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Background Patient falls in hospitals are common and may lead to negative outcomes such as injuries, prolonged hospitalization and legal liability. Consequently, various hospital fallsprevention programs have been implemented in the last decades. However, most of the programs had no sustained effects on falls reduction over extended periods of time. Methods This study used a serial survey design to examine in-patient fall rates and consequent injuries before and after the implementation of an interdisciplinary fallsprevention program (IFP) in a 300-bed urban public hospital. The population under study included adult patients, hospitalized in the departments of internal medicine, geriatrics, and surgery. Administrative patient data and fall incident report data from 1999 to 2003 were examined and summarized using frequencies, proportions, means and standard deviations and were analyzed accordingly. Results A total of 34,972 hospitalized patients (mean age: 67.3, SD ± 19.3 years; female 53.6%, mean length of stay: 11.9 ± 13.2 days, mean nursing care time per day: 3.5 ± 1.4 hours) were observed during the study period. Overall, a total of 3,842 falls affected 2,512 (7.2%) of the hospitalized patients. From these falls, 2,552 (66.4%) were without injuries, while 1,142 (29.7%) falls resulted in minor injuries, and 148 (3.9%) falls resulted in major injuries. The overall fall rate in the hospitals' patient population was 8.9 falls per 1,000 patient days. The fall rates fluctuated slightly from 9.1 falls in 1999 to 8.6 falls in 2003. After the implementation of the IFP, in 2001 a slight decrease to 7.8 falls per 1,000 patient days was observed (p = 0.086). The annual proportion of minor and major injuries did not decrease after the implementation of the IFP. From 1999 to 2003, patient characteristics changed in terms of slight increases (female gender, age, consumed nursing care time) or decreases (length of hospital stay), as well as the prevalence of fall risk factors increased up to 46.8% in those patients who fell. Conclusion Following the implementation of an interdisciplinary fallsprevention program, neither the frequencies of falls nor consequent injuries decreased substantially. Future studies need to incorporate strategies to maximize and evaluate ongoing adherence to interventions in hospital fallsprevention programs.
Schwendimann, Rene; Buhler, Hugo; De Geest, Sabina; Milisen, Koen
The prevention of accidental injury associated with falls in older people is a public health target in many countries. Older people make up a large and increasing percentage of the population. As people grow older, they are at increasing risk of falling and suffering injury from falling. Falls are not an inevitable result of ageing, but they are the most
... your browser. Home Bone Basics Falls and Fractures PreventingFalls and Related Fractures Publication available in: PDF ( ... Senior Health) Caídas y fracturas (NIA) Director’s Comments: PreventingFalls
Background Accidental falls among inpatients are a substantial cause of hospital injury. A number of successful experimental studies on fallprevention have shown the importance and efficacy of multifactorial intervention, though success rates vary. However, the importance of staff compliance with these effective, but often time-consuming, multifactorial interventions has not been fully investigated in a routine clinical setting. The purpose of this observational study was to describe the effectiveness of a multidisciplinary quality improvement (QI) activity for accidental fallprevention, with particular focus on staff compliance in a non-experimental clinical setting. Methods This observational study was conducted from July 2004 through December 2010 at St. Luke’s International Hospital in Tokyo, Japan. The QI activity for in-patient fallsprevention consisted of: 1) the fall risk assessment tool, 2) an intervention protocol to prevent in-patient falls, 3) specific environmental safety interventions, 4) staff education, and 5) multidisciplinary healthcare staff compliance monitoring and feedback mechanisms. Results The overall fall rate was 2.13 falls per 1000 patient days (350/164331) in 2004 versus 1.53 falls per 1000 patient days (263/172325) in 2010, representing a significant decrease (p?=?0.039). In the first 6?months, compliance with use of the falling risk assessment tool at admission was 91.5% in 2007 (3998/4368), increasing to 97.6% in 2010 (10564/10828). The staff compliance rate of implementing an appropriate intervention plan was 85.9% in 2007, increasing to 95.3% in 2010. Conclusion In our study we observed a substantial decrease in patient fall rates and an increase of staff compliance with a newly implemented fallsprevention program. A systematized QI approach that closely involves, encourages, and educates healthcare staff at multiple levels is effective.
Given the rapid aging of the population, we can expect the number of older adult falls and fall-related injuries and deaths to increase exponentially unless we make a serious commitment to providing evidence-based, fall risk screening and assessments, and appropriate interventions to those increasingly at risk. National, state, and local partners are coming together to address this growing public health issue through evidence-based interventions that promote collaboration between public health, health care, and aging service providers. Physical therapists are uniquely positioned to make a significant contribution to this effort and to promote older adult participation in programs and services that can augment or supplement the plan of treatment. The purpose of this special interest paper is to describe the efforts of the National Council on Aging's Falls Free Initiative and the role that physical therapists and other rehabilitation professionals can play in community-based programs aimed at reducing risk and occurrence of falls in later life. PMID:23478394
This study was conducted to identify the effects of a fall-prevention exercise program on the participation and static balance of elderly persons in daily life roles. [Subjects] Ten participants over 65?years of age (75.29±2.93) who were healthy community-dwellers (two men and eight women) were recruited. [Methods] The participants exercised three times a week for eight weeks. The exercise program was based on the fitness and mobility exercise (FAME) protocol. The outcome measures were changes in activity participation level and the fall index. [Results] After the exercise, the activity participation level significantly increased, and the fall index significantly decreased. [Conclusion] A fallprevention exercise program can have a positive effect on participation and static balance in older adults.
Objectives To systematically document the implementation, components, comparators, adherence, and effectiveness of published fallprevention approaches in U.S. acute care hospitals. Design Systematic review. Studies were identified through existing reviews, searching five electronic databases, screening reference lists, and contacting topic experts for studies published through August 2011. Setting U.S. acute care hospitals. Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before–after studies). Intervention Fallprevention interventions. Measurements Incidence rate ratios (IRR, ratio of fall rate postintervention or treatment group to the fall rate preintervention or control group) and ratings of study details. Results Fifty-nine studies met inclusion criteria. Implementation strategies were sparsely documented (17% not at all) and included staff education, establishing committees, seeking leadership support, and occasionally continuous quality improvement techniques. Most interventions (81%) included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and postfall evaluations). Fifty-four percent did not report on fallprevention measures applied in the comparison group, and 39% neither reported fidelity data nor described adherence strategies such as regular audits and feedback to ensure completion of care processes. Only 45% of concurrent and 15% of historic control studies reported sufficient data to compare fall rates. The pooled postintervention incidence rate ratio (IRR) was 0.77 (95% confidence interval = 0.52–1.12, P = .17; eight studies; I2: 94%). Meta-regressions showed no systematic association between implementation intensity, intervention complexity, comparator information, or adherence levels and IRR. Conclusion Promising approaches exist, but better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully preventfalls.
Hempel, Susanne; Newberry, Sydne; Wang, Zhen; Booth, Marika; Shanman, Roberta; Johnsen, Breanne; Shier, Victoria; Saliba, Debra; Spector, William D; Ganz, David A
Objective To determine whether, and to what extent, fallprevention exercise interventions for older community dwelling people are effective in preventing different types of fall related injuries. Data sources Electronic databases (PubMed, the Cochrane Library, Embase, and CINAHL) and reference lists of included studies and relevant reviews from inception to July 2013. Study selection Randomised controlled trials of fallprevention exercise interventions, targeting older (>60 years) community dwelling people and providing quantitative data on injurious falls, serious falls, or fall related fractures. Data synthesis Based on a systematic review of the case definitions used in the selected studies, we grouped the definitions of injurious falls into more homogeneous categories to allow comparisons of results across studies and the pooling of data. For each study we extracted or calculated the rate ratio of injurious falls. Depending on the available data, a given study could contribute data relevant to one or more categories of injurious falls. A pooled rate ratio was estimated for each category of injurious falls based on random effects models. Results 17 trials involving 4305 participants were eligible for meta-analysis. Four categories of falls were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant effect in all categories, with pooled estimates of the rate ratios of 0.63 (95% confidence interval 0.51 to 0.77, 10 trials) for all injurious falls, 0.70 (0.54 to 0.92, 8 trials) for falls resulting in medical care, 0.57 (0.36 to 0.90, 7 trials) for severe injurious falls, and 0.39 (0.22 to 0.66, 6 trials) for falls resulting in fractures, but significant heterogeneity was observed between studies of all injurious falls (I2=50%, P=0.04). Conclusions Exercise programmes designed to preventfalls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.
Falls can have lasting psychological and physical consequences, particularly fractures and slow-healing processes, and patients may also lose confidence in walking. Injuries from falls lead to functional decline, institutionalization, higher health care costs, and decreased quality of life. The process related to the problem of patient falls in the hospital, using the nursing model developed by the theorist, Ida Jean Orlando, is explained in this article. The useful tool that provides guidance to marketers in this endeavor is Maslow's hierarchy of needs. During acute illness, individuals are greatly in need of satisfying their physiological needs. If these needs are not met, patients leave the hospital lacking a positive experience. Initial fall risk assessment is critical to plan intervention and individualize care plan. Interventions depend on the severity of fall risk factors. PMID:21537141
Peer education models are well established as a means of delivering health and social welfare information. Common themes identified in regard to peer education are that information sharing and transfer take place; attempts are made to influence knowledge, attitudes or behaviour; that it occurs between people who share similar characteristics or experiences; and that it relies on influential members of a social group or category. Although it is most often associated with younger age-groups, there is growing evidence of involvement of older people as peer educators. As part of community-based fallprevention interventions, there is considerable scope for contribution by peer mentors. This paper explores the theoretical basis for using senior volunteers as peer educators, discusses advantages and disadvantages of this model of service delivery for health promotion of older people and, specifically, reviews the evidence for effectiveness in relation to fallprevention. PMID:19243369
Preventingfalls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting results as some studies failed to show any effect, while others reported a significant decrease of falls and fractures. Through a 15-year literature overview, and after a brief reminder on mechanism of falls in older adults, we reported evidences for a vitamin D action on postural adaptations - i.e., muscles and central nervous system - which may explain the decreased fall and bone fracture rates and we underlined the reasons for differences and controversies between published data. Vitamin D supplementation should thus be integrated into primary and secondary fallprevention strategies in older adults.
Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model. Three output tools available to be generated from the toolkit are bed poster, plan of care, and patient education handout. A preliminary design of the application was based on initial requirements defined by project leaders and informed by focus groups with end users. Preliminary design partially simulated the paper version of the Morse Fall Scale currently used in hospitals involved in the research study. Strengths and weaknesses of the first prototype were identified by heuristic evaluation. Usability testing was performed at sites where research study is implemented. Suggestions mentioned by end users participating in usability studies were either directly incorporated into the toolkit and output tools, were slightly modified, or will be addressed during training. The next step is implementation of the fallprevention toolkit on the pilot testing units.
ZUYEV, LYUBOV; BENOIT, ANGELA N.; CHANG, FRANK Y.; DYKES, PATRICIA C.
Tai Chi—Moving for Better Balance, a falls-prevention program developed from a randomized controlled trial for community-based use, was evaluated with the RE-AIM framework in 6 community centers. The program had a 100% adoption rate and 87% reach into the target older adult population. All centers implemented the intervention with good fidelity, and participants showed significant improvements in health-related outcome measures. This evidence-based tai chi program is practical to disseminate and can be effectively implemented and maintained in community settings.
Li, Fuzhong; Harmer, Peter; Glasgow, Russell; Mack, Karin A.; Sleet, David; Fisher, K. John; Kohn, Melvin A.; Millet, Lisa M.; Mead, Jennifer; Xu, Junheng; Lin, Mei-Li; Yang, Tingzhong; Sutton, Beth; Tompkins, Yvaughn
Background Falls in older people are a major public health issue, but the underlying causes are complex. We sought to evaluate the effectiveness of preventive home visits as a multifactorial, individualized strategy to reduce falls in community-dwelling older people. Methods Data were derived from a prospective randomized controlled trial with follow-up examination after 18 months. Two hundred and thirty participants (?80 years of age) with functional impairment were randomized to intervention and control groups. The intervention group received up to three preventive home visits including risk assessment, home counseling intervention, and a booster session. The control group received no preventive home visits. Structured interviews at baseline and follow-up provided information concerning falls in both study groups. Random-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates. Results Random-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group (incidence rate ratio 1.96) and a significant decrease in the intervention group (incidence rate ratio 0.63) controlling for age, sex, family status, level of care, and impairment in activities of daily living. Conclusion Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people.
Background: Falls are a geriatric syndrome that is considered a significant public health problem in terms of morbidity and mortality because they lead to a decline in functional capacity and an impaired quality of life in the elderly. Lower limb muscle strengthening seems to be an effective intervention for preventingfalls; however, there is no consensus regarding the best method for increasing lower limb muscle strength. Objectives: To analyze the effectiveness of lower limb muscle strengthening and to investigate and describe the protocols used for preventingfalls in elderly subjects. Method: We performed a systematic review of randomized and controlled clinical trials published between 2002 and 2012 in the databases PubMed, EMBASE, Scopus, Web of Science, and PEDro that cited some type of lower limb muscle strengthening protocol and that evaluated the incidence of falls as the primary outcome exclusively in elderly subjects. Twelve studies met the inclusion criteria. Qualitative analysis was performed by independent reviewers applying the PEDro scale. Results: The data obtained from the selected studies showed lower fall rates in the intervention groups compared to controls. Six studies described the lower limb muscle strengthening protocol in detail. High methodological quality was found in 6 studies (PEDro score â‰¥7/10 points). Conclusions: The methodological quality of the studies in this area appears to leave little doubt regarding the effectiveness of lower limb strengthening exercises for preventingfalls in elderly subjects, however the interventions in these studies were poorly reported. PMID:24760166
Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital inpatients. Falls can threaten both immediate and longer-term health and independence. There is need to identify cost-effective means for preventingfalls in hospitals. Hospital-based fallsprevention interventions tested in randomized trials have not yet been subjected to economic evaluation. Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective, over the period of hospitalization (time horizon) using the Australian Dollar (A$) at 2008 values. Analyses were based on data from a randomized trial among n = 1,206 acute and rehabilitation inpatients. Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research. The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients. Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$14,591 (2008). The education program cost A$526 (2008) to prevent one cognitively intact patient becoming a faller and A$294 (2008) to prevent one fall based on primary trial data. These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial. There was a 52% probability the complete program was both more effective and less costly (from the health service perspective) than providing usual care alone. Decision tree modeling sensitivity analyses identified that when provided in real life contexts, the program would be both more effective in preventingfalls among cognitively intact inpatients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0%. Conclusions This economic evaluation was designed to assist health care providers decide in what circumstances this intervention should be provided. If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4% or greater, then provision of the complete program in addition to usual care will likely both preventfalls and reduce costs for a health service. Trial registration Australia and New Zealand Clinical Trials Register: ACTRN12608000015347.
Patient falls are serious problems in hospitals. Risk factors for falls are well understood and nurses routinely assess for fall risk on all hospitalized patients. However, the link from nursing assessment of fall risk, to identification and communication of tailored interventions to preventfalls is yet to be established. The Fall TIPS (Tailoring Interventions for Patient Safety) Toolkit was developed to leverage existing practices and workflows and to employ information technology to improve fallprevention practices. The purpose of this paper is to describe the Fall TIPS Toolkit and to report on strategies used to drive adoption of the Toolkit in four acute care hospitals. Using the IHI "Framework for Spread" as a conceptual model, the research team describes the "spread" of the Fall TIPS Toolkit as means to integrate effectivefallprevention practices into the workflow of interdisciplinary caregivers, patients and family members. PMID:20351840
This article summarizes research and draws overall conclusions from the body of literature on fallprevention interventions to provide nurse administrators with a basis for developing evidence-based fallprevention programs in the hospital setting. Data are obtained from published studies. Thirteen articles are retrieved that focused on fall interventions in the hospital setting. An analysis is performed based on levels
Sandra L. Spoelstra; Barbara A. Given; Charles W. Given
The risk of accidental falls and fall-related injuries increases with age. Regular physical exercises can delay the age-related changes affecting postural balance and reduce the risk of falls. Although Tai Chi (TC) has become a popular exercise among the elderly, does regular TC exercise lead to fewer falls and fall-related injuries? Who would receive the most benefit from TC exercise?
Preventingfalls and fall-related fractures in the elderly is an objective yet to be reached. There is increasing evidence that a supplementation of vitamin D and\\/or of calcium may reduce the fall and fracture rates. A vitamin D-calcium supplement appears to have a high potential due to its simple application and its low cost. However, published studies have shown conflicting
Cedric Annweiler; Manuel Montero-Odasso; Anne M Schott; Gilles Berrut; Bruno Fantino; Olivier Beauchet
Recognizing that risk factors for falls are multifactorial and interacting, providers require guidance on the components, intensity, dose, and duration for an effectivefall and fall injury prevention program. Administrators of health care facilities require guidance on resources needed for these programs. Clear guidance does not exist for specifying the right combination of interventions to adequately protect specific at-risk populations, such as nursing home residents with dementia or osteoporosis. Staff education about fallprevention and resident fall risk assessment and reassessments has become part of standards of practice; however, the selection, specificity, and combination of fallprevention and injury protection interventions are not standardized. To address these gaps, this team of researchers conducted a critical examination of selected intervention studies relevant to nursing home populations. The objectives of this literature review were to (1) examine the selection and specificity of fallprevention and injury protection interventions described in the literature since 1990; (2) evaluate the strength of evidence for interventions that both preventfalls and protect residents from fall-related injury; and, (3) provide clinical and policy guidance to integrate specific interventions into practice. PMID:20439049
Falls consistently rank among the most serious problems facing older persons and cause a tremendous amount of morbidity, mortality,\\u000a and disability (Brown, 1999; Nevitt, 1997; Robbins et al., 1989; Rubenstein, Josephson, & Robbins, 1994; Tinetti, Williams,\\u000a & Mayewski, 1986). At least a third of community-dwelling people aged 65 years and older fall each year (Centers for Disease\\u000a Control and Prevention
Laurence Z. Rubenstein; Judy A. Stevens; Vicky Scott
Objective To determine the effectiveness of a multifaceted podiatry intervention in preventingfalls in community dwelling older people with disabling foot pain.Design Parallel group randomised controlled trial.Setting University health sciences clinic in Melbourne, Australia.Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to
Martin J Spink; Hylton B Menz; Mohammad R Fotoohabadi; Elin Wee; Karl B Landorf; Keith D Hill; Stephen R Lord
Objectives: To evaluate the evidence for strategies to preventfalls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. Design: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. Data
David Oliver; James B. Connelly; Christina R. Victor; Fiona E. Shaw; Anne Whitehead; Yasemin Genc; Alessandra Vanoli; Finbarr C. Martin; Margot A. Gosney; Kurrle
Falls and associated injury and mortality are of increasing concern among aging Americans. Effectivefall risk management is a complicated process requiring involvement by both health care professionals and older adults for three related actions: (a) early screening to detect risk factors; (b) prescription of tailored interventions; and (c) implementation of, adherence to, and compliance with the intervention by the older adult. Early detection of fall risk can prevent future falls; however, uptake of evidence-based screening and assessment protocols in the clinical setting has been limited. A variety of practice guidelines and financial incentives are available to health care professionals to facilitate adoption. Yet, there remains a gap between recommended practices and current clinical activities. This commentary addresses the complexities of fallprevention practices and offers solutions that can facilitate adoption by clinical practices. Toward this end, this commentary will present two models (i.e., a clinical approach and a financial incentive approach) to summarize current clinical recommendations and practice guidelines for fall risk management in clinical settings. The various drivers to encourage adoption of evidence-based fall risk management strategies will be described. In this context, we will discuss how understanding the different systemwide practice improvement initiatives and factors that drive action in physician groups, can facilitate adoption and implementation of fall risk management behaviors by clinicians. Additional efforts are needed to explore and assess similar initiatives to adopt and implement fall risk management practices at different entry points into the system (e.g., community settings, patients, caregivers). PMID:23887933
Shubert, Tiffany E; Smith, Matthew Lee; Prizer, Lindsay Penny; Ory, Marcia G
Falls at home among the elderly are frequent and costly occurrences. Timely responses to falls are possible when initiated by the use of Personal Emergency Response Systems (PERS). More work is needed, however, in preventing these falls from occurring. Means to preventfalls among the elderly include using higher technology such as telehealth systems and lower technology such as home
Introduction: This investigation examined the effects of two training programs on blood pressure regulation, body fat percentage, and balancing performance with regards to primary preventiveeffects and fallprevention in a unisex group of seniors. Individual parameters of blood pressure regulation and body fat percentage can be considered in- dicative of circulation performance and can also ultimately be used to
Objective To determine the effectiveness of a multifaceted podiatry intervention in preventingfalls in community dwelling older people with disabling foot pain. Design Parallel group randomised controlled trial. Setting University health sciences clinic in Melbourne, Australia. Participants 305 community dwelling men and women (mean age 74 (SD 6) years) with disabling foot pain and an increased risk of falling. 153 were allocated to a multifaceted podiatry intervention and 152 to routine podiatry care, with 12 months’ follow-up. Interventions Multifaceted podiatry intervention consisting of foot orthoses, advice on footwear, subsidy for footwear ($A100 voucher; £65; €74), a home based programme of foot and ankle exercises, a fallsprevention education booklet, and routine podiatry care for 12 months. The control group received routine podiatry care for 12 months. Main outcome measures Proportion of fallers and multiple fallers, falling rate, and injuries resulting from falls during follow-up. Results Overall, 264 falls occurred during the study. 296 participants returned all 12 calendars: 147 (96%) in the intervention group and 149 (98%) in the control group. Adherence was good, with 52% of the participants completing 75% or more of the requested three exercise sessions weekly, and 55% of those issued orthoses reporting wearing them most of the time. Participants in the intervention group (n=153) experienced 36% fewer falls than participants in the control group (incidence rate ratio 0.64, 95% confidence interval 0.45 to 0.91, P=0.01). The proportion of fallers and multiple fallers did not differ significantly between the groups (relative risk 0.85, 0.66 to 1.08, P=0.19 and 0.63, 0.38 to 1.04, P=0.07). One fracture occurred in the intervention group and seven in the control group (0.14, 0.02 to 1.15, P=0.07). Significant improvements in the intervention group compared with the control group were found for the domains of strength (ankle eversion), range of motion (ankle dorsiflexion and inversion/eversion), and balance (postural sway on the floor when barefoot and maximum balance range wearing shoes). Conclusions A multifaceted podiatry intervention reduced the rate of falls in community dwelling older people with disabling foot pain. The components of the intervention are inexpensive and relatively simple to implement, suggesting that the programme could be incorporated into routine podiatry practice or multidisciplinary fallsprevention clinics. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392.
Falls and fear of falling can affect independence and quality of life of older adults. Fallsprevention programs may help avoiding these issues if completed. Understanding factors that are associated with completion of fallsprevention programs is important. To reduce fear of falling and increase activity levels, a Matter of Balance (MOB) and un Asunto de Equilibrio (ADE) workshops were offered to 3420 older adults in South Florida between 1 October 2008 and 31 December 2011. Workshops were conducted in English or Spanish over eight, 2-hour sessions. Participants completed a demographic and a pre-post questionnaire. Factors associated with program completion were identified using logistic regression. For MOB, females were more likely to complete the program (OR = 2.076, P = 0.02). For ADE, females, moderate and extreme interference by falls in social activities were found to affect completion (OR = 2.116, P = 0.001; OR = 2.269, P = 0.003 and OR = 4.133, P = 0.008, respectively). Different factors predicted completion of both programs. Awareness of these factors can help lower the attrition rates, increase benefits and cost effectiveness of program. Future research needs to explore why certain groups had a higher likelihood of completing either program. PMID:24122324
Batra, Anamica; Page, Timothy; Melchior, Michael; Seff, Laura; Vieira, Edgar Ramos; Palmer, Richard C
Older adults value their independence, and a fall can significantly limit their ability to remain self-sufficient. More than one-third of people aged 65 and older fall each year, and those who fall once are two to three times more likely to fall again. Fa...
Executive Summary In early August 2007, the Medical Advisory Secretariat began work on the Aging in the Community project, an evidence-based review of the literature surrounding healthy aging in the community. The Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the ministry’s newly released Aging at Home Strategy. After a broad literature review and consultation with experts, the secretariat identified 4 key areas that strongly predict an elderly person’s transition from independent community living to a long-term care home. Evidence-based analyses have been prepared for each of these 4 areas: falls and fall-related injuries, urinary incontinence, dementia, and social isolation. For the first area, falls and fall-related injuries, an economic model is described in a separate report. Please visit the Medical Advisory Secretariat Web site, http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html, to review these titles within the Aging in the Community series. Aging in the Community: Summary of Evidence-Based Analyses Prevention of Falls and Fall-Related Injuries in Community-Dwelling Seniors: An Evidence-Based Analysis Behavioural Interventions for Urinary Incontinence in Community-Dwelling Seniors: An Evidence-Based Analysis Caregiver- and Patient-Directed Interventions for Dementia: An Evidence-Based Analysis Social Isolation in Community-Dwelling Seniors: An Evidence-Based Analysis The Falls/Fractures Economic Model in Ontario Residents Aged 65 Years and Over (FEMOR) Objective To identify interventions that may be effective in reducing the probability of an elderly person’s falling and/or sustaining a fall-related injury. Background Although estimates of fall rates vary widely based on the location, age, and living arrangements of the elderly population, it is estimated that each year approximately 30% of community-dwelling individuals aged 65 and older, and 50% of those aged 85 and older will fall. Of those individuals who fall, 12% to 42% will have a fall-related injury. Several meta-analyses and cohort studies have identified falls and fall-related injuries as a strong predictor of admission to a long-term care (LTC) home. It has been shown that the risk of LTC home admission is over 5 times higher in seniors who experienced 2 or more falls without injury, and over 10 times higher in seniors who experienced a fall causing serious injury. Falls result from the interaction of a variety of risk factors that can be both intrinsic and extrinsic. Intrinsic factors are those that pertain to the physical, demographic, and health status of the individual, while extrinsic factors relate to the physical and socio-economic environment. Intrinsic risk factors can be further grouped into psychosocial/demographic risks, medical risks, risks associated with activity level and dependence, and medication risks. Commonly described extrinsic risks are tripping hazards, balance and slip hazards, and vision hazards. Note: It is recognized that the terms “senior” and “elderly” carry a range of meanings for different audiences; this report generally uses the former, but the terms are treated here as essentially interchangeable. Evidence-Based Analysis of Effectiveness Research Question Since many risk factors for falls are modifiable, what interventions (devices, systems, programs) exist that reduce the risk of falls and/or fall-related injuries for community-dwelling seniors? Inclusion and Exclusion Criteria Inclusion Criteria English language; published between January 2000 and September 2007; population of community-dwelling seniors (majority aged 65+); and randomized controlled trials (RCTs), quasi-experimental trials, systematic reviews, or meta-analyses. Exclusion Criteria special populations (e.g., stroke or osteoporosis; however, studies restricted only to women were included); studies only reporting surrogate outcomes; or studies whose outcome cannot be extracted fo
The purpose of this research was to assess participants' responses to a fallprevention educational program. Fourteen persons volunteered to participate in the study conducted at a large senior center. Descriptive statistics were used to characterize the sample and to assess subjects' awareness about falls, attitudes about fall risk, fallprevention behaviors, and incidence of falls before the fallprevention program and again at one month and three months after the program. Forty-six percent of the sample had fallen in the previous year. In general, subjects' perceptions that their risk of falling was lower than others of the same age and sex increased following the fallprevention program. Additionally, subjects were somewhat more concerned about falling after attendance at the fallprevention program. Most of the participants completed the home safety checklist; however, very few subjects made changes at home to reduce the risk of falling or did the recommended muscle strengthening exercises. Suggestions for community fallprevention programs are offered based upon the pilot results. PMID:9439178
The purpose of this perspective article is to describe the use of a physiological profile approach to falls risk assessment and prevention that has been developed by the Falls and Balance Research Group of the Prince of Wales Medical Research Institute, Sydney, Australia. The profile's use for people with a variety of factors that put them at risk for falls is discussed. The Physiological Profile Assessment (PPA) involves a series of simple tests of vision, peripheral sensation, muscle force, reaction time, and postural sway. The tests can be administered quickly, and all equipment needed is portable. The results can be used to differentiate people who are at risk for falls ("fallers") from people who are not at risk for falls ("nonfallers"). A computer program using data from the PPA can be used to assess an individual's performance in relation to a normative database so that deficits can be targeted for intervention. The PPA provides valid and reliable measurements that can be used for assessing falls risk and evaluating the effectiveness of interventions and is suitable for use in a range of physical therapy and health care settings. PMID:12620088
We have developed a wearable airbag that incorporates a fall-detection system that uses both acceleration and angular velocity signals to trigger inflation of the airbag. The fall-detection algorithm was devised using a thresholding technique with an accelerometer and gyro sensor. Sixteen subjects mimicked falls, and their acceleration waveforms were monitored. Then, we developed a fall-detection algorithm that could detect signals
Background Limited attention has been paid in the literature to multiple component fallprevention interventions that comprise two or more fixed combinations of fallprevention interventions that are not individually tailored following a risk assessment. The study objective was to determine the effect of multiple component interventions on fall rates, number of fallers and fall-related injuries among older people and to establish effect sizes of particular intervention combinations. Methods Medline, EMBASE, CINAHL, PsychInfo, Cochrane, AMED, UK Clinical Research Network Study Portfolio, Current Controlled Trials register and Australian and New Zealand Clinical Trials register were systematically searched to August 2013 for randomised controlled trials targeting those aged 60 years and older with any medical condition or in any setting that compared multiple component interventions with no intervention, placebo or usual clinical care on the outcomes reported falls, number that fall or fall-related injuries. Included studies were appraised using the Cochrane risk of bias tool. Estimates of fall rate ratio and risk ratio were pooled across studies using random effects meta-analysis. Data synthesis took place in 2013. Results Eighteen papers reporting 17 trials were included (5034 participants). There was a reduction in the number of people that fell (pooled risk ratio?=?0.85, 95% confidence interval (95% CI) 0.80 to 0.91) and the fall rate (pooled rate ratio?=?0.80, 95% CI 0.72 to 0.89) in favour of multiple component interventions when compared with controls. There was a small amount of statistical heterogeneity (I2?=?20%) across studies for fall rate and no heterogeneity across studies examining number of people that fell. Conclusions This systematic review and meta-analysis of randomised controlled trials found evidence that multiple component interventions that are not tailored to individually assessed risk factors are effective at reducing both the number of people that fall and the fall rate. This approach should be considered as a service delivery option.
Fragility fracture prevention has been historically associated with the diagnosis and treatment of osteoporosis. Given that the strongest determinant of fracture is falls, it is critical to add fall risk into clinical decision-making guidelines for fracture prevention. This special interest paper proposes an algorithm based on 2 validated tools: (1) World Health Organization's Fracture Risk Assessment Tool, which evaluates probability of fracture and (2) Functional Gait Assessment, which evaluates fall risk. Physical therapists can use this algorithm to better identify patients at greatest risk for fracture in order to customize interventions designed to promote bone health, minimize falls, and ultimately prevent fractures. Recommendations for referral, patient education, and exercise are provided for categories of varying fall and fracture risk. PMID:23249725
Downey, Patricia A; Perry, Susan B; Anderson, Janice M
BackgroundUnintentional paediatric falls from heights represent a longstanding public health problem, particularly in industrialised countries.ObjectiveTo determine incidence rates and epidemiological risk factors of unintentional paediatric falls from heights in France. To help prevent these injuries.MethodAn epidemiological survey was carried out in the Paris region (11.5 million inhabitants). It collected all unintentional falls from heights among children under 15 years of
Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about fallsprevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP…
Kramer, B. Josea; Vivrette, Rebecca L.; Rubenstein, Laurence Z.
Provides an overview of the epidemiology of falls among older adults, describes current prevention strategies, and highlights key areas that need to be addressed, including risk assessments, exercise, and environmental changes. (Contains 50 references.) (JOW)
The provision of fallsprevention education to older patients after hospital discharge could see seniors living longer and healthier lives according to Dr Anne-Marie Hill, Senior Lecturer in the School of Physiotherapy at The University of Notre Dame Australia’s (UNDA) Fremantle Campus.\\u000aDr Hill will commence a four year research project on ‘Preventingfalls in older patients after hospital discharge
An organizational goal to decrease fall rates was initiated using a multidisciplinary, multimodal approach. One innovative strategy was the Friday fall review, where nurse managers present each fall that occurred to determine causes and potential preventive measures. Results of the project include a fall rate below the benchmark for 9 of 10 recent consecutive quarters. Because of the success of this initiative, the quality department has adopted the format to review all core measure indicators where there is noncompliance or less than optimal performance. PMID:23708501
The potential for accidental falls among geriatric patients is of mounting concern. Two hundred forty-one accidental falls over a 12-month period at the VA Medical Center were analyzed retrospectively and the literature reviewed in order to highlight factors that have bearing on the incidence and severity of falls. If a patient's potential for falling could be identified through a grading system based on these premonitory features, preventive measures might be more clearly focused where needed to reduce this frequent hazard in our hospital population.
Background Exercise is an effective intervention for the prevention of falls; however, some forms of exercises have been shown to be more effective than others. There is a need to identify effective and efficient methods for training health professionals in exercise prescription for fallsprevention. Objective The objective of our study was to compare two approaches for training clinicians in prescribing exercise to preventfalls. Methods This study was a head-to-head randomized trial design. Participants were physiotherapists, occupational therapists, nurses, and exercise physiologists working in Victoria, Australia. Participants randomly assigned to one group received face-to-face traditional education using a 1-day seminar format with additional video and written support material. The other participants received Web-based delivery of the equivalent educational material over a 4-week period with remote tutor facilitation. Outcomes were measured across levels 1 to 3 of Kirkpatrick’s hierarchy of educational outcomes, including attendance, adherence, satisfaction, knowledge, and self-reported change in practice. Results Of the 166 participants initially recruited, there was gradual attrition from randomization to participation in the trial (n = 67 Web-based, n = 68 face-to-face), to completion of the educational content (n = 44 Web-based, n = 50 face-to-face), to completion of the posteducation examinations (n = 43 Web-based, n = 49 face-to-face). Participant satisfaction was not significantly different between the intervention groups: mean (SD) satisfaction with content and relevance of course material was 25.73 (5.14) in the Web-based and 26.11 (5.41) in the face-to-face group; linear regression P = .75; and mean (SD) satisfaction with course facilitation and support was 11.61 (2.00) in the Web-based and 12.08 (1.54) in the face-to-face group; linear regression P = .25. Knowledge test results were comparable between the Web-based and face-to-face groups: median (interquartile range [IQR]) for the Web-based group was 90.00 (70.89–90.67) and for the face-to-face group was 80.56 (70.67–90.00); rank sum P = .07. The median (IQR) scores for the exercise assignment were also comparable: Web-based, 78.6 (68.5–85.1), and face-to-face, 78.6 (70.8–86.9); rank sum P = .61. No significant difference was identified in Kirkpatrick’s hierarchy domain change in practice: mean (SD) Web-based, 21.75 (4.40), and face-to-face, 21.88 (3.24); linear regression P = .89. Conclusion Web-based and face-to-face approaches to the delivery of education to clinicians on the subject of exercise prescription for fallsprevention produced equivalent results in all of the outcome domains. Practical considerations should arguably drive choice of delivery method, which may favor Web-based provision for its ability to overcome access issues for health professionals in regional and remote settings. Trial Registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000135011; http://www.anzctr.org.au/ACTRN12610000135011.aspx (Archived by WebCite at http://www.webcitation.org/63MicDjPV)
Haas, Romi; Keating, Jennifer L; Molloy, Elizabeth; Jolly, Brian; Sims, Jane; Morgan, Prue; Haines, Terry
Background Falls are common in old age and may have serious consequences. There are many strategies to predict and preventfalls from occurring in long-term care and hospitals. The aim of this study was to describe licensed practical nurse experiences of predicting and preventing further falls when working with patients who had experienced a fall-related fracture. Licensed practical nurses are the main caretakers that work most closely with the patients. Methods A qualitative study of focus groups interviews and field observations was done. 15 licensed practical nurses from a rehabilitation ward and an acute ward in a hospital in northern Sweden were interviewed. Content was analyzed using qualitative content analysis. Results The result of the licensed practical nurse thoughts and experiences about risk of falling and fallprevention work is represented in one theme, “the balancing act”. The theme includes three categories: “the right to decide”, “the constant watch”, and “the ongoing negotiation” as well as nine subcategories. The analysis showed similarities and differences between rehabilitation and acute wards. At both wards it was a core strategy in the licensed practical nurse work to always be ready and to pay attention to patients’ appearance and behavior. At the rehabilitation ward, it was an explicit working task to judge the patients’ risk of falling and to be active to preventfalls. At the acute ward, the words “risk of falling” were not used and fallprevention were not discussed; instead the licensed practical nurses used for example “dizzy and pale”. The results also indicated differences in components that facilitate workplace learning and knowledge transfer. Conclusions Differences between the wards are most probably rooted in organizational differences. When it is expected by the leadership, licensed practical nurses can express patient risk of falling, share their observations with others, and take actions to preventfalls. The climate and the structure of the ward are essential if licensed practical nurses are to be encouraged to routinely consider risk of falling and implement risk reduction strategies.
