Usual Residence Research Articles

Impact of COVID-19 public health restrictions on fall-related hip fracture hospitalizations: An interrupted time series analysis

PurposeThere is limited evidence regarding the impact of public health restrictions on hip fracture hospitalization by place of fracture occurrence. This study aimed to examine the impact of COVID-19 public health restrictions on fall-related hip fracture hospitalization rates by place of occurrence. MethodsThis retrospective cohort study was conducted using hospitalization data in New South Wales, Australia, between January 2014 and June 2022. Older adults aged ≥65 years admitted to hospital following a fall-related hip fracture. An interrupted time-series analysis using autoregressive integrated moving average models evaluated the impact of public health restrictions on fall-related hip fracture hospitalization by place of fracture occurrence (home/residence, residential aged care facility (RACF), or away from usual residence). ResultsThe mean observed fall-related hip fracture hospitalization rate during COVID-19 public health restrictions (36.3 per 100,000 people per month) was 13.4 % lower than the forecasted rate (41.1 per 100,000 people per month). The mean observed hospitalization rates for fall-related hip fractures at home/residence, at a RACF, and away from the usual residence were 3.8 %, 18.5 %, and 40.1 % lower than the forecasted rates, respectively. Level changes in the fall-related hip fracture hospitalization rates at RACFs and away from usual residences were −0.9 per 100,000 people per month (95 % CI −1.6 to −0.2) and −1.7 per 100,000 people per month (95 % CI −2.5 to −0.9), respectively. ConclusionsThere was a decline in fall-related hip fracture hospitalization rates among older adults, where the fracture occurred at RACFs and away from a person's usual residence during COVID-19 public health restrictions.

Modeling spatial correlation between earthquake insured losses in New Zealand: A mixed-effects analysis.

Earthquake insurance is a critical risk management strategy that contributes to improving recovery and thus greater resilience of individuals. Insurance companies construct premiums without taking into account spatial correlations between insured assets. This leads to potentially underestimating the risk, and therefore the exceedance probability curve. We here propose a mixed-effects model to estimate losses per ward that is able to account for heteroskedasticity and spatial correlation between insured losses. Given the significant impact of earthquakes in New Zealand due to its particular geographical and demographic characteristics, the government has established a public insurance company that collects information about the insured buildings and any claims lodged. We thus develop a two-level variance component model that is based on earthquake losses observed in New Zealand between 2000 and 2021. The proposed model aims at capturing the variability at both the ward and territorial authority levels and includes independent variables, such as seismic hazard indicators, the number of usual residents, and the average dwelling value in the ward. Our model is able to detect spatial correlation in the losses at the ward level thus increasing its predictive power and making it possible to assess the effect of spatially correlated claims that may be considerable on the tail of lossdistribution.

Of ‘international exposure’, place and mobility trajectories: domestic students and international students in the education hub of Dubai

ABSTRACT In 2023, the UAE hosted the second largest number of international branch campuses in the world. They cater for ‘local’ Emirati students and the large resident community of ‘expatriates’, but there also is a growing number of international students coming to study in Dubai from abroad. Drawing on semi-structured interviews with students in Dubai, this paper compares the locational and study choices of international and domestic students at international branch campuses. The findings show that the domestic students often opt to study locally due to the more affordable tuition fees and gendered expectations to stay close to their families. Meanwhile for international students, the prestige associated with certain international branch campuses, usually is a decisive factor in motivating them to study in Dubai, alongside concerns for safety and proximity to their country of usual residence. In addition, many international students believe that Dubai’s reputation as a ‘world’ city, which attracts people, goods, and investments from various part of the world, and the transnational education they are engaged in, will enable them to benefit from ‘international exposure’. Both international and domestic students regard the academic credentials they attain in Dubai as potentially paving the way for the realisation of post-study aspirations.

New migrants' access to primary healthcare services in Aotearoa New Zealand.

