Does action follow intention with participation in home and group-based falls prevention exercise programs? An exploratory,prospective, observational study

BackgroundExercise for falls prevention is effective but of limited uptake in real life. The link between intention and behavior is central to many health-behavior models, but has not been examined in the falls prevention exercise context.ObjectiveThis study examines this relationship and prospectively identifies factors associated with participation in group and home-based falls prevention exercise.DesignThis was an observational study of community-dwelling adults in Australia >70 years of age with a 12 month follow-up (n = 394 commenced baseline assessment, n = 247 commenced follow-up).MethodsIntention, and other potential predictive factors examined, were measured at baseline while participation was measured using self-report at 12 month follow-up.ResultsBetween 65% and 72% of our sample at baseline agreed or strongly agreed they would participate in the falls prevention exercise programs. n = 27 respondents participated in home-based exercise during follow-up and had intention to do so while n = 29 who participated did not have intention. In contrast, n = 43 respondents participated in group exercise and had intention to do so compared to 11 who participated but did not intend to at baseline. Perception of personal effectiveness and previous exposure to the exercise intervention were most strongly predictive of future participation.ConclusionMore people who do not want to participate in home exercise actually participate in home exercise than people who do not want to participate in group exercise that actually do. It may be easier to convince people who do not want to participate in falls prevention exercise to participate in a home program.     

Tailored education program using home floor plans for falls prevention in discharged older patients: A pilot randomized controlled trial

ObjectiveTo investigate the effect of a tailored education program using home floor plans on falls prevention in discharged older patients.DesignA single-center, parallel, pragmatic, pilot randomized controlled trial with equal allocation to the intervention and control groups.SettingDischarged hospital patients were followed-up in their home settings.ParticipantsAll discharged orthopedic patients aged ≥65 years who experienced ≥1 fall(s) in the past year (n = 60).InterventionsBoth groups received standard care (exercises) and the intervention group also received a tailored education program for falls prevention using home floor plans.MeasurementsFalls and near-falls at the participants’ homes using a 1-month fall calendar during the 1-month period after discharge. The evaluators were blinded at the baseline assessment.ResultsNine participants were withdrawn from the study, leaving 51 of 60 (85%) participants for the final analyses. No falls occurred in the intervention group (n = 25) during follow-up. However, 2 participants (7.7%) fell in the control group (n = 26). Near-falls were reported by 7 participants (28.0%) in the intervention group and 13 participants (50.0%) in the control group. The intervention group had 75% less near-falls compared with the control group, as assessed using a Cox proportional hazards model (hazard ratio, 0.25; 95% confidence interval, 0.09–0.75).ConclusionsThe tailored education program using home floor plans at the hospital was effective for reducing falls and near-falls among discharged orthopedic patients.Registration of clinical trials: This study was registered with the Research Ethics Committee of University Hospital Medical Information Network (UMIN) Center (000018201).     

Oral tacrolimus as maintenance therapy for refractory ulcerative colitis—an analysis of outcomes in two London tertiary centres

BackgroundThe medical management of refractory ulcerative colitis (UC) remains a significant challenge. Two randomised controlled studies have demonstrated tacrolimus therapy is effective for the induction of remission of moderate to severe UC. However, the long term outcomes of UC patients treated with tacrolimus as maintenance therapy are not certain.AimsThis study aims to assess the efficacy of tacrolimus maintenance therapy for refractory UC.MethodsA retrospective review of patients with UC treated with tacrolimus at two London tertiary centres was performed. Clinical outcomes were assessed at six months, at the end of tacrolimus treatment, or at the last follow-up for patients continuing tacrolimus treatment. Modified Truelove–Witts score (mTW) and Mayo endoscopy subscores were calculated.Results25 patients with UC, treated with oral tacrolimus between 2005 and 2011, were identified. The median duration of tacrolimus treatment was 9 months (IQR 3.7–18.2 months). The median duration of follow-up was 27 months (range 3–66 months). At six months thirteen (52%) patients had achieved and maintained clinical response and eleven (44%) were in clinical remission. The mean mTW score decreased from 10 +/− 0.5 before therapy, to 5.8 +/− 0.8 (p ≤ 0.001 95% CI 2.7–5.8) at cessation of treatment or last follow-up. Mayo endoscopy subscore decreased from 2.6 +/− 0.1 to 1.2 +/− 0.2 (p ≤ 0.001 mean reduction 1.4, 95% CI 0.8–1.9). Eight patients (32%) subsequently underwent a colectomy within a mean time of 17 months (range 2–45 months).ConclusionTacrolimus is effective for the maintenance of refractory UC and can deliver sustained improvement in mucosal inflammation.     

