Physical performance, fear of fall and urinary incontinence among premenopausal, perimenopausal and postmenopausal women

Background: The menopausal transition, which occurs when a woman transitions from reproductive to post-reproductive life, is an important turning point in the female life cycle. The prevalence of menopausal symptoms has been shown to vary widely across various Asian research. It's critical to comprehend the connection between menopausal women's health and well-being and physical performance, fear of falling, and urine incontinence in order to design effective therapies.Methods: The study was approved for conduct by the ethical committee. 195 women in the 45� age range participated in this 1.5-year observational analytical study, which was conducted in a community setting.Results: Statistical package for the social sciences (SPSS) version 20.0 was used to analyze the data, and a significance level of less than 0.05 was regarded as statistically significant.Conclusions: Transition through menopause is associated with lowered physical performance, high concern fear of fall in postmenopausal compared to premenopausal and perimenopausal while urinary incontinence varies across different stages of menopause.

Entrenamiento de la marcha con la cinta rodante antigravitatoria en pacientes con Parkinson / Gait training with the anti-gravity treadmill in Parkinson's patients / Treinamento de marcha com fita rolante antigravitatoria em pacientes com Parkinson

La enfermedad de Parkinson (EP) es una condición neurodegenerativa caracterizada por alteraciones motoras que afectan principalmente el desarrollo de la marcha, produciéndose generalmente el fenómeno del congelamiento de la marcha con la posibilidad del riesgo de caída. Objetivo: Analizar los beneficios del entrenamiento de la marcha con la cinta rodante antigravitatoria en pacientes con EP. Materiales y métodos: Es un estudio pre-experimental con un solo grupo de intervención. Se llevó a cabo el entrenamiento de la marcha a través de una cinta rodante antigravitatoria (AlterG) durante un mes dividido en 2 sesiones por semana. Los parámetros de la marcha arrojados por el equipo AlterG fueron la descarga de peso, cadencia, tiempo de apoyo y longitud del paso; además se valoró el congelamiento de la marcha con el cuestionario (FOGQ) y el riesgo de caída con el test Timed Up and Go (TUG). Resultados: En los parámetros de la marcha y en el FOGQ se encontró diferencias significativas (p<0,05) entre los valores de pre y post intervención, exceptuando a la variable cadencia. El riesgo de caída disminuyó 4,6 y 4,3 segundos promedio en el test TUG en hombres y mujeres respectivamente. Conclusión: El entrenamiento de la marcha en la cinta rodante antigravitatoria mejora las condiciones de la marcha y reduce el riesgo de caídas en pacientes con EP.

Parkinson's disease (PD) is a neurodegenerative condition characterized by motor alterations that mainly affect the development of gait, generally producing the phenomenon of freezing of gait with the possibility of risk of falling. Objective: To analyze the benefits of gait training with the antigravity treadmill in patients with PD. Materials and methods: It is a pre-experimental study with a single intervention group. Gait training was carried out using an antigravity treadmill (AlterG) for one month divided into 2 sessions per week. The gait parameters returned by the AlterG team were weight unloading, cadence, support time and step length; Furthermore, freezing of gait was assessed with the questionnaire (FOGQ) and the risk of falling with the Timed Up and Go test (TUG). Results: In the gait parameters and in the FOGQ, significant differences (p<0.05) were found between the pre- and post-intervention values, except for the cadence variable. The risk of falling decreased by 4.6 and 4.3 seconds on average in the TUG test in men and women respectively. Conclusion: Antigravity treadmill gait training improves walking conditions and reduces the risk of falls in PD patients.

A doença de Parkinson (DP) é uma condição neurodegenerativa caracterizada por alterações motoras que afetam principalmente o desenvolvimento da marcha, geralmente produzindo o fenômeno de congelamento da marcha com possibilidade de risco de queda. Objetivo: Analisar os benefícios do treino de marcha com esteira antigravitacional em pacientes com DP. Materiais e métodos: Trata-se de um estudo pré-experimental com um único grupo de intervenção. O treinamento de marcha foi realizado em esteira antigravitacional (AlterG) durante um mês dividido em 2 sessões semanais. Os parâmetros de marcha retornados pela equipe AlterG foram descarga de peso, cadência, tempo de apoio e comprimento do passo; Além disso, o congelamento da marcha foi avaliado com o questionário (FOGQ) e o risco de queda com o teste Timed Up and Go (TUG). Resultados: Nos parâmetros da marcha e no FOGQ foram encontradas diferenças significativas (p<0,05) entre os valores pré e pós-intervenção, exceto na variável cadência. O risco de queda diminuiu em média 4,6 e 4,3 segundos no teste TUG em homens e mulheres respectivamente. Conclusão: O treino de marcha em esteira antigravitacional melhora as condições de marcha e reduz o risco de quedas em pacientes com DP.

