From trauma to resilience: advancing cultural responsiveness and equity in the Muskowekwan First Nation's healing journey.

Introduction: The Muskowekwan First Nation (MFN) in Saskatchewan, Canada, epitomizes the enduring strength and cultural preservation of the Saulteaux people. This community faces the lasting effects of colonial trauma, especially the violence, abuse, and adversity experienced by students at the Muskowequan Indian Residential School (MIRS). Decades of abuse by institutional leaders caused generational trauma, contributing to current mental health and well-being challenges. This study highlights the community's role in sharing experiences and shaping healing processes to develop the MFN Family Healing and Wellness Centre in response to urgent community concerns. It examines the integration of Justice, Diversity, Equity, and Inclusion (J-DEI) principles and cultural responsiveness in fostering community resilience and mental well-being. Methods: Adopting a community-based participatory research framework, this study employs a mixed-methods approach, including community engagement sessions and surveys. Collaborating closely with the MFN leadership, it draws upon the specialized expertise of Author2 and Author1, leaders in Indigenous health and research. The research uses qualitative and quantitative data collection, emphasizing the importance of community input and leadership in shaping the research process and outcomes. Results: Findings emphasize the community's commitment to spiritual and cultural practices as vital healing components. Amidst the heightened awareness of the lingering effects of the MIRS within the MFN community, these insights informed the development of the Centre, ensuring it incorporates the community's desires for culturally relevant healing practices. The grand opening of Phase I of the Centre in February 2023 emerged as a significant step forward, symbolizing a move towards holistic community health that honors resilience, holistic wellness, and cultural continuity. Discussion: This case study contributes to the literature on integrated, culturally responsive healthcare models that address the needs of Indigenous peoples and communities. The study provides insights to guide the Centre's future programs and services, ensuring they are culturally tailored and responsive to the community's needs. By illustrating the potential for traditional wisdom and contemporary health practices to foster well-being, the case study advocates for holistic approaches to healing in Indigenous settings, offering a replicable framework for similar initiatives globally.

Evaluating radon concentration and temporal correction factors in residential and workplace buildings: A comparison of passive and active methods.

Effective mitigation of the health impacts of radon exposure begins with accurate measurement of this environmental contaminant. Typically, radon surveys require measurements over a period of several months. This process involves the application of temporal correction factors (TCF). Disparities in indoor radon concentration (IRC) are evident across building types. While the integrated technique has traditionally been considered the most reliable for measuring IRC, the active method is becoming more prevalent due to the availability of commercial radon measurement instruments. The aim of this study is to compare IRC using passive (CR-39) and active (ICA device) methods across 69 indoor spaces, including 35 workplaces and 34 residential buildings. The investigation was conducted over a span of one year and included 966 CR-39 detectors that were replaced every 3 and 6 months, respectively, to assess seasonal fluctuations and facilitate the computation of TCF. Statistically significant differences in IRC were observed between residential and workplace buildings (p < 0.001). Among workplaces, educational and research institutions showed the highest average IRC (166 Bq/m3), while hospitals exhibited the lowest (25 Bq/m3). Significant differences in TCF were found between the two measurement methods (p < 0.05), making TCF specific to the passive method inapplicable to active method. Moreover, distinctions between workplace and residential buildings, including the presence of air conditioning units and differing occupancy patterns, lead to substantial differences in both IRC (p < 0.001) and TCF. The assessment of radon exposure based on room occupancy duration revealed substantial variations: workplaces showed lower actual exposure (62 Bq/m3 vs. 75 Bq/m3, p < 0.001), while residential settings, particularly at night, displayed higher exposure (278 Bq/m3 vs. 245 Bq/m3, p = 0.02) than integrated measurements suggest. Continuous monitoring systems offer critical insights into true radon exposure levels.

Is Trauma-Informed Care Possible without Information? - Experience of Trauma Awareness among Estonian Foster Parents and Residential Caregivers.

