Explore the vast range of titles available.

Decolonizing the History Curriculum in Malaysia and Singapore is a unique study in the history of education because it examines decolonization in terms of how it changed the subject of history in the school curriculum of two colonized countries - Malaysia and Singapore. Blackburn and Wu's book analyzes the transition of the subject of history from colonial education to postcolonial education, from the history syllabus upholding the colonial order to the period after independence when the history syllabus became a tool for nation-building. Malaysia and Singapore are excellent case studies of this process because they once shared a common imperial curriculum in the English language schools that was gradually 'decolonized' to form the basis of the early history syllabuses of the new nation-states (they were briefly one nation-state in the early to mid-1960s). The colonial English language history syllabus was 'decolonized' into a national curriculum that was translated for the Chinese, Malay, and Tamil schools of Malaysia and Singapore. By analyzing the causes and consequences of the dramatic changes made to the teaching of history in the schools of Malaya and Singapore as Britain ended her empire in Southeast Asia, Blackburn and Wu offer fascinating insights into educational reform, the effects of decolonization on curricula, and the history of Malaysian and Singaporean education.

This chapter treats Japan’s conquest of Southeast Asia as a window to the longer history of Anglo-American perceptions of the region’s interconnectedness. Japanese victories fuelled what would become the domino logic, entwining race with the struggle for ascendancy in the region, preparing the way for U.S. Cold War fixations with the perceived threat from China and its diaspora to Southeast Asia. At base, the domino theory in U.S. policy toward the region arose from apocalyptic visions of China using its diasporic links across Southeast Asia to repeat Imperial Japan’s shocking wartime triumphs over the colonial powers, the most notable of these being the fall of British-controlled Singapore in 1942.

This chapter contains sections titled: Rule 1: Every incident is different, but the solutions are the same Rule 2: Prior planning and preparation prevents poor performance Rule 3: When exercising, start small and build up Rule 4: No plan ever survives first contact with the enemy Rule 5: Disasters do not respect borders: cross‐border agreements must be in place Rule 6: Children can get hurt too References

Background Falls and fall-related injuries among older adults in Singapore are a serious health problem that require early intervention. In previous research, exercise interventions have been effective in improving functional outcomes and reducing falls for a broad group of older adults. However, results from multi-domain, multi-component falls prevention programs for high fall risk older adults in the community remain equivocal. One reason for these results is that there is significant heterogeneity in falls risk factors amongst high falls risk older adults which makes tailoring multicomponent interventions complex. The objective of the trial is to evaluate the effectiveness of an enhanced version of the predecessor program, SAFE. The Steps to Avoid Falls in the Elderly—a TECHnology enhanced intervention (SAFE-TECH) is designed for older adults in the community who are at high risk of falls, with candidate selection and program tailoring based on gait variables derived from wearable sensors and various questionnaire-based features. Methods SAFE-TECH is a 12-month randomized controlled trial involving 400 older adults at high risk of falling, who are randomly allocated to an intervention or control group in a 1:1 ratio. Participants will be assessed at baseline, 3rd-month and 12th-month for functional status, physical performance, cognitive status, quality of life, and medical history. Monthly phone calls will assess fall status, healthcare utilization, physical activity, and exercise self-efficacy. Participants in the intervention group will undergo a tailored, multi-domain, multi-component falls prevention program. The active intervention phase will last for 12-weeks with exercises focusing on strength, balance, coordination, flexibility, and aerobic endurance; and weekly educational sessions on falls risk with personalized feedback based on participant’s falls risk assessments and environmental checklist. Discussions SAFE-TECH seeks to evaluate enhanced existing falls prevention programs by addressing the heterogeneity of falls risk through rapid assessments and personalisation of exercise and education components while maintaining the efficiency of the group setting. Our findings will inform practical efforts to reduce falls and falls-related injuries among community-dwelling older adults. Trial registration ClinicalTrials.gov. Clinical Trial Number: NCT06102954|| 22–10-2023.