To explore new migrants' access to primary healthcare services in the first 10 years after arrival in Aotearoa New Zealand. Data come from three New Zealand Health Surveys (2014/2015, 2015/2016 and 2016/2017), which each sampled around 13,500 people, aged 15+ years, who were usual residents of Aotearoa New Zealand. Respondents who said they were born overseas were asked the first year they had come to Aotearoa New Zealand. Those who had arrived in the 10 years before their survey was completed were considered new migrants. The survey data were pooled and around 3,700 respondents were estimated to fit this category. Log-linear models, with adjustments for age, sex, ethnicity and New Zealand Deprivation Index, were used to look at last year use of primary healthcare. Overall, new migrants used primary healthcare similarly to other New Zealanders. They were more likely to have comprehensive health insurance and paid more for GP visits upon arrival but acted similarly to other New Zealanders after 4 years. Generally, new migrants-after adjusting for covariates-appear to be accessing primary healthcare services in a similar manner to other New Zealanders, on average, soon after arrival.

Does the level of mobility on ICU discharge impact post-ICU outcomes? A retrospective analysis

Purpose Mobilisation is a common intervention in Intensive Care (ICU). However, few studies have explored the relationship between mobility levels and outcomes. This study assessed the association of the level of mobility on ICU discharge with discharge destination from the hospital and hospital length of stay. Materials and methods A retrospective analysis of data from 522 patients admitted to a single UK general ICU who were ventilated for ≥5 days was performed. The level of mobility was assessed using the Manchester Mobility Score (MMS). Multivariable regression analysed demographic and clinical variables for the independence of association with discharge destination and hospital length of stay. Results MMS ≥5 on ICU discharge was independently associated with discharge destination and hospital LOS (p < 0.001). Patients achieving MMS ≥5 on ICU discharge were more likely to be discharged home (OR 3.86 95% CI 2.1 to 6.9, p < 0.001), and had an 11.8 day shorter hospital LOS (95% CI −17.6 to −6.1, p < 0.001). Conclusions The ability to step transfer to a chair (MMS ≥5) before ICU discharge was independently associated with discharge to usual residence and hospital LOS, irrespective of preadmission morbidity. Increasing the level of patient mobility at ICU discharge should be a key focus of rehabilitation interventions.

Time is brain, so we must BEFAST: Improving stroke identification and triage in a rural emergency department.

Shoalhaven District Memorial Hospital is a rural (MM3) secondary hospital which is over an hour travel time from the nearest tertiary centre. The objective of the present study was to pilot the implementation of the BEFAST (Balance, Eyes, Face, Arms, Speech and Time) stroke screening tool at the ED, and determine whether its usage improved timely stroke detection. During initial implementation and training (October-December 2019), triage nurses consulted with senior medical officers before activating stroke calls. Data were collected for the subsequent 24 months (January 2020-2022), and retrospective records for confirmed strokes during a 24-month period prior to BEFAST implementation (October 2017-2019) were also collected. The main outcome measures were triage category, CT scan result time, discharge destination, length of stay (LOS) and Modified Rankin Score (MRS). After BEFAST implementation, patients (n = 268) were three times more likely to be triaged at category 1 or 2, and door-to-CT scan time was reduced by 20.7 min on average. More patients were discharged to their usual residence and more quickly (LOS 7.9 vs 11.1 days). MRS 90 days after stroke was less, and patients were nearly twice as likely to experience an improvement in neurological symptoms. Patient outcomes were improved after implementation of the BEFAST stroke triage tool. More stroke patients were identified upon presentation to the ED, and in a timely fashion. For those with a stroke diagnosis, time-critical interventions can take place earlier, allowing patients to return home sooner, and with less disability.

