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Wee LE, Lim JT, Tay AT, Pang D, Dickens B, Chiew CJ, Ong B, Lye DCB, Tan KB. Long-term neuropsychiatric sequelae of Delta versus Omicron SARS-CoV-2 infection. Clin Microbiol Infect 2024; 30:531-539. [PMID: 38141822 DOI: 10.1016/j.cmi.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES Studies have reported increased rates of long-term neuropsychiatric sequelae after SARS-CoV-2 infection using electronic health-record (EHR) data; however, the majority were conducted before Omicron and booster rollout. We estimated the long-term risks and excess burdens of pre-specified new-incident neuropsychiatric diagnoses after Delta versus Omicron BA.1/2 infection in a highly-vaccinated and boosted cohort of adult Singaporeans. METHODS The national SARS-CoV-2 testing registry was used to construct cohorts of Singaporean adults infected during periods of Delta and Omicron BA.1/2 predominance and a contemporaneous test-negative control group. New-incident neuropsychiatric diagnoses recorded in the national health care claims database were identified up to 300 days postinfection. Risks and excess burden were estimated using a doubly robust competing-risks survival analysis. RESULTS 104 179 and 375 903 infected cases were assigned to Delta and Omicron cohorts and compared against test-negative controls (Delta: N = 666 575 and Omicron: N = 619 379). Elevated risk of cognition or memory disorders was consistently reported across Omicron (Adjusted hazards ratio [aHR], 1.24; 95% CI, 1.12-1.38) and Delta cohorts (aHR, 1.63; 95% CI, 1.39-1.92). Delta-variant infection was associated with an increased risk of anosmia or dysgeusia (aHR, 4.53; 95% CI, 2.78-7.41) and psychosis (aHR, 1.65; 95% CI, 1.22-2.22). By contrast, Omicron-variant infection was associated with a risk of abnormal involuntary movements (aHR, 1.93; 95% CI, 1.32-2.83). Risks of neuropsychiatric sequelae predominantly accrued in hospitalized individuals. DISCUSSIONS A modestly increased risk of cognition and memory disorders at 300 days after SARS-CoV-2 infection was observed among adult Singaporeans infected during the Delta/Omicron BA.1/2 transmission. There was no overall increased risk of neuropsychiatric sequelae observed across other domains. Variant-specific differences were also observed in individual neuropsychiatric sequelae, including an elevated risk of anosmia or dysgeusia after Delta-variant infection.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Jue Tao Lim
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - An Ting Tay
- Division of Communicable Disease, Ministry of Health, Singapore
| | - Deanette Pang
- Division of Communicable Disease, Ministry of Health, Singapore
| | - Borame Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Division of Communicable Disease, Ministry of Health, Singapore
| | - Benjamin Ong
- Division of Communicable Disease, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Boon Lye
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- National Centre for Infectious Diseases, Singapore General Hospital, Singapore; Division of Communicable Disease, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Lim JT, Liang En W, Tay AT, Pang D, Chiew CJ, Ong B, Lye DCB, Tan KB. Long-term Cardiovascular, Cerebrovascular, and Other Thrombotic Complications in COVID-19 Survivors: A Retrospective Cohort Study. Clin Infect Dis 2024; 78:70-79. [PMID: 37746872 PMCID: PMC10810710 DOI: 10.1093/cid/ciad469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 05/30/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Growing evidence suggests that some coronavirus disease 2019 (COVID-19) survivors experience a wide range of long-term postacute sequelae. We examined the postacute risk and burden of new-incident cardiovascular, cerebrovascular, and other thrombotic complications after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a highly vaccinated multiethnic Southeast Asian population, during Delta predominance. METHODS This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals who had a positive SARS-CoV-2 test between 1 September and 30 November 2021 when Delta predominated community transmission. Concurrently, we constructed a test-negative control group by enrolling individuals between 13 April 2020 and 31 December 2022 with no evidence of SARS-CoV-2 infection. Participants in both groups were followed up for a median of 300 days. We estimated risks of new-incident cardiovascular, cerebrovascular, and other thrombotic complications using doubly robust competing-risks survival analysis. Risks were reported using 2 measures: hazard ratio (HR) and excess burden (EB) with 95% confidence intervals. RESULTS We included 106 012 infected cases and 1 684 085 test-negative controls. Compared with the control group, individuals with COVID-19 exhibited increased risk (HR, 1.157 [1.069-1.252]) and excess burden (EB, 0.70 [.53-.88]) of new-incident cardiovascular and cerebrovascular complications. Risks decreased in a graded fashion for fully vaccinated (HR, 1.11 [1.02-1.22]) and boosted (HR, 1.10 [.92-1.32]) individuals. Conversely, risks and burdens of subsequent cardiovascular/cerebrovascular complications increased for hospitalized and severe COVID-19 cases (compared to nonhospitalized cases). CONCLUSIONS Increased risks and excess burdens of new-incident cardiovascular/cerebrovascular complications were reported among infected individuals; risks can be attenuated with vaccination and boosting.
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Affiliation(s)
- Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University
- National Centre for Infectious Diseases
| | - Wee Liang En
- National Centre for Infectious Diseases
- Duke-NUS Graduate Medical School, National University of Singapore
- Department of Infectious Diseases, Singapore General Hospital
| | | | | | - Calvin J Chiew
- National Centre for Infectious Diseases
- Singapore Ministry of Health
| | - Benjamin Ong
- Singapore Ministry of Health
- Yong Loo Lin School of Medicine, National University of Singapore
| | - David Chien Boon Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University
- National Centre for Infectious Diseases
- Yong Loo Lin School of Medicine, National University of Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital
| | - Kelvin Bryan Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University
- Singapore Ministry of Health
- Saw Swee Hock School of Public Health, National University of Singapore
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Lim JT, En WL, Tay AT, Pang D, Chiew CJ, Ong B, Lye DCB, Tan KB. Unlinking time zero from test-negative date does not influence risk estimates of long-term cardiovascular complications due to COVID-19. Clin Infect Dis 2023:ciad742. [PMID: 38059493 DOI: 10.1093/cid/ciad742] [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] [Received: 11/09/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Affiliation(s)
- Jue Tao Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Wee Liang En
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | | | - Calvin J Chiew
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Boon Lye
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Wee LE, Tang N, Pang D, Chiew C, Yung CF, Chong CY, Lee V, Ong B, Lye DC, Tan KB. Effectiveness of Monovalent mRNA Vaccines Against Omicron XBB Infection in Singaporean Children Younger Than 5 Years. JAMA Pediatr 2023; 177:1324-1331. [PMID: 37843856 PMCID: PMC10580153 DOI: 10.1001/jamapediatrics.2023.4505] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 06/05/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023]
Abstract
Importance Literature on vaccine effectiveness of SARS-CoV-2 messenger RNA (mRNA) vaccines for children younger than 5 years is limited. Objective To report the effectiveness of monovalent mRNA vaccines against SARS-CoV-2 infection among Singaporean children aged 1 through 4 years during a COVID-19 pandemic wave of the Omicron XBB variant. Design, Setting, and Participants This was a population-based cohort study, conducted over a 6-month study period from October 1, 2022, through March 31, 2023, after the implementation of community vaccination among all Singaporean children aged 1 through 4 years. The study period was dominated by the Omicron XBB subvariant. Exposure Receipt of SARS-CoV-2 mRNA vaccines. Main Outcome Measure Vaccine effectiveness against confirmed SARS-CoV-2 infection. The adjusted incidence rate ratio for confirmed infections using Poisson regression was reported, with the reference group being those who were unvaccinated. Analyses were stratified by prior documented SARS-CoV-2 infection. Results A total of 121 628 children (median [IQR] age, 3.1 [2.2-3.9] years; 61 925 male [50.9%]) were included in the study, contributing 21 015 956 person-days of observation. The majority of children (11 294 of 11 705 [96.5%]) received the mRNA-1273 COVID-19 vaccine (Moderna). Vaccine effectiveness against confirmed infection was 45.2% (95% CI, 24.7%-60.2%) in partially vaccinated, infection-naive children and 63.3% (95% CI, 40.6%-77.3%) in fully vaccinated, infection-naive children compared with the unvaccinated group. Among previously infected children, vaccine effectiveness against reinfections in those with at least 1 vaccine dose was estimated at 74.6% (95% CI, 38.7%-89.5%). Conclusions and Relevance Study results suggest that completion of a primary mRNA vaccine series provided protection against SARS-CoV-2 infection in children aged 1 through 4 years. Although incidence of hospitalization and severe illness is low in this age group, there is potential benefit of vaccination in preventing infection and potential sequelae.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | | | - Calvin Chiew
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
| | - Chee-Fu Yung
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | - Chia Yin Chong
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vernon Lee
- National Centre for Infectious Diseases, Singapore
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Wang LF, Ren EC, Lye DC, Tan KB. Effectiveness of bivalent mRNA vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals: a retrospective cohort study. Lancet Infect Dis 2023; 23:1343-1348. [PMID: 37543042 DOI: 10.1016/s1473-3099(23)00373-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Emergence of the SARS-CoV-2 omicron (B.1.1.529) variant with high immune evasion has led to the development and roll-out of bivalent mRNA vaccines targeting original and omicron strains. However, real-world observational data on effectiveness of bivalent vaccines are scarce. We aimed to assess the relative effectiveness of a fourth vaccine dose with the BA.1-adapted or BA.4/BA.5-adapted bivalent vaccines against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission among SARS-CoV-2-naive and previously infected individuals in Singapore. METHODS We conducted a retrospective cohort study among Singapore residents aged 18 years and older who had received three monovalent mRNA vaccine doses and were eligible for a fourth dose. Data were collected from official databases on COVID-19 cases and vaccinations maintained by the Singapore Ministry of Health. We analysed the incidence of medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission between Oct 14, 2022, and Jan 31, 2023, by previous infection status and type of fourth vaccine dose received. Inverse probability-weighted Cox regressions were used to estimate hazard ratios (HRs). FINDINGS 2 749 819 individuals were included in the analysis. For the SARS-CoV-2-naive group, a fourth monovalent vaccine dose did not confer additional protection over three monovalent doses against symptomatic infection (HR 1·09 [95% CI 1·07-1·11]), whereas the bivalent vaccine did provide additional protection (0·18 [0·17-0·19]). Among individuals with previous infection, the HR was 0·87 (95% CI 0·84-0·91) and 0·14 (0·13-0·15) with receipt of the fourth monovalent and bivalent doses, respectively. Against COVID-19-related hospital admission, the bivalent vaccine (HR 0·12 [95% CI 0·08-0·18] in SARS-CoV-2-naive participants and 0·04 [0·01-0·15] in previously infected participants) conferred greater benefit compared with the fourth monovalent dose (0·84 [0·77-0·91] in SARS-CoV-2-naive participants and 0·85 [0·69-1·04] in previously infected participants). INTERPRETATION A fourth dose with the bivalent vaccine was substantially more effective against medically attended symptomatic SARS-CoV-2 infection and COVID-19-related hospital admission than four monovalent doses among both SARS-CoV-2-naive and previously infected individuals. Boosters with the bivalent vaccine might be preferred in this omicron-predominant pandemic, regardless of previous infection history. FUNDING None.
