[OCULAR DISEASES, FALLS AND HIP FRACTURES].

BACKGROUND: Falls occur among old people and sometimes cause fractures in the hip. There are many reasons for falls. OBJECTIVES: To examine which ocular diseases are frequent among old people who fell and had hip fractures; to verify whether the use of glasses can prevent fall events. METHODS: A survey was conducted on a sample of 100 patients, 63 women and 37 men, who fell and broke their hip between the years 2008 - 2012, were operated on and hospitalized for rehabilitation. Their mean age was 78+8.4 years old and mean weight, 69+14.4 kg. All these patients were examined by an ophthalmologist to detect ocular diseases. RESULTS: Only 67% of them suffered from ophthalmic disease. Among them, 49.3% suffered from problems in the anterior compartment of at least one eye, 32.8% in the posterior compartment and 17.9% in both compartments. The cataract was the most frequent disease (42%), and the second, was the retinopathy. We must mention that 77.6% of the patients who needed glasses were not using them at the time of the fall. The mean age of the patients who had no ocular disease was 4 years younger than the age of those who suffered from it (Independent t-test, p=0.0115 1-side). CONCLUSIONS: Treatment for optic diseases and the use of glasses are important factors in falls prevention among the elderly. DISCUSSION: Elderly people are more prone to fall and break their hip than younger people. Even though it was not statistically proved, disorders in visual acuity and in the visual field, can cause falls among old people.

[Analysis of serious trauma injury patterns in Navarre (Spain) (2010-2019)].

BACKGROUND: The aim of this study is to describe major trauma cases in Navarre and analyze differences based on mortality groups, sex, and mode of injury. METHODS: Cross-sectional study of major traumas (severity =3) registered in Navarre between 2010 and 2019. We analyzed the type of trauma, intentionality, the mode of injury, and the affected anatomical area. The odds ratio for major trauma associated with different variables was calculated. RESULTS: The study included 2,609 patients; mean age was 54.7 years (0-101) and 70.9% were male. A predominance of accidental (84%) / blunt (94.7%) major traumas was recorded, primarily resulting from falls (46.5%) and car accidents (18.4%). Women experienced more falls and pedestrian accidents, while men had more motorcycle, bicycle, knife/firearm accidents, and contusions. Most major traumas affected the head and thorax. Head trauma was significantly more common in deceased individuals and women, while thoracic trauma was more frequent in patients who died on-site and in men. Head injuries were caused by falls from low heights and firearms, whereas thoracic injuries resulted from car accidents and falls from height. The risk of major trauma decreased with age; deceased patients were between two and three times more likely to present lesions in all anatomical areas. CONCLUSIONS: Gender differences are observed in intentionality, type, and mode of injury. Head and thoracic injuries are potentially life-threatening and abdominal and extremity/pelvic ring injuries are associated with early deaths. This suggests that the extent and severity of these injuries complicate treatment and management.

Craniofacial fractures sustained under the influence of alcohol: what are the differences between the sexes?

OBJECTIVE: To identify mechanisms and types of injuries in patients having sustained craniofacial fractures under the influence of alcohol, and to compare the frequencies of them between males and females. MATERIALS AND METHODS: Patients included were adults who had been diagnosed with craniofacial fractures at Töölö Hospital Emergency Department, Helsinki University Hospital, Finland, and who had been under the influence of alcohol at the time of injury. The primary outcome variables were assault-related and fall-related injury mechanisms. The secondary outcome variables were other injury mechanisms, time of accident, type of craniofacial fracture and severity of facial fracture. The primary predictor variable was sex. The control variable was age at the time of injury. The statistical modelling was executed using logistic regression. RESULTS: Of the total of 2,859 patients with craniofacial fractures, 1,014 patients (35.5%) fulfilled the inclusion criteria. Males predominated (84.6%). Assault (38.0%) was the most frequent aetiology. Compared to the odds of females, males had 2.8 times greater odds for assault, 2.4 times greater odds for isolated cranial fracture and 1.7 times greater odds for a facial injury severity score of ≥ 3. Females had 2.0 times greater odds for any fall compared to the odds of males. CONCLUSIONS: Particularly male patients are frequently under the influence of alcohol at the time of injury, predisposing them to assault and severe facial fractures more often than females. Codes of practice on how to identify unhealthy alcohol use and how to intervene are recommended.

