Robyn Norton

Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women

Abstract Objective: To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing falls and injuries in elderly women. Design: Randomised controlled trial of an individually tailored programme of physical therapy in the home (exercise group, n=116) compared with the usual care and an equal number of social visits (control group, n=117). Setting: 17 general practices in Dunedin, New Zealand. Subjects: Women aged 80 years and older living in the community and registered with a general practice in Dunedin. Main outcome measures: Number of falls and injuries related to falls and time between falls during one year of follow up; changes in muscle strength and balance measures after six months. Results: After one year there were 152 falls in the control group and 88 falls in the exercise group. The mean (SD) rate of falls was lower in the exercise than the control group (0.87 (1.29) v 1.34 (1.93) falls per year respectively; difference 0.47; 95% confidence interval 0.04 to 0.90). The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 (0.52 to 0.90). The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 (0.39 to 0.97). After six months, balance had improved in the exercise group (difference between groups in change in balance score 0.43 (0.21 to 0.65). Conclusions: An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing falls and injuries in women 80 years and older. Key messages Modifiable risk factors for falls in elderly people have been well defined; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin, New Zealand The benefit was most noticeable in elderly people who fell often

Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial.

OBJECTIVE: To assess the effectiveness of psychotropic medication withdrawal and a home‐based exercise program in reducing falls in older people.

Association of angiotensinogen gene T235 variant with increased risk of coronary heart disease

Several genes, including some encoding components of the renin angiotensin system, are associated with the risk of cardiovascular diseases. There have been reports linking a homozygous deletion allele of the angiotensin converting enzyme (ACE) gene (DD) with an increased risk of myocardial infarction, and some variants of the angiotensinogen gene with an increased risk of hypertension. In a case-control study of a caucasian population from New Zealand, we examined the associations with coronary heart disease (CHD) of ACE DD and of a mis-sense mutation with methionine to threonine aminoacid substitution at codon 235 in the angiotensinogen gene (T235). We studied 422 patients (mean age 62 years, 81% male) with documented CHD (50% with myocardial infarction) and 406 controls without known CHD (frequency-matched to cases by age and sex). Risk factors for CHD were assessed by standard questionnaire, physical examination, and blood tests. Genomic DNA from leucocytes was analysed for various ACE and angiotensinogen alleles. Angiotensinogen T235 homozygotes were at significantly increased risk of CHD generally (odds ratio 1.7, 2 p = 0.008) and of myocardial infarction specifically (1.8, 2 p = 0.009). Adjustment for several risk factors increased the estimate of CHD risk associated with this allele to 2.6 (2 p < 0.001) and the estimate for myocardial infarction risk to 3.4 (2 p < 0.001). By contrast, there was no evidence of a significant increase in the risk of CHD or myocardial infarction among individuals with ACE DD. We conclude that the T235 polymorphism of the angiotensinogen gene is an independent risk factor, which carries an approximately two-fold increased risk of CHD. In this study, however, ACE DD was not associated with any detectable increase in CHD risk.

Circumstances of Falls Resulting in Hip Fractures Among Older People

OBJECTIVES: To describe the circumstances of falls resulting in hip fractures among older people and to determine whether the circumstances differ by gender, age, and residential status.

Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case-control participants

PURPOSEnTo identify declines in physical functioning, directly attributable to the effects of hip fracture.nnnMETHODSnA follow-up study of participants in a case-control study was conducted in Auckland, New Zealand, between 1993 and 1996. Nine hundred and eleven randomly selected older people with a hip fracture at the time of the initial interview (cases) and 910 randomly selected older people, without hip fracture (controls), were invited to participate in the study. Two year changes in physical functioning, defined in terms of self-reported mobility, functional dependence and physical activity were examined.nnnRESULTSnData from the survivors (572 cases and 756 controls) showed that, after controlling for pre-existing chronic medical conditions and disabilities, cases were 4.2 times more likely than controls to be community immobile (95% confidence interval (CI) 2.8-6.2, p < 0.001) and 2.6 times more likely to be functionally dependent (95% CI 1.7-4.1, p < 0.001). Cases were also spending less hours per day on their feet (2.9) compared with controls (3.5) (F1,1211 = 55.7, p < 0.001).nnnCONCLUSIONSnHip fractures are associated with dramatic declines in physical functioning at two years, independent of the effects of increasing age, pre-existing medical conditions and disabilities.Purpose : To identify declines in physical functioning, directly attributable to the effects of hip fracture. Methods : A follow-up study of participants in a case-control study was conducted in Auckland, New Zealand, between 1993 and 1996. Nine hundred and eleven randomly selected older people with a hip fracture at the time of the initial interview (cases) and 910 randomly selected older people, without hip fracture (controls), were invited to participate in the study. Two year changes in physical functioning, defined in terms of selfreported mobility, functional dependence and physical activity were examined. Results : Data from the survivors (572 cases and 756 controls) showed that, after controlling for pre-existing chronic medical conditions and disabilities, cases were 4.2 times more likely than controls to be community immobile (95 % confidence interval (CI) 2.8-6.2, p < 0.001) and 2.6 times more likely to be functionally dependent (95% CI 1.7-4.1, p < 0.001). Cases were also spending less hours per day on their feet (2.9) compared with controls (3.5) (F 1,1211 = 55.7, p < 0.001). Conclusions : Hip fractures are associated with dramatic declines in physical functioning at two years, independent of the effects of increasing age, pre-existing medical conditions and disabilities.

