Urinary incontinence (UI) is known to be more prevalent among women and is associated with decline in quality of life. The aim of our study was to investigate the prevalence, risk factors of urinary ...incontinence and its impact on quality of life among community dwelling older women living in urban and rural populations.
This study was conducted based on secondary data analysed from the third phase of the longitudinal study "Neuroprotective Model for Health Longevity among Malaysian Elderly" (LRGS TUA). Stratification of urban and rural study areas were in accordance to that determined by the Department of Statistics. A total of 814 community dwelling older women (53% urban, 47% rural), aged 60 years and above, across four states within Peninsular Malaysia were included in this analysis. Interview-based questionnaires were used to obtain respondents' sociodemographic details and clinical characteristics. The Timed Up and Go test and Handgrip Strength tests were used to assess physical function. Urinary incontinence was self-reported, and quality of life of those with incontinence was assessed using the King's Health Questionnaire (KHQ).
Prevalence of urinary incontinence was 16% and 23% among older women living in urban and rural areas, respectively. Ethnicity was significantly associated with incontinence among older women in both urban and rural population (p < 0.05). Chronic constipation, functional mobility and muscle strength were associated with UI in participants from rural setting (p < 0.05). Binary logistic regression analysis showed that risk of incontinence is lower among Chinese OR 0.430, 95% C.I: 0.224-0.825, p = 0.011 compared to Malay older women living in urban population. Within the rural population, respondents with chronic constipation OR: 3.384, 95% C.I: 1.556-7.360, p = 0.002 were found to be at a higher risk of UI. In terms of quality of life, respondents in rural areas experienced more role, physical, social, emotional limitations and sleep disturbance as compared to their urban counterparts (p < 0.05).
UI is more prevalent and had a more profound impact on quality of health among older women in the rural setting. The risk factors of UI were ethnicity and chronic constipation among urban and rural older women respectively. It is important to provide holistic strategies in the prevention and management of UI among older women especially within the rural population.
Salvage chemotherapy followed by high-dose therapy and autologous stem-cell transplantation (ASCT) is the standard treatment for relapsed diffuse large B-cell lymphoma (DLBCL). Salvage regimens have ...never been compared; their efficacy in the rituximab era is unknown.
Patients with CD20(+) DLBCL in first relapse or who were refractory after first-line therapy were randomly assigned to either rituximab, ifosfamide, etoposide, and carboplatin (R-ICE) or rituximab, dexamethasone, high-dose cytarabine, and cisplatin (R-DHAP). Responding patients received high-dose chemotherapy and ASCT.
The median age of the 396 patients enrolled (R-ICE, n = 202; R-DHAP, n = 194) was 55 years. Similar response rates were observed after three cycles of R-ICE (63.5%; 95% CI, 56% to 70%) and R-DHAP (62.8%; 95 CI, 55% to 69%). Factors affecting response rates (P < .001) were refractory disease/relapse less than versus more than 12 months after diagnosis (46% v 88%, respectively), International Prognostic Index (IPI) of more than 1 versus 0 to 1 (52% v 71%, respectively), and prior rituximab treatment versus no prior rituximab (51% v 83%, respectively). There was no significant difference between R-ICE and R-DHAP for 3-year event-free survival (EFS) or overall survival. Three-year EFS was affected by prior rituximab treatment versus no rituximab (21% v 47%, respectively), relapse less than versus more than 12 months after diagnosis (20% v 45%, respectively), and IPI of 2 to 3 versus 0 to 1 (18% v 40%, respectively). In the Cox model, these parameters were significant (P < .001).
In patients who experience relapse more than 12 months after diagnosis, prior rituximab treatment does not affect EFS. Patients with early relapses after rituximab-containing first-line therapy have a poor prognosis, with no difference between the effects of R-ICE and R-DHAP.
The Bottom of the Pyramid (BOP) market deserves further attention from researchers. The purpose of the paper is to profile the psychographic and behavioral heterogeneity within the BOP market in ...India employing a theoretical approach. We use constructs of the Theory of planned behavior (TPB) to identify distinct BOP segments. It segments the BOP market in the context of durable goods, non-durable goods, and services. The findings demonstrate the presence of three consumer segments, each of the durable and non-durable goods. In the context of services, the findings show the existence of four segments of BOP consumers. This study offers insights into application of behavioral theories for segmentation, which could help with behavioral change of BOP consumers to use high-quality products and services. Further, it is significant because the BOP market has witnessed a progressive decline in size as a large segment of the BOP market is being transformed into the middle class. Comprehension of the cognitive and behavioral tendencies of each consumer segment would strategically help in retaining the brand loyal BOP customers when they upgrade to the middle class.
