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Purpose: The aim was to compare the probability of discharge after hip fracture surgery conditional on being alive and in hospital between patients mobilised within and beyond 36-hours of surgery across groups defined by depression. Methods: Data were taken from the National Hip Fracture Database and included patients 60 years of age or older who underwent hip fracture surgery in England and Wales between 2014 and 2016. The conditional probability of postsurgical live discharge was estimated for patients mobilised early and for patients mobilised late across groups with and without depression. The association between mobilisation timing and the conditional probability of live discharge were also estimated separately through adjusted generalized linear models. Results: Data were analysed for 116,274 patients. A diagnosis of depression was present in 8.31% patients. In those with depression, 7,412 (76.7%) patients mobilised early. In those without depression, 84,085 (78.9%) patients mobilised early. By day 30 after surgery, the adjusted odds ratio of discharge among those who mobilised early compared to late was 1.79 (95% CI: 1.56–2.05, p<0.001) and 1.92 (95% CI: 1.84–2.00, p<0.001) for those with and without depression, respectively. Conclusion: A similar proportion of patients with depression mobilised early after hip fracture surgery when compared to those without a diagnosis of depression. The association between mobilisation timing and time to live discharge was observed for patients with and without depression. [ABSTRACT FROM AUTHOR] more...

Nidhi Sofat,1 Abiola Harrison,1 Mark D Russell,1 Salma Ayis,2 Patrick D Kiely,3 Emma H Baker,1 Thomas Richard Barrick,4 Franklyn A Howe4 1Institute for Infection and Immunity, St George’s University of London, 2Division of Health & Social Care Research, King’s Clinical Trials Unit, King’s College London, 3Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, 4Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK Abstract: Osteoarthritis (OA) is the most prevalent arthritis worldwide and is characterized by chronic pain and impaired physical function. We hypothesized that heightened pain in hand OA could be reduced with duloxetine or pregabalin. In this prospective, randomized clinical study, we recruited 65 participants, aged 40–75 years, with a Numerical Rating Scale (NRS) for pain of at least 5. Participants were randomized to one of the following three groups: duloxetine, pregabalin, and placebo. The primary endpoint was the NRS pain score, and the secondary endpoints included the Australian and Canadian Hand Osteoarthritis Index (AUSCAN) pain, stiffness, and function scores and quantitative sensory testing by pain pressure algometry. After 13 weeks, compared to placebo, ANOVA found significant differences between the three groups (P=0.0078). In the intention-to-treat analysis, the pregabalin group showed improvement for NRS pain (P=0.023), AUSCAN pain (P=0.008), and AUSCAN function (P=0.009), but no difference between duloxetine and placebo (P>0.05) was observed. In the per protocol analysis, NRS pain was reduced for pregabalin (P more...

Longitudinal evidence on the association between air pollution and blood pressure (BP) in adolescence is scarce. We explored this association in an ethnically diverse cohort of schoolchildren. Sex-stratified, linear random-effects modelling was used to examine how modelled residential exposure to annual average nitrogen dioxide (NO2), particulate matter (PM2.5, PM10) and ozone (O3), measures in μg/m3, associated with blood pressure. Estimates were based on 3,284 adolescents; 80% from ethnic minority groups, recruited from 51 schools, and followed up from 11–13 to 14–16 years old. Ethnic minorities were exposed to higher modelled annual average concentrations of pollution at residential postcode level than their White UK peers. A two-pollutant model (NO2 & PM2.5), adjusted for ethnicity, age, anthropometry, and pubertal status, highlighted associations with systolic, but not diastolic BP. A μg/m3 increase in NO2 was associated with a 0.30 mmHg (95% CI 0.18 to 0.40) decrease in systolic BP for girls and 0.19 mmHg (95% CI 0.07 to 0.31) decrease in systolic BP for boys. In contrast, a 1 μg/m3 increase in PM2.5 was associated with 1.34 mmHg (95% CI 0.85 to 1.82) increase in systolic BP for girls and 0.57 mmHg (95% CI 0.04 to 1.03) increase in systolic BP for boys. Associations did not vary by ethnicity, body size or socio-economic advantage. Associations were robust to adjustments for noise levels and lung function at 11–13 years. In summary, higher ambient levels of NO2 were associated with lower and PM2.5 with higher systolic BP across adolescence, with stronger associations for girls. [ABSTRACT FROM AUTHOR] more...