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Affiliation(s)
- Celine Y Tan
- Communicable Diseases Division, Ministry of Health, Singapore.
| | - Calvin J Chiew
- Communicable Diseases Division, Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Deanette Pang
- Communicable Diseases Division, Ministry of Health, Singapore
| | - Vernon J Lee
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Communicable Diseases Division, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | - Ee Chee Ren
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore Immunology Network, Agency for Science Technology and Research, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Communicable Diseases Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Goh O, Pang D, Tan J, Lye D, Chong CY, Ong B, Tan KB, Yung CF. mRNA SARS-CoV-2 Vaccination Before vs During Pregnancy and Omicron Infection Among Infants. JAMA Netw Open 2023; 6:e2342475. [PMID: 37948079 PMCID: PMC10638647 DOI: 10.1001/jamanetworkopen.2023.42475] [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] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Infants younger than 6 months are at risk of severe SARS-CoV-2 infection. Data are lacking on the optimum timing for maternal vaccination and estimated effectiveness against Omicron variants, including XBB, for infants. Objective To investigate maternal vaccination against Omicron variants, including XBB, and the association of vaccination timing during pregnancy vs prior to pregnancy and risks of SARS-CoV-2 infection among infants aged 6 months or younger. Design, Setting, and Participants This population-based cohort study was conducted between January 1, 2022, and March 31, 2023. Singapore's national dataset was used to study infants born at greater than 32 weeks' gestation between January 1, 2022, and September 30, 2022. The study included infants whose parents had a confirmed SARS-CoV-2 infection from the date of birth up to 6 months of age. Of 21 609 infants born during this period, 7292 (33.7%) had at least 1 parent infected with SARS-CoV-2 before the age of 7 months. Statistical analysis was performed from April to July 2023. Exposure Infants' mothers were unvaccinated, vaccinated prior to pregnancy, or vaccinated with a messenger RNA (mRNA) SARS-CoV-2 vaccine during pregnancy. Main Outcome and Measure Infants were considered infected if they had a positive polymerase chain reaction test. Results Among 7292 infants included in this study, 4522 (62.0%) had mothers who were Chinese, 527 (7.2%) had mothers who were Indian, 2007 (27.5%) had mothers who were Malay, and 236 (3.2%) had mothers who were other ethnicity; 6809 infants (93.4%) were born at full term, and 1272 infants (17.4%) were infected during the study period. There were 7120 infants (97.6%) born to mothers who had been fully vaccinated or boosted as of 14 days prior to delivery. The crude incidence rate was 174.3 per 100 000 person-days among infants born to mothers who were unvaccinated, 122.2 per 100 000 person-days among infants born to mothers who were vaccinated before pregnancy, and 128.5 per 100 000 person-days among infants born to mothers who were vaccinated during pregnancy. The estimated vaccine effectiveness (VE) was 41.5% (95% CI, 22.8% to 55.7%) among infants born to mothers vaccinated during pregnancy. Infants of mothers who received vaccination prior to pregnancy did not have a lower risk for infection (estimated VE, 15.4% [95% CI, -17.6% to 39.1%]). A lower risk for Omicron XBB infection was only observed among mothers vaccinated with the third (booster) dose antenatally (estimated VE, 76.7% [95% CI, 12.8% to 93.8%]). Conclusions and Relevance In this population-based cohort study, maternal mRNA vaccination was associated with a lower risk of Omicron SARS-CoV-2 infection among infants up to 6 months of age only if the vaccine was given during the antenatal period. These findings suggest that mRNA vaccination during pregnancy may be needed for lower risk of SARS-CoV-2 infection among newborns.
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Affiliation(s)
- Orlanda Goh
- Department of Internal Medicine, Singapore General Hospital, Singapore
- SingHealth Duke-NUS Medicine Academic Clinical Programme, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore
| | | | | | - David Lye
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National Centre for Infectious Disease, Singapore
| | - Chia Yin Chong
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Chee Fu Yung
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
- Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
- SingHealth Duke-NUS Paediatrics Academic Clinical Programme, Singapore
- Duke-NUS Medical School, Singapore
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Wee LE, Pang D, Chiew C, Tan J, Lee V, Ong B, Lye DC, Tan KB. Long-term Real-world Protection Afforded by Third mRNA Doses Against Symptomatic Severe Acute Respiratory Syndrome Coronavirus 2 Infections, Coronavirus Disease 19-related Emergency Attendances and Hospitalizations Amongst Older Singaporeans During an Omicron XBB Wave. Clin Infect Dis 2023; 77:1111-1119. [PMID: 37280047 DOI: 10.1093/cid/ciad345] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Literature on long-term real-world vaccine effectiveness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) booster vaccines (up to and beyond 360 days) is scarce. We report estimates of protection against symptomatic infection, emergency department (ED) attendances and hospitalizations up to and beyond 360 days post-receipt of booster messenger RNA (mRNA) vaccines among Singaporeans aged ≥60 years during an Omicron XBB wave. METHODS We conducted a population-based cohort study including all Singaporeans aged ≥60 years with no documented prior SARS-CoV-2 infection who had previously received ≥3 doses of mRNA vaccines (BNT162b2/mRNA-1273), over a 4-month period during transmission of Omicron XBB. We reported the adjusted incidence-rate-ratio (IRR) for symptomatic infections, ED attendances and hospitalizations at different time-intervals from both first and second boosters, using Poisson regression; with the reference group being those who received their first booster 90 to 179 days prior. RESULTS In total, 506 856 boosted adults were included, contributing 55 846 165 person-days of observation. Protection against symptomatic infections among those who received a third vaccine dose (first booster) waned after 180 days with increasing adjusted IRRs; however, protection against ED attendances and hospitalizations held up, with comparable adjusted IRRs with increasing time from third vaccine doses (≥360 days from third dose: adjusted IRR [ED attendances] = 0.73, 95% confidence interval [CI] = .62-.85; adjusted IRR [hospitalization] = 0.58, 95% CI = .49-.70). CONCLUSIONS Our results highlight the benefit of a booster dose in reducing ED attendances and hospitalizations amongst older adults aged ≥60 years with no documented prior SARS-CoV-2 infection, during an Omicron XBB wave; up to and beyond 360 days post-booster. A second booster provided further reduction.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, Singapore, Singapore
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | | | - Calvin Chiew
- National Centre for Infectious Diseases, Singapore, Singapore
- Ministry of Health, Singapore, Singapore
| | - Janice Tan
- Ministry of Health, Singapore, Singapore
| | - Vernon Lee
- Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Kearney E, Brownsett SLE, Copland DA, Drummond KJ, Jeffree RL, Olson S, Murton E, Ong B, Robinson GA, Tolkacheva V, McMahon KL, de Zubicaray GI. Relationships between reading performance and regional spontaneous brain activity following surgical removal of primary left-hemisphere tumors: A resting-state fMRI study. Neuropsychologia 2023; 188:108631. [PMID: 37356540 DOI: 10.1016/j.neuropsychologia.2023.108631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/08/2023] [Accepted: 06/23/2023] [Indexed: 06/27/2023]
Abstract
Left-hemisphere intraparenchymal primary brain tumor patients are at risk of developing reading difficulties that may be stable, improve or deteriorate after surgery. Previous studies examining language organization in brain tumor patients have provided insights into neural plasticity supporting recovery. Only a single study, however, has examined the role of white matter tracts in preserving reading ability post-surgery and none have examined the functional reading network. The current study aimed to investigate the regional spontaneous brain activity associated with reading performance in a group of 36 adult patients 6-24 months following left-hemisphere tumor resection. Spontaneous brain activity was assessed using resting-state fMRI (rs-fMRI) regional homogeneity (ReHo) and fractional amplitude low frequency fluctuation (fALFF) metrics, which measure local functional connectivity and activity, respectively. ReHo in the left occipito-temporal and right superior parietal regions was negatively correlated with reading performance. fALFF in the putamen bilaterally and the left cerebellum was negatively correlated with reading performance, and positively correlated in the right superior parietal gyrus. These findings are broadly consistent with reading networks reported in healthy participants, indicating that reading ability following brain tumor surgery might not involve substantial functional re-organization.
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Affiliation(s)
- Elaine Kearney
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Sonia L E Brownsett
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072, Australia; Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, University of Queensland and Metro North Health, Queensland, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, 4072, Australia; Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, University of Queensland and Metro North Health, Queensland, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Katharine J Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Parkville, 3050, Australia; Department of Surgery, University of Melbourne, Parkville, 3052, Australia
| | | | - Sarah Olson
- Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Emma Murton
- Department of Speech Pathology, Royal Melbourne Hospital, Parkville, 3050, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Gail A Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, Brisbane, 4072, Australia
| | - Valeriya Tolkacheva
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, 4059, Australia; Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, 4029, Australia
| | - Greig I de Zubicaray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, 4059, Australia
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Azman MZB, Huang KS, Koh WJ, Leong SS, Ong B, Soon JL, Tan SW, Chan MY, Yang M, Yeung MT. Normative reference values, determinants and regression equations for the incremental shuttle walk test (ISWT) in healthy Asian population aged 21 to 80 years. PLoS One 2023; 18:e0291132. [PMID: 37669286 PMCID: PMC10479918 DOI: 10.1371/journal.pone.0291132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND The validated Incremental Shuttle Walk Test (ISWT) is widely used for evaluating maximal exercise capacity, with the distance-walked (IWSD) as the primary outcome. However, there are no normative reference values (NRV) and reference equations to predict ISWD for the Singaporean population. OBJECTIVES This study aims to establish the NRV and reference equations for ISWD in healthy Singaporeans aged 21 to 80 and investigate the determining variables during ISWT. METHODS This cross-sectional study recruited community-dwelling healthy subjects aged 21-80 from the community via convenience sampling. Each subject completed two trials of the ISWT according to the standard protocol. Variables measured during the trials included ISWD, pre-and post-test heart rate (HR), oxygen saturation, blood pressure (BP), modified Borg's dyspnoea score and Borg's rate of perceived exertion (RPE). RESULTS 199 healthy Singaporean (females = 114, males = 85) participated in the study. The overall median ISWD was 660.0 metres (m) [interquartile range (IQR):440.0-850.0]. The age-stratified mean ISWD ranged from 430.0 m (IQR:350.0-450.0) (aged 60-80) to 480.0 m (IQR:438.0-650.0) (aged 40-59) to 780.0 m (IQR:670.0-960.0) (aged 21-39). Gender, age, weight, height and HR change (highest post-test HR minus pre-test HR) were the most significant variables (p < 0.001). IWSD (m) = 651.4(Height, m) +89.7(Gender, male = 1; female = 0) -6.31(Age, years) -3.61(Weight, kilograms) +2.54(HR change, beats per minute); R2 = 0.741. Previously published ISWT reference equations cannot accurately predict the ISWD in the Singaporean population. CONCLUSIONS This study investigated the ISWD NRV and established reference equations for healthy Singaporeans aged 21-80. The information would be beneficial in setting performance benchmarks to guide physical assessment, intervention and rehabilitation.
