Meta-Analysis Comparing Outcomes of Two Different Closed Incision Negative Pressure Systems in Breast Surgery and Implications to Cost of Care.

Background: Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pressure therapy (ciNPT) systems to mitigate surgical site complications (SSC) and surgical site infections (SSI) in breast surgery were assessed. Methods: A systematic literature review for breast surgery studies was conducted comparing ciNPT use against standard of care (SOC). SSC, SSI, and dehiscence rates were examined. SSCs were defined as all surgical site complications including SSI, dehiscence, seroma, hematoma, and necrosis. Risk ratios and random effects models were used to assess the effect of ciNPT with multilayer absorbent dressing (ciNPT-MLA) and ciNPT with foam dressing (ciNPT-F) compared with SOC. Results: Eight articles were included in the meta-analysis. No significant differences in SSC rates (P = .307) or SSI rates (P = .453) between ciNPT-MLA and SOC were observed. ciNPT-MLA use was associated with a reduction in dehiscence compared with SOC (RR = 0.499, 95% CI = 0.303, 0.822; P = .006). A significant reduction in SSC rates (RR = 0.498, 95% CI = 0.271, 0.917; P = .025) was observed with ciNPT-F use. Similarly, dehiscence rate reduction was associated with ciNPT-F use (RR = 0.349, 95% CI= 0.168, 0.725; P = .005). A trend towards reduction of SSI rates with ciNPT-F use compared with SOC was also noted (P = .053). Conclusions: Compared with SOC, ciNPT-MLA significantly reduced rates of dehiscence, while ciNPT-F use resulted in significantly reduced SSC and dehiscence rates with a trend toward reducing SSI.

Combined knee osteoarthritis and diabetes is associated with reduced muscle strength, physical inactivity, and poorer quality of life.

OBJECTIVE: This study delves into the intriguing connection between knee osteoarthritis and diabetes in Malaysia. Specifically, the exacerbation of knee osteoarthritis in the presence of diabetes in terms of symptoms, physical performance, physical activity, psychological status, social participation, and quality of life was discussed. DESIGN: This cross-sectional study recruited adults aged 50 and above by convenient sampling and grouped them into: knee osteoarthritis-diabetes-, knee osteoarthritis+diabetes-, knee osteoarthritis-diabetes+, and knee osteoarthritis+diabetes+. SUBJECTS/PATIENTS: Of 436 recruited participants, 261 (59.8%) participants reported knee osteoarthritis. METHODS: Handgrip strength, Timed Up and Go test, 6 Meter Walk Test, and 5 Times Sit to Stand Test were measured using standardized procedures. Six questionnaires were administered for the remaining parameters. RESULTS: Across groups, there were significant differences: 6 Meter Walk Test (p = 0.024), Timed Up and Go test (p = 0.020), and 5 Times Sit to Stand Test (p < 0.001), quality of life (p = 0.009), and physical activity (p = 0.036). Knee osteoarthritis+diabetes+ was independently associated with reduced handgrip strength, 5 Times Sit to Stand Test, quality of life, and physical inactivity after adjustment. Knee osteoarthritis+diabetes- was independently associated with reduced Timed Up and Go test and social isolation. CONCLUSION: The findings revealed the diabetic knee osteoarthritis subgroup's unique physical and psychosocial features of reduced muscle strength and physical inactivity. Future studies should investigate whether managing metabolic factors, and enhancing physical activity and strength exercises, can reduce knee osteoarthritis symptoms and disease severity.

Transition of physical, psychological and cognitive frailty and its' associated determinants in Malaysian older adults: A 5 year follow-up study.

