Reproductive Factors and Postmenopausal FSH Levels

Recent studies have shown that postmenopausal follicle stimulating hormone (FSH) levels may be predictive of future cardiovascular disease risk. However, little is known about postmenopausal FSH levels, including the level of variation between women and factors associated with this variation. We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001). Reproductive factors were assessed at baseline, along with FSH levels. After adjustment for sex steroids, adiposity measures, plasma lipids, blood pressure, and behavioral factors, we observed that women with 3 or more births and an age at first birth of 25 or later had mean FSH levels that were significantly 7.6 IU/L lower than those of women with a 1 to 2 births and an age at first birth of 24 or less. Number of miscarriages was inversely correlated with FSH levels. Women reporting a 7 or more years of OC use and 4-6 or 7 or more years of HT use each had significantly higher mean FSH levels than women who had never used OCs or HT. In summary, multiple reproductive factors were associated with postmenopausal FSH levels, independent of estradiol, adiposity, and other factors. These findings warrant replication and further exploration of potential underlying mechanism

Policies of Loss: Coastal Erosion and the Struggle to Save Louisiana\u27s Wetlands

Since the 1930s, Louisiana has lost approximately 1,800 square miles of land due to the subsidence of the state’s coastal wetlands. By the early 1970s, public officials and private citizens were starting to become aware of the crisis on the coast, and a broad agreement developed among state and federal representatives that action was needed to address the problem. Over the course of nearly forty years, policymakers in Louisiana and Washington, D.C., implemented a series of laws and regulations meant to protect vulnerable ecosystems like the state’s wetlands. In the 1980s, officials also started crafting policies to help restore Louisiana’s shrinking coastline. While considerable progress has been made to slow the subsidence, stopping or reversing coastal erosion has proven to be nearly impossible. Inefficient bureaucratic management, insufficient funding, and the failure to substantially alter land-use and water-use policies in Louisiana have undermined the state’s conservation and restoration efforts since the 1970s. The catastrophic consequences of Hurricane Katrina forced officials in Baton Rouge and the federal government to correct some long-standing problems, but the implementation of a fully comprehensive restoration and management plan remains piecemeal – even a decade after the devastating 2005 hurricane season. This dissertation examines the broad context of the political and economic climate that contributed to the development of coastal erosion in Louisiana and closely examines the state and federal policy responses to the crisis between 1970 and 2009

The Achilles tendon total rupture score : a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures

Background The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published. Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Methods Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D). These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. Results The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8) and correlated significantly (p < 0.001) with the Disability Rating Index at five time points (pre-injury, six weeks, three, six and nine months) with correlation coefficients between -0.5 and -0.9. However, the confidence intervals were wide. Furthermore, the ability of the new score to detect clinically important changes over time (responsiveness) was shown to be greater than the Disability Rating Index and EQ 5D. Conclusions A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference between scores

Investigating Alternative Measures of Functional Recovery in Rat Sciatic Nerve Injury

There is a pressing need for advancements in peripheral nerve repair techniques and functional recovery evaluation methods. The rat sciatic nerve injury model is a well examined model for peripheral nerve repair. One measure of functional recovery after nerve damage, the sciatic functional index (SFI), fails in the presence of self-mutilation, toe contracture, and other abnormalities in gait. In this IACUC approved study, the sciatic nerve was severed in four experimental groups (n=5). The nerves were repaired with Arginylglycylaspartic acid-poly(ε-caprolactone) (RGD-PCL) peptide functionalized nanofibers, non-functionalized PCL control nanofibers, an isograft, and a negative control empty conduit. Video walking track analysis allowed for a retrospective analysis with three other evaluation techniques: imbalance coupling (IC), stance factor (SF), and toe out angle (TOA). While these techniques are independent of self-mutilation and toe contracture, walking speed remained as a confounding variable. One way repeated measures ANOVA tests showed no significant difference between treatments or subjects in SFI, SF, or TOA. For SFI, 6 and 12 week trials both saw significant increases over time (p=0.00 for both). A significant difference was found between treatments in IC (p=0.03). Imbalance coupling showed promising Pearson correlation with the current industry standard, SFI (p=0.03). In a regression model, SFI over time had an R-squared value of 94.5%. IC, SF, and TOA had low R-squared values. Future investigation with updated protocol is necessary to confirm the degree of correlation and to evaluate the potential for a new industry standard for evaluating nerve repair

