human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Climatic conditions may affect the incidence of fractures and fall deaths . Analysis of national fatality data shows that among white women , those living in colder climates have higher rates of fall deaths . Fall deaths increase in winter in all regions , but especially so in colder states . In a prospect i ve cohort study of 96,506 predominantly white female nurses 35 - 59 years of age , we found that , after controlling for personal and lifestyle characteristics , those women residing in colder climate also had a higher incidence of hip and forearm fracture . In colder states , fracture rates were substantially higher in winter than in summer . A cold climate appears to be a significant risk factor for both fractures and fall deaths among white women , particularly as they age Objectives . Falls among old people is a well-documented phenomenon ; however , falls among people living in the community and receiving home help services have been under- research ed . The aim of this study was to investigate the incidence , including possible seasonal variation , circumstances and injuries related to falls among community living home help receivers , and to investigate whether fall incidence is associated with the type and amount of home help services received . Study design . Prospect i ve cohort study . Methods . All 614 persons aged 65 and over who were living in a particular northern Swedish community and receiving municipality home help were included . Data on age , sex and home help service use were collected from home help service records , and falls were reported by staff on report forms specifically design ed for the study . Results . A total number of 264 falls  were recorded among 122 participants . The overall fall incidence was 626 per 1,000 PY , and incidence rate ratios were significantly correlated to the total amount of services used ( p&0.001 ) , as well as to the degree of help for I-ADL needs ( p&0.001 ) , P-ADL needs ( p&0.001 ) and escort service ( p=0.007 ) . The proportion of falls reported as result ing in injury was 33 % . The monthly fall incidence was significantly associated to daylight photoperiod , however it was not associated to temperature . Conclusions . Fall incidence among home help receivers aged 65 and over seems correlated to the amount of services they receive . This is probably explained by the fact that impairments connected to ADL limitations and home help needs also are connected to an increased risk of falls . This implies that fall prevention should be considered when planning home help care for old people with ADL limitations . Further research on the connection between daylight photoperiod and fall incidence in population s at different latitudes is needed Objective —To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older . Population and methods —A prospect i ve , population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997 , a total of 459 904 person years . Cases were identified through a prospect i ve registration system . Results —There were 10 992 ( 2390 per 100 000 person years ) fall related fractures . The risk was higher in the colder seasons ( October through March ) among people aged 65–79 years ( relative risk ( RR ) = 1.39 , 95 % confidence interval ( CI ) 1.32 to 1.47 ) and in people aged 80 years and older ( RR = 1.17 , 95 % CI 1.09 to 1.22 ) . For arm fractures , the RR was 1.69 ( 95 % CI 1.56 to 1.83 ) among people aged 65–79 years and 1.30 ( 95 % CI 1.13 to 1.43 ) among those aged 80 years and older . The RR for hip fractures was 1.27 ( 95 % CI 1.15 to 1.37 ) among people aged 65–79 years and 1.08 ( 95 % CI 1.00 to 1.15 ) for people aged 80 years and older . Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months . Conclusion —Season affects the incidence of all types of fractures in elderly people . Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect . Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture , but the size of the effect is difficult to estimate with certainty The type of environmental hazards implicated in the aetiology of a consecutive series of 787 hip-fracture patients was prospect ively studied . Most falls occurred between 09 h 00 and midday and there was no seasonal variation . Fifty-one different environmental hazards were implicated in the aetiology of the fall for 58 % of patients . The nature of environmental hazards was diverse , implying that measures to reduce the risk of falls due to these factors are unlikely to lead to a significant reduction in the incidence of hip fractures BACKGROUND knowledge of the circumstances and consequences of falls in older adults is important for underst and ing the aetiology of falls as well as for effective clinical assessment and design of fall prevention