Initial Validation of the Toulouse St. Louis University Mini Falls Assessment in Older Adults

Background/Objectives

Falls are one of the most prevalent health issues facing older adults. This study examines the validity of the Toulouse-St. Louis University Mini Falls Assessment (TSLUMFA). Objectives were to validate the TSLUMFA by testing if it differentiates between prior non fallers (n=80) and fallers (n=23), and predicts future falls as well as or better than the gold standard Tinetti Gait and Balance Instrument (TGBI). Examine if the subset of FRAIL Scale items on the TSLUMFA distinguishes between previous non fallers (n=75) and fallers (n=20), and predicts future falls as well as or better than the TGBI. Identify TSLUMFA cut offs scores for fall risk.

Design

Prospective validation study.

Setting

Participants were ambulatory patients presenting to the SLU Geriatrics Clinic.

Participants

103 ambulatory older adults.

Measurements

Fall risk was assessed using the three assessments. Outcome measures were previous falls and follow up falls.

Results

TSLUMFA, FRAIL, and TGBI differentiated between previous fallers and non fallers. A TSLUMFA score <23 stratified patients as moderate risk (Sensitivity=0.806 Specificity=0.776) and a score <21 stratified patients as high risk (Sensitivity=0.929 Specificity=0.897). 78% of patients (n=80) participated in follow up and 20% (n=16) of these patients fell during follow up. TSLUMFA and TGBI absolute scores were lower among patients who fell during the follow up period versus non fallers but the observed differences were not statistically significant (TSLUMFA P=0.123 and TGBI P=0.074).

Conclusion

This study validated the TSLUMFA and FRAIL. No test predicted falls with statistical significance (most likely due to the low follow up participation) but a positive trend was seen. Clinical recommendations from this study are to use the FRAIL as an initial fall screen and patients scoring > 3 should be analyzed by TSLUMFA. The TSLUMFA’s advantage is that it pinpoints areas that will directly benefit from therapy to reduce falls.

     

Falls Risk Prediction for Older Inpatients in Acute Care Medical Wards: Is There an Interest to Combine an Early Nurse Assessment and the Artificial Neural Network Analysis?

Background

Identification of the risk of falls is important among older inpatients. This study aims to examine performance criteria (i.e.; sensitivity, specificity, positive predictive value, negative predictive value and accuracy) for fall prediction resulting from a nurse assessment and an artificial neural networks (ANNs) analysis in older inpatients hospitalized in acute care medical wards.

Methods

A total of 848 older inpatients (mean age, 83.0±7.2 years; 41.8% female) admitted to acute care medical wards in Angers University hospital (France) were included in this study using an observational prospective cohort design. Within 24 hours after admission of older inpatients, nurses performed a bedside clinical assessment. Participants were separated into non-fallers and fallers (i.e.; ≥1 fall during hospitalization stay). The analysis was conducted using three feed forward ANNs (multilayer perceptron [MLP], averaged neural network, and neuroevolution of augmenting topologies [NEAT]).

Results

Seventy-three (8.6%) participants fell at least once during their hospital stay. ANNs showed a high specificity, regardless of which ANN was used, and the highest value reported was with MLP (99.8%). In contrast, sensitivity was lower, with values ranging between 98.4 to 14.8%. MLP had the highest accuracy (99.7).

Conclusions

Performance criteria for fall prediction resulting from a bedside nursing assessment and an ANNs analysis was associated with a high specificity but a low sensitivity, suggesting that this combined approach should be used more as a diagnostic test than a screening test when considering older inpatients in acute care medical ward.

     

The effectiveness of respiratory protection worn by communities to protect from volcanic ash inhalation. Part II: Total inward leakage tests