Using Walking Interviews in Migration Research: A Systematic Review of the Qualitative Research Literature

In the field of migration research, the frequency of employing qualitative walking interviews has risen in recent years to delve into the construction, evolution, and negotiation mechanisms of migrant identities within everyday spatial practices. This novel mobile method emphasizes the interaction between micro-experience and macro-structure. It facilitates a shift away from viewing migrants as passive outsiders, empowering them with increased agency, and allow researchers to gain deeper insights into migrants’ emotional dynamics, life experiences, and self-identification within new social landscapes and power configurations. This systematic review aims to evaluate, integrate, and analyse the current empirical evidence in qualitative migration research using walking/go-along interviews for different types of migrants (defined as an individual who moves away from his or her place of usual residence, whether within a country or across an international border, temporarily or permanently, and for a variety of reasons). This review brings together for the first time the knowledge and insights from migration research that involves walking interviews. This review employs framework synthesis to analyse the 24 included articles, identifying five major themes: (1) synergising diverse research methods within different research designs; (2) adjustment of power dynamics; (3) migrants’ place-based threefold agency; (4) migrants' identity construction; (5) place-based sense of belonging or exclusion. By integrating these themes, the methodological contribution of this review lies in recognizing the advantages of combining walking interviews with other research methods, which lies in capturing the multidimensional aspects of mobility, allowing researchers to flexibly switch between methodological strategies and spatial scales. Additionally, this paper recommends a deeper exploration of migratory experiences to transcend prevailing practical knowledge and pay sensitive attention to potential ethical issues throughout the research. Such investigation has the potential to uncover the dynamic evolution of agency, identity construction, and the fluctuating sense of belonging among various migrants throughout their journey.

Older People and Carers’ experiences of ‘Hospital-at-Home’

Introduction: Hospital at home (HAH) is an acute model of care that provides episodes of care to acutely unwell persons in their usual residence, i.e., their own home or in a care home. Providing intense and integrated care and treatment packages enables people to remain in their familiar environment and avoid the potential harm from in-patient stays. &#x0D; Background Research: Currently, hospital-at-home research in the United Kingdom and internationally is limited regarding the lived experiences of older people and their unpaid carers. When older people and carers are excluded from research or not considered, we cannot understand how their experiences of services impact their everyday lives. The research also provides insight into how professionals can support people outside of hospitals more effectively by integrating this care model with other statutory services, such as social care, occupational and physiotherapy. Hospital-at-home initiatives can potentially reduce the risks associated with hospitalisation, such as infection, mental health and physical decline. Older people, carers and health and social care professionals may find this exciting and helpful research.&#x0D; Involvement: The research is nested into a wider research programme which people with lived experience have framed. There is also a panel of people with lived experience of receiving adult social care and those who support them, all of which form the approach to public and patient involvement.&#x0D; Data Collection &amp; Methodology: There will be approximately 65 participants in this qualitative study, including health and social care staff, older people, and unpaid carers. All participants will be offered a one-off 60-minute semi-structured interview allowing them to respond in their own words. This contrasts with previous HaH studies in the United Kingdom that rely on fixed yes or no responses in surveys or questionnaires. Inductive Thematic Analysis is being used to analyse the data. As the data collection and analysis is still in progress, results are not fully concluded; however, the aim is to have themes fully developed from the data before the conference in May 2023. Some initial themes have emerged from the interviews with professionals, including risk, person-centred care, communication, and service delivery.&#x0D; Findings: The findings will create learning opportunities for an international audience, for example, concerning effective interprofessional working and person-centred care in HAH. Indeed, there is evidence of international HAH models in the literature review so that any new learning can be cascaded internationally via this conference. For example, when referring to communication, there could be an effective communication system developed at the point of discharge from HAH back to the care of their general practitioner, as this is an area of concern emerging from the professional interviews. The next steps will be to complete the research and give feedback to the local site in England where the research is taking place and to the Applied Research Collaboration (ARC) that has funded the research. This will highlight ideas and improvements for the future of community-based health and social care for older people and their carers.&#x0D; &#x0D;