strategies . Such data , however , are relatively scarce , especially in community-dwelling elders . METHOD accidental falls ( including their circumstances and consequences ) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospect ively for 1 year . After the monitoring period , participants were divided into three groups based on fall status : non-fallers ( n = 46 ) ,  one-time fallers ( n = 27 ) and recurrent fallers ( n = 23 ) . Frequency distributions were created for selected circumstances and consequences of falls and the prevalence of these consequences were examined . RESULTS 50 participants ( 52 % ) fell during the 1 year period , amassing 91 falls . Trips and slips were the most prevalent causes of falls , accounting for 59 % of falls . Falls most often occurred during the afternoon and while subjects walked on level or uneven surfaces . Fallers most commonly attributed falls to hurrying too much . Fractures result ed from five of the 91 falls and eight other falls result ed in soft tissue injuries that required treatment by a physician . There were no differences between one-time and recurrent fallers in the circumstances and consequences of falls . However , several notable differences were found between men ( n = 20 ) and women ( n = 30 ) who fell . Falls by men most often result ed from slips whereas falls by women most often result ed from trips . Moreover , women and men differed in the time of the year in which falls occurred , with men falling most often during winter and women during summer . CONCLUSIONS the results of this study provide insight into the circumstances and consequences of falls among independent community-dwelling older adults and suggest some possible ways of preventing falls . Preventive services , however , should not solely target recurrent fallers , nor should the type of services necessarily differ for one-time and recurrent fallers INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia A prospect i ve analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogenous , elderly urban population . Special emphasis was placed on the season of year , time of day , location of fall , and other circumstances in which the fracture occurred . All patients were community dwelling , cognitively intact , previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture . Most fractures occurred at home , particularly in patients who were older , less healthy , and poorer ambulators . More than 75 % of fractures result ed from a fall while the patient was st and ing or walking . Most falls occurred during daylight hours with a peak seen in the afternoon . No seasonal variation in the incidence of hip fractures was observed BACKGROUND Although the circumstances surrounding falls among community-dwelling elderly people have been described by numerous studies , there are few that have reported falls in the northern regions of Japan , such as Hokkaido , that experience a severe winter with heavy snow . As a preliminary study , we surveyed the circumstances of falls among community-dwelling elderly people in Hokkaido with a self-administered question naire . METHODS Residents living in private homes throughout Hokkaido were r and omly contacted by telephone and those aged over 65 years were recruited for this study . In all , 1000 subjects participated in the survey . A question naire was used to obtain the histories of falls , including the number of falls , the season and place of occurrence , and the cause of the falls in the year prior to the survey . RESULTS Of the 1000 subjects , 849 ( 436 men and 413 women ; mean age , 73.0 years ) completed the question naire . Among the 849 subjects , 277 ( 32.6 % ) fell at least once during the year of the survey . Of these 277 subjects , 155 subjects ( 56.0 % ) experienced two or more falls in the year . Approximately 60 % of the falls occurred during the winter . The most common location where falls occurred was on roads or sidewalks , and slipping was the most prevalent cause . CONCLUSION Our findings revealed several aspects regarding the circumstances surrounding falls among community-dwelling elderly people in Hokkaido Six hours of mild surface cooling in moving air at 24 degrees C with little fall in core temperature ( 0.4 degree C ) increased the packed cell volume by 7 % and increased the platelet count and usually the mean platelet volume to produce a 15 % increase in the fraction of plasma volume occupied by platelets . Little of these increases occurred in the first hour . Whole blood viscosity increased by 21 % ; plasma viscosity usually increased , and arterial pressure rose on average from 126/69 to 138/87 mm Hg . Plasma cholesterol concentration increased , in both high and low density lipoprotein fractions , but values of total lipoprotein and lipoprotein fractions were