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  1. Article ; Online: Misinterpretations of P-values and statistical tests persists among researchers and professionals working with statistics and epidemiology.

    Lytsy, Per / Hartman, Mikael / Pingel, Ronnie

    Upsala journal of medical sciences

    2022  Volume 127

    Abstract: Background: The aim was to investigate inferences of statistically significant test results among persons with more or less statistical education and research experience.: Methods: A total of 75 doctoral students and 64 statisticians/epidemiologist ... ...

    Abstract Background: The aim was to investigate inferences of statistically significant test results among persons with more or less statistical education and research experience.
    Methods: A total of 75 doctoral students and 64 statisticians/epidemiologist responded to a web questionnaire about inferences of statistically significant findings. Participants were asked about their education and research experience, and also whether a 'statistically significant' test result (
    Results: Almost all participants reported having a university degree, and among statisticians/epidemiologist, most reported having a university degree in statistics and were working professionally with statistics. Overall, 9.4% of statisticians/epidemiologist and 24.0% of doctoral students responded that the statistically significant finding proved that H
    Conclusions: Misinterpretation of
    MeSH term(s) Humans ; Probability ; Surveys and Questionnaires
    Language English
    Publishing date 2022-08-04
    Publishing country Sweden
    Document type Journal Article
    ZDB-ID 183949-4
    ISSN 2000-1967 ; 0300-9734
    ISSN (online) 2000-1967
    ISSN 0300-9734
    DOI 10.48101/ujms.v127.8760
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Breast cancer risk stratification using genetic and non-genetic risk assessment tools for 246,142 women in the UK Biobank.

    Ho, Peh Joo / Lim, Elaine H / Hartman, Mikael / Wong, Fuh Yong / Li, Jingmei

    Genetics in medicine : official journal of the American College of Medical Genetics

    2023  Volume 25, Issue 10, Page(s) 100917

    Abstract: Purpose: The benefit of using individual risk prediction tools to identify high-risk individuals for breast cancer (BC) screening is uncertain, despite the personalized approach of risk-based screening.: Methods: We studied the overlap of predicted ... ...

    Abstract Purpose: The benefit of using individual risk prediction tools to identify high-risk individuals for breast cancer (BC) screening is uncertain, despite the personalized approach of risk-based screening.
    Methods: We studied the overlap of predicted high-risk individuals among 246,142 women enrolled in the UK Biobank. Risk predictors assessed include the Gail model (Gail), BC family history (FH, binary), BC polygenic risk score (PRS), and presence of loss-of-function (LoF) variants in BC predisposition genes. Youden J-index was used to select optimal thresholds for defining high-risk.
    Results: In total, 147,399 were considered at high risk for developing BC within the next 2 years by at least 1 of the 4 risk prediction tools examined (Gail
    Conclusion: Risk-based BC screening may require a multipronged approach that includes PRS, predisposition genes, FH, and other recognized risk factors.
    MeSH term(s) Female ; Humans ; Breast Neoplasms/diagnosis ; Breast Neoplasms/genetics ; Biological Specimen Banks ; Genetic Predisposition to Disease ; Risk Factors ; Risk Assessment ; United Kingdom/epidemiology
    Language English
    Publishing date 2023-06-16
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1455352-1
    ISSN 1530-0366 ; 1098-3600
    ISSN (online) 1530-0366
    ISSN 1098-3600
    DOI 10.1016/j.gim.2023.100917
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  3. Article: End-to-End Calcification Distribution Pattern Recognition for Mammograms: An Interpretable Approach with GNN.

    Yao, Melissa Min-Szu / Du, Hao / Hartman, Mikael / Chan, Wing P / Feng, Mengling

    Diagnostics (Basel, Switzerland)

    2022  Volume 12, Issue 6

    Abstract: ... ...

    Abstract Purpose
    Language English
    Publishing date 2022-06-02
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2662336-5
    ISSN 2075-4418
    ISSN 2075-4418
    DOI 10.3390/diagnostics12061376
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  4. Article: Will Absolute Risk Estimation for Time to Next Screen Work for an Asian Mammography Screening Population?