2322. Challenges Faced by Perinatally-Infected Young People Living with HIV in Kenya During the COVID-19 Pandemic

Abstract Background Understanding challenges experienced by young people living with HIV (YPLWH) during the COVID-19 pandemic could guide care during public health crises, particularly in resource-limited settings. Methods Surveys utilizing validated and self-reported measures were administered to perinatally-infected YPLWH receiving care at four clinics at the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya between February 2021 and July 2022. Reported psychological, physical, and socioeconomic challenges were summarized overall and across viral load (VL) thresholds (virologic failure VL &amp;gt;40 copies/mL; treatment failure VL &amp;gt;1000 copies/mL). COVID-19-related events, restrictions, and interventions in Kenya from the beginning of the pandemic through the entirety of the study period were compiled into a pandemic timeline and temporal patterns of the evaluated challenges within this timeline were assessed using generalized additive models. Results Among 442 participants (median age 17 years, IQR 14-19; 49% female), 89% reported any challenge (mean 2.92 of the 23 challenges estimated; SD=2.14); 48% psychological, 66% physical, and 62% socioeconomic. Major psychological challenges included moderate to severe depression (36%) and anxiety (29%) symptoms. Major physical challenges included recent illness (31%), and recent symptoms of cough (34%), congestion (25%), and fatigue (23%). Major socioeconomic challenges included food insecurity (31%), household income loss (27%), and departure from usual residence (20%). Participants with virologic or treatment failure experienced more challenges compared to those suppressed. Trends of challenges over time were stable for all but physical challenges, which decreased in parallel with the reduced incidence of respiratory infections as masking and social distancing measures were implemented. Conclusion The vast majority of Kenyan YPLWH experienced significant wellness challenges during the COVID-19 pandemic, conceivably due to pandemic-imposed travel restrictions and mitigation measures, and possibly impacting HIV care. This knowledge could guide intervention opportunities in this vulnerable population for current and future pandemics. Disclosures All Authors: No reported disclosures

Development and first-in-human testing of FLUME urinary catheter with protected tip and relocated drainage holes

Purpose:Evaluation of a catheter design which protects its tip with the retaining balloon when inflated, and has eyeholes at the base of the balloon to improve drainage. Materials and methods:Preclinical tests included assessment of retaining balloon performance, and microbiological blockage. Clinical testing evaluated short-term use and safety in hospital (stage 1) or the patient’s usual residence (stage 2). Results:The retaining balloon supported static loads of 0.7kg, with reduced trauma when modelling forced evulsion. In vitro time to blockage with P. Mirabilis was significantly slower for FLUME compared with latex Foley catheters, but not the silicone Foley. Stage 1 testing (10 patients) confirmed balloon inflation, drainage, retention and removal, with no serious adverse events caused by catheterisation; one balloon failed to inflate, one patient could not be catheterised. Of five patients at stage 2, one had the catheter for 28 days without complication, one experienced spontaneous balloon deflation (14th day) and three needed early removal (blood clot, bypassing, difficulty connecting the drainage bag). Bacterial profiles of two FLUME catheters retained at least 2 weeks matched the Foley catheters. Acquired catheter colouration (two FLUME, one Foley) was not associated with biochemical change in the material. Conclusion:FLUME catheter performed well in preclinical blockage and balloon tests. Tests in 15 patients confirmed basic function and additional training was not needed for staff familiar with Foley catheterisation. Clinical issues commonly seen with catheters included failed catheterisation, clot blockage and bypassing. In addition, an unintended balloon deflation and a failure of bag connection occurred. Plain language summary:This article describes a new catheter design which aims to improve patient comfort and safety, and maximise bladder drainage, by protecting the bladder from the exposed catheter tip and by locating the drainage holes better. Various tests were done to check the catheter retaining balloon was safe and how well the catheter did when exposed to bacteria that could block it. The catheter was also used in people for the first time, to check it could be put in safely and functioned as intended. The results showed the FLUME catheter did well in the balloon and blockage tests. Tests in 15 patients confirmed basic function and showed placement was easy for staff familiar with conventional catheters. There were some clinical issues typical of urinary catheters and some possible improvements were identified.

