Traumatic injury to the eye can occur due to various causes, most of which are avoidable. Here we report three cases of intrastromal corneal foreign bodies (FB) which required surgical removal. Most corneal FBs are removed easily at the slit lamp, however, these cases required surgical intervention due to the mechanism of which the FB penetrated into the stroma. Although the mechanism of injury was similar, with all three cases occurring at high velocity, we observed that the entry and level of penetration differed in each case. In the first case, the corneal FB penetrated the cornea and was embedded in the anterior stroma, whereas in the second case, the FB was embedded in the posterior stroma, but with an intact endothelium. In the third case, the FB caused a full thickness, self-sealed laceration wound but remained embedded in the stroma. Through further evaluation, we noted that several factors contribute towards the severity of the injury, namely, anatomy of the cornea, area affected, shape, size, mass and velocity of the object. We speak in depth about the mechanism of injury and physics associated with these injuries and why the penetration differed in each case.
We compared the analgesic profile between patient-controlled analgesia (PCA) using oxycodone and morphine in post total abdominal hysterectomy patients. Eighty-four ASA I or II patients, aged 18 to 65 years who underwent total abdominal hysterectomy were recruited into this prospective, double blind, randomised controlled study. They were randomised to receive either PCA oxycodone 0.7 mg per bolus or PCA morphine 1 mg per bolus for postoperative pain relief. At the end of surgery, all patients received IV morphine 0.1 mg/kg and skin incision was infiltrated with 20 mls of bupivacaine 0.25%. Post-operative pain scores, opioids consumptions, sedation scores and side effects were assessed upon arrival and at 30 minutes after arrival to recovery area, as well as at 6 hours and 24 hours after the operation in the ward. Patients’ overall satisfaction was also assessed 24 hours postoperatively.No significant differences were observed in terms of postoperative pain scores, opioids consumption, sedation scores, side effects as well as patient’s overall satisfaction between the PCA oxycodone and PCA morphine group. Oxycodone was comparable to morphine as PCA in terms of total opioid consumption, pain scores and satisfaction level for patients undergoing total abdominal hysterectomy and therefore may be an alternative to morphine in postoperative pain management as PCA.
Perioperative intravenous (IV) dexamethasone is administered prophylactically for post operative nausea and vomiting. However, its glucocorticoid property which raises blood glucose is of concern, especially among diabetic patients. The surgical stress response also contributes to increased perioperative blood glucose. Prior studies showed higher glucose levels with dexamethasone 8 mg compared to 4 mg, hence we studied the effect of the lower dose amongst diabetic patients. This prospective, single blinded, randomised study recruited forty-six type 2 diabetes mellitus patients planned for surgery under general anaesthesia. They received IV dexamethasone 4 mg or saline (placebo) after induction of anaesthesia. Capillary blood glucose levels were recorded preoperatively, and subsequently at recovery (T0), and at 6, 12, 18 and 24 (T6, T12, T18, T24) hours post-operatively. Median glucose levels were higher at 9.0 [10.5-7.7] mmol/l in the dexamethasone group, versus 7.4 [9.2-5.9] mmol/l in the placebo group at T0, p = 0.022. Similarly at T6, the dexamethasone group recorded higher glucose levels of 11.2 [15.0-9.3] mmol/l, versus 7.7 [9.0-6.2] mmol/l in the placebo group, p = 0.001. This corresponded to a significant difference between the groups, in the change of glucose levels from baseline values, p = 0.042. Subsequent readings at T12, T18, and T24 were comparable between the groups. In conclusion, IV dexamethasone 4 mg in type 2 diabetic patients, resulted in higher glucose levels immediately postoperative and 6 hours later. The change in blood glucose from baseline levels was significant between the groups at 6 hours postoperatively. Glucose levels however remained within acceptable range of approved guidelines in both groups at all recorded intervals.
MeSH terms: Anesthesia, General; Anesthesiology; Blood Glucose; Dexamethasone; Diabetes Mellitus, Type 2; Glucocorticoids; Humans; Prospective Studies; Postoperative Nausea and Vomiting
Thyroidectomy for benign and malignant diseases has progressed dramatically over the last two decades. Moving from large collar incision to no scar is a very good news to the patient with neck swellings. The morbidity of the surgery remains low regardless of the technique and approaches used but scarless surgery is still limited to benign diseases and small cancers. Further study and future refinement of the technique might make these techniques also applicable to large tumours.
