Assessment of needs, challenges, and re-design considerations for culturally sensitive provision and delivery of palliative care supports and services for older adults who prefer to age and die in place in diverse India.

As the global older adult population continues to grow, challenges related to managing multiple chronic conditions (MCCs) or multimorbidity underscore the growing need for palliative care. Palliative care preferences and needs vary significantly based on context, location, and culture. As a result, there is a need for more clarity on what constitutes palliative care in diverse settings. Our objective was to present an international perspective on palliative care in India, a culturally diverse and large ancient Eastern middle-income country. In this narrative review article, we considered three questions when re-designing palliative care for older adults aging-in-place in India: (I) what are the needs for palliative care for persons and their families? (II) Which palliative care domains are essential in assessing improvements in the quality of life (QoL)? (III) What patientreported measures are essential considerations for palliative care? To address these questions, we provide recommendations based on the following key domains: social, behavioral, psychological, cultural, spiritual, medical, bereavement, legal, and economic. Using an established and widely reported conceptual framework on aging and health disparities, we provide how these domains map across multiple levels of influence, such as individual or family members, community, institutions, and health systems for achieving the desired QoL. For greater adoption, reach, and accessibility across diverse India, we conclude palliative care must be carefully and systematically re-designed to be culturally appropriate and community-focused, incorporating traditions, individual preferences, language(s), supports and services from educational and health institutions, community organizations and the government. In addition, national government insurance schemes such as the Ayushman Bharat Yojna can include explicit provisions for palliative care so that it is affordable to all, regardless of ability to pay. In summary, our considerations for incorporating palliative care domains to care of whole person and their families, and provision of supports of services from an array of stakeholders broadly apply to culturally diverse older adults aging in place in India and around the globe who prefer to age and die in place.

Evolution of rehabilitation services in response to a global pandemic: reflection on opportunities and challenges ahead.

The rapidly evolving COVID-19 public health emergency has disrupted and challenged traditional healthcare, rehabilitation services, and treatment delivery worldwide. This perspective paper aimed to unite experiences and perspectives from an international group of rehabilitation providers while reflecting on the lessons learned from the challenges and opportunities raised during the COVID-19 pandemic. We discuss the global appreciation for rehabilitation services and changes in access to healthcare, including virtual, home-based rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by highlighting successful rehabilitation approaches from the US, Belgium, and Japan.

Advancing Academic Capacity in Physical and Rehabilitation Medicine to Strengthen Rehabilitation in Health Systems Worldwide: A Joint Effort by the European Academy of Rehabilitation Medicine, the Association of Academic Physiatrists, and the International Society of Physical and Rehabilitation Medicine.

Not available.

Cranial neural tube defect after trimethoprim exposure.

OBJECTIVES: The Neural Tube Defects Research Group of University of Malaya was approached to analyze a tablet named TELSE, which may have resulted in a baby born with central nervous system malformation at the University of Malaya Medical Centre. In this animal experimental study, we investigated the content of TELSE and exposure of its contents that resulted in failure of primary neurulation. RESULTS: Liquid Chromatography Tandem Mass spectrophotometry analysis of the TELSE tablet confirmed the presence of trimethoprim as the active compound. The TELSE tablet-treated females produced significant numbers of embryos with exencephaly (n = 8, 36.4%, *P < 0.0001), in all litters. The TELSE tablet-treated females subsequently given folic acid did not result in pregnancies despite there being evidence of possible resorption. Furthermore, after multiple rounds of mating which did not yield viable pregnancies, eventually, 2 embryos with exencephaly were harvested in a litter of 6 at 0.05% w/v pure trimethoprim once. The use of trimethoprim, a folic acid antagonist, peri-conceptionally increased the risk of exencephaly in the mouse.

The Prevalence and Distribution of Spina Bifida in a Single Major Referral Center in Malaysia.

