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Xiao W, Wang B, Bai X, Tang S, Zhang Y. Taoist way of a balanced exercise training cocktail for the management of primary hypertension in older persons. Front Public Health 2023; 11:1308375. [PMID: 38155893 PMCID: PMC10754045 DOI: 10.3389/fpubh.2023.1308375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
High blood pressure is the world's leading risk factor for mortality, affecting nearly half of the global population aged 50-79 years. Physical inactivity is one factor contributing to the prevalence of hypertension. This paper discusses a new concept for the management of hypertension in older persons. We are inclined to fade the current guidelines used in China, the United States, and Europe. Although demonstrating irrefutable benefits for blood pressure regulation, the guidelines fail to address the need to incorporate balance exercises, which are crucial for mitigating the risk of falling. We address three pressing questions regarding the efficacy of various combinations of exercise modes for blood pressure regulation, alongside providing an overview of balance exercises. At the core of our concept, we explicate the challenges inherent in addressing the global pandemic of physical inactivity and hypertension in regular socioeconomic people. No guidelines could change the state of inactivity by jumping between zero and all things, where "zero" symbolizes conditions such as physical inactivity and hypertension, and the concept of "all things" encompasses the ideals of an active lifestyle and healthy aging. We advocate a Taoist way, "zero-one-all things," where "one" in this context refers to an inclusive and culturally diverse exercise training cocktail. The Tao guides us to illuminate an ancient way of overcoming physical inactivity-associated diseases in the present day.
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Affiliation(s)
- Wensheng Xiao
- School of Physical Education, Huzhou University, Huzhou, China
| | - Bihan Wang
- College of Physical Education, Hunan Normal University, Changsha, China
| | - Xiaorong Bai
- School of Physical Education, Huzhou University, Huzhou, China
| | - Shouyong Tang
- Institute of Sports and Health Industry, HEHA CAT Fitness, Changsha, China
| | - Yang Zhang
- Independent Person, Windermere, FL, United States
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Yuan L, Yibo W, Yuqian D, Haiye R, Jiaxin L, Liping Z. The relationship between fall and loneliness among older people in China: the mediating role of personality trait. Front Psychiatry 2023; 14:1204544. [PMID: 37614652 PMCID: PMC10442840 DOI: 10.3389/fpsyt.2023.1204544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/25/2023] [Indexed: 08/25/2023] Open
Abstract
Aims We aimed to explore the role of personality traits between fall and loneliness. Methods A questionnaire survey was used to investigate falls, the big five personality traits, and loneliness among older people (≥ 60 years old) in China mainland. Results A total of 4,289 older people participated in the survey. There are significant differences in age, marital status, education level, residence, solitariness, and fall in relation to loneliness among older people. Falls, especially when they occurred one time increase the loneliness of older people. Agreeableness, conscientiousness, and neuroticism were significant mediating effects between falls and loneliness. Conclusion This study implied that agreeableness, conscientiousness, and neuroticism were meditating factors between falls and loneliness. In the future, we should consider the big five personality traits more to understand loneliness and offer older people interventions for reducing their loneliness. The study design was cross-sectional, so the temporal precedence of mediators and causality could not be tested. Because the data were collected retrospectively, current loneliness is likely to have confounding effects on retrospective recall.
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Affiliation(s)
- Luo Yuan
- School of Nursing, Capital Medical University, Beijing, China
| | - Wu Yibo
- School of Public Health, Peking University, Beijing, China
| | - Deng Yuqian
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Ran Haiye
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Liu Jiaxin
- Xiang Ya Nursing School, Central South University, Changsha, Hunan Province, China
| | - Zhao Liping
- Xiang Ya Second Hospital of Central South University, Changsha, Hunan Province, China
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3
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Zhang K, Ju Y, Yang D, Cao M, Liang H, Leng J. Correlation analysis between body composition, serological indices and the risk of falls, and the receiver operating characteristic curve of different indexes for the risk of falls in older individuals. Front Med (Lausanne) 2023; 10:1228821. [PMID: 37559927 PMCID: PMC10409486 DOI: 10.3389/fmed.2023.1228821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Objective This study assessed the risk factors for falls and evaluated the correlation between body composition, serological indices, and the risk of falls in older individuals. Method This cross-sectional study included 387 individuals ≥60 years of age in the cadre ward of the First Hospital of Jilin University. The information used in this study was obtained from the comprehensive geriatric assessment database of the cadre ward. The body composition of the individuals was measured by bioelectrical impedance analysis using an InBody S10 device. We assessed fall risk using the fall risk assessment tool. Individuals with ≤2 points were placed in the low-risk group, those with 3-9 points were placed in the medium-risk group, and those with ≥10 points were placed in the high-risk group. Results Differences in age, educational background, height, cognitive impairment, malnutrition, ability of daily living, depression, diastolic blood pressure, heart rate, intracellular water, total body moisture, water ratio, limb moisture (right and left, upper and lower), trunk moisture, fat-free weight, arm girth, body cell mass, skeletal muscle mass, limb muscle (right and left, upper and lower), appendicular skeletal muscle mass index (ASMI), sarcopenia, hemoglobin level, hematocrit level, aspartate aminotransferase level, albumin level, anemia, and hypoproteinemia were observed among the three groups (p < 0.001, p = 0.002, p = 0.006, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.008, p = 0.010). Ordinal logistic regression analysis showed that the probability of the fall risk increasing by one level was 1.902 times higher for each unit of decrease in educational background, respectively. In addition, the probability of the fall risk increasing by one level was 2.971, 3.732, 3.804, 1.690 and 2.155 times higher for each additional unit of age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia, respectively. Conclusion Our findings suggest that educational background, age, cognitive impairment, lower limb edema, decreased skeletal muscle mass, and sarcopenia were associated with falls in older individuals. Body composition and serological indices can assist in the early identification of falls in the older people.