Falling is a serious danger to older adults that is usually only addressed after a person has fallen, when doctors administer clinical tests to determine the patient's risk of falling again. Having the technological capability of performing fall risk assessment tests with a smartphone, the authors set out to design a mobile application that would enable users to monitor their risk themselves and consequently preventfalls from occurring. The authors conducted a literature review and two observation sessions before beginning the iterative design process that resulted in the Dance! Don't Fall (DDF) game, a mobile application that enables users to both monitor their fall risk and actively reduce it through fun and easy exercise. PMID:22942064
Kerwin, Maureen; Nunes, Francisco; Silva, Paula Alexandra
ABSTRACT Purpose: To investigate the concurrent validity of the Saskatoon FallsPrevention Consortium's Falls Screening and Referral Algorithm (FSRA). Method: A total of 29 older adults (mean age 77.7 [SD 4.0] y) residing in an independent-living senior's complex who met inclusion criteria completed a demographic questionnaire and the components of the FSRA and Berg Balance Scale (BBS). The FSRA consists of the Elderly Fall Screening Test (EFST) and the Multi-factor Falls Questionnaire (MFQ); it is designed to categorize individuals into low, moderate, or high fall-risk categories to determine appropriate management pathways. A predictive model for probability of fall risk, based on previous research, was used to determine concurrent validity of the FSRI. Results: The FSRA placed 79% of participants into the low-risk category, whereas the predictive model found the probability of fall risk to range from 0.04 to 0.74, with a mean of 0.35 (SD 0.25). No statistically significant correlation was found between the FSRA and the predictive model for probability of fall risk (Spearman's ?=0.35, p=0.06). Conclusion: The FSRA lacks concurrent validity relative to to a previously established model of fall risk and appears to over-categorize individuals into the low-risk group. Further research on the FSRA as an adequate tool to screen community-dwelling older adults for fall risk is recommended.
Purpose of Study: To describe the ongoing efforts of the Connecticut Collaboration for FallPrevention (CCFP) to move evidence regarding fallprevention into clinical practice and state policy. Methods: A university-based team developed methods of networking with existing statewide organizations to influence clinical practice and state policy. Results: We describe steps taken that led to funding and legislation of fallprevention efforts in the state of Connecticut. We summarize CCFP’s direct outreach by tabulating the educational sessions delivered and the numbers and types of clinical care providers that were trained. Community organizations that had sustained clinical practices incorporating evidence-based fallprevention were subsequently funded through mini-grants to develop innovative interventional activities. These mini-grants targeted specific subpopulations of older persons at high risk for falls. Implications: Building collaborative relationships with existing stakeholders and care providers throughout the state, CCFP continues to facilitate the integration of evidence-based fallprevention into clinical practice and state-funded policy using strategies that may be useful to others.
On the basis of evidence obtained in previous studies, this paper outlines effective music therapy programs for group instructions and the basic contents of exercise and training that the elderly are able to do at home by themselves in their daily lives to reduce the risk of falls. The contents of effective exercise and training are to take a series of steps as quickly as possible, back and forth and to the right and left, in a standing position in combination with vertical movement in large amplitude for center of gravity. Furthermore, simple movements such as obeying an order of "right face", as well as dynamic movements that mostly involve higher brain functions such as instant thinking and judgment, are more effective. It should be noted that it is not sufficient for instructors to merely demand that the elderly do effective exercise. To preventfalls by the participants and to also obtain comprehensive effects such as satisfaction, amusement, and quality of life (QOL) , it is important to pay appropriate attention to parts other than the narrowly-defined evidence elements, such as modifications to maintain compliance and consideration of people with locomotive syndrome. PMID:23628686
Objective. From a public health perspective, the effectiveness of any prevention program depends on integrated medical and managerial strategies. In this way, quality management methods drawn from organization and business management can help design prevention programs. The aim of this study was to analyze the potential value of these methods in the specific context of preventingfalls in hospital. Setting.
IntroductionFall-related occupational injuries and fatalities are serious problems in the U.S. construction industry, especially incidents related to unguarded holes. The National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV conducted a project to evaluate the effectiveness of guardrail systems to preventfalls through roof and floor holes.
Thomas G. Bobick; E. A. McKenzie Jr.; Tsui-Ying Kau
Falls are a major public health problem for older adults, and community-based organizations play a key role in educating seniors about fallsprevention (FP). We conducted a qualitative process evaluation at six sites to report community-based centers' perspectives on adoption, adaptation, and sustainability of an evidence-based multifactorial FP model. Wide dissemination of new health-oriented programs requires marketing to center directors,
B. Josea Kramer; Rebecca L. Vivrette; Laurence Z. Rubenstein
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at https://villanova.gosignmeup.com/dev_students.asp?action=browse&main=Nursing+Journals&misc=564. To obtain contact hours you must: 1. Read the article, "Do Sitters PreventFalls? A Review of the Literature" found on pages 24-33, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until April 30, 2016. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the correlation between sitter use and fallprevention. 2. Review ways that sitters can affect the workflow of nursing care with patient and family satisfaction. DISCLOSURE STATEMENT Neither the planners nor the author have any conflicts of interest to disclose. Preventingfalls is a primary nursing concern, especially among older adult patients. Employing a sitter is a common but costly intervention. This article is a comprehensive review of the literature on sitter use and its effect on fall rates in acute care. The search was conducted in CINAHL, MEDLINE, PsycINFO, and the Psychology and Behavioral Sciences Collection and included articles published between 1995 and 2013. The articles included reported data on studies increasing or decreasing sitter use. Sitter reduction studies showed no increase in fall rates; studies implementing sitters to reduce falls showed conflicting results. Implications include the impact to staffing and nursing practice that results from sitter use, the need for staff education programs, how sitter use can affect patient satisfaction, and the need for additional, more robust research on this topic to determine whether sitter use is evidence-based practice. [Journal of Gerontological Nursing, 40 (5), 24-33.]. PMID:24640963
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Falls are a common geriatric syndrome and are the third leading cause of chonic disability worldwide. Falls are not random events and occur, at least in part, due to impaired physiological function, such as impaired balance, and cognitive impairment. The clinical syndrome of falls is important for Sports and Exercise Medicine Clinicians as there is Level 1 evidence that targeted exercise prescription is an effective intervention strategy. The widely accepted dogma is that improved physical function, balance and muscle strength, underlies the effectiveness of the exercise in reducing falls. However, findings from randomised controlled trials suggest that exercise reduce falls via mechanisms other than improved physiological function. The authors propose that improved cognitive function - specifically, executive functions - and associated functional plasticity may be an important yet underappreciated mechanism by which the exercise reduces falls in older adults. PMID:22522589
Liu-Ambrose, Teresa; Nagamatsu, Lindsay S; Hsu, Chun Liang; Bolandzadeh, Niousha
This article describes the development of a fall risk assessment tool for hospitalized patients that became the key component in a fallprevention program at one medical center. The characteristics of 102 patients who fell were compared with those of 102 patients matched by age and length of stay who did not fall. The statistically significant differences found between these two groups of patients were used to develop a fall risk assessment tool that was further tested on 334 patients for reliability and validity. This assessment tool was used in conjunction with a standardized nursing care plan, fall risk alert signs and stickers, a written nursing evaluation of all falls, and new safety equipment as part of an integrated fallprevention program. In the 12 months following the institution of the fallprevention program, decreases in monthly falls per patient day have averaged 20% lower than peak levels in 1988, or 41 falls per 10,000 patient days. PMID:2114579
At 16 senior centers, we studied the effectiveness of exercise and cognitive-behavioral programs, compared with a discussion control program, in reducing falls and injuries among 230 older adults. After 1 year of the programs, we observed no significant difference in time to first fall. Even though a relatively high percentage (38.6%) suffered at least one fall, only 7.8% of these community-residing elderly required medical attention. Secondary outcome measures such as strength, balance, fear of falling, and perceived health did not significantly change. PMID:1427246
Reinsch, S; MacRae, P; Lachenbruch, P A; Tobis, J S
We considered the effect of vitamin D on fall and fracture prevention, since it has been suggested that vitamin D acts on cellular receptors in the muscles and nervous system to reduce muscle weakness and body sway, thereby preventingfall. Bone strength is defined by the bone mineral density plus bone quality, and vitamin D is also thought to improve bone quality and increase bone strength, although its effect on bone mineral density is only small. Vitamin D insufficiency is prevalent at a high rate in senior citizens and we suggest that vitamin D supplementation in this population is useful for prevention of fracture and fall. PMID:18515952
OBJECTIVES: To determine the characteristics and the effectiveness of hospital fallprevention programs. DESIGN: Systematic literature search of multiple da- tabases (Medline, Cinahl, Precinahl, Invert, the Cochrane Library) and of the reference list of each identified publi- cation. SETTING: Inclusion of prospective controlled-design studies reporting the effectiveness of fallprevention pro- grams in hospitals. PARTICIPANTS: Two reviewers. MEASUREMENTS: The methodological
Objective: to evaluate the effectiveness of a multifactorial intervention on incidence of falls in psychogeriatric nursing home patients. Design: cluster-randomised controlled 12-month trial. Setting: psychogeriatric wards in 12 nursing homes in The Netherlands. Participants: psychogeriatric nursing home patients (n = 518). Intervention: a general medical assessment and an additional specific fall risk evaluation tool, applied by a multidisciplinary fallprevention
JACQUES C. L. NEYENS; B. P. J. Dijcks; J. W. R. Twisk; J. M. G. A. Schols; J. C. M. van Haastregt; Witte de L
\\u000a This chapter reviews the potential of vitamin D for the prevention of falls and fractures. Evidence from randomized-controlled\\u000a trials will be reviewed for both endpoints, as well as epidemiological data that link higher 25-hydroxyvitamin D [25(OH)D]\\u000a status to better bone and muscle health. The chapter addresses the evidence of fracture and fallprevention by dose of vitamin\\u000a D, by type
Oral health care practices are ever more frequently visited by frail elderly people. Frail elderly people are at risk for fall accidents due to intrinsic and extrinsic factors. Intrinsic factors are patient-related and extrinsic factors are environment-related. Significant intrinsic fall risk factors for elderly people are orthostatic and postprandial hypotension. The most important effect of hypotension is cerebral hypoperfusion, which can induce syncope and fall. Five to ten per cent of fall accidents of elderly people result in trauma. A serious trauma with possible extreme consequences is hip fracture. One year after a surgical hip fracture treatment of elderly people, 25% are experiencing mobility impairment and 25% have died as a result of co-morbidity or complications. Fallprevention deserves serious attention. Provision of information and strengthening and protecting bones are important prevention measures. In an oral health care practice, general risks of falling must be inventoried on a regular basis, and each (frail) elderly patient should be provided with individual fall-prevention guidance. PMID:20726500
Smit, S H B J M; de Baat, P; Schols, J M G A; de Baat, C
Objectives: The prevention of falls in the elderly trial (PROFET) provides evidence of the benefits of structured interdisciplinary assessment of older people presenting to the accident and emergency department with a fall. However, the service implications of implementing this effective intervention are significant. This study therefore examined risk factors from PROFET and used these to devise a practical approach to streamlining referrals from accident and emergency departments to specialist falls services. Methods: Logistic regression analysis was used in the control group to identify patients with an increased risk of falling in the absence of any intervention. The derived predictors were investigated to see whether they also predicted loss to follow up. A second regression analysis was undertaken to test for interaction with intervention. Results: Significant positive predictors of further falls were; history of falls in the previous year (OR 1.5 (95%CI 1.1 to 1.9)), falling indoors (OR 2.4 (95%CI 1.1 to 5.2)), and inability to get up after a fall (OR 5.5 (95%CI 2.3 to 13.0)). Negative predictors were moderate alcohol consumption (OR 0.55 (95%CI 0.28 to 1.1)), a reduced abbreviated mental test score (OR 0.7 (95%CI 0.53 to 0.93)), and admission to hospital as a result of the fall (OR 0.26 (95%CI 0.11 to 0.61)). A history of falls (OR 1.2 (95%CI 1.0 to 1.3)), falling indoors (OR 3.2 (95%CI 1.5 to 6.6)) and a reduced abbreviated mental test score (OR 1.3 (95%CI 1.0 to 1.6)) were found to predict loss to follow up. Conclusions: The study has focused on a readily identifiable high risk group of people presenting at a key interface between the primary and secondary health care sectors. Analysis of derived predictors offers a practical risk based approach to streamlining referrals that is consistent with an attainable level of service commitment.
Close, J; Hooper, R; Glucksman, E; Jackson, S; Swift, C
We assessed knowledge, attitude, and provision of recommended fallprevention (FP) practices by employees of senior-serving organization and participation in FP practices by at-risk elders. The Washington State Department of Health administered structured telephone surveys to 50 employees and 101 elders in Washington State. Only 38% of employees felt "very knowledgeable" about FP, and a majority of their organizations did not regularly offer FP services. Almost half (48%) of seniors sustained a fall within the past 12 months; however, one-third perceived falling to be among their least important health concerns, and most had minimal working knowledge of proven FP practices. Seniors who perceived avoiding falls as important to their well-being were more likely to participate in practices about which they had the least knowledge (risk assessment, medication management). Increased awareness and availability of FP services might help engage older adults in FP practices and reduce the adverse effects of falls. PMID:21915377
Laing, Sharon S; Silver, Ilene F; York, Sally; Phelan, Elizabeth A
Background guidelines recommend that fallprevention programmes for older people include multifactorial interventions. Objective we aimed to determine if randomised controlled trial evidence supports interventions with multiple components over single strategies in community based fallprevention. Methods we searched the literature for trials of interventions aimed at preventingfalls. We included trials if they met the following criteria: (i) participants
Background Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by mental health conditions. Existing reviews have focused on people with dementia and cognitive impairment, but not those with other mental health conditions or in mental health settings. The objective of this review is to evaluate the effectiveness of fallprevention interventions for older people with mental health problems being cared for across all settings. Methods A systematic review of fallprevention interventions for older people with mental health conditions. We undertook electronic database and lateral searches to identify studies reporting data on falls or fall related injuries. Searches were initially conducted in February 2011 and updated in November 2012 and October 2013; no date restrictions were applied. Studies were assessed for risk of bias. Due to heterogeneity results were not pooled but are reported narratively. Results Seventeen RCTs and four uncontrolled studies met the inclusion criteria; 11 involved single interventions and ten multifactorial. Evidence relating to fall reduction was inconsistent. Eight of 14 studies found a reduction in fallers (statistically significant in five), and nine of 14 reported a significant reduction in rate or number of falls. Four studies found a non-significant increase in falls. Multifactorial, multi-disciplinary interventions and those involving exercise, medication review and increasing staff awareness appear to reduce the risk of falls but evidence is mixed and study quality varied. Changes to the environment such as increased supervision or sensory stimulation to reduce agitation may be promising for people with dementia but further evaluation is needed. Most of the studies were undertaken in nursing and residential homes, and none in mental health hospital settings. Conclusions There is a dearth of falls research in mental health settings or which focus on patients with mental health problems despite the high number of falls experienced by this population group. This review highlights the lack of robust evidence to support practitioners to implement practices that prevent people with mental health problems from falling.
Objective To test the effectiveness of, and explore interactions between, three interventions to preventfalls among older people. Design A randomised controlled trial with a full factorial design. Setting Urban community in Melbourne, Australia. Participants 1090 aged 70 years and over and living at home. Most were Australian born and rated their health as good to excellent; just over half
Lesley Day; Brian Fildes; Ian Gordon; Michael Fitzharris; Harold Flamer; Stephen Lord; Victoria Melbourne; Australia Ian Gordon
Problem Falls from heights in residential construction are common, especially among inexperienced workers. Methods We conducted a comprehensive needs assessment to determine gaps in the school-based apprentice carpenters' fallprevention training. A team of carpenter instructors and researchers revised the fallprevention training to fill these gaps. Apprentice evaluation and feedback guided ongoing curricular improvements. Results Most apprentice carpenters performed work tasks at heights prior to training and fall protection techniques were not commonly used at residential construction sites. Priorities of the revised school-based training included safe ladder habits, truss setting, scaffold use, guarding floor openings, and using personal fall arrest systems. New apprentices were targeted to ensure training prior to exposure at the workplace. We used adult learning principles to emphasize hands-on experiences. A framed portion of a residential construction site was fabricated to practice fall protection behaviors in a realistic setting. The revised curriculum has been delivered consistently and apprentice feedback has been very favorable. Conclusions Integration of needs assessment results was invaluable in revising the school-based carpenters apprentice fallprevention curriculum. Working closely with the instructors to tailor learning experiences has provided preliminary positive results. Impact on Industry The fall safety of the residential construction industry continues to lag behind commercial construction and industrial settings. The National Occupational Research Agenda includes a Strategic Goal to strengthen and extend the reach of quality training and education in the construction industry via mechanisms such as construction safety and health training needs assessments. This study demonstrates how a structured process can be used to identify and remedy gaps and improve training effectiveness. We encourage others to take steps to assess and increase the impact of training efforts directed at all residential construction professionals; including both union and non-union workers. The implications are even greater in the non-union sector where most U.S. residential work is done.
Given the significant health and socioeconomic consequences of falls, to develop and promote effectivefallsprevention strategies among older adults represents a major issue. Jaques-Dalcroze eurhythmics is a music education program through movement method developed in Geneva, Switzerland, in the early 20th century. This new exercise form, adapted for elderly people, features various multitask exercises performed to the rhythm of improvised piano music and mainly challenge gait and balance, but also memory, attention and coordination. We report here the results of a randomized controlled trial conducted in Geneva showing that Jaques-Dalcroze eurythmics practice can improve gait performance under single and dual-task conditions, and balance, as well as reduce both rate of falls and the risk of falling in at-risk elderly community-dwellers. PMID:21793420
Background Falls are one of the most common health problems among older people and pose a major economic burden on health care systems. Exercise is an accepted stand-alone fallprevention strategy particularly if it is balance training or regular participation in Tai chi. Dance shares the ‘holistic’ approach of practices such as Tai chi. It is a complex sensorimotor rhythmic activity integrating multiple physical, cognitive and social elements. Small-scale randomised controlled trials have indicated that diverse dance styles can improve measures of balance and mobility in older people, but none of these studies has examined the effect of dance on falls or cognition. This study aims to determine whether participation in social dancing: i) reduces the number of falls; and ii) improves cognitive functions associated with fall risk in older people. Methods/design A single-blind, cluster randomised controlled trial of 12 months duration will be conducted. Approximately 450 participants will be recruited from 24 self-care retirement villages that house at least 60 residents each in Sydney, Australia. Village residents without cognitive impairment and obtain medical clearance will be eligible. After comprehensive baseline measurements including physiological and cognitive tests and self-completed questionnaires, villages will be randomised to intervention sites (ballroom or folk dance) or to a wait-listed control using a computer randomisation method that minimises imbalances between villages based on two baseline fall risk measures. Main outcome measures are falls, prospectively measured, and the Trail Making cognitive function test. Cost-effectiveness and cost-utility analyses will be performed. Discussion This study offers a novel approach to balance training for older people. As a community-based approach to fallprevention, dance offers older people an opportunity for greater social engagement, thereby making a major contribution to healthy ageing. Providing diversity in exercise programs targeting seniors recognises the heterogeneity of multicultural populations and may further increase the number of taking part in exercise. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000889853 The trial is now in progress with 12 villages already have been randomised.
Introduction This project concerns the identification of the smallest worthwhile effect (SWE) of exercise-based programmes to preventfalls in older people. The SWE is the smallest effect that justifies the costs, risks and inconveniences of an intervention and is used to inform the design and interpretation of systematic reviews and randomised clinical trials. Methods and analysis This study will comprise two different methodological approaches: the benefit-harm trade-off method and the discrete choice experiment to estimate the SWE of exercise interventions to preventfalls in older people. In the benefit-harm trade-off method, hypothetical scenarios with the benefits, costs, risks and inconveniences associated with the intervention will be presented to each participant. Then, assuming a treatment effect of certain magnitude, the participant will be asked if he or she would choose to have the intervention. The size of the hypothetical benefit will be varied up and down until it is possible to identify the SWE for which the participant would choose to have the intervention. In the discrete choice experiment, the same attributes (benefits, costs, risks and inconveniences) with varying levels will be presented as choice sets, and participants will be asked to choose between these choice sets. With this approach, we will determine the probability that a person will consider the effects of an intervention to be worthwhile, given the particular costs, risks and inconveniences. For each of the two approaches, participants will be interviewed in person and on different occasions. A subsample of the total cohort will participate in both interviews. Ethics and dissemination This project has received Ethics Approval from the University of Sydney Human Ethics Committee (Protocol number: 14404). Findings will be disseminated through conference presentations, seminars and peer-reviewed scientific journals.
Franco, Marcia Rodrigues; Ferreira, Manuela L; Howard, Kirsten; Sherrington, Catherine; Rose, John; Haines, Terry P; Ferreira, Paulo
Purpose: The purpose of this study was to determine which of 2 primary prevention education programs was more effective in increasing knowledge and prompting behavior change to reduce fall risks among community-dwelling older adults who attended Senior Centers. Methods: A convenience sample (N=69) was recruited at 4 local senior centers to com- pare 2 fall risk education methods. Subjects were
Background: Attenuation of the peak impact force is essential in any protective devices for prevention of fall-related injuries.Hypothesis: Common wrist guards have limited effectiveness because of the multifaceted nature of wrist injury mechanisms, and other modalities may provide enhanced shock-absorbing functions.Study Design: Controlled laboratory study.Methods: A free-fall device was constructed using a mechanical surrogate to simulate falling impact. At 4
Kyu-Jung Kim; Ali M. Alian; William S. Morris; Young-Hwa Lee
We describe a distributed falls management system capable of real-time falls detection in an unsupervised living context and remote longitudinal tracking of falls risk parameters using a waist-mounted triaxial accelerometer. A self-administrable falls risk assessment is used to facilitate fallsprevention. A Web-interface allows clinicians to monitor the status of individuals and track their compliance with exercise interventions. Early identification
Michael R. Narayanan; Steven R. Lord; Marc M. Budge; Branko G. Celler; Nigel H. Lovell
Falls are a common occurrence amongst older adults yet participation in prevention strategies is often poor. Although older adults may perceive a strategy works in general, they may not participate because they feel it will not benefit them personally. We aimed to describe how frequently and why older adults identify fallsprevention strategies as being "better for others than for me". A cross-sectional survey with n=394 community-dwelling older adults in Victoria, Australia was undertaken. Participants were provided with detailed descriptions of four evidence-based fallsprevention strategies and for each were asked whether they felt that the strategy would be effective in preventingfalls for people like them, and then whether they felt that the strategy would be effective for preventingfalls for them personally. Follow-up questions asked why they thought the strategy would be more effective for people like them than for them personally where this was the case. We found the "better for others than for me" perception was present for between 25% and 34% of the strategies investigated. Participants commonly said they felt this way because they did not think they were at risk of falls, and because they were doing other activities they thought would provide equivalent benefit. Strategies to promote participation in evidence-based fallsprevention strategies may need to convince older adults that they are at risk of falls and that what activities they are already doing may not provide adequate protection against falls in order to have greater effect. PMID:24745812
Haines, Terry P; Day, Lesley; Hill, Keith D; Clemson, Lindy; Finch, Caroline
... But many cannot and need long-term care. Fear of Falling Fear of falling becomes more common with age, even ... and restore your walking confidence. Getting over your fear can help you to stay active, maintain your ...
The influence of exposure to the free-fall state on the orientation, morphogenesis, physiology, and radiation response of higher plants is briefly summarized. It is proposed that the duration of the space-flight experiments has been to brief to permit meaningful effects of free fall on general biochemistry, growth, and development to appear. However, two types of significant effect did occur. The first is on differential growth - i.e., tropism and epinasty - resulting from the absence of a normal geostimulus. For these phenomena it is suggested that ground-based experiments with the clinostat would suffice to mimic the effect of the free-fall state. The second is an apparent interaction between the radiation response and some flight condition, yielding an enhanced microspore abortion, a disturbed spindle function, and a stunting of stamen hairs. It is suggested that this apparent interaction may be derived from a shift in the rhythm of the cell cycle, induced by the free fall.
Background Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people. Methods The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to preventfalls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components. Results Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified. Conclusions Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000065392.
Background: in 2007, the National Patient Safety Agency (NPSA) published 'Slips trips and falls in hospital' and 'Using bedrails safely and effectively'. Objectives: this observational study aimed to identify changes in local policies in hospitals in England and Wales following these publications. Method: policies in place during 2006 and 2009 were requested from 50 randomly selected acute hospital trusts and their content was categorised by a single reviewer using defined criteria. Results: thirty-seven trusts responded. Trusts with an inpatient fallsprevention policy increased from 65 to 100%, the use of unreferenced numerical falls risk assessments reduced from 50 to 19%, and trusts with a bedrail policy increased from 49 to 89%. It was concerning to find that by 2009 advice on clinical checks after a fall was available in only 51% of trusts, and only 46% of trust policies included specific guidance on avoiding bedrail entrapment gaps. Conclusions: the observed changes in policy content were likely to have been influenced not only by the NPSA publications but also by contemporaneous publications from the Royal College of Physicians' National Audit of Falls and Bone Health, and the Medicines and Healthcare products Regulatory Agency. Most areas of local policy indicated substantial improvement, but further improvements are required. PMID:22572240
Background More than a third of people over the age of 65?years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventingfalls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes. Methods We conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography. Results Of the 5010 articles identified through database searching, 19 were included in the review. Analysis of the 19 studies revealed limited information about the mechanisms by which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person. Conclusions The current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice.
Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for fallsprevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventingfalls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventingfalls. PMID:24297980
Najafi, Bijan; de Bruin, Eling D; Reeves, Neil D; Armstrong, David G; Menz, Hylton B
Work-related slip, trip, and fall incidents can frequently result in serious disabling injuries that impact a healthcare employee's ability to do his or her job, often resulting in lost workdays, reduced productivity, expensive worker compensation claims,...
The present review summarizes the pathogenic mechanisms leading to hip fracture based on epidemiological, experimental, and controlled studies. The estimated lifetime risk of hip fracture is about 14% in postmenopausal women and 6% in men. The incidence of hip fractures increases exponentially with aging, but the time-trend in increasing age-specific incidence may not be a universal phenomenon. Postmenopausal women suffering earlier non-hip fractures have an increased risk of later hip fracture. The relative risk being highest within the first years following the fracture. Nursing home residents have a high risk of hip fracture (annual rate of 5-6%), and the incidence of falls is about 1,500 falls/1,000 persons/year. Most hip fractures are a result of a direct trauma against the hip. The incidence of falls on the hip among nursing home residents is about 290 falls/1,000 persons/year and about 24% of these impacts lead to hip fracture. The force acting on the hip may reach 3.7 kN in falls on the hip from standing height, which means that only susceptible subjects will sustain a hip fracture in such falls. The effective load acting on the hip is 35% of the body weight in unprotected falls on the hip. Women with hip fractures have a lower body weight compared with controls, and they may also have less soft tissue covering the hip even when adjusted for body mass index, indicating a more android body habitus. Experimental studies show that the passive energy absorption in soft tissue covering the hip may influence the risk of hip fracture, and being an important determinant for the development of hip fracture, maybe more important than bone strength. External hip protectors were developed and tested in an open randomised nursing home study. The rate of hip fractures was reduced by 50%, corresponding to 9 out of 247 residents saved from sustaining a hip fracture. The review points to the essentials of the development of hip fracture, which constitutes; risk of fall, type of fall, type of impact, energy absorption, and lastly bone strength, which is the ultimate and last permissive factor in the cascade leading to hip fracture. Risk estimation and prevention of hip fractures may prove realistic when these issues are taken into consideration. PMID:9151010
A randomized comparison of pre-and post-experimental design was used to examine the effects of a fallprevention exercise program (FPEP) on muscle strength, ankle flexibility, balance, instrumental activities of daily living (IADLs), and depression for the community-dwelling elderly in Korea. Twenty-two subjects were assigned to an experimental group and twenty-three to a control group. The experimental group participated in a 4-day-per week FPEP of 8 weeks duration, twice a week by direct instruction and twice a week with videotaped instruction by the program instructor at each senior center. The eight-week FPEP turned out to be significantly effective in enhancing muscle strength, ankle flexibility and balance, and in reducing depression, after intervention among community-dwelling elderly in Korea. IADLs, however, was not changed by the intervention. Further research with a larger sample and longer follow up period is needed to expand our understanding about the effects of FPEP. Future study is also recommended to differentiate between the effects of FPEP by direct instruction and by videotaped. PMID:14584107
Sohng, Kyeong-Yae; Moon, Jung-Soon; Song, Hae-Hiang; Lee, Kwang-Soo; Kim, Young-Sook
This paper presents a state-of-the-art survey of smartphone (SP)-based solutions for fall detection and prevention. Falls are considered as major health hazards for both the elderly and people with neurodegenerative diseases. To mitigate the adverse consequences of falling, a great deal of research has been conducted, mainly focused on two different approaches, namely, fall detection and fallprevention. Required hardware for both fall detection and prevention are also available in SPs. Consequently, researchers' interest in finding SP-based solutions has increased dramatically over recent years. To the best of our knowledge, there has been no published review on SP-based fall detection and prevention. Thus in this paper, we present the taxonomy for SP-based fall detection and prevention solutions and systematic comparisons of existing studies. We have also identified three challenges and three open issues for future research, after reviewing the existing articles. Our time series analysis demonstrates a trend towards the integration of external sensing units with SPs for improvement in usability of the systems.
Habib, Mohammad Ashfak; Mohktar, Mas S.; Kamaruzzaman, Shahrul Bahyah; Lim, Kheng Seang; Pin, Tan Maw; Ibrahim, Fatimah
This paper presents a state-of-the-art survey of smartphone (SP)-based solutions for fall detection and prevention. Falls are considered as major health hazards for both the elderly and people with neurodegenerative diseases. To mitigate the adverse consequences of falling, a great deal of research has been conducted, mainly focused on two different approaches, namely, fall detection and fallprevention. Required hardware for both fall detection and prevention are also available in SPs. Consequently, researchers' interest in finding SP-based solutions has increased dramatically over recent years. To the best of our knowledge, there has been no published review on SP-based fall detection and prevention. Thus in this paper, we present the taxonomy for SP-based fall detection and prevention solutions and systematic comparisons of existing studies. We have also identified three challenges and three open issues for future research, after reviewing the existing articles. Our time series analysis demonstrates a trend towards the integration of external sensing units with SPs for improvement in usability of the systems. PMID:24759116
Habib, Mohammad Ashfak; Mohktar, Mas S; Kamaruzzaman, Shahrul Bahyah; Lim, Kheng Seang; Pin, Tan Maw; Ibrahim, Fatimah
Elderly patients are at risk for high levels of morbidity and mortality from falls related to gait disorders. Gait disorders\\u000a are often missed in clinical practice but can be easily detected and characterized so at-risk patients can be given appropriate\\u000a therapy.
We examined the circumstances of death and injury among victims of the tornado that struck Wichita Falls, Texas, on 10 April 1979. We also assessed the protective measures taken by a representative sample of community residents who suffered no major injury in order to estimate the relative risk of injury to people directly in the tornado's path. Twenty-six (60 percent)
Roger I. Glass; Robert B. Craven; Dennis J. Bregman; Barbara J. Stoll; Neil Horowitz; Peter Kerndt; Joe Winkle
The Gesture Recognition Interactive Technology (GRiT) Chair Alarm aims to prevent patient falls from chairs and wheelchairs by recognizing the gesture of a patient attempting to stand. Patient falls are one of the greatest causes of injury in hospitals. Current chair and bed exit alarm systems are inadequate because of insufficient notification, high false-alarm rate, and long trigger delays. The
In a randomized trial of Steady as You Go, a falls-prevention program for the elderly, the treatment group (n=235) reduced eight of nine risk factors. Over a 4-month follow-up, the treatment group fell less than controls (n=236) and significantly fewer treatment group participants who had fallen before experienced falls (20%) compared to 35% of…
IntroductionThe purpose of this study was to addresses a gap in the fallprevention literature with a focus on Assisted Living Residences (ALRs) – a new community housing option for a rapidly growing number of older persons that are at high risk falls. The result of the 1-year collaborative study was the development of Best Practice Guidelines for integration into
V Scott; H Bawa; F Feldman; J S Gould; M Leung; F Rajabali
Background: Persons with intellectual disabilities (ID) constitute a special-needs population at high risk of falling. This is the first study to evaluate whether obstacle course training can improve mobility and preventfalls in this population. Methods: The intervention was implemented as part of an institution-wide health care improvement plan…
Van Hanegem, E.; Enkelaar, L.; Smulders, E.; Weerdesteyn, V.
IntroductionThe need to preventfalls and related injuries among seniors is a significant public health issue in Canada, and all nations where an aging demographic puts higher numbers at risk. To address this costly and complex problem, a sustained collaboration has occurred over the past 20 years among fallsprevention leaders within government, the health system, academia and local communities.MethodsThis
Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for
Johanne Filiatrault; Manon Parisien; Sophie Laforest; Carole Genest; Lise Gauvin; Michel Fournier; Francine Trickey; Yvonne Robitaille
Objectives We examined risk factors for falls among older people according to indoor and outdoor activity at the time of the fall and explored risk factors for seriously injurious falls. Methods Data came from MOBILIZE Boston, a prospective cohort study of 765 community-dwelling women and men, mainly aged 70 years or older. Over 4.3 years, 1737 falls were recorded, along with indoor or outdoor activity at the time of the fall. Results Participants with poor baseline health characteristics had elevated rates of indoor falls while transitioning, walking, or not moving. Healthy, active people had elevated rates of outdoor falls during walking and vigorous activity. For instance, participants with fast, rather than normal, gait speed, had a rate ratio of 7.36 (95% confidence interval [CI] = 2.54, 21.28) for outdoor falls during vigorous activity. The likelihood of a seriously injurious fall also varied by personal characteristics, activity, and location. For example, the odds ratio for serious injury from an outdoor fall while walking outside compared to inside a participant’s neighborhood was 3.31 (95% CI = 1.33, 8.23). Conclusions Fallprevention programs should be tailored to personal characteristics, activities, and locations.
