Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study.

BACKGROUND: comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. OBJECTIVE: to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. DESIGN: complementary mixed-methods pre-post study, based on an embedded quasi-experimental model. SETTING: geriatric fracture centre. METHODS: qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. RESULTS: thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. CONCLUSION: as patients' individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.

Water quality and management of private drinking water wells in Pennsylvania.

Pennsylvania has over three million rural residents using private water wells for drinking water supplies but is one of the few states that lack statewide water well construction or management standards. The study described in this article aimed to determine the prevalence and causes of common health-based pollutants in water wells and evaluate the need for regulatory management along with voluntary educational programs. Water samples were collected throughout Pennsylvania by Master Well Owner Network volunteers trained by Penn State Extension. Approximately 40% of the 701 water wells sampled failed at least one health-based drinking water standard. The prevalence of most water quality problems was similar to past studies although both lead and nitrate-N were reduced over the last 20 years. The authors' study suggests that statewide water well construction standards along with routine water testing and educational programs to assist water well owners would result in improved drinking water quality for private well owners in Pennsylvania.

Mercury speciation in seafood using isotope dilution analysis: a review.

Mercury is a toxic compound that can contaminate humans through food and especially via fish consumption. Mercury's toxicity depends on the species, with methylmercury being the most hazardous form for humans. Hg speciation analysis has been and remains a widely studied subject because of the potential difficulty of preserving the initial distribution of mercury species in the analysed sample. Accordingly, many analytical methods have been developed and most of them incur significant loss and/or cross-species transformations during sample preparation. Therefore, to monitor and correct artefact formations, quantification by isotope dilution is increasingly used and provides significant added value for analytical quality assurance and quality control. This review presents and discusses the two different modes of application of isotope dilution analysis for elemental speciation (i.e. species-unspecific isotope dilution analysis and species-specific isotope dilution analysis) and the different quantification techniques (i.e. classical and multiple spike isotope dilution analyses). Isotope tracers are thus used at different stages of sample preparation to determine the extent of inter-species transformations and correct such analytical artefacts. Finally, a synthesis of the principal methods used for mercury speciation in seafood using isotope dilution analysis is presented.

Mercury speciation analysis in seafood by species-specific isotope dilution: method validation and occurrence data.

Methylmercury (MeHg) and total mercury (THg) in seafood were determined using species-specific isotope dilution analysis and gas chromatography combined with inductively coupled plasma mass spectrometry. Sample preparation methods (extraction and derivation step) were evaluated on certified reference materials using isotopically enriched Hg species. Solid-liquid extraction, derivation by propylation and automated agitation gave excellent accuracy and precision results. Satisfactory figures of merit for the selected method were obtained in terms of limit of quantification (1.2 µg Hg kg(-1) for MeHg and 1.4 µg Hg kg(-1) for THg), repeatability (1.3-1.7%), intermediate precision reproducibility (1.5% for MeHg and 2.2% for THg) and trueness (bias error less than 7%). By means of a recent strategy based on accuracy profiles (ß-expectation tolerance intervals), the selected method was successfully validated in the range of approximately 0.15-5.1 mg kg(-1) for MeHg and 0.27-5.2 mg kg(-1) for THg. Probability ß was set to 95% and the acceptability limits to ±15%. The method was then applied to 62 seafood samples representative of consumption in the French population. The MeHg concentrations were generally low (1.9-588 µg kg(-1)), and the percentage of MeHg varied from 28% to 98% in shellfish and from 84% to 97% in fish. For all real samples tested, methylation and demethylation reactions were not significant, except in one oyster sample. The method presented here could be used for monitoring food contamination by MeHg and inorganic Hg in the future to more accurately assess human exposure.