Benzodiazepines and hip fractures in elderly people: case-control study

ObjectiveTo determine whether benzodiazepines are associated with an increased risk of hip fracture.DesignCase-control study.ParticipantsAll incident cases of hip fracture not related to traffic accidents or cancer in patients over 65 years of age. 245 cases were matched to 817 controls.SettingEmergency department of a university hospital.ResultsThe use of benzodiazepines as determined from questionnaires, medical records, or plasma samples at admission to hospital was not associated with an increased risk of hip fracture (odds ratio 0.9, 95% confidence interval 0.5 to 1.5). Hip fracture was, however, associated with the use of two or more benzodiazepines, as determined from questionnaires or medical records but not from plasma samples. Of the individual drugs, only lorazepam was significantly associated with an increased risk of hip fracture (1.8, 1.1 to 3.1).ConclusionExcept for lorazepam, the presence of benzodiazepines in plasma was not associated with an increased risk of hip fracture. The method used to ascertain exposure could influence the results of case-control studies.

What is already known on this topic

Benzodiazepines increase the risk of elderly people falling in a dose dependent wayTheir role in hip fracture remains disputed, with increased risk sometimes attributed to drugs with a longer half life or those used to induce sleep

What this study adds

Benzodiazepines were not associated with hip fracture either as a group or according to half life or to characterisation as hypnotic or anxiolyticPatients using two or more benzodiazepines may be at higher riskPatients using lorazepam or certain other benzodiazepines may also be at a higher risk of fracture     

Patterns of fractures in accidental and non-accidental injury in children: a comparative study.

The incidence and pattern of fractures in children who had been abused were compared with those of fractures sustained by children of similar ages in whom abuse had been excluded. From 1976 to 1982 there were 35 children with fractures resulting from child abuse, and all were aged under 5. Of the 826 children in the control group, seen from January to June 1981, 85% were aged over 5. Abused children were much more likely to have multiple fractures (p less than 0.001) and bruising of the head and neck (p less than 0.001). Fractures of the ribs were common in children who had been abused, and their presence, in the absence of major chest trauma, strongly suggested that abuse was occurring. Injuries to the long bones were invariably spiral or oblique fractures or subperiosteal new bone formation--both "gripping or twisting" injuries. Spiral fracture of the humeral shaft was significantly more common (p less than 0.001) in the group of abused children. Classic metaphyseal chip fractures were uncommon. One child in eight aged under 18 months who sustains a fracture may be a victim of child abuse.     

A prospective study on elderly patients with facial fractures in a developing country

Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low.     

Rapid screening: a comparative study

Although rapid screening of negative and inadequate cervical smears is a quality assurance requirement for all UK laboratories, there has been little attempt to standardize the method and laboratories make use of a number of different techniques and times. The aim of this study was to assess the sensitivity of these various techniques by measuring their ability to pick out known false-negative smears. Completed questionnaires from 123 laboratories across England revealed that 52% of laboratories use a "step" technique, 19% use "turret", 15% use random paths and 34% attempt to rescreen the whole slide quickly. Twenty-two percent of laboratories use a mixture of techniques. Timings are also variable, with the majority of laboratories allowing screeners to review slides at a pace decided by themselves but usually between 1 and 2 min. The study involved 120 participants who performed a total of 24 000 rapid screens. The results showed that, of the 90 abnormal slides used in the study, 62 cases (69%) were identified as abnormal or needing review by more than 50% of participants. Overall rapid screening picked out 58% of high-grade squamous abnormalities, 59% of low-grade abnormalities and 72% of glandular lesions. Step screening performed best, followed by whole slide/random and then turret. One minute was the optimum time and there was a significant fall in performance once individuals attempted to rescreen large numbers (>50). The most significant finding was the marked variation in the performance of individuals using the same slide sets.     

Vitamin D and fractures in the elderly

Osteoporosis and the subsequent fractures caused by this are a source of morbidity and mortality in the elderly population. It is also often the start of the cascade that culminates in frailty and dependence. Vitamin D has a direct relationship with the appearance of osteoporosis and with the risk of fractures. Receptors of this vitamin have also recently been described in other organs and systems of the body that are associated with muscle strength, cancer and overall mortality. Deficiency of this vitamin in the elderly population in Spain is very prevalent, both in the community and the hospitalised elderly. The diagnosis and treatment are straightforward and cheap. Its efficacy in the prevention of osteoporosis and in the appearance of fractures is perfectly demonstrated. In this review, we will look at the physiology and actions of this vitamin, as well as the principal studies that have demonstrated its effectiveness in the elderly population.     

The sarcoplasmic reticulum: a comparative study

The diversity of cellular membrane structures associated with regulation of intracellular calcium level is described in several different groups of organisms and cells. All the instances reported refer to cellular processes related to movement, in which calcium ion acts as trigger and/or modulator. In addition, a simplified five-stage picture of the underlying view of evolution of these structures is presented. In short: the choice made by nature in using calcium as intracellular messenger was very early in the history of life; all cellular structures devoted to intracellular calcium regulation, from the simplest form of amoeba to the highly sophisticated apparatus of mammalian skeletal muscle, can be linked together in the chain of evolution. Because the evidence is still sparse, any conclusion more positive would be speculative and of little value. Hopefully, in the coming years, with a better understanding of membrane architecture as a whole and its protein components (i.e. calcium channels, calcium-binding proteins), we will be able to test the first segments of this evolutionary hypothesis.     

