Prognostic factors associated with clear cell sarcoma in 14 Chinese patients

PURPOSE. To identify prognostic factors associated with clear cell sarcomas in 14 Chinese patients. METHODS. Medical records of 7 men and 7 women (mean age, 36 years) with histologically confirmed clear cell sarcoma of tendons and aponeuroses were reviewed. Patient demographics, tumour characteristics, and treatment modalities were retrieved. Prognostic factors associated with favourable 5-year survival were determined. RESULTS. The most affected sites were the thigh (n=5) and the foot (n=4); the mean time from symptom onset to diagnosis was 9.5 months. The tumour stage at diagnosis was IIA in 8 patients, IIB in 2, and III in 4. The mean tumour size was 4.5 cm in diameter. One patient was lost to follow-up. For the remaining 13 patients, the mean time to disease-related mortality was 2.5 years. Nine patients had distant metastases; the most common sites were lungs and pleura (n=7), followed by distant lymph nodes (n=4), bone (n=2), pericardium (n=2), and brain (n=1). All patients underwent surgical excision. Three women and one man (mean age, 27 years) attained 5-year disease-free survival. All had stage IIA tumours at diagnosis. Their mean tumour size was 1.75 cm in diameter, which was significantly smaller than that of all patients (4.5 cm). Tumour size of ≤ 2.5 cm in diameter (p=0.004) and stage IIA tumour at diagnosis (p=0.04) were significant prognostic factors for 5-year survival. CONCLUSION. Tumour size of ≤ 2.5 cm and early stage tumour are associated with 5-year disease-free survival. Early detection is crucial for the prognosis of clear cell sarcomas.

Tea consumption and physical function in older adults: a cross-sectional study

BACKGROUND

Tea consumption has been reported to be associated with lowered risk of cardiovascular disease, stroke and osteoporosis that cause functional disability, but its association with physical function has not been investigated directly.

OBJECTIVE

We examined the association between tea consumption and performance in gait and balance, instrumental and basic activities of daily living (IADL and BADL) in a cross-sectional study of community-living older persons.

METHOD

Baseline data of 2398 adults aged ≥ 55 years in the Singapore Longitudinal Ageing Studies who completed self-reported current tea consumption, Performance Oriented Mobility Assessment (POMA) of gait and balance, and self reports of BADL and IADL were analyzed.

RESULTS

In multivariate analyses controlling for age, gender, education, housing type, co-morbidities, hospitalization, arthritis and hip fracture, GDS depression score, MMSE cognitive score, body mass index, creatinine, serum albumin, haemoglobin, physical activities score and coffee consumption, tea consumption was positively associated with better balance (β=0.06, p<0.01), gait (β=0.01, p=0.02), IADL (β=0.03, p=0.01) and BADL (β=0.01, p=0.05). Strongly positive associations were observed for black/oolong tea in multivariate analyses, and for green tea consumption only in univariate analysis, whereas coffee consumption was not associated at all.

CONCLUSIONS

Tea consumption was associated with better physical functional performances in community-living older adults.

Asymptomatic grade-2 central chondrosarcoma of the distal femur with non-aggressive radiological features

This paper discusses the case of a 57-year-old man with an incidental finding of a radiologically non-aggressive chondroid lesion and concomitant osteonecrosis in the left distal femur. The final resected specimen showed a grade-2 chondrosarcoma. This case illustrates that long-term follow-up is necessary for non-aggressive chondroid lesions. If surgical management is considered, resection with an adequate margin is superior to intralesional curettage.

Growth differentiation factor 15, ST2, high-sensitivity troponin T, and N-terminal pro brain natriuretic peptide in heart failure with preserved vs. reduced ejection fraction

AIMS

Growth differentiation factor 15 (GDF15), ST2, high-sensitivity troponin T (hsTnT), and N-terminal pro brain natriuretic peptide (NT-proBNP) are biomarkers of distinct mechanisms that may contribute to the pathophysiology of heart failure (HF) [inflammation (GDF15); ventricular remodelling (ST2); myonecrosis (hsTnT); and wall stress (NT-proBNP)].

