Long-term Health Outcomes For Adult Women Who Experienced Sexual Assault

The purpose of this study is to understand the impact of sexual assault pre- and post-sexual assault on health, health care experience, and health-related quality of life in adult women. Research identifying quality of life as a health outcome post-sexual assault is limited. No long-term studies to evaluate differences in health-related quality of life pre-and post-sexual assault have been conducted. In addition, only a few studies have investigated mental health changes over time. An exploration into self-perceived general health pre-and post-sexual assault and overall current quality of life needs to be conducted to determine improvements in health care services for patients. A convergent parallel mixed-method design was used to obtain self-reported general health information. Individual interviews were conducted in the qualitative strand to elicit lived experiences of health pre- and post-sexual assault. Bronfenbrenner’s Ecological Theory using the Process-Person-Context-Time (PPCT) model served as the organizing framework for the quantitative strand. Colaizzi’s (1978) descriptive phenomenology was the methodology used to help understand the lived experience of adult women post-sexual assault

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

Australia’s Digital Economy Strategy: Our Perspective

No abstract available

Using presurgical biopsychosocial features to develop an advanced clinical decision-making support tool for predicting recovery trajectories in patients undergoing total knee arthroplasty: protocol for a prospective observational study

Following total knee arthroplasty (TKA), 10% to 20% of patients report dissatisfaction with procedural outcomes. There is growing recognition that postsurgical satisfaction is shaped not only by the quality of surgery but also by psychological and social factors. Surprisingly, information on the psychological and social determinants of surgical outcomes is rarely collected before surgery. A comprehensive collection of biopsychosocial information could assist clinicians in making recommendations in relation to rehabilitation, particularly if there is robust evidence to support the ability of presurgical constructs to predict postsurgical outcomes. Clinical decision support tools can help identify factors influencing patient outcomes and support the provision of interventions or services that can be tailored to meet individuals' needs. However, despite their potential clinical benefit, the application of such tools remains limited.Published versionThis research study was funded by the Ramsay Hospital Research Foundation

Ohio Child and Adolescent Sexual Abuse Protocol

Since development of the first protocol in 2000 developed by the Ohio American Academy of Pediatrics Committee on Child Abuse and Neglect in collaboration with the Ohio Department of Health and the Ohio Attorney General’s office, the field of child abuse pediatrics and the development of coordinated efforts to provide comprehensive, standardized, non-judgmental, equitable treatment of pediatric sexual abuse/assault has changed and improved. This protocol is a modification of the Ohio Department of Health Protocol For The Treatment Of Sexual Assault Survivors, and addresses many of the complex services necessary to facilitate consistent, comprehensive health care treatment to include emotional, social, and crisis intervention as well as provide information about available follow up services in the community

Ohio Child and Adolescent Sexual Abuse Protocol

Since development of the first protocol in 2000 developed by the Ohio American Academy of Pediatrics Committee on Child Abuse and Neglect in collaboration with the Ohio Department of Health and the Ohio Attorney General’s office, the field of child abuse pediatrics and the development of coordinated efforts to provide comprehensive, standardized, non-judgmental, equitable treatment of pediatric sexual abuse/assault has changed and improved. This protocol is a modification of the Ohio Department of Health Protocol For The Treatment Of Sexual Assault Survivors, and addresses many of the complex services necessary to facilitate consistent, comprehensive health care treatment to include emotional, social, and crisis intervention as well as provide information about available follow up services in the community

Health and healthcare of people with learning disabilities in the UK through the COVID-19 pandemic

Background:During the COVID-19 pandemic in the UK, many health services were withdrawn from people with learning disabilities, with negative impacts on people’s health. What has happened to people’s health and healthcare as we move beyond the pandemic?Methods:Access to health services and health status were tracked for 550 UK adults with learning disabilities, using structured online interviews with people with learning disabilities and online surveys with family members or paid carers. Information was provided four times, from Wave 1 (in the winter 2020/2021 ‘lockdown’) to Wave 4 (autumn 2022, over a year after public health protections stopped).Findings:By Wave 4, most people with learning disabilities had had COVID-19, although high vaccination rates limited the number of people hospitalised. There was little evidence that use of GP services, community nurses, other therapists or annual health checks had increased over time, and at Wave 4 more people were having difficulty getting their medicines. People’s health did not substantially improve over time. People with profound and multiple learning disabilities had poorer health and were less likely to be accessing health services.Conclusions:Improvements in access to health services for people with learning disabilities after the pandemic have not yet happened.<br/

Dietary interventions in overweight and obese pregnant women: a systematic review of the content, delivery, and outcomes of randomized controlled trials

CONTEXT: Interventions targeting maternal obesity are a healthcare and public health priority. OBJECTIVE: The objective of this review was to evaluate the adequacy and effectiveness of the methodological designs implemented in dietary intervention trials for obesity in pregnancy. DATA SOURCES: A systematic review of the literature, consistent with PRISMA guidelines, was performed as part of the International Weight Management in Pregnancy collaboration. STUDY SELECTION: Thirteen randomized controlled trials, which aimed to modify diet and physical activity in overweight and obese pregnant women, were identified. DATA SYNTHESIS: There was significant variability in the content, delivery, and dietary assessment methods of the dietary interventions examined. A number of studies demonstrated improved dietary behavior in response to diet and/or lifestyle interventions. Nine studies reduced gestational weight gain. CONCLUSION: This review reveals large methodological variability in dietary interventions to control gestational weight gain and improve clinical outcomes in overweight and obese pregnant women. This lack of consensus limits the ability to develop clinical guidelines and apply the evidence in clinical practice