Physical exercise for bone health in men with prostate cancer receiving androgen deprivation therapy: a systematic review

PURPOSE: Androgen deprivation therapy (ADT) is a treatment used in men with prostate cancer (PCa); however it is responsible for many adverse effects, with negative impact on quality of life. ADT causes loss of bone mineral density (BMD) and skeletal muscle mass, alteration of body composition, and cognitive function, which altogether lead to increased risk of accidental falls and fractures. This systematic review analyses the effectiveness of physical exercise (PE) in preventing accidental falls and fractures and reducing the loss of BMD in men with PCa receiving ADT.METHODS: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for articles between database inception and September 2, 2020. Eligible studies included randomized controlled trials (RCTs) investigating the effects of exercise on bone health in men with PCa receiving ADT.RESULTS: Nine RCTs were included. Experimental PE consisted in multicomponent programmes that involved aerobic, resistance, impact-loading exercise, and football training. None of the RCTs investigated the risk of accidental falls and fractures, while two trials reported beneficial effects of PE on lumbar spine, hip, and femoral shaft BMD. No further significant difference was detected in the outcomes investigated.CONCLUSION: Evidence of the effectiveness of PE to prevent the risk of accidental falls and fractures and BMD loss is lacking. Nevertheless, clinical guidelines recommend PE as a part of the clinical management of men with PCa receiving ADT due to its known numerous health benefits. Research should focus on PE strategies to prevent accidental falls, a clinically relevant outcome in this vulnerable population.TRIAL REGISTRATION: The study protocol was registered with International Prospective Register of Systematic Reviews (PROSPERO, number CRD 42020158444 ) on 04/28/2020

New Vascular-Access Intervention Assistance Plate Provides Good Operability and Safety by Preventing Accidental Falls: First Experience of 1,872 Cases

Vascular-access interventions are necessary for the continuation of hemodialysis, and they are performed under X-ray guidance. During interventions, patients’ accidental falls from the bed are a serious problem, and spe-cialized fixation systems for hemodialysis patients to prevent their falls from the bed have been lacking. We developed a new fixation plate made of polypropylene homopolymer and tested its ability to prevent such falls retrospectively. This plate, which we named the ‘vascular-access intervention assistance plate,’ offers functional features such as the concurrent fixation of the body and either arm and an arm space with serrations for fixing a forearm strap. We performed computer simulations to examine the strength of the plate, and we evaluated the efficacy of fall prevention by reviewing patients’ medical records. The results demonstrated that the functional design of the plate provides good operability via accurate concurrent fixations of the body and arm. The com-puter simulation analysis results indicated the plate’s sufficient strength. The medical records analysis revealed three accidental falls before the plate’s introduction (401 patients, 1,437 interventions), and none after plate introduction (683 patients, 1,872 interventions). Accidental falls were significantly prevented by use of the plate (p < 0.05). The dementia rate and type of procedure were not significantly different between the patients who fell and those who did not. This vascular-access intervention assisted plate provides good operability and safety by preventing accidental falls among hemodialysis patients

Physical activity and accidental falls in senior center users

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Depto. de EnfermagemUNIFESP, EPM, Depto. de EnfermagemSciEL

Accidental falls and psychological trauma in older people.

Unintentional falls may pose a threat of death or injury to an older person. The psychological burden experienced by older adults after a fall adds to recovery difficulties. Persistent psychological problems post-fall may be related to posttraumatic stress disorder (PTSD). The limited research on the phenomenon suggested that some older adults develop PTSD after falling. The present research sought to gather data on post-fall trauma in older adults. The aims of this mixed methods study were to explore factors related to PTSD development and the impact of PTSD on older people’s recovery and lives. Participants in the quantitative study were 119 adults age 60 years or older admitted to one of three general hospitals in Poland. There were 11 individuals who took part in two qualitative interviews – one post-discharge and one post-recovery. PTSD symptoms were reported by 32% of patients. Older age, gender, multiple chronic conditions, injury severity, the length of time spent on the ground waiting for help and falls history were significantly correlated with PTSD symptoms. The qualitative interviews revealed that older adults’ lives were heavily affected they their falls. For some participants, their falls did not impact their lives long-term, yet for several individuals there was a sense of no return to the lives they had previously lived. It affected their perception on their lives, their approach to the recovery, and the strategies they applied in order to cope with their fall- related injuries. Results may have implications for understanding the psychological burden of falls. This study can be seen as a first step in patient characterisation, and predicts who may benefit from PTSD intervention. Further investigations are needed to assess the proposed factors related to post-fall PTSD, as well as new fall interventions which would target fall patients who are at risk of PTSD development ought to be introduced

