Older hip fracture patients: three groups with different needs

BACKGROUND: Norway, and particularly Oslo, has the highest reported incidence of hip fractures in the world. It is increasingly common to care for older hip fracture patients in orthogeriatric units where orthopaedic care is combined with interdisciplinary geriatric care. The characteristics and needs of older hip fracture patients are poorly described. The aim of this paper is to describe the characteristics of these patients in order to better understand their need for care and rehabilitation. METHODS: This is an observational study based on a quality register for all patients 65+ years in an orthogeriatric unit who are operated for a hip fracture. The unit covers 250,000 inhabitants in Oslo. Patient data were collected in the aim of quality control. The quality database includes demographic, medical, and functional data collected from routine assessment by the interdisciplinary team. RESULTS: From January 2007 to September 2009, 1010 patients, included 241 (24%) from long-term care institutions, were enrolled in the database. Mean age was 85.1 years (SD 7.1), 76% were female, and 83% had experienced an indoor fall. Chronic diseases were registered in 88%, and 38% of the community-dwelling patients had pre-fracture cognitive impairment defined as IQCODE-SF > 3.6. Complications were observed in 51% of the patients, of which the most common were a need for blood transfusion, delirium, and urinary tract infections. Post-operative orthopaedic infections were rare (3.1%). Patients from long-term care were older, (87 vs. 84 years, p < 0.001), more had American Society of Anaesthesiologists (ASA) score >/= 3 (67% vs. 48%, p < 0.001) and a higher number of chronic medical conditions (mean 2.2 vs. 1.6, p < 0.001). Among community-dwelling patients, those who had fallen indoors were older, more often female, had ASA score >/= 3, chronic medical conditions, impairment in pre-fracture ADL and cognitive function, and more complications during hospital stay. CONCLUSIONS: Older hip fracture patients in this orthogeriatric unit may be divided into three groups; patients who are relatively fit and have experienced outdoors falls (17%), frail community-dwelling patients who have fallen indoors (59%), and patients from long-term care institutions (24%). Different caring pathways are needed for these groups

Production of relativistic positronium in collisions of photons and electrons with nuclei and atoms

We consider the production of ultrarelativistic positronium (Ps) in $\gamma A \to Ps + A$ and $e A \to Ps + e A$ processes where $A$ is an atom or a nucleus with charge $Ze$. For the photoproduction of para- and ortho-Ps and the electroproduction of para-Ps we obtain the most complete description compared with previous works. It includes high order $Z \alpha$ corrections and polarization effects. The accuracy of the obtained cross sections is determined by omitted terms of the order of the inverse Ps Lorentz factor squared. The studied high order multi-photon electroproduction of ortho-Ps dominates for the collision of electrons with heavy atoms over the bremsstrahlung production from the electron via a virtual photon proposed by Holvik and Olsen. Our results complete and correct the studies of those authors.Comment: 19 pages, 9 figures, RevTex; v2: minor corrections for the accuracy of the results, a discussion of the literature added in a footnote, one additional reference; v3: diagram of Fig.2 correcte

Grip strength in men and women aged 50–79 years is associated with non-vertebral osteoporotic fracture during 15 years follow-up: The Tromsø Study 1994–1995

Under embargo until: 2020-10-25Summary In 50–79-year-olds who participated in the Tromsø Study (1994–1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50–64 years. Introduction We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994–1995. Methods Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. Results In 2891 men and 4002 women aged 50–79 years, 1099 non-vertebral osteoporotic fractures—including 393 hip fractures—were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05–1.43) in men and 1.09 (95% CI 1.01–1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02–2.45) in men and 1.28 (95% CI 1.03–1.59) in women. The association was most pronounced in men aged 50–64 years with HR = 3.39 (95% CI 1.76–6.53) in the lower compared to the upper quintile. Conclusions The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50–64 years.acceptedVersio

Production of para-- and orthopositronium at relativistic heavy ion colliders

We consider the ortho-- and parapositronium production in the process $AA \to AA+$ Ps where A is a nucleus with the charge number Z. The inclusive cross section and the energy distribution of the relativistic Ps are calculated which are of primary interest from the experimental point of view. The accuracy of the corresponding cross sections is given by omitting terms $\sim (Z\alpha )^2/L^2$ for the para--Ps and $\sim (Z\alpha)^2/L$ for the ortho--Ps production where $L=\ln{\gamma^2} \approx 9$ and 16 for the RHIC and the LHC. Within this accuracy the multiphoton (Coulomb) corrections are taken into account. We show that the RHIC and the LHC will be Ps factories with a productions rate of about $10^5 \div 10^8$ relativistic Ps per day. The fraction of the ortho--Ps is expected to be of the same order as that of the para--Ps for Au--Au and Pb--Pb collisions.Comment: 22 pages, 5 figures, RevTeX, misprint correcte

Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study

Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: 2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors

Sunlight exposure or vitamin D supplementation for vitamin D-deficient non-western immigrants: a randomized clinical trial

Summary: Vitamin D deficiency is very common in non-western immigrants. In this randomized clinical trial, vitamin D 800 IU/day or 100,000 IU/3 months were compared with advised sunlight exposure. Vitamin D supplementation was more effective than advised sunlight exposure in improving vitamin D status and lowering parathyroid hormone levels. Introduction: Vitamin D deficiency (25-hydroxyvitamin D [25(OH)D]<25 nmol/l) is common among non-western immigrants. It can be treated with vitamin D supplementation or sunlight exposure. Methods: To determine whether the effect of vitamin

Prevalence of vitamin D deficiency among Turkish, Moroccan, Indian and sub-Sahara African populations in Europe and their countries of origin: an overview

Public Health and primary carePrevention and community carePrevention, Population and Disease management (PrePoD