Trauma-informed care (TIC) is a relatively new topic in the Estonian child protection system, but it has become the particular focus of substitute care. The Estonian child protection system focuses on protecting children from maltreatment, and neglects the adult carers' right to adequate information about the child's trauma experience. This makes trauma-informed care vague. This article is based on focus groups conducted for a wider study that aims to develop the basis for a TIC training course for foster parents and staff members working as direct caregivers in residential substitute care. The foster parents and staff members participated in four focus groups, with special attention on their experiences with TIC. The participants eagerly shared their experiences, and thematic narrative analysis was used during the data analysis. The central theme of the participants' stories was the need for information about the child's traumatic past. The findings indicate that a complex interplay exists between the needs of children entering substitute care and the capacity of the foster parents and residential care staff to meet those needs. It is complicated for a child to heal from trauma if the child's past is hidden from their carers. This could result in re-traumatisation and hinder the child from making sense of past trauma. Estonia's child protection system needs greater awareness of the impact of trauma on the child's behaviour and how to help the child heal. This is directly connected to the need for clear and precise information, which is one of the basic rights of the child.

Lower regional urbanicity and socioeconomic status attenuate associations of green spaces with hypertension and diabetes mellitus: a national representative cross-sectional study in China.

BACKGROUND: High blood pressure (HBP) and diabetes mellitus (DM) are two of the most prevalent cardiometabolic disorders globally, especially among individuals with lower socio-economic status (SES). Studies have linked residential greenness to decreased risks of HBP and DM. However, there has been limited evidence on whether SES may modify the associations of residential greenness with HBP and DM. METHODS: Based on a national representative cross-sectional study among 44,876 adults, we generated the normalized difference vegetation index (NDVI) at 1 km spatial resolution to characterize individuals' residential greenness level. Administrative classification (urban/rural), nighttime light index (NLI), individual income, and educational levels were used to characterize regional urbanicity and individual SES levels. RESULTS: We observed weaker inverse associations of NDVI with HBP and DM in rural regions compared to urban regions. For instance, along with per interquartile range (IQR, 0.26) increment in residential NDVI at 0∼5 year moving averages, the ORs of HBP were 1.04 (95%CI: 0.94, 1.15) in rural regions and 0.85 (95%CI: 0.79, 0.93) in urban regions (P = 0.003). Along with the decrease in NLI levels, there were continuously decreasing inverse associations of NDVI with DM prevalence (P for interaction <0.001). In addition, weaker inverse associations of residential NDVI with HBP and DM prevalence were found among individuals with lower income and lower education levels compared to their counterparts. CONCLUSIONS: Lower regional urbanicity and individual SES could attenuate the associations of residential greenness with odds of HBP and DM prevalence.

Mitigating black carbon emissions: key drivers in residential usage and coke/brick production.

Black carbon (BC) is a crucial air pollutant that contributes to short-lived climate forcing and adverse health impacts. BC emissions have rapidly declined over the past three decades and it is important to uncover the major factors behind this decline. Herein, the temporal trends in BC emissions were compiled from 146 detailed sources from 1960 to 2019. Results revealed that the major emission sources were residential solid fuel usage, coke production and brick production. Furthermore, 96.9% of the emission reduction from 3.03 Tg in 1995 to 1.02 Tg in 2019 was attributed to these three sources. It was determined that the transition in residential energy/stove usage, phasing-out of beehive coke ovens and brick kiln upgrading were the most important drivers leading to this reduction and will continue to play a key role in future emission mitigation. In addition, this study identified the need to address emissions from coal used in vegetable greenhouses and the commercial sector, and diesel consumption in on/off-road vehicles.

Meaningful Associations Between Motivation for Treatment and Interpersonal Needs Within a Residential Sample of Women With Eating Disorders.

