Factors related to urinary incontinence among the Malaysian elderly

Background

Urinary incontinence is a prevalent condition in the elderly that is the spontaneous leakage of urine. It is an age-related problem and increases especially in people aged above 65 years. It can cause many psychological, behavioral, biological, economic and social effects. The treatment of urinary incontinence can reduce morbidity and mortality. Thus, this study aimed to determine the effects of variables including age, ethnicity, gender, education, marital status, body weight, blood elements and nutritional parameters on urinary incontinence among the Malaysian elderly.

Methods

The study was on 2322 non-institutionalized Malaysian elderly. The hierarchy logistic regression analysis was applied to estimate the risk of independent variables for urinary incontinence among respondents.

Results

The findings indicated that approximately 3.80% of subjects had urinary incontinence. In addition, constipation was found a significant factor that increased the risk of urinary incontinence in samples (p=0.006; OR=3.77). The increase in dietary monounsaturated fat (p=0.038; OR=0.59) and plasma triglyceride levels (p=0.029; OR=0.56) significantly reduced the risk of incontinence in subjects. Many of suspected variables including socio-demographic factors, diseases, nutritional minerals, blood components and body weight were non-relevant factors to urinary incontinence in respondents.

Conclusions

Constipation increased the risk of urinary incontinence in subjects, and increase in dietary monounsaturated fat and plasma triglyceride levels decreased the risk.

     

A recombinant antigen-based IgG4 ELISA for the specific and sensitive detection of Brugia malayi infection

An IgG4 ELISA based on a novel recombinant antigen was evaluated for detection of Brugia malayi infection, using 2487 sera from various institutions: 2031 samples from Universiti Sains Malaysia, 276 blinded sera from 2 other institutions in Malaysia, 140 blinded sera from India and 40 blinded sera from Thailand. These sera were from various groups of individuals, i.e., microfilaraemics, chronic patients, endemic normals, non-endemic normals and individuals with other parasitic and bacterial infections. Based on a cut-off optical density reading of 0.300, the IgG4 ELISA demonstrated specificity rates of 95.6-100%, sensitivity rates of 96-100%, positive predictive values of 75-100% and negative predictive values of 98.9-100%. These evaluation studies demonstrated the high specificity and sensitivity of this test for the detection of active B. malayi infection. Thus, the IgG4 ELISA would be very useful as a tool in diagnosis and in elimination programmes for brugian filariasis.     

Self-perceived depression, anxiety, stress and their relationships with psychosocial job factors in male automotive assembly workers

Depression, anxiety and stress have been recognized as important mental outcome measures in stressful working settings. The present study explores the prevalence of self-perceived depression, anxiety and stress; and their relationships with psychosocial job factors. A cross-sectional study involving 728 male automotive assembly workers was conducted in two major automotive assembly plants in Malaysia using the validated Malay versions of the Depression Anxiety Stress Scales (DASS) and Job Content Questionnaire (JCQ). Based on the DASS cut-off of > or =78 percentile scores, the prevalence of self-perceived depression, anxiety and stress was 35.4%, 47.2% and 31.1%, respectively. Four (0.5%), 29 (4.0%) and 2 (0.3%) workers, respectively, reported extremely severe self-perceived depression, anxiety and stress. Multiple linear regression analyses, controlling for age, education, salary, duration of work and marital status, revealed that psychological job demand, job insecurity and hazardous condition were positively associated with DASS-Depression, DASS-Anxiety and DASS-Stress; supervisor support was inversely associated with DASS-Depression and DASS-Stress. We suggest that reducing psychological job demand, job insecurity and hazardous condition factors may improve the self-perceived depression, anxiety and stress in male automotive assembly workers. Supervisor support is protective for self-perceived depression and stress.     

Validation of a method to replace frozen section during parathyroid exploration by using the rapid parathyroid hormone assay on parathyroid aspirates

HYPOTHESIS: The parathyroid hormone (PTH) content of tissue aspirates is an accurate indicator of parathyroid tissue and can replace frozen section during parathyroid surgery. DESIGN AND SETTINGS: Prospective data collection in a tertiary care hospital with a single surgeon. PATIENTS: One hundred sixty-seven consecutive patients completing limited parathyroid explorations. INTERVENTIONS: Parathyroid adenomas removed during limited parathyroid exploration were aspirated through a 22-gauge needle into 0.5 mL isotonic sodium chloride solution and the solution held on ice in a purple-top tube. Aspirates of in situ thyroid tissue were also taken for comparison. Samples were then assessed to monitor the physiologic impact of the surgery. MAIN OUTCOME MEASUREMENTS: The PTH content of tissue aspirates was compared with histologic identification of removed putative parathyroid tissue. RESULTS: Elevated tissue PTH content was associated with the identification of origin as parathyroid in every case. Tissue aspirates from pathologically proven parathyroid tissue had a mean PTH level of at least 1691 pg/mL, with 160 having values exceeding the upper limit of the assay. This measure was significantly higher than values obtained from thyroid aspirates, which had a mean PTH level of 88 pg/mL (P<.01), reflective of blood levels at the time of aspiration. Using the 99% confidence interval of histologically confirmed parathyroid glands as the lower limit of a positive test result at 1610 pg/mL, tissue aspirate PTH assay has a sensitivity of 97% and a specificity of 100%. CONCLUSIONS: Positive identification of removed tissue as parathyroid is necessary adjunct to limited parathyroid exploration, where decreases in false positive blood PTH levels can be a result of operative manipulation of the neck. Analysis of tissue PTH content during the same assay that is being used for assessing blood PTH concentration is an efficient and accurate method for identifying the tissue with certainty. This measure also prevents the occasional ambiguity in frozen sections of parathyroid tissue that apparently contain thyroidlike colloid material.     