Acute histological inflammatory activity is associated with clinical relapse in patients with ulcerative colitis in clinical and endoscopic remission

BackgroundIt has been suggested that acute histological activity has a prognostic value in the outcome of ulcerative colitis (UC) patients in clinical and endoscopic remission. Our aim was to assess the role of histology as a risk factor for clinical relapse (CR) in patients in both clinical and endoscopic remission.MethodsPatients with left-sided or extensive UC in clinical and endoscopic remission (Mayo endoscopic subscore ≤1) undergoing colonoscopy for dysplasia surveillance with random colonic biopsies between 2005–2015 were included. Basal plasmacytosis, acute (AHA), and the chronic (CHA) histological inflammatory activity of all biopsy sets were evaluated.ResultsOne hundred and thirteen patients were included. Median time in clinical remission at inclusion was 27 months (IQR 15–56). Eight percent of patients relapsed within the first year and 33% during the whole follow-up period. In the univariate analysis, the presence of AHA, alone (P = 0.048) or together with a past flare within the previous 12 months (P = 0.01), was associated with CR within the first year of follow-up. In the multivariate analysis, AHA, together with a flare within the previous 12 months, remained the only risk factor for relapse (RR = 7.5; IC95%; 1.8–29.9; P = 0.005).ConclusionsIn UC patients in clinical and endoscopic remission, the presence of AHA is a risk factor for clinical relapse.     

Dose-Response and Self-Efficacy Effects of an Exercise Program on Vigor Change in Obese Women

BackgroundThe causative factors of exercise-induced mood change remain unclear. The objective of this study was to clarify the relationship of exercise with change in vigor (energy level).MethodsObese women in an exercise support treatment (n = 122) or control condition (n = 70) were assessed on vigor, exercise barriers self-efficacy, and physical self-concept at baseline and at month 6. Exercise session attendance was also assessed in the treatment group. The relationship between exercise attendance and vigor change was tested. Multiple regression analyses also tested whether change in vigor was predicted by exercise barriers self-efficacy and physical selfconcept scores, both at baseline and change over 6 months.ResultsVigor, exercise barriers self-efficacy, and physical self-concept were significantly improved in the treatment group only. Exercise session attendance was not significantly related to change in vigor. Multiple regression analyses indicated that exercise barriers self-efficacy and physical self-concept scores, both at baseline and change from baseline to month 6, explained a significant portion of the variance in changes in vigor (R²_adj = 0.13 and 0.21, respectively). In post hoc analyses, entry of depressed mood (indicated by a cut point on depression score) into the regression equations increased the variance accounted for to R²_adj = 0.15 and 0.25, respectively.ConclusionsFindings supported behavioral explanations of the exercise-mood change relationship emanating from social cognitive and self-efficacy theory. The use of manageable amounts of exercise early in the weight loss intervention process was suggested.     

Fistulizing pattern in Crohn's disease and pancolitis in ulcerative colitis are independent risk factors for cancer: A single-center cohort study

Background & AimsThe combined role of immunomodulators (IMM) and clinical characteristics of Inflammatory Bowel Disease (IBD) in determining the cancer risk is undefined. The aim was to assess whether clinical characteristics of IBD are independent risk factors for cancer, when considering thiopurines and anti-TNFs use.MethodsIn a single-center cohort study, clinical characteristics of IBD patients with IBD duration ≥ 1 year and ≥ 2 visits from 2000 to 2009 were considered. Tests for crude rates and survival analysis methods were used to assess differences of incidence of cancer between groups. The methods were adjusted for the time interval between diagnosis and immunomodulatory treatments.ResultsIBD population included 1222 patients :615 Crohn's disease (CD), 607 ulcerative colitis (UC). Cancer was diagnosed in 51 patients (34 CD,17 UC), with an incidence rate of 4.3/1000 pt/year. The incidence rate of cancer was comparable between CD and UC (4.6/1000 pt/year vs 2.9/1000 pt/year ;p = n.s.). Cancer most frequently involved the breast, the GI tract, the skin. Lymphoma was diagnosed in CD (1HL,1NHL,0 HSTCL). Risk factors for cancer included older age at diagnosis of IBD (CD: HR 1.25;95%CI 1.08–1.45; UC:HR 1.33;95%CI 1.15–1.55 for an increase by 5 years; p = 0.0023; p = 0.0002), fistulizing pattern in CD (HR 2.55; 95%CI 1.11–5.86,p = 0.0275), pancolitis in UC (HR 2.79;95%CI 1.05–7.40 p = 0.0396 vs distal). IMM and anti-TNFs did not increase the cancer risk in CD, neither IMM in UC (anti-TNFs risk in UC not feasible as no cases observed).ConclusionsFistulizing pattern in CD, pancolitis in UC and older age at diagnosis of IBD are independent risk factors for cancer.     