OBJECTIVE: Perceived burdensomeness (PB) and thwarted belongingness (TB), two proximal risk factors for suicide, may rise during residential eating disorder (ED) treatment when patients are separated from support and face exorbitant costs of care. In this setting, fostering motivation for treatment is challenging, and low motivation for treatment may exacerbate feelings of PB and TB. Simultaneously, PB and TB could reduce motivation for treatment, though no studies have explored this relationship longitudinally. Accordingly, this study examined associations between interpersonal needs (TB, PB) and motivation for treatment across the first 6 weeks of residential ED treatment. METHODS: Participants (n = 98) completed the Interpersonal Needs Questionnaire (INQ) and rated treatment motivation weekly. Pearson bivariate correlations examined the relationship between motivation and interpersonal needs at each timepoint. Two autoregressive cross-lagged panel models (AR-CLPMs) tested reciprocal relationships between these constructs longitudinally across the first 6 weeks of treatment. RESULTS: Motivation was significantly negatively correlated with PB and TB at all timepoints. In AR-CLPM 1, Week 2 Motivation predicted Weeks 3 PB, then Week 3 PB predicted Week 4 Motivation. In AR-CLPM 2, Week 2 TB predicted Week 3 Motivation, but Motivation did not predict TB at any timepoint. DISCUSSION: This study is the first to examine longitudinal relations between interpersonal needs and treatment motivation in residential ED care. PB and TB may influence one's motivation for treatment, although motivation and PB had a stronger reciprocal relationship than motivation and TB. Interpersonal needs should be addressed early in residential treatment to mitigate negative cycling.

Evaluating emissions and air quality implications of residential waste incineration.

In Europe mainly at winter season the PM levels exceed air quality limits, which correlated with the operation of solid-fired boilers. More and more people are returning to using these devices due to energy shortage caused by the pandemic and regional conflicts. In addition, the phenomena of co-burning fuels and municipal waste in residential boilers in primarily fuel poverty households increases further the amount of pollutants in the atmosphere. This study aims to correlate the quantity and quality of air pollutants with the type of fuel (wood and wastes) burned. Combustion experiments were conducted using oak fuel mixed with three waste groups: (1) plastics (PP, HDPE, PET); (2) textiles (polyester-PES, cotton-COT); and (3) papers (cardboard-CARD, glossy coated paper-GCP, 84C/PAP). The addition of waste to wood fuel altered the morphology of emitted particles. While waste burning doesn't always increase particle quantity, it significantly raises PAH concentrations. A strong relationship exists between waste type, particle morphology, and PAH quality, where with lower molecular weight PAHs linked to tar agglomerates and higher ones to soot agglomerates with inorganic crystals.

Sources of PM2.5 exposure misclassification in three Finnish register-based study populations and the impact on attenuation of health effect estimates.

Air pollution is a leading environmental health risk factor. The risk estimates, primarily based on air pollution epidemiology, are sensitive to exposure misclassification, which can result in underestimation. To address some of these challenges, our aim is to investigate how the length of the period over which the exposure is averaged, trends in long-term PM2.5 concentrations, and the seasonal variability are associated with each other. Furthermore, we assess the impact of residential relocation on exposure levels and quantify random exposure misclassification due to modelling and its impact on the attenuation of effects with respect to averaging time. We used nested air quality modelling across Finland, gridded population, and address histories from three study populations: the MATEX pregnancy and preschool children cohorts, as well as the FINPARK study's individuals diagnosed with Parkinson's disease and their controls, to estimate PM2.5 exposures. The prediction error was estimated by comparing modelled concentrations to observations and by using previous estimates for random monitoring instrument error. Due to the decreasing trend in PM2.5 concentrations, exposure levels rose progressively with longer averaging times, increasing by up to 28 % over a 16-year period. The shorter the exposure period, the more pronounced the seasonal effects: pregnant mothers' trimester-specific exposures were 13-22 % higher for trimesters ending in spring and 10-16 % lower for those ending in autumn compared to the average for the entire pregnancy. Residential relocation had a relatively minor impact on the exposure levels of the preschool children and adult FINPARK study population, but this effect was possibly partly masked by the decreasing trend. The results indicated that using predicted concentrations led to random exposure misclassification and potentially attenuated health effects. This effect became more notable when increasing the length of the exposure period from 3 months to 5 years, doubling the underestimation ratio from 1.5 to 3.1.

Functioning Management and Recovery, a psychoeducational intervention for psychiatric residential facilities: a multicenter follow-up study.

