Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty

Aims The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. Methods This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from wait-ing lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five -dimension questionnaire (EQ- 5D) and visual analogue scores (EQ- VAS), Rockwood Clini-cal Frailty Scale (CFS), and 36 -Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ- 5D of less than zero. Results There were significant deteriorations in the EQ- 5D (mean 0.175, 95% confidence inter- val (CI) 0.145 to 0.204;p < 0.001), EQ- VAS (mean 8.6, 95% CI 7.0 to 10.4;< 0.001), and CFS (from 3 "managing well" to 4 "vulnerable";p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48;p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ- 5D (-0.14, 95% CI 0.08 to 0.28;p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26;p = 0.031) were associated with a deterioration in the EQ- 5D. THA (0.21, 95% CI 0.07 to 0.34;p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20;p < 0.001) were independently significantly associated with a deterioration in the CFS. Conclusion Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened.

Persistence of inflammatory and vascular damage mediators 5 months after acute COVID-19

Background: In the acute phase, patients with severe COVID-19 exhibit pulmonary inflammation and vascular injury, as well as an exaggerated cytokine response. Aim(s): To describe the inflammatory cytokine and vascular injury mediator profiles in patients previously hospitalised with COVID-19, and to compare these profiles with those in healthy controls and in patients recovering from severe sepsis of other aetiology. Method(s): Plasma levels of 28 different cytokine, chemokine, angiogenic and vascular injury markers were measured by MSD V-PLEX multiplex assays in 49 post-COVID patients 5.0+/-1.9 (mean+/-SD) months after hospitalisation with COVID-19 pneumonia, 11 post-sepsis patients (5.4+/-2.9 months after hospitalised non-COVID sepsis) and 18 healthy controls. Kruskal-Wallis or ANOVA were used to compare groups;false discovery rate correction (Benjamini Hochberg) allowed for multiple testing. Result(s): In the post-COVID group, IL-6, TNFalpha, SAA, MCP1, Tie-2, Flt1, PIGF and CRP were significantly elevated, whereas IL-7 and bFGF were significantly depressed. The differences in TNFalpha, SAA, MCP1, Tie-2, Flt1, IL-7 and bFGF appeared unique to the post-COVID group, but increased IL-6, PIGF and CRP levels were also seen in postsepsis patients compared with controls. In post-COVID patients we found strong negative spearman correlations between each of IL-6 (r=-0.51) and CRP (r=-0.57) with TLCO %predicted (p<0.001) and positive correlations with post-recovery CT abnormality scores: IL-6 (r=0.28) and CRP (r=0.46), p<0.05. Conclusion(s): A unique signature of inflammatory and vascular damage markers is seen months after acute COVID19 infection. Further research is needed to determine their pathophysiological significance.

Tackling post-COVID-19 pandemic food crises through the adoption of improved maize seeds and technologies by smallholder farmers: The case of Ejura Sekyeredumase in Ghana

Amidst the COVID-19 pandemic, the need to accelerate food production efforts to achieve the UN SDG two, i. e., zero hunger target by 2030, is gaining momentum across the global food security discourse. One way to accelerate food production is to adopt improved seeds and technologies that may close existing yield gaps and support food security efforts in regions such as Sub-Saharan Africa. This paper uses mixed methods, including key informant interviews, structured household questionnaire surveys and focus group discussions, to examine the factors influencing the adoption of improved seeds and complementing technologies in Ghana. In particular, we draw insight from theories of failed market-induced behavior, innovation diffusion and induced-innovation theories to explore farmers' perceptions and adoption of different specific improved maize varieties and technologies for agricultural productivity. Our findings suggest that the level of awareness of improved seeds, particularly hybrid seeds and technologies, and the adoption rate of these technologies are low among Ghana's rural farmers. The findings reveal that socio-demographic and economic factors such as gender, age, cost of seeds, the promise of more yields, market access, social networks' influence, seed availability and accessibility are essential determinants of adopting improved planting technologies among smallholder farmers. This paper argues that location and context-specific-targeted extension services delivery to enhance the widespread adoption of improved seeds and technologies across scales can build farmers' capacity to increase agricultural productivity.