Why older people refuse to participate in falls prevention trials: A qualitative study

Background/Objectives: Falls are a major public health problem. Older persons are frequently underrepresented in trials, including falls prevention trials. Insight into possible reasons for non-participation could help to improve trial designs and participation rates among this age-group. The aim of this study was to explore reasons why older people refuse to participate in falls prevention trials. Setting: A qualitative study. Participants: Community-dwelling adults aged ≥ 65. years who attended the Emergency Department due to a fall and refused to participate in a falls prevention trial (IMPROveFALL-study). Measurements: A structured interview guide was used, and interview transcripts were subjected to an independent content analysis by two researchers. Results: 15 interviews were conducted. A main reason to refuse trial participation was mobility impairment. In contrast, younger and more "active" and mobile seniors considered themselves "too healthy" to participate. Persons with multiple comorbidities mentioned that they attended a hospital too often, or experienced adequate follow-up by their own physicians already. Transport problems, including distance to the hospital, parking facilities, and travel expenses were another issue. During the interviews it was emphasized by the patients, that they knew the reason for their fall. However, they were not familiar with the positive effects of falls prevention programmes. Conclusions: Older persons reported multiple reasons to refuse participation in a falls prevention study, such as health-related factors, several practical problems, and personal beliefs about the causes and preventability of falls. Anticipation of those issues might contribute to an improvement in participation rates of older fallers, shorter study duration, and a better generalizability of research findings

The impact of falls in the elderly

The number of falls in the elderly is becoming a major public health problem in our society. In the past decade, life expectancy has increased from 75 years in 1990 to 79 years in 2009 in the US. It has been estimated that the number of persons aged 65 years and older in the US will double by 2050. In 2000, falls accounted for 45% of all injury-related inpatient stays with almost 750,000 hospitalizations. Fractures were the most common primary injury diagnosis, including 314,006 hip fractures. Injury following a fall is associated with a decreased quality of life and poor functional outcome, in severe injuries these effects continue for a prolonged period of time. In 2006, fall-related medical costs in the population aged ≥65 in the US amounted to US$19 billion for non-fatal and US$0.2 billion for fatal injuries. In this article, we provide a literature overview on the impact of falls in the elderly, the demands on healthcare, and the costs for our society

Sensitivity bond graphs

A sensitivity bond graph, of the same structure as the system bond graph, is shown to provide a simple and effective method of generating sensitivity functions of use in optimisation. The approach is illustrated in the context of partially known system parameter and state estimation

Gait analysis using ultrasound and inertial sensors

Introduction and past research:\ud Inertial sensors are great for orientation estimation, but they cannot measure relative positions of human body segments directly. In previous work we used ultrasound to estimate distances between body segments [1]. In [2] we presented an easy to use system for gait analysis in clinical practice but also in-home situations. Ultrasound range estimates were fused with data from foot-mounted inertial sensors, using an extended Kalman filter, for 3D (relative) position and orientation estimation of the feet.\ud \ud Validation:\ud From estimated 3D positions we calculated step lengths and stride widths and compared this to an optical reference system for validation. Mean (±standard deviation) of absolute differences was 1.7 cm (±1.8 cm) for step lengths and 1.2 cm (±1.2 cm) for stride widths when comparing 54 walking trials of three healthy subjects.\ud \ud Clinical application:\ud Next, the system presented in [2] was used in the INTERACTION project, for measuring eight stroke subjects during a 10 m walk test [3]. Step lengths, stride widths and stance and swing times were compared with the Berg balance scale score. The first results showed a correlation between step lengths and Berg balance scale scores. To draw real conclusions, more patients and also different activities will be investigated next.\ud \ud Future work:\ud In future work we will extend the system with inertial sensors on the upperand lower legs and the pelvis, to be able to calculate a closed loop and improve the estimation of joint angles compared with systems containing only inertial sensors

The Role of Europe in World-Wide Science and Technology: Monitoring and Evaluation in a Context of Global Competition

Noyons ECM, Buter RK, van Raan AFJ, Schwechheimer H, Winterhager M, Weingart P. The Role of Europe in World-Wide Science and Technology: Monitoring and Evaluation in a Context of Global Competition. Leiden: Universiteit Leiden; 2000

Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: A prospective cohort study

Background: Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury.Methods: A prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD.Results: One year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year followin

Voorspellende factoren van functionele beperkingen na ernstig letsel

OBJECTIVE: To assess the health-related quality of life and prognostic factors of disability in survivors of severe trauma one year after injury. DESIGN:Prospective cohort study. METHOD: All severely-injured trauma patients presenting at a level I trauma centre during a 30-month period and surviving 30 days after admission were included. The EuroQol-5D (EQ-5D) and Health Utilities Index (HUI) were used to determine the health status 12 months after injury. RESULTS: 362 patients were included during the study period, 246 of whom returned the follow-up assessments (response rate: 68%). The median EQ-5D utility score was 0.73 (EQ-5D Dutch general population norm: 0.88). The HUI2, HUI3 and EQ-5D Visual Analogue Scale scores were 0.81, 0.65 and 70, respectively. One year after trauma only 22% of the patients reported no functional limitation in the 5 domains of the EQ-D5. Females and patients with co-morbidity at the time of the injury had a higher risk of low scores after 1 year. CONCLUSION: One year after severe injury, the functional outcome and quality of life of trauma patients were far from normalized. Female gender and comorbidity were predictors of poorer functional outcome

Willingness to pay for lives saved by helicopter emergency medical services

Introduction. Currently, policy makers in the Netherlands are discussing the possibility to expand the availability of Helicopter Emergency Medical Services (HEMS) from 12 hours to 24 hours per day. For this, the preferences of the general public towards both the positive effects and negative consequences of HEMS should be taken into account. Therefore, the willingness to pay (WTP) for lives saved by HEMS was calculated. Methods. A discrete choice experiment (DCE) was performed in order to explore the preferences of respondents towards (expansion of) HEMS availability. The attributes: costs (for HEMS) per household number of additional lives saved (by HEMS), number of noise disturbances (caused by HEMS) during day time or night time were used. A written questionnaire was presented to 150 individuals by convenience sampling. Result. One hundred and thirty-six (91%) of the 150 individuals completed the DCE questionnaire. The marginal WTP for one additional life saved (in a month) was 3.43 (95% CI; 2.96-3.90) per month per household. Overall, the WTP for expansion to a 24-hour availability of HEMS can therefore be estimated at 12.29 (∼ US$ 17.50) per household per month. Conclusion. The WTP derived from this study is by far exceeding the 1-1.5 Million-euro necessary per HEMS per year for the expansion from a daytime HEMS to a 24-h availability in the Netherlands. Respondents are willing to pay for lives saved by HEMS in spite of increases in flights and concurrent noise disturbances. These results may be helpful for the decision-making process,

N-acetylcysteine (NAC) and Hydrogen Sulfide (H₂S) in Coronavirus Disease 2019 (COVID-19)

Significance: Hydrogen sulfide (H2S) is one of the three main gasotransmitters which is endogenously produced in humans and is protective against oxidative stress. Recent findings from studies focusing on coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), shifted our attention to a potential modulatory role of H2S in this viral respiratory disease. Recent Advances: H2S levels at hospital admission may be of importance since this gasotransmitter has been shown to be protective against lung damage through its antiviral, antioxidant and anti-inflammatory actions. Furthermore, many COVID-19 cases have been described demonstrating remarkable clinical improvement upon administration of high doses of N-acetylcysteine (NAC). NAC is a renowned pharmacological antioxidant substance acting as a source of cysteine, thereby promoting endogenous glutathione (GSH) biosynthesis as well as generation of sulfane sulfur species when desulfurated to H2S. Critical Issues: Combining H2S physiology and currently available knowledge of COVID-19, H2S is hypothesized to target three main vulnerabilities of SARS-CoV-2: 1) cell entry through interfering with functional host receptors, 2) viral replication through acting on RNA-dependent RNA-polymerase (RdRp), and 3) the escalation of inflammation to a potentially lethal hyperinflammatory cytokine storm (TLR4 pathway and NLRP3 inflammasome). Future Directions: Dissecting the breakdown of NAC reveals the possibility of increasing endogenous H2S levels, which may provide a convenient rationale for the application of H2S-targeted therapeutics. Further randomized controlled trials (RCT) are warranted to investigate its definitive role