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Affiliation(s)
| | | | | | | | | | - Jiyan Leng
- Department of Cadre Ward, The First Hospital of Jilin University, Changchun, China
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Zhao M, Li L, Rao Z, Schwebel DC, Ning P, Hu G. Suicide Mortality by Place, Gender, and Age Group - China, 2010-2021. China CDC Wkly 2023; 5:559-564. [PMID: 37415793 PMCID: PMC10319904 DOI: 10.46234/ccdcw2023.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/08/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Suicide is an important public health concern in China. We examined suicide mortality by place, sex, and age group from 2010 to 2021 to identify and quantify significant suicide mortality changes in China. Methods We retrieved age-standardized and age-specific suicide mortality rates by place (urban vs. rural) and sex from the Chinese Health Statistical Yearbook and population data from the 2010 and 2020 Chinese National Population Census. Line graphs were used to demonstrate trends in suicide mortality. Joinpoint regression models were fitted to detect the time periods experiencing significant suicide mortality changes, and average annual percent change (AAPC) and annual percent change were reported to quantify changes in suicide mortality from 2010 to 2021. Results The overall age-standardized suicide mortality rate decreased from 10.88 to 5.25 per 100,000 population between 2010 and 2021 (AAPC=-5.3%, 95% confidence interval: -6.5%, -4.0%). Similar reductions in suicide mortality were observed for both males and females, as well as in urban and rural settings during this period. From 2010 to 2021, significant declines in suicide mortality were observed among the three older age groups (25-44 years, 45-64 years, and 65 years or above), while a substantial increase was noted in the youngest age group (5-14 years). No significant change was found in suicide mortality rates for the 15-24 year age group. Subgroup analyses based on location and sex revealed consistent findings. Conclusion The findings of this study suggest a probable overall success of suicide prevention efforts in China over the past decade. However, the recent increase in suicide mortality among children aged 5-14 years calls for the attention of injury researchers, policymakers, and public health practitioners.
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Affiliation(s)
- Min Zhao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha City, Hunan Province, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
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Huang Y, Li C, Lu X, Wang Y. The geographic environment and the frequency of falling: a study of mortality outcomes in elderly people in China. GEOSPATIAL HEALTH 2023; 18. [PMID: 37246537 DOI: 10.4081/gh.2023.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/28/2023] [Indexed: 05/30/2023]
Abstract
Falling has become the first and second cause of death due to injury among urban and rural residents in China. This mortality is considerably higher in the southern part of the country than in the North. We collected the rate of mortality due to falling for 2013 and 2017 by province, age structure and population density, taking topography, precipitation and temperature into account. 2013 was used as the first year of the study since this year marks the expansion of the mortality surveillance system from 161 counties to 605 counties making available data more representative. A geographically weighted regression was used to evaluate the relationship between mortality and the geographic risk factors. High levels of precipitation, steep topography and uneven land surfaces as well as a higher quantile of the population aged above 80 years in southern China are believed to have led to the significantly higher number of falling compared with that in the North. Indeed, when evaluated by geographically weighted regression, the factors mentioned found a difference between the South and the North with regard to falling of 81% and 76% for the years 2013 and 2017, respectively. Interaction effects were observed between geographic risk factors and falling that, apart from the age factor, could be explained by topographic and climatic differences. The roads in the South are more difficult to negotiate on foot, particularly when it rains, which increases the probability of falling. In summary, the higher mortality due to falling in southern China emphasizes the need to apply more adaptive and effective measures in rainy and mountainous region to reduce this kind of risk.