Inhalation of ash can be of great concern for affected communities, during and after volcanic eruptions. Governmental and humanitarian agencies recommend and distribute a variety of respiratory protection (RP), most commonly surgical masks. However, there is currently no evidence on how effective such masks are in protecting wearers from volcanic ash. In Part I of this study (Mueller et al., 2018), we assessed the filtration efficiency (FE) of 17 materials from different forms of RP against volcanic ash and a surrogate, low-toxicity dust, Aloxite. Based on those results, we now present the findings from a volunteer simulation study to test the effect of facial fit through assessment of Total Inward Leakage (TIL).Four different disposable RP types that demonstrated very high median FE (≥96% for Aloxite; ≥89% for volcanic ash) were tested without provision of training on fit. These were an industry-certified mask (N95-equiv.); a surgical mask from Japan designed to filter PM_2.5; a flat-fold basic mask from Indonesia; and a standard surgical mask from Mexico, which was also tested with an added medical bandage on top, as an additional intervention to improve fit.Ten volunteers (6 female, 4 male) were recruited. Each RP type was worn by volunteers under two different conditions simulating cleaning-up activities during/after volcanic ashfall. Each activity lasted 10?min and two repeats were completed for each RP type per activity. Dust (as PM_2.5) concentration inside and outside the mask was measured with two TSI SidePak aerosol monitors (Models AM510 and AM520, TSI, Minnesota, USA) to calculate TIL. A questionnaire was administered after each test to collect perceptions of fit, comfort, protection and breathability.The best-performing RP type, across both activities, was the industry-certified N95-equiv. mask with 9% mean TIL. The standard surgical mask and the basic flat-fold mask both performed worst (35% TIL). With the additional bandage intervention, the surgical mask mean TIL improved to 24%. The PM_2.5 surgical mask performed similarly, with 22% TIL. The N95-equiv. mask was perceived to provide the best protection, but was also perceived as being uncomfortable and more difficult to breathe through.This study provides a first objective evidence base for the effectiveness of a selection of RP types typically worn around the world during volcanic crises. The findings will help agencies to make informed decisions on the procurement and distribution of RP in future eruptions.     

Urinary metal concentrations among mothers and children in a Mexico City birth cohort study

Personal care product use is a potential source of metals exposure among children, but studies have been limited. We measured urinary concentrations of 10 metals (aluminum, arsenic [As], barium [Ba], cadmium, cobalt [Co], lead [Pb], manganese [Mn], molybdenum [Mo], nickel, and zinc [Zn]) in third trimester pregnant women (n?=?212) and their children at 8–14 years of age (n?=?250). Demographic factors (child sex, age, socioeconomic status, and maternal education), body mass index (BMI) z-score, and child personal care product use in the 24?h prior to urine collection were examined as predictors of urinary metal concentrations. Metals were detected in 80–100% of urine samples, with significant differences in maternal versus childhood levels. However, metal concentrations were not strongly correlated within or between time points. In linear regression models including all demographic characteristics, BMI z-score, and specific gravity, age was associated with higher Co (6% [95% CI: 2, 10]), while BMI z-score was associated with lower Mo (-6% [95% CI: -11, -1). In addition, significantly higher metal concentrations were observed among users of colored cosmetics (Mo: 42% [95% CI: 1, 99]), deodorant (Ba: 28% [3, 58]), hair spray/hair gel (Mn: 22% [3, 45]), and other toiletries (As: 50% [9, 108]), as well as with an increasing number of personal care products used (As: 7% [3, 11]) after adjustment for child sex, age, total number of products used, and specific gravity. However, significantly lower metal concentrations were noted for users of hair cream (As and Zn: -20% [-36, -2] and -21% [-35, -2], respectively), shampoo (Pb: -40% [-62, -7]), and other hair products (Pb: -44% [-65, -9]). We found that personal care product use may be a predictor of exposure to multiple metals among children. Further research is recommended to inform product-specific exposure source identification and related child health risk assessment efforts.     

Economic evaluation of telephone-based weight loss support for patients with knee osteoarthritis: a randomised controlled trial

Background

The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese.

Methods

An economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6?weeks and 26?weeks. The primary cost-effectiveness analysis was performed from the societal perspective.

Results

Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values.

Conclusions

From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis.

Trial registration number

ACTRN12615000490572, registered 18th May 2015

     

Sociodemographic and Lifestyle Factors,and Health Conditions of Dominican Adults Living in Puerto Rico

Dominicans are the largest migrant community in Puerto Rico, yet understudied. We compared risk factors and health conditions of Dominicans versus Puerto Ricans (PRs). Cross-sectional survey of Dominicans (n?=?55) and PRs (n?=?310) aged 30–75 years, assessed with validated questionnaires and standardized anthropometric measurements. Significantly, more Dominicans than PRs had attained <8th grade education (37.7 vs. 8.0%), reported household income ≤$10,000 (76.1 vs. 56.9%), lacked health insurance (19.6 vs. 5.5%), and reported food insecurity (24.5 vs. 12.1%). They spent fewer hours/day watching television (2.9 vs. 3.8), and were less likely to smoke (7.6 vs. 19.6%). Medically-diagnosed depression was lower among Dominicans than PRs (9.6 vs. 23.0%); questionnaire-based high depressive symptomatology was similar (47.9 vs. 52.8%). Dominicans living in Puerto Rico had more socioeconomic risk factors but healthier lifestyle behaviors and lower prevalence of medically-diagnosed depression than PRs. Tailored approaches are needed to ameliorate disparities in each ethnic group.