Effect of Life-Style Modification Intervention Programme on Bone Mineral Density among Postmenopausal Women with Osteoporosis

Objectives: Osteoporosis is one of the major public health problems worldwide among postmenopausal osteoporotic women. Lifestyle modification interventions along with pharmacotherapy helps to revert the bone loss and prevent the complications. Methods: A randomized controlled trial was conducted at Kasturba Hospital, Manipal from January 2019 to December 2021 among postmenopausal women with osteoporosis. The postmenopausal women who attended the osteoporosis clinic and were within the age group of 45-65 years, could speak and understand English or Kannada, and whose Bone Mineral Density (BMD) score was between -1 and -3 were included for the study. The total sample size of the study was 120 with 60 in each of the experimental and control group. After obtaining the informed consent, stratified block randomization method was used to allocate the participants to intervention and control group. The BMD was monitored by the portable ultrasound densitometer by a technician at the outpatient departments. The baseline information was collected by a structured demographic questionnaire. Intervention group participants received Lifestyle Modification Intervention Program (LMIP) whereas control group received the standard regular care by the physician.  Follow up was done at three and six months. Results: The results revealed that the increase in the BMD median score among the experimental group was from -2.2 [(-2.5, -1.8)] to -1.5 [(-1.8, -0.65)] where as in the control group it was from -2.3 [(-2.6, -1.9)] to -2.0 [(-2.4, -1.5)].  The increase in the median score of the experimental group (0.7) was higher than in the control group (0.3). The results of Mann Whitey U test showed a statistical significance between the intervention and control groups in the post test after 6 months (U =.505.5, p<0.05). Wilcoxon signed rank test showed the significant change in both the intervention and control groups from pre-test to post-test I (3 months) and Post-test II (6 months) (p<0.001). Conclusion: The lifestyle modification intervention was found to be effective in improving the bone health status of postmenopausal women. Hence it is very important to integrate in regular therapy. Keywords: LMIP, postmenopausal women, bone health status, bone mineral density

Pleural Tuberculosis in Patients with Early HIV Infection Is Associated with Increased TNF-Alpha Expression and Necrosis in Granulomas

Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB). Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-γ, TNF-α and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-α and necrosis. This study demonstrates immune dysregulation which may include TNF-α-mediated immunopathology at the site of disease in HIV infected pleural TB patients

Social patterning of chronic disease risk factors in a Latin American city

Most studies of socioeconomic status (SES) and chronic disease risk factors have been conducted in high-income countries, and most show inverse social gradients. Few studies examine these patterns in lower- or middle-income countries. Using cross-sectional data from a 2005 national risk factor survey in Argentina (a middle-income country), we investigated the associations of individual- and area-level SES with chronic disease risk factors (body mass index [BMI], hypertension, and diabetes) among residents of Buenos Aires. Associations of risk factors with income and education were estimated after adjusting for age, sex (except in sex-stratified models), and the other socioeconomic indicators. BMI and obesity were inversely associated with education and income for women, but not for men (e.g., mean differences in BMI for lowest versus highest education level were 1.55 kg/m2, 95%CI = 0.72-2.37 in women and 0.17 kg/m2, 95%CI = -0.72-1.06 in men). Low education and income were also associated with increased odds of hypertension diagnosis in all adults (adjusted odds ratio [AOR] = 1.48, 95%CI = 0.99-2.20 and AOR = 1.50, 95%CI = 0.99-2.26 for the lowest compared to the highest education and income categories, respectively). Lower education was strongly associated with increased odds of diabetes diagnosis (AOR = 4.12, 95%CI = 1.85-9.18 and AOR = 2.43, 95%CI = 1.14-5.20 for the lowest and middle education categories compared to highest, respectively). Area-level education also showed an inverse relationship with BMI and obesity; these results did not vary by sex as they did at the individual level. This cross-sectional study of a major urban area provides some insight into the global transition with a trend toward concentrations of risk factors in poorer populations.http://deepblue.lib.umich.edu/bitstream/2027.42/78528/1/FleischerDiezRoux2008_JUrbanHealth.pd

Desigualdades no uso e acesso aos serviços de saúde entre idosos do município de São Paulo Desigualdades en el uso y acceso a los servicios de salud entre ancianos del municipio de São Paulo Inequalities in access to health care services and utilization for the elderly in São Paulo, Brazil