METHODS AND RESULTS

We compared circulating levels of GDF15, ST2, hsTnT, and NT-proBNP, as well as their combinations, in compensated patients with clinical HF with reduced ejection fraction (HFREF) (n = 51), HF with preserved ejection fraction (HFPEF) (n= 50), and community-based controls (n = 50). Compared with controls, patients with HFPEF and HFREF had higher median levels of GDF15 (540 pg/mL vs. 2529 and 2672 pg/mL, respectively), hsTnT (3.7 pg/mL vs. 23.7 and 35.6 pg/mL), and NT-proBNP (69 pg/mL vs. 942 and 2562 pg/mL), but not ST2 (27.6 ng/mL vs. 31.5 and 35.3 ng/mL), adjusting for clinical covariates. In receiver operating characteristic curve analyses, NT-proBNP distinguished HFREF from controls with an area under the curve (AUC) of 0.987 (P < 0.001); GDF15 distinguished HFPEF from controls with an AUC of 0.936 (P < 0.001); and the combination of NT-proBNP and GDF15 distinguished HFPEF from controls with an AUC of 0.956 (P < 0.001). NT-proBNP and hsTnT levels were higher in HFREF than in HFPEF (adjusted P < 0.04). The NT-proBNP:GDF15 ratio distinguished between HFPEF and HFREF with the largest AUC (0.709; P < 0.001).

CONCLUSIONS

Our study provides comparative data on physiologically distinct circulating biomarkers in HFPEF, HFREF, and controls from the same community. These data suggest a prominent role for myocardial injury (hsTnT) with increased wall stress (NT-proBNP) in HFREF, and systemic inflammation (GDF15) in HFPEF.

A sarcoma of 23 years' duration: symptom duration is not a reliable parameter to exclude malignancy

This report describes a 31-year-old woman with a 23-year history of a right buttock mass that was otherwise asymptomatic, but was proven to be a low-grade fibromyxoid sarcoma (a fully malignant soft tissue tumour with a potential for distant metastasis). This case illustrates that a long-standing tumour does not necessarily imply a benign pathology. A vigilant approach should be taken for any tumours that are of significant size (larger than 5 cm).

Serum albumin and hemoglobin are associated with physical function in community-living older persons in Singapore

OBJECTIVES

Albumin and hemoglobin are viewed as markers of nutritional and inflammatory status. This study examined the associations of serum albumin and hemoglobin with physical function in community-living older adults.

DESIGN

Population-based cross-sectional and longitudinal study.

SETTING

The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore.

PARTICIPANTS

2762 older adults aged 55 and above assessed at baseline, and 1829 at follow up 1-2 years later.

MEASUREMENTS

Serum albumin and hemoglobin, Performance Oriented Mobility Assessment (POMA), knee extension strength at baseline, and Instrumental Activities of Daily Living (IADL) at baseline and follow up.

RESULTS

In cross-sectional multivariate analyses that adjusted for haemoglobin and other confounders, albumin showed a significant linear association (p<0.001) with POMA balance score (b=0.06, SE=0.02) and knee extension strength (b=0.70, SE=0.10). Independently of albumin, hemoglobin also showed a significant linear association with POMA balance score (b=0.09, SE=0.04). In longitudinal analyses, albumin was significantly associated with IADL decline (IADL total score drop>=1 during follow-up), OR= 0.92 (0.87 - 0.97), p=<0.01.

CONCLUSION

The findings suggest that low levels of albumin and hemoglobin are potentially useful risk markers of physical functional decline in older adults. Further research should investigate whether improvements in the levels of albumin and hemoglobin alter the level of functional disability and risk of functional decline.

Arthroscopic treatment of popliteal cyst

OBJECTIVE

To review the results of arthroscopic treatment of popliteal cysts in our centre and analyse outcomes including complications.

