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Background: Long-term care hospitals have been considered an efficient response to the health care needs of an increasingly aging population. These centers are expected to contribute to better hospital bed management and more personalized care for patients needing continuous care. The evaluation of their outcomes is necessary after a sufficient period to assess their impact. Hospitals for Acute and Chronic Long-Term Extended Stay (HACLES) emerged in Spain in the late 20th century as a response to the aging population and the increase in chronic diseases., Objective: This study aimed to analyze the profile of patients treated in a HACLES, particularly analyzing gender differences, and evaluate the cost savings associated with using these centers., Methods: A retrospective study was conducted based on data from patients 65 years old or older admitted to a HACLES between 2022 and 2023. Gender, age, household cohabitation data, diagnosis and comorbidity, daily medication intake, and degree of dependency were obtained to describe the profile of patients who attended the HACLES. Data coded in SIA-Abucasis (version 37.00.03; Consellería Sanitat, Generalitat Valenciana; a digital medical record system used in the Valencian region) were reviewed, and descriptive statistics and comparison tests were used. The direct cost savings of HACLES admissions were calculated by comparing the daily cost of a general hospital bed with that of a HACLES bed., Results: Data from 123 patients with a mean age of 77 years were analyzed. Most (n=81, 65.9%) had a cohabiting family member as their primary caregiver. Palliative care was the most frequent reason for admission (n=75, 61%). The mortality rate (odds ratio [OR] 61.8, 95% CI 53.2-70.5) was similar between men and women (OR 54.1, 95% CI 47.8-71.5 vs OR 59.7, 95% CI 42.2-66.0; P=.23). The cognitive assessment, using the Pfeiffer scale, improved at discharge (mean 3.2, SD 3.2 vs mean 2.5, SD 3.1; P=.003). The length of stay was significantly larger for patients who returned home compared with patients discharged to other facilities (mean 89.8, SD 58.2 versus mean 33.1, SD 43.1 days; P<.001). The direct cost savings were estimated at US $42,614,846 per 1000 admissions., Conclusions: Patients typically treated in HACLES are older, with a high level of cognitive impairment and physical dependency, and a significant proportion are in palliative care, highlighting the importance of adapting care to the individual needs of the admitted patients. The HACLES model contributes to the sustainability of the public health system., (©José Joaquín Mira, Daniel García-Torres, María del Mar Bonell-Guerrero, Ana Isabel Cáceres-Sevilla, Martina Ramirez-Sanz, Rosa Martínez-Lleo, Concepción Carratalá. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 19.11.2024.)

Introduction: The time dedicated to movement (e.g., physical activity) and non-movement behaviours (e.g., sitting) has important implications in terms of maintaining physical performance (PP), while it has also been independently associated with better or poorer PP. Physical performance in older adults may be significantly improved by changing daily movement and non-movement behaviours. Therefore, the aims of this study were: (i) to analyse the associations of the time dedicated to movement and non-movement behaviours (i.e., lying down, sitting, standing, and locomotion) with PP (Time up and Go test and the Short Physical Performance Battery); and (ii) to examine how theoretically reallocating time between these behaviours is associated with this outcome., Methods: Forty-nine older adults (mean age: 82.9 ± 6.9 yrs) wore an activity monitor to measure periods of lying down, sitting, standing and locomotion. PP measures included the Time up and Go test (TUG) and the Short Physical Performance Battery (SPPB)., Results: Replacing 60 min∙d-1 of lying down time with standing resulted in a significant improvement in TUG (β = -4.99, 95% CI = -8.81, -1.17), and SPPB (β = -0.93, 95% CI = 0.04, 1.82). Likewise, replacing 60 min∙d-1 of sitting time with standing also resulted in a significant improvement in TUG (β = -4.51, 95% CI = -8.67, -0.37). Meanwhile, replacing 60 min∙d-1 of lying down or sitting time with locomotion resulted in a significant improvement in the Sit to Stand test of the SPPB (β = 0.82, 95% CI = 0.14, 1.49, and β = 0.90, 95% CI = 0.23, 1.56, respectively)., Discussion and Conclusion: Isotemporal substitution modelling suggests that replacing 60 min∙d-1 of non-movement or stationary behaviours, such as standing, with an equivalent locomotion time may contribute to improved PP in older adults., Competing Interests: Declaration of competing interest This work received a grant from the Community of Madrid within the framework of the Multi-year Agreement with the University of Alcalá in the line of action “Estímulo a la Excelencia para Profesores Universitarios Permanentes”. EPU-DPTO/2020/004., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The aim of this study was to examine, theoretically, how reallocating time between the intensity of mutually exclusive categories of physical activity and sedentary behavior time is associated with metabolic syndrome. Four hundred and six older adults (61.6% women) from the second wave of the EpiFloripa Aging Cohort Study were included in the study (mean age 71.7 ± 5.9 years). Isotemporal substitution analysis showed a decrease of 35% (odds ratio: 0.65; 95% confidence interval [0.45, 0.96]) in the risk for metabolic syndrome when replacing 30 min/day of sedentary behavior with an equivalent amount of moderate to vigorous physical activity. Furthermore, it has been observed that older adults classified as low sedentary behavior and physically active were 57% less likely to have metabolic syndrome than participants classified as high sedentary and physically inactive (odds ratio: 0.43; 95% confidence interval [0.19, 0.97]). This study highlights the importance of behavioral categories that may emerge concerning the interrelationships of physical activity and health in older adults, having important implications for future health intervention programs.

Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article.

Although it is well established that stromal intercellular adhesion molecule-1 (ICAM-1), ICAM-2, and vascular cell adhesion molecule-1 (VCAM-1) mediate lymphocyte recruitment into peripheral lymph nodes (PLNs), their precise contributions to the individual steps of the lymphocyte homing cascade are not known. Here, we provide in vivo evidence for a selective function for ICAM-1 > ICAM-2 > VCAM-1 in lymphocyte arrest within noninflamed PLN microvessels. Blocking all 3 CAMs completely inhibited lymphocyte adhesion within PLN high endothelial venules (HEVs). Post-arrest extravasation of T cells was a 3-step process, with optional ICAM-1-dependent intraluminal crawling followed by rapid ICAM-1- or ICAM-2-independent diapedesis and perivascular trapping. Parenchymal motility of lymphocytes was modestly reduced in the absence of ICAM-1, while ICAM-2 and alpha4-integrin ligands were not required for B-cell motility within follicles. Our findings highlight nonredundant functions for stromal Ig family CAMs in shear-resistant lymphocyte adhesion in steady-state HEVs, a unique role for ICAM-1 in intraluminal lymphocyte crawling but redundant roles for ICAM-1 and ICAM-2 in lymphocyte diapedesis and interstitial motility.