Stability recovery performance in adults over a wide age range: A multicentre reliability analysis using different lean-and-release test protocols.

The ability to effectively increase the base of support is crucial to prevent from falling due to stability disturbances and has been commonly assessed using the forward-directed lean-and-release test. With this multicentre study we examined whether the assessment of stability recovery performance using two different forward lean-and-release test protocols is reliable in adults over a wide age range. Ninety-seven healthy adults (age from 21 to 80 years) were randomly assigned to one out of two lean angle protocols: gradual increase to maximal forward-lean angle (maximal lean angle; n = 43; seven participants were excluded due to marker artefacts) or predefined lean angle (single lean angle; n = 26; 21 participants needed to be excluded due to multiple stepping after release or marker artefacts). Both protocols were repeated after 0.5 h and 48 h to investigate intra- and inter-session reliability. Stability recovery performance was examined using the margin of stability at release (MoSRL) and touchdown (MoSTD) and increase in base of support (BoSTD). Intraclass correlation coefficients (confidence intervals at 95%) for the maximal lean angle and for the single lean angle were respectively 0.93 (0.89-0.96) and 0.94 (0.89-0.97) in MoSRL, 0.85 (0.77-0.91) and 0.67 (0.48-0.82) in MoSTD and 0.88 (0.81-0.93) and 0.80 (0.66-0.90) in BoSTD, with equivalence being revealed for each parameter between all three measurements (p < 0.01). We concluded that the assessment of stability recovery performance parameters in adults over a wide age range with the means of the forward lean-and-release test is reliable, independent of the used lean angle protocol.

Risk of traumatic intracranial haemorrhage is increased in older people exposed to oral anticoagulation with phenprocoumon.

BACKGROUND: Hospital admissions resulting from traumatic intracranial haemorrhages (TIH) in older people are increasing. There are concerns regarding an increased risk of a TIH in people taking oral anticoagulants (OAC) like phenprocoumon. AIMS: The aim of this study was to estimate the incremental risk of a TIH associated with OAC in older people. Furthermore, this study explored differences in risk according to functional status. METHODS: The study took data from a large German health insurance provider and combined hospital diagnoses with data regarding drug dispensing to estimate rates of a TIH in people with and without exposure to phenprocoumon. Analyses were stratified by sex and by severe functional impairment as disclosed by the long-term care insurance provider. RESULTS: Overall, exposure to OAC resulted in 2.7 times higher rates of TIH. People with severe functional impairment had a higher baseline risk of TIH than people without severe functional impairment. However, the incremental risk in those exposed to OAC was similar among people with and without severe functional impairment (standardised incidence rate difference 15.73 (95% CI 7.84; 23.61) and 12.10 (95% CI 9.63; 14.57) per 10,000 person-years, respectively). CONCLUSIONS: OAC increases the risk of TIH considerably. The incremental risk of TIH in those exposed to OAC is comparable between people with and without severe functional impairment. The presence of severe functional impairment per se should not exclude such patients from the potential benefits of OAC. For now, the prescription should be personalized based on individual fall risk factors and risk-taking behaviour.

Analysis of mortality after hip fracture on patient, hospital, and regional level in Germany.

Knowledge about risk factors of mortality after hip fracture might encourage prevention and further improvements in care. This study identified patient risk factors as well as hospital and regional characteristics associated with a decreased risk. Variation of mortality was largest on patient level and modest on hospital and regional level. INTRODUCTION: Among numerous studies analyzing mortality as worst consequence after hip fracture, the majority focused on patient level and fewer on hospital and regional level. Comprehensive knowledge about contributing factors on all levels might help to reveal relevant inequalities, which would encourage prevention and further improvements in care. This study aimed at investigating variation of mortality after hip fracture on patient, hospital, and regional level in Germany. METHODS: We performed a retrospective cohort study on hip fracture patients aged 65 and older using statutory health insurance claims data from Jan 2009 through Dec. 2012 and additional information from the Federal Statistical Office Germany. Regions were classified based on two-digit postal code. We applied a multilevel Cox proportional hazard model with random intercepts on hospital and regional level to investigate the risk factors for mortality within 6 and 12 months after hip fracture. RESULTS: The dataset contained information on 123,119 hip fracture patients in 1014 hospitals in 95 German regions. Within 6/12 months, 20.9%/27.6% of the patients died. On patient level, male sex, increasing age, increased pre-fracture care level, and increasing comorbidity were associated with an increased hazard of mortality. Hospitals with increasing hip fracture volume or with orthogeriatric co-management and regions with increased population density were associated with a decreased hazard. Variation was largest on patient level and rather modest on hospital and regional level. CONCLUSIONS: The identification of patient-related risk factors enables prognosticating mortality after hip fracture. After adjusting for those, variation seemed to be attributable rather to hospitals than to regions.

