Psychosis in Parkinson’s disease in a Southeast Asian cohort: prevalence and clinical correlates

Introduction: Psychosis is a prominent neuropsychiatric symptom of Parkinson’s disease (PD) and is associated with negative outcomes, such as poorer quality of life and greater rate of functional impairment. Early identification of patients with PD at risk of developing psychosis facilitates appropriate management to improve outcomes. However, this phenomenon has not been examined locally. This study aimed to examine the prevalence of PD-associated psychosis in the local setting, identify any associated risk factors, as well as characterise the cognitive trajectory of patients with PD with psychosis. Methods: A retrospective cohort of 336 patients with PD, who presented to the National Neuroscience Institute, Singapore, in 2006 and 2007 and attended follow-up visits through to 2013 was analysed. The data analysed included scores from clinician assessments of cognitive function, disease severity and presence of psychotic symptoms, conducted when clinically appropriate during patients’ medical visits. Survival analysis and logistic and linear regression analysis were performed. Results: Psychosis was diagnosed in 63 patients with PD, indicating a prevalence of 18.8% for PD-associated psychosis. Incidence of psychosis in PD was calculated to be 40 per 1,000 person-years. No significant association was found between demographic variables and the odds of developing psychosis in PD. Regression analyses found that the presence of psychosis significantly predicted greater cognitive decline and disease severity. Conclusion: Psychosis has a significant presence among the PD population in Singapore, possibly serving as an indicator of more rapid cognitive decline and progression of PD severity.

Assessing the impact of educational methods on influenza vaccine uptake and patient knowledge and attitudes: a randomised controlled trial

Introduction: Although influenza vaccination reduces rates of pneumonia, hospitalisation and mortality, influenza vaccination uptake remains low in older patients. The primary aim was to compare individualised counselling with educational pamphlets alone in improving influenza vaccination uptake. The secondary aims were to evaluate knowledge and attitudes towards influenza vaccination and factors influencing uptake. Methods: A randomised controlled study was conducted in two government polyclinics with 160 participants per arm. Patients aged 65 years and above attending for doctor consultation were recruited. All participants received an educational pamphlet on influenza vaccination. The intervention group received additional face-to-face counselling. Participants filled a pre- and postintervention questionnaire assessing knowledge of influenza and attitudes towards the vaccine. Follow-up calls and verification of electronic records was done at three months to determine actual vaccine uptake. Results: At three months, 16 (10%) patients in the intervention group and 20 (12.5%) patients in the control group had completed influenza vaccination (p = 0.48). Factors positively associated with vaccine uptake were willingness to receive vaccination immediately after intervention (adjusted odds ratio [OR] 12.15, 95% confidence interval [CI] 4.42–33.38), and male gender (adjusted OR 2.96, 95% CI 1.23–7.12). Individualised counselling was more effective in improving knowledge (p < 0.01). Overall knowledge scores did not influence actual vaccine uptake rates. (adjusted OR 1.10 [0.90–1.3]). Conclusion: Both arms of patient education increased uptake of influenza vaccination. Individualised counselling was not superior to pamphlets alone in improving uptake. Performing vaccination at the initial point of contact improves actual uptake rates.

Relationship between weather parameters and risk of exertional heat injuries during military training

Introduction: The Singapore Armed Forces (SAF) collaborated with the Meteorological Service Singapore (MSS) to study the relationship between weather parameters and the incidents of exertional heat injury (EHI) to mitigate the risk of EHI in a practical manner. Methods: Data from the SAF’s heat injury registry and MSS’ meteorological data from 2012 to 2018 were used to establish a consolidated dataset of EHI incidents and same-day weather parameters rank-ordered in deciles. Poisson regression modelling was used to determine the incidence rate ratios (IRRs) of the EHI, referencing the first decile of weather parameters. Two frames of analysis were performed - the first described the relationship between the weather parameters and the adjusted IRR for the same day (D), and the second described the relationship between the weather parameters and the adjusted IRR on the following day (D+1). Results: For wet-bulb temperature, the IRR on D+1 approximated unity for the first nine deciles but rose to 3.09 at the tenth decile. For dew-point temperature, the IRR on D+1 approximated unity for the first nine deciles but rose to 3.48 at the tenth decile. By designating a single dew-point temperature cut-off at  25.1°C (transition between the ninth and tenth decile), the adjusted IRR on D +1 was 2.26 on days with dew-point temperature  25.1°C,. Conclusion: Integrating the data from the SAF and MSS demonstrated that a dew-point temperature ≥ 25.1°C on D correlates statistically with the risk of EHI on D +1and could be used to supplement the risk mitigation system.