Association of Pain and Impact of Dual-Task Exercise on Function, Cognition and Quality of Life.

PURPOSE: This study aimed to assess the factors associated with pain and evaluate the impact of dual-task exercise on pain improvement, quality of life (QOL), cognition and function in older adults. PATIENTS AND METHODS: This study is a secondary data analysis of the HAPPY (Healthy Ageing Promotion Program for You) study. At risk older adults ≥ 60 years old were enrolled in a community dual-task exercise program. Assessments for frailty, sarcopenia, falls, quality of life (QOL) and perceived health, depression, cognition and physical function were performed at baseline and 3 months. Pain intensity was derived from EQ-5D and stratified into no pain, slight pain and moderate to extreme pain. RESULTS: Out of 296 participants, 37.2% had slight pain and 11.1% had moderate to severe pain. Both slight and moderate to extreme pain compared with no pain group were significantly associated with lower perceived health (68.2,63.6 vs 76.0) and QOL index (0.70,0.59 vs 0.93); moderate to extreme pain was also significantly associated with depression, low mental vitality, frailty, sarcopenia and poorer physical performance. After 3 months of dual-task exercise, pain improved in 70.8% of the moderate to extreme pain group and 50.8% of slight pain group. Significant improvement in perceived health, QOL, physical function and cognition were also observed. CONCLUSION: Proactive efforts are required to screen for pain and manage frailty, sarcopenia and depression. Dual-task exercise proved safe and possibly effective in reducing pain and improving QOL, physical and cognitive function in older adults. Prospective randomized studies are needed to validate the effectiveness of dual-task vs single-task exercise, including impact of reversal of frailty and sarcopenia in pain management.

Income disparity in school readiness and the mediating role of perinatal maternal mental health: a longitudinal birth cohort study.

AIMS: There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness. METHODS: Prospective data from 505 mother-child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models. RESULTS: Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034). CONCLUSIONS: Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.

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.

Screening for cardiovascular disease risk factors at baseline and post intervention among adults with intellectual disabilities in an urbanised Asian society.

BACKGROUND: Adults with intellectual disabilities (ID) face significant barriers to screening participation. We determined predictors for regular cardiovascular health screening at baseline among adults with ID in Singapore, and evaluated the effectiveness of a 3-month screening intervention. METHODS: The study population involved all adults with ID aged ≥40 years receiving services from the Movement for the Intellectually Disabled of Singapore (MINDS), the largest such provider in Singapore. Over 3 months in 2011, adult clients not screened regularly at baseline for hypertension, diabetes and dyslipidaemia were offered free and convenient blood pressure, fasting blood glucose and lipid testing; data on other cardiovascular disease risk factors were also collected. Chi-square and logistic regression identified predictors of regular screening at baseline. RESULTS: Participation was 95.0% (227/239). At baseline, among adults with ID, 61.8% (118/191), 24.8% (52/210) and 18.2% (34/187) had gone for regular hypertension, diabetes and dyslipidaemia screening respectively; post intervention, rates rose to 96.9%, 89.5% and 88.8% respectively. Prevalence of cardiovascular disease risk factors (22.5% with hypertension, 10.6% with diabetes, 34.8% with dyslipidaemia, 10.7% obese and 90.6% lacking regular exercise) was high compared against the general population. While receiving residential services was associated with regular hypertension screening, receiving non-residential services and being independently mobile were associated with regular participation in fasting blood tests (all P < 0.05). CONCLUSION: Cardiovascular disease risk factors are common among adults with ID and clinicians should proactively screen such populations. Provision of free and convenient screening for cardiovascular disease risk improved screening participation.

All-cause and cause-specific mortality after hip fracture among Chinese women and men: the Singapore Chinese Health Study.

