Neutrophil-to-Lymphocyte Ratio Predicts Development of Immune-Related Adverse Events and Outcomes from Immune Checkpoint Blockade: A Case-Control Study.

The utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) utility in predicting immune-related adverse events (irAEs) and survival have not been well studied in the context of treatment with immune checkpoint inhibitors (ICIs). We performed a case-control study of cancer patients who received at least one dose of ICI in a tertiary hospital. We examined NLR and PLR in irAE cases and controls. Logistic and Cox regression models were used to identify independent risk factors for irAEs, progression-free survival (PFS), and overall survival (OS). The study included 91 patients with irAEs and 56 controls. Multiple logistic regression showed that NLR < 3 at baseline was associated with higher occurrence of irAEs. Multivariate Cox regression showed that development of irAEs and reduction in NLR from baseline to week 6 were associated with longer PFS. Higher NLR values at baseline and/or week 6 were independently associated with shorter OS. A reduction in NLR from baseline to week 6 was associated with longer OS. In this study of cancer patients treated with ICIs, NLR has a bidirectional relationship with adverse outcomes. Lower NLR was associated with increased occurrence of irAEs while higher NLR values were associated with worse clinical outcomes.

Trends in health screening participation and lifestyle behaviours after participation in a free, access-enhanced screening intervention in a low-income Singaporean rental-flat community.

Our objective was to evaluate the impact of an access-enhanced health screening intervention on screening adherence in a rental-flat community. In Singapore, public rental flats provide heavily subsidised rentals for the needy who cannot afford to own their own homes; with a majority of Singaporeans (≥85%) staying in owner-occupied public housing. We observed trends in health screening adherence and health behaviours among residents of a multi-ethnic public rental-flat community in Singapore from 2013 to 2017, after participation in a free, access-enhanced multi-modality screening programme in 2011. Residents staying in neighbouring owner-occupied housing who participated in the same screening programme served as a basis of comparison. A total of 478 rental-flat residents and 505 owner-occupied flat residents participated. In the rental-flat community, hypertension screening rates improved from 18.3% (24/131) in 2013, to 61.2% (52/85) in 2015 and 44.2% (34/77) in 2017 (p < .001). For diabetes, rates improved from 26.2% (43/164) → 47.0% (54/115) → 49.5% (45/91; p < .001). For dyslipidaemia screening, rates improved from 18.2% (31/170) → 39.6% (38/96) → 47.5% (38/80; p < .001). In the owner-occupied community (n = 505), screening rates largely remained stagnant (hypertension: 52.2% → 75.0% → 54.5%, p = .059; diabetes: 66.0% → 56.5% → 66.7%, p = .434; dyslipidaemia: 53.1% → 50.0% → 57.1%, p = .818). In the rental-flat community, unhealthy behaviours increased from 2013 to 2017, with higher proportions of overweight (30.4% → 24.8% → 52.1%, p < .001), higher smoking (11.7% → 36.9% → 32.5%, p < .001) and higher drinking rates (1.4% → 0.7% → 8.1%, p < .001). This shift was also reflected in the owner-occupied community, with higher percentages of overweight and higher drinking rates (p < .001).

Perceived Neighborhood Environment and Its Association with Health Screening and Exercise Participation amongst Low-Income Public Rental Flat Residents in Singapore.

Background: In Singapore, an Asian city-state, more than 80% live in public housing. While the majority (90%) own their homes, a needy minority lives in rental flats. Public rental flats are built in the same location as owner-occupied blocks. We evaluated factors associated with perceptions of the neighborhood environment and its association with exercise and health screening participation. Methods: Logistic regression was used to identify associations between perceptions of the neighborhood environment (overall perceived neighborhood disadvantage, safety, and convenience) and sociodemographic factors, as well as exercise and screening participation, amongst residents aged ≥60 years in two Singaporean public housing precincts in 2016. Results: Our response rate was 62.1% (528/800). Staying in a rental flat independently was associated with increased neighborhood disadvantage (adjusted odds ratio, aOR = 1.58, 95%CI = 1.06⁻2.35). Staying in a stand-alone block (as opposed to staying in a mixed block comprised of both rental and owner-occupied units) was associated with perceptions of a poorer physical environment (aOR = 1.81, 95%CI = 1.22⁻2.68) and lower perceived proximity to recreational areas (aOR = 1.14, 95%CI = 1.04⁻1.25). Perceptions of neighborhood disadvantage were independently associated with reduced exercise participation (aOR = 0.67, 95%CI = 0.45⁻0.98) and reduced participation in diabetes screening (aOR = 0.63, 95%CI = 0.41⁻0.95). Conclusion: Despite sharing the same built environment, differences in the perception of the neighborhood environment between low-socioeconomic status (SES) and high-SES communities persist. Perceived neighborhood disadvantage is associated with lower participation in regular exercise and diabetes screening.

Loneliness amongst Low-Socioeconomic Status Elderly Singaporeans and its Association with Perceptions of the Neighbourhood Environment.

In Singapore, a densely urbanised Asian city state, more than 80% of the population stays in public housing estates and the majority (90%) own their own homes. For the needy who cannot afford home ownership, public rental flats are available. We were interested in exploring social-environmental factors that are associated with loneliness among elderly residents of public rental housing in Singapore. We surveyed residents aged ≥60 in two Singapore public housing precincts in 2016. Loneliness was measured using a three-item scale. Sociodemographic information was obtained via standardised questionnaires. We used chi-square to identify associations between loneliness and sociodemographic characteristics, as well as neighbourhood perceptions (safety, convenience and the physical environment), on univariate analysis; and logistic regression for multivariate analysis. The response rate was 62.1% (528/800). On multivariate analysis, staying in a rental flat block was independently associated with loneliness (adjusted odds ratio, aOR = 2.10, 95% confidence interval (CI) = 1.32⁻3.36), as was staying in a poorer physical environment (aOR = 1.92, 95% CI = 1.15⁻3.22). Although needy Singapore residents share the same built environment as more well-to-do neighbours, differences in the impact of loneliness do exist.

Weight management during pregnancy: a qualitative thematic analysis on knowledge, perceptions and experiences of overweight and obese women in Singapore.

BACKGROUND: The effect of maternal weight on pregnancy and birth outcomes is of great public health concern. For example, overweight and obesity among pregnant women is associated with adverse reproductive health outcomes including gestational diabetes, birth defects, macrosomia and infant mortality. OBJECTIVES: To understand the knowledge, perceptions and experiences during pregnancy among overweight and obese women in Singapore. METHODS: This is a cross-sectional study which employed qualitative techniques. The inclusion criteria is as follows: (1) Women who were overweight or obese before or during first trimester of pregnancy, (2) are able to report their specific pre-pregnancy or first trimester Body Mass Index (BMI), or weight and height, (3) had singleton pregnancy when overweight, are post-delivery for the pregnancy in which they were overweight, and (4) are 21 to 55 years old. Fifteen interviews were voice-recorded and transcribed verbatim. Then, two researchers independently performed the thematic analysis of the transcripts. RESULTS: The findings revealed that women had gaps in knowledge on the adverse effects of maternal overweight and obesity during pregnancy, and various misconceptions on diet and weight management during pregnancy were prevalent. Conflicting data was obtained for perceptions on the importance, difficulty and levels of motivation for weight management during pregnancy. CONCLUSION: There is a pressing need to address knowledge gaps and misconceptions of pregnant women who are overweight or obese. The importance of weight management during pregnancy should be emphasized, and enabling factors put in place.