Meeting the challenge of falls prevention at the population level: a community-based intervention with older people in Australia

Older people form a large and growing segment of our population,experience disproportionately more illness and require moreuse of health services than any other group. This differentialis largely due to falls, which are the leading cause of injuryfor those aged 65 plus. The North Coast ‘Stay On YourFeet’ programme is a 4-year multi-strategic, community-basedintervention to address this problem among 80000 older residents.This paper presents key results of the first 18 months of theprogramme. It demonstrates potential achievements of this typeof intervention and examines some barriers. Programme effectwas measured quasi-experimentally by monitoring indicators ofawareness, knowledge, attitudes and risk factors via a telephonesurvey with random cohorts in intervention and control areas.After allowing for baseline covariates, the intervention wassignificantly associated with: raised awareness both of theproblem of falling and its preventability; improved knowledgeof the risk factors for falling; and a higher self-rated riskof falling. As expected, there is as yet no population changein falls rate. Initial changes shown in risk factors for fallingraise interesting challenges. A reduction in physical activitymay indicate that older people, now more aware of risk, arebeing advised to restrict their activities. An increase in proportionof older people taking medications which may cause unsteadinessalso presents a challenge. However, a concomitant decrease inreported dizziness may indicate that medications are now bettermanaged. This evaluation shows that in 18 months, a well-fundedand managed community-based falls prevention programme can achievechanges in awareness, knowledge and attitudes but that continuedintervention is required to substantially change behaviouralrisk factor profiles and the likelihood of an older person falling.     

Management of Major Coronary Artery Dissection Complicating Percutaneous Transluminal Coronary Angioplasty-Successful Application of Two New Techniques

Percutaneous transluminal coronary angioplasty may be complicated by the occurrence of major coronary artery dissection, which may precipitate critical myocardial ischemia, necessitating urgent surgical intervention. We report two cases of massive dissection following angioplasty, in which novel methods were used to stabilize arterial integrity. In the first, laser balloon angioplasty was used to repair the dissection; in the other, a coronary stent was inserted. In both cases, coronary artery patency was achieved with reperfusion of the distal coronary bed, thus avoiding the need for acute surgical intervention. Both patients are free of limiting symptoms at follow-up.     

Levetiracetam treatment of idiopathic generalised epilepsy

Levetiracetam (LEV) is effective for treating localisation-related epilepsy, but it is uncertain whether it is effective for treating idiopathic generalised epilepsy. We compared 12-week baseline and LEV treatment periods for patients with generalised seizure types-myoclonic, tonic-clonic and absence seizures--who had failed other anticonvulsants. The majority of 55 patients (76%) had >50% seizure reduction with LEV therapy, 40% became seizure-free; 15% discontinued LEV due to adverse events, mostly sedation. This is preliminary evidence that LEV is effective for treating idiopathic generalised epilepsy.     

Use of aromatherapy (with or without hypnosis) in the treatment of intractable epilepsy—a two-year follow-up study

We have been trying the effect of aromatherapy (with or without hypnosis) in patients with intractable epilepsy who ask for it. This is a report of the first 100 patients to try the treatment, followed up for at least two years after the treatment ended.It is important to remember that this was a treatment for people who had asked for it and for whom time and a therapist was available. It was not a controlled trial but was carried out when we could and at a time when we were experimenting with the best way of using it. Results must therefore be treated with caution and with due regard to other therapeutic factors that may be implicated in the results, both good and bad. We assume that the result (with over a third of the patients using aromatherapy with or without hypnosis becoming seizure free for at least a year) as being the best that could be achieved and likely to be less in a properly controlled trial. Of the three treatments tried (aromatherapy on its own, aromatherapy plus hypnosis and hypnosis without aromatherapy), aromatherapy plus hypnosis seems to have had the best and most lasting effect (a third of patients still seizure free at two years), but was the most labour intensive and needed medical therapist input. Aromatherapy itself might be best reserved as a short-term treatment for people going through a bad time with their seizures. A fuller and more lasting effect may be obtained with aromatherapy plus hypnosis, but this needs a patient who is prepared to put much time and personal effort into the treatment.     

Complications of Intestinal Tubes

Complications of intestinal tubes are infrequent and not well appreciated by physicians. The relative rarity of these complications, however, should not give the physician a false sense of security. We report three categories of major complications of intestinal tubes: 1. obstructive phenomena; 2. spillage of mercury and 3. gut perforation. Awareness of the major problems that might arise from intestinal tube use can facilitate appropriate prevention and/or treatment of these complications.     

Action spectra of topical psoralens: a re-evaluation

The action spectra for producing minimal phototoxic erythema with topical 0 1% trimethyl psoralen (TMP) and 8-mcthoxypsoralen (8-MOP) were determined with a double monochromator in the range of 295–380 nm. Both psoralens induced photosensitivity in the range of 313–365 nm; TMP was 54% more effective than 8-MOP. There was no difference in the dose needed to produce minimal UV erythema or phototoxic erythema with 8-MOP and TMP at 295 and 305 nm, but at 313 nm with 8-MOP, photosensitivity was enhanced 3.5 times, and with TMP, sensitivity was enhanced 55 times. The peak sensitivity with 8-MOP was at 330 nm and for TMP it was 335 nm. No photosensitivity occurred above 380 nm. Results suggest that TMP and 8-MOP are significantly photoreactive at 320–335 nm. Commonly used UV-A light sources show peak emission around 360 nm. If there is a relationship between development of erythema and therapeutic effectiveness then this raises the possibility of alternative UV light sources for phototherapy with psoralens.