Association between dizziness and future falls and fall-related injuries in older adults: a systematic review and meta-analysis.

BACKGROUND: Dizziness is common in older adults, especially in those attending falls services. Yet, the extent to which dizziness is associated with future falls has not been reviewed. This systematic review and meta-analysis assessed the association between dizziness and future falls and related injuries in older adults. METHODS: EMBASE, CINAHL Plus, SCOPUS and PsycINFO databases were searched from inception to 5 February 2024. The review was registered on PROSPERO (registration ID: CRD42022371839). Meta-analyses were conducted for the associations of dizziness with future falls (including recurrent and injurious falls). Three meta-analyses were performed on different outcomes: any-type falls (≥1 falls), recurrent falls (≥2 falls) and injurious falls. RESULTS: Twenty-nine articles were included in the systematic review (N = 103 306 participants). In a meta-analysis of 14 articles (N = 46 795 participants), dizziness was associated with significantly higher odds of any-type future falls (OR = 1.63, 95% CI = 1.44-1.84). In another meta-analysis involving seven articles (N = 5630 participants), individuals with dizziness also had significantly higher odds of future recurrent falls (OR = 1.98, 95% CI = 1.62-2.42). For both meta-analyses, significant overall associations were observed even when adjusted for important confounding variables. In contrast, a meta-analysis (three articles, N = 46 631 participants) revealed a lack of significant association between dizziness and future injurious falls (OR = 1.12, 95% CI = 0.87-1.45). CONCLUSIONS: Dizziness is an independent predictor of future falls in older adults. These findings emphasise the importance of recognising dizziness as a risk factor for falls and implementing appropriate interventions.

[Is there a correlation between increasing hospital falls and Covid-19 infection? Retrospective study on the entire hospital population.] / Esiste una correlazione tra l'aumento delle cadute in ospedale e le infezioni da Covid-19? Studio retrospettivo sull'intera popolazione ospedaliera.

Introduction Falls are the second leading cause of accidental or unintentional death worldwide. In hospital falls represent a relevant health problem, in particular after their increasing since Covid year 2020. The aim of this study is to evaluate correlation between falls and Covid infection. METHODS: Risk Management Unit at Mauriziano hospital analyzed in the present observational study possible correlation with Covid Pandemic and falls risk factors, through comparison of patients falls occurred during year 2021 in Covid and no-Covid wards. The primary outcome of the study is the evaluation of relationship between falls and Covid infection. The secondary outcome is identification of falls risk factors. RESULTS: No direct correlation between falls and Covid-19 infection was found. Among falls risk factors, the most interesting emerged is the fall itself that enhances the risk of relapse. DISCUSSION: Increasing in patients falls since 2020 could be affected indirectly by strong hospital organization modifications during Covid pandemic.

Association between personality traits and concerns about falling among older patients: the mediating role of subjective age.