Treatment-seeking behaviour among 15–49-year-olds with self-reported heart disease, cancer, chronic respiratory disease, and diabetes: a national cross-sectional study in India

BackgroundEighty per cent of India´s non-communicable disease (NCD) mortality is due to four conditions: heart disease, cancer, chronic respiratory disease, and diabetes, which are primarily cause-amenable through treatment. Based on Andersen’s behavioural model of health services use, the current study aimed to identify the predisposing, enabling, and need factors associated with treatment-seeking status among people self-reporting the four main NCDs in India.MethodsCross-sectional study using secondary data. Usual residents aged 15–49 who self-reported cancer (n = 1 056), chronic respiratory disease (n = 10 534), diabetes (n = 13 501), and/or heart disease (n = 5 861) during the fifth National Family and Health Survey (NFHS-5), 2019–21, were included. Treatment-seeking status was modelled separately for each disease using survey-adjusted multivariable logistic regression.Results3.9% of India´s 15–49-year-old population self-reported ≥ 1 of the four main NCDs (0.1% cancer, 1.4% chronic respiratory disease, 2% diabetes, 0.8% heart disease). The percentage that had sought treatment for their condition(s) was 82%, 68%, 76%, and 74%, respectively. Greater age and having ≥ 1 of the NCDs were associated with greater odds of seeking disease-specific treatment. People in the middle or lower wealth quintiles had lower odds of seeking care than the wealthiest 20% for all conditions. Women with diabetes or chronic respiratory disease had greater odds of seeking disease-specific treatment than men. Muslims, the unmarried, and those with health insurance had greater odds of seeking cancer treatment than Hindus, the married, and the uninsured.ConclusionPredisposing, enabling, and need factors are associated with treatment-seeking status among people reporting the four major NCDs in India, suggesting that multiple processes inform the decision to seek disease-specific care among aware cases. Successfully encouraging and enabling as many people as possible who knowingly live with major NCDs to seek treatment is likely contingent on a multi-pronged approach to healthcare policy-making. The need to improve treatment uptake through accessible healthcare is further underscored by the fact that one-fifth (cancer) to one-third (chronic respiratory disease) of 15–49-year-olds reporting a major NCD have never sought treatment despite being aware of their condition.

Understanding the Current Geographic Disposition of the Jewish Population of England and Wales: Growth and Contraction

The release in March/April 2023 of England and Wales 2021 Census complete data on “usual residents” by the Office for National Statistics provides an opportunity to analyze, understand and comment on the current geographic disposition of Anglo–Jewry. The analysis presented in this paper incorporates data from the 2001 and 2011 censuses, and makes use of a geodemographic assessment of Jewish communities developed from the 2011 census, setting the scene for changes which have taken place, particularly in the last 10 years. Estimates of the scale of births, deaths and net migration in the 2011–2021 period have been developed to explain why the changes in population have taken place. The potential impact of the coronavirus disease 2019 (COVID-19) pandemic on the census results is also considered. A total of 26 sub-communities in the London and Manchester areas, together with 34 free-standing communities, each with more than 200 Jewish residents, have been analyzed in detail. Unexpected changes in Stamford Hill, Gateshead and Bristol are investigated. A total of 42 smaller communities (60–200 members) are also identified. The paper shows that an understanding of the socio-economic characteristic of each of the communities explains their changes in population since 2011, particularly when factors such as “meta-suburbanisation” in the London fringe area, the impact of student numbers in university towns, and special factors affecting Haredi areas are also taken into account. The picture presented is one of a stable (indeed slightly growing) overall population, but with a large variation in fortunes of the many communities which make up Anglo–Jewry.

