Fall related self-efficacy among elderly: a comparison of resistance training with balance exercise.

Aims: To evaluate the effectiveness of individualized progressive resistance strength training (PRT) program in improving the confidence level among the institutionalized elderly with balance impairment, in comparison with traditional balance exercise (TBE), and combination of both (COMBI). Place and Duration of Study: The study was conducted between June 2008 and December 2012 in the geriatric care homes, Mangalore, India. Methodology: The eligible subjects were assigned to 3 groups (TBE, PRT and COMBI) using block randomization technique and allocation concealment was done. PRT group received strength training for the key muscles (hip flexors, extensors and abductors, knee flexors and extensors, ankle dorsiflexors and plantar flexors) essential for maintenance of balance. TBE group received conventional balance training and the participants of the COMBI group received TBE and PRT interventions alternately. All the three groups received their respective interventions 4 times a week for 6 months. The data was collected at baseline, 3rd and 6th month and the analysis was performed using Statistical Package for Social Sciences (SPSS) version 15. Both per-protocol and intention to treat methods of analyses were used. Results: Mean age of the 54 elderly participants (18 in each group) was 75.17 years and the comparison of the baseline variables revealed homogeneity between the groups. Between the baseline and six months, all the three groups showed notable reduction in Falls Efficacy Scale (FES) scores. The change scores (pre-post intervention) of FES were notable for all the three groups, but the statistical test did not reveal any significant differences between the groups. Conclusion: Individualized structured PRT intervention targeting the key muscles of lower limbs for balance maintenance, for a period of 6 months, is comparable to TBE in improving the falls efficacy. This in turn reduces self-induced functional restrictions among the non-frail elderly people living in geriatric homes.

Environmental lead levels in a coastal city of India: The lead burden continues.

Background: Urbanization, rapid industrialization, increased vehicular traffic, and consequent increase in the use of petroleum fuels in India are constantly emitting lead along with other pollutants into the environment. Apart from atmospheric lead, this element is the most widely used in everyday life. Although infants and children are the most susceptible to the effects of lead, adults are also affected to varying degrees and it had ranked as one of the most serious environmental threats to human health. Hence, we must understand the benefits of preventing lead exposure as it reduces treatment costs, increases productivity in industry, and also reduces infant mortality. These are good enough reasons for a nation wide program to prevent lead poisoning. Objectives: In the view of elevated blood lead levels (BLL) in majority of the school children in the city of Mangalore, we aimed to identify the potential sources of lead in the environment which would have probably caused the elevated BLL. Materials and Methods: More than 600 readings were taken throughout the city of Mangalore using X-ray fluorimeter. Results: Our results showed that there were elevated levels of lead in the environment surrounding the battery repair shops, battery recyclers, automotive workshops, and tyre retreaders, but interestingly, the soil around the petrol bunks did not show elevated levels of lead. Among the paints, the yellow paint showed high levels of lead. Conclusion: Similar surveys would be useful elsewhere in India and in other developing countries in order to identify the potential sources of lead and to prevent lead poisoning.

Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India.

Context : Lead is a major health hazard, especially in children. Impact of lead poisoning on our society is not known. Effectiveness of environmental interventions in reducing blood lead levels is not exactly known, though the Center for Disease Control and Prevention strongly advocates use of such means. Aims: We aimed at screening school children for blood lead levels (BLLs) and reducing the BLLs of children with preliminary BLL> 20 microg/dL by environmental intervention and intensive education. Materials and Methods: To assess the extent of lead poisoning, a screening of 106 children was done, which showed that children belonging to a particular government primary school had higher BLLs. A second screening program of 87 children conducted in that school showed that only 19% had BLL < 10 microg/dL; whereas 44% had BLL between 10 and 20 microg/dL, and 37% had BLL> 20 microg/dL. Thirty-eight children having BLL> 20 microg/dL were selected from the two screening programs. After removing all potential sources of lead from their environment and educating them about the ways to prevent exposure to lead, follow-up of their BLLs was carried out at an interval of 6 months for a period of 1 year. Statistical Analysis: Values of the different follow-up studies were compared using repeated-measure ANOVA. Results : Our results showed that there was a significant (P < 0.0001) reduction in the BLLs in the first and second follow-up studies. Conclusions: The study is a proof of the concept that a decline in the BLLs can be achieved by intense education and avoiding the potential environmental sources of lead.