[Epidemiology and prevention of heat-related adverse health effects on elderly people]. / Epidemiologie und Prävention hitzebedingter Gesundheitsschäden älterer Menschen.

Heat waves increase the morbidity and mortality in Germany, particularly of older patients in need of care. Due to climate change the number of heat waves in Germany will increase threefold by the end of the century. In addition, the proportion of patients at risk will grow due to demographic change. Therefore, the Government and the Federal States have developed recommendations for heat action plans, in which the medical profession should also participate in the prevention of heat-related damage to health. Physicians and their team should first become acquainted with the topic. In addition, they should inform patients at risk and their relatives of the risks and preventive measures. In the summer a critical check of drugs is also needed because medications impair cooling mechanisms in heat waves, the pharmacokinetics can change and unwanted side effects of drugs occur more frequently. Lastly, due to their central position in the healthcare system, physicians should participate in the coordination of a good nursing care and intensification of social contacts during heat waves.

Risk of institutionalization following fragility fractures in older people.

Previously independent living older people suffering fractures of the hip have a high risk of new admission to a nursing home during the subsequent months. This study shows that older people admitted to hospital for fractures of the pelvis and spine have a similar risk of admission to a nursing home. INTRODUCTION: Fall-related fractures are a serious threat to the health and well-being of older persons. Long-term consequences of hip fractures such as institutionalization and mortality are well-known. The impact of other fragility fractures is less well-understood. The aim of this study was to estimate risks of institutionalization and death for different fragility fractures and compare them with the corresponding risks after hip fracture. METHODS: Data was retrieved from a German health insurance company. Between 2005 and 2008 more than 56,000 community-dwelling people with a hospital admission or discharge diagnosis of a fracture of the femur, spine, pelvis, proximal humerus, distal radius, tibia, or fibula were included. Crude and age-adjusted 6-month incidence rates for institutionalization and death were calculated. To compare the risks of institutionalization or mortality of non-hip fractures with the risk after hip fracture, multivariate regression models were applied. RESULTS: Crude institutionalization rates and mortality were highest in patients with hip fracture. However, after adjustment for age, functional status, and comorbidity, risks of institutionalization after fractures of pelvis (relative risk (RR), 0.94; 95% confidence interval (CI) 0.86; 1.02 in women and 0.89; 95% CI 0.70; 1.12 in men), and spine (RR, 0.95; 95% CI 0.87; 1.03 in women and 0.91; 95% CI 0.76; 1.08 in men) were not statistically different compared to the risk after hip fracture. CONCLUSIONS: The risk of institutionalization after fractures of the spine and pelvis was similar to the risk after hip fracture. These fracture sites seem to be associated with a significant decline in physical function.

Factors Influencing Acute Stroke Thrombolytic Treatments in Hispanics In the San Diego Region.

