriculography and echocardiography. J Nucl Cardiol 2000; 7:301-11. [PMID: 10958271 DOI: 10.1067/mnc.2000.105279] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [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: 11/22/2022]
Abstract
BACKGROUND Gated single photon emission computed tomography (SPECT) with automated methods allows the quantitative assessment of left ventricular function and perfusion; however, its accuracy must be defined for patients with large earlier infarctions and severe rest perfusion defects, in whom the estimation of endocardial and epicardial borders might be more difficult, even with automated edge-detection techniques. METHODS AND RESULTS We prospectively compared the automated measurements of left ventricular ejection fraction (LVEF) and volumes from rest-injected gated Technetium 99m (Tc99m) perfusion SPECT with equilibrium radionuclide angiocardiography (ERNA) in 62 patients and the assessment of regional function with echocardiography in 22 patients. Forty-six patients had an earlier myocardial infarction (mean defect size, 34% of left ventricle; SD, 12.7%; range, 8% to 56%); 27 patients had large defects (> or = 20% of left ventricle; LVEF range, 8% to 75%). LVEF, as determined with Cedars-Sinai software (quantitative gated SPECT), correlated well with ERNA (r = 0.941; y = 1.003x + 1.15; P<.0001; SE of the estimate = 6.3%; mean difference -1.3% for LVEF) in the entire study population and in the subgroups of patients with an earlier infarction, severe defects, and large infarctions (> or = 20% of the left ventricle). A correlation existed between gated SPECT and ERNA volumes (r = 0.882, y = 1.040x - 14.7, P<.0001 for end-diastolic volume; r = 0.954, y = 1.147x - 13.9, P<.0001 for end-systolic volumes with the count-ratio technique), but with wider limits of agreement. The exact segmental score agreement between gated SPECT and echocardiography for regional function was 79.8% (281 of 352, kappa = 0.682). CONCLUSIONS Automated gated SPECT provides an accurate assessment of ejection fraction and regional function, even in the presence of an earlier myocardial infarction with large perfusion defects and significant left ventricular dysfunction.
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Affiliation(s)
- T Chua
- Department of Cardiology, National Heart Centre, Mistri Wing, Singapore.
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