Wellness Matters: A Website Content Analysis of Wellness Resources in Academic Libraries Supporting Medical Schools in the United States

While it is standard for academic libraries to support education and research, many libraries also offer space or dedicated programming to promote the wellness and self-care of their users. Addressing student wellness demonstrates responsiveness to institutional priority and efforts to meet evolving student needs. In addition, it serves as an excellent opportunity for libraries to innovate and collaborate visibly in the community they support, further committing to a culture of wellness. This study examined wellness initiatives, resources, services, and events offered in academic libraries that support medical schools in the United States

Favoriser l’éducation intergénérationnelle : Un programme d’apprentissage par l’expérience pour les étudiants en médecine et les adultes plus âgés

Educational initiatives providing intergenerational, experiential learning opportunities can engage students of various education levels and disciplines. All persons can benefit from initiatives with older adults because our aging population suggests more of these interactions will occur across sectors. While students pursuing an education in health or medical fields are primarily identified as benefiting from intergenerational education to gain skills and knowledge to effectively care for the elderly, these teachings are invaluable regardless of one’s age, education, or career background. The program delivery and evaluation criteria can be adapted to assess competencies essential to different education or career paths

Injection therapies for Achilles tendinopathy

Background: Achilles tendinopathy is a common condition, often with significant functional consequences. As a wide range of injection treatments are available, a review of randomised trials evaluating injection therapies to help inform treatment decisions is warranted. Objectives: To assess the effects (benefits and harms) of injection therapies for people with Achilles tendinopathy. Search methods: We searched the following databases up to 20 April 2015: the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, AMED, CINAHL and SPORTDiscus. We also searched trial registers (29 May 2014) and reference lists of articles to identify additional studies. Selection criteria: We included randomised and quasi-randomised controlled trials evaluating injection therapies in adults with an investigator-reported diagnosis of Achilles tendinopathy. We accepted comparison arms of placebo (sham) or no injection control, or other active treatment (such as physiotherapy, pharmaceuticals or surgery). Our primary outcomes were function, using measures such as the VISA-A (Victorian Institute of Sport Assessment-Achilles questionnaire), and adverse events. Data collection and analysis: Two review authors independently extracted data from the included studies. We assessed treatment effects using mean differences (MDs) and 95% confidence intervals (CIs) for continuous variables and risk ratios (RRs) and 95% CIs for dichotomous variables. For follow-up data, we defined short-term as up to six weeks, medium-term as up to three months and longer-term as data beyond three months. We performed meta-analysis where appropriate. Main results: We included 18 studies (732 participants). Seven trials exclusively studied athletic populations. The mean ages of the participants in the individual trials ranged from 20 years to 50 years. Fifteen trials compared an injection therapy with a placebo injection or no injection control, four trials compared an injection therapy with active treatment, and one compared two different concentrations of the same injection. Thus no trials compared different injection therapies. Two studies had three trial arms and we included them twice in two different categories. Within these categories, we further subdivided injection therapies by mode of action (injury-causing versus direct repair agents). The risk of bias was unclear (due to poor reporting) or high in six trials published between 1987 and 1994. Improved methodology and reporting for the subsequent trials published between 2004 and 2013 meant that these were at less risk of bias. Given the very low quality evidence available from each of four small trials comparing different combinations of injection therapy versus active treatment and the single trial comparing two doses of one injection therapy, only the results of the first comparison (injection therapy versus control) are presented. There is low quality evidence of a lack of significant or clinically important differences in VISA-A scores (0 to 100: best function) between injection therapy and control groups at six weeks (MD 0.79, 95% CI -4.56 to 6.14; 200 participants, five trials), three months (MD -0.94, 95% CI -6.34 to 4.46; 189 participants, five trials) or between six and 12 months (MD 0.14, 95% CI -6.54 to 6.82; 132 participants, three trials). Very low quality evidence from 13 trials showed little difference between the two groups in adverse events (14/243 versus 12/206; RR 0.97, 95% CI 0.50 to 1.89), most of which were minor and short-lasting. The only major adverse event in the injection therapy group was an Achilles tendon rupture, which happened in a trial testing corticosteroid injections. There was very low quality evidence in favour of the injection therapy group in short-term (under three months) pain (219 participants, seven trials) and in the return to sports (335 participants, seven trials). There was very low quality evidence indicating little difference between groups in patient satisfaction with treatment (152 participants, four trials). There was insufficient evidence to conclude on subgroup differences based on mode of action given that only two trials tested injury-causing agents and the clear heterogeneity of the other 13 trials, which tested seven different therapies that act directly on the repair pathway. Authors' conclusions: There is insufficient evidence from randomised controlled trials to draw conclusions on the use, or to support the routine use, of injection therapies for treating Achilles tendinopathy. This review has highlighted a need for definitive research in the area of injection therapies for Achilles tendinopathy, including in older non-athletic populations. This review has shown that there is a consensus in the literature that placebo-controlled trials are considered the most appropriate trial design