Orfordness and Dungeness: a comparative study

FULLER, R. M., 1989. Orfordness and Dungeness: a comparative study . Dungeness originally developed as a shingle spit from Winchelsea, across the bay which now forms the Romney Marshes and, 700–800 years ago, probably had its distal end between New Romney and Hythe. The structure seems to have been very similar to present-day Orfordness. Then a breach at the spit's origin produced an abrupt change in accretion and erosion patterns with the eventual development of the present-day cuspate foreland. It would seem that Orfordness is on the verge of such a breach, which is prevented by coastal defence works. Much can be learned by comparing physiographic and ecological processes at Orfordness with those at Dungeness, using Orfordness as an historical model for early Dungeness. This paper considers some of the evidence for these conclusions, examines the structures which survive to the present-day and discusses the ecological significance of the features, especially in terms of plant successional developments.     

Pollen capture media: a comparative study

Research laboratories, part of international aerobiological networks are often using different collection media on their exposed tape (or slides). However, their relative pollen capture efficiency has rarely been tested. A single Hirst-trap was used, in Bologna, in February and March 1993, for this experiment. Melinex tapes were divided longitudinally in two equal parts, so that two different media could be tested simultaneously. The tested media were: gelatine/glycerine, hexane/vaseline, silicone/carbon tetrachloride, and paraffin. Each comparisons were repeated on 4 different days. At the time of the sampling, the dominant airborne particles were Cupressaceae andCladosporium. The differences between the different media were non-significant (meanF of different days of 1.720, mean probability of 0.241 (min. of 0.077, max. of 0.356)). The highest probabilities of a significative difference all involved glycerine/gelatine either in comparison with paraffin (0.76), with silicone (0.75), or with vaseline (0.75), while the lowest was for the couple silicone-vaseline (0.59). In general, even if these differences were non-significant, gelatine underestimated spore counts in comparison to silicone, but overestimated them if compared to vaseline or paraffin. However, vaseline looked more efficient then silicone for spore capture. For pollen counts, the same ratios were found, except for the couple silicone-gelatine, which has given similar results. The lowest differences were found withAlternaria andDreschlera, while the highest were found withCladosporium andEpicoccum. The relationship between spore diameter and differences between media was highly significant (τ=?0.786,P=0.027). This was not the case for pollen, withPopulus andAlnus giving the highest differences, andBetula andUlmus the lowest (τ=0.048,P=0.873).     

Vertebrate liver cytokeratins: a comparative study

The structure and composition of intermediate filaments isolated from liver of representatives of different vertebrate classes have been studied by electron microscopy and biochemical and immunochemical methods. It has been shown that the methodological approach for isolation of rat liver intermediate filaments can be efficiently applied to all other classes of vertebrates. The intermediate filaments studied have the same electron microscopic morphology and are species undistinguishable. The molecular weight of intermediate filament proteins varies from 40,000 to 60,000 and their isoelectric point varies from 5.0 to 6.45. Immunological investigations show that in all animals studied the intermediate filaments are built up of cytokeratins belonging to both types of keratins: type I and type II. Only one protein of the type II cytokeratins is present in all vertebrate classes, whereas in lower vertebrates two or even three type I cytokeratins contribute to the structure of liver intermediate filaments. The biochemical and immunochemical results are discussed with regard to the evolution of liver cytokeratins.     

Ultrastructure of the corneal stroma: a comparative study.

Using a high intensity synchrotron x-ray source, we have recorded diffraction over a range of angles from the corneas of a wide variety of species. The results show that the interfibrillar Bragg spacing varies from 39 nm to 67 nm, the fibril diameter varies from 24 nm to 43 nm, but in the species studied intermolecular Bragg spacing is constant (1.58 +/- 0.03 nm). Using these data, a number of other structural parameters were calculated including the interfibrillar volume, V, and the surface-to-surface fibril separation, S. Large variations were found, particularly between aquatic and terrestrial animals. We found that the parameter which appears to be most constant throughout the species was the volume fraction, that is, the proportion of the tissue occupied by the hydrated fibrils. Ignoring the volume of the stroma occupied by cells, the tissue fibril volume fraction was (28 +/- 3)% for both aquatic and land animals. The observation of a constant volume fraction led us to propose a simple model in which collagen molecules and interfibrillar glycosaminoglycans occur in a fixed ratio in all the species--thus species with narrow fibrils have fewer interfibrillar glycosaminoglycans and the fibrils are thus more closely spaced, and vice versa. This model agrees with many of the experimental data on corneal composition and on the physical properties of the tissue reported in the literature.     

Hepatocyte polarity and the peroxisomal compartment: a comparative study

In search of factors that regulate the phenotype of the peroxisomal compartment in wild-type liver parenchymal cells, we compared hepatocyte polarity to peroxisome differentiation, using adult liver as the standard. Differentiation parameters were evaluated in a three-dimensional culture model (spheroid), in 'sandwich' and monolayer primary hepatocyte cultures, and in 15.5 and 18.5-day-old foetal rat liver.Peroxisomes, studied by immunohistochemistry, enzyme histochemistry, and catalase specific activity, were better differentiated depending on foetal age (day 18.5 > day 15.5) and culture type (spheroid > sandwich > monolayer). The hepatocyte polarity markers ATP-, ADP-, and AMP-hydrolysing activities were, in all models, mislocalized at the lateral plasma membrane, whereas in contrast the multidrug resistance-associated protein 2 (mrp2) antigen was always correctly immunolocalized at the apical membrane domain. In cultures, the correct secretion of fluorescein (mrp2-mediated) into bile canaliculi was observed. Bile canaliculi (branching, ultrastructure and immunolocalization of the tight-junction associated protein ZO-1), were better differentiated in 18.5 than in 15.5-day-old foetal liver and in spheroid > sandwich > monolayer cultures.Our results show a parallelism between changes of the peroxisomal compartment and bile canalicular structure together with mrp2-mediated secretory function. Distinct polarization characteristics do not necessarily change simultaneously, suggesting different regulatory mechanisms.