BACKGROUND: The aim of this study is to review the medical history of patients with spina bifida, encompassing both aperta and occulta types born between the years 2003 until 2016, spanning a 13-year time period. We assessed each patient and maternal parent information, details of the defects, and conditions associated with the primary defect. We also include information on patients' ambulation and education level (where available). METHODS: Data from the Department of Patient Information University of Malaya Medical Centre (UMMC), Malaysia was captured from spina bifida patients (ICD10: Q05 spina bifida). Data involved patients referred to UMMC between 2003 and 2016 and/or born in UMMC within that particular time frame. We filtered and extracted the information according to the data of clinical examination, medical review, and social history provided in the medical records. RESULTS: A total of 86 patient records with spina bifida were analyzed. Spina bifida prevalence rate in this study ranged from 1.87 to 8.9 per 1,000 live births depending on weightage. We note that ethnicity was a factor whereby the highest numbers of spina bifida were from Malays (n = 36, 41.86%), followed by equal numbers of Chinese and Indians (n = 24, 27.91%). The highest number of diagnoses reported was myelomeningocele type-spina bifida (n = 39, 45.35%). The most common site of the spina bifida lesion was located at the lumbar region irrespective of aperta or occulta types (n = 23, 26.74%). Data on other associated phenotypes of spina bifida such as hydrocephalus and encephalocele was also captured at 37.21% (n = 32) and 1.16% (n = 1), respectively. In terms of mobility, 32.84% (n = 22/67) of patients between the ages 4 and 16 years old were found to be mobile. As many as 36.07% of patients ranging from 5 to 16 years of age (n = 22/61) received formal education ranging from preschool to secondary school. CONCLUSION: The prevalence of spina bifida in UMMC is as according to international statistics which is in the range of 0.5-10 per 1,000 live births. Majority of the reported cases were males, Malays, full term babies, and of the myelomeningocele phenotype located at the lumbar region.

Evaluation of the topic lists used in two world Congresses (2015 and 2016) in Physical and Rehabilitation Medicine.

BACKGROUND: Evaluation of the initial list of proposed abstract topics for Congresses of Physical and Rehabilitation Medicine (PRM) was needed in order to ensure its feasibility for use in future congress announcements and invitations for abstract submission. METHODS: The initial proposals were based on 5 main areas of PRM research: biosciences in rehabilitation, biomedical rehabilitation sciences and engineering, clinical PRM sciences, integrative rehabilitation sciences, and human functioning sciences. This list became a model for structuring the abstracts for the 9th and 10th World Congresses of PRM, held in Berlin, Germany (2015) and Kuala Lumpur, Malaysia (2016), respectively. The next step was to evaluate the implementation of this model in both congresses. RESULTS: It was found that the 5 main research areas were still used as the main principles (chapters) in which to organize the abstracts. However, some modifications have been made to cover topics that were not included in the initial proposal. CONCLUSION: A more comprehensive list of topics has been developed, not only for topic list announcements, but also for the structuring and classification of abstracts for future international, regional or national PRM congresses.

Effects of chemical interesterification on the physicochemical, microstructural and thermal properties of palm stearin, palm kernel oil and soybean oil blends.

Blends of palm stearin (PS), palm kernel oil (PKO) and soybean oil (SBO) at certain proportions were formulated using a mixture design based on simplex-lattice (Design Expert 8.0.4 Stat-Ease Inc., Minneapolis, 2010). All the 10 oil blends were subjected to chemical interesterification (CIE) using sodium methoxide as the catalyst. The solid fat content (SFC), triacylglycerol (TAG) composition, thermal properties (DSC), polymorphism and microstructural properties were studied. Palm-based trans-free table margarine containing ternary mixture of PS/PKO/SBO [49/20/31 (w/w)], was optimally formulated through analysis of multiple isosolid diagrams and was found to have quite similar SMP and SFC profile as compared to the commercial table margarine. This study has shown chemical interesterification are effective in modifying the physicochemical properties of palm stearin, palm kernel oil, soybean oil and their mixtures.

Validation of the comprehensive ICF core sets for diabetes mellitus:a Malaysian perspective.