    Ho, Peh Joo / Lim, Elaine Hsuen / Mohamed Ri, Nur Khaliesah Binte / Hartman, Mikael / Wong, Fuh Yong / Li, Jingmei

    Cancers

    2023  Volume 15, Issue 9

    Abstract: Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and ... ...

    Abstract Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and 15-year) absolute risks in 28,234 asymptomatic Asian women. Absolute risks were calculated using different relative risk estimates and Breast cancer incidence and mortality rates (White, Asian-American, or the Singapore Asian population). Using linear models, we tested the association of absolute risk and age at breast cancer occurrence. Model discrimination was moderate (AUC range: 0.580-0.628). Calibration was better for longer-term prediction horizons (E/O
    Language English
    Publishing date 2023-04-29
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15092559
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  5. Article ; Online: Presentation of breast cancer, help seeking behaviour and experience of patients in their cancer journey in Singapore: a qualitative study.

    Ng, Celene W Q / Lim, Jennifer N W / Liu, Jenny / Hartman, Mikael

    BMC cancer

    2020  Volume 20, Issue 1, Page(s) 1080

    Abstract: Background: Little is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey.: Methods: A qualitative interview study with ... ...

    Abstract Background: Little is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey.
    Methods: A qualitative interview study with thematic analysis, conducted with 36 patients.
    Results: There is no clear pattern of presentation for breast cancer by cancer stage at diagnosis, age and ethnicity in the cancer journey of this group of patients. Patients were diagnosed with early to advanced stages cancer regardless of when they presented or took up treatment in their cancer journey. The reasons patients sought medical attention also did not appear to differ between the stages of cancer diagnosed, ethnic and age. Without setting a measure to define early and late presentation, we found that women shared similar experience in their breast cancer journey, regardless of age, ethnicity and stage of cancer at diagnosis. Poor knowledge of breast cancer (symptoms and causes); few practised regular BSE; denial of symptom; fear of hospitalisation, diagnosis and treatment; worries and stress over financial burden of treatment; misinformation in magazine and online sources; diet; stress; caring responsibility; support network; and use of alternative medicine before and after diagnosis were identified in patients' narratives. Strong social support; fear of being an emotional and financial burden for the family; and financial worries during treatment were also the recurring themes after diagnosis.
    Conclusion: A measure of breast cancer presentation - that accounts for the patient's experience in the cancer journey, the time interval and tumour biology - that is meaningful to patients, clinicians and researchers is needed. For research on late and delayed presentation, details on BSE practice - how often, when and was it done correctly - will improve the accuracy of time delay interval. For the public, concerted efforts to improve knowledge of breast cancer, survival and prognosis for early-diagnosed cancer, and the importance of regular and correct technique to perform BSE, are critical and urgent to address the rising breast cancer incidence in the country.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Breast Neoplasms/diagnosis ; Breast Neoplasms/epidemiology ; Breast Neoplasms/psychology ; Delayed Diagnosis/statistics & numerical data ; Early Detection of Cancer/psychology ; Female ; Follow-Up Studies ; Health Knowledge, Attitudes, Practice ; Help-Seeking Behavior ; Humans ; Middle Aged ; Patient Acceptance of Health Care/psychology ; Prognosis ; Qualitative Research ; Singapore/epidemiology ; Social Support
    Language English
    Publishing date 2020-11-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2041352-X
    ISSN 1471-2407 ; 1471-2407
    ISSN (online) 1471-2407
    ISSN 1471-2407
    DOI 10.1186/s12885-020-07585-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Multi-level determinants of breast cancer screening among Malay-Muslim women in Singapore: a sequential mixed-methods study.

    Goh, Su-Ann / Lee, Jeong Kyu / Seh, Wei Yan / Ho, Elaine Qiao Ying / Hartman, Mikael / Chou, Cynthia / Wong, Mee Lian

    BMC women's health

    2022  Volume 22, Issue 1, Page(s) 383

    Abstract: Objective: Ethnic disparity persists despite equal access to health care in Singapore, with Malay-Muslim women having the lowest mammogram uptake rate and highest breast cancer mortality rate. We sought to understand barriers to and facilitators for ... ...