Introduction: There are increasing trend in using information and communication technology to enhance the deliverance of reminiscence work for people with dementia. Thus this study aimed to explore the feasibility of Digital Memory Album (DMA) to support reminiscence work and subsequently evaluate the psychosocial benefits of the DMA system for older adults with dementia living in community. Method: This was an exploratory case study involved five participants with mild to moderate dementia and their primary caregivers. Each participant had an opportunity to review their own life history using Life Review Experience Form (LREF) with the researcher for 8 consecutive weeks in which subsequently facilitated in development of a personalised digital life story. Caregivers provided additional information to support the development of DMA. The whole process was audio recorded. The digital life story was presented in multimedia format and displayed using the DMA. The DMA was given to the participants for review. Qualitative data was collected using semi structure questions with the participants and caregivers immediately after the completion of DMA and 6 weeks after having the DMA as a gift. Results: Analysis of the audio-records and interview data indicated that DMA promoted psychosocial wellbeing which included enjoyment, comfort, stimulate long term memory and enhanced communication and social interactions with family members and friends. Caregivers expressed the DMA helped them in recollecting the past and better understanding of their loved ones. It also reoriented their focus on their loved ones from their disability to the remaining strength. Conclusion: For the first time, this study demonstrates the feasibility of using DMA in improving the psychosocial wellbeing for people with dementia in Malaysia.
The relationship between disability and depression is complex, and previous studies showed that the relationship may be mediated by positive social interaction. The main objective of this study was to examine whether positive social interaction mediates the association between disability and depression in older adults. The data of this analysis were drawn from 2322 community-dwelling older adults aged 60 to 92 years in Peninsular Malaysia who participating in the baseline Neuroprotective Model for Health Longevity (TUA) study. Depression was measured by Geriatric Depression Scale, disability was assessed by World Health Organization Disability Assessment Schedule 2.0, and positive social interaction was measured by 4 items under the positive social interaction domain of The Medical Outcomes Study Social Support Survey. Hierarchical Multiple Linear Regression was performed by using SPSS version 23.0 to examine the mediation effect of positive social interaction. Next, Sobel Test was used to validate the mediation effect. Results showed that both disability (β = 0.086, p < 0.001) and positive social interaction (β = -0.107, p < 0.001) significantly predicted depression in the final model, after controlling for possible confounders (gender, marital status, year of education). Of most interest, positive social interaction was found partially mediated the association between disability and depression (from β = 0.094, p < 0.001 to β = 0.086, p < 0.001). Furthermore, significant Sobel Test (z = 2.519, p = 0.012) confirmed the mediation effect of positive social interaction. These findings reinforce the role of disability and positive social interaction in predicting mental health in old age. To prevent depression in old age, specific intervention to maximize the positive social interaction among disabled older adults is warranted.
There is some evidence stated that mood states might influence cognitive functioning, such as episodic memory, working memory and creative problem solving. This study was conducted to evaluate the relationship between mood states and cognitive functioning among older adults with Mild Cognitive Impairment (MCI). This study involved 12 male and 37 female subjects from Klang Valley aged 60 year old and above. MCI was defined based on criteria proposed by Peterson. Cognitive functions of the subjects were accessed using Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT), Digit Span, Digit Symbol Substituition Test (DSST) and Visual Reproduction; while mood states including tension, depression, anger, vigour, esteem related affect, fatigue and confusion were accessed using Profile of Mood States (POMS) questionnaire. Total positive subscales score, total negative subscales score and total mood disturbance (TMD) were also calculated. There were significant positive correlations between tension (r = 0.325, p = 0.30), vigour (r = 0.235, p = 0.036), esteem related affect (r = 0.316, p = 0.034) and total positive subscales score (r = 0.307, p = 0.040) with verbal episodic memory as measured using RAVLT fifth trial. In addition, positive correlations were also observed between vigour (r = 0.228, p = 0.035) and total positive subscales score (r = 0.237, p = 0.025) with DSST. After adjusted for confounding factors, subjects who scored higher in esteem related affect (Adjusted OR = 0.390, 95% CI [0.069-0.711], p = 0.019) and tension (Adjusted OR = 0.253, 95% CI [0.075-0.431], p = 0.007) had better verbal episodic memory. Subjects who have higher total positive subscales score were also had faster processing speed (OR = 0.856, 95% CI [0.099-1.614], p = 0.028). However after adjusted for confounding factors, the relationship was not significant (Adjusted OR = 0.383, 95% CI [-0.247-1.013], p = 2.226). Older adults with MCI who had a more positive mood tend to have a better short-term verbal memory and faster processing speed.
