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  1. Article ; Online: A cross-sectional study of symptoms and health-related quality of life in menopausal-aged women in China.

    Rautenberg, Tamlyn A / Ng, Shu Kay Angus / Downes, Martin

    BMC women's health

    2023  Volume 23, Issue 1, Page(s) 563

    Abstract: Objective: To measure symptoms and health-related quality of life in a cross-sectional cohort of menopausal-aged women in China.: Method: A cross-sectional survey was conducted in a general population cohort of 2,000 Chinese females over the age of ... ...

    Abstract Objective: To measure symptoms and health-related quality of life in a cross-sectional cohort of menopausal-aged women in China.
    Method: A cross-sectional survey was conducted in a general population cohort of 2,000 Chinese females over the age of 45 years. Patients completed the Chinese version of the EuroQol-5D five level (EQ5D5L) health-related quality of life instrument via Personal Digital Assistant. Raw scores were converted to utility tariffs using value sets for China. Statistical analysis included Pearson's chi-square test, z test for multiple comparisons with adjustment by the Bonferroni method, independent-sample t-test, ANOVA, and adjustment by the Tukey method for multiple comparison. Results were considered statistically significant when p < 0.05 and the study was reported according to the STROBE recommendations.
    Results: In a cohort of 2000 women, 732 (37%) were premenopausal, 798 (40%) were perimenopausal and 470 (23%) were postmenopausal. Perimenopausal women reported significantly more symptoms (91%) compared to premenopausal (77%) and postmenopausal (81%) women. Health-related quality of life was significantly lower in symptomatic perimenopausal women compared to premenopausal (0.919, p < 0.05) and postmenopausal (0.877, p < 0.05) women. Within each group there was a statistically significant difference between the health-related quality of life of women with symptoms compared to without symptoms.
    Conclusion: The perimenopausal phase of menopause is associated with significantly more symptoms and significantly lower HRQoL compared to premenopausal and postmenopausal phases.
    MeSH term(s) Humans ; Female ; Aged ; Middle Aged ; Male ; Cross-Sectional Studies ; Perimenopause ; Quality of Life ; Menopause ; Premenopause
    Language English
    Publishing date 2023-11-01
    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/s12905-023-02728-y
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  2. Article ; Online: Risk of extracolonic second primary cancers following a primary colorectal cancer: a systematic review and meta-analysis.

    Robertson, Dylan / Ng, Shu Kay / Baade, Peter D / Lam, Alfred K

    International journal of colorectal disease

    2022  Volume 37, Issue 3, Page(s) 541–551

    Abstract: Purpose: The purpose of the study is to assess the global risk of extracolonic secondary primary cancers (SPCs) in patients with colorectal cancer (CRC).: Methods: Studies of SPC in patients with CRC were included if they reported the standardised ... ...

    Abstract Purpose: The purpose of the study is to assess the global risk of extracolonic secondary primary cancers (SPCs) in patients with colorectal cancer (CRC).
    Methods: Studies of SPC in patients with CRC were included if they reported the standardised incidence ratio (SIR) for extracolonic SPCs in patients with CRC compared with the general population. Pooled summary estimates were calculated using a random-effects model.
    Results: A total of 7,716,750 patients with CRC from 13 retrospective cohort studies that reported extracolonic SPC incidence were included. The overall risk of several SPCs was significantly higher in patients with CRC compared with the general population, including cancers of the urinary bladder (pooled SIR 1.19, 95% confidence interval (CI) 1.06-1.33; p = 0.003), female genital tract (1.88, 1.07-3.31; p = 0.03), kidney (1.50, 1.19-1.89; p = 0.0007), thorax (lung, bronchus and mediastinum) (1.16, 1.01-1.32; p = 0.03), small intestine (4.26, 2.58-7.01; p < 0.0001), stomach (1.22, 1.07-1.39; p = 0.003), and thyroid (1.40, 1.28-1.53; p < 0.0001), as well as melanoma (1.28, 1.01-1.62; p = 0.04). There was also a decreased risk of developing cancer of the gall bladder (0.75, 0.60-0.94; p = 0.01).
    Conclusion: Patients with CRC had a significantly increased risk of extracolonic SPCs compared with the general population. These findings highlight the need to develop research strategies for the management of second primary cancer in patients with CRC.
    MeSH term(s) Colorectal Neoplasms/complications ; Colorectal Neoplasms/epidemiology ; Female ; Humans ; Incidence ; Melanoma/complications ; Neoplasms, Second Primary/epidemiology ; Neoplasms, Second Primary/etiology ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2022-02-12
    Publishing country Germany
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review
    ZDB-ID 84975-3
    ISSN 1432-1262 ; 0179-1958
    ISSN (online) 1432-1262
    ISSN 0179-1958
    DOI 10.1007/s00384-022-04105-x
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  3. Article ; Online: A bivariate joint frailty model with mixture framework for survival analysis of recurrent events with dependent censoring and cure fraction.

