Online youth concussion resources for Canadian teachers and school staff: A systematic search strategy.

INTRODUCTION: Teachers and school staff (i.e., principals, coaches, trainers, educational assistants, guidance counselors, school healthcare professionals, etc.) are well positioned to support students' return-to-school post-concussion. Teachers and school staff may access concussion resources online as they are readily available; however, their quality and accuracy are unknown. OBJECTIVE: To identify accurate online concussion resources suitable for Canadian teachers and school staff. METHODS: A five-phased systematic search strategy was conducted: 1) initial identification of resources; 2) consultation of pediatric concussion experts; 3) inclusion and exclusion criteria; 4) content review; and, 5) material evaluation. RESULTS: A total of 837 resources were identified initially and 40 resources were included in the final list. Across all resources, 310 (37%) resources were excluded as they were not designed primarily for teachers and school staff. Thirty-four (43%) of 80 resources reviewed for content accuracy were excluded. Among resources reviewed for readability, usability and suitability, six (13%) were excluded. CONCLUSIONS: The 40 resources identified in this study can enable teachers and school staff to educate themselves about concussion and how to optimally support a student's return-to-school post-concussion.

Australian public health COVID-19 messaging is missing its mark in some vulnerable communities and people who reject COVID-19 safety advice.

Background: There are groups in our community who may be more vulnerable to contracting, transmitting, or experiencing negative health impacts of COVID-19 than the general community. They may also have greater difficulty accessing, accepting, and acting upon COVID-19 public health information. Our aim was to understand if vulnerable communities and those who express "COVID-risk" behavioural intentions seek and respond differently to COVID-19 public health information. Methods: This observational, cross-sectional study recruited adults aged over 18 years from the Australian general community and six community groups (people with disabilities and their caregivers, Aboriginal and Torres Strait Islanders, aged care workers, street-based sex workers, refugees and asylum seekers, and the deaf and hard of hearing). We investigated attitudes and beliefs about COVID-19 public health messages. We identified factors associated with the respondent's perception of the ease of finding information and understanding it, and its relevance to them. We also examined latent classes that were developed based on attitudes to public health measures and vulnerable group categories, along with demographic variables. Results: We received 1444 responses (n = 1121 general community; n ≥50 for each vulnerable group). The vulnerable groups examined found COVID-19 public health messages as easy, if not easier, to find and understand than the general community. Four latent classes were identified: COVID-safe mask wearers (10% of sample), COVID-safe test takers (56%), COVID-risk isolators (19%) and COVID-risk visitors (15%). The COVID-risk classes (34% of sample) were less likely to consider COVID-19 information easy to find, understandable, and relevant. Conclusions: Additional public health messaging strategies may be needed for targeting people with "COVID-risk" beliefs and attitudes who appear across the community (general and vulnerable groups) rather than just targeting specific cultural or other groupings that we think may be vulnerable. COVID-risk classes identified through this study were not defined by demographic characteristics or cultural groupings, but were spread across vulnerable communities and the general community. Different approaches for tailoring and delivery of specific public health information for these groups are needed.

Effectiveness of knowledge brokering and recommendation dissemination for influencing healthcare resource allocation decisions: A cluster randomised controlled implementation trial.

BACKGROUND: Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services. METHODS AND FINDINGS: This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control ß 18.11 [95% CI -8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control ß 1.24 [95% CI -6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker ß -9.12 [95% CI -3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control ß 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control ß -0.12 [95% CI -0.54 to 0.30] p = 0.581; recommendation versus knowledge broker ß -0.19 [-1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control ß 2.19 [95% CI -1.36 to 5.74] p = 0.219; knowledge broker versus control ß -0.55 [95% CI -1.16 to 0.06] p = 0.075; recommendation versus knowledge broker ß -3.75 [95% CI -8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination. CONCLUSIONS: Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000029291.

Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review.

This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.

Prevalence and variability in use of physical and chemical restraints in residential aged care facilities: A systematic review and meta-analysis.