BACKGROUND: Since the introduction of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, rt-PA rate and number of stroke centers have increased. Despite this, studies have shown racial and ethnic disparities in stroke care especially in Black and Hispanic populations. What factors are related to the administration of rt-PA within the Hispanic population has to date been unclear. METHODS: We performed a retrospective review of IRB approved, prospectively collected data from the UC San Diego Stroke Registry from 7/2004-7/2016. Patients were included based on the primary diagnosis of Transient Ischemic Attack or Ischemic Stroke. Hispanic vs non-Hispanic patients were compared to assess for overall rt-PA treatment rates and process of care intervals. For the Hispanic cohort itself, demographics and NIHSS scores were assessed to determine why some Hispanics received rt-PA while others were not. RESULTS: Overall, 1489 patients (300 Hispanic vs. 1189 non-Hispanic) were included. Comparing Hispanics to non-Hispanics, there was no difference in rt-PA rate (35.3% vs. 33.1%; p=0.49). In rt-PA treated patients, "onset to arrival" interval was higher in Hispanics (1.03 vs. 0.88 hours; p=0.04), while the "arrival to treatment" interval was not different (1.13 vs. 1.02 hours; p=0.07). When looking at Hispanic patients only, there was no difference in baseline characteristics except for initial NIHSS in treated vs. non-treated patients (13.27 vs. 7.24; p<.001). CONCLUSION: Our analyses sought to determine the factors important to administration of rt-PA to Hispanic patients. These findings highlight the need for strategies to improve recognition and presentation pathways for Hispanics.

Fracture risk in people with developmental disabilities: results of a large claims data analysis.

Age- and sex-specific fracture rates of 18,000 people with developmental disabilities aged 0-69 years were compared to the general population. Age-standardized incidence of femoral fracture was 4.8- and 7.1-fold higher in women and men, respectively. Comparable fracture risks to the general population occurred 10-15 years earlier in females and 20-40 years earlier in males. INTRODUCTION: Previous studies suggested that fracture risks in people with developmental disabilities (DD) may be higher than in people in the general population. However, there are no current sufficiently large studies to compare age- and sex-specific fracture rates of single fracture types. METHODS: People with DD and incident fractures were identified by routine data of a health insurance company. Fractures in the general population were derived from the official fracture statistics. Age-specific and age-standardized fracture incidences were analyzed. To compare fracture risks in people with DD with that of the general population incidence ratios were calculated. RESULTS: Between 2008 and 2010, 148 femoral fractures and 469 other fractures were observed in nearly 18,000 people with DD aged 0-69 years. The three most frequent fracture types leading to hospital admission were fractures of the femur, lower leg/ankle, and shoulder/arm. For femoral fractures, a particularly high risk was observed in children and adolescents with DD. In adults with DD, the risk of femoral fractures increased with increasing age. Even if the youngest age category was not considered, the age-standardized incidence was 4.8- and 7.1-fold higher in women and men, respectively. For all other fracture types, except fractures of forearm/hand and of pelvis, people with DD had also higher fracture incidences than the general population. CONCLUSIONS: People with DD have a high fracture burden. Comparable risks of femoral fracture, for example, occurred about 10-15 years earlier in females and even 20-40 years earlier in males with DD than in the general population.

Non-enhanced CT Maximum Intensity Projections for the Detection of Large Vessel Occlusions.

BACKGROUND: Identification of large vessel occlusions (LVO) is important with recent guidelines supporting endovascular therapy in selected acute ischemic stroke patients. Many stroke centers perform CT angiography (CTA) in patients with suspected LVO, however this requires additional time and contrast administration. Non-enhanced CT maximum intensity projection (NECT-MIPs) may offer a rapid alternative to CTA. METHODS: We retrospectively reviewed acute stroke patients with LVO in the UCSD Stroke Registry, presenting between 6/2014-7/2016. NECT-MIPs were evaluated for presence of LVO. Gold standard comparison was to CTA. Results were stratified by level of training (Faculty, Fellow and Acute Care Practitioners [ACPs]). Inter-rater agreement was assessed using Fleiss' Kappa Coefficient. RESULTS: We reviewed 24 patients using NECT-MIPs for the detection of LVO. Faculty had a sensitivity and specificity of 95% & 92% for ICA/M1, 42% & 100% for M2, and 67% & 96% for basilar occlusions. Fellows and ACPs had a sensitivity and specificity of 61% & 94% for ICA/M1, 19% & 83% for M2, and 75% & 95% for basilar occlusions. Inter-rater agreement among Faculty readers was k=0.75 for ICA/M1, k=0.79 for M2 and k=0.14 for basilar occlusions. Among Fellows and ACPs, k=0.57 for ICA/M1, k=0.40 for M2, and k=0.27 for basilar occlusions. CONCLUSIONS: NECT-MIPs have high sensitivity and specificity for the detection of LVO when compared to CTA. Inter-rater agreement is fair and higher amongst more experienced reviewers. These results suggest that NECT-MIPs may be helpful to streamline the identification of LVO and reduce door to needle and door to intervention times.