The article presents a systematic review which examined the effects of equity factors to the eligibility criteria of rehabilitation intervention trials in hip fracture patients. Other topics include the founding principle of equity in access to healthcare of the National Health Service in Great Britain, as well as the factors affecting equity like age, time-dependent relationships, socioeconomic status, and gender. more...

Background and purpose: Depression is a common neuropsychiatric consequence of stroke. We identified trajectories of depression symptoms in men and women and examined their associations with 10‐year all‐cause mortality. Methods: Data were obtained from the South London Stroke Register (1998–2016). Socio‐demographic, stroke severity and clinical measures were collected during the acute phase. The Hospital Anxiety and Depression Scale was used to screen for depression at 3 months after stroke and then annually. We used group‐based trajectory models to identify trajectories of depression and Cox proportional hazards models to study the risk of mortality in them. Results: We studied 1275 men and 1038 women. Three trajectories of depression symptoms were identified in men: I‐M (42.12%), low and stable symptoms; II‐M (46.51%), moderate increasing symptoms; and III‐M (11.37%), severe persistent symptoms. Four trajectories were identified in women; I‐F (29.09%), low symptoms; II‐F (49.81%), moderate symptoms; III‐F (16.28%), severe symptoms; and IV‐F (4.82%), very severe symptoms, all with stable symptoms. The 10‐year adjusted mortality hazard ratios in men were: 1.68 [95% confidence interval (CI), 1.38–2.04] and 2.62 (95% CI, 1.97–3.48) for trajectories II‐M and III‐M, respectively, compared with I‐M. In women these were: 1.38 (95% CI, 1.09–1.75), 1.65 (95% CI, 1.23–2.20) and 2.81 (95% CI, 1.90–4.16) for trajectories II‐F, III‐F and IV‐F, respectively, compared with I‐F. Conclusions: Depression trajectories varied independent of sex. Severe symptoms in women were double those in men. Moderate symptoms in men became worse over time. Increased symptoms of depression were associated with higher mortality rates. Data on symptom progression may help a better long‐term management of patients with stroke. [ABSTRACT FROM AUTHOR] more...

Introduction: Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression. Methods: We searched MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection databases for published studies. We searched OpenGrey, Greynet and BASE and conference proceedings for unpublished studies. We identified any further relevant studies from the reference lists of included studies. We did not impose any date, geographical, or language limitations. Two reviewers independently screened studies against predefined eligibility criteria to identify relevant papers. We included observational studies investigating prognostic factors of depression up to one year after surgery in adults surgically managed for non-pathological hip fracture. We resolved conflicts by consensus. Two reviewers independently extracted data (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist) and completed quality appraisal (using Quality in Prognosis Studies tool). We resolved conflicts by consensus. Results: 3,402 studies were identified, 2,915 studies were excluded leaving 13 studies included in this review. 3,769 patients were included across all studies with a mean age ranging from 76.21 to 81.82 years. A total of 39 prognostic factors were investigated and most studies failed to identify a primary prognostic factor of interest. Most of these factors were patient factors with only a few being process or structure factors. Conclusion: Various potential prognostic factors of depression after hip fracture were identified; however, methodological quality and heterogeneity between studies limited the certainty of which prognostic factors were the strongest. High-quality research investigating prognostic factors using the same study design, methodology and measurements is warranted to allow for comparisons of the predictive power of factors, as well as future research into the underlying mechanisms of prognostic factors. [ABSTRACT FROM AUTHOR] more...