Background: Older patients are at high risk of falling, and regular assessments of their concerns about falling (CaF) are often recommended. The present study aimed to investigate the association between CaF and personality traits among older patients as well as to elucidate the mediating role of subjective age. Method: A cross-sectional study was conducted among 407 patients aged over 60 years in a tertiary hospital located in Chengdu, Sichuan Province, from March 2023 to May 2023. Predesigned electronic questionnaires were distributed to collect relevant data. Four different models (both crude and adjusted weighted linear regression models) were constructed based on the confounders. Confounders were gradually put into the models to control for bias and to examine the stability of the correlations. Bootstrap sampling was employed to examine the mediating role of subjective age. Result: According to the fully adjusted model, neuroticism (ß = 0.17, 95% CI: 0.02 to 0.31, p for trend = 0.02), extraversion (ß = -0.07, 95% CI: -0.15 to 0.001, p for trend = 0.05), and subjective age (ß = 2.02, 95% CI: 1.28 to 2.78, p for trend <0.001) were consistently correlated with CaF. Mediating analysis revealed that extraversion was negatively related with CaF both directly and indirectly, via subjective age [23.2% partial effect, bootstrap 95%CI: -0.024(-0.080, -0.000)]. Higher neuroticism was consistently related to older subjective age (ß = 0.002, 95% CI: 0.001 to 0.004, p for trend = 0.006), while higher levels of conscientiousness, openness, and extraversion were consistently correlated with younger subjective age(ß = -0.002, p for trend = 0.04; ß = -0.003, p for trend = 0.003; ß = -0.002, p for trend = 0.0, respectively). Conclusion: Extraversion and neuroticism were significantly correlated with CaF. Moreover, subjective age partially mediated the relationship between extraversion and CaF. Furthermore, subjective age was found to be associated with both CaF and personality traits. These findings highlighted the important roles of personality traits and subjective age in assessments of CaF and in the development of strategies for preventing falls among older patients.

Plant-based index linked to fall risk in older Chinese adults: cross-sectional evidence from a national cohort.

OBJECTIVES: Epidemiology showed that the falling incidences increased with advanced age, and recent findings found link between nutritional intake and risk of falls. Nevertheless, the relationship between different plant-based diets and the risk of falls in older adults remains unclear. Our investigation aimed to evaluate the correlation between various plant-based diet indices and the occurrence of falls. DESIGN: This study is a cross-sectional and post-hoc analysis from a national cohort study. SETTING AND PARTICIPANTS: We included individuals over 65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) recruited in 2018 with information on falls and dietary assessments, finally 11,044 participants were eligible. MEASUREMENTS: Using food frequency questionnaire (FFQ), we calculated plant-based index scores categorized as unhealthy plant-based index (uPDI) and healthy plant-based index (hPDI). The primary outcome was falls obtained from questionnaire. Statistical analysis was performed utilizing logistic regression model to investigate the relationship between the plant-based diet indices and falls. We also used the subgroup analysis to investigate the interaction of falls and plant-based diet index (PDI) among different status and used the restricted cubic spline (RCS) curves to investigate the connection between the PDI scores and falls risk. RESULTS: Among 11,044 participants included in our study, a total of 2493 fall cases were observed. The logistic regression analysis revealed that the plant-based index related to falls. In the adjusted model, per 10-unit increment of hPDI has a significant decreased risk of falls (odd ratio [OR]: 0.85, 95% confidence interval [CI]: 0.79-0.91, P for trend < 0.001) and per 10-unit increment in uPDI increased the risk of falls (OR: 1.21, 95% CI: 1.13-1.30, P for trend < 0.001). We also revealed an interaction between smoking status and falls among the uPDI group (Pinteraction = 0.012). Finally, we found that with plant-based index scores increased, the odds of falls among hPDI decreased (P for overall < 0.001, P nonlinear = 0.0239), and the odds of falls among uPDI increased (P for overall < 0.001, P nonlinear = 0.0332). CONCLUSION AND IMPLICATIONS: We found significant association between the Plant-based diet index and the risk of falls, highlighting the key role of the consumption of nutritious plant-based foods on the risk of falls, which needed take into account in developing intervention and prevention strategies to decrease falls among older Chinese adults.

Falls among Pediatric Patients Receiving Home Care.