INTRODUCTION: Frailty, a multifaceted syndrome, affects approximately 26% of older adults globally, yet there is limited data on the prevalence and longitudinal impact of frailty subtypes. Therefore, in this study, we aim to determine the prevalence of physical, psychological, and cognitive frailty, transitions between subtypes, and associated health determinants among Malaysian community-dwelling older adults. METHOD: This study is part of the longitudinal ageing study in Malaysia (LRGS Ageless and TUA). We assessed 815 older adults in 2014, with successful follow-up of 402 participants (mean age: 67.08±5.38 years) after 5 years. Frailty subtypes were assessed at baseline, and transitions were evaluated at the 5-year mark. RESULTS: At baseline, the prevalence of older adults categorised as robust, physical frailty, cognitive frailty, and psychological frailty was 26.7%, 36.3%, 12.1%, and 16.7%, respectively, with 8.1% exhibiting concurrent psychological and cognitive frailty. Follow-up results showed that 22.9% remained robust, 46.8% experienced no change, 24.9% deteriorated (adversed), and 5.5% improved (reversed). Logistic regression analysis identified living alone ( p<0.001), increased body fat percentage p<0.05), increased waist circumference (p<0.05), reduced fat-free mass (p<0.05), decreased lower limb flexibility (p<0.05), and declined cardiorespiratory fitness (p<0.05) as significant predictors of frailty deterioration. Higher Mini Mental State Examination (MMSE) scores and improved Timed Up and Go and Chair Stand test results (p<0.05) were significantly associated with the reversal of frailty subtypes. (p<0.05). Younger older adults (p<0.001), males (p<0.05), those with lower WHO Disability Scale scores (p<0.05), and higher MMSE scores (p<0.05) were significantly less likely to develop frailty subtypes. CONCLUSION: Intervention strategies that focus on combined physical, cognitive, and psychosocial functions are crucial for both reversing and preventing the progression of frailty subtypes in older adults.

Development of cognitive frailty screening tool among community-dwelling older adults.

Purpose: To develop a brief screening tool consisting of twelve items that can be self-administered for rapid identification of older adults at risk of cognitive frailty (CF), named as Cognitive Frailty Screening Tool (CFST). Patients and methods: A total of 1318 community-dwelling individuals aged 60 years and above were selected and assessed for cognitive frailty using a set of neuropsychology batteries and physical function tests. A binary logistic regression (BLR) was used to identify predictors of CF to be used as items in the screening tool. A suitable cut-off point was developed using receiver operating characteristic analysis. Results: Twelve items were included in the screening tool, comprising of gender, education years, medical history, depressive symptoms and functional status as well as lifestyle activities. The area under the curve (AUC) was 0.817 (95 % CI:0.774-0.861), indicating an excellent discriminating power. The sensitivity and specificity for cut-off 7 were 80.8 % and 79.0 %, with an acceptable range of positive predictive value (PPV) (73.3 %) and negative predictive value (NPV) (85.2 %) for screening tools. Concurrent validity of CFST score with standard cognitive and frailty assessment tools shows a significant association with the total score of CFST with low to moderate correlation (p < 0.05 for all parameters). Conclusion: CFST had good sensitivity and specificity and was valid for community-dwelling older adults. There is a need to evaluate further the cost-effectiveness of implementing CFST as a screening for the risk of CF in the community. Its usage in clinical settings needs further validation.

Physiotherapists' Perception of and Readiness to Use, Telerehabilitation for Musculoskeletal Disorders in Malaysia: A Cross-Sectional Study.