Background Chronic pain, defined as pain persisting for ≥ 3 months, is associated with frailty, falls, and reduced quality of life. Falls remain a major cause of morbidity and mortality in older adults, yet the value of integrating pain severity into falls risk assessment is underexplored. This study examined associations between chronic pain severity and subsequent falls, frailty, physical performance, and perceived health in older adults at risk of falls. Methods In this cross-sectional study, baseline data from 143 community-dwelling adults aged ≥ 60 years at risk of falls were analysed. Participants were recruited from community and primary care centres in Singapore. Pain severity was assessed using the Wong–Baker Faces Pain Rating Scale (0–10) and classified as no pain, mild pain (< 3), or at least moderate pain (≥ 3). Data on demographics, frailty, sarcopenia (SARC-F ≥ 2), nutrition, cognition, fear of falling, and perceived health (EuroQol Visual Analogue Scale [EQ-VAS] and EuroQoL 5-Dimensions [EQ-5D]) were collected. Physical performance tests included handgrip strength, gait speed, 5-times sit-to-stand, and Timed-Up-and-Go (TUG). Logistic and linear regression models examined associations between pain severity and outcomes, adjusting for demographic and clinical covariates. Results Chronic pain was prevalent in 37.1%. Compared with no pain, at least moderate pain was associated with higher odds of future falls (adjusted odds ratio (aOR) 3.54, 95% CI 1.53–8.19), moderate/high falls risk (aOR 4.78, 95% CI 1.65–10.77), frailty (aOR 4.17, 95% CI 1.42–8.26), sarcopenia (aOR 4.99, 95% CI 1.63–7.28), slower gait speed (aOR 3.87, 95% CI 1.18–8.67), longer TUG (aOR 4.52, 95% CI 1.36–10.01), and poor physical performance (aOR 12.50, 95% CI 3.94–17.17). Pain severity was associated with EQ-VAS (β = − 4.07, 95% CI − 7.67 to − 1.47) and EQ-5D index (β = − 0.11, 95% CI − 0.15 to − 0.07). Conclusion Higher chronic pain severity was associated with future falls, frailty, poor physical performance and lower perceived health in at-risk older adults. Incorporating pain severity assessment into falls risk stratification could support earlier, targeted interventions to prevent injurious falls. Longitudinal studies are needed to determine the causal impact of pain management on falls, frailty, and quality of life. Clinical relevance Chronic pain in older adults is significantly associated with an increased risk of future falls, frailty, poor physical performance, and lower perceived health, highlighting the importance of evaluating chronic pain in fall risk assessments and vice versa. Implementing targeted prevention measures for individuals with chronic pain can potentially mitigate the risk of falls and improve overall health outcomes in this population.

Multiple falls preventions exercise programs have been rolled out globally, however, few studies have explored the factors necessary for their implementation. This study aimed to investigate the factors influencing the implementation of \"Steady Feet\" (SF), a 12-week community fall prevention exercise intervention, for older adults living in Singapore. This study utilized purposive sampling to recruit two participant groups: (i) older adults who declined or withdrew from the program and (ii) providers of the program (eg, instructors). We conducted 22 semi-structured interviews, recordings were transcribed and translated, followed by thematic analysis. Data collection and analysis were informed by the PRECEDE-PROCEED framework, focusing on predisposing, enabling, and reinforcing factors. Findings revealed two predisposing, four enabling, and two reinforcing themes. Predisposing themes encompassed (i) knowledge, attitudes, and practices of older adults towards exercises and falls prevention, and (ii) perceptions and attitudes of providers towards SF. Both older adults and providers identified several enabling elements in implementing SF, emphasizing the significance of (i) accessibility, availability, and affordability. Providers highlighted (ii) tools and structural support for continual engagement, (iii) minimizing variations in capabilities through a competency development program, and (iv) fostering synergistic partnerships. Positive reinforcement included (i) the role of providers in engaging and promoting participation, (ii) family support, social networks, and (iii) incentives for older adults. Conversely, both groups highlighted negative reinforcements, including (iv) communication issues and (v) repetitive exercises, while providers specifically identified (vi) labor constraints as a deterrent for implementation. Findings indicate that effective implementation necessitates a multifaceted approach. Promoting participation involves engaging instructors, emphasizing social bonds and family involvement, offering incentives, and providing subsidized or free classes. A competency development program proved effective in reducing variations in providers' capabilities. Strengthening community partnerships, with management support, was crucial for ensuring the availability and accessibility of falls prevention programs.

Background Old age and diabetes mellitus are risk factors for vitamin deficiencies, weakness and falls. Deficiencies of vitamin D, and possibly vitamin B12 and folate (which are associated with hyperhomocysteinaemia), contribute to sarcopenia. Determination of the physical effects of vitamin deficiencies in specific groups of people can help to guide public health policy with regard to vitamin supplementation. Methods A pilot cross-sectional study was conducted to determine the association of levels of vitamin D, vitamin B12, folate and homocysteine with muscle strength, gait and fall history in 56 patients >65 years old with diabetes mellitus in primary care in Singapore. Hand-grip and leg-quadriceps strength measures were obtained and divided by body mass index (BMI). The timed up-and-go and Tinetti tests were used to measure gait. A history of “at least one fall in the preceding year” was obtained. Results Vitamin B12 deficiency (<150 pmol/l) was present in 43 % of patients, folate deficiency (<13.5 mmol/l) in 20 %, hyperhomocysteinaemia (≥15.0 μmol/l) in 52 % and vitamin D deficiency (<49.9 nmol/l) in 25 %. Levels of vitamin D, vitamin B12 and homocysteine did not significantly predict muscle strength in regression analyses. Folate (B = 0.010, P  < 0.01) and gender (B = 0.356, P  < 0.001) predicted average grip strength corrected for BMI (F(2,53) = 17.74, P  < 0.001, R 2  = 0.40) Folate (B = 0.011, P  < 0.05) and gender (B = 0.367, P  < 0.001) also predicted average leg quadriceps strength corrected for BMI (F(2,53) = 9.79, P  < 0.001, R 2  = 0.27). Average leg strength and average leg strength corrected for BMI were both negatively associated with the risk of having fallen in the preceding year (odds ratio (OR) = 0.89, 95 % CI 0.80–0.98, P  < 0.05 and OR = 0.12, 95 % CI 0.02–0.92, P  < 0.05, respectively). Conclusions The prevalence of vitamin deficiency was very high in our sample of patients >65 years old with diabetes mellitus. Folate levels were significantly correlated with grip and leg strength (with correction for BMI). Leg strength was positively correlated with gait measures and negatively correlated with a history of falls. The role of folate in muscle weakness and falls warrants further study.