    Abstract Objective: Ethnic disparity persists despite equal access to health care in Singapore, with Malay-Muslim women having the lowest mammogram uptake rate and highest breast cancer mortality rate. We sought to understand barriers to and facilitators for mammogram uptake in this community.
    Methods: We used a sequential mixed-methods design to first explore reasons for screening and not screening for breast cancer, then determine factors associated with screening and regular screening in a survey. We used maximum variation sampling for semi-structured in-depth interviews to select screeners and non-screeners of diverse ages and educational levels. Twenty-three Malay-Muslim women aged 40-69 years old were interviewed. Themes were categorized using thematic analysis. For the survey, we applied the Health Belief Model, Social Ecological Model, as well as themes from the interviews and findings from previous studies on factors influencing screening in Muslim women to guide questionnaire design. We surveyed 271 Malay-Muslim women aged 50-69 years old in a nationally representative sample. Multivariable logistic regression was used to determine factors associated with ever gone for mammogram and regular mammogram uptake.
    Results: Through in-depth-interviews, we found perceived benefits of saving lives and breasts from early detection, reminders from doctors and husbands, symptoms, perceived test from God, and personal responsibility to care for one's health facilitated screening. Barriers were perceived low susceptibility, inconvenience, cost, negative psychological effects, misinformation on mammogram triggering cancer cells, religious beliefs, perceived negative outcomes from mammography and distrust of doctor. From the survey, we found cues from health care professionals and needing symptoms before deciding to go for mammogram to be significantly associated with ever gone for mammogram and regular mammogram. Factors associated with ever gone for mammogram only included age, perceived benefits of saving lives from early detection, perceived importance of mammogram, Punishing Allah Reappraisal, and modesty. Factors associated with regular mammogram only included household income, perceived structural barriers to screening and perceived susceptibility to breast cancer.
    Conclusions: Mammogram uptake is affected by multiple levels of influence. Interventions to promote screening should be designed with multiple stakeholders including doctors, religious leaders and women who had attended screening.
    MeSH term(s) Adult ; Aged ; Breast Neoplasms/psychology ; Early Detection of Cancer/psychology ; Female ; Humans ; Islam ; Malaysia ; Middle Aged ; Singapore
    Language English
    Publishing date 2022-09-19
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2050444-5
    ISSN 1472-6874 ; 1472-6874
    ISSN (online) 1472-6874
    ISSN 1472-6874
    DOI 10.1186/s12905-022-01972-y
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Estimating transmission dynamics of SARS-CoV-2 at different intraspatial levels in an institutional outbreak.

    Jin, Shihui / Dickens, Borame Lee / Quek, Amy Ml / Hartman, Mikael / Tambyah, Paul Anantharajah / Seet, Raymond Chee Seong / Cook, Alex R

    Epidemics

    2022  Volume 40, Page(s) 100617

    Abstract: Introduction: Large, localised outbreaks of COVID-19 have been repeatedly reported in high-density residential institutions. Understanding the transmission dynamics will inform outbreak response and the design of living environments that are more ... ...

    Abstract Introduction: Large, localised outbreaks of COVID-19 have been repeatedly reported in high-density residential institutions. Understanding the transmission dynamics will inform outbreak response and the design of living environments that are more resilient to future outbreaks.
    Methods: We developed an individual-based, multilevel transmission dynamics model using case, serology and symptom data from a 60-day cluster randomised trial of prophylaxes in a densely populated foreign worker dormitory in Singapore. Using Bayesian data augmentation, we estimated the basic reproduction number and the contribution that within-room, between-level and across-block transmission made to it, and the prevalence of infection over the study period across different spatial levels. We then simulated the impact of changing the building layouts in terms of floors and blocks on outbreak size.
    Results: We found that the basic reproduction number was 2.76 averaged over the different putative prophylaxes, with substantial contributions due to transmission beyond the residents' rooms. By the end of ~60 days of follow up, prevalence was 64.4 % (95 % credible interval 64.2-64.6 %). Future outbreak sizes could feasibly be halved by reducing the density to include additional housing blocks, or taller buildings, while retaining the overall number of men in the complex.
    Discussion: The methods discussed can potentially be utilised to estimate transmission dynamics at any high-density accommodation site with the availability of case and serology data. The restructuring of infrastructure to reduce the number of residents per room can dramatically slow down epidemics, and therefore should be considered by policymakers as a long-term intervention.
    MeSH term(s) Basic Reproduction Number ; Bayes Theorem ; COVID-19/epidemiology ; Disease Outbreaks ; Humans ; Male ; SARS-CoV-2
    Language English
    Publishing date 2022-07-22
    Publishing country Netherlands
    Document type Journal Article ; Randomized Controlled Trial
    ZDB-ID 2467993-8
    ISSN 1878-0067 ; 1755-4365
    ISSN (online) 1878-0067
    ISSN 1755-4365
    DOI 10.1016/j.epidem.2022.100617
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  8. Article ; Online: Development and validation of a circulating microRNA panel for the early detection of breast cancer.