Introduction: Musculoskeletal ailments exert a significant impact on global populations. To address challenges posed by geographical constraints and financial limitations, physiotherapists have explored and found telerehabilitation to be a viable solution. Despite its proven effectiveness in clinical practice, the integration of telerehabilitation has been sluggish. This cross-sectional survey sought to delve into the perspectives and readiness of physiotherapists in Malaysia regarding telerehabilitation for musculoskeletal disorders. Methods: A customized survey instrument was developed and evaluated for face validity and reliability. The 36-item questionnaire was distributed through the Google Form platform, targeting respondents via social media channels such as Facebook and WhatsApp. Data analysis used descriptive statistics (frequency and percentage). Results: The survey garnered responses from 271 physiotherapists. A majority (76.3%, n = 202) expressed agreement regarding the potential benefits of telerehabilitation in physiotherapy practice. About 77% of the respondents also showcased greater readiness for monitoring client progress through telerehabilitation as opposed to assessment and treatment. Notable benefits identified by respondents included preventing cross-infection (98.5%) and reducing travel time for both clients (94.0%) and physiotherapists (90.6%). Conclusion: The study reveals that physiotherapists in Malaysia exhibit positive attitudes and preparedness for implementing telerehabilitation in managing musculoskeletal conditions.

Innervated breast reconstruction: a narrative review of neurotization techniques and outcomes.

Background and Objective: While significant sensation recovery improvements in neurotized breasts following reconstruction have been reported, sensation testing methods and surgical techniques have been widely variable. This narrative review aims to summarize available literature on current neurotization practices and sensory recovery outcomes in patients undergoing innervated breast reconstruction. Methods: A comprehensive literature search of PubMed Medline, Web of Science, and Embase was conducted to identify all studies reporting outcomes of neurotization in breast reconstruction surgeries. Data analyzed included operative times, neurotization techniques, sensory outcomes, and methods as well as patient reported outcomes. Key Content and Findings: Despite the heterogeneity of various studies reviewed, all forms of neurotization achieved earlier and superior sensory recovery throughout the reconstructed breast skin compared to non-innervated breasts. In absence of randomized controlled trials or high-quality comparative studies, further evidence is required to objectively confirm this technique offers better sensory recovery. Conclusions: Neurotization at the time of breast reconstruction may lead to improved sensation and patient reported outcomes delineating improved quality of life compared to non-innervated breasts. Future studies need to standardize the way that breast sensation is measured and determine pre-operative variables leading to expected changes in final sensation recovery to help manage surgical outcome expectations of both the surgeon and the patient.

Er 3 + , Nd 3 + , Tm 3 + : Up-conversion in Lead Borophosphate Glasses for Visible Emission.

To investigate the role of PbO as a former or a modifier and effect of its compositional variation on the physical, structural and optical properties, lithium lead borophosphate glasses were synthesized by melt quenching technique. For the physical properties of the prepared glasses, density was measured using the Archimedes principle, which showed an increasing trend from 3.13 to 4.51 with increasing concentrations of lead oxide. Additionally, other physical parameters were calculated based on the measured density values. The structural analysis were performed through X-ray diffraction and Fourier transform infrared spectroscopy. Lack of sharp and characteristic peaks in the XRD spectra confirmed the non crystalline nature of the prepared glasses. Structural units due to PbO, P 2 O 5 and B 2 O 3 were identified from the FTIR spectra. Ultraviolet-visible absorption spectroscopy was performed for optical properties and increase in the indirect band gap from 4.80 eV to 4.90 eV was observed. One glass sample was chosen for doping of erbium, neodymium, thulium and ytterbium, for study of their up-conversion properties. The UV-Vis-NIR absorption spectra of erbium, neodymium, and thulium samples were recorded, and wavelength of 980 nm was chosen for excitation. Ytterbium, acting as a sensitizer, facilitated the conversion of the excitation infrared light into visible light. Upon excitation at 980 nm, the erbium-doped sample emitted light at 520 nm, 547 nm, and 665 nm, utilizing excited state up-conversion (ESA) and energy transfer up-conversion (ETU) mechanisms. Similarly, the neodymium-doped sample emitted at 542 nm, 602 nm, and 660 nm, while the thulium-doped sample emitted at 488 nm, 521 nm, and 649 nm. The results of up-conversion indicate that rare earth-doped lithium lead borophosphate glasses are excellent hosts for up-conversion processes.

Development and Evaluation of Content Validity and Acceptance of a Multidomain Intervention Module for Reversal of Cognitive Frailty Among Older Adults.

