Falls, especially recurrent, cause significant morbidity. Research on falls generally focuses on older adults but patterns of falling may start earlier in life. This study aimed to quantify the prevalence of falls and recurrent falls among late middle-aged community-dwelling adults and identify the socio-demographic, lifestyle and health-related factors associated with recurrent falls.

The Health and Employment After Fifty (HEAF) study is a longitudinal cohort of men and women aged 50–64 years recruited in 2013–14 from across England. At baseline and each of five approximately annual follow-ups, participants reported falls in the preceding year. Participants were categorised as recurrent fallers if they experienced more than one fall on at least two occasions, non-fallers if they never reported a fall, or intermediate fallers otherwise. Multinomial logistic regression explored associations between fall category and potential risk factors, presented as relative risk ratios with 95%CI.

Among 8134 participants, 7051 were eligible for this analysis. The prevalence of any falls ranged from 14–18% across follow-ups. Overall, 437 (6%) were recurrent fallers, 2738 (39%) intermediate and 3876 (55%) non-fallers. Independent predictors of recurrent falls included female gender, unpartnered, unemployed or retired and lack of home ownership. Health-related factors included obesity, fair/poor self-rated health, depression, poor sleep, slow walking speed and memory problems. The final model correctly classified 60% of participants.

Recurrent falls in mid-life were relatively common. Both socio-economic and health-related characteristics, alongside female gender, were identified as predictors, suggesting potential targets for early identification and risk mitigation in this age group.

To describe diagnostic and management characteristics of acute rheumatic fever (ARF) among participants in the ‘Searching for a Technology-Driven Acute Rheumatic Fever Test’ study, in order to answer clinical questions and determine epidemiological and practice differences in different settings.

Multisite, prospective cohort study.

One hospital in northern Australia and two hospitals in New Zealand, 2018–2021.

143 episodes of definite, probable or possible ARF among 141 participants (median age 10 years, range 5–23; 98% Indigenous).

Participant characteristics, clinical, biochemical and echocardiographic data were explored using descriptive data. Associations with length of stay were determined using multivariable regression analysis.

ARF presentations were heterogeneous with the most common ARF ‘phenotype’ in 19% of cases being carditis with joint manifestations (polyarthritis, monarthritis or polyarthralgia), fever and PR prolongation. The total proportion of children with carditis was 61%. Australian compared with New Zealand participants more commonly had ARF recurrence (22% vs 0%), underlying RHD (48% vs 0%), possible/probable ARF (23% vs 9%) and were underweight (64% vs 16%). Erythrocyte sedimentation rate (ESR) provided an incremental diagnostic yield of 21% compared with C reactive protein. No instances of RHD were diagnosed among participants in New Zealand. Positive throat Group A Streptococcus culture was more common in New Zealand than in Australian participants (69% vs 3%). Children often required prolonged hospitalisation, with median hospital length-of-stay being 7 days (range 2–66). Significant predictors for length of stay in a multivariable regression model were valve disease (adjusted OR (aOR) 1.56, 95% CI 1.23 to 1.98, p

This study provides new knowledge on ARF characteristics and management and highlights international variation in diagnostic and management practice. Differing approaches need to be aligned. Meanwhile, locally specific information can help guide patient expectations after ARF diagnosis.