Introduction: To compare 30-day survival and recovery of prefracture ambulation between patients mobilised early (on the day of or day after surgery) and patients mobilised late (2 days of more after surgery) in England and Wales. To determine whether the presence of dementia influences the association between mobilisation timing and 30-day survival and recovery. Methods: Analysis of the National Hip Fracture Database linked to hospitalisation records for 126,897 patients ≥60 years surgically treated for hip fracture in England/Wales between 2014 and 2016. Using logistic regression, we adjusted for covariates with a propensity score to estimate the association between mobilisation timing and survival and ambulation recovery. Results: 99,667 (79%) patients mobilised early. Among those mobilised early compared to those mobilised late, the weighted odds ratio of survival was 1.92 (95% CI 1.802.05), of recovering outdoor ambulation was 1.25 (95% CI 1.03-1.51), and of recovering indoor ambulation was 1.53 (95% CI 1.32-1.78) by 30 days. The weighted probability (%) of survival at 30-days post-admission were 95.9 (95% CI 95.7-96.0) and 92.4 (95% CI 92.0-92.8), respectively, among those mobilised early and those mobilised late. The weighted probability of ambulation recovery given outdoor and indoor ambulation prefracture were 9.7 (95% CI 9.2-10.2) and 81.2 (95% CI 80.0-82.4), respectively, among those mobilised early, and were 7.9 (95% CI 6.69.2) and 73.8 (95% CI 71.3-76.2), respectively, among those mobilised late. Patients with dementia were less likely to mobilise early despite observed associations with survival and ambulation recovery for those with and without dementia. Conclusion: Early mobilisation was associated with survival and recovery for patients (with and without dementia) after hip fracture. Early mobilisation should be incorporated as a measured indicator of quality. Reasons for failure to mobilise early should also be captured to inform quality improvement initiatives. [ABSTRACT FROM AUTHOR] more...

Introduction: To explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. Methods: A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. Results: Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. Conclusion: Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles. [ABSTRACT FROM AUTHOR] more...

OBJECTIVE: This article explores psychosocial variables associated with illness and age-related losses during old age. METHOD: The study is cross-sectional and comprised 999 people aged 65 and older. The variables included health problems and limitations, self-perceptions of health, optimism, and quality of life. RESULTS: In general, people aged 80+ years show high prevalence of health problems and disability, good self-perception of health, and quality of life. However, among the oldest age group, those in better health were more optimistic, but more problems meant lower self-perception of health, quality of life, and optimism. DISCUSSION: This does not fully confirm the disability paradox (high disability and high optimism and self-perception of quality of life). The dual-process coping model helps to understand the results of our study: First is an attempt to avoid losses; afterward, people lower goals and standards to meet constraints and foster adaptation. [ABSTRACT FROM AUTHOR] more...

This paper describes a study of older people's interpretations of a survey question about long-standing illness, disability or infirmity. This and similar questions are frequently used in various studies and surveys that influence policy and planning. With population ageing and growing concern about the health of older people, we sought to examine the survey question's relevance to older people. Following-on from a cross-sectional survey of 999 people aged 65 and over in the UK, we explored their interpretations of the survey item by asking it in the context of in-depth interviews with 24 respondents. We found that few of our respondents subscribed to the constructs of long-standing illness, disability or infirmity that surveys often employ. Older people's descriptions of their health status in response to a 'standard-issue' survey question are informed by their understandings of health itself as well as elements such as control, engagement with health service providers, time and ageing. This implies that questionnaire-based surveys may not only be unable to capture the meaning of chronic illness to older people, but also its prevalence. We conclude on a methodological note by reminding ourselves that answers to survey and in-depth interviews are narratives told about health status. As such, both represent many facets of social and cultural life, and are best assessed as 'trustworthy' rather than 'truthful'. [ABSTRACT FROM AUTHOR] more...

