Objective: This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people. Patients and methods: This population-based case–control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan): a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revi- sion, Clinical Modification: E880–E888) during 2006–2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls.
With regard to the hypothesis that increases in mortal- ity trends could be due to changes in the severity of falls, our results show a recent increase in the mortality trends for men even in the younger age group (65- 74 years). According to Sung et al. people aged 65-74 may have a better health and functional condition than previous cohorts making it easier to engage in activities that increase their risk of accidental falls  mainly in the case of men . Furthermore, those aged less than 75 years tend to be more active, doing more activities and are more likely to suffer falls outside the home com- pared with older age groups, [14, 29] and these falls are supposed to be caused by more severe mechanisms. On the other hand, it has also been reported that minor falls in older people caused by a seemingly innocuous mech- anism could produce disproportionately severe injuries, even death, compared to younger population . Ac- cording to Bath et al. falls within the home were associ- ated with an increased mortality, to be 75 and older, to have less mobility and with indicators of greater frailty . Perhaps for different age groups the severity of the consequences of the falls may have increased by different mechanisms. However, data from the last Spanish National Health Survey (2012) show that incidence of falls has declined over the last 10 years , but we have appreciated a fall mortality increase between 2011 and 2015 so the lethal consequences may have increased, perhaps due to different causes for each age group. It is advisable to assess if future trends maintain this mortal- ity increase due to accidental falls with special focus in younger groups.
This study analyzed postural balance in the elderly with mild cognitive impairment and its rela- tionship to accidental falls. A quantitative and quasi-experimental method was used in a sample of 43 elderlies between 64 and 88 years old, mostly females. Data collection was performed in two Basic Health Units in the city of Rio de Janeiro in 2014. The instruments used were the Mini-Mental State Examination (MMSE), Tinetti scale, Motor Scale for the Elderly (EMTI) scale, and Elderly Falls Diary. The data were analyzed with the SAS statistical software version 9.3.1. The scales were ap- plied before and after the psychomotor interventions. A significant difference was observed be- tween the evaluating moments. Balance improvements were observed in all age groups, suggest- ing that all elderlies, regardless of age, showed satisfactory responses to the implemented psy- chomotor activities. The elderlies who fell more frequently were those between 60 and 69 years old. It is noteworthy that the age group with the lowest incidence of falls was that of elderlies be- tween 70 and 79 years old. It was concluded that psychomotor activities are beneficial, regardless of age, proving their effectiveness when continued stimuli with cognitive and psychomotor activi- ties are carried out.
Frailty is an important risk factor for falls, however frailty has not been universally defined, and several con- ceptual models to define it have been used [35–37]. Frailty can be considered to be a syndrome of impaired homeostasis and resistance to stresses that leads to an individual’s increased vulnerability and risk of adverse outcomes . The Fried model is the most commonly used, and a person is considered to be frail when he/she de- velops three or more of the following symptoms: weight loss, exhaustion, loss of grip strength, decreased gait or low physical activity . Only two studies [23, 25] reported a relationship between frailty and falling in CKD patients, and the association was strong. The lack of data regarding this relationship could be ascribed to the heterogeneity in the definitions used or to underestimation of the problem by nephrologists. In the general population, there is a widespread range in the prevalence of frailty ranging from 33 to 88 % .
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Abstract: It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure 110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively). Upon comparison of UF and syncope, the number of cen- tral nervous system drugs, female gender, musculoskeletal diseases, and SBP 110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55]), respectively. These results indicate specific differences, in terms of demograph- ics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.
The analysis also has some weaknesses, so that the results should be interpreted with caution. A first weakness is the small number of original studies, which led to meta-analyses only for case manage- ment and information provision and reduced the re- liability of the results. One reason for the small numbers of included publications is the lack of oper- ationalization of ‘ frailty ’ in studies. An absence of an operationalization of frailty is also a feature in other studies [15, 17]. Other reasons for exclusion were a lack of usual care, no relevant outcomes, and the re- cruitment of non-community-dwelling participants. A second weakness is the concept of frailty. Several methods are used to operationalize frailty, and some may not be accurate enough to recruit frail older adults, making study comparison and evaluation dif- ficult . A third weakness is that several concepts, such as case management, information provision, institutionalization, and formal health costs, have dif- ferent operationalizations, leading to heterogeneity among studies. In the current analysis, mortality, institutionalization, accidental falls, formal health costs, and hospitalization were used because they are often cited as adverse outcomes. Other outcomes not included in this systematic review include func- tional status, physical performances, quality of life, mastery, disability, etc. , which can be seen as a weakness. These outcomes are not included because of the different methods to operationalize these concepts.
