Predictors of COVID-19 outcomes: Interplay of frailty, comorbidity, and age in COVID-19 prognosis.

Prior research has identified frailty, comorbidity, and age as predictors of outcomes for patients with coronavirus disease 2019 (COVID-19), including mortality. However, it remains unclear how these factors play different roles in COVID-19 prognosis. This study focused on correlations between frailty, comorbidity and age, and their correlations to discharge outcome and length-of-stay in hospitalized patients with COVID-19. Clinical data was collected from 56 patients who were ≥50 years old and admitted from March 2020 to June 2020 primarily for COVID-19. Frailty Risk Score (FRS) and the Charlson Comorbidity Index (CCI) were used for assessment of frailty and comorbidity burden, respectively. Age had significant positive correlation with FRS and CCI (P < .001, P < .001, respectively). There was also significant positive correlation between FRS and CCI (P < .001). For mortality, patients who died during their hospitalization had significantly higher FRS and CCI (P = .01 and P < .001, respectively) but were not significantly older than patients who did not. FRS, CCI, and age were all significantly associated when looking at overall adverse discharge outcome (transfer to other facility or death) (P < .001, P = .005, and P = .009, respectively). However, none of the 3 variables were significantly correlated with length-of-stay. Multivariate analysis showed FRS (P = .007) but not patient age (P = .967) was significantly associated with death. We find that frailty is associated with adverse outcomes from COVID-19 and supplants age in multivariable analysis. Frailty should be part of risk assessment of older adults with COVID-19

Maternal activity level in patients with preterm premature rupture of membranes: A Prospective Observational Cohort Study

Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM) Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor occurred. Patients were provided a pedometer to wear for the duration of their antepartum course and they have maternal activity at lib and were encouraged to go to the physical therapy gymnasium. Results: We enrolled 32 women. We stratified them in two groups: low activity as less than 500 step a day and higher maternal activity more than 500 steps a day, There were no significant differences in the demographics. Latency from PPROM to delivery were significantly prolonged in women with maternal activity \u3e 500 steps a day: 11.0 ± 8.42 vs 21.18 ± 4.26 days p = 0.004. No maternal or fetal adverse outcomes were identified. Conclusion: Maternal activity more than 500 steps a day showed a significant association with prolongation of latencyhttps://jdc.jefferson.edu/obgynposters/1001/thumbnail.jp

Asset-based and citizen-led development: Using a diffracted power lens to analyze the possibilities and challenges

Asset-based community development or Asset-based and citizen-led development (ABCD) is being used in a range of development contexts. Some researchers have been quick to dismiss ABCD as part of the neoliberal project and an approach that perpetuates unequal power relations. This article uses a diffracted power analysis to explore the possibilities associated with ABCD as well as the challenges. It focuses on the application of ABCD in the Philippines, Ethiopia and South Africa, and finds that ABCD can reverse internalized powerlessness, strengthen opportunities for collective endeavours and help to build local capacity for action

The application of salutogenesis to work

Work is both detrimental and health promoting. Antonovsky accentuated the distinction between eliminating stressors and developing health-enhancing job characteristics. He elaborated on job characteristics that potentially relate to a sense of coherence, offering a dense description of a workplace where individuals experience meaningfulness, manageability, and comprehensibility. This chapter presents models, measures, and intervention approaches that relate to the double nature of work and to both its pathogenic and its salutogenic qualities. Hereby, the view of Antonovsky is enhanced, insofar that health-promoting, salutogenic job characteristics are not solely understood as buffering the pathogenic effects of stressors at work, but have a direct effect on positive health outcomes. Antonovsky’s original model is first specified and simplified for the context of work. Then, Antonovsky’s line of thinking is related to frameworks researching job resources and demands. After a review of the prevalence of salutogenic measures in worksite health promotion, the point of making salutogenesis more visible in work-related research and practice is elaborated upon. This is illustrated with a practical example of a survey-feedback process promoting salutogenic work. Finally, the implications and challenges for practice and future research on salutogenic work are discussed

Early stage anal margin cancer: towards evidence-based management.

Anal squamous cell carcinoma is an uncommon Human Papilloma Virus (HPV)‐related malignancy, the incidence of which has increased two‐ to four‐fold over the past three decades. Results from the first three phase III trials, performed in the 1990s (the largest being the ACT I trial in the UK), established concurrent mitomycin C (MMC), 5‐fluorouracil chemotherapy and radiotherapy (CRT) as the main primary treatment. Three subsequent trials (including ACT II in the UK, performed between 1998 and 2008, demonstrated evidence of no benefit from the use of additional chemotherapy before or after CRT, or concurrent cisplatin