The consequences of combined undernourishment and decreased physical performance in older adults are debilitating and increases cost of care. To date, the information regarding the association ...between nutritional status and physical performance does not provide a complete picture. Most studies used limited or self-reported measures to evaluate physical performance. The objective of this study was to examine the correlation between nutritional status and comprehensive physical performance measures among undernourished older adults who reside in residential institutions.
Forty-seven older adults (26 males, 21 females) aged ≥ 60 (69.23 ± 8.63) years who were identified as undernourished from two residential institutions participated in this study. A battery of physical performance tests (10 m gait speed test, dominant hand grip strength test, timed five-repetition sit-to-stand test, ten step test, arm curl test, scratch test, and respiratory muscle strength test), biochemical profiles (serum albumin, hemoglobin, serum ferritin, and prealbumin levels), and falls risk using the short-form Physiological Profile Approach were performed. The Functional Ability Questionnaire and Geriatric Depression Scale were also administered.
The results demonstrated that generally older adults with undernourishment scored poorly on the physical performance tests, had depression, and a high risk of falls. Biochemical results demonstrated that 10.9% of the participants were anemic, 63% had hypoalbuminemia (<3.5 g/dL), and 21.7% were at risk of protein energy malnutrition with prealbumin level (100-170 mg/L). A significant correlation (P<0.05) was demonstrated between hand grip strength and ferritin, between self-reported mobility dependence and prealbumin levels, and between self-reported mobility tiredness and body mass index.
These results confirm that older adults with undernutrition have poor physical function, higher falls risk, and depression. Clinically, overall health that includes nutritional status, physical function, and depression level should be taken into consideration in the assessment and treatment of older adults residing at residential institutions.
The aim of this study was to determine the concurrent validity and reliability of telerehabilitation (TR)-based evaluation of the cervical spine among adults with non-specific neck pain (NS-NP).
A ...total of 11 participants with NS-NP were recruited. Pain intensity, active range of motion (AROM), posture, deep neck flexor (DNF) endurance, combined neck movements and disability were measured using face-to-face and TR methods, with a one-hour break in between. TelePTsys, an image-based TR system, was used for TR assessment.
A high degree of concurrent validity for pain (bias = 0.90), posture (bias = 0.96°), endurance (bias = -2.3 seconds), disability (bias = 0.10), AROM (extension bias = -0.60 cm, flexion bias = 1.2 cm, side flexion bias = -1.00, rotation bias = -0.30 cm) was found. Standard error of measurement and coefficient of variation (CV) values were within the acceptable level for concurrent validity, except the CV for cervical flexion and endurance. There was a high degree of reliability demonstrated for pain, posture, AROM, endurance and disability measurements. The average-measure interclass correlation coefficient (ICC
) ranged from 0.96 to 0.99 for inter-rater, and 0.93 to 0.99 for intra-rater reliabilities. There was moderate agreement for combination movement for validity (78.5%,
< 0.05), inter- (78.5%,
< 0.05) and intra-rater (76.4%,
< 0.05) reliabilities.
TR-based physiotherapy assessment of cervical spine is a valid and reliable tool for measuring pain intensity, AROM, DNF muscle endurance, sagittal neck posture and disability among adults with NS-NP via telePTsys.
Physical performance and balance declines with aging and may lead to increased risk of falls. Physical performance tests may be useful for initial fall-risk screening test among community-dwelling ...older adults. Physiological profile assessment (PPA), a composite falls risk assessment tool is reported to have 75% accuracy to screen for physiological falls risk. PPA correlates with Timed Up and Go (TUG) test. However, the association between many other commonly used physical performance tests and PPA is not known. The aim of the present study was to examine the association between physiological falls risk measured using PPA and a battery of physical performance tests.
One hundred and forty older adults from a senior citizens club in Kuala Lumpur, Malaysia (94 females, 46 males), aged 60 years and above (65.77±4.61), participated in this cross-sectional study. Participants were screened for falls risk using PPA. A battery of physical performance tests that include ten-step test (TST), short physical performance battery (SPPB), functional reach test (FRT), static balance test (SBT), TUG, dominant hand-grip strength (DHGS), and gait speed test (GST) were also performed. Spearman's rank correlation and binomial logistic regression were performed to examine the significantly associated independent variables (physical performance tests) with falls risk (dependent variable).
Approximately 13% older adults were at high risk of falls categorized using PPA. Significant differences (P<0.05) were demonstrated for age, TST, SPPB, FRT, SBT, TUG between high and low falls risk group. A significant (P<0.01) weak correlation was found between PPA and TST (r=0.25), TUG (r=0.27), SBT (r=0.23), SPPB (r=-0.33), and FRT (r=-0.23). Binary logistic regression results demonstrated that SBT measuring postural sways objectively using a balance board was the only significant predictor of physiological falls risk (P<0.05, odds ratio of 2.12).