The main aim of this research work is to design and implement a system for Health monitoring and fall detection in elderly people i.e,Geriatric patients accompanied by a system to perform Gait Analysis. Health monitoring involves continuous monitoring of health conditions of disabled, elderly patientsusing many measures and parameters based on Remote Patient Monitoring (RPM) technologies. Gait Analysis involves conveying important information about one’s physical and cognitive conditions using inertial sensors. Health monitoring provides a platform for monitoring health conditions like temperature, heartbeat rate of elderly citizens using an intelligent and a versatile health monitoring system that could help the elderly and individuals with disability, live independently in their own homes. If the monitored health conditions are abnormal, a message can be sent via GSM to the people concerned. It serves as a cost effective approach for personal care. Thiswork presents a foot-step analysis based gait Analysis, where certain foot-step related gait parameters are calculated from the simulated graphical values and sensors that are used for the purposes.An unobtrusive system capable of detecting accidental falls is also designed. The parameters obtained from the above mentioned systems are transmitted via GSM to the concerned health care professionals.
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He looks up to check Hélène’s reaction, but she’s gone. The shock of vacant space. Nothing but the rail glazed with moisture where she was standing, the air completely emptied of her presence. Then he spots her striding toward the far end of the bridge without a goodbye, as usual. He wipes the damp film from his face, his work shirt heavy with moisture, an urgency beginning to take hold of him. Papa has been working in the foundry all day with the river nearby and does he know how quickly it’s rising? That’s the question. He walks back to the truck and takes one last look at the falls and the shoe factory nearby, the mills with their flanks of brick and honeycombed glass. Holy water. That’s the answer. Every Sunday he dips his finger in the basin and brings it to his forehead, his gut, his shoulders left and right, amen.
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Discussion and Conclusion: Imam Musa Kazem and Imam Hussein Children’s Teaching Hospital including: the high average of staying patients, type and cost of equipment in Al Zahra educational health treatment center, the consuming prostheses and the utilization of capital equipment such as CT scan machine Multi 64 makes to increase the average cost of a patient in centers compared to other health centers. On the other hand, the cost of accidental outpatients is not registered in the system, so these factors make the average cost of hospitals higher than country standard.
In the last stage of the study, a logistic regression was performed to establish which of the factors had the greatest incidence on the security of CAIS used in the firms evaluated. For that purpose in providing a response to hypothesis 2, the selected independent variables identified as the “perceived security threats” provided in the list of survey items were regressed against the dependent factor (perception of security threats to their CAIS’s in recent past – one year or less). Regarding the independent variables, the resulting values of the factorial analysis were gathered for each one of the 158 observations in the survey, according to the recorded by the SPSS during the study. The final result was that the optimal variables for the model that represented significant relationship with the dependent variable out of the list of 19 items in the survey instrument were: (a) accidental entry of bad data by employees (p=0.023); (b) accidental destruction of data by employees (p=0.016); (c) employees sharing of password (p=0.001); (d) introduction (entry) of computer viruses to the system (p=0.031); (e) unauthorized copying of output (p=0.006); (f) unauthorized document visibility by displaying on monitors or printed on paper (p=0.0000). Tables 8 through to 12 in appendix II detailed the logistic regression results. Consequently, propensity in the significance of the perceived threats to the non-significance is greater when the accidental entry of bad data (Exp (B) = 1.048); accidental destruction of data by employees (Exp (B) = 0.930); employees sharing of passwords (Exp (B) = 0.402); introduction/entry of computer viruses to the system (Exp (B) = 0.882); unauthorized copying of output (Exp (B) = 5.432); and unauthorized document visibility by displaying on monitors or printed on paper (Exp (B) = 0.967). Conclusively, there are perceived threats which are significant to CAIS’s in Nigerian companies contrary to hypothesis 2.
