BackgroundFalls pose major health problems to the middle-aged and older adults and may potentially lead to various levels of injuries. Sleep duration and disturbances have been shown to be associated with falls in literature; however, studies of the joint and distinct effects of those sleep problems are still sparse. To fill this gap, we aimed to determine the association between sleep duration, sleep disturbances and falls among middle-aged and older adults in China controlling for psychosocial, lifestyle, socio-demographical factors and comorbidity.MethodsData were derived from the China Health and Retirement Longitudinal Study (CHARLS) based on multi-stage sampling designs, with respondents aged 50 and older. Associations were evaluated by using multiple logistic regression adjusting for confounders and complex survey design. To further determine if the association of sleep duration/disturbance and falls depends on age groups, the study data were divided into two samples (age 50–64 vs. age 65+) and comparison was made between the two age groups.ResultsOf the 12,759 respondents, 2172 (17%) had falls within the last 2 years. Our findings indicated that the participants who had nighttime sleep duration ≤5 were more likely to report falls than those who had nighttime sleep duration ≥6 h; whereas no association between nighttime sleep duration > 8 h and falls. Participants having sleep disturbances 1–2 days, or 3–4 days, and 5–7 days per week were also more likely to report falls than those who had no sleep disturbance. The nap sleep duration was not significantly associated with falls. Although the combined sample found both sleep duration and sleep disturbance to be strongly associated with falls after adjusting for various confounders, sleep disturbance was not significantly related to falls among participants aged 65 + .ConclusionsOur study suggested that there is an independent association between falls and short sleep duration and disturbed sleep among middle-aged and older adults in China. Findings underscore the need for evidence-based prevention and interventions targeting sleep duration and disturbance among this study population.

Background There is conflicting evidence whether limb amputation (LA) disproportionately affects indigenous populations. To better understand this disparity, we compared the LA incidence rate between First Nations persons registered under the Indian Act of Canada (RI) and the general population (GP) in Saskatchewan. Methods We used Saskatchewan’s retrospective administrative data containing hospital discharge LA cases, demographic characteristics (age and sex), and residents population reported in the database stratified by RI and GP from 2006–2019. The LA cases for each stratified group were first disaggregated into three broad categories: overall LA (all reported LA), primary LA (first reported LA), and subsequent LA (revision or contralateral LA), with each category further split into the level of amputation defined as major amputation (through/above the ankle/wrist joint) and minor amputation (below the ankle/wrist joint). LA rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial regressions were performed to explore the trends further. Results Overall, there were 1347 RI and 4520 GP LA cases reported in Saskatchewan from 2006–2019. Primary LA made up approximately 64.5% (869) of RI and 74.5% (3369) of GP cases, while subsequent LA constituted 35.5% (478) of RI and 25.5% (1151) of GP cases. The average age-adjusted LA rate was 153.9 ± 17.3 per 100,000 in the RI cohort and 31.1 ± 2.3 per 100,000 in the GP cohort. Overall and primary LA rates for the GP Group declined 0.7% and 1.0%, while subsequent LA increased 0.1%. An increased LA rate for all categories (overall 4.9%, primary 5.1%, and subsequent 4.6%) was identified in the RI group. Overall, minor and major LA increased by 6.2% and 3.3%, respectively, in the RI group compared to a 0.8% rise in minor LA and a 6.3% decline in major LA in the GP group. RI females and males were 1.98–1.66 times higher risk of LA than their GP counterparts likewise, RI aged 0–49 years and 50+ years were 2.04–5.33 times higher risk of LA than their GP cohort. Diabetes mellitus (DM) was the most prevalent amputation predisposing factor in both groups with 81.5% of RI and 54.1% of GP diagnosed with DM. Also, the highest proportion of LA was found in the lowest income quintile for both groups (68.7% for RI and 45.3% for GP). Conclusion Saskatchewan’s indigenous individuals, specifically First Nations persons registered under the Indian Act of Canada, experience LA at a higher rate than the general population. This disparity exists for all variables examined, including overall, primary, and subsequent LA rates, level of amputation, sex, and age. Amplification of the disparities will continue if the rates of change maintain their current trajectories. These results underscore the need for a better understanding of underlying causes to develop a targeted intervention in these groups.

Nevirapine (NVP) single dose is widely used in developing countries to prevent HIV-1 mother-to-child transmission. However, this regimen selects key drug resistance mutations that can impair further HAART efficacy. We studied the HIV-1 reverse transcriptase genotype from 29 Ivoirian women 1 month after an NVP single-dose prophylaxis. NVP resistance mutations were observed in six (20.7%) women. The majority of the isolates were CRF02_AG. These results confirm previous studies and suggest the need for different prophylaxis regimens in this setting.

Background The effect of predisposing factors on post-operative acute care length of stay (POALOS) after lower extremity amputation (LEA) has been sparsely studied with reports largely focused on major (through/proximal to the ankle) LEA specifically due to diabetes mellitus (DM). Although valuable, the narrow focus disregards the impact of other causes and minor levels (distal to the ankle) of LEA. To address this gap, this study aimed to identify predisposing factors associated with prolonged POALOS after index LEA stratified by amputation level in Saskatchewan. Methods The study used Saskatchewan’s provincial linked administrative health data and demographic factors between 2006 and 2019. Amputation levels, identified as major or minor, were derived from the amputation procedure codes. POALOS was calculated by subtracting patients’ intervention date from discharge date, recorded in days, and categorized as short (< 7 days) or prolonged (> 7 days). Multivariable logistic regression was performed to identify predictors associated with prolonged POALOS. Results Of the 3123 LEA cases 1421 (45.5%) had prolonged POALOS. The median POALOS for the entire cohort was 7 days (IQR 3 to 16 days); 5 days (IQR 1 to 10 days) for minor LEA and 11 days (IQR 5 to 23 days) for major LEA. Predictors of prolonged POALOS after minor LEA were diabetes (AOR = 2.47, 95% CI: 1.87–3.27) and general surgeon (AOR = 1.52, 95% CI: 1.21–1.91). Minor LEA performed by orthopedic surgeons were half (AOR = 0.49, 95% CI: 0.35–0.70) as likely to experience prolonged POALOS. Predictors of prolonged POALOS after major LEA were diabetes (AOR = 1.34, 95% CI: 1.04–1.71), general surgeon (AOR = 1.91, 95% CI: 1.45–2.49), urban residence (AOR = 1.58, 95% CI: 1.25–1.99), Resident Indian (RI) status (AOR = 1.57, 95% CI: 1.15–2.15), and age with the likelihood of prolonged POALOS after LEA attenuating with increasing age: 35–54 years (AOR = 2.73, 95% CI: 1.56–4.76); 55–69 years (AOR = 2.65, 95% CI: 1.54–4.58); and 70+ years (AOR = 1.81, 95% CI: 1.05–3.11). Conclusion This study identified only diabetes and surgical specialty predicted prolonged POALOS after both major and minor LEA in Saskatchewan while residence, RI status, and age were predictors of POALOS after major LEA. These findings shed light on the need for further research to identify confounding factors. It is not clear if general surgeons care for more unplanned, emergent cases with poor entry-level health while specialty surgeons perform more scheduled procedures.

A firm conclusion is difficult due to heterogeneity in, LBDs definition, type of farm commodity, study design, and statistical strategy. Direct comparisons and synthesis were not possible. Although retrospective cohort studies tended to show a relationship, future studies with a prospective cohort design could help clarify this association further.