A Mixed-Methods Evaluation of a Fall Prevention Program at a Continuing Care Retirement Community

Background One-third of Americans over age 65 experience a fall each year. Risk of falling increases with age, thus individuals over the age of 80 are more prone to experience falls. Falling is a major public health concern due to its costly and disabling consequences. Falls result from an interaction between environmental hazards and inadequate physiology to cope with the hazards. Most fall risk factors are modifiable and preventable. The common threads throughout the literature suggest that in order to ensure fall prevention efforts are effective, interventions should be multi-factorial (containing educational, behavioral change and exercise components) and individualized as much as possible. Fall prevention research with seniors who are community-dwelling or institutionalized is plentiful. However, fall prevention efforts in continuing care retirement community (CCRC) settings are under-studied. The primary purpose of this study was to evaluate the influence of a fall prevention program (called Seniorcize) on the reduction of fall risk factors among high-functioning residents at Asbury Heights, a CCRC, in Pittsburgh, PA. A secondary purpose of this study was to examine the contextual factors at the study site, which influence program participation. Methods Quantitative data were collected and analyze on dependent variables (balance, gait, fear of falling and depression) for 82 high-functioning Asbury Heights residents. Outcomes from Seniorcize participants were compared with non-participants. To explore facilitators and barriers to program participation, qualitative data were also collected via interviews with key informants and two focus groups—one with Seniorcize participants and one with non-participants. Results Outcomes on the dependent variables were not significantly different between the group of Seniorcize participants and the group of non-participants. The frequency of program participation was only significantly related to depression. Male subjects had significantly less fear of falling than females. Facilitators to program participation pertained to staff, equipment, class offerings, and publicity. Barriers included pre-conceived notions of Seniorcize participants, competing priorities, and limited personnel. Public Health Significance CCRCs need to examine the individualized needs and motivations of high-functioning residents. Interventions should include customized education and behavioral assessments, in addition to exercise routines

Happiness as stable extraversion : internal consistency reliability and construct validity of the Oxford Happiness Questionnaire among undergraduate students

The Oxford Happiness Questionnaire (OHQ) was developed by Hills and Argyle (2002) to provide a more accessible equivalent measure of the Oxford Happiness Inventory (OHI). The aim of the present study was to examine the internal consistency reliability, and construct validity of this new instrument alongside the Eysenckian dimensional model of personality. The Oxford Happiness Questionnaire was completed by a sample of 131 undergraduate students together with the abbreviated form of the Revised Eysenck Personality Questionnaire. The data demonstrated good internal consistency reliability (alpha = .92) and good construct validity in terms of positive association with extraversion (r = .38 p < .001) and negative association with neuroticism (r = −.57 p < .001). The kind of happiness measured by the OHQ is clearly associated with stable extraversion

Health, Height and Welfare: Britain 1700-1980

This paper reviews the evidence regarding the main trends in the height of the British population since the early eighteenth century. We argue that the average heights of successive birth cohorts of British males increased slowly between the middle of the eighteenth century and the first quarter of the nineteenth century. Average heights fell during the second quarter of the nineteenth century, before rising from the 1850s onwards. This analysis is supported by an examination of the main trends in children's heights during the twentieth century. Our findings are compared with the results of an alternative method of measuring human welfare - a modified version of the United Nations' Human Development Index. The main trends in human development reinforce the conclusions drawn from our own interpretation of the anthropometric evidence.

Diet, Health and Work Intensity in England and Wales, 1700-1914

In their different ways, both Thomas Malthus and Thomas McKeown raised fundamental questions about the relationship between food supply and the decline of mortality. Malthus argued that food supply was the most important constraint on population growth and McKeown claimed that an improvement in the population’s capacity to feed itself was the most important single cause of mortality change. This paper explores the implications of these arguments for our understanding of the causes of mortality decline in Britain between 1700 and 1914. It presents new estimates showing changes in the calorific value and composition of British diets in 1700, 1750, 1800 and 1850 and compares these with the official estimates published by the Royal Society in 1917. It then considers the implications of these data in the light of new arguments about the relationship between diet, work intensity and economic growth. However the paper is not solely concerned with the analysis of food-related issues. It also considers the ways in which sanitary reform may have contributed to the decline of mortality at the end of the nineteenth century and it pays particular attention to the impact of cohort-specific factors on the pattern of mortality decline from the mid-nineteenth century onwards.

Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care

Background: poorly controlled hypertension is independently associated with mortality, cardiovascular risk and disease progression in chronic kidney disease (CKD). In the UK, CKD stage 3 is principally managed in primary care, including blood pressure (BP) management. Controlling BP is key to improving outcomes in CKD. This study aimed to investigate associations of BP control in people with CKD stage 3.Methods: 1,741 patients with CKD 3 recruited from 32 general practices for the Renal Risk in Derby Study underwent medical history, clinical assessment and biochemistry testing. BP control was assessed by three standards: National Institute for Health and Clinical Excellence (NICE), National Kidney Foundation Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were used to compare characteristics of people achieving and not achieving BP control. Univariate and multivariate logistic regression was used to identify factors associated with BP control.Results: the prevalence of hypertension was 88%. Among people with hypertension, 829/1426 (58.1%) achieved NICE BP targets, 512/1426 (35.9%) KDOQI targets and 859/1426 (60.2%) KDIGO targets. Smaller proportions of people with diabetes and/or albuminuria achieved hypertension targets. 615/1426 (43.1%) were only taking one antihypertensive agent. On multivariable analysis, BP control (NICE and KDIGO) was negatively associated with age (NICE odds ratio (OR) 0.27; 95% confidence interval (95% CI) 0.17-0.43) 70–79 compared to &lt;60), diabetes (OR 0.32; 95% CI 0.25-0.43)), and albuminuria (OR 0.56; 95% CI 0.42-0.74)). For the KDOQI target, there was also association with males (OR 0.76; 95% CI 0.60-0.96)) but not diabetes (target not diabetes specific). Older people were less likely to achieve systolic targets (NICE target OR 0.17 (95% CI 0.09,0.32) p?&lt;?0.001) and more likely to achieve diastolic targets (OR 2.35 (95% CI 1.11,4.96) p?&lt;?0.001) for people &gt;80 compared to?&lt;?60).Conclusions: suboptimal BP control was common in CKD patients with hypertension in this study, particularly those at highest risk of adverse outcomes due to diabetes and or albuminuria. This study suggests there is scope for improving BP control in people with CKD by using more antihypertensive agents in combination while considering issues of adherence and potential side effects.<br/

Prevalence of chronic kidney disease in adults in England: comparison of nationally representative cross-sectional surveys from 2003 to 2016

Objectives: To identify recent trends in chronic kidney disease (CKD) prevalence in England and explore their association with changes in sociodemographic, behavioural and clinical factors. Design: Pooled cross-sectional analysis.Setting: Health Survey for England 2003, 2009/2010 combined, and 2016.Participants: 17,663 individuals (aged 16+) living in private households.Primary and secondary outcome measures: Prevalence of estimated glomerular filtration rate (eGFR

Perspectives on flu vaccination advertisement messaging in the era of COVID-19: Thematic analysis centering adult Black voices

Influenza (flu) is an infectious, respiratory disease that causes substantial burden and mortality, and Non-Hispanic Black people experience profound disparities in flu disease burden in the United States. One contributor to flu disease disparities is lower flu vaccination rates among Black populations. This qualitative study was conducted during the COVID-19 pandemic and used the Public Health Critical Race Praxis framework to center and elicit Black adults’ perspectives of desired flu vaccine messaging. This work builds upon efforts to increase access to flu vaccinations and recommendations are provided to aid in tailoring flu vaccine messaging via a health equity lens. Recommendations for flu messaging include: 1) increased transparency in calling out racial disparities in flu disease burden through the use of local statistics, 2) being upfront with provision of flu vaccine information in easy-to-understand language when addressing concerns, and 3) providing desired education around what the vaccine is doing to one’s body, what the ingredients are, potential side effects and normalizing side effects, and the duration of protection elicited by vaccination. Recommendations also highlight the importance of incorporating the family/community/social context in flu vaccination messaging and for targeted messaging to address the most vulnerable while also providing reasons why persons who may consider themselves to not be vulnerable to the flu (i.e., healthy, no risk factors) should be vaccinated (e.g., get vaccinated in order to reduce exposure risk to your grandmother)

Active collaboration with primary care providers increases specialist referral in chronic renal disease

BACKGROUND: Late referral to specialist nephrological care is associated with increased morbidity, mortality, and cost. Consequently, nephrologists' associations recommend early referral. The recommendations' effectiveness remains questionable: 22–51% of referrals need renal replacement therapy (RRT) within 3–4 months. This may be due to these recommendations addressing the specialist, rather than the primary care providers (PCP). The potential of specialist intervention aiming at slowing progression of chronic renal failure was introduced individually to some 250 local PCPs, and referral strategies were discussed. To overcome the PCPs' most often expressed fears, every referred patient was asked to report back to his PCP immediately after the initial specialist examination, and new medications were prescribed directly, and thus allotted to the nephrologist's budget. METHODS: In retrospective analysis, the stage of renal disease in patients referred within three months before the introductory round (group A, n = 18), was compared to referrals two years later (group B, n = 50). RESULTS: Relative number of patients remained stable (28%) for mild/ moderate chronic kidney disease (MMCKD), while there was a noticeable shift from patients referred severe chronic kidney disease (SCKD) (group A: 44%, group B: 20%) to patients referred in moderate chronic kidney disease (MCKD) (group A: 28%, group B: 52%). CONCLUSION: Individually addressing PCPs' ignorance and concerns noticeably decreased late referral. This stresses the importance of enhancing the PCPs' problem awareness and knowledge of available resources in order to ensure timely specialist referral

The Reproducibility of Lists of Differentially Expressed Genes in Microarray Studies

Reproducibility is a fundamental requirement in scientific experiments and clinical contexts. Recent publications raise concerns about the reliability of microarray technology because of the apparent lack of agreement between lists of differentially expressed genes (DEGs). In this study we demonstrate that (1) such discordance may stem from ranking and selecting DEGs solely by statistical significance (P) derived from widely used simple t-tests; (2) when fold change (FC) is used as the ranking criterion, the lists become much more reproducible, especially when fewer genes are selected; and (3) the instability of short DEG lists based on P cutoffs is an expected mathematical consequence of the high variability of the t-values. We recommend the use of FC ranking plus a non-stringent P cutoff as a baseline practice in order to generate more reproducible DEG lists. The FC criterion enhances reproducibility while the P criterion balances sensitivity and specificity