Fall and Injury Prevention in Residential Care—Effects in Residents with Higher and Lower Levels of Cognition

Artikkelen omhandler en studie hvor hensikten var å evaluere effekten av et program for forebygging av fall og fallskade hos eldre med ulikt kognitivt funksjonsnivå.To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. A preplanned subgroup comparison of the effectiveness of a cluster‐randomized, nonblinded, usual‐care, controlled trial. Nine residential facilities in Umeå, Sweden. All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini‐Mental State Examination (MMSE; n = 378). An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean ± standard deviation = 83.9 ± 5.8 vs 82.2 ± 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6–15) vs 17 (13–18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem‐solving conferences. The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls = .016 and = .121 and adjusted hazard ratio < .001 and = .420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group ( = .006). The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group

Large variations in walking, standing up from a chair, and balance in women and men over 85 years: an observational study

QuestionsWhat is the physical ability of very old people? Is physical ability affected by age or sex? Is it affected by type of housing, level of independence in activities of daily living, cognition, or nutrition?DesignA population-based cross-sectional observational study.ParticipantsHalf the 85-year-old population, and the total population aged 90 and ≥ 95 (range 95–103) in Umeå, Sweden who were measured in the Umeå 85+ Study (n = 238).Outcome measuresUsual and fastest gait speed (m/s) over 2.4 metres, three consecutive chair stands (s), the Berg Balance Scale, and ability to perform the measures (yes/no).ResultsThe median (10th to 90th percentile) usual gait speed was 0.49 m/s (0.23–0.75), time to perform the chair stands test was 12.6 seconds (8.5–20.2), and the Berg Balance Scale score was 45 (0–54). Men had greater physical ability than women. An age-related decline in physical ability was seen in women, but not in men. The Berg Balance Scale showed no floor or ceiling effects, but gait speed and chair stands resulted in a floor effect, especially for women.ConclusionThere were large variations in physical ability in these very old people. These data provide valuable reference values of physical ability in the oldest age groups for commonly-used clinical measures

Digital innovation during terror and crises

Terror attacks are moments of chaos and destabilization. From a journalistic perspective, terror attacks disrupt everyday news work where journalists find themselves struggling to restore order and report the event at hand as accurate and speedy as possible. From the perspective of the affected audience, journalism fills vital functions in making sense of the attack, by responding to a complex and rapidly changing mix of social needs. In this article, we explore how such disrupting events as terror can contribute to newsroom innovation in terms of journalistic processes, journalistic products, and even journalistic genres. We use the terror attack and massacre in Norway on 22 July 2011 as a case study, as it to a large extent forced journalists to think outside the box in order to meet the audience’s informational and rhetorical needs. The study shows that innovation is tightly connected to the development of the rhetorical situation through three phases: shock, start-up, and transformation. The analysis is based on qualitative interviews with journalists who covered the attack, as well as a rhetorical exploration of the evolving situational context and the texts that were created in response

Falls in very old people: the population-based Umeå 85+ Study in Sweden

Artikkelen omhandler en studie hvor hensikten var å beskrive forekomst av fall og fallrelaterte skader, og å identifisere predisponerende faktorer for fall hos eldre 85 år og eldre.The aim of this study was to describe incidences of falls and fall-related injuries, and to identify predisposing factors for falls in very old people in a prospective population-based follow-up study for falls. The study is part of the Umeå 85+ Study which includes half of the population aged 85, and the total population aged 90 and ≥95 (−103), in Umeå, Sweden. Of the 253 people interviewed, 220 (87%) were followed up for falls for 6 months, of whom 109 lived in ordinary and 111 in institutional housing. A comprehensive geriatric baseline assessment was made through interviews and testing during home visits. Forty percent of the participants did fall a total 304 times, corresponding to 2.17 falls per Person Year (PY). It occurred 0.83 injuries per PY, including 0.14 fractures per PY. In a Cox regression analysis, the independent explanatory risk factors for time to first fall were dependency in activities of daily living (ADL), thyroid disorders, treatment with selective serotonin reuptake inhibitors (SSRIs) and occurrence of falls in the preceding year. It could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture within 1 year. ADL, thyroid disorders and treatment with SSRIs should be considered in fall prevention programmes

Global democratic consensus on neuropathological disease criteria.

peer reviewe

Strukturkostnaden som kvalitetsmått

I denna uppsats behandlas frågan om kommunerna kan använda strukturkostnaden som en legitim fingervisning på vad förskoleverksamheten bör kosta vid en genomsnittlig kvalité. För att alla kommuner skall kunna erbjuda en liknande service till sina invånare oavsett kommunens strukturella förutsättningar har det införts ett kommunalt kostnads och intäktsutjämningssystem. Systemet skall utjämna de strukturella skillnader som kommunen inte kan påverka. Det gäller befolkningstäthet, skattekraft och demografisk struktur. Förskoleverksamheten regleras i skollagen (SFS 1985:1100) och av Läroplanen för förskolan (lpfö 98). Skollagen är tydlig med vad kommunerna är skyldiga att erbjuda. Den reglerar emellertid inte hur det skall erbjudas. Det innebär att så länge kommunen erbjuder förskoleverksamhet i den volym som lagen stipulerar har skyldigheten fullgjorts. Verksamhetens innehåll regleras i läroplanen. Det är följaktligen upp till varje enskild kommun att besluta vilken kvalitet man vill erbjuda och till vilken kostnad den skall produceras. Problemet är att beslutsfattarna inte vet vad som är rätt kostnad för att producera beslutad kvalitet. Syftet med uppsatsen är att se om kommunerna kan använda strukturkostnaden som en legitim fingervisning på vad förskoleverksamheten bör kosta vid en genomsnittlig kvalité. För att realisera detta syfte har vi utgått från två teorier och två kommuner. Teorierna är C.K. Lindbloms legitimitetsteori och Grönroos teori om totalkvalitet. Kommunerna är Bjuv och Klippan. De har valts för att de har en stor avvikelse mellan strukturell och redovisad kostnad för förskoleverksamheten. Slutsatsen i studien är att kommunerna kan använda strukturkostnaden som en legitim fingervisning på vad förskoleverksamheten bör kosta vid en genomsnittlig kvalit

Sorption of Pu(VI) onto TiO2

The sorption of Pu(VI) onto TiO2 was studied as a function of pH (210) and Pu concentration (10−810−4 M) under an N2 atmosphere, in 0.016 and 0.1 M NaClO4. A batch-wise method was used, in which pH was measured in separate experimental containers after removal of a sample to determine the amount of Pu that had been sorbed. As Pu is radioactive, it was used as a tracer and measured by liquid scintillation counting. No ionic strength dependence was discerned, which was taken as an indication of inner sphere complex formation. In the interval of pH 27 the system could be described by the formation of two positively charged surface complexes using a 1-pK Stern model. Sorption of the plutonyl ion (PuO22+) and the first hydrolysis species (PuO2(OH)+) was estimated using FITEQL to logK1=6.9 and logK2=1.4, respectively