Children with medical complexity (CMC) often require home healthcare services to manage chronic health conditions. Evaluation of home safety is recommended when children transition from hospital to home care, though despite best efforts, safety events, such as falls, still occur. Understanding the prevalence and causal factors of falls in CMC is critical for the development of fall prevention interventions and protocols. This study aims to describe demographics and reasons for falls reported in CMC receiving home healthcare services. A retrospective analysis was performed using data from an incident reporting database from January 2019 to March 2023. Participants included CMC who received home healthcare services from a single institution and had at least one documented fall. A total of 43 falls were experienced by 31 unique participants. The participants were predominantly male (58.1%), White (71.0%), and non-Hispanic/Latino (96.8%), with a median age of 10 years at the time of the fall. Primary diagnoses of CMC with falls included neurological disorders (41.9%), congenital chromosomal abnormalities (25.8%), and oncological conditions (16.1%). The most common reasons for falls were loss of balance (32.6%), unknown factors (19.6%), and trip/slips (17.4%). Half of falls were deemed to be potentially preventable. This study provides valuable insight into falls among CMC receiving home healthcare services and emphasizes the multifactorial nature of fall risks in this population. Understanding demographic characteristics, diagnoses, and causal factors of falls is critical in the development of proactive fall prevention strategies. Responding proactively to mitigate fall risks is an important step in enhancing the safety and quality of life for CMC. Future collaborative research efforts are warranted to validate findings and evaluate potentially successful fall prevention interventions.

Regional differences in the Association of Healthy Aging with the incidence of falls: an analysis based on the China Health and Retirement Longitudinal Study from 2011 to 2020.

Background: Falls frequently occur among the older adult population. In this study, we examined the variations in fall incidence across different regions over time, focusing on the disparities between urban and rural areas among older adult Chinese individuals, Healthy aging is comprised of five dimensions: (1) absence of chronic diseases, (2) good physical functioning, (3) normal cognitive function, (4) active social participation, and (5) absence of depression. Additionally, we explored the relationship between healthy aging and the occurrence of falls in middle-aged and older adults. Falls are defined as events that occurred within the past two years. Results: Among 9,918 participants, 33.8% lived in urban areas and 23.0% achieved healthy aging. In contrast, 66.2% resided in rural areas with 16.5% achieving healthy aging. In 2011, rural residents had a higher fall incidence rate (17% in rural vs. 13.5% in urban); by 2020, the fall rate remained higher in rural areas (19.5% in rural vs. 17.3% in urban). Unhealthy aging (HR = 1.08, 95%CI: 1.00-1.16) were risk factors for falls. Subgroup analysis revealed that in rural areas, unhealthy aging increased the risk of falls. In urban areas, the increased risk of falls associated with unhealthy aging was not significant (Rural HR = 1.11, 95%CI:1.01-1.22; Urban HR = 1.05, 95%CI: 0.93-1.18). Conclusion: Healthy aging may be more strongly associated with a lower risk of falls in rural areas, while this association might be less pronounced in urban areas due to different environmental and social factors. This highlights the need for environment-specific fall prevention strategies and targeted measures for the older adult.

Quality of life, pain and use of analgesic, anxiolytic and antidepressant medication, in people living in care homes.

BACKGROUND: People living in care homes often have problems with pain, anxiety and depression. Whether being on analgesia, anxiolytics or antidepressants has any bearing on pain severity and quality of life (QoL) in this population, requires further investigation. OBJECTIVES: (i) to examine the relationship between pain, anxiety and depression and medication use in care home residents and (ii) to compare those on medications to treat pain, anxiety and depression, and those who were not, and associations with pain severity and overall QoL. METHODS: This was a secondary analysis of a randomised controlled trial testing a falls prevention intervention in care homes. We recorded pain, anxiety and depression, QoL measurements and prescribed medication use. RESULTS: In 1589 participants, the mean age was 84.7 years (±9.3 SD), 32.2% were male and 67.3% had a diagnosis of dementia. 54.3% and 53.2% of participants had some level of pain and anxiety or depression respectively, regardless of prescribed medication use. There was a direct association between pain severity and being on any analgesia, opioid analgesia, and antidepressants, but no associations between pain severity and use of paracetamol and anxiolytics. QoL was best for residents with no pain and not on any analgesia, anxiolytics or antidepressants and worst for those with moderate-extreme pain and taking at least two of these classes of medications. CONCLUSION: Many care home residents live with pain, anxiety and depression. Addressing residents' pain may also increase their quality of life, but using medication alone to reach this goal may be inadequate.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns.

INTRODUCTION: During 2020-2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings. METHODS: A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality. RESULTS: During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0-4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19-1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12-1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86-1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates. CONCLUSION: These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.