Effect of Kaolin Geopolymer Ceramics Addition on the Microstructure and Shear Strength of Sn-3.0Ag-0.5Cu Solder Joints during Multiple Reflow

Solder interconnection in three-dimensional (3D) electronic packaging is required to undergo multiple reflow cycles of the soldering process. This paper elucidates the effects of multiple reflow cycles on the solder joints of Sn-3.0Ag-0.5Cu (SAC305) lead (Pb)-free solder with the addition of 1.0 wt.% kaolin geopolymer ceramics (KGC). The samples were fabricated using powder metallurgy with the hybrid microwave sintering method. Apart from using conventional cross-sectioned microstructure imaging, advanced synchrotron real-time in situ imaging was used to observe primary IMC formation in SAC305-KGC solder joints subjected to multiple reflow soldering. The addition of KGC particles in SAC305 suppressed the Cu₆Sn₅ IMC’s growth as primary and interfacial layers, improving the shear strength after multiple reflow soldering. The growth rate constant for the interfacial Cu₆Sn₅ IMC was also calculated in this study. The average growth rate of the primary Cu₆Sn₅ IMCs decreased from 49 µm/s in SAC305 to 38 µm/s with the addition of KGC particles. As a result, the average solidified length in the SAC305-KGC is shorter than SAC305 for multiple reflow soldering. It was also observed that with KGC additions, the growth direction of the primary Cu₆Sn₅ IMC in SAC305 changed from one growth to two growth directions. The observed results can be attributed to the presence of KGC particles both at grains of interfacial Cu₆Sn₅ IMCs and at the surface of primary Cu₆Sn₅ IMC.     

Properties of PEMA-NH4CF3SO3 Added to BMATSFI Ionic Liquid

Polymer electrolyte films, comprising ammonium trifluoromethanesulfonate salt and butyl-trimethyl ammonium bis(trifluoromethylsulfonyl)imide ionic liquid immobilized in poly (ethyl methacrylate) was studied. Structural, morphological, thermal and electrical properties of the polymer electrolyte films were investigated by differential scanning calorimetry, scanning electron microscopy, and impedance spectroscopy, respectively. Interactions of the salt and ionic liquid with the host polymer were investigated by Fourier transform infra-red spectroscopy. Electrochemical stability of the electrolytes was determined using linear sweep voltammetry and transference numbers corresponding to ionic transport has been evaluated by means of the Wagner polarization technique. The highest conductivity achieved is in the order of 10⁻⁴ S cm⁻¹ for the film added with 35 wt % butyl trimethylammonium bis (trifluoromethanesulfonyl)imide. The film has high amorphicity and low glass transition temperature of 2 °C. The film is electrochemically stable up to 1.8 V. The ion transference number in the polymer film is 0.82 and the conductivity behavior obeys Vogel-Tamman-Fulcher equation.     

Rome III survey of irritable bowel syndrome among ethnic Malays

AIM: To survey irritable bowel syndrome (IBS) using Rome III criteria among Malays from the north-eastern region of Peninsular Malaysia.METHODS: A previously validated Malay language Rome III IBS diagnostic questionnaire was used in the current study. A prospective sample of 232 Malay subjects (80% power) was initially screened. Using a stratified random sampling strategy, a total of 221 Malay subjects (112 subjects in a “full time job” and 109 subjects in “no full time job”) were recruited. Subjects were visitors (friends and relatives) within the hospital compound and were representative of the local community. Red flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated questionnaires. Subjects with IBS were sub-typed into constipation-predominant, diarrhea-predominant, mixed type and un-subtyped. Univariable and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with IBS.RESULTS: IBS was present in 10.9% (24/221), red flags in 22.2% (49/221) and psychosocial alarm features in 9.0% (20/221). Red flags were more commonly reported in subjects with IBS (83.3%) than psychosocial alarm features (20.8%, P < 0.001). Subjects with IBS were older (mean age 41.4 years vs 36.9 years, P = 0.08), but no difference in gender was noted (P = 0.4). Using univariable analysis, IBS was significantly associated with a tertiary education, high individual income above RM1000, married status, ex-smoker and the presence of red flags (all P < 0.05). In multiple logistic regression analysis, only the presence of red flags was significantly associated with IBS (odds ratio: 0.02, 95%CI: 0.004-0.1, P < 0.001). The commonest IBS sub-type was mixed type (58.3%), followed by constipation-predominant (20.8%), diarrhea-predominant (16.7%) and un-subtyped (4.2%). Four of 13 Malay females (30.8%) with IBS also had menstrual pain. Most subjects with IBS had at least one red flag (70.8%), 12.5% had two red flags and 16.7% with no red flags. The commonest red flag was a bowel habit change in subjects > 50 years old and this was reported by 16.7% of subjects with IBS.CONCLUSION: Using the Rome III criteria, IBS was common among ethnic Malays from the north-eastern region of Peninsular Malaysia.     

