Association of Physical Activity and Fracture Risk Among Postmenopausal Women

Importance: Physical activity is inversely associated with hip fracture risk in older women. However, the association of physical activity with fracture at other sites and the role of sedentary behavior remain unclear. Objective: To assess the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women. Design, Setting, and Participants: The Women\u27s Health Initiative prospective cohort study enrolled 77206 postmenopausal women aged 50 to 79 years between October 1993 and December 1998 at 40 US clinical centers. Participants were observed for outcomes through September 2015, with data analysis conducted from June 2017 to August 2019. Exposures: Self-reported physical activity and sedentary time. Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for total and site-specific fracture incidence. Results: During a mean (SD) follow-up period of 14.0 (5.2) years among 77206 women (mean [SD] age, 63.4 [7.3] years; 66072 [85.6%] white), 25516 (33.1%) reported a first incident fracture. Total physical activity was inversely associated with the multivariable-adjusted risk of hip fracture ( \u3e 17.7 metabolic equivalent [MET] h/wk vs none: HR, 0.82; 95% CI, 0.72-0.95; P for trend \u3c .001). Inverse associations with hip fracture were also observed for walking ( \u3e 7.5 MET h/wk vs none: HR, 0.88; 95% CI, 0.78-0.98; P for trend = .01), mild activity (HR, 0.82; 95% CI, 0.73-0.93; P for trend = .003), moderate to vigorous activity (HR, 0.88; 95% CI, 0.81-0.96; P for trend = .002), and yard work (HR, 0.90; 95% CI, 0.82-0.99; P for trend = .04). Total activity was positively associated with knee fracture ( \u3e 17.7 MET h/wk vs none: HR, 1.26; 95% CI, 1.05-1.50; P for trend = .08). Mild activity was associated with lower risks of clinical vertebral fracture (HR, 0.87; 95% CI, 0.78-0.96; P for trend = .006) and total fractures (HR, 0.91; 95% CI, 0.87-0.94; P for trend \u3c .001). Moderate to vigorous activity was positively associated with wrist or forearm fracture (HR, 1.09; 95% CI, 1.03-1.15; P for trend = .004). After controlling for covariates and total physical activity, sedentary time was positively associated with total fracture risk ( \u3e 9.5 h/d vs \u3c 6.5 h/d: HR, 1.04; 95% CI, 1.01-1.07; P for trend = .01). When analyzed jointly, higher total activity mitigated some of the total fracture risk associated with sedentary behavior. Analysis of time-varying exposures resulted in somewhat stronger associations for total physical activity, whereas those for sedentary time were materially unchanged. Conclusions and Relevance: In older ambulatory women, higher total physical activity was associated with lower total and hip fracture risk but higher knee fracture risk. Mild activity and walking were associated with lower hip fracture risk, a finding with important public health implications because these activities are common in older adults. The positive association between sedentary time and total fracture risk requires further investigation

Change in Physical Activity after a Diabetes Diagnosis: Opportunity for Intervention

INTRODUCTION: Moderate intensity physical activity is recommended for individuals with diabetes to control glucose and prevent diabetes-related complications. The extent to which a diabetes diagnosis motivates patients to increase physical activity is unclear. This study used data from the Women\u27s Health Initiative Observational Study (baseline data collected from 1993-1998) to examine change in physical activity and sedentary behavior in women who reported a diabetes diagnosis compared to women who did not report diabetes over 7 years of follow-up (up to 2005). METHODS: Participants (n=84,300) were post-menopausal women who did not report diabetes at baseline [mean age=63.49; standard deviation (SD)=7.34; mean BMI=26.98 kg/m; SD=5.67]. Linear mixed model analyses were conducted adjusting for study year, age, race/ethnicity, BMI, education, family history of diabetes, physical functioning, pain, energy/fatigue, social functioning, depression, number of chronic diseases and vigorous exercise at age 18. Analyses were completed in August 2012. RESULTS: Participants who reported a diabetes diagnosis during follow-up were more likely to report increasing their total physical activity (p=0.002), walking (p CONCLUSION: A diabetes diagnosis may prompt patients to increase physical activity. Healthcare professionals should consider how best to capitalize on this opportunity to encourage increased physical activity and maintenance

