Introduction: To determine the relationship between participation in supervised and unsupervised therapy, and predictors of participation in supervised therapy during the first post-stroke year. Materials & Methods: Design: Prospective longitudinal study with interviews at admission, discharge, one month, six months and one year after discharge. Setting: Two subacute inpatient rehabilitation units and the community after discharge in Singapore. Participants: 215 subacute non-aphasic stroke patients. Intervention: Participation rate in supervised therapy (at outpatient rehabilitation centres) and unsupervised therapy (at home) defined as proportion of time spent performing therapy as prescribed by the subacute hospital’s multidisciplinary rehabilitation team at discharge. Main Outcome Measure: Predictors of participation in supervised and unsupervised therapy. Results: Patients who participated in supervised therapy (i.e. at an outpatient rehabilitation centre) >25% of the time recommended were more likely to participate in unsupervised therapy (i.e. at home) >75% of the time recommended at one, six and 12 months (crude odds ratio, OR = 4.41 [95%CI:2.09–10.17], 4.45 [95%CI:2.17–9.12], 6.93 [95%CI:2.60–18.48] respectively). Greater participation in supervised therapy at one and six months independently predicted greater participation in supervised therapy at six (adjusted OR=11.64 [95%CI:4.52-29.97]) and twelve months (adjusted OR=76.46 [95%CI:12.52-466.98]) respectively. Caregiver availability at six months independently predicted poorer participation in supervised therapy at 12 months. Conclusion: Interventions to increase participation in supervised therapy in the first post-stroke year should focus on transition of care in the first month after discharge. Further studies are needed to understand why caregiver availability was associated with low participation in supervised therapy.

INTRODUCTIONSexually transmitted infections have increased sharply among adolescents both locally and internationally in recent years. Parents play an important role in their children's sexual health development. An integral part of this includes effective parent-child sexuality communication.

MATERIALS AND METHODSA nationwide cross-sectional community-based household survey was conducted in Singapore between August 2008 and March 2009 to assess parents'/caregivers' attitudes and practices regarding caregiver-child sexuality communication. With an overall response rate of 81.4%, 1169 questionnaires from parents/caregivers of children aged 10 to 17 years were analysed.

RESULTSAlmost all (94.2%) the caregivers were parents. A majority (>80%) of caregivers considered talking to their children about sexuality issues such as abstinence, consequences of premarital sex and condom use as important. However, a significantly lower percentage (about 60%) felt comfortable and confident doing so. Only 8.3% among them discussed sexual health issues with their children very often, 37.2% sometimes, 22.0% seldom/hardly ever (once or twice) and 32.5% never, in the past year. In the multivariate analysis, caregiver-child sexuality communication was significantly associated with caregivers' relationship to children, ethnicity, educational level, and their perceived levels of comfort and confidence in sexuality communication.

CONCLUSIONCaregivers generally felt it was important but were significantly much less comfortable and confident talking about sexuality issues with their children, which leads to a lower frequency of caregiver-child sexuality communication. Educational programmes on adolescent sexual health targeting parents/caregivers are needed. They must be equipped with skills and provided with resources to enable them to talk to their adolescent children about sexuality.

Adolescent ; Adolescent Behavior ; Communication ; Condoms ; utilization ; Cross-Sectional Studies ; Data Collection ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Parenting ; psychology ; Residence Characteristics ; Sex Education ; methods ; Sexual Abstinence ; Sexuality ; Singapore ; Statistics as Topic

Caregivers are important in post-stroke rehabilitation, but little work has been done on the caregivers of stroke survivors in Asian cultures. We examined the association between patient profile (age, gender, socioeconomic status, functional level, religion, and ethnicity) and caregiver availability, number of potential caregivers and primary caregiver identity amongst Singaporean community hospitals' stroke patients. Data was obtained from all Singaporean community hospitals from 1996-2005. 3796 patients fulfilled inclusion criteria. Mixed logistic regression identified independent predictors of caregiver availability and primary caregiver identity. Mixed Poisson modelling identified independent predictors of the number of caregiver(s). Among recent stroke survivors, 95.8% (3640/3796) had potential caregivers, of which 94.2% (3429/3640) had identified primary caregivers. Of the latter, 41.2% relied on live-in hired help (foreign domestic workers-FDWs), 27.6% on spouses and 21.6% on first-degree relatives. Independent patient factors associated with caregiver availability and number were older, female, married, higher socioeconomic status, having a religion and lower functional level at admission. Independent patient factors associated with FDW caregivers were older age, female, Chinese compared to Malay, with higher socioeconomic class and lower functional level at admission. Caregiver availability for post-stroke patients in Singapore community hospitals is relatively high, with heavy dependence on FDWs.

