[Cost]effectiveness of withdrawal of fall-risk increasing drugs versus conservative treatment in older fallers: design of a multicenter randomized controlled trial (IMPROveFALL-study)

Background: Fall incidents represent an increasing public health problem in aging societies worldwide. A major risk factor for falls is the use of fall-risk increasing drugs. The primary aim of the study is to compare the effect of a structured medication assessment including the withdrawal of fall-risk increasing drugs on the number of new falls versus 'care as usual' in older adults presenting at the Emergency Department after a fall. Methods/Design. A prospective, multi-center, randomized controlled trial will be conducted in hospitals in the Netherlands. Persons aged 65 years who visit the Emergency Department due to a fall are invited to participate in this trial. All patients receive a full geriatric assessment at the research outpatient clinic. Patients are randomized between a structured medication assessment including withdrawal of fall-risk increasing drugs and 'care as usual'. A 3-monthly falls calendar is used for assessing the number of falls, fallers and associated injuries over a one-year follow-up period. Measurements will be at three, six, nine, and twelve months and include functional outcome, healthcare consumption, socio-demographic characteristics, and clinical information. After twelve months a second visit to the research outpatient clinic will be performed, and adherence to the new medication regimen in the intervention group will be measured. The primary outcome will be the incidence of new falls. Secondary outcome measurements are possible health effects of medication withdrawal, health-related quality of life (Short Form-12 and EuroQol-5D), costs, and cost-effectiveness of the intervention. Data will be analyzed using an intention-to-treat analysis. Discussion. The successful completion of this trial will provide evidence on the effectiveness of withdrawal of fall-risk increasing drugs in older patients as a method for falls reduction. Trial Registration. The trial is registered in the Netherlands Trial Register (NTR1593)

Selection against Adh null alleles in Drosophila melanogaster

Populations of Drosophila melanogaster polymorphic for an Adh null and an Adh positive allele (either Adhs or AdhF), were founded on regular food, on food supplemented with ethanol and on food suplemented with methanol. On ethanol-supplemented food Adh null was rapidly eliminated, but on regular food and on food supplemented with methanol a consistent decline in the frequency of the Adh null allele was also observed. Estimates of fitness, based on the rate of elimination of Adh nulls in the polymorphic populations were compared with estimates derived from egg-to-adult survival of F2's from crosses between homozygotes for Adh null alleles and homozygotes for Adh positive alleles. On 1-pentene-3-ol a rise in Adh null frequency was observed. Even in the absence of alcohol stress the Adh null genotypes are at a selective disadvantage which is relevant to the metabolic role of ADH and the Adh polymorphism in natural populations