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Affiliation(s)
- Muhammad Zulhaziq Bin Azman
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Katherin S. Huang
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Wei Jun Koh
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Sarah S. Leong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Benjamin Ong
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Sengkang General Hospital, Singapore, Singapore
| | - Johanna L. Soon
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Sherman W. Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
- Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Melissa Y. Chan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Mingxing Yang
- Department of Physiotherapy, Singhealth Polyclinics, Singapore, Singapore
| | - Meredith T. Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
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Tan WC, Tan JYJ, Lim JSJ, Tan RYC, Lee ARYB, Leong FL, Lee SC, Chai LYA, Tan TT, Malek MIBA, Ong B, Lye DC, Chiew CJ, Chng WJ, Lim ST, Bharwani LD, Tan IB, Sundar R, Tan KB. COVID-19 Severity and Waning Immunity After up to 4 mRNA Vaccine Doses in 73 608 Patients With Cancer and 621 475 Matched Controls in Singapore: A Nationwide Cohort Study. JAMA Oncol 2023; 9:1221-1229. [PMID: 37440245 PMCID: PMC10346511 DOI: 10.1001/jamaoncol.2023.2271] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/05/2023] [Indexed: 07/14/2023]
Abstract
Importance Despite patients with cancer being at risk of poor outcomes from COVID-19, there are few published studies for vaccine efficacy in this group, with suboptimal immunogenicity and waning vaccine efficacy described in small studies being a concern. Objective To assess the incidence rate of severe COVID-19 disease outcomes associated with the number of vaccine doses received and the waning of protection over time. Design, Setting, and Participants A prospective multicenter observational cohort study was carried out over 2 time periods (September 15, 2021, to December 20, 2021 [delta wave], and January 20, 2022, to November 11, 2022 [omicron wave]) predominated by SARS-CoV-2 delta and omicron variants, respectively. Overall, 73 608 patients with cancer (23 217 active treatment, 50 391 cancer survivors) and 621 475 controls matched by age, sex, race and ethnicity, and socioeconomic status were included. Exposure Vaccine doses received, from zero to 4 doses, and time elapsed since last vaccine dose. Outcomes Competing-risk regression analyses were employed to account for competing risks of death in patients with cancer. Main outcomes were incidence rate ratios (IRRs) of COVID-19 infection, hospitalization, and severe disease (defined as requirement for supplemental oxygen, intensive care, or death). The IRRs stratified by time from last vaccine dose served as indicators of waning of vaccine effectiveness over time. Results The mean (SD) age of actively treated patients with cancer, cancer survivors, and controls were 62.7 (14.7), 62.9 (12.6), and 61.8 (14.7) years, respectively. Of 73 608 patients with cancer, 27 170 (36.9%) were men; 60 100 (81.6%) were Chinese, 7432 (10.1%) Malay, 4597 (6.2%) Indian, and 1479 (2.0%) were of other races and ethnicities. The IRRs for the 3-dose and 4-dose vs the 2-dose group (reference) for COVID-19 hospitalization and severe disease were significantly lower during both the delta and omicron waves in cancer and control populations. The IRRs for severe disease in the 3-dose group for active treatment, cancer survivors, and controls were 0.14, 0.13, and 0.07 during the delta wave and 0.29, 0.19, and 0.21 during omicron wave, respectively. The IRRs for severe disease in the 4-dose group during the omicron wave were even lower at 0.13, 0.10 and 0.10, respectively. No waning of vaccine effectiveness against hospitalization and severe disease was seen beyond 5 months after a third dose, nor up to 5 months (the end of this study's follow-up) after a fourth dose. Conclusion This cohort study provides evidence of the clinical effectiveness of mRNA-based vaccines against COVID-19 in patients with cancer. Longevity of immunity in preventing severe COVID-19 outcomes in actively treated patients with cancer, cancer survivors, and matched controls was observed at least 5 months after the third or fourth dose.
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Affiliation(s)
- Wei Chong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Joline Si Jing Lim
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ryan Ying Cong Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Fun Loon Leong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
| | - Louis Yi Ann Chai
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Benjamin Ong
- Ministry of Health, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Calvin J. Chiew
- Ministry of Health, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Wee Joo Chng
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Experimental Therapeutics Programme, Cancer Science Institute, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | | | - Iain Beehuat Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
- Genome Institute of Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Raghav Sundar
- Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore
- Singapore Gastric Cancer Consortium, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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11
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Yung CF, Pang D, Kam KQ, Lye DC, Ong B, Chong CY, Tan KB. BNT162b2 vaccine protection against omicron and effect of previous infection variant and vaccination sequence among children and adolescents in Singapore: a population-based cohort study. Lancet Child Adolesc Health 2023; 7:463-470. [PMID: 37201540 PMCID: PMC10185330 DOI: 10.1016/s2352-4642(23)00101-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Information on variant-specific vaccine protection and the effect of previous infection variant is scarce in children. We aimed to ascertain the level of protection conferred by BNT162b2 COVID-19 vaccination against omicron variant infection (BA.4 or BA.5, and XBB) in a previously infected national paediatric cohort. We also explored the association between sequence of previous infection (variant) and vaccination on protection. METHODS We did a retrospective, population-based cohort study using the national databases of all confirmed SARS-CoV-2 infections, vaccines administered, and demographic records maintained by the Ministry of Health, Singapore. The study cohort consisted of children aged 5-11 years and adolescents aged 12-17 years who had a previous SARS-CoV-2 infection from Jan 1, 2020, to Dec 15, 2022. People who were infected during the pre-delta period or were immunocompromised (received three vaccination doses [children 5-11 years old] and four vaccinations doses [adolescents 12-17 years old]) were excluded. Those who had multiple episodes of infection before the study start date, were not vaccinated before infection but completed three doses, received bivalent mRNA vaccine, or received non-mRNA vaccine doses were also excluded. All SARS-CoV-2 infections confirmed by reverse transcriptase polymerase chain reaction or rapid antigen testing were grouped into delta, BA.1, BA.2, BA.4 or BA.5, or XBB variants using a combination of whole-genome sequencing, S-gene target failure results, and imputation. For BA.4 or BA.5, the study outcome period was June 1-Sept 30, 2022, and for XBB variants the outcome period was Oct 18-Dec 15, 2022. Incidence rate ratios between vaccinated and unvaccinated were derived using adjusted Poisson regressions and vaccine effectiveness was estimated as (1-risk ratio) × 100%. FINDINGS 135 197 people aged 5-17 years (79 332 children and 55 865 adolescents) were included in the cohort for the vaccine effectiveness analysis against omicron BA.4 or BA.5, and 164 704 people aged 5-17 years (97 235 children and 67 469 adolescents) were included for the analysis against omicron XBB. Approximately 47% of participants were female and 53% were male. Among those previously infected, vaccine effectiveness against BA.4 or BA.5 infection in fully vaccinated children (two doses) was 74·0% (95% CI 67·7-79·1) and in adolescents (three doses) was 85·7% (80·2-89·6). Against XBB, protection conferred with full vaccination was lower at 62·8% (95% CI 42·3-76·0) in children and 47·9% (20·2-66·1) in adolescents. In children, receipt of two-dose vaccination before first SARS-CoV-2 infection provided them with the highest protection against subsequent BA.4 or BA.5 infection at 85·3% (95% CI 80·2-89·1); however, this was not shown to be the case for adolescents. First infection variant had an effect on vaccine effectiveness against omicron BA.4 or BA.5 reinfection in the following descending order: BA.2 conferred the highest protection (92·3% [95% CI 88·9-94·7] in children and 96·4% [93·5-98·0] in adolescents) followed by BA.1 (81·9% [75·9-86·4] in children and 95·0% [91·6-97·0] in adolescents), and delta which conferred the lowest protection (51·9% [5·3-75·6] in children and 77·5% [63·9-86·0] in adolescents). INTERPRETATION In previously infected children and adolescents, BNT162b2 vaccination provided additional protection against omicron BA.4 or BA.5 and XBB variants compared with those who remained unvaccinated. Hybrid immunity against XBB was lower than against BA.4 or BA.5, especially in adolescents. Early vaccination of previously uninfected children before their first SARS-CoV-2 exposure could potentially strengthen population immunity resilience against future variants. FUNDING None.
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Affiliation(s)
- Chee Fu Yung
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore.
| | | | - Kai Qian Kam
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National Centre for Infectious Diseases, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Paediatrics, and SingHealth Duke-NUS Paediatrics Academic Clinical Program, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin B Tan
- Duke-NUS Medical School, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore; Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
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12
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de Zubicaray GI, Brownsett SLE, Copland DA, Drummond K, Jeffree RL, Olson S, Murton E, Ong B, Robinson GA, Tolkacheva V, McMahon KL. Chronic aphasias after left-hemisphere resective surgery. Brain and Language 2023; 239:105244. [PMID: 36889018 DOI: 10.1016/j.bandl.2023.105244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/23/2023] [Accepted: 02/23/2023] [Indexed: 05/10/2023]
Abstract
Surgical resection of brain tumours is associated with an increased risk of aphasia. However, relatively little is known about outcomes in the chronic phase (i.e., >6 months). Using voxel-based lesion symptom mapping (VLSM) in 46 patients, we investigated whether chronic language impairments are related to the location of surgical resection, residual tumour characteristics (e.g., peri-resection treatment effects, progressive infiltration, oedema) or both. Approximately 72% of patients scored below the cut-off for aphasia. Action naming and spoken sentence comprehension deficits were associated with lesions in the left anterior temporal and inferior parietal lobes, respectively. Voxel-wise analyses revealed significant associations between ventral language pathways and action naming deficits. Reading impairments were also associated with increasing disconnection of cerebellar pathways. The results indicate chronic post-surgical aphasias reflect a combination of resected tissue and tumour infiltration of language-related white matter tracts, implicating progressive disconnection as the critical mechanism of impairment.
