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This paper compares the findings of two sequential cross-sectional studies of Singaporeans conducted in 2001 and 2011 with regard to the stability of values and their influence on life satisfaction. Using supporting literature, we propose several hypotheses on the relationships between values and Singaporeans' life satisfaction. We first report the means, importance ranks and changes in percentages for the values in the List of Values and the movements over the years. While values like security and sense of belonging have become more important, being well-respected has become less important over the decade. We then discuss the levels of life satisfaction, satisfaction with specific life domains and overall life satisfaction for Singaporeans, and the changes over 10 years. Using regression analyses and ANOVA, we examine the impact of shifting values and certain demographic variables on the life satisfaction of Singaporeans over the decade. Excitement and warm relationships with others were found to have a significant and positive influence on life satisfaction for both 2001 and 2011. The positive impact of self respect on life satisfaction was only significant in 2001, while security and sense of belonging had a significant negative and positive impact respectively on life satisfaction only in 2011. The effects of these values on life satisfaction were felt differently across age, gender, marital status, education, and income levels in 2001 and 2011. We conclude the paper with limitations and implications for policy making and future research. [ABSTRACT FROM AUTHOR]

Purpose – This study aims to examine the effects of balanced scorecard (BSC) usage on performances in the context of four contingent variables in Singaporean manufacturing firms. The results show that firms are more likely to adopt BSC if they are large in size, have products at an early product lifecycle (PLC) stage, operate in highly uncertain environments or adopt differentiation strategies. However, the adoption of BSC improves performance only in firms that are large or have products at an early PLC stage. The results suggest that contingent factors in which a firm operates can exert significant effects on the results of adopting BSC. Design/methodology/approach – Survey data are collected, then the authors check data correlations, principle components analysis, run regression analysis and ANOVA. Findings – BSC use is positively and significantly correlated with PLC stage, external environment and performance. Size and strategy are positively correlated with BSC usage, but are not statistically significant. Higher BSC use is found in large firms with products at an early PLC stage or operating in a highly uncertain environment. Companies with a cost leadership strategy are significantly associated with BSC use. Research limitations/implications – This study has small sample size and uses survey research method. The measurements to capture all aspects of BSC usage are non-exhausting. Future research can use different methodologies, such as field studies, case studies and lab experiments, to examine other industries than manufacturing. Practical implications – The authors results show the positive association between BSC use and certain firm characteristics. Firms with those characteristics should get insights about the benefit of using BSC and extract the maximum benefit from their investment on the BSC use and those firms which don’t have BSC in implication may think of implementing the BSC use. Social implications – Firms’ contingent factors affect the value of adopting BSC. With the authors research result, firms will be aware of how to extract the most value out of BSC and improve the social wealth of the manufacturing industries. Originality/value – The authors paper is the first paper to use survey method to examine the association between BSC and firms’ contingent factors in the Singaporean manufacturing firms setting. [ABSTRACT FROM AUTHOR]

This study comprised two parts. The first was part of a study at the Dyslexia Association of Singapore to monitor the progress of students undergoing literacy intervention with an enhanced reading comprehension curriculum. The reading comprehension performance of primary school students with dyslexia (n = 42) was monitored at three time-points (Time 1: baseline, Time 2: pre-enhanced curriculum and Time 3: post-enhanced curriculum) over the course of two years. Analysis of variance revealed significant improvement in reading comprehension performance from Time 1 to Time 2 and Time 1 to Time 3, but no significant difference between Time 2 and Time 3. Significant improvements were observed only in students with weaker verbal ability from Time 1 to Time 2 whereas students with stronger verbal ability showed no significant changes in reading comprehension performance over time. The second part of the study explored the ability of cognitive factors, namely verbal ability, non-verbal ability, phonological awareness, working memory and rapid naming ability, to predict concurrent (n = 31) and future reading comprehension performance at the end of one (n = 48) and two years (n = 44). There were neither significant correlations between rapid naming ability and reading comprehension performance at any of the time-points, nor between phonological awareness and future reading comprehension performance after one and two years. Verbal ability was a consistent and significant predictor of reading comprehension at the three time-points. Phonological awareness significantly correlated with concurrent reading comprehension performance but did not significantly predict it. Non-verbal ability and working memory significantly correlated with reading comprehension at all time-points but were not significant predictors of reading comprehension across time. Implications and future considerations for reading comprehension intervention were discussed, and theoretical implications with regard to the Simple View of Reading were considered as well. [ABSTRACT FROM AUTHOR]

As a contribution to worldwide efforts towards a tobacco-free society, this paper considers the possibility of a long-term phasing-in of a total ban, by proposing that individuals born in or after the year 2000 have their supply of tobacco restricted. In conjunction, a survey that we have conducted in Singapore indicates strong public support (even among current smokers) for the proposal. [ABSTRACT FROM AUTHOR]

Objective:The association between exposure to stressful life events (SLEs) and late-life depression is well-documented. However, the role of resilience as a buffer against the adverse mental health effects of SLEs in late life has not been convincingly demonstrated. In this paper, the moderating effect of resilience in the relationship between SLEs and depressive symptomatology in older Chinese adults is investigated. Method:A population sample of 385 community-dwelling older Chinese adults aged ≥60 years responded to questionnaires on resilience (Connor–Davidson resilience scale), depressive symptomatology (Geriatric Depression Scale, GDS-15) and SLEs. Results:Increased numbers of SLEs (β = 0.343,p< .001) and lower levels of resilience (β = –0.137,p< 0.001) were significantly associated with higher levels of depressive symptomatology. There was a significant interaction of resilience and number of SLEs on depressive symptomatology (p= 0.003). The sense of personal competence and optimism was the principal underlying resilience dimension moderating the relationship for both the young–old (aged 60–69) and the old–old (aged 70 and above). Conclusion:The finding of significant interaction supported the role of resilience in moderating the adverse effect of SLEs in terms of depressive symptoms among older Chinese adults. [ABSTRACT FROM PUBLISHER]

Previous work on the rhythm of Malaysian English has been based on impressionistic observations. This paper utilizes acoustic analysis to measure the rhythmic patterns of Malaysian English. Recordings of the read speech and spontaneous speech of 10 Malaysian English speakers were analyzed and compared with recordings of an equivalent sample of Singaporean English speakers. Analysis was done using two rhythmic indexes, the PVI and VarcoV. It was found that although the rhythm of read speech of the Singaporean speakers was syllable-based as described by previous studies, the rhythm of the Malaysian speakers was even more syllable-based. Analysis of the syllables in specific utterances showed that Malaysian speakers did not reduce vowels as much as Singaporean speakers in cases of syllables in utterances. Results of the spontaneous speech confirmed the findings for the read speech; that is, the same rhythmic patterning was found which normally triggers vowel reductions. [ABSTRACT FROM PUBLISHER]

