INTRODUCTIONChronic illnesses are common and have detrimental effects not only on the affected individuals but also on their families. These negative consequences on the physical and psychological health of caregivers constitute the burden of care. We investigate the predictors of perceived burden of care among relatives of people with any chronic physical or mental illness using secondary data from a nationwide survey in Singapore.

MATERIALS AND METHODSA cross-sectional household survey was conducted among adult residents of age 18 years and above and data were analysed to explore the predictors of high perceived burden of care. Two thousand four hundred and fifty-eight respondents having at least 1 close relative with any chronic physical and/or mental illness were included.

RESULTSMajority of the respondents had at least 1 close family member with physical illness (88.3%)--the most common illnesses reported were memory problems (86.9%), physical disability (74.8%), heart problems (70.1%) and cancer (62.2%). About 30.9% (n = 723) perceived high burden resulting from their relatives' health condition. Logistic analysis showed that women were more likely (OR 1.58, P = 0.0026) and Malays were less likely (OR 0.68, P = 0.0044) to perceive burden. Those who were able to open up to their family or friends (OR 1.65, P = 0.0162) and those who had dysthymia had higher odds (OR 4.91, respectively, P =0.0364) of perceiving burden.

CONCLUSIONOur results suggest that regardless of the nature of the chronic illnesses, gender or ethnicity, the capacity to open up to family or friends and the mental health status of caregivers can predict their perceived burden. The results provide valuable preliminary information for planning social policies and interventions for improving the well-being of caregivers.

Adult ; Aged ; Caregivers ; psychology ; Chronic Disease ; psychology ; therapy ; Cost of Illness ; Cross-Sectional Studies ; Dysthymic Disorder ; psychology ; Family ; psychology ; Female ; Humans ; Logistic Models ; Male ; Mental Disorders ; psychology ; therapy ; Middle Aged ; Singapore ; epidemiology

INTRODUCTIONThis study assessed occupational differences in the prevalence of mental and physical disorders in an employed general population sample in Singapore and investigated the impact of these disorders on work productivity losses in terms of work-loss days and work-cutback days. The association of occupation with alcohol use disorders (AUD) and nicotine dependence (ND) was also investigated.

MATERIALS AND METHODSData from a population-based mental health survey of a representative sample of multi-ethnic residents aged 18 years and above were used. The World Health Organization's (WHO) Composite International Diagnostic Interview (CIDI) was administered to establish the lifetime diagnosis of key mental disorders. Self-report on sociodemographic characteristics, productivity loss, ND, and lifetime physical conditions were obtained. Nine occupational groups were included in this analysis.

RESULTSThe sample comprised 4361 participants with a mean (SD) age of 42.2 (11.9) years, ranging between 19 to 80 years. 'Associate professionals and technicians' (26.2%), 'Services and sales workers' (17.7%) and 'Professionals' (15.4%) were the 3 predominant occupational categories. Sociodemographic characteristics differed significantly across occupations (P <0.001). The lifetime prevalences of having 'any mental disorder' and 'any physical disorder' were 13.0% and 37.9%, respectively; major depressive disorder was the most prevalent mental disorder (5.9%) and hypertension was the most common physical disorder (15.6%). There were no significant differences in work productivity loss across occupations. Sociodemographic and occupational correlates for AUD and ND were identified.

CONCLUSIONSociodemographic and health disparities exist in the major occupational categories in Singapore. The strength of the associations between occupation and AUD and ND are significant, indicating the need for preventative measures in select occupations.

Adolescent ; Adult ; Aged ; Alcohol-Related Disorders ; epidemiology ; Chronic Disease ; epidemiology ; Depressive Disorder, Major ; epidemiology ; Female ; Health Surveys ; Humans ; Male ; Middle Aged ; Occupations ; Prevalence ; Singapore ; epidemiology ; Tobacco Use Disorder ; epidemiology ; Young Adult

INTRODUCTION: Dengue continues to be a major health concern in the Philippines. This study aimed to establish trends and correlations between the incidence of dengue and rainfall, humidity and temperature, respectively, in the different regions. METHODS: Using 2018 records obtained from DOH and PAGASA, correlations were made between monthly measurements of climatic factors and the incidence of dengue using Pearson’s r, while maps and interpolations were generated using quantum geographical information system software. RESULTS: There was a significant positive but weak correlation between the incidence of dengue and rainfall (r = 0.379, 95% CI 0.255, 0.491; p < 0.001) and humidity (r = 0.215, 95% CI 0.080, 0.342; p = 0.002). There was a significant negative but weak correlation between the incidence of dengue and temperature (r = -0.145, 95% CI -0.277, -0.008; p = 0.039). A strong positive correlation was noted between the incidence of dengue, and rainfall and humidity, respectively, in several regions. Multiple regression indicates that rainfall, humidity and temperature are poor predictors of the incidence of dengue (R2 = 0.1436, 0.0461 and 0.0209, respectively). CONCLUSION This study showed overall a significant but weak correlation between an increased incidence of dengue and heavy rainfalls and high relative humidity, and a weak negative correlation for temperature. A high positive correlation of an increased incidence of dengue and heavy rainfalls and high relative humidity was observed in several regions.
Dengue ; humidity ; temperature