INTRODUCTION: Primary healthcare providers play a crucial role in educating their patients on chronic disease self-management (CDSM). This study aims to evaluate CDSM competency and satisfaction in patients receiving their healthcare from public or private healthcare providers. METHODS: A cross-sectional household study was conducted in a public housing estate using a standardised questionnaire to interview Singaporeans and permanent residents aged 40 years and above, who were diagnosed with at least 1 of these chronic diseases: hyperlipidaemia, hypertension or diabetes mellitus. CDSM competency was evaluated with the Partners In Health (PIH) scale and a knowledge based questionnaire. Satisfaction was evaluated using a satisfaction scale. RESULTS: In general, the 420 respondents demonstrated good CDSM competency, with 314 followed up at polyclinics and 106 by general practitioners (GPs). There was no significant difference between patients of polyclinics and GPs in CDSM competency scores (mean PIH score 72.9 vs 75.1, P=0.563), hypertension knowledge scores (90.9 vs 85.4, P=0.16) and diabetes knowledge scores (84.3 vs 79.5, P=0.417), except for hyperlipidaemia knowledge scores (78.6 vs 84.7, P=0.043). However, respondents followed up by GPs had higher satisfaction rates than did those followed up at polyclinics (odds ratio 3.6, confidence interval 2.28-5.78). Favourable personality of the doctors and ideal consultation duration led to higher satisfaction in the GP setting. A longer waiting time led to lower satisfaction in the polyclinic group. CONCLUSION Polyclinics and GPs provide quality primary care as evidenced by high and comparable levels of CDSM competency. Redistribution of patients from public to private clinics may result in improvements in healthcare service quality.

INTRODUCTIONLittle data is available on community hospital admissions. We examined the differences between community hospitals and the annual trends in sociodemographic characteristics of all patient admissions in Singaporean community hospitals over a 10- year period from 1996 to 2005.

MATERIALS AND METHODSData were manually extracted from medical records of 4 community hospitals existent in Singapore from 1996 to 2005. Nineteen thousand and three hundred and sixty patient records were examined. Chisquare test was used for univariate analysis of categorical variables by type of community hospitals. For annual trends, test for linear by linear association was used. ANOVA was used to generate beta coefficients for continuous variables.

RESULTSMean age of all patient admissions has increased from 72.8 years in 1996 to 74.8 years in 2005. The majority was Chinese (88.4%), and female (58.1%) and admissions were mainly for rehabilitation (88.0%). Almost one third had foreign domestic workers as primary caregivers and most (73.5%) were discharged to their own home. There were significant differences in socio-demographic profile of admissions between hospitals with one hospital having more patients with poor social support. Over the 10-year period, the geometric mean length of stay decreased from 29.7 days (95% CI, 6.4 to 138.0) to 26.7 days (95% CI, 7.5 to 94.2), and both mean admission and discharge Barthel Index scores increased from 41.0 (SD = 24.9) and 51.8 (SD = 30.0), respectively in 1996 to 48.4 (SD = 24.5) and 64.2 (SD = 27.3) respectively in 2005.

CONCLUSIONThere are significant differences in socio-demographic characteristics and clinical profile of admissions between various community hospitals and across time. Understanding these differences and trends in admission profiles may help in projecting future healthcare service needs.

Aged ; Aged, 80 and over ; Analysis of Variance ; Confidence Intervals ; Diagnosis ; Female ; Hospitals, Community ; Humans ; Male ; Medical Records ; statistics & numerical data ; Middle Aged ; Odds Ratio ; Patient Admission ; statistics & numerical data ; trends ; Singapore ; Social Class