Singapore is expected to experience a demographic revolution in its ageing population in the coming decades. In an effort to deal with this projected burgeoning need, the Singapore Parliament enacted the Maintenance of Parents Act in 1995. The Act legislates the financial responsibility of adult children towards their indigent aged parents. Using archival data, including parliamentary debates, official reports, and print media records, this study examines the Act’s underlying ideologies and cultural assumptions. The authors move beyond the rhetoric of filial piety and draw on the political economy of ageing perspective to uncover the contradictions that are inherent in the Act’s stated and unstated functions. This paper contextualizes the enactment of the Act within the larger governmental goals of nation-building, regime maintenance and wealth accumulation, and notes the Act’s coherence with other governmental ideologies, namely self-reliance and pragmatism. [ABSTRACT FROM PUBLISHER]

This study examines generalized trust and trust in institutions in Confucian Asia, covering six countries namely, China, Japan, Singapore, South Korea, Taiwan and Vietnam, and one dependent region, Hong Kong. Using data from the 2006 AsiaBarometer Survey, our study affirms the reliability and validity of using a two-item scale to measure generalized trust. Our analysis suggests that due to demographic differences, there are variations in the level of generalized trust of countries in Confucian Asia, despite the fact that these societies share a similar background in Confucian philosophy. The relationships between generalized trust and political trust, and between generalized trust and trust in public institutions, are weak but positive. The positive relationship between generalized trust and trust in economic institutions is only significant for some of the economies, while trust in international institutions has the weakest relationship with generalized trust for all societies. We conclude the paper with research implications. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a descriptive study of nurses' experiences of daily stress and coping. Background. Much of the research on stress in nursing is quantitative and has focused on only work stressors. Moreover, few studies have examined the uplifting side of living and the role it may play in moderating stress. A theoretical framework on stress and coping, 'hassles' and 'uplifts' was used to examine nurses' experiences across their personal and professional lives from a qualitative perspective. Methods. A purposive sample of Singaporean hospital nurses (n = 23) identified using a snowball sampling technique, participated in two sets of email interviews in 2009. The qualitative data were analysed using thematic analysis. Results. Three themes were identified as constituting daily hassles: (i) time pressures, (ii) nature of nursing work and (iii) multiple roles. Uplifts were expressed in relation to one main theme of feeling good extending across nurses' personal and professional lives. Three themes were identified as ways of coping: (i) taking time out, (ii) seeking emotional support and (iii) belief systems. Conclusion. The interaction between personal and professional life plays a major role in Singaporean nurses' experiences of stress and coping. However, stress may be ameliorated through effective management and strong familial support. Nurses and employers are recommended to use uplifts and identify ways of coping to minimize attrition and contribute to the development of a healthy workforce. [ABSTRACT FROM AUTHOR]

Background: There are no language assessment tools designed specifically for the 200 million Malay-speaking people in SE Asia so practitioners use translations or informal tests. This paper describes the development of a semantic battery in Malay, a language that differs substantially from English. Methods & Procedures: The battery was developed in Singapore using a cognitive neuropsychological model of language representation and administered to three cohorts of neurologically intact adults with Malay as their first-language (N = 63, age ranges 20-40, 40-60, > 60 years). The 12 subtests (6 each for nouns and verbs) cover input and output modalities (listening, reading, speaking, and spelling) and all the picture referents were standardised locally. Outcomes & Results: From an initial pool of 130 items, an item analysis revealed that 52 nouns and 45 verbs (97 words) achieved > 80% accuracy across subtests for first-language speakers of Malay. The normative profiles developed for each cohort suggest that educational background influenced processing abilities, especially reading and spelling skills. Conclusions: The Malay Semantic Battery provides an example of how culturally and linguistically appropriate assessment tools can be developed from first principles at minimal cost. Details of the battery will be made available to clinicians online, or through e-mail, to support their planning of targeted intervention programmes. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine cross-cultural differences in gesture frequency and the extent to which exposure to two cultures would affect the gesture frequency of bilinguals when speaking in both languages. The Chinese-speaking monolinguals from China, English-speaking monolinguals from America, and Chinese-English bilinguals from Singapore were videotaped while retelling two stories, and their speech and gestures were coded. The bilinguals retold the stories twice, once in Mandarin-Chinese and once in English. We looked at both representational (iconic gestures and abstract deictic gestures) and nonrepresentational gestures (speech beats, emblems, and concrete deictic gestures) and calculated the number of gestures per clause for each speaker. The English monolinguals overall produced more representational and nonrepresentational gestures than the Chinese monolinguals, suggesting that American culture is a relatively high-gesture culture and Chinese culture is a relatively low-gesture culture. When speaking in English, the bilinguals resembled the English monolinguals regarding the frequency of both representational and nonrepresentational gestures. When speaking in Mandarin-Chinese, the bilinguals produced more representational gestures than the Chinese monolinguals but more or less the same number of representational gestures as the English monolinguals. In contrast, the bilinguals and the Chinese monolinguals produced similar number of nonrepresentational gestures. Thus, gesture frequency of representational gestures (but not that of nonrepresentational gestures) seems to transfer from English to Chinese, suggesting the closely intertwined relationship of representational gestures and accompanying speech. [ABSTRACT FROM AUTHOR]

Purpose — The purpose of this study is to analyze Singapore's diverse cardholders in search of variations among demographic groups, credit card profiles, and their perceptions with regard to credit card ownership and use. It then aims to discuss possible reasons governing Singaporeans' credit card ownership and use. Design/methodology/approach — A survey was conducted, decision trees were then constructed using Chi-square automatic interaction detection algorithm (CHAID) and SPSS software AnswerTree to examine the association between the number of credit cards (target variable) and the demographic characteristics, perceptions and other credit card-related variables. Findings — The number of credit cards was found to be significantly influenced by income and gender as well as perceptions that include "credit card leads to overspending", "savings as payment source", "unreasonable interest rates", "credit card as status symbol". The number of credit cards was also affected by credit card-related variables such as missing payments sometimes, frequency of use, entertainment expenditures, and petrol purchase. Practical implications — This research provides an in-depth understanding of Singaporean multiple cardholders, thus it is useful in designing marketing strategies for card-issuers as well as anti-debt strategies for policy-makers in Singapore. Originality/value — Despite the importance of consumer credit, virtually no literature or research exists on the ownership and use of credit cards in Singapore, so this paper intends to close this gap. Further, by combining the demographics, cardholders' profiles and usage patterns with the respondents' perceptions concerning credit card ownership and use, our study offers a richer analysis to explain consumer behavior than previous literatures. [ABSTRACT FROM AUTHOR]