The reference values of physical performance tests in our study may be used as a guide for initial falls screening to categorize high and low physiological falls risk among community-dwelling older adults. A more comprehensive assessment of falls risk can be performed thereafter for more specific intervention of underlying impairments.
This article reports for the first time a phoretic pygmephorid mite on a muscid fly from India, with pygmephorid mites classified under the order Prostigmata and the family Pygmephoridae. The mites, ...identified as species of the genus Pediculaster belonging to the family Pygmephoridae, were collected in July 2019 from Khajjiar town, located in the Chamba district of Himachal Pradesh, India. The flies, identified as Musca crassirostris belonging to the family Muscidae, were also noted. While this study marks a significant step in Indian research, further investigation is warranted to comprehensively compile data on the species accuracy of mites and their habitat preferences.
Negative-pressure therapy has recently been used over closed incisions to decrease surgical-site occurrences, including infection and dehiscence. A meta-analysis was performed to evaluate the ...effectiveness of closed incision negative-pressure therapy in lowering the incidence of surgical-site infections compared with standard dressings.
A literature search was conducted to find publications comparing closed incision negative-pressure therapy to standard incisional care. A fixed-effects model was used to assess between-study and between-incision location subgroup heterogeneity and effect size. Funnel plots were used to assess publication bias.
The overall weighted average rates of surgical-site infection in the closed incision negative-pressure therapy and control groups were 6.61 percent and 9.36 percent, respectively. This reflects a relative reduction in surgical site infection rate of 29.4 percent. A decreased likelihood of surgical-site infection was evident in the closed incision negative-pressure therapy group compared with the control group across all studies, and across all four incision location subgroups. Across all studies, odds of surgical-site infections decreased 0.564 (p < 0.00001). After excluding groin incision studies because of heterogeneity following sensitivity analysis, the odds of surgical-site infection decrease was still 0.496 (p < 0.00001). In addition, overall rates of dehiscence in closed incision negative-pressure therapy and control groups were 5.32 percent and 10.68 percent, respectively.
The results of this meta-analysis suggest that closed incision negative-pressure therapy is a potentially effective method for reducing surgical-site infections. It also appears that closed incision negative-pressure therapy may be associated with a decreased incidence of dehiscence, but the published data available were too heterogeneous to perform meta-analysis.
Abstract Objective The objective of this study was to quantify the effectiveness of virtual reality balance games (VRBG) to decrease risk and fear of falls among women. Methods Thirty six community ...dwelling women aged 56 and above were randomly divided into experimental (exercises using VRBG focus on improving balance) and control (conventional balance exercises) groups. Both groups attended a twice 6 weekly exercise session for an hour. Risk and fear of falls were measured with Physiological Profile Approach (PPA) and Activity Specific Balance Scale (ABC-6). Pre and post intervention differences between the groups were examined using two way repeated measures ANOVA. Results Both VRBG and conventional balance exercise groups had significant decrease in PPA ( p < 0.001) and ABC-6 ( p < 0.01) after the interventions. However, no significant effects were demonstrated between the groups in PPA ( p = 0.18) and ABC-6 ( p = 0.25) post intervention. Time and group interaction effect were not significant for PPA ( p = 0.18) and ABC-6 ( p = 0.45). Conclusions Practising VRBG can increase balance confidence and decrease risk of falls among community dwelling women.
Falls is a common and debilitating condition among the older population, intensifying the need to educate older persons about falls. Technology advancement enables effective and efficient delivery of ...falls education to the older population. However, there is paucity of information on the perception of Malaysian older population on falls and their preferred website characteristics such as font size, design, layout, colour, navigation, and use of graphics or videos. Physiological changes in vision, cognition and psychomotor skills can affect how the older persons use the website. As Malaysia is a multicultural country, the needs of the website characteristics and falls perception of older persons may differ greatly. The aim of this study was to explore the perceptions of the older persons about falls and their desired website characteristics. Twenty-five community-living older persons (n = 25) of age 60 years and above were involved in the focus group discussions. NvivoTM software was used for data management and thematic analysis was undertaken. Emerging themes included ’Perceptions of falls in older persons’, ’Actions taken when falls occurred’, ’Perceived prevention strategies for falls’ and ’End user requirements for falls educational website’. Falls were perceived as both an avoidable and a non-avoidable incident. Although the participants mentioned physical activity and home hazard modifications as strategies to prevent falls, they mainly discussed self-initiated precautionary approaches in falls prevention. Regarding desired website characteristics, the participants emphasized on easily readable text, appealing design, clear information, use of images/videos, and simple website navigation. Special requirements for colour selection and multi-language options were also raised. The delivery of falls education through website can be made possible by understanding the perception of older persons about falls and their requirements for the website. This is especially important as ethnic and cultural influences may play a role on their perceptions about falls and desired website characteristics.
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