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Very quick screening can be carried out in any med- ical practice by inquiring about falls in the past year and gait or balance problems. Individuals who are 65 years of age or older have an annual pretest probabil- ity of falling of 27%. Patients who have fallen in the past year are more likely to fall again (likelihood ratio 2.3 to 2.8), as are those who have clinically detected abnormalities of gait or balance (likelihood ratio 1.7 to 2.4). The presence of any of these factors brings the annual risk to 50%, and therefore should prompt a full assessment. 13
The strength of the conclusions of this study must be tempered by the study’s limitations. The subjects were all aware that they had some neurological symptom involving the lower extremities, although not necessarily PN, be- cause their physicians referred most of them to the elec- trodiagnostic laboratory for evaluation. This could bias the population studied. They may have had more-severe or more-symptomatic disease or may have been more health conscious and willing to see a physician; therefore, it is not possible to extend the findings to persons with asymptom- atic PN. Recall bias is likely, and the retrospective record- ing of falls may have underestimated the actual preva- lence. However, this seems less likely for falls that cause injury, given the emotional effect of such events, and it is therefore reassuring that the findings in this study are sim- ilar with regard to all three outcomes: at least one fall, multiple falls, and injurious falls. Furthermore, the overall incidence of falls in this known high-risk group of commu- nity dwellers was about 50%, which is, appropriately, greater than the incidence reported in other studies of older persons in the community not known to be at in- creased risk for falls. 34,35
males were more commonly involved than females (2:1 ratio) in the non-accidental group as compared to the above author’s group whereby the findings was reversed (male to female ratio was 1:5.6). For the ethnic group involved, non- accidental traumatic brain injury was found to be most common among Malays followed by others (no specific subgrouping of the ethnicity of ‘others’ was done in this particular study). The distribution among Chinese and Indians seems to be equal. However, these ethnicity distributions reflect not just the ethnic distribution of the country in general but also that of the paediatric admissions to HKL. Further study needs to be conducted to determine the association between the incidence of non-accidental TBI and ethnicity in terms of their socioeconomic background, cultural belief or practice etc.
between March 2014 to December 2018 at UCMS College of Dental Surgery, Bhairahawa, Rupandehi, Nepal; 23 sub- mental intubations were performed for panfacial trauma. Patients with midface fractures (Le Fort I, Le Fort II, Le Fort III), along with frontal or NOE and mandibular frac- tures planned for open reduction internal ﬁ xation, and in whom submental intubation was done were selected for the study. Parameters recorded were personal details of patient, mode of trauma, type of maxillofacial trauma, intubation time, accidental extubation, accidental perforation of the pilot balloon during its insertion, period of hospital stay and any post-operative complications including the healing of submental scars. Polytrauma patients with concomitant severe head injury; serious thoracic injury; patients for whom more than two major operations were expected; patients who require mechanical ventilation for more than 8 days after surgical management, as tracheostomy is the choice as per protocol were excluded from the study. 3,11 Patients with incomplete medical records were not included in the study.
been carried out to see the significant factors. None of these studies have attempted to model the accidental deaths by using some statistical model. In this paper we have modeled the accidental deaths by using statistical modeling techniques. The theoretical framework used in the modeling in given in section 2 of the paper and the data analysis have been carried out in section 3.
Somewhat surprisingly, given the shared population, risk factors, consequences of falling and accidental domestic fire, and services ’ emphasis on preventative work, preventative joint working between the Fire and Rescue services and NHS has not, to our knowledge, been investigated in the UK. This is despite the Fire and Rescue Service National Framework 2008 - 2011  encouraging Fire and Rescue Authorities to work locally with partners to identify targets that are priorities within their local area and to offer appropriate contributions, both in terms of time and resources, to meet these. Within the Framework a strong emphasis is placed on building community safety to prevent emergencies occurring, and on working with other providers to improve ‘ life safety ’ services. With encouragement from the UK government for partnership working between local public services ; its commitment to a greater emphasis on prevention of avoidable morbidity and dis- ability  and fire fighters positively evaluating an increased skill base , substantial personal, social and economic benefits of joint working in the community might now be achievable.