Comparison of demographic and clinical characteristics of patients with early vs. adult vs. late onset ulcerative colitis

Background & aimsThere is limited data comparing influence of age on the presentation, clinical course, and therapeutic response of patients with ulcerative colitis. We aimed to compare the demographic and clinical characteristics of patients diagnosed with UC in older age vs. adulthood vs. early age.MethodsFive-hundred sixty one patients with UC seen at our center from 1995 to 2011 were categorized into early onset (EO), adult onset (AO) and late onset (LO) due to age at date of initial diagnosis. Patients diagnosed younger than age 17 were defined as EO, while those diagnosed between 17 and 60 were defined as AO and older than age 60 as LO. All patients were analyzed for demographic and clinical characteristics.ResultsThere was a male predominancy among LO patients (50% vs. 57.7% vs. 78.6%, p = 0.004). Patients with EO UC were more likely to be non-smokers (p < 0.001), and had higher family history of UC (p = 0.02). Patients with EO UC had more steroid use (p = 0.03), total colectomy (p = 0.04), presence of chronic active disease (p = 0.04) rates when compared with AO and LO groups. Patients in EO group had higher overall probability of surgery in 1, 5 and 10 years, when compared with patients in LO group (p = 0.02), but it wasn't different between EO and AO groups (p = 0.09).ConclusionsOur study showed that clinical course of UC was more aggressive in younger ages. Also the difference between the demographic characteristics suggests that different age groups have different risk factors for the disease development.     

The role of postural instability/gait difficulty and fear of falling in predicting falls in non-demented older adults

IntroductionPostural instability/gait difficulty (PIGD) and fear of falling (FoF) frequently co-exist, but their individual predictive values for falls have not been compared in aging. This study aims to determine both independent and combined effect of PIGD and FoF to falls in older adults without dementia.MethodsPIGD and other extrapyramidal signs were systematically assessed in 449 community-dwelling participants without Parkinson’s disease (76.48 ± 6.61 ys; 56.8% female) enrolled in this longitudinal cohort study. Presence of FoF was measured by a single-item question (Do you have a FoF?) and self-confidence by the Activities-specific Balance Confidence scale (ABC scale).ResultsOne hundred sixty-nine participants (38%) had an incident fall over a mean follow-up of 20.1 ± 12.2 months. PIGD was present in 32% and FoF in 23% of the participants. Both PIGD (adjusted hazard ratio (aHR): 2.28; p = 0.016) and self-confidence (aHR: 0.99; p = 0.040) predicted falls when entered simultaneously in the Cox model. However, presence of FoF (aHR: 1.99; p = 0.021) and self-confidence (aHR: 0.98; p = 0.006) predicted falls only in individuals with PIGD.ConclusionsPIGD and FoF were associated with future falls in older adults without dementia but FoF was a fall’s predictor only in individuals with PIGD.     