INTRODUCTION: Diabetes mellitus (DM) is a chronic disease that is prevalent in many countries. The prevalence of DM is on the rise, and its complications pose a heavy burden on the healthcare systems and on the patients' quality of life worldwide. MATERIALS AND METHODS: This is a multicentre, cross-sectional study involving 5 Health Clinics conducted by Family Medicine Specialists in Malaysia. Convenience sampling of 100 respondents with DM were selected. The International Classifi cation of Functioning, Disability and Health (ICF) based measures were collected using the Comprehensive Core Set for DM. SF-36 and self-administered forms and comorbidity questionnaire (SCQ) were also used. RESULTS: Ninety-seven percent had Type 2 DM and 3% had Type 1 DM. The mean period of having DM was 6 years. Body functions related to physical health including exercise tolerance (b455), general physical endurance (b4550), aerobic capacity (b4551) and fatiguability (b4552) were the most affected. For body structures, the structure of pancreas (s550) was the most affected. In the ICF component of activities and participation, limitation in sports (d9201) was the highest most affected followed by driving (d475), intimate relationships (d770), handling stress and other psychological demands (d240) and moving around (d455). Only 7% (e355 and e450) in the environmental category were documented as being a relevant factor by more than 90% of the patients. CONCLUSION: The content validity of the comprehensive ICF Core set DM for Malaysian population were identified and the results show that physical and mental functioning were impaired in contrast to what the respondents perceived as leading healthy lifestyles.

Prevalence and impact of physical disability on Malaysian school-aged children: a population-based survey.

PURPOSE: To determine the magnitude and impact of physical disability on Malaysian school-aged children between 7 and less than 18 years old. METHOD: Cross-sectional population-based household interview with two-stage stratified sampling design. SETTING: The Malaysian Third National Health of Morbidity Survey, 2006. RESULTS: Overall prevalence of physical disability was 2.8 per 1000 population among children aged between 7 and less than 18 years old. The commonest cause was congenital, in 61.5% of the affected children. Slightly more than a third of these children with physical disability were partially or totally dependent on their caregivers in the various areas of self care (37.4%) and mobility (34.9%). We also found that the more severe the physical disability, the more adverse impact it had on the functional independence and community participation of these children. Among these children, almost 40% of them had no verbal communication, 31.5% had not attended formal education and 21% were housebound. CONCLUSION: This population-based survey on physical disability among school-aged children highlighted the key areas where physical disability can greatly impact on the child's function. It has identified the areas of needs that require multisectoral involvement and commitment from the government, non-government and private agencies.

Impact, distress and HRQoL among Malaysian men and women with a mobility impairment.

BACKGROUND: Although non-communicable and chronic disease now accounts for 47% of the global burden of disease, little is known of the everyday experiences and social aspects of disability and disablement in middle and low income countries. This article aims to address this gap by exploring the subjective experience of mobility impairment in Malaysia. Specifically, it examines health-related quality of life and the impact and distress related to impaired mobility, and investigates any gender differences in relation to the experience of disability. METHODS: The data were collected as part of an interdisciplinary, multi-country study known as RESILIENCE (Research into Social Inclusion, Locomotive Impairment and Empowerment through Networking, Collaboration and Education). Cluster sampling was used to administer the EQ-5D and the Perceived Impact of Problems Profile (PIPP) to 210 adults from Selangor state, west coast Peninsular Malaysia. RESULTS: The participants consisted of 94 males and 116 females, aged between 18-90 years (mean 60 years), with the majority being Malay. The majority of participants were also married, from rural areas and had primary education only. Very few participants lived alone. In addition, males were more likely to attribute their impaired mobility to an accident. The majority of participants with mobility impairment experienced a moderate to high level of pain/discomfort (79%) and anxiety/depression (72%), and at least some problems with performing usual activities (71%), as measured by the EQ-5D. In addition, using the Perceived Impact of Problems Profile (PIPP), participants also reported high levels of impact and distress related to participation in community life. In general, males reported higher impact and distress across several items, most significantly in regard to participation in community activities, moving around the neighbourhood, ability to live independently, and ability to assist their family members. CONCLUSION: This paper provides preliminary data regarding the health-related quality of life among Malaysians with impaired mobility, and highlights the multifaceted impact of disability and the importance of acknowledging the diverse cultural contexts in which disability can occur. It also raises questions regarding gender differences in the subjective experience of disability in Malaysia.