AIM: Functional Management and Recovery is a standardized Psychoeducational Intervention, derived from "Integro", an effective salutogenic-psychoeducational intervention for people in recovery journey, designed to improve recovery and functioning of individuals with psychotic disorders in Psychiatric Residential Facilities (PRFs). The aim of this study is to evaluate the primary and secondary outcomes of this intervention elaborated specifically for PRFs where evidence based structured interventions seem rare and desirable. METHODS: 66 individuals with psychotic disorders were recruited in 9 PRFs dislocated in the North, Center and South Italy and 63 underwent a multicenter follow-up study with a two time-point evaluation (t0, pre-treatment and t1, 6 months; ). At each time point, social functioning was assessed as primary outcome by the Personal and Social Performance scale (PSP); furthermore, psychopathological status was assessed by Brief Psychiatric Rating Scale (BPRS), Recovery by Recovery Assessment Scale (RAS), Cognitive Functioning by Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Stress management by Stress-Scale, Cognitive Flexibility by Modified Five-Point Test (M-FPT), Emotional Intelligence by Emotional Intelligence Index (EI-I), the PRF Atmosphere and the Opinion of users about the PFR by an ad hoc questionnaire. The Abilities Knowledge, the Utility and Pleasantness of sessions were measured by an ad hoc list of items. RESULTS: 63 individuals out of 66, 52 (82,5%) affected by schizophrenia and 11 (17,5%) by bipolar I disorder with psychotic symptoms according to DSM-5-TR completed the study. At the end of the study, 43 (68,3%) were male, 57 (90.5%) were single, 5 (7.9%) engaged, 1 (1.6%) married; 45 (71.4%) unemployed. The total scores of PSP, RAS, BPRS, BANS, Stress management, Abilities Knowledge, Utility and Pleasantness of sessions showed a statistically significant improvement at t1 vs. t0. Two sub-scales out of 5 of M-FPT showed a statistically significant improvement. The Emotional Intelligence, the Unit Atmosphere and the Opinion of Users about PFR improved without statistical significance. Six months after the end of the follow-up study 22 individuals of the sample were dismissed with a very high turnover. CONCLUSIONS: After a six-month follow-up (a short period of time), these results showed improvement in functioning, the primary outcome, as well as in the following secondary outcome variables: RAS, BPRS, BANS, Stress management, Abilities Knowledge, two sub-scales out of 5 of M-FPT, Utility and Pleasantness of sessions. Overall, a remarkable impact of psychoeducational structured intervention on the key Recovery variables is observed. Further studies are needed to address extent and duration of these improvements.

No medication prescription and residential distance from the hospital are important factors associated with nonsurgical weight-loss treatment discontinuance in Japanese patients with high-degree obesity: a retrospective study.

BACKGROUND: Although the percentage of the population with a high degree of obesity (body mass index [BMI] ≥ 35 kg/m2) is low in Japan, the prevalence of obesity-related diseases in patients with high-degree obesity is greater than that in patients with a BMI < 35 kg/m2. Therefore, treatment for high-degree obesity is important. However, clinical studies have reported that 20-50% of patients with obesity discontinue weight-loss treatment in other countries. The circumstances surrounding antiobesity agents are quite different between Japan and other countries. In this study, we investigated the predictors of treatment discontinuation in Japanese patients with high-degree obesity. METHODS: We retrospectively reviewed the medical charts of 271 Japanese patients with high-degree obesity who presented at Toho University Sakura Medical Center for obesity treatment between April 1, 2014, and December 31, 2017. The patients were divided into non-dropout and dropout groups. Patients who discontinued weight-loss treatment within 24 months of the first visit were defined as "dropouts." Multivariate Cox proportional hazards regression analysis and Kaplan-Meier survival analysis were performed to examine the factors predicting treatment withdrawal. RESULTS: Among the 271 patients, 119 (43.9%) discontinued treatment within 24 months of the first visit. The decrease in BMI did not significantly differ between the two groups. No prescription of medication and residential distance from the hospital exceeding 15 km were the top contributors to treatment discontinuation, and the absence of prescription medication was the most important factor. The dropout-free rate was significantly higher in patients with medication prescriptions than in those without and in patients who lived within 15 km of the hospital than in those who lived farther than 15 km from the hospital. CONCLUSIONS: No medication prescription and longer residential distance from the hospital were associated with treatment dropout in Japanese patients with high-degree obesity; therefore, the addition of antiobesity medications and telemedicine may be necessary to prevent treatment discontinuation in such patients.