MeSH terms: Adult; Affect; Anger; Cognition; Depression; Female; Humans; Male; Memory, Short-Term; Problem Solving; Surveys and Questionnaires; Memory, Episodic
The term metabolic syndrome (MetS) describes a clustering of risk factors for cardiovascular disease and type 2 diabetes mellitus which include high blood pressure, low fasting high-density lipoprotein cholesterol (HDL-c), high fasting triglyceride (TG), high fasting blood glucose (BG), and abdominal obesity. The aim of this cross sectional study was to determine the dietary patterns (DPs) associated with MetS among 451 older adults in Malaysia. Food intake was determined using validated Diet History. DP was identified based on 40 food groups by using principal component analysis (PCA), and the factors were rotated by varimax rotation. Fasting venous blood samples were taken to determine HDL-c, TaG and BG level. Blood pressure and anthropometric measurements were also performed. Three major dietary patterns have been identified; 1) bread, spreads and oats, 2) Malaysia traditional pancakes and 3) vegetables and healthy cooked dishes. Three models were built to compare the potential confounder such as age, education years, marital status, calorie intakes, ciggarate smoking and body mass indeks (BMI). Only vegetables and healthy cooked dishes DP was associated with MetS. This DP reflects high consumption of various types of vegetables, noodle in soup, healthy cooked fish or seafood and low consumption of all type of high calorie rice, noodles and fried desserts. For all models, subject in the highest tertile of vegetables and healthy cooked dishes DP had a lower odd ratio (OR) for MetS as compared to lowest tertile. As more potential confounders added in new models, the significant values are increased. After adjustment of body mass index, the association for vegetables and healthy cooked dishes DP was attenuated (OR: 0.67, CI: 0.39-1.16, p: 0.156). In conclusion, high consumption of vegetable and healthy cooked dishes may lower the occurance of MetS among Malaysian elderly.
Excess added sugar consumption is related to poor health outcomes in older adults. The sugar content of local food is limited. However, this information is imperative for understanding potential risks from overconsumption of sugars among older adults. This study was carried out to determine the type and total sugar contents in 70 types of local desserts, snacks and cooked foods, using high performance liquid chromatography. The type of food chosen was based on the highly consumed food by the older adults in Malaysia. The samples were collected in triplicates from local restaurants or stalls located in Selangor, Perak and Johor, stored at -20°C and freeze dried prior to analysis. Results showed that average sugar in each 100 g of local desserts, snacks and cooked foods were 13.69 ± 5.94 g, 8.41 ± 6.15 g and 2.1 ± 1.87 g respectively. The highest sugar content per 100 g samples was found to be in sweet potato donut (kuih keria), mashed banana fritter (cekodok pisang) and noodles with sweet potato gravy (mee rebus). The lowest sugar content per 100 g samples was found to be baked glutinous rice (pulut panggang), vadai and noodle soup (mee sup). Meanwhile, the highest sugar content per standard portion was found to be noodles with sweet potato gravy (mee rebus), peanut pancake (kuih apam balik) and banana savoury (pengat pisang). Percentage of recovery for the sugar analysis was 95.2 ± 6.8%. The main type of sugar found in this analysed food samples was sucrose followed by maltose, glucose, fructose and lactose. Sucrose was the most common added sugars in local desserts, snacks and cooked foods of this study. However, compliance with low added sugar recommendations may not be achievable for the general public. Thus, these findings can be utilised in raising public awareness and assist in better estimation of sugar contents and intake.