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Affiliation(s)
- Greig I de Zubicaray
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia.
| | - Sonia L E Brownsett
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - David A Copland
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD 4072, Australia; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Kate Drummond
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | | | - Sarah Olson
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Emma Murton
- Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Gail A Robinson
- Queensland Brain Institute and School of Psychology, University of Queensland, Brisbane, QLD 4072, Australia
| | - Valeriya Tolkacheva
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Katie L McMahon
- School of Clinical Sciences, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4059, Australia; Herston Imaging Research Facility, Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia
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13
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Lye DC, Tan KB. Protective immunity of SARS-CoV-2 infection and vaccines against medically attended symptomatic omicron BA.4, BA.5, and XBB reinfections in Singapore: a national cohort study. Lancet Infect Dis 2023:S1473-3099(23)00060-9. [PMID: 36924786 DOI: 10.1016/s1473-3099(23)00060-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/09/2022] [Accepted: 01/26/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Despite a large proportion of the population having been vaccinated and infected, Singapore had SARS-CoV-2 waves driven by the BA.5 and XBB sublineages of the omicron (B.1.1.529) variant. Data on the protective immunity against medically attended, symptomatic reinfections with omicron BA.4, BA.5, and XBB conferred by previous SARS-CoV-2 infections and vaccinations are scarce. We therefore aimed to derive information from Singapore's experience as one of the first countries with an XBB-driven wave. METHODS For this retrospective national cohort study, we used information from official databases of the Ministry of Health of Singapore to assess hybrid immunity (obtained from previous infection and vaccination) against medically attended, symptomatic BA.4 and BA.5 reinfections from Oct 1, 2022, to Nov 1, 2022, and medically attended, symptomatic XBB reinfections from Oct 18, 2022, to Nov 1, 2022, among Singapore citizens and permanent residents aged at least 18 years. All individuals with acute respiratory symptoms who presented at any health-care facility in Singapore between the stated dates were tested for SARS-CoV-2. Individuals were grouped into SARS-CoV-2-naive, pre-omicron, omicron BA.1, and omicron BA.2 groups according to their previous infection status. Data were also stratified by time from first infection to analyse the waning of immunity. Incidence rate ratios (IRRs) were measured by generalised linear Poisson regressions, with SARS-CoV-2-naive individuals as the reference group, and protective immunity was calculated as one minus the risk ratio multiplied by 100. FINDINGS 2 456 791 individuals were included in the study, contributing 53·1 million person-days of observation for the SARS-CoV-2-naive group, 3·4 million person-days for the pre-omicron group, 6·6 million person-days for the BA.1 group, and 13·7 million person-days for the BA.2 group between Oct 1, 2022, and Nov 1, 2022. Compared with SARS-CoV-2-naive individuals, first infections with pre-omicron variants did not confer protection against reinfection with BA.4 or BA.5 (IRR 0·87 [95% CI 0·73-1·05] for pre-omicron infection with booster vaccination) or XBB (IRR 1·29 [1·23-1·35] for pre-omicron infection with booster vaccination). Previous BA.2 infection with booster provided the greatest protection against reinfection, but this was lower against reinfection with XBB (protective immunity 51%; 95% CI 49-53) than against reinfection with BA.4 or BA.5 (78%; 74-82). Protection conferred by previous BA.2 infection against XBB reinfection waned faster over time from first infection (from 74% [72-75] at 3-6 months to 49% [47-52] at 7-8 months) than protection against BA.4 or BA.5 reinfection (from 87% [82-90] at 3-6 months to 74% [66-80] at 7-8 months). INTERPRETATION Protection against XBB reinfection conferred by a previous omicron infection with vaccination was lower and waned faster than protection against BA.4 or BA.5 reinfection, which is indicative of the greater immune evasiveness of the XBB sublineage. Although severe COVID-19 is uncommon, populations remain vulnerable to future reinfection waves from emerging SARS-CoV-2 variants despite high rates of vaccination and infection, as reflected by substantially higher reinfection rates during Singapore's XBB wave than during the previous BA.5-driven wave. Policy makers could consider emerging public health interventions, such as omicron-adapted bivalent vaccines, to maintain population immunity against COVID-19. FUNDING None.
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Affiliation(s)
- Celine Y Tan
- Public Health Group, Ministry of Health, Singapore.
| | - Calvin J Chiew
- Public Health Group, Ministry of Health, Singapore; National Centre for Infectious Diseases, Singapore
| | - Deanette Pang
- Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Vernon J Lee
- Public Health Group, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- DMS Office, Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Crisis Strategy and Operations Group, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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14
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Chiew CJ, Premikha M, Chong CY, Wei WE, Ong B, Lye DC, Heng D, Lee VJ, Tan KB. Effectiveness of primary series and booster vaccination against SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years in Singapore: a national cohort study. Lancet Infect Dis 2023; 23:177-182. [PMID: 36182678 PMCID: PMC9519171 DOI: 10.1016/s1473-3099(22)00573-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Singapore offered the BNT162b2 vaccine (tozinameran; Pfizer-BioNTech) to adolescents aged 12-17 years in May 18, 2021, and extended booster vaccines to this group in Jan 21, 2022. Literature on the effectiveness of primary series and booster vaccination among adolescents is scarce outside of Europe and North America. We aimed to determine primary series and booster vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adolescents in Singapore. METHODS For this national cohort study, we assessed the incidence of confirmed SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years vaccinated with BNT162b2 in Singapore from Sept 1 to Dec 15, 2021, during the delta (B.1.617.2) variant wave, and from Jan 21 to April 28, 2022, during the omicron (B.1.1.529) variant wave. Data were collected from official databases maintained by the Ministry of Health of Singapore. Individuals were classified as partly vaccinated (those who had received one dose and those who had received the second dose no more than 7 days previously), fully vaccinated (8 days after receiving a second dose), or boosted (8 days after receiving a third dose) and compared with unvaccinated individuals. FINDINGS 249 763 individuals aged 12-17 years were included in the study, contributing over 56·2 million person-days of observation. Compared with unvaccinated individuals, two vaccine doses achieved vaccine effectiveness of 66% (95% CI 63-69) against infection with the delta variant and 25% (21-29) against infection with the omicron variant, and 83% (74-89) against delta variant-associated hospitalisation and 75% (56-86) against omicron variant-associated hospitalisation. Booster vaccination with a third dose achieved vaccine effectiveness of 56% (53-58) against infection with the omicron variant and 94% (86-97) against omicron-associated hospitalisation, compared with unvaccinated adolescents. Vaccine effectiveness against infection for both variants after two doses waned over time, whereas vaccine effectiveness against hospitalisation for both variants remained stable; both were increased after three doses. INTERPRETATION Among adolescents aged 12-17 years, vaccine effectiveness against confirmed SARS-CoV-2 infection after two doses of BNT162b2 decreased over time and increased after a third dose. Boosted adolescents were also the most protected from hospitalisation compared with fully vaccinated, partly vaccinated, and unvaccinated adolescents. Therefore, the booster dose of BNT162b2 can help to reduce the burden on the health-care system and individual morbidity during an omicron wave. FUNDING None.
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Affiliation(s)
| | - M Premikha
- Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Chia Yin Chong
- Department of Infectious Diseases, KK Women's and Children's Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Duke-NUS Medical School, Singapore
| | | | - Benjamin Ong
- DMS Office, Ministry of Health, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,National Centre for Infectious Diseases, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vernon J Lee
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Crisis Strategy and Operations Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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15
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Tan CY, Chiew CJ, Pang D, Lee VJ, Ong B, Lye DC, Tan KB. Vaccine effectiveness against Delta, Omicron BA.1, and BA.2 in a highly vaccinated Asian setting: a test-negative design study. Clin Microbiol Infect 2023; 29:101-106. [PMID: 36028091 PMCID: PMC9398552 DOI: 10.1016/j.cmi.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES We compared the vaccine effectiveness over time of the primary series and booster against infection and severe disease with the Delta, Omicron BA.1, and BA.2 variants in Singapore, an Asian setting with high vaccination coverage. METHODS We conducted a test-negative case-control study on all adult residents in Singapore who underwent PCR testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in acute hospitals. Individuals with a negative PCR from 1 September, 2021, to 30 November, 2021, and 1 December, 2021, to 25 April, 2022, served as controls for the Delta and Omicron variants respectively, and PCR-positive individuals within these two time periods served as cases. Associations between vaccination status and SARS-CoV-2 infection and severe disease with the Delta or Omicron variants were measured using Poisson regressions. Vaccine effectiveness was calculated by taking 1 minus risk ratio. RESULTS There were 68 114 individuals comprising 58 495 controls and 9619 cases for the Delta period, of whom 53 093 completed the primary series and 9161 were boosted. For the Omicron period, 104 601 individuals comprising 80 428 controls, 8643 BA.1 cases, and 15 530 BA.2 cases were included, of whom 29 183 and 71 513 were vaccinated with the primary series and boosted, respectively. The primary series provided greater protection against infection with Delta (45%, 95% CI 40-50%) than against infection with Omicron (21%, 95% CI 7-34% for BA.1; 18%, 95% CI 6-29% for BA.2) at <2 months from vaccination. Vaccine effectiveness of the booster was similar against infection with BA.1 (44%, 95% CI 38-50%) and BA.2 (40%, 95% CI 35-40%). Protection against severe disease by the booster for BA.1 (83%, 95% CI 76-88%) and BA.2 (78%, 95% CI 73-82%) was comparable to that by the primary series for Delta (80%, 95% CI 73-85%). CONCLUSION Our findings support the use of a booster dose to reduce the risk of severe disease and mitigate the impact on the healthcare system in an Omicron-predominant epidemic.
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Affiliation(s)
- Celine Y. Tan
- Ministry of Health, Singapore,Corresponding author. Communicable Diseases Division, Ministry of Health, 12 College Road, Singapore 169852
| | | | | | - Vernon J. Lee
- Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,National Centre for Infectious Diseases, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Tan CY, Chiew CJ, Lee VJ, Ong B, Lye DC, Tan KB. Effectiveness of a Fourth Dose of COVID-19 mRNA Vaccine Against Omicron Variant Among Elderly People in Singapore. Ann Intern Med 2022; 175:1622-1623. [PMID: 36095316 PMCID: PMC9578545 DOI: 10.7326/m22-2042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - Calvin J Chiew
- Ministry of Health, and National Centre for Infectious Diseases, Singapore
| | - Vernon J Lee
- Ministry of Health, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, and Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Yong Loo Lin School of Medicine, National University of Singapore, Lee Kong Chian School of Medicine, Nanyang Technological University, and Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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17
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Abstract
BACKGROUND Since it was first identified in early November 2021, the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread quickly and replaced the B.1.617.2 (delta) variant as the dominant variant in many countries. Data on the real-world effectiveness of vaccines against the omicron variant in children are lacking. METHODS In a study conducted from January 21, 2022, through April 8, 2022, when the omicron variant was spreading rapidly, we analyzed data on children in Singapore who were 5 to 11 years of age. We assessed the incidences of all reported SARS-CoV-2 infections (confirmed on polymerase-chain-reaction [PCR] assay, rapid antigen testing, or both), SARS-CoV-2 infections confirmed on PCR assay, and coronavirus disease 2019 (Covid-19)-related hospitalizations among unvaccinated, partially vaccinated (≥1 day after the first dose of vaccine and up to 6 days after the second dose), and fully vaccinated children (≥7 days after the second dose). Poisson regression was used to estimate vaccine effectiveness from the incidence rate ratio of outcomes. RESULTS A total of 255,936 children were included in the analysis. Among unvaccinated children, the crude incidence rates of all reported SARS-CoV-2 infections, PCR-confirmed SARS-CoV-2 infections, and Covid-19-related hospitalizations were 3303.5, 473.8, and 30.0 per 1 million person-days, respectively. Among partially vaccinated children, vaccine effectiveness was 13.6% (95% confidence interval [CI], 11.7 to 15.5) against all SARS-CoV-2 infections, 24.3% (95% CI, 19.5 to 28.9) against PCR-confirmed SARS-CoV-2 infection, and 42.3% (95% CI, 24.9 to 55.7) against Covid-19-related hospitalization; in fully vaccinated children, vaccine effectiveness was 36.8% (95% CI, 35.3 to 38.2), 65.3% (95% CI, 62.0 to 68.3), and 82.7% (95% CI, 74.8 to 88.2), respectively. CONCLUSIONS During a period when the omicron variant was predominant, BNT162b2 vaccination reduced the risks of SARS-CoV-2 infection and Covid-19-related hospitalization among children 5 to 11 years of age.