    Tawiah, Richard / McLachlan, Geoffrey J / Ng, Shu Kay

    Biometrics

    2020  Volume 76, Issue 3, Page(s) 753–766

    Abstract: In the study of multiple failure time data with recurrent clinical endpoints, the classical independent censoring assumption in survival analysis can be violated when the evolution of the recurrent events is correlated with a censoring mechanism such as ... ...

    Abstract In the study of multiple failure time data with recurrent clinical endpoints, the classical independent censoring assumption in survival analysis can be violated when the evolution of the recurrent events is correlated with a censoring mechanism such as death. Moreover, in some situations, a cure fraction appears in the data because a tangible proportion of the study population benefits from treatment and becomes recurrence free and insusceptible to death related to the disease. A bivariate joint frailty mixture cure model is proposed to allow for dependent censoring and cure fraction in recurrent event data. The latency part of the model consists of two intensity functions for the hazard rates of recurrent events and death, wherein a bivariate frailty is introduced by means of the generalized linear mixed model methodology to adjust for dependent censoring. The model allows covariates and frailties in both the incidence and the latency parts, and it further accounts for the possibility of cure after each recurrence. It includes the joint frailty model and other related models as special cases. An expectation-maximization (EM)-type algorithm is developed to provide residual maximum likelihood estimation of model parameters. Through simulation studies, the performance of the model is investigated under different magnitudes of dependent censoring and cure rate. The model is applied to data sets from two colorectal cancer studies to illustrate its practical value.
    MeSH term(s) Computer Simulation ; Frailty ; Humans ; Models, Statistical ; Recurrence ; Survival Analysis
    Language English
    Publishing date 2020-01-07
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 213543-7
    ISSN 1541-0420 ; 0099-4987 ; 0006-341X
    ISSN (online) 1541-0420
    ISSN 0099-4987 ; 0006-341X
    DOI 10.1111/biom.13202
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  4. Article ; Online: Trading Health for Wealth: The Effect of COVID-19 Response Stringency.

    Cross, Megan / Ng, Shu-Kay / Scuffham, Paul

    International journal of environmental research and public health

    2020  Volume 17, Issue 23

    Abstract: International governments' COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 ... ...

    Abstract International governments' COVID-19 responses must balance human and economic health. Beyond slowing viral transmission, strict lockdowns have severe economic consequences. This work investigated response stringency, quantified by the Oxford COVID-19 Government Response Tracker's Stringency Index, and examined how restrictive interventions affected infection rates and gross domestic product (GDP) in China and OECD countries. Accounting for response timing, China imposed the most stringent restrictions, while Sweden and Japan were the least stringent. Expected GDP declines range from -8% (Japan) to -15.4% (UK). While greater restrictions generally slowed viral transmission, they failed to reach statistical significance and reduced GDP (
    MeSH term(s) COVID-19/economics ; COVID-19/prevention & control ; China/epidemiology ; Health ; Humans ; Japan/epidemiology ; Pandemics ; Sweden/epidemiology
    Language English
    Publishing date 2020-11-24
    Publishing country Switzerland
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph17238725
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  5. Article ; Online: Joint frailty modeling of time-to-event data to elicit the evolution pathway of events: a generalized linear mixed model approach.

    Ng, Shu Kay / Tawiah, Richard / Mclachlan, Geoffrey J / Gopalan, Vinod

    Biostatistics (Oxford, England)

    2021  Volume 24, Issue 1, Page(s) 108–123

    Abstract: Multimorbidity constitutes a serious challenge on the healthcare systems in the world, due to its association with poorer health-related outcomes, more complex clinical management, increases in health service utilization and costs, but a decrease in ... ...