UNLABELLED: All-cause mortality risk persisted for 5 years after hip fractures in both men and women. There may be gender-specific differences in effect and duration of excess risk for cause-specific mortality after hip fracture. INTRODUCTION: To determine all-cause and cause-specific mortality risk in the first 5 years after hip fracture in an Asian Chinese population. METHODS: The Singapore Chinese Health Study is a population-based cohort of 63,257 middle-aged and elderly Chinese men and women in Singapore recruited between 1993 and 1998. This cohort was followed up for hip fracture and death via linkage with nationwide hospital discharge database and death registry. As of 31 December 2008, we identified 1,166 hip fracture cases and matched five non-fracture cohort subjects by age and gender for each fracture case. Cox proportional hazards and competing risks regression models with hip fracture as a time-dependent covariate were used to determine all-cause and cause-specific mortality risk, respectively. RESULTS: Increase in all-cause mortality risk persisted till 5 years after hip fracture (adjusted hazard ratio, aHR = 1.58 [95 % CI, 1.35-1.86] for females and aHR = 1.64 [95 % CI, 1.30-2.06] for males). Men had higher mortality risk after hip fracture than women for deaths from stroke and cancer up to 1 year post-fracture but women with hip fracture had higher coronary artery mortality risk than men for 5 years post-fracture. Men had higher risk of death from pneumonia while women had increased risk of death from urinary tract infections. There was no difference in mortality risk by types of hip fracture surgery. CONCLUSIONS: All-cause mortality risk persisted for 5 years after hip fractures in men and women. There are gender-specific differences in effect size and duration of excess mortality risk from hip fractures between specific causes of death.

An association between floor vacuuming and dust-mite and serum eosinophil cationic protein in young asthmatics.

UNLABELLED: Although vacuum cleaning is recommended to reduce allergen levels and improve asthma and allergic rhinitis symptoms, some studies suggest it may increase allergen load in homes. We conducted a cross-sectional study to determine if home floor vacuuming was associated with sensitization to dust-mites and cockroaches, and serum eosinophil cationic protein (ECP), a biomarker for atopy, in 102 physician-diagnosed spirometry-confirmed asthmatics. We collected data on floor type, floor cleaning method and frequency, asthma severity, allergy medications used, serum ECP and skin prick tests (SPT) to three dust-mites [Dermatophagoides pteronyssisinus (Der p), Dermatophagoides farinae (Der f) and Blomia tropicalis (Blo t)] and two cockroaches [Periplanata americana (Per a) and Blatella germanica (Bla g)]. Those who vacuumed had increased sensitization to three dust-mites [adjusted ORs (95%CI) = Der p: 26.6 (1.8-405.2); Der f: 44.8 (3.2-620.9); Blo t: 14.1 (1.8-108.1)] but not to cockroaches, adjusted for cleaning frequency and other methods of floor cleaning. Subjects who vacuumed their floor had higher levels of serum ECP than those who did not [adjusted median difference (95%CI): 9.4 (1.1-17.7)], adjusted for use of nasal corticosteroids among those with allergic rhinitis. Vacuuming is associated with increased sensitization to dust-mite allergens and higher serum ECP. PRACTICAL IMPLICATIONS: We found an association between floor vacuuming and increased sensitization to dust-mite allergens and higher levels of an atopy biomarker. Current recommendations to use vacuuming to control allergen exposure and allergic conditions may need to be reconsidered until further studies are performed.

Determinants of length of stay during post-stroke rehabilitation in community hospitals.

INTRODUCTION: Length of stay (LOS) in hospitals is the largest contributor of direct stroke care cost. Rehabilitation accounts for 16 percent of healthcare cost in the six-month post-stroke period. It is important to determine factors extending LOS in rehabilitation hospitals to identify focus areas of cost-control strategies. The aim of the study was to ascertain the predictors of LOS of post-stroke patients admitted into two community hospitals offering rehabilitation. METHODS: An observational cohort study was conducted on 200 stroke patients admitted from acute hospitals into two community hospitals. Data collected included baseline sociodemographical variables, and the National Institute of Health Stroke Scale, Abbreviated Mental Test, Geriatric Depression Scale and Barthel Index were used to assess neurological impairment, cognitive impairment, depressive symptoms and functional disability, respectively. Medical complications (defined as new or exacerbated medical problems that generated additional physician evaluation, a change in medication or additional medical intervention), after patients were admitted to the community hospitals until discharged, were recorded. The outcome variables measured were length and cost of stay. RESULTS: The mean LOS in our study was 34.4 (standard deviation [SD] 18.4) days, and the mean cost of hospital stay was S$2,410.83 (SD S$2,167.26). Length and cost of hospital stay were significantly correlated (r equals 0.52; p-value is less than 0.01). On multiple linear regression analysis, the significant variables positively associated with LOS were medical complications and functional dependence on admission. Significant variables negatively associated with LOS were unplanned discharge and recurrent strokes. CONCLUSION: Medical complication is a key reversible determinant of increased LOS of post-stroke patients receiving rehabilitation in community hospitals. Strategies for prevention, early detection and treatment of medical complications during stroke rehabilitation are discussed.