Evaluación del riesgo de caídas en adultos mayores con Diabetes Mellitus tipo 2 / Evaluation of fall risk assessmentin in older adults with Type 2 Diabetes Mellitus / Avaliação do risco de quedas em idosos com Diabetes Mellitus tipo 2

Introducción: La diabetes mellitus 2 es una enfermedad frecuente en adultos mayores, con múltiples complicaciones que pueden llegar a afectar el equilibrio y la marcha e incrementar el riesgo de caída. Objetivo: Determinar el riesgo de caídas en dos grupos de adultos mayores, uno con padecimiento de DM2 y otro sin este padecimiento. Metodología: Estudio de enfoque cuantitativo, alcance descriptivo, diseño observacional, y de cohorte transversal; muestra poblacional de 120 adultos mayores en la ciudad de Guayaquil divididos en dos grupos: grupo A con 60 adultos mayores que no padecían DM2 y grupo B con 60 adultos mayores con DM2; que cumplen con los criterios de inclusión y a quienes se evalúan mediante las técnicas: observación, evaluación y entrevista; y los instrumentos: Escala de Berg, Mini-BESTest y formulario estándar. Se utilizó la prueba estadística Chi cuadrado para la comparación de los resultados obtenidos. Resultados: Los resultados indican que, en la determinación del riesgo de caídas, se encontraron diferencias estadísticamente significativas (p0.05). El estudio además encontró que los resultados obtenidos, en las dos pruebas de riesgo de caídas, difieren entre sí. Conclusiones: Los adultos mayores diabéticos presentan un mayor riesgo de caída a comparación de adultos mayores no diabéticos.

Introduction: Diabetes mellitus 2 is a common disease in older adults, with multiple complications that can affect balance and gait and increase the risk of falling. Objective: To determine the risk of falls in two groups of older adults, one with and the other without DM2. Methodology: Quantitative approach study, descriptive scope, observational design, and cross-sectional cohort; population sample of 120 older adults in the city of Guayaquil divided into two groups: group A with 60 older adults who did not suffer from DM2 and group B with 60 older adults with DM2; who meet the inclusion criteria and who are evaluated by means of the techniques: observation, evaluation and interview; and the instruments: Berg scale, Mini-BESTestest and standard form. The Chi-square statistical test was used to compare the results obtained. Results: The results indicate that, in the determination of the risk of falls, statistically significant differences (p0.05) were found. The study further found that the results obtained, in the two fall risk tests, differed from each other. Conclusions: Diabetic older adults present a higher risk of falling compared to non-diabetic older adults.

Introdução: O diabetes mellitus tipo 2 é uma doença comum em idosos, com múltiplas complicações que podem afetar o equilíbrio e a marcha e aumentar o risco de quedas. Objetivo: Determinar o risco de quedas em dois grupos de idosos, um com DM2 e outro sem essa condição. Metodologia: Estudo com abordagem quantitativa, escopo descritivo, desenho observacional e coorte transversal; amostra populacional de 120 idosos da cidade de Guayaquil dividida em dois grupos: grupo A com 60 idosos que não sofriam de DM2 e grupo B com 60 idosos com DM2; que atendam aos critérios de inclusão e que sejam avaliados pelas técnicas: observação, avaliação e entrevista; e os instrumentos: Escala de Berg, Mini-BESTest e formulário padrão. O teste estatístico Qui-quadrado foi utilizado para comparação dos resultados obtidos. Resultados: Os resultados indicam que, na determinação do risco de quedas, foram encontradas diferenças estatisticamente significativas (p0,05). O estudo também constatou que os resultados obtidos nos dois testes de risco de queda diferem entre si. Conclusões: Idosos diabéticos apresentam maior risco de queda em comparação aos idosos não diabéticos.

Tecnologia educativa para disseminação do programa Fall TIPS Brasil / Educational technology for disseminating the Fall TIPS Brasil program

Resumo: Esta tese integra o projeto de pesquisa e desenvolvimento tecnológico "Difusão e adoção do programa Fall Tailoring Interventions for Patient Safety (Fall TIPS): engajamento de pacientes, profissionais e liderança clínica para a prevenção de quedas em ambiente hospitalar". Está conectada à linha de Pesquisa de Gerenciamento de Serviços de Saúde e Enfermagem do Programa de Pós-Graduação em Enfermagem da Universidade Federal do Paraná e objetivou construir, de maneira colaborativa, uma tecnologia educativa em formato de Curso Massivo, Aberto e Online (MOOC) sobre o programa Fall TIPS Brasil para a prevenção de quedas hospitalares, valendo-se de recursos variados, como infográficos, vídeos, podcasts e jogos interativos, destinada à disseminação da proposta entre profissionais e estudantes da área da saúde; e verificar o aprendizado estatisticamente significativo em relação ao conhecimento dos cursistas antes e após o seu acesso. Primeiramente ocorreu o processo de construção do MOOC com colaboração multidisciplinar, envolvendo docentes, estudantes de graduação e pós-graduação, profissionais de saúde e do setor de ensino a distância da universidade participante, fase de desenvolvimento tecnológico. Após, a abordagem quase experimental não randomizada e não concorrente foi realizada com 21 estudantes do último período do curso de graduação em enfermagem de uma universidade pública, tendo sido submetidos a um questionário contendo 10 questões objetivas antes e após o acesso ao MOOC. Os dados foram analisados mediante estatística descritiva e analítica. A construção do MOOC foi iniciada em 2020, com a primeira edição lançada em outubro de 2023. As etapas observadas na sua elaboração incluíram a escolha do tema, a produção do curso, a avaliação preliminar e a divulgação. O conhecimento dos cursistas após o acesso foi significativamente (p <0,001) maior, quando comparado com os resultados antes do acesso. A média das notas antes do acesso ao curso foi 7,1 e, após, foi 8,9. As evidências encontradas demonstram o sucesso da intervenção. O desenvolvimento do MOOC de maneira colaborativa, o direcionamento dos materiais para o público-alvo respeitando suas dificuldades e potencialidades permitem aderência a proposta, contribuindo para que a intervenção possibilite a ampliação do conhecimento sobre o programa Fall TIPS Brasil. Assim, destaca-se a importância de os profissionais de saúde possuírem conhecimento para poderem promover o engajamento dos pacientes e acompanhantes em prol da prevenção de quedas, sendo o MOOC um recurso promissor para essa finalidade.