Objective: The World Health Organization (WHO) recommends prone positioning for mechanically ventilated COVID-19 patients with Acute Respiratory Distress Syndrome (ARDS) to improve oxygenation. Subsequently, researchers facilitated the position to non-intubated COVID-19 patients as early management which showed significant improvement but with discerned limitations. Tripod position is explored as an alternative exhibiting promising results. This present study describes a case series of four COVID-19 patients with moderate to severe ARDS who demonstrated considerable breakthrough. Methods: Four COVID-19 cases of moderate to severe ARDS were instructed to do tripod positioning as long as they can tolerate while under close supervision. Results: An hour after assuming tripod position, all four patients presented a decrease in respiratory rate, increase in peripheral oxygen saturation, and increase in partial oxygen saturation in arterial blood gas. The assumed position was maintained by four patients without discomfort and was maintained with a mean of 12 - 20 hours per day. Conclusions Our findings confirmed that tripod position is advantageous to non-intubated COVID-19 patients with moderate to severe ARDS and may delay or prevent invasive mechanical ventilation. The position also manifested tolerance to extended duration which permitted time for the medical team to focus on managing their disease in its entirety. Nevertheless, certain aspects such as contraindication, side effects, and other adverse events that may occur have yet to be sufficiently clarified and investigated.
Prone Position ; Respiratory Distress Syndrome ; COVID-19

A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.
Laryngeal Neoplasms ; Laryngectomy ; Radiotherapy

A 61-year-old male diagnosed with laryngeal squamous cell carcinoma presented with hoarseness, progressive dysphagia leading to aspiration, and dyspnea one month after definitive radiation therapy. Examination revealed a diffusely swollen glottis, paralyzed vocal cords, and post-radiation fibrosis. Several glottic biopsies yielded results negative for malignancy and favored radiation-induced changes. When presented with the option of further diagnostic testing with a positron emission tomography (PET) scan or an outright laryngectomy, the patient decided on the latter. Final histopathologic diagnosis was negative for recurrence of malignancy. This case demonstrates treatment dilemmas for patients with laryngeal carcinoma with uncertain recurrence wherein radical surgical management may prove to be a viable option to achieve both diagnostic certainty and ultimate relief of symptoms.
Laryngeal Neoplasms ; Laryngectomy ; Radiotherapy

BACKGROUNDFibromyalgia is a syndrome characterized by chronic pain, fatigue, depression, and sleep disturbances. Its primary cause is unclear. Several studies have reported decreased intracellular magnesium levels in patients with fibromyalgia and have found negative correlation between magnesium levels and fibromyalgia symptoms.

OBJECTIVETo gather preliminary data on whether transdermal magnesium can improve quality of life for women who have fibromyalgia.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONSThis is a patient questionnaires and survey in a fibromyalgia clinic at a tertiary medical center. Forty female patients with the diagnosis of fibromyalgia were enrolled. Each participant was provided a spray bottle containing a transdermal magnesium chloride solution and asked to apply 4 sprays per limb twice daily for 4 weeks. Participants were asked to complete the Revised Fibromyalgia Impact Questionnaire, SF-36v2 Health Survey, and a quality-of-life analog scale at baseline, week 2, and week 4.

MAIN OUTCOME MEASUREQuestionnaire and survey scores, evaluated through intent-to-treat and per-protocol analyses.

RESULTSTwenty-four patients completed the study (mean [SD] age, 57.2 [7.6] years; white, 95%; mean body mass index, 31.3 kg/m2). With intention-to-treat analysis, Revised Fibromyalgia Impact Questionnaire subscale and total scores were significantly improved at week 2 and week 4 (total score, P=0.001). Per-protocol analysis results were similar: all subscales of the Revised Fibromyalgia Impact Questionnaire were significantly improved at week 2 and week 4 (total score, P=0.001).

CONCLUSIONThis pilot study suggests that transdermal magnesium chloride applied on upper and lower limbs may be beneficial to patients with fibromyalgia.

TRIAL REGISTRATIONClinicalTrials.gov.ldentifier NCT01968772.

Administration, Cutaneous ; Aged ; Feasibility Studies ; Female ; Fibromyalgia ; drug therapy ; psychology ; Humans ; Magnesium Chloride ; administration & dosage ; adverse effects ; Middle Aged ; Pilot Projects ; Quality of Life