unchanged . The increases in platelets , red cells , and viscosity associated with normal thermoregulatory adjustments to mild surface cooling provide a probable explanation for rapid increases in coronary and cerebral thrombosis in cold weather . The raised arterial pressure and possibly cholesterol concentration may contribute to slower components of the increased thrombosis Mean deep body temperature fell by 0.4 + /- 0.1 ( SD ) degrees C in five sedentary , clothed 63 - 70 year old men and by 0.1 + /- 0.1 degrees C in four young adults after 2 h exposure in still air at 6 degrees C ( P less than 0.001 ) . The mean increase in systolic and diastolic pressure was significantly greater ( P less than 0.002 ) in the older subjects ( 24 + /- 4 mmHg systolic , 13 + /- 4 mmHg diastolic ) than in the young ( 14 + /- 6 mmHg systolic , 7 + /- 3 mmHg diastolic ) after 2 h at 6 degrees C. A small rise in blood pressure occurred in the older men at 12 degrees C , but there was no increase in either group at 15 degrees C. The association of variables is particularly marked between systolic blood pressure and core temperature changes at 6 degrees C. There were no appreciable cold-adaptive changes in blood pressure or thermoregulatory responses after 7 - 10 days repeated exposure to 6 degrees C for 4 h each day . Blood pressure elevation in the cold was slower but more marked in the older men . These changes in blood pressure may provide a possible basis for delineating low domestic limiting temperature conditions As the elderly population increases and they lead more active and healthy lifestyles , their exposure to the threats of injury multiply . Undoubtedly , the geriatric population will comprise a growing percentage of trauma patients . The role of alcohol and drug use in geriatric trauma has not been clearly defined . The purpose of this study is to determine the incidence of  alcohol  and illicit drug  use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years . A retrospective analysis was performed on 3 years of data ( January 1 , 19 
    Output:
    
agent
Ranging from the lower ambient temperature , the presence of snow cover , seasonal factors , and time of the day to location of fall , these factors have different levels of impact related to higher incidence or mortality of fall .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Climatic conditions may affect the incidence of fractures and fall deaths . Analysis of national fatality data shows that among white women , those living in colder climates have higher rates of fall deaths . Fall deaths increase in winter in all regions , but especially so in colder states . In a prospect i ve cohort study of 96,506 predominantly white female nurses 35 - 59 years of age , we found that , after controlling for personal and lifestyle characteristics , those women residing in colder climate also had a higher incidence of hip and forearm fracture . In colder states , fracture rates were substantially higher in winter than in summer . A cold climate appears to be a significant risk factor for both fractures and fall deaths among white women , particularly as they age Objectives . Falls among old people is a well-documented phenomenon ; however , falls among people living in the community and receiving home help services have been under- research ed . The aim of this study was to investigate the incidence , including possible seasonal variation , circumstances and injuries related to falls among community living home help receivers , and to investigate whether fall incidence is associated with the type and amount of home help services received . Study design . Prospect i ve cohort study . Methods . All 614 persons aged 65 and over who were living in a particular northern Swedish community and receiving municipality home help were included . Data on age , sex and home help service use were collected from home help service records , and falls were reported by staff on report forms specifically design ed for the study . Results . A total number of 264 falls  were recorded among 122 participants . The overall fall incidence was 626 per 1,000 PY , and incidence rate ratios were significantly correlated to the total amount of services used ( p&0.001 ) , as well as to the degree of help for I-ADL needs ( p&0.001 ) , P-ADL needs ( p&0.001 ) and escort service ( p=0.007 ) . The proportion of falls reported as result ing in injury was 33 % . The monthly fall incidence was significantly associated to daylight photoperiod , however it was not associated to temperature . Conclusions . Fall incidence among home help receivers aged 65 and over seems correlated to the amount of services they receive . This is probably explained by the fact that impairments connected to ADL limitations and home help needs also are connected to an