Risk of osteoporotic fractures following stroke in older persons.

UNLABELLED: The aim of this study was to explore the increased risk of stroke survivors to different sustained osteoporotic fractures. We used hospital data and data on functional impairment. We found a higher risk in stroke survivors without functional impairment with the risk higher for lower than for upper extremity fractures. INTRODUCTION: Stroke survivors are at high risk of osteoporotic fractures due to frequent falls and an increased risk to develop osteoporosis. Data on their relative risk to sustain other than hip fractures is limited. Furthermore, the role of severe functional impairment on their fracture risk has not been considered yet. The aim of this study was to determine the relative risk of stroke survivors to sustain different osteoporotic fractures with regard to the presence of severe functional impairment. METHODS: Data from 2004 to 2009 of more than 1.2 million individuals aged 65 years or older and insured at a large German health insurance company were used for the analyses. Incident stroke and fractures were obtained from hospital diagnoses. Analyses were stratified by gender and information on severe functional impairment. Persons without preceding incident stroke were used as the reference group. Multistate models were used to estimate hazard ratios. RESULTS: Stroke survivors had a higher risk for fractures. However, a strong effect modification by functional impairment was apparent. Stroke survivors with functional impairment had no significantly increased risk for any fractures site compared to the corresponding reference group with functional impairment. In contrast, stroke survivors without functional impairment had a clearly and significantly increased fracture risk for most fracture sites. In these persons, the relative fracture risk for fractures of the lower extremities was higher than for fractures of the upper extremities. CONCLUSION: To evaluate the relative risk of stroke survivors for osteoporotic fractures, functional status appears to be a relevant parameter.

[Effectiveness and Cost-Effectiveness of a Multifactorial Fall Prevention Programme in Nursing Homes in a Real-World Setting]. / Effektivität und Kosteneffektivität einer multifaktoriellen Sturzpräventions-maßnahme in Pflegeheimen im Versorgungsalltag.

The purpose of the present study was to analyse the effectiveness and cost-effectiveness of a multifactorial fall prevention programme in nursing home residents in a real-world setting. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93) in residents exposed to the fall and fracture prevention programme compared to residents from the control group. Given a willingness-to-pay of 50,000 EUR per year free of femoral fractures from a payer perspective the probability that the intervention is cost-effective was 83%.

Prospective evaluation of renal function, serum vitamin D level, and risk of fall and fracture in community-dwelling elderly subjects.

SUMMARY: This prospective study in elderly showed that kidney function plays a minor role in explaining the high prevalence of vitamin D deficiency seen in noninstitutionalized elderly subjects. However, 25-hydroxyvitamin D levels were clearly inversely associated with risk for first fall, which was especially seen in subjects with calcium levels above median. INTRODUCTION: Few prospective studies in elderly exist that have investigated the association of renal dysfunction and vitamin D status on risk of falls. The aim of this study is to evaluate the association of renal function with 25-hydroxyvitamin D (25-OH-D) levels and, secondly, to assess the role of both factors on the risk of falls and subsequent bone fractures. METHODS: This is a prospective population-based cohort study among noninstitutionalized elderly subjects during a 1-year follow-up. 25-OH-D levels and renal function were estimated, the latter by cystatin C-based equations. Information on falls was assessed prospectively. RESULTS: Overall, 1,385 subjects aged 65 and older were included in the study (mean age 75.6 years), of whom 9.2 % had a 25-OH-D serum level above 75 nmol/L (US units 30 ng/mL); 41.4 %, between 50 and 75 nmol/L (US units 20 to 29 ng/mL, insufficiency); and 49.4 %, <50 nmol/L (US units <20 ng/mL, deficiency). We found no association of chronic kidney disease with risk of first fall. In contrast, 25-OH-D serum categories were clearly associated with risk of first fall and we found evidence of effect modification with calcium levels. In the group with a calcium level above the median (≥ 9.6 mg/dL), subjects with 25-OH-D serum level between 50 and 75 nmol/L and with concentrations <50 nmol/L had a hazard rate ratio (HRR) of 1.75 (1.03-2.87) and 1.93 (1.10-3.37) for risk of first fall. 25-OH-D serum levels were also associated with several markers of inflammation and hemodynamic stress. CONCLUSIONS: We demonstrated an association of 25-OH-D serum levels and risk of first fall, which was especially evident in subjects with serum calcium in upper normal, independent of renal function.