Electric vehicle charging dataset with 35,000 charging sessions from 12 residential locations in Norway.

This data article refers to the paper "A method for generating complete EV charging datasets and analysis of residential charging behaviour in a large Norwegian case study" [1]. The Electric Vehicle (EV) charging dataset includes detailed information on plug-in times, plug-out times, and energy charged for over 35,000 residential charging sessions, covering 267 user IDs across 12 locations within a mature EV market in Norway. Utilising methodologies outlined in [1], realistic predictions have been integrated into the datasets, encompassing EV battery capacities, charging power, and plug-in State-of-Charge (SoC) for each EV-user and charging session. In addition, hourly data is provided, such as energy charged and connected energy capacity for each charging session. The comprehensive dataset provides the basis for assessing current and future EV charging behaviour, analysing and modelling EV charging loads and energy flexibility, and studying the integration of EVs into power grids.

The nutritional and feeding status of children living in selected residential child care facilities in Zambia: implications for programs and policies.

Introduction: This study aimed to estimate the prevalence of undernutrition and risk of feeding difficulties and describe common feeding practices for children from birth to 10 years of age living in residential care in Zambia. Methods: This was a secondary analysis of de-identified cross-sectional data on 397 children living in 22 residential care facilities in four provinces. Child demographics, anthropometrics, hemoglobin levels, risk for feeding difficulties, and facility-level feeding practices were collected by a trained study team using Count Me In, a digital health app. Interviews with staff were conducted at 15 residential care facilities. Results: Around half of the study sample were boys (53.4%) and <5 years old (55.4%). Special healthcare needs were reported in 10.3% of the children, with cerebral palsy being the most common (3.5%). Underweight, stunting, wasting (using weight-for-length/height), and anemia were found in 22.4, 28.0, 7.1 and 54.7% of children, respectively, with higher rates in children with special healthcare needs and children <24 months old. Duration of residential care was positively associated with length/height-for-age but not weight-for-age or weight-for-length/height z-scores. A risk for feeding difficulties was found in 41.4 and 26.0% of children with and without special healthcare needs, respectively. Suboptimal bottle-feeding practices, including the use of altered nipples and poor caregiver-infant interactions, were observed for infants <12 months old. Residential care staff reported suboptimal diets in their facilities and gaps in knowledge and resources to meet children's nutritional needs. Conclusion: These results demonstrate that a large proportion of children living in residential care in Zambia are at high risk for undernutrition and feeding difficulties and contribute to the small body of literature on children living in residential care, both in Zambia and globally. In the context of Zambia's efforts to improve child nutrition and reform its alternative care, these findings can inform programming and policies for children living in residential care to fulfill their rights to health and family care.

Daily Diversity Flows: Racial and Ethnic Context Between Home and Work.

The racial and ethnic diversification of the U.S. population has transformed the demographic makeup of communities and rapidly increased exposure to diversity in American neighborhoods. Although diversity exposure occurs throughout people's daily lives, the conventional approach to describing diversity only at places of residence potentially understates the full extent of this phenomenon. In this study, we explore short-term, within-day changes in the diversity of different neighborhoods by considering U.S. workers' work and residential locations. Using estimates for daytime and nighttime populations among metropolitan census tracts, our empirical analyses investigate the extent to which the process of daytime mobility for work relates to changes in the racial and ethnic diversity of different spaces. Our results indicate widespread daily shifts toward diversity for most neighborhood types, especially those with residential (nighttime) populations that are predominantly Black, Latino, or Asian. We find that patterns of intraday diversification experienced minor declines across recent decades but are present in most metropolitan areas. Our findings also show that intraday changes in racial and ethnic diversity overlap with nonracial forms of daily diversity change. Further, average within-day changes in diversity are more pronounced in areas with greater residential segregation.

Improving Residential Aged Care Placement from Hospital Through the Implementation of a Digital Matching Solution - A Before-After Evaluation.