129 Can we improve the patient experience for frail, older persons admitted with delirium?

Abstract Background Delirium is a common feature in admission of older adults to inpatient wards. The diagnosis of delirium is often over-looked by healthcare professionals. This leads to lack of early intervention; associated with negative outcomes including prolonged Length of Stay (LoS), avoidable complications, and use of psychotropic medications. We assessed whether a Quality Improvement Program (QIP) should be implemented for frail older patients focused on identification and intervention of delirium. Methods The pre-intervention retrospective audit included patients aged 75 or older, assessed by the Frailty at the Front Door team in a four-month period (2022). All patients had 4AT score of 4 or greater, indicating a delirium syndrome. Data was collected on discharge destination, Clinical Frailty Score (CFS), LoS, and number of bed-moves. A selection of patients had in-depth medical record reviews to identify whether delirium was documented, and what interventions occurred, including pharmacological. Results Data was collected on 40 patients, age range 77–97 years, median age 86 years. 57.5% were aged 85 or older (23/40). Median CFS was 5, Median 4AT score was 5. 30% had a 4AT score ≥ 7 (12/40). 57.6% (19/33) were discharged home to their usual residence, 30.3%(10) went to inpatient ‘respite’. 4 patients were not admitted. Longest LOS was 42 days, average LOS 8 days. One patient experienced 13 bed moves during their inpatient stay (average = 8). 19 patients had in-depth chart review: 2/19 had appropriate documentation of delirium in the ED, 6/19 as an inpatient. 1 patient had non-pharmacological interventions recommended. 2 patients were discharged on a new psychotropic medication. Conclusion In an older, frail population presenting to ED, delirium is under-recognised despite routine use of 4AT score. Non-pharmacological interventions are under-utilised. Patients experience prolonged inpatient stays and frequent bed moves, and are likely to be discharged to a different inpatient unit for ‘respite’. A QIP will be developed aiming to improve patient experiences.

Prevention and treatment of noncognitive complications.

Patients aged 65 and older are the fastest growing segment in the population of many countries. Based on evolving demographics showing increasing life expectancies, it is expected that there will be a concurrent rise in the demand for a large variety of surgical and anesthesia services. Surgery offers definitive management of many age-related diseases and provides symptom-relieving (morbidity) and life-extending (mortality) benefits. However, elderly adult surgical patients, especially the frail ones, often require a different level of care than younger patients during the perioperative period. As many have chronic illnesses and acquired deconditioning and functional decline, older patients are prone to develop untoward outcomes such as postoperative complications and loss of independence. This manuscript focuses on the holistic quality person-centered care, supported by a wide stakeholder team of health-care workers, ensuring fidelity to comprehensive geriatric assessment and optimization services where possible, offering a systematic approach to early health risk assessment and risk modification in the perioperative period, with the ultimate goal of reducing postoperative complications and health-care costs. The "comprehensive geriatric assessment and optimization" cost-effective approach builds on robust evidence with older people more likely to be alive, a shorter length of hospital stay due to fewer postoperative medical complications, and improved rates of return to usual residence. Prehabilitation programs are delivered focusing on primary (through counseling) and secondary prevention (through screening) with an aim to improve fitness for surgery, by evaluating functional capacity, nutritional and psychological health, prompting interventions, targeting physical exercise, lifestyle and nutritional advice, and psychological support.

Türkiye için Demografik Mikrosimülasyon Modeli

This paper focuses on the use of microsimulation methodology to generate reliable population estimations for Türkiye. Microsimulation closely mimics life course dynamics and is therefore well-suited for predicting demographic changes. Using data from the 2018 Türkiye Demographic Health Survey, we developed a new microsimulation method that allows for greater customization and accuracy without relying on external patterns or models. The resulting population simulation includes age, education, marital status, usual residence, and labour force status for each individual until 2030. Our study demonstrates the flexibility and adaptability of microsimulation for demography and argues that it provides a coherent and meaningful way to estimate and project population attributes that other tools cannot provide. Ultimately, the dynamic simulation model has the potential to inform important policy decisions related to the population in Türkiye.

