The effectiveness of an integrated pain management program for older persons and staff in nursing homes

This study examined the effects of an 8-week integrated pain management program (IPMP) on enhancing the knowledge and attitude toward pain management among staff; and improving the pain, quality of life, physical and psychosocial functions, and use of non-drug therapies for the elderly in nursing homes. Nursing home staff (N=147) and residents (N=535) were recruited from ten nursing homes. Nursing homes were randomly assigned into an experimental group (N=296) with IPMP or control group (N=239) without IPMP. The IPMP consisted of pain education for staff and physical exercise and multisensory stimulation art and craft therapy for residents. Data were collected before and after the IPMP. The staff demonstrated a significant improvement in knowledge and attitude to pain management, with the survey score increasing from 8.46±3.74 to 19.43±4.07 (p<0.001). Among the residents, 74% had experienced pain within the previous 6 months, with pain intensity of 4.10±2.20. Those in the experimental group showed a significantly better reduction in pain scores than the control group, from 4.19±2.25 to 2.67±2.08 (p<0.001). Group differences were also found in psychological well-being, including happiness, loneliness, life satisfaction and depression (p<0.05), and the use of non-drug methods (p<0.05). These results suggested that IPMP is beneficial for staff, and is effective in reducing geriatric pain and negative impacts. Management support and staff involvement in the program are important for its long-term continuation.     

Identification of new CRF51_01B in Singapore using full genome analysis of three HIV type 1 isolates

A recent HIV-1 molecular epidemiology survey in Singapore identified a novel CRF01_AE/B recombinant form, which accounted for 13 (11.9%) of 109 patient samples. Peripheral blood mononuclear cell DNA from three of these 13 patients was used to generate near full-length sequences to characterize the novel CRF01_AE/B recombinant form. The three isolates had a recombinant structure composed of CRF01_AE and subtype B, and shared identical breakpoints. As the three patients were not epidemiologically linked, this recombinant form has been designated CRF51_01B. Identification of the novel recombinant forms indicates ongoing active HIV-1 transmission in Singapore.     

Chlamydia trachomatis infection among HIV-infected women attending an AIDS clinic in the city of Manaus,Brazil

This was a cross-sectional study aimed to determine the prevalence of and to identify risk factors for Chlamydia trachomatis (CT) among human immunodeficiency virus (HIV)-infected women attending the acquired immunodeficiency syndrome (AIDS) clinic in the city of Manaus, Brazil, in 2009-2010. Participants answered a questionnaire containing demographic, epidemiological, and clinical data. A genital specimen was collected during examination to detect CT-DNA by hybrid capture, and blood samples were taken to determine CD4⁺T and HIV viral load. There were 329 women included in the study. Median age was 32 years (IQR = 27-38) and median schooling was nine years (IQR = 4-11). The prevalence of CT was 4.3% (95%CI: 2.1-6.5). Logistic regression analysis showed that age between 18-29 years [OR = 4.1(95%CI: 1.2-13.4)] and complaint of pelvic pain [OR = 3.7 (95%CI: 1.2-12.8)] were independently associated with CT. The use of condom was inversely associated with CT [OR = 0.39 (95%CI: 0.1-0.9)]. The results showed that younger women who did not use condoms are at a higher risk for CT. Screening for sexually transmitted infections must be done routinely and safe sexual practices should be promoted among this population.     

Limited knowledge of chronic kidney disease among primary care patients – a cross-sectional survey

Background

Kidney disease is the 9th leading cause of death in Singapore. While preventive effects have focused on early detection and education, little is known about the knowledge level of chronic kidney disease (CKD) locally. We seek to evaluate the knowledge of CKD among primary care patients.

Methods

We conducted a cross-sectional survey of a convenience sample of 1520 patients from 3 primary care centers. Those with existing CKD or on dialysis were excluded. Knowledge was assessed based on 7 questions on CKD in the self-administered questionnaire. One point was given for each correct answer with a maximum of 7 points.

Results

1435 completed all 7 questions on CKD. Mean age was 48.9 ±15.0 (SD) years. 50.9% were male. 62.3% had a secondary and below education and 52.4% had a monthly household income of????$2000. 43.7% had chronic diseases. Mean score was 3.44?±?1.53 (out of a maximum of 7). Median score was 4. In multivariate logistic regression, being older {>60?years [Odds Ratio (OR) 0.50, 95% Confidence Interval (CI) 0.32-0.79]; 40?C60?years (OR 0.62, 95% CI 0.43,0.89)}, less educated [up to primary education (OR 0.33, 95% CI 0.22-0.49)], having a lower monthly household income [<S$2000 (OR 0.41, 95% CI 0.26-0.66); S$2000-4999 (OR 0.53, 95%CI, 0.33-0.83)], and being non-professionals [OR 0.66, 95% CI 0.43-0.99] (all p?<?0.05)] were likely to score less.

Conclusion

This suggests that CKD education should be targeted at older patients with lower education and lower socioeconomic status.