Purpose: There is a limited availability of multidomain interventions that target cognitive frailty. Thus, the aim of the present study was to develop and evaluate the content validity and acceptance of the multidomain intervention module to reverse cognitive frailty among older adults (iAGELESS). Patients and Methods: This study was conducted in two phases: Phase I included the development of the multidomain intervention module iAGELESS and evaluation of content validity, while Phase II consisted of evaluating the acceptance of the module among 18 healthcare and social care providers, 13 older adults with cognitive frailty, and 13 caregivers. Content validity index (CVI) was used to quantify the content validity. Respondents completed a questionnaire which consisted of information on sociodemographic, followed by module acceptance evaluation with respect to content, terminologies, and graphics. The data was then analyzed descriptively. Results: A multidomain intervention module, iAGELESS was developed. The module was found to have appropriate content validity (overall CVI = 0.83). All the caregivers, 92% of older adults with cognitive frailty and 83% of healthcare and social care providers were satisfied with the overall content of the module. More than 50% of those who accepted the module had satisfactory consensus on the ease of the terminologies, length of sentences, pictures, information, color, and font size included in the module. Conclusion: The iAGELESS module demonstrated good content validity and was well accepted, thus warranting its utilization in future studies to determine its effectiveness in reversing cognitive frailty among older adults.

Cultural Adaptation and Validation of a Malay Version of the Craig Hospital Inventory of Environmental Factors (CHIEF) Among Older Adults in Malaysia.

BACKGROUND/AIM: The Craig Hospital Inventory of Environmental Factors (CHIEF) is a tool designed to assess and quantify the impact of environmental factors on an individual's functioning and social participation. In this study, we aim to culturally adapt the CHIEF from its original English version into the Malay language (M-CHIEF) and examine its validity and reliability among older adults in Malaysia. METHODS: The original CHIEF was cross-culturally adapted into the Malay language following the published guidelines on cross-cultural adaptation of health questionnaires. Its content and convergent validity were assessed using the content validity index and correlation with participants' gait speed, respectively. The reliability of M-CHIEF was assessed for its internal consistency using Cronbach's coefficient alpha and Cohen's kappa and its test-retest reliability was assessed using intraclass correlation coefficients (ICCs). RESULTS: The M-CHIEF was rated with excellent content validity with a scale-level content validity index (S-CVI) of 0.86. Its internal consistency was demonstrated to be high with Cronbach's alpha of 0.84. The test-retest reliability at a two-week interval showed a stable score of the M-CHIEF and its subscales with an ICC value of 0.89. CONCLUSIONS: The M-CHIEF is deemed relevant for use among Malay speakers. It can function as an instrument to quantify the environmental barriers of an individual while considering broad environmental factors including policy, physical/ structural, work/school, attitude/support, and services/assistance.

Acceptability, feasibility, and effectiveness of WE-SURF™: a virtual supervised group-based fall prevention exercise program among older adults.

Conducted physically, supervised group-based falls prevention exercise programs have demonstrated effectiveness in reducing the risk of falls among older adults. In this study, we aimed to assess the acceptability, feasibility, and effectiveness of a virtual supervised group-based falls prevention exercise program (WE-SURF™) for community-dwelling older adults at risk of falls. METHOD: A preliminary study utilizing virtual discussions was conducted to assess the acceptability of the program among six older adults. Effectiveness was evaluated in a randomized controlled feasibility study design, comprising 52 participants (mean age: 66.54; SD: 5.16), divided into experimental (n = 26) and control (n = 26) groups. The experimental group engaged in a 6-month WE-SURF™ program, while the control group received standard care along with a fall's prevention education session. Feasibility of the intervention was measured using attendance records, engagement rates from recorded videos, dropouts, attrition reasons, and adverse events. RESULTS: Preliminary findings suggested that WE-SURF™ was acceptable, with further refinements. The study revealed significant intervention effects on timed up and go (TUG) (η2p:0.08; p < 0.05), single leg stance (SLS) (η2p:0.10; p < 0.05), and lower limb muscle strength (η2p:0.09; p < 0.05) tests. No adverse events occurred during the program sessions, and both attendance and engagement rates were high (> 80% and 8/10, respectively) with minimal dropouts (4%). The WE-SURF™ program demonstrated effectiveness in reducing the risk of falls while enhancing muscle strength and balance. CONCLUSION: In conclusion, WE-SURF™ was demonstrated to be an acceptable, feasible, and effective virtual supervised group-based exercise program for fall prevention in community-dwelling older adults at risk of falls. With positive outcomes and favourable participant engagement, WE-SURF™ holds the potential for wider implementation. Further research and scaling-up efforts are recommended to explore its broader applicability. (Registration number: ACTRN 12621001620819).

