No abstract

and Barratt, T. M. (1974). Archives of Disease in Childhood, 49,97. Urinary excretion of calcium and magnesium in children. Urine calcium excretion in healthy children was 2 38±0 66 (SD; no. 52) mg/kg per 24 hr and urinary magnesium excretion was 2 82±0 79 (SD; no. 23). The 24-hour urine calcium excretion could be predicted with reasonable confidence from the calcium/ creatinine concentration ratio of the second urine specimen passed in the morning. In this specimen the urine calcium/creatinine concentration ratio was 0-14±0-06 (SD; no. = 60) mg/mg and the magnesium/creatinine concentration ratio was 0 -21 ±0 10 (SD; no. = 29) mg/mg.The upper limit of the urine calcium excretion is taken to be 4 mg/kg per 24 hr and that of the calcium/creatinine concentration ratio in the second morning urine is 0 -25 mg/mg. After a milk load of 700 ml/1*73 m2 the urinary calcium/creatinine concentration ratio rose in the first two hours, but in no sample exceeded 0-25 mg/mg.During a study of children with urolithiasis (Ghazali, Barratt, and Williams, 1973), we detected several individuals with apparent hypercalciuria. We were dissatsified, however, with the available data on calcium excretion in healthy children in England and expressed the view that data collected on children in other countries or in other decades were not satisfactory, because, for example, habits of diet and prescription of vitamin D vary. We therefore decided to measure the urinary excretion of calcium and magnesium in healthy children.The collection of 24-hour urine samples from children is notoriously prone to error. We have therefore also examined the use of the calcium/ creatinine concentration ratio of random urine samples, as first suggested by Nordin (1959). As it also seemed possible to us that the parameter of calcium excretion relevant to the genesis of urinary calculi was not the total 24-hour excretion but rather the peak calcium excretion after an oral calcium load, we measured the calciuretic response to a standardized intake of milk.Patients and methods Urine collections were obtained 24-hourly from 54 apparently healthy children aged 1 to 15 years. 13 children were at home; in the remainder the urine was Received 27 July 1973. collected during the first 24 hours of admission to hospital for elective minor operation. The children were fed a normal diet and their activity was not restricted. In 15 of these children, aged 4 to 15 years, each voided urine specimen was collected separately for the determination of diurnal rhythm of calcium and magnesium excretion.The second urine sample passed in the morning (designated morning urine), i.e. the first specimen voided after the overnight urine had been passed, was collected in the hydrated but fasted state. Separate morning urine specimens were obtained during the 24-hour collection from 30 of the above healthy children and from 18 postoperative children, some of whom had hypercalciuria; morning urine specimens were also collected in a further 30 healthy children.A standardized milk load was adm...

Introduction: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs).  One factor causing VAP is aspiration of oral colonisation, which may result from poor oral care practice.  Oral care using tooth brushing can prevent formulation of dental plaque that can be a reservoir for microbes causing VAP. Methodology: A cross-sectional survey was conducted among 124 nurses, using a self-administered questionnaire, to determine methods used, frequency, and attitude of nurses toward oral care provided to mechanically ventilated patients in Malaysian ICUs.  Results: Methods for oral care and their frequency of use varied between nurses even in the same unit. Cotton with forceps was used by 73.4% of the nurses. Some nurses used forceps and gauze (65%) or spatulas and gauze (36%). Toothbrushes were used by 50.8% of the nurses. Nurses in this hospital reported to have positive attitude toward providing oral care. Conclusions: The survey showed the need to have standardised oral care protocols in ICUs to improve quality of oral care provided to ventilated patients.

ObjectiveA pilot self-efficacy education programme was conducted to assess the feasibility, acceptability and potential impact of the self-efficacy education programme on improving foot self-care behaviour among older patients with diabetes in a public long-term care institution.MethodA prequasi-experimental and postquasi-experimental study was conducted in a public long-term care institution in Selangor, Malaysia. Patients with diabetes aged 60 years and above who fulfilled the selection criteria were invited to participate in this programme. Four self-efficacy information sources; performance accomplishments, vicarious experience, verbal persuasion and physiological information were translated into programme interventions. The programme consisted of four visits over a 12-week period. The first visit included screening and baseline assessment and the second visit involved 30 min of group seminar presentation. The third and fourth visits entailed a 20-min one-to-one follow-up discussion and evaluation. A series of visits to the respondents was conducted throughout the programme. The primary outcome was foot self-care behaviour. Foot self-efficacy (efficacy-expectation), foot care outcome expectation, knowledge of foot care, quality of life, fasting blood glucose and foot condition were secondary outcomes. Data were analysed with descriptive and inferential statistics (McNemar's test and Wilcoxon signed-rank test) using the Statistical Package for the Social Sciences V.20.0.ResultsFifty-two residents were recruited but only 31 met the inclusion criteria and were included in the analysis at baseline and at 12 weeks postintervention. The acceptability rate was moderately high. At postintervention, foot self-care behaviour (p<0.001), foot self-efficacy (efficacy-expectation), (p<0.001), foot care outcome expectation (p<0.001), knowledge of foot care (p<0.001), quality of life (physical symptoms) (p=0.003), fasting blood glucose (p=0.010), foot hygiene (p=0.030) and anhydrosis (p=0.020) showed significant improvements.ConclusionFindings from this pilot study would facilitate the planning of a larger study among the older population with diabetes living in long-term care institutions.Trial registration numberACTRN12616000210471; Pre-results.

Background Sarcopenia is the age-related loss of muscle mass and function, which increases fall risks in older persons. Hyperglycemia relating to Type-2 Diabetes Mellitus (T2DM) is postulated to aggravate sarcopenia. This study aimed to determine the prevalence of sarcopenia among ambulatory community-dwelling older patients, aged 60–89 years, with T2DM in a primary care setting and to identify factors which mitigate sarcopenia. Methods A total of 387 patients were recruited from a public primary care clinic in Singapore. Data on their socio-demography, clinical and functional status, levels of physical activity (International Physical Activity Questionnaire) and frailty status was collected. The Asian Working Group for Sarcopenia (AWGS) criteria were used to define sarcopenia based on muscle mass, grip strength and gait speed. Results The study population comprised men (53%), Chinese (69%), mean age = 68.3 ± SD5.66 years, lived in public housing (90%), had hypertension (88%) and dyslipidemia (96%). Their mean muscle mass was 6.3 ± SD1.2 kg/m 2 ; mean gait speed was 1.0 ± SD0.2 m/s and mean grip strength was 25.5 ± SD8.1 kg. Overall, 30% had pre-sarcopenia, 24% with sarcopenia and 4% with severe sarcopenia. Age (OR = 1.14; 95%CI = 1.09–1.20; p < 0.001), multi-morbidity (OR = 1.25;95%CI = 1.05–1.49; p = 0.011) diabetic nephropathy (OR = 2.50;95%CI = 1.35–5.13; p = 0.004), hip circumference (OR = 0.86;95%CI = 0.82–0.90;p < 0.001) and number of clinic visits in past 1 year (OR = 0.74; 95%CI = 0.59–0.92; p = 0.008) were associated with sarcopenia. Conclusions Using AWGS criteria, 58% of older patients with T2DM had pre-sarcopenia and sarcopenia. Age, diabetic nephropathy, hip circumference, multi-morbidity and fewer clinic visits, but not a recent single HBA1c reading, were significantly associated with sarcopenia among patients with T2DM. A longitudinal relationship between clinic visits and sarcopenia should be further evaluated. (250 words)