Oral versus intra‐vaginal imidazole and triazole anti‐fungal treatment of uncomplicated vulvovaginal candidiasis (thrush)

Internal sources: • Health Services Research Unit, University of Aberdeen, UK • Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Canada (Salary support for Julia Worswick) • Centre of Academic Primary Care, University of Aberdeen, UK External sources: • JMG holds a Tier 1 Canadian Research Chair in Knowledge Transfer and Uptake, Canada • MCW was funded by a Health Foundation Improvement Science Fellowship and the University of Strathclyde, UK • The Health Services Research Unit is funded by the Chief Scientist ODice, Scottish Executive Health Department, UK • The Health Economic Research Unit is funded by the Chief Scientist ODice, Scottish Executive Health Department, UKPeer reviewedPublisher PD

Prevention and optimal management of sarcopenia: a review of combined exercise and nutrition interventions to improve muscle outcomes in older people.

The growing recognition of sarcopenia, the age-related loss of skeletal muscle mass and function, has highlighted the need to understand more about its etiology. Declines in muscle mass and strength are expected aspects of aging, but there is significant variability between individuals in rates of loss. Although some of these differences can be explained by fixed factors, such as sex, much of the remaining variation is unexplained. This has led to increasing interest in the influence of adult lifestyle, particularly in the effects of modifiable factors such as physical activity and diet, and in identifying intervention opportunities both to prevent and manage sarcopenia. A number of trials have examined the separate effects of increased exercise or dietary supplementation on muscle mass and physical performance of older adults, but less is known about the extent to which benefits of exercise training could be enhanced when these interventions are combined. In a comprehensive review of the literature, we consider 17 studies of older adults (?65 years) in which combined nutrition and exercise interventions were used to increase muscle strength and/or mass, and achieve improvements in physical performance. The studies were diverse in terms of the participants included (nutritional status, degree of physical frailty), supplementation strategies (differences in nutrients, doses), exercise training (type, frequency), as well as design (duration, setting). The main message is that enhanced benefits of exercise training, when combined with dietary supplementation, have been shown in some trials - indicating potential for future interventions, but that existing evidence is inconsistent. Further studies are needed, particularly of exercise training combined with dietary strategies that increase intakes of a range of nutrients, as well as bioactive non-nutrients, to provide the evidence on which public health and clinical recommendations can be based

What are the barriers to adoption of a lifestyle associated with optimal peak bone mass acquisition? A qualitative study of young adults in New Zealand

Objective: this study aimed to investigate the barriers to adopting lifestyle factors other than physical activity important for optimal peak bone mass (PBM) acquisition—namely, dietary factors, avoidance of cigarette smoking, and keeping alcohol consumption within recommended limits. Materials and Methods: university students and staff aged 18–35 years were recruited. Six semi-structured, in-depth focus group interviews were conducted with a total of 28 participants. The interviews were digitally recorded and transcribed. A thematic approach for data analysis using a constant comparative method was performed using NVivo software. Results: three major themes emerged: socio-cultural barriers (peer pressure and cultural norms); personal barriers (time, cost, and diet preferences); and other barriers (medical illness and lack of symptoms associated with low bone mass density). Conclusions: we identified several barriers to adoption of lifestyle behaviours that might be beneficial to PBM acquisition. These data might facilitate the development of public health interventions designed to help young adults embrace osteoprotective lifestyles, and hence reduce the burden of osteoporotic fracture in later life

What influences university students to seek sexually transmitted infection testing?: A qualitative study in New Zealand

Objective: Untreated sexually transmitted infections (STIs) can lead to serious health complications, increase susceptibility to contracting further STIs including human immunodefiniceny virus (HIV), and can be transmitted to others. The early diagnosis and treatment of STIs is therefore central to comprehensive STI management and prevention, but this relies on those at risk of STIs presenting for testing. In order to understand STI testing behaviours in view of their improvement, this study aimed to elucidate why people seek STI testing. Methods: Qualitative semi-structured interviews were conducted with 24 university students who had recently had an STI test. Resulting data were analysed employing a qualitative thematic analysis method to produce a final set of themes. Results: Five drivers for STI testing were identified from the data: crisis, partners, clinicians, routines, and previous knowledge. The final driver, previous knowledge, intersected with the previous four, particularly in relation to routines. Many participants acknowledged that the more they knew about STIs the more likely they were to undertake routine tests. However, at the same time, many participants felt they did not have a good knowledge base and that their school-based sex education had been lacking. Conclusion: This study highlights important drivers for STI testing, which may aid the design of public health campaigns. It also underlines that school-based education could provide stronger foundations with regards to STIs and their prevention.</p

The relationship between non-elite sporting activity and calcaneal bone density in adolescents and young adults: a narrative systematic review