The Patient Simple Clinical Colitis Activity Index (P-SCCAI) can detect ulcerative colitis (UC) disease activity in remission: A comparison of the P-SCCAI with clinician-based SCCAI and biological markers

AimTo develop a patient-based Simple Clinical Colitis Activity Index (P-SCCAI) of ulcerative colitis (UC) activity and to compare it with the clinician-based SCCAI, C-reactive protein (CRP) and Physician's Global Assessment (PGA) of UC activity. Monitoring UC activity may give patients disease control and prevent unnecessary examinations.MethodsConsecutive UC patients randomly completed the P-SCCAI either before or after consultation. Gastroenterologists assessed patients' UC activity on the same day. Overall agreement between SCCAI and P-SCCAI was calculated with Spearman's Rho and Mann–Whitney U test. Agreement regarding active disease versus remission and agreement at domain level were calculated by percent agreement and kappa (κ).Results149 (response rate 84.7%) UC patients participated. P-SCCAI and SCCAI showed a large correlation (r_s = 0.79). The medians (IQR) of the P-SCCAI (3.78;0–15) tended to be higher than those of the SCCAI (2.86;0–13), although this difference did not reach statistical significance (z = 1.71| p = 0.088). In 77% of the cases the difference between clinicians' and patients' scores was not clinically different (i.e. ≤ 2). Percentage agreement between clinicians and patients, judging UC as active or in remission, was 87%, r_s = 0.66, κ = 0.66, indicating a substantial agreement. In general patients tended to report more physical symptoms than clinicians. C-Reactive protein (CRP) was found to have a significant association with both P-SCCAI and SCCAI (κ = 0.32, κ = 0.39 respectively) as was PGA (κ = 0.73 for both indices).ConclusionsThe P-SCCAI is a promising tool given its substantial agreement with the SCCAI and its feasibility. Therefore, P-SCCAI can complement SCCAI in clinical care and research.     

Prevention of falls by outdoor-walking in elderly persons at risk (“power”) – a pilot study

PurposeIt has been shown that morbidity and mortality, associated with falls in older persons, can be reduced by physical activity. Many previous programs for prevention of falls were too demanding to be implemented. We aimed to test the feasibility and acceptability of a program of regular lay people, assisted outdoor walking for nursing home residents including a possible impact on the prevention of falls.Patients and methodsWe included five nursing homes; whereof three were assigned for the intervention and two for the control group. Inclusion criteria were age above 65 years and increased risk of falls. The intervention group (n = 32) benefited from regular assisted outdoor walking, the control group (n = 20) did not practice physical activities. We evaluated participants at the start of the study (T0) and after 6 months (T1) for history of falls, physical and cognitive impairment. In addition, we performed qualitative interviews with nursing home managers.ResultsThe program was evaluated positively by the participating nursing homes. Half of the participants reported an improvement in their general condition, general mood and walking ability. There was a slight intervention effect on depressive symptoms, but no differences between intervention and control group in the proportion of falls, in regard to risk of falls and functional status (daily activities).ConclusionsThis study shows the feasibility of implementing a simple program of outdoor walking for older people in nursing homes. A sufficiently powered randomized controlled trial is necessary to prove the effectiveness and safety of our approach.     

Physical activity reduces circulating TNF-alpha but not pro-thrombotic factors levels in patients with metabolic syndrome

AimsThe metabolic syndrome (MS) creates a pro-inflammatory state. Some cytokines increase their levels in patients with MS, among them tumor necrosis factor-alpha (TNF-alpha). On the other hand, MS is associated with a pro-thrombotic state in which increased levels of fibrinogen and plasminogen activator inhibitor type-1 (PAI-1) have been described.We tested the hypothesis that an intervention based on physical activity in adults with MS would reduce TNF-alpha, and the thrombogenic factors fibrinogen and PAI-1.Materials and MethodsWe studied 51 non-smoking subjects, both genders, between 39 and 62 years old. All of them presented MS and were randomly separated into two groups: Intervened-MS group (I-MS, n = 27), who participated in an 18-week intervention based on exercise and dietary counseling, and non-intervened MS group (NI-MS, n = 24), as control. Biochemical and anthropometric parameters were determined at baseline and at final time (18 weeks).ResultsThe intervention decreased the TNF-alpha serum levels (expressed as median and interquartile range IQR) from basal 3.6 (IQR = 2.1) to a final level of 1.7 (IQR = 1.8) pg/ml, in comparison to the NI-MS group: basal 4.0 (IQR = 1.8) to final 4.7 (IQR = 10.5) pg/ml (p < 0.0001). On the contrary, this treatment did not produce changes in the pro-thrombotic factors fibrinogen and PAI-1, although variations in PAI-1 were associated with changes in waist circumference (p = 0.026) and high-density lipoprotein cholesterol (p = 0.04).ConclusionOur results suggest that a non-pharmacological intervention program based on physical exercise is effective in reducing TNF-alpha levels in patients with MS, but had no effect regarding the levels of the pro-thrombotic factors PAI-1 and fibrinogen.     