BACKGROUND: Use of physical and chemical restraints are common in residential aged care facilities worldwide. Restraint use can pose harm to residents even causing deaths. OBJECTIVE: To synthesize the prevalence and variability in physical and chemical restraint use, and examine factors that may contribute to this variability of prevalence rates. METHODS: Six health science databases were searched from inception up to 21st January 2020. Quantitative studies investigating restraint use in residential aged care facilities that reported data from year 2000 onwards were included. Meta-analyses of binomial data using a random effect model were performed to pool proportions of physical or chemical restraints with 95% confidence intervals. Univariable meta-regression analyses were used to assess factors that may contribute to the variability in physical and chemical restraint prevalence. Multiple meta-regression analyses were performed where possible to construct models of factors contributing to these variations. RESULTS: Eighty-five papers were included. The pooled proportion of physical and chemical restraint use in residential aged care facilities were 33% and 32% respectively. Bedrails (44%) and benzodiazepines (42%) were the most prevalent forms of physical and chemical restraint respectively. Studies from North America (lower prevalence) [coefficient (95% CI): -0.15 (-0.27, -0.03)], measurement approaches using direct observation (higher prevalence) [0.17 (0.02, 0.33)] and a combination of multiple measurement approaches (higher prevalence) [0.17 (0.05, 0.29)] explained 25.5% of variability in the prevalence of physical restraint. Multiple meta-regression analyses were not performed to identify factors that may explain the observed variability in chemical restraint prevalence due to the small number of studies with data available. CONCLUSION: Variability in prevalence of physical restraint could be explained partly by different measurement approaches and geographical regions. Valid and reliable measurement approaches across different regions is required to understand cultural differences due to geographical region effects on the prevalence of physical restraint use.

Community integration programs and interventions for people with spinal cord injury: a scoping review.

AIM: The focus of this scoping review was to identify the extent, range, and nature of studies that have been published regarding community integration programs and interventions that support people during the transition home from hospital following spinal cord injury. METHODS: Four electronic databases and one search engine were searched for articles published between 2010 and 2020. Grey literature and manual searches were also done. RESULTS: Of the 16 articles included, 8 were published in peer-reviewed journals. Two of these did not include an evaluation. Study designs included but were not limited to pilot studies (n = 2); mixed methods evaluations (n = 2); single-site randomized controlled trials (n = 3); and, non-randomized single-arm study design (n = 1). The articles were from the United States (n = 12), Canada (n = 2), Australia (n = 1), and the United Kingdom (n = 1). CONCLUSION: The majority of interventions focused on addressing health-related educational needs, followed by community mobility. Goal setting and promoting self-efficacy were identified as important components, and the importance of involvement of people with lived experience was also highlighted. There was a lack of focus on management of relationships, including addressing sexuality needs. This review highlights the need for further empirical evaluation of implemented programs and interventions in this area, particularly in countries other than the USA, to inform service development.IMPLICATIONS FOR REHABILITATIONSuccessful community integration is an important outcome of spinal cord injuries rehabilitation.The majority of published programs focus on health-related educational needs, followed by community mobility.It is recommended that goal setting and promoting self-efficacy are included in programs.It is recommended that people with lived experience of spinal cord injuries are involved in interventions.It is recommended that programs include a focus on management of relationships, including addressing sexuality needs.

Risk factors for social isolation in post-hospitalized older adults.

INTRODUCTION: Social isolation in older adults is associated with high rates of adverse health outcomes. Older adults who have had a recent significant health event are likely to be at risk of social isolation following hospitalization. This study aims to identify risk factors amongst older adults at hospital discharge that are associated with social isolation at three months post-hospitalization. METHODS: Older adults were surveyed at hospital discharge and three months post-hospitalization. Baseline data including demographics, self-reported quality of life, physical activity and capacity levels, lifestyle factors, symptoms of depression and anxiety were collected at discharge. Social isolation was measured using the Friendship Scale at the three-month follow-up. Regression analyses were used to examine the relationship between baseline characteristics and social isolation at three months post-hospitalization. RESULTS: Older adults (n = 311) participated in the baseline survey, of whom 241 (78 %) completed the three-month survey. Higher depressive and anxiety symptoms at hospital discharge, comorbidity of cancer, history of cigarette smoking, prior access to community and respite service, and arrangement for shopping assistance post-discharge were factors independently associated with an increased risk of social isolation at three months post-hospitalization. DISCUSSION: This study identified risk factors for social isolation that are unique to older post-hospitalized adults. These findings can help clinicians identify individuals at risk of social isolation and to target interventions that address these risk factors for the prevention of social isolation in older adults after hospitalization.

