Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis

Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.     

Systematic review and meta-analysis of fear of falling and fall-related efficacy in a widely disseminated community-based fall prevention program

BackgroundFear of falling restricts mobility and increases fall risk among older adults. Fall-related efficacy (i.e. the confidence to perform activities without falling), a construct related to fear of falling, has also been associated with active living and fall prevention. This study statistically synthesized the program effects of A Matter of Balance Volunteer Lay Leader (AMOB/VLL) model, designed to improve fall-related efficacy and promote daily activities among community-dwelling older adults.MethodsResearch articles and doctoral dissertations that examined the effect of the AMOB/VLL on fear of falling and fall-related efficacy were searched from multiple databases. A random effects model was used to compute mean weighted effect sizes, 95 % CIs, and heterogeneity (I²). Bias was examined through a funnel plot and Egger’s test. Factors associated with heterogeneity were also explored.ResultsSeventeen AMOB/VLL studies involving 3,860 participants were identified. The pooled effects of the 13 studies with sufficient information for effect size calculation, were −0.29 (95 % CI: −0.40, −0.19) for fear of falling and 0.51 (95 % CI: 0.42, 0.60) for fall-related efficacy. Effect sizes differed partially due to outcome measures of fall-related efficacy. Covariate adjustment and study quality were not associated with differences in effect sizes. No substantial evidence of asymmetry and publication bias was found.ConclusionThis study provides evidence supporting AMOB/VLL as an effective intervention for reducing fear of falling and improving fall-related efficacy. A greater consistency in outcome measures is needed to optimally capture changes in fear of falling and fall-related efficacy among community-dwelling older adults.     

重度牙周炎致牙齿松动脱落患者前牙美学区综合治疗1例报告及文献复习

目的：探讨重度牙周炎致前牙松动脱落患者的治疗和美学修复,阐明多学科综合治疗对前牙美学区的治疗效果,为其临床应用提供参考。方法：患者,男性,57岁,因上下前牙松动不适半年余就诊。专科检查见11、21、22、41松动Ⅲ°,42松动Ⅱ°。经多学科会诊后,行牙周基础治疗,炎症控制后,拔除11、21、22、41、42并行即刻种植,富血小板纤维蛋白（PRF）联合引导骨再生（GBR）技术修复种植体周围骨缺损。因患者美学要求,12、13、23、31、32、33、43根管治疗后行牙体预备,13-23、33-43行固定修复。结果：种植术后显示种植体位置良好,种植体周围骨量充足,口内见牙龈软组织愈合良好,牙槽嵴丰满度较好;修复完成后较好地恢复了患牙的咀嚼发音功能,患者对美学效果满意。结论：通过多学科综合治疗的应用,成功实现了对重度牙周炎患者前牙美学区的种植修复,为前牙美学区的诊疗开辟了新途径。     

Translation and validation study of the Chinese version Iconographical Falls Efficacy Scale-Short Version (Icon-FES)

BackgroundThe 30-item Iconographical Falls Efficacy Scale (Icon-FES) is the first instrument developed to assess older people’s concern about falling using pictures. The short version of Icon-FES (10-item Icon-FES) was translated and adapted to a local Chinese version, and its psychometric properties was evaluated in Chinese older people.MethodsA forward-backward translation procedure was used, followed by an expert panel review to finalize the 10-item Chinese Icon-FES. One hundred and sixteen Hong Kong Chinese older people (65–95 years) were assessed using the 10-item Chinese Icon-FES in conjunction with the Chinese version 7-item Falls Efficacy Scale-International (FES-I (Ch)).ResultsFive of the 10 items in the Icon-FES were modified to achieve the conceptual and cultural relevance in local context. The final Chinese Icon-FES had excellent internal consistency (Cronbach’s alpha = 0.91) and test-retest reliability (intra-class correlation coefficient ICC = 0.93). High correlation was found between the Chinese Icon-FES and FES-I (Ch) (r = .75, p < .001). Construct validity was supported by its ability to discriminate between groups related to demographic and fall risk factors.ConclusionsThe Chinese Icon-FES is a valid, efficient and easy-to-use instrument for understanding of local Chinese older people’s concerns about falling in Hong Kong.     

助行设备在美国老年人群中防跌倒作用的现状分析

本文分析各种助行设备(AAD),包括助行器、助行车、手杖等对美国老年使用者姿态、步态的影响及其与跌倒的关系;分析了为什么即使有AAD的帮助,老年人跌倒现象还是频繁出现。提出要在社区医疗服务中对老年人AAD的使用情况进行评估,并向他们宣传和培训正确使用AAD的知识,以便帮助老年人合理地使用AAD,尽可能地避免跌倒的发生。     

上海市某区家庭病床服务现状分析研究

目的：对上海市虹口区2009—2012年4年的家庭病床服务状况进行分析研究,为改善家庭病床服务状况提供依据。方法：对4年来收集的家庭病床工作报表数据进行统计,对撤床患者治疗结果、撤床结算患者费用支出等情况进行分析。结果：2012年与2009年相比,期内家庭病床撤床数增加1540张,增幅35．34％;治愈、好转和稳定率大于90％,医保人均费用减少95．44元。结论：家庭病床服务对完善社区医疗保障体系具有积极作用。