Patient discharges from hospital to residential aged care facilities (RACFs) are often delayed due to inefficiencies in matching them to suitable available beds. To investigate the improvements that digital solutions can offer here, case-mix adjusted Length of Stay (LOS) of patients discharged to RACFs from a major metropolitan Victorian hospital were compared before and after the introduction of a digital solution for matching patient needs and preferences to available RACFs places. The study found that after the digital solution was implemented, the period where a patient would wait in the hospital for a RACF placement post the Aged Care Assessment Services (ACAS) assessment, the LOS reduced by 26.0% [95% confidence interval (95%CI):8.5%-40.5%]. The corresponding decrease in complete LOS for the After period was 16.5% (95%CI=1.5%-29.4%). This equates to a significant reduction in time spent by vulnerable patients in hospital while potentially freeing up 88,805 (95%CI:28,934- 137,864) patient bed days and delivering a cost saving of $105,993,947 (95%CI:$34,651,867-$165,105,956) if applied to the reported number of hospital patient days used by those eligible and waiting for residential age care nationally across the country in 2021-22.

Dwellings occupied by mobility-limited older people emerge as strong control centers and more age-friendly places.

The future will witness the substantial worldwide growth of older people with functional limitations or disabilities who have difficulties leaving their dwellings and traveling to their neighborhoods or other community destinations to realize their obligatory and discretionary needs and goals. This commentary offers conceptual arguments and literature findings proposing that the dwellings of this vulnerable population deserve new scrutiny because they have become more salient and positively experienced places to live where their occupants can maintain their independence and age in place. The catalyst for this commentary is the emergence of gerontechnological innovations relying on digital and sensor technologies, offering these older occupants a new category of dwelling connectivity solutions-constituting a paradigm shift-whereby goods, care, services, social supports, and information and leisure activities can be delivered to their houses and apartments. Incorporating this technological component has transformed their dwellings into dynamic "control centers," connecting their occupants in real-time with the resources and activities offered in other places. These solutions enable older people to cope more effectively with declines and losses because their ability to live independently is less threatened by challenges they face accessing destinations with inadequate transportation options and less age-friendly land use or physical design features. By occupying more supportive, safer, and connected dwellings, these older people have overall more positive and salient residential mastery emotional experiences and feel more competent and in control of their lives and environment. Planning or policy recommendations directed to the World Health Organization (WHO) and its age-friendly city/community agenda follow from its conclusions. They highlight how dwelling environments containing gerontechnological solutions are becoming more critical influences of "active aging." The commentary recommends that WHO allocates more resources to dwelling interventions that increase the awareness, availability, usability, and acceptability of these gerontechnological solutions, thus reducing the disincentives for older people to be adopters.

Does poor health influence residential selection? Understanding mobility among low-income housing voucher recipients in the Moving to Opportunity Study.

Housing mobility programs and housing choice vouchers provide low-income families with a potentially-transformative opportunity to move to low-poverty neighborhoods. However, families often face barriers to attaining upward residential mobility; poor health may be one important barrier, although few studies have examined this hypothesis. We used the experimental Moving to Opportunity (MTO) Study, constructed residential trajectories, and linked neighborhood opportunity measures to over 14,000 addresses of 3526 families across 7 years. We used latent growth curve longitudinal models to test how baseline health modified effects of MTO housing voucher treatment on neighborhood opportunity trajectories. Results show that poor baseline health adversely influenced how the voucher induced upward mobility. Voucher receipt strongly promoted residential mobility if families were healthy; moreover the low-poverty neighborhood voucher plus counseling treatment promoted higher opportunity neighborhood attainment compared to controls, regardless of the baseline health of the family. However families with health vulnerabilities did not retain the same initial neighborhood gains conferred by the housing choice voucher treatment, as families without health vulnerabilities. These results suggest that housing counseling may be one necessary element to expand neighborhood choice into higher opportunity neighborhoods for families with health challenges. Providing housing vouchers alone are insufficient to promote low-income family high opportunity moves, for families who have disabilities or special needs. The implications of these results point to scaling up housing mobility programs, to provide tailored support for low-income families to use housing choice vouchers to make high opportunity moves, which is particularly necessary for families with health challenges.