increased risk of falls . This implies that fall prevention should be considered when planning home help care for old people with ADL limitations . Further research on the connection between daylight photoperiod and fall incidence in population s at different latitudes is needed Objective —To investigate seasonal variations in the incidence of fall related fractures among people 65 years and older . Population and methods —A prospect i ve , population based cohort study was performed on people aged 65 years and older followed up from 1990 to 1997 , a total of 459 904 person years . Cases were identified through a prospect i ve registration system . Results —There were 10 992 ( 2390 per 100 000 person years ) fall related fractures . The risk was higher in the colder seasons ( October through March ) among people aged 65–79 years ( relative risk ( RR ) = 1.39 , 95 % confidence interval ( CI ) 1.32 to 1.47 ) and in people aged 80 years and older ( RR = 1.17 , 95 % CI 1.09 to 1.22 ) . For arm fractures , the RR was 1.69 ( 95 % CI 1.56 to 1.83 ) among people aged 65–79 years and 1.30 ( 95 % CI 1.13 to 1.43 ) among those aged 80 years and older . The RR for hip fractures was 1.27 ( 95 % CI 1.15 to 1.37 ) among people aged 65–79 years and 1.08 ( 95 % CI 1.00 to 1.15 ) for people aged 80 years and older . Slipping on ice and snow seems to entirely explain the excessive incidence of hip and arm fractures during winter months . Conclusion —Season affects the incidence of all types of fractures in elderly people . Slipping on ice and snow seems to be a causal mechanism behind the seasonal effect . Preventive measures targeting this causal mechanism are likely to reduce the risk of fracture , but the size of the effect is difficult to estimate with certainty The type of environmental hazards implicated in the aetiology of a consecutive series of 787 hip-fracture patients was prospect ively studied . Most falls occurred between 09 h 00 and midday and there was no seasonal variation . Fifty-one different environmental hazards were implicated in the aetiology of the fall for 58 % of patients . The nature of environmental hazards was diverse , implying that measures to reduce the risk of falls due to these factors are unlikely to lead to a significant reduction in the incidence of hip fractures BACKGROUND knowledge of the circumstances and consequences of falls in older adults is important for underst and ing the aetiology of falls as well as for effective clinical assessment and design of fall prevention strategies . Such data , however , are relatively scarce , especially in community-dwelling elders . METHOD accidental falls ( including their circumstances and consequences ) occurring in 96 male and female participants between 60 and 88 years of age were monitored prospect ively for 1 year . After the monitoring period , participants were divided into three groups based on fall status : non-fallers ( n = 46 ) ,  one-time fallers ( n = 27 ) and recurrent fallers ( n = 23 ) . Frequency distributions were created for selected circumstances and consequences of falls and the prevalence of these consequences were examined . RESULTS 50 participants ( 52 % ) fell during the 1 year period , amassing 91 falls . Trips and slips were the most prevalent causes of falls , accounting for 59 % of falls . Falls most often occurred during the afternoon and while subjects walked on level or uneven surfaces . Fallers most commonly attributed falls to hurrying too much . Fractures result ed from five of the 91 falls and eight other falls result ed in soft tissue injuries that required treatment by a physician . There were no differences between one-time and recurrent fallers in the circumstances and consequences of falls . However , several notable differences were found between men ( n = 20 ) and women ( n = 30 ) who fell . Falls by men most often result ed from slips whereas falls by women most often result ed from trips . Moreover , women and men differed in the time of the year in which falls occurred , with men falling most often during winter and women during summer . CONCLUSIONS the results of this study provide insight into the circumstances and consequences of falls among independent community-dwelling older adults and suggest some possible ways of preventing falls . Preventive services , however , should not solely target recurrent fallers , nor should the type of services necessarily differ for one-time and recurrent fallers INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia A prospect i ve analysis was performed on 832 patients to determine the circumstances surrounding falls leading to hip fracture within a homogenous , elderly urban population . Special emphasis was placed on the season of year , time of day , location of fall , and other circumstances in which the fracture