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Background: Graves' disease is the most common cause of hyperthyroidism. It results in accelerated tissue metabolism with multi-organ involvement ranging from cardiovascular to neuropsychological function. This results in a negative impact on the quality of life (QOL) of the individual patient. We aim to evaluate the psychometric properties of ThyPRO, a Thyroid-related Patient Reported Outcome questionnaire, and validate its use in our multi-ethnic Asian patients with Graves' hyperthyroidism. Methods: Forty-seven consecutive Graves' hyperthyroidism patients answered the ThyPRO questionnaire at baseline and at 4 months after treatment initiation. Data were recorded for thyroid related symptoms and signs, thyroid function tests and thyroid volume. We analyzed the internal consistency using Cronbach's alpha, construct validity by evaluating relationship between clinical variables and ThyPRO scales, ceiling and floor effects, and responsiveness of ThyPRO to treatment based on Cohen's effect size. Results: Correlations between individual scale scores and free thyroxine concentrations were moderate and statistically significant: 0.21–0.64 (p < 0.05). There was high internal consistency between the items in this instrument, Cronbach's alpha > 0.7 for all scales. ThyPRO was responsive to the changes in QOL after treatment (Effect Size: 0.20–0.77) in 9 of the 14 scales including the hyperthyroid symptoms and psychosocial scales (Tiredness, Cognitive complaints, Anxiety, Emotional susceptibility, Impact on Social, Daily and Sex life). Conclusion: This study provides evidence that ThyPRO has satisfactory measurement properties in hyperthyroid Graves' disease patients in Singapore population with the potential to complement clinical care. [ABSTRACT FROM AUTHOR]

Introduction: Moisturizers are one of the mainstays of the topical treatment of atopic dermatitis (AD). One of the adverse effects of moisturizers is skin irritation, especially on excoriated AD skin. We compared the potential for irritation of two commercially available moisturizer products for the treatment of AD: a ceramide-based moisturizer (Ceradan® Cream; Hyphens Pharma Pte Ltd, Singapore) and a urea 5% moisturizer (Aqurea Lite Cream; ICA Pharma Pte Ltd, Singapore). Methods: We performed a prospective single-blind randomized controlled study recruiting AD patients aged between 8 and 16 years with symmetrical or near symmetrical scratch marks (excoriations) of at least grade 2 to 3 severity score, according to the Eczema Area and Severity Index (EASI), over bilateral antecubital fossae. Subjects were randomized to receive the ceramide-based moisturizer to either the left or right antecubital fossa or urea 5% cream to the other antecubital fossa. Subjects were asked to grade the immediate skin irritation of both creams on a standard visual analogue scale (VAS) and which cream they would prefer to use as a daily moisturizer. Primary outcome was the mean irritant score of each cream, and secondary outcome was the subjects' preference of either cream as their daily moisturizer. Results: A total of 42 participants were enrolled with a mean age of 11 years 5 months. The ceramide-based cream had a significantly lower mean VAS score (mean 0.69, SD = 1.63) for irritation compared with urea 5% cream (1.43, SD = 1.64) (p = 0.035). More participants also preferred the ceramide-based cream over urea 5% cream (62% versus 38%) as their daily moisturizer, but this did not reach statistical significance (p = 0.164). Conclusions: A ceramide-based moisturizer may be considered as a suitable choice for children to minimize irritation from moisturizer treatment for AD. [ABSTRACT FROM AUTHOR]

Objective: Studies suggest the protective effect of mastery and caregiving competence against psychological stressors of caregiving in the context of dementia, although the interplay between the two with caregiver outcomes is not well understood. This study examines the independent and moderating impact of mastery and caregiving competence on burden, anxiety and depression among caregivers of older adults with frailty-related care needs.Design, Setting and Participants: This is a cross-sectional study of 274 older adults-family caregiver dyads from a hospital in Singapore. Mean ages of the older adults and their caregivers were 85 and 59 years respectively.Measurements: We performed hierarchical linear regression models to examine the independent influence of mastery and caregiving competence on caregiver burden, anxiety and depression. We also examined the interaction effect between mastery and caregiving competence for each outcome.Results: Mastery and caregiving competence were independently negatively associated with caregiver burden, anxiety and depression. Mastery explained more variance than caregiving competence and had a stronger correlation with all outcomes. There was a statistically significant interaction between mastery and caregiving competence for depression (interaction term beta=.14, p<0.01), but not burden and anxiety. High levels of mastery are associated with less depression. particularly among caregivers with below-average levels of caregiving competence. Likewise, high levels of caregiving competence are associated with less depression. particularly among caregivers with below-average levels of mastery.Conclusion: Our findings suggest potential benefits adressing targeted interventions for mastery and caregiving competence of caregivers to older adults as they independently influence caregiver outcomes and moderate each other's effect on depression. Mastery-based interventions should be incorporated into current caregiver training which traditionally has focused on caregiver competence alone. [ABSTRACT FROM AUTHOR]