In our study most number of fatal injuries resulting in deaths were from road traffic accidents (36.41%) which is very similar to study conducted by Jason London et al in Ghana in which 34% fatal injuries were due to motor vehicle crash. 7 The same study finds 68.7% of the victims to be males similar to our study in which males suffered the highest casualty accounting for 61.85% of total fatal injuries. In our study 85.07% of the total 2130 RTA death victims were males compared to 75% in a study conducted by Kual et al on fatal road traffic accidents at the mortuary of SRN Hospital, MLN Medical College, Allahabad. 8 The same study had similar findings of highest percentage (33.68%) of deaths among 25-44 years age group compared to our study in which highest 53.14% (1132) deaths were registered among 25-44 years of age group. The studies differed in the deaths in terms of road use. Our study finds most deaths in drivers/riders (36.66%) in compared to their study in which pedestrians registered highest 42.2% of deaths. However another fatal RTA trend study conducted by Dr. Kumar et al in Central India finds highest 47.7% of death victims were the motorcycle riders. 9 The study too had a preponderance of male victims (78.26%) over females similar to our study. According to WHO fact sheet on Road traffic injuries, people aged between 15 and 44 years account for 48% of global road traffic deaths. 10 Compared to this, in our study the same age group comprise of 74% of total Road traffic accidents. The above WHO fact sheet says, young males under the age of 25 years are almost 3 times as likely to be killed in a road traffic crash as young females. In our study in the same age group, the males had 6 times more mortality than females. Suicide is the second leading cause of death globally among 15–29-year-olds according to WHO fact sheet on suicide. 11 According to WHO fact sheet on drowning, drowning is the 3rd leading cause of unintentional injury death. 12 Compared to this in our study drowning came out to be second leading cause of unintentional injury after road traffic injuries. In our study among 279 fatal burn victims 58.8% were unintentional/accidental, which is very similar to the study conducted by Afify et al in Cairo City, Egypt in which 55.7% of total burn deaths were accidental. 2
Multiple interventions: The results from eight trials, which include study populations living in their own housing en- vironment, are inconsistent. Clinical heterogeneity of the trials along with their often obscure internal validity pre- vents further interpretation of discrepant results. There- fore, it remains unclear whether it is possible to effectively prevent falls by a combination of different measures in elderly citizens living in their own housing environment. The two trials with study populations from long-term care facilities indicate positive effects on fall risk but not on the risk of fall-related injuries. The low number and com- promised validity of studies do not permit robust conclu- sions on the causality of the observed preventive effects. Multifactorial interventions: Almost 30 trials investigate programs consisting of fall risk assessment and sub- sequently individually tailored interventions. The majority of these studies include community-dwelling seniors known to be at elevated risk for falls. The trials as well as their results are very heterogeneous. The investigation of heterogeneity suggests that low intensity programs (interventions are applied on a recommendation or refer- ral basis) have no effects on fall-related endpoints. Among the trials applying high intensity programs (programs with immediate intervention after fall risk assessment) positive results are mainly reported by three types of studies: i) with compromised methodological quality, ii) with study populations with a high baseline fall risk, and iii) investi- gations from specific countries (Great Britain). There is no indication of an effect on the incidence of fall-related injuries. Summarizing, it must be stated that the effect- iveness of multifactorial programs for fall prevention in senior citizens living in their own housing environment is not backed by empirical data. Nine trials, which investi- gate the effectiveness of multifactorial programs for fall prevention in long-term care facilities, present inconsist- ent but mostly negative results on fall risk and fall-related injuries. Their results resemble those reported for educa- tional interventions presented to health care workers in
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A number of universities, especially public Land Grant institutions with Cooperative Extension programs across the nation, have dedicated resources and programs pertaining to sustainable living and sustainable development. These include the University of Florida’s Sustainable Floridians and Living Green programs; Utah State University’s Sustainable Living program; and the University of Maine’s Center for Sustainable Living to note a few. As it is for most of us, there is a growing imperative to do more with less, and many people are finding these programs to be just what they need to adjust to a changing quality of living standard. Likewise, universities across the nation also seek to endure shrinking budgets and decreased state funding year after year. These timely sustainable living education programs may very well fall victim to budget cuts unless universities are able to capitalize on the resources they already have. Nevertheless, the nation’s Cooperative Extension system remains the ideal vehicle to address sustainability education because of its grassroots strengths and connection with university research and learning. This article will feature the University of Arizona (UA) Cooperative Extension’s efforts in educating both its faculty and the state’s residents in the principles of sustainability, without deliberately creating new programming in sustainable living education. Hence, the ‘accidental’ sustainability agent.
Research on user views on and involvement with falls prevention is not readily available apart from at a local level. Recent user consultation in Sheffield revealed that all participants were worried about falling, aware that it could cause broken bones and concerned about summoning help. Participants gave the following reasons for falling: environmental hazards (trips, slips, patterned carpets), footwear, dizziness, loss of balance, rushing and non-use of walking aids. Also, many falls occur from bed or in a bedroom. Unfortunately, users sometimes saw falling as a ‘way of life’ and that nothing can be done to prevent falls. Conversely, the users were positive about group exercise programmes to improve muscle strength, balance and provide motivation. The apparent lack of studies of user views may indicate that barriers to effective resident consultation could include dementia (9) and confusion (16). It is clear that more research and guidelines are needed in this area.