Hormone replacement therapy and prevention of vertebral fractures: a meta-analysis of randomised trials

BACKGROUND: Hormone replacement therapy (HRT) is often seen as the treatment of choice for preventing fractures in women. We undertook a recent meta-analysis of randomised trials which suggested that HRT reduced non-vertebral fractures by 30%. In this analysis we extend that analysis to vertebral fractures. METHODS: We searched the main electronic databases until the end of August 2001. We sought all randomised controlled trials (RCTs) of HRT where women had been randomised to at least 12 months of HRT or to no HRT. RESULTS: We found 13 RCTs. Overall there was a 33% reduction in vertebral factures (95% confidence interval (CI) 45% to 98%). CONCLUSIONS: This review and meta-analysis showed a significant reduction in vertebral fractures associated with HRT use

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Poem by Sally Lou Bel

Mathematical models assessing the importance of disease on ecological invasions

A general understanding of the role that both shared disease and competition may play in ecological invasions is lacking. We develop a theoretical framework to determine the role of disease, in addition to competition, in invasions. We first investigate the e ect of disease characteristics on the replacement time of a native species by an invader. The outcome is critically dependent on the relative e ects that the disease has on the two species and less dependent on the basic epidemiological characteristics of the interaction. This framework is extended to investigate the e ect of disease on the spatial spread of an invader and indicates that a wave of disease spreads through a native population in advance of the replacement. A probabilistic simulation model is developed to examine the particular example of the replacement of red squirrels by grey squirrels in the United Kingdom. This model is used to examine conservation strategies employed within red squirrel refuges and compared to observations from Sefton Coast Red Squirrel Refuge. Our findings indicate that culling greys may be e ective at protecting red populations from replacement, but none of the conservation strategies currently employed can prevent periodic outbreaks of infection within red squirrel refuges.Engineering and Physical Sciences Research Council (EPSRC

What I Do Matters, Too: Transformation and Success of First-Generation Adult Women in Undergraduate Education

Researchers qualitatively examined the experiences of first-generation adult women in a 4-year university, and found that participants (a) experienced enhanced academic self-efficacy through positive instructor feedback, (b) resolved the “dilemma of choice” regarding role expectations, and (c) developed a sense of responsibility for the academic status of the next generation

Exploring Parental Approval and Disapproval for Black and White Interracial Couples

Black and White interracial couples encounter societal and familial assessments that create additional tensions and conflict for their romantic relationship. This study examines parental approval and disapproval messages and their impact on interracial couples. Interdependence Theory and Facework provide the theoretical frameworks guiding this qualitative, interpretive examination. Thirty-eight individuals who represent 19 Black and White romantic pairs were each separately interviewed about their experiences as an interracial couple. Of particular interest is the communication of parental support or disapproval. Data were analyzed using Owen’s (1984) thematic analysis procedures. Results reveal that interracial dyads both experience public disapproval and illustrate that not all couples experience parental disapproval. However, couples with dual parental approval were less bothered by negative outside experiences than were one-sided approval couples. Data also reveal the importance of parental approval messages and highlight the destructive nature of disapproval messages with regards to the interracial couple’s face needs

Systematic review of topical treatments for fungal infections of the skin and nails of the feet

OBJECTIVE: To identify and synthesise the evidence for efficacy and cost effectiveness of topical treatments for superficial fungal infections of the skin and nails of the feet. DESIGN: Systematic review. INTERVENTIONS: Topical treatments for superficial fungal infections. MAIN OUTCOME MEASURES: Cure confirmed by culture and microscopy for skin and by culture for nails in patients with clinically diagnosed fungal infections. RESULTS: Of 126 trials identified in 121 papers, 72 (57.1%) met the inclusion criteria. Placebo controlled trials yielded pooled relative risks of failure to cure skin infections: allylamines (0.30, 95% confidence interval 0.24 to 0.38); azoles (0.54, 0.42 to 0.68); undecenoic acid (0.28, 0.11 to 0.74); and tolnaftate (0.46, 0.17 to 1.22). Although meta-analysis of 11 trials comparing allylamines and azoles showed a relative risk of failure to cure of 0.88 (0.78 to 0.99) in favour of allylamines, there was evidence of language bias. Seven reports in English favoured allylamines (0.79, 0.69 to 0.91), but four reports in foreign languages showed no difference between the two drugs (1.01, 0.90 to 1.13). Neither trial of nail infections showed significant differences between alternative topical treatments. CONCLUSIONS: Allylamines, azoles, and undecenoic acid were efficacious in placebo controlled trials. There are sufficient comparative trials to judge relative efficacy only between allylamines and azoles. Allylamines cure slightly more infections than azoles but are much more expensive than azoles. The most cost effective strategy is first to treat with azoles or undecenoic acid and to use allylamines only if that fails

Developing research support services : mapping relationships

I discussed how analysing the relationships involved in delivering different services can help to define how you interact with different stakeholders and allow you to consider which relationships needs strengthened and in what ways. The analysis of relationships was visualised via a web illustrating the connections involved in delivering specific services

Randomised controlled trial of exercise for low back pain : clinical outcomes, costs and preferences

Objective: To evaluate effectiveness of an exercise programme in a community setting for patients with low back pain to encourage a return to normal activities. Design: Randomised controlled trial of progressive exercise programme compared with usual primary care management. Patients' preferences for type of management were elicited independently of randomisation. Participants: 187 patients aged 18-60 years with mechanical low back pain of 4 weeks to 6 months' duration. Interventions: Exercise classes led by a physiotherapist that included strengthening exercises for all main muscle groups, stretching exercises, relaxation session, and brief education on back care. A cognitive-behavioural approach was used. Main outcome measures: Assessments of debilitating effects of back pain before and after intervention and at 6 months and 1 year later. Measures included Roland disability questionnaire, Aberdeen back pain scale, pain diaries, and use of healthcare services. Results: At 6 weeks after randomisation, the intervention group improved marginally more than the control group on the disability questionnaire and reported less distressing pain. At 6 months and 1 year, the intervention group showed significantly greater improvement in the disability questionnaire score (mean difference in changes 1.35, 95% confidence interval 0.13 to 2.57). At 1 year, the intervention group also showed significantly greater improvement in the Aberdeen back pain scale (4.44, 1.01 to 7.87) and reported only 378 days off work compared with 607 in the control group. The intervention group used fewer healthcare resources. Outcome was not influenced by patients' preferences. Conclusions: The exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference, and was cost effective