Purpose: There are wide inter-individual differences in glycemic response (GR). We aimed to examine key digestive parameters that influence inter-individual and ethnic differences in GR in healthy Asian individuals. Methods: Seventy-five healthy male subjects (25 Chinese, 25 Malays, and 25 Asian-Indians) were served equivalent available carbohydrate amounts (50 g) of jasmine rice (JR) and basmati rice (BR) on separate occasions. Postprandial blood glucose concentrations were measured at fasting (−5 and 0 min) and at 15- to 30-min interval over 180 min. Mastication parameters (number of chews per mouth and chewing time per mouthful), saliva α-amylase activity, AMY1 gene copy numbers and gastric emptying rate were measured to investigate their relationships with GR. Results: The GR for jasmine rice was significantly higher than for basmati rice ( P < 0.001). The median number of AMY1 gene copies was 6, with a range of 2-15. There was a significant positive relationship between AMY1 copy number and α-amylase activity ( P = 0.002). There were no significant ethnic differences in GR. For both rice varieties, the number of chews per mouthful was positively associated with the GR (JR, P = 0.011; BR, P = 0.005), while chewing time per mouthful showed a negative association (JR, P = 0.039; BR, P = 0.016). Ethnicity, salivary α-amylase activity, particle size distribution, gastric emptying rate and AMY1 gene copy numbers were not significant contributors to GR ( P > 0.05). Conclusion: Mastication parameters contribute significantly to GR. Eating slowly and having larger food boluses before swallowing (less chewing), both potentially modifiable, may be beneficial in glycemic control. [ABSTRACT FROM AUTHOR]

Purpose: Muffins made with wheat flour are a popular snack consumed in western and emerging countries. This study aimed to examine the content of amylose, glycemic response (GR) and glycemic index (GI) of muffins baked with refined wheat and rice flours, as well as wholegrain corn, oat and barley flours. Methods: This study adopted a randomized, controlled, crossover, non-blind design. Twelve healthy participants consumed wheat, rice, corn, oat and barley muffins once and the reference glucose solution three times in a random order on non-consecutive day. Capillary blood samples were taken every 15 min in the first 60 min and every 30 min for the remaining 60 min for blood glucose analysis. The Megazyme amylose/amylopectin assay procedure was employed to measure amylose content. Results: The GR elicited from the consumption of wheat, rice and corn muffins was comparable between these samples but significantly greater when compared with oat and barley muffins. Consumption of wholegrain muffins, apart from corn muffin, blunted postprandial GR when compared with muffins baked with refined cereal flours. Muffins baked with wheat, rice, corn, oat and barley flours gave rise to GI values of 74, 79, 74, 53 and 55, respectively. The content of amylose was significantly higher in corn, oat and barley muffins than wheat and rice muffins. Conclusions: The greater content of amylose and fibre may play a part in the reduced glycemic potency of oat and barley muffins. Wheat flour can be substituted with oat and barley flours for healthier muffins and other bakery products. [ABSTRACT FROM AUTHOR]

Purpose: In Caucasian women, research has shown that energy balance and taste preference change throughout the menstrual cycle. However, the contributory role of the menstrual cycle to obesity and insulin resistance among Asian women remains unclear. We investigate the impact of the menstrual cycle on energy balance and taste preference in Singaporean Chinese females. Methods: Thirty-one healthy young Chinese female subjects with regular menstrual cycles were recruited. Anthropometrics, body composition, energy intake, resting metabolic rate, premenstrual syndrome (PMS) severity and taste preference to sucrose were assessed during three phases (menses, follicular and luteal), over one ( N = 18) to two ( N = 13) menstrual cycles. Results: For all subjects ( N = 31), we found significant reductions in energy, fat intake ( p < 0.05) and taste preference for sucrose ( p < 0.05) in the luteal phase compared to early follicular phase as far as Cycle 1 is concerned. No significant differences were observed for carbohydrate and protein intake as well as PMS score. In those evaluated for two full cycles ( N = 13), we found that taste preference for sucrose and PMS score were significantly higher in the menstrual phase in Cycle 2 ( p < 0.05). No significant differences were observed in energy and macronutrient intake throughout Cycle 2. RMR was similar across the three phases. However, non-significant cyclic variations were noted within and between the cycles. Conclusion: Cyclic variations in energy intake and expenditure contributed by sensory and behavioural changes occur during the menstrual cycle. Whether this contributes to cyclic weight gain is speculative and remains to be proven. Further research in non-Caucasians spanning more than one menstrual cycle is needed to establish the impact of the menstrual cycle on taste preference and energy balance. [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]

Purpose: White rice is the main staple for the majority in the world. The effects of protein, fat and vegetables on the glycaemic and insulinaemic responses to a white rice-based meal have not been reported. The aim of this study was to determine the effect of co-ingesting a high-protein food (breast chicken), a fat (ground nut oil), a leafy vegetable or all three on the glycaemic and insulinaemic responses of white rice in healthy adults. Methods: This was a randomized crossover trial conducted at the Clinical Nutrition Research Centre in Singapore. Twelve healthy volunteers were given five test meals (white rice alone, white rice with chicken, white rice with oil, white rice with vegetable and white rice with chicken, oil and vegetable) once and the reference food (glucose solution) three times in a random order at 1-week intervals. Capillary blood samples were then drawn serially for 3 h, and glucose and insulin were analysed. Results: The glycaemic response (GR) to white rice with chicken breast, ground nut oil and vegetable was significantly lower than to white rice alone. The glycaemic index (GI) of pure white rice was 96, whereas combined with chicken breast, ground nut oil and vegetable, it was 50. The addition of oil delayed the peak glucose response and reduced the iAUC, resulting in a GI value of 67. The addition of chicken and vegetable resulted in a GI value of 73 and 82, respectively. The insulinaemic index (II) of the white rice-based meals varied between 54 and 89. Chicken breast in the meal increased the insulinaemic response and decreased the GR. White rice II was lower than the glucose control, which indicated that the former was not as insulinogenic as the latter. White rice with vegetable had the lowest II. Conclusions: Co-ingesting chicken, oil or vegetable with white rice considerably influences its glycaemic and insulinaemic responses. Co-ingesting white rice with all three components attenuates the GR to a greater degree than when it is eaten with any single one of them, and that this is not at the cost of an increased demand for insulin. [ABSTRACT FROM AUTHOR]