A comparative examination of models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for spinal cord injury.

STUDY DESIGN: Qualitative study using semi-structured interviews. OBJECTIVES: To describe and compare models of service delivery intended to support community integration in the immediate period following inpatient rehabilitation for SCI, and describe the characteristics of these models or approaches. SETTING: Spinal services from multiple international countries METHODS: Semi-structured interviews were completed with 12 participants from a convenience sample of ten spinal services from developed economies. Interviews were audio-recorded, transcribed verbatim and thematically analysed. RESULTS: Three themes were identified, and are described with supporting quotations. These are: Theme One-Models of service delivery (sub-themes: staffing, peer mentors, facilitating community integration during inpatient rehabilitation; Theme Two-Services provided (sub-themes: telehealth, vocational services, groups); Theme Three-Facilitating self-efficacy and self-management. CONCLUSIONS: A variety of models aimed at supporting community integration in the immediate period following inpatient rehabilitation for SCI were found. Multi-disciplinary staffing and involvement of peer mentors was common to all services. The importance of vocational rehabilitation was acknowledged by all participants, although the approaches taken to this varied. Telehealth has the potential to assist in self-management, particularly for patients who live a long distance from the spinal unit or are confined to the home for health reasons, and could be further developed. Although service models are greatly influenced by the funding context, the findings from this study can be used to inform service planning in this area.

Programme frequency, type, time and duration do not explain the effects of balance exercise in older adults: a systematic review with a meta-regression analysis.

OBJECTIVE: The objective of this systematic review was to examine the effects of different balance exercise interventions compared with non-balance exercise controls on balance task performance in older adults. DESIGN: Systematic review. DATA SOURCES: Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Scopus and Cochrane Database of Systematic Reviews were searched until July 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews and meta-analyses of randomised trials of balance exercise interventions for older adults were identified for extraction of eligible randomised trials. Eligibility criteria for inclusion of randomised trials in meta-analyses were comparison of a balance exercise intervention with a control group that did not perform balance exercises, report of at least one end-intervention balance outcome measurement that was consistent with the five subgroups of balance exercise identified, and full-text article available in English. RESULTS: Ninety-five trials were included in meta-analyses and 80 in meta-regressions. For four balance exercise types (control centre of mass, multidimensional, mobility and reaching), significant effects for balance exercise interventions were found in meta-analyses (standardised mean difference (SMD) 0.31-0.50), however with considerable heterogeneity in observed effects (I2: 50.4%-80.6%). Risk of bias assessments (Physiotherapy Evidence Database score and funnel plots) did not explain heterogeneity. One significant relationship identified in the meta-regressions of SMD and balance exercise frequency, time and duration explained 2.1% of variance for the control centre of mass subgroup. CONCLUSION: Limitations to this study included the variability in design of balance interventions, incomplete reporting of data and statistical heterogeneity. The design of balance exercise programmes provides inadequate explanation of the observed benefits of these interventions.

Does blood lactate predict the chronic adaptive response to training: A comparison of traditional and talk test prescription methods.