BACKGROUND: The aim of this study was to test the hypothesis that in Europeans and South Asians (Indians, Pakistanis, Bangladeshis) alike, worse socio-economic status is associated with a higher prevalence of coronary heart disease (CHD), glucose intolerance (impaired glucose tolerance and diabetes) and related risk factors (the predicted direction of association). METHODS: Cross-sectional data were analysed from a community-based prevalence study seeking associations between social class, education and Townsend deprivation score and ECG evidence of CHD, glucose tolerance test and 12 cardiovascular risk factors. The study population consisted of South Asians (n = 684) comprising Indians (n = 259), Pakistanis (n = 305) and Bangladeshis (n = 120), and Europeans (n = 825), aged 25-74 years in Newcastle. The analysis examined up to 84 associations for each ethnic group. Interactions between ethnicity and socio-economic variables were examined using regression analysis. The main outcome measure was the number of associations in the predicted direction. RESULTS: Europeans fared better in some indicators of socio-economic position, South Asians in others. Indians were socio-economically advantaged compared with Pakistanis and Bangladeshis. Most measures of socio-economic position were associated with health measures in the predicted direction in Europeans [71/84 (85 per cent) associations, 25 statistically significant] and less so in the South Asians combined [58/84 (69 per cent) associations, 12 statistically significant]. In South Asian men 25/42 (60 per cent) of associations were as predicted, seven significantly so, in women 33/42 (79 per cent) were, five being statistically significant. There were apparent differences between Indians 152/78 (67 per cent) of associations as predicted, seven statistically significant], Pakistanis [41/84 (49 per cent), four statistically significant] and Bangladeshis [39/79 (49 per cent), one statistically significant]. In Indians, Townsend deprivation score was mostly associated as predicted [23/27 (85 per cent), five associations statistically significant], more so than social class [14/27 (52 per cent), none statistically significant]. In South Asian men and women combined, associations with anthropometric [18/24 (75 per cent)], biochemical [15/18 (83 per cent)], and lifestyle 114/18 (78 per cent)] measures were often as predicted, but those with blood pressure (4/12, 33 per cent) and CHD and glucose intolerance (7/12, 58 per cent) were less often so. Interactions between socio-economic position and ethnicity were found. CONCLUSIONS: The European pattern of inequalities is being established in South Asian men and women, possibly at a different pace in different subgroups. Future studies of inequalities should be large, separate Indian, Pakistani and Bangladeshi populations, study men and women separately and track changes over time. [ABSTRACT FROM AUTHOR] more...

Introduction Patients with hip fracture and depression are less likely to recover. This review aimed to identify prognostic factors of depression up to one year after hip fracture surgery in adults. Secondary aims were to determine whether identified factors are modifiable or non-modifiable and describe proposed underlying mechanisms for their association with depression. Methods We searched MEDLINE, Embase, PsychInfo, CINAHL and Web of Science Core Collection databases for published studies as well as grey literature. We did not impose any date, geographical, or language limitations. Two reviewers independently screened studies against predefined eligibility criteria to identify relevant papers. We included observational studies investigating prognostic factors of depression up to one year after surgery in adults surgically managed for non-pathological hip fracture. Two reviewers independently extracted data (Checklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies, adapted for use with prognostic factors studies Checklist) and completed quality appraisal (using Quality in Prognosis Studies tool). Results 3,402 studies were identified; 2,915 studies were excluded leaving 13 studies included in this review. 3,769 patients were included across all studies with a mean age ranging from 76.21–81.82 years. A total of 39 prognostic factors were investigated and most studies failed to identify a primary prognostic factor of interest. Most of these factors were patient factors with only a few being process or structure factors. Conclusion Various potential prognostic factors of depression after hip fracture were identified however, Methodological quality and heterogeneity between studies limited the certainty of which prognostic factors were the strongest. High-quality research investigating prognostic factors using the same study design, Methodology and measurements is warranted to allow for comparisons of the predictive power of factors. As well as future research into the underlying mechanisms of prognostic factors. [ABSTRACT FROM AUTHOR] more...