    Abstract Multimorbidity constitutes a serious challenge on the healthcare systems in the world, due to its association with poorer health-related outcomes, more complex clinical management, increases in health service utilization and costs, but a decrease in productivity. However, to date, most evidence on multimorbidity is derived from cross-sectional studies that have limited capacity to understand the pathway of multimorbid conditions. In this article, we present an innovative perspective on analyzing longitudinal data within a statistical framework of survival analysis of time-to-event recurrent data. The proposed methodology is based on a joint frailty modeling approach with multivariate random effects to account for the heterogeneous risk of failure and the presence of informative censoring due to a terminal event. We develop a generalized linear mixed model method for the efficient estimation of parameters. We demonstrate the capacity of our approach using a real cancer registry data set on the multimorbidity of melanoma patients and document the relative performance of the proposed joint frailty model to the natural competitor of a standard frailty model via extensive simulation studies. Our new approach is timely to advance evidence-based knowledge to address increasingly complex needs related to multimorbidity and develop interventions that are most effective and viable to better help a large number of individuals with multiple conditions.
    MeSH term(s) Humans ; Frailty ; Cross-Sectional Studies ; Survival Analysis ; Computer Simulation ; Linear Models
    Language English
    Publishing date 2021-11-08
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2031500-4
    ISSN 1468-4357 ; 1465-4644
    ISSN (online) 1468-4357
    ISSN 1465-4644
    DOI 10.1093/biostatistics/kxab037
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  6. Article ; Online: The determinants of growth failure in children under five in 25 low- and middle-income countries.

    Jiang, Stephen / Sung, Jerry / Sawhney, Rakshat / Cai, Jinxuan / Xu, Huaying / Ng, Shu Kay / Sun, Jing

    Journal of global health

    2023  Volume 13, Page(s) 4077

    Abstract: Background: Past studies have identified determinants of growth failure (GF) such as socio-economic, nutritional, parenting, and inequality factors. However, few studies investigate the numerous causes of GF across multiple countries. By analysing the ... ...

    Abstract Background: Past studies have identified determinants of growth failure (GF) such as socio-economic, nutritional, parenting, and inequality factors. However, few studies investigate the numerous causes of GF across multiple countries. By analysing the data of children under five in 25 low and middle-income countries, this study aims to examine the correlations of determinants with GF to identify the strongest modifiable risk factors.
    Methods: Cross-sectional study design was used, and data were collected across 25 LMICs by the United Nations Children's Fund in 2019. Regions and households were randomly selected in participating LMICs. The four outcome measures were stunting, wasting, underweight and low body mass index (BMI).
    Results: Multilevel analysis was performed to identify the impact of country, suburb, and household levels on the variance of outcome variables. GF measures were significantly correlated with low gross domestic product (GDP) per capita (odds ratio (OR) = 2.482), rural areas (OR = 1.223), lack of health insurance (OR = 1.474), low maternal education (OR = 2.260), lack of plain water (OR = 1.402), poor maternal physical caregiving ability (OR = 1.112), low carbohydrate consumption (OR = 1.470), and continued breastfeeding in children >12 months old (OR = 0.802).
    Conclusions: By identifying key GF risk factors, this study may provide valuable insights for policymaking and interventions. This may allow the prioritisation of resources within countries for preventative measures to be developed.
    MeSH term(s) Female ; Child ; Humans ; Infant ; Developing Countries ; Cross-Sectional Studies ; Breast Feeding ; Thinness ; Growth Disorders/epidemiology
    Language English
    Publishing date 2023-08-04
    Publishing country Scotland
    Document type Journal Article
    ZDB-ID 2741629-X
    ISSN 2047-2986 ; 2047-2986
    ISSN (online) 2047-2986
    ISSN 2047-2986
    DOI 10.7189/jogh.13.04077
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  7. Article ; Online: Are clinical outcomes associated with baseline sensory profiles in people with musculoskeletal shoulder pain? Protocol for a prospective longitudinal observational study.

    Hollis, Danielle / Mendis, M Dilani / Ng, Shu-Kay / Thomas, Michael / Marks, Darryn / Lewis, Jeremy / Hides, Julie / Bisset, Leanne

    Musculoskeletal care

    2023  Volume 21, Issue 3, Page(s) 895–907

    Abstract: Background: Musculoskeletal shoulder pain is a common problem and its symptoms often become persistent. The experience of pain is multidimensional, and therefore, a range of patient characteristics may influence treatment response. An altered sensory ... ...