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Affiliation(s)
- Yi Huang
- School of Geographic Sciences, Nantong University, Nantong.
| | - Chen Li
- School of Management, Shanghai University of Engineering Science, Shanghai.
| | - Xianjing Lu
- School of Geographic Sciences, Nantong University, Nantong.
| | - Yue Wang
- School of Geographic Sciences, Nantong University, Nantong.
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Gong H, Wang Y, Li Y, Ye P, Xie L, Lu G, Liu J, Song J, Zhai X, Xu H, Duan L. Development of a core dataset for child injury surveillance: a modified Delphi study in China. Front Pediatr 2023; 11:970867. [PMID: 37187581 PMCID: PMC10175816 DOI: 10.3389/fped.2023.970867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Background Understanding the occurrence and severity of child injuries is the cornerstone of preventing child injuries. Currently, there is no standardized child injury surveillance dataset in China. Methods Multistage consultation by a panel of Chinese experts in child injury to determine items to include in the core dataset (CDS) was performed. The experts participated in two rounds of the modified Delphi method comprising a consultation questionnaire investigation (Round 1) and a face-to-face panel discussion (Round 2). Final consensus was established based on the opinions of the experts regarding the modified CDS information collection items. Enthusiasm and authority exhibited by the experts were evaluated by the response rate and using the expert authority coefficient, respectively. Results The expert panel included 16 experts in Round 1 and 15 experts in Round 2. The experts during both rounds had a high degree of authority, with an average authority coefficient of 0.86. The enthusiasm of the experts was 94.12%, and the proportion of suggestions reached 81.25% in Round 1 of the modified Delphi method. The draft CDS evaluated in Round 1 included 24 items, and expert panelists could submit recommendations to add items. Based on findings in Round 1, four additional items, including nationality, residence, type of family residence, and primary caregiver were added to the draft of the CDS for Round 2. After Round 2, consensus was reached on 32 items arranged into four domains-general demographic information, injury characteristics, clinical diagnosis and treatment, and injury outcome-to include in the final CDS. Conclusion The development of a child injury surveillance CDS could contribute to standardized data collection, collation, and analysis. The CDS developed here could be used to identify actionable characteristics of child injury to assist health policymakers in designing evidence-based injury prevention interventions.
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Affiliation(s)
- Hairong Gong
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
| | - Yuan Wang
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yongzhen Li
- Department of Clinical Nutrition New Hong Qiao Campus for Children's Hospital of Fudan University, ShanghaiChina
| | - Pengpeng Ye
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Li Xie
- Clinical Research Institute School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guoping Lu
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
| | - Jing Liu
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
| | - Jun Song
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
| | - Xiaowen Zhai
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
| | - Hong Xu
- Emergency Department Children's Hospital of Fudan University, Shanghai, China
- Correspondence: Hong Xu Leilei Duan
| | - Leilei Duan
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Correspondence: Hong Xu Leilei Duan
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Mortality from fall: A descriptive analysis of a multicenter Indian trauma registry. Injury 2022; 53:3956-3961. [PMID: 36244832 DOI: 10.1016/j.injury.2022.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 09/21/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fall is the second most common mechanism of trauma worldwide after road traffic injuries. Data on fall predominantly comes from the high-income countries (HICs) and mostly includes injuries in children and elderly. There are very few studies from low- and middle-income countries(LMICs) that describe fall related injuries other than fragility fractures in elderly. This study describes the profile of poly-trauma patients admitted with a history of 'fall' and assesses the variables associated with mortality. METHOD We analyzed data from the 'Towards Improved Trauma Care Outcome' (TITCO) database which prospectively collected data of poly-trauma patients admitted to four major tertiary care hospitals of India between 2013 to 2015. Patients across all age groups admitted to hospital with the history of 'fall'; were included in our study. Single bone fractures were excluded. The Kaplan Meier survival analysis was used to estimate the survival probability in different age groups. RESULTS A total of 3686 patients were included in our study. The median age of the patients was 28 years (IQR: 9, 47) with the majority being males (73.6%). Almost one-third of the patients were within the age group of 0-14 (30.4%). Most of the patients (79.9%) had a diagnosis of traumatic brain injury (TBI). The overall in-hospital mortality was 18% (664), but higher at 39.0% among patients over 65 years of age. Probability of survival decreased with increase of age. CONCLUSION Falling from height is a common injury mechanism in India, occurring more in young males and usually associated with TBI. Isolated TBI and TBI associated with other injuries are the main contributors of mortality in fall injuries. Mortality from these injuries increased with age and ISS.