Breast cancer is the number one killer disease among women. It is known that early detection of a tumour ensures better prognosis and higher survival rate. In this paper an intelligent, inexpensive and non-invasive diagnostic tool is developed for aiding breast cancer detection objectively. This tool is based on thermographic scanning of the breast surface in conjunction with numerical simulation of the breast using the bioheat equation. The medical applications of thermographic scanning make use of the skin temperature as an indication of an underlying pathological process. The thermal pattern over a breast tumour reflects the vascular reaction to the abnormality. Hence an abnormal temperature pattern may be an indicator of an underlying tumour. Seven important parameters are identified and analysis of variance (ANOVA) is performed using a 2n design (n = number of parameters, 7). The effect and importance of the various parameters are analysed. Based on the above 2(7) design, the Taguchi method is used to optimize the parameters in order to ensure the signal from the tumour maximized compared with the noise from the other factors. The model predicts that the ideal setting for capturing the signal from the tumour is when the patient is at basal metabolic activity with a correspondingly lower subcutaneous perfusion in a low temperature environment.

Background: While dialectical behaviour therapy (DBT) has much empirical support for treating borderline personality disorder (BPD) and other conditions, little research has examined the dissemination of DBT in Southeast Asia. Aims: This study evaluated training outcomes following a 5‐day intensive DBT training programme in a group of psychologists in Singapore, who were in the process of implementing DBT as part of the training's objectives. Methodology: A mixed‐methods design was employed. Fourteen psychologists from a public psychiatric hospital in Singapore were recruited. Seven self‐selected into DBT training, and the remaining were matched controls who were not attending the training programme. The latter served as a nonrandomised control group. Prior to and 3 months after training, all participants completed measures of stigma towards BPD patients, burnout and therapeutic alliance. DBT training participants additionally attended a focus group discussion assessing their experiences and challenges implementing DBT in Singapore's context. Findings: Quantitative analyses using mixed ANOVA showed that, compared with controls, DBT‐trained participants demonstrated significantly greater increases in acceptance towards BPD patients. No between‐group differences were found on changes in burnout or therapy alliance with patients. Analyses of qualitative data using thematic analysis revealed that DBT training impacted the way participants conceptualised and delivered therapy for BPD patients, and highlighted several challenges in implementing DBT in the local hospital context. Conclusion: The findings demonstrate the potential of DBT training in improving clinicians' attitudes towards BPD patients and support a need for policymakers to prepare organisations for DBT implementation to ensure programme sustainability. [ABSTRACT FROM AUTHOR]

Mineral oil–based liquids are normally used as the dielectric fluid in electrical discharge machining (EDM) where it has the ability in improving the efficiency of the machining process. Nevertheless, these dielectric fluids have the tendency to cause environmental problems. Therefore, as an alternative, gas has been introduced as the dielectric fluid also known as dry EDM (DEDM) process. However, kerf variation in dry micro-wire EDM (DμWEDM) process remains a critical issue. Thus, the objective of this research is to investigate kerf accuracy in DμWEDM. Experimental investigation was carried out on a stainless steel (SS304) with a tungsten wire as the electrode and compressed air as the dielectric fluid using integrated multi-process machine tool, DT 110 (Mikrotools Inc., Singapore). Central composite design (CCD) was used to design the experiment using two controlled parameters: capacitance and gap voltage. Analysis of variance (ANOVA) was used to analyse the results and to evaluate the adequacy of the developed model. The results were obtained by measuring the kerf using a scanning electron microscope (SEM) (JEOL JSM-5600, Japan). The investigation of kerf was divided into two responses which were upper kerf and bottom kerf. Empirical models were developed, and it was found that both parameters (capacitance and gap voltage) have high influence on both responses. The optimum parameters for both minimum upper and bottom kerf were found to be 0.1 nF capacitance and 91 V gap voltage. The developed models were found to be adequate since the percentage error is relatively small (< 3%). [ABSTRACT FROM AUTHOR]

Objective(s): The global demographic changes resulting in an ageing population require attention on xerostomia, as its prevalence appears to increase with age. The Xerostomia Inventory (XI) is a 11‐item instrument developed to evaluate the symptoms and behavioural components of xerostomia, while a shortened 5‐item version named Summated Xerostomia Inventory (SXI) was later proposed. The aim of the present study was to evaluate the construct validity of the XI and whether the SXI can provide a shortened version. Since previous studies focused only on dimensionality and reliability, we employed modern psychometric methodology to investigate properties such as differential item functioning (DIF) and targeting. Study Design: The XI was applied to 164 middle‐aged to older adults who participated in a randomized controlled trial to investigate the effects of alcohol‐containing mouth rinse in Singapore. The psychometric properties of the XI were investigated with the Rasch model (Partial Credit Model). Overall model fit was evaluated with a summary chi‐square statistic. Item fit was evaluated with the Fit Residual, and values between −2.5 and 2.5 are considered acceptable. DIF by sex was evaluated through a two‐way ANOVA of the residuals. Results: After collapsing the categories of "Hardly ever" and "Fairly often", the test of global fit (χ2 (30) = 34.32, P =.27) indicated overall fit to the Rasch model. Since Fit Residuals were between −2 and 2, the fit of individual items was also adequate. No DIF was found between men and women, and targeting was adequate (μ = −0.56). Conclusion: The current study expanded the evidence on the XI and SXI validity and provides new implications for practice: a 3‐point categorization ("Never," "Occasionally" and "Very often") should be preferred rather than the original 5‐point categorization; the XI and SXI scores can be compared between men and women and will reflect true differences in xerostomia rather than measurement bias. [ABSTRACT FROM AUTHOR]

A randomised, waitlist controlled, trial was conducted to evaluate the effects of the Adult Resilience Program (ARP), a universal prevention social–emotional programme for adolescents and adults, on self‐reported depression, anxiety, stress, resilience, and self‐esteem. Seventy‐six students from a private university in Singapore were randomised to the ARP group or wait‐list control (WLC) group and assessments were conducted at pre‐intervention (T1), post‐intervention (T2), and 6‐month follow‐up (T3). A 2 × 3 mixed between‐within groups multivariate analysis of variance with the between‐group factor of Group (ARP, WLC) and the within‐group factor of time (T1, T2, and T3) and the dependent variables of depression, anxiety, stress, resilience and self‐esteem, with age and stage of degree as covariates showed a significant decrease over time in depression (ηp2 =.20), and anxiety (ηp2 =.06). There was a significant decrease in stress for the ARP only from T1 to T2 (ηp2 =.16). While there was a significant interaction of Time and Group for resilience (ηp2 =.07), there was no significant change in resilience for the ARP group alone. The results provide preliminary support that the ARP can impart essential skills that can have a positive impact on mental health in university students. [ABSTRACT FROM AUTHOR]

