Medical conditions and driving fitness of older Singaporean taxi drivers.

BACKGROUND: Taxi driving has been associated with the risk of various diseases (e.g. cardiovascular disease, hypertension, diabetes, hyperlipaemia, back pain). Little is known about the relationship between health conditions and driving fitness of older taxi drivers who continue to work. AIMS: To investigate the (i) prevalence of medical conditions and (ii) relationship between age and medical conditions, with on-road driving tests in the relicensing process of older taxi drivers aged ≥70 years, prior to the mandatory retirement age of 75 years. METHODS: We analysed retrospectively all relicensing records (N = 855) of taxi drivers aged 70, 73 and 74 years that were submitted from April 2014 to April 2015. RESULTS: All passed their medical fitness screening. Ninety-eight per cent passed their driving tests. Thirty-one per cent, 36% and 24% reported none, one and two medical conditions, respectively. These included hypertension (56%), eye disease (25%; cataracts 19%), diabetes (24%), corrected hearing impairment (14%), hyperlipaemia (12%) and heart disease (9%). Deafness (P < 0.001) was associated with older age. No past medical condition affected driving outcome. CONCLUSION: Older Singaporean taxi drivers were healthy and generally competent drivers. Early effective preventive health screening and modifiable lifestyle intervention are recommended in older taxi drivers.

Return to car driving is safe 6 weeks after operative treatment of right ankle fractures.

BACKGROUND: There is no clear consensus on when patients with surgically treated right ankle fractures can return to car driving, or how best to assess their fitness to drive. Through a rigorous driving assessment program consisting of both off-road and on-road tests, we aim to determine if these patients are able to pass a standard driving test, even before weight bearing has been initiated. METHODS: A prospective grant-funded (Supported by AOTrauma Asia Pacific Ref: AOTAP12-17) clinical study was conducted. Patients aged 25-65 years who underwent surgery for right ankle fractures and held a valid motorcar driving license were recruited in a single institution from 2013 to 2015. The surgeon and a specialist occupational therapist assessed the patients at 2, 6 and 12 weeks post-surgery. A Short Musculoskeletal Functional Assessment (SMFA) Questionnaire was administered and the brake reaction time was measured using a driving simulator. Patients who met the minimal criteria were then subjected to a full on-road driving test in a real-world environment with a driving instructor. A follow-up telephone questionnaire was administered at least 6 months after return to driving to determine if patients had returned to driving safely. RESULTS: A total of 23 patients (8 females, 15 males) were recruited. The mean age was 42.8 (± 12.9) years. There was a significant improvement in the SMFA (p < 0.05) and braking time (p < 0.05) at 6 and 12 weeks post-surgery. Nearly all (91%) patients passed the on-road driving test at 6 weeks, before their fractures had healed or weight bearing was initiated. The questionnaire administered at least 6 months after return to driving revealed that all patients had returned to regular driving safely. CONCLUSION: We conclude that patients with isolated, surgically treated right ankle fractures can successfully pass a standard driving test at 6 weeks post-surgery, even before weight bearing has been initiated. We also showed that the ability to drive correlates with improvements in the SMFA scores and braking times. LEVEL OF EVIDENCE: II.

First pregnancy and live birth resulting from cryopreserved embryos obtained from in vitro matured oocytes after oophorectomy in an ovarian cancer patient.

In vitro maturation (IVM) of immature oocytes retrieved from surgically resected ovaries has been proposed as a method of fertility preservation in ovarian cancer patients undergoing definitive surgery. While there had been several reports of successful derivation of mature oocytes and or embryos, there have been no reports as yet of successful pregnancies. In this case report, we present a pregnancy and live birth from a young patient, with stage IIIC ovarian cancer, who had undergone fertility sparing surgery. The immature oocytes recovered after oophorectomy were fertilized after IVM. The embryos obtained were cryopreserved and later transferred to achieve a singleton healthy pregnancy leading to a live birth.

Survey of health and licensing policies for taxi drivers in Singapore, Hong Kong and Australia: a perspective from evidence on older drivers.

