Understanding how Victoria, Australia gained control of its second COVID-19 wave.

During 2020, Victoria was the Australian state hardest hit by COVID-19, but was successful in controlling its second wave through aggressive policy interventions. We calibrated a detailed compartmental model of Victoria's second wave to multiple geographically-structured epidemic time-series indicators. We achieved a good fit overall and for individual health services through a combination of time-varying processes, including case detection, population mobility, school closures, physical distancing and face covering usage. Estimates of the risk of death in those aged ≥75 and of hospitalisation were higher than international estimates, reflecting concentration of cases in high-risk settings. We estimated significant effects for each of the calibrated time-varying processes, with estimates for the individual-level effect of physical distancing of 37.4% (95%CrI 7.2-56.4%) and of face coverings of 45.9% (95%CrI 32.9-55.6%). That the multi-faceted interventions led to the dramatic reversal in the epidemic trajectory is supported by our results, with face coverings likely particularly important.

What does state-level inpatient palliative care data tell us about service provision?

BACKGROUND: Palliative care is increasingly seen as an integral component of care for patients with advanced malignant and nonmalignant illness. Clinical audit data can provide important insights into patient care, but limited published data are available investigating statewide palliative care provision issues. OBJECTIVES: Our aim was to provide a comprehensive perspective on inpatient palliative care within a populous Australian state, and highlight potential gaps in service provision. METHODS: Descriptive analysis was conducted of the Victorian Admitted Episodes Dataset (VAED, a comprehensive database of inpatient activity from all hospitals in Victoria). Variables analyzed included overall number of separations, average length of stay, referral source, age profile, and indigenous status. RESULTS: The mean length of stay for patients in Victorian inpatient palliative care settings was 12.8 days, and there were 6004 separations reported over an 11 month period from approximately 264 designated palliative care beds in the state. The mode of separation for the majority of admissions to inpatient palliative care was death (65%). Few patients resided outside metropolitan regions, and no patients admitted identified as Aboriginal and/or Torres Strait Islander (the indigenous communities of Australia). CONCLUSION: The pooled epidemiological data reviewed identify a number of areas of interest including the lack of Aboriginal Australians identified and accessing inpatient palliative care, and variations in inpatient care across geographical areas. This highlights issues of access and equity of access to inpatient palliative care.

HFE C282Y/H63D compound heterozygotes are at low risk of hemochromatosis-related morbidity.

UNLABELLED: The risk of hemochromatosis-related morbidity is unknown among HFE compound heterozygotes (C282Y/H63D). We used a prospective population-based cohort study to estimate the prevalence of elevated iron indices and hemochromatosis-related morbidity for compound heterozygotes. In all, 31,192 subjects of northern European descent were genotyped for HFE C282Y and H63D. An HFE-genotype stratified random sample of 1,438 subjects, followed for an average of 12 years to a mean age of 65 years, completed questionnaires and gave blood. Clinical examinations were blinded to HFE genotype. A total of 180 (84 males) clinically examined C282Y/H63D participants were compared with 330 (149 males) controls with neither HFE mutation; 132 (65 males) and 270 (122 males), respectively, had serum iron measures at both timepoints. Mean serum ferritin (SF) and transferrin saturation (TS) were significantly greater for male and female compound heterozygotes than for wild-types at baseline and follow-up (all P < 0.02) except for females who were premenopausal at baseline, where SF was similar in both genotype groups. For subjects with serum measures from both baseline and follow-up, mean SF and TS levels did not change significantly for men or for postmenopausal women, but for premenopausal women SF levels increased from 43 to 109 microg/L for compound heterozygotes and from 35 to 64 microg/L for wild-types (both P < 0.001). Male and female compound heterozygotes had a similar prevalence of hemochromatosis-related morbidity to wild-types. One of 82 males and zero of 95 females had documented iron overload-related disease. CONCLUSION: For male compound heterozygotes, mean iron indices do not change during middle age but for female compound heterozygotes menopause results in increased mean SF. Although compound heterozygotes might maintain elevated iron indices during middle age, documented iron overload-related disease is rare.

Short-term relationships between footstep variables in young adults.

Autocorrelation analyses were used to quantify the short-term relationships between selected footstep variables during steady state, straight-line over-ground walking in 20 healthy young adults. The serial dependency for step length, step time, heel to heel base of support (HHBS) and double limb support time were examined for a minimum of six consecutive steps using an 8.3m GAITRite analysis system. As well as investigating the dependence of data obtained from consecutive steps (lag 1) and between steps of consecutive strides (lag 2), cross correlation analyses were used to explore the relationships between step length and HHBS. The results showed serial dependency from one step to the next for step length and step time, whereas HHBS and double limb support duration showed stride-to-stride autocorrelations. Cross correlational analyses did not reveal a relationship between stride length and HHBS, suggesting independence between these variables.

Outcomes of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease: a systematic review.

This article describes a systematic review and critical evaluation of the international literature on the effects of physical therapy, speech pathology, and occupational therapy for people with motor neuron disease (PwMND). The results were interpreted using the framework of the International Classification of Functioning, Disability and Health. This enabled us to summarize therapy outcomes at the level of body structure and function, activity limitations, participation restrictions, and quality of life. Databases searched included MEDLINE, PUBMED, CINAHL, PSYCInfo, Data base of Abstracts of Reviews of Effectiveness (DARE), The Physiotherapy Evidence data base (PEDro), Evidence Based Medicine Reviews (EMBASE), the Cochrane database of systematic reviews, and the Cochrane Controlled Trials Register. Evidence was graded according to the Harbour and Miller classification. Most of the evidence was found to be at the level of "clinical opinion" rather than of controlled clinical trials. Several nonrandomized small group and "observational studies" provided low-level evidence to support physical therapy for improving muscle strength and pulmonary function. There was also some evidence to support the effectiveness of speech pathology interventions for dysarthria. The search identified a small number of studies on occupational therapy for PwMND, which were small, noncontrolled pre-post-designs or clinical reports.