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Wang J, Liu N, Zhao X. Assessing the relationship between hearing impairment and falls in older adults. Geriatr Nurs 2022; 47:145-150. [PMID: 35914491 DOI: 10.1016/j.gerinurse.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022]
Abstract
Falls and fall-related injuries are the major sources of mortality, disability, and dysfunction among older people. The study aimed to examine the association between hearing impairment and falls in Chinese older adults, using data from the Chinese Longitudinal Healthy Longevity Survey. The outcome variable was experienced falls in the past year, and the exposure variable was hearing impairment. The odds ratio (OR) of falls was 1.51 and 1.47 for men and women with hearing impairment than those without hearing impairment after adjusting for covariates. For participants aged 60-69 years, 70-79 years, 80-89 years, and ≥ 90 years, the OR of risk of falls associated with hearing impairment was 2.80, 1.41, 1.50 and 1.44, respectively. These results suggested that there was an association between hearing impairment and falls. Older adults with hearing impairment had a higher risk of falls than those without hearing impairment in the Chinese older population.
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Affiliation(s)
- Jin Wang
- Faculty of Sport Science, Ningbo University, Ningbo, Zhejiang, China
| | - Nan Liu
- Faculty of Sport Science, Ningbo University, Ningbo, Zhejiang, China
| | - Xiaoguang Zhao
- Faculty of Sport Science, Ningbo University, Ningbo, Zhejiang, China; Research Academy of Grand Health, Ningbo University, Ningbo, Zhejiang, China.
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Zhao X, Yu J, Hu F, Chen S, Liu N. Association of body mass index and waist circumference with falls in Chinese older adults. Geriatr Nurs 2022; 44:245-250. [DOI: 10.1016/j.gerinurse.2022.02.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022]
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Crowson MG, Beyea JA, Cottrell J, Karmali F, Lampasona G, Saunders JE, Lewis RF. The predictive power of geographic health care utilization for unintentional fatal fall rates. BMC Public Health 2022; 22:328. [PMID: 35172791 PMCID: PMC8848674 DOI: 10.1186/s12889-022-12731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Falls are the leading cause of fatal and nonfatal injuries among adults over 65 years old. The increase in fall mortality rates is likely multifactorial. With a lack of key drivers identified to explain rising rates of death from falls, accurate predictive modelling can be challenging, hindering evidence-based health resource and policy efforts. The objective of this work is to examine the predictive power of geographic utilization and longitudinal trends in mortality from unintentional falls amongst different demographic and geographic strata. Methods This is a nationwide, retrospective cohort study using the United States Centers for Disease Control (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS) database. The exposure was death from an unintentional fall as determined by the CDC. Outcomes included aggregate and trend crude and age-adjusted death rates. Health care utilization, reimbursement, and cost metrics were also compared. Results Over 2001 to 2018, 465,486 total deaths due to unintentional falls were recorded with crude and age-adjusted rates of 8.42 and 7.76 per 100,000 population respectively. Comparing age-adjusted rates, males had a significantly higher age-adjusted death rate (9.89 vs. 6.17; p < 0.00001), but both male and female annual age-adjusted mortality rates are expected to rise (Male: + 0.25 rate/year, R2= 0.98; Female: + 0.22 rate/year, R2= 0.99). There were significant increases in death rates commensurate with increasing age, with the adults aged 85 years or older having the highest aggregate (201.1 per 100,000) and trending death rates (+ 8.75 deaths per 100,000/year, R2= 0.99). Machine learning algorithms using health care utilization data were accurate in predicting geographic age-adjusted death rates. Conclusions Machine learning models have high accuracy in predicting geographic age-adjusted mortality rates from health care utilization data. In the United States from 2001 through 2018, adults aged 85+ years carried the highest death rate from unintentional falls and this rate is forecasted to accelerate. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12731-x.