Trends in Gender Authorship of Abstract Presentations at Plastic Surgery the Meeting: A Decade Long Analysis.

ABSTRACT: Current literature fails to examine gender differences of authors presenting abstracts at national plastic surgery meetings. This study aims to assess the ratio of female to male abstract presentations at Plastic Surgery The Meeting (PSTM).The gender of all abstract presenters from PSTM between 2010 and 2020 was recorded. The primary outcome variable was authorship (first, second, or last). Trends in gender authorship were assessed via Cochran-Armitage trend tests. Chi-square was utilized to evaluate the association between author gender and presentation type and author gender and subspecialty.Between 2010 and 2020, 3653 abstracts were presented (oral = 3035, 83.1%; poster = 618, 16.9%) with 19,328 (5175 females, 26.8%) authors. Of these, 34.5%, 32.0%, and 18.6% of first, second, and last authors were female, respectively. The total proportion of female authors increased from 153 (20.4%) in 2010 to 1065 (33.1%) by 2020. The proportion of female first, second, and last authors increased from 21.8% to 44.8%, 24.0% to 45.3%, and 14.3% to 22.1%, respectively, and demonstrated a positive linear trend ( P < 0.001 ). The proportion of female first authors in aesthetics (23.9%) was lower than that for breast (41.8%), cranio/maxillofacial/head & neck (38.5%), practice management (43.3%), and research/technology (39.4%) ( P < 0.001 ).Our study demonstrates a significant increase in female representation as first, second, and last authors in abstract presentations at PSTM within the last decade, although the absolute prevalence remains low.

Physiotherapists' perceptions, readiness, enablers, and barriers to use telerehabilitation: A scoping review.

BACKGROUND: The growing use of telerehabilitation within the healthcare community has garnered substantial attention. In congruence with other healthcare fields, examining perceptions, barriers, and facilitators assumed paramount significance in the continuation and fortification of telerehabilitation practices among physiotherapists. OBJECTIVE: In this scoping review, we aimed to systematically map the literature on the perceptions of physiotherapists as well as the barriers and enablers of telerehabilitation in their daily practice. METHODS: The five-stage methodological framework recommended by Arksey and O'Malley (2005) was used for this scoping review. In the framework, eight databases were searched using key search terms such as "telerehabilitation", "physiotherapists", "readiness", "enablers" and "barriers" All findings were organised into perceptions and readiness, enablers, and barriers. RESULTS: Fourteen articles met the inclusion criteria and were categorized as: (1) perception and readiness, (2) enablers, and (3) barriers. In the perception and readiness category, new trends in healthcare, advancement in physiotherapy practices and the benefits to clients were identified. The enablers identified included prior training, personal experience, familiarity with technology, functional equipment and space, and client selection. The barriers to the adoption of telerehabilitation in physiotherapy practice are pinpointed to poor technology, communication hurdles, limited availability, lack of familiarity, and client-related concerns. CONCLUSION: While initial evidence suggests a generally positive perceptions it is important to consider both facilitators and barriers when understanding adoption. This review's findings revealed a wide research gap, with unequal weightage towards barriers compared to enablers, and highlights the need for further research. Developing telerehabilitation guidelines that cater to both physiotherapists and clients is necessary.