Prospective analytical study of pattern of injuries in fatal cases of accidental fallautopsy conducted at Madurai Medical College

Falls account for 11% of accidental injury deaths worldwide. 1/5th of global fall related deaths occurred in India. OBJECTIVE: To study the pattern of injuries in the victims of various level of accidental falls. STUDY DESIGN: Prospective Analytical descriptive study design. MATERIALS & METHODS: All victims of accidental falls who were autopsied at the mortuary of Government Rajaji Hospital, Madurai Medical College, Madurai from January 2016 & December 2016 were included in the study. RESULTS: • 210 people died due to accidental falls in the study period. The incidence of accidental fall for the year 2016 was 6.16% of which 54.8% were Ground level falls and 45.2% fall from height. There was a marked male preponderance in victims of both ground level falls & fall from height. • Most Vulnerable age group in ground level fall was 61-70 years and in fall from height 21-30 years age group. • Head injury was the commonest injury in both type of accidental falls and subdural hematoma was the commonly observed lesion. CONCLUSION: Elderly age group more vulnerable to death in ground level falls and working middle age group people vulnerable to fall from height in working places. Adequate preventive measures can prevent mortality due to accidental falls

Lower-Limb Falling Detection System Using Gated Recurrent Neural Networks

Accidental falls are one of the most common causes of premature disability and mortality related to unnatural causes. This affects mainly the elderly population. With the current aging of the population, the rate of accidental falls increases. Computer systems for gait analysis and fast assistance in ubiquitous environments can be effective tools to prevent these accidents. In this article we present the advances in the creation of an intelligent device for detecting falls and risk situations based on accelerometer signals registered on the user’s ankle. The proposed method makes use of Deep Learning techniques, specifically Gated Recurrent Neural Networks. The results show that the proposed model is a viable alternative to detect falls and fall risk, which can be implemented in low performance devices for greater autonomy, lower cost and comfortable portability. These results open the possibility of combining fall detection with a biomechanical analysis system to identify gait deficiencies and their relation with falls

An investigation of accidental falls in people with multiple sclerosis

More than 50% of people with MS fall in any six-month period. The importance of developing a suitable falls management programme has been identified by people with MS and professionals. This thesis aimed to develop a model for an MS falls intervention. The studies employed a systematic approach to evaluate the risk factors for falls and to identify the optimal programme content, format and structure. Methods The thesis comprises two sections; the first involving a systematic review and an observational study of falls risk factors (n=148). Part two included a second systematic review to inform programme content, and a nominal group study (n=36) to explore approach, format and structure from the perspective of key stakeholders. Results Part one identified the potential target group (people at key mobility transition stages and those with progressive MS), and mechanisms by which the intervention could act (the identification of specific risk factors associated with falls in MS). These include non-modifiable disease and demographic characteristics (e.g. MS classification and gender), and potentially modifiable clinical characteristics (including balance, mobility, continence issues and medication usage). Part two identified that an MS specific falls programme should address falls and participation-related outcomes, incorporating educational activities and a programme of individually tailored gait, balance and functional training. The programme should use a collaborative approach; supporting participants to achieve sufficient intensity and duration of exercise and to integrate falls prevention strategies into their daily lives. The programme should enable participants to engage flexibly according to individual needs and preferences. Conclusions This thesis has identified specific risk factors associated with accidental falls in MS. The evaluation indicates that the success and sustainability of an MS falls programme requires that it is MS specific, employs a collaborative approach and moves away from the group-based, weekly format common to many generic falls programmes

Accidental falls in hospitalized children: an analysis of the vulnerabilities linked to the presence of caregivers

Introduction. This study stemmed from the data gathered by a research conducted by the coordinator of the Department of Healthcare Services and a group of nurses involved in a research on accidental falls in hospitalized children at the ?G. Gaslini? Children?s Hospital and Scientific Research Institute in Genoa, Italy. The first retrospective study evaluated the accidental falls in hospitalized children referred to the three-year period 2003- 2006, while the second perspective study, referred to the trimester March-May 2007, found that the main cause of falls in children was parent?s distraction. Methods. The method adopted in the first phase of our study was a proactive risk analysis (The Basics of Healthcare Failure Mode and Effect Analysis), identified in the first place by the VA National Centre for Patient Safety and applied to the ?Child and parent hospital admission process?. This proactive risk analysis has proven to be very effective in preventing the risk of accidental falls in hospitalized children through effective communication and educational interventions. The second phase of our study consisted of two Focus Groups for accidental traumatic events. Results. The analysis of the results of the study showed how effective communication is instrumental, not only to have a better awareness of the children and their parents during their stay in hospital, but also to implement educational sessions on prevention to reduce the risk of accidental traumatic events. Conclusions. The present study contributes to improve safety and the quality of care by motivating nurses to keep their attention high on falls in hospitalized children, by monitoring and the development of new risk assessment tools