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Affiliation(s)
- Matthew Gordon Crowson
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114, USA. .,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA.
| | - Jason A Beyea
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.,ICES Queen's, Queen's University, Kingston, Ontario, Canada
| | - Justin Cottrell
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Faisal Karmali
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Giovanni Lampasona
- Faculté de Médecine et des Sciences de la Santé, l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - James E Saunders
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA
| | - Richard F Lewis
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, 243 Charles Street, Boston, MA, 02114, USA.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
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Zhang K, Qi J, Zuo P, Yin P, Liu Y, Liu J, Wang L, Li L. The mortality trends of falls among the elderly adults in the mainland of China, 2013-2020: A population-based study through the National Disease Surveillance Points system. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 19:100336. [PMID: 35257118 PMCID: PMC8897056 DOI: 10.1016/j.lanwpc.2021.100336] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Fall in elderly is a major public health problem. Characterizing trends in fall mortality in different subpopulations could help identifying the needs and developing preventive program for target groups. Here we evaluated the trends of fall-related deaths in Chinese mainland among adults aged ≥60 years specific in sex, age, and provinces, to measure the change in this mortality rate between 2013 and 2020, and to explore the underlying factors influencing this change. METHODS Mortality data were retrieved from the National Disease Surveillance Points system(DSPs) of China, a national-level and provincial-level representative data source, to estimate the impact of elderly falls on mortality in the mainland of China and the specific provinces from 2013 to 2020. The joinpoint regression model was used to estimate the temporal trend of mortality in elderly fallen by calculating the annual percentage change (APC). FINDINGS The age-standardized falls mortality was 10·438 per 100 000 in 2020. The age-standardized mortality of elderly falls in total and female showed a steady increasing trend (APC=1·96%, p = 0·023 total; APC=3·42%, p = 0·003 female), with it was stable in males (APC=1.26%, p>0·05). Fall mortality among the elderly was more common in people over 70 years of age and increased sharply. The death rates and APCs were highest among the oldest age groups(aged≥85 years). The higher fall mortality was mainly focused in the southeast and central regions, and lower rates were in the northeast provinces and Tibet. INTERPRETATION Since 2013, the overall fall-related mortality trend among individuals aged ≥60 years has been consistently increasing in China, making it most critical public health challenge. Adherence interventions and increased social support for those at most risk should be considered. FUNDING None.
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Affiliation(s)
- Kaiting Zhang
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, Guangdong Province, China
- School of Public Health, Shantou University, Shantou 515041, Guangdong Province, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Peijun Zuo
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, Guangdong Province, China
- School of Public Health, Shantou University, Shantou 515041, Guangdong Province, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou 515041, Guangdong Province, China
- School of Public Health, Shantou University, Shantou 515041, Guangdong Province, China
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Ye P, Er Y, Wang H, Fang L, Li B, Ivers R, Keay L, Duan L, Tian M. Burden of falls among people aged 60 years and older in mainland China, 1990-2019: findings from the Global Burden of Disease Study 2019. Lancet Public Health 2021; 6:e907-e918. [PMID: 34838197 PMCID: PMC8646839 DOI: 10.1016/s2468-2667(21)00231-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Falls in older people have become a major public health concern worldwide, but a comprehensive assessment of the burden of falls for older people in mainland China has not been done. We aimed to investigate the burden of falls among older people at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. METHOD Using data from GBD 2019, we estimated the burden of falls among people aged 60 years and older by sex and age group in terms of incidence, mortality, and disability-adjusted life-year (DALY) rates and assessed these indicators at the subnational level in 31 geographical units (hereafter called provinces). We investigated the overall trend in the burden of falls across these 31 provinces from 1990 to 2019, and assessed the change in the burden of falls by sex, age group (60-64, 65-69, 70-74, 75-79, and ≥80 years), and province between 1990 and 2019. FINDINGS In 2019, in mainland China, the incidence rate of falls among people aged 60 years and older was 3799·4 (95% uncertainty interval [UI] 3062·4-4645·0) new falls per 100 000 population, and 39·2 deaths (21·8-48·8) per 100 000 population and 1238·9 DALYs (920·5-1553·2) per 100 000 population were due to falls. We found no significant difference in the burden of falls between males and females. The incidence, mortality, and DALY rates of falls for people aged 80 years and older were significantly higher than those in the other age groups, except for incidence rate, which was non-significantly different between the age 75-79 years group and the oldest age group. Large variations in the incidence and DALY rates of falls were observed across 31 provinces. Although between 1990 and 2019 we found no significant changes in overall mortality due to falls in all provinces and in DALY rates for 23 provinces (DALY rates significantly decreased in two provinces and increased in six provinces), we found large increases in the incidence rate of falls in both males (percentage change between 1990 and 2019: 82·9% [67·4-100]) and females (77·0% [63·3-91·8]). The percentage change in incidence rate of falls between 1990 and 2019 varied from 50·0% (42·2-59·5) for people aged 60-64 years to 123·8% (105·4-141·9) for people aged 80 years and older. All provinces had significant increases in the incidence rate of falls between 1990 and 2019, with Sichuan having the greatest increase (148·5% [125·5-171·4]) and Jilin the smallest increase (14·7% [3·6-26·1]). INTERPRETATION Between 1990 and 2019, the incidence rate of falls increased substantially in older adults across mainland China, whereas the rates of mortality and DALY of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Nevertheless, falls remain an ongoing health burden for older people in mainland China, and there is an urgent need to introduce system-wide, integrated, and cost-effective measures to protect and support older people to minimise their risks and combat an increasing absolute burden as the population continues ageing. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Pengpeng Ye
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia; National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Yuliang Er
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Haidong Wang
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Lijie Fang
- School of Sociology and Population Studies, Renmin University of China, Beijing, China
| | - Bingqin Li
- Faculty of Medicine and Health and Social Policy Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia; School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia; School of Optometry and Vision Science, UNSW Sydney, Sydney, NSW, Australia
| | - Leilei Duan
- National Centre for Non-Communicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Maoyi Tian
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia; The George Institute for Global Health at Peking University Health Science Centre, Beijing, China; School of Public Health, Harbin Medical University, Harbin, China.