Relatively less comprehensive web based programme has been developed for detecting risk of mild cognitive impairment (MCI) and further impart preventive strategies and lifestyle education. Thus, this study has developed a comprehensive web based programme for early screening of risk of MCI together with education package for preventing MCI known as WESIHAT 2.0. WESIHAT 2.0 is a senior friendly website which has appropriate design interface facilitating access of older people especially with the use of touch-screen technology. WESIHAT 2.0 has incorporated four major components namely TUA WELLNESS screening tool, which is a comprehensive, online based, 10-item screening tool for detecting risk of MCI, 10-guides for preventing MCI, health diary and healthy food. Evaluation of acceptance of WESIHAT 2.0 was done among 71 people which comprised of 30 older people and 30 caregivers, chosen equally based on ethnic composition and 11 health care professionals who has experience working in the field of geriatric and 2 freelance website developer. All older people and caregivers stated that the content of website was very useful for preventing MCI, however, about 36.4% of health professionals stated several improvements needed to be done before releasing the end-product to the users. Comments given were smaller font size (27.3), addition of more pictures (27.3%), using simpler terms (36.4%) and changing certain design for better view of older people (18.2%). Amendments were made based on each comment given and the finalized website were used for a 6-month intervention programme for neuroprotection among older people who failed to achieve successful aging. It is timely for an online based approach for prevention of MCI. WESIHAT 2.0 is the first website in Malaysia which has been accepted by all older people and caregiver and more than half of healthcare professionals to prevent memory decline.
MeSH terms: Neuroprotection; Drug Packaging; Health Personnel; Humans; Life Style; Malaysia; Medical Records; Memory; Risk; Caregivers; Internet
Body weight can be estimated using equations developed from the anthropometric measurements when body weight is difficult to measure for example among bedridden older adults. This study has developed the equation to estimate body weight among older adults resided in Klang Valley from several anthropometric measurements. A cross sectional study was carried out among community dwelling older adults aged 60 years old and above in Klang Valley area. Subjects were recruited through convenience sampling method. Weight, height, knee height (KH), demi span (DS), subscapular skinfold (SSF), calf circumference (CC), waist circumference (WC), hip circumference (HC), mid upper arm circumference (MUAC) and wrist circumference (WrC) were measured according to the standard protocol. Cross validation was performed. 61% from total subjects were selected randomly for the development of equation meanwhile, 39% subjects as control subjects. Equation was generated using stepwise multiple regression analysis. A total of 164 older adults involved in this study which consist of 39.0% men and 61.0% women. Mean age of the subjects was 68.32 ± 5.79 years meanwhile mean of measured body weight was 66.46 ± 11.98 kg. Predictive equation obtained was: estimated body weight = 5.149 (Sex) – 0.082 (Age) + 0.889 (Hip circumference) + 1.112 (Knee Height) – 72.778 (R2 = 0.848, p < 0.001). Correlation coefficient for 61% subjects were higher (r = 0.921) compared to the correlation coefficient for 39% subjects (r = 0.883) (p < 0.001). However, the differences between measured and estimated body weight was not significant (p = 0.798). This showed that the equation developed was able to estimate body weight among older adults, because the value of estimated body weight was closed to the value of measured body weight. The equation developed can be used to estimate body weight among Malaysian older adults. However, further study is warranted to explore this equation into the different settings such as clinical setting.