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Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore. Design: Retrospective cross-sectional study. Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013. Results: Half of the subjects presented with more severe (>55 dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4 h of daily HA usage. Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly. [ABSTRACT FROM AUTHOR]

Aim: Children with developmental disabilities are at risk of excessive screen time and are more vulnerable to sleep problems. The aim of this study was to determine the extent of screen time use in children with developmental disabilities and its relationship with sleep duration.Methods: Consecutive children aged 6-15 years diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fourth or Fifth Edition (DSM-IV or DSM-5) developmental disabilities were recruited for this study from December 2014 to April 2015. Of those recruited, 87.0% of families gave consent and provided questionnaire information on demographics and child's screen time use and completed the Children's Sleep Habits Questionnaire.Results: Parents of 102 children in a tertiary-care developmental clinic completed the study. The mean age of children was 10 years, 1 month (standard deviation (SD), 22.7 months). The mean daily total screen time exposure was 2 h, 52.7 min (172.7 min, SD 120.8 min), with a median of 150.0 min. The mean amount of sleep per weekday was 8 h, 23.3 min (SD 64.6 min). Linear regression showed that, for every additional 9.17 min of screen time per day, sleep was reduced by 1 min (β = -0.11, P = 0.04). Older age (β = -0.64, P = 0.02) and living with a single parent (β = -69.29, P = 0.003) were also associated with less sleep.Conclusions: Among children with developmental disabilities, greater daily screen time is associated with lower sleep duration. Older children and those from single-parent families are at risk of lower sleep duration. Clinicians should routinely ask about screen time exposure and sleep habits in order to provide appropriate anticipatory guidance. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of a multi-dimensional community-based health promotion and risk prevention programme, named Salutogenic Healthy Ageing Programme Embracement (SHAPE) for senior-only households in Singapore. Background: In view of ageing population and its significant impacts on economy, societal structure and policy-making, healthy ageing emerges as an important concept in maintaining health through the engagement of health-promoting behaviour and risk prevention actions in older people. Design: A stratified randomized control trial with process evaluation is proposed. Methodology: The salutogenic model, which focuses on positive well-being and optimizing health outcomes, provides an underpinning theoretical framework for this study. SHAPE is a 12-week intervention programme comprising of both weekly group-based activity sessions and home visits. One hundred and fifty-four eligible participants will be stratified and randomly allocated to either the SHAPE intervention or the control group. Both outcome and process evaluation will be conducted. Outcome measures include sense of coherence, quality of life, health-promoting behaviours, self-efficacy and other health-related outcomes. These data will be collected at four time points: baseline, 3 months, 6 months and 12 months. Individual qualitative face-to-face interviews will be conducted for older people receiving SHAPE to explore their views on the programme. Discussion: The use of salutogenic model breaks away from the negatively connoted conventional biomedical model and addresses optimization of positive health, providing an overall holistic approach to care of older people. The intervention SHAPE seeks to identify, equip and strengthen resources for senioronly households, encouraging the adaption of health-promoting and risk-preventing actions to achieve better health outcomes and higher quality of life. [ABSTRACT FROM AUTHOR]

Aim To develop and compare a nurse-led smartphone-based self-management programme with an existing nurse-led diabetes service on health-related outcomes for people with poorly controlled type 2 diabetes in Singapore. Background Over the past decades, Asia has emerged as the 'diabetes epicentre' in the world due to rapid economic development, urbanization and nutrition transition. There is an urgent need to develop more effective care management strategies in response to this rising diabetes epidemic. Design A randomized controlled trial with pre- and repeated posttests control group design. Methodology A total of 128 adults with poorly controlled type 2 diabetes will be recruited from the diabetes clinic of a public acute hospital in Singapore through convenience sampling. Study participants will be randomly allocated either to the experimental group or the control group. Outcome measures will include the 10-item General Self-Efficacy Scale, 11-item Revised Summary of Diabetes Self-care Activities and 19-item Diabetes-Dependent Quality of Life. Data will be collected at three time points: baseline, 3 and 6 months from the baseline. Discussion It is expected that this programme will be an alternative offered to diabetes patients to master their self-care management skills, in addition to the existing diabetes service provided in diabetes clinics in Singapore hospitals. Furthermore, the self-supporting and less resource-intensive nature of this programme, using a smartphone application as the mode of intervention delivery, will greatly reduce nurses' direct contact time with patients and allow more time to be allocated to those who require more attention. The study has been registered with ClinicalTrials.gov. The trial registration number is NCT03088475. [ABSTRACT FROM AUTHOR]

Aims The aim of this study was to describe a study protocol that evaluates the effectiveness of the 'Home-but not Alone' educational programme delivered via a mobile health application in improving parenting outcomes. Background The development in mobile-based technology gives us the opportunity to develop an accessible educational programme that can be potentially beneficial to new parents. However, there is a scarcity of theory-based educational programmes that have incorporated technology such as a mobile health application in the early postpartum period. Design A randomized controlled trial with a two-group pre-test and post-test design. Methods The data will be collected from 118 couples. Eligible parents will be randomly allocated to either a control group (receiving routine care) or an intervention group (routine care plus access to the 'Home-but not Alone' mobile health application. Outcome measures comprise of parenting self-efficacy, social support, parenting satisfaction and postnatal depression. Data will be collected at the baseline (on the day of discharge) and at four weeks postpartum. Discussion This will be an empirical study that evaluates a theory-based educational programme delivered via an innovative mobile health application on parental outcomes. Results from this study will enhance parenting self-efficacy, social support and parenting satisfaction, which may then reduce parental risks of postnatal depression. [ABSTRACT FROM AUTHOR]

Active Ageing is conceptualised to measure the extent to which older people remain actively engaged with life. However, there is no evidence that the concept of Active Ageing is actually associated with the activity levels of older persons. Influences of age, ethnicity and spirituality on Active Ageing are also unexplored. Using the Active Ageing Index (AAI), this study examines whether the level of Active Ageing predicted the actual activity level of 120 Singaporeans of Chinese, Malay and Indians ethnicities, aged 55–64 years old or 65 years and above. Spirituality, measured by the Spirituality Index of Well-Being, was added to the AAI, to see if the predictive power of AAI improved. Hierarchical multiple regression showed that the AAI alone (controlling for age) did not significantly predict the activity level of older persons. The predictive power of the AAI improved significantly with spirituality included. Two-way between-groups Analysis of Variance revealed main effects of age and ethnicity, with higher AAI in those aged 55–64 and in Indian-Singaporeans. These findings suggest that the theoretical construct of Active Ageing needs further examination to identify the domains that distinguish it from chronological age, and support broadening the construct by including spirituality in Active Ageing. [ABSTRACT FROM AUTHOR]

