Non-traumatic back pain commonly leads people to seek health care from paramedics via triple-zero (emergency phone number in Australia), yet the management approaches by providers of ambulance services remain unclear.

This study aims to investigate paramedic management of non-traumatic back pain in New South Wales (NSW), Australia, including the call characteristics, provisional diagnoses, and the clinical care being delivered by paramedics.

This study is a retrospective analysis of NSW Ambulance computer-aided dispatch and electronic medical records from January 1, 2017 through December 31, 2022. Adults who sought ambulance service with a chief complaint of back pain, were triaged as non-traumatic back pain, and subsequently received treatment by paramedics were included. Multivariable logistic regression models were used to explore factors associated with primary outcomes; ambulance transport, opioid use, and use of medication combinations were reported as odds ratios (ORs).

There were 73,128 calls to NSW Ambulance with a chief complaint of back pain that were triaged as non-traumatic back pain. Of these, 54,444 (74.4%) were diagnosed with spinal pain, of which 52,825 (97.1%) were categorized by the paramedic as back or neck pain, 1,573 (2.9%) as lumbar radicular pain, and 46 (0.1%) as serious spinal pathology. Eight out of ten patients with spinal pain were transported to emergency departments. The medicine most administered by a paramedic was an opioid (37.4% of patients with spinal pain). Older patients (OR = 1.36; 95% CI, 1.30 to 1.44) were more likely to be transported to an emergency department. Patients with moderate (OR = 4.39; 95% CI, 4.00 to 4.84) and severe pain (OR = 18.90; 95% CI, 17.18 to 20.79) were more likely to be administered an opioid.

Paramedic management of non-traumatic back pain in NSW typically results in the administration of an opioid and transport to an emergency department.

Excellence is that quality that drives continuously improving outcomes for patients. Excellence must be measurable. We set out to measure excellence in forensic mental health services according to four levels of organisation and complexity (basic, standard, progressive and excellent) across seven domains: values and rights; clinical organisation; consistency; timescale; specialisation; routine outcome measures; research and development.

To validate the psychometric properties of a measurement scale to test which objective features of forensic services might relate to excellence: for example, university linkages, service size and integrated patient pathways across levels of therapeutic security.

A survey instrument was devised by a modified Delphi process. Forensic leads, either clinical or academic, in 48 forensic services across 5 jurisdictions completed the questionnaire.

Regression analysis found that the number of security levels, linked patient pathways, number of in-patient teams and joint university appointments predicted total excellence score.

Larger services organised according to stratified therapeutic security and with strong university and research links scored higher on this measure of excellence. A weakness is that these were self-ratings. Reliability could be improved with peer review and with objective measures such as quality and quantity of research output. For the future, studies are needed of the determinants of other objective measures of better outcomes for patients, including shorter lengths of stay, reduced recidivism and readmission, and improved physical and mental health and quality of life.

Diets with a low proportion of energy from protein have shown to cause overconsumption of non-protein energy, known as Protein Leverage. Older adults are susceptible to nutritional inadequacy. The aim was to investigate associations between protein to non-protein ratio (P:NP) and intakes of dietary components and assess the nutritional adequacy of individuals aged 65–75 years from the Nutrition for Healthy Living (NHL) Study.

Cross-sectional. Nutritional intakes from seven-day weighed food records were compared with the Nutrient Reference Values for Australia and New Zealand, Australian Guide to Healthy Eating, Australian Dietary Guidelines and World Health Organisation Free Sugar Guidelines. Associations between P:NP and intakes of dietary components were assessed through linear regression analyses.

NHL Study.

113 participants.

Eighty-eight (59 female and 29 male) with plausible dietary data had a median (interquartile range) age of 69 years (67–71), high education level (86 %) and sources of income apart from the age pension (81 %). Substantial proportions had intakes below recommendations for dairy and alternatives (89 %), wholegrain (89 %) and simultaneously exceeded recommendations for discretionary foods (100 %) and saturated fat (92 %). In adjusted analyses, P:NP (per 1 % increment) was associated with lower intakes of energy, saturated fat, free sugar and discretionary foods and higher intakes of vitamin B12, Zn, meat and alternatives, red meat, poultry and wholegrain % (all P < 0·05).

Higher P:NP was associated with lower intakes of energy, saturated fat, free sugar and discretionary. Our study revealed substantial nutritional inadequacy in this group of higher socio-economic individuals aged 65–75 years.

To describe the incidence of systemic overlap and typical coronavirus disease 2019 (COVID-19) symptoms in healthcare personnel (HCP) following COVID-19 vaccination and association of reported symptoms with diagnosis of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection in the context of public health recommendations regarding work exclusion.

This prospective cohort study was conducted between December 16, 2020, and March 14, 2021, with HCP who had received at least 1 dose of either the Pfizer-BioNTech or Moderna COVID-19 vaccine.

Large healthcare system in New England.

HCP were prompted to complete a symptom survey for 3 days after each vaccination. Reported symptoms generated automated guidance regarding symptom management, SARS-CoV-2 testing requirements, and work restrictions. Overlap symptoms (ie, fever, fatigue, myalgias, arthralgias, or headache) were categorized as either lower or higher severity. Typical COVID-19 symptoms included sore throat, cough, nasal congestion or rhinorrhea, shortness of breath, ageusia and anosmia.

Among 64,187 HCP, a postvaccination electronic survey had response rates of 83% after dose 1 and 77% after dose 2. Report of ≥3 lower-severity overlap symptoms, ≥1 higher-severity overlap symptoms, or at least 1 typical COVID-19 symptom after dose 1 was associated with increased likelihood of testing positive. HCP with prior COVID-19 infection were significantly more likely to report severe overlap symptoms after dose 1.

Reported overlap symptoms were common; however, only report of ≥3 low-severity overlap symptoms, at least 1 higher-severity overlap symptom, or any typical COVID-19 symptom were associated with infection. Work-related restrictions for overlap symptoms should be reconsidered.

Cognitive reserve, or the extent to which brain can cope with damage, is associated with extended healthy aging and with slow age-related cognitive decline, as well as a lower number of dementia-associated clinical cognitive signs. Thus, understanding how cognitive reserve might affect different cognitive abilities is important. This study aims at investigating the associations between cognitive reserve and linguistic abilities in a group of Spanish older adults with Alzheimer’s disease.

The sample comprised 25 older adults with a clinical diagnostic of AD with mild to moderate dementia, and 25 controls who were residing in care homes from the province of Granada and with ages between 52 and 92 years old (M= 83.40, SD= 7.18). The Mini Mental State Examination (MMSE), the Global Deterioration Scale, the Cognitive Reserve Questionnaire, and the Short Form of the Boston Naming Test for Individuals with Aphasia were used to collect data. Correlations and regression analysis were performed.

Results showed that cognitive reserve positively and significantly correlated with naming and with phonological fluency but not with semantic fluency word or sentence repetitions or with the global cognitive functioning and the severity of cognitive impairment. The regression analysis showed that cognitive reserve explained 24.7% of the variance in spontaneous naming (F=3.764, p=.039). On the contrary cognitive reserve did not predict verbal fluency.

People with higher cognitive reserve score obtained higher scores in phonological fluency and in spontaneous naming and in naming after a semantic clue. Thus, cognitive reserve is linked with better linguistic abilities in AD patients and therefore it should be considered when designing speech therapy interventions for these patients.