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Biomedical subjects

N Peel

Publications and source records attributed to N Peel.

14 recordsLinked to original sources
PubMed2005

Population-based interventions for the prevention of fall-related injuries in older people.

BACKGROUND: Fall-related injuries are a significant cause of morbidity and mortality in the older population. Summary information about counter-measures that successfully address the risk factors for fall-related injuries in research settings has been widely disseminated. However, less available is evidence-based information about successful roll-out of these counter-measures in public health programmes in the wider community. Population-based interventions in the form of multi-strategy, multi-focused programmes are hypothesised to result in a reduction in population-wide injury rates. This review tests this hypothesis with regards to fall-related injuries among older people. OBJECTIVES: To assess the effectiveness of population-based interventions, defined as coordinated, community-wide, multi-strategy initiatives, for reducing fall-related injuries among older people. SEARCH STRATEGY: The search strategy was based on electronic searches, handsearches of selected journals and snowballing from reference lists of selected publications. SELECTION CRITERIA: Studies were independently screened for inclusion by two reviewers. Included studies were those that reported changes in medically treated fall-related injuries among older people following the implementation of a controlled population-based intervention. DATA COLLECTION AND ANALYSIS: Data were independently extracted by two reviewers. Meta-analysis was not appropriate, due to the heterogeneity of the included studies. MAIN RESULTS: Out of 23 identified studies, five met the criteria for inclusion. There were no randomised controlled trials. Significant decreases or downward trends in fall-related injuries were reported in all five of the included studies with the relative reduction in fall-related injuries ranging from 6 to 33%. AUTHORS' CONCLUSIONS: Despite methodological limitations of the evaluation studies reviewed, the consistency of reported reductions in fall-related injuries across all programmes support the preliminary claim that the population-based approach to the prevention of fall-related injury is effective and can form the basis of public health practice. Randomised, multiple community trials of population-based interventions are indicated to increase the level of evidence in support of the population-based approach. Research is also required to elucidate the barriers and facilitators in population-based interventions that influence the extent to which population programmes are effective.

Accident Prevention↗
PubMed2002

Appropriate indicators for injury control?

Indicators are valuable tools used to measure progress towards a desired health outcome. Increased awareness of the public health burden due to injury has lead to a concomitant interest in monitoring the impact of national initiatives that aim to reduce the size of the burden. Several injury indicators have now been proposed. This study examines the ability of each of the suggested indicators to reflect the nature and extent of the burden of non-fatal injury. A criterion validity, population-based, prospective cohort study was conducted in Brisbane, a sub-tropical Metropolitan City on the eastern seaboard of Australia, over a 12-month period between 1 January and 31 December 1998. Neither the presence of a long bone fracture nor the need for hospitalisation for 4 or more days were sensitive or specific indicators for 'serious' or major injury as defined by the 'Gold Standard' Injury Severity Score (ISS). Subsequent analysis, using other public health outcome measures demonstrated that the major component of the illness burden of injury was in fact due to 'minor' not serious injury. However, the suggested indicators demonstrated low sensitivity and specificity for these outcomes as well. The results of the study support the need to include at least all hospitalisations in any population-based measure of injury and not attempt to simplify the indicator to a more convenient measure aimed at identifying just those cases of 'serious' injury.

Adolescent↗
PubMed2001

Glucocorticoid-induced osteoporosis.

Glucocorticoids remain a key component in the management of many inflammatory disorders but the adverse consequences, especially on bone, can be devastating. The incidence of glucocorticoid-induced osteoporosis (GIO) may be as high as 50% after 6 months' treatment with steroids. This manifests itself as a 30 to 400% increase in the incidence of low trauma fractures. The incidence rates can be even greater in specific clinical settings such as following organ transplantation. The pathogenesis of glucocorticoid-induced osteoporosis remains complex and perplexing.The concomitant prescription of bone-active drugs for the prevention and treatment of GIO in the United Kingdom population remains low, despite the availability of effective therapies. In addition, there remain many unanswered questions about the pathogenesis of GIO and clinical management. These include identification of the optimum bone mineral density threshold at which to intervene with bone-active drugs, the dose or duration of exposure to steroid therapy that warrants intervention, and the demonstration of the efficacy of fracture prevention for different bone-active drugs or for a combination of these drugs.

Glucocorticoids↗
PubMed2000

Validating recall of falls by older people.

Falls among older people are a priority issue for accident analysis because they are relatively common, carry a significant burden of morbidity and mortality, affect lifestyle choices, are a high cost to the community, and are potentially preventable.

Accidental Falls↗
PubMed2000

Home safety assessment in the prevention of falls among older people.

OBJECTIVE: Home safety assessment was examined as part of a randomised trial of falls prevention interventions among older community dwellers. METHOD: Falls prevention strategies, including education and awareness-raising, exercise, home modifications and medical assessment, were trialed with 252 members of the National Seniors Association. Falls outcomes were monitored using a daily calendar diary during intervention and follow-up periods. RESULTS: The home assessment group was significantly more likely to modify their home environment than the controls (p < 0.0001). Participants, regardless of group allocation, reported a significant reduction in concern about falling (p < 0.0001). During the intervention, the home assessment group had lower incidence rates for falls and injuries than the control group, although differences were not significant. The lowered rates were sustained post-intervention. CONCLUSIONS: While the effect on falls incidence of a home safety intervention on its own could not be demonstrated, other benefits, including improved confidence attributable to awareness of such falls prevention measures, were recorded. IMPLICATIONS: The null effects of home modifications on falls prevention in this study may indicate that the program is more appropriate for the frail aged.

Accidental Falls↗
PubMed2000

A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial.

STUDY OBJECTIVE: In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN: Four groups with approximately equal numbers of participants were randomly allocated to interventions. The prevention strategies included education and awareness raising of falls risk factors, exercise sessions to improve strength and balance, home safety advice to modify environmental hazards, and medical assessment to optimise health. The interventions combined the strategies in an add on approach. The first intervention group receiving the information session only was regarded as the control. The outcome of interest was the occurrence of a slip, trip or fall, monitored prospectively using a daily calendar diary. PARTICIPANTS AND SETTING: Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate. National Seniors clubs provide a forum for active, community dwelling Australians aged 50 and over to participate in policy, personal development and recreation. MAIN RESULTS: Using Cox's proportional hazards regression model, adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 (95% CI 0.17, 0.73) to 0.48 (0.25, 0.91) for slips; 0.29 (0.16, 0.51) to 0.45 (0.27, 0.74) for trips; and 0.60 (0.36, 1.01) to 0.82 (0.51, 1.31) for falls. While calendar monitoring recorded outcome, it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical nonintervened group. At one year after intervention, reductions in the probability of slips, trips and falls (61 (95% CI 54, 66)%; 56 (49, 63)%; 29 (22, 36)% respectively) were demonstrated. CONCLUSIONS: This study makes an important contribution to the priority community health issue of falls prevention by showing that effective, sustainable, low cost programmes can be introduced through community-based organisations to reduce the incidence of slips, trips and falls in well older people.

Accidental Falls↗
PubMed1993

Measurement of bone mass and turnover.

Bone mass is the most important determinant of fracture risk. Current bone mass of an individual will be determined by the peak bone mass achieved in early adult life and the subsequent duration and rate of bone loss. In attempting to predict an individual's future risk of fracture it is therefore logical to attempt to assess both of these parameters. Serial measurements of bone mineral density and estimation of the rate of bone turnover may also be used to determine the response to treatment. In this chapter we review the currently available methods of measuring BMD and bone turnover, and discuss their place in the diagnosis and management of osteoporosis.

Algorithms↗
PubMed1992

Markers of bone and collagen breakdown in early inflammatory arthritis.

Inflammatory arthritis has the potential to cause irreversible erosive damage to cartilage and bone. This may occur very early in the course of the disease. At present it is not possible at diagnosis to identify those patients who will develop erosive damage. If this were possible, it would enable aggressive therapy to be targeted to those patients at greatest risk. There is therefore a need for sensitive markers to detect and quantify joint damage at as early a stage as possible. In this chapter we review potential biochemical markers of such damage and assess their clinical usefulness.

Arthritis↗
PubMed1990

Localized neuropathy following jellyfish sting.

This report describes the case of an 18 year old female who sustained a jellyfish sting on her right wrist. She subsequently developed complete radial, ulnar and median nerve palsies distal to the site of the sting, which recovered fully over the next 10 months. We believe this to be due to a direct neurotoxic effect of the jellyfish venom.

Adolescent↗
PubMedDate not supplied

Osteoporosis.

Explore the source record for details and available documents.

Humans↗