Cardiovascular risk factors among older persons with cognitive frailty in middle income country.

BACKGROUND: Cognitive frailty, characterized by the coexistence of cognitive impairment and physical frailty, represents a multifaceted challenge in the aging population. The role of cardiovascular risk factors in this complex interplay is not yet fully understood. AIM: To investigate the relationships between cardiovascular risk factors and older persons with cognitive frailty by pooling data from two cohorts of studies in Malaysia. METHODS: A comprehensive approach was employed, with a total of 512 community-dwelling older persons aged 60 years and above, involving two cohorts of older persons from previous studies. Datasets related to cardiovascular risks, namely sociodemographic factors, and cardiovascular risk factors, including hypertension, diabetes, hypercholesterolemia, anthropometric characteristics and biochemical profiles, were pooled for analysis. Cognitive frailty was defined based on the Clinical Dementia Rating scale and Fried frailty score. Cardiovascular risk was determined using Framingham risk score. Statistical analyses were conducted using SPSS version 21. RESULTS: Of the study participants, 46.3% exhibited cognitive frailty. Cardiovascular risk factors including hypertension (OR:1.60; 95%CI: 1.12-2.30), low fat-free mass (OR:0.96; 95%CI: 0.94-0.98), high percentage body fat (OR:1.04; 95%CI: 1.02-1.06), high waist circumference (OR:1.02; 95%CI: 1.01-1.04), high fasting blood glucose (OR:1.64; 95%CI: 1.11-2.43), high Framingham risk score (OR:1.65; 95%CI: 1.17-2.31), together with sociodemographic factors, i.e., being single (OR 3.38; 95%CI: 2.26-5.05) and low household income (OR 2.18; 95%CI: 1.44-3.30) were found to be associated with cognitive frailty. CONCLUSION: Cardiovascular-risk specific risk factors and sociodemographic factors were associated with risk of cognitive frailty, a prodromal stage of dementia. Early identification and management of cardiovascular risk factors, particularly among specific group of the population might mitigate the risk of cognitive frailty, hence preventing dementia.

Predictive value of the World falls guidelines algorithm within the AGELESS-MELoR cohort.

AIM: The World Falls Guidelines (WFG) Task Force published a falls risk stratification algorithm in 2022. However, its adaptability is uncertain in low- and middle-income settings such as Malaysia due to different risk factors and limited resources. We evaluated the effectiveness of the WFG risk stratification algorithm in predicting falls among community-dwelling older adults in Malaysia. METHODS: Data from the Malaysian Elders Longitudinal Research subset of the Transforming Cognitive Frailty into Later-Life Self-Sufficiency cohort study was utilized. From 2013-2015, participants aged ≥55 years were selected from the electoral rolls of three parliamentary constituencies in Klang Valley. Risk categorisation was performed using baseline data. Falls prediction values were determined using follow-up data from wave 2 (2015-2016), wave 3 (2019) and wave 4 (2020-2022). RESULTS: Of 1,548 individuals recruited, 737 were interviewed at wave 2, 858 at wave 3, and 742 at wave 4. Falls were reported by 13.4 %, 29.8 % and 42.9 % of the low-, intermediate- and high-risk groups at wave 2, 19.4 %, 25.5 % and 32.8 % at wave 3, and 25.8 %, 27.7 % and 27.0 % at wave 4, respectively. At wave 2, the algorithm generated a sensitivity of 51.3 % (95 %CI, 43.1-59.2) and specificity of 80.1 % (95 %CI, 76.6-83.2). At wave 3, sensitivity was 29.4 % (95 %CI, 23.1-36.6) and specificity was 81.6 % (95 %CI, 78.5-84.5). At wave 4, sensitivity was 26.0 % (95 %CI, 20.2-32.8) and specificity was 78.4 % (95 %CI, 74.7-81.8). CONCLUSION: The algorithm has high specificity and low sensitivity in predicting falls, with decreasing sensitivity over time. Therefore, regular reassessments should be made to identify individuals at risk of falling.