Ruolo dell’imaging TC nella valutazione post-mortem dei soggetti deceduti per caduta da altezze elevate: nostra esperienza

The CT-v can therefore be considered an effective method as an aid in the autopsy evaluation of individuals who died for various causes; in particular, in the case of deaths due to accidental falls from high altitudes, is able to identify the primary cause of death and all the epiphenomena due to precipitation

Accidental falls in the elderly and their relation with functional capacity

AIM: This study aimed to determinate the prevalence of falls in the elderly and its relationship with the functional capacity. METHOD: This is an epidemiological and cross-sectional study; a two-stage cluster sample of 240 male and female subjects aged over 60 years was used. Data were collected from November 2010 to February 2011. The following questionnaires were used: socio-demographic profile, assessment of falls, Functional Independence Measure, Lawton and Brody Scale. Significance was set at 0.05. To identify the occurrence of falls and their relation with functional capacity, the prevalence ratio and prevalence odds ratios were used, as well as multiple logistic regression. RESULTS: Average age was 73.5 years (±8.4); 25% 80 years or more, with preponderance of female gender; 48.8% attended school between 1-4 years. The average was 1.33 falls (±0.472), with prevalence in women and elderly between 60 and 79 years old; the most frequently sites were the backyard and bathroom. Strong correlation between the level of functional independence and instrumental activities and age was found, but no relation between elderly victims of falls and the gender and age variables. CONCLUSION: Women who suffered falls related to functional independence were predominant, which can be prevented through elderly health promotion strategies, a policy that serves to offer living conditions to people in the aging process.OBJETIVO: Determinar la superioridad de caídas en los mayores y su relación con la capacidad funcional. MÉTODO: Estudio epidemiológico transversal de base de la población, con una muestra por conglomerado de doble cursillo de 240 sujetos, con edad arriba de 60 años, de ambos los sexos, residentes en Ribeirão Preto. Los datos fueron colectados entre noviembre de 2010 y febrero de 2011 y se utilizaron los cuestionarios: perfil social, evaluación de caídas; Medida de Independencia Funcional y Escala de Lawton y Brody. Fue adoptado el nivel de significancia de 0,05. Para la identificación de la ocurrencia de las caídas y su relación con la capacidad funcional fueron utilizadas razón de superioridad y de chances de superioridad y regresión logística múltiple. RESULTADOS: La media mayores fue de 73,5 años (±8,4), 25% con 80 años o más, predominio del sexo femenino; 48,8% estudiaron durante 1 a 4 años. Media 1,33 caídas (±0,472); con mayor superioridad en mujeres y mayores más jóvenes; el local más frecuente fue el patio y el baño. Hubo fuerte correlación entre nivel de independencia funcional y las actividades instrumentales con la edad y no hubo relación entre los mayores que sufrieron caída y las variables sexo y edad. CONCLUSIÓN: Hubo predominio de mujeres que sufrieron caídas relacionados a la independencia funcional, lo que puede ser prevenido con estrategias de promoción a la salud al mayores, política ésta para ofrecer condición de vida a la persona en el proceso de envejecer.OBJETIVO: determinar a prevalência de quedas em idosos e sua relação com a capacidade funcional. MÉTODO: trata-se de estudo epidemiológico transversal de base populacional, com uma amostra por conglomerado de duplo estágio de 240 sujeitos, com idade acima de 60 anos, de ambos os sexos, residentes em Ribeirão Preto, SP. Os dados foram coletados entre novembro de 2010 e fevereiro de 2011 e utilizaram-se os questionários: perfil social, avaliação de quedas, Medida de Independência Funcional e Escala de Lawton e Brody. Foi adotado o nível de significância de 0,05. Para a identificação da ocorrência das quedas e sua relação com a capacidade funcional, foram utilizadas razão de prevalência e de chances de prevalência e regressão logística múltipla. RESULTADOS: a média de idade foi de 73,5 anos (±8,4), 25% com 80 anos ou mais, predomínio do sexo feminino; 48,8% estudaram de 1 a 4 anos. Média de 1,33 quedas (±0,472); com maior prevalência em mulheres e idosos mais jovens; o local mais frequente foi o quintal e o banheiro. Houve forte correlação entre o nível de independência funcional e as atividades instrumentais com a idade, e não houve relação entre os idosos que sofreram queda e as variáveis sexo e idade. CONCLUSÃO: houve predomínio de mulheres que sofreram quedas relacionadas à independência funcional, podendo-se prevenir com estratégias de promoção à saúde ao idoso, política essa para oferecer condição de vida à pessoa no processo de envelhecer