Environmentally sustainable design guide for haemodialysis facilities: An Australian and New Zealand society of Nephrology initiative.

Haemodialysis facilities have a large environmental impact due to high energy, water and consumable usage by haemodialysis equipment. As climate change and natural resource scarcity escalate, all the while the number of people requiring dialysis increases, there is an urgent need for dialysis facilities that meet care needs while minimising environmental impact. To address this, the Australian and New Zealand Society of Nephrology engaged an environmental sustainability consulting practise to develop a best practise guide for the environmentally sustainable design and operation of haemodialysis facilities. Four opportunity areas were considered, namely energy, water, waste and resource recovery, and additional sustainability. A total of 28 environmental improvement initiatives were identified. The majority (n = 23) were general measures that could be applied across all healthcare settings, while five were specific to haemodialysis facilities. Recommendations were made regarding specific measures that should be undertaken and/or standards that must be met to achieve the intent of each initiative. These were stratified to enable their application to both existing dialysis facilities and new builds. The lifecycle stage of a haemodialysis facility to which each initiative applied was highlighted, as was its potential impact. This guide provides a tailored and comprehensive resource for the kidney care community to enable the integration of best practise sustainability considerations into both existing and new facilities. If broadly implemented, it has the potential to markedly improve the environmental impact of haemodialysis provision.

Fall Risk Factors in Mid-Age Women: The Australian Longitudinal Study on Women's Health.

INTRODUCTION: In contrast to older adults, little is known about risk factors for falls in adults aged 50-64 years, despite a high prevalence of falls in this age group. The aim was to identify risk factors for falls in mid-age women and explore how associations change with age. METHODS: Data were analyzed in 2016 from women aged 50-55 years in 2001 (born 1946-1951) in the Australian Longitudinal Study on Women's Health. The predictor variables were health-related factors (measured 2001, 2004, 2007, 2010) and the outcome was falls in the past 12 months (measured 2004, 2007, 2010, 2013). Prospective associations between predictor variables and falls measured 3 years later were analyzed using logistic regression with complete data for 4,629, 7,096, 5,911, and 5,774 participants. RESULTS: In surveys, 20.5% (2004), 30.7% (2007), 30.5% (2010), and 26.6% (2013) of women reported a fall in the previous 12 months. In the univariable models, most factors were associated with falls 3 years later. In the multivariable models, higher odds of falling were found for overweight and obese women compared with healthy weight women at all survey intervals (OR range, 1.15-1.43). Impaired vision (OR range, 1.25-1.35) and poor physical functioning (OR range, 1.24-1.66) were associated with falls at three survey intervals. Depression (OR range, 1.31-1.42), leaking urine (OR range, 1.25-1.49), stiff/painful joints (OR range, 1.26-1.62), severe tiredness (OR range, 1.29-1.49), osteoporosis (OR range, 1.25-1.52), and hormone replacement therapy (OR range, 0.69-0.79) were associated with falls at two survey intervals. There was no obvious age-related increase or decrease in the number of statistically significant associations. CONCLUSIONS: Identified fall risk factors varied over time, highlighting that falling involves a complex interplay of risk factors in mid-age women.