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Wang Z, Hu Y, Peng F. Long-Term Trends in Unintentional Fall Mortality in China: A Population-Based Age-Period-Cohort Study. Front Public Health 2021; 9:749295. [PMID: 35024364 PMCID: PMC8744467 DOI: 10.3389/fpubh.2021.749295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/05/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Unintentional falls seriously threaten the life and health of people in China. This study aimed to assess the long-term trends of mortality from unintentional falls in China and to examine the age-, period-, and cohort-specific effects behind them. Methods: This population-based multiyear cross-sectional study of Chinese people aged 0–84 years was a secondary analysis of the mortality data of fall injuries from 1990 to 2019, derived from the Global Burden of Disease Study 2019. Age-standardized mortality rates of unintentional falls by year, sex, and age group were used as the main outcomes and were analyzed within the age-period-cohort framework. Results: Although the crude mortality rates of unintentional falls for men and women showed a significant upward trend, the age-standardized mortality rates for both sexes only increased slightly. The net drift of unintentional fall mortality was 0.13% (95% CI, −0.04 to 0.3%) per year for men and −0.71% (95% CI, −0.96 to −0.46%) per year for women. The local drift values for both sexes increased with age group. Significant age, cohort, and period effects were found behind the mortality trends of the unintentional falls for both sexes in China. Conclusions: Unintentional falls are still a major public health problem that disproportionately threatens the lives of men and women in China. Efforts should be put in place urgently to prevent the growing number of fall-related mortality for men over 40 years old and women over 70 years old. Gains observed in the recent period, relative risks (RRs), and cohort RRs may be related to improved healthcare and better education.
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Affiliation(s)
- Zhenkun Wang
- Outpatient Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Scientific Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youzhen Hu
- Outpatient Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Peng
- Outpatient Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Fang Peng
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14
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Su FY, Fu ML, Zhao QH, Huang HH, Luo D, Xiao MZ. Analysis of hospitalization costs related to fall injuries in elderly patients. World J Clin Cases 2021; 9:1271-1283. [PMID: 33644194 PMCID: PMC7896694 DOI: 10.12998/wjcc.v9.i6.1271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/03/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With the aging world population, the incidence of falls has intensified and fall-related hospitalization costs are increasing. Falls are one type of event studied in the health economics of patient safety, and many developed countries have conducted such research on fall-related hospitalization costs. However, China, a developing country, still lacks large-scale studies in this area.
AIM To investigate the factors related to the hospitalization costs of fall-related injuries in elderly inpatients and establish factor-based, cost-related groupings.
METHODS A retrospective study was conducted. Patient information and cost data for elderly inpatients (age ≥ 60 years, n = 3362) who were hospitalized between 2016 and 2019 due to falls was collected from the medical record systems of two grade-A tertiary hospitals in China. Quantile regression (QR) analysis was used to identify the factors related to fall-related hospitalization costs. A decision tree model based on the chi-squared automatic interaction detector algorithm for hospitalization cost grouping was built by setting the factors in the regression results as separation nodes.
RESULTS The total hospitalization cost of fall-related injuries in the included elderly patients was 180479203.03 RMB, and the reimbursement rate of medical benefit funds was 51.0% (92039709.52 RMB/180479203.03 RMB). The medical material costs were the highest component of the total hospitalization cost, followed (in order) by drug costs, test costs, treatment costs, integrated medical service costs and blood transfusion costs The QR results showed that patient age, gender, length of hospital stay, payment method, wound position, wound type, operation times and operation type significantly influenced the inpatient cost (P < 0.05). The cost grouping model was established based on the QR results, and age, length of stay, operation type, wound position and wound type were the most important influencing factors in the model. Furthermore, the cost of each combination varied significantly.