Global Learning through Partnered Inquiry

The emergence of Global Learning associated with the internationalization of U.S. higher education signals a convergence of international/global studies and international education with the potential to dramatically innovate and transform the academy. Over the past decade the original aim of international education to foster intercultural understanding has become linked with the aims of international studies to enhance our knowledge of the world, and in particular, the ways in which new knowledge is created through non-western epistemologies and cultural perspectives. This paper seeks to situate the emerging discourse and initiatives around global learning in an understanding of the transformation potential of collaborative inquiry and pedagogy for U.S. higher education

International Perspectives on International Studies

This paper aims to address the principle question asked at the 2008 conference of the International Studies Association -southern region: As international education is mainstreamed and increasingly both an expectation and assumption of university education, what is the nexus between international education and international studies

Study Abroad, Global Knowledge and the Epistemic Communities of Higher Education

International education and study abroad change the boundaries of who is included in the community of US higher education as more and more colleges and universities incorporate mission statements with aspirations of global citizenship. I argue that this changing frame of the community, moral purpose and appreciation of different worldviews has profound and significant implications for the academic and professional disciplines that constitute the academy. The impact of study abroad can be – and perhaps with a new generation of scholars will be – an epistemological shift within the disciplines to include both new modes of knowledge acquisition as well as new understandings of global realities

Exploring Leadership Through International Education: Civic Learning Through Study Abroad in Uganda

Leadership education in the 21st century cannot ignore the global risks, opportunities and realities of our interconnected world; so too international education cannot avoid its responsibility to provide the knowledge and vision needed to resolve critical issues we will face as a global community. We argue that a model of international education is needed which acknowledges the diverse global community in which institutions are based and learning takes place. In linking leadership and international education, we propose an alternative approach to both based on recognition, reciprocity and responsibility toward others

The Ethnographic Experience: Experiential Learning via Ethnographic Practice

Ethnography and experiential learning share assumptions on the primacy of everyday lived experience for learning culture. This presentation offers perspectives on ethnography as pedagogy for cultural learning through demonstration of ethnographic inquiry, discussion of pre-departure preparation for field work, and faculty reflections on students’ experiential learning

Proposition 187 reexamined: Attitudes toward immigration among California voters

The purposes of this study were to examine socio-demographic predictors of attitudes toward immigration in a community-based sample (N = 494) from the Los Angeles area; and to explore the relationship between attitudes toward immigration and the providing of educational and health services to the children of undocumented immigrants. Not providing services to the children of undocumented immigrants was a key element of California\u27s Proposition 187. Attitudes toward immigration were measured with the Attitudes Toward Immigration Scale (ATIS). The providing of services was measured through the participants\u27 evaluations of a school scenario and a health care scenario. Results indicated that participants who were middle-aged or older, less educated, identified as Republican, and were third generation or greater were more likely to hold negative attitudes toward immigration. Furthermore, participants holding negative attitudes toward immigration were less likely to provide education and health care services to the children of undocumented immigrants

The Effects of Inaccurate Expectations on Experiences with Psychotherapy

Inaccurate expectations have been shown to negatively affect patients’ experiences with medical treatments; however, much less is known about the effects of inaccurate expectations on patients’ experiences with psychotherapy. This may be particularly important at the current time because, while many cultural outlets depict either nondirective or psychodynamic therapy, the majority of empirically supported treatments are guided by cognitive behavioral theory. Two studies examined (1) current expectations for psychological treatment and (2) the effects of accurate versus inaccurate expectations on students undergoing either cognitive behavioral therapy (CBT) or nondirective therapy for nonclinical academic problems. Results from Study 1 suggest that people presenting for psychotherapy may be unlikely to expect the specific tasks and goals common to many CBTs. Results from Study 2 demonstrate negative effects of inaccurate expectations on affective reactions to treatment regardless of the type of treatment received. The implications for dissemination of empirically supported CBTs are discussed