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Affiliation(s)
- Sharon H X Tan
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
| | - Alex R Cook
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
| | - Derrick Heng
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
| | - Benjamin Ong
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
| | - David C Lye
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
| | - Kelvin B Tan
- From the Saw Swee Hock School of Public Health (S.H.X.T., A.R.C., D.H., K.B.T.) and the Yong Loo Lin School of Medicine (D.C.L.), National University of Singapore, the Ministry of Health (D.H., B.O., K.B.T.), the National Centre for Infectious Diseases (D.C.L.), Tan Tock Seng Hospital (D.C.L.), the Lee Kong Chian School of Medicine, Nanyang Technological University (D.C.L.), and the Centre of Regulatory Excellence, Duke-National University of Singapore Medical School (K.B.T.) - all in Singapore
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18
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Ong B, Rocimo A, King R, Yasay E. P-135 Capecitabine maintenance chemotherapy in the treatment of metastatic colorectal cancer: A meta-analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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19
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Premikha M, Chiew CJ, Wei WE, Leo YS, Ong B, Lye DC, Lee VJ, Tan KB. Comparative Effectiveness of mRNA and Inactivated Whole Virus Vaccines against COVID-19 Infection and Severe Disease in Singapore. Clin Infect Dis 2022; 75:1442-1445. [PMID: 35412612 PMCID: PMC9047219 DOI: 10.1093/cid/ciac288] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 12/15/2022] Open
Abstract
Compared to individuals vaccinated with Pfizer-BioNTech/Comirnaty, recipients of Sinovac-CoronaVac and Sinopharm were 2.37 (95% CI 2.29–2.46) and 1.62 (95% CI 1.43–1.85) times more likely to be infected with COVID-19 respectively, while individuals vaccinated with Moderna were 0.42 (95% CI 0.25–0.70) times less likely to develop severe disease.
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Affiliation(s)
| | | | | | - Yee-Sin Leo
- National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Benjamin Ong
- Ministry of Health, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- National Centre for Infectious Diseases, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Vernon J Lee
- Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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20
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Abstract
This study estimates SARS-CoV-2 infections and disease severity with the receipt of a booster and by type of booster.
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Affiliation(s)
- Sharon Hui Xuan Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | - Lin-Fa Wang
- Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore
| | | | | | - Alex R. Cook
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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21
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Tan A, Lai G, Saw S, Chua K, Takano A, Ong B, Koh T, Jain A, Tan W, Ng Q, Kanesvaran R, Rajasekaran T, Kalshnikova E, Shchegrova S, H. -Ta, Lin J, Renner D, Sethi H, Zimmermann B, Aleshin A, Lim W, Tan E, Skanderup A, Ang M, Tan D. MA07.06 Circulating Tumor DNA for Monitoring Minimal Residual Disease and Early Detection of Recurrence in Early Stage Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Waters E, Ong B, Mikes-Liu K, McCloughen A, Rosen A, Mayers S, Sidis A, Dawson L, Buus N. Open Dialogue, need-adapted mental health care, and implementation fidelity: A discussion paper. Int J Ment Health Nurs 2021; 30:811-816. [PMID: 33848029 DOI: 10.1111/inm.12866] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer's needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.
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Affiliation(s)
- Edward Waters
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Benjamin Ong
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Child and Youth Mental Health Service, Penrith, New South Wales, Australia
| | - Kristof Mikes-Liu
- Faculty of Medicine and Health, Nepean Clinical School, University of Sydney, Kingswood, New South Wales, Australia.,Nepean Blue Mountains Local Health District, Mental Health Service, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Andrea McCloughen
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alan Rosen
- Illawarra Institute for Mental Health (iiMH), University of Wollongong, Wollongong, New South Wales, Australia.,Brain & Mind Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - Steven Mayers
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Anna Sidis
- Northfields Clinic, School of Psychology, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lisa Dawson
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia
| | - Niels Buus
- The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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23
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Tan A, Ong B, Koh T, Chen J, Oo H, Lai G, Tan W, Ang M, Kanesvaran R, Ng Q, Jain A, Rajasekaran T, Zhai W, Skanderup A, Lim K, Tan E, Lim W, Tan D, Takano A. P38.03 Immunohistochemical, Histologic and Genomic Characterisation of Early Stage Pulmonary Invasive Mucinous Adenocarcinoma. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Tan DT, Siri JG, Gong Y, Ong B, Lim SC, MacGillivray BH, Marsden T. Systems approaches for localising the SDGs: co-production of place-based case studies. Global Health 2019; 15:85. [PMID: 31847865 PMCID: PMC6918641 DOI: 10.1186/s12992-019-0527-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 11/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Localisation is a pervasive challenge in achieving sustainable development. Contextual particularities may render generalized strategies to achieve the Sustainable Development Goals (SDGs) unfeasible, impractical, or ineffective. Furthermore, many localities are resource- and data-poor, limiting applicability of the global SDG indicator framework. Tools to enable local actors to make sense of complex problems, communicate this understanding, and act accordingly hold promise in their ability to improve results. AIM Systems approaches can help characterise local causal systems, identify useful leverage points, and foster participation needed to localise and catalyse development action. Critically, such efforts must be deeply rooted in place, involving local actors in mapping decision-processes and causation within local physical, social and policy environments. Given that each place has a unique geographical or spatial extent and therein lies its unique characters and problems, we term these activities "placially explicit." We describe and reflect on a process used to develop placially explicit, systems-based (PESB) case studies on issues that intersect with and impact urban health and wellbeing, addressing the perspectives of various actors to produce place-based models and insights that are useful for SDG localisation. METHODS Seven case studies were co-produced by one or more Partners with place-based knowledge of the case study issue and a Systems Thinker. In each case, joint delineation of an appropriate framing was followed by iterative dialogue cycles to uncover key contextual factors, with attention to institutional and societal structures and paradigms and the motivations and constraints of other actors. Casual loop diagrams (CLDs) were iteratively developed to capture complex narratives in a simple visual way. RESULTS Case study development facilitated transfer of local knowledge and development of systems thinking capacity. Partners reported new insights, including a shifting of problem frames and corresponding solution spaces to higher systems levels. Such changes led partners to re-evaluate their roles and goals, and thence to new actions and strategies. CLD-based narratives also proved useful in ongoing communications. CONCLUSION Co-production of PESB case studies are a useful component of transdisciplinary toolsets for local SDG implementation, building the capacity of local actors to explore complex problems, identify new solutions and indicators, and understand the systemic linkages inherent in SDG actions across sectors and scales.
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Affiliation(s)
- David T Tan
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
| | - José Gabriel Siri
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Yi Gong
- Sustainable Places Research Institute, Cardiff University, Cardiff, Wales, UK.
| | - Benjamin Ong
- Urban Biodiversity Initiative, Kuala Lumpur, Malaysia
| | - Shiang Cheng Lim
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | | | - Terry Marsden
- Sustainable Places Research Institute, Cardiff University, Cardiff, Wales, UK
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Roughead EE, Kim DS, Ong B, Kemp-Casey A. Pricing policies for generic medicines in Australia, New Zealand, the Republic of Korea and Singapore: patent expiry and influence on atorvastatin price. WHO South East Asia J Public Health 2018; 7:99-106. [PMID: 30136668 DOI: 10.4103/2224-3151.239421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Little is known about how the different policies available to promote use of generic medicines affect the price per unit supplied or sold. This study compares the influence of pricing policies for generic medicines on atorvastatin prices in Australia, New Zealand, the Republic of Korea and Singapore, after market entry of generic atorvastatin. Methods The annual price of atorvastatin per defined daily dose supplied (price/DDD) was examined for each country from 2006 to 2015 (≥2 years before and ≥4 years after generic market entry). Prices were converted to international dollars and cumulative percentage price reductions were calculated for the first 4 years following generic entry. Results Prior to market entry of generic atorvastatin, New Zealand had the lowest price ($0.10/DDD), and the Republic of Korea the highest ($2.89/DDD). The price/DDD fell immediately after generic entry in all countries except New Zealand, which already had low prices. The largest immediate decrease was observed in Singapore (46%, year 1). By the fourth year after generic entry, the price had fallen by 46-80% in all countries; however, large price differences between countries remained. Conclusion New Zealand's tendering system and use of preferred medicines resulted in very low atorvastatin prices well before patent expiry. Pricing policies in the other three countries were effective in reducing atorvastatin prices, with reductions of between 46% and 80% within 4 years of generic entry. Where tendering and use of preferred medicines were the mechanisms for atorvastatin procurement (New Zealand), prices were lowest before and after generic entry. Mandatory price cuts, combined with price-disclosure policies (Australia), produced similar relative price reductions to tendering systems (New Zealand, Singapore) at 4 years. By comparison, mandatory price cuts upon generic entry as the sole measure, while initially effective, were associated with the smallest relative reduction in price after 4 years (Republic of Korea).
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Affiliation(s)
- Elizabeth E Roughead
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Dong-Sook Kim
- Pharmaceutical Policy Research Team, Research Centre, Health Insurance Review and Assessment Service, Seoul, Republic of Korea
| | - Benjamin Ong
- Health Products Regulation Group, Health Sciences Authority, Singapore
| | - Anna Kemp-Casey
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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Devlin M, Swayne A, Newman M, O'Gorman C, Brown H, Ong B, Robertson T, Airey C, Blum S. A case of immune-mediated encephalitis related to daclizumab therapy. Mult Scler 2018; 25:750-753. [PMID: 30073905 DOI: 10.1177/1352458518792403] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report will detail a case of immune-mediated encephalitis in the context of daclizumab therapy. Daclizumab is a humanised monoclonal antibody which, prior to its recent worldwide withdrawal due to safety concerns, was utilised as a disease-modifying therapy in relapsing-remitting multiple sclerosis. The withdrawal of this therapy was prompted by concerns over 12 cases of serious immune-mediated adverse reactions in the central nervous system. We report an additional case, including clinical data and results of neuroimaging, cerebrospinal fluid (CSF) examination and brain biopsy.
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Affiliation(s)
- Michael Devlin
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Andrew Swayne
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Mater Centre for Neurosciences, Mater Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Martin Newman
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | | | - Helen Brown
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Benjamin Ong
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Thomas Robertson
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.,Anatomical Pathology, Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Caroline Airey
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Mater Centre for Neurosciences, Mater Hospital, South Brisbane, QLD, Australia
| | - Stefan Blum
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Mater Centre for Neurosciences, Mater Hospital, South Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Abstract
Research to understand the genetic basis of disease, particularly complex disease, regularly involves single nucleotide polymorphism (SNP) genotyping. The use of genome-wide SNP genotyping arrays has become increasingly more commonplace for gene discovery. However, smaller-scale genotyping platforms capable of efficiently genotyping tens to hundreds of SNPs are still crucial for many aspects of this work, including replication of associations. The Agena Bioscience MassARRAY System is one such platform. Here, we provide a guide to using the MassARRAY System, from assay design, through mass spectrometry, to generation of genotype data.