Abstract: This thesis integrates the research and technological development project "Diffusion and adoption of the Fall Tailoring Interventions for Patient Safety (Fall TIPS) program: engagement of patients, professionals, and clinical leadership for the prevention of falls in the hospital environment." It is connected to the Research Line in Health Services Management and Nursing of the Graduate Program in Nursing at the Federal University of Paraná and aimed to collaboratively construct an educational technology in the form of a Massive Open Online Course (MOOC) on the Fall TIPS Brazil program for the prevention of hospital falls, utilizing various resources such as infographics, videos, podcasts, and interactive games, intended for disseminating the proposal among healthcare professionals and students; and to verify statistically significant learning regarding the knowledge of the participants before and after accessing the course. First, the process of building the MOOC occurred through multidisciplinary collaboration, involving faculty, undergraduate and graduate students, healthcare professionals, and the university's distance education sector, in the phase of technological development. Subsequently, a quasi-experimental non-randomized and non-concurrent approach was conducted with 21 final-year nursing students from a public university, who were subjected to a questionnaire containing 10 objective questions before and after accessing the MOOC. Data were analyzed using descriptive and analytical statistics. The construction of the MOOC began in 2020, with the first edition launched in October 2023. The stages observed in its development included choosing the theme, producing the course, preliminary evaluation, and dissemination. Participants' knowledge after accessing the course was significantly higher (p <0,001) compared to the results before access. The average score before accessing the course was 7,1 and after was 8,9. The evidence found demonstrates the success of the intervention. Collaborative development of the MOOC, directing materials to the target audience while respecting their difficulties and potentialities, allows adherence to the proposal, contributing to expanding knowledge about the Fall TIPS Brazil program. Thus, the importance of healthcare professionals having knowledge to promote the engagement of patients and caregivers in fall prevention is highlighted, with the MOOC being a promising resource for this purpose.

Relationship between sarcopenia and fall risk in elderly patients with type 2 diabetes mellitus / 重庆医学

Objective To investigate the onset situation of sarcopenia in elderly patients with type 2 di-abetes mellitus(T2DM),and to analyze the influence factors of fall risk and the relationship between the com-plicating muscle function reduction and the fall risk.Methods A total of 512 cases of T2DM aged ≥60 years old in this hospital from January 2020 to December 2022 served as the study subjects.The grip strength(HS)was tested by the CAMRY-EH101 grip tester,the walking speed(GS)was measured by the stopwatch and tape measure,the muscle content was analyzed and determined by bioelectrical impedance.The skeletal muscle mass index(SMI)was calculated.Sarcopenia was grouped by the AWGS2019 standard,the Morse fall Risk Prediction Scale was used to evaluate the fall risk,and the influencing factors of fall risk were analyzed by bi-nary logistic regression.Results The detection rate of sarcopenia among the study subjects was 19.92％,and 399 patients(77.93％)had the fall risk.Whether having sarcopenia or the severity of sarcopenia had no influ-ence on the fall risk(P＞0.05).Among the patients without sarcopenia,the fall risk in the HS,GS and SMI decrease group was increased compared with the normal group(P＜0.001).The results of the multi-factor a-nalysis showed that the 7 types of variables such as gender,BMI,blood glucose,IL-6,T2DM retinopathy,T2DM pe-ripheral neuropathy and T2DM vascular disease were the influencing factors of fall risk(P＜0.05).Conclusion Eld-erly patients with T2DM have a higher fall risk,and T2DM combined with decreased muscle function could aggravate the fall risk,but T2DM combined with sarcopenia has no significant effect on the fall risk.

Analysis of cause and application of detachment after hookwire puncture positioning of peripheral lung nodules / 临床外科杂志

Objective To study the relationship between detachment and puncture site and chest wall thickness after preoperative positioning of peripheral lung nodules by CT-guided Hookwire puncture.Methods From July 2017 to December 2021,190 patients in our hospital underwent thoracoscopic surgery for peripheral lung nodules.All patients underwent preoperative CT-guided HOOKWIRE puncture mapping,recording the puncture site,whether the needle had fallen off,chest wall thickness,and the interval between the end of the puncture and the start of the surgery,logistic regression analysis,and receiver operating characteristic(ROC)curve analysis to explore the risk factors affecting needle fall off.Results Clinical data were collected for 190 patients,including 119 males and 71 females,age 22 to 78(58.1±10.2)years.There were 31 cases of shedding,with a shedding rate of 16.3％.Among them,31 cases were detached in the medial aspect of the subscapular horn line,15 cases were detached,with detachment rate being 48.4％;67 cases were detached in the medial axillary line,10 cases were detached,with detachment rate being 14.9％;65 cases were detached in the medial axillary line of the midclavicular line,5 cases were detached,with detachment rate being 7.6％;27 cases were detached in the medial axillary line,1 case was detached,with detachment rate being 3.7％;the detachment rate was highest in the subscapular horn line,with statistical significance(P＜0.05)compared with other locations;the tissue thickness of the thoracic wall was(49.38±6.28)mm,but the tissue thickness of the thoracic wall was(36.36±7.77)mm,with statistical significance(P＜0.05).The interval between puncture and operation was 73 to 98 min,with an average one of(81.99±4.48)min.Conclusions The detachment of the positioning needle is related to the thickness of the chest wall,and the proportion of detachment is significantly higher in the chest back,especially in the subscapular angle,before surgical treatment of peripheral lung nodules.In cases of peripheral pulmonary nodules with surface projections medial to the inferior scapular horn line,other methods of localization should be preferably considered.