    Zou, Ruiyang / Loke, Sau Yeen / Tang, Yew Chung / Too, Heng-Phon / Zhou, Lihan / Lee, Ann S G / Hartman, Mikael

    British journal of cancer

    2022  Volume 126, Issue 3, Page(s) 472–481

    Abstract: Background: Mammography is widely used for breast cancer screening but suffers from a high false-positive rate. Here, we perform the largest comprehensive, multi-center study to date involving diverse ethnic groups, for the identification of circulating ...

    Abstract Background: Mammography is widely used for breast cancer screening but suffers from a high false-positive rate. Here, we perform the largest comprehensive, multi-center study to date involving diverse ethnic groups, for the identification of circulating miRNAs for breast cancer screening.
    Methods: This study had a discovery phase (n = 289) and two validation phases (n = 374 and n = 379). Quantitative PCR profiling of 324 miRNAs was performed on serum samples from breast cancer (all stages) and healthy subjects to identify miRNA biomarkers. Two-fold cross-validation was used for building and optimising breast cancer-associated miRNA panels. An optimal panel was validated in cohorts with Caucasian and Asian samples. Diagnostic ability was evaluated using area under the curve (AUC) analysis.
    Results: The study identified and validated 30 miRNAs dysregulated in breast cancer. An optimised eight-miRNA panel showed consistent performance in all cohorts and was successfully validated with AUC, accuracy, sensitivity, and specificity of 0.915, 82.3%, 72.2% and 91.5%, respectively. The prediction model detected breast cancer in both Caucasian and Asian populations with AUCs ranging from 0.880 to 0.973, including pre-malignant lesions (stage 0; AUC of 0.831) and early-stage (stages I-II) cancers (AUC of 0.916).
    Conclusions: Our panel can potentially be used for breast cancer screening, in conjunction with mammography.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/genetics ; Breast Neoplasms/diagnosis ; Breast Neoplasms/genetics ; Case-Control Studies ; Circulating MicroRNA/genetics ; Early Detection of Cancer/methods ; Female ; Gene Expression Profiling ; Humans ; Middle Aged ; Neoplasm Staging ; ROC Curve
    Chemical Substances Biomarkers, Tumor ; Circulating MicroRNA
    Language English
    Publishing date 2022-01-10
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Validation Study
    ZDB-ID 80075-2
    ISSN 1532-1827 ; 0007-0920
    ISSN (online) 1532-1827
    ISSN 0007-0920
    DOI 10.1038/s41416-021-01593-6
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    Uh III Zs.142: Show issues Location:
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  9. Article ; Online: Assertive community treatment for high-utilizing alcohol misuse patients: a before-and-after cohort study protocol.

    Wu, Juntian / Siddiqui, Fahad Javaid / Mak, Charles Chia Meng / Chua, Ivan Si Yong / Thangayah, Jeevan Raaj / Tan, Esther Xi Xiang / Seet, Huey Ying / Rao, Adriel Kailing / Tan, Hann Yee / Mohamed, Asif / Hartman, Mikael / Leong, Benjamin Sieu-Hon / Ong, Marcus Eng Hock / Mao, Desmond Renhao

    BMC health services research

    2024  Volume 24, Issue 1, Page(s) 256

    Abstract: Background: The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to ... ...