Aim To develop and examine the effectiveness of an advanced practice nurse-led telehealth rehabilitative programme as a transitional nursing therapeutic on readmission rates and health-related outcomes among patients with acute myocardial infarction postdischarge. Background Patients suffering from acute myocardial infarction are experiencing an increasing trend of frequent readmissions. This implicates both the effectiveness of healthcare services and patient's quality of life. Advanced Practice Nurse-led telehealth rehabilitative programme has yet to be explored as a strategy to minimize preventable readmissions and improve patient's self-efficacy so as to enhance quality of life after a heart attack. Design Randomized controlled trial with repeated measures. Methodology A consecutive sampling of 172 patients with acute myocardial infarction will be recruited from a tertiary acute hospital in Singapore. Participants will be randomized into two groups. The experimental group ( ALTRA) will receive Advanced Practice Nurse-led telehealth rehabilitative programme on discharge. The control group will receive only standard follow-up care. The outcome measures include readmissions, cardiac self-efficacy, cardiovascular risk factors, quality of life, anxiety and depression. The data will be collected at the baseline, 1 and 6 month postdischarge. A postprogramme evaluation will be conducted among the participants to assess its acceptability, strengths and weakness. Discussion ALTRA aims to engage and support patients with acute myocardial infarction by increasing self-care management through education and telehealth contacts with Advanced Practices Nurses. This provides a smoother transition of illness to health and ultimately, reduces preventable costly readmissions. Trial registration The study has been registered with clinicaltrials.gov. The trial registration number is NCT02483494. [ABSTRACT FROM AUTHOR]

Background: With children today being tested at younger ages, test anxiety has an earlier onset age. There is relatively limited research on test anxiety management programs with elementary school children. The theoretical basis for this nonrandomized pre-post intervention study is grounded in cognitive and behavioral interventions for test anxiety found to be efficacious with children. Objective: The purpose is to examine the impact of a school-based test anxiety prevention program on a sample of Singaporean fourth grade students relative to their levels of academic achievement and to identify active treatment components. Methods: 115 children aged 9-12 were assigned to group-based cognitive-behavioral treatment ( n = 58) or control condition ( n = 57). They completed the Children's Test Anxiety Scale and Cognitive-Behavioral Skills Checklist at pre-, post-treatment, and 2 months' follow-up. Anxiety ratings were hypothesized to be lower for the intervention than the control group at post-treatment. Skills that contributed to treatment outcomes were identified. Results: A mixed-design analysis of variance revealed significant test anxiety reduction with medium treatment effect that was maintained for the intervention group across time. There was no change in the control group. Behavioral skills (e.g., relaxation exercises, study skills) contributed to treatment outcomes. Cognitive skills such as calming self-talk did not. Conclusions: The study provided preliminary evidence on the utility of brief, school-based anxiety interventions in test anxiety prevention for children. It added credence to adopting behavioral over cognitive strategies in treating test anxious children. Children with severe test anxiety at baseline benefited particularly from treatment. [ABSTRACT FROM AUTHOR]

This study aimed to determine whether definable profiles existed in a cohort of nursing staff with regard to demographic characteristics, job satisfaction, acculturation, work environment, stress, cultural values and coping abilities. A survey was conducted in one hospital in Singapore from June to July 2012, and 814 full-time staff nurses completed a self-report questionnaire (89% response rate). Demographic characteristics, job satisfaction, acculturation, work environment, perceived stress, cultural values, ways of coping and intention to leave current workplace were assessed as outcomes. The two-step cluster analysis revealed three clusters. Nurses in cluster 1 ( n = 222) had lower acculturation scores than nurses in cluster 3. Cluster 2 ( n = 362) was a group of younger nurses who reported higher intention to leave (22.4%), stress level and job dissatisfaction than the other two clusters. Nurses in cluster 3 ( n = 230) were mostly Singaporean and reported the lowest intention to leave (13.0%). Resources should be allocated to specifically address the needs of younger nurses and hopefully retain them in the profession. Management should focus their retention strategies on junior nurses and provide a work environment that helps to strengthen their intention to remain in nursing by increasing their job satisfaction. [ABSTRACT FROM AUTHOR]

This study examined psychological well-being and coping in parents of children with ASD and parents of typically developing children. 73 parents of children with ASD and 63 parents of typically developing children completed a survey. Parents of children with ASD reported significantly more parenting stress symptoms (i.e., negative parental self-views, lower satisfaction with parent-child bond, and experiences of difficult child behaviors), more depression symptoms, and more frequent use of Active Avoidance coping, than parents of typically developing children. Parents of children with ASD did not differ significantly in psychological well-being and coping when compared as according to child's diagnosis. Study results reinforced the importance of addressing well-being and coping needs of parents of children with ASD. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims The aim of this study was to examine nurses' self-confidence and attitudes towards the Glasgow Coma Scale ( GCS). Background The GCS measures the depth and duration of impaired consciousness. However, there is an increasing evidence that problems are encountered in completing some aspects of the GCS. Design This descriptive correlational study recruited 114 Registered Nurses ( RNs) in one acute care hospital in Singapore. Methods A set of questionnaires were given to the participants. The questionnaire had three parts, which collected data on demographics, attitudes and self-confidence. Results Data analysis showed the type of clinical discipline ( B = 0·19), seniority in nursing (Staff Grade) ( B = 0·28) and higher attitude scores towards the GCS ( B = 0·41) were significant factors determining a nurse's confidence in using the GCS. A longer length of time working in a Neuroscience setting ( B = 0·21) and higher self-confidence scores ( B = 0·41) were significant factors determining a nurse's attitude towards the GCS. Conclusion To ensure patient safety, the GCS has to be performed accurately. This study has shown there are differences in attitudes and self-confidence in using the GCS between nurses of different demographics, and that there are a variety of factors influencing their attitudes and confidence. Relevance to clinical practice Mentoring and educational interventions are suggested in order to reduce safety risks resulting from lower proficiency in using the GCS. [ABSTRACT FROM AUTHOR]