Application of fall prevention and management strategies based on patient participation and Internet plus in elderly inpatients / 中国实用护理杂志

Objective:To explore the effectiveness of patient participation and Internet plus in fall prevention management strategies of elderly inpatients and analyze the causes of falls, so as to provide a basis for continuous improvement in fall prevention to investigate their continuous improvement.Methods:A pre- and post-control study was conducted. Totally 8 480 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2020 to 31 May 2021 in Chenzhou NO. 1 People′s Hospital were selected by convenient sampling as the control group, and 8 662 elderly inpatients hospitalized in the Department of Internal Medicine from 1 June 2021 to 31 May 2022 were in the experimental group. The routine fall prevention measures were used in the control group, and on this basis, the experimental group formulated and implemented fall prevention management strategies involving patients based on the patient participation framework "informing, participating, empowering, cooperating, and electronic information support" and introduced Internet plus. Then the differences between the two groups in terms of the incidence of falls and the satisfaction rate of nursing care were compared.Results:The experimental group included 8 662 cases (5 110 males and 3 552 females) with (73.96 ± 8.78) years old, while the control group included 8 480 cases (4 918 males and 3 562 females) with (74.11 ± 8.59) years old. The incidence of falls in experimental group (0.092%, 8/8 662) was lower than that in control group (0.224%, 19/8 480), and the difference was statistically significant ( χ 2=4.71, P<0.05); the nursing care satisfaction rate of experimental group (98.880%, 8 565/8 662) was higher than that of control group (96.450%, 8 179/8 480), and the difference also was statistically significant ( χ 2=106.50, P<0.01); the analysis of the fall causes of the patients revealed that the toilet squatting commode was an important hidden risk of falls in elderly patients. Conclusions:Fall prevention management strategies based on patient participation can reduce the incidence of falls in elderly patients and improve the satisfaction rate of nursing care. Patient participation introduced "Internet plus" can prevent patient falls. The root causes of patient falls will continue to change, and care managers should continually track real-time changes in the root causes of falls to identify problems, develop and adjust prevention strategies accordingly, and pay attention to the importance of infrastructure in the safety of older patients.

Characterization of temporal and intensity parameters of early postural adjustment phase during gait initiation in stroke patients / 中国组织工程研究

BACKGROUND:Early postural adjustments serve as preparatory measures for forthcoming actions or potential disruptions in posture,thereby facilitating improved movement execution and mitigating destabilizing effects caused by posture interference. OBJECTIVE:To investigate the characteristics of temporal and intensity parameters of key lower limb muscles during early postural adjustment phase when stroke patients with varying levels of balance initiate walking at a self-selected comfortable pace. METHODS:The characteristics of early postural adjustments in 16 stroke patients were observed.Sixteen patients were divided into a non-fall group(n=8)and a fall group(n=8)based on the history of falls and Berg Balance Scale scores.Noraxon inertial sensors and Noraxon Ultium EMG wireless surface electromyography were utilized to collect body kinematic data and surface electromyography data during gait initiation.Muscle activation time and activation sequence of six key muscles in the lower limbs(tibialis anterior,medial and lateral gastrocnemius,rectus femoris,lateral femoris and biceps femoris muscles)during the early postural adjustment phase,as well as normalized electromyography integral values for the four time windows(each 150 ms)before gait initiation,were analyzed. RESULTS AND CONCLUSION:Stroke patients with a history of falls exhibited earlier activation times for the six key muscles in the lower limbs during gait initiation compared with those in the non-fall group.The fall group demonstrated significantly earlier activation times for tibialis anterior,lateral head of gastrocnemius,and vastus lateralis(P<0.01,P<0.05).In contrast,the non-fall group displayed a consistent pattern of activating extensor muscles before flexor muscles,with thigh muscle activation preceding calf muscle activation.However,in the fall group,calf extensor muscle activation occurred prior to thigh extensor muscle activation,and the vastus lateralis was activated even earlier.The tibialis anterior was the last activated muscle in both groups.Specifically during T3(>-300 to-150 ms),the tibialis anterior exhibited significantly higher activity in the fall group compared with the non-fall group(P<0.05),while the lateral head of gastrocnemius demonstrated significant inhibition during T3(P<0.05)and the medial head of gastrocnemius showed significant inhibition during both T3 and T4(>-150 to 0 ms)stages compared with the non-fall group(P<0.01,P<0.05).To conclude,stroke patients with varying balance abilities employ distinct early postural adjustment strategies prior to stepping,as evidenced by differences in muscle activation timing,recruitment order,and muscle activity amplitude.Patients at a high risk of falling exhibit prolonged duration of early postural adjustment and delayed initiation of gait,indicating earlier activation of the tibialis anterior muscle and inhibition of gastrocnemius muscle activity.These delays in gait initiation and variations in muscle recruitment strategies may contribute to unstable posture and an increased susceptibility to falls.

