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- Helgadóttir, Björg, et al.
(författare)
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Medication and fall injury in the elderly population; do individual demographics, health status and lifestyle matter?
- 2014
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The simultaneous use of several medications is an important risk factor for injurious falls in older people. The aim of this study is to investigate the effect of the number of medications dispensed to elderly persons on fall injuries and to assess whether this relationship is explained by individual demographics, health habits and health status.METHODS: A population-based, nested, case-control study on people 65 years and older (N = 20.906) was conducted using data from the Stockholm Public Health Cohort (SPHC) derived from self-administered surveys and linked at the individual level with various Swedish health registers. Fall injuries leading to hospitalization recorded in the Swedish National Patient Register (NPR) were considered as the outcome. The main exposure, obtained from the Swedish Prescribed Drug Register (SPDR), was the number of medications dispensed within 90 days prior to the injurious fall. The injury risk was estimated using adjusted odds ratios (ORs) from logistic regression. Results were adjusted by selected demographic, social circumstances, lifestyle and health status data extracted from the SPHC.RESULTS: After adjusting for common risk factors within demographics, lifestyle, social circumstances and health status, using more than one medication increased the risk of fall injury but no clear dose-response relationship was observed, with point estimates ranging from 1.5-1.7 for the use of two, three, four or five or more medications as compared to using none. An increased risk remained, and was even elevated, after adjusting for the use of fall-risk-increasing drugs (FRIDs).CONCLUSIONS: Using more than one medication affects the risk of injurious falls among older people. The effect of any given number of medications studied remains and is even strengthened after adjusting for individual demographics, health habits, health conditions and the use of FRIDs.
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| 2. |
- Johnell, Kristina, et al.
(författare)
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The Role of Marital Status in the Association between Benzodiazepines, Psychotropics and Injurious Road Traffic Crashes : A Register-Based Nationwide Study of Senior Drivers in Sweden
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:1, s. e86742-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Among senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers. Methods: Matched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50-80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1-30 days prior to the crash date stratified by marital status. Results: BZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17-1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12-1.41). Compared to married drivers, those divorced (1.48, 1.43-1.53) and widowed (1.54; 1.45-1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers. Conclusions: Both BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.
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| 3. |
- Laflamme, Lucie, et al.
(författare)
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Type, Number or Both? : A Population-Based Matched Case-Control Study on the Risk of Fall Injuries among Older People and Number of Medications beyond Fall-Inducing Drugs
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Drug use is a modifiable risk factor for fall-related injuries in older people. Whereas the injurious effect of polypharmacy is established, that of low numbers of medications has not been fully ascertained. Neither do we know whether it is the number per se or the type of medications that actually matters. We assessed this question for fall injuries leading to hospitalization. Design National register-based, population-based, matched case-control study. Setting Community dwellers aged 65+ years living in Sweden between March 2006 and December 2009. Methods Cases (n = 64,399) were identified in the national inpatient register and four controls per case were randomly matched by gender, date of birth and residential area. The association between number of prescribed medications, assessed through linkage with the Swedish prescribed drug register, and the risk of injurious falls was estimated with odds ratios with 95% confidence intervals using conditional logistic regression, adjusted for demographic and health status. Results The number of medications was associated with an increased risk of fall injury in a dose-response fashion, even after adjustment for marital status, comorbidity and number of fall-risk-inducing drugs (FRIDs). Using ten or more medications was associated with an almost two-fold higher risk (adjusted OR: 1.76, 95% CI: 1.66 to 1.88). When stratified by use (or not) of at least one FRID, the association weakened slightly among both non-users (adjusted OR: 1.50, 95% CI: 1.34 to 1.67) and users (adjusted OR: 1.67, 95% CI: 1.58 to 1.77). Conclusion In older people, not only large but also small numbers of medications may affect the risk for them to sustain injurious falls. Although the mechanisms lying behind this are complex, the finding challenges the prevention strategies targeting either specific types of medications (FRIDs) or high numbers of them.
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| 5. |
- Monárrez-Espino, Joel, 1967-
(författare)
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Health and Nutrition in the Tarahumara of Northern Mexico : Studies among Women and Children
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Belonging to an indigenous group in Mexico is usually associated with poor health, mainly as the result of social isolation from the mainstream society. The Tarahumara are no exception. They constitute the largest indigenous group in northern Mexico and one of the most marginalized ethnic minorities in North America. Health conditions are precarious, yet very little data are available to facilitate the design and implementation of programs to prevent and manage the main public health problems affecting this people. This thesis aims at overcoming part of this information gap. It presents and discusses the results from studies focusing on the nutrition of women and children carried out between 1997 and 2002.A survey in a representative district sample of Tarahumara women of reproductive age found the highest prevalence of anemia among pregnant women in their third trimester (38.5%) and those lactating during the first 6 months after delivery (42.9%), along with a high prevalence of iron deficiency. In this study a technique was developed to collect capillary serum samples spotted onto filter paper to measure serum ferritin in remote settings. In the same study, 52.5% of adult women were overweight, suggesting a process of ‘de-Indianization’ of their traditional diet and activity patterns. This issue was followed-up in a later study based on perceptions of food and body shape using cognitive anthropological methods. Speaking Spanish emerged as a clear indication of acculturation that could be associated with an increase in the prevalence of obesity and its consequences. A nutrition survey among Tarahumara children at boarding schools found evidence of zinc, vitamin B12, iron, and iodine deficiencies but found similar anthropometric status to other rural Mexicans. Finally, a qualitative assessment was carried out to identify culturally accepted foods to redesign a food aid basket aimed at alleviating malnutrition among young Tarahumara children.The results from this thesis provide relevant data for an improved design of interventions to combat and prevent some of the nutritional problems that affect the Tarahumara. These data could also constitute a baseline to which future changes can be compared if similar sampling strategies are used. Overall, the findings highlight the importance and challenge of achieving modernization in a way that not only improves health but at the same time supports, maintains and encourages traditional cultural values. These are not only the foundations of the Tarahumara society, but in some cases also contribute to a better diet and health.