Aim To report a study protocol that tests the effectiveness of an educational intervention on outcomes of parents and their children who undergo inpatient elective surgery. Background Inadequate children's postoperative pain management remains a global problem. Parents are required to be involved in their child's pain assessment and management, yet they often lack relevant knowledge and skills. Education is an effective strategy for enhancing a person's knowledge, attitudes and behaviour. However, few studies have examined its effectiveness in parents and their children undergoing inpatient elective surgery. Design Randomized controlled trial and embedded qualitative process evaluation. Methods One hundred and sixty-two pairs of participants (each comprised of one parent and his/her child undergoing inpatient elective surgery) will be recruited (protocol approved in January 2013). Participants will be randomized to either a Control group (routine care), an Intervention group 1 (routine care and an educational intervention with face-to-face teaching), or an Intervention group 2 (routine care and an educational intervention without face-to-face teaching). Outcome measures will include parents' knowledge, attitude and behaviour related to postoperative pain management; their child's postoperative pain; and parents' satisfaction with their child's pain management at baseline and around 6, 12 and 24 hours after the operation. Discussion A standardized educational intervention protocol and detailed study procedure have been developed in this study to improve parents' knowledge, attitude and behaviour related to postoperative pain management and reduce their child's postoperative pain. [ABSTRACT FROM AUTHOR]

Background/Study Context: The safety of older pedestrians in road crossing has received considerable attention but previous studies measure gait characteristics only under unloaded conditions. The aim of this study was to investigate the start-up time and walking speed under loaded conditions that reflect daily activities of older adults in Singapore. Methods: Thirty-two older adults (age (SD) = 69.4 (7.0) years) and 20 young controls (age (SD) = 23.1 (2.0) years) walked under four conditions: (1) unloaded, (2) pushing a stroller loaded with 10 kg, (3) pulling a shopping cart loaded with 15 kg, and (4) carrying two shopping bags each loaded with 2 kg. Start-up time was determined from video recordings and walking speed measured using timing gates. A mixed-model analysis of variance (ANOVA; age by walking condition) with repeated measures was applied. Results: Start-up times were slower in the stroller and shopping cart conditions compared with the unloaded and shopping bags conditions. Loading reduced walking speed, with the shopping cart being the slowest, followed by the stroller and then the shopping bags. A significant interaction was found, with young controls reducing their speeds more substantially while handling the stroller/cart than older participants. Conclusion: Loading caused a compromise in start-up time and walking speed. The start-up time was slower when pushing a stroller or pulling a shopping cart but remained unaffected by carrying shopping bags. Speed was reduced under all loaded conditions, with a greater effect in young than older participants when handling a stroller or shopping cart. [ABSTRACT FROM PUBLISHER]

Aim: To report a trial protocol to determine if a self-care program enhances quality of life and sense of coherence in community-dwellers aged 65 years or over. Design: A randomized controlled trial with a two-group pretest and posttest will be conducted in a community activity center involving a sample of 64 community-dwellers who are 65 years or over. Methods: The intervention group will receive Resource Enhancement and Activation Program, a structured 12-week self-care program comprising 24 activities based on a salutogenic framework. The control group will receive the routine service. Both outcome and process evaluations will be used. Outcomes will be measured using standardized tools and these include quality of life, sense of coherence, satisfaction with life, activation measure, well-being, depression, loneliness and resilience. Focus group interviews will be conducted to explore participants’ views on the program. Conclusion: This study will provide evidence on the feasibility and effectiveness of a self-care program that is based on a salutogenic framework to promote quality of life and sense of coherence among older community-dwellers. [ABSTRACT FROM AUTHOR]

This experimental investigation explores differences in reciprocal norms between friends and strangers and the effects of culture on reciprocity. Based on altruistic and strong reciprocity theories, a hybrid trust-dictator game tested the influence of relationship (i.e. friends vs. strangers), treatment (i.e. positive vs. negative) and culture (i.e. collectivistic vs. individualistic) on reciprocation. The results show that participants reciprocated more positively when treated positively in general. However, the results demonstrate intercultural differences in reciprocal norms, specifically in the negative treatment condition. Participants from the individualistic culture provided stronger punishment to the norm violator, compared to participants from the collectivistic culture. We discuss implications of the impact of relationship and culture on reciprocation with respect to the olive branch response. [ABSTRACT FROM AUTHOR]

Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children's Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxiety disorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach's alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed. [ABSTRACT FROM AUTHOR]

Aim and objective To examine the correlation between maternal parental self-efficacy and social support as well as predictors of self-efficacy in the early postpartum period. Background Maternal parental self-efficacy is important for mothers' adaptation to motherhood. Lack of support could result in decreased maternal parental self-efficacy in newborn care. Limited studies have focused on maternal parental self-efficacy in the postpartum period in Asia and none in Singapore. Study design A correlational study design was adopted. Methods Data were collected from both primiparas and multiparas during the first to third days postpartum in a public hospital, using the Perceived Maternal Parental Self-efficacy and Perinatal Infant Care Social Support Scales. The data were analysed using descriptive and inferential statistics. Results Maternal parental self-efficacy in newborn care and the level of social support that mothers received were moderate. In terms of the social support subscales, informational and instrumental support was lower than emotional and appraisal support. Informal support from husbands, parents and parents-in-law was the main source of support. A significant correlation was found between maternal parental self-efficacy and total social support in addition to the informational, instrumental and appraisal subscales of functional support. The predictors of maternal parental self-efficacy were parity, social support and maternal age. Conclusion The findings highlight the predictors and correlates of maternal parental self-efficacy in newborn care and the social support needs of mothers in the early postpartum period. Healthcare professionals could provide more information and instrumental support and involve family members to enhance maternal parental self-efficacy. Relevance to clinical practice Because maternal parental self-efficacy and social support in the early postpartum period are interrelated components, they could be assessed to identify at-risk mothers. There is a need to develop perinatal educational programmes to provide culturally competent individualised support to mothers in need. [ABSTRACT FROM AUTHOR]

Background Lower urinary tract symptoms ( LUTS) in men are associated with obesity, particularly central obesity as measured by waist circumference ( WC), and may improve with weight loss. We aimed to compare effects of a meal-replacement based diet with isocaloric reduced-fat plan on LUTS and nutrient intake in obese Asian men. Methods Obese Asian [mean (range) body mass index of 32.9 (30.5-42.3) kg m-2] men [mean (range) age 40.2 (30-61) years] were randomised to a reduced-fat (< 30% of energy) diet [conventional reduced-fat diet (CD) group; n = 23] or meal-replacement-based plan [meal replacement (MR) group; n = 23], to reduce daily intake by 2000 kJ for 12 weeks. Results CD and MR groups had statistically significant and similar reductions in weight (−2.6 ± 1.9 kg versus −4.2 ± 3.8 kg), overall LUTS severity measured with International Prostate Symptom Scale ( IPSS) scores (−1.71 ± 1.93 points versus −2.42 ± 2.12 points) and insulin resistance [homeostasis model assessment ( HOMA) calculated from plasma glucose and insulin]. The MR group had significantly greater decreases in WC (−4.8 ± 3.3 cm versus −2.5 ± 2.3 cm), fat mass (−2.47 ± 3.63 kg versus −1.59 ± 2.32 kg), fat intake, plasma C-reactive protein, and in storage LUTS score (−1.59 ± 1.33 points versus −1.00 ± 0.87 points), which was associated with a decreased fat intake ( r = 0.48, P = 0.03). A decrease in overall IPSS score was associated with reductions in weight, WC and HOMA. Conclusions Weight loss as a result of CD or MR had similar efficacy in relieving LUTS. MR produced greater reductions in fat intake, adiposity and storage LUTS. [ABSTRACT FROM AUTHOR]

