Protocol for a randomized controlled trial to compare bone-loading exercises with risedronate for preventing bone loss in osteopenic postmenopausal women

BACKGROUND: In the United States, over 34 million American post-menopausal women have low bone mass (osteopenia) which increases their risk of osteoporosis and fractures. Calcium, vitamin D and exercise are recommended for prevention of osteoporosis, and bisphosphonates (BPs) are prescribed in women with osteoporosis. BPs may also be prescribed for women with low bone mass, but are more controversial due to the potential for adverse effects with long-term use. A bone loading exercise program (high-impact weight bearing and resistance training) promotes bone strength by preserving bone mineral density (BMD), improving bone structure, and by promoting bone formation at sites of mechanical stress. METHODS/DESIGN: The sample for this study will be 309 women with low bone mass who are within 5 years post-menopause. Subjects are stratified by exercise history (≥2 high intensity exercise sessions per week; < 2 sessions per week) and randomized to a control or one of two treatment groups: 1) calcium + vitamin D (CaD) alone (Control); 2) a BP plus CaD (Risedronate); or 3) a bone loading exercise program plus CaD (Exercise). After 12 months of treatment, changes in bone structure, BMD, and bone turnover will be compared in the 3 groups. Primary outcomes for the study are bone structure measures (Bone Strength Index [BSI] at the tibia and Hip Structural Analysis [HSA] scores). Secondary outcomes are BMD at the hip and spine and serum biomarkers of bone formation (alkaline phosphase, AlkphaseB) and resorption (Serum N-terminal telopeptide, NTx). Our central hypothesis is that improvements in bone strength will be greater in subjects randomized to the Exercise group compared to subjects in either Control or Risedronate groups. DISCUSSION: Our research aims to decrease the risk of osteoporotic fractures by improving bone strength in women with low bone mass (pre-osteoporotic) during their first 5 years’ post-menopause, a time of rapid and significant bone loss. Results of this study could be used in developing a clinical management pathway for women with low bone mass at their peak period of bone loss that would involve lifestyle modifications such as exercises prior to medications such as BPs. TRIAL REGISTRATION: Clinicaltrials.gov NCT02186600. Initial registration: 7/7/2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12905-016-0339-x) contains supplementary material, which is available to authorized users

Markers of prolonged hospitalisation in severe dengue

BACKGROUND: Dengue is one of the most common diseases in the tropics and subtropics. Whilst mortality is a rare event when adequate supportive care can be provided, a large number of patients get hospitalised with dengue every year that places a heavy burden on local health systems. A better understanding of the support required at the time of hospitalisation is therefore of critical importance for healthcare planning, especially when resources are limited during major outbreaks. METHODS: Here we performed a retrospective analysis of clinical data from over 1500 individuals hospitalised with dengue in Vietnam between 2017 and 2019. Using a broad panel of potential biomarkers, we sought to evaluate robust predictors of prolonged hospitalisation periods. RESULTS: Our analyses revealed a lead-time bias, whereby early admission to hospital correlates with longer hospital stays - irrespective of disease severity. Importantly, taking into account the symptom duration prior to hospitalisation significantly affects observed associations between hospitalisation length and previously reported risk markers of prolonged stays, which themselves showed marked inter-annual variations. Once corrected for symptom duration, age, temperature at admission and elevated neutrophil-to-lymphocyte ratio were found predictive of longer hospitalisation periods. CONCLUSION: This study demonstrates that the time since dengue symptom onset is one of the most significant predictors for the length of hospital stays, independent of the assigned severity score. Pre-hospital symptom durations need to be accounted for to evaluate clinically relevant biomarkers of dengue hospitalisation trajectories

The Geography of Mental Health: An Examination of Police Calls for Service

The purpose of this chapter is to explore the geographic distribution of mental health-related 911 calls for service in the City of Detroit, Michigan. Optimized hot spot analysis found that the calls were not randomly distributed. Statistically significant hot and cold spots were identified for all mental health calls, suicides and suicide attempts, as well as people with mental illness who were violent and non-violent. Using risk terrain modeling, various characteristics of the physical/built environment were examined to see if there was a relationship between place and mental health related calls for service. For all mental health calls, the range of Relative Risk Scores was 1–384, which means that cells with an RRS of 384 have an expected rate of mental health calls for service that is 384 times higher than a place with a score of 1. While the locations of crimes of violence do influence risk of calls for service for mental health issues, locations of non-violent property crimes, blight violations, and quality of life offenses have a greater influence on the risk of suicide, non-violent mental health, and violent mental health calls for service

Applied Resiliency and Suicide Prevention: a Strengths-based, Risk- Reduction Framework

Book Summary: This inspiring resource presents theories, findings, and interventions from Positive Suicidology, an emerging strengths-based approach to suicide prevention. Its synthesis of positive psychology and suicidology theories offers a science-based framework for promoting wellbeing to complement or, if appropriate, replace traditional deficit-driven theories and therapies used in reducing suicidal thoughts and behaviors. Coverage reviews interpersonal, intrapersonal, and societal risk factors for suicide, and identifies protective factors, such as hope and resilience, that can be enhanced in therapy. From there, chapters detail a palette of approaches and applications of Positive Suicidology, from the powerful motivating forces described in Self-Determination Theory to meaning-building physical and social activities. Among the topics covered: Future-oriented constructs and their role in suicidal ideation and enactment. Gratitude as a protective factor for suicidal ideation and behavior: theory and evidence. Considering race and ethnicity in the use of positive psychological approaches to suicide. The Six R’s framework as mindfulness for suicide prevention. Community-based participatory research and empowerment for suicide prevention. Applied resiliency and suicide prevention: a strengths-based, risk-reduction framework. Psychotherapists, counselors, social workers, psychiatrists, and health psychologists, as well as educators, clergy and healthcare professionals, will find A Positive Psychological Approach to Suicide an invaluable source of contemporary evidence-based strategies for their prevention and intervention efforts with suicidal clients