Falls in rural elders: an empirical study of risk factors.
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BACKGROUND: Our objective was to analyze and determine several risk factors of falls in the rural elderly population. Our study examined several variables believed to be positively correlated with the likelihood of an elderly person sustaining a fall. METHODS: Analysis was performed on a prospective study of 308 community-dwelling rural elders during a span of 6 years. Factors such as prescription medication, eyesight, age, sex, recent hospitalizations, and personal health ratings were analyzed through a series of advanced empirical techniques. RESULTS: Of the five significant variables found in our analysis, four were different types of prescription drugs. The biometric results suggest the probability of falling increases by as much as 4% for each year of age. Prescription painkillers increase the probability of falling by 20% to 85%. Arthritis medication decreases the probability of falling by 20% to 60%. CONCLUSION: Although our results are necessary to the body of falls research, further study is required for precise determination of those medications found to be statistically significant in our analysis. (+info)
Transitions in insurance coverage from before pregnancy through delivery in nine states, 1996-1999.
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Efforts to extend coverage to pregnant women, along with an expanding economy, did not prevent increases in the uninsured in the latter 1990s. Welfare reform may have led to declining Medicaid enrollments and caseloads. Data representative of live births in nine states show that in some states more than one-third of all pregnant women and almost two-thirds of low-income pregnant women lacked insurance before their pregnancy in 1996 and 1999. More than one-third of all pregnant women made some change in coverage by the time they delivered their baby. Among low-income women, the largest change was from uninsured status before pregnancy to Medicaid at delivery. (+info)
Serotyping group B streptococci in a small community hospital: an analysis of distribution and site of isolation.
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OBJECTIVE: To determine the prevalence and site of isolation of different serotypes of group B streptococcus (GBS) colonization or infection at a small community hospital. METHODS: GBS isolates were obtained from a small community hospital and were then serotyped as la, Ib, II, III, IV, V or nontypeable. Hospital records were reviewed for patient sex, age and pregnancy status as well as the site of GBS isolation. RESULTS: GBS serotypes Ia, III and V were most common and accounted for over 60% of the total number of isolates. Serotype Ia was most prevalent in reproductive-age females, while serotypes V and III were most prevalent in non-reproductive-age females and males, respectively. Serotype la was most frequent in both pregnant and nonpregnant females. Serotype IV was more common in this study population than in those from other locations. CONCLUSIONS: The GBS serotype distribution in this small community did not differ significantly from distributions described in larger North American centers. A GBS vaccine designed against multiple serotypes would be protective for most of this population. (+info)
Spatial distribution of nitrogen on grazed karst landscapes.
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The impact on water quality by agricultural activity in karst terrain is an important consideration for resource management within the Appalachian region. Karst areas comprise about 18% of the region"s land area. An estimated one-third of the region"s farms, cattle, and agricultural market value are located on karst terrain. Mean nitrate concentrations in several karst springs in southeastern West Virginia exhibit a strong linear relationship with the percentage of agriculture land cover. Development of best management practices for efficient nitrogen (N) use and reduction of outflow of N to water from karst areas requires knowledge about N dynamics on those landscapes. Water extractable NO3-N and NH4-N were measured along transects at four soil depths in two grazed sinkholes and one wooded sinkhole. Distribution of soil NO3-N and NH4-N were related to frequency of animal presence and to topographic and hydrologic redistribution of soil and fecal matter in the grazed sinkholes. Karst pastures are characterized by under drainage and funneling of water and contaminants to the shallow aquifer. Control of NO3-N leaching from karst pasture may depend on management strategies that change livestock grazing behavior in sinkholes and reduce the opportunity for water and contaminants to quickly reach sinkhole drains. (+info)
Factors influencing spatial variability in nitrogen processing in nitrogen-saturated soils.
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Nitrogen (N) saturation is an environmental concern for forests in the eastern U.S. Although several watersheds of the Fernow Experimental Forest (FEF), West Virginia exhibit symptoms of N saturation, many watersheds display a high degree of spatial variability in soil N processing. This study examined the effects of temperature on net N mineralization and nitrification in N-saturated soils from FEF, and how these effects varied between high N-processing vs. low N-processing soils collected from two watersheds, WS3 (fertilized with [NH4]2SO4) and WS4 (untreated control). Samples of forest floor material (O1 horizon) and mineral soil (to a 5-cm depth) were taken from three subplots within each of four plots that represented the extremes of highest and lowest rates of net N mineralization and nitrification (hereafter, high N and low N, respectively) of untreated WS4 and N-treated WS3: control/low N, control/high N, N-treated/low N, N-treated/high N. Forest floor material was analyzed for carbon (C), lignin, and N. Subsamples of mineral soil were extracted immediately with 1 N KCl and analyzed for NH4+ and NO3- to determine preincubation levels. Extracts were also analyzed for Mg, Ca, Al, and pH. To test the hypothesis that the lack of net nitrification observed in field incubations on the untreated/low N plot was the result of absence of nitrifier populations, we characterized the bacterial community involved in N cycling by amplification of amoA genes. Remaining soil was incubated for 28 d at three temperatures (10, 20, and 30 degrees C), followed by 1 N KCl extraction and analysis for NH4+ and NO3-. Net nitrification was essentially 100% of net N mineralization for all samples combined. Nitrification rates from lab incubations at all temperatures supported earlier observations based on field incubations. At 30 degrees C, rates from N-treated/high N were three times those of N-treated/low N. Highest rates were found for untreated/high N (two times greater than those of N-treated/high N), whereas untreated/low N exhibited no net nitrification. However, soils exhibiting no net nitrification tested positive for presence of nitrifying bacteria, causing us to reject our initial hypothesis. We hypothesize that nitrifier populations in such soil are being inhibited by a combination of low Ca to Al ratios in mineral soil and allelopathic interactions with mycorrhizae of ericaceous species in the herbaceous layer. (+info)
Outcomes of cardiopulmonary resuscitation in dialysis patients.