Achilles tendon rupture rehabilitation : a mixed methods investigation of current practice among orthopaedic surgeons in the United Kingdom

Abstract OBJECTIVES: The evidence base to inform the management of Achilles tendon rupture is sparse. The objectives of this research were to establish what current practice is in the United Kingdom and explore clinicians' views on proposed further research in this area. This study was registered with the ISRCTN (ISRCTN68273773) as part of a larger programme of research. METHODS: We report an online survey of current practice in the United Kingdom, approved by the British Orthopaedic Foot and Ankle Society and completed by 181 of its members. A total of ten of these respondents were invited for a subsequent one-to-one interview to explore clinician views on proposed further research in this area. RESULTS: The survey showed wide variations in practice, with patients being managed in plaster cast alone (13%), plaster cast followed by orthoses management (68%), and orthoses alone (19%). Within these categories, further variation existed regarding the individual rehabilitation facets, such as the length of time worn, the foot position within them and weight-bearing status. The subsequent interviews reflected this clinical uncertainty and the pressing need for definitive research. CONCLUSIONS: The gap in evidence in this area has resulted in practice in the United Kingdom becoming varied and based on individual opinion. Future high-quality randomised trials on this subject are supported by the clinical community. Cite this article: Bone Joint Res 2015;4:65-9. ©2015 The British Editorial Society of Bone & Joint Surgery. KEYWORDS: Achilles tendon; Orthotics; Plaster Cast; Rehabilitation; Ruptur

The comprehensive cohort model in a pilot trial in orthopaedic trauma

Background: The primary aim of this study was to provide an estimate of effect size for the functional outcome of operative versus non-operative treatment for patients with an acute rupture of the Achilles tendon using accelerated rehabilitation for both groups of patients. The secondary aim was to assess the use of a comprehensive cohort research design (i.e. a parallel patient-preference group alongside a randomised group) in improving the accuracy of this estimate within an orthopaedic trauma setting. Methods: Pragmatic randomised controlled trial and comprehensive cohort study within a level 1 trauma centre. Twenty randomised participants (10 operative and 10 non-operative) and 29 preference participants (3 operative and 26 non-operative). The ge range was 22-72 years and 37 of the 52 patients were men. All participants had an acute rupture of their Achilles tendon and no other injuries. All of the patients in the operative group had a simple end-to-end repair of the tendon with no augmentation. Both groups then followed the same eight-week immediate weight-bearing rehabilitation programme using an off-the-shelf orthotic. The disability rating index (DRI; primary outcome), EQ-5D, Achilles Total Rupture Score and complications were assessed ed at two weeks, six weeks, three months, six months and nine months after initial injury. Results: At nine months, there was no significant difference in DRI between patients randomised to operative or non-operative management. There was no difference in DRI between the randomised group and the parallel patient preference group. The use of a comprehensive cohort of patients did not provide useful additional information as to the treatment effect size because the majority of patients chose non-operative management. Conclusions: Recruitment to clinical trials that compare operative and non-operative interventions is notoriously difficult; especially within the trauma setting. Including a parallel patient preference group to create a comprehensive cohort of patients has been suggested as a way of increasing the power of such trials. In our study, the comprehensive cohort model doubled the number of patients involved in the study. However, a strong preference for non-operative treatment meant that the increased number of patients did not significantly increase the ability of the trial to detect a difference between the two interventions