Long-term participation in peer-led fall prevention classes predicts lower fall incidence.

OBJECTIVE: To investigate the association between length of participation in Steady As You Go (SAYGO) peer-led fall prevention exercise classes for older adults and 12-month fall incidence. DESIGN: Twelve-month prospective cohort study. SETTING: Community settings. PARTICIPANTS: Older adults (N=207; 189 women, 18 men) aged ≥ 65 y (mean age ± SD, 77.7 ± 6.6 y) actively participating in SAYGO classes. INTERVENTION: Peer-led fall prevention exercise classes. MAIN OUTCOME MEASURES: Twelve-month prospective fall incidence data were collected by monthly calendars. Falls in the previous year and number of years of SAYGO participation were obtained by baseline questionnaire. Class attendance was monitored weekly by class attendance records. RESULTS: Mean length ± SD of SAYGO participation was 4.3 ± 2.5 years (range, 1-10 y). Average class attendance was 69%. Crude fall rate was .75 per person-year. Fall incidences at 12 and 24 months were highly correlated (r=.897, P<.001). Longer SAYGO participation (≥ 3 y) resulted in a lower 12-month fall incidence (incidence rate ratio, .90; 95% confidence interval, .82-.99; P=.03) compared with a shorter duration of participation (1-2 y). CONCLUSIONS: SAYGO appears to be an effective fall prevention intervention with a high attendance rate and a lower fall incidence with long-term participation. Prospective controlled studies on long-term participation in peer-led fall prevention exercise programs are needed to confirm and extend these findings.

Personal, social and environmental correlates of active transport to school among adolescents in Otago, New Zealand.

OBJECTIVES: With increasingly sedentary lifestyles, opportunities for physical activity such as active transport to school need to be promoted in adolescents. This study examines personal, social and environmental correlates of active transport to school among adolescents including sociodemographics, behavioural patterns, motivational factors, perceived barriers, peer support, family resources, school characteristics, urban/rural setting, distance to school and neighbourhood safety perceptions. DESIGN: Cross-sectional study. METHODS: In 2009 and 2011, 2018 secondary school students (age: 14.8±1.3 years; 73% urban; 53% boys) from 22 out of 24 schools from Otago, New Zealand completed the Otago School Students Lifestyle Survey. Multivariate binary logistic regression models were used to compare active transport to school correlates in students using active transport to school versus bus and car users (motorised transport). RESULTS: Overall, 37% of students used active transport to school, 24% bus, and 39% car. Compared to motorised transport users, active transport to school users were more likely to live closer to school (1.4±1.4 active transport to school vs. 8.3±8.4km motorised transport; p<0.001). In a multivariate analysis, shorter distance to school (OR (95%CI) (0.03 (0.01-0.05)), younger age (0.85 (0.78-0.92)), fewer vehicles (0.66 (0.49-0.89)) and fewer screens (0.53 (0.35-0.82)) per household, meeting screen time guidelines (1.74 (1.22-2.50)), opportunity to chat with friends (2.26 (1.58-3.23)), nice scenery (1.69 (1.14-2.50)), and parental perceptions of active transport to school safety (2.32 (1.25-4.30)) were positively associated with active transport to school, while perceived time constraints (0.46 (0.29-0.72)) and attending girls-only school (0.51 (0.35-0.75)) had a negative association with active transport to school. CONCLUSIONS: Future active transport to school interventions in adolescents should focus on encouraging active transport to school, reiterating its social benefits, and addressing parental safety concerns around active transport to school.

Role of routine early angiography post-fibrinolysis for ST elevation myocardial infarction--a meta-regression analysis using angiography rate in the non-routine arm.

BACKGROUND: The current European and American Guidelines differ with regard to the recommended level for the use of routine early angiography after fibrinolysis for STEMI. Previous meta-analyses on randomized controlled trials have supported the routine early approach, but its advantage may be because of an excessively low angiography rate among patients in the non-routine strategy arm of the trials. METHODS: We update the meta-analysis and apply meta-regression to evaluate whether the difference in outcome between the 2 randomized arms could be explained by the angiography rates in the non-routine strategy arm. Because reinfarction and recurrent ischemia are often the reported indication for angiography, we only use mortality endpoint in our meta-regression analysis. RESULTS: Among the eight trials included with 3195 patients, the angiography rate in the non-routine strategy arms ranges from 15% to 100%. The overall odds ratio for 30-day mortality comparing the routine early angiography arm vs the non-routine arm is 0.86 (95% confidence interval 0.60-1.24). On the plot listing the eight trials according to angiography rates, there is no visual trend in the odds ratio estimates for mortality when comparing the 2 treatment strategies as angiography rate decreases. In meta-regression analysis, angiography rate does not predict 30-day mortality (p=0.461). CONCLUSION: For STEMI, mortality endpoint trumps the softer endpoints of recurrent infarction and ischemia. The current study shows that the equipoise between the routine early invasive versus the non-routine strategy on 30-day mortality cannot be explained by the variable performance of angiography in the non-routine strategy arm.

Endovascular aortic repair: can we predict who will not get long-term benefit?

AIM: The aim of this study is to review our endovascular aortic repair (EVAR) experience in Dunedin Public Hospital as well as assessing the applicability of Mount Sinai score and the American Society of Anesthesiologists physical status classification (ASA) in finding which patients will be most likely to benefit from EVAR. METHODS: A retrospective study of 54 patients who had EVAR from 2000 to December 2009 in Dunedin Public Hospital was conducted. Univariate, bivariate and multivariate regressions analyses were used in assessing the data with the occurrence of postoperative complications and mortality as the primary outcome variable. RESULTS: The overall mortality at 30 days was 1.8%. The Mount Sinai score and smoking status were both found to be significant predictors of mortality. DISCUSSION: The Mount Sinai score was a good predictor for mortality as it factors in the patient's comorbidities. This study indicates that smoking status was an important factor and it should be added to long-term risk predicting models.

