Role of assessment components and recent adverse outcomes in risk estimation and prediction: use of the Short Term Assessment of Risk and Treatability (START) in an adult secure inpatient mental health service

The Short Term Assessment of Risk and Treatability is a structured judgement tool used to inform risk estimation for multiple adverse outcomes. In research, risk estimates outperform the tool's strength and vulnerability scales for violence prediction. Little is known about what its’component parts contribute to the assignment of risk estimates and how those estimates fare in prediction of non-violent adverse outcomes compared with the structured components. START assessment and outcomes data from a secure mental health service (N=84) was collected. Binomial and multinomial regression analyses determined the contribution of selected elements of the START structured domain and recent adverse risk events to risk estimates and outcomes prediction for violence, self-harm/suicidality, victimisation, and self-neglect. START vulnerabilities and lifetime history of violence, predicted the violence risk estimate; self-harm and victimisation estimates were predicted only by corresponding recent adverse events. Recent adverse events uniquely predicted all corresponding outcomes, with the exception of self-neglect which was predicted by the strength scale. Only for victimisation did the risk estimate outperform prediction based on the START components and recent adverse events. In the absence of recent corresponding risk behaviour, restrictions imposed on the basis of START-informed risk estimates could be unwarranted and may be unethical.

The effects of ageing and exercise on skeletal muscle structure and function

Musculoskeletal ageing is associated with profound morphological and functional changes that increase fall risk and disease incidence and is characterised by age-related reductions in motor unit number and atrophy of muscle fibres, particularly type II fibres. Decrements in functional strength and power are relatively modest until the 6th decade, after which the rate of loss exponentially accelerates, particularly beyond the 8th decade of life. Physical activity is a therapeutic modality that can significantly attenuate age-related decline. The underlying signature of ageing, as manifested by perturbed redox homeostasis, leads to a blunting of acute and chronic redox regulated exercise adaptations. Impaired redox regulated exercise adaptations are mechanistically related to altered exercise-induced reactive oxygen and nitrogen species generation and a resultant failure to properly activate redox regulated signaling cascades. Despite the aforementioned specific impairment in redox signaling, exercise induces a plethora of beneficial effects, irrespective of age. There is, therefore, strong evidence for promoting regular physical exercise, especially progressive resistance training as a lifelong habitual practice.