Aim: To evaluate possible differences in health-related quality of life (HRQoL) according to self-reported smoking status in a multiethnic urban Asian population in Singapore. Subjects and methods: In this community-based cross-sectional survey of a stratified random sample, interviewers obtained socioeconomic, clinical and HRQoL-Short Form-36, Version 2 (SF-36v2), Health Utilities Index Mark 3 (HUI3) and EuroQoL 5-Dimensions (EQ-5D)-data in English, Chinese or Malay. The association between self-reported smoking status and HRQoL at the overall scale and individual attribute levels stratified by gender were evaluated using regression analyses. Results: Of 3,006 consenting participants with a mean age of 48 (SD: 16.44) years, 49.9 % males, Chinese: Malay: Indian = 49.9 %: 25.3 %: 24.8 %, 727 (34.4 %) male and 1,386 (65.6 %) female are never smokers, 208 (86.7 %) male and 32 (13.3 %) female are ex-smokers, 104 (78.8 %) male and 28 (21.2 %) female are occasional smokers, while 460 (88.3 %) male and 61 (11.7 %) female are regular smokers. After adjusting for socioeconomic and clinical variables, male ex-smokers reported lower SF-36v2 MCS (regression coefficient: −1.60, P = 0.026) and HUI3 utility scores (regression coefficient: −0.024, P = 0.040) compared to never smokers. Female regular smokers reported lower HUI3 utility scores as compared to never smokers (regression coefficient: −0.056, P = 0.004). Conclusion: Compared with never smokers, male ex-smokers and female regular smokers reported poorer HRQoL in this multiethnic Asian study. [ABSTRACT FROM AUTHOR]

This national survey tracks changes in Singaporeans' attitudes toward lesbians and gay men ( ATLG) and examines value predispositions, interpersonal contact, and mediated exposure as predictors of ATLG and acceptance of homosexuals. The study replicates and extends research done previously and addresses temporal shifts in values and views. Findings indicate that the relatively small positive change in ATLG from 2005 to 2010 was mainly due to values and demographic factors. The addition of several new predictive variables increased the variance explained for why people hold certain ATLG and their acceptance. Conformity to norms, intrinsic religiosity, Western orientation, interpersonal contact, and mediated exposure were significantly associated with both ATLG and acceptance of homosexuals. Perception of homosexuality as a choice was significantly associated with ATLG but not with acceptance of homosexuals. Asian orientation and extrinsic religiosity showed no significant association with either dependent variable. The findings are discussed in the context of a multicultural Asian society and future directions for research. [ABSTRACT FROM AUTHOR]

BackgroundAbnormalities in cortical thickness and subcortical structures have been studied in schizophrenia but little is known about corresponding changes in mania and brain structural differences between these two psychiatric conditions, especially early in the stage of the illness. In this study we aimed to compare cortical thickness and shape of the amygdala–hippocampal complex in first-episode schizophrenia (FES) and mania (FEM).MethodStructural magnetic resonance imaging (MRI) was performed on 28 FES patients, 28 FEM patients and 28 healthy control subjects who were matched for age, gender and handedness.ResultsOverall, the shape of the amygdala was deformed in both patient groups, relative to controls. Compared to FEM patients, FES patients had significant inward shape deformation in the left hippocampal tail, right hippocampal body and a small region in the right amygdala. Cortical thinning was more widespread in FES patients, with significant differences found in the temporal brain regions when compared with FEM and controls.ConclusionsSignificant differences were observed between the two groups of patients with FES and FEM in terms of the hippocampal shape and cortical thickness in the temporal region, highlighting that distinguishable brain structural changes are present early in the course of schizophrenia and mania. [ABSTRACT FROM PUBLISHER]

Four studies examined whether thought suppression could enhance attitude accessibility and whether behaviours that are consistent with the more accessible attitudes would follow. Thinness was examined as the attitude object. Experiments 1 and 2 showed that suppression of positive thoughts about thinness increased the accessibility of the positive attitudes associated with thinness. Experiments 3 and 4 showed that suppression of positive thinness thoughts also elicited more health-promoting behaviours. The implications of the findings for attitude accessibility and the practical consequences of thought suppression are discussed. [ABSTRACT FROM AUTHOR]

This study examines the factor structure of Asian child-reported parenting from a Rasch perspective. Participants comprised 291 sixth graders (11 to 13 years) in Singapore. Six different aspects of parenting were measured, namely warmth, rejection, structure, chaos, autonomy support, and coercion. Rasch Analysis was used to transform ordinal data into linear measures; category functioning was examined; residual-based principal components were analysed; differential item functioning was assessed; and items and subjects that were misfitting were removed. Results showed that parenting comprised six dimensions, namely warmth, autonomy support, structure-control, structure-warmth, chaos, and negative parenting. The findings suggest that it is important for Asian parents to provide guidance to their children (in structure-control and structure-warmth) and reaffirms the relevance of warmth in Asian parenting. [ABSTRACT FROM AUTHOR]

Objective To assess the perceived effectiveness of cigarette health warnings in China, compared with picture and text-only warnings from other countries. Method 1169 individuals (adult smokers, adult nonsmokers and youth) from four Chinese cities (Beijing, Shanghai, Kunming and Yinchuan) viewed 10 health warnings on cigarette packages, which included (a) the current Chinese text warnings covering 30% of the front/back of the pack (introduced October 2008); (b) the former Chinese text warning located on the side of the pack; (c) four picture warnings covering 50% of the front/back of the pack from Canada (lung cancer), Singapore (mouth disease), Hong Kong (gangrene) and European Union (clogged arteries); and (d) the same four warnings without the picture. Participants rated and ranked the 10 warnings on dimensions including how effective each would be in motivating smokers to quit and in convincing youth not to start smoking. Results Both Chinese warnings were consistently rated as least effective, with the new Chinese warning rated only slightly higher than the old warning. The picture warnings were consistently ranked or rated as most effective, with the text-only versions in the middle. Results were consistent across subject group, city and sex. Conclusions (1) Picture warnings are rated as much more effective than the same warnings without pictures. (2) The revised health warnings in China, introduced in October 2008, are only marginally more effective than the previous warning and far less effective than even text warnings from other countries. These results, coupled with population-based evaluation studies, suggest that pictorial warnings would significantly increase the impact of health warnings in China. [ABSTRACT FROM PUBLISHER]