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Affiliation(s)
- Justine A Ellis
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia. .,Department of Pediatrics, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Benjamin Ong
- Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia
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Ratnasingam J, Lenders N, Ong B, Boros S, Russell AW, Inder WJ, Ho KKY. Predictors for secondary therapy after surgical resection of nonfunctioning pituitary adenomas. Clin Endocrinol (Oxf) 2017. [PMID: 28626928 DOI: 10.1111/cen.13402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Factors determining recurrence of nonfunctioning pituitary adenomas (NFAs) that require further therapy are unclear as are postoperative follow-up imaging guidelines. We aimed to identify predictors for secondary therapy after surgical resection of NFAs and use this knowledge to inform postoperative management. DESIGN AND PATIENTS A single-centre retrospective study of surgically resected NFAs in 108 patients followed for up to 15 years. Serial tumour images were analysed for size, location and growth rate (GR) and tissue analysed for hormone cell type and proliferation indices with secondary treatment as outcome measure. RESULTS Twenty-four of 66 (36%) patients harbouring a postoperative remnant required secondary treatment, all occurring within 10 years. No secondary treatment was required in any of 42 patients with complete tumour resection. Age, gender, remnant volume and tumour histology were not different between patients requiring and not requiring secondary therapy. Remnant GRs in those requiring secondary therapy were more than 10-fold higher (P<.01). Tumours with a GR ≥80 mm3 /y (Hazard Ratio[HR]: 8.1, Confidence Interval [CI]: 2.4-27.3,P<.01) and those located in the suprasellar region (HR: 6.1, CI: 1.1-32, P=.03) had a higher risk for secondary therapy. Tumour GR in the first three postoperative years correlated significantly (r2 =.6, P<.01) with GR during the period of follow-up. CONCLUSION In surgically resected NFAs further treatment is dependent on the presence of residual tumour, growth rate and location but not tumour histology. Postoperative growth rate of NFAs in the first 3 years of imaging can be used to tailor long-term follow-up to optimize use of health resources.
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Affiliation(s)
- Jeyakantha Ratnasingam
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Nele Lenders
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Benjamin Ong
- Department of Diagnostic Radiology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Samuel Boros
- Pathology Queensland Anatomical Pathology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Anthony W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Ken K Y Ho
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Ong B. Inaugural Chee Kuan Tsee Lecture: Mental Health Care for the 21 st Century. Ann Acad Med Singap 2017; 46:258-262. [PMID: 28733694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Zhao YJ, Khoo AL, Tan G, Teng M, Tee C, Tan BH, Ong B, Lim BP, Chai LYA. Network Meta-analysis and Pharmacoeconomic Evaluation of Fluconazole, Itraconazole, Posaconazole, and Voriconazole in Invasive Fungal Infection Prophylaxis. Antimicrob Agents Chemother 2016; 60:376-86. [PMID: 26525782 PMCID: PMC4704197 DOI: 10.1128/aac.01985-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/22/2015] [Indexed: 11/20/2022] Open
Abstract
Invasive fungal infections (IFIs) are associated with high mortality rates and large economic burdens. Triazole prophylaxis is used for at-risk patients with hematological malignancies or stem cell transplants. We evaluated both the efficacy and the cost-effectiveness of triazole prophylaxis. A network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating fluconazole, itraconazole capsule and solution, posaconazole, and voriconazole was conducted. The outcomes of interest included the incidences of IFIs and deaths. This was coupled with a cost-effectiveness analysis from patient perspective over a lifetime horizon. Probabilities of transitions between health states were derived from the NMA. Resource use and costs were obtained from the Singapore health care institution. Data on 5,505 participants in 21 RCTs were included. Other than itraconazole capsule, all triazole antifungals were effective in reducing IFIs. Posaconazole was better than fluconazole (odds ratio [OR], 0.35 [95% confidence interval [CI], 0.16 to 0.73]) and itraconazole capsule (OR, 0.25 [95% CI, 0.06 to 0.97]), but not voriconazole (OR, 1.31 [95% CI, 0.43 to 4.01]), in preventing IFIs. Posaconazole significantly reduced all-cause deaths, compared to placebo, fluconazole, and itraconazole solution (OR, 0.49 to 0.54 [95% CI, 0.28 to 0.88]). The incremental cost-effectiveness ratio for itraconazole solution was lower than that for posaconazole (Singapore dollars [SGD] 12,546 versus SGD 26,817 per IFI avoided and SGD 5,844 versus SGD 12,423 per LY saved) for transplant patients. For leukemia patients, itraconazole solution was the dominant strategy. Voriconazole was dominated by posaconazole. All triazole antifungals except itraconazole capsule were effective in preventing IFIs. Posaconazole was more efficacious in reducing IFIs and all-cause deaths than were fluconazole and itraconazole. Both itraconazole solution and posaconazole were cost-effective in the Singapore health care setting.
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Affiliation(s)
- Ying Jiao Zhao
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Ai Leng Khoo
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Gloria Tan
- Pharmacoeconomics and Drug Utilisation, Health Products Regulation Group, Health Sciences Authority, Singapore
| | - Monica Teng
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Caroline Tee
- Department of Pharmacy, National University Health System, Singapore
| | - Ban Hock Tan
- Department of General Internal Medicine and Infectious Diseases, Singapore General Hospital, Singapore
| | - Benjamin Ong
- Pharmacoeconomics and Drug Utilisation, Health Products Regulation Group, Health Sciences Authority, Singapore
| | - Boon Peng Lim
- Pharmacy and Therapeutics Office, Group Corporate Development, National Healthcare Group, Singapore
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, University Medicine Cluster, National University Health System, Singapore
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Mohamad ZF, Nasaruddin A, Abd Kadir SN, Musa MN, Ong B, Sakai N. Community-based shared values as a ‘Heart-ware’ driver for integrated watershed management: Japan-Malaysia policy learning perspective. Journal of Hydrology 2015; 530:317-327. [DOI: 10.1016/j.jhydrol.2015.09.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Saxena N, You AX, Zhu Z, Sun Y, George PP, Teow KL, Chong PN, Sim J, Wong JEL, Ong B, Foo HJ, Soh EF, Tham L, Heng BH, Choo P. Singapore's regional health systems-a data-driven perspective on frequent admitters and cross utilization of healthcare services in three systems. Int J Health Plann Manage 2015; 32:36-49. [DOI: 10.1002/hpm.2300] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nakul Saxena
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Alex Xiaobin You
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Zhecheng Zhu
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Yan Sun
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Pradeep Paul George
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | - Kiok Liang Teow
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
| | | | - Joe Sim
- National University Health System; Singapore
| | | | | | | | | | | | - Bee Hoon Heng
- Health Services and Outcomes Research; National Healthcare Group; Singapore
- National Healthcare Group; Singapore
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Teasdale S, Hashem F, Olson S, Ong B, Inder WJ. Recurrent pituitary apoplexy due to two successive neoplasms presenting with ocular paresis and epistaxis. Endocrinol Diabetes Metab Case Rep 2015; 2015:140088. [PMID: 25755879 PMCID: PMC4322370 DOI: 10.1530/edm-14-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/19/2015] [Indexed: 11/08/2022] Open
Abstract
UNLABELLED A case of recurrent pituitary apoplexy is described in a 72-year-old man who initially presented with haemorrhage in a non-functioning pituitary adenoma. Five years later, he re-presented with a severe pituitary haemorrhage in an enlarging sellar mass invading both cavernous sinuses causing epistaxis and bilateral ocular paresis. Subsequent histology was consistent with a sellar malignant spindle and round cell neoplasm. Multiple pituitary tumours have previously been reported to coexist in the same individual, but to our knowledge this is the only case where two pathologically distinct pituitary neoplasms have sequentially arisen in a single patient. This case is also notable with respect to the progressive ocular paresis, including bilateral abducens nerve palsies, and the presentation with epistaxis. LEARNING POINTS Ocular paresis in pituitary apoplexy can result from tumour infiltration of nerves, or by indirect compression via increased intrasellar pressure.Epistaxis is a very rare presentation of a pituitary lesion.Epistaxis more commonly occurs following trans-sphenoidal surgery, and can be delayed.
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Affiliation(s)
- Stephanie Teasdale
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Fahid Hashem
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Sarah Olson
- Department of Neurosurgery, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Benjamin Ong
- Department of Radiology, Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Warrick J Inder
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia ; School of Medicine, The University of Queensland Brisbane, Queensland , Australia
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Tan SSL, Ong B, Cheng C, Ho WE, Tam JKC, Stewart AG, Harris T, Wong WSF, Tran T. The antimalarial drug artesunate inhibits primary human cultured airway smooth muscle cell proliferation. Am J Respir Cell Mol Biol 2014; 50:451-8. [PMID: 24066853 DOI: 10.1165/rcmb.2013-0273oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Airway smooth muscle (ASM) cell hyperplasia contributes to airway wall remodeling (AWR) in asthma. Glucocorticoids, which are used as first-line therapy for the treatment of inflammation in asthma, have limited impact on AWR, and protracted usage of high doses of glucocorticoids is associated with an increased risk of side effects. Moreover, patients with severe asthma often show reduced sensitivity to glucocorticoids. Artesunate, a semisynthetic artemisinin derivative used to treat malaria with minimal toxicity, attenuates allergic airway inflammation in mice, but its impact on AWR is not known. We examined the effects of artesunate on ASM proliferation in vitro and in vivo. Primary human ASM cells derived from nonasthmatic donors were treated with artesunate before mitogen stimulation. Artesunate reduced mitogen-stimulated increases in cell number and cyclin D1 protein abundance but had no significant effect on ERK1/2 phosphorylation. Artesunate, but not dexamethasone, inhibited phospho-Akt and phospho-p70(S6K) protein abundance. Artesunate, but not dexamethasone, inhibited mitogen-stimulated increases in cell number, cyclin D1, and phospho-Akt protein abundance on ASM cells derived from asthmatic donors. In a murine model of allergic asthma, artesunate reduced the area of α-smooth muscle actin-positive cells and decreased cyclin D1 protein abundance. Our study provides a basis for the future development of artesunate as a novel anti-AWR agent that targets ASM hyperplasia via the PI3K/Akt/p70(S6K) pathway and suggests that artesunate may be used as combination therapy with glucocorticoids.
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Harvey M, Cave G, Ong B. Intravenous lipid emulsion-augmented plasma exchange in a rabbit model of clomipramine toxicity; survival, but no sink. Clin Toxicol (Phila) 2014; 52:13-9. [DOI: 10.3109/15563650.2013.866242] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gorayski P, Boros S, Ong B, Olson S, Foote M. Radiation-induced primary cerebral atypical teratoid/rhabdoid tumour in an adult. J Clin Neurosci 2013; 20:1466-8. [PMID: 24018258 DOI: 10.1016/j.jocn.2013.03.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 03/30/2013] [Indexed: 02/03/2023]
Abstract
Atypical teratoid/rhabdoid tumours (ATRT) of the central nervous system are uncommon embryonal carcinomas that predominantly affect infants and young children, and less commonly adults. We report a 58 year old woman who presented with ATRT involving the right parietal lobe which was treated with surgery and adjuvant radiotherapy. Her history was significant for soft tissue sarcoma of the right ear treated with surgery and adjuvant radiotherapy at age 3, thus raising the possibility of radiation-induced aetiology.