Disease severity in familial cases of IBD

BackgroundPhenotypic traits of familial IBD relative to sporadic cases are controversial, probably related to limited statistical power of published evidence.AimTo know if there are phenotype differences between familial and sporadic IBD, evaluating the prospective Spanish registry (ENEIDA) with 11,983 cases.Methods5783 patients (48.3%) had ulcerative colitis (UC) and 6200 (51.7%) Crohn's disease (CD). Cases with one or more 1st, 2nd or 3rd degree relatives affected by UC/CD were defined as familial case.ResultsIn UC and CD, familial cases compared with sporadic cases had an earlier disease onset (UC: 33 years [IQR 25–44] vs 37 years [IQR 27–49]; p < 0.0001); (CD: 27 years [IQR 21–35] vs 29 years [IQR 22–40]; p < 0.0001), higher prevalence of extraintestinal immune-related manifestations (EIMs) (UC: 17.2% vs 14%; p = 0.04); (CD: 30.1% vs 23.6%; p < 0.0001). Familial CD had higher percentage of ileocolic location (42.7% vs 51.8%; p = 0.0001), penetrating behavior (21% vs 17.6%; p = 0.01) and perianal disease (32% vs 27.1%; p = 0.003). Differences are not influenced by degree of consanguinity.ConclusionWhen a sufficiently powered cohort is evaluated, familial aggregation in IBD is associated to an earlier disease onset, more EIMs and more severe phenotype in CD. This feature should be taken into account at establishing predictors of disease course.     

Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: A randomized controlled trial

ObjectiveTo assess the effectiveness of a culturally sensitive, structured education programme (CSSEP) on biomedical, knowledge, attitude and practice measures among Arabs with type two diabetes.Research designs and methodsA total of 430 patients with type II diabetes mellitus living in Doha, Qatar were enrolled in the study. They were randomized to either intervention (n = 215) or a control group (n = 215). A baseline and one-year interval levels of biomedical variables including HbA1C, lipid profile, urine for microalbuminuria; in addition to knowledge, attitude and practice (KAP) scores were prospectively measured. The intervention was based on theory of empowerment, health belief models and was culturally sensitive in relation to language (Arabic), food habits and health beliefs. It consisted of four educational sessions for each group of patients (10–20 patients per session), lasting for 3–4 h. The first session discussed diabetes pathophysiology and complications; while the second session discussed healthy life style incorporating the Idaho plate method; and the third session dealt with exercise benefits and goal setting and the fourth session concentrated enhancing attitude and practice using counselling techniques. Outcomes were assessed at base line and 12 months after intervention.ResultsAfter 12 months participation in the intervention was shown to have led to a statistically significant reduction in HbA1C in the (CSSEP) group (?0.55 mmol/L, P = 0.012), fasting blood sugar (?0.92 mmol/L, P = 0.022), body mass index (1.70, P = 0.001) and albumin/creatinine ratio (?3.09, P < 0.0001) but not in the control group. The intervention group also had improvement in Diabetes knowledge (5.9%, P < 0.0001), attitude (6.56%, P < 0.0001), and practice (6.52%, P = 0.0001).ConclusionThis study demonstrates the effectiveness of culturally sensitive, structured, group-based diabetes education in enhancing biomedical and behavioural outcomes in Diabetic patients.     

Effect of intensive counselling on physical activity in pregnant women at high risk for gestational diabetes mellitus. A clinical study in primary care

ObjectiveThe level of physical activity (PA) of pregnant women in Finland is unknown. Even more limited is our knowledge of PA of women at high risk for gestational diabetes mellitus (GDM).MethodsThe women (n = 54) were randomly assigned to a lifestyle intervention group (n = 27) including exercise advice by a physiotherapist six times during pregnancy or to a control group (n = 27) without additional exercise advice. Outcomes of the present study were required sample size, timing of counselling and change of PA. PA was retrospectively reported during 12 months before pregnancy and recorded one week monthly during pregnancy.ResultsIndividualized counselling by a physiotherapist resulted in small changes of recreational PA (2.7 MET hours/week, p = 0.056) up to gestational week 25 compared with the similar decreasing tendency of PA in the control group. The women decreased recreational PA after week 30. Sample size of 550 women at high risk for GDM per group would be needed for a PA study.ConclusionsThe optimal time window for increasing PA must be earlier than in the last trimester of pregnancy. Sample size for a study to increase PA by 2.7 MET hours/week on pregnant women at high risk of GDM should be about 550 per group.     

