Can Waterlow score predict 30-day mortality and length of stay in acutely admitted medical patients (aged ≥65 years)? Evidence from a single centre prospective cohort study

OBJECTIVE: This study aimed to explore the potential for the Waterlow score (WS) to be used as a predictor of 30-day mortality and length of hospital stay (LHS) in acutely admitted medical patients aged 65 years and older. DESIGN: Prospective observational cohort study. SETTING: UK District General Hospital. SUBJECTS: 834 consecutive patients aged 65 years and older admitted acutely to medical specialties between 30 May and 22 July 2014. METHODS ADMISSION: WS (range 4–64) assessment paired with the patient’s status at 30 days in terms of mortality and their LHS. PRIMARY OUTCOMES: 30-day mortality and length of inpatient stay. RESULTS: 834 consecutive acute medical admissions had their WS recorded. 30-day mortality was 13.1% (109 deaths). A significant difference in the distribution of WS (p<0.001) was seen between those who survived (median 12) and those who died (median 16) within 30 days, particularly within respiratory (p<0.001), stroke (p<0.001), cardiology (p<0.016), non-respiratory infections (p<0.018) and trauma (p<0.044) subgroups. Odds of dying within 30 days increased threefold for every 10-unit increase in the WS (p<0.001, 95% CI 2.1 to 4.3). LHS was also positively linearly associated with the WS in those who survived 30 days (median=5, IQR=10; r=0.32, p<0.01). A five-unit increase in WS was associated with approximately 5 days increase in LHS. On the other hand, quadratic regression showed this relationship was curvilinear and negative (concave) for those who died within 30 days where a five-unit increase in WS was associated with an approximately 10 days decrease in LHS. CONCLUSION: This study demonstrates an association between a high WS and both 30-day mortality and LHS. This is particularly significant for mortality in patients in the respiratory, stroke and cardiac subcategories. The WS, a nursing-led screening tool that is carried out on virtually all admissions to UK hospitals, could have additional use at the time of patient admission as a risk assessment tool for 30-day mortality as well as a predictor of LHS

Regulation of Intestinal Immune Response by Selective Removal of the Anterior, Posterior, or Entire Pituitary Gland in Trichinella spiralis Infected Golden Hamsters

The influence of anterior pituitary hormones on the gastrointestinal tract of humans and animals has been previously reported. Hypophysectomy (HYPOX) in the rat causes atrophy of the intestinal mucosa, and reduction of gastric secretion and intestinal absorption, as well as increased susceptibility to bacterial and viral infections. However, to our knowledge, no findings have been published concerning the immune response following HYPOX during worm infection, particularly that which is caused by the nematode Trichinella spiralis. The aim of this work was to analyze the effects of total or partial HYPOX on colonization of T. spiralis in the intestinal lumen, together with duodenal and splenic cytokine expression. Our results indicate that 5 days post infection, only neurointermediate pituitary lobectomy (NIL) reduces the number of intestinally recovered T. spiralis larvae. Using semiquantitative inmunofluorescent laser confocal microscopy, we observed that the mean intensity of all tested Th1 cytokines was markedly diminished, even in the duodenum of infected controls. In contrast, a high level of expression of these cytokines was noted in the NIL infected hamsters. Likewise, a significant decrease in the fluorescence intensity of Th2 cytokines (with the exception of IL-4) was apparent in the duodenum of control and sham infected hamsters, compared to animals with NIL surgeries, which showed an increase in the expression of IL-5 and IL-13. Histology of duodenal mucosa from NIL hamsters showed an exacerbated inflammatory infiltrate located along the lamina propria, which was related to the presence of the parasite. We conclude that hormones from each pituitary lobe affect the gastrointestinal immune responses to T. spiralis through various mechanisms

Atlantic Region

Chapter 2 explores recreation and tourism practices in forest areas in the Atlantic region, which refers to the geographical area close to the North Sea and the Atlantic Ocean. The Atlantic countries described in this section are Belgium (Flanders and Wallonia), Denmark, Iceland, Ireland, the Netherlands, and the United Kingdom (England, Scotland, Wales and Northern Ireland, although there is no specific data for Northern Ireland in the survey) (Fig. 2.1). In this chapter, instead of always focussing on the level of the country, we sometimes refer to a region within a country. This region might be largely political-administrative independent or geomorphologically distinct. Good examples are the regions of Flanders and Wallonia in Belgium and Scotland, England and Wales in the United Kingdom (UK), where there are separate administrations and forestry policies, organisations and support systems. We have chosen to describe them predominantly at the country level

Promoting social cohesion and social capital increasing wellbeing

This chapter discusses how green places contribute to well-being and health through social cohesion. Social cohesion contributes positively to both mental and physical health and is influenced by neighbourhood characteristics (such as socioeconomic deprivation) and individual characteristics (such as age). As neighbourhood green spaces are often perceived as attractive places to visit, they provide ample opportunities for residents to meet other people and interact. These interactions form the basis of neighbourhood social cohesion. This chapter reveals that although people generally do not visit public green areas to meet strangers, they do like to engage in small talk with other visitors. These casual encounters appear to be very relevant as they create public familiarity, which results in feeling at home in a neighbourhood. Occasionally, this provides opportunities to perpetuate existing friendships and develop new ones. To facilitate neighbourhood social cohesion, the availability, functions, and quality of green areas are important

Management of Recreation and Nature Based Tourism in European Forests

This book provides a Europe-wide overview on the state of the art of management of recreation and nature tourism in forests. It describes the current situation and conflicts in the different regions of Europe and provides solutions illustrated by good practise examples. It addresses traditions, differences and similarities in European forests as well as new tasks, goals and strategies. The final discussion provides a profound insight into future trends regarding forest recreation and nature based tourism