The nutritional status of children in resettlement villages in Kelantan

A cross-sectional survey of the nutritional status of children aged 1-10 years old from the Kuala Betis resettlement villages was carried out. A total of 620 children were examined, of which 329 were preschool children and 291 were schoolchildren. The age was determined and anthropometric measurements such as weight, height and MUAC were taken. The nutritional status was assessed by looking at the distributions of the z-scores of weight-for-age (WAZ), height-for-age (HAZ) and weight-for-height (WHZ) in relation to the growth charts of the National Center for Health Statistics reference population. It was found that the nutritional status of the Orang Asli children was poor, with a prevalence of 33.7-65.3% underweight, 55.3-74.4% stunting and 4.4-29.7% wasting based on the NCHS reference values. The prevalence of malnutrition among the Malay children was lower, underweight--7.3-34.1%, stunting--9.8-34.1% and wasting--1.7-17.1%. The nutritional status of the Orang Asli children were poorer compared to the Malay children. More preschool Orang Asli children were stunted compared to the Orang Asli schoolchildren. This may be due to the poor economic base of the Orang Asli community during the transformation period after resettlement. A comprehensive primary health care program is essential, especially targeting the preschool Orang Asli children in these resettlement villages.     

Postural blood pressure electrocardiographic changes are associated with falls in older people

Objectives

To determine the magnitude of postural blood pressure change, differences in ECG between fallers and non-fallers were measured. Postural blood pressure change is associated with symptoms of dizziness, presyncope, and syncope.

Methods

In this cross-sectional study were included participants from The Malaysian Falls Assessment and Intervention Trial: fallers, aged 65 years or older with two or more falls or one injurious fall in 12 months, from a teaching hospital; and non-fallers, aged 65 years and older found through word-of-mouth and advertising. Noninvasive beat-to-beat blood pressure was measured at 10 min supine rest and 3 min standing. The maximal drop in systolic and diastolic pressure was calculated from a 12-lead ECG interpreted by a cardiologist. Basic demographics, medical history, and symptoms of dizziness, presyncope, and syncope were recorded for all patients.

Results

We recruited 155 fallers and 112 non-fallers. Fallers had a significantly longer PR interval (179 ± 32 vs. 168 ± 27 ms, p = 0.013) and a longer corrected QT interval (449 ± 41 vs. 443 ± 39 msec, p = 0.008), and larger change in SBP (28 ± 14 vs. 19 ± 9 mmHg, p < 0.001) with posture change. SBP drop of ≥30mmHg associated with recurrent and injurious falls [odds ratio [95 % confidence interval] = 7.61 (3.18–18.21)]. The changes remained significant after adjustment for symptoms of dizziness, presyncope and syncope.

Interpretation

Older individuals with recurrent and injurious falls have significantly longer PR and QT intervals and larger SBP reduction with posture change as compared to non-fallers, and these are not explained by the presence of dizziness, presyncope, or syncope. SBP cut-off of ≥30mmHg considered for postural measurements using continuous BP monitors, the significance of this value needs to be evaluated.

     

Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk

The term polypharmacy has negative connotations due to its association with adverse drug reactions and falls. This spectrum of adverse events widens when polypharmacy occurs among the already vulnerable geriatric population. To date, there is no consensus definition of polypharmacy, and diverse definitions have been used by various researchers, the most common being the consumption of multiple number of medications. Taking multiple medications is considered a risk factor for falls through the adverse effects of drug–drug or drug–disease interactions. Falls studies have determined that taking ≥ 4 drugs is associated with an increased incidence of falls, recurrent falls, and injurious falls. In light of existing evidence, careful and regular medication reviews are advised to reduce the effect of polypharmacy on falls. However, intervention studies on medication reviews and their effectiveness on falls reduction have been scarce. This article reviews and discusses the evidence behind polypharmacy and its association with falls among older individuals, and highlights important areas for future research.