Hip fracture types in Canadian men and women change differently with age: A population-level analysis

© the authors, publisher and licensee Libertas Academica Limited. Background: We have previously reported a gender difference in the occurrence of hip fracture type with age in our local population. In the current report, we have explored this phenomenon in a Canadian population using five years of data from a national administrative database. We have com-pared community-dwelling and institutionalized individuals to determine if frailty is important and has a differential effect on the type of hip fracture experienced.Methods: Hospitalization records from 2005 to 2009, in which the most responsible diagnosis, that is the diagnosis causing the admission to hospital, was a hip fracture, were obtained from the Discharge Abstract Database of the Canadian Institute for Health Information. Hip fracture type was identified using the Canadian Classification of Health Interventions and the International Classification of Diseases 10th Revision, Canada (ICD-10-CA). Hip fracture proportions were calculated for the study period and stratified by age group and sex.Results: The relative proportion of intertrochanteric fractures in women rose from 35% in the youngest group (55-59 years) to 51% in the oldest group (84+ years; P, 0.0001). In men, the proportions remain relatively stable (47% and 44%, respectively). Community and institutionalized patients showed the same pattern.Conclusions: The change in the proportion of the two hip fracture types that occur in women but not men may point to differences in the etiology and consequently the approaches to prevention for the two fracture types. Level of frailty did not seem to be important

Purchasing and Using Personal Emergency Response Systems (PERS): How decisions are made by community-dwelling seniors in Canada

© 2015 McKenna et al. Background: As the demographic of older people continues to grow, health services that support independence among community-dwelling seniors have become increasingly important. Personal Emergency Response Systems (PERS) are medical alert systems, designed to serve as a safety net for seniors living alone. Health care professionals often recommend that seniors in danger of falls or other medical emergencies obtain a PERS. The purpose of the study was to investigate the experience of seniors living with and using a PERS in their daily lives, using a qualitative grounded theory approach. Methods: Five focus groups and 10 semi-structured interviews, with a total of 30 participants, were completed using a grounded theory approach. All participants were PERS subscribers over the age of 80, living alone in a naturally occurring retirement community (NORC) with high health service utilization in a major urban centre in Ontario. Constant comparative analysis was used to develop themes and ultimately a model of why and how seniors obtain and use the PERS. Results: Two core themes, unpredictability and decision-making around PERS activation, emerged as major features of the theoretical model. Being able to get help and the psychological value of PERS informed the context of living with a PERS. Conclusions: A number of theoretical conclusions related to unpredictability and the decision-making process around activating PERS were generated

Towards Regional Environmental Accounts for Ireland. ESRI WP293. April 2009

Existing environmental accounts for the Republic of Ireland are at the national level. This is fine for continental and global environmental problems, but information at a finer spatial scale is needed for local environmental problems. Furthermore, the impact of environmental policy may differ across space. We therefore construct regional estimates of the environmental pressures posed by Irish households and the environmental problems faced by them. The basic unit of analysis is the electoral district, and the prime data source is the CSO’s Small Area Statistics, a product of the Census. We use the results of classifying regressions of the Household Budget Survey to impute domestic energy use. We use engineering relations to impute transport fuel use, and secondary data on household behaviour to impute waste arisings. We use EPA data on drinking water use and quality per county. The results show marked regional differences. Electricity use and waste arisings are higher in the East and in the cities and towns. Transport fuel use is highest in the commuter belts around the cities and towns. Other energy is relatively uniform. There is no clear pattern in estimated drinking water use, which may be due to data quality. Drinking water quality is poor across much of the country, but different counties suffer from different problems. The regional estimates are constructed using data in the public domain. However, various government agencies hold data that would allow for the construction of more detailed, more accurate, and more extensive regional environmental accounts

Hip Fractures in Long-Term Care: Is the Excess Explained by the Age and Gender Distribution of the Residents?

Introduction. This study compares hip fracture rates in Long Term Care (LTC) residents with those in the community to determine if their high rate of fracturing reflects the extreme age and predominantly female nature of that population. Methods. Hospital discharge data in London Ontario (population 350,000) and Statistics Canada data were used to correct the hip fracture rate in the LTC setting for age and gender. Results. The risk of hip fracture is 1.8 times greater in LTC than in the community for people of similar age and gender. The rate in women is 1.5 times higher whereas in men it is 4.3 times higher. In the oldest residents, the risk in men exceeds that of women in LTC. Conclusion. The high hip fracture rate in LTC is not just a reflection of the age and predominantly female nature of this population. The oldest men in LTC are a particularly high risk group, deserving more attention