Estimation of Ultrasonic Velocity, Density, Internal Pressure, and Thermophysical Parameters of Ionic Liquid Mixtures: Application of Flory's Statistical Theory.

Flory's statistical theory (FST) has been employed to estimate the ultrasonic velocity, density, internal pressure, and several important thermophysical parameters such as the energy of vaporization, the heat of vaporization, cohesive energy density, polarity index, and solubility for eight binary mixtures of ionic liquids and water within the temperature range of 288.15 to 308.15 K. The ionic liquids chosen for this investigation are [BMim][dca], [BMim][TfO], [BMpy][TfO], [BMpyr][dca], [BMpyr][TfO], [EEPy][ESO4], [HMim][dca], and [MPy][MSO4]. The predicted values of ultrasonic velocity and density show good agreement with the data reported in the literature. It endorses the applicability of FST to these binary mixtures. A comparative analysis of the internal pressure values (Pi) determined by using FST and the standard thermodynamic approach is also presented. The results obtained for Pi using both approaches show good agreement. Besides, for the mixtures under study, the correlation between ultrasonic velocity, density, and surface tension has also been examined. The variation of thermophysical parameters with concentration and temperature changes has been utilized to explore the nature and strength of the solute-solvent interactions prevalent in these mixtures. It is pointed out that A-A-type interactions dominate over A-B-type interactions in water-rich regions of the mixtures.

Synergistic effects of cognitive frailty and comorbidities on disability: a community-based longitudinal study.

OBJECTIVE: In this study, we aimed to assess the synergistic effects of cognitive frailty (CF) and comorbidity on disability among older adults. METHODS: Out of the 1318 participants from the Malaysian Towards Useful Aging (TUA) study, only 400 were included in the five-year follow-up analysis. A comprehensive interview-based questionnaire covering socio-demographic information, health status, biochemical indices, cognitive and physical function, and psychosocial factors was administered. Binary logistic regression analysis was employed to estimate the independent and combined odd ratios (ORs). Measures such as the relative excess risk due to interaction (RERI), the attributable proportion of risk due to the interaction, and the synergy index were used to assess the interaction between CF and comorbidity. RESULTS: Participants with CF (24.1%) were more likely to report disability compared to those without CF (10.3%). Synergistic effects impacting disability were observed between CF and osteoarthritis (OA) (OR: 6.675, 95% CI: 1.057-42.158; RERI: 1.501, 95% CI: 1.400-1.570), CF and heart diseases (HD) (OR: 3.480, 95% CI: 1.378-8.786; RERI: 0.875, 95% CI: 0.831-0.919), CF and depressive symptoms (OR: 3.443, 95% CI: 1.065-11.126; RERI: 0.806, 95% CI: 0.753-0.859), and between CF and diabetes mellitus (DM) (OR: 2.904, 95% Confidence Interval (CI): 1.487-5.671; RERI: 0.607, 95% CI: 0.577-0.637). CONCLUSION: These findings highlight the synergism between the co-existence of CF and comorbidity, including OA, HD, DM, and depressive symptoms, on disability in older adults. Screening, assessing, and managing comorbidities, especially OA, HD, DM and depressive symptoms, when managing older adults with CF are crucial for reducing the risk of or preventing the development of disability.

Predictors, Protective Factors, and Adverse Outcomes of Joint Pain among Malaysian Community-Dwelling Older Adults: Findings from the LRGS-TUA Longitudinal Study.