The purpose of this study was to test the hypotheses (i) that interindividual variability in acute blood lactate responses during exercise at 65% of peak work rate (WRpeak; relative WRpeak protocol (REL)) will predict variability in the chronic responses to exercise training and (ii) that exercising at an intensity that causes uncomfortable speech production (negative talk test (TT) stage (NEG)) elicits high acute blood lactate responses and large adaptations to training. Twenty-eight participants completed 4 weeks of exercise training consisting of REL (n = 14) or NEG (TT, n = 14). Fifteen additional participants were assigned to a no-exercise control group (n = 15). In REL, acute blood lactate responses during the first training session significantly predicted changes in peak oxygen consumption (r = 0.69) after training. TT resulted in consistently high acute blood lactate responses. REL and TT improved (p < 0.05) peak oxygen consumption, WRpeak, and work rate at the onset of blood lactate accumulation (WROBLA). Despite nonsignificance, small to medium between-group effect sizes for changes in peak oxygen consumption, WRpeak, and WROBLA and a higher work rate, heart rate, rating of perceived exertion, and blood lactate during training at NEG support the potential superiority of TT over REL. When exercise is prescribed using a traditional method (a fixed percentage of WRpeak; REL), acute metabolic stress may partly explain the variance in the adaptations to training. In addition, TT elicited significant increases in peak oxygen consumption, WRpeak, and WROBLA, and although our small sample size limits our ability to confidently compare training adaptations between groups, our preliminary results suggest that future investigations with larger sample sizes should assess the potential superiority of TT over REL.

Moving beyond threshold-based dichotomous classification to improve the accuracy in classifying non-responders.

We examined maximal oxygen consumption responses following exercise training to demonstrate the limitations associated with threshold-based dichotomous classification of responders and non-responders and proposed alternative methods for classification. Specifically, we: 1) calculated individual probabilities of response, and 2) classified individuals using response confidence intervals (CI) and reference points of zero and a smallest worthwhile change of 0.5 METs. Our findings support the use of individual probabilities and individual CIs to improve the accuracy in non-response classification.

Barriers and enablers to ongoing exercise for people with chronic health conditions: Participants' perspectives following a randomized controlled trial of two interventions.

BACKGROUND: At present there is no clear evidence to support any one particular intervention for engaging adults with chronic health issues in ongoing exercise. An understanding of consumer perceptions and preferences is important, because low rates of exercise adherence are likely to limit any benefits obtained. OBJECTIVE: To identify and compare participants' perceptions about their own motivation, capacity and opportunity to adhere to an allocated exercise program during either a gym-based or a home-based exercise program with telephone follow-up. METHOD/DESIGN: This qualitative study used convenience sampling to recruit participants (adults with chronic health issues) immediately after a randomised controlled trial comparing gym-and home-based exercise programs conducted for 12 months. Ten people, five from each intervention group, attended face-to- face semi-structured interviews at a local Community Health Service. Thematic analysis methods were used to analyse the dataset. RESULTS: Improved social interaction in the gym-based program was seen to contribute to adherence, however home-based programs were perceived as more convenient and easily integrated into daily routines. Individualized exercise prescription by a health professional with regular follow up (in person or by telephone) promoted an active practitioner-participant relationship. Health coaching combined with exercise was perceived to improve self-efficacy and assisted with the removal of intrinsic and extrinsic exercise barriers. CONCLUSION: This research presented many common and different themes in participant's motivation, capacity and opportunity in sustained adherence to a gym or home-based exercise program. However, this study found no superior intervention or individual preference to improve ongoing exercise adherence.

Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial.

QUESTION: What is the comparative cost-effectiveness of a gym-based maintenance exercise program versus a home-based maintenance program with telephone support for adults with chronic health conditions who have previously completed a short-term, supervised group exercise program? DESIGN: A randomised, controlled trial with blinded outcome assessment at baseline and at 3, 6, 9 and 12 months. The economic evaluation took the form of a trial-based, comparative, incremental cost-utility analysis undertaken from a societal perspective with a 12-month time horizon. PARTICIPANTS: People with chronic health conditions who had completed a 6-week exercise program at a community health service. INTERVENTIONS: One group of participants received a gym-based exercise program and health coaching for 12 months. The other group received a home-based exercise program and health coaching for 12 months with telephone follow-up for the first 10 weeks. OUTCOME MEASURES: Healthcare costs were collected from government databases and participant self-report, productivity costs from self-report, and health utility was measured using the European Quality of Life Instrument (EQ-5D-3L). RESULTS: Of the 105 participants included in this trial, 100 provided sufficient cost and utility measurements to enable inclusion in the economic analyses. Gym-based follow-up would cost an additional AUD491,572 from a societal perspective to gain 1 quality-adjusted life year or 1year gained in perfect health compared with the home-based approach. There was considerable uncertainty in this finding, in that there was a 37% probability that the home-based approach was both less costly and more effective than the gym-based approach. CONCLUSION: The gym-based approach was more costly than the home-based maintenance intervention with telephone support. The uncertainty of these findings suggests that if either intervention is already established in a community setting, then the other intervention is unlikely to replace it efficiently. REGISTRATION: ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2018) Gym-based exercise was more costly compared with home-based exercise with telephone support when used as maintenance programs for adults with chronic health conditions: cost-effectiveness analysis of a randomised trial. Journal of Physiotherapy 64: 48-54].