Effect of micronutrient sprinkles on reducing anemia: a cluster-randomized effectiveness trial.

OBJECTIVE: To evaluate the effectiveness of Sprinkles alongside infant and young child feeding (IYCF) education compared with IYCF education alone on anemia, deficiencies in iron, vitamin A, and zinc, and growth in Cambodian infants. DESIGN: Cluster-randomized effectiveness study. SETTING: Cambodian rural health district. PARTICIPANTS: Among 3112 infants aged 6 months, a random subsample (n = 1350) was surveyed at baseline and 6-month intervals to age 24 months. INTERVENTION: Daily micronutrient Sprinkles alongside IYCF education vs IYCF education alone for 6 months from ages 6 to 11 months. MAIN OUTCOME MEASURES: Prevalence of anemia; iron, vitamin A, and zinc deficiencies; and growth via biomarkers and anthropometry. RESULTS: Anemia prevalence (hemoglobin level <11.0 g/dL [to convert to grams per liter, multiply by 10.0]) was reduced in the intervention arm compared with the control arm by 20.6% at 12 months (95% CI, 9.4-30.2; P = .001), and the prevalence of moderate anemia (hemoglobin level <10.0 g/dL) was reduced by 27.1% (95% CI, 21.0-31.8; P < .001). At 12 and 18 months, iron deficiency prevalence was reduced by 23.5% (95% CI, 15.6-29.1; P < .001) and 11.6% (95% CI, 2.6-17.9; P = .02), respectively. The mean serum zinc concentration was increased at 12 months (2.88 µg/dL [to convert to micromoles per liter, multiply by 0.153]; 95% CI, 0.26-5.42; P = .03). There was no statistically significant difference in the prevalence of zinc and vitamin A deficiencies or in growth at any time. CONCLUSIONS: Sprinkles reduced anemia and iron deficiency and increased the mean serum zinc concentration in Cambodian infants. Anemia and zinc effects did not persist beyond the intervention period. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12608000069358.

Predicted versus absolute values in the application of exhaled nitric oxide measurements.

BACKGROUND: Constitutional factors such as age, sex and height, and acquired factors such as atopy and smoking, influence exhaled nitric oxide (F(E)NO) levels. The utility of predicted values based on reference equations which account for these factors has not been evaluated. AIM: To compare the performance characteristics of absolute versus % predicted values for F(E)NO as predictors of diagnosed asthma and steroid response. METHODS: We compared the sensitivities, specificities and likelihood ratios using F(E)NO (% predicted) with absolute values for F(E)NO (ppb) in 52 steroid-naive subjects with non-specific respiratory symptoms. The reference equations of Olin et al. (Chest, 2007) and Dressel et al. (Resp. Med., 2008) were used to derive predicted values. Receiver operating curve analyses were performed and the areas under the curve (AUC) were calculated for two outcomes: diagnosed asthma (yes/no), and steroid response after fluticasone for 4 weeks (defined as ≥ 12% increase in FEV(1); increase in mean morning PEF ≥ 15%; reduction in symptoms ≥ 1 point; increase in PC(20)AMP of ≥ 2 doubling doses). RESULTS: The AUCs for diagnosed asthma were: F(E)NO (absolute) 0.770; F(E)NO (% pred.): 0.758 (Olin) and 0.775 (Dressel) (NS). The AUCs for F(E)NO (abs.) and F(E)NO (% pred.) with respect to the four indices of steroid response were likewise not significantly different. CONCLUSION: Correcting F(E)NO for combinations of age, sex, height, smoking and atopy using reference equations did not enhance the performance characteristics of F(E)NO as a predictor of either the diagnosis of asthma or steroid responsiveness in patients with chronic airways-related symptoms.

A decade of NHMRC People Support expenditure in review: is support for Indigenous health research increasing?

OBJECTIVE: To investigate National Health and Medical Research Council (NHMRC) support over the decade to 2006 for researchers studying Indigenous health and researchers who self-identified as Indigenous. DESIGN AND SETTING: Review of data on all recipients of People Support awards and Capacity Building Grants in Population Health Research who were researching Indigenous health or who self-identified as Indigenous between 1996 and 2006. MAIN OUTCOME MEASURES: Annual People Support and Capacity Building grants and expenditure, by broad research area, state or territory, administering institution, and Indigenous status (as self-identified by award recipients in their applications). RESULTS: Between 1996 and 2006, 134 People Support awards were made to researchers studying Indigenous health; of these, 27 (20%) were to researchers who self-identified as Aboriginal or Torres Strait Islander. In 2006, about 2.9% of the annual expenditure on all People Support funding was for Indigenous health research, representing a doubling in the proportion of funds since 2001. There was no increase in the number of self-identified Indigenous researchers funded under People Support, but Capacity Building Grants increased the number of people from Indigenous backgrounds supported by the NHMRC, with funds allocated to 36 Indigenous researchers from 2002 to 2006, compared with 14 funded by People Support during the same period. CONCLUSIONS: Funding to support Indigenous health research through the People Support scheme has increased since the NHMRC adopted policy changes in 2002, but it has not reached the targeted expenditure of at least 5% of agency allocations. The Capacity Building Grants have been a more effective vehicle for funding researchers from Indigenous backgrounds.