Differences in hip bone mineral density may explain the hip fracture pattern in osteoarthritic hips

Introduction In patients with osteoarthritis of the hip (OAH), trochanteric fractures are much more common than femoral neck fractures. One reason may be altered bone composition in the proximal femurs. OAH often leads to a fixed external rotation of the hip, leading to difficulties in positioning during DXA measurements. We compared BMD in OAH-affected legs and healthy legs

Are health systems interventions gender blind? examining health system reconstruction in conflict affected states

Background Global health policy prioritizes improving the health of women and girls, as evident in the Sustainable Development Goals (SDGs), multiple women’s health initiatives, and the billions of dollars spent by international donors and national governments to improve health service delivery in low-income countries. Countries recovering from fragility and conflict often engage in wide-ranging institutional reforms, including within the health system, to address inequities. Research and policy do not sufficiently explore how health system interventions contribute to the broader goal of gender equity. Methods This paper utilizes a framework synthesis approach to examine if and how rebuilding health systems affected gender equity in the post-conflict contexts of Mozambique, Timor Leste, Sierra Leone, and Northern Uganda. To undertake this analysis, we utilized the WHO health systems building blocks to establish benchmarks of gender equity. We then identified and evaluated a broad range of available evidence on these building blocks within these four contexts. We reviewed the evidence to assess if and how health interventions during the post-conflict reconstruction period met these gender equity benchmarks. Findings Our analysis shows that the four countries did not meet gender equitable benchmarks in their health systems. Across all four contexts, health interventions did not adequately reflect on how gender norms are replicated by the health system, and conversely, how the health system can transform these gender norms and promote gender equity. Gender inequity undermined the ability of health systems to effectively improve health outcomes for women and girls. From our findings, we suggest the key attributes of gender equitable health systems to guide further research and policy. Conclusion The use of gender equitable benchmarks provides important insights into how health system interventions in the post-conflict period neglected the role of the health system in addressing or perpetuating gender inequities. Given the frequent contact made by individuals with health services, and the important role of the health system within societies, this gender blind nature of health system engagement missed an important opportunity to contribute to more equitable and peaceful societies

Triple access planning for uncertain futures: a handbook for practitioners

Planning for the future continues to evolve in the face of a changing world. What we did in the past will not work for the future. Even the recent shift, with greater interest in transport planning being vision-led and focused on people rather than traffic, it is still not enough. This Handbook is the next evolutionary step. It supports a way of thinking and acting that is intended to mark a change from transport planning in the ‘predict and provide’ paradigm to ‘Triple Access Planning’ in the ‘decide and provide’ paradigm. This is vision-led (‘decide’) instead of forecast-led (‘predict’). It includes digital accessibility alongside spatial proximity and mobility (together making ‘triple access’). It also includes addressing uncertainty about the future. The Handbook is a companion guide for those who are already conversant with transport planning or other planning approaches. It explains the triple access perspective on planning, the handling of uncertainty, addressing access for goods, and the organisational and institutional challenges associated with Triple Access Planning. For each of these themes, four planning phases are examined: (i) Philosophy - why take this approach?; (ii) Preparation and Analysis – assessing the current and future situations; (iii) Strategy Development – determining visions/goals and the approaches to achieving these; and (iv) Measure Planning – identifying more specifically what needs to be implemented to achieve goals. The first of these is an important (informal) orientation phase. The other phases reflect those recognised in European Sustainable Urban Mobility Planning (which also includes ‘Implementation and Monitoring’). Whilst Triple Access Planning does not offer an easier approach than established planning practices and institutions, it is more fit for purpose in relation to the challenge and opportunities we now face. This Handbook is a staging post in the onward journey of change in how we make sense of, and seek to be prepared for and shape, the future. Please embrace it