INTRODUCTION: With an ageing population, policy makers need to balance active ageing needs with older driver safety. In 2009, a survey of licensing policies for taxi drivers in Singapore, Hong Kong and Australia was undertaken for an evidence-based review of policies. METHODS: Licensing requirements collected using semi-structured questionnaires were compared descriptively and with evidence from licensing policies on older drivers. RESULTS: All the regions used medical certifications with vision screening. The frequency of medical certification varied according to the renewal cycle and age. Medical guidelines on fitness to drive were available in Australia and Singapore. Legislation for self-reporting of medical conditions by drivers existed in Australia and Hong Kong. Legislation for reporting at-risk drivers by doctors was limited to two Australian states. There were differences in the minimum age and driving experience criteria, the use of practical training, written and English tests, age-based screening, mandatory retirement age, refresher courses, off- and on-road tests. CONCLUSION: Medical screening for at-risk drivers remains crucial. Age-based mandatory retirement policy at 73 years in Singapore is contrary to evidence-based practice. The lack of legislation for self-reporting of illness by drivers, the high minimum age criteria and therapy driving assessments for healthy taxi drivers are also unique to Singapore. There was stricter age-based relicensing from the age of 65 years in some Australian states and in Singapore. Continuing education for doctors, multi-tier screening for at-risk drivers and licensing policy changes are indicated.

Educational inequalities associated with health-related behaviours in the adult population of Singapore.

INTRODUCTION: Socioeconomic differences in health-related behaviours have been widely studied in the Western populations, but are seldom considered in Asian populations. We examined the effect of education attainment on health-related behaviours (physical activity, cigarette smoking and alcohol consumption) among non-institutionalised Singaporeans aged 18-69 years. METHODS: We used data from the Singapore National Health Survey 2004. Information on physical activity, cigarette smoking, alcohol consumption and sociodemographic characteristics was collected from 4,084 adults. Age-adjusted prevalence of the three health-related behaviours by educational attainment was calculated by the direct method. Logistic regression models, adjusted for age, gender, ethnic group and employment status, were used to estimate the odds ratio and 95% confidence interval, in order to study the prevalence of health-related behaviours according to educational attainment. RESULTS: The prevalence of physical inactivity, daily smoking and regular alcohol consumption was found to be consistently highest among men and women with the least education. Prevalence of physical inactivity and smoking was inversely related to educational attainment for both genders. However, no clear gradient was found between education and alcohol consumption for men and women. CONCLUSION: Less-educated Singaporeans were more likely to smoke daily, drink alcohol regularly or not to exercise regularly. Health promotion policies or programmes aimed at encouraging healthy lifestyles in the Singapore population should take into account the educational inequalities in these health-related behaviours.

Nail infestation by Liposcelis bostrychophila Badonnel.

We report an unusual case of nail infestation by Liposcelis bostrychophila Badonnel in a 70-year-old woman with onychomycosis. Liposcelis spp., also known as booklouse, are tiny insects that feed on fungi, lichen and decaying materials. In this case, the loosened hyperkeratotic nail provided a favourable environment for these insects. This is the second report of human infestation by Liposcelis spp.

Design of sliding mode controllers for bilinear systems with time varying uncertainties.

Sliding mode controllers for the bilinear systems with time varying uncertainties are developed in this paper. The bilinear coefficient matching condition which is similar to the traditional matching condition for linear system is defined for the homogeneous bilinear systems. It can be seen that the bilinear coefficient matching condition is very limited and is not generally applicable to the nonhomogeneous bilinear system. Thus, the sliding coefficient matching condition is also considered for the bilinear systems with time varying uncertainties. Then, the sufficient conditions are provided for the reaching mode of the time varying uncertain bilinear systems to be guaranteed by the designed sliding mode controllers. Moreover, the stability of the uncertain bilinear systems with the sliding mode controller is discussed. Simulation results are included to illustrate the effectiveness of the proposed sliding mode controllers.

Improving mechanical stability and density distribution of hepatocyte microcapsules by fibrin clot and gold nano-particles.

Bio-artificial livers (BAL) with microencapsulated hepatocytes have the typical limitations in maintaining hepatocyte functions, mechanical stability and uniform perfusion in packed or fluidized-bed bioreactors. We have previously developed microcapsules with enhanced hepatocyte functions. Here we have introduced a fibrin network inside microcapsules by (1) mixing collagen and fibrinogen with the encapsulated hepatocytes to support the cells; (2) submerging the microcapsules into a thrombin solution to induce the formation of an insoluble fibrin network inside the microcapsules. Fracture analysis on the microcapsules revealed significant improvement in mechanical stability. We have also introduced different amounts of gold nano-particles into microcapsules to achieve different densities for uniform bioreactor perfusion. These gold nano-particles also improved the mechanical stability of the microcapsules. Both the fibrin network and gold nano-particles exhibited the additional benefits of enhancing certain bio-functions of the encapsulated hepatocytes. The applications of these improved microcapsules in the development of bio-artificial livers are discussed.

Adaptive fuzzy control for strict-feedback canonical nonlinear systems with H/sub /spl infin// tracking performance.

