The Relationship between Electromyographically Documented Peripheral Neuropatny and Falls

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111114/1/j.1532-5415.1992.tb04477.x.pd

The Green Economy: Functional Domains and Theoretical Directions of Enquiry

The green economy is a highly complex construct in terms of its attempts to integrate economic, environmental, and social concerns, the wide range of actors involved, its material outcomes, and the forms of governance needed to regulate processes of economic greening. As such, it poses new empirical and theoretical challenges for social science research on socioenvironmental futures. This paper has two main aims. The first is to survey the emergent features and functional domains of the green economy. The second is to consider theoretical tools that might be used to analyse the drivers and processes shaping the green economy. Focusing on literature on sociotechnical transitions, ecological modernisation, the ‘green’ cultural economy, and postpolitical governance, we argue that understanding the functional and spatial heterogeneity of the green economy necessitates a multitheoretical approach. We then explore how combining branches of research on socioenvironmental governance can lead to theoretically and ontologically richer insights into the drivers, practices, and power relations within the green economy. In so doing, we respond to calls for socioeconomic research on environmental change which is neither just empirical nor bound to one theoretical outlook to the detriment of understanding the complexity of socioenvironmental governance and human–nature relations.</jats:p

“Love for sale”: biodiversity banking and the struggle to commodify nature in Sabah, Malaysia

In Malaysia, second largest palm oil producer worldwide, logging companies, palm oil corporations, and even responsible citizens can now compensate their biodiversity impacts by purchasing Biodiversity Conservation Certificates in an emerging new biodiversity market: the Malua BioBank. Biodiversity markets are part of a wider trend of marketisation and neoliberalisation of biodiversity governance; introduced and promoted as (technical) win–win solutions to counter biodiversity loss and enable sustainable development. The existing neoliberalisation and nature literature has tended to analyse these processes as consequences of an inherent drive of capital to expand accumulation and submit ever more areas of nature to the neoliberal market logic. In contrast, I aim (a) to problematise the agency and the “work” behind marketisation of biodiversity, challenging the story of (corporate-driven) neoliberalisation as the realisation of an inherent market-logic (based on the a false conceptual state–market divide, often prevalent even in activist academic circles working on neoliberalisation of nature) and to see the state not only as regulator, but driving force behind, and part of “the market”; (b) to question the myth of neoliberalisation as state losing control to the market and to show how the state is using the biodiversity market as mode of governing; re-gaining control over its forests and its conservation policy; and (c) to demonstrate empirically the distinction between neoliberal ideology and practice, and to show that marketisation was based on pragmatic decisions, not ideology-driven political action. My analysis is based on 35 qualitative interviews with actors involved in the BioBank

Predictors for falls and fractures in the longitudinal aging study Amsterdam

The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38- month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9-31.4) for women and 8.2 (95% CI, 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9-7.5%) to 59.2% (95% CI, 24.1-86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0-0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4- 32.2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures

Cohort Randomised Controlled Trial of a Multifaceted Podiatry Intervention for the Prevention of Falls in Older People (The REFORM Trial)

BACKGROUND: Falls are a major cause of morbidity among older people. A multifaceted podiatry intervention may reduce the risk of falling. This study evaluated such an intervention. DESIGN: Pragmatic cohort randomised controlled trial in England and Ireland. 1010 participants were randomised (493 to the Intervention group and 517 to Usual Care) to either: a podiatry intervention, including foot and ankle exercises, foot orthoses and, if required, new footwear, and a falls prevention leaflet or usual podiatry treatment plus a falls prevention leaflet. The primary outcome was the incidence rate of self-reported falls per participant in the 12 months following randomisation. Secondary outcomes included: proportion of fallers and those reporting multiple falls, time to first fall, fear of falling, Frenchay Activities Index, Geriatric Depression Scale, foot pain, health related quality of life, and cost-effectiveness. RESULTS: In the primary analysis were 484 (98.2%) intervention and 507 (98.1%) control participants. There was a small, non statistically significant reduction in the incidence rate of falls in the intervention group (adjusted incidence rate ratio 0.88, 95% CI 0.73 to 1.05, p = 0.16). The proportion of participants experiencing a fall was lower (49.7 vs 54.9%, adjusted odds ratio 0.78, 95% CI 0.60 to 1.00, p = 0.05) as was the proportion experiencing two or more falls (27.6% vs 34.6%, adjusted odds ratio 0.69, 95% CI 0.52 to 0.90, p = 0.01). There was an increase (p = 0.02) in foot pain for the intervention group. There were no statistically significant differences in other outcomes. The intervention was more costly but marginally more beneficial in terms of health-related quality of life (mean quality adjusted life year (QALY) difference 0.0129, 95% CI -0.0050 to 0.0314) and had a 65% probability of being cost-effective at a threshold of £30,000 per QALY gained. CONCLUSION: There was a small reduction in falls. The intervention may be cost-effective. TRIAL REGISTRATION: ISRCTN ISRCTN68240461

Multifactorial day hospital intervention to reduce falls in high risk older people in primary care: a multi-centre randomised controlled trial [ISRCTN46584556]

Falls in older people are a major public health concern in terms of morbidity, mortality and cost. Previous studies suggest that multifactorial interventions can reduce falls, and many geriatric day hospitals are now offering falls intervention programmes. However, no studies have investigated whether these programmes, based in the day hospital are effective, nor whether they can be successfully applied to high-risk older people screened in primary care. The hypothesis is that a multidisciplinary falls assessment and intervention at Day hospitals can reduce the incidence of falls in older people identified within primary care as being at high risk of falling. This will be tested by a pragmatic parallel-group randomised controlled trial in which the participants, identified as at high risk of falling, will be randomised into either the intervention Day hospital arm or to a control (current practice) arm. Those participants preferring not to enter the full randomised study will be offered the opportunity to complete brief diaries only at monthly intervals. This data will be used to validate the screening questionnaire. Three day hospitals (2 Nottingham, 1 Derby) will provide the interventions, and the University of Nottingham's Departments of Primary Care, the Division of Rehabilitation and Ageing Unit, and the Trent Institute for Health Service Research will provide the methodological and statistical expertise. Four hundred subjects will be randomised into the two arms. The primary outcome measure will be the rate of falls over one year. Secondary outcome measures will include the proportion of people experiencing at least one fall, the proportion of people experiencing recurrent falls (>1), injuries, fear of falling, quality of life, institutionalisation rates, and use of health services. Cost-effectiveness analyses will be performed to inform health commissioners about resource allocation issues. The importance of this trial is that the results may be applicable to any UK day hospital setting. SITES: General practices across Nottinghamshire and Derbyshire. Day hospitals: Derbyshire Royal Infirmary (Southern Derbyshire Acute Hospitals NHS Trust) Sherwood Day Service (Nottingham City Hospital Trust) Leengate Day Hospital (Queen's Medical Centre Nottingham University Hospital NHS Trust