Mandibular bone structure, bone mineral density, and clinical variables as fracture predictors: a 15-year follow-up of female patients in a dental clinic

ObjectiveTo compare three mandibular trabeculation evaluation methods, clinical variables, and osteoporosis as fracture predictors in women.Study designOne hundred and thirty-six female dental patients (35-94 years) answered a questionnaire in 1996 and 2011. Using intra-oral radiographs from 1996, five methods were compared as fracture predictors: (1) mandibular bone structure evaluated with a visual radiographic index, (2) bone texture, (3) size and number of intertrabecular spaces calculated with Jaw-X software, (4) fracture probability calculated with a fracture risk assessment tool (FRAX), and (5) osteoporosis diagnosis based on dual-energy-X-ray absorptiometry. Differences were assessed with the Mann–Whitney test and relative risk calculated.ResultsPrevious fracture, gluco-corticoid medication, and bone texture were significant indicators of future and total (previous plus future) fracture. Osteoporosis diagnosis, sparse trabeculation, Jaw-X, and FRAX were significant predictors of total but not future fracture.ConclusionClinical and oral bone variables may identify individuals at greatest risk of fracture

Gender differences in care-seeking behavior and health care consumption after work-related whiplash injuries injuries: Arthur Tenenbaum

Background: The aim was to study gender differences in care-seeking behaviour regarding type of facility, time span and type of treatment after work-related motor vehicle trauma (WRMVT) and to investigate the incidence of WRMVT. Methods: - Design: Cross-sectional retrospective study. - Setting: A population-based register in a Swedish county from 1999 to 2008. - Participants: A cohort of 820 persons, 18-65 years of age, involved in traffic accidents, either working at the time of the trauma, or on their way to or from work, resulting in a clinical whiplash diagnosis. Results: Women sought care at primary health care units more often than men, who sought care mainly at hospitals (p = 0.0048). Four percent of the injured persons were treated at hospital. Twelve percent of all patients involved in WRMVT sought care with a delay of at least three days. Women sought care later than men (p = 0.011). There was no difference in gender regarding type of treatment after trauma. Ninety-one percent were treated and discharged and six percent were sent home untreated after examination. Fifty-two percent of the injured persons sought care at primary care units. The annual incidence of WRMVT decreased from 68/100 000 to 43/100 000. Conclusion: The incidence of WRMVT in the rural and urban county declined during 1999-2008. Women sought care at primary care units more often then men. Women sought care later then men after the trauma which may reduce especially women's probability of getting workers compensation. Key messages: • Gender differences exist in WRMVT, women seek primary health care more often, and later than men do which may affect insurance outcomes for women. • The annual incidence of acute whiplash disorders due to WRMVT decreased from 68/100 000 to 43/100 000 inhabitants annually between 1999 to 2008

Lung cancer research and its citation on clinical practice guidelines.

BACKGROUND: The impact of medical research is usually judged on the basis of citations in the serial literature. A better test of its utility is through its contribution to clinical practice guidelines (CPGs) on how to prevent, diagnose, and treat illness. This study aimed to compare the parameters of lung cancer research papers with those cited as references in lung cancer CPGs from 16 countries, and the Cochrane Collaboration. These comparisons were mainly based on bibliographic data compiled from the Web of Science (WoS). METHODOLOGY: We examined 7357 references (of which 4491 were unique) cited in a total of 77 lung cancer CPGs, and compared them with 73,214 lung cancer papers published in the WoS between 2004 and 2018. RESULTS: References used by lung CPGs were much more clinical than the overall body of research papers on this cancer, and their authors predominantly came from smaller northern European countries. However, the leading institutions whose papers were cited the most on these CPGs were from the USA, notably the MD Anderson Cancer Center in Texas, the Memorial Sloan Kettering Cancer Center, New York, and the Mayo Clinic in Rochester, Minnesota. The types of research cited by the CPGs were primarily clinical trials, as well as three treatment modalities (chemotherapy, radiotherapy and surgery). Genetics, palliative care and quality of life were largely neglected. The median time gap between papers cited on a lung CPG and its publication was 3.5 years longer than for WoS citations. CONCLUSIONS: Analysis of the references on CPGs allows an alternative means of research evaluation, and one that may be more appropriate for clinical research than citations in academic journals. Own-country references show the direct contribution of research to a country's health care, and other-country references show the esteem in which this research has been held internationally

Working out of the ‘toolbox’: an exploratory study with complementary therapists in acute cancer care

