HR‐pQCT measures of bone microarchitecture predict fracture : systematic review and meta‐analysis

HR‐pQCT is a non‐invasive imaging modality for assessing volumetric bone mineral density (vBMD) and microarchitecture of cancellous and cortical bone. The objective was to (i) assess fracture‐associated differences in HR‐pQCT bone parameters and (ii) to determine if HR‐pQCT is sufficiently precise to reliably detect these differences in individuals. We systematically identified 40 studies that used HR‐pQCT (39/40 used XtremeCT scanners) to assess 1291‐3253 and 3389‐10,687 individuals with and without fractures, respectively, ranging in age from 10.9 to 84.7 years with no comorbid conditions. Parameters describing radial and tibial bone density, microarchitecture, and strength were extracted and percentage differences between fracture and control subjects were estimated using a random effects meta‐analysis. An additional meta‐analysis of short‐term in vivo reproducibility of bone parameters assessed by XtremeCT was conducted to determine whether fracture‐associated differences exceeded the least significant change (LSC) required to discern measured differences from precision error. Radial and tibial HR‐pQCT parameters, including failure load, were significantly altered in fracture subjects, with differences ranging from −2.6% (95% CI: −3.4 to −1.9) in radial cortical vBMD to −12.6% (95% CI: −15.0 to −10.3) in radial trabecular vBMD. Fracture‐associated differences reported by prospective studies were consistent with those from retrospective studies, indicating that HR‐pQCT can predict incident fracture. Assessment of study quality, heterogeneity and publication biases verified the validity of these findings. Finally, we demonstrated that fracture‐associated deficits in total and trabecular vBMD, and certain tibial cortical parameters, can be reliably discerned from HR‐pQCT‐related precision error and can be used to detect fracture‐associated differences in individual patients. Although differences in other HR‐pQCT measures, including failure load, were significantly associated with fracture, improved reproducibility is needed to ensure reliable individual cross‐sectional screening and longitudinal monitoring. In conclusion, our study supports the use of HR‐pQCT in clinical fracture prediction

Processes and experiences of creative cognition in seven Western classical composers

In a qualitative study, we explored the range of reflections and experiences involved in the composition of score-based music by administering a 15-item, open-ended, questionnaire to seven professional composers from Europe and North America. Adopting a grounded theory approach, we organized six different codes emerging from our data into two higher-order categories ( the act of composing and establishing relationships). Our content analysis, inspired by the theoretical resources of 4E cognitive science, points to three overlapping characteristics of creative cognition in music composition: it is largely exploratory, it is grounded in bodily experience, and it emerges from the recursive dialogue of agents and their environment. More generally, such preliminary findings suggest that musical creativity may be advantageously understood as a process of constant adaptation – one in which composers enact their musical styles and identities by exploring novel interactivities hidden in their contingent and historical milieux

Forebyggende hjemmebesøk til eldre. Utbredelse, diffusjonsprosesser og spredning

Bakgrunn: Forebyggende hjemmebesøk til eldre (FHB) har fått økende helsefaglig og helsepolitisk oppmerksomhet de seneste årene. Det eksisterer internasjonalt en omfattende forskning omkring tjenestetilbudets effekt og betydning for målgruppene, men vi vet lite om hvordan tilbudet sprer seg i en kommunekontekst. Metode: Alle norske kommuner ble kontaktet med spørsmål om å besvare et spørreskjema om utbredelse og innhold av FHB. Disse svarene ble koblet med andre data om kommunene hentet fra Statistisk sentralbyrå og andre kilder. Resultater og konklusjon: Utbredelsen av FHB i norske kommuner har økt fra 8 % i 2003 til 24 % i 2013. Halvparten av nyetableringene foregikk mellom 2010 og 2013. Resultatene tyder på at FHB spredte seg først lokalt og regionalt gjennom ildsjeler og samhandling mellom kommuner, særlig i store, mellomstore og sentrale kommuner. Funnene indikerer at kommuner med lite økonomisk slingringsmonn i større grad enn rike kommuner ser seg nødt til å tenke nytt, forebyggende og helsefremmende, men mer forskning om denne sammenhengen er påkrevet. Sterkere nasjonale føringer og retningslinjer for FHB vil sannsynligvis komme til å framstå som en tydeligere faktor for spredning og utbredelse i årene som kommer

Predictors of outcomes following reablement in community-dwelling older adults

Hanne Tuntland,1,2 Ingvild Kjeken,3,4 Eva Langeland,2,5 Bjarte Folkestad,2,6 Birgitte Espehaug,7 Oddvar Førland,2,8 Mona Kristin Aaslund1 1Department of Global Public Health and Primary Care, Faculty of Medicine and Dentistry, University of Bergen, 2Centre for Care Research Western Norway, Bergen University College, Bergen, 3National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, 4Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, 5Department of Nursing, Faculty of Health and Social Sciences, Bergen University College, 6Uni Research Rokkan Centre, 7Centre for Evidence-Based Practice, Bergen University College, 8Faculty of Health Studies, VID Specialized University, Campus Bergen, Bergen, Norway Background: Reablement is a rehabilitation intervention for community-dwelling older adults, which has recently been implemented in several countries. Its purpose is to improve functional ability in daily occupations (everyday activities) perceived as important by the older person. Performance and satisfaction with performance in everyday life are the major outcomes of reablement. However, the evidence base concerning which factors predict better outcomes and who receives the greatest benefit in reablement is lacking. Objective: The objective of this study was to determine the potential factors that predict occupational performance and satisfaction with that performance at 10 weeks follow-up. Methods: The sample in this study was derived from a nationwide clinical controlled trial evaluating the effects of reablement in Norway and consisted of 712 participants living in 34 municipalities. Multiple linear regression was used to investigate possible predictors of occupational performance (COPM-P) and satisfaction with that performance (COPM-S) at 10 weeks follow-up based on the Canadian Occupational Performance Measure (COPM). Results: The results indicate that the factors that significantly predicted better COPM-P and COPM-S outcomes at 10 weeks follow-up were higher baseline scores of COPM-P and COPM-S respectively, female sex, having a fracture as the major health condition and high motivation for rehabilitation. Conversely, the factors that significantly predicted poorer COPM-P and COPM-S outcomes were having a neurological disease other than stroke, having dizziness/balance problems as the major health condition and having pain/discomfort. In addition, having anxiety/depression was a predictor of poorer COPM-P outcomes. The two regression models explained 38.3% and 38.8% of the total variance of the dependent variables of occupational performance and satisfaction with that performance, respectively. Conclusion: The results indicate that diagnosis, functional level, sex and motivation are significant predictors of outcomes following reablement. Keywords: home-based rehabilitation, Canadian Occupational Performance Measure, aged, sex, frailt