The association between physical activity and social isolation in community-dwelling older adults.

OBJECTIVES: Social isolation is an increasing concern in older community-dwelling adults. There is growing need to determine effective interventions addressing social isolation. This study aimed to determine whether a relationship exists between physical activity (recreational and/or household-based) and social isolation. An examination was conducted for whether group- or home-based falls prevention exercise was associated with social isolation. METHODS: Cross-sectional analysis of telephone survey data was used to investigate relationships between physical activity, health, age, gender, living arrangements, ethnicity and participation in group- or home-based falls prevention exercise on social isolation. Univariable and multivariable ordered logistic regression analyses were conducted. RESULTS: Factors found to be significantly associated with reduced social isolation in multivariable analysis included living with a partner/spouse, reporting better general health, higher levels of household-based physical activity (OR = 1.03, CI = 1.01-1.05) and feeling less downhearted/depressed. Being more socially isolated was associated with symptoms of depression and a diagnosis of congestive heart failure (pseudo R2 = 0.104). DISCUSSION: Findings suggest that household-based physical activity is related to social isolation in community-dwelling older adults. Further research is required to determine the nature of this relationship and to investigate the impact of group physical activity interventions on social isolation.

Social Isolation, Physical Capacity, and Physical Activity in Older Community-Dwelling Adults Post-Hospitalization.

This paper investigated the potential relationships between physical capacity and physical activity (recreational and household) with social isolation amongst older adults. Data for hospitalized Victorians (n = 311) were analyzed in univariable, multivariable and latent growth curve analyses over six months. Measures included items from the Friendship Scale, Lubben Social Network Scale (LSNS-6), Australian Survey of Disability, Ageing and Carers Household (SDAC), and Phone-FITT. Over six months, improvements in physical capacity were related to reduced social isolation (-0.65, CI = -1.21, -0.09). Increased total (0.02, CI = 0.004, 0.04) and household-based physical activity (0.03, CI = 0.001, 0.06) were related to contact with more relatives. Higher baseline household-based physical activity was related to contact with fewer relatives (-0.01, CI = -0.02, -0.001). Along with physical capacity and activity, household-based physical activity appears to be strongly related to social isolation. Further research is required to determine the direction of relationships, to provide evidence for effective interventions.

Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial.

QUESTION: What is the effectiveness of gym-based exercise versus home-based exercise with telephone follow-up amongst adults with chronic conditions who have completed a short-term exercise program supervised by a health professional? DESIGN: A randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome assessment at baseline and 3, 6, 9 and 12 months. PARTICIPANTS: The participants were recruited following a 6-week exercise program at a community health service. INTERVENTION: One group of participants received a gym-based exercise program for 12 months (gym group). The other group received a home-based exercise program for 12 months with telephone follow-up for the first 10 weeks (home group). OUTCOME MEASURES: Outcome measures included European Quality of Life Instrument (EQ-5D), the Friendship Scale, the Hospital and Anxiety and Depression Scale, Phone-FITT, 6-minute walk test, body mass index and 15-second sit-to-stand test. RESULTS: There was no significant difference between study groups in the primary outcome (EQ-5D visual analogue scale, 0 to 100) across the 12-month intervention period, with an estimate (adjusted regression coefficient) of the difference in effects of 0 (95% CI -5 to 4). The gym group demonstrated slightly fewer symptoms of depression over the 12-month period compared to the home group (mean difference 0.8 points on a 21-point scale, 95% CI 0.1 to 1.6). CONCLUSION: Similar long-term clinical outcomes and long-term exercise adherence are achieved with the two approaches examined in this study. Participation in gym-based group exercise may improve mental health outcomes slightly more, although the mechanisms for this are unclear because there was no change in the selected measure of social isolation or other measures of health and wellbeing. This finding may also be a Type 1 error. Further research to reproduce these results and that investigates the economic efficiency of these models of care is indicated. TRIAL REGISTRATION: ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2017) Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154-160].