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Patients with renal failure are believed to have a poor survival rate after cardiopulmonary resuscitation, but there is little specific information about the outcomes of cardiopulmonary resuscitation in dialysis patients. To be better able to inform dialysis patients and assist them in decision making about cardiopulmonary resuscitation, the eight-year experience with cardiopulmonary resuscitation in dialysis patients at a university dialysis program was analyzed and outcomes were compared with those of a control group of nondialysis patients undergoing cardiopulmonary resuscitation during the same time period in the same hospital. Of 221 dialysis patients experiencing cardiopulmonary arrest, 74 (34%) had CPR compared with 247 (21%) of 1,201 control patients (P = 0.0002). Six of 74 (8%; 95% confidence interval, 2 to 14%) dialysis patients survived to hospital discharge compared with 30 of 247 (12%; 95% confidence interval, 8 to 16%) control patients (P = not significant). At 6 months after CPR, 2 (3%) of 74 dialysis patients were still alive compared with 23 (9%) of 247 controls (P = 0.044); this difference was not explained by age or comorbid conditions. Twenty-one (78%) of the 27 successfully resuscitated dialysis patients died a mean of 4.4 days later; 95% were on mechanical ventilation in an intensive care unit at the time of death. It was concluded that cardiopulmonary resuscitation is a procedure that rarely results in extended survival for dialysis patients. In discussions about cardiopulmonary resuscitation with dialysis patients, nephrologists should provide this information. (+info)
Fatal traumatic brain injury, West Virginia, 1989-1998.
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OBJECTIVE: The objective of this study was to describe fatal cases of traumatic brain injury (TBI) among West Virginia residents. METHODS: The authors analyzed data from the National Center for Health Statistics Multiple Cause of Death tapes for the period 1989-1998. They compared West Virginia's annualized average TBI death rate with the rates of other states and with the rate among U.S. residents for the same period. U.S. Bureau of Census population estimates were used as denominators. RESULTS: A total of 4,416 TBI deaths occurred in West Virginia in 1989-1998, for an annual average death rate of 23.6 per 100,000 population. From 1989 to 1998, TBI death rates declined 5% (p=0.4042). Seventy-five percent (n=3,315) of fatalities occurred among men. Adults > or =65 years of age accounted for the highest percentage of fatal injuries (n=1,135). The leading external causes of fatal TBI were: firearm-related (39% of reported fatalities), motor vehicles-related (34%), and fall-related (10%). Firearm-related TBI became the leading cause of TBI fatalities in 1991, surpassing motor vehicle-related TBI. Seventy-five percent of firearm-related TBI deaths were suicides (n=1,302). West Virginia's TBI death rate (23.6 per 100,000) was higher than the national rate (20.6 per 100,000). In 23 states, the average TBI death rates over the 10-year period were higher than West Virginia's. Whereas modest declines in TBI death rates occurred for motor vehicle-related and firearm-related causes in West Virginia, a concomitant 38% increase occurred in the fall-related TBI death rate during the decade. CONCLUSION: Data presented in this report can be used to develop targeted prevention programs in West Virginia. (+info)
Assessing safety awareness and knowledge and behavioral change among West Virginia loggers.
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OBJECTIVE: To determine if a video used during logger training influences safety attitude, knowledge, and workplace habits. METHOD: From April 2002 to October 2003, loggers receiving training through the West Virginia Division of Forestry were given a new safety module. This consisted of a pre-training survey, viewing video, brief introduction to field safety guide, and an immediate post-training survey. Six months after training, loggers were contacted by telephone to assess workplace behavioral changes. RESULTS: 1197 loggers attended 80 training sessions and completed surveys; 21% were contacted at follow up. Pre-training surveys indicated that half said "accidents" were part of the job and had experienced a "close call" in their work. An overwhelming majority felt that safety management and periodic meetings were important. Over 75% indicated they would not take risks in order to make a profit. Several statistically significant improvements were noted in safety knowledge after viewing the video: logger's location in relation to the tree stump during fatal incidents and the pictorial identification of an overloaded truck and the safest cutting notch. At follow up, many of the loggers said they related to the real life victim stories portrayed in the video. Further, the field guide served as a quick and easy reference and taught them valuable tips on safe cutting and felling. CONCLUSIONS: Significant changes in safety knowledge and attitude among certified loggers resulted from viewing the video during training. Subsequent use of the video and field guide at the worksite encouraged positive change in self reported work habits and practices. (+info)