Prevalence and burden of skin diseases among the elderly in Singapore: a 15-year clinical cohort study.

BACKGROUND: Populations around the world are rapidly ageing. The profile of skin diseases in the elderly is likely to present unique demands on the healthcare system. OBJECTIVES: To provide current data on the burden of skin diseases in Singaporean patients and identify differences in the pattern of skin diseases between elderly patients and the rest of the population. METHODS: This was a retrospective cohort study of 858 117 patients who attended the National Skin Centre between 2004 and 2018. Prevalence was calculated by grouping International Classification of Diseases codes into different categories of skin conditions based on Global Burden of Disease and American Academy of Dermatology classifications. Years lost to disability (YLDs) and disability-adjusted life years (DALYs) were calculated to report the morbidity and mortality of skin diseases. Differences of each skin condition between age groups were compared. RESULTS: The three most prevalent dermatoses across all age groups were dermatitis (33.3%), acne vulgaris (8.3%) and viral skin diseases (7.5%). The top three most common skin conditions among the elderly were dermatitis (37.7%), viral skin diseases (6.2%) and fungal skin diseases (4.3%). Decubitus ulcers, keratinocyte carcinomas and scabies represented a significant proportion of YLD per 100 000 in the elderly (P < 0.001). Malignant melanomas, keratinocyte carcinomas, cellulitis, pyoderma and decubitus ulcers contributed to high DALYs in patients aged 70-80 years. CONCLUSION: Aligning health systems with specific healthcare needs will reduce the disproportionately high burden of skin disease observed in the elderly.

COVID-19 Vaccination for Frail Older Adults in Singapore - Rapid Evidence Summary and Delphi Consensus Statements.

OBJECTIVE: This study aimed to synthesize available evidence on the effectiveness and safety of COVID-19 vaccines for frail older adults through a rapid review, supplemented with geriatricians' consensus statements. METHODS: References were identified through MEDLINE and Web of Science on 1st February 2021 using relevant terms related to COVID-19, vaccine, and older adults. Searches were also conducted on reference lists of review articles and Google Scholar. The content was updated on 8th April via hand searching. We included studies on Phase III randomized controlled trials, and data from real world administration of vaccines. A two-round Delphi study was conducted with 15 geriatricians to elicit their thoughts and recommendations regarding COVID-19 vaccination for frail older adults. RESULTS: Five Phase III randomized controlled efficacy trials reported vaccine efficacy ranging from 66.7% to 95% among participants aged 16 to 95. The vaccine efficacy for participants aged 65 and above is 94.7% and 86.4% for Pfizer-BioNTech and Moderna respectively. Sputnik V reported a vaccine efficacy of 91.8% for participants 60 and above. Serious adverse events were reported by 0.27% to 1% of participants who received at least one dose of the four vaccines. For the Delphi study, 16 out of 24 statements achieved consensus. The Delphi panel opined that frail or very old adults, except those with limited life expectancy, should be vaccinated due to their vulnerability. They also agree that vaccination decisions should be made by patients when possible, with the involvement of next-of-kin should the frail older adult be unable to do so. Lastly, the panel thought that frail older adults should be included in future clinical trials. CONCLUSION: In early clinical trials, there is paucity of evidence on efficacy and safety of current COVID-19 vaccines among frail older adults. Geriatricians' consensus indicate that frail older adults should be vaccinated except where life expectancy is limited. Future trials assessing efficacy and safety should include frail older adults.

A Rapid Review of the Measurement of Intrinsic Capacity in Older Adults.

OBJECTIVES: This study aims to address the knowledge gap and summarise the measurement for intrinsic capacity for the five WHO domains across different populations. It specifically aims to identify measurement tools, methods used for computation of a composite intrinsic capacity index and factors associated with intrinsic capacity among older adults. METHODS: We performed literature review in Medline, including search terms "aged" or "elderly" and "intrinsic capacity" for articles published from 2000 - 2020 in English. Studies which assessed intrinsic capacity in the five WHO domains were included. Information pertaining to study setting, methods used for measuring the domains of intrinsic capacity, computation methods for composite intrinsic capacity index, and details on tool validation were extracted. RESULTS: Seven articles fulfilling the inclusion criteria were included in the review. Of these, the majority were conducted in community settings (n=5) and were retrospective studies (n=6). The most commonly used tools for assessing intrinsic capacity were gait speed test and chair stand test (locomotion); handgrip-strength and mini-nutritional assessment (vitality); Mini-Mental State Examination (cognition); Geriatric Depression Scale (GDS) and Center for Epidemiological Studies Depression Scale (CES-D) (psychological), and self-reported vision and health questionnaires (sensory). Among the tools used to operationalise the domains, we found variations and non-concordance, especially in the vitality and psychological domains, which make inter-study comparison difficult. Validated scales were less commonly used for vitality and sensory domains. Biomarkers were used for locomotion, vitality, and sensory domains. Self-reported measures were mostly used in the psychological and sensory domains. Three studies operationalised a global score for intrinsic capacity, whereby scores from the individual domains were used to create a composite intrinsic capacity index, using two approaches: a) Structural equation modelling, and b) Sub-scores for each domain which were combined either by arithmetic sum or average. CONCLUSION: We identified considerable variations in measurement instruments and processes which are used to assess intrinsic capacity, especially among the vitality and psychological domains. A standardized intrinsic capacity composite score for clinical or community settings has not been operationalised yet. Further validation via prospective studies of the intrinsic capacity concept and computation of composite score using validated scales are needed.

