Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Commercial Sexual Exploitation and Sex Trafficking of Children and Adolescents: A Narrative Review

Commercial sexual exploitation and sex trafficking of children and adolescents represent a severe form of child abuse and an important pediatric health concern. Youth who are commercially sexually exploited have a constellation of clinical risk factors and high rates of unmet physical and mental health needs, including conditions that directly result from their victimization. Common physical health needs among commercially sexually exploited children and adolescents include violence-related injuries, pregnancy, sexually transmitted infections, and other acute infections. Common mental health conditions include substance use disorders, post-traumatic stress disorder, depression and suicidality, and anxiety. The existing literature indicates that trauma-informed approaches to the care of commercially sexually exploited youth are recommended in all aspects of their health care delivery. Additionally, medical education that attunes providers to identify and appropriately respond to the unique needs of this highly vulnerable group of children and adolescents is needed. The available research on commercial sexual exploitation and sex trafficking of children and adolescents remains fairly limited, yet is expanding rapidly. Especially relevant to the field of pediatrics, future research to guide health professionals in how best to identify and care for commercially sexually exploited children and adolescents in the clinical setting signifies a key gap in the extant literature and an important opportunity for future study

Geografi Penduduk & Pembangunan

Buku bahan ajar geografi penduduk dan pembangunan disusun berdasarkan pada penelitian-penelitian selama 10 tahun terakhir di bidang penduduk dan pembangunan. Geografi Penduduk dan Pembangunan menjadi banan ajar yang memuat mengenai penduduk dan pertumbuhan ekonomi wilayah, analisis potensi wilayah untuk pertumbuhan penduduk, kendala-kendala kependudukan dalam pembangunan sumberdaya manusia. Pemberdayaan kearifan lokal dalam perspektif pembangunan wilayah, dan sistem informasi geografi untuk pembangunan nasional. Penduduk dan Pembangunan merupakan dua sisi yang tidak dapat dipisahkan. Oleh Sebab itu pembangunan tidak dapat terjadi apabila tidak dibarengi dengan pembangunan manusia. Integrasi variabel kependudukan dengan pembangunan merupakan suatu upaya memberikan posisi penting pada perencanaan pembangunan sebuah wilayah. Sebagai negara yang memiliki keindahan dalam perbedaan dan keberagaman menurut arah pembangunan nasional yang sesuai dengan nilai-nilai luhur dan budaya masing-masing daerah oleh sebab itu maka dipandang penting untuk memperhatikan kearifan lokal disetiap wilayah dalam kebijakan pembangunan agar pembangunan dapat berjalan lancar dan tepat sasaran, didukung dengan pemanfaatan teknologi sistem informasi geografis yang memudahkan dalam perencanaan sebuah pembangunan