In this paper, an adaptive fuzzy controller for strict-feedback canonical nonlinear systems is proposed. The completely unknown nonlinearities and disturbances of the systems are considered. Since fuzzy logic systems can uniformly approximate nonlinear continuous functions to arbitrary accuracy, the adaptive fuzzy control theory is employed to derive the control law for the strict-feedback system with unknown nonlinear functions and disturbances. Moreover, H/sub /spl infin// tracking performance is applied to substantially attenuate the effect of the modeling errors and disturbances. Finally, examples are simulated to confirm the applicability of the proposed methods.

Benefits of exercise training in patients on continuous ambulatory peritoneal dialysis.

We examined the effects of a 12-week exercise program on the exercise tolerance, blood biochemistry, blood pressure (BP) control, cardiac function, and quality-of-life (QOL) scores in 13 patients undergoing continuous ambulatory peritoneal dialysis (CAPD; six men, seven women; mean age, 46.5+/-12.8 years; mean duration on dialysis, 4.8+/-3.8 years). The patients underwent exercise training on treadmill, bike, and arm ergometers thrice weekly. Seven CAPD patients matched for age, sex, and duration on dialysis served as controls. The mean peak aerobic capacity (VO2peak) of the exercisers increased by 16.2% after training (pre- and postexercise, 17.2+/-5.2 v 20.0+/-6.4 mL/kg/min; P=0.004). Although there were no significant changes in serum urea, creatinine, albumin, and hematocrit levels; left ventricular diastolic/systolic diameters; and ejection fraction, an increasing trend of high-density lipoproteins (HDLs) was observed in the exercisers (baseline v postexercise, 33+/-11 v 40+/-14 mg/dL; P=0.06). Twenty-four-hour ambulatory BP monitoring showed a significant increase in daytime systolic BP in the exercisers (pre- and postexercise, 142+/-26 v 157+/-22 mm Hg; P=0.003), but no significant changes could be found in the ambulatory daytime diastolic BP, nocturnal BP, and resting clinic BP. The patients' QOL improved after training, with better scores in two Kidney Disease Quality of Life scales (KDQOL): burden of kidney disease and physical functioning. Two mild and uncomplicated hypotensive episodes were reported in two patients immediately after training. No changes occurred in exercise capacity, blood biochemistry, BP profile, and QOL scores in the controls. We conclude that structured aerobic exercise is safe and can improve the exercise tolerance and QOL outcomes in CAPD patients.

The role of occupational therapy in rheumatoid arthritis management.

Occupational therapy has been defined as the science of eliciting adaptive responses characterised by prescription of purposeful activities that are goal-orientated to maximise independence and functional life skills in disability management. The scope of its intervention in the rehabilitation of rheumatoid arthritis is outlined with an overview of literature update on patient education.

Synthesis and characterization of singly modified (carboxyferrocenyl)cytochrome c derivatives.

Carbodiimide-activated coupling chemistry has been used to covalently attach 1,1'-dicarboxyferrocene (dcFc) to the epsilon-amine of surface lysine residues of horse heart cytochrome c. Conditions have been found that optimize the production of singly modified (dcFc)cytochrome c derivatives and the presence of one free carboxylate per modification site allows separation and purification of about 10 of these derivatives by cation-exchange chromatography. Reversed-phase HPLC tryptic peptide mapping techniques have been used to identify the attachment sites of eight pure (dcFc)cytochrome c derivatives (at lysines 7, 8, 13, 25, 60, 72, 73, and 100). Through-space distances from these lysines to the nearest heme edge span the 6-16 A range and these derivatives should prove useful in exploring the distance dependence of long-range intramolecular electron transfer in cytochrome c.

Selective area tuberculosis surveys in Singapore 1978.

A random population sample survey in Singapore 1975 revealed that a relatively high proportion of active pulmonary tuberculosis patients remained undiagnosed, mainly in the older age groups. Previous studies disclosed the cause to the lack of symptoms of concern in these patients. A new programme was devised to discover hidden elderly patients by mass chest X-ray screening of population aged 45 years and older living in areas with known high incidence of tuberculosis. The yield of cases was less than expected mainly due to the dislocation and dispersion of population from recent extensive urban re-development in Singapore. Nevertheless the results were comparable to the most productive case finding programme carried out in this department.

Further characterization of a lipopolysaccharide from Coxiella burneti.

The lipopolysaccharide previously isolated from the rickettsial agent of Q fever, Coxiella burneti, phase I, has been further characterized. The sugar residues ribose, mannose, gluclose, D-glycero-D-mannoheptose, and L-glycerto-D-mannoheptose are present. Two sugars remain unidentified, one of which is a minor and the other a major constituent. Isomyristic, palmitic, and beta-hydroxymyristic acids are the major fatty acid residues of the 15 identified. The nature and content of other lipopolysaccharide constituents are presented.