Relationship between muscle activation characterization and fall risk in older adults during walking up and down stairs / 中国组织工程研究

BACKGROUND:During stair walking,different muscles work in concert and compensate for each other,and it is unclear whether weakened muscle strength actually affects stair fall risk in older adults.Real-time electromyographic signals from older adults during stair walking are used to reflect high fall risk in older adults during stair walking,which may further improve the accuracy of prediction methods. OBJECTIVE:To investigate the effects of aging on lower limb muscle activation in older adults during stair walking and to analyze the relationship between their muscle activation characteristics and stair fall risk. METHODS:Subjects were divided by age into an older group(n=19)and a younger group(n=18)group and were asked to walk on a 10-step staircase at a natural speed,incorporating surface electromyography acquisition technology,to capture surface electromyography signals during stair walking and calculate the root mean square(RMS)to analyze differences in muscle activation levels.Logistic regression analysis was utilized to establish a predictive model for stair fall risk in older adults by incorporating the lateral femoral and gastrocnemius muscle RMS.The discrimination of the model was evaluated by the receiver operating characteristic curve and area under the curve,and the fit of the model was evaluated using the Hosmer-Lemeshow test RESULTS AND CONCLUSION:Activation of the rectus femoris(Z=-3.464,P=0.001;t=3.379,P=0.002)and lateral gastrocnemius muscle(Z=-2.978,P=0.003;Z=-3.555,P<0.001)was higher in older adults than in younger adults when walking up and down stairs.Activation of the anterior tibialis(Z=-2.350,P=0.019)and medial(Z=2.321,P=0.020)and lateral(t=3.158,P=0.004)gastrocnemius muscles was higher in older adults when ascending stairs than descending stairs.Older adults at risk for falls had less activation of the lateral femoral muscle(Z=-2.613,P=0.009),medial gastrocnemius muscle(Z=-2.286,P=0.022)when walking upstairs,and lateral femoral muscle(Z=-2.368,P=0.018)when walking downstairs than did older adults not at risk for falls.The predictive ability,goodness of fit,and discrimination of the stair fall prediction model for older adults based on surface electromyography were good(P-value of 0.010 for the Omnibus test of the model coefficients,P-value of 0.214 for the Hosmer-Lemeshow test,and the area of the curve of the upper staircase lateral femoral muscle=0.856,P=0.009).(5)The model was modeled with a cut-off value of 38.64 for the upper staircase lateral femoral muscle RMS value and there was a 0.952-fold increase in the risk of staircase falls for each unit decrease in the upper staircase lateral femoral muscle RMS in older adults.

Establishment and validation of a prediction model of hip fracture risk factors in elderly stroke patients / 中国组织工程研究

BACKGROUND:Prevention of fractures after stroke is very important,and there are currently no models to predict the occurrence of hip fractures after stroke. OBJECTIVE:To investigate the risk factors leading to hip fracture in stroke patients and to establish a risk prediction model to visualize this risk. METHODS:A total of 439 stroke patients were selected from the Affiliated Hospital of Xuzhou Medical University from June 2014 to June 2017,including 107 males and 332 females,with a mean age of(71.38±9.74)years.They were divided into fracture group(n=35)and non-fracture group(n=404)according to the presence or absence of hip fracture.Univariate and multivariate analyses were used to determine the risk factors for hip fracture after stroke.The data were randomly divided into training set(70%)and test set(30%).Nomogram predicting the risk of hip fracture occurrence was created based on the results of the multifactor analysis,and performance was evaluated using receiver operating characteristic curve,calibration curves,and decision curve analysis.A web calculator was created to facilitate a more convenient interactive experience for clinicians. RESULTS AND CONCLUSION:(1)Univariate analysis showed significant differences between the two groups in the number of falls,smoking,hypertension,glucocorticoids,number of strokes,Mini-Mental State Examination,visual acuity level,National Institute of Health Stroke Scale,Berg Balance Scale,and Stop Walking When Talking scale scores(P<0.05).(2)Multivariate analysis showed that number of falls[OR=17.104,95%CI(3.727-78.489),P=0.000],National Institute of Health Stroke Scale[OR=1.565,95%CI(1.193-2.052),P=0.001],Stop Walking When Talking[OR=12.080,95%CI(2.398-60.851),P=0.003]were independent risk factors positively associated with new hip fractures.Bone mineral density[OR=0.155,95%CI(0.044-0.546),P=0.012]and Berg Balance Scale[OR=0.840,95%CI(0.739-0.954),P=0.007]were negatively associated with new hip fractures after stroke.(3)The AUC values of nomogram were 0.956 and 0.907 in the training and test sets,respectively,and the calibration curves showed a high agreement between predicted and actual status with an area under the decision curve of 0.038 and 0.030,respectively.(4)These findings conclude that the number of falls,low bone mineral density,low Berg Balance Scale score,high National Institute of Health Stroke Scale score,and positive Stop Walking When Talking are risk factors for hip fracture after stroke.Based on this,a nomogram with high accuracy was developed and a web calculator(https://stroke.shinyapps.io/DynNomapp/)was created.

Design and implementation of a fall detection system for elderly patients / 中国医学装备

Objective:To design a fall detection system for elderly patients to solve the problem of elderly patients failing to detect accidental falls in time and to improve the efficiency of medical care.Methods:Based on real-time stream transmission protocol(RTSP),combined with YOLOv5 and Kalman algorithms,a fall detection system for elderly patients was designed by using Vue and Flask technologies.A visual background system management was established,and a unified management platform was provided for medical staff through comprehensive processing of multiple video streams to realize the autonomous detection and alarm of human fall behavior.30 healthy volunteers who underwent fall testing at Xijing Hospital of Air Force Medical University in 2020 to 2022 were selected and divided into normal walking group,squatting group and falling group according to the simulated behavioural categories,with 10 in each group.The fall detection performance was evaluated using two evaluation indicators:detection accuracy and detection speed to verify and determine whether the fall detection system for elderly patients can meet the requirements of timely and accurate fall detection and alarm.Results:The overall fall detection rate of the normal walking group,the squatting group and the falling group can reach 29 frames per second,and the accuracy rate can reach 95.24%.and the system can respond to the fall alarm in time.Conclusion:The fall detection system for elderly patients can assist medical staff to promptly detect and deal with the occurrence of falls,improve the efficiency of fall detection for elderly patients,and meet the real-time detection and alarm of fall behavior for elderly patients.