    Abstract Background: Musculoskeletal shoulder pain is a common problem and its symptoms often become persistent. The experience of pain is multidimensional, and therefore, a range of patient characteristics may influence treatment response. An altered sensory processing has been associated with persistent musculoskeletal pain states and may contribute to outcomes in patients with musculoskeletal shoulder pain. The presence and potential impact of altered sensory processing in this patient cohort is not currently known. The aim of this prospective longitudinal cohort study is to investigate if baseline sensory characteristics are associated with clinical outcomes in patients presenting to a tertiary hospital with persistent musculoskeletal shoulder pain. If found, a relationship between sensory characteristics and outcome may lead to the creation of more effective treatment strategies and improvements in risk adjustment and prognosis.
    Methods: This is a single-centre prospective cohort study with 6-, 12- and 24-month follow-up. A total of 120 participants aged ≥18 years with persistent musculoskeletal shoulder pain (≥3 months) will be recruited from an Australian public tertiary hospital orthopaedic department. Baseline assessments, including quantitative sensory tests and a standardised physical examination, will be performed. In addition, information will be obtained from patient interviews, self-report questionnaires and medical records. Follow-up outcome measures will comprise information from the Shoulder Pain and Disability Index and a six-point Global Rating of Change scale.
    Analysis: Descriptive statistics will be used to report baseline characteristics and outcome measures over time. Change in outcome measures at the primary endpoint of six months from baseline will be calculated using paired t-tests. Associations between baseline characteristics and outcomes at a 6-month follow-up will be reported using multivariable linear and logistic regression models.
    Discussion: Understanding the relationship between sensory profile and the variable response to treatment in people with persistent musculoskeletal shoulder pain may enhance our understanding of the mechanisms contributing to the presentation. In addition, through better understanding of the contributing factors, the results of this study may contribute to the development of an individualised, patient-centred approach to treatment for people with this highly prevalent and debilitating condition.
    MeSH term(s) Humans ; Adolescent ; Adult ; Musculoskeletal Pain/therapy ; Shoulder Pain ; Prospective Studies ; Longitudinal Studies ; Pain Measurement ; Australia ; Observational Studies as Topic
    Language English
    Publishing date 2023-05-04
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2171452-6
    ISSN 1557-0681 ; 1478-2189
    ISSN (online) 1557-0681
    ISSN 1478-2189
    DOI 10.1002/msc.1770
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  8. Article ; Online: Ferroportin expression and regulation in human placenta/fetal membranes: Implications for ferroptosis and adverse pregnancy outcomes.

    Ng, Shu-Wing / Lee, Chungyan / Ng, Allen / Ng, Shu-Kay / Arcuri, Felice / House, Michael D / Norwitz, Errol R

    Reproductive biology

    2023  Volume 23, Issue 4, Page(s) 100816

    Abstract: Iron overload is associated with pregnancy complications. Ferroportin (FPN) is the only known iron exporter in mammalian cells. We hypothesize that FPN is functionally important in ferrotopsis, a process of iron-dependent non-apoptotic programmed cell ... ...

    Abstract Iron overload is associated with pregnancy complications. Ferroportin (FPN) is the only known iron exporter in mammalian cells. We hypothesize that FPN is functionally important in ferrotopsis, a process of iron-dependent non-apoptotic programmed cell death, and may have a critical role to play in pregnancy success. We investigated the expression of FPN in placenta/fetal membranes by immunohistochemistry in tissues collected from pregnancies with/without preeclampsia (PE) and spontaneous preterm birth (SPTB). FPN was highly expressed in both trophoblasts and decidual cells found in placenta/fetal membranes. Staining was significantly reduced in fetal membranes from SPTB versus healthy pregnancies (P = 0.046). FPN expression in immortalized human endometrial stromal cells (HESC) increased with in vitro decidualization induction using 1 μM of medroxyprogesterone acetate and 0.5 mM of dibutyryl-cAMP. In addition, both HESC cells and immortalized extravillous trophoblast SW71 cells with FPN knockdown showed significant sensitivity to ferroptosis inducer, erastin (P < 0.001 and P = 0.009, respectively). The survival of both HESC and SW71 cells was not negatively affected by iron supplementation with ferric ammonium citrate in the medium. However, SW71 cells were more sensitive than HESC cells to physiologic iron in the presence of a non-lethal dose of erastin (P < 0.001). Taken together, our data demonstrating increased sensitivity of FPN knockdown HESC and SW71 cells to erastin and increased sensitivity of trophoblasts to iron overload under ferroptotic stress support the hypothesis that FPN protects against ferroptosis during pregnancy.
    MeSH term(s) Infant, Newborn ; Pregnancy ; Female ; Animals ; Humans ; Pregnancy Outcome ; Ferroptosis ; Premature Birth/metabolism ; Placenta/metabolism ; Iron ; Iron Overload/metabolism ; Mammals/metabolism
    Chemical Substances metal transporting protein 1 ; Iron (E1UOL152H7)
    Language English
    Publishing date 2023-10-25
    Publishing country Poland
    Document type Journal Article
    ZDB-ID 2189316-0
    ISSN 2300-732X ; 1642-431X
    ISSN (online) 2300-732X
    ISSN 1642-431X
    DOI 10.1016/j.repbio.2023.100816
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  9. Article ; Online: Identifying compliant participants through data matching improved estimation of intervention efficacy: randomized trials with opt-in/opt-out strategies.