Background: Joint pain has been recognized as one of the major causes of limitations in mobility, functional decline, and consequently declined quality of life in older adults. Hence, this study aimed to identify the predictors, protective factors, and adverse outcomes of joint pain in community-dwelling older adults. Methods: In this Long-term Research Grant Scheme-Towards Useful Ageing (LRGS-TUA) longitudinal study, a total of 1005 older participants aged 60 years and above who were successfully followed up after five years were included in the analysis. The participants self-reported their joint pain status at baseline and during the fifth year. Subsequently, the baseline characteristics were used to predict changes in joint pain status. Adverse outcomes related to joint pain were evaluated based on the participants' joint pain statuses. Results: Results showed that being female, having diabetes mellitus, and higher body mass index were associated with the incidence of joint pain. Meanwhile, increased intake of pantothenic acid and higher levels of blood albumin levels were associated with recovery from joint pain. Participants with persistent joint pain at baseline and follow-up showed higher levels of depression and disability compared to individuals who never experience any joint pain. However, participants who had recovered from joint pain did not differ significantly from those without joint pain at baseline and follow-up in these measures. Conclusions: By identifying the modifiable risk factors, factors associated with recovery, and adverse outcomes related to joint pain, this study adds to current evidence that may contribute to further management strategies for joint pain in older adults.

Lifestyle and incident dementia: A COSMIC individual participant data meta­analysis.

INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis. RESULTS: A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. HIGHLIGHTS: A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.

Impact of diabetes mellitus on osteoarthritis: a scoping review on biomarkers.

Osteoarthritis (OA) commonly affects the knee and hip joints and accounts for 19.3% of disability-adjusted life years and years lived with disability worldwide (Refs , ). Early management is important in order to avoid disability uphold quality of life (Ref. ). However, a lack of awareness of subclinical and early symptomatic stages of OA often hampers early management (Ref. ). Moreover, late diagnosis of OA among those with severe disease, at a stage when OA management becomes more complicated is common (Refs , , , ). Established risk factors for the development and progression of OA include increasing age, female, history of trauma and obesity (Ref. ). Recent studies have also drawn a link between OA and metabolic syndrome, which is characterized by insulin resistance, dyslipidaemia and hypertension (Refs , ).

Exploring physiotherapists' perceptions of telerehabilitation for musculoskeletal disorders: Insights from focus groups.

Objective: This study explored the perceived benefits, barriers, and recommendations of telerehabilitation for musculoskeletal disorders among physiotherapists in Malaysia. Methods: This study employed an exploratory qualitative methodology to gather the perceptions of government-employed physiotherapists in Malaysia regarding the benefits, barriers, and recommendations for telerehabilitation in treating musculoskeletal disorders. The researchers conducted semistructured focus group discussions (FGDs) via Google Meet, which were recorded, transcribed, and analyzed using thematic analysis. Results: Five FGDs were conducted with 24 participants, 37.5% of whom had prior experience with telerehabilitation. The data analysis returned three main themes: (1) perceived benefits, (2) barriers, and (3) recommendations. Four subthemes were derived from perceived benefits: (1a) saving time and money, (1b) convenience, (1c) clients responsible for their treatment, and (1d) alternatives for infectious diseases. Perceived barriers revealed three subthemes: (2a) technology, (2b) organization, and (2c) personal barriers. Finally, participants provided recommendations for improving telerehabilitation services, including training programs to facilitate greater acceptance of this modality. Conclusion: The findings of this study offer crucial insights into the evolving landscape of telerehabilitation in Malaysia. These findings revealed a greater prevalence of barriers to enablers among Malaysian physiotherapists, potentially influenced by varying experience levels. Despite the prevailing lack of experience among participants, this research underscores the significance of identifying barriers and enablers in implementing telerehabilitation with participants offering recommendations for integrating telerehabilitation into their practices. This study provides clear insights and a roadmap for stakeholders aiming to shape the future of telerehabilitation among physiotherapists in Malaysia.