Increasing the knowledge, identification and treatment of osteoporosis through education and shared decision-making with residents living in a retirement village community

Objective: This pilot study explored whether individual goal setting in a retirement village setting could improve strategies to strengthen bones in an ageing population and help prevent osteoporosis. Methods: A two-phased osteoporosis prevention program was developed, piloted and evaluated involving a group education session followed by the development of individualised Bone Plans based upon personal understanding of individual fracture risk and lifestyle factors. Results: A significant improvement in knowledge and understanding of factors to prevent and manage osteoporosis was achieved, and changes in lifestyle behaviours were sustained at six months. Conclusion: Success was due to education by specialist medical and health personnel, flexibility of goal setting, use of group sessions and location of the program within the retirement community setting. The ‘Mind Your Bones’ program is a feasible and acceptable way to translate preventative bone health messages to a large number of people via the retirement village network

Diasporas and democratization in the post-communist world

If diaspora communities are socialized with democratic values in Western societies, they could be expected to be sympathetic to the democratization of their home countries. However, there is a high degree of variation in their behavior. Contrary to the predominant understanding in the literature that diasporas act in exclusively nationalist ways, this article argues that they do engage with the democratization of their home countries. