Background/Objectives The role of chronic pain in the occurrence of falls and as a target for falls prevention has received limited attention. We sought to determine the prevalence of clinically relevant falls-related outcomes according to pain status in the older population of the United States. Design Cross-sectional analysis of the 2011 National Health and Aging Trends Study, a sample of Medicare enrollees aged ≥65 years (response rate= 71.0%). Setting In-person assessments were conducted in the home or residential care facility of the sampled study participant. Participants 7,601 participants representing 35.3 million Medicare beneficiaries. Measurements Participants were asked whether they had been “bothered by pain” and the location of pain as well as questions about balance/coordination, fear of falls, and falls. Results Bothersome pain was reported by 52.9% of the population. Comparing participants with pain to those without pain, the prevalence of recurrent falls (≥2 falls) in the past year was 19.5% and 7.4%, respectively [age- and sex-adjusted prevalence ratio (PR)=2.63; 95% confidence interval (CI):2.28-3.05]. For fear of falls that limits activity, prevalence was 18.0% and 4.4% in those with and without pain, respectively (adjusted PR=3.98; 95% CI:3.24-4.87). Prevalence of balance and falls outcomes increased with number of pain sites. For example, prevalence of problems with balance/coordination that limited activity among participants with 0, 1, 2, 3, and ≥4 sites of pain was 6.6%, 11.6%, 17.7%, 25.0%, and 41.4%, respectively (P<0.001 for trend). Associations were robust to adjustment for several potential confounders, including cognitive and physical performance. Conclusion Falls-related outcomes were substantially more common among older adults with pain than in those without pain. Accordingly, pain management strategies should be developed and evaluated for falls prevention.
Background Outbreaks of vector-borne diseases such as dengue, and malaria can overwhelm health systems in resource-poor countries. Environmental management strategies that reduce/eliminate vector breeding sites combined with improved personal prevention strategies can help to significantly reduce transmission of these infections. Objective This study was conducted to assess the knowledge, attitudes and practices (KAPs) of residents in Western Jamaica regarding control of mosquito vectors and protection from mosquito bites. Methods A cross-sectional study was conducted between May and August 2010 among patients or family members of patients waiting to be seen at hospitals in Western Jamaica. Participants completed an interviewer-administered questionnaire on sociodemographic factors and KAPs regarding vector-borne diseases. KAP scores were calculated and categorized as high or low based on number of correct/positive responses. Logistic regression analyses were conducted to identify predictors of KAP and linear regression analysis conducted to determine if knowledge and attitude scores predicted practice scores. Results Three-hundred and sixty-one people (85 males and 276 females) participated in the study. Most participants (87%) scored low on knowledge and practice items (78%). Conversely, 78% scored high on attitudes items. By multivariate logistic regression, housewives were 82% less likely to have high attitude scores than laborers, and homeowners were 65% less likely to have high attitude scores than renters. Participants from households with 1–2 children were 3.4 times more likely to have high attitude scores compared to those from households with no children. Participants from households ≥5 people were 65% less likely to have high practice scores compared to those from households with <5. By multivariable linear regression knowledge and attitude scores were significant predictors of practice score. Conclusion The study revealed poor knowledge of vector-borne diseases and poor prevention practices among participants. It identified specific groups that can be targeted with vector-control and personal protection interventions to decrease transmission of the infections.
BackgroundEfforts to control agricultural injuries have been underway for years. Yet, very little is known about their trends over time. We examined trends in non-fatal agricultural injuries through analyzing injuries reported in a state trauma registry.MethodsUsing Iowa Trauma Registry data collected by the Iowa Department of Public Health, we examined trends in non-fatal agricultural injuries reported by acute care hospitals accredited as Level I, II, and III Trauma Care Facilities from 2005 to 2013. Rate ratios and corresponding 95 % confidence intervals were used to examine the burden of non-fatal agricultural injuries across this period. Negative binomial regression was used to calculate the average annual change in agricultural injury rates over time. Joinpoint regression analysis was used to examine the average annual change in the number of injuries over time.ResultsBetween 2005 and 2013, a total of 1238 agricultural injuries were reported to the trauma registry by Level I, II and III trauma facilities. From 2005 to 2013, the rate of agricultural injuries per 100,000 hired workers, ranchers, and farm operators increased by 11 % for every unit increase in year and had nearly tripled over this time period. From 2005 to 2008 there was a significant annual increase of 31.74 % in the number of agricultural injuries whereas from 2008 to 2013 there was a non-significant annual increase of 3.70 %. The number of moderate and severe/critical injuries increased steadily and significantly over the study period, with annual percent increases of 13 and 20 %, respectively.ConclusionNon-fatal agricultural injuries are rising, although the documented increases could be influenced in some part by treatment patterns in the trauma system, reporting bias or increases in farm work exposure. However, these issues do not likely account for all of the increase found, and this calls for an increase in priority of agricultural safety programs. Since the majority of research involves fatal injuries, information about non-fatal injuries may help inform new intervention approaches.
Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.
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