Motorcycle engine size and risk of moderate to fatal injury from a motorcycle crash

Current New Zealand law requires that motorcyclists with a learner or restricted licence ride a motorcycle with an engine capacity of 250 cc or less. Previous research has reported inconsistent findings regarding the relationship between cubic-capacity and risk of a crash. We sought to determine: (1) compliance with the law; (2) if the risk of an injury crash is increased for learner/restricted licence holders who do not comply with the cubic capacity regulations; and (3) whether the risk of an injury crash increases with increasing capacity of the motorcycle. A population-based case-control study was conducted in the Auckland region over a 3 year period from February 1993. Among the controls, 66% were riding motorcycles with a capacity greater than 250 cc. The percentages for those with: full, learner and restricted, and no licence were 82, 29 and 60%, respectively. There was no evidence that learner and restricted licence holders who did not comply with the cubic capacity requirement were at increased risk. It should be noted however, that 75% of those who were complying were doing so on motorcycles of 250 cc or less. Relative to motorcycles of less than 250 cc the risk of an injury crash was elevated by at least 50% for all cubic capacity categories, with the exception of the 251-499 group. There was, however, no consistent pattern of increasing risk as cubic capacity increased. The findings of this study coupled with the fact that cubic capacity is a poor measure of power suggest that, if cubic capacity was to remain the sole basis for restricting learner and restricted licence holders, consideration should be given to having a substantially lower cubic capacity than 250 cc. An analysis of risk in terms of power to weight ratio and style of motorcycle may provide a more useful insight into the benefits of motorcycle design restrictions for novice riders.

OUTCOME EVALUATION OF AN EMERGENCY DEPARTMENT PROTOCOL OF CARE ON PARTNER ABUSE

Study objective: To evaluate the impact of a protocol on partner abuse (PA) at increasing identification and improving acute management of abused women by emergency department (ED) staff.

One year follow-up of an emergency department protocol for abused women

Objective: To evaluate if the positive effects of an initially successful emergency department protocol of care for victims of partner abuse (PA) were maintained at one year follow‐up.

Risk–taking behaviours in a sample of New Zealand adolescents

Abstract: We surveyed the risk–taking behaviour of students aged 16 years and over in two New Zealand high schools, with a particular focus on road safety, substance use, sexual behaviour and personal safety. The questionnaire was completed by 471 students, a participation rate of 99 per cent. We found that seven out of 10 students who had ridden either a bicycle or motorcycle in the previous 12 months had not always worn a helmet; that 56 per cent had driven a car without a licence; and 23 per cent had been involved in a motor vehicle crash. A lifetime incidence of 63 per cent for cigarette smoking, 34 per cent for marijuana use and 78 per cent for alcohol use was found. Forty per cent of the students reported ever having sexual intercourse. During the previous 12 months, 49 per cent of these had not always used contraceptives and 61 per cent reported not always wearing condoms as protection for sexually transmitted diseases. Twenty–five per cent had physically harmed another person and 10 per cent reported carrying a weapon with the intent of harming someone else. This study shows that adolescents are willing to provide information on risk taking and that they are engaging in high levels of health–harming behaviour. Such information is important for designing health promotion programs to address adolescent risk taking. (Aust N Z J Public Health 1997; 21: 455–61)

Developing and implementing an intervention. Evaluation of an emergency department pilot on partner abuse.

This article discusses the role offormative and process evaluation in the development and implementation of a pilot intervention to improve the identification, treatment, and referral of women abused by their partners who present to an emergency department (ED). These evaluations were undertaken in conjunction with an outcome evaluation of training in and use of a five-step protocol of care piloted in a New Zealand public hospital. The outcome evaluation showed there was an improvement in identification and acute care of abused womenfollowing the intervention. The article highlights key factors that were relevant to the interventions development and implementation, including social context, development processes, appropriateness for the setting, and level of support from key stakeholders. Factors identified as key to intervention effectiveness included its appropriateness for abused women and responsiveness to specific hospital, department, and staff needs. The key role offormative and process evaluation in the development and implementation ofpilot interventions is highlighted, and the particular lessons gained from this study have relevance and application to other interventions.