Knee osteoarthritis (KOA) is a major cause of disability and significantly reduce quality of life (QOL). There is limited information about knee associated problems and functional mobility among Malaysian adults with KOA. The aim of our study was to examine knee associated problems and functional mobility among this population. Forty-five (45) adults with KOA with mean age of 65.02 ± 8.083 were recruited from Hospital Canselor Tuanku Muhriz, UKM. Knee associated problems and functional mobility were measured using Knee injury and Osteoarthritis Outcome Scores (KOOS) and Timed-Up and Go (TUG) test respectively. The mean score and standard deviation for TUG test was 11.44 ± 2.69 seconds. Median scores (with interquartile ranges [IQR]) for the KOOS subscale domains were; Symptoms: 80.56, (69.44 to 91.67); Pain: 71.43 (50 to 78.57); Functional Activities of Daily Living: 82.3 (67.65 to 86.76); Sports and Recreation Function: 30 (20 to 60); and Knee-Related Quality of Life: 50 (25 to 75). Generally, participants’ TUG test performance showed that time taken to complete the test was higher than the reference values (7.14 to 8.43 seconds) identified among Malaysian community dwelling older adults with low to high risk of falls. The KOOS scores in adults with KOA in our study is similar to previous reports with Sport and Recreation Function and QOL domains been the most affected. It is important to improve functional mobility and balance in order to decrease falls risk and optimise sport and recreation function and QOL among adults with KOA.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
Urinary incontinence (UI) is a common disorder among older adults, with a global prevalence between 2% to 58%. UI has been associated with social isolation, increased morbidity and reduced quality of life (QoL). The aim of this study was to investigate the sociodemographic, clinical, cognitive and physical function risk factors of UI among Malaysian community dwelling older adults. This study is part of a larger scale population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). A total of 1560 Malaysian community dwelling older adults aged 60 years and above were screened in this phase III LRGS study. Participants sociodemographic and clinical history were obtained. Mini Mental State Examination (MMSE), Rey Auditory Verbal Learning Test (RAVLT) and Digit Span tested cognitive function. Timed Up and Go Test (TUG), Hand Grip Strength Test, Chair Stand Test and Lawton Instrumental Activities of Daily Living tested physical function. The overall prevalence of UI was 15.7% (n = 245) in this study, with 11.8% (n = 88) in men and 19.3% (n = 157) in women. Logistic regression analysis showed that TUG (Adjusted odds ratio [OR], 1.071; 95% confidence interval [CI], 1.02-1.13), MMSE (OR, 0.93; CI, 0.90-0.97), weight (OR, 1.02; CI, 1.00-1.03), and constipation (OR 0.60; CI, 0.46-0.78) (p < 0.005) were significant risk factors of UI. The results indicate, decreased physical and cognitive function; increase in weight and having constipation increased the risk of UI. Maintaining optimum mobility, cognitive function, body weight and constipation prevention are vital in the prevention and management of UI among older adults.
MeSH terms: Activities of Daily Living; Body Weight; Cognition; Constipation; Female; Humans; Longevity; Longitudinal Studies; Maintenance; Male; Morbidity; Quality of Life; Risk Factors; Social Isolation; Urinary Incontinence; Prevalence; Confidence Intervals; Logistic Models; Odds Ratio; Hand Strength; Independent Living
Falls is a global health issue among older adults. Identifying measuring tools that can predict falls risk among older adults can assist in early falls risk detection and prevention. Best measuring tools that can predict falls risk among Malaysian community dwelling older adults is not known. The objective of our study was to determine if Timed Up and Go (TUG) test and Activities-Specific Balance Confidence (ABC) scale could be used as a falls risk predictor tools among Malaysian community dwelling older adults. Hundred and six (n = 106) community dwelling older adults who were attending Klinik Kesihatan Cheras participated in this cross sectional study. Falls incidence in the past one year was obtained from the participants. TUG test was performed and ABC scale was administered. Data was analysed using binomial logistic regression and receiver operating curves (ROC). The cut off values identified for TUG test and ABC scale were 9.02 seconds (area under the curve, AUC was 0.711; 95% CI 0.577-0.844) and 82.81% (area under the curve, AUC was 0.682; 95% CI 0.562-0.802) respectively. Hence, older adults with a score of above 9.02 seconds for TUG test and a score of below 82.81% for ABC scale were noted to have a higher risk of falls. Results of this study demonstrated that both TUG test (p < 0.001) and ABC scale (p < 0.01) were significant predictors of falls risk. Our study results indicated that both mobility (TUG test) and fear of falls (ABC scale) measuring tools, with the present cut off values can be used to identify community dwelling older adults who are at a higher risk of falls. Identifying older adults with higher risk of falls can assist the health professionals to optimise falls prevention and management approaches.