    Ng, Shu Kay / Byrnes, Joshua / Scuffham, Paul

    Journal of clinical epidemiology

    2019  Volume 115, Page(s) 125–132

    Abstract: Objectives: We propose a data-matching approach to estimate intervention efficacy for randomized controlled trials (RCTs) when there is noncompliance to the allocated treatment with induced selection bias.: Study design and setting: We considered a ... ...

    Abstract Objectives: We propose a data-matching approach to estimate intervention efficacy for randomized controlled trials (RCTs) when there is noncompliance to the allocated treatment with induced selection bias.
    Study design and setting: We considered a large RCT to compare health care costs and hospital length of stay 12 months after randomization. Participants allocated to the intervention group were eligible to receive health-coaching and disease-management services. An opt-out approach was adopted for recruitment. Control-group participants received usual care but were allowed to opt-in to receive the intervention. Using "nearest-neighbor"-matched data, we identified compliant participants in both arms to estimate intervention efficacy. Results were compared with intention-to-treat (ITT), instrumental-variable-adjusted ITT, per-protocol (PP), and as-treated (AT) analyses.
    Results: The ITT estimated an intervention effect of a 1.5% reduction in cost, but 56.7% of intervention-group participants did not receive health coaching. The PP and AT found an increase in cost of 9.4% and 17.1%, respectively. The matching method estimated a 12.3% reduction in cost. After adjustment for baseline covariates, the intervention group had lower same-day admission cost (13.6%; 95% CI: 7.3%-20.0%; P < 0.001) and shorter hospital stay (11.2%; 95% CI: 2.6%-19.9%; P = 0.021).
    Conclusion: Opt-in/opt-out strategies in RCTs misled intervention comparisons and the matching approach improved estimation of intervention efficacy.
    MeSH term(s) Disease Management ; Female ; Health Care Costs ; Humans ; Intention to Treat Analysis ; Length of Stay ; Male ; Patient Compliance/statistics & numerical data ; Patient Selection ; Research Design ; Selection Bias
    Language English
    Publishing date 2019-07-24
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 639306-8
    ISSN 1878-5921 ; 0895-4356
    ISSN (online) 1878-5921
    ISSN 0895-4356
    DOI 10.1016/j.jclinepi.2019.07.013
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  10. Article ; Online: Mixture cure models with time-varying and multilevel frailties for recurrent event data.

    Tawiah, Richard / McLachlan, Geoffrey J / Ng, Shu Kay

    Statistical methods in medical research

    2019  Volume 29, Issue 5, Page(s) 1368–1385

    Abstract: Many medical studies yield data on recurrent clinical events from populations which consist of a proportion of cured patients in the presence of those who experience the event at several times (uncured). A frailty mixture cure model has recently been ... ...

    Abstract Many medical studies yield data on recurrent clinical events from populations which consist of a proportion of cured patients in the presence of those who experience the event at several times (uncured). A frailty mixture cure model has recently been postulated for such data, with an assumption that the random subject effect (frailty) of each uncured patient is constant across successive gap times between recurrent events. We propose two new models in a more general setting, assuming a multivariate time-varying frailty with an AR(1) correlation structure for each uncured patient and addressing multilevel recurrent event data originated from multi-institutional (multi-centre) clinical trials, using extra random effect terms to adjust for institution effect and treatment-by-institution interaction. To solve the difficulties in parameter estimation due to these highly complex correlation structures, we develop an efficient estimation procedure via an EM-type algorithm based on residual maximum likelihood (REML) through the generalised linear mixed model (GLMM) methodology. Simulation studies are presented to assess the performances of the models. Data sets from a colorectal cancer study and rhDNase multi-institutional clinical trial were analyzed to exemplify the proposed models. The results demonstrate a large positive AR(1) correlation among frailties across successive gap times, indicating a constant frailty may not be realistic in some situations. Comparisons of findings with existing frailty models are discussed.
    MeSH term(s) Humans ; Models, Statistical ; Survival Analysis ; Frailty ; Computer Simulation ; Linear Models
    Language English
    Publishing date 2019-07-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1136948-6
    ISSN 1477-0334 ; 0962-2802
    ISSN (online) 1477-0334
    ISSN 0962-2802
    DOI 10.1177/0962280219859377
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