Oral Diseases (2012) 18, 661-666 Objectives: The aims of this study were to determine the frequency of bleeding complications following dental procedures in patients with known or suspected chronic liver disease and whether international normalized ratio (INR) determination could aid in predicting bleeding complications in these patients. Patients and Method: We identified 90 patients (mean age: 51 ± 9 years) in this retrospective chart review. Sixty-nine patients had a known history of chronic liver disease and 21 had suspected chronic liver disease. Descriptive statistics were determined. Independent sample t-test and one-way variance test were utilized for continuous variables and chi-square test for dichotomous variables. Results: The mean INR value for all patients was 1.2 ± 0.3. The INR value was significantly associated with the diagnosis of liver cirrhosis, the diagnoses of Hepatitis B and C together, the presence of ascites alone, and the number of clinical signs and symptoms (i.e. ascites, jaundice and encephalopathy) present. Nine patients with INR values between 1.5 and 2 underwent invasive dental procedures without postoperative bleeding complications. Conclusion: There were no episodes of postoperative bleeding in patients. The findings suggest that clinicians should not rely solely on an INR value to predict post-procedure bleeding in patients with liver disease. [ABSTRACT FROM AUTHOR]

Aims and objectives. Examined the levels of burden and the coping strategies experienced by caregivers of persons with schizophrenia in the community. It aims (1) to provide mental healthcare professionals with more information about caregiver stressors and (2) to recommend more effective community resources and support. Background. A caregiver's burden increases due to negative coping skills and lack of resources. However, insufficient studies of caregiver burden and coping skills accentuate the already inadequate understanding of the field. This lack of understanding often leads to frequent readmission of patients when caregivers give up their care-giving responsibilities. Design. Descriptive and quantitative methods. Methods. Convenience sampling method was used at three outpatient clinics on 150 caregivers. The Burden Assessment Scale measured care-giving burden. The Family Crisis-Oriented Personal Scales examined the coping strategies. Results. Findings reveal that 31·3% caregivers felt distress and 33·3% found stigma upsetting. Only 14·7% sought help from healthcare workers and 49·3% were interested to know more. Nevertheless, 24·7% verbalized sufficient social support. Conclusions. Results demonstrated a high burden on caregivers because of many factors such as other commitments, lack of resources, insufficient financial support, education level and ageing. This study found that long-term caregivers suffer more than short-term ones, which is contrary to Seng's study (2005). Burden increases further for those having to cope with both work and care giving at the same time. Relevance to clinical practice. It is critical to improve and increase services and resources to support care giving. It is also essential to educate and ensure that the people affected know how to leverage the available resources. It is important to improve and increase our services and resources. It is also essential to educate and ensure the people concerned know how to make use of them. It also essential to educate and ensure the people concerned know how to make use of them. [ABSTRACT FROM AUTHOR]

Context--Kidney transplantation is the best treatment option for kidney failure, but the supply of donor kidneys remains small. Objective--To understand the public's attitude toward living donor kidney donation in Singapore. Design, Setting and Participants, Intervention, Outcome Measures--A cross-sectional study of a convenience sample of 1520 members of the general public seeking care at local medical centers. A self-administered questionnaire included questions on demographics and subjects' willingness and unwillingness to donate a kidney. Respondents were aged at least 18 years and did not have underlying chronic kidney disease, end-stage renal disease requiring dialysis, or history of kidney transplant. Results--Overall mean age of respondents was 49 (SD, 15) years and 50% were male. Response rate to the question on "willingness to donate kidney while alive" was 96% (1460); 707 (48.4%) were willing to donate a kidney while alive. Respondents who were willing to donate were younger (<40 years; P< .001); had above a secondary level education (P< .001); had monthly household income 2000 SGD (or US$1660; exchange rate at 1 SGD = US$0.83) or higher (P< .001); were not married, single, or divorced (P< .001); and were professionals (P< .001). Fear of surgical risks (86.5% strongly agree or agree) and poorer health consequent to donation (87.5% strongly agree or agree) were the main reasons for not considering being a living kidney donor. Demographic factors and concerns of surgical risks and ill health after transplant influenced willingness to donate a kidney while alive. Addressing these concerns may alleviate anxiety with regard to living kidney donation. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the developmental pathways of high- performance basketball coaches in Singapore. Such information is useful in providing information about appropriate training and development programmes for high-performance coaches. Nine head coaches and assistant coaches from several senior and youth national basketball teams participated in structured retrospective quantitative interviews. All coaches had at least a Level 2 coaching certificate (technical), with Level 3 being the highest standard attainable in Singapore. They were experienced coaches at the developmental level (i.e., school or club team) prior to their current appointment. Results are partially consistent with previous studies that: (1) most of the coaches were competitive athletes before coaching, and (2) coaches had engaged in coaching for at least 10 years prior to coaching at the elite level. All participant coaches played a variety of sports in the early stages of sport participation. They also trained and prepared for structured competition from their early primary school days. Participant coaches also acknowledged the importance of informal and non-formal learning opportunities in enhancing their coaching knowledge and skills. Unique to the Singaporean context were the absence of mentoring, the structure of the sporting system, and the support for coach development through the national sporting organisation. The results are discussed in relation to coach education and coach development. [ABSTRACT FROM AUTHOR]

Objectives: Albumin and hemoglobin are viewed as markers of nutritional and inflammatory status. This study examined the associations of serum albumin and hemoglobin with physical function in communityliving older adults. Design: Population-based cross-sectional and longitudinal study. Setting: The Singapore Longitudinal Aging Studies (SLAS), a community-based study in urban Singapore. Participants: 2762 older adults aged 55 and above assessed at baseline, and 1829 at follow up 1-2 years later. Measurements: Serum albumin and hemoglobin, Performance Oriented Mobility Assessment (POMA), knee extension strength at baseline, and Instrumental Activities of Daily Living (IADL) at baseline and follow up. Results: In crosssectional multivariate analyses that adjusted for haemoglobin and other confounders, albumin showed a significant linear association (p<0.001) with POMA balance score (b=0.06, SE=0.02) and knee extension strength (b=0.70, SE=0.10). Independently of albumin, hemoglobin also showed a significant linear association with POMA balance score (b=0.09, SE=0.04). In longitudinal analyses, albumin was significantly associated with IADL decline (IADL total score drop>=1 during follow-up), OR= 0.92 (0.87-0.97), p=<0.01. Conclusion: The findings suggest that low levels of albumin and hemoglobin are potentially useful risk markers of physical functional decline in older adults. Further research should investigate whether improvements in the levels of albumin and hemoglobin alter the level of functional disability and risk of functional decline. [ABSTRACT FROM AUTHOR]