Lower mood and higher acute TL are associated with increased injury risk, while higher chronic TL increases the risk of illness. Monitoring well-being and TL may facilitate intervention to reduce in-season injury and illness.
BackgroundLength of stay in psychiatric hospitals interests health service planners, economists and clinicians. At a systems level it is preferable to study general adult and forensic psychiatric beds together since these are likely to be inter-dependent. We examined whether patients were placed according to specialist need or according to their cross-sectional length of stay.MethodsA one night census of all registered mental nursing home (RMNH) beds was carried out for a defined catchment area of 1.2 m population in north London in November 1999. This included all public sector psychiatric hospital beds, independent sector and forensic beds in and outside the catchment area. Cross-sectional length of stay was defined as time since the date of admission from the community. Log rank (Mantel-Cox) Chi squared was used to test for differences between groups and hierarchical logistic regression for statistical modelling.ResultsThere were 1,085 occupied psychiatric beds. Cross-sectional LOS was greater than 365 days in 43.5%. Forensic beds had longer cross-sectional LOS than general beds. LOS increased with the level of therapeutic security from open through low, medium and high secure. Cross-sectional LOS was shorter for open hospital beds than community RMNH beds, shorter for informal patients than those detained under civil mental health law, and longest for forensic detentions. Longest cross-sectional LOS were for patients placed in RMNHs in the community, 10.7% of whom were ‘forensic’ as were 25.4% of low secure patients. Designated length of stay (acute, rehab/medium term and long term) was also associated with increasing cross-sectional LOS. In regression analysis only three variables contributed to a model of cross-sectional LOS, commissioning status (general or forensic), designated length of stay and designated level of therapeutic security.ConclusionsStudying cross-sectional LOS for whole systems (all psychiatric beds) is essential for operational health service management. At the time of this survey ‘forensic’ status was the main way of accessing long term high dependency places. This has been an organic development over time, a response to patient needs rather than the outcome of any specific policy or plan.
Background:Although preseason aerobic fitness has been suggested as a modifiable risk factor for injury in adult athletes, the relationship between aerobic fitness, injury, and illness in youth athletes is unknown.Purpose:To determine whether preseason aerobic fitness predicts in-season injury and illness risk in female adolescent soccer players.Study Design:Case-control study; Level of evidence, 3.Methods:Fifty-four female adolescent soccer players underwent preseason evaluation to determine years of experience, body mass index (BMI), maximal aerobic capacity (VO2max), and time to exhaustion (Tmax) during cycle ergometer testing. All injuries and illnesses during the subsequent 20-week season were recorded. Variables were compared between individuals with and without a self-reported injury and individuals with and without a self-reported illness. Separate Poisson regression models were developed to predict number of injuries and illnesses for each individual by use of age, years of experience, BMI, VO2max, and Tmax. Results:Twenty-eight injuries and 38 illnesses in 23 individuals were recorded during the season. Although not a statistically significant finding, individuals who reported an in-season injury had lower VO2max than those who did not (54.9 ± 7.3 vs 58.3 ± 8.5 mL/kg/min, P = .13). Individuals who reported an illness had significantly lower VO2max than those who did not (54.5 ± 9.9 vs 58.8 ± 6.2 mL/kg/min, P = .014). With the Poisson regression models, VO2max was a significant predictor of both injury (odds ratio [OR], 0.95; P = .046) and illness (OR, 0.94; P = .009), while no significant relationships were identified between injury or illness and age, years of experience, Tmax, or BMI (all P > .05).Conclusion:Among adolescent female soccer players, greater preseason aerobic fitness is associated with a reduced risk of in-season injury and illness. Off-season intervention to promote aerobic fitness may help reduce the risk of lost time during the season due to injury and illness.
While health care evolves from volume to value, there is increasing interest by payors to use patient-reported outcomes (PROs) to determine value and more specifically, quality from the patient's perspective. This article reviews the current state of PROs and discusses future directions. Specifically, this article will review the current history and background of PROs; it will highlight the perspective of the National Quality Forum and review the efforts of the musculoskeletal community related to PROs. Goals, positive aspects, limitations, and barriers related to PROs will be discussed. Additionally, development considerations and strategies will be highlighted. Finally, development recommendations from the American Academy of Orthopaedic Surgery position statement “principles for musculoskeletal based PRO performance measurement development” will be introduced.
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