Self-reported falls and fall-related injuries among persons aged>or=65 years--United States, 2006.

PROBLEM: In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD: To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION: This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY: The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY: Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.

HIV-related behaviors and perceptions among adults in 25 states: 1997 Behavioral Risk Factor Surveillance System.

OBJECTIVES: To assess the level of HIV-related risk behavior among the general US adult population, we analyzed data from the first sexual behavior questions available for states to use with the Behavioral Risk Factor Surveillance System. METHODS: The Behavioral Risk Factor Surveillance System is a state-specific, population-based, random telephone survey. In 1997, 25 states collected sexual behavior data. Annual prevalence estimates for selected behaviors were calculated and examined by sociodemographic characteristics. The correlation between actual and perceived HIV risk also was determined. RESULTS: Most (77.1%) of the respondents reported just 1 sexual partner in the past year; 26.0% reported using a condom at last intercourse. Males, persons who were younger, and Blacks were more likely to report 2 or more partners but also more likely to report using a condom at last intercourse. Only 4.1% of the respondents reported a risk factor for HIV infection; 7.7% reported that they were at medium or high risk for HIV. Actual and perceived HIV risk were positively associated. CONCLUSIONS: Most US adults do not engage in HIV-related risk behavior; those that do are more likely to report protective behavior.

Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS).

OBJECTIVES: To assess the reliability and validity of measures on the BRFSS, to assist users in evaluating the quality of BRFSS data, and to identify areas for further research. METHODS: Review and summary of reliability and validity studies of measures on the BRFSS and studies of measures that were the same or similar to those on the BRFSS from other surveys. RESULTS: Measures determined to be of high reliability and high validity were current smoker, blood pressure screening, height, weight, and BMI, and several demographic characteristics. Measures of both moderate reliability and validity included when last mammography was received, clinical breast exam, sedentary lifestyle, intense leisure-time physical activity, and fruit and vegetable consumption. Few measures were of low validity and only one measure was determined to be of low reliability. Several other measures were of high or moderate reliability or validity, but not both. The reliability or validity could not be determined for some measures, primarily due to lack of research. CONCLUSIONS: Most questions on the core BRFSS instrument were at least moderately reliable and valid, and many were highly reliable and valid. Additional research is needed for some measures.

Sequencing of the Francisella tularensis strain Schu 4 genome reveals the shikimate and purine metabolic pathways, targets for the construction of a rationally attenuated auxotrophic vaccine.

Francisella tularensis is the etiological agent of tularemia, a serious disease in several Northern hemisphere countries. The organism has fastidious growth requirements and is very poorly understood at the genetic and molecular levels. Given the lack of data on this organism, we undertook the sample sequencing of its genome. A random library of DNA fragments from a highly virulent strain (Schu 4) of F. tularensis was constructed and the nucleotide sequences of 13,904 cloned fragments were determined and assembled into 353 contigs. A total of 1.83 Mb of nucleotide sequence was obtained that had a G+C content of 33.2%. Genes located on plasmids pOM1 and pNFL10, which had been previously isolated from low virulence strains of F. tularensis, were absent but all of the other known F. tularensis genes were represented in the assembled data. F. tularensis Schu4 was able to grow in the absence of aromatic amino acids and orthologues of genes which could encode enzymes in the shikimate pathway in other bacteria were identified in the assembled data. Genes that could encode all of the enzymes in the purine biosynthetic and most of the en- zymes in the purine salvage pathways were also identified. This data will be used to develop defined rationally attenuated mutants of F. tularensis, which could be used as replacements for the existing genetically undefined live vaccine strain.

Acupressure for nausea: results of a pilot study.

PURPOSE/OBJECTIVES: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care. DESIGN: Single-cycle, randomized clinical trial. SETTING: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice. SAMPLE: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%). METHODS: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data. MAIN RESEARCH VARIABLES: Nausea experience measured by the Rhodes inventory of Nausea, Vomiting, and Retching and nausea intensity. FINDINGS: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea. CONCLUSIONS: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer. IMPLICATIONS FOR NURSING PRACTICE: This study must be replicated prior to advising patients about the efficacy of acupressure for the treatment of nausea.

HIV testing behaviors and attitudes regarding HIV/AIDS of adults aged 50-64.

This article explores knowledge, attitudes, and behaviors regarding HIV/AIDS for persons aged 50-64 by using data from the 1996 Behavioral Risk Factor Surveillance System. It examines what percentage have been tested for HIV, where and why they have been tested, knowledge about condom effectiveness, and self-perceived risk. The purpose is twofold: First, it presents an epidemiologic analysis of HIV/AIDS-related attitudes and behaviors of adults aged 50-64; second, it explores whether theoretical models used on other groups fit well with this age group. The authors conclude that the conceptual model is less robust for this group and there is a substantial need for health promotion efforts directed at older adults.

Corneal topography after excimer laser photorefractive keratectomy for myopia.

BACKGROUND: This study was performed to assess and correlate the changes in central corneal power with the changes in manifest refraction after myopic photorefractive keratectomy (PRK) and to measure ablation zone centration. METHODS: Fourteen patients had computerized videokeratography and manifest refraction performed preoperatively, and than 1, 2, 3, 4, 6, and 12 months after photorefractive keratectomy. RESULTS: There was a significant association (r = -0.9; p < 0.0001) between changes in manifest refraction and changes in central corneal power at the 12-month postoperative examination; however, a mean difference of 1.1 D was seen between the two readings. The mean decentration of the ablation zone was 0.47 +/- 0.26 mm (range, 0.08 to 1.05 mm: 0 to 0.49 mm, six patients; 0.50 to 0.99 mm, seven patients; and 1.00 to 1.50 mm, one patient). CONCLUSIONS: Corneal power-as measured by videokeratography-is not an accurate predictor of manifest refraction, although the two parameters did demonstrate good correlation. Centration of ablations was comparable to previous studies.

Central and peripheral endothelial cell changes after excimer laser photorefractive keratectomy for myopia.

OBJECTIVE: To investigate changes in the human corneal endothelium after photorefractive keratectomy for treatment of myopia. DESIGN: Specular microscopy of the central, paracentral, and peripheral zones of the corneas of 14 patients (12 of whom were previous contact lens wearers) was performed preoperatively and at 1, 2, 3, 6, and 12 months after photorefractive keratectomy. The corneal endothelial cell density, coefficient of variation (CV) of the endothelial cell area, and percentage of hexagonal cells were assessed at each examination. RESULTS: The central endothelial cell density was increased by 7% during the first 3 postoperative months (P < .05). In contrast, the peripheral cell density declined steadily by 6.9% during the first year (P < .01). The CV of the cell area was decreased in all 3 zones, whereas the percentage of hexagonal cells was increased in the central and paracentral zones (P < .05). CONCLUSIONS: We observed statistically significant changes in the central and peripheral endothelial cell densities and morphological features that could have resulted from photorefractive keratectomy; however, these changes also may have been explained by the discontinuation of contact lens wear. If such changes are contact lens-related, they could mask the effects of laser-induced damage to the central zone of the endothelium.