Kelsey, Jennifer L.; Procter-Gray, Elizabeth; Hannan, Marian T.; Li, Wenjun
Background An increasing number of falls result in an emergency call and the subsequent dispatch of paramedics. In the absence of physical injury, abnormal physiological parameters or change in usual functional status, it could be argued that routine conveyance by ambulance to the Emergency Department (ED) is not the most effective or efficient use of resources. Further, it is likely that non-conveyed older fallers have the potential to benefit from timely access to fall risk assessment and intervention. The aim of this randomised controlled trial is to evaluate the effect of a timely and tailored falls assessment and management intervention on the number of subsequent falls and fall-related injuries for non-conveyed older fallers. Methods Community dwelling people aged 65 years or older who are not conveyed to the ED following a fall will be eligible to be visited at home by a research physiotherapist. Consenting participants will receive individualised intervention strategies based on risk factors identified at baseline. All pre-test measures will be assessed prior to randomisation. Post-test measures will be undertaken by a researcher blinded to group allocation 6 months post-baseline. Participants in the intervention group will receive individualised pro-active fallprevention strategies from the clinical researcher to ensure that risk factors are addressed adequately and interventions carried out. The primary outcome measure will be the number of falls recorded by a falls diary over a 12 month period. Secondary outcome measures assessed six months after baseline will include the subsequent use of medical and emergency services and uptake of recommendations. Data will be analysed using the intention-to-treat principle. Discussion As there is currently little evidence regarding the effectiveness or feasibility of alternate models of care following ambulance non-conveyance of older fallers, there is a need to explore assessment and intervention programs to help reduce subsequent falls, related injuries and subsequent use of health care services. By linking existing services rather than setting up new services, this pragmatic trial aims to utilise the health care system in an efficient and timely manner. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN 12611000503921
Objectives To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Design Randomised controlled trial. Setting Dunedin and Auckland, New Zealand. Participants 391 women and men aged ?75 with visual acuity of 6/24 or worse who were living in the community; 92% (361 of 391) completed one year of follow-up. Interventions Participants received a home safety assessment and modification programme delivered by an occupational therapist (n = 100), an exercise programme prescribed at home by a physiotherapist plus vitamin D supplementation (n = 97), both interventions (n = 98), or social visits (n = 96). Main outcome measures Numbers of falls and injuries resulting from falls, costs of implementing the home safety programme. Results Fewer falls occurred in the group randomised to the home safety programme but not in the exercise programme (incidence rate ratios 0.59 (95% confidence interval 0.42 to 0.83) and 1.15 (0.82 to 1.61), respectively). However, within the exercise programme, stricter adherence was associated with fewer falls (P = 0.001). A conservative analysis showed neither intervention was effective in reducing injuries from falls. Delivering the home safety programme cost $NZ650 (£234, 344 euros, $US432) (at 2004 prices) per fallprevented. Conclusion The home safety programme reduced falls and was more cost effective than an exercise programme in this group of elderly people with poor vision. The Otago exercise programme with vitamin D supplementation was not effective in reducing falls or injuries in this group, possibly due to low levels of adherence. Trial registration number ISRCTN15342873.
Campbell, A John; Robertson, M Clare; La Grow, Steven J; Kerse, Ngaire M; Sanderson, Gordon F; Jacobs, Robert J; Sharp, Dianne M; Hale, Leigh A
The FallPrevention Center of Excellence designed three progressive-intensity fallprevention program models, Increasing Stability Through Evaluation and Practice (InSTEP), to reduce risk in community-dwelling older adults. Each model included physical activity, medical risk, and home safety components and was implemented as a 12-week program for small class sizes (12-15 people) in community and senior centers. Change in fall rates and fall risk factors was assessed using a battery of performance tests, self-reports of function, and fall diaries in a 3-group within-subjects (N = 200) design measured at baseline, immediately postintervention, and at 3 and 9 months postintervention. Overall, participants experienced a reduction in falls, improved selfperception of gait and balance, and improved dynamic gait function. The medium-intensity InSTEP model significantly (p = .003) reduced self-reported falls in comparison with the other models. InSTEP is a feasible model for addressing fall risk reduction in community-dwelling older adults. PMID:23945593
Kramer, B Josea; Creekmur, Beth; Mitchell, Michael N; Rose, Debra J; Pynoos, Jon; Rubenstein, Laurence Z
The aim of this exploratory study was to understand the opinions and observations of recently discharged senior patients concerning the fall-prevention education received during their most recent hospitalization. The focus was on the extrinsic risk factors for falls. This project was conducted in a Michigan home care agency. Participants had to be Medicare home care patients, discharged from the affiliated hospital within 30 days, 65 years or older, and alert. Practical implications that might lead to fewer falls in the future as the goal of this research are discussed. PMID:19092478
Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
Nurses help to ensure patient safety, which includes preventingfalls and fall related injuries. The aging Veteran population, like the general population, is at risk for falls and fall related injuries whether at home, in hospitals or in long term care facilities. Nurses are leading practice innovations to systematically assess patients' risk for falls and implement population based prevention interventions. To determine the effectiveness of programs, data can be analyzed using a variety of statistical measures to determine program impacts. Thus, data analysis of fall rates by type of fall and severity of fall related injury can help facilities examine the effectiveness of their interventions and program outcomes. Examples of actual fallprevention programs and their approaches to measurement are showcased in this article. PMID:21848355
Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this…
BACKGROUND: The National Health Service (NHS) was tasked in 2001 with developing service provision to preventfalls in older people. We carried out a national survey to provide a description of health and social care funded UK fallers services, and to benchmark progress against current practice guidelines. METHODS: Cascade approach to sampling, followed by telephone survey with senior member of
Sarah E Lamb; Joanne D Fisher; Simon Gates; Rachel Potter; Matthew W Cooke; Yvonne H Carter
Quality indicators are standardized measures of health care quality. We designed a survey to assess how knowledge, attitude, and organizational practices might affect healthcare provider behaviors in meeting quality indicators for fallprevention to plan curricula for a continuing educational intervention. The survey was pilot tested in the…
Kramer, B. Josea; Ganz, David A.; Vivrette, Rebecca L.; Harker, Judith O.; Josephson, Karen R.; Saliba, Debra
The risk of sustaining a fall and fall-related injuries is particularly high in children and seniors, which is why there is a need to develop fall-preventive intervention programs. An intergenerational approach in balance and strength promotion appears to have great potential because it is specifically tailored to the physical, social and behavioural needs of children and seniors. Burtscher and Kopp
Urs Granacher; Thomas Muehlbauer; Albert Gollhofer; Reto W. Kressig; Lukas Zahner
Prevention of unintended falls among adults is a major public health focus. Previous researchers have indicated the importance of addressing the physiological issues impacting fall risk, as well as the inclusion of activities designed to improve self efficacy regarding the completion of activities of daily living. However, less published research has examined the impact of psychological variables impacting falls efficacy.
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Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fallprevention among the healthy elderly in the community. PMID:12081122
Decreasing patient fall injuries during hospitalization continues to be a challenge at the bedside. Empowering patients to become active participants in their own fallprevention care could be a solution. In a previous study, elderly patients recently discharged from a United States hospital expressed a need for nurses to give and repeat directives about fallprevention; when the nurse left a brochure on the topic, but did not provide any (or limited) verbal explanations about the content or the importance of the information, the patient felt that the information was insufficient. To address patients’ needs, we developed “i Engaging”, a Web-based software application for use at the bedside. i Engaging is an innovative approach that is used to engage patients in their own fallprevention care during hospital stays. The application was designed based on the assumption that patients are the best and most critical sources of information about their health status. i Engaging has not yet been tested in clinical trials.
Background There are many studies that associate vitamin D serum levels in older persons with muscle strength, physical performance and risk of fractures and falls. However, current evidence is insufficient to make a general recommendation for administrating calcium and vitamin D to older persons. The objective of this study is to determine the effectiveness of calcium and vitamin D supplementation in improving musculoskeletal function and decreasing the number of falls in person aged over 65 years. Methods/Design Phase III, randomized, double blind, placebo-controlled trial to evaluate the efficacy of already marketed drugs in a new indication. It will be performed at Primary Care doctor visits at several Healthcare Centers in different Spanish Health Areas. A total of 704 non-institutionalized subjects aged 65 years or older will be studied (sample size calculated for a statistical power of 80%, alpha error 0.05, annual incidence of falls 30% and expected reduction of 30% to 20% and expected loss to follow up of 20%). The test drug containing 800 IU of vitamin D and 1000 mg of calcium will be administered daily. The control group will receive a placebo. The subjects will be followed up over two years. The primary variable will be the incidence of spontaneous falls. The secondary variables will include: consequences of the falls (fractures, need for hospitalization), change in calcidiol plasma levels and other analytical determinations (transaminases, PTH, calcium/phosphorous, albumin, creatinine, etc.), change in bone mass by densitometry, change in muscle strength in the dominant hand and change in musculoskeletal strength, risk factors for falls, treatment compliance, adverse effects and socio-demographic data. Discussion The following principles have been considered in the development of this Project: the product data are sufficient to ensure that the risks assumed by the study participants are acceptable, the study objectives will probably provide further knowledge on the problem studied and the available information justifies the performance of the study and its possible risk for the participants. If calcium and vitamin D supplementation is effective in the prevention of falls and fractures in the elderly population, a recommendation may be issued with the aim of preventing some of the consequences of falls that affect quality of life and the ensuing personal, health and social costs. Trial Registration ClinicalTrials.gov: NCT01452243 Clinical trial authorized by the Spanish Medicines Agency: EudraCT number 2006-001643-63.
Falls represent a serious hazard to workers in many industries. Workers who perform tasks at elevation - workers in the construction, structural metal working, and tree trimming industries, for example - are at risk of falls from heights, with frequently ...
Falls are a significant cause of injury and accidental death among persons over the age of 65. Gait velocity is one of the parameters which have been correlated to the risk of falling. We aim to build a system which monitors gait in seniors and reports any changes to caregivers, who can then perform a clinical assessment and perform corrective and preventative actions to reduce the likelihood of falls. In this paper, we deploy a Doppler radar-based gait measurement system into the apartments of thirteen seniors. In scripted walks, we show the system measures gait velocity with a mean error of 14.5% compared to the time recorded by a clinician. With a calibration factor, the mean error is reduced to 10.5%. The radar is a promising sensing technology for gait velocity in a day-to-day senior living environment. PMID:23365880
Objective. The purpose of this study was to evaluate the effectiveness of a 12-month community-based intervention on falls and risk factors (balance, lower extremity strength, and mobility) in community-living older adults. Methods. Four hundred fifty-three sedentary adults (65 years old or older) were randomized to either a multifaceted intervention (3 times a week group exercise, 6 hours of fallprevention
Anne Shumway-Cook; Ilene F. Silver; Mary LeMier; Sally York; Peter Cummings; Thomas D. Koepsell
Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fallprevention videos in that they include video footage of real life falls captured in the LTC setting. Methods Two educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory. Results The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection). Conclusions Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice.
Occupational therapists are primary candidates in taking a proactive role in meeting the community dwelling senior citizen's safety, environmental, and cognitive needs through the development of community based programs in conjunction with aging organizations. The purpose of this paper is to provide recommendations to occupational therapists in developing, implementing, and marketing a senior community based fallprevention and home safety program in conjunction with a Council on Aging and occupational therapy outpatient private practice. PMID:23927615
Falls are a significant threat to the safety, health and independence of older citizens. Despite the substantial evidence that is available around effectivefallsprevention programmes and interventions, their translation into falls reduction programmes and policies has yet to be fully realised. While hip fracture rates are decreasing, the number and incidence of fall-related hospital admissions among older people continue to rise. Given the demographic trends that highlight increasing numbers of older people in the UK, which is broadly reflected internationally, there is a financial and social imperative to minimise the rate of falls and associated injuries. Falling is closely aligned to growing older (Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010). According to the World Health Organization, around 30% of older people aged over 65 and 50% of those over 80 will fall each year (Falls Fact Sheet Number 344, WHO, Geneva, 2010). Falls happen as a result of many reasons and can have harmful consequences, including loss of mobility and independence, confidence and in many cases even death (Cochrane Database Syst Rev 15, 2009, 146; Slips, Trips and Falls Update: From Acute and Community Hospitals and Mental Health Units in England and Wales, Department of Health, HMSO, London, 2010; Falling Standards, Broken Promises: Report of the National Audit of Falls and Bone Health in Older People 2010, Health Care Quality Improvement Partnership, London, 2011). What is neither fair nor correct is the common belief by old and young alike that falls are just another inconvenience to put up with. The available evidence justifiably supports the view that well-organised services, based upon national standards and expert guidance, can prevent future falls among older people and reduce death and disability from fractures. This paper will draw from the UK, as an exemplar for policy and practice, to discuss the strategic direction of fallsprevention programmes for older people and the partnerships that need to exist between researchers, service providers and users of services to translate evidence to the clinical setting. Second, it will propose some mechanisms for disseminating evidence to healthcare professionals and other stakeholders, to improve the quality and capacity of the clinical workforce. PMID:22078021
This is a reading-comprehension lesson about historical meteorite falls. Learners will read about large historical meteors and meteorites falls, discuss the effects on people, and compare their reactions with those in recorded history. Suggestions for student mapping and vocabulary words are included. This is lesson 15 of 19 in Exploring Meteorite Mysteries.
STUDY OBJECTIVE---In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN---Four groups with approximately
Margaret A Steinberg; Colleen M Cartwright; Nancy M Peel; Gail M Williams
`Children Can't Fly' is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children 10 years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: (1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral and data collecting by public health nurses; (2) a media campaign to inform the public and elevate their awareness of the hazards; (3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; (4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50% from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation and maintenance of the injured and permanently disabled.
A person's ability to transfer the acquired improvements in the control of center of mass (COM) state stability to slips induced in everyday conditions can have profound theoretical and practical implications for fallsprevention. This study investigated the extent to which such generalization could take place. A training group (N=8) initially experienced 24 right-side slips in blocked-and-random order (from the first unannounced, novel slip, S-1 to the last, S-24) resulting from release of a low-friction moveable platform in walking. They then experienced a single unannounced slip while walking on an oil-lubricated vinyl floor surface (V-T). A control group (N=8) received only one unannounced slip on the same slippery floor (V-C). Results demonstrated that the incidence of balance loss and fall on V-T was comparable to that on S-24. In both trials fall and balance loss incidence was significantly reduced in comparison with that on S-1 or on V-C, resulting from significant improvements in the COM state stability. The observed generalization indicates that the control of COM stability can be optimally acquired to accommodate alterations in environmental constraints, and it may be broadly coded and easily modifiable within the CNS. Because of such mechanisms, it is possible that the locomotor-balance skills acquired with the aid of low friction moveable platforms can translate into resisting falls encountered in daily living.
Tanvi Bhatt (University of Illinois); Yi-Chun Clive Pai (University of Illinois)
Evidence-based patient and consumer health information (EBPI) implies unbiased presentation of the scientific evidence aimed at consumers' informed decision making. A number of consumer information brochures on fallprevention in the elderly have been developed. However, none of these fulfil the criteria of EBPI. It is almost unknown how elderly people respond to EBPI. We performed three focus-group interviews including 19 senior citizens to explore the comprehensibility and acceptance of an EBPI on risk of falling and fallprevention strategies. The analysis of the interviews revealed that the majority of participants did not understand the aim of the brochure, although it was explicitly stated. Most of them had expected concrete instructions on fall-risk management. The numerical and graphical figures and tables displaying fall-risk factors, fall and fracture incidence, and efficacy of the interventions were predominantly judged as confusing and unfamiliar. Beside negative emotional reactions, devaluation, and selective information seeking, a relevant number of participants also appreciated the objective and non-indoctrinating character of the EBPI. Our investigation confirms limited acceptance of EBPI which might predominately be caused by unsatisfied expectations and unfamiliarity with this kind of information. PMID:20687039
ObjectivesTo investigate the value for money of strategies to preventfalls in older adults living in the community.DesignSystematic review of peer reviewed journal articles reporting an economic evaluation of a fallsprevention intervention as part of a randomised controlled trial or a controlled trial, or using an analytical model. MEDLINE, PUBMED, EMBASE and NHS EED databases were searched to identify
J C Davis; M C Robertson; M C Ashe; T Liu-Ambrose; K M Khan; C A Marra
A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a physical activity component. Interviewer-administered pre- and posttests evaluated fallpreventive home safety behavior, intakes of calcium- and vitamin D-rich foods, use of calcium- and vitamin D-containing supplements, and five modifiable fall- and fracture-related risk factors. Following the intervention, there were significant increases in the intake of calcium- and vitamin D-rich foods (p < 0.001), the use of calcium- or vitamin D-containing supplements (p < 0.05), days of week with physical activity (p < 0.001) and fallpreventive home safety behaviors (p < 0.001), and decreases in overall modifiable fall- and fracture-related risk factors (?4 to 5 risk factors: pre: 32% vs. post: 18%; p < .001). This evaluation provides evidence that a multi-factorial fallprevention intervention offered at senior centers and delivered by trained staff can be beneficial for improving behaviors that may contribute to decreasing the risk of falls and fractures in older adults. PMID:23286642
Teems, Jennifer; Hausman, Dorothy B; Fischer, Joan G; Lee, Jung Sun; Johnson, Mary Ann
The purpose of the report is to determine if participation in evidence-based practice (EBP) interventions designed to promote and sustain the use of fall and pressure ulcer (PU) prevention clinical practice guidelines (CPGs) improves nursing care processe...
Investigating the implementation and dissemination of evidence-based health-promotion programs to reach large numbers of diverse\\u000a older adults is needed. The purpose of this study is to examine relationships between class size and session attendance and\\u000a assess differences in intervention outcomes based on these community-based fallprevention program characteristics. Pre-post\\u000a data were analyzed from 2,056 fallsprevention program participants. PROC MIXED
Matthew Lee Smith; Angela K Hochhalter; Yichen Cheng; Suojin Wang; Marcia G Ory
Background: Multifaceted programs that combine assessment with interventions have been shown to reduce subsequent falls in some clinical trials. We tested this approach to see whether it would be effective if offered as a consultation service using existing health care resources. Methods: The subjects of this randomized controlled trial had to be aged 65 years or more and had to
David B. Hogan; Frank A. MacDonald; Jennifer Betts; Sheila Bricker; Erika M. Ebly; Barb Delarue; Tak S. Fung; Cathy Harbidge; Maggie Hunter; Colleen J. Maxwell; Barb Metcalf
The prevention of fall from height accidents has long been a popular topic in the field of construction safety. Previous research has indicated one of the potential hazards was induced by the use of steel bracket as scaffold support. While researchers are focusing to improve the existing scaffolding system, this research introduces a newly developed device to minimize fall accidents. The working platform, namely Rapid Demountable Platform (RDP) can be applied across window frames without fixing anchor bolts. Emphasizing on the rapid installation/dismantling, the RDP provides another safer option for working at height. The development of the RDP has incorporated modular concept and aesthetic factor into the design, achieving a more user-friendly platform. Although the RDP is not intended to totally replace the traditional bamboo truss-out scaffold, it is designed to act as an alternative or a supplement to the existing bamboo truss-out scaffold. The RDP is the first of this kind to minimize fall from height accidents especially in cities similar to Hong Kong where external working at height is frequently encountered. PMID:22664686
Background People with Parkinson’s (PwP) experience frequent and recurrent falls. As these falls may have devastating consequences, there is an urgent need to identify cost-effective interventions with the potential to reduce falls in PwP. The purpose of this economic evaluation is to compare the costs and cost-effectiveness of a targeted exercise programme versus usual care for PwP who were at risk of falling. Methods One hundred and thirty participants were recruited through specialist clinics, primary care and Parkinson’s support groups and randomised to either an exercise intervention or usual care. Health and social care utilisation and health-related quality of life (EQ-5D) were assessed over the 20 weeks of the study (ten-week intervention period and ten-week follow up period), and these data were complete for 93 participants. Incremental cost per quality adjusted life year (QALY) was estimated. The uncertainty around costs and QALYs was represented using cost-effectiveness acceptability curves. Results The mean cost of the intervention was £76 per participant. Although in direction of favour of exercise intervention, there was no statistically significant differences between groups in total healthcare (?£128, 95% CI: -734 to 478), combined health and social care costs (£-35, 95% CI: -817 to 746) or QALYs (0.03, 95% CI: -0.02 to 0.03) at 20 weeks. Nevertheless, exploration of the uncertainty surrounding these estimates suggests there is more than 80% probability that the exercise intervention is a cost-effective strategy relative to usual care. Conclusion Whilst we found no difference between groups in total healthcare, total social care cost and QALYs, analyses indicate that there is high probability that the exercise intervention is cost-effective compared with usual care. These results require confirmation by larger trial-based economic evaluations and over the longer term.
Background Falls and fall-related injuries pose a major threat to older peoples’ health, and are associated with increased morbidity and mortality. In the course of demographic changes, development and implementation of fallprevention strategies have been recognized as an urgent public health challenge. Various risk factors for falls and a number of effective interventions have been recognized. A substantial proportion of falls occur for people who are neither frail nor at high risk. Therefore, population-based approaches reaching the entire older population are needed. Objective The objective of the study presented is the development, implementation, and evaluation of a population-based intervention for the prevention of falls and fall-related injuries in a medium sized city in Germany. Methods The study is designed as a population-based approach. The intervention community is a mid sized city named Reutlingen in southern Germany with a population of 112,700 people. All community dwelling inhabitants 65 years and older are addressed. There are two main measures that are defined: (1) increase of overall physical activity, and (2) reduction of modifiable risk factors for falls such as deficits in strength and balance, home and environmental hazards, impaired vision, unsafe footwear, and improper use of assistive devices. The implementation strategies are developed in a participatory community planning process. These might include, for example, training of professionals and volunteers, improved availability of exercise classes, and education and raising awareness via newspaper, radio, or lectures. Results The study starts in September 2010 and ends in December 2013. It is evaluated primarily by process evaluation as well as by telephone survey. Conclusions Physical activity as a key message entails multiple positive effects with benefits on a range of geriatric symptoms. The strength of the design is the development of implementation strategies in a participatory community planning. The problems that we anticipate are the dependency on the stakeholders’ willingness to participate, and the difficulty of evaluating population-based programs by hard end points.
We examined the feasibility of using a remotely manoeuverable robot to make home hazard assessments for fallprevention. We employed use-case simulations to compare robot assessments with in-person assessments. We screened the homes of nine elderly patients (aged 65 years or more) for fall risks using the HEROS screening assessment. We also assessed the participants' perspectives of the remotely-operated robot in a survey. The nine patients had a median Short Blessed Test score of 8 (interquartile range, IQR 2-20) and a median Life-Space Assessment score of 46 (IQR 27-75). Compared to the in-person assessment (mean?=?4.2 hazards identified per participant), significantly more home hazards were perceived in the robot video assessment (mean?=?7.0). Only two checklist items (adequate bedroom lighting and a clear path from bed to bathroom) had more than 60% agreement between in-person and robot video assessment. Participants were enthusiastic about the robot and did not think it violated their privacy. The study found little agreement between the in-person and robot video hazard assessments. However, it identified several research questions about how to best use remotely-operated robots. PMID:24352900
Sadasivam, Rajani S; Luger, Tana M; Coley, Heather L; Taylor, Benjamin B; Padir, Taskin; Ritchie, Christine S; Houston, Thomas K
Falls frequently cause injury-related hospitalization or death among older adults. This article reviews a new conceptual framework on dynamic stability and weight support in reducing the risk for falls resulting from a forward slip, based on the principles of motor control and learning, in the context of adaptation and longer-term retention induced by repeated-slip training. Although an unexpected slip is severely destabilizing, a recovery step often is adequate for regaining stability, regardless of age. Consequently, poor weight support (quantified by reduction in hip height), rather than instability, is the major determinant of slip-related fall risk. Promisingly, a single session of repeated-slip training can enhance neuromechanical control of dynamic stability and weight support to preventfalls, which can be retained for several months or longer. These principles provide the theoretical basis for establishing task-specific adaptive training that facilitates the development of protective strategies to reduce falls among older adults.
Falls frequently cause injury-related hospitalization or death among older adults. This article reviews a new conceptual framework on dynamic stability and weight support in reducing the risk for falls resulting from a forward slip, based on the principles of motor control and learning, in the context of adaptation and longer-term retention induced by repeated-slip training. Although an unexpected slip is severely destabilizing, a recovery step often is adequate for regaining stability, regardless of age. Consequently, poor weight support (quantified by reduction in hip height), rather than instability, is the major determinant of slip-related fall risk. Promisingly, a single session of repeated-slip training can enhance neuromechanical control of dynamic stability and weight support to preventfalls, which can be retained for several months or longer. These principles provide the theoretical basis for establishing task-specific adaptive training that facilitates the development of protective strategies to reduce falls among older adults. PMID:17712033
A community-based intervention to reduce risk factors related to falls and fractures administered to Georgians participating in the Older Americans Act (OAA) congregate meal-site program (N = 691, mean age = 75, 84% female, 45% Black and 55% White, convenience sample) was evaluated. The intervention consisted of 16 weekly sessions, with 8 focused on prevention of falls and fractures, and all 16 including a
Jennifer Teems; Dorothy B. Hausman; Joan G. Fischer; Jung Sun Lee; Mary Ann Johnson
This study aimed to examine the effect of visual training on obstacle course performance of independent community dwelling older adults. Agility is the ability to rapidly alter ongoing motor patterns, an important aspect of mobility which is required in obstacle avoidance. However, visual information is also a critical factor in successful obstacle avoidance. We compared obstacle course performance of a group that trained in visually driven body movements and agility drills, to a group that trained only in agility drills. We also included a control group that followed the American College of Sports Medicine exercise recommendations for older adults. Significant gains in fitness, mobility and power were observed across all training groups. Obstacle course performance results revealed that visual training had the greatest improvement on obstacle course performance (22%) following a 12 week training program. These results suggest that visual training may be an important consideration for fallprevention programs. PMID:22206782
Reed-Jones, Rebecca J; Dorgo, Sandor; Hitchings, Maija K; Bader, Julia O
This document is a narrative summary of an institutional effectiveness survey administered in the fall of 2000 at Cerritos College (California). The survey was designed to assess satisfaction with the institution. Administered to help meet the accreditation standards set by the Western Association of Schools and Colleges (WASC), the survey…
Background: Falls are a significant health care problem, resulting in significant morbidity and mortality in the elderly population. Previous research has shown that medications play a contributing role in falls. It has also been shown that multifactorial interventions can reduce the risk of falls in community dwelling or institutional ized patients. Even though there are a significant number of publications
Falls among older adults are a major public health concern because they have a high incidence and impose substantial personal and societal burdens (Marks & Allegrante, 2004). Physical, emotional, social, environmental, and financial costs of fall-related injuries can be devastating. The direct annual financial cost in the United States for treating fall-related injuries is more than $20 billion annually (Centers
Fall detection and prevention require logged physiological activity data of a patient for a long period of time. This work develops a data acquisition system to collect motion data from multiple patients and store in a data base. A wireless sensor network is built using high precision inertia sensors and low power Zigbee wireless transceivers. Testing results prove the system
A. Dinh; D. Teng; L. Chen; S. B. Ko; Y. Shi; J. Basran; V. Del Bello-Hass
BackgroundFall-related morbidity is a serious public health issue in older adults referred to emergency departments (EDs). Emergency physicians mostly focus on immediate injuries, whereas the specific assessment of functional consequences and opportunities for prevention remain scarce. The aim of this study was to determine the factors influencing 6-month independence.
Objective: This study examines the 9-month impact of a 12-week fallsprevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three
Sophie Laforest; Anne Pelletier; Lise Gauvin; Yvonne Robitaille; Michel Fournier; Hélène Corriveau; Johanne Filiatrault
Objective To evaluate the effectiveness of multifactorial assessment and intervention programmes to preventfalls and injuries among older adults recruited to trials in primary care, community, or emergency care settings.Design Systematic review of randomised and quasi-randomised controlled trials, and meta-analysis.Data sources Six electronic databases (Medline, Embase, CENTRAL, CINAHL, PsycINFO, Social Science Citation Index) to 22 March 2007, reference lists of
S Gates; J D Fisher; M W Cooke; Y H Carter; S E Lamb
STUDY OBJECTIVE: To describe a community based programme to prevent fractures resulting from falls and evaluate the outcome in terms of changes in fracture rates and short term hospital care costs. DESIGN: Prospective intervention study. SETTING: The Norwegian municipalities of Harstad (intervention) and Trondheim (reference) from 1 July 1985 to 30 June 1993. PARTICIPANTS: The person-years of the study were
Falls from bed are common in subacute hospital settings, particularly for patients with cognitive impairment. This repeated measures, single cohort study in 1 subacute ward evaluated effectiveness of an electronic sensor alarm in reducing falls in patients (n = 34) with cognitive impairment. Nursing staff feedback (focus group, survey) was used to determine electronic sensor alarm feasibility. The electronic alarm system was found to be a feasible, effective, and acceptable fallprevention strategy for patients with cognitive impairment. PMID:24487696
Wong Shee, Anna; Phillips, Bev; Hill, Keith; Dodd, Karen
Objective To determine the pattern of blood sugar and HbA1c testing among supportive living residents with diabetes and whether, in those with diabetes, blood glucose measurement was done at the time of a fall. Research design and methods The management of diabetes in relation to falls in the supportive living sector is unknown. A cross-sectional questionnaire study in Edmonton Alberta, Canada of Designated Supportive Living (DSL) homes have places funded by Alberta Health Services and other homes (SL) that have no funded places. A questionnaire was distributed to Directors of Care/managers of supportive living homes, with telephone interview follow-up if required. Results Sixty responses from 61 of the 71 homes (86%) provided information. 21 were DSL and 39 were SL homes. DSL homes were significantly more likely than SL ones to report that residents with diabetes had blood glucose measurements as part of regular care, to be aware that glycosylated haemoglobin was measured, and to say that blood glucose was measured at the time of a fall. Regression analysis identified that facilities with a policy to measure blood glucose at the time of a fall had a lower rate of falls in residents with diabetes than facilities without such a policy (p?0.05). No effect of this policy was seen in residents without diabetes. Conclusion Residents with diabetes were less likely to fall in homes that indicated that they had a policy to measure blood glucose at the time of a fall.
Walking is a complex motor task generally performed automatically by healthy adults. Yet, by the elderly, walking is often no longer performed automatically. Older adults require more attention for motor control while walking than younger adults. Falls, often with serious consequences, can be the result. Gait impairments are one of the biggest risk factors for falls. Several studies have identified
Purpose: Our study identified factors common to a variety of populations and settings that may promote or inhibit uptake and adherence to falls-related interventions. Design and Methods: Semistructured interviews to assess perceived advantages and barriers to taking part in falls-related interventions were carried out in six European countries…
Yardley, Lucy; Bishop, Felicity L.; Beyer, Nina; Hauer, Klaus; Kempen, Gertrudis I. J. M.; Piot-Ziegler, Chantal; Todd, Chris J.; Cuttelod, Therese; Horne, Maria; Lanta, Kyriaki; Holt, Anne Rosell
This quotation from the late Bernard Isaacs still portrays, four decades after being written, the crude consequence that an\\u000a older adult may experience after a single fall (1). Despite the enormous efforts of researchers and clinicians to understand\\u000a the falls syndrome, there is still a significant gap between the knowledge gained about this challenging syndrome and the\\u000a clinical application of
Horizontal tube falling film evaporators find various applications like multi effect distillation for sea water desalination, power and process applications, refrigeration applications, etc. In this system, latent heat released inside the tube due to condensation is transferred to the falling film on the tube surface resulting in convective evaporation. Among many heat transfer enhancement techniques, thermal spray coatings enjoy diverse
Falls are the leading cause of all external injuries. Outcomes of falls include the leading cause of traumatic brain injury and bone fractures, and high direct medical costs in the billions of dollars. This work focused on developing three areas of enabling component technology to be used in postural control monitoring tools targeting the mitigation of falls. The first was an analysis tool based on stochastic fractal analysis to reliably measure levels of motor control. The second focus was on thin film wearable pressure sensors capable of relaying data for the first tool. The third was new thin film advanced optics for improving phototherapy devices targeting postural control disorders. Two populations, athletes and elderly, were studied against control groups. The results of these studies clearly show that monitoring postural stability in at-risk groups can be achieved reliably, and an integrated wearable system can be envisioned for both monitoring and treatment purposes. Keywords: electro-active polymer, ionic polymer-metal composite, postural control, motor control, fallprevention, sports medicine, fractal analysis, physiological signals, wearable sensors, phototherapy, photobiomodulation, nano-optics.