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Affiliation(s)
- Peter Gorayski
- Department of Radiation Oncology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
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Fisher D, Tambyah PA, Lin RTP, Jureen R, Cook AR, Lim A, Ong B, Balm M, Ng TM, Hsu LY. Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore. J Hosp Infect 2013; 85:141-8. [PMID: 24011440 PMCID: PMC7114850 DOI: 10.1016/j.jhin.2013.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/22/2013] [Indexed: 11/25/2022]
Abstract
Background Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities. Aim To study the impact of an MRSA control bundle that was implemented via gradual geographic extension across hospital wards. Methods The bundle included active surveillance on admission and transfer/discharge to identify ward-based acquisition of MRSA, isolation and cohorting of MRSA-infected patients, enhanced hand hygiene initiatives, and publicly displayed feedback of MRSA acquisition and hand hygiene compliance rates. Implementation was between October 2006 and June 2010 in order to provide lead-time for the incremental development of infrastructural capacity, and to develop an ethic of infection prevention among staff. Results were analysed via interrupted time-series analysis. Findings MRSA infections fell midway through the implementation, with MRSA bacteraemia declining from 0.26 [95% confidence interval (CI): 0.18–0.34] cases per 1000 inpatient-days in the first quarter of 2004 to 0.11 (95% CI: 0.07–0.19) cases per 1000 inpatient-days in the first quarter of 2012. MRSA acquisition rates fell a year after the programme had been fully implemented, whereas hand hygiene compliance rose significantly from 47% (95% CI: 44–49) in the first quarter of 2009 to 69% (95% CI: 68–71) in the first quarter of 2012. Conclusion Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.
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Affiliation(s)
- D Fisher
- Department of Medicine, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Infection Control Team, National University Health System, Singapore.
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Hutchens RL, Kinsella GJ, Ong B, Pike KE, Clare L, Ames D, Saling MM, Storey E, Mullaly E, Rand E, Parsons S. Relationship Between Control Beliefs, Strategy Use, and Memory Performance in Amnestic Mild Cognitive Impairment and Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2013; 68:862-71. [DOI: 10.1093/geronb/gbt016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ojaghi-Haghighi Z, Mostafavi A, Moladoust H, Noohi F, Maleki M, Esmaeilzadeh M, Samiei N, Hosseini S, Jasaityte R, Teske A, Claus P, Verheyden B, Rademakers F, D'hooge J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Maniatakis P, Parthenakis F, Vardas P, Hilde JM, Skjoerten I, Humerfelt S, Hansteen V, Melsom M, Hisdal J, Steine K, Ippolito R, Gripari P, Muraru D, Esposito R, Kocabay G, Tamborini G, Galderisi M, Maffessanti F, Badano L, Pepi M, Yurdakul S, Oner F, Sahin T, Avci B, Tayyareci Y, Direskeneli H, Aytekin S, Filali T, Jedaida B, Lahidheb D, Gommidh M, Mahfoudhi H, Hajlaoui N, Dahmani R, Fehri W, Haouala H, Andova V, Georgievska-Ismail L, Srbinovska-Kostovska E, Gardinger Y, Joanna Hlebowicz J, Ola Bjorgell O, Magnus Dencker M, Liao MT, Tsai CT, Lin JL, Piestrzeniewicz K, Luczak K, Maciejewski M, Komorowski J, Jankiewicz-Wika J, Drozdz J, Ismail MF, Alasfar A, Elassal M, El-Sayed S, Ibraheim M, Dobrowolski P, Klisiewicz A, Florczak E, Prejbisz A, Szwench E, Rybicka J, Januszewicz A, Hoffman P, Santos Furtado M, Nogueira K, Arruda A, Rodrigues AC, Carvalho F, Silva M, Cardoso A, Lira-Filho E, Pinheiro J, Andrade JL, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Taha N, Zagari D, Oteri A, Quattrone A, Boretti I, Carerj S, Obremska O, Boratynska B, Poczatek P, Zon Z, Magott M, Klinger K, Szenczi O, Szelid Z, Soos P, Bagyura Z, Edes E, Jozan P, Merkely B, Ahn J, Kim D, Jeon D, Kim I, Baeza Garzon F, Delgado M, Mesa D, Ruiz M, De Lezo JS, Pan M, Leon C, Castillo F, Morenate M, Toledano F, Zhong L, Lim E, Shanmugam N, Law S, Ong B, Katwadi K, Tan R, Chua Y, Liew R, Ding Z, Von Bibra H, Leclerque C, Schuster T, Schumm-Draeger PM, Bonios M, Kaladaridou A, Papadopoulou O, Tasoulis A, Pamboucas C, Ntalianis A, Nanas J, Toumanidis S, Silva D, Cortez-Dias N, Carrilho-Ferreira P, Placido R, Jorge C, Calisto C, Robalo Martins S, Carvalho De Sousa J, Pinto F, Nunes Diogo A, Przewlocka-Kosmala M, Orda A, Karolko B, Mysiak A, Kosmala W, Moral Torres S, Rodriguez-Palomares J, Pineda V, Gruosso D, Evangelista A, Garcia-Dorado D, Figueras J, Cambronero E, Corbi MJ, Valle A, Cordoba J, Llanos C, Fernandez M, Lopez I, Hidalgo V, Barambio M, Jimenez J, D'andrea A, Riegler L, Cocchia R, Russo M, Bossone E, Calabro R, Iniesta Manjavacas A, Valbuena Lopez S, Lopez Fernandez T, Garcia-Blas S, De Torres Alba F, De Diego JG, Ramirez Valdiris U, Mesa Garcia J, Moreno Yanguela M, Lopez-Sendon J, Logstrup B, Andersen H, Thuesen L, Christiansen E, Terp K, Klaaborg K, Poulsen S, Cacicedo A, Velasco S, Aguirre U, Onaindia J, Rodriguez I, Oria G, Subinas A, Zugazabeitia G, Romero A, Laraudogoitia Zaldumbide E, Weisz S, Magne J, Dulgheru R, Rosca M, Pierard L, Lancellotti P, Auffret V, Donal E, Bedossa M, Boulmier D, Laurent M, Verhoye J, Le Breton H, Van Hall S, Herbrand T, Ketterer U, Keymel S, Boering Y, Rassaf T, Meyer C, Zeus T, Kelm M, Balzer J, Floria M, Seldrum S, Mariciuc M, Laurence G, Buche M, Eucher P, Louagie Y, Jamart J, Marchandise B, Schroeder E, Venkatesh A, Sahlen A, Johnson J, Brodin L, Winter R, Shahgaldi K, Manouras A, Maffessanti F, Tamborini G, Fusini L, Gripari P, Muratori M, Alamanni F, Bartorelli A, Ferrari C, Caiani E, Pepi M, Yaroslavskaya E, Kuznetsov V, Pushkarev G, Krinochkin D, Zyrianov I, Ciobotaru C, Kobayashi Y, Yamamoto K, Kobayashi Y, Hirose E, Hirohata A, Ohe T, Jhund P, Cunningham T, Murday V, Findlay I, Sonecki P, Rangel I, Sousa C, Goncalves A, Correia A, Vigario A, Martins E, Silva-Cardoso J, Macedo F, Maciel M, Lovric D, Samardzic J, Milicic D, Reskovic V, Baricevic Z, Ivanac I, Separovic Hanzevacki J, Kim K, Song J, Jeong H, Yoon H, Ahn Y, Jeong M, Cho J, Park J, Kang J, Iorio A, Pinamonti B, Bobbo M, Merlo M, Barbati G, Massa L, Faganello G, Di Lenarda A, Sinagra G, Heggemann F, Hamm K, Streitner F, Sueselbeck T, Papavassiliu T, Borggrefe M, Haghi D, Ferreira F, Galrinho A, Soares R, Branco L, Abreu J, Feliciano J, Papoila A, Alves M, Leal A, Ferreira R, Reynaud A, Donal E, Lund LH, Oger E, Drouet E, Hage C, Bauer F, Linde C, Daubert J, Schnell F, Donal E, Lentz P, Kervio G, Leurent G, Mabo P, Carre F, Rodrigues A, Roque M, Arruda A, Becker D, Barros S, Kay F, Emerick T, Pinheiro J, Sampaio-Barros P, Andrade J, Yamada S, Okada K, Iwano H, Nishino H, Nakabachi M, Yokoyama S, Kaga S, Mikami T, Tsutsui H, Mincu R, Magda S, Dumitrache Rujinski S, Constantinescu T, Mihaila S, Ciobanu A, Florescu M, Vinereanu D, Ashcheulova T, Kovalyova O, Ardeleanu E, Gurgus D, Gruici A, Suciu R, Ana I, Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew M, Charalampopoulos A, Howard L, Davies R, Gin-Sing W, Tzoulaki I, Grapsa I, Gibbs S, Caiani E, Massabuau P, Weinert L, Lairez O, Berry M, Sotaquira M, Vaida P, Lang R, Khan I, Waterhouse D, Asegdom S, Alqaseer M, Foley D, Mcadam B, Colonna P, Michelotto E, Genco W, Rubino M, Pugliese S, Belfiore A, Sorino M, Trisorio Liuzzi M, Antonelli G, Palasciano G, Duszanska A, Skoczylas I, Streb W, Kukulski T, Polonski L, Kalarus Z, Fleig A, Seitz K, Secades S, Martin M, Corros C, Rodriguez M, De La Hera J, Garcia A, Velasco E, Fernandez E, Barriales V, Lambert J, Zwas DR, Hoss S, Leibowitz D, Beeri R, Lotan C, Gilon D, Wierzbowska-Drabik K, Roszczyk N, Sobczak M, Plewka M, Chrzanowski L, Lipiec P, Kasprzak J, Wita K, Mizia-Stec K, Wrobel W, Plonska-Gosciniak E, Goncalves A, Sousa C, Rangel I, Pinho T, Wang Y, Houle H, Madureira AJ, Macedo F, Zamorano J, Maciel MJ, Ancona R, Comenale Pinto S, Caso P, Coppola M, Rapisarda O, Calabro' R, Cadenas Chamorro R, Lopez T, Gomez J, Moreno M, Salinas P, Jimenez Rubio C, Valbuena S, Manjavacas A, De Torres F, Lopez-Sendon J, Vaugrenard T, Huttin O, Rouge A, Schwartz J, Zinzius P, Popovic B, Sellal J, Aliot E, Juilliere Y, Selton-Suty C, Looi J, Lee A, Hsiung M, Song W, Wong R, Underwood MJ, Fang F, Lin Q, Lam Y, Yu C, Vitarelli A, Nguyen B, Capotosto L, D-Alessandro G, D-Ascanio M, Rafique A, Gang E, Barilla F, Siegel R, Kydd A, Khan F, Watson W, Mccormick L, Virdee M, Dutka D, Ranjbar S, Karvandi M, Hassantash S, Grapsa J, Efthimiadis I, Pakrashi T, Dawson D, Punjabi P, Nihoyannopoulos P, Jasaityte R, D'hooge J, Rademakers F, Claus P, Henein M, Soderberg S, Tossavainen E, Henein M, Lindqvist P, Bellsham-Revell H, Bell A, Miller O, Simpson J, Altekin E, Kucuk M, Yanikoglu A, Karakas S, Er A, Ozel D, Ermis C, Demir I, Henein M, Soderberg S, Henein M, Lindqvist P, Bajraktari G, Di Salvo G, Baldini L, Del Gaizo F, Rea A, Pergola V, Caso P, Pacileo G, Fadel B, Calabro R, Russo M, Seo JS, Choi GN, Jin HY, Seol SH, Jang JS, Yang TH, Kim DK, Kim DS, Papadopoulou E, Kaladaridou A, Hatzidou S, Agrios J, Pamboukas C, Antoniou A, Toumanidis S, Gargiulo P, Dellegrottaglie S, Bruzzese D, Scala O, D'amore C, Ruggiero D, Marciano C, Vassallo E, Pirozzi E, Perrone Filardi P, Mor-Avi V, Kachenoura N, Lodato J, Port S, Chandra S, Freed B, Bhave N, Newby B, Lang R, Patel A, Dwivedi G, Alam M, Boczar K, Chow B, Staskiewicz G, Czekajska-Chehab E, Uhlig S, Tomaszewski A, Przegalinski J, Maciejewski R, Drop A, Di Giammarco G, Canosa C, Foschi M, Liberti G, Bedir M, Marinelli D, Masuyama S, Rabozzi R, Vijayan S, Miller H, Muthusamy R, Smith S, Gargani L, Pang P, Davis E, Schumacher A, Sicari R, Picano E, Mizia-Stec K, Chmiel A, Mizia M, Haberka M, Gieszczyk K, Sikora - Puz A, Lasota B, Trojnarska O, Grajek S, Gasior Z, Koumoulidis A, Vlasseros I, Tousoulis D, Katsi V, Avgeropoulou A, Divani M, Stefanadis C, Kallikazaros I. Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morze J, Palamuthusingam D, Gillinder L, Fryer M, Coucher J, Ong B, Ngai S, Wang W, Ng A. High Pitch Spiral Coronary Computed Tomography Angiography Results in Significantly Lower Mean Effective Radiation Exposure Compared to Sequential Mode. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ang L, Ooi KL, Lim A, Ong B, Tambyah P, Fisher D. Improving hand hygiene compliance in Singapore via innovation. BMC Proc 2011. [PMCID: PMC3239538 DOI: 10.1186/1753-6561-5-s6-p124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Poulgrain K, Gurgo R, Winter C, Ong B, Lau Q. Papillary tumour of the pineal region. J Clin Neurosci 2011; 18:1007-17. [PMID: 21658955 DOI: 10.1016/j.jocn.2010.12.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/15/2010] [Accepted: 12/19/2010] [Indexed: 11/18/2022]