MeSH terms: Aged; Ambulatory Care Facilities; Cross-Sectional Studies; Fear; Humans; Logistic Models; Area Under Curve; Independent Living
Falls is a global health concern due to its many negative consequences in older adults. Early falls screening and prevention is important among older adults. We developed Falls Screening Mobile Application (FallSA) as a self falls screening tool among older adults. FallSA was developed using data of physical performance test, demographic information and questions to inform falls risk from a larger population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). The aim of this study was to determine validity and reliability of FallSA as a self-screening tool to inform falls risk among Malaysian older adults. This cross sectional study was conducted among 91 community dwelling older adults aged 60 years and above. FallSA was validated against Physiological Profile Assessments (PPA), a comprehensive falls risk assessment tool. Participants used FallSA to test their falls risk by repeating the test twice between an hour. Validity and test–retest reliability of FallSA was examined by using Spearman correlation, Kappa, Sensitivity and Specificity, Intra correlation coefficient (ICC), Cronbach alpha and Bland-Altman. Concurrent validity test was significant with moderate correlation rs = 0.518, p < 0.001, moderate agreement K = 0.516, p < 0.001 and acceptable Sensitivity: 80.4% and Specificity: 71.1%. Reliability of FallSA was shown to be good (ICC: 0.948, CI: 0.921-0.966), good internal consistency α = 0.948, p < 0.001 and good agreement was indicated by small mean differences and narrow limits of agreement (LoA). The results of this study suggest that FallSA was a valid and reliable tool to inform falls risk among Malaysian older adults. Further prospective studies are required to determine the accuracy of FallSA to correctly classify older adults into fallers and non-faller groups.
Physical performance in older adults is known to decline with ageing. However, there is limited information about physical performance difference among older adults with; successful (SA), usual ageing (UA) and mild cognitive impairment (MCI). The purpose of this study was to compare the differences in physical performance among older adults in these three categorised groups. This study is part of a larger scale population based longitudinal study on neuroprotective model for healthy longevity among older adults (LRGS TUA). Physical performance was assessed using hand grip (HGT; upper limb strength), 2 minutes step (2MST; endurance), sit to stand (STS; lower limb strength), sit and reach (SRT; lower body flexibility), timed up and go (TUG; mobility and balance), back scratch (BST; upper body flexibility) and gait speed (GS; walking speed) tests. Cognitive status was measured using Mini Mental Status Examination (MMSE) for global function, Digit Span for attention and working memory; Rey Auditory Verbal Learning Test (RAVLT) for verbal memory. Participants were categorised in three groups; SA, UA and MCI. SA group were those without diabetes, hypertension, chronic lung disease, cancer, heart diseases and stroke, had normal scores in MMSE (score of >22), optimum self-rated health and no functional limitations measured using Instrumental Activities of Daily Living questionnaire (IADL). Participants with MCI had subjective information of cognitive impairment from caretakers, minimum or low functional limitation, global function with ≤ 19 score on MMSE and 1 SD from below the normal mean of the group for Digit Span and RAVLT. Older adults with UA had minimal or no functional limitation and average scores of MMSE, Digit Span and RAVLT which were between the scores of SA and MCI group. Data was collected among 1291 participants in Phase three of LRGS TUA study. Data was analysed for differences among the three groups using one way ANOVA test. The results showed that majority of older adults was categorized as UA group (71.14%), followed by SA (15.19% ) and MCI (12.72%). Higher performance in physical performance measures except in SRT were demonstrated in SA group compared to MCI and UA groups. Post hoc Sheffe test showed that there was a significant difference (p < 0.05) in the SA and UA group for all tests except for HGT and SRT. MCI and UA groups were significantly different (p < 0.05) in STS, TUG and GST tests. The results suggested that UA and MCI groups had reduced physical performance in lower limb muscle strength, mobility, balance and walking speed compared SA group. Promoting optimum physical performance is important among older adults for successful ageing.
Optimum physical health is important in maintaining independence among older adults. There is limited information regarding physical health status among older adults attending primary care clinics in the local population. The aim of this study was to examine physical health among older adults attending Primary Care Clinic at Cheras, Malaysia. A cross-sectional study was conducted at Primary Care Clinic at Cheras, Malaysia with a total 106 participants (mean age of 68 ± 6.3 years). Participants performed a battery of physical function tests. The results showed that the percentages of participants who performed below recommended norms for the 30secs Chair Stand Test (lower limb strength), Chair Sit and Reach Test (lower limb flexibility), Back Scratch Test (upper limb flexibility), Timed Up and Go (TUG) (functional mobility), Single Leg Stance Test (balance) and 2 mins Walk Test (2MWT) (aerobic endurance) were 32%, 18%, 21%, 29%, 22% and 78% respectively. The results suggest that majority of older adults visiting primary health care clinics had inadequate physical function in relation to aerobic endurance. Older adults attending primary health care clinics should be encouraged to improve their physical health status, especially aerobic endurance, to optimise their physical independence.