Background With increasing age neuromuscular deficits (e.g., sarcopenia) may result in impaired physical performance and an increased risk for falls. Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline. Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice. Thus, the objective of the present trial is to assess the effects of a fallprevention program that was developed by an interdisciplinary expert panel on measures of balance, strength / power, body composition, cognition, psychosocial well-being, and falls self-efficacy in healthy older adults. Additionally, the time-related effects of detraining are tested. Methods/Design Healthy old people (n?=?54) between the age of 65 to 80 years will participate in this trial. The testing protocol comprises tests for the assessment of static / dynamic steady-state balance (i.e., Sharpened Romberg Test, instrumented gait analysis), proactive balance (i.e., Functional Reach Test; Timed Up and Go Test), reactive balance (i.e., perturbation test during bipedal stance; Push and Release Test), strength (i.e., hand grip strength test; Chair Stand Test), and power (i.e., Stair Climb Power Test; countermovement jump). Further, body composition will be analysed using a bioelectrical impedance analysis system. In addition, questionnaires for the assessment of psychosocial (i.e., World Health Organisation Quality of Life Assessment-Bref), cognitive (i.e., Mini Mental State Examination), and fall risk determinants (i.e., Fall Efficacy Scale – International) will be included in the study protocol. Participants will be randomized into two intervention groups or the control / waiting group. After baseline measures, participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week, with each training session lasting 30 min. (actual training time). One intervention group will complete an extensive supervised training program, while the other intervention group will complete a short version ('3 times 3’) that is home-based and controlled by weekly phone calls. Post-tests will be conducted right after the intervention period. Additionally, detraining effects will be measured 12 weeks after program cessation. The control group / waiting group will not participate in any specific intervention during the experimental period, but will receive the extensive supervised program after the experimental period. Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance, strength / power, body composition, cognitive function, psychosocial well-being, and falls self-efficacy of older adults. In addition, information regarding fall risk assessment, dose–response-relations, detraining effects, and supervision of training will be provided. Further, training-induced health-relevant changes, such as improved performance in activities of daily living, cognitive function, and quality of life, as well as a reduced risk for falls may help to lower costs in the health care system. Finally, practitioners, therapists, and instructors will be provided with a scientifically evaluated feasible, safe, and easy-to-administer exercise program for fallprevention. Trial registration ClinicalTrials.gov Identifier: NCT01906034
The ageing neuromuscular system is affected by structural and functional changes that lead to a general slowing down of neuromuscular performance and an increased risk of falling. As a consequence, the process of ageing results in a reduced ability to develop maximal and explosive force, as well as in deficits in static and dynamic postural control. A decrease in the
For a senior person, the fall is danger with the risk of the injuries such as bone fractures. Plantar tactile sensibility is one of the senses contributing to stability of gait. In this study, we develop a device improving plantar tactile sensitivity by stochastic resonance to improve stability of gait of elderly person. For development of the device, we tested
Satoshi Kudoh; Ming Ding; Hirohsi Takemura; Hiroshi Mizoguchi
Disabled or cognition impaired elderly may lie in the bed most of their time. It is important to monitor their health conditions and look out for life threatening events in and around the bed continuously. Abrupt unassisted movements may lead to falls whereas the lack of desirable movements may cause bedsores. In order to alleviate these problems, we propose automated
Aung Aung Phyo Wai; Kow Yuan-Wei; Foo Siang Fook; M. Jayachandran; J. Biswas; J.-J. Cabibihan
The iterative development of the Falls Risk Assessment and Management System (FRAMS) drew upon research evidence and early consumer and clinician input through focus groups, interviews, direct observations, and an online questionnaire. Clinical vignettes were used to validate the clinical model and program logic, input, and output. The information model was developed within the Australian General Practice Data Model (GPDM)
Siaw-Teng Liaw; Nabil Sulaiman; Christopher Pearce; Jane Sims; Keith Hill; Heather Grain; Justin Tse; Choon-Kiat Ng
Falls among older people are a major public health issue. Increasing numbers of older people are accessing the internet for health-related information, including information on falls risk and prevention. However, we are aware of no study that has assessed the quality of such websites. Using techniques for conducting systematic literature reviews, we evaluated English-language websites offering falls-related advice to members
Sarah H. Whitehead; Samuel R. Nyman; Freya Broaders; Dawn A. Skelton; Chris J. Todd
Fall season fertilization is a widely recommended practice for turfgrass. Fertilizer applied in the fall, however, may be subject to substantial leaching losses. A field study was conducted in Connecticut to determine the timing effects of fall fertilization on nitrate N (NO3-N) leaching, turf color, shoot density, and root mass of a 90% Kentucky bluegrass (Poa pratensis L.), 10% creeping
Background Evidence-based patient and consumer information (EBPI) is an indispensable component of the patients' decision making process\\u000a in health care. Prevention of accidental falls in the elderly has gained a lot of public interest during preceding years.\\u000a Several consumer information brochures on fallprevention have been published; however, none fulfilled the criteria of an\\u000a EBPI. Little is known about the reception
Objectives To assess the efficacy and cost effectiveness of a home safety programme and a home exercise programme to reduce falls and injuries in older people with low vision. Design Randomised controlled trial. Setting Dunedin and Auckland, New Zealand. Participants 391 women and men aged ? 75 with visual acuity of 6\\/24 or worse who were living in the community;
A John Campbell; M Clare Robertson; Steven J La Grow; Ngaire M Kerse; Gordon F Sanderson; Robert J Jacobs; Dianne M Sharp; Leigh A Hale
Falls related injuries among elderly patients in hospitals or residents in residential care facilities is a significant problem that causes emotional and physical trauma to those involved while presenting a rising healthcare expense in countries such as Australia where the population is ageing. Novel approaches using low cost and privacy preserving sensor enabled Radio Frequency Identification (RFID) technology may have the potential to provide a low cost and effective technological intervention to preventfalls in hospitals. We outline the details of a wearable sensor enabled RFID tag that is battery free, low cost, lightweight, maintenance free and can be worn continuously for automatic and unsupervised remote monitoring of activities of frail patients at acute hospitals or residents in residential care. The technological developments outlined in the paper forms part of an overall technological intervention developed to reduce falls at acute hospitals or in residential care facilities. This paper outlines the details of the technology, underlying algorithms and the results (where an accuracy of 94-100% was achieved) of a successful pilot trial. PMID:23367394
Background Falls are the leading cause of injury death in older adults and present a significant public health problem and a major burden to healthcare. Although there is sufficient evidence from randomized controlled trials to indicate that exercise can preventfalls in older people, few effective, evidence-based fallprevention programs exist in community practice. Thus, there is a pressing need to translate and disseminate evidence-based exercise programs to community providers that serve older adults at increased risk of falling. The current study addresses this public health need by disseminating the evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program through community senior centers. Methods/Design The study uses a single-group design in which the TJQMBB program is being delivered to community-dwelling older adults through collaboration with senior centers in selected counties in Oregon, USA, for 48 weeks, followed by a 24-week post-intervention follow-up. Study process and outcome measures will be evaluated in accordance with the components of the RE-AIM framework that focus on Reach, Effectiveness, Adoption, Implementation and Maintenance. Discussion This study will determine whether the evidence-based TJQMBB fallprevention program can be disseminated through a broad spectrum of community-based senior centers that often cater to low-income, underserved community-dwelling older adults at risk of falling. If shown to be both practically implementable and sustainable, the TJQMBB program will provide an effective, potentially low-cost, easy-to-implement intervention that could be used by public health practitioners and community-based organizations to address the problem of falls among older adults. Trial registration ClinicalTrials.gov Identifier: NCT01854931
Objective To determine whether the provision of single lens distance glasses to older wearers of multifocal glasses reduces falls. Design Parallel randomised controlled trial stratified by recruitment site and source of referral, with 13 months’ follow-up and outcome assessors blinded to group allocation. Setting Community recruitment and treatment room assessments in Sydney and Illawarra regions of NSW, Australia. Participants 606 regular wearers of multifocal glasses (mean age 80 (SD 7) years). Inclusion criteria included increased risk of falls (fall in previous year or timed up and go test >15 seconds) and outdoor use of multifocal glasses at least three times a week. Interventions Provision of single lens distance glasses with recommendations for wearing them for walking and outdoor activities compared with usual care. Main outcome measures Number of falls and injuries resulting from falls during follow-up. Results Single lens glasses were provided to 275 (90%) of the 305 intervention group participants within two months; 162 (54%) of the intervention group reported satisfactory use of distance glasses for walking and outdoor activities for at least 7/12 months after dispensing. In the 299 intervention and 298 control participants available to follow-up, the intervention resulted in an 8% reduction in falls (incidence rate ratio 0.92, 95% confidence interval 0.73 to 1.16). Pre-planned sub-group analyses showed that the intervention was effective in significantly reducing all falls (incidence rate ratio 0.60, 0.42 to 0.87), outside falls, and injurious falls in people who regularly took part in outside activities. A significant increase in outside falls occurred in people in the intervention group who took part in little outside activity. Conclusions With appropriate counselling, provision of single lens glasses for older wearers of multifocal glasses who take part in regular outdoor activities is an effectivefallsprevention strategy. The intervention may be harmful, however, in multifocal glasses wearers with low levels of outdoor activity. Trial registration Clinical trials NCT00350855.
We aimed to develop a new scale for evaluating risks and preventive measures for in-hospital falls of newborn infants, from admission to discharge of the expectant mother. Our study was prepared in accordance with Failure Modes and Effects Analysis criteria. The risks and preventive measures for in-hospital falls of newborns were determined. Risk Priority Numbers (RPNs) were determined by multiplication of the scores of severity, probability of occurrence, and probability of detection. Analyses showed that risks having the highest RPNs were the mother with epidural anesthesia (RPN: 350 point), holding of the baby at the moment of delivery (RPN: 240), and transportation of baby right after delivery (RPN: 240). A reduction was detected in all RPNs after the application of preventive measures. Our risk model can function as a guide for obstetric clinics that need to form strategies to prevent newborn falls.
Background Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of fall-risk increasing drugs on the number of new falls versus 'care as usual' in older adults presenting at the Emergency Department after a fall. Methods/Design A prospective, multi-center, randomized controlled trial will be conducted in hospitals in the Netherlands. Persons aged ?65 years who visit the Emergency Department due to a fall are invited to participate in this trial. All patients receive a full geriatric assessment at the research outpatient clinic. Patients are randomized between a structured medication assessment including withdrawal of fall-risk increasing drugs and 'care as usual'. A 3-monthly falls calendar is used for assessing the number of falls, fallers and associated injuries over a one-year follow-up period. Measurements will be at three, six, nine, and twelve months and include functional outcome, healthcare consumption, socio-demographic characteristics, and clinical information. After twelve months a second visit to the research outpatient clinic will be performed, and adherence to the new medication regimen in the intervention group will be measured. The primary outcome will be the incidence of new falls. Secondary outcome measurements are possible health effects of medication withdrawal, health-related quality of life (Short Form-12 and EuroQol-5D), costs, and cost-effectiveness of the intervention. Data will be analyzed using an intention-to-treat analysis. Discussion The successful completion of this trial will provide evidence on the effectiveness of withdrawal of fall-risk increasing drugs in older patients as a method for falls reduction. Trial Registration The trial is registered in the Netherlands Trial Register (NTR1593)
The effects of fall rice (Oryza sativa L.) straw management and winter flooding on the yield and profitability of subsequent irrigated and dryland soybean [Glycine max (L.) Merr.] crops were studied for 3 years. Rice straw treatments consisted of disking, rolling, or standing stubble. Winter flooding treatments consisted of maintaining a minimum water depth of 10 cm by pumping water when necessary, impounding available rainfall, and draining fields to prevent flooding. The following soybean crop was managed as a conventional-tillage system or no-till system. Tillage system treatments were further divided into irrigated or dryland. Results indicated that there were no significant effects from either fall rice straw management or winter flooding treatments on soybean seed yields. Soybean seed yields for, the conventional tillage system were significantly greater than those for the no-till system for the first 2 yrs and not different in the third year. Irrigated soybean seed yields were significantly greater than those from dryland plots for all years. Net economic returns averaged over the 3 yrs were greatest ($390.00 ha-1) from the irrigated no-till system.
Background Accidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences for older patients, including serious physical injury and reduced quality of life, and are also a source of substantial cost to health systems worldwide. There have been a limited number of randomised controlled trials, mainly using multifactorial interventions, aiming to prevent older people falling whilst inpatients. Trials to date have produced conflicting results and recent meta-analyses highlight that there is still insufficient evidence to clearly identify which interventions may reduce the rate of falls, and falls related injuries, in this population. Methods and design A prospective randomised controlled trial (n = 1206) is being conducted at two hospitals in Australia. Patients are eligible to be included in the trial if they are over 60 years of age and they, or their family or guardian, give written consent. Participants are randomised into three groups. The control group continues to receive usual care. Both intervention groups receive a specifically designed patient education intervention on minimising falls in addition to usual care. The education is delivered by Digital Video Disc (DVD) and written workbook and aims to promote fallsprevention activities by participants. One of the intervention groups also receives follow up education training visits by a health professional. Blinded assessors conduct baseline and discharge assessments and follow up participants for 6 months after discharge. The primary outcome measure is falls by participants in hospital. Secondary outcome measures include falls at home after discharge, knowledge of fallsprevention strategies and motivation to engage in fallsprevention activities after discharge. All analyses will be based on intention to treat principle. Discussion This trial will examine the effect of a single intervention (specifically designed patient education) on rates of falls in older patients in hospital and after discharge. The results will provide robust recommendations for clinicians and researchers about the role of patient education in this population. The study has the potential to identify a new intervention that may reduce rates of falls in older hospital patients and could be readily duplicated and applied in a wide range of clinical settings. Trial Registration ACTRN12608000015347
Hill, Anne-Marie; Hill, Keith; Brauer, Sandra; Oliver, David; Hoffmann, Tammy; Beer, Christopher; McPhail, Steven; Haines, Terry P
... AS. Falls in the nursing home. Annals of Internal Medicine 1994;121:442–51. Rubenstein LZ. Preventingfalls ... elderly population. A randomized clinical trial. Annals of Internal Medicine 1990;113(4):308–16. Thapa PB, Brockman ...
This Alert presented the warning that workers may die or be injured if scaffold equipment and fall protection systems are either defective or are misused. Falls have been a leading cause of traumatic occupational death. Fatal falls from scaffolds during t...
Background Falls among the elderly are an issue internationally and a public health problem that brings substantial economic and quality-of-life burdens to individuals and society. Fallsprevention is an important measure of nursing quality and patient safety. Numerous studies have evaluated the association of medication use with fall risk in elderly patients. However, an up-to-date review has not been available to summarize the multifaceted pharmaceutical concerns in the prevention of medication-related falls. Materials and methods Relevant literature was identified by performing searches in PubMed, Web of Science, and the Cochrane Library, covering the period until February 2014. We included studies that described an association between medications and falls, and effects of drug pharmacokinetic/pharmacodynamic properties, characteristics of medication use, and pharmacological interventions on fall risk in elderly patients. The full text of each included article was critically reviewed, and data interpretation was performed. Results Fall-risk-increasing drugs (FRIDs) include central nervous system-acting agents, cough preparations, nonsteroidal anti-inflammatory drugs, anti-Alzheimer’s agents, antiplatelet agents, calcium antagonists, diuretics, ?-blockers, digoxin, hypoglycemic drugs, neurotoxic chemotherapeutic agents, nasal preparations, and antiglaucoma ophthalmic preparations. The degree of medication-related fall risk was dependent on one or some of the following factors: drug pharmacokinetic/pharmacodynamic properties (eg, elimination half-life, metabolic pathway, genetic polymorphism, risk rating of medications despite belonging to the same therapeutic class) and/or characteristics of medication use (eg, number of medications and drug–drug interactions, dose strength, duration of medication use and time since stopping, medication change, prescribing appropriateness, and medication adherence). Pharmacological interventions, including withdrawal of FRIDs, pharmacist-conducted clinical medication review, and computerized drug alerts, were effective in reducing fall risk. Conclusion Based on the literature review, clear practical recommendations for clinicians to preventfalls in the elderly included making a list of FRIDs, establishing a computerized alert system for when to e-prescribe FRIDs, seeking an alternative drug with lower fall risk, withdrawing FRIDs if clinically indicated, taking pertinent cautions when the use of FRIDs cannot be avoidable, paying attention to prescribing appropriateness, simplifying the medication regimen, strengthening pharmacist-conducted clinical medication review, ensuring the label of each FRID dispensed contains a corresponding warning sign, being careful when medication change occurs, enhancing medication adherence, and mandating for periodic reassessment of potential risk associated with the patient’s medication regimen. Further studies should be conducted in this area, such as investigating whether medication reconciliation and improving medication adherence could decrease the rate of falls.
The purpose of this multicenter, before-and-after observational study was to determine whether a short educational intervention was associated with improvement in self-reported safety behavior in older adults. We developed 4 original injury prevention presentations with companion testing materials: Motor Vehicle Safety, FallPrevention, Pedestrian Safety, and Home Safety. Participants also completed pre-post Short Form Health Survey Instrument (SF-12) quality-of-life surveys. Of 414 participants, 226 completed follow-up testing and SF-12 surveys, for a 54.6% response rate. Those who completed either Pedestrian or Home Safety program showed no significant changes (P > .05) in either test scores or SF-12, and they comprised 61.9% of the final sample. Participants in the Motor Vehicle Safety and FallPrevention programs accounted for 38.1% of the final sample and did show significant improvements between pre-post test scores. Only FallPrevention participants showed significant differences in pre-post SF-12 scores. In the FallPrevention group, numerous SF-12 subscores from the initial survey were significantly inversely correlated with pretest scores, and improvements in some SF-12 subscores correlated with improvements in test scores. Findings from the FallPrevention group suggest that seniors with quality-of-life limitations may be aware of their increased risk and more willing to make changes to enhance safety. Further study is needed because many questions regarding optimal approaches to injury prevention in the aging demographic remain unanswered. PMID:19543017
Koestner, Amy; Walters, Madonna R; Mattice, Connie; Manion, Pat; Seguin, Cara
Objectives. We investigated the effectiveness of a group-based exercise intervention to improve balancing ability among older adults delivered in natural settings by staff in local community organizations. Methods. The main component of the intervention consisted of biweekly group-based exercise sessions conducted over 12 weeks by a professional, coupled with home-based exercises. In a quasiexperimental design, 10 community organizations working with older adults offered the intervention to groups of 5 to 15 persons concerned about falls, while 7 organizations recruited similar groups to participate in the control arm of the study. Participants (98 experimental and 102 control) underwent balance assessments by a physiotherapist at registration and 3 months later. Results. Eighty-nine percent of participants attended the 3-month measurement session (n=177). A linear regression analysis showed that after adjusting for baseline levels of balance and demographic and health characteristics, the intervention significantly improved static balance and mobility. Conclusion. Structured, group-based exercise programs offered by community organizations in natural settings can successfully increase balancing ability among community-dwelling older adults concerned about falls.
In 1908, when the giant Tunguska meteor disintegrated in the earth's atmosphere over Siberia, it may have generated as much as 30 million metric tons of nitric oxide (NO) in the stratosphere and mesosphere. The photochemical aftereffects of the event have been simulated using a comprehensive model of atmospheric trace composition. Calculations indicate that up to 45 percent of the ozone in the Northern Hemisphere may have been depleted by Tunguska's nitric oxide cloud early in 1909 and large ozone reductions may have persisted until 1912. Measurements of atmospheric transparentiy by the Smithsonian Astrophysical Observatory for the years 1909 to 1911 show evidence of a steady ozone recovery from unusually low levels in early 1909, implying a total ozone deficit of 30 +/- 15 percent. The coincidence in time between the observed ozone recovery and the Tunguska meteor fall indicates that the event may provide a test of current ozone depletion theories. PMID:17802551
Turco, R P; Toon, O B; Park, C; Whitten, R C; Pollack, J B; Noerdlinger, P
... t stable on the ladder. More Information In English: The National Institute for Occupational Safety and Health ( ... The Center for Construction Research and Training (CPWR) [English only] Hollywood, Health, and Society, a project of ...
Older adults should be screened for fall risk annually. Community providers (people without formal medical training who work with older adults in senior centers or aging services) may be a viable group to expand the reach of screenings. Our community-academic partnership developed a program to increase and assess fall risk screenings by community providers. Community sites hosted training workshops and screening events. Community screenings were well attended and received by providers and older adults. With administrative support from the regional fallprevention coalition and technical support from academia, community providers screened 161 older adults from a broad geographic area. Twenty-one community providers completed the training. Knowledge and confidence surveys demonstrated improvements before and after training (P<.001). Skills assessments demonstrated mastery of most skills, but some providers required additional training. Provider feedback indicated screening procedures were complex. Future projects will examine this model using simplified screening procedures. PMID:23968584
Schrodt, Lori A; Garbe, Kathie C; Chaplin, Rebecca; Busby-Whitehead, Jan; Shubert, Tiffany E
OBJECTIVE: To determine the effects of community group exercise on fallsprevention in older people living in their own residences. DESIGN: Systematic review with meta-analysis. Twenty randomized controlled trials that compared fall rates in older people, who participated in group exercise programs, with fall rates in those who did not exercise. SETTING: Community exercise centers. PARTICIPANTS: Subjects 60 years of
A 2-yr study was initiated in the fall of 2000 to generate fundamental information on the effects of application date, landscape position, and a combined urease and nitrification inhibitor (NBPT (N-(n-butyl) thio- phosphoric triamide) and DCD (dicyandiamide), respectively) on the rate of transformation of fall-banded urea fertilizer into NH4 1 and eventually NO3 2 under conditions typical for Manitoba, Canada.
Kevin H. D. Tiessen; Donald N. Flaten; Paul R. Bullock; David L. Burton; Cynthia A. Grant; Rigas E. Karamanos
The risk of sustaining a fall is particularly high in children and seniors. Deficits in postural control and muscle strength either due to maturation, secular declines or biologic aging are two important intrinsic risk factors for falls. During life span, performance in variables of static postural control follows a U-shaped curve with children and seniors showing larger postural sway than
Urs Granacher; Thomas Muehlbauer; Albert Gollhofer; Reto W. Kressig; Lukas Zahner
Falls are the most common medical complication during the post-stroke period. Falls are of great concern in this population in particular because of their severe consequences. Stroke survivors have an increased frequency of hip fracture and psychosocial problems such as fear of falling. The most important risk factors for falls in these patients are balance and gait deficits. Balance deficits in post-stroke patients entail reduced postural stability during standing and disturbed responses to self-induced and external balance perturbations. Gait deficits in post-stroke patients involve reduced propulsion at push-off, disturbed hip and knee flexion in the swing phase and disturbed stability in the stance phase. Beneficial effects can be expected from fallprevention programs targeting these deficits. The few studies that have evaluated the efficacy of task-oriented exercises have shown that these programs are the most promising in preventingfalls in post-stroke patients. Technological advances in assistive devices also have potential for fall reduction. Larger randomized controlled trials are needed to provide more conclusive evidence. PMID:24791565
One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effectivepreventive approaches, policy and clinical efforts at preventingfalls among older adults have been limited. In this article we present the burden of falls, review evidence…
Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.
Falls and fall-related injuries, such as fractures, are a growing problem among older adults, often causing longstanding pain, functional impairments, reduced quality of life and excess health-care costs and mortality. These problems have led to a variety of single component or multicomponent intervention strategies to preventfalls and subsequent injuries. The most effective physical therapy approach for the prevention of
Maarit Piirtola; Harri Sievänen; Kirsti Uusi-Rasi; Pekka Kannus; Saija Karinkanta
Fall detection and prevention require logged physiological activity data of a patient for a long period of time. This work develops a data acquisition system to collect motion data from multiple patients and store in a data base. A wireless sensor network is built using high precision inertia sensors and low power Zigbee wireless transceivers. Testing results prove the system function properly. Researchers and physicians can now retrieve and analyze the accurate data of the patient movement with ease. PMID:19163174
Dinh, A; Teng, D; Chen, L; Ko, S B; Shi, Y; Basran, J; Del Bello-Hass, V
ObjectivePatient falls constitute a serious problem both for the persons fallen and for the institutions involved. Bed-exit alarm systems are used to reduce patient falls. Existing bed-exit alarm systems have several disadvantages depending on the technology used. As in “Evaluation of Bed-Exit Alarms” stated, restless, light weighted, uncooperative, incontinent and confused patients require different systems.The aim of this work is
Johannes Hilbe; Eva Schulc; Barbara Linder; Christa Them
Observations of the effects of relative humidity on coalescence are limited to studies using supported drops or streams of drops, and the results are contradictory. In this paper, findings are presented on the effect of high and low relative humidity on collisions between freely falling drops. Comparisons between the collision outcomes (coalescence, bounce, and temporary coalescence with and without satellite
Harry T. Ochs III; Kenneth V. Beard; Neil F. Laird; Donna J. Holdridge; Daniel E. Schaufelberger
We investigate the dynamics of a thin liquid film on an inclined planar substrate in the presence of an insoluble surfactant on its free surface. We consider both the linear and nonlinear regimes. The linear regime is examined through the Orr-Sommerfeld eigenvalue problem of the full Navier-Stokes and concentration equations and wall and free-surface boundary conditions. The nonlinear regime is investigated through two different models. The first one is obtained from the classical long-wave expansion and the second one through an integral-boundary-layer approximation combined with a simple Galerkin projection. Although accurate close to the instability threshold, the first model fails to describe the dynamics of the system far from criticality. On the other hand, the second model not only captures accurately the behavior close to the instability threshold, but is also valid far from criticality. Analytical and numerical results on the role of the surfactant on the free-surface dynamics are presented. In the linear regime, the Marangoni stresses induced by the surfactant reduce the domain of instability for the base flow. In the nonlinear regime, the system evolves into solitary pulses for both the free surface and surfactant concentration. The amplitude and velocity of these pulses decrease as the Marangoni effect becomes stronger. PMID:18851148
Background Falls in older people continue to be a major public health issue in industrialized countries. Extensive research into fallsprevention has identified exercise as a proven fallprevention strategy. However, despite over a decade of promoting physical activity, hospitalisation rates due to falls injuries in older people are still increasing. This could be because efforts to increase physical activity amongst older people have been unsuccessful, or the physical activity that older people engage in is insufficient and/or inappropriate. The majority of older people choose walking as their predominant form of exercise. While walking has been shown to lower the risk of many chronic diseases its role in fallsprevention remains unclear. This paper outlines the methodology of a study whose aims are to determine: if a home-based walking intervention will reduce the falls rate among healthy but inactive community-dwelling older adults (65 + years) compared to no intervention (usual activity) and; whether such an intervention can improve risk factors for falls, such as balance, strength and reaction time. Methods/Design This study uses a randomised controlled trial design. A total of 484 older people exercising less than 120 minutes per week will be recruited through the community and health care referrals throughout Sydney and neighboring regions. All participants are randomised into either the self-managed walking program group or the health-education waiting list group using a block randomization scheme. Outcome measures include prospective falls and falls injuries, quality of life, and physical activity levels. A subset of participants (n = 194) will also receive physical performance assessments comprising of tests of dynamic balance, strength, reaction time and lower limb functional status. Discussion Certain types of physical activity can reduce the risk of falls. As walking is already the most popular physical activity amongst older people, if walking is shown to reduce falls the public health implications could be enormous. Conversely, if walking does not reduce falls in older people, or even puts older people at greater risk, then health resources targeting fallsprevention need to be invested elsewhere. Trial Registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000380099
A BSTRACT : Morinda citrifolia (Noni) has been extensively used in folk medicine by Polynesians for over 2,000 years. It has been reported to have broad thera- peutic effects, including anticancer activity, in both clinical practice and labo- ratory animal models. The mechanism for these effects remains unknown. The hypothesis that Morinda citrifolia possesses a cancer preventiveeffect at the
Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes, yet there is currently no evidence to guide fallsprevention in this population. Methods A randomised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fallprevention program. The program was tailored to participant’s individual cognitive levels and implemented as a carer-supported intervention. Feasibility of recruitment, retention and implementation of intervention were recorded through observation and documented in field notes. Adherence, carer burden and use of task simplification strategies were also monitored. Outcome measures, collected at 12 weeks included physiological, fear of falling, cognitive and functional measures. Results Recruitment was achievable but may be more challenging in a multisite trial. Twenty two dyads of persons with mild dementia and their carers were randomised to intervention or usual care control group. Of 38 dyads referred to the study, there was a high rate of willingness to participate, with 6 (16%) declining and 10 (26%) not meeting inclusion criteria. The intervention was well received by participants and carers and adherence to both program components was very good. All participants implemented some home safety recommendations (range 19-80%) with half implementing 50% or more. At the end of 12 weeks, 72% of the intervention group were exercising. Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant (RR= 0.50 (95% CI 0.11-2.19). There were no differences in physiological outcome measures between the control and intervention groups. However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up. Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers. The lessons learnt included: recruitment for a larger trial will require multiple approaches; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change; strategies to ensure an adequate dosage of exercise should be further explored. We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication. A refined intervention should be tested in a randomised trial with an adequately powered sample size. Trial registration Australia and New Zealand Clinical Trials Registry 126100001049066
Abstract Question The rate of migraine diagnosed among children is increasing. Is riboflavin, an alternative to traditional pharmacologic agents, effective and safe for prevention of migraine in children? Answer Because migraine is a very common condition in childhood and adolescence, often contributing to substantial burden of illness, there is increased interest in alternatives to traditional pharmacologic prevention. The expectation is that over-the-counter alternative medication will be less toxic, better tolerated, and have fewer side effects. A few studies in adults show that riboflavin (vitamin B2) might decrease frequency of migraine headaches. It has become common practice to recommend that children try riboflavin to prevent migraine; however, research on riboflavin use in children is inconclusive.
Morinda citrifolia (Noni) has been extensively used in folk medicine by Polynesians for over 2,000 years. It has been reported to have broad therapeutic effects, including anticancer activity, in both clinical practice and laboratory animal models. The mechanism for these effects remains unknown. The hypothesis that Morinda citrifolia possesses a cancer preventiveeffect at the initiation stage of carcinogenesis was studied. Our preliminary data indicated that 10% Tahitian Noni Liquid Dietary Supplement or Tahitian Noni Juice (TNJ), made from Morinda citrifolia fruit by Morinda Inc, in drinking water for one week was able to prevent DMBA-DNA adduct formation. The levels of DMBA-DNA adducts were reduced by 30% in the heart, 41% in the lung, 42% in the liver, and 80% in the kidney of female SD rats. Even more dramatic results were obtained in male C57 BL-6 mice: 10% TNJ was able to reduce DMBA-DNA adduct formation by 60% in the heart, 50% in the lung, 70% in the liver, and 90% in the kidney. In order to explore the mechanism of this preventiveeffect, the antioxidant activity of TNJ was examined in vitro by lipid hydroperoxide (LPO) and tetrazolium nitroblue (TNB) assays. In the LPO assay, LPO oxidizes leucomethylene blue to methylene blue in the presence of hemoglobin. The resultant blue color was quantified at 660 nm spectrophotometrically. In the TNB assay, superoxide anion radicals (SAR) reduce TNB into formazan blue that was also measured by absorption at 602 nm. TNJ showed a dose-dependent inhibition of both LPO and SAR in our system. The antioxidant activity of TNJ was compared to the effects of vitamin C, grape seed powder (GSP), and pycnogenol (PYC) at the daily dose per serving level recommended by U.S.RDAs or manufacturers. The results suggest that prevention of carcinogen-DNA adduct formation and the antioxidant activity of TNJ may contribute to the cancer preventiveeffect of Morinda citrifolia. PMID:11795436
A set of experimental facilities were set up to measure overall heat transfer coefficient of horizontal-tube falling film evaporator with square-pitch bundle. Effect of spray density, saturation temperature, total temperature difference, and inlet steam velocity on the overall heat transfer coefficient K is studied. The tubes are made of HAL77-2A aluminum brass with an outer diameter of 25.4?mm. Fluids inside
Shengqiang Shen; Gangtao Liang; Yali Guo; Rui Liu; Xingsen Mu
Summary Forty-eight fall-calving Angus cows were utilized to study the effects of supplemental energy and magnesium on serum metabolites and body weight changes. The three groups of cows (control, Mg0 and energy) grazed similar pasture that had been fertilized with 112 kg ammonium nitrate\\/ha on July 23. All groups of cows were fed equal quantities of hay when forage was
symptoms of dizziness, and known categories of medications increasing risk.10 This tool screens for primary prevention of falls and is integral in a post-fall assessment for the secondary prevention of falls. TARGET POPULATION: The Hendrich II Fall Risk Model is intended to be used in the acute care setting to identify adults at risk for falls. The Model is being
The study of snow avalanches and their geomorphological effect in the periglacial parts of the cryosphere is important for enhanced geomorphological process understanding as well as hazard-related studies. Only a few field studies, and particularly few in the High Arctic, have quantified avalanche sedimentation. Snow avalanches are traditionally ranked behind rockfall in terms of their significance for mass-wasting processes of rockslopes. Cornice fall avalanches are at present the most dominant snow avalanche type at two slope systems, called Nybyen and Larsbreen, in the valley Longyeardalen in central Svalbard. Both slope systems are on northwest-facing lee slopes underneath a large summit plateau, with annual cornices forming on the top. High-frequency and magnitude cornice fall avalanching is observed by daily automatic time-lapse photography. In addition, rock debris sedimentation by cornice fall avalanches was measured directly in permanent sediment traps or by snow inventories. The results from a maximum of seven years of measurements in a total of 13 catchments show maximum mean rock debris sedimentation rates ranging from 8.2 to 38.7 kg m-2 at Nybyen, and from 0.8 to 55.4 kg m-2 at Larsbreen. Correspondingly, avalanche fan surfaces accreted from 2.6 to 8.8 mm yr-1 at Nybyen, and from 0.2 to 13.9 mm yr-1 at Larsbreen. This comparably efficient rockslope mass wasting is due to collapsing cornices producing cornice fall avalanches containing large amounts of rock debris throughout the entire winter. The rock debris of different origin stems from the plateau crests, the adjacent free rock face and the transport pathway, accumulating distinct avalanche fans at both slope systems. Cornice fall avalanche sedimentation also contributed to the development of a rock glacier at the Larsbreen site during the Holocene. We have recorded present maximum rockwall retreat rates of 0.9 mm yr-1 at Nybyen, but as much as 6.7 mm yr-1 at Larsbreen, while average Holocene rockwall retreat rates of 1.1 mm yr-1 at Nybyen have been determined earlier. As cornice fall avalanches are the dominant type of avalanche in central Svalbard, the related geomorphological effect is assumed to be of significance at periglacial landscape scale. A climate-induced shift in prevailing winter wind direction could change the rockslope sedimentation effectively by changing the snow avalanche activity.
Eckerstorfer, M.; Christiansen, H. H.; Rubensdotter, L.; Vogel, S.
An increasing body of scientific literature suggests that dietary components may exert cancer preventiveeffects. Tea, soy, cruciferous vegetables and other foods have been investigated for their cancer preventive potential. Some non-edible mushrooms like Reishi (Ganoderma lucidum) have a history use, both alone and in conjunction with standard therapies, for the treatment of various diseases including cancer in some cultures. They have shown efficacy in a number of scientific studies. By comparison, the potential cancer preventiveeffects of edible mushrooms have been less well-studied. With similar content of putative effective anticancer compounds such as polysaccharides, proteoglycans, steroids, etc., one might predict that edible mushrooms would also demonstrate anticancer and cancer preventive activity. In this review, available data for five commonly-consumed edible mushrooms: button mushrooms (Agaricus bisporus), A. blazei, oyster mushrooms (Pleurotus ostreatus), shiitake mushrooms (Lentinus edodes), and maitake (Grifola frondosa) mushrooms is discussed. The results of animal model and human intervention studies, as well as supporting in vitro mechanistic studies are critically evaluated. Weaknesses in the current data and topics for future work are highlighted. PMID:22583406
Xu, Tongtong; Beelman, Robert B; Lambert, Joshua D
To summarize, from preliminary observations on the possible effects of radioactive fall-out, it may be inferred that in addition to the secondary products of ionizing irradiation per se, the stable end-products of the transmutation of certain radionuclides may adversely influence cellular metabolism, including mutagenesis. The discussion of the possible role of intracellular barium as an end-product of 137Cs decay is offered as an example of an unpredictable number of broad ecological, as well as the more limited medical, effects that may be of both clinical and climatological significance. Images Fig. 1 Fig. 2
Burrows, B. A.; Cardarelli, J. C.; Boling, E. A.; Sinex, F. M.
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Falls in older adults are the leading cause of injury hospitalizations and fatalities in the United States; primary risk factors are muscle weakness, impaired mobility, and balance deficits. This article describes the 12-month translational research evaluation of the Stay Active and Independent for Life (SAIL) community-based public health, public domain fallprevention exercise and education program. Recruitment reached the target goal by 154%; 331 adults (mean age = 74.6) attended more than one class (mean classes attended = 24.8, SD = 26.6, range = 1-120) at nine community sites in one county in the 12-month period; 173 completed health and demographic forms, 132 completed program surveys, and 91 completed baseline and follow-up physical function tests. Physical function test results showed significant improvements in strength, balance, and mobility in those who were below normal limits at baseline, and in those who attended classes twice a week or more for more than 2 months. Survey results found that 93% of respondents reported improved performance of daily activities; 92% reported improved strength, balance, fitness, or flexibility; and 80% found the SAIL information guide education component helpful. PMID:21191079
York, Sally C; Shumway-Cook, Anne; Silver, Ilene F; Morrison, A Clare
BACKGROUND: Falls in older people are a major public health problem, with at least one in three people aged over 65 years falling each year. There is increasing evidence that foot problems and inappropriate footwear increase the risk of falls, however no studies have been undertaken to determine whether modifying these risk factors decreases the risk of falling. This article
This study evaluated effects of a key session from a nationally recognized drug abuse prevention program on basic memory processes in 211 high-risk youth in Southern California. In a randomized, between-subject design, the authors manipulated assignment to a Myth and Denial program session and the time of assessment (immediate vs. one-week delay). The authors examined program decay effects on memory accessibility and judgment errors. Those participants exposed to the program session generated more myths and facts from the program than those in the control group, suggesting that even a single program session influenced students’ memory for program information and this was retained at least one week and detectable with indirect tests of memory accessibility. However, consistent with basic research perspectives, participants in the program delayed assessment group erroneously generated more fact-related information from the session to the prompt “It is a myth that_____” than the participants in the program immediate assessment group; that is, they retained more facts as myths. These types of program effects, anticipated by basic memory theory, were not detected with a traditional judgment task in the present sample. The results suggest that basic science approaches offer a novel way of conceptually recasting preventioneffects to more completely understand how these effects may operate. Implications for program evaluation and conceptualization are discussed.