DESIGN

Retrospective study.

SETTING

University teaching hospital, Hong Kong.

PATIENTS

From July 2007 to July 2009, 11 patients with symptomatic popliteal cysts were treated arthroscopically. All of them had preoperative magnetic resonance imaging to confirm the diagnosis, identify the valvular opening, and the associated intra-articular pathology. We used the Rauschning and Lindgren criteria for evaluation.

RESULTS

Intra-articular pathology like cartilage degeneration and meniscus tear were commonly associated with popliteal cysts. All patients achieved symptomatic improvement after treatment and the recurrence rate was low. No major complications were encountered. We failed to identify (and correct) any valvular opening in one patient.

CONCLUSION

From our experience, we conclude that arthroscopic treatment of popliteal cyst with correction of the valvular opening and treatment of associated intra-articular pathology is effective and safe.

Osteomalacia: a case series of patients with atypical clinical orthopaedic presentations

Osteomalacia is uncommon in an affluent subtropical city like Hong Kong, where sunlight exposure is adequate and nutritional support is good. We present three patients who had osteomalacia with different presentations. A 74-year-old male with oncogenic osteomalacia presented with multiple bone pain. His biochemical markers returned to normal 4 days postoperatively after resection of a second toe giant cell tumour of tendon sheath. A 62-year-old woman with a history of liver problem and proximal muscle weakness was admitted with atraumatic fracture of the left distal humerus due to osteomalacia. An 81-year-old vegetarian woman with inadequate sun exposure complained of multiple bone pains. Subsequent investigation revealed dietary- and sunlight-deficient osteomalacia with multiple bony abnormalities including marked femur bowing.

The influence of childhood atopic dermatitis on health of mothers, and its impact on Asian families

This study examines maternal perceptions of paediatric atopic dermatitis (AD) on family and determines risk factors including severity of AD, maternal physical and mental health (MH), quality of life of patients and sociodemographics which predict a negative family impact. A cross-sectional assessment using the Dermatitis Family Impact Questionnaire Scale to assess the impact of AD on family, Infant's Dermatitis Quality of Life Index (<5-yrs old) or Children's Dermatitis Life Quality Index (5-17 yrs old) was used to measure health-related quality of life (HRQOL) of paediatric patients with AD. A 12-item Short-Form Health Survey (SF-12) was used to assess physical and MH of their mothers. Risk factors of adverse family impact were assessed using multiple regression analysis. One hundred and four patients with AD and their mothers were studied. Their mean ages (+/-s.d.) were respectively 6.4 +/- 4.3 and 37.2 +/- 6.6 yrs. In multiple regression analysis, Severity Scoring of Atopic Dermatitis (SCORAD) appeared to be associated with negative family impact and the association remained significant after adjustment for bio-psycho-social factors and HRQOL of patients. The association remained insignificant after adjustment for physical and MH of the mothers. Our results show that the severity of paediatric AD leads to negative family impact through reduction of physical and MH of the mothers, and is independent of patients' HRQOL and sociodemographics. The current approach for managing paediatric AD in Asian society could include early multidisciplinary intervention, aiming at enhancing physical and MH of mothers while minimizing negative impact on family and social isolation. Further research will be welcomed as the results of this study mainly applied to Asian society which could be different to populations from other geographic areas.

Inter- and intra-observer errors in identifying the transepicondylar axis and Whiteside's line

PURPOSE

To assess inter- and intra-observer errors in identifying the transepicondylar axis and Whiteside's line in a cadaveric model mimicking total knee arthroplasty.

METHODS

Four cadaveric knees with intact soft tissues were used. The knees were exposed anteriorly using the Insall approach, with the patella everted laterally. Three observers (2 surgeons and one trainee) took turns to identify the anatomic landmarks of the transepicondylar axis and Whiteside's line. Each observer repeated the process 20 times. Each identification was photographed and referenced with the true values obtained from the knees after they were stripped of all soft tissue. Inter- and intra-observer errors in the anatomic landmarks were compared.