Construction and verification of a clinical fall prevention information system) / 中华护理杂志

Objective The clinical fall prevention information system is developed and its effect is verified,pro-viding references for the prevention of clinical falls through information technology.Methods Based on the screen-ing-assessment-intervention-evaluation process recommended by the toolkit,a clinical fall prevention information sys-tem was constructed through the steps of team formation and group discussion.The system includes 2 modules of fall prevention clinical practice and fall adverse event management,and 5 basic functions of fall risk assessment,structured risk point screening,personalized intervention measures,evaluation report and intervention prescription,and adverse event reporting.From September to December 2021,the system was tested in 6 departments with a high incidence of falls in a tertiary A hospital in Chongqing,and the application effect of the system was verified from 5 aspects:friendliness of the system interface,professional guidance,improvement of patient participation,reduction of fall incidence and injury rate.Results 68.9％of nurses thought that the system was user-friendly;82.7％thought that the system was professional and instructive;75.3％thought that the system could improve patients'participation in fall prevention.After trial of the system,the incidence of falls and injury decreased,but the statistical difference was not obvious(P＞0.05).Conclusion This system realized multi-team cooperation to jointly pay attention to pa-tients'falls,and it was well recognized by nurses in terms of professional guidance and improving patients'partici-pation in fall prevention.At the same time,due to the short trial and verification time,narrow scope and small sample size of this system,its fall prevention effect needs to be further promoted and verified.

Characteristics of fall injuries among primary and middle school students in Yinzhou District from 2010 to 2022 / 预防医学

Objective@#To investigate the characteristics of fall injuries among primary and middle school students in Yinzhou District, Ningbo City, Zhejiang Province from 2010 to 2022, so as to provide insights into prevention and control of fall injuries among primary and middle school students.@*Methods@#Data of 6 to 17 year-old primary and middle school students with initial diagnosis of fall injury from 2010 to 2022 were collected through Injury Subsystem of Zhejiang Provincial Chronic Disease Surveillance Information Management System. The time, place, activity and clinical characteristics of fall injury were analyzed using a descriptive method.@*Results@#Totally 7 808 fall injury cases among primary and middle school students were reported in Yinzhou District from 2010 to 2022, accounting for 45.72% of the total injury cases in the same age. There were 5 413 boys and 2 395 girls, with a boy/girl ratio of 2.26∶1. Primary school students were the majority, accounting for 55.10%. The incidence of fall injuries among girls, junior high school students and high school students showed increasing trends from 2012 to 2022 (both P<0.05). The primary peak of fall injury was from September to November, and the secondary peak was from May to July, with 4 510 cases (57.76%). The place of fall injury development mainly included schools (2 680 cases, 34.32%), homes (2 343 cases, 30.01%) and streets/urban areas (2 247 cases, 28.78%). The activities at the time of fall injury mainly included leisure time (3 490 cases, 44.70%), sports (2 861 cases, 36.64%) and school activities (1 094 cases, 14.01%). Soft tissue injury was the main characteristics (6 224 cases, 79.71%). Lower limbs (3 101 cases, 39.72%), head (2 419 cases, 30.98%) and upper limbs (1 974 cases, 25.28%) were the main injury sites. Mild injury was predominant (5 896 cases, 75.51%).@*Conclusions@#Boys and primary school students are high-risk groups of fall injury in Yinzhou District, schools are high-risk places of fall injury. Schools should be regarded as key intervention places and health education on fall injury prevention should be strengthened.

Survey on the home environmental hazards related to falls of the elderly in Changning District, Shanghai / 公共卫生与预防医学

Objective To investigate the current situation of home environment safety of the elderly in Changning District, identify the risk factors related to the fall of the home environment of the elderly, and take targeted rectification measures, so as to create a safer environment for the elderly. Methods A phased random sampling method was used to select 201 elderly households from 10 streets in Changning District. Community doctors conducted on-the-spot investigation and assessment to collect information, and Epidata3.1 was used to input data and SAS 9.2 was used for statistical analysis. Results The incidence of falls in the past year was 19.90%, and the score of environmental risk factors/the number of environmental risk factors in each family ranged from 0 to 25, with an average of 9 items (standard deviation of 4.71). The results of multivariate logistic regression analysis show that the high level of falling environment (the number of falling risk factors in home environment ≥12) is still an independent risk factor for falls of the elderly, except for the influence of age and the number of drugs taken (OR=3.835, 95% CI:1.718-8.561). Conclusion The environmental risk factors causing falls are common in the home environment of the elderly in the community. It is necessary to focus on improving the home environment, reducing the risk of falls for the elderly, and creating a safe and comfortable home environment for the elderly.

Research progress on fall risk and prevention in elderly population / 公共卫生与预防医学

Fall is an important cause of serious injury and even death in the elderly. With the increasing proportion of the elderly in China, fall in the elderly has become a major public problem in society. There are many causes of fall in the elderly, and age, gender, chronic diseases, physical function and living environment are closely related to the fall risk in the elderly. Therefore, it is of great significance to understand and analyze the risk factors of fall in the elderly in detail, formulate targeted and rational preventive interventions and reduce the incidence rate of fall in the elderly, so as to relieve the personal and family burdens, save the social resources and enhance the quality of life of the elderly.

