• Community-based health efforts for the prevention of falls in the elderly.

      Hanley, Alan; Silke, Carmel; Murphy, John; Department of Medicine, Letterkenny General Hospital, Letterkenny, Co Donegal,, Ireland. alan.hanley@gmail.com (2012-01-31)
      Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
    • Exercise and limitations in physical activity levels among new dialysis patients in the United States: an epidemiologic study.

      Stack, Austin G; Murthy, Bhamidipati; Regional Kidney Center, Department of Medicine, Letterkenny General Hospital, Health Services Executive (HSE) West, Letterkenny, County Donegal, Ireland. Austin.Stack@hse.ie (Annals of epidemiology, 2008-12)
      Epidemiologic studies of physical activity among patients with end-stage renal disease (ESRD) are lacking. The aim of this study was to describe the patterns of physical activity among new dialysis patients in the United States.
    • Survival trends of US dialysis patients with heart failure: 1995 to 2005.

      Stack, Austin G; Mohammed, Amir; Hanley, Alan; Mutwali, Arif; Nguyen, Hoang; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Letterkenny, Donegal, Ireland. Austin.Stack@hse.ie (2012-01-31)
      BACKGROUND AND OBJECTIVES: Congestive heart failure (CHF) is a major risk factor for death in end-stage kidney disease; however, data on prevalence and survival trends are limited. The objective of this study was to determine the prevalence and mortality effect of CHF in successive incident dialysis cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based cohort of incident US dialysis patients (n = 926,298) from 1995 to 2005. Age- and gender-specific prevalence of CHF was determined by incident year, whereas temporal trends in mortality were compared using multivariable Cox regression. RESULTS: The prevalence of CHF was significantly higher in women than men and in older than younger patients, but it did not change over time in men (range 28% to 33%) or women (range 33% to 36%). From 1995 to 2005, incident death rates decreased for younger men (70 years). For women, the pattern was similar but less impressive. During this period, the adjusted mortality risks (relative risk [RR]) from CHF decreased in men (from RR = 1.06 95% Confidence intervals (CI) 1.02-1.11 in 1995 to 0.91 95% CI 0.87-0.96 in 2005) and women (from RR = 1.06 95% CI 1.01-1.10 in 1995 to 0.90 95% CI 0.85-0.95 in 2005 compared with referent year 2000; RR = 1.00). The reduction in mortality over time was greater for younger than older patients (20% to 30% versus 5% to 10% decrease per decade). CONCLUSIONS: Although CHF remains a common condition at dialysis initiation, mortality risks in US patients have declined from 1995 to 2005.