Hip Fracture Types in Men and Women Change Differently with Age

BACKGROUND: Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. METHODS: Patients of 50 years and older, with a diagnosis of hip fracture, discharged from two local acute care hospitals over a 5 year period (n = 2150) were analyzed as a function of age and gender to explore the relative proportions of intertrochanteric and subcapital fractures, and the change in relative proportion in the two genders with age. RESULTS: Overall, for the genders combined, the proportion of intertrochanteric fractures increases with age (p = .007). In women this increase is significant (p \u3c .001), but in men the opposite pattern is observed, with the proportion of intertrochanteric fractures falling significantly with age (p = .025). CONCLUSIONS: The pattern of hip fractures is different in men and women with aging. It is likely that the pattern difference reflects differences in type and rate of bone loss in the genders, but it is conjectured that the changing rate and pattern of falling with increasing age may also be important. The two main hip fracture types should be considered distinct and different and be studied separately in studies of cause and prevention

A Capstone Project on Robust Dynamic Positioning and Data Acquisition Systems

The United States Coast Guard is responsible for enforcing Dynamic Positioning System (DPS) standards in the maritime industry. It is important for the members of the U. S. Coast Guard to understand how these systems work. Students have gained a much greater understanding of how DPS platforms work and what might be required to maintain them by building one from scratch. Aside from this, the project has served as a great opportunity to work on a one year term project that may resemble engineering or acquisitions projects that might be encountered in the students’ future careers. The overall goal of the Robust Dynamic Positioning and Data Acquisition System project was to prototype a dynamic positioning system similar to the ones on buoy tenders in the fleet. The primary goal was to maintain a desired heading and position within a certain range. The secondary goals included robust capabilities (the ability to continue functioning despite motor failures) and data acquisition (to analyze system performance post-testing). Students built a vessel from scratch out of a salvage drum and an inner tube for buoyancy. The internal construction consists of three tiers containing batteries at the lowest level, an onboard computer at the second level, and control hardware at the top level (micro controllers, H-bridges, and fuse boxes). Students successfully used a light detection and ranging (LIDAR) device to determine the relative position to two stationary poles. They were able to communicate with the onboard computer via either a wired connection or a remote desktop connection through an ad-hoc wireless network. All programming for this project was done in MATLAB®. Students have completed all project milestones through the application of past courses they have taken in computer control systems, network communication, and digital signal processing at the U.S. Coast Guard Academy. The first challenge of this project was to focus on constructing the vessel and installing the control hardware. One of the obstacles for the students was establishing communication between the various pieces of software, hardware, and the power distribution system. The LIDAR sensor determined the vessel’s relative position and heading to two stationary poles. Using the position and heading resolution algorithms, students conducted a set of system identification tests in an indoor tank to determine how the system reacts to various thrusts from the motors. This allowed students to collect “Open-Loop” system data. Using the data acquisition system, students were able to identify the system and calculate coefficients for the controller and implement a “Closed- Loop” control system. Students successfully implemented a proportional integral derivative (PID) controller that satisfies all design requirements including robust functionality. Currently, all milestones for the project have been accomplished and plans for continuation of the project are underway

Comparison of hip fracture and osteoporosis medication prescription rates across Canadian provinces

Summary The study explores osteoporosis medication prescribing across Canadian provinces and any impact on hip fracture rates. Despite a marked variation in the prescribing of such medication, there is no effect on the hip fracture rate in either gender or any age group, suggesting either poor targeting or lack of efficacy. Introduction Hip fractures are the most disabling and costly of osteoporotic fractures, and a reduction in the risk of hip fracture is an expectation of osteoporosis medications. In this study, we have compared the use of osteoporosis medication across Canadian provinces with the rate of hip fractures in the same regions. Methods Three years of hip fracture data (2007–2009 inclusive) were obtained from the Canadian Institute for Health Information for all Canadian provinces excluding Quebec. Population information was obtained from Statistics Canada and medication information from the Brogan Inc. database. Because osteoporosis medication is available daily, weekly, monthly, and yearly, medication prescriptions were converted to “units” of prescribing, so that a once a year infusion represented 365 units, a monthly prescription 30 units, and so forth. Results There is a fourfold difference in prescribing across provinces but no corresponding variation in hip fracture rate. No significant correlation exists between prescribing load and hip fracture rate. This was true for all age groups, both genders, and for both intertrochanteric and subcapital hip fracture. Conclusions We find no association between osteoporosis medication prescribing and hip fracture rate. Possible explanations include insufficient numbers of at-risk patients on treatment, inappropriate targeting, and either lack of efficacy or efficacy limited to only certain subgroups of patients such as those with demonstrable trabecular osteoporosis