Epidemiological studies of falls among the elderly: a review / 预防医学

Abstract@#Falls are the leading cause of accidental injury deaths among the elderly. Currently, the incidence and disease burden of falls among the elderly remain high. By understanding the influencing factors of falls among the elderly and formulating targeted preventive measures, the risk of falls can be effectively reduced. Studies have found that falls among the elderly are results of the interaction of multiple factors. When formulating fall prevention strategies, attention should be paid to fall risk assessment and stratification, fall prevention exercise support and health education, living environment improvement, and primary healthcare service enhancement. Reviewing publications pertaining to the epidemiological studies of falls from January 2004 to January 2024, this article summarizes the epidemiological characteristics, risk factors, prevention and control strategies of falls among the elderly, aiming to provide the reference for prevention and control.

Association between intrinsic capacity and falls among older adults / 预防医学

Objective @#To examine the association between intrinsic capacity and falls in older adults, so as to provide insights into the risk assessment of falls. @*Methods@#Older adults aged 60 years and above were selected from two districts and one county in Bengbu City, Anhui Province from September 2022 to June 2023 using convenience sampling method. Demographic information, health-related behaviors and incidence of falls among participants were collected through questionnaire surveys. The intrinsic capacity included five dimensions: sensory, motor, vitality, cognition and psychology, which were investigated by the sensory dimension screening scale recommended by the World Health Organization, the Simple Physical Functioning Battery (SPPB), the Micro Nutritional Assessment Scale (MNAS-SF), the Brief Intelligent Mental State Examination Scale (MMSE), and the Center for Evaluation of Streamlined Depression Levels 10-entry scale (CESD-10), respectively. A total score of 1 or more indicated a decrease in intrinsic capacity. The association between intrinsic capacity and falls in older adults was analyzed by a multivariable logistic regression model.@*Results@#A total of 1 950 questionnaires were allocated, and 1 917 were valid, with an effective rate of 98.30%. There were 934 men (48.72%) and 983 women (51.28%), with a mean age of (68.15±3.42) years. There were 1 352 rural residents (70.53%) and 1 431 illiterate and primary school-educated residents (74.65%). In the past year, 347 residents fell, accounting for 18.10%. The median comprehensive score for intrinsic capacity was 1.00 (interquartile range, 2.00) points, and 1 320 had a decrease in intrinsic capacity, accounting for 68.86%. Multivariable logistic regression analysis showed that decline in intrinsic ability was associated with the risk of falls after adjustment for age, gender, educational level, marital status, alcohol consumption and self-rated health status (OR=1.531, 95%CI: 1.408-1.721).@*Conclusion@#Decreased intrinsic capacity in older adults may contribute to an increased risk of falls.

Analysis of Biomechanical Characteristics of Lower Limbs During Stair Descent in Patients with Hemiplegia / 医用生物力学

Objective To conduct a comparative analysis of the biomechanical characteristics of the lower limbs during stair descent in patients with hemiplegia using different method to provide theoretical references for reducing fall risk during stair descent.Methods Ten healthy subjects and 20 patients with hemiplegia were selected,and their kinematic and dynamic data during stair descent were collected using the Qualisys Motion capture system and the Kistler three-dimensional dynamometer.Their biomechanical characteristics and fall risks were also analyzed.Results Compared with that of healthy subjects and patients that step on the healthy side(SHS),the range of motion(ROM)of the affected side in the lower-limb joints of patients that step on the affected side(SAS)was smaller.SHS reduced the flexion and extension ranges of the healthy side of the knee joint,and the ROM of the affected side in the lower-limb joints of SHS patients was greater than that of SAS patients.The ground reaction force(GRF)curve changes of SAS patients in left and right directions during stair descent were relatively consistent with those of normal subjects.The maximum vertical GRF of the affected side in SAS patients at the moment of landing was 1.05 times the body weight,whereas that of the healthy side was 1.25 times the body weight,which was lower than that of normal subjects(1.5 times the body weight).The maximum vertical GRF of the healthy side in SHS patients at the moment of landing was 1.85 times the body weight,which was higher than that of SAS patients and normal subjects.Conclusions Compared with that of SAS patients,the affected limb side of SHS patients has a greater ROM and vertical GRF at the moment of landing during stair descent,making SHS difficult to master.SAS is most consistent with the biomechanical characteristics during stair descent of patients with hemiplegia.

Estudo de avaliabilidade do Programa Fall TIPS Brasil / Evaluability study of the Fall TIPS Brazil Program