Objective To explore physiotherapists' perceptions of mechanisms to explain observed variation in early postoperative practice after hip fracture surgery demonstrated in a national audit. Methods A qualitative semi-structured interview study of 21 physiotherapists working on orthopaedic wards at 7 hospitals with different durations of physiotherapy during a recent audit. Thematic analysis of interviews drawing on Normalisation Process Theory to aid interpretation of findings. Results Four themes were identified: achieving protocolised and personalised care; patient and carer engagement; multidisciplinary team engagement across the care continuum; and strategies for service improvement. Most expressed variation from protocol was legitimate when driven by what is deemed clinically appropriate for a given patient. This tailored approach was deemed essential to optimise patient and carer engagement. Participants reported inconsistent degrees of engagement from the multidisciplinary team attributing this to competing workload priorities, interpreting 'postoperative physiotherapy' as a single professional activity rather than a care delivery approach, plus lack of integration between hospital and community care. All participants recognised changes needed at both structural and process levels to improve their services. Conclusion Physiotherapists highlighted an inherent conflict between their intention to deliver protocolised care while allowing for an individual patient-tailored approach. This conflict has implications for how audit results should be interpreted, how future clinical guidelines are written, and how physiotherapists are trained. Physiotherapists also described additional factors explaining variation in practice which may be addressed through increased engagement of the multidisciplinary team and resources for additional staffing and advanced clinical roles. [ABSTRACT FROM AUTHOR] more...

Introduction: Early mobilisation leads to a two-fold increase in the odds of discharge by 30-days compared to late mobilisation. Whether this association varies by identified reasons for delayed mobilisation is unknown. Methods: Audit data linked to hospitalisation records for patients 60 years or older surgically treated for hip fracture in England/Wales 2014-2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed for early compared with late mobilisation across subgroups defined by dementia, delirium, hypotension, prefracture ambulation and residence, accounting for competing risk of death. Results: Overall, 34,253 patients presented with dementia, 9,818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 10%, 8%, 8%, 12%, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or from residential care mobilised early compared to those without dementia, delirium, hypotension, with outdoor ambulation prefracture, or from home. Adjusted odds ratios of discharge by 30-days for early compared with late mobilisation were 1.71 (95% CI 1.62-1.81) for those with dementia, 2.06 (95% CI 1.982.15) without dementia, 1.56 (95% CI 1.41-1.73) with delirium, 2.00 (95% CI 1.93-2.07) without delirium, 1.83 (95% CI, 1.66-2.02) with hypotension, 1.95 (95% CI, 1.89-2.02) without hypotension, 2.00 (95% CI 1.92-2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.701.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19-2.41) from home, and 1.64 (95% CI 1.51-1.77) from residential care. Conclusion: Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of discharge by 30-days. Fewer patients with these conditions, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation. [ABSTRACT FROM AUTHOR] more...

SummaryAims To assess whether four proxy measures of abdominal obesity (waist circumference; waist-to-hip ratio (WHR); waist-to-height ratio and C index, a measure of body shape) were uniformly associated with features of the metabolic syndrome (triglycerides, high density lipoprotein (HDL) cholesterol, 2-h glucose) in three ethnic groups. Methods Anthropometric and biochemical data were collected in 629 Europeans (320 men, 309 women), 380 Chinese (183 men, 197 women) and 597 South Asians (275 men, 322 women) aged 25–64 years in Newcastle upon Tyne, UK. Linear regression models were used to determine whether relationships differed between ethnic groups. Results Linear regression analysis showed that most proxy measures of abdominal obesity were associated with features of the metabolic syndrome. There were significant interactions between WHR and ethnicity and C index and ethnicity in the relationship with log triglycerides when comparing European and Chinese women. Interactions existed between all proxy measures and ethnicity in the relationship with log triglycerides and HDL cholesterol when comparing European and South Asian women. In men, interactions between ethnicity and waist circumference, WHR and C index when comparing Europeans and South Asians, and between ethnicity and WHR and C index when comparing South Asian and Chinese for log 2-h glucose were significant (P < 0.001). All interactions remained significant when differences in smoking, alcohol and physical activity were taken into account. Conclusions Not all the proxy measures of abdominal obesity were consistently related to features of the metabolic syndrome across the ethnic groups studied. However, waist circumference and waist to height ratio were the most consistent and WHR the least when comparing across the ethnic groups. [ABSTRACT FROM AUTHOR] more...