The impact of postponement of reforms to long-term care financing in England

The delay in the introduction of a lifetime cap on spending on long-term care will result in single and widowed homeowners with modest incomes who need care now or in the near future having to use up twice as much of their capital to pay for their care

Management and outcomes of femoral periprosthetic fractures at the hip : data from the characteristics, outcomes and management of periprosthetic fracture service evaluation (COMPOSE) cohort study.

AIMS: The aim of this study was to describe the management and associated outcomes of patients sustaining a femoral hip periprosthetic fracture (PPF) in the UK population. METHODS: This was a multicentre retrospective cohort study including adult patients who presented to 27 NHS hospitals with 539 new PPFs between 1 January 2018 and 31 December 2018. Data collected included: management strategy (operative and nonoperative), length of stay, discharge destination, and details of post-treatment outcomes (reoperation, readmission, and 30-day and 12-month mortality). Descriptive analysis by fracture type was performed, and predictors of PPF management and outcomes were assessed using mixed-effects logistic regression. RESULTS: In all, 417 fractures (77%) were managed operatively and 122 (23%) conservatively. The median time to surgery was four days (interquartile range (IQR) 2 to 7). Of those undergoing surgery, 246 (59%) underwent revision and/or fixation and 169 (41%) fixation alone. The surgical strategy used differed by Unified Classification System for PPF type, with the highest rate of revision in B2/B3 fractures (both 77%, 176/228 and 24/31, respectively) and the highest rate of fixation alone in B1- (55/78; 71%) and C-type (49/65; 75%) fractures. Cemented stem fixation (odds ratio (OR) 2.66 (95% confidence interval (CI) 1.42 to 4.99); p = 0.002) and B2/B3 fracture type (OR 7.56 (95% CI 4.14 to 13.78); p < 0.001) were predictors of operative management. The median length of stay was 15 days (IQR 9 to 23), 12-month reoperation rate was 5.6% (n = 30), and 30-day readmission rate was 8.4% (n = 45). The 30-day and 12-month mortality rates were 5.2% (n = 28) and 21.0% (n = 113). Nonoperative treatment, older age, male sex, admission from residential or nursing care, and sustaining the PPF around a revision prosthesis were significant predictors of an increased 12-month mortality. CONCLUSION: Femoral hip PPFs have mortality, reoperation, and readmission rates comparable with hip fracture patients. However, they have a longer wait for surgery, and surgical treatment is more complex. There is a need to create a national framework for data collection for this heterogeneous group of patients in order to understand the outcomes of different approaches to treatment. Cite this article: Bone Joint J 2022;104-B(8):997-1008

Most women living with HIV can deliver vaginally-National data from Finland 1993-2013

Introduction Vaginal delivery has been recommended for more than ten years for women living with HIV (WLWH) with good virological control. However, in Europe most WLWH still deliver by cesarean section (CS). Our aim was to assess the rate of vaginal delivery and the indications for CS in WLWH over 20 years in a setting of low overall CS rate. Materials and methods This was a retrospective study of all WLWH delivering in Finland 1993-2013. We identified the women by combining national health registers and extracted data from patient files. Results The study comprised 212 women with 290 deliveries. Over 35% of the women delivered several children during the study years. During 2000-2013, with consistent viral load monitoring, 80.0% showed HIV viral loads Conclusions Most WLWH can achieve good virological control and deliver vaginally. This will help them to maintain their future child bearing potential and reduce CS-related morbidity.Peer reviewe

Penobscot Policy Choices: a Summary of the Findings of the Penobscot River Study Team

Preface The Penobscot River is one of the most extensively researched rivers in Maine. Some skeptics have noted a negative relationship between the amount of such research and constructive action. In an effort to synchronize the two a bit more closely we offer what we hope is a fairly nontechnical primer on the river\u27s water pollution problems, condensed from the results of a two-year multidisciplinary research project. We also offer a brief review of public pollution policy issues and suggestions for future action. When the Penobscot Valley was in its heyday as the lumber capital of the world, around the middle of the last century, one used to be able to walk from Bangor to Brewer across the Penobscot River on the decks of the ships at anchor. This waterborn commerce is largely gone now, but sometimes it still seems as if one could walk across the River on its thick covering of foam. These images convey the region\u27s spirit at different times, the first of vitality and expanding opportunity, the second of stagnation - both environmental and economic. Contributors from the University of Maine at Orono: Richard Harvey, editor (Sociology), Franklin Woodard (Sanitary Engineering), Charles Wallace (Business Administration), James Henderson (Political Science), Harriet Henry (Law), John Maroney and Gary White (Wildlife Management), and Edgar Imhoff (Hydrology).https://digicom.bpl.lib.me.us/books_pubs/1288/thumbnail.jp

overall results and recommendations for the biomonitoring of occupational exposure to hexavalent chromium

Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.Exposure to hexavalent chromium [Cr(VI)] may occur in several occupational activities, e.g., welding, Cr(VI) electroplating and other surface treatment processes. The aim of this study was to provide EU relevant data on occupational Cr(VI) exposure to support the regulatory risk assessment and decision-making. In addition, the capability and validity of different biomarkers for the assessment of Cr(VI) exposure were evaluated. The study involved nine European countries and involved 399 workers in different industry sectors with exposures to Cr(VI) such as welding, bath plating, applying or removing paint and other tasks. We also studied 203 controls to establish a background in workers with no direct exposure to Cr(VI). We applied a cross-sectional study design and used chromium in urine as the primary biomonitoring method for Cr(VI) exposure. Additionally, we studied the use of red blood cells (RBC) and exhaled breath condensate (EBC) for biomonitoring of exposure to Cr(VI). Personal measurements were used to study exposure to inhalable and respirable Cr(VI) by personal air sampling. Dermal exposure was studied by taking hand wipe samples. The highest internal exposures were observed in the use of Cr(VI) in electrolytic bath plating. In stainless steel welding the internal Cr exposure was clearly lower when compared to plating activities. We observed a high correlation between chromium urinary levels and air Cr(VI) or dermal total Cr exposure. Urinary chromium showed its value as a first approach for the assessment of total, internal exposure. Correlations between urinary chromium and Cr(VI) in EBC and Cr in RBC were low, probably due to differences in kinetics and indicating that these biomonitoring approaches may not be interchangeable but rather complementary. This study showed that occupational biomonitoring studies can be conducted successfully by multi-national collaboration and provide relevant information to support policy actions aiming to reduce occupational exposure to chemicals.publishersversionpublishe

Associating sporadic, foodborne illness caused by Shiga toxin-producing Escherichia coli with specific foods : a systematic review and meta-analysis of case-control studies

Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses caused by STEC. Searches were conducted from 01 August to 30 September 2017, using bibliographic and grey literature databases, websites and expert consultation. We identified 22 case-control studies of sporadic STEC infection in humans, from 10 countries within four World Health Organization subregions, from 1985 to 2012. We extracted data from 21 studies, for 237 individual measures in 11 food categories and across three status types (raw or undercooked, not raw and unknown). Beef was the most significant food item associated with STEC illness in the Americas and Europe, but in the Western Pacific region, chicken was most significant. These findings were not significantly moderated by the raw or cooked status of the food item, nor the publication year of the study. Data from the African, South-East Asian and Eastern Mediterranean subregions were lacking and it is unclear whether our results are relevant to these regions

Maternity Rights and Mothers' Return to Work

In this paper we use the ALSPAC cohort of 12,000 births to examine the effect of maternity rights on mothers' post-birth return to employment decisions. We aim to disentangle the effects of the terms of maternity rights entitlements from the effects of other factors (such as household wealth, personal preferences and labour market opportunities) that influence the timing of a mother's return to work. We adopt a discrete hazard model with instrumental variables to estimate a counterfactual of what mothers with rights would have done in the absence of this legislation. Mothers with rights have an underlying (but unobserved) stronger attachment to the labour market which prompts earlier return than on average. Nevertheless, even when we take this into account we find a substantial impact of maternity rights on behaviour. Having rights induces around 20 per cent more women to return to their previous job before 7 months than would otherwise be the case. Women from lower skilled groups return disproportionately at the date at which maternity pay expires, while managerial and professional women tend to return at the expiry of unpaid leave.government policy, welfare, child care, labor supply

Treatment expectations but not preference affect outcome in a trial of CBT and exercise for pain

The following are members of the MUSICIAN study team: Gary Macfarlane (Principal Investigator), John McBeth (Investigator), Deborah Symmons (Investigator), Karina Lovell (investigator), Philip Keeley (Investigator), Phil Hannaford (Investigator), Chrysa Gkazinou (Trial manager), Marcus Beasley (Research Assistant), Elizabeth Jones (PhD student), Gordon Prescott (Statistician), and Steve Woby (Investigator). We are grateful to the practices and patients in Aberdeen city and Cheshire, which participated in the study: Carden medical centre, Elmbank medical practice, Great Western Road medical practice, Garthdee medical group, Readesmoor medical group practice, Lawton House surgery, Bollington medical practice, Park Lane surgery. The Scottish Primary Care Research Network facilitated access to patient information at the practices in Aberdeen city. Charlie Stockton was the study manager and Ashraf El-Metwally an Investigator during the setting up and for part of the conduct of the study. John Norrie was originally an investigator of the MUSICIAN study while Director of the Centre for Health Care Randomised Trials (CHART) at the University of Aberdeen. We are grateful for the input of members of the Health Services Research Unit (HSRU) at The University of Aberdeen in the conduct of the study: Alison MacDonald and Gladys McPherson. We are grateful to the project assistants who worked on the survey: Dev Acharya, Jennifer Bannister, Flora Joyce, Michelle Rein., Karen Kane, and Rowan Jasper. Alison Littlewood was responsible for study management at the Cheshire site. Finally, we thank the independent members of the trial steering committee (Professor Matthew Hotopf, Professor Tracey Howe, Professor Martin Underwood) and data monitoring committee (Dr. Marwan Bukhari, Professor Hazel Inskip, Dr. Chris Edwards). Funding details The study was funded by Arthritis Research UK, grant number 17292.Peer reviewedPublisher PD