CONCLUSION Our grouping model of hospitalization costs clearly reflected the key factors affecting hospitalization costs and can be used to strengthen the reasonable control of these costs.
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Affiliation(s)
- Fei-Yue Su
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Mei-Ling Fu
- Department of Medical Insurance, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qing-Hua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Huan-Huan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Di Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ming-Zhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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15
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Chen B, Shin S. Bibliometric Analysis on Research Trend of Accidental Falls in Older Adults by Using Citespace-Focused on Web of Science Core Collection (2010-2020). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041663. [PMID: 33572483 PMCID: PMC7916410 DOI: 10.3390/ijerph18041663] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
The present study aimed to identify the trends in research on accidental falls in older adults over the last decade. The MeSH (Medical Subject Headings) and entry terms were applied in the Web of Science Core Collection. Relevant studies in English within articles or reviews on falls in older adults were included from 2010 to 2020. Moreover, CiteSpace 5.6.R5 (64-bit) was adopted for analysis with scientific measurements and visualization. Cooper Cyrus, Stephen R Lord, Minoru Yamada, Catherine Sherrington, and others have critically impacted the study of falls in older adults. Osteoporosis, dementia, sarcopenia, hypertension, osteosarcopenia, traumatic brain injury, frailty, depression, and fear of falling would be significantly correlated with falls in older adults. Multiple types of exercise can provide effective improvements in executive cognitive performance, gait performance, quality of life, and can also lower the rates of falls and fall-related fractures. Fall detection, hospitalization, classification, symptom, gender, and cost are the current research focus and development direction in research on falls in older adults. The prevention of falls in older adults is one of the most important public health issues in today’s aging society. Although lots of effects and research advancements had been taken, fall prevention still is uncharted territory for too many older adults. Service improvements can exploit the mentioned findings to formulate policies, and design and implement exercise programs for fall prevention.
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Affiliation(s)
- Boyuan Chen
- School of Physical Education (Main Campus), Zhengzhou University, Zhengzhou 450001, China;
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
| | - Sohee Shin
- School of Sport and Exercise Science, University of Ulsan, 93 Daehak-ro, Nam-gu, Ulsan 44610, Korea
- Correspondence:
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16
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Li F, Wen S, Tang Q, Zhou Q, Hao Y, Sun C. Impact of injury-related deaths on life expectancy in China, 2016. CAD SAUDE PUBLICA 2020; 36:e00123719. [PMID: 33237201 DOI: 10.1590/0102-311x00123719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 04/17/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to illustrate the impact of injury-related deaths on life expectancy in China in 2016 and to identify the high-risk population. Standard life tables were used to calculate life expectancy and cause-eliminated life expectancy by utilizing mortality data from the national mortality surveillance system. In 2016, the life expectancy of Chinese residents was 78.91 years. After eliminating injury-related mortality, the life expectancy of the residents increased by 1.13 years, which was higher in male and rural residents compared with female and urban residents. The life expectancy on the Eastern and Central regions increased slowly compared with the Western region. The greatest influencing factor on life expectancy was road traffic injuries, followed by falls. Falls had a greater impact on life expectancy for children under 5 years old and those aged over 65 years. This study indicates that deaths caused by injury had a noteworthy impact on life expectancy in China. More attention should be paid to road traffic injuries, and effective preventive measures should be taken to reduce deaths related to injury to increase the life expectancy of residents, especially in children under 5 years and adults over 65 years. By reducing the deaths caused by injury, the life expectancy level is likely to further improve.
