Introduction: Air pollution and air quality are growing concerns among urban citizens of Southeast Asia, especially the University students who devote most of their days to the vicinity of campus. However, there is limited data available on the extent of the problem, as well as an understanding of the knowledge of and perceptions of people who may be exposed to poor air quality. Methods: This focused study evaluated University students’ opinions, perceptions, and behavioral responses to local air quality in the Iskandar Puteri, Johor region of Malaysia using an online questionnaire, and measurements of NO2, SO2, formaldehyde, and particulate matter levels in the area using diffusion tubes. All air quality parameters were within the standards recommended by the local environmental authority, however, NO2 levels exceeded the recommended World Health Organization (WHO) standards at all sites. Results: Questionnaire findings indicate that students most commonly suffered from respiratory diseases, and were very concerned about air pollution and its impacts. Respondents perceived the situation to be worse in the afternoons and weekends, corroborated by the PM2.5 readings in the area. Preferred preventive measures included wearing masks and limiting active time outdoors. Conclusions The evidence from this study highlighted the need to improve air quality in Iskandar Puteri as the NO2 level exceeded international standards for human health at all study sites. This could be supported by educational programs for industry, limitations on traffic emissions, and general awareness of air quality issues present locally.

Methods: Patients with 1-year postoperative dynamic cervical spine radiographs following ACDF were grouped into serotonin reuptake inhibitor prescriptions (SSRI, serotonin-norepinephrine reuptake inhibitor [SNRI], or tricyclic antidepressant [TCA]) and no prescription (atypical antidepressant or no antidepressant). Pseudarthrosis was defined as ≥1 mm interspinous process motion on dynamic radiographs. Logistic regression models were controlled for confounding to analyze pseudarthrosis rates. Alpha was set at p - values of <0.05. Results: Of the 523 patients who meet the inclusion criteria, 137 (26.2%) were prescribed an SSRI, SNRI, or TCA. Patients with these prescriptions were more likely to have pseudarthrosis (p =0.008) but not a revision surgery due to pseudarthrosis (p =0.219). Additionally, these patients had worse 1-year postoperative mental component summary (MCS)-12 (p =0.015) and Neck Disability Index (NDI) (p =0.006). The multivariate logistic regression analysis identified SSRI/SNRI/TCA use (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.11–2.99; p =0.018) and construct length (OR, 1.91; 95% CI, 1.50–2.44; p <0.001) as pseudarthrosis predictors. A SSRI/SNRI/TCA prescription was a revision surgery predictor due to adjacent segment disease on univariate analysis (OR, 2.51; p =0.035) but not on multivariate logistic regression analysis (OR, 2.24; p =0.10). Conclusions Patients taking serotonin reuptake-inhibiting antidepressants are at increased risk of worse postoperative outcome scores, including NDI and MCS-12, likely due to their underlying depression. This may contribute to their greater likelihood of having adjacent segment surgery. Additionally, preoperative use of serotonin reuptake inhibitors in patients undergoing an ACDF is a predictor of radiographic pseudarthrosis but not pseudarthrosis revision.

Objective: Comprehensive understanding of polyenvironmental risk factors for the development of psychosis is important. Based on a review of related evidence, we developed the Korea Polyenvironmental Risk Score (K-PERS) for psychosis. We investigated whether the K-PERS can differentiate patients with schizophrenia spectrum disorders (SSDs) from healthy controls (HCs). Methods: We reviewed existing tools for measuring polyenvironmental risk factors for psychosis, including the Maudsley Environmental Risk Score (ERS), polyenviromic risk score (PERS), and Psychosis Polyrisk Score (PPS). Using odds ratios and relative risks for Western studies and the “population proportion” (PP) of risk factors for Korean data, we developed the K-PERS, and compared the scores thereon between patients with SSDs and HCs. In addition, correlation was performed between the K-PERS and Positive and Negative Syndrome Scale (PANSS). Results: We first constructed the “K-PERS-I,” comprising five factors based on the PPS, and then the “K-PERS-II” comprising six factors based on the ERS. The instruments accurately predicted participants’ status (case vs. control). In addition, the K-PERS-I and -II scores exhibited significant negative correlations with the negative symptom factor score of the PANSS. Conclusion The K-PERS is the first comprehensive tool developed based on PP data obtained from Korean studies that measures polyenvironmental risk factors for psychosis. Using pilot data, the K-PERS predicted patient status (SSD vs. HC). Further research is warranted to examine the relationship of K-PERS scores with clinical outcomes of psychosis and schizophrenia.

Ambulatory Care ; COVID-19 ; Health Facility Planning ; Hospital Bed Capacity ; Hospitals, Rehabilitation ; Humans ; Infection Control ; Rehabilitation ; Remote Consultation ; SARS-CoV-2 ; Singapore ; Telerehabilitation ; Triage

OBJECTIVE: X-linked dystonia parkinsonism (XDP) is an adult-onset, progressive and debilitating movement disorder described among Filipino males from Panay Island. The available oral medications have been ineffective. While chemodenervation with botulinum toxin A works and deep brain stimulation surgery is promising, these are not affordable for the vast majority of patients. Thus, we decided to look into the efficacy, safety and tolerability of levodopa+carbidopa (levodopa) versus placebo among patients with XDP.

METHODS: This was a double blind, randomized, placebo-controlled clinical trial. Patients were randomized to receive levodopa or placebo for 6 months. The dose was increased gradually until 1000 mg levodopa/day is reached or until side effects appear.

RESULTS: A total of 86 out of 94 randomized patients (91.5%) were included in the intention-to-treat cohort for the primary efficacy analysis. Nineteen patients (9 in levodopa, 10 in placebo) dropped out or were lost to follow up. There was no significant difference in the baseline and last visit Burke Fahn Marsden Dystonia Rating Scale and the part III of the Unified Parkinson's Disease Rating Scale scores between levodopa and placebo. The most common adverse events in the levodopa group were increased movements, pain and nausea/ vomiting.

CONCLUSION: While levodopa is safe and well-tolerated, it does not have any effect in alleviating the dystonia or parkinsonism in XDP.

BACKGROUND: Sex-linked dystonia-parkinsonism (XDP) is an adult-onset, progressive, debilitating movement disorder that manifests with features of dystonia and parkinsonism. It is endemic among Filipino males from Panay Island. Many of these patients would have peculiar postures and bizarre movements forcing them to retreat to the confines of their home or probably in solitude.

OBJECTIVE: To describe the rate of suicide among XDP patients.

METHODS: We identified the patients from the Philippine XDP registry maintained by the XDP Study Group. A retrospective chart review was then done.

RESULTS: There were 21 deaths attributable to suicide from the 194 deaths from the XDP registry (10.8%). The mean age at suicide was 44 + 11.38 years, around 7.76 + 4.65 years from onset of illness and 5.81 + 4.32 years from the diagnosis. Most patients (17/21) were in the generalized dystonia stage at the time of suicide. Five of the suicide cases belonged to two families. The most common method of suicide were hanging (10, 47.6%), refusal to eat (5, 23.8%), non-accidental organophosphate poisoning and self-mutilation (1 each, 4.8%).

CONCLUSION: There was a high rate of suicide (10.8%) among XDP patients compared to the national suicide rate of 3.59/100,000. Hanging was the most common method used to commit suicide.