Unravelling elder abuse through a human rights lens: a case study.

This article examines the connection between human rights and elder abuse, employing a human rights-based approach. Through a critical examination of a fictional case study on elder abuse, the discussion highlights the vital role of nurses when safeguarding the rights of older individuals in residential care settings. The PANEL framework - encompassing Participation, Accountability, Non-discrimination, Empowerment and Legality - is a comprehensive guide for safeguarding practice and is applied to the example provided. By applying this human rights-based approach, nurses can proactively address elder abuse, ensuring individuals' rights are protected, promoted and supported. Through accountability measures, non-discriminatory practices, empowerment strategies and adherence to legal standards, the authors advocate for a holistic approach to enhance the quality of care and foster a safe environment for older adults.

Evaluating and identifying changes in the rate of unplanned discharge among Department of Veterans Affairs (VA) facilities providing substance use disorder residential care.

INTRODUCTION: Quality improvement (QI) methods play a critical role in ensuring that patients receive high-quality and timely care. Healthcare systems should use valid and reliable measures to inform QI efforts. Mental health settings including substance use disorder (SUD) residential programs have been slow to develop and incorporate quality measurement into routine practice. Unplanned discharge is of particular concern because this event is associated with harm including suicide. Healthcare systems require criteria that they can use to operationalize unplanned discharge as a quality measure in SUD residential programs. METHODS: The study included all discharges from the Department of Veterans Affairs (VA) residential SUD programs between 2018 and 2022. The study calculated crude and adjusted rates of irregular discharge. The study used the first two years of observation (2018-2019) in a logistic regression model to determine the parameter estimates for three important covariates, age, risk for homelessness, and principal diagnosis. The study tested permutations of bin size (N) and days (D) per bin to identify a single set of parameters to enable small and large facilities to have sufficient power to detect out-of-control processes (i.e., significant worsening or improvement in rates). Aligned with standard nomenclature, the study calculated the control limits based on three standard deviations (SD). Values that fell above or below three SD were statistically significant. RESULTS: The cohort included 56 facilities (26,361 discharges). Irregular discharge was associated with younger age (18-40 years) and a principal diagnosis of a drug use disorder. Testing parameter values of 100 discharges (N) over 120 days (D) would yield enough power to detect modest relative changes to the irregular discharge rate for small and large facilities while testing frequently enough to make the evaluations temporally relevant. Because secular trends such as staff changes over time will impact results, the quality control method should allow for real-time feedback to those most proximal to the event. CONCLUSIONS: The study created a set of parameters and a methodology that residential SUD programs can use to operationalize unplanned discharge locally. These data could assist programs in conducting QI work to address unplanned discharge and related harms.

Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns.

INTRODUCTION: During 2020-2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings. METHODS: A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality. RESULTS: During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0-4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19-1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12-1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86-1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates. CONCLUSION: These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.

Maintaining daily living activities in older adults: The impact of a functional exercise program in long-term nursing homes. A single-group pre-post intervention.

OBJECTIVE: To evaluate the impact of a function-focused multicomponent exercise program on long-term nursing home (LTNH) residents' ability to maintain activities of daily living (ADL), physical performance, cognitive function, quality of life, and frailty. METHODS: This multicenter single-group pre-post quasi-experimental study involved 148 participants from 16 LTNHs in Gipuzkoa, Spain. Participants underwent a twice-weekly, 6-month function-focused multicomponent exercise program and were assessed both before and after the intervention. RESULTS: Following the intervention, participants significantly maintained ADL ability, improved physical performance and quality of life, and reduced frailty (all p < 0.05). Cognitive function showed a positive trend. Subgroup analysis showed consistent improvements across demographics and health variables. CONCLUSIONS: The exercise program effectively maintained or improved ability to perform ADL, cognitive function, physical performance, and quality of life while reducing frailty in LTNH residents, irrespective of individual characteristics. This highlights the importance of exercise interventions to preserve overall function and wellbeing in this population. TRIAL REGISTRATION: NCT04221724.