Self-renewing resident arterial macrophages arise from embryonic CX3CR1(+) precursors and circulating monocytes immediately after birth.

Resident macrophages densely populate the normal arterial wall, yet their origins and the mechanisms that sustain them are poorly understood. Here we use gene-expression profiling to show that arterial macrophages constitute a distinct population among macrophages. Using multiple fate-mapping approaches, we show that arterial macrophages arise embryonically from CX3CR1(+) precursors and postnatally from bone marrow-derived monocytes that colonize the tissue immediately after birth. In adulthood, proliferation (rather than monocyte recruitment) sustains arterial macrophages in the steady state and after severe depletion following sepsis. After infection, arterial macrophages return rapidly to functional homeostasis. Finally, survival of resident arterial macrophages depends on a CX3CR1-CX3CL1 axis within the vascular niche.

Older Adult Perceptions of Participation in Group- and Home-Based Falls Prevention Exercise.

This paper describes why older adults begin, continue, and discontinue group- and home-based falls prevention exercise and benefits and barriers to participation. Telephone surveys were used to collect data for 394 respondents. Most respondents reported not participating in group- (66%) or home-based (78%) falls prevention exercise recently. Reasons for starting group-based falls prevention exercise include health benefits (23-39%), health professional recommendation (13-19%), and social interaction (4-16%). They discontinued because the program finished (44%) or due to poor health (20%). Commonly reported benefits were social interaction (41-67%) and health (15-31%). Disliking groups was the main barrier (2-14%). Home-based falls prevention exercise was started for rehabilitation (46-63%) or upon health professional recommendation (22-48%) and stopped due to recovery (30%). Improvement in health (18-46%) was the main benefit. These findings could assist health professionals in prescribing group-based falls prevention exercise by considering characteristics of older adults who perceive social interaction to be beneficial.

Anxiety and Depression during Transition from Hospital to Community in Older Adults: Concepts of a Study to Explain Late Age Onset Depression.

The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care.

Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review.

QUESTION: How has balance challenge intensity been reported in trials of balance exercise interventions? Are there any instruments designed to measure the intensity of balance challenge in balance training exercises? DESIGN: Systematic review of randomised trials of balance training exercises. PARTICIPANTS: Older adults, ie, the majority of subjects were aged over 55 years. INTERVENTION: Balance exercise intervention, or multi-dimensional intervention that included a balance exercise intervention. OUTCOME MEASURES: The included trials were examined for descriptions and instruments used to report the intensity of the challenge to the patient's balance system provided by the balance exercise prescribed. The other included studies were examined for instruments that measure balance challenge intensity. RESULTS: In most of the 148 randomised trials identified, measures of reported balance challenge 'intensity' were actually measures of some other aspect of the exercise, eg, aerobic intensity or a hierarchy of task difficulty without reference to the patient's ability. Three potential systems of measuring the balance challenge intensity were identified. Two were not described in any detail. One was defined in terms of the limits of the patient's postural stability, but this system appears not to have been validated. No adequate measures of balance challenge intensity were found among the other types of studies identified. CONCLUSION: The review highlights a serious gap in the methods used to prescribe, implement, and evaluate the effect of balance exercise programs. Comprehensive work in this area is required to develop a psychometrically sound measure of balance exercise intensity.