RESULTS

Inter-observer error was significant with both the transepicondylar axis and Whiteside's line (p<0.001, one-way ANOVA). The intra-observer variation was greater for Whiteside's line than the transepicondylar axis (standard deviation, 4.2 vs 2.5 degrees). The maximum potential errors in the transepicondylar axis and Whiteside's line were 13 degrees and 24 degrees, respectively.

CONCLUSION

The accuracy of rotational alignment of the transepicondylar axis and Whiteside's line were operator-dependent, and their intra-operative reproducibility was low.

Hip pain many years after fusion: a report of two cases

Arthrodesis of the hip has been employed since the late 19th century. Late complications can arise decades after fusion in patients who were previously asymptomatic. We describe two patients who developed pain in the hip many years after a successful fusion. There was no infection or loosening of the implants. After careful investigation, including oblique radiographs and diagnostic injections of local anaesthetic, the pain was found to be caused by protrusion of the implant. Subsequent removal of the device resulted in complete resolution of the symptoms.

Differential item functioning of the Geriatric Depression Scale in an Asian population

BACKGROUND

The Geriatric Depression Scale (GDS) is widely used for screening and assessment of major depressive disorder (MDD). Screening scales are often culture-specific and should be evaluated for item response bias (synonymously differential item functioning, DIF) before use in clinical practice and research in a different population. In this study, we examined DIF associated with age, gender, ethnicity and chronic illness in a heterogeneous Asian population in Singapore.

METHODS

The GDS-15 and Structured Clinical Interview for DSM-IV diagnosis of MDD were independently administered by interviewers on 4253 non-institutionalized community living elderly subjects aged 60 years and above who were users of social service agencies. Multiple Indicator Multiple Cause latent variable modelling was used to identify DIF.

RESULTS

We found evidence of significant DIF associated with age, gender, ethnicity and chronic illness for 8 items: dropped many activities and interests, afraid something bad is going to happen, prefer staying home to going out, more problems with memory than most, think it is (not) wonderful to be alive, feel pretty worthless, feel (not) full of energy, feel that situation is hopeless.

LIMITATIONS

The smaller number of minority Indian and Malay subjects and the self-report of chronic medical illnesses.

CONCLUSIONS

In a heterogeneous mix of respondents in Singapore, eight items of the GDS-15 showed DIF for age, gender, ethnicity and chronic illness. The awareness and identification of DIF in the GDS-15 provides a rational basis for its use in diverse population groups and guiding the derivation of abbreviated scales.

The association between maternal depression and frequent non-routine visits to the infant's doctor--a cohort study

BACKGROUND

Perinatal depression is common, but women typically do not seek help for it. We studied its association with frequent non-routine physician visits, which may be a form of help-seeking behaviour.

METHODS

A prospective cohort study of women in their 34th to 38th week of pregnancy at the outpatient obstetrics clinic at a Singapore tertiary hospital was done. Screening was done using the Edinburgh Postnatal Depression Scale and diagnosis of major or minor depressive disorder was made using the SCID-IV. At 6 to 12 months' post-partum, women were screened and interviewed again for depression and asked to report the frequencies with which they had brought their infants to the doctor on non-routine visits in the preceding 6 weeks. Four hundred and seventy-one of the 559 patients recruited before delivery were re-interviewed.

RESULTS

After adjusting for confounders, women who had brought their infants for three or more non-routine visits to the infant's doctor had a significantly higher prevalence of depression (32.6%) than those with fewer visits (13.6%) (OR 2.87, 95% CI 1.41 to 5.85, p=0.004). The relative risk reduction for women who did not bring their infants for frequent non-routine visits was 0.583 (95% CI 0.44 to 0.73, p=0.002). They were also more likely to have poorer perceived emotional support from their families.

LIMITATIONS

These included use of self-reported doctor visits, and relatively high educational levels of the participants.