Quantitative Analysis of the Causes of Falls in Adult Hospitalized Patients Based on the Perspective of Text Mining.

OBJECTIVE: This study harnesses the power of text mining to quantitatively investigate the causative factors of falls in adult inpatients, offering valuable references and guidance for fall prevention measures within hospitals. METHODS: Employing KH Coder 3.0, a cutting-edge text mining software, we performed co-occurrence network analysis and text clustering on fall incident reports of 2,772 adult patients from a nursing quality control platform in a particular city in Jiangsu Province, spanning January 2017 to December 2022. RESULTS: Among the 2,772 patients who fell, 80.23% were aged above 60, and 73.27% exhibited physical frailty. Text clustering yielded 16 distinct categories, with four clusters implicating patient factors, four linking falls to toileting processes, four highlighting dynamic interplays between patients, the environment, and objects, and another four clusters revealing the influence of patient-caregiver interactions in causing falls. CONCLUSION: This study highlights the complex, multifactorial nature of falls in adult inpatients. Effective prevention requires a collaborative effort among healthcare staff, patients, and caregivers, focusing on patient vulnerabilities, environmental factors, and improved care coordination. By strengthening these aspects, hospitals can significantly reduce fall risks and promote patient safety.

Visual field loss and falls requiring hospitalisation: results from the eFOVID study.

BACKGROUND: Visual fields are important for postural stability and ability to manoeuvre around objects. OBJECTIVE: Examine the association between visual field loss and falls requiring hospitalisation in adults aged 50 +. METHODS: Older adults aged 50+ with and without visual field loss were identified using a fields database obtained from a cross-section of ophthalmologists' practices in Western Australia (WA). Data were linked to the Hospital Morbidity Data Collection and WA Hospital Mortality System to identify participants who experienced falls-related hospitalisations between 1990 and 2019. A generalised linear negative binomial regression model examined the association between falls requiring hospitalisation for those with and without field loss, based on the better eye mean deviation (mild: -2 to -6 dB, moderate: -6.01 dB to -12 dB, severe < -12.01 dB) in the most contemporaneous visual field test (3 years prior or if not available, 2 years after the fall), after adjusting for potential confounders. RESULTS: A total of 31 021 unique individuals of whom 6054 (19.5%) experienced 11 818 falls requiring hospitalisation during a median observation time of 14.1 years. Only mean deviation index of <-12.01 dB (severe) was significantly associated with an increased rate of falls requiring hospitalisations by 14% (adjusted IRR 1.14, 95% CI 1.0-1.25) compared with no field loss, after adjusting for potential confounders. Other factors included age, with those aged 80+ having an increased rate (IRR 29.16, 95% CI 21.39-39.84), other comorbid conditions (IRR 1.49, 95% CI 1.38-1.60) and diabetes (IRR 1.25, 95% CI 1.14-1.37). Previous cataract surgery was associated with a decreased rate of falls that required hospitalisations by 13% (IRR 0.87, 95% CI 0.81-0.95) compared with those who did not have cataract surgery. CONCLUSION: The findings highlight the importance of continuous clinical monitoring of visual field loss and injury prevention strategies for older adults with visual field loss.

Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care.