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| 6. |
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| 7. |
- Monárrez-Espino, Joel, et al.
(författare)
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Nutritional status of indigenous children at boarding schools in northern Mexico
- 2004
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Ingår i: European Journal of Clinical Nutrition. - : Springer Science and Business Media LLC. - 0954-3007 .- 1476-5640. ; 58:3, s. 532-540
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:To assess the nutritional status of Tarahumara children at indigenous boarding schools.DESIGN:Cross-sectional comprehensive nutritional survey.SETTING:The schools sampled were located in indigenous municipalities of the northern Mexican state of Chihuahua.SUBJECTS:The study was carried out in 2001 among 331 children aged 6-14 y from a sample of five schools. Anthropometric measurements, a thyroid exam and capillary haemoglobin levels were obtained from the children. Serum concentrations of ferritin, iron, total iron-binding capacity, vitamin B(12), folic acid and zinc were collected from a subsample of 100 children.RESULTS:The prevalence of wasting and overweight (children 6-9 y) was 1.1 and 4.6%, respectively, and of underweight, risk of overweight and overweight (10-14 y) was 3.2, 5.1 and 0.6%, respectively. Stunting (6-12 y) was present in 22.3% of the children. The total goitre rate was 5.4%. The prevalence of anaemia was 13% (boys 11.4, girls 14.5%). Overall, 24.2% of the children were iron deficient (depletion 11.1%, deficient erythropoiesis 3%, iron deficiency anaemia 10.1%). No child had folic acid values <3 ng/ml, but 20.2% had low (<200 microg/dl) and 27.3% marginal (200-300 microg/dl) vitamin B(12) levels, and 80.2% had low zinc concentrations (<60 microg/dl).CONCLUSIONS:Nutritional underweight and stunting were similar to those reported in rural localities at the national level, but overweight was less prevalent in children aged 10-14 y. Various micronutrient deficiencies was identified including zinc and vitamin B(12), but the prevalence of iron and folic acid deficiency was lower than expected. These results suggest that Tarahumara children attending boarding schools may be the better-off children from these extremely poor and marginalized areas.
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| 8. |
- Monárrez-Espino, Joel, et al.
(författare)
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Perception of food and body shape as dimensions of Western acculturation potentially linked to overweight in Tarahumara women of Mexico
- 2004
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Ingår i: Ecology of Food and Nutrition. - : Informa UK Limited. - 0367-0244 .- 1543-5237. ; 43, s. 193-212
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Tidskriftsartikel (refereegranskat)abstract
- A recent survey in northern Mexico found that 52.8% of adult Tarahumarawomen were overweight. A process of “de-Indianization” of their diet washypothesized. The present study aimed at exploring food and body shapeperceptions as dimensions contributing to the role that Western acculturationcould be playing in increasing overweight in this isolated indigenouspopulation. Data were obtained from structured interviews of a type commonlyused in cognitive anthropology. Partial rank ordering of photographicseries’ depicting dishes, food preparation methods and drinks, andconstrained pile sorting of photographs portraying Tarahumara womenarranged from the thinnest to the fattest were used to assess food and body shape perceptions, respectively. Data analytic techniques employedincluded cultural consensus, tabu search clustering, and multidimensionalscaling. Respondents judged mestizo and Western foods as tastier than traditionalfoods. Spanish language capacity was linked to preferences formestizo and Western foods and for fatter body shapes as ideals for beauty,health, and motherhood. Thin-normal women were considered the mostindustrious. Speaking Spanish emerged as the only clear element of acculturationthat could be defined.
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| 9. |
- Monárrez-Espino, Joel, et al.
(författare)
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Rapid qualitative assessment to design a food-aid basket for young Tarahumara children in Mexico
- 2004
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Ingår i: Scandinavian Journal of Nutrition/Næringsforskning. - 1102-6480 .- 1651-2359. ; 48:1, s. 4-12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Infant mortality among the Tarahumaras of Mexico is high and often linked to malnutrition, such as wasting, found in 10.3% of children aged 6–23 months. This has prompted the government to offer a food-aid basket. However, this aid may often not reach the child, as the foods offered are not tailored to the Tarahumaras’ cultural beliefs on young child feeding. Objective: This study was undertaken to determine whether a different group of foods might increase the cultural acceptance of the food basket. Design: Data were collected from 100 mothers of children aged 6–36 months from 51 communities using a combination of qualitative data collection methods, including free listing of foods from key informants, paired comparisons of food preferences, choices of foods to be added/deleted from the government basket, structured interviews about mothers’ concepts related to young child feeding practices, and focus group discussions to validate findings fro m the previous methods. Results: Canned sardines, cookies, lard and chocolate powder were removed from the government basket, and were replaced by beans, broad beans, green peas, milk and potatoes. Noodles, maize, sugar and salt remained from the original basket. Conclusions: Rapid qualitative techniques proved useful in redesigning a food basket targeted towards young Tarahumara children that mothers in focus groups agreed was culturally acceptable.
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