Abstract
Papillary tumour of the pineal region (PTRR) is one of the new tumour entities to be included in the latest World Health Organization classification of central nervous system tumours. We report two illustrative patients, a 25-year-old female who presented following a head injury sustained from a fall due to gait disturbances, and a 42-year-old man who presented with headaches. Histology of both cases showed distinct papillary growth patterns with lining of the papillae by multi-layered cuboidal to columnar cells, prominent perivascular rosette and focal true rosette formation. Immunohistochemistry exhibited strong cytokeratin immunoreactivity in addition to CD56, focal S100, glial fibrillary acidic protein and neuron specific enolase positivity which supported a diagnosis of PTPR in both patients. Postoperatively, both patients underwent courses of adjuvant radiation therapy. One patient reported local recurrence of the tumour 23 months after surgery. While PTPR may have been misdiagnosed in the past, clear and consistent characteristics are beginning to be elucidated in the published reports and literature, which have been reviewed. As a relatively new distinct clinicopathological entity, prognostic data are limited and guidelines for treatment protocols are still being investigated in view of its propensity for local recurrence.
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Affiliation(s)
- Katherine Poulgrain
- School of Medicine, University of Queensland, St. Lucia, Queensland, Australia
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Thumboo J, Seah A, Tan CT, Singhal BS, Ong B. Asian Adaptation and Validation of an English Version of the Multiple Sclerosis International Quality of Life Questionnaire (MusiQoL). Ann Acad Med Singap 2011. [DOI: 10.47102/annals-acadmedsg.v40n2p67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: The Multiple Sclerosis International Quality of Life questionnaire (MusiQoL) is a self-administered, multi-dimensional, patient-based health-related quality of life (HRQoL) instrument. With increasing prevalence of multiple sclerosis (MS) in Asian countries, a valid tool to assess HRQoL in those patients is needed. The aim of this study was to evaluate patient acceptability, content validity and psychometric properties of an Asian version of the English MusiQoL in Singapore, Malaysia and India. Materials and Methods: English speaking patients older than 18 years of age with a definite diagnosis of MS were included. The self-administered survey material included the adapted HRQoL questionnaire, a validated generic HRQoL questionnaire: the short-form 36 (SF-36), as well as a checklist of 14 symptoms. We assessed the internal and external validity of the adapted MusiQoL. Results: A total of 81 patients with MS were included in the study. The questionnaire was generally well accepted. In the samples from Malaysia and Singapore, all scales exhibited good internal consistency (Cronbach’s alpha >0.70). Correlation to SF-36 was generally good, demonstrating high construct validity (P <0.001) in some aspects of the MusiQoL. Conclusion: The Asian adaptation of the English version of the MusiQoL in evaluating HRQoL seems to be a valid, reliable tool with adequate patient acceptability and internal consistency.
Keywords: Asia, Multiple sclerosis, Outcomes assessment, Quality of life, Questionnaires, Validation studies
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Affiliation(s)
| | | | | | - Bhim S Singhal
- Bombay Hospital Institute of Medical Science, Mumbai, India
| | - Benjamin Ong
- Yong Loo Lin School of Medicine, National University Health System, Singapore
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Thumboo J, Seah A, Tan CT, Singhal BS, Ong B. Asian adaptation and validation of an English version of the multiple sclerosis international quality of life questionnaire (MusiQoL). Ann Acad Med Singap 2011; 40:67-73. [PMID: 21468459] [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: 05/30/2023]
Abstract
INTRODUCTION The Multiple Sclerosis International Quality of Life questionnaire (MusiQoL) is a self-administered, multi-dimensional, patient-based health-related quality of life (HRQoL) instrument. With increasing prevalence of multiple sclerosis (MS) in Asian countries, a valid tool to assess HRQoL in those patients is needed. The aim of this study was to evaluate patient acceptability, content validity and psychometric properties of an Asian version of the English MusiQoL in Singapore, Malaysia and India. MATERIALS AND METHODS English speaking patients older than 18 years of age with a defi nite diagnosis of MS were included. The self-administered survey material included the adapted HRQoL questionnaire, a validated generic HRQoL questionnaire: the short-form 36 (SF-36), as well as a checklist of 14 symptoms. We assessed the internal and external validity of the adapted MusiQoL. RESULTS A total of 81 patients with MS were included in the study. The questionnaire was generally well accepted. In the samples from Malaysia and Singapore, all scales exhibited good internal consistency (Cronbach's alpha >0.70). Correlation to SF-36 was generally good, demonstrating high construct validity (P <0.001) in some aspects of the MusiQoL. CONCLUSION The Asian adaptation of the English version of the MusiQoL in evaluating HRQoL seems to be a valid, reliable tool with adequate patient acceptability and internal consistency.
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Affiliation(s)
- Julian Thumboo
- Department of Rheumatology, Singapore General Hospital, Singapore.
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Kinsella GJ, Mullaly E, Rand E, Ong B, Burton C, Price S, Phillips M, Storey E. Early intervention for mild cognitive impairment: a randomised controlled trial. J Neurol Neurosurg Psychiatry 2009; 80:730-6. [PMID: 19332424 DOI: 10.1136/jnnp.2008.148346] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [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: 12/16/2022]
Abstract
BACKGROUND Positive effects are reported for memory training for healthy older adults, and yet there is limited information about the benefit of cognitive intervention for older adults with increasing memory difficulties-mild cognitive impairment. OBJECTIVE To investigate the usefulness of an early cognitive intervention for the memory difficulties experienced by people with amnestic mild cognitive impairment. METHODS Using a randomised control design, 52 participants with amnestic mild cognitive impairment and their family partners were randomly assigned to a cognitive intervention (memory rehabilitation group) or waitlist (control group). Participants were assessed on primary measures of everyday memory (prospective memory) and memory strategies at 2 weeks' and 4 months' follow-up; secondary measures of contentment with memory and the family participants' knowledge of memory strategies were also assessed. RESULTS Everyday memory, measured by performance on prospective memory tasks, significantly improved following intervention, although self-appraisal of everyday memory did not demonstrate a similar intervention effect. Knowledge and use of memory strategies also significantly increased following intervention. Furthermore, family knowledge of memory strategies increased following intervention. There was a strong trend towards improvement in contentment with memory immediately following intervention, but this effect was not significant. CONCLUSIONS Early intervention for memory difficulties in amnestic mild cognitive impairment, using cognitive rehabilitation in compensatory strategies, can assist in minimising everyday memory failures as evaluated by performance on prospective memory tasks and knowledge of memory strategies.
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Affiliation(s)
- G J Kinsella
- Psychological Science, La Trobe University, Melbourne, Victoria 3086, Australia.
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Singh MP, Armstrong J, Murphy MA, Coucher J, Ong B. Is this really pneumothorax? Thorax 2009; 64:276. [PMID: 19252037 DOI: 10.1136/thx.2007.094375] [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: 11/03/2022]
Affiliation(s)
- M P Singh
- QE II Jubilee Hospital, Brisbane, QLD 4108, Australia.
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Abstract
Prospective memory, or the timely remembering of a planned action, is conceptualised as a cognitive process demanding episodic memory and executive attention. Impairments in these skills are characteristic of the cognitive decline in early Alzheimer's disease, providing an expectation of prominent prospective memory difficulties in this population, and yet surprisingly, memory performance in early Alzheimer's disease has rarely been evaluated within a prospective memory framework. In a preliminary study we demonstrated that older adults with early Alzheimer's disease (n=14), as compared to healthy older adults (n=14), were significantly impaired in a simple experimental paradigm of prospective remembering (a text-reading task). In a subsequent intervention study, we investigated the efficacy of spaced-retrieval for improving the prospective remembering performance of older adults with early Alzheimer's disease (n=16) compared to healthy older adults (n=16) under two learning conditions: a spaced-retrieval technique alone or spaced-retrieval combined with elaborated encoding of task. The majority of the Alzheimer's disease group (63%) demonstrated benefit in prospective remembering in the combined condition as compared to spaced-retrieval alone. Participants with Alzheimer's disease who demonstrated better executive attention (Trail Making- set-shifting) and/or better retrospective memory (Hopkins Verbal Learning Test-Revised- recognition) were more successful in the combined learning condition.
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Affiliation(s)
- G J Kinsella
- School of Psychological Science, La Trobe University, Victoria, Australia.
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