Pediatric trauma plays a crucial role in pediatric mortality, with traffic injuries and falls frequently cited as leading causes of significant injuries among children. A comprehensive investigation, including geographical factors, is essential for developing effective strategies to prevent injuries and alleviate the burden of pediatric trauma. This study involved a retrospective analysis of clinical data from pediatric patients admitted to our hospital's intensive care unit (ICU) due to trauma over a 10-year period. Comprehensive analyses were conducted to elucidate trends, demographics, injury patterns, and risk factors associated with these admissions. This retrospective study included 951 pediatric patients (mean age: 4.79 ± 3.24 years; mean weight: 18.45 ± 9.02 kg; median time to ICU admission post-injury: 10.86 ± 14.95 h). Among these patients, 422 (44.4%) underwent emergency surgery, and 466 (49%) required mechanical ventilation support, with a mean duration of 70.19 ± 146.62 h. The mean duration of ICU stay was 6.24 ± 8.01 days, and the overall mean hospitalization duration was 16.08 ± 15.56 days. The predominant cause of unintentional injury was traffic accidents (47.9%), followed by falls (42.5%) and burns/scalds (5.3%). Most incidents involved children aged 0-6 years (70.7%), with males comprising 60.0% of patients. Injury incidents predominantly occurred between 12 and 6 PM (44.5%) and on non-workdays (37.6%). The most common locations where injuries occurred were roadsides (49%) and rural areas (64.35%). Single-site injuries (58.78%) were more prevalent than multiple-site injuries (41.22%), and head injuries were the most common among single-site injuries (81.57%). At ICU admission, the mean injury severity score was 18.49 ± 8.86. Following active intervention, 871 patients (91.59%) showed improvement, while 80 (8.41%) succumbed to their injuries. Traffic injuries remain the primary cause of pediatric trauma leading to ICU admission, underscoring the importance of using appropriate child restraint systems and protective gear as fundamental preventive measures. The increased incidence of injuries among children aged < 6 years and those residing in rural areas highlights the need for targeted preventive strategies, necessitating tailored interventions and public policy formulations that address these high-risk populations.

Association of oral frailty and gait characteristics in patients with cerebral small vessel disease.

BACKGROUND: The objectives of this study were twofold: (1) to compare gait characteristics between cerebral small vessel disease (CSVD) patients with low-risk oral frailty (OF) and high-risk OF, particularly during dual-task walking (DTW); (2) to investigate the association of OF, the gait characteristics of DTW, and falls among older adults patients with CSVD. METHODS: A total of 126 hospitalized patients diagnosed with CSVD were recruited and classified into a low-risk group (n = 90) and a high-risk group (n = 36) based on OF status in our study. Comprehensive data pertaining to basic parameters (cadence, as well as stride time, velocity and length), variability, asymmetry, and coordination were gathered during both single-task walking (STW) and DTW. Additionally, the number of falls was calculated. Subsequently, t-test or chi-squared test was used for comparison between the two groups. Furthermore, linear regression analysis was employed to elucidate the association of the OF index-8 score and gait parameters during cognitive DTW. Also, logistic regression models were utilized to assess the independent association of OF risk and falls. RESULTS: During cognitive DTW, the high-risk group demonstrated inferior performance in terms of basic parameters (p < 0.01), coefficient of variation (CV) of velocity and stride length (p < 0.05), as well as phase coordination index (PCI) when compared with the low-risk group (p < 0.05). Notably, differences in basic gait parameters were observed in cognitive DTW and STW conditions between the two groups (p < 0.01). However, only the high-risk group evinced significant variations in CV and PCI during cognitive DTW, as opposed to those during STW (p < 0.05). Furthermore, our findings also revealed the association of OF, the gait characteristics of cognitive DTW, (p < 0.01) and falls (p < 0.05). CONCLUSION: CSVD patients with a high risk of OF need to pay more attention to their gait variability or coordination. Also, they are recommended to undergo training involving dual-task activities while walking in daily life, thereby reducing the deterioration and mitigating the risk of falls. Besides, this study has confirmed an association of OF and DTW gait as well as falls in patients with CSVD.

Prevalence and Patterns of Seizure-related Injuries: A Study of People Living with Epilepsy Found in a Community-based Door-to-door Survey in Southeast Nigeria.