Gait speed and risk assessment for falls among men aged 80 years and older: A prospective cohort study in Taiwan

PurposeTo evaluate the effectiveness of adding gait speed to the history of falls in predicting falls among men aged 80 years and older in Taiwan.MethodsThis prospective cohort study recruited 230 ambulatory men aged 80 years and older in 2012 and followed for 12 months. In addition to demographic characteristics and history of falls, a comprehensive geriatric assessment was performed for all study subjects. Gait speed was obtained by the 6-m walk and three different cut-offs (< 0.5, ≤ 0.8 and < 1.0 m/s) were tested in improving the ability of predicting subsequent falls by using history of falls.ResultsAmong all subjects (mean age: 85.5 ± 4.0 years), 26.1% (60/230) reported falls during follow-up period. Univariate analysis showed that polypharmacy, urinary incontinence, history of falls, pain, poorer baseline physical function, depressive mood, and gait speed < 0.5 m/s were associated with falls. Logistic regression showed that history of falls (OR: 4.255, 95% CI 2.089–8.667; P < 0.001), pain (OR: 2.674, 95% CI 1.332–5.369; P = 0.006), older age (OR: 1.128, 95% CI 1.031–1.234; P = 0.008), and slow gait speed (OR: 2.964, 95% CI 1.394–6.300; P = 0.005) were all independent risk factors for falls. Fast gait speed (defined as ≥ 1 m/s) was a protective factor for falls, even among subjects with history of falls, but slow gait speed (defined as < 0.5 m/s) was an independent risk factor even among subjects without history of falls.ConclusionsCombined history of falls and gait speed is a simple and effective tool in risk assessment of falls among older old population.     

Elevated immunoglobulin G4 level is associated with reduced colectomy-free survival in patients with primary sclerosing cholangitis and ulcerative colitis

Background and aimPatients with primary sclerosing cholangitis (PSC) and elevated immunoglobulin (Ig) G4 have been shown to have more severe disease with a shorter time to orthotopic liver transplantation (OLT). The aim of the study was to investigate the clinical outcomes of PSC and UC in patients with elevated serum IgG4.MethodsWe analyzed data from 50 patients with PSC and known serum levels of IgG4. They were divided into groups called high IgG4 (> 112 IU/L; n = 10) or normal IgG4 (n = 40). We compared the requirement of OLT and colectomy between groups.ResultsHigh IgG4 was found in 10 PSC patients (20%). UC was associated in 9/10 patients with high IgG4 vs. 32/40 patients with normal IgG4 (p = 0.67). Patients with high IgG4 were younger at PSC diagnosis (28.1 ± 13.9 vs. 37.6 ± 13.4 years, P = 0.04), more likely to have backwash ileitis (7/9 vs. 12/32, P < 0.001) and UC flares (median of 5.5 vs. 1.5, P = 0.02). Kaplan–Meier curve analysis showed that patients with elevated IgG4 had reduced colectomy-free survival than patients with normal IgG4 (Log Rank p < 0.001). The median time to colectomy was 5 years from UC diagnosis in high IgG4 group vs. 12 years in the normal IgG4 group (p = 0.01).ConclusionsElevated IgG4 was seen in a small number of PSC patients. Most of these patients had associated UC, were younger at the time of PSC diagnosis, more likely to have backwash ileitis and had reduced colectomy-free survival than patients with normal IgG4.     

Genetic and environmental factors as predictors of disease severity and extent at time of diagnosis in an inception cohort of inflammatory bowel disease,Copenhagen County and City 2003–2005