Analysis of gene expression during parabolic flights reveals distinct early gravity responses in Arabidopsis roots.

Plant roots are among most intensively studied biological systems in gravity research. Altered gravity induces asymmetric cell growth leading to root bending. Differential distribution of the phytohormone auxin underlies root responses to gravity, being coordinated by auxin efflux transporters from the PIN family. The objective of this study was to compare early transcriptomic changes in roots of Arabidopsis thaliana wild type, and pin2 and pin3 mutants under parabolic flight conditions and to correlate these changes to auxin distribution. Parabolic flights allow comparison of transient 1-g, hypergravity and microgravity effects in living organisms in parallel. We found common and mutation-related genes differentially expressed in response to transient microgravity phases. Gene ontology analysis of common genes revealed lipid metabolism, response to stress factors and light categories as primarily involved in response to transient microgravity phases, suggesting that fundamental reorganisation of metabolic pathways functions upstream of a further signal mediating hormonal network. Gene expression changes in roots lacking the columella-located PIN3 were stronger than in those deprived of the epidermis and cortex cell-specific PIN2. Moreover, repetitive exposure to microgravity/hypergravity and gravity/hypergravity flight phases induced an up-regulation of auxin responsive genes in wild type and pin2 roots, but not in pin3 roots, suggesting a critical function of PIN3 in mediating auxin fluxes in response to transient microgravity phases. Our study provides important insights towards understanding signal transduction processes in transient microgravity conditions by combining for the first time the parabolic flight platform with the transcriptome analysis of different genetic mutants in the model plant, Arabidopsis.

Unintended hand movements after abrupt cessation of variable and constant opposing forces.

Humans are highly efficient in moving in a world of variable resistive forces which result, e.g., from different masses of objects or different directions of movements relative to gravity. However, the underlying mechanisms are challenged when an opposing force is suddenly removed. The resulting involuntary movements are known as accident risks in everyday life. We studied their characteristics upon abrupt cessations of opposing forces of 1, 2, and 4N which were presented in a series of variable or constant forces. The characteristics of the involuntary hand movements are largely determined by the mechanical impedance of the limb. The involuntary movements are oscillatory in nature, and their amplitude increases with stronger opposing force. Limb impedance is modulated both in a reactive and in an anticipatory manner. The reactive modulation occurs during each involuntary movement as a consequence of the neural responses elicited by the rapid limb acceleration consequent upon the cessation of the opposing force. Anticipatory modulation of limb impedance may serve to produce similar involuntary movements in spite of different opposing forces. The modulation is thus stronger with variable forces, where differences between resulting involuntary movements can be experienced more easily, than with constant forces.

The health burden and costs of incident fractures attributable to osteoporosis from 2010 to 2050 in Germany--a demographic simulation model.