CONCLUSIONS

Doctors should have a high index of suspicion for enquiring about depression and emotional support in mothers who bring their infants for frequent non-routine visits.

COPD in Asia: where East meets West

COPD is a global health concern, and is a major cause of chronic morbidity and mortality worldwide. According to the World Health Organization, it is currently the sixth leading cause of death in the world, and further increases in the prevalence and mortality of the disease is predicted for the coming decades. These increases are mainly linked to the epidemic of tobacco exposure and indoor and outdoor air pollution in Asian countries. The burden of COPD in Asia is currently greater than that in developed Western countries, both in terms of the total number of deaths and the burden of disease, as measured in years of life lost and years spent living with disability. The types of health-care policies and the practice of medicine vary considerably among the regions of Asia and have an impact on the burden of disease. Treatment aims in Asian countries are based on evidence-based management guidelines. Barriers to the implementation of disease management guidelines are related to issues of resource conflict and lack of organizational support rather than cultural differences in medical practice. To reduce this burden of COPD in Asian countries, there is a need for a multifaceted approach in improving awareness of prevalence and disease burden, in facilitating accurate diagnosis of COPD among chronic respiratory diseases, in championing health policies that reduce the burden of the main risk factors for COPD and in the wider use of evidence-based management for COPD.

Subthreshold depression and cognitive impairment but not demented in stroke patients during their rehabilitation

BACKGROUND

Subthreshold depression (sD) and cognitive impairment but not demented (CIND) in stroke patients are associated with poorer rehabilitative outcomes. Their diagnosis can easily be operationalized using validated scales.

AIM

The aim of the study was to ascertain the prevalence of depressive symptoms and cognitive impairment in stroke patients during three crucial stages of the rehabilitative process, viz. upon admission, upon planned discharges from rehabilitation hospitals and at 6 months post-stroke, using validated scales like the Geriatric Depression Scale and Abbreviated Mental Test (recommended by the British Geriatric Society). Their baseline risk factors were also ascertained.

RESULTS

On admission, the prevalence of depressive symptoms and cognitive impairment was 60% and 54% respectively. The prevalence upon planned discharges and 6 months post-stroke, respectively, of depressive symptoms was 38% and 34% and that of impaired cognition was 33% and 40%. Baseline independent correlates at 6 months post-stroke depressive symptoms were: recurrent stroke (OR 3.34); on admission cognitive impairment (OR 4.78) and ADL dependence (OR 5.28). And that of cognitive impairment were: increasing age (OR 8.07); post-stroke dysphagia (OR 4.58); on admission cognitive impairment (OR 23.95) and on admission depressive symptoms (OR 3.50).

CONCLUSIONS

Continuous screening and appropriate intervention, especially at baseline, would significantly decrease the burden posed by stroke patients with such psychological impairments in the community.

Emotional and behavioural problems in Singaporean children based on parent, teacher and child reports

INTRODUCTION

This study aims to determine the prevalence of emotional and behavioural problems in a community sample of Singaporean children aged 6-12 years, and its agreement according to parent, teacher and child reports.

METHODS

The Child Behaviour Checklist (CBCL), Teacher Rating Form (TRF) and child report questionnaires for depression and anxiety were administered to a community sample of primary school children. 60 percent of the children sampled (n = 2,139) agreed to participate. Parents of a sub-sample of 203 children underwent a structured clinical interview.

RESULTS

Higher prevalence of emotional and behavioural problems was identified by CBCL (12.5 percent) than by TRF (2.5 percent). According to parent reports, higher rates of internalising problems (12.2 percent) compared to externalising problems (4.9 percent), were found. Parent-teacher agreement was higher for externalising problems than for internalising problems. Correlations between child-reported depression and anxiety, and parent and teacher reports were low to moderate, but were better for parent reports than for teacher reports.