Ta2O5 nanobars and their composites: synthesis and characterization.

Novel Ta2O5 nanobars anchored on micron-sized carbon spheres were synthesized by the thermal decomposition of pentaethoxy tantalate, Ta(OEt)5. This one-step reaction was carried out using the RAPET (Reaction Under Autogenic Pressure at Elevated Temperature) method by dissociating Ta(OEt)5 at 800 degrees C for 3 h. The as-prepared Ta2O5/C nanobar-composite was annealed under air at 500 degrees C for 3 h (eliminating the carbon spheres), resulting in neat Ta2O5 nanobars. The products, Ta2O5/C and Ta2O5 nanobars, were characterized using methods such as electron microscopy (SEM, TEM, HRTEM, SAEDS, EA, EDX) and Powder-XRD. Transmission electron microscope (TEM) images indicated the particle size of the Ta2O5 nanobars coated on 40-60 nm carbon spheres. The optical properties of the Ta2O5/C nanobar-composite and the neat Ta2O5 nanobars were determined by UV-vis absorption spectrometry and their band gaps were found at 265 (4.7 eV) and 260 nm (4.8 eV), respectively. A PL band was also observed for a Ta2O5/C nanobar-composite and Ta2O5 nanobars. The above results indicate that Ta2O5 nanobars have a promising application in optical devices.

Selective oxidation of CO in the presence of air over gold-based catalysts Au/TiO2/C (sonochemistry) and Au/TiO2/C (microwave).

Two model catalysts, Au/TiO2/C (S) (sonochemically derived) and Au/TiO2/C (M) (microwave derived), were produced by employing ultrasound irradiation and microwave irradiation, respectively. The deposition of gold colloids onto the support powders, TiO2/C, was accomplished by using a solvated metal atom impregnation (SMAI) method. The SMAI technique provides highly-dispersed gold particles on the TiO2/C support. The catalytic performance of Au based catalysts 1 wt% Au-TiO2/C (S) and 1 wt%Au-TiO2(M)/C (M) have been tested for the oxidation of CO in the temperature range of 0-300 degrees C and compared to that of 1 wt% Au-TiO2 (Degussa-P25). A boost in the conversion of CO was observed for the sonochemically-derived catalyst, Au/TiO2/C (S), at low temperature. Hence, the reactivity order found for CO oxidation is (Au/TiO2/C (S)>Au/TiO2 (P25)>Au/TiO2/C (M)).

Synthesis of a conducting SiO2-carbon composite from commercial silicone grease and its conversion to paramagnetic SiO2 particles.

The thermal decomposition of commercial silicone grease was carried out in a closed reactor (Swagelok) that was heated at 800 degrees C for 3 h, yielding a SiO2-carbon composite with a BET surface area of 369 m2/g. The bulk conductivity (5.72 x 10(-6) S x cm(-2)) of the SiO2-carbon composite was determined by impedance measurements. The as-prepared SiO2-carbon composite was further annealed at 500 degrees C in air for 2 h, which led to the formation of white paramagnetic silica particles (confirmed by ESR), possessing a surface area of 111 m2/g. The present synthetic technique requires unsophisticated equipment and a low-cost commercial precursor, and the reaction is carried out without a solvent, surfactant, or catalyst. The mechanism for the formation of a porous SiO2-carbon composite from the silicone grease is also presented.

Current trends in the management of schizophrenia.

Schizophrenia is a common and devastating illness. Patients with schizophrenia may develop many disabilities both due to the disease process as well as due to side effects of the medication used. There are many advances in the treatment of schizophrenia, which can effectively reduce many of these disabilities. Treatment of schizophrenia is a primary health care responsibility and thus all health care personnel need to equip themselves with the latest knowledge on management issues. This article outlines the current management issues in schizophrenia.