Care-Related Risk Factors for Hospital-Acquired Pressure Ulcers in Elderly Adults with Hip Fracture

To identify care-related factors associated with increased incidence of hospital-acquired pressure ulcers (HAPU

Assessing the potential of acoustic telemetry to underpin the regional management of basking sharks (Cetorhinus maximus)

Acoustic telemetry can provide valuable space-use data for a range of marine species. Yet the deployment of species-specific arrays over vast areas to gather data on highly migratory vertebrates poses formidable challenges, often rendering it impractical. To address this issue, we pioneered the use of acoustic telemetry on basking sharks (Cetorhinus maximus) to test the feasibility of using broadscale, multi-project acoustic receiver arrays to track the movements of this species of high conservation concern through the coastal waters of Ireland, Northern Ireland, and Scotland. Throughout 2021 and 2022, we tagged 35 basking sharks with acoustic transmitters off the west coast of Ireland; 27 of these were detected by 96 receiver stations throughout the study area (n = 9 arrays) with up to 216 detections of an individual shark (mean = 84, s.d. 65). On average, sharks spent ~ 1 day at each acoustic array, with discrete residency periods of up to nine days. Twenty-one sharks were detected at multiple arrays with evidence of inter-annual site fidelity, with the same individuals returning to the same locations in Ireland and Scotland over 2 years. Eight pairs of sharks were detected within 24 h of each other at consecutive arrays, suggesting some level of social coordination and synchronised movement. These findings demonstrate how multi-project acoustic telemetry can support international, cost-effective monitoring of basking sharks and other highly mobile species. Decision support tools such as these can consolidate cross-border management strategies, but to achieve this goal, collaborative efforts across jurisdictions are necessary to establish the required infrastructure and secure ongoing support

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Cross-national research using contemporary birth cohort studies: a look at early maternal employment in the UK and USA

The recent establishment of two national, longitudinal studies of contemporary birth cohorts in the UK and USA creates a valuable opportunity for cross‐national research on the experiences of young children and their families. This article describes these new datasets and highlights the potential advantages and challenges of their combined use. To illustrate some of the issues involved in comparative research, we describe our study of the patterns and predictors of UK and US mothers’ (re)entry into the labour force during infants’ first 9 months of life. Similar to previous studies, we find that US mothers engage in paid work much sooner after childbirth than UK mothers. In both samples, greater financial and human capital predict higher rates (and earlier entries) of post‐birth employment; however, among the subset of US mothers who were employed pre‐birth, it is socioeconomic disadvantage that predicts sooner returns. We consider how different policy environments in the UK and USA help to explain these findings, and discuss directions for future research with these data

Factors that influence exercise activity among women post hip fracture participating in the Exercise Plus Program

Barbara Resnick1, Denise Orwig2, Christopher D’Adamo2, Janet Yu-Yahiro3, William Hawkes2, Michelle Shardell2, Justine Golden2, Sheryl Zimmerman4, Jay Magaziner21University of Maryland School of Nursing, 655 West Lombard Street, Baltimore, MD,21201, USA; 2University of Maryland School of Medicine, Howard Hall, Redwood Street, Baltimore MD 21201, USA; 3Department of Orthopaedic Surgery, Union Memorial Hospital, Baltimore, USA; 4University of North Carolina Chapel Hill, 301 Pittsboro St., CB#3550, Chapel Hill, NC 27599-3550, USAAbstract: Using a social ecological model, this paper describes selected intra- and interpersonal factors that influence exercise behavior in women post hip fracture who participated in the Exercise Plus Program. Model testing of factors that influence exercise behavior at 2, 6 and 12 months post hip fracture was done. The full model hypothesized that demographic variables; cognitive, affective, physical and functional status; pain; fear of falling; social support for exercise, and exposure to the Exercise Plus Program would influence self-efficacy, outcome expectations, and stage of change both directly and indirectly influencing total time spent exercising. Two hundred and nine female hip fracture patients (age 81.0 ± 6.9), the majority of whom were Caucasian (97%), participated in this study. The three predictive models tested across the 12 month recovery trajectory suggest that somewhat different factors may influence exercise over the recovery period and the models explained 8 to 21% of the variance in time spent exercising. To optimize exercise activity post hip fracture, older adults should be helped to realistically assess their self-efficacy and outcome expectations related to exercise, health care providers and friends/peers should be encouraged to reinforce the positive benefits of exercise post hip fracture, and fear of falling should be addressed throughout the entire hip fracture recovery trajectory.Keywords: hip fracture, exercise, self-efficacy, outcome expectations, recover

Estado e mercado: adversários ou aliados no processo de implementação da Política Nacional de Alimentação e Nutrição? Elementos para um debate sobre medidas de regulamentação State and market: adversaries or allies in the implementation of the National Food and Nutrition Policy? Some reflections on regulation measures

A alimentação e a nutrição constituem requisitos básicos para a promoção e a proteção da saúde, possibilitando a afirmação plena do potencial de crescimento e desenvolvimento humano, com qualidade de vida e cidadania. As mudanças na relação do Estado, sociedade civil e mercado têm trazido uma série de conseqüências sociais adversas, especialmente no campo da saúde e nutrição. Este artigo tem como propósito provocar algumas reflexões relativas à necessidade de pactuação entre Estado, sociedade e mercado para a efetivação de medidas capazes de atuar positivamente no controle da obesidade e conseqüentemente melhorar as condições de saúde e nutrição da população brasileira. Apresenta uma breve descrição de contexto histórico sobre política social no Brasil e seus reflexos específicos na temática de alimentação e nutrição; identifica aspectos políticos principais para uma análise das diretrizes da Política Nacional de Alimentação e Nutrição; destaca o fortalecimento de medidas de regulamentação como estratégia de enfrentamento do problema de excesso de peso / obesidade na sociedade, identificando suas raízes a partir do modo de viver urbano, globalizado e neoliberal das ultimas décadas, e, por fim, sugere elementos para enriquecer esse debate. Medidas de regulamentação parecem poder influenciar positivamente nas ações de promoção da saúde, pois estabelecem limites e um conjunto de critérios para mediar as relações entre sociedade e mercado, além de refletir o apoio e a proteção da saúde do cidadão como objetivo principal do Estado nesse processo.<br>Food and nutrition constitute basic requirements for health promotion and protection, enabling the full expression of the human potential for growth and development, with quality of life and citizenship. Changes in the relationship between State, Civil Society, and the Market have brought several adverse social consequences, particularly in the health and nutrition field. This article intends to stimulate some reflections related to the need of an agreement between State, Civil Society and the Market for the accomplishment of measures that are able to contribute to obesity control and, as a consequence, to improve health and nutrition conditions of the Brazilian population. The article also presents a brief description of the historical context of social policies in Brazil and their specific consequences to food and nutrition matters; it identifies the main political aspects to analyze guidelines of the National Food and Nutrition Policy; it emphasizes the strengthening of regulation measures as a strategy to face the problem of excess of weight / obesity in society, identifying its roots in the urban, 'global' and neoliberal way of life of the last decades and, as a conclusion, it suggests more elements to enrich this debate. Regulation Measures seem to have a positive influence on health promotion actions by setting up the boundaries and criteria to mediate the relationship between Civil Society and the Market, besides reflecting the support and protection of the citizen's health as the main purpose of the State in this process