Intraindividual variability and falls in older adults.

OBJECTIVE: We investigated whether a simple measure of reaction time (RT) intraindividual variability (IIV) was associated with falls in older adults. Falls and fall-related injuries represent a major cost to health care systems, it is therefore critically important to find measures that can readily identify older adults at greater risk of falling. METHOD: Cognitive and motor function were investigated in 108 adults aged 53 to 93 years (M = 73.49) recruited across the local community and hospital outpatient department. Forty-two participants had experienced either an injurious fall, or multiple falls, in the previous 2 years. RESULTS: Logistic regression suggested that fallers could be distinguished from nonfallers by greater medication use, IIV, postural sway, weaker grip strength and slower gait speed. Structural equation models revealed that IIV was predictive of falls via the mediating variable of motor function (e.g., gait). IIV also predicted higher order cognition (executive function) but higher order cognitive function did not uniquely predict falls or account for the associations between IIV and falls. CONCLUSIONS: These findings indicate that IIV measures capture important aspects of cognitive and motor decline and may have considerable potential in identifying older adults at risk of falling in health care and community settings. (PsycINFO Database Record

Performance and characteristics of the Newborn Hearing Screening Programme in England: The first seven years.

OBJECTIVE: To assess the performance of the universal newborn hearing screen in England. DESIGN: Retrospective analysis of population screening records. STUDY SAMPLE: A total of 4 645 823 children born 1 April 2004 to 31 March 2013. RESULTS: 97.5% of the eligible population complete screening by 4/5 weeks of age and 98.9% complete screening by three months of age. The refer rate for the 12/13 birth cohort is 2.6%. The percentage of screen positive (i.e. referred) babies commencing follow up by four weeks of age and six months of age is 82.5% and 95.8% respectively. The yield of bilateral PCHL from the screen is around 1/1000. For bilateral PCHL in the 12/13 birth cohort the median age is nine days at screen completion, 30 days at entry into follow up, 49 days at confirmation, 50 days at referral to early intervention, and 82 days at hearing-aid fitting. CONCLUSION: The performance of the newborn hearing screening programme has improved continuously. The yield of bilateral PCHL from the screen is about 1/1000 as expected. The age of identification and management is well within the first six months of life, although there remains scope for further improvement with respect to timely entry into follow up.

Acute coronary syndrome management in older adults: guidelines, temporal changes and challenges.

Advancing age is a risk factor for the development of coronary artery disease and is an important indicator of outcome after acute coronary syndrome. As the number of older adults increases, the burden of cardiovascular disease is set to grow particularly as older adults remain disadvantaged in the delivery of acute cardiac care. This article reviews the temporal changes in the provision of guideline recommended therapies for the management of acute coronary syndrome, discusses reasons for age-dependent inequalities in care and the challenges facing clinicians.

Effectiveness of targeted surveillance to identify moderate to profound permanent childhood hearing impairment in babies with risk factors who pass newborn screening.

OBJECTIVE: To examine the effectiveness of targeted surveillance for the identification of moderate-profound PCHI in babies who pass the newborn hearing screen in England and have risk factors. DESIGN: Retrospective analysis. STUDY SAMPLE: 2,307,880 children born 01/04/06-30/09/09 in England. RESULTS: Overall the prevalence for all PCHI in children with risk factors who pass newborn hearing screening is 1.49/1000. The risk factors with the highest prevalence are (1) Syndrome (other than Down's) associated with a hearing loss; (2) NICU with refer in both ears at OAE and pass in both ears at AABR; (3) Craniofacial anomaly; (4) Down's syndrome; (5) Congenital infection. CONCLUSION: Targeted surveillance for children who pass the screen and have the risk factors 1-5 listed above will be retained within the English NHSP; targeted surveillance for children who pass the screen and have other risk factors is not effective and has been discontinued.

Is the relation of social class to change in hearing threshold levels from childhood to middle age explained by noise, smoking, and drinking behaviour?

Recent work shows that variation in adult hearing function is related both to social class of origin and current social class. This study examines how much of this relationship after adjustment for childhood hearing impairment is explicable by occupational noise, current smoking, and alcohol consumption. A cohort of 9023 persons born in the UK during one week in 1958 was followed periodically, and hearing threshold levels (HTLs) were measured at 1 kHz and 4 kHz at age 45 years. Most (71% and 68%, at 1 kHz and 4 kHz respectively) of the relation to social class of origin of adult HTLs remains after adjustment for these other factors. For the relation to current social class, corresponding values are 64% and 44% (though varying by gender). The magnitude of social class effect is comparable to that of occupational noise. Susceptibility to hearing impairment is likely to be appreciably determined in early childhood.

General practitioner notifications of gastroenteritis and food poisoning: cause for concern.

BACKGROUND: Under the Public Health (Infectious Diseases) Regulations 1988, all doctors are required by law to notify suspected cases of specific infections and food poisoning. Doctors' propensity to notify is known to be low, and we sought to quantify this locally. METHODS: From July 2000 to June 2002, we conducted a baseline audit of notifications by Wakefield GPs of cases of suspected gastrointestinal infection or food poisoning. We repeated the audit during 2005-06, following a series of local interventions to improve notification. RESULTS: The baseline audit demonstrated considerable variation in reporting behaviour and timeliness of notification. Following the re-audit, we found that notification rates and timeliness had not improved, indeed they had deteriorated. CONCLUSION: We suggest that the current notification system is not working in respect of gastroenteritis and food poisoning, and should be either substantially revised or abandoned.

Putrid gums and 'dead men's cloaths': James Lind aboard the Salisbury.

18th century sailors often suffered from scurvy. In 1747 James Lind conducted his classic experiments aboard the Salisbury, in which he cured scurvy with oranges and lemons. The Royal Navy did not introduce citrus rations until 1795. The original ship's papers allow the circumstances of the experiment to be reconstructed. The relevant patrol began in March 1747, and Lind's experiment began after 8 weeks at sea. The muster roll records almost no sickness aboard until the ship returned to Plymouth in June. This is at odds with Lind's account and suggests an antisickness official culture, which may have contributed to the neglect of his work.