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.

     

The risk of neurodevelopmental disorders following Thimerosal-containing Hib vaccine in comparison to Thimerosal-free Hib vaccine administered from 1995 to 1999 in the United States

Investigators postulated that early-life exposure to organic mercury (Hg) significantly increases the risk of childhood neurodevelopmental disorders (NDs). The Vaccine Adverse Event Reporting System database was utilized to conduct a hypothesis testing case-control study by evaluating 3486 total adverse event reports reported following Haemophilus influenza type b (Hib) vaccination. Exposed subjects received a Thimerosal-containing formulation (HIBTITER?, Wyeth-Lederle), while unexposed subjects received a Thimerosal-free formulation (PEDVAXHIB?, Merck). Subjects were included if they received either of these two Hib vaccine formulations between 1995 and 1999. Cases were defined as adverse event reports with a reported outcome of autism, developmental delay, psychomotor delay, or NDs in general. Cases with reported outcomes of febrile convulsions, pyrexia, or injection site pain, all of which have no biologically plausible relation to Hg exposure, were also examined. Controls were defined as adverse event reports without any mention of the specific case outcome examined. Cases of reported autism (odds ratio (OR)?=?2.75, p?<?0.02), developmental delay (OR?=?5.39, p?<?0.01), psychomotor disorder (OR?=?2.38, p?<?0.03), and neurodevelopmental disorder in general (OR?=?2.70, p?<?0.001) were each significantly more likely than their respective controls to receive Thimerosal-containing Hib vaccine than Thimerosal-free Hib vaccine. Significant effects for neurodevelopmental disorder in general were observed for males (OR?=?2.52, p?<?0.005), but not females when separated by gender. For the outcomes that had no biologically plausible relation to Hg exposure, the cases were no more likely than their respective controls to receive Thimerosal-containing Hib vaccine than Thimerosal-free Hib vaccine. This study provides suggestive evidence of an association between Thimerosal and neurodevelopmental outcomes and provides support for carrying out additional well-designed studies examining the association between Thimerosal-containing vaccines and a wide range of neurodevelopmental outcomes.     

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

     

A Representative Study of Deaths of North Indian Migrants and Its Medical Certification Across the World

Many Indians is moving to other nations of the world in the search of employment, education or other reasons. The process of globalization along with the faster mode of traveling and communication has facilitated this movement in the hope of getting more opportunities and earning of easy money abroad, than in India. Unfortunately, sometimes they meet a tragic end and their families in India get only their dead bodies back from abroad. This study focuses on these kind of unfortunate tragic events faced by Indians in different countries and thereby raise a concern on their safety abroad and necessitate the need of relooking in to the quality of medical certification of death and medico legal investigations to find out the real reasons of deaths to avoid any kind of doubt in mind. Data was collected from medical death certificates and passports of the deceased Indians. There was a total of 711 dead bodies/human remains received in 2012 at IGI airport New Delhi. The Middle East countries together contributed a total of 398 (55.98?%) cases. The distribution as per manner of death shows that in maximum number of cases (269), the manner of death was ambiguous with unspecified aetiology. The study therefore recommends for upgradation of the level of medico legal investigations in form of 2nd autopsy in recipient country and proper medical death certification.