RESUMEN
Thermography is a non-invasive method for measuring surface temperatures and may be a convenient way of identifying hypo/hyperthermic areas under a saddle that may be related to saddle pressures. A thermal camera quantified minimum/maximum/mean temperatures at specific locations (left/right) of the thoracic region at three-time points: (1) baseline; (2) post lunging; (3) post ridden exercise in eight non-lame sports horses ridden by the same rider. A Pliance (Novel) pressure mat determined the mean/peak saddle pressures (kPa) in the cranial and caudal regions. General linear mixed models with the horse as the random factor investigated the time point (fixed factor: baseline; lunge; ridden) and saddle fit (fixed factor: correct; wide; narrow) on thermal parameters with Bonferroni post hoc comparison. The saddle pressure data (grouped: saddle width) were assessed with an ANOVA and Tukey post hoc comparison (p ≤ 0.05). Differences between the saddle widths in the cranial/caudal mean (p = 0.05) and peak saddle pressures (p = 0.01) were found. The maximum temperatures increased post lunge (p ≤ 0.0001) and post ridden (p ≤ 0.0001) compared to the baseline. No difference between post lunge and post ridden exercise (all p ≥ 0.51) was found. The thermal activity does not appear to be representative of increased saddle pressure values. The sole use of thermal imaging for saddle fitting should be applied with caution.
RESUMEN
Background: People experiencing homelessness are known to have complex health needs, which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilization among homeless people in England. Methods: A cross-sectional sample of 2505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilization. Results: Rough sleepers were much less likely to be registered with a general practitioner (GP) (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.30-0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48, 95% CI 0.88-2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, 95% CI 0.49-0.91) or using an ambulance (OR 0.73, 95% CI 0.54-0.99). Conclusions: The most vulnerable homeless people face the greatest barriers to utilizing healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital hospital services which they are currently missing out on.