Background Fear of falling (FoF) has far-reaching implications including activity restriction, functional decline and reduced quality of life. It is a common consequence of falls but may be present even in non-fallers. This study aimed to determine the factors associated with FoF in a segment of Singapore’s community-dwelling older adults. Methods This descriptive cross-sectional study recruited a convenience sample of adults aged 65 and above from 4 primary care clinics from September 2020 to March 2021. Data were collected on demographic factors, clinical factors such as multi-morbidity, falls characteristics such as history of falls, injuries, and reasons for falls and frailty as determined by the Clinical Frailty Scale (CFS). FoF was measured using the Short Falls Efficacy Scale–International (Short FES-I), cut-off score of 14 and above indicated high FoF. Logistic regression was used to determine factors associated with high FoF. Results Out of 360 older adults, 78.1% were Chinese and 59.7% females. The mean age was 78.3 years and 76 (21.1%) had a history of falls in the past six months. Almost half (43.1%) were mildly to moderately frail and most (80.6%) had multi-morbidity. The mean FoF score was 15.5 (SD 5.97) and 60.8% reported high FoF. There were statistically significant differences in age, gender, ethnicity, marital status, educational level, use of walking aid, multi-morbidity, frailty status, history of falls within six months and reason for falls between patients who had high FoF versus those who had moderate or low FoF. Logistic regression found that Malay ethnicity (OR = 5.81, 95% CI 1.77–19.13), marital status, use of walking aids (OR = 3.67, 95% CI = 1.54–8.77) and frailty were significant factors associated with high FoF. Compared to those who were never married, the odds of high FoF were significantly higher in married older adults (OR = 6.75, 95% CI 1.39 to 32.76), those who were separated or divorced (OR 10.40, 95% CI 1.13 to 95.76) and those who were widowed (OR = 7.41, 95% CI 1.51 to 36.41). Compared to well older adults, the odds of high FoF were significantly higher in pre frail older adults (OR = 6.87, 95% CI = 2.66–17.37), mildly frail older adults (OR = 18.58, 95% CI = 4.88–70.34) and moderately frail older adults (OR = 144.78, 95% CI = 13.86–1512.60). Conclusions The study found that pre frail to moderately frail older adults as determined by CFS have significantly higher risk of high FoF. The demographic factors such as marital status and ethnicity and falls characteristics associated with FoF in this study will be helpful to develop targeted and tailored interventions for FoF.

Frailty is associated with adverse outcomes including disability, mortality and risk of falls. Trauma registries capture a broad range of injuries. However, frail patients who fall comprise a large proportion of the injuries occurring in ageing populations and are likely to have different outcomes compared to non-frail injured patients. The effect of frail fallers on mortality is under-explored but potentially significant. Currently, many trauma registries define low falls as less than three metres, a height that is likely to include non-frailty falls. We hypothesized that the low fall from less than 0.5 metres, including same-level falls, is a surrogate marker of frailty and predicts long-term mortality in older trauma patients. Using data from the Singapore National Trauma Registry, 2011-2013, matched till September 2014 to the death registry, we analysed adults aged over 45 admitted via the emergency department in public hospitals sustaining blunt injuries with an injury severity score (ISS) of 9 or more, excluding isolated hip fractures from same-level falls in the over 65. Patients injured by a low fall were compared to patients injured by high fall and other blunt mechanisms. Logistic regression was used to analyze 12-month mortality, controlling for mechanism of injury, ISS, revised trauma score (RTS), co-morbidities, gender, age and age-gender interaction. Different low fall height definitions, adjusting for injury regions, and analyzing the entire adult cohort were used in sensitivity analyses and did not change our findings. Of the 8111 adults in our cohort, patients who suffered low falls were more likely to die of causes unrelated to their injuries (p<0.001), compared to other blunt trauma and higher fall heights. They were at higher risk of 12-month mortality (OR 1.75, 95% CI 1.18-2.58, p = 0.005), independent of ISS, RTS, age, gender, age-gender interaction and co-morbidities. Falls that were higher than 0.5m did not show this pattern. Males were at higher risk of mortality after low falls. The effect of age on mortality started at age 55 for males, and age 70 for females, and the difference was attributable to the additional mortality in male low-fallers. The low fall mechanism can optimize prediction of long-term mortality after moderate and severe injury, and may be a surrogate marker of frailty, complementing broader-based studies on aging.