    Abstract Background: The challenge posed by Alcohol-Related Frequent Attenders (ARFAs) in Emergency Departments (EDs) is growing in Singapore, marked by limited engagement with conventional addiction treatment pathways. Recognizing this gap, this study aims to explore the potential benefits of Assertive Community Treatment (ACT) - an innovative, community-centered, harm-reduction strategy-in mitigating the frequency of ED visits, curbing Emergency Medical Services (EMS) calls, and uplifting health outcomes across a quartet of Singaporean healthcare institutions.
    Methods: Employing a prospective before-and-after cohort design, this investigation targeted ARFAs aged 21 years and above, fluent in English or Mandarin. Eligibility was determined by a history of at least five ED visits in the preceding year, with no fewer than two due to alcohol-related issues. The study contrasted health outcomes of patients integrated into the ACT care model versus their experiences under the exclusive provision of standard emergency care across Hospitals A, B, C and D. Following participants for half a year post-initial assessment, the evaluation metrics encompassed socio-demographic factors, ED, and EMS engagement frequencies, along with validated health assessment tools, namely Christo Inventory for Substance-misuse Services (CISS) scores, University of California, Los Angeles (UCLA) Loneliness scores, and Centre for Epidemiologic Studies Depression Scale Revised (CESD-R-10) scores.
    Discussion: Confronted with intricate socio-economic and medical challenges, the ARFA cohort often grapples with heightened vulnerabilities in relation to alcohol misuse. Pioneering the exploration of ACT's efficacy with ARFAs in a Singaporean context, our research is anchored in a patient-centered approach, designed to comprehensively address these multifaceted clinical profiles. While challenges, like potential high attrition rates and sporadic data collection, are anticipated, the model's prospective contribution towards enhancing patient well-being and driving healthcare efficiencies in Singapore is substantial. Our findings have the potential to reshape healthcare strategies and policy recommendations.
    Trial registration: ClinicalTrials.gov, NCT04447079. Initiated on 25 June 2020.
    MeSH term(s) Humans ; Alcoholism/therapy ; Cohort Studies ; Community Mental Health Services ; Prospective Studies ; Emergency Medical Services ; Emergency Service, Hospital ; Alcohol-Related Disorders
    Language English
    Publishing date 2024-02-28
    Publishing country England
    Document type Journal Article
    ZDB-ID 2050434-2
    ISSN 1472-6963 ; 1472-6963
    ISSN (online) 1472-6963
    ISSN 1472-6963
    DOI 10.1186/s12913-023-10516-5
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  10. Article: How Asian Breast Cancer Patients Experience Unequal Incidence of Chemotherapy Side Effects: A Look at Ethnic Disparities in Febrile Neutropenia Rates.

    Lim, Zi Lin / Ho, Peh Joo / Hartman, Mikael / Tan, Ern Yu / Riza, Nur Khaliesah Binte Mohamed / Lim, Elaine Hsuen / Nitar, Phyu / Joint Breast Cancer Registry Jbcr / Wong, Fuh Yong / Li, Jingmei

    Cancers

    2023  Volume 15, Issue 14

    Abstract: The majority of published findings on chemotherapy-induced febrile neutropenia (FN) are restricted to three ethnic groups: Asians, Caucasians, and African Americans. In this two-part study, we examined FN incidence and risk factors in Chinese, Malay, and ...

    Abstract The majority of published findings on chemotherapy-induced febrile neutropenia (FN) are restricted to three ethnic groups: Asians, Caucasians, and African Americans. In this two-part study, we examined FN incidence and risk factors in Chinese, Malay, and Indian chemotherapy-treated breast cancer (BC) patients. Hospital records or ICD codes were used to identify patients with FN. In both the Singapore Breast Cancer Cohort (SGBCC) and the Joint Breast Cancer Registry (JBCR), the time of the first FN from the start of chemotherapy was estimated using Cox regression. Multinomial regression was used to evaluate differences in various characteristics across ethnicities. FN was observed in 170 of 1014 patients in SGBCC. The Cox model showed that non-Chinese were at higher risk of developing FN (HR
    Language English
    Publishing date 2023-07-12
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527080-1
    ISSN 2072-6694
    ISSN 2072-6694
    DOI 10.3390/cancers15143590
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