UNLABELLED: To predict the burden of incident osteoporosis attributable fractures (OAF) in Germany, an economic simulation model was built. The burden of OAF will sharply increase until 2050. Future demand for hospital and long-term care can be expected to substantially rise and should be considered in future healthcare planning. INTRODUCTION: The aim of this study was to develop an innovative simulation model to predict the burden of incident OAF occurring in the German population, aged >50, in the time period of 2010 to 2050. METHODS: A Markov state transition model based on five fracture states was developed to estimate costs and loss of quality adjusted life years (QALYs). Demographic change was modelled using individual generation life tables. Direct (inpatient, outpatient, long-term care) and indirect fracture costs attributable to osteoporosis were estimated by comparing Markov cohorts with and without osteoporosis. RESULTS: The number of OAF will rise from 115,248 in 2010 to 273,794 in 2050, cumulating to approximately 8.1 million fractures (78 % women, 22 % men) during the period between 2010 and 2050. Total undiscounted incident OAF costs will increase from around 1.0 billion Euros in 2010 to 6.1 billion Euros in 2050. Discounted (3 %) cumulated costs from 2010 to 2050 will amount to 88.5 billion Euros (168.5 undiscounted), with 76 % being direct and 24 % indirect costs. The discounted (undiscounted) cumulated loss of QALYs will amount to 2.5 (4.9) million. CONCLUSIONS: We found that incident OAF costs will sharply increase until the year 2050. As a consequence, a growing demand for long-term care as well as hospital care can be expected and should be considered in future healthcare planning. To support decision makers in managing the future burden of OAF, our model allows to economically evaluate population- and risk group-based interventions for fracture prevention in Germany.

Cost-effectiveness of a multifactorial fall prevention program in nursing homes.

UNLABELLED: The purpose of this study was to analyze the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. Given a willingness-to-pay (WTP) of 50,000 EUR per year free of femoral fracture, the probability that the intervention is cost-effective is 83%. INTRODUCTION: Despite their increased risk of falls and fractures, nursing home residents have been neglected in economic evaluations of fall prevention programs so far. The purpose of this study was to analyze, for the first time, the cost-effectiveness of a multifactorial fall prevention program in nursing home residents. METHODS: This study is part of a prospective, unblinded, cluster, nonrandomized, controlled study focusing on the transfer of an efficacious fall prevention program into a real-world setting. The analyzed subsample was derived from claims data and consisted of data on intervention (n=256, residents n=10,178) and control homes (n=893, residents n=22,974), representing all insurants of a sickness fund (AOK Bavaria, Germany) who were 65 years or older, residing in a nursing home on the 31st of March 2007 and had a level of care of ≥1 according to the classification of the statutory long-term care insurance. Time free of femoral fracture (ICD-10, S72) was used as measure of health effects. Femoral fracture-related costs and intervention costs were measured from a payer perspective. Multivariate regression models were applied. Sensitivity analyses were performed and cost-effectiveness acceptability curves computed. RESULTS: Within the first year of the intervention, femoral fracture rate was significantly reduced, resulting in a nonsignificant incremental mean time of 1.41 days free of femoral fracture. Incremental mean total direct costs were 29 EUR per resident, which was not significant. The incremental cost-effectiveness ratio (ICER) was 7,481 EUR per year free of femoral fracture. The probability of an ICER<50,000 EUR per year free of femoral fracture was 83%. CONCLUSION: Depending on the amount the decision-maker is willing to pay for the incremental effect, the fall prevention program might be cost-effective within the first year. Future studies should expand the range of costs and effects measured.

[Fall and fracture prevention based on the National Expert Standard. Implementation and costs in a real world setting in nursing homes]. / Sturz- und Frakturprävention auf der Grundlage des Nationalen Expertenstandards Sturzprophylaxe. Umsetzung und Kosten im Versorgungsalltag im Setting Pflegeheim.

BACKGROUND: A National Expert Standard for Fall and Fracture Prevention ("Expertenstandard Sturzprophylaxe") was established a few years ago in Germany. The purpose of this study was to determine for the first time the implementation and costs of fall and fracture prevention measures based on this National Expert Standard in German nursing homes in a real world setting. MATERIAL AND METHODS: This before/after study is based on an un-blinded, controlled translational study focussing on the primary prevention of fall-related hip fractures in nursing homes in Bavaria. 274 nursing homes were included in this study in 2008. The intervention aimed at implementing fall and fracture prevention measures based on the National Expert Standard. A random sample of 79 nursing homes was assessed via telephone at baseline and two follow ups. Costs were determined from a societal perspective, based on a questionnaire covering use and costs of fall and fracture prevention measures. Costs were analysed using paired t-tests and non-parametric bootstrapping techniques. RESULTS: The implementation of this program led to an increase in fall and fracture prevention activities and to additional mean costs of 6,248 EUR (± SD 7,340 EUR; pricing year 2008) per nursing home over 18 months. Costs varied widely between nursing homes. The majority of additional costs occurred for the implementation of strength and balance training. Depending on type and costs of staff conducting the training, total costs varied between 4,347 EUR (± SD 7,167 EUR) and 7,024 EUR (± SD 7,439 EUR). CONCLUSION: The implementation of fall and fracture prevention measures based on the National Expert Standard led to additional costs. Cost figures can be used by decision-makers with respect to decisions on resource allocation for different prevention programs (e.g., different National Expert Standards), to determine the main cost components, and finally for model-based cost-effectiveness analyses of fall-prevention programs in nursing homes.