Median and Ulnar 14-cm Antidromic Sensory Studies to the Third and Fifth Digits-A Comparison of Amplitude.

There are multiple reports of peripheral nerve injury following the implantation or removal of surgical hardware. Electrodiagnostic testing can be useful in assessing the chronicity, severity, and recovery of such a nerve injury. The purpose of this study is to establish a normative data set to allow for comparison of median and ulnar antidromic sensory peak-to-peak amplitude values. Median and ulnar antidromic sensory studies to digits 3 and 5 are commonly performed in electrodiagnosis to aid in the diagnosis of a variety of clinical conditions. Numerous studies have examined normal latency and amplitude values for these studies. To our knowledge there has been one other study that compared the relationship between median and ulnar sensory amplitude results taken from the same limb. That study had limited generalizability to the population at large. One hundred-nineteen volunteers were tested with antidromic sensory technique to digits 3 and 5 at 14-cm stimulation distance. Peak latency and peak-to-peak amplitude were recorded. Possible relationships between age, gender, height, weight, BMI, and median and ulnar amplitude were examined through simple linear regressions. Age, weight, height, and BMI were all found to negatively correlate with both median and ulnar amplitude. Female subjects were found to have statistically greater median and ulnar amplitudes than male subjects. Factors were said to be statistically significant at the P

Identifying the concepts contained in outcome measures of clinical trials on stroke using the International Classification of Functioning, Disability and Health as a reference.

OBJECTIVES: To systematically identify and quantify the concepts contained in outcome measures in stroke trials using the International Classification of Functioning, Disability and Health (ICF) as a reference. METHODS: Randomized controlled trials between 1992 and 2001 were located in MEDLINE and selected according to predefined criteria. Outcome measures were extracted and concepts contained in the outcome measures were linked to the ICF. RESULTS: A random sample of 160 (50%) of 320 eligible studies was included. A total of 148 standardized health status measures were identified. Of 11,283 extracted concepts, 91% could be linked to the ICF. The most used ICF categories for each component were d450 walking (70%) for activities and participation, b525 defecation functions (62%) for body functions, and e399 support and relationships, unspecified (30%) for environmental factors. CONCLUSION: The ICF provides a useful reference to identify and quantify the concepts contained in outcome measures used in stroke trials. Outcome measurement in stroke refers to an enormous variety of concepts; for comparability of research findings agreement on what should be measured is needed.

ICF Core Sets for diabetes mellitus.

OBJECTIVE: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for diabetes mellitus. METHODS: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS: The preliminary studies identified a set of 253 ICF categories at the second, third, and fourth ICF levels with 99 categories on body functions, 40 on body structures, 55 on activities and participation, and 59 on environmental factors. Fifteen experts attended the consensus conference on diabetes mellitus (8 physicians with various sub-specializations; 5 physical therapists, one epidemiologist and one social worker). Altogether 99 categories (85 second-level and 14 third-level categories) were included in the Comprehensive ICF Core Set with 36 categories from the component body functions, 16 from body structures, 18 from activities and participation, and 29 from environmental factors. The Brief ICF Core Set included a total of 33 second-level categories with 12 on body functions, 6 on body structures, 5 on activities and participation, and 10 on environmental factors. CONCLUSION: A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for diabetes mellitus. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

ICF Core Sets for stroke.

OBJECTIVE: To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of the Comprehensive ICF Core Set and the Brief ICF Core Set for stroke. METHODS: A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review, and an empirical data collection. After training in the ICF and based on these preliminary studies relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS: The preliminary studies identified a set of 448 ICF categories at the second, third and fourth ICF levels with 193 categories on body functions, 26 on body structures, 165 on activities and participation, and 64 on environmental factors. Thirty-nine experts from 12 different countries attended the consensus conference on stroke. Altogether 130 second-level categories were included in the Comprehensive ICF Core Set with 41 categories from the component body functions, 5 from body structures, 51 from activities and participation, and 33 from environmental factors. The Brief ICF Core Set included a total of 18 second-level categories (6 on body functions, 2 on body structures, 7 on activities and participation, and 3 on environmental factors). CONCLUSION: A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for stroke. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.