FEAR: A fall epidemiological analysis and risk factor assessment

Objective: To determine the prevalence of falls among older adults and to determine the risk factors associated with falls. Design and Methodology: In this cross-sectional study, a sample of 416 participants from four distinct geographic regions completed an interviewer administered demographic questionnaire. Participants also answered questions on factors known to be related to fall risk in addition to performing functional tests of gait and balance. Data was analysed using SPSS Ver 23.0. Person Chi-squared test was used to identify factors associated with falls at a significance level of p<0.05. Results: There were 331 females (79.6%) and 85 males (20.4 %) with a mean age of 66.3 years (SD +/- 4.2) and a mean Body Mass Index (BMI) of 24.1 kg/m2 (SD +/- 3.5). The prevalence of falls was 43% and the significant factors associated with falls included age, hypertension, glaucoma, and poly -pharmacy (> 4 drugs). Low scores in the functional tests, the use of walking aids and living alone were also significantly associated with the risk of falling. Conclusions: Falls are very common in older persons, in this study the prevalence was found to be 43%. The significant risk factors for falls correlate with regional and international studies. Fall prevention measures should focus resources on this vulnerable group.

The appropriateness of the current antibiotic empiric therapy based on the bacteria isolated from severely malnourished Jamaican children

We performed a retrospective audit of antimicrobial sensitivities of bacteria isolated from children admitted with a diagnosis of malnutrition to the Tropical Metabolism Research Unit (TMRU), University of the West Indies, between January 1995 and December 1999. There were 150 admissions for severe malnutrition to the TMRU during this period, which was approximately 50 percent fewer than in a previous TMRU study done ten years ago, between 1984 and 1989. In the present study, bacteraemia was documented in 10 percent of 150 severely malnourished children between 1 and 31 months of age. The most common organism isolated were coagulase-negative Staphylococci, which represented 40 percent of the total isolates. The micro-organism grown were most likely to be sensitive to amoxycillin/clavulanic acid. The current TMRU treatment protocol for severe malnutrition recommends use of crystalline penicillin plus gentamicin as empirical antibiotic therapy. This study has provided valuable information suggesting that the current empiric antibiotic therapy may be inappropriate. (AU)

Epidemiology of hepatitis A virus in Jamaica

OBJECTIVE: Between January 1995 and August 1998, a study was conducted to elucidate the epidemiology of hepatitis A virus (HAV) in Jamaica. DESIGN AND METHODS: Participants were recruited from seven sites located in rural and urban areas of Jamaica. There were 128 and 211 females. The ages of the participants ranged from 3 to 90 years. The average ages of males and females were 24.9 and 25.6 years, respectively. Social and demographic data were collected by questionnaire. Potential risk factors which were studied included age of the individual, gender residence in an urban and rural are, type of toilet facilities and source of domestic water supply (indoor or outdoor plumbing). RESULTS: The seroprevalence of HAV in the study population using ELISA was 59.9 percent. Based on logistic regression, age and source of domestic water supply were found to be the major contributors to exposure to HAV (p<0.001) and p=0.006, respectively). The rate of exposure to the virus increased with age. By age 10 years, 30 percent of children were exposed. This was followed by a steady increase to about 73 percent by age 30 years. Prevalence remained at a plateau up to age 50 years after which there was an increase to almost 100 percent in the oldest individuals. Rates of exposure to HAV were higher amongst households with outdoor plumbing which included standpipes, rivers and tanks than those with indoor plumbing. CONCLUSIONS: The seroprevalence of HAV in Jamaica is higher than that seen generally in developed countries, although the age related acquisition of infection was similar. It is expected that the pattern and severity of disease from the virus is similar to that seen in developed countries. Improved water supply and educating the public on the epidemiology of HAV could reduce the prevalence of HAV in Jamaica.(AU)

Respiratory syncytial virus infections in Curacao

OBJECTIVE: To collect epidemiological data on the prevalence of respiratory syncytial virus (RSV) in Curacao and to assess a possible relation to seasons. DESIGN AND METHODS: All children aged 0 to 24 months admitted to the paediatric ward of St. Elisabeth Hospital in Curacao with acute lower respiratory tract illness (tachypnoea, dyspnoea with wheezing, crepitations or cough), from October 1998, to October 1999, were enrolled. Excluded from the study were patients whose respiratory symptoms were caused by a foreign body, congenital malformation of heart, lung or thorax. RESULTS: Forty-four children fulfilled the study criteria; 20 (47 percent) were RSV positive for parainfluenza virus. Almost half (48 percent) of the total population was ex-premature. The majority of the RSV infections occurred during the two rainy periods and >50 percent (n=34) of all children had acute otitis media. The frequency of otitis media, positive RSV test and length of hospital stay was higher for the ex-prematures. Cyanosis was present in 2/10 (20 percent) of RSV positive and 2/23 (9 percent) of RSV negative cases. None of the patients required artificial ventilation and none died. CONCLUSION: RSV infection does occur in Curacao mostly during the rainy season. Ex-prematures seem to be especially at risk and otitis media is found in the majority of cases. In the light of the growing number surviving extreme prematurity, RSV prophylaxis needs to be considered.(Au)