Ames, Susan L.; Krank, Marvin; Grenard, Jerry L.; Sussman, Steve; Stacy, Alan W.
Locomotive syndrome means a condition at a risk for requiring nursing care due to deteriorated musculoskeletal organs in the middle-aged and older people. Considering that this concept aims to care prevention and that fracture for fall consists of one-tenth of causes for requiring using care, fallprevention should be an important goal of preventing or improving locomotive syndrome. As a matter of fact, locomotion check - a short form for predicting locomotive syndrome- contains items evaluating fall risk, and locomotion training - recommended exercises designated for strengthening muscles of lower extremities and balance - likely to decrease future incidence of falls. Thus, locomotive syndrome seems to be deeply related to prevention of falls as well as care prevention. PMID:23628679
The purpose of each paper in the National Child Protection Clearinghouse's Child Abuse Prevention: What Works? project is to document research concerning the effectiveness of different types of child maltreatment prevention programs. The Child Abuse Prevention: What Works? project is comprised of six individual papers, which are based on research undertaken for the Child Abuse Prevention Issues Paper No. 24
The nursing round system (NRS) means checking patients on an hourly basis during the A (0700-2200 h) shift and once every 2 h during the B (2200-0700 h) by the assigned nursing staff. The overall goal of this prospective study is to implement an NRS in a major rehabilitation centre-Sultan Bin Abdulaziz Humanitarian City-in the Riyadh area of the Kingdom of Saudi Arabia. The purposes of this study are to measure the effect of the NRS on: (i) the use of patient call light; (ii) the number of incidences of patients' fall; (iii) the number of incidences of hospital-acquired bed sores; and (iv) the level of patients' satisfaction. All patients hospitalized in the male stroke unit will be involved in this study. For the period of 8 weeks (17 December 2009-17 February 2010) All Nursing staff on the unit will record each call light and the patient's need. Implementation of the NRS would start on 18 February 2010 and last for 8 weeks, until 18 April 2010. Data collected throughout this period will be compared with data collected during the 8 weeks period immediately preceding the implementation of the NRS (17 December 2009-17 February 2010) in order to measure the impact of the call light use. The following information were collected on all subjects involved in the study: (i) the Demographic Information Form; (ii) authors' developed NRS Audit Form; (iii) Patient Call Light Audit Form; (iv) Patient Fall Audit Record; (v) Hospital-Acquired Bed Sores Audit Form; and (vi) hospital developed Patient Satisfaction Records. The findings suggested that a significant reduction on the use of call bell (P < 0.001), a significant reduction of fall incidence (P < 0.01) while pressure ulcer reduced by 50% before and after the implementation of NRS. Also, the implementation of NRS increased patient satisfaction by 7/5 (P < 0.05). PMID:21605271
Saleh, Bassem S; Nusair, Hussam; Al Zubadi, Nariman; Al Shloul, Shams; Saleh, Usama
A Prevention Service Development Model (PSDM) is presented as an approach to develop prevention programs that are both effective and that are readily adopted for implementation in community settings. The model is an integration of concepts and methods from two fields, prevention research and marketing research as applied to new service development. Questions that are posed at each stage of
Irwin Sandler; Amy Ostrom; Mary Jo Bitner; Tim S. Ayers; Sharlene Wolchik; Vicki-Smith Daniels
Falling-film heat and mass transfer in an absorber can be influenced by the motion of the surrounding refrigerant vapor. In this study, the effect of the vapor flow direction on the absorption heat and mass transfer has been investigated for a falling-film helical coil absorber which is frequently used in the ammonia\\/water absorption refrigerators. The heat and mass transfer performance
Published twice a year and distributed nationwide, "Strategies for Success" keeps readers informed about events and developments in the field of drug testing. It reports the latest research findings on the effectiveness of drug testing as a tool for reducing substance abuse. Each issue also provides a wealth of guidance and resources on student…
Automatic fall event detection has attracted research attention recently for its potential application in fall alarming system and wearable fall injury prevention system. Nevertheless, existing fall detection research is facing various limitations. The current study aimed to develop and validate a new fall detection algorithm using 2-D information (i.e., trunk angular velocity and trunk angle). Ten healthy elderly were involved in a laboratory study. Sagittal trunk angular kinematics was measured using inertial measurement unit during slip-induced backward falls and a variety of daily activities. The new algorithm was, on average, able to detect backward falls prior to impact, with 100% sensitivity, 95.65% specificity, and 255 ms response time. Therefore, it was concluded that the new fall detection algorithm was able to effectively detect falls during motion for the elderly population. PMID:24718566
Despite extensive preventive efforts, falls continue to be a major source of morbidity and mortality among elderly. Real-time detection of falls and their urgent communication to a telecare center may enable rapid medical assistance, thus increasing the sense of security of the elderly and reducing some of the negative consequences of falls. Many different approaches have been explored to automatically detect a fall using inertial sensors. Although previously published algorithms report high sensitivity (SE) and high specificity (SP), they have usually been tested on simulated falls performed by healthy volunteers. We recently collected acceleration data during a number of real-world falls among a patient population with a high-fall-risk as part of the SensAction-AAL European project. The aim of the present study is to benchmark the performance of thirteen published fall-detection algorithms when they are applied to the database of 29 real-world falls. To the best of our knowledge, this is the first systematic comparison of fall detection algorithms tested on real-world falls. We found that the SP average of the thirteen algorithms, was (mean±std) 83.0%±30.3% (maximum value?=?98%). The SE was considerably lower (SE?=?57.0%±27.3%, maximum value?=?82.8%), much lower than the values obtained on simulated falls. The number of false alarms generated by the algorithms during 1-day monitoring of three representative fallers ranged from 3 to 85. The factors that affect the performance of the published algorithms, when they are applied to the real-world falls, are also discussed. These findings indicate the importance of testing fall-detection algorithms in real-life conditions in order to produce more effective automated alarm systems with higher acceptance. Further, the present results support the idea that a large, shared real-world fall database could, potentially, provide an enhanced understanding of the fall process and the information needed to design and evaluate a high-performance fall detector.
Objective To evaluate central and peripheral visual impairment as independent risk factors for falls and falls with injury among adults. Design Population-based prospective cohort study. Participants A total of 3,203 LALES participants. Methods Baseline presenting binocular central distance acuity was measured and impairment was classified as mild (20/40–20/63), moderate/severe (20/80 or worse). Peripheral visual impairment was classified as mild (?6dBFalls and falls with injury in the past 12 months were assessed by self-report at 4-year follow-up visit. Results Out of 3,203 individuals, 19% reported falls and 10% falls with injury; participants with falls were more likely to: be ? 60 years of age, be female, report lower income, have more than two co-morbidities, report alcohol use, report wearing bifocal glasses and report obesity. Among those who reported falls, 7% had central visual impairment (visual acuity?20/40) compared to 4% who did not report falls; and 49% had peripheral visual impairment (mean deviation2dB) compared to 39% of those who did not report falls (both p-values<.0001). After adjusting for confounders, moderate to severe central and peripheral visual impairment were associated with increased risk for falls (odds ratio 2.36 95% confidence interval 1.02–5.45, p-trend= .04 and odds ratio 1.42 95% confidence interval 1.06–1.91, p-trend= .01, respectively) and with falls with injury (odds ratio 2.76 95% confidence interval 1.10–7.02, p-value= .03, and odds ratio 1.40 95% confidence interval .94–2.05, p-trend= .04, respectively). Conclusion Both central and peripheral visual impairment were independently associated with increased risk for falls and falls with injury in a dose-response manner. Although vision related interventions for preventingfalls have mainly focused on correcting central visual impairment, this study suggests that targeting both central and peripheral components may be necessary to reduce rates of falls and falls with injury related to vision loss effectively.
Patino, Cecilia M.; McKean-Cowdin, Roberta; Azen, Stanley P.; Allison, Jessica Chung; Choudhury, Farzana; Varma, Rohit
This paper applies concepts and methods developed in management to translate efficacious prevention programs into effectiveprevention services. The paper describes Quality Function Deployment (QFD) as a method for structured planning and development that connects the needs and wants of the consumer with the design of the product or service. The paper describes basic tools used in quality management, and discusses how they might be applied to prepare a prevention program for implementation by community agencies. Prevention programs are conceptualized as having multiple consumers (i.e., stakeholders), including the participants who receive the service, the service providers, the organizations that deliver the program, and the researchers who evaluate the programs. As an illustration of one step in the application of QFD to translate efficacious prevention programs into effectiveprevention services, analysis of the needs and preferences of Family Courts for the implementation of an the New Beginnings Program is presented. PMID:18351452
A model lift containing a figure of Albert Einstein is released from the side of a tall building and its free fall is arrested by elastic ropes. This arrangement allows four simple experiments to be conducted in the lift to demonstrate the effects of free fall and show how they can lead to the concept of the equivalence of inertial and…
A model lift containing a figure of Albert Einstein is released from the side of a tall building and its free fall is arrested by elastic ropes. This arrangement allows four simple experiments to be conducted in the lift to demonstrate the effects of free fall and show how they can lead to the concept of the equivalence of inertial and gravitational masses.
... Seek Medical Care Think Prevention! With all the running, climbing, and exploring kids do, it's no surprise that falls are common. Although many result in mild bumps, cuts, and bruises, some can cause serious injuries that need immediate medical attention. What to Do Call 911 for emergency help ...
Pedestrians are exposed to risks when crossing roads in urban areas. The crossing behaviour of pedestrians was studied as a factor contributing to their exposure to risks on the road and to their involvement in road accidents. This work explores two specific aspects of crossing behaviour: crossing speed and head pitches-the proportion of time pedestrians point their heads down (rather than towards the traffic) when crossing a road. The last one is used as an indicator of the (lack of) attention to cross-traffic. We also explored the possible effect of fear of falling (FOF) among pedestrians, as it might be associated with slow walking, less attention to cross traffic, and more attention to the pavement and their footsteps. This paper reports on a field study that combined an observatory technique with short survey. 203 pedestrians in two sites (signalised and unsignalised crosswalks) were video recorded while crossing the road. The FOF of pedestrians and other measures of pedestrian behaviour at crosswalks were revealed by means of questionnaire. Age and gender had the most significant effects on crossing speed, and FOF had a significant effect on the proportion of downward head pitches during crossing. PMID:22062333
Objective To examine changes in children's receipt of well-child and preventive dental care in Medicaid/Children's Health Insurance Program (CHIP) in two states that adopted policies aimed at promoting greater preventive care receipt. Data Sources The 2004–2008 Medicaid/CHIP claims and enrollment data from Idaho and Kentucky. Study Design Logistic and hazard pre–post regression models, controlling for age, gender, race/ethnicity, and eligibility category. Data Extraction Methods Claims and enrollment data were de-identified and merged. Principal Findings Increased reimbursement had a small, positive association with well-child care in Idaho, but no consistent effects were found in Kentucky. A premium forgiveness program in Idaho was associated with a substantial increase (between 20 and 113 percent) in receipt of any well-child care and quicker receipt of well-child care following enrollment. In Kentucky, children saw modest increases in receipt of preventive dental care and received such care more quickly following increased dental reimbursement, while the move to managed care in Idaho was associated with a small increase in receipt of preventive dental care. Conclusions Policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but reported preventive care receipt still falls short of recommended levels.
Kenney, Genevieve M; Marton, James; Klein, Ariel E; Pelletier, Jennifer E; Talbert, Jeffery
Stroke is a major cause of mortality and disability worldwide. During the past three decades, major advances have occurred in secondary prevention, which have demonstrated the broader potential for the prevention of stroke. Risk factors for stroke include previous stroke or transient ischemic attack, hypertension, high blood cholesterol and diabetes. Proven secondary prevention strategies are anti-platelet agents, antihypertensive drugs, statins and glycemic control. In the present review, we evaluated the secondary prevention of stroke in light of clinical studies and discuss new pleiotropic effects beyond the original effects and emerging clinical evidence, with a focus on the effect of optimal oral pharmacotherapy. PMID:23060914
Stroke is a major cause of mortality and disability worldwide. During the past three decades, major advances have occurred in secondary prevention, which have demonstrated the broader potential for the prevention of stroke. Risk factors for stroke include previous stroke or transient ischemic attack, hypertension, high blood cholesterol and diabetes. Proven secondary prevention strategies are anti-platelet agents, antihypertensive drugs, statins and glycemic control. In the present review, we evaluated the secondary prevention of stroke in light of clinical studies and discuss new pleiotropic effects beyond the original effects and emerging clinical evidence, with a focus on the effect of optimal oral pharmacotherapy.
This case—bicycle helmet effectiveness—is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine.This case examines the cost-effectiveness of three interventions to increase utilization of
Lloyd F. Novick; Martha Wojtowycz; Cynthia B. Morrow; Sally M. Sutphen
The Feldkamp-David-Kress (FDK) algorithm is widely adopted for cone-beam reconstruction due to its one-dimensional filtered backprojection structure and parallel implementation. In a reconstruction volume, the conspicuous cone-beam artifact manifests as intensity fall-off along the longitudinal direction (the gantry rotation axis). This effect is inherent to circular cone-beam tomography due to the fact that a cone-beam dataset acquired from circular scanning fails to meet the data sufficiency condition for volume reconstruction. Upon observations of the intensity fall-off phenomenon associated with the FDK reconstruction of a ball phantom, we propose an empirical weight formula to compensate for the fall-off degradation. Specifically, a reciprocal cosine can be used to compensate the voxel values along longitudinal direction during three-dimensional backprojection reconstruction, in particular for boosting the values of voxels at positions with large cone angles. The intensity degradation within the z plane, albeit insignificant, can also be compensated by using the same weight formula through a parameter for radial distance dependence. Computer simulations and phantom experiments are presented to demonstrate the compensation effectiveness of the fall-off effect inherent in circular cone-beam tomography. PMID:19002227
The Feldkamp–David–Kress (FDK) algorithm is widely adopted for cone-beam reconstruction due to its one-dimensional filtered backprojection structure and parallel implementation. In a reconstruction volume, the conspicuous cone-beam artifact manifests as intensity fall-off along the longitudinal direction (the gantry rotation axis). This effect is inherent to circular cone-beam tomography due to the fact that a cone-beam dataset acquired from circular scanning fails to meet the data sufficiency condition for volume reconstruction. Upon observations of the intensity fall-off phenomenon associated with the FDK reconstruction of a ball phantom, we propose an empirical weight formula to compensate for the fall-off degradation. Specifically, a reciprocal cosine can be used to compensate the voxel values along longitudinal direction during three-dimensional backprojection reconstruction, in particular for boosting the values of voxels at positions with large cone angles. The intensity degradation within the z plane, albeit insignificant, can also be compensated by using the same weight formula through a parameter for radial distance dependence. Computer simulations and phantom experiments are presented to demonstrate the compensation effectiveness of the fall-off effect inherent in circular cone-beam tomography.
The need to reduce falls is driven by the need to reduce injury. If patients at risk of injury can be distinguished from the patients at risk of falls, there is the potential for a more effectivefall risk management policy by targeting injury prevention measures. We conducted a prospective observational study, with blinded endpoint evaluation of 825 consecutive patients admitted to geriatric rehabilitation wards. We identified 150 fallers (18.2%) contributing 243 falls. Fifty-six patients sustained an injury contributing 73 (30.0%) injurious falls. Only five (6.8%) falls resulted in injury of major severity. We identified no significant differences in demographics between injurious and non-injurious falls. A logistic regression analyses of the independent risk factors of suffering an injurious fall were a history of falls (p=0.036), confusion (p=0.001) and an unsafe gait (p=0.03). However, we identified no significant differences in clinical characteristics between patients suffering injurious and non-injurious falls. None of the characteristics studied can identify patients prone to injury after a fall. Injury is largely unpredictable, and more research is needed to determine how injury can be prevented in patients at risk of falls. PMID:15707458
Vassallo, M; Vignaraja, R; Sharma, J C; Briggs, R; Allen, S
Falls are common cause of injuries among elderly people, and fractures are the most serious consequence of falls. For seniors, hip fractures are the second major cause of bedridden. The feature and acute care of head injury, spinal cord injury, vertebrae fracture, and hip fracture are described. Just had fracture fixation, the patient can not go back to the original ADL. In order not to become bedridden, both medication and physical examination are important based on the new disease concept of locomotive syndrome. To do so, requires hospital and clinic cooperation. Sufficient cooperation is not currently possible, and spread of liaison service is essential. PMID:23855211
HCl treatment has been, for about 80 years, the primary method for the prevention of entry into embryonic diapauses of Bombyx mori. This is because no method is as effective as the HCl treatment. In this study, we discovered that dimethyl sulfoxide (DMSO) prevented entry into the diapause of the silkworm, Bombyx mori. The effect of diapause prevention was 78% as a result of treatment with 100% DMSO concentration, and the effect was comparable to that of the HCl treatment. In contrast, in the case of non-diapause eggs, hatchability was decreased by DMSO in a concentration-dependent manner. The effect of DMSO was restricted within 24 hours after oviposition of diapause eggs, and the critical period was slightly shorter than the effective period of the HCl treatment. DMSO analogs, such as dimethyl formamide (DMF) and dimethyl sulfide (DMS), did little preventiveeffect against the diapause. Furthermore, we also investigated the permeation effects of chemical compounds by DMSO. When treated with an inhibitor of protein kinase CK2 (CK2) dissolved in DMSO, the prevention rate of the diapause was less than 40%. This means that the inhibition effect by the CK2 inhibitor was the inhibition of embryonic development after diapause prevention by DMSO. These data suggest that DMSO has the effects of preventing from entering into the diapause and permeation of chemicals into diapause eggs. PMID:23675522
Observations of the effects of relative humidity on coalescence are limited to studies using supported drops or streams of drops, and the results are contradictory. In this paper, findings are presented on the effect of high and low relative humidity on collisions between freely falling drops. Comparisons between the collision outcomes (coalescence, bounce, and temporary coalescence with and without satellite drops) for high-humidity (RH > 95%) and low-humidity (RH 30%) experiments were made for small precipitation drops at terminal velocity and with minimal electric charge. Coalescence begins after the air-film between colliding drops is drained sufficiently to allow the drops to make contact. For temporary coalescence, the union of the two drops is not permanent because the rotational energy caused by a non-head-on collision is sufficient to pull the coalesing drops apart. One or more satellite drops form during a temporary coalescence when water filament between the separating drops breaks in more than one location. Experiments with higher drop charge were used to examine further the influence of humidity on coalescence. Our results show that relative humidity does not affect the coalescence efficiency for small precipitation drops. The effect of humidity is limited to collisions where permanent coalescence does not occur, and the collision outcome can be temporary coalescence. In cases where bounce is also a possible outcome, it was found that the probability of bounce is enhanced at the expense of temporary coalescence when relative humidity is decreased. For two of the comparisons between high-humidity and low-humidity results, the fraction of temporary coalescence collision outcomes halved at low humidity. Since the colliding drops are at the wet-bulb temperature, this effect is traced to the colder air gap that drains more slowly and retards coalescence at lower humidifies. At high relative humidity the number of satellite drops about doubles with the increased probability of temporary coalescence. Other experiments showed that the increase in satellite drops at higher relative humidities also occurs for cases where collision outcomes are limited to coalescence or temporary coalescence. Since there are more temporary coalescence outcomes at the higher relative humidities in clouds, there are also more satellite drops that can act as embryos for new raindrops. These results apply to rain shafts within and below clouds.
Ochs, Harry T., III; Beard, Kenneth V.; Laird, Neil F.; Holdridge, Donna J.; Schaufelberger, Daniel E.
In this quick activity (page 1 of PDF), learners will use a simple physics of motion and gravity demonstration to test their predicting skills. Learners predict which quarter will hit the floor first during this free fall experiment. This activity not only requires learners to observe carefully, but also listen carefully! Relates to the linked video, DragonflyTV: Hockey.
In this activity about gravity (page 6 of the PDF), learners will come to understand how all objects will fall at the same rate, but that air will slow things down. This is a simple activity (it uses only two pieces of paper) that provides an excellent "Wow!" moment.
From Boston to Beijing, thousands of students traveled to San Francisco for the 2011 AGU Fall Meeting. Of those who participated, 183 students were able to attend thanks to AGU's student travel grant program, which assists students with travel costs and seeks to enrich the meeting through ethnic and gender diversity. Students at Fall Meeting enjoyed a variety of programs and activities designed to help them better network with their peers, learn about new fields, and disseminate their research to the interested public. More than 800 students attended AGU's first annual student mixer, sharing drinks and ideas with fellow student members and future colleagues as well as forging new friendships and intellectual relationships.
Relapse prevention programming is arguably the most significant development in the addiction field since the formation of Alcoholics Anonymous. A multiple time series design was employed to evaluate the effectiveness of delivering relapse prevention programming through a small group format. Using the Coping Behaviours Inventory, significant changes were found between pre-test scores and scores after completion of eight weeks of
Analgesic effects of etidronate, alendronate and risedronate were compared in patients with osteoporosis and\\/or osteoarthritis\\u000a by measuring the fall of skin impedance along with conventional subjective pain-estimation by visual rating scale (VRS). One\\u000a hundred ninety-nine postmenopausal women consulting the Osteoporosis and Osteoarthritis Clinic of Katsuragi Hospital complaining\\u000a of back and\\/or knee pain were randomly divided into four groups; Group A
Based on the mechanism of falling film evaporation condensation, a new four-stage distillation unit with triple-effect regeneration has been designed, constructed and field tested. The seawater desalination system is driven by 80m2 all-glass vacuum tube solar collection system with an additional 1kW wind power system to provide electricity for pumps. The field testing and monitoring of the system had been
Colima Volcano in western Mexico had several small ash emitting eruptions during 2005-2006. In this time period we studied the impact of the ash fall on human health through field observations, interviews and health data processing. The volcano was most active in May-June 2005. Data from 15.000 medical records of the Colima and Jalisco State Health Departments show two main health problems in humans during this time: Conjunctivitis was detected in 1,933 people and respiratory disease in 12,630 people in an area of 1,841,283 km2 which was affected by small amounts of ash fall near the volcano in 2005. Ash emissions from Colima Volcano correlate well with increased affections. When emissions increased so did the frequency of these health problems in the population.
Lava Falls Rapid is the most formidable reach of whitewater on the Colorado River in Grand Canyon and is one of the most famous rapids in the world. Debris flows in 1939, 1954, 1955, 1966, and 1995, as well as prehistoric events, completely changed flow through the rapid. Floods cleared out much of the increased constrictions, but releases from Glen Canyon Dam, including the 1996 controlled flood, are now required to remove the boulders deposited by the debris flows.
Webb, Robert H.; Melis, Theodore S.; Griffiths, Peter G.; Elliott, John G.; Cerling, Thure E.; Poreda, Robert J.; Wise, Thomas W.; Pizzuto, James E.
Since 1996, U.S. Fish and Wildlife Service biologists have annually used fish wheels to capture migrating adult fall chum salmon Oncorhynchus keta in the main-stem Yukon River, Alaska, and estimated their abundance via mark–recapture methods. In each year of the study, the mark rate of captured fish at a site near Rampart has been substantially greater than rates observed at
Jeffrey F. Bromaghin; Tevis J. Underwood; Raymond F. Hander
This paper examines the ways in which HIV prevention is understood including “biomedical”, “behavioural”, “structural”, and “combination” prevention. In it I argue that effectiveprevention entails developing community capacity and requires that public health addresses people not only as individuals but also as connected members of groups, networks and collectives who interact (talk, negotiate, have sex, use drugs, etc.) together. I also examine the evaluation of prevention programmes or interventions and argue that the distinction between efficacy and effectiveness is often glossed and that, while efficacy can be evaluated by randomized controlled trials, the evaluation of effectiveness requires long-term descriptive strategies and/or modelling. Using examples from a number of countries, including a detailed account of the Australian HIV prevention response, effectiveness is shown to be dependent not only on the efficacy of the prevention technology or tool but also on the responses of people – individuals, communities and governments – to those technologies. Whether a particular HIV prevention technology is adopted and its use sustained depends on a range of social, cultural and political factors. The paper concludes by calling on biomedical and social scientists to work together and describes a “social public health”.
This book describes an analysis of the cost-effectiveness of model school-based drug prevention programs at reducing cocaine consumption. It compares prevention's cost-effectiveness with that of several enforcement programs and with that of treating heavy cocaine users. It also assesses the cost of nationwide implementation of model prevention…
Caulkins, Jonathan P.; Rydell, C. Peter; Everingham, Susan S.; Chiesa, James; Bushway, Shawn
This publication describes improved methods of roof support designed to protect face workers in mechanized coal mines against the hazards of falling rock and coal. The various methods of roof support discussed are the pin-jack method, skid-mounted supports, expansion-bolt method, peg timbering, the hitch method, and suspension supports. Detailed drawings and photographs illustrating the various roof-support methods discussed are included.
Background Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions. Methods Data were obtained from a survey on a probabilistic sample of residents aged ?65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy. Results The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR?=?2.56 [95% CI, 1.32-4.94]); antidepressant use (RR?=?2.32 [95% CI, 1.22-4.40]); arrhythmias (RR?=?2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR?=?1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with???1 condition) was 84% (95% CI, 45-95%). Conclusions Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/3916151157277337
Objective: The goal of this research was to evaluate economically three interventions designed to prevent substance use in general populations of adolescents, specifically focusing on the prevention of methamphetamine use and its subsequent benefits to employers. Method: In a randomized, controlled trial, three preventive interventions were delivered to 6th- or 7th-grade youth in 58 Iowa school districts, with 905 of these youth (449 girls) providing follow-up assessments as 12th graders. Intervention conditions included the family-focused Iowa Strengthening Families Program (ISFP), the school-based Life Skills Training (LST) program, and a combined condition of both the Strengthening Families Program: For Parents and Youth 10-14 (SFP10-14; an ISFP revision) plus LST (LST + SFP10-14). Analyses based on intervention costs, 12th-grade methamphetamine use rates, and meth-amphetamine-related employer costs yielded estimates of intervention cost, cost-effectiveness, benefit—cost ratio, and net benefit. Results: The ISFP lowered methamphetamine use by 3.9%, cost $25,385 to prevent each case, and had a benefit-cost ratio of 3.84, yielding a net benefit of $2,813 per youth. The LST program reduced methamphetamine use by 2.5%, required $5,122 per prevented case, and had a benefit-cost ratio of 19.04, netting $2,273 per youth. The combined LST + SFP10-14 prevention condition lowered methamphetamine use rates by 1.8%, cost $62,697 to prevent each case, had a benefit-cost ratio of 1.56, and netted $620 per youth. Findings were robust after varying a number of key parameters across a range of plausible values. Conclusions: Substance use prevention programming is economically feasible, particularly for effective interventions that have lower per person treatment delivery costs.
The fall detection sensor for fall protection airbag was investigated to evaluate the airbag system. There are several methods to detect the fall: contact to the ground and detection of free fall. The problems with both methods are discussed. Since the usability of the latter come into practical use, tests in the future standard of airbag are discussed.
This report presents results from two experiments conducted for the lower extremity assistance for parachutist (LEAP) program. These experiments are part of a systematic effort to develop a device to prevent lower extremity injuries to airborne soldiers. ...
H. P. Crowell T. A. Treadwell J. A. Faughn K. L. Leiter A. A. Woodward
This study examined falls data reported by staff to (a) describe characteristics of falls in this population and (b) analyze the quality and utility of the data available from incident reports (IRs) to improve fallprevention. Data from 34 incident reports were analyzed. Descriptive and frequency analyses were conducted to describe fall characteristics, use of assistive devices, high-risk medication use, and prevalence of omitted data on IRs. Thirty-four falls occurred among 15 residents (age, M = 84 years). More than half resulted in injury. Significant omissions of data were noted in the IRs, which may have limited full analysis of fall events and the ability to communicate about health outcomes of these events and the prevention of subsequent falls. This study provides data about falls in assisted living and recommendations for enhanced data collection to support the monitoring of falls risk and the prevention of future falls. PMID:23983004
Silva-Smith, Amy L; Kluge, Mary Ann; LeCompte, Michelle; Snook, Alison
The fall risk has 3.6 fold in Dementia with Lewy Bodies (DLB) and 16 fold post faller syndrome among diseases to cause dementia, and it was reported that have a significant parkinsonism and a fall more. DLB has multiple symptoms such as that physical symptom, rather than worsening a symptom by characteristics of high sensibility medical intervention for medication, and has severe problem falls. It was indicated that make a decrease a fall risk for restored cognitive function with executive function in the elderly peoples. Thus, improve the quality of care and the establishment of non - pharmacological therapies, for it is important to further therapeutic exercise as prevention is required cooperation and sharing information across professions. PMID:23628687
This is the second part of the publication on approaches to occupational stress prevention and a state of the art in different European countries. In this part, stress prevention within an organization is described and discussed. Although there is no one way of tackling stress at work, some recommendations can be formulated to increase the effectiveness of such interventions. The effective stress reducing programs should be aimed both at changes in the organization itself and empowerment of employees' coping with stress resources. It is also important to take the advantage of wide spectrum of methods and techniques (e.g., work redesign, participation, team work, cognitive behavioral methods, relaxation, etc.) remembering that one size does not fit all. The intervention should be carefully planned and adopted to the various branches, an individual organization or department and should be preceded by the identification of stress risks and risk groups. To have the stress prevention program successfully introduced one should also consider factors which may influence (positively or negatively) the process of program implementation. PMID:20509556
Abstract Purpose: The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Methods: Thirty spastic diplegic cerebral palsied children (10-12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30?min/d, 3?d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Results: Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p?0.05). The results also showed significantly better improvement in the measured parameters for the study group, as compared to the control group (p?0.05). Conclusion: Balance training on Biodex system is a useful tool that can be used in improving postural balance control in children with diplegic cerebral palsy. Implications for Rehabilitation Postural problems play a central role in the motor dysfunction of children with diplegic cerebral palsy. Balance control is important in the competence in the performance of most functional skills. The Biodex Balance System is an important balance assessment and training tool. Balance training in children with cerebral palsy can improve performance in postural control. PMID:24032716
El-Shamy, Shamekh Mohamed; Abd El Kafy, Ehab Mohamed
Previously we reported that about 30% to 60% of the area predicted to be used by fall Chinook salmon (Oncorhynchus tshawytscha) for spawning in the Hanford Reach of the Columbia River did not contain redds. One explanation for the overprediction of habitat was that our model did not incorporate streamflow fluctuation. Daily fluctuation in flow caused by load-following operations (power generation to meet short-term electrical demand) at Priest Rapids Dam, situated at the upper end of the Hanford Reach, changes the hydraulic characteristics to which fish respond in selecting redd sites. The purpose of the study described here was to examine the effect of flow changes on spawning habitat modeling and, in particular, to look at the connection between spawning and the variability and persistence of habitat variables caused by rapid changes in flow resulting from load-following operations at Priest Rapids Dam. We found that spawning habitat use by fall Chinook salmon was consistent with previous fall Chinook salmon studies in the Reach. Dynamic variables that were based on hourly time series were used to account for the variability in habitat as a result of flow fluctuations. The analysis showed that the proportion of velocities that fell within the range of 1.0 to 2.5 m/s differed significantly between locations that were predicted to be spawning by the logistic regression model where spawning actually occurred and locations that were predicted to be spawning where spawning did not occur. However, the resulting sequential logistic regression model that incorporated the dynamic variables did not provide significant improvement in the percentage of errors for areas predicted to be spawning; the model’s overprediction errors still ranged from 63% to 78%. We suggest that while flow fluctuation may affect spawning habitat and individual fish behavior, the high correlation between time-averaged velocities and the proportion of hourly velocities that fell within the most favorable range negated any improvements in model predictions.
Geist, David R.; Murray, Christopher J.; Hanrahan, Timothy P.; Xie, YuLong
At approximately 5 AM on March 18, 2012, a significant collapse occurred in a potash mine near the Department of Energy's Waste Isolation Pilot Plant (WIPP). The US Geological Survey estimated the event to be magnitude 2.9. Two wells in the WIPP regional groundwater monitoring network experienced oscillatory water level fluctuations greater than 5 feet in response to the event. The changes in water level decayed slowly over several weeks following the event. The potash mine is located in the McNutt Potash zone of the Salado Formation, which is 1000-1400 feet below ground surface (BGS) near the location of the roof fall. The monitoring wells are completed in the semi-confined Culebra Dolomite member of the Rustler Formation, which is 375 feet BGS. The observed response is compared to published well responses to earthquakes and other seismic events. We explore the potential for using the event to characterize aquifer parameters. This research is funded by WIPP programs administered by the Office of Environmental Management (EM) of the U.S Department of Energy. Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000
Unique features of body segment kinematics in falls and activities of daily living (ADL) are applied to make automatic detection of a fall in its descending phase, prior to impact, possible. Fall-related injuries can thus be prevented or reduced by deploying fall impact reduction systems, such as an inflatable airbag for hip protection, before the impact. In this application, the
We assess the cost-effectiveness of maintenance treatment for heroin addiction, with emphasis on its role in preventing HIV infection. The analysis is based on a dynamic compartmental model of the HIV epidemic among a population of adults, ages 18 to 44. The population is divided into nine compartments according to infection status and risk group. The model takes into account
Gregory S. Zaric; Margaret L. Brandeau; Paul G. Barnett
Objective. To examine the effects of health maintenance organization (HMO) penetration on preventable hospitalizations. Data Source. Hospitalinpatientdischarge abstracts for932 urban countiesin22states from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), hospital data from American Hospital Association (AHA) annual survey, and population characteristics and health care capacity data from Health Resources and Services Administration (HRSA) Area Resource File
Chunliu Zhan; Marlene R. Miller; Herbert Wong; Gregg S. Meyer
A 3.5-year study of dropout prevention programs in New York City public schools shows that current programs have been effective in increasing professional and public awareness of the dropout problem and providing needed support to some students. However, the categorical approach of most programs is inadequate, providing special services to only a…
Three studies show a way to prevent fluency effects independently of judgmental correction strategies by identifying and procedurally blocking the sources of fluency variations, which are assumed to be embodied in nature. For verbal stimuli, covert pronunciations are assumed to be the crucial source of fluency gains. As a consequence, blocking such pronunciation simulations through a secondary oral motor task
Homelessness prevention programs intervene with households apparently in imminent danger of becoming homeless, and try to keep them housed. If they are at least partially successful, how do they change the average shelter spell of households actually becoming homeless? We use data from 2003 to 2008 for Homebase, a New York City homelessness prevention program that studies have found to be effective in reducing shelter entries. Homebase made no difference in average shelter spells at the community level. This result, like many results about shelter spell length, is not easy to reconcile with the idea that shelter spell length is a reflection of the seriousness of underlying problems.