Background and aimsThe etiology of the inflammatory bowel diseases (IBD), Crohn's disease (CD) and ulcerative colitis (UC) remains unknown. We aimed to investigate the influence of genetic, serological, and environmental factors on phenotypic presentation of IBD at diagnosis in a population-based Danish inception cohort from 2003–2005.MethodsThree-hundred-forty-seven (62%) of 562 cohort patients were genotyped. ASCA and p/c-ANCA were determined and patients answered a questionnaire concerning environmental factors with possible influence on IBD.ResultsFourteen percent of CD patients vs. 11% of controls were positive for common CARD15 mutation (ns), whereas more CD patients than healthy controls were homozygous for the OCTN-TC haplotype (p = 0.03). ASCA was more common in CD (22%) than UC (14%) (p = 0.045) and was related to age and localization of CD. p-ANCA was more frequent in UC (p = 0.00001) but was related to pure colonic CD (p = 0.0001). Sugar consumption was significantly higher in CD patients than in UC patients (p = 0.0001) and more CD patients than UC patients had undergone appendectomy prior to IBD diagnosis (p = 0.03). A possible relation between tonsillectomy and disease severity in CD, and a relation between use of oral contraception and disease localization of UC to rectum/left-sided colon were found.ConclusionsIn this cohort of unselected IBD patients we found a very low frequency of mutations in IBD susceptibility genes and observed a greater impact of ASCA and ANCA than of genetic factors on disease phenotypes. In addition, several environmental factors seemed to influence disease occurrence and disease presentation in both UC and especially CD.     

The circumstances,orientations, and impact locations of falls in community-dwelling older women

ObjectiveWe sought to characterize the circumstances, orientations, and impact locations of falls in community-dwelling, ambulatory, older women.MethodsFor this longitudinal, observational study, 125 community-dwelling women age ≥ 65 years were recruited. Over 12-months of follow-up, fall details were recorded using twice-monthly questionnaires.ResultsMore than half (59%) of participants fell, with 30% of participants falling more than once (fall rate = 1.3 falls per person-year). Slips (22%) and trips (33%) accounted for the majority of falls. Approximately 44% of falls were forward in direction, while backward falls accounted for 41% of falls. About a third of all falls were reported to have lateral (sideways) motion. Subjects reported taking a protective step in response to 82% of forward falls and 37% of backward falls. Of falls reporting lateral motion, a protective step was attempted in 70% of accounts. Common impact locations included the hip/pelvis (47% of falls) and the hand/wrist (27%). Backwards falls were most commonly reported with slips and when changing direction, and increased the risk of hip/pelvis impact (OR = 12.6; 95% CI: 4.7–33.8). Forward falls were most commonly reported with trips and while hurrying, and increased the risk of impact to the hand/wrist (OR = 2.6; 95% CI: 1.2–5.9).ConclusionFalls in older ambulatory women occur more frequently than previously reported, with the fall circumstance and direction dictating impact to common fracture locations. Stepping was a common protective recovery strategy and that may serve as an appropriate focus of interventions to reduce falls in this high risk population.     

Low mannose-binding lectin (MBL) is associated with paediatric inflammatory bowel diseases and ileal involvement in patients with Crohn disease

BackgroundMannose-binding lectin (MBL) is a pattern-recognition molecule of the innate immune system and may be involved in the pathogenesis of inflammatory bowel disease (IBD). Our aim was to assess the prevalence of MBL deficiency in a cohort of patients with paediatric-onset IBD and study whether it is associated with the clinical manifestations, serum antibody formation, or genetic factors.MethodsThis prospective study included 159 paediatric patients (mean age: 14.0 years) with IBD [107 patients with Crohn disease (CD) and 52 patients with ulcerative colitis (UC)]. Furthermore, 95 controls were investigated. Serum samples were determined for MBL by enzyme-linked immunosorbent assay (ELISA) and for serologic markers [autoantibodies against Saccharomyces cerevisiae (ASCA) and perinuclear components of neutrophils (pANCA)] by indirect immunofluorescent assay. NOD2/CARD15 variants were tested by polymerase chain reaction/restriction fragment length polymorphism.ResultsThe MBL serum concentration was significantly lower in IBD patients(both with CD and UC) compared to controls (IBD, p = 0.007, CD, p = 0.04, UC p = 0.004). Prevalence of low MBL level (< 500 ng/mL) was significantly higher in both CD and UC groups compared to controls (p = 0.002 and p = 0.006). Furthermore, low MBL level was associated with isolated ileal involvement (p = 0.01) and MBL deficiency (< 100 ng/mL) with male gender (p = 0.004) in patients with CD. We failed to confirm any correlation between MBL deficiency and serum autoantibodies or NOD2/CARD15 variants.ConclusionsOur results suggest that low MBL associated with paediatric-onset IBD and ileal CD may be considered an additional marker of the IBD pathogenesis.