[Falling in geriatrics. Diagnosis and treatment]. / Stürze in der Geriatrie. Diagnostik und Therapie.

Falls are among the most frequent adverse events in the life of an older person. Accident and emergency units, outpatient services and internal medicine wards should have a diagnostic concept for falls and fall-related injuries and implement an evidence-based risk management for fall prevention. The recently published Reviews of the Cochrane Collaboration and the revised guidelines of the Anglo-American medical societies are a proper basis to plan these steps. This, of course, has to be adapted for the needs of each institution. Currently, it is probable that at least 30% of all falls are preventable. A structured fall history and multifactorial assessment is not part of the routine of outpatient and inpatient services in Germany. The planned revision of the German nursing guideline on fall prevention and the current activities of the Aktionsbündnis Patientensicherheit will also lead to a legal dilemma for those institutions that have not implemented an adequate workup.

Retinal remodeling in the Tg P347L rabbit, a large-eye model of retinal degeneration.

Retinitis pigmentosa (RP) is an inherited blinding disease characterized by progressive loss of retinal photoreceptors. There are numerous rodent models of retinal degeneration, but most are poor platforms for interventions that will translate into clinical practice. The rabbit possesses a number of desirable qualities for a model of retinal disease including a large eye and an existing and substantial knowledge base in retinal circuitry, anatomy, and ophthalmology. We have analyzed degeneration, remodeling, and reprogramming in a rabbit model of retinal degeneration, expressing a rhodopsin proline 347 to leucine transgene in a TgP347L rabbit as a powerful model to study the pathophysiology and treatment of retinal degeneration. We show that disease progression in the TgP347L rabbit closely tracks human cone-sparing RP, including the cone-associated preservation of bipolar cell signaling and triggering of reprogramming. The relatively fast disease progression makes the TgP347L rabbit an excellent model for gene therapy, cell biological intervention, progenitor cell transplantation, surgical interventions, and bionic prosthetic studies.

Availability and use of hip protectors in residents of nursing homes.

SUMMARY: Potential predictors of availability and use of hip protectors were studied in residents of 48 nursing homes. The likelihood of being offered a hip protector was reduced in men, in residents with very low or very high care needs, in residents with migration background, and in recipients of welfare aid. INTRODUCTION: The purpose of this study is to analyze potential predictors of availability and use of hip protectors in residents of nursing homes. METHODS: In 48 German nursing homes, individual information on availability and use of hip protectors was collected from all institutionalized residents (3,924 residents; 78.2% women). Information on nursing home characteristics was obtained by telephone interview. The effect of individual variables and of nursing home characteristics on hip protector availability and use was estimated using multilevel logistic regression analyses. RESULTS: The prevalence of hip protectors being made available was 10.0% in women and 6.2% in men. Sixty-four percent of those with a hip protector used it during the 4 weeks prior to the examination. The likelihood of being offered a hip protector was reduced in men (odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43; 0.83), in residents with very low or very high care needs (OR, 0.32; 95% CI, 0.18; 0.56 and OR, 0.55; 95% CI, 0.38; 0.79, respectively), in residents with a migration background (OR, 0.30; 95% CI, 0.09; 0.99), and in recipients of welfare aid (OR, 0.60; 95% CI, 0.44; 0.81). Nursing home characteristics such as the size of the nursing home or staff participation rate in training measures had no effect on hip protector availability and use. CONCLUSION: Predictors of hip protector availability were sex, the degree of care need, migration status, and welfare aid. The lower availability of hip protectors in residents with welfare aid and migration status may be an indicator for health inequality in the German health system.