CONTEXT: Epileptic seizures and the unpredictable falls resulting from epileptic seizures predispose the people living with epilepsy (PLWE) to various physical injuries as well as postictal cognitive and behavioral changes. AIMS: The aim of the study was to determine the frequency and patterns of seizure-related physical injuries, postictal cognitive impairments, and behavioral changes. SETTINGS AND DESIGN: This was a cross-sectional descriptive study in a Southeast Nigeria local government area. SUBJECTS AND METHODS: PLWE identified during a two-phase door-to-door survey and their caregivers were interviewed using a semi-structured questionnaire. STATISTICAL ANALYSIS USED: The Statistical Package for the Social Sciences version 22.0 was used. RESULTS: There were 56 cases of active convulsive seizures comprising 33 (58.9%) males and 23 (41.1%) females, with a mean age of 32.9 ± 14.2. The lifetime prevalence of seizure-related physical injuries, postictal behavioral changes, and postictal cognitive impairments was 9.8 per 1000 (95% confidence interval [CI]: 9.1-10.0), 8.4 per 1000 (95% CI: 7.2-9.2), and 6.3 per 1000 (95% CI: 4.9-7.5), respectively. Skin/soft-tissue injuries and tongue laceration were the most frequent physical injuries found in 66.1% ( n = 37/56) and 60.7% ( n = 34/56) of cases, respectively. The frequency of soft-tissue injuries was significantly higher (χ 2 = 5.038; P = 0.0248) in the females 78.3% ( n = 18/23) than the males 48.5% ( n = 16/33). About a third of the females 39.1% had burn injuries compared to 18.1% of the males. CONCLUSIONS: Seizure-related injuries are common and have the tendency to increase the burden of epilepsy and epilepsy-related stigma from deformities and the chronic disfiguring scars resulting from such injuries.

Résumé Contexte:Les crises d'épilepsie et les chutes imprévisibles résultant des crises d'épilepsie prédisposent les personnes vivant avec l'épilepsie (PLWE) à diverses blessures physiques ainsi que des changements cognitifs et comportementaux post-critiques.Objectifs:Le but de l'étude était de déterminer la fréquence et les caractéristiques des blessures physiques liées aux crises, des déficiences cognitives post-critiques et des changements de comportement. Paramètres et conception: il s'agissait d'une étude descriptive transversale dans une zone de gouvernement local du sud-est du Nigeria. Sujets et méthodes: PLWE identifiées lors d'une enquête porte-à-porte en deux phases et leurs soignants ont été interrogés à l'aide d'un questionnaire semi-structuré. Analyse statistique utilisée: Le progiciel statistique pour les sciences sociales version 22.0 a été utilisé.Résultats:Il y a eu 56 cas de crises convulsives actives comprenant 33 (58,9 %) hommes et 23 (41,1 %) femmes, avec un âge moyen de 32,9 ± 14,2 ans. La prévalence au cours de la vie des blessures physiques, des changements de comportement post-critiques et des troubles cognitifs post-critiques liés aux crises était de 9,8 pour 1 000 (95 % intervalle de confiance [IC]: 9,1 à 10,0), 8,4 pour 1 000 (IC à 95 %: 7,2 à 9,2) et 6,3 pour 1 000 (IC à 95 %: 4,9 à 7,5), respectivement. Blessures de la peau/des tissus mous et les lacérations de la langue étaient les blessures physiques les plus fréquentes trouvées dans 66,1 % (n = 37/56) et 60,7 % ( n = 34/56) des cas, respectivement. La fréquence de les blessures des tissus mous étaient significativement plus élevées (χ 2 = 5,038; P = 0,0248) chez les femmes 78,3 % ( n = 18/23) que chez les hommes 48,5 % ( n = 16/33). Environ un tiers Parmi les femmes, 39,1 % avaient des brûlures, contre 18,1 % des hommes.Conclusions:Les blessures liées aux convulsions sont fréquentes et ont tendance à accroître le fardeau de l'épilepsie et de la stigmatisation liée à l'épilepsie due aux malformations et aux cicatrices défigurantes chroniques résultant de telles blessures.

Impact of Vitamin D Status and Nutrition on the Occurrence of Long Bone Fractures Due to Falls in Elderly Subjects in the Vojvodina Region of Serbia.