Intergenerational caregiving on mental health of middle-aged and older adults in China: empirical insights.

The impact of intergenerational caregiving on the mental health of providers remains a controversial topic, especially in countries like China where it is prevalent. Given the country's aging population and recent liberalization of the two-child policy, understanding the effects of intergenerational caregiving on the mental health of middle-aged and older adult(s) individuals is crucial. This study aimed to explore the impact of intergenerational caregiving on mental health among middle-aged and older adult(s) individuals. We analyzed data from the China Health and Aging Tracking Survey (CHARLS) 2013, consisting of 6602 participants finally. Personal information, family structure, financial support, health status, and physical measurements were selected for analysis. Correlation and regression analyses were used for relationships among variables controlling for potential confounding variables. Mental health status was evaluated using the depression self-rating scale. There is a significant positive effect of intergenerational care on the mental health of middle-aged and older adult(s) people. Additionally, we re-profiled intergenerational care variables by considering the number and length of intergenerational caregivers, and found that the effects remained significant. Furthermore, the effects of intergenerational care vary across subgroups based on gender, age, nature of usual residence, marital status, and physical health status. Finally, we identified two mechanisms through which intergenerational caregiving positively affects mental health: intergenerational financial support and intergenerational spiritual support. These findings have important implications for policymakers, healthcare professionals, and family members in promoting the mental health of middle-aged and older adult(s) individuals in China.

Nigeria’s Human Capital Migration and the Socio-economic Implications

This research presents the implications of human emigration from Nigeria and the socio-economic development implications for the Nigerian Economy. Migration, which is a form of geographic mobility involving a permanent or semi-permanent change of usual residence within 10 years, is rapidly on the increase worldwide. This research intends to undertake further exposition of all the activities of the incessant migration and brain drain, which impacts adversely on needed man-power for economic development in Nigeria. The work is anchored on push-pull theories of migration. Push-pull theory is an important theoretical approach that is often used to understand human capital migration. The theory proposes that there are factors responsible for the decisions of migrants to move from their places of origin to new destinations. In Nigeria, there are environmental, social, political, demographic, and economic factors that influence people to move from one geographical location to the other. Since the post-colonial era, Nigeria has been experiencing missed opportunities, low development, and frustrated hope. The research thus concluded that the failure of governance is seen in poor socio-economic performance, causing suffering and unfulfilled expectations leading to political instability, conflict, insurgency, etc. These conditions have led to massive migration of trained professionals like doctors, nurses, engineers, and academics to developed countries. To this extent, the following recommendations were made: &#x0D; &#x0D; Creation of job opportunities, &#x0D; Provision of quality educational opportunities, &#x0D; Provision of local incentives, &#x0D; Provision of conducive environment for workers, &#x0D; Funding of tertiary institutions, &#x0D; Accountability in governance, amongst others.&#x0D;

Depopulation in Moldova: The main challenge in the context of extremly high emigration

In Moldova, there has been a long-term decline in the population, mainly due to high levels of emigration. The article presents an analysis of population dynamics in Moldova over the last three decades, and estimates the contributions of fertility, mortality and migration to this process. Using population censuses, data on the population with usual residence, vital statistics and data on Moldovan immigrants from the host countries’ statistical institutes,we estimate population changes between 1991–2021, and present demographic projections up to 2040. The results show that migration outflows account for more than 90% of the depopulation trend, with high levels of premature mortality accelerating the natural decline. The fall in births is associated with a decrease in the reproductive-age population. The total fertility rate has been decreasing gradually, while the cohort fertility rates have not fallen below 1.75 live births per woman. Past migration and low fertility are projected to result in long-term population decline. Demographic ageing is expected to increase. While population decline cannot be stopped, its scale can be limited through reductions in emigration and mortality. This study on population decline in Moldova helps to complete the demographic picture of Europe in the 20th century and into the 21st century.