CONCLUSION

The prevalence rates of emotional and behavioural problems in Singaporean children based on CBCL ratings are comparable to those in the West, but the low response rate and exclusion of children with special needs limit the generalisability of our findings. Singaporean children have higher rates of internalising problems compared to externalising problems, while Western children have higher rates of externalising problems compared to internalising problems.

Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method

We presented a simple and economic method of preparing articulating antibiotic-loaded cement spacers for treatment of infection after total knee arthroplasty. From 1996 to 2004, 28 infected total knee arthroplasties were treated with 2-stage reimplantation. Static spacers were used in 7 knees, and articulating spacers were used in 21 knees. A minimum of 2 years' follow-up after final treatment was evaluated. In the static group, 1 (14%) knee had recurrence of infection. In the articulating group, 2 (9%) knees had recurrence of infection with the original organism. Patients receiving articulating spacer had better range of motion, better knee score, and less bone loss than patients with static spacer.

Nutrition screening among community-dwelling older adults in Singapore

INTRODUCTION

This study aimed to describe responses to the DETERMINE checklist and the nutritional risk level of community-dwelling older Chinese in Singapore, aged 55 years and older.

METHODS

Data was collected from a community health screening project for elderly residents in Singapore. All residents aged 55 years and older in the survey area were identified in door-to-door census surveys and were invited to participate. Participants completed a questionnaire interview conducted by research nurses. The survey also included questions which were potential predictors of nutritional risk: sociodemographic factors (age, gender, education, housing type, marital status, and living arrangement) and health-related factors (self-rated health, number of medical comorbidities, hospitalisations in the past year, functional disabilities and physical health status).

RESULTS

Data for analysis was provided by 2,605 Chinese subjects aged between 55 and 98 years (mean/standard deviation 66.0/7.7). The overall prevalence of nutritional risk (according to a DETERMINE score of 3 or greater) was 30.1 percent. 1,822 (69.9 percent) subjects had no nutritional risk (scores of 2 or lower), 664 (25.5 percent) had moderate nutritional risk and 119 (4.6 percent) had high nutritional risk. The most common contributions to nutritional risks were: changing food intake due to illness (40.3 percent), taking three or more different medications daily (25.0 percent), eating alone (14.5 percent) and consuming insufficient amount of fruits, vegetables or milk products on a daily basis (9.0 percent). Respondents at nutritional risk were more likely to have three or more comorbid medical conditions, were hospitalised in the past year, were functionally dependent on one or more instrumental or basic activities of daily living, were reported to have poor or fair self-rated health, and were in the lowest tertile scores for SF-12 quality of life and depression.

CONCLUSION

Self-rated general health, lowered quality of life, functional disability and depression have meaningful non-circular associations with the checklist. These support the validity of the DETERMINE checklist in predicting the risk of adverse health conditions and events.

Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial

AIM

This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers.

BACKGROUND

Osteoarthritis of the knee is a major source of loss of function in older people. Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice.

METHOD

A randomized control trial was carried out from December 2002 to May 2003 and 120 participants (65.9%, including 67 in intervention group and 53 in control group) completed the 16-week postintervention assessments. Outcome measures included arthritis self-efficacy, use of self-management techniques, pain intensity and daily activity.

FINDINGS

At 16 weeks, there was a 'statistically' significant improvement in the arthritis self-efficacy level (P <or= 0.001), in most of the self-management skills, i.e. use of cold and hot compresses, in two of three joint protective practices (P <or= 0.001; P = 0.01), an increase in the duration of light exercise practice (P <or= 0.001), reduction of current arthritis pain (P <or= 0.001) and in the ability to perform daily activities (P <or= 0.001) among the intervention group but not for the control group (P-range from 0.04 to 0.95). One joint protective practice showed a statistically significant increase in both groups (P <or= 0.001).

CONCLUSION

Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes. Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness.