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Affiliation(s)
- Fangwei Li
- Department of Social Medicine and Health Management, Zhengzhou University, Zhengzhou, China
| | - Shujing Wen
- Petrochemical Hospital of Luoyang, Luoyang, China
| | - Qixin Tang
- Department of Social Medicine and Health Management, Zhengzhou University, Zhengzhou, China
| | - Qianyu Zhou
- Department of Social Medicine and Health Management, Zhengzhou University, Zhengzhou, China
| | - Yibin Hao
- Zhengzhou People's Hospital, Zhengzhou, China
| | - Changqing Sun
- Department of Social Medicine and Health Management, Zhengzhou University, Zhengzhou, China
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Zhang YJ, Fu SH, Zhu Q, Ning CX, Luan FX, Zhang F, Zhao YL, Yao Y. Underweight in Men had a Closer Relationship with Falls than Women in Centenarians. J Nutr Health Aging 2020. [DOI: 10.1007/s12603-020-1508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Mekkodathil A, El-Menyar A, Kanbar A, Hakim S, Ahmed K, Siddiqui T, Al-Thani H. Epidemiological and clinical characteristics of fall-related injuries: a retrospective study. BMC Public Health 2020; 20:1186. [PMID: 32727594 PMCID: PMC7388431 DOI: 10.1186/s12889-020-09268-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Fall-related injuries are important public health problem worldwide. We aimed to describe the epidemiological and clinical characteristics of fall-related injuries in a level 1 trauma center. Method A retrospective analysis of Qatar Trauma Registry data was conducted on patients admitted for fall-related injuries between 2010 and 2017. Comparative analyses of data by gender, age-groups and height of falls were performed to describe the epidemiological and clinical characteristics of patients, and in-hospital outcomes. Results A total of 4040 patients with fall-related injuries were identified in the study duration which corresponds to the rate of 2.34 per 10,000 population. Although the rate of fall-related injuries decreased over the years, the average number of patients per year remained high accounting for 32% of the hospitalized patients with moderate to severe injuries. Most of the injuries affected the head (36%) followed by spines (29%) and chest (23%). Males were predominant (89%), more likely to fall at workplace, fall from a greater height and have polytrauma than females. The working age-group (20–59 years) constituted the majority of injured (73%) and were more likely to fall at workplace, and to fall from higher heights compared to the older adults who sustained more fall at home. Overall in-hospital mortality was 3%. Outcomes including longer hospital length of stay and mortality were generally correlated with the height of fall except for the fall at home. Conclusion Fall-related injuries remain as significant burden even in a level 1 trauma center. Variations in the pattern of injuries by age, gender and height of fall provide important information for targeted preventive measures.
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Affiliation(s)
- Ahammed Mekkodathil
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma & Vascular Surgery Section, Hamad General Hospital , PO Box 3050, Doha, Qatar. .,Clinical Medicine, Weill Cornell Medical College, Doha, Qatar.
| | - Ahad Kanbar
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Suhail Hakim
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Tariq Siddiqui
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery, Trauma &Vascular Surgery Section, HGH, Doha, Qatar
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Pellicer-García B, Antón-Solanas I, Ramón-Arbués E, García-Moyano L, Gea-Caballero V, Juárez-Vela R. Risk of Falling and Associated Factors in Older Adults with a Previous History of Falls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114085. [PMID: 32521701 PMCID: PMC7312873 DOI: 10.3390/ijerph17114085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022]
Abstract
Falls in the elderly are one of the main geriatric syndromes and a clear indicator of fragility in the older adult population. This has serious consequences, leading to an increase in disability, institutionalization and death. The purpose of this cross-sectional study was to analyze the prevalence of risk of falling and associated factors in a population of 213 non-institutionalised, able older adults with a history of falling in the previous year. We used the following assessment tools: Questionnaire of the WHO for the study of falls in the elderly, Geriatric Depression Scale and Tinetti’s Gait and Balance Assessment Tool. Age, using ambulatory assistive devices, polymedication, hospital admission following a fall and depression were significantly associated with risk of falling. In order to prevent fall reoccurrence, community-based fall prevention programs should be implemented.
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Affiliation(s)
- Begoña Pellicer-García
- Servicio Aragonés de Salud, Sector Alcañiz Atención Primaria, Centro de Salud Andorra Calle Huesca s/n, 44500 Andorra, Teruel, Spain;
| | - Isabel Antón-Solanas
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Autovía A-23 Zaragoza-Huesca Km. 299, 50830 Villanueva de Gállego, Zaragoza, Spain;
- Correspondence:
| | - Enrique Ramón-Arbués
- Faculty of Health Sciences, Universidad San Jorge, Campus Universitario, Villanueva de Gállego, Autovía A-23 Zaragoza-Huesca Km. 299, 50830 Villanueva de Gállego, Zaragoza, Spain;
| | - Loreto García-Moyano
- Servicio Aragonés de Salud, Hospital General San Jorge, Av. Martínez de Velasco 36, 22004 Huesca, Spain;
| | - Vicente Gea-Caballero
- Nursing School La Fe, adscript center of University of Valencia, Research Group GREIACC, Health Research Institute La Fe, Valencia (Spain), Pabellón Docente, Torre H, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Raúl Juárez-Vela
- School of Nursing, University of La Rioja, Research Group PBM Idi-Paz, C/Duquesa de la Victoria 88, 26004 Logroño, La Rioja, Spain;
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