OBJETIVO: Analisar os fatores relacionados à determinação e às desigualdades no acesso e uso dos serviços de saúde por idosos. MÉTODOS: Estudo integrante do Projeto Saúde, Bem-estar e Envelhecimento (SABE), no qual foram entrevistados 2.143 indivíduos com 60 anos ou mais no município de São Paulo, SP, em 2000. A amostra foi obtida em dois estágios, utilizando-se setores censitários com reposição, probabilidade proporcional à população e complementação da amostra de pessoas de 75 anos. Foi mensurado o uso de serviços hospitalares e ambulatoriais nos quatro meses anteriores à entrevista, relacionando-os com fatores de capacidade, necessidade e predisposição (renda total, escolaridade, seguro saúde, morbidade referida, auto-percepção, sexo e idade). O método estatístico utilizado foi regressão logística multivariada. RESULTADOS: Dos entrevistados, 4,7% referiram ter utilizado a internação hospitalar e 64,4% o atendimento ambulatorial. Dos atendimentos ambulatoriais em serviço público, 24,7% ocorreram em hospital e 24,1% em serviço ambulatorial; dentre os que ocorreram em serviços privados, 14,5% foram em hospital e 33,7% em clínicas. Pela análise multivariada, observou-se associação entre a utilização de serviços e sexo, presença de doenças, auto-percepção de saúde, interação da renda e escolaridade e posse de seguro saúde. A análise isolada com escolaridade apresentou efeito inverso. CONCLUSÕES: Foram observadas desigualdades no uso e acesso aos serviços de saúde e inadequação do modelo de atenção, indicando necessidade de políticas públicas que levem em conta as especificidades dessa população, facilitem o acesso e possam reduzir essas desigualdades.<br>OBJETIVO: Analizar los factores relacionados a la determinación y las desigualdades en el acceso y uso de los servicios de salud por ancianos. MÉTODOS: Estudio integrante del Proyecto Sáude, Bem-Estar e Envelhecimento (SABE Salud, Bienestar y Envejecimiento), en el cual fueron entrevistados 2.143 individuos con 60 años o más en el municipio de Sao Paulo (Sudeste de Brasil), en 2000. La muestra fue obtenida en dos fases, utilizándose sectores sometidos a censo con reposición, probabilidad proporcional a la población y complementación de la muestra de personas de 75 años. Fue medido el uso de servicios hospitalarios y ambulatoriales en los cuatro meses anteriores a la entrevista, relacionándolos con factores de capacidad, necesidad y predisposición (renta total, escolaridad, seguro de salud, morbilidad referida, autopercepción, sexo y edad). El método estadístico utilizado fue regresión logística multivariada. RESULTADOS: De los entrevistados, 4,7% refirieron haber utilizado la internación hospitalaria y 64,4% el atendimiento ambulatorial. De los atendimientos ambulatoriales en servicio público, 24,7% ocurrieron en hospital y 24,1% en servicio ambulatorial; dentro de los que ocurrieron en servicios privados, 14,5% fueron en hospital y 33,7% en clínicas. Por análisis multivariada, se observó asociación entre la utilización de servicios y sexo, presencia de enfermedades, autopercepción de salud, interacción de renta y escolaridad y posesión de seguro de salud. El análisis solamente con escolaridad presentó efecto inverso. CONCLUSIONES: Fueron observadas desigualdades en el uso y acceso a los servicios de salud y modelo inadecuado de atención, indicando necesidad de políticas públicas que lleven en cuenta las especificaciones de esa población, faciliten el acceso y puedan reducir esas desigualdades.<br>OBJECTIVE: To describe factors associated to inequalities in access to health care services and utilization for the elderly. METHODS: Study part of the Health, Well-being and Aging in Latin America and the Caribbean ("SABE") Survey that included 2,143 elderly individuals aged 60 or older in the city of São Paulo, southeastern Brazil, in 2000. A two-step sampling procedure with probability proportional to size was carried out using census tracts with replacement. To achieve the desired number of respondents aged 75 or older, additional households close to the selected census tracts were sampled. Access to health services and utilization were measured for outpatient and hospital services during a 4-month period prior to the interview, and correlated to factors related to ability, need and predisposition (total income, schooling, health insurance, reported medical condition, self-perception, gender and age).Multivariate logistic regression was performed in the analysis. RESULTS: Of all respondents, 4.7% reported being hospitalized and 64.4% seeking outpatient care in the four months prior to the study. As for public outpatient care provided, 24.7% were in hospital clinics and 24.1% in other public outpatient services. As for private care, 14.5% received care in hospitals and 33.7% in health clinics. The multivariate analysis showed an association between health service utilization and sex, medical condition, self-perceived health, income, schooling, and health insurance. However, an inverse effect was found for the variable "schooling". CONCLUSIONS: The study results show inequalities in access to health services and utilization as well as a deficient health care system. Public policies should take into account the specific needs of the elderly population to facilitate access to health care services and reduce inequalities