HOW DOES PROVISION OF ORTHOGERIATRICIAN TIME INFLUENCE MANAGEMENT OF PATIENTS WITH A HIP FRACTURE?

A hip fracture represents the extreme end of osteoporosis, placing a significant burden on secondary care, society, and the individual patient. The National Hip Fracture Database (NHFD) reports each hospital's attainment of the BPT with other measures, along with reporting outcomes. There is clearly wide variability in provision of orthogerriatrician (OG) services across the dataset. Unfortunately, despite overwhelming evidence that provision of an OG service is of benefit, it is presently challenging to recruit to this important specialty within the UK.Publicly available reports from the NHFD were obtained for each of the 177 participating hospitals for 2017. This was matched with information held within the annual NHFD Facilities Audit for the same period, which include hours of OG support for each hospital. This information was combined with a Freedom of Information request made by email to each hospital for further details concerning OG support. The outcome measures used were Length of Stay (LoS), mortality, and return to usual residence. Comparison was made with provision of OG services by use of Pearson's correlation coefficient. In addition, differences in services were compared between the 25% (44) hospitals delivering outcomes at the extremes for each measure.Attainment of BPT correlated fairly with LoS (−0.48) and to less of a degree with mortality (−0.1) and return home (0.05). Perioperative medical assessment contributed very strongly with BPT attainment (0.75). In turn perioperative medical assessment correlated fairly with LoS (−0.40) and mortality (−0.23) but not return home (0.02). Provision of perioperative medical assessment attainment was correlated fairly with total OG minutes available per new patient (0.22), total OG minutes available per patient per day (0.29) and number of days per week of OG cover (0.34); with no link for number of patients per orthogeriatrician (0.01). Mortality for the best units were associated with 30% more consultant OG time available per patient per day, and 51% more OG time available per patient. Units returning the most patients to their usual residence had little association with OG time, although had 59% fewer patients per OG, the best units had a 19% longer LoS. For all three measures results for the best had on average 0.5 days per week better routine OG access.There is no doubt that good quality care gives better results for this challenging group of patients. However, the interaction of BPT, other care metrics, level of OG support and patient factors with outcomes is complex. We have found OG time available per patient per day appears to influence particularly LoS and mortality. Options to increase OG time per patient include reducing patient numbers (ensuring community osteoporosis/falls prevention in place, including reducing in-patient falls); increasing OG time across the week (employing greater numbers/spreading availability over 7 days per week); and reducing LoS. A reduction in LoS has the largest effect of increasing OG time, and although it is dependent on OG support, it is only fairly correlated with this and many other factors play a part, which could be addressed in units under pressure.

Influence of Neighborhood-Based Identity and Social Participation on the Social Integration of the Drifting Elderly

The drifting elderly are an interprovincial floating elderly population that is mainly composed of unemployed older parents in China. They have left their usual residence and relocated to urban areas, facing challenge about social integration. As a neighborhood has played important roles in the floating population’s social integration, this study was designed to investigate the influence of neighborhood-based identity and social participation on the social integration of the drifting elderly. Five rounds of data collection and analysis were conducted in a continuous crossover sequence using grounded theory. Twenty-four participants were recruited from three districts in Shanghai, China. The neighborhood was shown to play a prominent role in the drifting elderly’s perceptions of social integration. Good neighborhood relations help the drifting elderly establish effective social support networks, interact with inflowing society, get in touch with more human resources, and form social relationships and networks. Neighborhood-based participants and identity were more conducive to eliminating heterogeneity and creating homogeneity for the drifting elderly. Thus, the neighborhood affects the social integration of the drifting elderly, which directly impacts their social feelings, integrations, and networks. Management of social integration among the drifting elderly should be focused on creating general opportunities for them to participate in neighborhood-based social events with a reasonable identity.