Introduction: osteoporotic fractures represent a major public health burden. The risk of fragility fractures in late adulthood is strongly impacted by peak bone mass acquisition by the third decade. Weight-bearing sporting activity may be beneficial to peak bone mass accrual, but previous studies have focused on elite sporting activity and have used dual energy X-ray absorptiometry as a measure of bone density. The authors performed a narrative systematic review of individual sports (performed non-competitively or at local level) and calcaneal quantitative ultrasound (cQUS) bone measures in young people.Methods: multiple databases were systematically searched up until the 31st of March 2019. The authors included studies of participants' mean age (11–35 years), reporting any level of recreational sporting activity and cQUS measures as well as excluding elite/professional sporting physical activity. Studies (title and abstract) were screened independently by two reviewers, and a third reviewer resolved any discrepancies. STROBE guidelines were used to check the reporting of observational studies. The Newcastle–Ottawa Scale was used to assess the risk of bias of the studies included in the review. The systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO).Results: a search yielded 29,512 articles that considered relationships between bone density assessed by any technique and sporting activity. Duplicate and out of scope abstracts were removed. This left 424 papers that were screened by two reviewers; of these, six met the inclusion criteria, including assessment by cQUS. The authors identified papers where sports were considered, included soccer (football), swimming, cycling, gymnastics, dancing, badminton, basketball, fencing, wrestling, and judokas. Although study heterogeneity prohibited meta-analysis, all six included studies reported significant benefits of weight-bearing non-elite sports on cQUS outcomes.Conclusion: our study found beneficial effects of non-elite sports participation on cQUS in adolescence and young adulthood, although further work is now indicated

Self-reported sleep quality and bone outcomes in older adults: findings from the Hertfordshire Cohort Study

Sleep duration may be associated with risk of osteoporosis, with suggestions that too little or indeed too much sleep may be detrimental to bone health. In this study, we considered whether perceived sleep quality is also associated with bone health in older adults. We explored this association in a cohort of 443 older community-dwelling UK adults. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI); poor sleep quality was defined as &gt; 5 on this score system. Bone density, shape and microarchitecture were assessed using dual energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) and high-resolution pQCT (HRpQCT). Thirty-seven percent of men and 43% of women had a PSQI score greater than 5, indicative of poor perceived sleep. We found that quality of sleep was associated with altered bone microarchitecture. In men, poor sleep quality was associated with lower radial trabecular (4% slice, p &lt; 0.04) and cortical (66% slice, p = 0.02) bone mineral density, as well as decreased tibial cortical density (p &lt; 0.02) and increased porosity (p &lt; 0.04), but increased size of the tibia (p &lt; 0.04). In women, poor perceived sleep quality was associated with thinner (p &lt; 0.03) and less dense (p &lt; 0.04) cortices of the radius, but greater tibial trabecular number (p &lt; 0.02) and lower separation (p &lt; 0.04). Relationships with DXA parameters were non-significant after adjustment for confounders. Taking sleep medications was associated with decreased tibial size (38% and 66% slices) and strength in women (all p &lt; 0.05), but not in men. Perceived sleep quality was associated with altered bone density and microarchitecture in older adults, and these differences varied according to biological sex and site. Further work is indicated to investigate possible mechanisms underlying these observations

Poor sleep quality and physical performance in older adults

Objectives: this study aimed to examine the association between sleep quality and physical performance among a group of UK community-dwelling older adults, according to sex. Methods: sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Physical performance was assessed using a short physical performance battery (SPPB), a timed up-and-go, and a hand-grip strength test. Results: of 591 eligible study members, 401 completed the PSQI. In regression analyses, men who reported poor sleep quality were significantly more likely to have a poor SPPB score, even after adjustment for confounding factors (OR=2.54, 95% CI 1.10-5.89, p=0.03). The direction of the relationship was reversed among women, where those who reported poor sleep were less likely to have a low SPPB score (OR=0.36, 95% CI 0.15-0.85, p=0.02). Poor sleep quality was associated with poorer hand-grip strength among women (regression coefficient=-0.34 z-score, 95% CI -0.64, -0.04, p=0.03), but this relationship was not observed among men (regression coefficient=0.28 z-score, 95% CI -0.01, 0.57, p=0.06).Conclusion: we found evidence of an association between poor sleep quality and poorer physical performance in older adults, though there appear to be important sex differences.Key words: Sleep, Physical Performance, Grip strength, Sarcopenia, Muscle, Ageing<br/

Inequities in exposure to occupational risk factors between Māori and non-Māori workers in Aotearoa New Zealand.

BACKGROUND: Health inequities between indigenous and non-indigenous people are well documented. However, the contribution of differential exposure to risk factors in the occupational environment remains unclear. This study assessed differences in the prevalence of self-reported exposure to disease risk factors, including dust and chemicals, physical factors and organisational factors, between Māori and non-Māori workers in New Zealand. METHODS: Potential participants were sampled from the New Zealand electoral rolls and invited to take part in a telephone interview, which included questions about current workplace exposures. Logistic regression, accounting for differences in age, socioeconomic status and occupational distribution between Māori and non-Māori, was used to assess differences in exposures. RESULTS: In total, 2344 Māori and 2710 non-Māori participants were included in the analyses. Māori had greater exposure to occupational risk factors than non-Māori. For dust and chemical exposures, the main differences related to Māori working in occupations where these exposures are more common. However, even within the same job, Māori were more likely to be exposed to physical factors such as heavy lifting and loud noise, and organisational factors such as carrying out repetitive tasks and working to tight deadlines compared with non-Māori. CONCLUSIONS: This is one of the first studies internationally to compare occupational risk factors between indigenous and non-indigenous people. These findings suggest that the contribution of the occupational environment to health inequities between Māori and non-Māori has been underestimated and that work tasks may be unequally distributed according to ethnicity