Associations of Low Vitamin D and Elevated Parathyroid Hormone Concentrations With Bone Mineral Density in Perinatally HIV-Infected Children

BACKGROUND: Perinatally HIV-infected (PHIV) children have, on average, lower bone mineral density (BMD) than perinatally HIV-exposed uninfected (PHEU) and healthy children. Low 25-hydroxy vitamin D [25(OH)D] and elevated parathyroid hormone (PTH) concentrations may lead to suboptimal bone accrual. METHODS: PHIV and PHEU children in the Pediatric HIV/AIDS Cohort Study had total body (TB) and lumbar spine (LS) BMD and bone mineral content (BMC) measured by dual-energy x-ray absorptiometry; BMD z-scores (BMDz) were calculated for age and sex. Low 25(OH)D was defined as ≤20 ng/mL and high PTH as >65 pg/mL. We fit linear regression models to estimate the average adjusted differences in BMD/BMC by 25(OH)D and PTH status and log binomial models to determine adjusted prevalence ratios of low 25(OH)D and high PTH in PHIV relative to PHEU children. RESULTS: PHIV children (n = 412) were older (13.0 vs. 10.8 years) and more often black (76% vs. 64%) than PHEU (n = 207). Among PHIV, children with low 25(OH)D had lower TB-BMDz [SD, -0.38; 95% confidence interval (CI), -0.60 to -0.16] and TB-BMC (SD, -59.1 g; 95% CI, -108.3 to -9.8); high PTH accompanied by low 25(OH)D was associated with lower TB-BMDz. Among PHEU, children with low 25(OH)D had lower TB-BMDz (SD, -0.34; 95% CI, -0.64 to -0.03). Prevalence of low 25(OH)D was similar by HIV status (adjusted prevalence ratio, 1.00; 95% CI, 0.81 to 1.24). High PTH was 3.17 (95% CI, 1.25 to 8.06) times more likely in PHIV children. CONCLUSIONS: PHIV and PHEU children with low 25(OH)D may have lower BMD. Vitamin D supplementation trials during critical periods of bone accrual are needed

An interdisciplinary analysis of professionalism: student perceptions, core concepts, and the implications for pharmacy practice and education

The aim of this interdisciplinary study was three-fold: to identify students' perceptions of professionalism, to analyse the literature for core concepts in professionalism and to examine the implications of the findings for pharmacy practice and pharmacy education worldwide

Personal development planning: first-year Master of Pharmacy students' engagement with, and attitudes towards, reflective self-assessment

The aims of this study were to determine whether first-year Master of Pharmacy (MPharm) students would engage with an activity similar to pharmacists' continuing professional development, and to explore attitudes surrounding this task. A paper version of the Royal Pharmaceutical Society of Great Britain's electronic template for recording continuing professional development was developed. Students were asked to use this paper version to record the planning, action and evaluation carried out while completing a written assignment. The records were assessed to determine any reflective self-assessment contained in the evaluation section, and whether this reflection related to the specified learning outcome and the planning and action stages. Six focus groups were run, during which the students discussed their reaction to completing these records. The study was carried out during the first semester with first-year undergraduate MPharm students in the School of Pharmacy and Pharmaceutical Sciences at the University of Central Lancashire in the UK. It was found that few students appeared to engage fully with the whole recording process. During focus-group sessions competence to self-assess was raised as an issue by students, and the value of the reflective process was questioned. Some students did recognize the value of undertaking and recording reflective self-assessment. It appears that undergraduate students need a more gradual introduction to the process of reflective self-assessment. We suggest that the findings are linked to students' previous education experience and conclude there is a need for students to be encouraged to take ownership of their undergraduate learning, to gain confidence in self-assessment and to increase the value they place on reflection

"Experiential Learning in European Studies: An EU Simulation Workshop"

Four separate presentations, no abstract

Growth at 2 Years of Age in HIV-exposed Uninfected Children in the United States by Trimester of Maternal Antiretroviral Initiation

Abnormal childhood growth may affect future health. Maternal tenofovir (TFV) use was associated with lower body length and head circumference at 1 year of age in HIV-exposed uninfected (HEU) US children. We studied 509 HEU children in the US-based Surveillance Monitoring of Antiretroviral Therapy Toxicities cohort whose HIV-infected mothers were not using antiretrovirals at the last menstrual period and began combination antiretroviral therapy (cART) in pregnancy (cART initiators). We examined adjusted associations between antiretrovirals and Centers for Disease Control 2000 growth Z scores at 2 years of age within trimester of cART initiation: weight (weight Z score), length (length Z score), weight-for-length [weight-for-length Z score (WFLZ)], triceps skinfold Z score (TSFZ) and head circumference (head circumference Z score). Mothers mean age was 28.6 years; 57% were black non-Hispanic and 19% delivered at 1.64 standard deviation (SD) (>95th percentile) in 13%. Among children of first-trimester cART initiators, TFV+emtricitabine-exposed children had slightly higher mean WFLZ (0.45 SD; 95% confidence interval: -0.10 to 1.00) and lower TSFZ (-0.55 SD; 95% confidence interval: -1.07 to -0.02) compared with zidovudine+lamivudine-exposed children. TSFZ was lower in those exposed to boosted protease inhibitors. In contrast, growth in children of second trimester cART initiators did not differ by antiretroviral exposures. Growth was above average in HEU; 13% were obese. Maternal TFV use was not associated with lower length or head circumference at 2 years of age, as hypothesized, but may be related to greater weight among those exposed to cART early in pregnancy