Stocking rate is a fundamental variable for managing pastures, and there is a distinct relationship between stocking rate and animal performance for each forage type. This research was conducted to determine the effects of fall stocking rate (SR) and method of establishment of wheat pasture planted into dedicated crop fields on animal performance during the fall and subsequent spring. There was a factorial arrangement of tillage methods used in the establishment of wheat pasture and fall stocking rates. Tillage treatments included 1) CT, seed sown into a prepared seedbed, 2) RT, a single pass with a light disk followed by broadcasting of seed, or 3) NT, direct seeding into the undisturbed stubble of the grazed-out wheat pasture from the previous year. The fixed SR during the fall were 1.9, 2.5, and 3.7 growing beef steers (Bos taurus L.)/ha. In the spring all pastures were grazed at the same fixed SR by steers for graze out. Data were analyzed using the mixed procedure of SAS as a randomized complete block design with field as the experimental unit and year as the block. Forage mass, forage nutritive composition, and animal performance during the fall or spring were not affected (P ? 0.14) by tillage method. During the fall grazing season, with increasing SR there were linear (P < 0.01) decreases in BW of steers upon removal from pasture, BW gain per steer, and ADG, whereas grazing-day per hectare and BW gain per hectare increased linearly (P < 0.01) with increasing SR. The carryover effects of fall SR into the spring grazing season decreased (P< 0.01) grazing-day per hectare and tended (P ? 0.09) to produce quadratic changes in BW upon removal from pasture and BW gain per hectare. Across the fall and spring grazing seasons, grazing-day per hectare increased linearly (P < 0.01) with greater SR, and BW gain per hectare increased quadratically (P = 0.02) with increased fall SR. A tillage treatment by fall SR interaction (P = 0.10) indicates that although there was no difference (P ? 0.12) due to tillage treatment in BW gain per hectare at 1.9 or 2.5 SR, NT fields produced (P ? 0.04) more BW gain per hectare than CT or RT at the 3.7 SR. Although increasing SR of growing steers leads to reduced animal performance in the fall and reduced carrying capacity in the spring, NT appears to be capable of withstanding greater fall SR with less impact on total production per hectare than CT or RT. PMID:22585811
Morgan, M S; Beck, P A; Hess, T; Hubbell, D S; Gadberry, M S
Background: A school-based obesity prevention study (Medical College of Georgia FitKid Project) started in the fall of 2003 in 18 elementary schools. Half of the schools were randomized to an after-school program that included moderate-to-vigorous physical activity, healthy snacks, homework assistance, and academic enrichment. All third graders…
There are compelling data suggesting that antiretroviral (ARV) drugs can prevent the transmission of HIV: 1) ARV therapy reduces the intrinsic risk of transmission by cutting down the viral load in infected people; 2) ARVs may be used to prevent transmission in uninfected subjects who experienced high risk exposures. Despite these encouraging preliminary results, there are several questions that need to be answered before recommending the use of ARV among uninfected subjects: 1) the efficacy of these strategies amongst women is not yet established; 2) the cost-effectiveness of pre-exposure prophylaxis (PrEP) in the long term is undefined since PrEP efficacy may depend on adherence; 3) treating uninfected individuals may be counter-effective, as it may increase risky behavior due to the belief that ARV drugs have unlimited protective power. In conclusion, the public-health use of ARV drugs represents a new paradigm in the field of HIV prevention. However, ARV treatment cannot be considered as a substitute for other measures for preventing transmission but a complement to individual protection. In particular, post-exposure prophylaxis may be used in selected cases, whereas PrEP appears to be a highly costly method with limited public-health potential and possible safety concerns. PMID:23471446
Revegetating construction sites in the fall requires the scheduling of seeding and mulching for either permanent or dormant seedings. Dormant seedings must be late enough in the fall to prevent germination, while permanent seedings must be early enough to...
Close to 75% of hip and non-hip fractures occur among seniors age 65 years and older. Notably, the primary risk factor for\\u000a a hip fracture is a fall, and over 90% of all fractures occur after a fall. Thus, critical for the understanding and prevention\\u000a of fractures at later age is their close relationship with muscle weakness and falling. In fact,
The preventiveeffects of Sophorae Fructus extracts (I: hot water extract and II: combination product using I) on bone loss in ovariectomized (OVX) rats were investigated. Sophorae Fructus extracts were orally administrated to OVX rats for 9 weeks. Ovariectomy caused the increase of body weight and deoxypyridinoline (Dpd: bone resorption marker) and decrease of calcium (Ca: bone formation marker) level in serum. Dpd level were significantly decreased and Ca levels were elevated at 9 weeks in Sophorae Fructus extracts administered groups after ovariectomy at a dose of 0.556 g/kg/day compared with control group. In administered groups, trabecular bone area (TBA) in the tibia and lumbar were also increased compared with control group in histomorphological analysis. The preventive or treatment effects of Sophorae Fructus extracts on bone loss in OVX rats appears to be due to suppression of bone turnover. PMID:15742817
Shim, Jae Geul; Yeom, Seung Hwan; Kim, Hyun Jung; Choi, Young Wook; Lee, Do Ik; Song, Kye Yong; Kwon, Suk Hyung; Lee, Min Won
Background: Orthostatic hypotension, postprandial hypotension, and falls are considered to be adverse drug reactions of antihypertensive therapy in older people with comorbidities. Concerns regarding these adverse events may limit the use of antihypertensive agents in this group of people. Objective: The aim of this study was to determine the relationship between antihypertensive therapy in octo- and nonagenarians and the risk for orthostatic hypotension, postprandial hypotension, and falls. Methods: This was a case-control study of octo- and nonagenarians living in residential care facilities who were receiving antihypertensive therapy and a control group who were not receiving antihypertensive therapy. Results: A total of 119 patients, 77 who were receiving regular antihypertensive therapy and 42 who were not taking any antihypertensive agents, were enrolled in the study. The prevalence of antihypertensive use, orthostatic hypotension, postprandial hypotension, and falls was high (65%, 29%, 57%, and 45%, respectively). There were no associations between antihypertensive therapy and orthostatic hypotension, postprandial hypotension, and falls. When individual classes of antihypertensive agents were examined, the only observed association was a negative association (ie, a protective effect) between potassium-sparing diuretics and falls (odds ratio, 0.2; 95% CI, 0.04–1.0). Conclusion: Antihypertensive therapy was not associated with an increased risk for orthostatic hypotension, postprandial hypotension, or falls in this case-control study of octo- and nonagenarians living in residential care facilities.
Fisher, Alex A; McLean, Allan J; Davis, Michael W; Le Couteur, David G
Background After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and critiques the CE literature related to HIV-prevention interventions in low- and middle-income countries during 2005-2008. Methods Systematic identification of publications was conducted through several methods: electronic databases, internet search of international organizations and major funding/implementing agencies, and journal browsing. Inclusion criteria included: HIV prevention intervention, year for publication (2005-2008), setting (low- and middle-income countries), and CE estimation (empirical or modeling) using outcomes in terms of cost per HIV infection averted and/or cost per disability-adjusted life year (DALY) or quality-adjusted life year (QALY). Results We found 21 distinct studies analyzing the CE of HIV-prevention interventions published in the past four years (2005-2008). Seventeen CE studies analyzed biomedical interventions; only a few dealt with behavioral and environmental/structural interventions. Sixteen studies focused on sub-Saharan Africa, and only a handful on Asia, Latin America and Eastern Europe. Many HIV-prevention interventions are very cost effective in absolute terms (using costs per DALY averted), and also in country-specific relative terms (in cost per DALY measured as percentage of GDP per capita). Conclusion There are several types of interventions for which CE studies are still not available or insufficient, including surveillance, abstinence, school-based education, universal precautions, prevention for positives and most structural interventions. The sparse CE evidence available is not easily comparable; thus, not very useful for decision making. More than 25 years into the AIDS epidemic and billions of dollars of spending later, there is still much work to be done both on costs and effectiveness to adequately inform HIV prevention planning.
Idiopathic Parkinson disease (PD) is an ?-synucleinopathy, one of several proteinopathies characterized by intracellular and extracellular accumulation of abnormal filament proteins.(1) Relentless progression of neuropathologic changes, consisting of ?-synuclein-positive Lewy bodies and Lewy neurites, and widespread neuronal loss closely correlate with clinical worsening of motor and nonmotor PD symptoms. Typically, unilateral onset of tremor, rigidity, or bradykinesia, the cardinal motor features, is followed by contralateral spread of disease signs. The presence of midline problems, such as gait disorder and balance impairment, generally represents a more advanced phase of the disease, used as the central criteria in Hoehn & Yahr staging. PMID:24682972
Three studies show a way to prevent fluency effects independently of judgmental correction strategies by identifying and procedurally blocking the sources of fluency variations, which are assumed to be embodied in nature. For verbal stimuli, covert pronunciations are assumed to be the crucial source of fluency gains. As a consequence, blocking such pronunciation simulations through a secondary oral motor task decreased the false-fame effect for repeatedly presented names of actors (Experiment 1) as well as prevented increases in trust due to repetition for brand names and names of shares in the stock market (Experiment 2). Extending this evidence beyond repeated exposure, we demonstrated that blocking oral motor simulations also prevented fluency effects of word pronunciation on judgments of hazardousness (Experiment 3). Concerning the realm of judgment correction, this procedural blocking of (biasing) associative processes is a decontamination method not considered before in the literature, because it is independent of exposure control, mood, motivation, and post hoc correction strategies. The present results also have implications for applied issues, such as advertising and investment decisions. PMID:20438220
The development of the Snake River hydroelectric system has affected fall chinook salmon smolts by shifting their migration timing to a period when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem operations to improve
Timothy P. Hanrahan; David R. Geist; Evan V. Arntzen; Cary S. Abernethy
Data are presented depicting the distribution of some stocks of Columbia River hatchery fall chinook salmon in the northeast Pacific Ocean. These are based on recoveries of marked fish. Also presented are the apparent growth histories for fish from the Kalama and Spring Creek Hatcheries as well as a graphic population model for Columbia River fall chinook salmon. Finally, the
A study of the effects of endrin on wildlife was conducted from 1981 to 1983 in fruit orchards in central Washington state. The single post-harvest application of endrin as a rodenticide resulted in both acute and chronic toxicity to a variety of avian species. Most mortality occurred soon after application, but several raptors died during the spring and summer. Most wildlife sampled in the orchard system contained residues of endrin. There was on evidence that endrin depressed reproductive success.
Clinical engineering programs typically establish the content and frequency of a device's inspection and preventive maintenance procedures at the time of implementation. In some programs, these are not altered throughout the device's useful life. In others, history data and traditional statistical methods are used to adapt procedures to change in risk measures. Such methods are essentially reactive in that they are based upon past trends and do not readily consider potentialities for future change in the performance and utilization environments. Chaos theoretical concepts and related measures, when implemented in artificial intelligence programs such as neural networks and genetic algorithms, and used as an adjunct with computerized technology management programs, can assist in asking and answering the more dynamic, proactive questions necessary for effective inspection and preventive maintenance optimization. Today's healthcare environment is ideal for exploring their utilization. PMID:10159655
This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale-International [FES-I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65-85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES-I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES-I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ?p 2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults. PMID:23881433
A study of the effects of endrin on wildlife was conducted from 1981 to 1983 in fruit orchards in central Washington State. The single post-harvest application of endrin as a rodenticide resulted in both acute and chronic toxicity to a variety of avian species. Of 194 birds found dead, brains of 125 were analysed; endrin toxicosis accounted for >24% of the total and 37% of those analysed. Most mortality occurred soon after application, but several raptors died during the spring and summer. Most wildlife sampled in the orchard system contained residues of endrin. There was no evidence that endrin depressed reproductive success. Use of endrin abruptly declined during this study and its use is currently limited to emergency situations. Wildlife mortality from endrin also decreased; only six endrin-related mortalities were detected the last year of the study and there have been no reports of die-offs since the study ended.
The purpose of this study was to test the implementation of a fall detection and "rewind" privacy-protecting technique using the Microsoft® Kinect™ to not only detect but preventfalls from occurring in hospitalized patients. Kinect sensors were placed in six hospital rooms in a step-down unit and data were continuously logged. Prior to implementation with patients, three researchers performed a total of 18 falls (walking and then falling down or falling from the bed) and 17 non-fall events (crouching down, stooping down to tie shoe laces, and lying on the floor). All falls and non-falls were correctly identified using automated algorithms to process Kinect sensor data. During the first 8 months of data collection, processing methods were perfected to manage data and provide a "rewind" method to view events that led to falls for post-fall quality improvement process analyses. Preliminary data from this feasibility study show that using the Microsoft Kinect sensors provides detection of falls, fall risks, and facilitates quality improvement after falls in real hospital environments unobtrusively, while taking into account patient privacy. PMID:24296567
Rantz, Marilyn J; Banerjee, Tanvi S; Cattoor, Erin; Scott, Susan D; Skubic, Marjorie; Popescu, Mihail
This report presents the results of censuses conducted during October 1981 to estimate the fall abundance of small mammals and avifauna on replicate plots in the vicinity of Federal Tract C-a (Rio Blanco Oil Shale Company). The objectives of the fall censuses were to evaluate alternative census techniques, test assumptions vital to the use of indices and abundance estimators, determine cost-functions associated with monitoring efforts, and estimate variance components needed to devise optimal monitoring designs. Analyses of the fall census data on small mammal abundance were performed.
Despite the importance of movement and activity indicators in predicting the risk of falls in older adults, collection and analysis of such data are limited. The dearth may result from recruitment challenges faced by fall-related studies that capture data on movement and activity in older adults. This article addresses recruitment and sampling methodology issues and draws attention to the gap in best practices left by previous literature. Authors conducted a systematic review of methods used to recruit elderly individuals for "activity-related fall studies" that assessed subjects' movement and mobility, and investigated incidence of real falls. The review highlighted effective recruitment strategies and identified challenges across several settings. Literature review findings were compared to recruitment challenges encountered in an activity-related fall study from 2011, focused on enrolling a target group of older adults with both high risk of falling and the requisite cognitive capacity to adhere to activity protocols. The analysis yielded several recommendations for improving recruitment of older adults for activity-related fall studies, including: recruiting from community-based settings; utilizing short-term activity protocols to promote involvement among institutionalized elderly; establishing eligibility criteria that may include those with lower cognitive functioning, mobility restrictions, and co-morbidities; employing direct-mail recruitment methods; and utilizing intermediaries to recruit institutionalized elderly. PMID:23274452
Periprosthetic joint infection (PJI) following total knee arthroplasty is a major burden for patients and health systems. Prevention of this challenging complication through implementation of effective strategies should be a priority. These strategies should encompass various levels of patient care. Multiple modifiable risk factors such as uncontrolled hyperglycemia, obesity, smoking, substance abuse, and nasal colonization with Staphylococcus aureus have been described for PJI. Preoperative recognition and mitigation of these risk factors along with optimization of nonmodifiable risk factors such as kidney, liver, or immune system insufficiency can considerably decrease the risk of PJI. A comprehensive perioperative protocol should involve optimization of the operative environment to reduce the number of bacteria and particulates in the air. Several surgical and nonsurgical details of intraoperative care such as maintenance of normothermia, skin preparation, surgical field irrigation, wound closure, and duration of surgical and anesthetic procedure can influence the occurrence of PJI. Prophylactic perioperative antibiotic administration is probably one of the most important strategies in preventing PJI. Implementation of surgical safety checklist can diminish the risk of perioperative complications, particularly surgical site infection. Controversy regarding efficacy, efficiency, and optimization of some preventive measures continues to exist due to inconsistency or inadequacy of available evidence. Novel research has focused on designing PJI-resistant implants and developing vaccines that target molecule components with major role in the process of bacterial adhesion to the implant or periprosthetic tissues. PMID:24792971
Patient falls in hospitals continue to be a major and costly problem. This study tested the mediating effect of missed nursing care on the relationship of staffing levels (hours per patient day [HPPD]) and patient falls. The sample was 124 patient units in 11 hospitals. The HPPD was negatively associated with patient falls (r = -0.36, P < .01), and missed nursing care was found to mediate the relationship between HPPD and patient falls. PMID:21738057
Falls are the number one cause of injury in older adults. Lack of objective evidence on the cause and circumstances of falls is often a barrier to effectiveprevention strategies. Previous studies have established the ability of wearable miniature inertial sensors (accelerometers and gyroscopes) to automatically detect falls, for the purpose of delivering medical assistance. In the current study, we extend the applications of this technology, by developing and evaluating the accuracy of wearable sensor systems for determining the cause of falls. Twelve young adults participated in experimental trials involving falls due to seven causes: slips, trips, fainting, and incorrect shifting/transfer of body weight while sitting down, standing up from sitting, reaching and turning. Features (means and variances) of acceleration data acquired from four tri-axial accelerometers during the falling trials were input to a linear discriminant analysis technique. Data from an array of three sensors (left ankle+right ankle+sternum) provided at least 83% sensitivity and 89% specificity in classifying falls due to slips, trips, and incorrect shift of body weight during sitting, reaching and turning. Classification of falls due to fainting and incorrect shift during rising was less successful across all sensor combinations. Furthermore, similar classification accuracy was observed with data from wearable sensors and a video-based motion analysis system. These results establish a basis for the development of sensor-based fall monitoring systems that provide information on the cause and circumstances of falls, to direct fallprevention strategies at a patient or population level. PMID:24148648
Aziz, Omar; Park, Edward J; Mori, Greg; Robinovitch, Stephen N
The development of the Snake River hydroelectric system has affected fall Chinook salmon smolts by shifting their migration timing to a period (mid- to late-summer) when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake...
C. S. Abernethy D. R. Geist E. V. Arntzen T. P. Hanrahan
Comprehensive water quality investigations in the Snake River Basin, Twin Falls Area (17040212) were conducted from November 2 to 17, 1971. Studies included an evaluation of municipal and industrial wastewater treatment facilities. Subsequently, stream surveys were conducted on...
For many seniors, patients, and vulnerable people, an accidental fall could bear consequences serious enough to be life-threatening. Accordingly, increasing expenditure on the prevention of accidental fall has been a trend in the developed countries. One of the methods of preventing an accidental fall includes a quick notification to the caregiver. In order to detect and inform an accidental fall
Jinwook Shim; Myung-hoon Shim; Yoon-su Baek; Tack-don Han
The study of the mechanisms of mechanical alloying requires knowledge of the impact characteristics between the ball and vial in the presence of milling powders. In this paper, free falling experiments have been used to investigate the characteristics of impact events involved in mechanical milling. The effects of milling conditions, including impact velocity, ball size and powder thickness, on the
H. Huang; M. P. Dallimore; J. Pan; P. G. McCormick
In 2002, the U. S. Fish and Wildlife Service continued a study, initiated in 2001, of the effects of capturing Yukon River fall chum salmon (Oncorhynchus keta) in fish wheels, marking them with spaghetti tags, and releasing them to continue their migratio...
... and Fractures Once Is Enough: A Guide to Preventing Future Fractures Publication available in: PDF (211 KB) ... and Fractures Caídas y fracturas (Falls and Fractures) PreventingFalls and Fractures Partner Resources Falls and Fractures ( ...
Lava Falls Rapid is the most formidable reach of whitewater on the Colorado River in Grand Canyon and is one of the most famous rapids in the world. Although the rapid was once thought to be controlled by the remnants of lava dams of Pleistocene age, Lava Falls was created and is maintained by frequent debris flows from Prospect Canyon. We used 232 historical photographs, of which 121 were replicated, and 14C and 3He dating methods to reconstruct the ages and, in some cases, the magnitudes of late Holocene debris flows. We quantified the interaction between Prospect Canyon debris flows and the Colorado River using image processing of the historical photographs. The highest and oldest debris-flow deposits on the debris fan yielded a 3He date of 2.9?0.6 ka (950 BC), which indicates predominately late Holocene aggradation of one of the largest debris fans in Grand Canyon. The deposit, which has a 25-m escarpment caused by river reworking, crossed the Colorado River and raised its base level by 30 m for an indeterminate, although probably short, period. We mapped depositional surfaces of 6 debris flows that occurred after 950 BC. The most recent prehistoric debris flow occurred no more than 500 years ago (AD 1434). From April 1872 to July 1939, no debris flows occurred in Prospect Canyon. Debris flows in 1939, 1954, 1955, 1963, 1966, and 1995 constricted the Colorado River between 35 and 80 percent and completely changed the pattern of flow through the rapid. The debris flows had discharges estimated between about 290 and 1,000 m3/s and transported boulders as heavy as 30 Mg. The recurrence interval of these debris flows, calculated from the volume of the aggraded debris fan, ranged from 35 to 200 yrs. The 1939 debris flow in Prospect Canyon appears to have been the largest debris flow in Grand Canyon during the last 125 years. Debris flows in Prospect Canyon are initiated by streamflow pouring over a 325-m waterfall onto unconsolidated colluvium, a process called the firehose effect. Floods in Prospect Valley above the waterfall are generated during regional winter storms, localized summer thunderstorms, and occasional tropical cyclones. Winter precipitation has increased in the Grand Canyon region since the early 1960s, and the most recent debris flows have occurred during winter storms. Summer rainfall has declined in the same period, decreasing the potential for debris flows in the summer months. The history of river reworking of the Prospect Canyon debris fan illustrates the interrelation between tributary debris fans and mainstem floods in bedrock canyons. Lava Falls Rapid did not change despite Colorado River floods of 8,500 m3/s in 1884 and 6,230 m3/s in 1921. Floods up to 3,540 m3/s that occurred after the historical, pre-dam debris flows removed most of the deposits within 3 years. Releases in 1965 from Glen Canyon Dam that were above powerplant capacity but less than 1,640 m3/s removed most of the debris fan deposited in 1963, and the combination of dam releases and a 1973 flood on the Little Colorado River removed the 1966 aggradation. About 4,800 m3 of the 1995 deposit was reworked on the day of the 1995 debris flow, dam releases of less than 570 m3/s had not reworked the remainder of the aggraded debris fan. Lava Falls Rapid has been the most unstable reach of whitewater in Grand Canyon during the late Holocene and particularly during the last 120 years. Rapids in bedrock canyons controlled by tributary deposition in the main channel are aggradational features that reflect the net effect of tributary-mainstem interactions. Boulders that form the core of rapids in Grand Canyon are essentially immobile by both regulated and unregulated Colorado River flows. Historical operation of Glen Canyon Dam, which was completed in 1963, has reduced the potential for reworking of debris fans, and has accelerated the rate of net aggradation at the mouths of tributary canyons. Because debris fans that formed after 196
Webb, Robert H.; Melis, Theodore S.; Wise, Thomas W.; Elliott, John G.
In cooperation with the City of Wichita Falls, the U.S. Geological Survey assessed channel changes on the Wichita River at Wichita Falls, Texas, and modeled historical floods to investigate possible causes and potential mitigation alternatives to higher flood stages in recent (2007 and 2008) floods. Extreme flooding occurred on the Wichita River on June 30, 2007, inundating 167 homes in Wichita Falls. Although a record flood stage was reached in June 2007, the peak discharge was much less than some historical floods at Wichita Falls. Streamflow and stage data from two gages on the Wichita River and one on Holliday Creek were used to assess the interaction of the two streams. Changes in the Wichita River channel were evaluated using historical aerial and ground photography, comparison of recent and historical cross sections, and comparison of channel roughness coefficients with those from earlier studies. The floods of 2007 and 2008 were modeled using a one-dimensional step-backwater model. Calibrated channel roughness was larger for the 2007 flood compared to the 2008 flood, and the 2007 flood peaked about 4 feet higher than the 2008 flood. Calibration of the 1941 flood yielded a channel roughness coefficient (Manning's n) of 0.030, which represents a fairly clean natural channel. The step-backwater model was also used to evaluate the following potential mitigation alternatives: (1) increasing the capacity of the bypass channel near River Road in Wichita Falls, Texas; (2) removal of obstructions near the Scott Avenue and Martin Luther King Junior Boulevard bridges in Wichita Falls, Texas; (3) widening of aggraded channel banks in the reach between Martin Luther King Junior Boulevard and River Road; and (4) reducing channel bank and overbank roughness. Reductions in water-surface elevations ranged from 0.1 foot to as much as 3.0 feet for the different mitigation alternatives. The effects of implementing a combination of different flood-mitigation alternatives were not investigated.
Primary prevention, as a medical term, involves taking action to prevent problems from occurring before the onset of symptoms. This concept, when related to the Global War on Terrorism (GWOT) in the Middle East, provides insights on the current strategy's...
Objective—To evaluate and summarize the house fire injury prevention literature. Methods—MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. Results—Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). Conclusions—This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.
The Albeni Falls Interagency Work Group continued to actively engage in implementing wildlife mitigation actions in 2002. Regular Work Group meetings were held to discuss budget concerns affecting the Albeni Falls Wildlife Mitigation Program, to present p...
The aim of this study was to investigate whether weight categories prevent young athletes from being exposed to a relative age effect. The dates of birth of all French female (n = 727) and male (n = 5440) amateur boxers who participated in the 2010-2011 season were collected from the federation database. The dates of birth of all French male professional boxers (n = 354) were also collected. The results show an absence of a relative age effect among French female and male amateur boxers. The results also show an absence of this phenomenon among French male professional boxers. The male 18-18+ age category reveal an inverse relative age effect. This inverse relative age effect might be interpreted as the result of a strategic adaptation from relatively younger children who shift from one sport to another where there are weight categories in order to ensure fair competition. The results of this study suggest that the weight category system is a possible solution within the relative age effect phenomenon. PMID:23879217
The Strategic Prevention Framework State Incentive Grant (SPF SIG) program is a national public health initiative sponsored by the U.S. Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention to prevent substance abuse and its consequences. State grantees used a data-driven planning model to allocate resources to 450 communities, which in turn launched over 2,200 intervention strategies to target prevention priorities in their respective populations. An additional goal was to build prevention capacity and infrastructure at the state and community levels. This paper addresses whether the state infrastructure goal was achieved, and what contextual and implementation factors were associated with success. The findings are consistent with claims that, overall, the SPF SIG program met its goal of increasing prevention capacity and infrastructure across multiple infrastructure domains, though the mediating effects of implementation were evident only in the evaluation/monitoring domain. The results also show that an initiative like the SPF SIG, which could easily have been compartmentalized within the states, has the potential to permeate more broadly throughout state prevention systems. PMID:24619188
Orwin, Robert G; Stein-Seroussi, Alan; Edwards, Jessica M; Landy, Ann L; Flewelling, Robert L
Youth suicide prevention is an important public health issue. However, few prevention programs are theory driven or systematically evaluated. This study evaluated Connect, a community-based youth suicide prevention program. Analysis of pre and posttraining questionnaires from 648 adults and 204 high school students revealed significant changes in…
Falls among older adults are a major health problem. When older adults fall, it is difficult to determine whether it is just a simple fall or is caused by syncope, as people often have amnesia for the loss of consciousness. We report three cases in which cardiac monitoring, for seven days or more, showed that falls had been caused by cardiac-related syncopes. PMID:17217872
Bundgaard, Lene Strauss; Holm, Ellen Astrid; Ottesen, Michael Mundt
Students learn that it is incorrect to believe that heavier objects fall faster than lighter objects. By close observation of falling objects, they see that it is the amount of air resistance, not the weight of an object, which determines how quickly an object falls.
For many years the three-step programme of skin protection, consisting of skin protection before work, cleaning and skin care after work, is one of the generally recommended measures to prevent occupational contact dermatitis. While protective creams are supposed to prevent skin damage caused by irritant contact, skin cleansing should mildly remove aggressive substances from the skin, whereas post-exposure skin care is intended to enhance epidermal barrier regeneration. This programme is strongly followed by most of the employees. But in spite of intensive preventive measurements the rate of reported occupational skin diseases according to BK 5101 is with a mean of 27.9% unchanged high since 1980. Occupational dermatologists even suggest that the reported cases mimic the top of an iceberg and that the incidence of occupational skin diseases might be much higher. These findings raise the question of how effective the actual recommended three-step programme really is in primary and secondary prevention of occupational contact dermatitis. This review is aimed to give an evaluation on the evidence of each single element of the three-step concept. Following results can be determined: In cases of impaired skin condition the therapeutic properties of skin protection (secondary prevention) is undoubted. The effectiveness of barrier creams in the primary prevention of hand eczema could not be proven. Beyond doubt is the fact that barrier creams facilitate the removal of sticky oils, greases, and resins from the skin, thus decreasing the need to wash with potentially irritating abrasives and waterless cleansers. PMID:18213554
Approximately one in three people over the age of 65 will fall each year, resulting in significant financial, physical, and\\u000a emotional cost on the individual, their family, and society. Currently, falls are managed using on-body sensors and alarm\\u000a pendants to notify others when a falls event occurs. However these technologies do not prevent a fall from occurring. There\\u000a is now
Cliodhna Ni Scanaill; Chiara Garattini; Barry R. Greene; Michael J. McGrath
Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year, resulting in direct medical costs of nearly $30 billion. Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities. Although the burden of falls among older adults is well-documented, research suggests that falls and fall injuries are also common among middle-aged adults. One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis. In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45-64 years) (30.2%) and older adults (aged ?65 years) (49.7%), and these populations account for 52% of U.S. adults. Moreover, arthritis is the most common cause of disability. To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged ?45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fallprevention programs in clinical and community practice. PMID:24785984
Barbour, Kamil E; Stevens, Judy A; Helmick, Charles G; Luo, Yao-Hua; Murphy, Louise B; Hootman, Jennifer M; Theis, Kristina; Anderson, Lynda A; Baker, Nancy A; Sugerman, David E
The objective of this review was to assess the trend in the US male circumcision rate and the impact that the affirmative 2012 American Academy of Pediatrics policy statement might have on neonatal circumcision practice. We searched PubMed for the term circumcision to retrieve relevant articles. This review was prompted by a recent report by the Centers for Disease Control and Prevention that found a slight increase, from 79% to 81%, in the prevalence of circumcision in males aged 14 to 59 years during the past decade. There were racial and ethnic disparities, with prevalence rising to 91% in white, 76% in black, and 44% in Hispanic males. Because data on neonatal circumcision are equivocal, we undertook a critical analysis of hospital discharge data. After correction for underreporting, we found that the percentage had declined from 83% in the 1960s to 77% by 2010. A risk-benefit analysis of conditions that neonatal circumcision protects against revealed that benefits exceed risks by at least 100 to 1 and that over their lifetime, half of uncircumcised males will require treatment for a medical condition associated with retention of the foreskin. Other analyses show that neonatal male circumcision is cost-effective for disease prevention. The benefits of circumcision begin in the neonatal period by protection against infections that can damage the pediatric kidney. Given the substantial risk of adverse conditions and disease, some argue that failure to circumcise a baby boy may be unethical because it diminishes his right to good health. There is no long-term adverse effect of neonatal circumcision on sexual function or pleasure. The affirmative 2012 American Academy of Pediatrics policy supports parental education about, access to, and insurance and Medicaid coverage for elective infant circumcision. As with vaccination, circumcision of newborn boys should be part of public health policies. Campaigns should prioritize population subgroups with lower circumcision prevalence and a higher burden of diseases that can be ameliorated by circumcision. PMID:24702735
Morris, Brian J; Bailis, Stefan A; Wiswell, Thomas E
Background Gait and balance problems are common in patients with multiple sclerosis, leading to high risk for falls. Local Dynamic Stability (LDS), a non-linear gait stability index, has been advocated as an early indicator of risk for falls. With this longitudinal study over three weeks, we aimed to assess the responsiveness of Local Dynamic Stability to a rehabilitation program and to compare it to other measures. Methods Eighteen patients (mean 54 years, median EDSS score: 5) participated. They were admitted to inpatient rehabilitation and received a three weeks individually tailored program. They performed a 3-minute walking test at the beginning and at the end of the stay, as well as pain, wellbeing, fatigue, and balance assessment. The Local Dynamic Stability was computed from the acceleration signals measured with a 3D-accelerometer. Results At the end of the rehabilitation process, patients reported reduced pain (Effect Size: ?0.7), fatigue (ES:-0.6), and increased wellbeing (ES: 1.1). A small positive effect on static balance was observed (ES: 0.3). LDS was improved (ES: 0.6), and the effect was higher than walking speed improvement (ES: 0.4). Conclusions The Local Dynamic Stability seemed responsive to assess rehabilitation effects in patients with multiple sclerosis. It could constitute a valuable gait quality index, which could evaluate potential effects of rehabilitation on fall risk. Trial registration Current Controlled Trials ISRCTN69803702.
Objective To enhance understanding of how nurse staffing relates to unassisted falls by exploring non-linear associations between unassisted fall rates and levels of registered nurse (RN) and non-RN staffing on 5 nursing unit types, thereby enabling managers to improve patient safety by making better-informed decisions about staffing. Design Cross-sectional analysis of routinely collected data using hierarchical negative binomial regression. Settings 8069 nursing units in 1361 U.S. hospitals participating in the National Database of Nursing Quality Indicators®. Main outcome measure Rate of unassisted falls per inpatient day. Results Associations between unassisted fall rates and nurse staffing varied by unit type. For medical–surgical units, higher RN staffing was weakly associated with lower fall rates. On step-down and medical units, the association between RN staffing and fall rates depended on the level of staffing: At lower staffing levels, the fall rate increased as staffing increased, but at moderate and high staffing levels, the fall rate decreased as staffing increased. Higher levels of non-RN staffing were generally associated with higher fall rates.. Conclusions Increasing non-RN staffing seems ineffective at preventing unassisted falls. Increasing RN staffing may be effective, depending on the unit type and the current level of staffing.
Fallprevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls-left and right lateral, forward trips, and backward slips-while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls. PMID:22586477
Albert, Mark V; Kording, Konrad; Herrmann, Megan; Jayaraman, Arun
Fallprevention is a critical component of health care; falls are a common source of injury in the elderly and are associated with significant levels of mortality and morbidity. Automatically detecting falls can allow rapid response to potential emergencies; in addition, knowing the cause or manner of a fall can be beneficial for prevention studies or a more tailored emergency response. The purpose of this study is to demonstrate techniques to not only reliably detect a fall but also to automatically classify the type. We asked 15 subjects to simulate four different types of falls–left and right lateral, forward trips, and backward slips–while wearing mobile phones and previously validated, dedicated accelerometers. Nine subjects also wore the devices for ten days, to provide data for comparison with the simulated falls. We applied five machine learning classifiers to a large time-series feature set to detect falls. Support vector machines and regularized logistic regression were able to identify a fall with 98% accuracy and classify the type of fall with 99% accuracy. This work demonstrates how current machine learning approaches can simplify data collection for prevention in fall-related research as well as improve rapid response to potential injuries due to falls.
Albert, Mark V.; Kording, Konrad; Herrmann, Megan; Jayaraman, Arun
The number of elderly who live on their own is increasing. Falls in the elderly are a major problem which has a long term effect. If the elderly can get help immediately after a fall, the severity of the injury, and the cost could be reduced. This paper presents a fall detection algorithm utilizing two thresholds for the resultant acceleration
P. Jantaraprim; P. Phukpattaranont; C. Limsakul; B. Wongkittisuksa
This paper describes the Project ALERT program (Adolescent Learning Experiences in Resistance Training) which was established by the Rand Corporation to prevent smoking and drug use among seventh graders. The program is based on the social influence model of drug use initiation. Curriculum features are described including motivation to resist and…
This study was conducted to evaluate the effect of Grateloupia elliptica, a seaweed native to Jeju Island, Korea, on the prevention of hair loss. When immortalized rat vibrissa dermal papilla cells were treated with extract of G. elliptica, the proliferation of dermal papilla cells significantly increased. In addition, the G. elliptica extract significantly inhibited the activity of 5?-reductase, which converts testosterone to dihydrotestosterone (DHT), a main cause of androgenetic alopecia. On the other hand, the G. elliptica extract promoted PGE2 production in HaCaT cells in a dose-dependent manner. The G. elliptica extract exhibited particularly high inhibitory effect on LPS-stimulated IL-12, IL-6, and TNF-? production in lipopolysaccharide (LPS)-stimulated bone marrow-derived dendritic cells. The G. elliptica extract also showed inhibitory activity against Pityrosporum ovale, a main cause of dandruff. These results suggest that G. elliptica extract has the potential to treat alopecia via the proliferation of dermal papilla, 5?-reductase inhibition, increase of PGE2 production, decrease of LPS-stimulated pro-inflammatory cytokines and inhibitory activity against Pityrosporum ovale.