Common Language of Sustainability for Built Environment Professionals—The Quintuple Helix Model for Higher Education

One of the repeating themes around the provision of the knowledge and skills needed for delivering sustainable communities is the idea of a “common language” for all built environment professionals. This suggestion has been repeated regularly with each new political and professional review within and between different sectors responsible for the delivery of sustainable communities. There have been multiple efforts to address academic limitations, industry fragmentation and promote more interdisciplinary working and sector collaboration. This research explored the role of skills for sustainable communities, particularly within the higher education (HE) sector, and the responses to support the development of a “common language of sustainability” that can be shared between different sectors, professional disciplines and stakeholders. As an interdisciplinary group of academics and practitioners working with the HE sector in the North East of England, we evaluate the progression of sector collaboration to develop a quintuple helix model for HE. We use this as a suitable framework for systematically “mapping” out the mixed sector (academic, public, business, community and environmental organisations) inputs and influences into a representative sample of HE degree modules that are delivered from foundation and undergraduate to postgraduate levels, including examples of part-time and distance-learning modules. We developed a cascade of models which demonstrate increasing levels of collaboration and their potential positive impact on the effectiveness of education on sustainable communities. The methodological assessments of modules were followed by semi-structured group reflective analysis undertaken through a series of online workshops (recorded during the Covid19 lockdown) to set out a collective understanding of the generic skills needed for the delivery of sustainable communities. These generic skills for sustainable communities are presented as a pedagogical progression model of teaching activities and learning outcomes applied to the levels within HE. We propose sustainability education principles and progressions with the hope that they can have an impact on the design or review of current degree modules and programmes. The paper informs future sustainability research to be grounded in holism and systems thinking; better understanding of values, ethics, influencing and political impact; and procedural authenticity

The Cost-Effectiveness Of The Manchester ‘Lung Health Checks’, A Community-Based Lung Cancer Low-Dose CT Screening Pilot

Background: Previous evaluations of low-dose CT (LDCT) lung cancer screening programmes have taken very different approaches in the design of the informative trials and the methods applied to determine cost-effectiveness. Therefore, it has not been possible to determine if differences in cost-effectiveness are due to different screening approaches or the evaluation methodology. This study reports the findings of an evaluation of the first round of a community-based, LDCT screening pilot Manchester, applying previously published methodology to ensure consistency. Methods: Using the economic evaluation method reported in the UKLS trial, applying Manchester specific evidence where possible, we estimate the cost-effectiveness of LDCT for lung cancer. Estimates of the total costs and quality adjusted life years (QALYs) were calculated. Results: The Manchester programme cost £663,076, diagnosed 42 patients with lung cancer resulting in a gain in population health of 88.13 discounted life years, equivalent to 65.85 QALYs. This implied an incremental cost-effectiveness ratio of £10,069/QALY. Conclusions: We found the Manchester programme to be a cost-effective use of limited NHS resources. The findings suggest that further research is now needed not as to whether LDCT screening is cost-effective but under what conditions can it improve patient health by the most while remaining cost-effective

A Scoping Review of Strategies for the Prevention of Hip Fracture in Elderly Nursing Home Residents

Elderly nursing home residents are at increased risk of hip fracture; however, the efficacy of fracture prevention strategies in this population is unclear.We performed a scoping review of randomized controlled trials of interventions tested in the long-term care (LTC) setting, examining hip fracture outcomes.We searched for citations in 6 respective electronic searches, supplemented by hand searches. Two reviewers independently reviewed all citations and full-text papers; consensus was achieved on final inclusion. Data was abstracted in duplicate.We reviewed 22,349 abstracts or citations and 949 full-text papers. Data from 20 trials were included: 7--vitamin D (n = 12,875 participants), 2--sunlight exposure (n = 522), 1--alendronate (n = 327), 1--fluoride (n = 460), 4--exercise or multimodal interventions (n = 8,165), and 5--hip protectors (n = 2,594). Vitamin D, particularly vitamin D(3) > or = 800 IU orally daily, reduced hip fracture risk. Hip protectors reduced hip fractures in included studies, although a recent large study not meeting inclusion criteria was negative. Fluoride and sunlight exposure did not significantly reduce hip fractures. Falls were reduced in three studies of exercise or multimodal interventions, with one study suggesting reduced hip fractures in a secondary analysis. A staff education and risk assessment strategy did not significantly reduce falls or hip fractures. In a study underpowered for fracture outcomes, alendronate did not significantly reduce hip fractures in LTC.The intervention with the strongest evidence for reduction of hip fractures in LTC is Vitamin D supplementation; more research on other interventions is needed