What are older people prepared to do to avoid falling? A qualitative study in London

Falls prevention strategies form a significant part of recent government policy relating to older people. In this article we report a qualitative study to examine the extent to which older people are willing to adopt any of the following strategies in order to avoid falling; balance and lower limb strengthening exercises, home safety advice, and 'taking care'. A sample of community-dwelling inpatients who were more or less afraid of falling were interviewed. Some older people blamed their own unsafe behaviour rather than hazards in their home for falls, so taking care (moving slowly, holding on, being vigilant to and avoiding danger) was a widespread strategy. The benefits of exercise in falls prevention were poorly understood and there was little enthusiasm for exercising especially if it was perceived to be inappropriate in old age or painful. Awareness of home hazards and taking measures against them was common but home visits tended to be regarded as intrusive. Inadequate negotiation about adaptations was widespread and led to resentment and unwillingness to cooperate. Building on the widespread 'taking care' strategy may help educated older people in safe behaviour. Health professionals should encourage older people to exercise and when making home safety visits should confer with their clients, taking their preferences about adaptations into account.     

Association between sea recreational water and gastroenteritis

Gastrointestinal infections represent one of the main cause of morbidity both in developing and industrialized areas. Quality of coastal waters is particularly important for countries as Italy that has several regions on coasts. Public health and economy aspects could be hardly affected by poor quality of sea waters. Several studies have been addressed to the association between sea recreational water and development of gastrointestinal infection but in Italy only sporadic cases of infection have been reported especially in immunocompromised hosts. Results of this study, either in the case control or in the active surveillance study seem to confirm the absence of an association between sea exposure and intestinal infections. One of the main risk factors for the development of these infections is still represented by the seafood consumption especially shellfish.     

Dialysis access induced limb ischemia corrected using quantitative duplex ultrasound

Dialysis access induced limb ischemia (DAILI) is a rare complication after the creation of an arteriovenous fistula in infancy but can cause irreversible ischemic limb damage in severe cases. The incidence of DAILI is higher in bridge graft fistulas than in native fistulas. DAILI patients may be managed by surgically reducing the volume flow in the fistula. However, in the pediatric age group, such a reduction of volume flow may result in thrombosis or an inadequate flow for effective dialysis. Several methods have been described to achieve the delicate balance between essential flow in the fistula and adequate limb perfusion pressure. We have developed a new method employing preoperative duplex ultrasonography to predict quantitatively the reduction in volume flow in the fistula that will allow effective dialysis while providing adequate limb perfusion. The preoperative assessment was reproduced on the operating table using intraoperative duplex. A 3-year-old girl thus treated has had resolution of her ischemic symptoms and maintains long-term patency of her dialysis access.     

Epidemiology of personality disorders

Epidemiology is concerned with the occurrence of disease in populations. Epidemiologic studies measure the prevalence and distribution of disorders, investigate questions of case definition, determine risk factors, and evaluate the natural history and consequences of disorders. This paper reviews and discusses empiric advances made over the past 2 years in the epidemiologic study of personality disorders.     

Reliability and validity of a modified self‐administered version of the Active Australia physical activity survey in a sample of mid‐age women

Objective: To assess the test‐retest reliability and validity of a modified self‐administered version of the Active Australia physical activity survey. Methods: One hundred and fifty‐nine mid‐age women (54–59 years) completed a mailed physical activity questionnaire before recording daily pedometer step counts for seven consecutive days. A random subsample (n=44) also wore an accelerometer during this period. Participants then completed the physical activity questionnaire again. Spearman's ρ and per cent agreement were used to assess test‐retest reliability. Self‐reported physical activity data (time 2) were compared with pedometer and accelerometer data using box plots and Spearman's correlations to assess validity. Results: Median time between surveys was 13 days. Median frequency and duration of moderate and vigorous physical activity were the same at both surveys, but median walking frequency was slightly higher at time 2 than time 1. Reliability coefficients for frequency/time in each domain of physical activity ranged from 0.56–0.64 and per cent agreement scores ranged from 40% to 65% for the physical activity categories; agreement was 76% for ‘meeting guidelines’. Correlations (p) between self‐reported physical activity and 1) weekly pedometer steps and 2) accelerometer data for duration of at least moderate intensity physical activity were 0.43 and 0.52 respectively. Conclusions: The measurement properties of this modified self‐administered physical activity survey are similar to those reported for the original computer assisted telephone interview survey. Implications: This modified version of the Active Australia survey is suitable for use in self‐administered format.     

Docetaxel neuropathy: a distal axonopathy

Docetaxel has been implicated as a causative agent in peripheral neuropathy, but pathological changes in peripheral nerve have not been described. During docetaxel treatment a 54-year-old man developed a sensorimotor polyneuropathy when the overall docetaxel dosage was 540 mg/m². Neurophysiological investigation revealed a sensorimotor axonal neuropathy. Fascicular sural nerve biopsy showed an axonal neuropathy with a preferentially loss of large myelinated fibers. There was evidence of considerable fiber regeneration. Sensory and motor symptoms progressively improved after docetaxel withdrawal. Received: 21 January 1999 / Revised, accepted: 25 March 1999     

Myocardial metabolic imaging by means of fluorine-18 deoxyglucose/technetium-99m sestamibi dual-isotope single-photon emission tomography

The detection of preserved glucose uptake in hypoperfused dysfunctional myocardium by fluorine-18 deoxyglucose (FDG) positron emission tomography (PET) represents the method of choice in myocardial viability diagnostics. As the technique is not available for the majority of patients due to cost and the limited capacity of the PET centres, it was the aim of the present work to develop and test FDG single-photon emission tomography (SPET) with the means of conventional nuclear medicine. The perfusion marker sestamibi (MIBI) was used together with the metabolic tracer FDG in dual-isotope acquisition. A conventional SPET camera was equipped with a 511-keV collimator and designed to operate with simultaneous four-channel acquisition. In this way, the scatter of 18F into the technetium-99m energy window could be taken into account by a novel method of scatter correction. Thirty patients with regional wall motion abnormalities at rest were investigated. The results of visual wall motion analysis by contrast cine-ventriculography in nine segments/heart were compared with the results of quantitative scintigraphy. The scintigraphic patterns of MIBI and FDG tracer accumulation were defined as normal, matched defects and perfusion-metabolism mismatches. Spatial resolution of the system was satisfactory, with a full width at half maximum (FWHM) of 15.2 mm for ¹⁸F and 14.0 mm for ^99mTe, as measured by planar imaging in air at 5 cm distance from the collimator. Image quality allowed interpretation in all 30 patients. 88% of segments without relevant wall motion abnormalities presented normal scintigraphic results. Seventy-five akinetic segments showed mismatches in 27%, matched defects in 44% and normal perfusion in 29%. We conclude that FDG-MIBI dual-isotope SPET is technically feasible with the means of conventional nuclear medicine. Thus, the method is potentially available for widespread application in patient care and may represent an alternative to the ²⁰¹T1 reinjection technique.