Kang, Jung-Il; Kim, Sang-Cheol; Han, Sang-Chul; Hong, Hye-Jin; Jeon, You-Jin; Kim, Bora; Koh, Young-Sang; Yoo, Eun-Sook; Kang, Hee-Kyoung
Objective : To compare the effect of calcium\\/vitamin D supplements with a combination of calcium\\/vitamin D supplements and exercise\\/protein on risk of falling and postural balance. Design : Randomized clinical trial. Setting : University hospital physiotherapy department. Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score (SD) of
Jaap Swanenburg; Eling Douwe de Bruin; Marguerite Stauffacher; Theo Mulder; Daniel Uebelhart
Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long-standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a 'simple' fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high-impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called 'fall-induced high-impact injuries' instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal-trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury-site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone-specific drugs, have a strong scientific basis. In fallprevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor-assessing and modifying interventions have also been successful in preventingfalls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury-site protection, padded strong-shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures. PMID:16019730
Kannus, Pekka; Uusi-Rasi, Kirsti; Palvanen, Mika; Parkkari, Jari
Abstract This was a quasi-experimental study to compare the effects of center-based training with home-based training on physical function, quality of life and fall incidence in older adults. Fifty older adults were recruited to receive exercise training for 6?months. Participants in the center-based group received training under supervision of a physiotherapist at the day training center. Those in the home-based group received training assisted by a care worker at home. The outcome measures were the Elderly Mobility Scale (EMS), Berg Balance Scale (BBS), Numeric Pain Rating Scale (NPRS), Short-form 12 (SF-12) and fall incidence. Assessments were performed on all participants before and after the 6-month intervention period. Center-based training supervised by a physiotherapist was found to have beneficial effects on physical function, quality of life and fall incidence while home-based training assisted by a care worker had no effect on physical condition and self-rated health status in community dwelling older adults. Service agents should provide center-based or home-based training to the ageing population in a user-friendly way with consideration of factors such as rehabilitation potential and accessibility of transportation. PMID:24328932
Background: Randomized prevention trials provide a unique opportunity to test hypotheses about the interaction of genetic predispositions with contextual processes to create variations in phenotypes over time. Methods: Using two longitudinal, randomized prevention trials, molecular genetic and alcohol use outcome data were gathered from more than…
Conducted a pilot study which combined nicotine-fading and relapse prevention with smokers (N=30) and compared this program to conditions where subjects (N=46) received nicotine-fading or relapse prevention only. Results showed no difference among groups in abstinence or rate at any follow-up point. (LLL)
The author examined the impact on resident assistants of a social change approach to sexual assault prevention. The interactive multi-media program focused on engaging men on sexual assault prevention, accurately defining rape for college men and women, identifying aspects of the rape culture in society and on-campus, and empowering college…
School-based cigarette smoking prevention was initiated shortly after the first Surgeon General's Report in 1964. This article highlights a sequence of events by which school-based tobacco use prevention research developed as a science, and illustrates a pendulum effect, with confidence in tobacco use prevention increasing and decreasing at…
Sussman, Steve; Black, David S.; Rohrbach, Louise A.
Preventing suicide is a commonly shared priority among college administrators, faculty, staff, students, and family members. Coalitions are popular health promotion mechanisms for solving community-wide problems and are valuable in campus-wide suicide prevention efforts. This article provides an example of an effective suicide prevention…
Kaslow, Nadine J.; Garcia-Williams, Amanda; Moffitt, Lauren; McLeod, Mark; Zesiger, Heather; Ammirati, Rachel; Berg, John P.; McIntosh, Belinda J.
BACKGROUND: Information on cost-effectiveness of the range of HIV prevention interventions is a useful contributor to decisions on the best use of resources to prevent HIV. We conducted this assessment for the state of Andhra Pradesh that has the highest HIV burden in India. METHODS: Based on data from a representative sample of 128 public-funded HIV prevention programs of 14
Lalit Dandona; SG Prem Kumar; G Anil Kumar; Rakhi Dandona
This paper examined whether community readiness, prevention knowledge, coalition functioning, and barriers are linked to perceived effectiveness of community prevention coalitions. Interviews were conducted with 203 key leaders in Communities That Care (CTC) prevention boards in 21 Pennsylvania communities. Community-level means for the reliable self-report measures were utilized separately and in combination with research staff ratings, state technical assistant staff
Mark E. Feinberg; Mark T. Greenberg; D. Wayne Osgood
At the fall of fragment Q2 of comet ShoemakerLevy 9 onto Jupiter in 1994, a 4.3% increase of Io brightness was recorded by the Tower Solar Telescope in the Crimean Astrophysical Observatory by means of a CCD matrix in the spectral range of 800 nm at July 20.813 UT. The appearance of a hot cloud at the eastern edge of Jupiter was recorded by the MTM-200 telescope with the use of a TV device in the spectral range of 560 nm 12 min after the previous event. The lower bound of the power released in the explosion was found to be 6 1025 erg/s, the height of the hot cloud was about 250 km, and the mean speed of its ascent was 0.3 km/s. Hot clouds on Jupiter's limb were observed after the fall of fragment Q1 in the spectral ranges of 380 and 560 nm at the epochs 20.836 and 20.840 UT, respectively. The hot cloud observed at 20.836 UT was at the height of the upper cloud layer of the Jovian atmosphere, provided that this small increase of brightness was caused by the explosion at 20.825 UT, when a small part of fragment Q fell down. The cloud height was 900 km, and the speed of its rise was 3.6 km/s, if this event was caused by the fall of fragment Q1a. The hot cloud observed at 20.840 UT was formed at the fall of Q1a. Its height was 350 km and the rise speed was 0.5 km/s. The analysis of photometric observations indicated that there were many components in the family of fragment Q. They fell down onto Jupiter at different instants and produced hot clouds of distinct heights and speeds of rise.
Prokof'eva, V. V.; Tarashchuk, V. P.; Stepanyan, N. N.; Karachkina, L. G.; Shcherbakova, Z. A.
Riparian vegetation on channel bars and banks can significantly influence flow, sediment transport, and channel morphology within fluvial systems. Changes in flow and sedimentation, caused by vegetation, may reciprocally affect biological stability and growth. Model predictions were tested against field-scale measurements obtained within the Outdoor StreamLab~(OSL) at the St. Anthony Falls Laboratory~(SAFL). Two floodway basins adjacent to SAFL's main building
A. Lightbody; J. T. Rominger; H. M. Nepf; C. Paola
Accidental falls are common causes of serious injury and health threats in the elder population. To deliver adequate medical support, the robust and immediate falls detection is important. Since the fall detection in the elderly remains a major challenge in the public health domain, effectivefall-detection will provide urgent support and dramatically reduce the cost of medical care. In this
Objective To examine effects of session intensity (number of slip exposures) and frequency on retention of acquired adaptation for prevention of backward balance loss following repeated-slip training. Setting Biomechanics research laboratory. Participants Healthy young subjects (N=46; 21 males). Intervention Twenty-four subjects experienced a high-intensity session of 24 repeated right-side slips; 12 received additional single-slip sessions at a frequency of 1-week, 2-week, and 1-month, while the rest got no ancillary training. Another 24 subjects received a low-intensity initial session of a single slip; 12 received the same high-frequency ancillary training, while the rest got none. All groups were retested with a single-slip, 4 months after first session. Main Outcome Measures Incidence of backward balance loss, gait stability, and limb support. Results The high-intensity groups irrespective of ancillary training displayed similar improvements in all 3 outcome measures. Remarkably, the low-intensity group receiving ancillary training also significantly improved in all measures, with retention comparable to that observed in the other 2 groups. A single slip exposure without ancillary sessions was insufficient to yield longer-term effect. Conclusions Frequent ancillary sessions may be unnecessary for slip-related fallprevention up to 4 months, if initial session intensity is sufficient. Furthermore, the minimum of a single slip may be as effective, if subject is exposed to frequent ancillary sessions.
Staphylococcus aureus decolonisation--treatment to eradicate staphylococcal carriage--is often considered as a measure to prevent S aureus infection. The most common approach to decolonisation has been intranasal application of mupirocin either alone or in combination with antiseptic soaps or systemic antimicrobial agents. Some data support the use of decolonisation in surgical patients colonised with S aureus, particularly in those undergoing cardiothoracic procedures. Although this intervention has been associated with low rates of postoperative S aureus infection, whether overall rates of infection are also decreased is unclear. Patients undergoing chronic haemodialysis or peritoneal dialysis might benefit from decolonisation, although repeated courses of treatment are needed, and the effects are modest. Eradication of meticillin-resistant S aureus (MRSA) carriage has generally been difficult, and the role of decolonisation as an MRSA infection control measure is uncertain. The efficacy of decolonisation of patients with community-associated MRSA has not been established, and the routine use of decolonisation of non-surgical patients is not supported by data. PMID:22115070
Aim To appraise the external validity of physical activity interventions designed to reduce falls among community-dwelling older adults, using the reach, efficacy/effectiveness, adoption, implementation, and maintenance framework. Background Falls are a globally common, significant, and preventable problem. The efficacy of physical activity interventions to reduce falls among older adults is well established. Translation of this research into practice is slow as evidenced by persistently low proportions of older adults who engage in physical activities and the rising incidence of falls. Data Sources Four electronic databases were searched for relevant studies published between 2000 and 2010. Studies that examined the effects of physical activity interventions designed to reduce falls among community dwelling older adults were included in this review (n = 46). Review Methods This was a quantitative systematic review with narrative synthesis. The reach, efficacy/effectiveness, adoption, implementation, and maintenance framework guided the identification, appraisal, and synthesis of indicators representing study validity. Results The majority of studies in this review described indicators representing internal validity. Details about indicators representing external validity were reported infrequently, limiting the generalizability of fall-preventive physical activity interventions in diverse cultures and social contexts over time. Conclusions To foster translational research in real world settings, additional programmatic intervention research is needed that: (a) targets diverse populations; (b) incorporates theories of behavioural change; (c) describes and operationalizes critical content that enables replication and translation; (d) tests innovative measures of fall risk and physical activity; and (e) evaluates feasibility and acceptability.
One of the most important adverse effects of cisplatin, a chemotherapeutic agent which is widely used in the treatment of cancer patients, is hearing loss. This has primarily been associated with the loss of inner ear hairy and spiral ganglion cells due to oxidative stress. Resveratrol is known to be an antioxidant agent, which has the theoretical potential of preventing cisplatin-related ototoxicity. This experimental study was approved by Animal Ethics Committee of Inonu University (2008-20) and supported by Inonu University Scientific Research Projects Support Fund (2009-17). Thirty-four 3-month-old Wistar albino female rats weighing 210-270 g were used in the study. The animals were allocated into four groups: in cisplatin group (Group A), a single dose of 12 mg/kg cisplatin was administered intraperitoneally to 10 rats; in cisplatin + resveratrol group (Group B), a single dose of 12 mg/kg cisplatin and 10 mg/kg resveratrol were administered intraperitoneally for 5 days to 10 rats; in resveratrol group (Group C), 10 mg/kg resveratrol was administered intraperitoneally for 5 days to seven rats and in control group (Group D), resveratrol solvent (5% alcohol-95% physiological saline) was administered intraperitoneally for 5 days to seven rats. Resveratrol administration has begun 1 day before cisplatin administration in the group treated with cisplatin and resveratrol combination. Distortion product otoacoustic emission (DPOAE) (Grason Stadler, Madison, USA) measurements were performed in the same ear of all rats (right ear) under general anesthesia at baseline, 1st and 5th days after drug administration. Statistically significant distortion product amplitude reductions were found in the cisplatin group at 1,418, 2,003, 3,363, 5,660, 8,003 and 9,515 Hz frequencies. Whereas in the cisplatin + resveratrol group, statistically significant difference was found between 1st and 5th day measurements only at 3,996 Hz frequency. No significant differences were noted between the measurements either in the resveratrol or in the control groups. According to these results, cisplatin-related ototoxicity has been greatly prevented by resveratrol use. PMID:22186767
Erdem, T; Bayindir, Tuba; Filiz, A; Iraz, M; Selimoglu, E
The study was conducted from November 1995 to May 1996 at the one general hospital in Seoul. The total subjects of this study were 412 patients who have the experience of fall accident, among them 31 was who have fallen during hospitalization and 381 was who visited emergency room and out patient clinic. The purposes of this study were to determine the characteristics, risk factors and results of fall accident and to suggest the nursing strategies for prevention of fall. Data were collected by reviewing the medical records and interviewing with the fallers and their family members. For data analysis spss/pc+ program was utilized for descriptive statistics, adjusted standardized X2-test. The results of this study were as follows: 1) Total subjects were 412 fallers, of which 245 (59.5%) were men and 167 (40.5%) were women. Age were 0-14 years 79 (19.2%), 15-44 years 125 (30.4%), 45-64 years 104 (25.2%), over 65 years 104 (25.2%). 2) There was significant association between age and the sexes (X2 = 39.17, P = 0.00). 3) There was significant association between age and history of falls (X2 = 44.41, P = .00). And history of falls in the elderly was significantly associated with falls. 4) There was significant association with age and medical diagnosis (X2 = 140.66, P = .00), chief medical diagnosis were hypertension (34), diabetes mellitus (22), arthritis (11), stroke (8), fracture (7), pulmonary tuberculosis (6), dementia (5) and cataract (5). 5) There was significant association between age and intrinsic factors: cognitive impairment, mobility impairment, insomnia, emotional problems, urinary difficulty, visual impairments, hearing impairments, use of drugs (sedatives, antihypertensive drugs, diuretics, antidepressants) (P < 0.05). But there was no significant association between age and dizziness (X2 = 2.87, P = .41). 6) 15.3% of total fallers were drunken state when they were fallen. 7) Environmental factors of fall accident were unusual posture (50.9%), slips (35.2%), trips (9.5%) and collision (4.4%). 8) Most of falls occurred during the day time, peak frequencies of falls occurred from 1 pm to 6 pm and 7 am to 12 am. 9) The places of fall accident were roads (22.6%), house-stairs (16.7%), rooms, floors, kitchen (11.2%), the roof-top, veranda, windows (10.9%), hospital (7.5%), ice or snowy ways (5.8%), bathroom (4.9%), playground, park (4.9%), subway-stairs (4.4%) and public-bathrooms (2.2%). 10) Activities at the time of fall accident were walking (37.6%), turning around or reaching for something (20.9%), going up or down stairs (19.2%), exercise, working (17.4%), up or down from a bed (2.7%), using wheelchair or walking aids, standing up or down from a chair (2.2%) and standing still (2.2%). 11) Anatomical locations of injuries by falls were head, face, neck (31.3%), lower extremities (29.9%), upper extremities (20.6%), spine, thorax, abdomen or pelvic contents (11.4%) and unspecified (2.9%). 12) Types of injures were fracture (47.6%), bruises (13.8%), laceration (13.3%), sprains (9.0%), headache (6.6%), abrasions (2.9%), intracranial hemorhage (2.4%) and burns (0.5%). 13) 41.5% of the fallers were hospitalized and average of hospitalization was 22.3 days. 14) The six fallers (1.46%) died from fall injuries. The two fallers died from intracranial hemorhage and the four fallers died of secondary infection; pneumonia (2), sepsis (1) and cellulitis (1). It is suggested that 1) Further study is needed with larger sample size to identify the fall risk factors. 2) After the fall accident, comprehensive nursing care and regular physical exercise should be emphasized for the elderly person. 3) Safety education and safety facilities of the public place and home is necessary for fallprevention. PMID:10437605
Objective To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. Design A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. Measurements Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time–motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of FallPrevention Subscale). Results Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive ‘head data’, temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. Conclusion Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.
Falls are a serious health problem in people over 65-years-old. It is estimated that one out of every three people in this population fall each year. Furthermore, 85% of falls occur in the home as a result of preventable extrinsic risk factors. Currently, there is limited research evaluating seniors awareness of fallprevention within the home. The purpose of this
FG5 absolute gravimeters are the most accurate gravimeters available at present and have significant influence on the realization of a gravity reference through international comparisons of absolute gravimeters. The latter comparisons are the only way to maintain the traceability of absolute gravimetry to the International System of Units (SI). Sources of systematic error such as the self-attraction effect (SAE) have to be taken into account when determining accurate values of the acceleration due to gravity, as needed, for example, for the watt balance project or the International Gravity Reference System. In this paper the SAE for two types of FG5 gravimeter is estimated using two independent methods. The resulting SAEs are 1.2(0.2) µGal and 1.7(0.2) µGal for FG5 with fibre and bulk interferometer types, respectively. The importance of accurately defining the measurement height is emphasized in the context of the SAE. The accuracy and advantages of referring gravity measurements to an effective position of the free-fall solution are demonstrated together with a simple and accurate empirical estimation of this effective position.
Walkers fall frequently, especially during infancy. Children (15, 21, 27, 33, and 39 month-olds) and adults were tested in a novel foam pit paradigm to examine age-related changes in the relationship between falling and prospective control of locomotion. In trial 1, participants walked and fell into a deformable foam pit marked with distinct…
Learners engage in close observation of falling objects. They determine it is the amount of air resistance, not the weight of an object, which determines how quickly an object falls. This demonstration and activity can be combined with other activities to create a larger lesson. Resource contains vocabulary definitions and suggestions for assessment, extensions, and scaling for different levels of learners.
OBJECTIVES: Despite the widespread promotion of safety standards no epidemiological studies have adequately evaluated their effectiveness in preventing injury in falls from playground equipment. This study evaluated the effectiveness of the height and surfacing requirements of the New Zealand standard for playgrounds and playground equipment. SETTING: Early childhood education centres and schools in two major cities in the South Island
D. J. Chalmers; S. W. Marshall; J. D. Langley; M. J. Evans; C. R. Brunton; A. M. Kelly; A. F. Pickering
SUMMARY Large disturbances can cause a biped to fall. If an upcoming fall can be detected, damage can be minimized or the fall can be prevented. We introduce the multi-way principal component analysis (MPCA) method for the detection of upcoming falls. We study the detection capability of the MPCA method in a simulation study with the simplest walking model. The
Summary Falls are widely recognized as a social problem due to the related economic burden on public health budgets. Following the growing body of evidences on the physiopathology of postural control in humans, many factors leading to falls are already well established in the literature. Given the high prevalence of falls among elderly people, the present review focuses on parkinsonism and those “mild parkinsonian signs” frequently presented by elderly subjects. Parkinsonism is a good paradigm for the understanding of the pathophysiology of falling. Specifically, parkinsonian patients display specific features related to falls, such as axial motor symptoms, the impairment of executive functions and of the interplay between motion and cognition, as revealed by the disruption of automaticity.
A mechanistic explanation for previously observed safety improvements with microprocessor-controlled prosthetic knees is needed. A repeated measures design of 15 subjects with unilateral transfemoral amputation was used to assess changes between baseline use of their standard of care, mechanical pros-theses, and a C-Leg microprocessor-controlled prosthetic knee. The primary outcome measures were sensory dependency scores for somatosensory, visual, vestibular, and visual preference, which were calculated based on a Sensory Organization Test. Falls during posturographic assessment were also recorded. Somatosensory system dependency significantly increased (p = 0.047) while using the C-Leg compared to a nonmicroprocessor prosthetic knee (NMPK). Reliance on visual with vestibular input and reliance on vestibular input alone were not significantly increased with C-Leg use (p = 0.41 and p = 0.15, respectively). When utilizing the C-Leg, there was a significant reduction in the average number of falls (p = 0.03). Hence, increased reliance on somatosensory input is a possible explanation for improved balance with use of a microprocessor prosthetic knee (MPK).
Highsmith, M. Jason; Kahle, Jason T.; Shepard, Neil T.; Kaufman, Kenton R.
141. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, IDAHO; CLOSE-UP OF MAIN HEADGATES, RADIAL GATES INSIDE, SOUTHEAST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
97. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; OVERALL WEST VIEW FROM CANAL SIDE. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
99. POINT SPILL, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; CLOSE-UP OF OUTLET SIDE OF GATES, SOUTH VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
98. SHOESTRING, TWIN FALLS MAIN CANAL, TWIN FALLS COUNTY NORTHWEST OF MURTAUGH, IDAHO; PROFILE VIEW, SOUTH. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
148. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER DAM; HEADGATES AT INLET, SOUTHWEST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
147. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER, IDAHO; VIEW OF MAIN HEADGATES, EAST VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
149. TWIN FALLS MAIN CANAL DIVERSION, TWIN FALLS COUNTY, MILNER DAM; CLOSE-UP OF MAIN CANAL GATES, SOUTH VIEW. - Milner Dam & Main Canal: Twin Falls Canal Company, On Snake River, 11 miles West of city of Burley, Idaho, Twin Falls, Twin Falls County, ID
We argue it is important regularly to take stock of what makes primary prevention and promotion programs in mental health effective and to use this information to guide future program design, implementation, and evaluation. Based upon a review of diverse program evaluations, including meta-analyses and best practices approaches, we identify 10 distinct (but interdependent) characteristics of effective primary prevention and
Background: studies of the effectiveness of alternating pressure air mattresses (APAMs) for the prevention of pressure ulcers are scarce and in conflict. Objective: evaluating whether an APAM is more or equally effective as the standard prevention. Design: randomised controlled trial. Setting and subjects: patients admitted to 19 surgical, internal, or geriatric wards in seven Belgian hospitals were included if they
KATRIEN VANDERWEE; MARIA H. F. GRYPDONCK; TOM DEFLOOR
Phishing attacks exploit users' inability to distinguish legitimate websites from fake ones. Strategies for combating phishing include: prevention and detection of phishing scams, tools to help users identify phishing web sites, and training users not to fall for phish. While a great deal of effort has been devoted to the first two approaches, little research has been done in the
Ponnurangam Kumaraguru; Steve Sheng; Alessandro Acquisti; Lorrie Faith Cranor; Jason I. Hong
Youth with sexual behavior problems pose a complicated challenge to the society. Yet the society has succeeded in developing only a limited range of actions and attitudes to grapple with and prevent this problem. Very few of the social service and criminal justice systems have rallied to create compassionate models that not only address and…
The prevalence of childhood obesity, as with that of adulthood, has increased considerably over the past few years and has become a serious public health problem. Once established, its treatment is very difficult and, hence, prevention of childhood obesity using different types of intervention appears promising. The objective of this present report is to review interventions that had been conducted
The prevalence of childhood obesity, as with that of adulthood, has increased considerably over the past few years and has become a serious public health problem. Once established, its treatment is very diffi- cult and, hence, prevention of childhood obesity using different types of intervention appears promising. The objective of this present report is to review interven- tions that had
Improving student attendance and truancy prevention have always been areas of concern for educators, as well as, community members, and legislators. Students who are not in school cannot learn, and frequently drop out. Truant students often engage in high-risk behaviors that eventually entangle them in the juvenile justice system. Since 1986, the…
Even though substance abuse prevention programs have been studied for more than two decades, outcome studies of programs focused on inner-city youth are rare. Communities with dense populations, low socio-economic conditions and a high degree of neighborhood disorganization are especially vulnerable to high rates of adolescent substance abuse. The goal of this study was to organize a coalition of neighborhood
This study evaluated benefits of a preventive intervention to the living standards of recently separated mothers. In the Oregon Divorce Study's randomized experimental design, data were collected 5 times over 30 months and evaluated with Hierarchical Linear Growth Models. Relative to their no-intervention control counterparts, experimental mothers…
In the United States, about 17% of adolescents meet diagnostic criteria for mental, emotional, and behavioral (MEB) disorders. Six million young people receive treatment services annually for mental, emotional, or behavioral problems. These problems affect one in five families and cost $247 million annually. Some strategies for preventing MEB…
Hawkins, J. David; Shapiro, Valerie B.; Fagan, Abigail A.
Adolescent pregnancy and parenting remains a pressing social and public health concern because the United States continues to have the highest teen pregnancy rate among Western developed nations and because of the attendant social, psychological, and physical problems for young parents and their children. Prevention efforts to reduce the incidence…
Teen depression and suicidal behaviors are intricately intertwined, with untreated depression being a leading cause of adolescent suicide. Most depressed or suicidal teens tend to show warning signs and possess specific risk factors. A key component to preventing teen depression is for adults to remain aware of such warning signs and risk factors…
What Happens Next?: Effect of plasticine on falling rods David Featonby Insights and Conundrums: de Broglie's wavelength has many applications in the study of gases Rick Marshall Signing Off: The life and work of Marie Curie David Smith
Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to preventfalls and increase mobility among older people.
Falls are a significant cause of traumatic brain injury (TBI). There has been little research into falls resulting in a TBI in adults under the age of 60. The authors retrospectively analysed consecutive referrals to their community rehabilitation service between 2009 and 2012 in order to determine whether falls are a common cause of TBI in adults under 60, the different types of falls, the presence of alcohol at the time of the fall, and return to work following TBI. Falls accounted for 25 % of TBI. Ground-level falls and falls down stairs were the main causes of falls leading to TBI. Alcohol was present in 30 % of the falls. 44 % of individuals who had been working prior to their fall related-TBI had returned to work 1 year post-TBI. The authors conclude that falls amongst adults under sixty is an important cause of traumatic brain injury, and requires preventative and reduction strategies. PMID:23963854
The EJS Falling Loop Model shows a conducting loop falling out of a uniform magnetic field. Users can change the size and orientation of the loop. If Ejs is installed, right-clicking within the plot and selecting âOpen Ejs Modelâ from the pop-up menu item allows for editing of the model. The Falling Loop model was created using the Easy Java Simulations (Ejs) modeling tool. It is distributed as a ready-to-run (compiled) Java archive. Double clicking the ejs_em_FallingLoop.jar file will run the program if Java is installed. Ejs is a part of the Open Source Physics Project and is designed to make it easier to access, modify, and generate computer models. Additional Ejs models are available. They can be found by searching ComPADRE for Open Source Physics, OSP, or Ejs.
From the fall's cascade of great new books, "Library Journal's" editors select their favorites--a dark rendition of Afghan life, a look at the "self-esteem trap," a celebration of Brooklyn activism, and much more.
Presents a secondary school lesson based on the Seneca Falls Declaration of Sentiments. Provides lesson objectives and step-by-step instructional procedures. Includes quoted sections of the Declaration of Sentiments. (CFR)
The Falling in Fluid model shows a sphere falling through a fluid. The sphere is acted on by gravitational, buoyant, and viscous drag forces acting at the interface between the fluid and the object. At high speed, the drag force is proportional to the square of the speed whereas at low speed it is proportional to the speed. These regimes are characterized by the Reynolds number and this model computes the viscous drag force using a phenomenological equation that depends on the Reynolds number. The Falling in Fluid model was created using the Easy Java Simulations (EJS) modeling tool. It is distributed as a ready-to-run (compiled) Java archive. Double clicking the ejs_mech__fluids_FallingInFluid.jar file will run the program if Java is installed.
This fun and simple hands-on astronomy activity lets learners experiment with a bucket, stretchy fabric, marbles, and weights to discover some basics about gravity. Learners will explore how mass curves space, how an object with more mass will curve more space, why things fall to Earth, and why all objects, regardless of their mass, will fall at the same rate into the same massive object. The pdf contains step-by-step instructions, photos, presentation tips, and links to background information.
... and burns, suffocation, drowning, choking, falls, poisoning, and firearms. According to the Centers for Disease Control and ... Preventing Injuries in the Crib Preventing Injuries From Firearms Reviewed by: Mary L. Gavin, MD Date reviewed: ...
Hospital inpatient falls are among the most frequently reported incidents and are a significant cause of hospital-acquired injuries. Many inpatient falls cause little or no harm, but falls can sometimes lead to severe injuries (e.g., hip fractures, head t...
Universal community-oriented interventions are an important component in the prevention of youth health and behavior problems. Testing the universality of the effects of an intervention that was designed to be universal is important because it provides information about how the program operates and for whom and under what conditions it is most effective. The present study examined whether the previously established significant effects of the universal, community-based Communities That Care (CTC) prevention program on the prevalence of substance use and the variety of delinquent behaviors held equally for boys and girls and in risk-related subgroups defined by early substance use, early delinquency, and high levels of community-targeted risk at baseline. Interaction analyses of data from a panel of 4,407 students followed from Grade 5 to Grade 8 in the first randomized trial of CTC in 12 matched community pairs suggests that CTC reduced students' substance use and delinquency equally across risk-related subgroups and gender, with two exceptions: the effect of CTC on reducing substance use in 8th grade was stronger for boys than girls and the impact of CTC on reducing 8th-grade delinquency was stronger for students who were nondelinquent at baseline.
Oesterle, Sabrina; Hawkins, J. David; Fagan, Abigail A.; Abbott, Robert D.; Catalano, Richard F.
Universal community-oriented interventions are an important component in the prevention of youth health and behavior problems. Testing the universality of the effects of an intervention that was designed to be universal is important because it provides information about how the program operates and for whom and under what conditions it is most effective. The present study examined whether the previously established significant effects of the universal, community-based Communities That Care (CTC) prevention program on the prevalence of substance use and the variety of delinquent behaviors held equally for boys and girls and in risk-related subgroups defined by early substance use, early delinquency, and high levels of community-targeted risk at baseline. Interaction analyses of data from a panel of 4,407 students followed from Grade 5 to Grade 8 in the first randomized trial of CTC in 12 matched community pairs suggests that CTC reduced students' substance use and delinquency equally across risk-related subgroups and gender, with two exceptions: The effect of CTC on reducing substance use in 8th grade was stronger for boys than girls and the impact of CTC on reducing 8th-grade delinquency was stronger for students who were nondelinquent at baseline. PMID:20422289
Oesterle, Sabrina; Hawkins, J David; Fagan, Abigail A; Abbott, Robert D; Catalano, Richard F
The world is clearly a very troubled place. Many problems contributing to this trouble, such as climatic changes, effects of global war, geophysical disasters, etc., are the concern and come under the purview of members of AGU. Within this context, it was clear at the last AGU Fall Meeting that the matter uppermost in most members minds was the large number of parallel sessions.In light of the overwhelming importance ascribed to this issue, I have devoted considerable thought as to how to solve this overcrowding. Putting aside for the moment the issue of whether or not the recent Cathedral Hill Hotel fire was a sign from on high in this matter, I wish to pursue what we, as a Union, can do to solve the problem. Remarkably enough, the Meetings Committee had already apparently perceived the nature of the solution (although dimly) and had stumbled upon a form of my result in a different context. It is perhaps worthwhile for me to review this previous situation prior to presenting my ideas for the West Coast meeting.
... by a player, they should be of approved construction with non-shattering glass (safety glass). Contact lenses ... prepared to begin participating in fall sports. During practices, have children take frequent water breaks to prevent ...
In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance – the most important element in fallsprevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life.
In prevention and management of osteoporosis, modern rehabilitation should focus on how to increase muscular and bone strength. Resistance exercises are beneficial for muscle and bone strength, and weight-bearing exercises help maintain fitness and bone mass. In subjects at higher risk for osteoporotic fractures, particular attention should be paid to improving balance - the most important element in fallsprevention. Given the close interaction between osteoporosis and falls, prevention of fractures should be based on factors related to bone strength and risk factors for falls. Fractures are the most serious complication of osteoporosis and may be prevented. The use of modern spinal orthosis helps to reduce pain and improve posture. Vibration platforms are used in rehabilitation of osteoporosis, based on the concept that noninvasive, short-duration, mechanical stimulation could have an impact on osteoporosis risk. Pharmacologic therapy should be added for those at high risk of fracture, and vitamin D/calcium supplementation is essential in all prevention strategies. Success of rehabilitation in osteoporotic and fractured subjects through an individualized educational approach optimizes function to the highest level of independence while improving the overall quality of life. PMID:24963273
In this article, we briefly summarize the incidence and significant consequences of falls among older adults, the insufficient effectiveness of commonly used multifactorial interventions and the evidence linking falls and cognitive function. Recent pharmacologic and nonpharmacologic studies that evaluated the effects of cognitive therapy on fall risk are reviewed. The results of this article illustrate the potential utility of multiple, diverse forms of cognitive therapy for reducing fall risk. The article also indicates that large-scale, randomized controlled trials are warranted and that additional research is needed to better understand the pathophysiologic mechanisms underlying the interplay between human mobility, fall risk and cognitive function. Nonetheless, we suggest that multimodality interventions that combine motor and cognitive therapy should, eventually, be incorporated into clinical practice to enable older adults and patients to move safer and with a reduced fall risk.
Falls are common in the elderly, and potentially result in injury and disability. Thus, preventingfalls as soon as possible in older adults is a public health priority, yet there is no specific marker that is predictive of the first fall onset. We hypothesized that gait features should be the most relevant variables for predicting the first fall. Clinical baseline characteristics (e.g., gender, cognitive function) were assessed in 259 home-dwelling people aged 66 to 75 that had never fallen. Likewise, global kinetic behavior of gait was recorded from 22 variables in 1036 walking tests with an accelerometric gait analysis system. Afterward, monthly telephone monitoring reported the date of the first fall over 24 months. A principal components analysis was used to assess the relationship between gait variables and fall status in four groups: non-fallers, fallers from 0 to 6 months, fallers from 6 to 12 months and fallers from 12 to 24 months. The association of significant principal components (PC) with an increased risk of first fall was then evaluated using the area under the Receiver Operator Characteristic Curve (ROC). No effect of clinical confounding variables was shown as a function of groups. An eigenvalue decomposition of the correlation matrix identified a large statistical PC1 (termed “Global kinetics of gait pattern”), which accounted for 36.7% of total variance. Principal component loadings also revealed a PC2 (12.6% of total variance), related to the “Global gait regularity.” Subsequent ANOVAs showed that only PC1 discriminated the fall status during the first 6 months, while PC2 discriminated the first fall onset between 6 and 12 months. After one year, any PC was associated with falls. These results were bolstered by the ROC analyses, showing good predictive models of the first fall during the first six months or from 6 to 12 months. Overall, these findings suggest that the performance of a standardized walking test at least once a year is essential for fallprevention.
Background: The aging of the population is likely to increase the number of osteoporosis-related fractures, such as hip fractures, and hence the economic burden for society. Therefore, strategies to identify women at increased risk are of major interest. Objective: The aim of this study was to determine the cost effectiveness of preventive services for osteoporosis, comparing secondary plus tertiary prevention
The European Smoking Prevention Framework Approach (ESFA) study in six countries tested the effects of a comprehensive smoking prevention approach after 24 (T3; N = 10751) and 30 months (T4; N = 9282). The programme targeted four levels, i.e. adolescents in schools, school policies, parents and the community. In Portugal, 12.4% of the T1…
de Vries, Hein; Dijk, Froukje; Wetzels, Joyce; Mudde, Aart; Kremers, Stef; Ariza, Carles; Vitoria, Paulo Duarte; Fielder, Anne; Holm, Klavs; Janssen, Karin; Lehtovuori, Riku; Candel, Math
Objective: Although a variety of sexual assault prevention programs are currently available to college health professionals, there is a dearth of information about the effect of these programs on sexual assault victimization rates. Participants: The authors evaluated the efficacy of a sexual assault prevention program for first-year students at a college in the Northeast (N = 1,982). Methods: They used
One in five students report experimenting with tobacco before the age of 13 and most prevention efforts take place in the school setting. This study measures the effect of a single-lesson tobacco prevention curriculum, conducted by a health education center, focusing on knowledge of tobacco, ability to identify refusal techniques, and intent not…
This paper focuses on the evidence for the effectiveness of community-based outreach intervention as one component of a comprehensive HIV prevention model for preventing HIV infection in injecting drug user (IDU) populations. Three empirical questions guided the review of the evidence. This article includes primarily published literature on community-based outreach derived mostly from developing countries but also unpublished literature. Wherever
Richard H. Needle; Dave Burrows; Samuel R. Friedman; Jimmy Dorabjee; Graziele Touzé; Larissa Badrieva; Jean-Paul C. Grund; Munirathinam Suresh Kumar; Luciano Nigro; Greg Manning; Carl Latkin
Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB…
Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.