Aims: The aim of this research was to explore and capture therapists’ experiences of and preparation for working with patients in an acute cancer care setting. Method: Semi structured interviews with therapists (n=18) in an acute cancer hospital in the North West of England. The interviews were transcribed and analysed using thematic coding. Results: Key themes identified included; the need for a ‘tool box’ that goes beyond initial training, building confidence with adapting these new skills in practice, helping patients to become empowered, the need to support carers, research evidence and resources issues, and the role of supervision. Conclusion: This study was limited by being set in a single acute cancer site. Therapists valued having a ‘tool box’ but needed confidence and support to navigate the challenges of clinical practice.The authors would like to acknowledge the support of ‘Walk the Walk’ Charity, who help fund the complementary therapy services in the Radiotherapy and Chemotherapy Departments

Massage Therapy for Osteoarthritis of the Knee: A Randomized Dose-Finding Trial

In a previous trial of massage for osteoarthritis (OA) of the knee, we demonstrated feasibility, safety and possible efficacy, with benefits that persisted at least 8 weeks beyond treatment termination.We performed a RCT to identify the optimal dose of massage within an 8-week treatment regimen and to further examine durability of response. Participants were 125 adults with OA of the knee, randomized to one of four 8-week regimens of a standardized Swedish massage regimen (30 or 60 min weekly or biweekly) or to a Usual Care control. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog pain scale, range of motion, and time to walk 50 feet, assessed at baseline, 8-, 16-, and 24-weeks.WOMAC Global scores improved significantly (24.0 points, 95% CI ranged from 15.3-32.7) in the 60-minute massage groups compared to Usual Care (6.3 points, 95% CI 0.1-12.8) at the primary endpoint of 8-weeks. WOMAC subscales of pain and functionality, as well as the visual analog pain scale also demonstrated significant improvements in the 60-minute doses compared to usual care. No significant differences were seen in range of motion at 8-weeks, and no significant effects were seen in any outcome measure at 24-weeks compared to usual care. A dose-response curve based on WOMAC Global scores shows increasing effect with greater total time of massage, but with a plateau at the 60-minute/week dose.Given the superior convenience of a once-weekly protocol, cost savings, and consistency with a typical real-world massage protocol, the 60-minute once weekly dose was determined to be optimal, establishing a standard for future trials.ClinicalTrials.gov NCT00970008

Mothers with breast cancer: A mixed‐method systematic review on the impact on the parent‐child relationship

Objective: To systematically review and integrate the findings from quantitative and qualitative studies on parenting and parent-child relationships in families where mothers had Breast Cancer (BC). Methods: Ten different databases were searched from inception to January 2016. All authors assessed these data independently. Full-text, peer-reviewed articles exploring parenting and/or mother-child relationships in families where the mother had BC, regardless of cancer stage, were considered for inclusion. PRISMA guidelines were followed. Results: From 116 studies, 23 were deemed eligible for inclusion. Five of them were quantitative, 15 were qualitative, and one study used a mixed-method approach. Most studies analysed the mother’s perceptions about the experience of having BC in parenting and in the parent-child relationship. The majority of studies explored experiences and perspectives on the parent-child relationship in mothers with minor children, although a minority of studies included adult children. Additionally, a few studies (17%) addressed perceptions and experiences of women with advanced stage cancer. Three main themes were found: priorities and concerns of patients; decision-making processes about sharing the diagnosis with their children; and mother-child relationship and parenting after mother’s diagnosis. Conclusions: Findings indicated that the diagnosis of BC is accompanied by an array of challenges that affect parental roles and parenting. Further studies are needed in order to explore these issues more sensitively. For now, however, the evidence suggests that the families of women with BC, and particularly the women themselves, may benefit from informal and formal support aimed at helping them cope effectively with this challenging life event

'When you have children, you're obliged to live': Motherhood, Chronic Illness and Biographical Disruption

Recent work on biographical disruption has emphasised the critical importance of timing and context to the understanding of the effects of illness on identity. This paper takes a different approach by examining the inter-relationship between illness and key sources of identity, in this instance HIV infection and motherhood. It is argued that, viewed in this light, biographical disruption remains a powerful analytic framework with which to explore the intense threat which may be posed to key identities by chronic, potentially fatal illnesses, and the fundamental re-working of such identities occasioned by such threats. With reference to the empirical study on which this paper draws, it is shown that, the respondents’ emphasis on their need to survive and to protect their children, represented a fundamental re-formulation of their identities as mothers and, therefore, a type of biographical disruption while paradoxically also containing elements of biographical reinforcement. It is further argued that the incorporation of such key identities into the analysis problematises work that suggests that biographical disruption is less relevant to those who have experienced difficult lives, while also highlighting the need to take greater account of gender and caring responsibilities in further work in this field