Sagittal pelvic mal-rotation and positioning of the acetabular component in total hip arthroplasty: Three-dimensional computer model analysis

Mal-rotation of pelvis on the sagittal plane, which is common in patients with fixed spinal kyhposis, for example, ankylosing spondylitis, can cause error in cup positioning when hip arthroplasty is performed. The present study was performed to quantify the effects of sagittal pelvic mal-rotation on the final cup position and to evaluate different methods of cup positioning to compensate for the mal-rotation. Three-dimensional reconstruction of computer tomograms of 15 sets of full pelvi was performed. Two methods of cup insertion were simulated and compared: a method mimicking genuine surgery (anatomical positioning) and one that compensates for the sagittal pelvic mal-rotation (functional positioning). Sagittal pelvic mal-rotation of more than 20 degrees , if ignored, resulted in a cup with an anterversion of more than 30 degrees and an inclination of more than 55 degrees. Half of the cup surface was not in contact with host bone when the cup position was maintained at 20 degrees anteversion and 45 degrees inclination in a patient with 50 degrees sagittal pelvic mal-rotation. The usual method of cup positioning may need to be modified in patients with sagittal pelvic mal-rotation in order to maintain the desired cup position. For each 10 degrees of sagittal pelvic mal-rotation beyond 20 degrees of mal-rotation, the cup needs to be put in such that it is 5 degrees less inclined and anteverted.

Prevalence of childhood asthma and control in children assessed in a pilot school-based intervention programme in Singapore

AIM

Because of a high childhood asthma burden in Singapore, assessment of disease control status is essential for formulating school-based strategy of childhood asthma control. The aim of the present study is to assess childhood asthma prevalence and control in Singapore and the socio-demographic and help-seeking correlates.

METHODS

School-based survey using parental self-administered questionnaire, conducted from February to April 2004. Four mixed-gender primary schools selected from geographically distinct zones of Singapore. All primary one (modal age - 6.5 years) and six (modal age - 11.9 years) students from selected schools were invited to participate. Questionnaire respondents were the students' parents or guardians. The response rate was 75.2% (2123/2825).

RESULTS

Prevalence of current asthma was 8.9% (190/2123). Among them, 26.3% (46/175) were assessed to have inadequate control. Asthma was more prevalent, and less adequately controlled in children from lower socio-economic backgrounds (lower-end housing type). Children with poorly controlled asthma were more likely to be treated by emergency room physicians and hospital specialists, and to be on preventer medications.

CONCLUSIONS

In Singapore, poor asthma control is found in a sizeable proportion of school children with asthma, is identifiable for high-risk groups of children from lower socio-economic backgrounds and having asthma-related attendance at the emergency rooms.

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.

Coronal bowing of the femur and tibia in Chinese: its incidence and effects on total knee arthroplasty planning

PURPOSES

To study the incidence of femoral or tibial bowing in the coronal plane in a Chinese population, and how it affects the accuracy of bone cuts for total knee replacement when an intramedullary alignment system is used.

METHODS

Standing radiographs of the entire lower limb of each patient with end-stage primary osteoarthritis of the knee were analysed. All radiographs were digitised and the extent of bowing in the coronal plane measured. A bowing was marked if an angulation was more than 2 degrees. The projected error of cutting was then calculated.

RESULTS

Of 93 lower limbs, 58 (62%) of the femurs had marked bowing in the coronal plane; 41 (44%) had a mean lateral bowing of 5.3 (standard deviation [SD], 3.2) degrees; 17 (18%) had a mean medial bowing of 4.4 (SD, 1.9) degrees. Marked tibial bowing in the coronal plane was less common (30 tibias, 32%). If a cutting error of more than 2 degrees was considered unacceptable, significantly more unacceptable cuts would ensue in the groups with marked bowing (p=0.003 for femurs and p<0.001 for tibia, respectively).

CONCLUSION

The incidence of femoral or tibial bowing in the coronal plane was high in a Chinese population with end-stage osteoarthritis of the knee. This phenomenon may increase bone cut errors in total knee replacement if an intramedullary alignment system is used and the extent of bowing is not recognised.