occurred . All patients were community dwelling , cognitively intact , previously ambulatory elderly who sustained a femoral neck or intertrochanteric fracture . Most fractures occurred at home , particularly in patients who were older , less healthy , and poorer ambulators . More than 75 % of fractures result ed from a fall while the patient was st and ing or walking . Most falls occurred during daylight hours with a peak seen in the afternoon . No seasonal variation in the incidence of hip fractures was observed BACKGROUND Although the circumstances surrounding falls among community-dwelling elderly people have been described by numerous studies , there are few that have reported falls in the northern regions of Japan , such as Hokkaido , that experience a severe winter with heavy snow . As a preliminary study , we surveyed the circumstances of falls among community-dwelling elderly people in Hokkaido with a self-administered question naire . METHODS Residents living in private homes throughout Hokkaido were r and omly contacted by telephone and those aged over 65 years were recruited for this study . In all , 1000 subjects participated in the survey . A question naire was used to obtain the histories of falls , including the number of falls , the season and place of occurrence , and the cause of the falls in the year prior to the survey . RESULTS Of the 1000 subjects , 849 ( 436 men and 413 women ; mean age , 73.0 years ) completed the question naire . Among the 849 subjects , 277 ( 32.6 % ) fell at least once during the year of the survey . Of these 277 subjects , 155 subjects ( 56.0 % ) experienced two or more falls in the year . Approximately 60 % of the falls occurred during the winter . The most common location where falls occurred was on roads or sidewalks , and slipping was the most prevalent cause . CONCLUSION Our findings revealed several aspects regarding the circumstances surrounding falls among community-dwelling elderly people in Hokkaido Six hours of mild surface cooling in moving air at 24 degrees C with little fall in core temperature ( 0.4 degree C ) increased the packed cell volume by 7 % and increased the platelet count and usually the mean platelet volume to produce a 15 % increase in the fraction of plasma volume occupied by platelets . Little of these increases occurred in the first hour . Whole blood viscosity increased by 21 % ; plasma viscosity usually increased , and arterial pressure rose on average from 126/69 to 138/87 mm Hg . Plasma cholesterol concentration increased , in both high and low density lipoprotein fractions , but values of total lipoprotein and lipoprotein fractions were unchanged . The increases in platelets , red cells , and viscosity associated with normal thermoregulatory adjustments to mild surface cooling provide a probable explanation for rapid increases in coronary and cerebral thrombosis in cold weather . The raised arterial pressure and possibly cholesterol concentration may contribute to slower components of the increased thrombosis Mean deep body temperature fell by 0.4 + /- 0.1 ( SD ) degrees C in five sedentary , clothed 63 - 70 year old men and by 0.1 + /- 0.1 degrees C in four young adults after 2 h exposure in still air at 6 degrees C ( P less than 0.001 ) . The mean increase in systolic and diastolic pressure was significantly greater ( P less than 0.002 ) in the older subjects ( 24 + /- 4 mmHg systolic , 13 + /- 4 mmHg diastolic ) than in the young ( 14 + /- 6 mmHg systolic , 7 + /- 3 mmHg diastolic ) after 2 h at 6 degrees C. A small rise in blood pressure occurred in the older men at 12 degrees C , but there was no increase in either group at 15 degrees C. The association of variables is particularly marked between systolic blood pressure and core temperature changes at 6 degrees C. There were no appreciable cold-adaptive changes in blood pressure or thermoregulatory responses after 7 - 10 days repeated exposure to 6 degrees C for 4 h each day . Blood pressure elevation in the cold was slower but more marked in the older men . These changes in blood pressure may provide a possible basis for delineating low domestic limiting temperature conditions As the elderly population increases and they lead more active and healthy lifestyles , their exposure to the threats of injury multiply . Undoubtedly , the geriatric population will comprise a growing percentage of trauma patients . The role of alcohol and drug use in geriatric trauma has not been clearly defined . The purpose of this study is to determine the incidence of  alcohol  and illicit drug  use in association with mechanism of injury in all elderly trauma patients presenting to level I and II trauma centers in the State of Illinois over 3 years . A retrospective analysis was performed on 3 years of data ( January 1 , 19 
    Output:
    