This study examined the effects of in-service training with performance feedback on preschool teachers' use of classroom preventive practices. Three practices designed to prevent challenging behavior were selected: transition preparations, rule reminders, and social-emotional teaching strategies. Following a brief training on each practice,…
All women face the threat of rape, forcing them to (a) decide what to do to reduce their chances of being assaulted (rape prevention) and (b) how to defend themselves if assaulted (self-defense). A principal basis for such decisions should be women's estimates of the effectiveness of possible prevention and self-defense strategies for reducing the risk of rape. This study
School-based prevention programs are an important component of problem gambling prevention, but empirically effective programs are lacking. Stacked Deck is a set of 5-6 interactive lessons that teach about the history of gambling; the true odds and "house edge"; gambling fallacies; signs, risk factors, and causes of problem gambling; and skills…
Williams, Robert J.; Wood, Robert T.; Currie, Shawn R.
OBJECTIVE — In the Indian Diabetes Prevention Programme (IDPP), a 3-year randomized, controlled trial, lifestyle modification (LSM) and metformin helped to prevent type 2 diabetes in subjects with impaired glucose tolerance (IGT). The direct medical costs and cost-effectiveness of the interventions relative to the control group are reported here. RESEARCH DESIGN AND METHODS — Relative effectiveness and costs of interven-
AMBADY RAMACHANDRAN; CHAMUKUTTAN SNEHALATHA; ANNASAMI YAMUNA; SIMON MARY; ZHANG PING
Falls remain a leading cause of unintentional injury mortality nationwide [corrected].Among workers, approximately 20% of fall injuries involve ladders. Among construction workers, an estimated 81% of fall injuries treated in U.S. emergency departments (EDs) involve a ladder. To fully characterize fatal and nonfatal injuries associated with ladder falls among workers in the United States, CDC's National Institute for Occupational Safety and Health (NIOSH) analyzed data across multiple surveillance systems: 1) the Census of Fatal Occupational Injuries (CFOI), 2) the Survey of Occupational Injuries and Illnesses (SOII), and 3) the National Electronic Injury Surveillance System-occupational supplement (NEISS-Work). In 2011, work-related ladder fall injuries (LFIs) resulted in 113 fatalities (0.09 per 100,000 full-time equivalent [FTE] workers), an estimated 15,460 nonfatal injuries reported by employers that involved ?1 days away from work (DAFW), and an estimated 34,000 nonfatal injuries treated in EDs. Rates for nonfatal, work-related, ED-treated LFIs were higher (2.6 per 10,000 FTE) than those for such injuries reported by employers (1.2 per 10,000 FTE). LFIs represent a substantial public health burden of preventable injuries for workers. Because falls are the leading cause of work-related injuries and deaths in construction, NIOSH, the Occupational Safety and Health Administration, and the Center for Construction Research and Training are promoting a national campaign to prevent workplace falls. NIOSH is also developing innovative technologies to complement safe ladder use. PMID:24759655
Socias, Christina M; Chaumont Menéndez, Cammie K; Collins, James W; Simeonov, Peter
Prepaid, case managed systems have been proposed as a method of controlling costs in Medicaid populations. We investigated the utilization of preventive services in two prepaid Medicaid Competition Demonstration programs in Santa Barbara County, Calif., and Jackson County, Mo. (containing the city of Kansas City). Care in the demonstration sites was compared with care given in similar counties functioning under a traditional fee-for-service Medicaid system--Ventura County, Calif., and St Louis, Mo. We tested the hypothesis that preventive care would be less in the capitated demonstrations. 2735 Children's and 3389 adult's charts were abstracted for care received during the calendar year 1985, after the prepaid demonstration had been in place for more than 1 year. No significant differences were found between the demonstration and comparison counties in the proportion of children with complete DPT or OPV immunizations at 1 year of age, with 56% complete in both California counties and 69 and 65% complete in Jackson County and St Louis, respectively. Regression analysis demonstrated a slight, but statistically significant trend towards more immunizations in the demonstration counties. Pap smear use in women of 15-44 years of age was little different in the California counties, but significantly greater in the Jackson County demonstration in Missouri (64 vs 45%). Physician breast examinations were somewhat more likely to occur in the prepaid, case managed demonstration counties. Capitated, case managed systems for the AFDC Medicaid population appear to result in no diminution of preventive services. Substantial problems exist in this, as in other poor populations, in childhood immunizations. PMID:2243257
Flaming Gorge Dam, a hydroelectric facility operated by the Bureau of Reclamation (Reclamation), is located on the Green River in Daggett County, northeastern Utah. In recent years, single peak releases each day or steady flows have been the operational pattern during the winter period. A double-peak pattern (two flow peaks each day) was implemented during the winter of 2006-2007 by Reclamation. Because there is no recent history of double-peaking at Flaming Gorge Dam, the potential effects of double-peaking operations on the body condition of trout in the dam's tailwater are not known. A study plan was developed that identified research activities to evaluate potential effects from double-peaking operations during winter months. Along with other tasks, the study plan identified the need to conduct a statistical analysis of existing data on trout condition and macroinvertebrate abundance to evaluate potential effects of hydropower operations. This report presents the results of this analysis. We analyzed historical data to (1) describe temporal patterns and relationships among flows, benthic macroinvertebrate abundance, and condition of brown trout (Salmo trutta) and rainbow trout (Oncorhynchus mykiss) in the tailwaters of Flaming Gorge Dam and (2) to evaluate the degree to which flow characteristics (i.e., flow volumes and flow variability) and benthic macroinvertebrate abundance affect the condition of trout in this area. This information, together with further analyses of size-stratified trout data, may also serve as baseline data to which the effects of potential future double-peaking flows can be compared. The condition (length, weight and/or relative weight) of rainbow trout (Oncorhynchus mykiss) at two sites in the Green River downstream of Flaming Gorge Dam (Tailrace and Little Hole) and weight of brown trout (Salmo trutta) at the Little Hole site has been decreasing since 1990 while the abundance of brown trout has been increasing at the two sites. At the same time, flow variability in the river has decreased and the abundance of total benthic macroinvertebrates at the Tailrace site has increased. The condition of trout in spring (averaged across all sampled trout) was positively correlated with fall and winter flow variability (including within-day skewness, within-season skewness and/or change in flow between days) at both locations. No negative correlations between trout condition and any measure of flow variability were detected. The length and weight of rainbow trout at the Little Hole site were negatively correlated with increasing fall and winter flow volume. The condition of brown trout at Little Hole and the condition of brown and rainbow trout at Tailrace were not correlated with flow volume. Macroinvertebrate variables during October were either positively correlated or not correlated with measures of trout condition at the Tailrace and Little Hole sites. With the exception of a positive correlation between taxa richness of macroinvertebrates in January and the relative weight of brown trout at Tailrace, the macroinvertebrate variables during January and April were either not correlated or negatively correlated with measures of trout condition. We hypothesize that high flow variability increased drift by dislodging benthic macroinvertebrates, and that the drift, in turn, resulted in mostly lower densities of benthic macroinvertebrates, which benefited the trout by giving them more feeding opportunities. This was supported by negative correlations between benthic macroinvertebrates and flow variability. Macroinvertebrate abundance (with the exception of ephemeropterans) was also negatively correlated with flow volume. The change in trout condition from fall to spring, as measured by the ratio of spring to fall relative weight, was evaluated to determine their usefulness as a standardized index to control for the initial condition of the fish as they enter the winter period. The ratio values were less correlated with the fall condition values than the spring condition values and did not show the same re
Magnusson, A. K.; LaGory, K. E.; Hayse, J. W.; Environmental Science Division
In 1991, treatment with low dose intramuscular desferrioxamine (DFO), a trivalent chelator that can remove excessive iron and/or aluminum from the body, was reported to slow the progression of Alzheimer’s disease (AD) by a factor of two. Twenty years later this promising trial has not been followed up and why this treatment worked still is not clear. In this critical interdisciplinary review, we provide an overview of the complexities of AD and involvement of metal ions, and revisit the neglected DFO trial. We discuss research done by us and others that is helping to explain involvement of metal ion catalyzed production of reactive oxygen species in the pathogenesis of AD, and emerging strategies for inhibition of metal-ion toxicity. Highlighted are insights to be considered in the quests to prevent potentially toxic effects of aluminum toxicity and prevention and intervention in AD.
Percy, Maire E.; Kruck, Theo P.A.; Pogue, Aileen I.; Lukiw, Walter J.
Background Topical steroid treatment induces diverse local Wand systemic adverse effects. Several approaches have been tried to reduce the steroid-induced adverse effects. Simultaneous application of physiological lipid mixture is also suggested. Objective Novel vehicles for topical glucocorticoids formulation were evaluated for the efficacy of reducing side-effects and the drug delivery properties of desonide, a low potency topical steroid. Methods Transcutaneous permeation and skin residual amount of desonide were measured using Franz diffusion cells. The in vivo anti-inflammatory activity was evaluated using murine model. Results Topical steroids formulation containing desonide, in either cream or lotion form, were prepared using multi-lamellar emulsion (MLE), and conventional desonide formulations were employed for comparison. MLE formulations did not affect the anti-inflammatory activity of the desonide in phobol ester-induced skin inflammation model, compared with conventional formulations. While the penetrated amounts of desonide were similar for all the tested formulations at 24 hours after application, the increased lag time was observed for the MLE formulations. Interestingly, residual amount of desonide in epidermis was significantly higher in lotion type MLE formulation. Steroid-induced adverse effects, including permeability barrier function impairment, were partially prevented by MLE formulation. Conclusion Topical desonide formulation using MLE as a vehicle showed a better drug delivery with increased epidermal retention. MLE also partially prevented the steroid-induced side effects, such as skin barrier impairment.
Sul, Geun Dong; Park, Hyun Jung; Bae, Jong Hwan; Hong, Keum Duck; Park, Byeong Deog; Chun, Jaesun; Jeong, Se Kyoo; Lee, Seung Hun; Ahn, Sung Ku
The prevention of fractures amongst older people consists of (i) prevention and treatment of osteoporosis, (ii) prevention of falling and (iii) prevention of fractures using injury-site protection. As the great majority of hip fractures are caused by a sideways fall with direct impact on the greater trochanter of the proximal femur, one approach to prevention is the use of an adequately configured padded, firm-shield external hip protector. With this type of two-part design, the impacting force and energy are, at the time of the fall-impact, first weakened by the padding part of the protector and then diverted away from the greater trochanter by the shield part of the same. Following this line, a series of consecutive studies by the Accident & Trauma Research Center at the UKK Institute, Tampere, Finland, found that a padded, strong-shield hip protector was effective in preventing hip fractures. In the context of the wider literature on hip protectors, these more encouraging results suggest the need for a more rigorous regulation of protector design and characteristics. Alongside inadequacies of design, the other most frequent general problem with hip protectors is compliance. Not all elderly people with a high risk of hip fracture will agree to use hip protectors and in those who do, long-term adherence may decrease. Caregiver motivation and involvement appear therefore to be crucial. PMID:16926206
The dependence of stress and sex hormone levels, size of mid-ventral skin gland, and body mass of young males on the presence in social groups of adult gerbils (>1 year old) were studied during the fall of 1999 in the non-breeding high density population of the great gerbil (Rhombomys opimus Licht; Bukhara region, Uzbekistan). Contents of corticosterone and testosterone in fecal samples collected from young males in the field were analyzed by non-invasive radioimmunoassay. The fall gerbil groups with adults were of larger size than those without adults. The total number of individuals in a group is positively correlated with concentration of corticosterone in feces of young males. Presence of adult male and especially of adult female suppresses maturation of juvenile males indicated by size of the androgene-dependent mid-ventral gland, but accelerates their total growth. Thus, the social environment influences morpho-physiological characters of young males, effecting rate of their maturation directly or indirectly through the density dependent stress. PMID:15559573
Rogovin, K A; Randall, J A; Kolosova, I E; Vasil'eva, N Iu; Moshkin, M P
This study evaluated the effectiveness of the falling weight deflectometer (FWD) for determining the presence of voids under concrete pavement slabs at bridge approach locations. It also evaluated the deflection improvement, after the slabs with voids had...
In this paper, experimental analysis was performed for ammonia-water falling film absorption process in a plate heat exchanger with enhanced surfaces such as offset strip fin. This paper examined the effect of vapor flow characteristics, inlet subcooling of the liquid flow and inlet concentration difference on heat and mass transfer performance. The inlet liquid concentration was kept constant at 0% while the inlet vapor concentration was varied from70. 36 to 77.31% It was found that before absorption started there was rectification process at the top of the test section by the inlet subcooling effect. Water desorption phenomenon was found near the bottom of test section. The lower inlet liquid temperature, the higher Nusselt and Sherwood numbers were obtained. NusseIt and Sherwood correlations were developed as functions of vapor Reynolds number ReV, inlet subcooling and inlet concentration difference with ±10% and ±5% error bands, respectively.
This non-randomized, controlled trial assessed the effects of ceasing fall-risk-increasing drugs (FRIDs) (psychotropics or opiates or potent anticholinergics) on the risk of falls requiring medical treatment as a sub-analysis of a randomized, controlled multifactorial fallprevention. The population in this 12-month study consisted of 528 community-dwelling subjects aged 65 years or older with a history of at least one fall. The subjects were divided retrospectively into three groups according to the use of any FRID, any psychotropic drug, and benzodiazepine or related drug (BZD/BZDRD). The subjects in the intervention group (IG) ceasing the drug use were compared with the subjects in IG and the control group (CG) not ceasing the use of the corresponding type of drugs during the intervention period. Falls were recorded from medical records. For the year after the 12-month intervention the relative risk ratio (with 95% confidence intervals=CI) for controls in CG compared with the withdrawal group in IG was 8.26 (1.07-63.73) among the users of psychotropics and 8.11 (1.03-63.60) among the users of BZDs/BZDRDs. Withdrawal of psychotropics, especially BZDs/BZDRDs may have played an important role by lowering the risk of falls requiring medical treatment during the year after the 12-month multifactorial intervention. PMID:21420744
Salonoja, M; Salminen, M; Vahlberg, T; Aarnio, P; Kivelä, S-L
Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide. PMID:20724686
Gibson, David R; Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M
Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide.
Zhang, Guili; Cassady, Diana; Pappas, Les; Mitchell, Joyce; Kegeles, Susan M.
Stroke is the third most common cause of death in the US. Primary prevention of stroke can be achieved by control of risk factors including hypertension, diabetes mellitus, elevated cholesterol levels and smoking. Approximately one-third of all ischaemic strokes occur in patients with a history of stroke or transient ischaemic attack (TIA). The mainstay of secondary prevention of ischaemic stroke is the addition of medical therapy with antithrombotic agents to control the risk factors for stroke. Antithrombotic therapy is associated with significant medical complications, particularly bleeding.Low-dose aspirin (acetylsalicylic acid) has been shown to be as effective as high-dose aspirin in the prevention of stroke, with fewer adverse bleeding events. Aspirin has been shown to be as effective as warfarin in the prevention of noncardioembolic ischaemic stroke, with significantly fewer bleeding complications. Ticlopidine may be more effective in preventing stroke than aspirin, but is associated with unacceptable haematological complications. Clopidogrel may have some benefit over aspirin in preventing myocardial infarction, but has not been shown to be superior to aspirin in the prevention of stroke. The combination of clopidogrel and aspirin may be more effective than aspirin alone in acute coronary syndromes, but the incidence of adverse bleeding is significantly higher. Furthermore, the combination of aspirin with clopidogrel has not been shown to be more effective for prevention of recurrent stroke than clopidogrel alone, while the rate of bleeding complications was significantly higher with combination therapy. The combination of aspirin and extended-release dipyridamole has been demonstrated to be more effective than aspirin alone, with the same rate of adverse bleeding complications as low-dose aspirin. When selecting the appropriate antithrombotic agent for secondary prevention of stroke, the adverse event profile of the drug must be taken into account when assessing the overall efficacy of the treatment plan. PMID:15733010
Multiple options are now available for prophylaxis of AIDS-related opportunistic infections. The authors' goal was to determine the clinical impact, cost, and cost-effectiveness of strategies for preventing opportunistic infections in patients with advanc...
A. D. Paltiel D. E. Craven G. R. Seage K. A. Freedberg L. Sullivan M. C. Weinstein
Previous research has developed a new embedded system, called iFall, for the detection of unexpected falls for elderly people. This paper reports a larger set of fall experiments that have been done in laboratory setups, similar to typical real-world experiments. These experiments indicate that with monitoring its own rotation along any axis, iFall is able to detect a fall in
Riparian vegetation on channel bars and banks can significantly influence flow, sediment transport, and channel morphology within fluvial systems. Changes in flow and sedimentation, caused by vegetation, may reciprocally affect biological stability and growth. Model predictions were tested against field-scale measurements obtained within the Outdoor StreamLab~(OSL) at the St. Anthony Falls Laboratory~(SAFL). Two floodway basins adjacent to SAFL's main building are being transformed into a new outdoor laboratory to study physical, chemical, and biological interactions among a channel, its floodplain, and wetland vegetation. Experiments were conducted within a 3-m-wide, 30-cm-deep, and 50-m-long sand-bed meandering channel constructed within the first of two OSL basins, which has a total length of 40~m and a total width of 20~m. Water discharge varied between 36 ± 6~L/s at base flow to 210 ± 20~L/s during weekly 9-hour-long bankfull flood events. Bed sediment (d50 = 0.7~mm) was also metered continuously into the channel. When constructed, the bed was flat, but beginning with the first flood event the streamflow created point bars on the inside of two replicate meander bends. Seedlings of native wetland vegetation species, including Juncus effusus and Scirpus atrovirens, were planted from the baseflow waterline to the top of bank along one side of the meandering channel, including all exposed areas of one point bar. Vegetation frontal area was measured in situ using photographs of the vegetation against a red board. Bed erosion was quantified as the time for a thin layer of sediment to be removed from flexible contrasting-color tiles mounted flush with the bed surface. All trials were repeated at different neighboring locations to sample the spatial heterogeneity at the stem scale. Erosion rates were significantly higher on the inside of meander bends, when compared both to the outside of meander bends and to riffle (straight) reaches. Moreover, in all of these locations erosion rates were lower when aquatic vegetation was present. Results suggest that the velocity within a patch of vegetation correlates with the potential for sediment trapping within the patch.
Lightbody, A.; Rominger, J. T.; Nepf, H. M.; Paola, C.
Rehabilitation nurses are in a critical position to lead interdisciplinary team fallprevention management, including injury risk reduction. This article provides an update for rehabilitation nurses on evidence-based strategies to reduce patients'risk of fall-related injuries. This content builds on existing literature by focusing on knowledge to promote patient responses that reduce the risk of falls and ultimately fall-related injuries. Although rehabilitation nurses understand the complex nature of falls, addressing the intrinsic and extrinsic risk factors that increase the risk of fall-related injuries requires both individually based treatment programs and a system-wide commitment. A plethora of literature discusses fall risks and falls, but this article profiles the at-risk patient and describes current and emerging evidence-based interventions to protect patients from fall-related injuries by reducing risk factors. This discussion is limited to exercise, environmental redesign, osteoporosis prevention, and hip protectors. PMID:17514996
Measurements have been made of the fall speeds and masses of a large number of different types of solid precipitation particles. Particular attention is paid to the effects of riming and aggregation on the fall speeds and masses. Empirical expressions are given for the relationships between fall speeds and maximum dimensions and between masses and maximum dimensions for the particles
Allogeneic hematopoietic cell transplantation has developed into a most successful form of immunotherapy for hematologic malignancies\\u000a in the past 50 years. However, its effectiveness and wider applications have been greatly limited by the development of graft-versus-host\\u000a disease (GVHD), a potentially lethal side effect associated with this procedure. Since the main effectors for both graft-versus-leukemia\\u000a (GVL) effect and GVHD are T lymphocytes
Presents an activity that connects art, science, and nature in which elementary school students learn about deciduous trees. Explains that students create a torn-tissue collage, using fall colors for a background and drawing a silhouette of a tree without leaves on top of the background with black crayon. (CMK)
In 1985, College of the Sequoias (COS) was asked by the Cooperative Institutional Research Program (conducted jointly by the American Council on Education and the University of California, Los Angeles) to participate in a survey of incoming freshmen for the fall 1985 semester. During the summer counseling session, 259 new COS freshmen were…
BACKGROUND: After more than 25 years, public health programs have not been able to sufficiently reduce the number of new HIV infections. Over 7,000 people become infected with HIV every day. Lack of convincing evidence of cost-effectiveness (CE) may be one of the reasons why implementation of effective programs is not occurring at sufficient scale. This paper identifies, summarizes and
Omar Galárraga; M Arantxa Colchero; Richard G Wamai; Stefano M Bertozzi
The extent to which the occurrence of falls, the dominant feature of human attempts to balance a stick at their fingertip, can be predicted is examined in the context of the "Dragon-King" hypothesis. For skilled stick balancers, fluctuations in the controlled variable, namely the vertical displacement angle ?, exhibit power law behaviors. When stick balancing is made less stable by either decreasing the length of the stick or by requiring the subject to balance the stick on the surface of a table tennis racket, systematic departures from the power law behaviors are observed in the range of large ?. This observation raises the possibility that the presence of departures from the power law in the large length scale region, possibly Dragon-Kings, may identify situations in which the occurrence of a fall is more imminent. However, whether or not Dragon-Kings are observed, there is a Weibull-type survival function for stick falling. The possibility that increased risk of falling can, at least to some extent, be predicted from fluctuations in the controlled variable before the event occurs has important implications for the development of preventative strategies for the management of phenomena ranging from earthquakes to epileptic seizures to falls in the elderly.
In the spectrum of adverse effects on the fetus or infant associated with maternal drinking during pregnancy the most dramatic is the fetal alcohol syndrome, a pattern of malformation that has been associated with maternal alcohol abuse. Other undesirable outcomes of pregnancy linked to alcohol exposure in utero include growth deficiency, major and minor anomalies, decrements in mental and motor performance, and fetal and perinatal wastage. Alcohol, like other teratogens, does not uniformly affect all those exposed to it. Rather, there seems to be a continuum of effects of alcohol on the fetus with increasingly severe outcomes generally associated with higher intakes of alcohol by the mother. The cost of fetal damage associated with alcohol exposure is very high. A program to decrease the incidence of fetal alcohol effects is therefore imperative. The cornerstone of such a program must be not only education of the public but also careful training of all professionals who provide health care for pregnant women.
User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 years and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001) for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant. The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.
Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive–behavioral (CB) intervention, group supportive expressive intervention, CB bibliotherapy, or assessment-only control condition. Results: The group CB intervention reduced depressive symptoms and negative cognitions
Eric Stice; Paul Rohde; John R. Seeley; Jeff M. Gau
School-based prevention programs are an important component of problem gambling prevention, but empirically effective programs\\u000a are lacking. Stacked Deck is a set of 5–6 interactive lessons that teach about the history of gambling; the true odds and\\u000a “house edge”; gambling fallacies; signs, risk factors, and causes of problem gambling; and skills for good decision making\\u000a and problem solving. An overriding
Robert J. WilliamsRobert; Robert T. Wood; Shawn R. Currie
Infections due to virulent gram positive bacteria, such as Staphylococcus aureus, group B streptococci and group A streptococci remain significant causes of morbidity and mortality despite progress in antimicrobial therapy. Despite significant advances in the understanding of the pathogenesis of infection due to these organisms, there are only limited strategies to prevent infection. In this paper, we review efforts to develop safe and effective vaccines that would prevent infections due to these 3 pathogens.
As research evidence for the effectiveness of community-based prevention has mounted, so has recognition of the gap between research and community practice. As a result, state and local governments are taking a more active role in building the capacity of community-based organizations to deliver evidence-based prevention interventions. Innovations are taking place in the establishment of technical assistance or support systems
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The development of the Snake River hydroelectric system has affected fall Chinook salmon smolts by shifting their migration timing to a period (mid- to late-summer) when downstream reservoir conditions are unfavorable for survival. Subsequent to the Snake River Chinook salmon fall-run Evolutionary Significant Unit being listed as Threatened under the Endangered Species Act, recovery planning has included changes in hydrosystem
Neurocognitive late effects are common sequelae of cancer in children, especially in those who have undergone treatment for brain tumors or in those receiving prophylactic cranial radiation therapy to treat leukemia. Neurocognitive morbidity in attention, executive functioning, processing speed, working memory, and memory frequently occurs and contributes to declines in intellectual and academic abilities. Oncologists are faced with the challenge
Summary This review examines the literature, including literature in Chinese, on the effectiveness of handwashing as an intervention against severe acute respiratory syndrome (SARS) transmission. Nine of 10 epidemiological studies reviewed showed that handwashing was protective against SARS when comparing infected cases and non-infected controls in univariate analysis, but only in three studies was this result statistically significant in multivariate
Many municipalities have recently extended residence restrictions for sex offenders beyond the provisions of state law, although the efficacy of these measures in reducing recidivism has not been empirically established. This study used arrest histories in Jacksonville, Florida, to assess the effects of a recently expanded municipal 2,500-foot…
Nobles, Matt R.; Levenson, Jill S.; Youstin, Tasha J.
Because subsequent pregnancy in teen parents often worsens the impact of adolescent parenting; therefore, a common goal of teenage parent programs has been to reduce repeat pregnancy. To examine the impact of this goal, a meta-analysis was conducted on 16 control-comparison group studies that evaluated the effect of teenage pregnancy and parenting…
Objective: To investigate if a central cholinesterase inhibitor will reduce falling frequency in subjects with Parkinson disease (PD) with advanced postural instability. Background: Falling due to postural instability is a significant problem in advancing PD, and is minimally impacted by dopaminergic therapy. Anticholinergic medications increase falling in the elderly. Further, CNS cholinergic neuron loss occurs in PD. We hypothesized that acetylcholine augmentation may reduce frequent falling in subjects with PD. Methods: We enrolled 23 subjects with PD who reported falling or nearly falling more than 2 times per week. In a randomized, placebo-controlled, crossover design, subjects were given 6 weeks of donepezil or placebo with a 3-week washout between phases. The primary outcomes were daily falls and near falls reported on postcards. Secondary outcomes included scores on the Activities of Balance Confidence Scale, Berg Balance Scale, Clinical Global Impression of Change, Folstein Mini-Mental State Examination, and the motor section of the Unified Parkinson's Disease Rating Scale. Results: Fall frequency per day on placebo was 0.25 ± 0.08 (SEM) compared with 0.13 ± 0.03 on donepezil (p < 0.05). The frequency of near falls was not significantly different between phases. The secondary outcomes did not differ; however, there was a trend to improvement on the subject-completed Global Impression of Change scale. Conclusions: Subjects with PD fell approximately half as often during the 6 weeks on donepezil than on placebo. Larger trials of cholinergic augmentation are warranted in subjects with PD with frequent falls. Classification of evidence: This study provides Class II evidence that donepezil (maximum 10 mg per day) significantly reduced the number of falls in patients with PD (0.13 falls/day, SEM = 0.03) than when taking placebo (0.25 falls/day, SEM = 0.08, p = 0.049). GLOSSARY NBM = nucleus basalis of Meynert; MMSE = Mini-Mental State Examination; OHSU = Oregon Health & Sciences University; PD = Parkinson disease; PPN = pedunculopontine nucleus; UPDRS = Unified Parkinson's Disease Rating Scale.
Chung, Kathryn A.; Lobb, Brenna M.; Nutt, John G.; Horak, Fay B.
In this study, we assessed the longitudinal effect of a Department of Veterans Affairs (VA) patient-centered Care Coordination Home Telehealth (CCHT) program on preventable hospitalization use by veterans with diabetes mellitus (DM) at four VA medical centers. We used a matched treatment-control design (n = 387 for both groups). All patients were followed for 4 years. We operationalized ambulatory care-sensitive conditions (ACSCs) by applying Agency for Healthcare Research and Quality criteria to VA inpatient databases to determine preventable hospitalization use. We used a generalized linear mixed model to estimate the adjusted effect of the CCHT program on preventable hospitalization use over time. During the initial 18 months of follow-up, CCHT enrollees were less likely to be admitted for a preventable hospitalization than their nonenrollee counterparts, and this difference diminished during the rest of the 4-year follow-up period. The VA CCHT program for DM patients reduced preventable hospitalizations. These findings are some of the first that have systematically examined the extent to which home telehealth programs have a long-term effect on preventable hospitalization use. PMID:19882490
Jia, Huanguang; Chuang, Ho-Chih; Wu, Samuel S; Wang, Xinping; Chumbler, Neale R
Community based injury prevention work has become a widely accepted strategy among safety promotion specialists. Hundreds of community based injury prevention programs have been implemented since the mid-1970s, but relatively few have been evaluated rigorously, resulting in a lack of consensus regarding the effectiveness of this approach. This study sought to identify key components that contribute to the effectiveness of these programs. The objective was to gain a better understanding of the community based model for injury prevention. The study was performed as a structured review of existing evaluations of injury prevention programs that employed multiple strategies to target different age groups, environments, and situations. The results of this study suggested that there are complex relationships between the outcome and the context, structure, and process of community-wide injury prevention programs. The interconnectedness of these variables made it difficult to provide solid evidence to prioritise in terms of program effectiveness. The evaluations of multifaceted community oriented injury prevention programs were found to have many shortcomings. Meagre descriptions of community characteristics and conditions, insufficient assessment of structural program components, and failure to establish process-outcome relationships contributed to the difficulty of identifying key success factors of the programs.
The objective of this study was to evaluate the cost-effectiveness of a state-of-the-art sexual-risk reduction intervention for high-risk men and women. The main intervention consisted of seven small-group sessions based on well-established principles of cognitive–behavioral therapy. This intervention was compared with a single-session video-based risk reduction intervention. The main outcome measure was the incremental cost–utility ratio, which equals the additional
Steven D. Pinkerton; David R. Holtgrave; Ana P. Johnson-Masotti; Mary E. Turk; Kristin L. Hackl; Wayne DiFranceisco
Emissions from TV programs are a dangerous light source for photosensitive individuals, because 48.9% of patients have photosensitive seizures caused by TV programs. The authors used a national survey to verify the effectiveness of current Japanese guidelines, which are based on neurophysiologic principles of photosensitivity. They show that the guidelines successfully control TV images to protect many photosensitive persons from harmful TV emissions. PMID:15037709
Community interventions and interventions targeting specific groups at risk of STDs\\/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainence of the intervention post?research funding; and buy?in by the community or target group.
The outermost layer of the epidermis, the stratum corneum, protects the body from harmful environmental conditions by serving as a selective barrier. Solar ultraviolet (UV) radiation is one of the most common conditions the body encounters and is responsible for many negative skin responses, including compromised barrier function. UV exposure has dramatic effects on stratum corneum cell cohesion and mechanical integrity that are related to its effects on the stratum corneum's intercellular lipids. Hypothesis Sunscreen contains chemicals that absorb UV radiation to prevent the radiation from penetrating the skin. Thus, it is expected that the application of sunscreen on human stratum corneum will reduce UV-induced alterations of human stratum corneum. Procedures/Equipment Human tissue was processed in order to isolate the stratum corneum, the top layer of the epidermis. Double cantilever beam (DCB) testing was used to study the effect of UV radiation on human stratum corneum. Two different types of DCB samples were created: control DCB samples with the application of carrier and UV light to the stratum corneum and DCB samples with the application of sunscreen and UV light to the stratum corneum. For the control sample, one side of the stratum corneum was glued to a polycarbonate beam and carrier was applied. Then, the sample was placed 10 cm away from the UV lamp inside of the environmental chamber and were exposed to UV dosages of about 800 J/cm2. Once this step was complete, a second polycarbonate beam was glued to the other side of the stratum corneum. The steps were similar for the DCB sample that had sunscreen applied and that was exposed to UV light. After gluing one side of the stratum corneum to a polycarbonate beam, Octinoxate sunscreen was applied. The next steps were similar to those of the control sample. All DCB samples were then let out to dry for two hours in a dry box in order for the moisture from the lab to be extracted. Each DCB sample was tested with a Delaminator test system (DTS Company). The Delaminator was used to measure the force required to break the bonds between the Stratum Corneum lipid layers. Delamination energies, Gc, were presented as mean values ± 1.96 x the standard error of the mean (STDEM) in which the mean values reported are expected to fall within these bounds with 95% confidence. Results The samples for the UV exposed carrier and Octinoxate samples were tested. Various samples were used to compare the average delamination energy in order to fulfill the 95% confidence level. The delamination energy was lower for the carrier samples than for the Octinoxate samples. The average Gc value for the carrier samples was 5, and the average Gc value for the Octinoxate samples was 7. Conclusion In response to the averaging lower Gc value for the carrier, it is evident that sunscreen does protect the stratum corneum's mechanical properties. It took higher delamination energy to break apart the lipids in the sunscreen sample than it did for the carrier sample. Therefore, the sunscreen helps the stratum corneum contain its intercellular cohesion.
Martinez, O.; Dauskardt, R.; Biniek, K.; Novoa, F.
The purpose of this study is to investigate unique features of body segments in fall and activities of daily living (ADL) to make automatic detection of fall in its descending phase before the impact. Thus, fall-related injuries can be prevented or reduced by deploying feedback systems before the impact. In this study, the authors propose the following hypothesis: (1) thigh
Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fallprevention are to be achieved. This study utilizes emerging non-invasive, portable
Thurmon E. Lockhart; Adam T. Barth; Xiaoyue Zhang; Rahul Songra; Emaad Abdel-Rahman; John Lach
Using a randomized controlled trial, we tested the efficacy of a fallprevention intervention to reduce falls among adults in a community-based health promotion program. Adults aged 65 and older within two counties were recruited (control n = 257; intervention n = 286). After 12 months, there was a significant decrease in the number of falls in…
Fox, Patrick J.; Vazquez, Laurie; Tonner, Chris; Stevens, Judy A.; Fineman, Norman; Ross, Leslie K.
Control strategies enforced by health agencies are a major type of practice to contain influenza outbreaks. Another type of practice is the voluntary preventive behavior of individuals, such as receiving vaccination, taking antiviral drugs, and wearing face masks. These two types of practices take effects concurrently in influenza containment, but little attention has been paid to their combined effectiveness. This article estimates this combined effectiveness using established simulation models in the urbanized area of Buffalo, NY, USA. Three control strategies are investigated, including: Targeted Antiviral Prophylaxis (TAP), workplace/school closure, community travel restriction, as well as the combination of the three. All control strategies are simulated with and without regard to individual preventive behavior, and the resulting effectiveness are compared. The simulation outcomes suggest that weaker control strategies could suffice to contain influenza epidemics, because individuals voluntarily adopt preventive behavior, rendering these weaker strategies more effective than would otherwise have been expected. The preventive behavior of individuals could save medical resources for control strategies and avoid unnecessary socio-economic interruptions. This research adds a human behavioral dimension into the simulation of control strategies and offers new insights into disease containment. Health policy makers are recommended to review current control strategies and comprehend preventive behavior patterns of local populations before making decisions on influenza containment.