Reduced muscle strength and quality of life (QoL) has an impact on adults at risk of osteoporotic fractures. Muscle strength and QoL among Malaysian adults at risk of osteoporotic fractures is not known. The aim of our study was to examine muscle strength and QoL status and its relationship among adults at low and moderate to high risk of osteoporotic fractures. In this cross-sectional study, we recruited 27 men and 78 women (mean age 69.3 ± 8.5 years) from Orthopaedic Clinic, Hospital Canselor Tuanku Muhriz Universiti Kebangsaan Malaysia. A 10-year probability of major osteoporotic fractures were calculated according to WHO fracture risk assessment tool (FRAX) with femoral neck BMD (cut-point 10%). Participants were categorized as low and moderate to high risk of osteoporotic fractures based on FRAX results. Back extensor muscle strength and dominant hand grip strength were measured using a load cell system and a hand dynamometer respectively. European QoL questionnaire (EQ5Dvas) was used to measure QoL. Multiple linear regression was performed with QoL as a dependent variable and back extensor muscle strength and hand grip strength as the independent variables. Approximate 40% of adults were categorized into moderate to high risk of osteoporotic fractures. The mean values among the low and moderate to high risk of osteoporotic fractures for QoL was 80.5 ± 13.2 and 76.9 ± 16.9 (p = 0.77); hand grip strength was 25.7 ± 17.3 and 20.6 ± 5.5 kg (p < 0.001) and back extensor muscle strength was 25.0 ± 7.0 and 18.9 ± 9.5 Newton (p < 0.01) respectively. Hand grip muscle strength appeared to be a determinant of QoL and accounted for 5.8% of the total variance. Improved muscle strength may lead to better QoL among adults at risk of osteoporotic fractures.
This paper describes the systematic process followed in the development of culturally appropriate equalized speech-in-noise sentences suitable for use in an adaptive Speech-In-Noise training protocol for adults in Malaysia. The process involved three iterative phases of development. They were (1) analysis, (2) design and (3) development phases. In the analysis phase, important variables that needed to be considered for speech-in-noise materials were identified through literature review and discussion with the experts in the field. Next, in the design phase, the compilation and formation of sentences, evaluation of naturalness and recording of the speech materials were done. The last phase was the development phase which involved the evaluation of performance intensity function and equalization of intelligibility. The final outcome of these phases were 171 sentences with equal intelligibility that can be used interchangeably in a speech-in-noise training protocol for adults in Malaysia.
Nutritional diet plays an important roles in the health of an individual. One of the simplest and suitable approach followed by certain individual especially older adults are Sunnah fasting. Sunnah fasting is reported to have a positive impact in maintaining public health and aids to prolong the life span of older adults. This study aimed to examine the relationship of Sunnah fasting in repairing DNA damage of older adults who suffer from mild cognitive impairment (MCI). The study design was comparative cross sectional study that comparing two phases (baseline and 36 months). A total of 99 subjects of MCI aged ≥ 60 years and have no terminally ill diseases involved in the study. Ten ml of whole blood, socio-demographic and cognitive assessment data was taken. The blood collected is used to determine DNA damage using the Alkaline Comet Assay. MMSE, IADL, ADL and GDS was conducted to determine the cognitive function. The study found that the percentage of DNA in tail (TD) for the subjects who practice Sunnah fasting for both phases is significantly lower than in subjects who did not practice Sunnah fasting (Baseline, TD: 12.49 ± 0.24% vs 17.40 ± 0.43%; 36 months, TD: 8.21 ± 0.43% vs 15.23 ± 1.16%). The percentage of tail moment (TM) for the subjects who practice Sunnah fasting for both phases is significantly lower than in subjects who did not practice Sunnah fasting (Baseline, TM: 0.92 ± 0.05% vs 1.46 ± 0.08%; 36 months, TM: 0.4 ± 0.03% vs 1.32 ± 0.13%). In conclusion, this shows the Sunnah fasting can reduce DNA damage among the older adult of MCI subjects. Thus, further research is warranted to determine the metabolomes in MCI subjects that related with Sunnah fasting to produce a predictive model of healthy diet to be used in the future.