Bone fractures are a significant public health issue among elderly subjects. This study examines the impact of diet and vitamin D status on the risk of long bone fractures due to falls in elderly subjects in Vojvodina, Serbia. Conducted at the University Clinical Center of Vojvodina in autumn/winter 2022-2023, the study included 210 subjects >65 years: 105 (F: 80/M: 15) with long bone fractures due to falls and 105 (F: 80/M: 15) controls. Groups were similar regarding age and BMI. Dietary intakes (by two 24-h recalls) and serum vitamin D levels were analyzed. The fracture group had a significantly lower median daily vitamin D intake (1.4 µg/day vs. 5.8 µg/day), intake of calcium, energy, proteins, fats, fibers, dairy products, eggs, fish, edible fats/oils, and a higher intake of sweets (p < 0.001 for all). Serum vitamin D levels were significantly lower in the fracture group (40.0 nmol/L vs. 76.0 nmol/L, p < 0.001). Logistic regression identified serum vitamin D as the most important protective factor against fractures, and ROC curve analysis indicated that serum vitamin D levels > 50.5 nmol/L decreased fracture risk. Nutritional improvements (increased intake of vitamin D and protein sources such as fish, eggs, and dairy), increased sun exposure, and routine vitamin D supplementation during winter are advised.

Recruitment Strategies for a Technology-Based Fall Risk Assessment Research Study Among Community-Dwelling Older Adults During a Global Pandemic.

PURPOSE: To describe successful strategies for the recruitment of diverse community-dwelling older adults for a technology-based fall risk assessment research study during the global coronavirus disease 2019 pandemic. METHOD: In this cross-sectional study, 124 adults aged ≥60 years agreed to participate. We used several recruitment strategies, including social media platforms, local community centers, flyers, contacting key persons, word of mouth, and contacting participants from previous research projects. RESULTS: Targeted and personalized strategies for recruitment, including contacting a key community leader (52.4%, n = 65) and communication with friends and family members (46.7%, n = 58), were the most successful. One (0.8%) participant was recruited from a prior research project. In contrast, individuals were not recruited from posted flyers and social media. CONCLUSION: Recruitment can be improved with word of mouth and contacting key persons, such as community leaders, which can be achieved by building a trusted relationship between researchers and community leaders. [Journal of Gerontological Nursing, 50(9), 18-23.].

Older patients with vertebral and pelvic fractures: Study protocol of a clinical cohort.

BACKGROUND: Vertebral and pelvic fractures are associated with a significant burden of negative health and psychosocial outcomes. The number of vertebral and pelvic fractures is increasing in an aging society. Vertebral and pelvic fractures are increasingly significant injuries for individuals and society. However, few epidemiological studies have examined the clinical course of vertebral and pelvic fractures. This is the protocol for a study that observes patients who have been admitted to the hospital with an incident vertebral or pelvic fracture for a period of 12 months. METHODS: The observational cohort study is conducted at three study sites in Germany. Patients affected by vertebral or pelvic fractures are recruited within the first few days of hospital admission. Data collection takes place at four-time points: baseline, before discharge, after 4 months, and after 12 months after admission to the hospital. Particular emphasis is laid on the assessment of the fall mechanisms, physical function, physical activity, life space, mobility, treatment approach, and quality of life. The hospital stay involves the collection of biomaterials (blood and urine). DISCUSSION: The study aims to enhance understanding of the clinical progression and outcomes in patients with fractures in the vertebrae or pelvis.

Associations Between Components of Self-Management Theory and Falls Among Older Adults.

PURPOSE: To examine the relationship of key individual and family self-management theory (IFSMT) components, including self-management process variables on proximal (self-management behaviors) and distal (falls) outcomes in older adults. METHOD: A secondary data analysis was conducted using data of 99 older adults living in continuing care retirement communities in the U.S. Midwest. Descriptive statistics, multiple regression, and logistic regression were performed to analyze the data. RESULTS: The multiple regression model demonstrated a positive association between self-efficacy for physical activity and steps per day. The logistic regression model showed that high expectations regarding aging are associated with reduced likelihood of meeting daily protein intake. CONCLUSION: Key components of the IFSMT, such as self-efficacy, steps per day, and expectations regarding aging, are important when designing self-management interventions to prevent falls. [Journal of Gerontological Nursing, 50(8), 19-28.].