Resumo: Esta tese compõe o projeto de pesquisa e desenvolvimento tecnológico "Difusão e adoção do Programa Fall TIPS: engajamento de pacientes, profissionais e liderança clínica para a prevenção de quedas em ambiente hospitalar. Está ligada à linha de Pesquisa de Gerenciamento de Serviços de Saúde e Enfermagem do Programa de Pós-Graduação em Enfermagem (PPGENF) da UFPR e teve por objetivo elaborar e validar um modelo teórico, modelo lógico e matriz de análise e julgamento do Programa Fall TIPS, em sua adaptação pioneira ao cenário brasileiro. O programa,baseado em evidências, está implantado em mais de 125 instituições de saúde no mundo, e é sustentado por mais de uma década de pesquisas. Ao utilizar-se de estratégias multimodais para a prevenção de quedas hospitalares, consiste em um conjunto de ferramentas e instrumentos. Seu diferencial está no engajamento de profissionais de saúde, pacientes e acompanhantes no desenvolvimento e execução, em conjunto, de um plano personalizado para prevenção de quedas entre pacientes internados. Trata-se de um estudo de avaliabilidade (EA), realizado em um hospital público e de ensino, na cidade de Curitiba, no Paraná, no período de 2021 a 2023. Utilizou-se o referencial de Trevisan e Walser mediante componentes como: definição do foco do estudo de avaliabilidade; desenvolvimento de uma teoria inicial do programa; coleta de feedback sobre a teoria do programa; e considerações sobre os usos do estudo de avaliabilidade. Contou com uma etapa documental e outra participativa. Na etapa documental foram analisadas legislações, diretrizes e publicações sobre segurança do paciente, prevenção de quedas e sobre o Programa Fall TIPS. A etapa participativa foi resultante de oficinas, junto a 15 profissionais de saúde ligados a um hospital público e de ensino, indicados pela gestão hospitalar. Posteriormente, os construtos provenientes foram validados, em oficinas, por três enfermeiras ligadas à docência e assistência, convidadas por suas atuações em avaliação, segurança do paciente e gestão de riscos assistenciais, além de conhecimentos prévios sobre o Programa Fall TIPS. Os dados da etapa documental foram analisados à luz de pontos-chave sobre o programa e sobre o problema que se propõe a enfrentar. Os dados oriundos das oficinas junto a profissionais de saúde e informantes-chave foram analisados por Análise de Conteúdo, mediante categorias de análise previamente definidas: contextos interno e externo à instituição hospitalar, recursos, objetivos, atividades, produtos, resultados, impacto, metas e questões ligadas à execução do programa em instituições de saúde. O estudo possibilitou melhor conhecimento do programa e da temática prevenção de quedas hospitalares. Ainda, ao ser disponibilizado em website brasileiro do programa, isso contribuirá para a disseminação do programa, adoção por profissionais de saúde e instituições de saúde interessadas e condução de processos avaliativos.

Abstract: This thesis entails the project of research and technological development "Dissemination and adoption of the Fall TIPS Program": engagement of patients, professionals and clinical leadership for fall prevention within hospital settings". It is connected with the line of research of Health and Nursing Services Management of the Postgraduation Program in Nursing at the Federal University of Paraná (PPGENF- UFPR). It aimed to elaborate and validate a theoretical model, logic model and matrix of analysis and judgement of the Fall TIPS Program in its pioneer adaptation to the Brazilian setting. The evidence-based program has been implemented in over 125 health institutions worldwide, and it is supported by over a decade of research. It consists of a set of tools and instruments by using multimodal strategies for hospital fall prevention. Its differential lies in the engagement of health professionals, patients and their companions in the joint development and execution of a personalized fall prevention plan among hospitalized patients. It is an availability study (AS) conducted in a public teaching hospital in the city of Curitiba, Paraná State ­ Brazil from 2021 to 2023. Trevisan and Walser's theoretical framework was used by means of components as follows: definition of the focus of the availability study; development of an initial theory of the program; feedback collection on the program theory; and considerations on the use of the availability study. It comprised documentary and participating steps. In the documentary step, legislations, guidelines and publications on patient safety, fall prevention, and on the Fall TIPS Program were analyzed. The participating step resulted from workshops with 15 health professionals from the public teaching hospital, appointed by the hospital management. Subsequently, the resulting constructs were validated, during the workshops, by three teaching and health care nurses, invited by their performance in assessment, patient's safety and management of health care hazards, in addition to their previous knowledge on the Fall TIPS Program. The data from the documentary step were analyzed in light of the key points on the program and on the aimed problem. The data gathered from the workshops with the health professionals and key informants were analyzed by the Content Analysis, by means of previously defined analysis categories, as follows: internal and external contexts to the hospital institution; resources, objectives, activities, products, results, impact, goals and questions related to the program execution within health institutions. The study enabled better knowledge of the program and the thematics of hospital fall prevention. In addition, the release of the program in its Brazilian website will contribute to the dissemination and adoption of the program by health professionals and interested health institutions, with the execution of evaluation processes.

A Systematic Review on Comparison between Otago Exercise Program and Balance Exercise in Balance and Fall Risk among elderly with Knee Osteoarthritis

Background: Patients with knee osteoarthritis have balance issues and an increased fall risk; nevertheless, it is unclear whether the Otago exercise programme (OEP) or balance exercise will improve balance and reduce fall risk among individuals with knee osteoarthritis. Therefore, there is a need to compare the effectiveness of these exercises in treating knee osteoarthritis. This review aims to investigate the effects of an OEP and balance exercise programme to improve balance and reduce fall risk among the elderly population with knee osteoarthritis (OA).Methodology: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to conduct this systematic review. Four databases (PubMed, Cochrane central register of controlled trails (CENTRAL), Physiotherapy Evidence Database (PEDro), and Science Direct) were searched until September 2022 using predefined terms by two independent reviewers. The methodological quality of the studies was assessed using PEDro. All literature published from each source was selected according to the inclusion and exclusion criteria, and data extraction was performed independently with the outcomes of the Berg balance scale (BBS), time up and go test (TUG), chair stand test (CST), and short falls efficacy scale (SFES I).RESULT: The literature review studied seven full-text articles that met the selection criteria and PRISMA guidelines. Those articles were reviewed by grouping them into five different sub-groups based on the interventions. The quality of studies ranged from good (5 studies) to fair (2 studies). The improvement in balance and fall risk prevention following OEP and balance training showed mixed results, and the findings from this review may form the basis for a future systematic research program. CONCLUSION: It is difficult to conclude clear evidence-based recommendations for Otago exercise programmes and balance exercises in improving balance and reducing fall risk among the elderly population with knee OA due to limited availability and weak evidence.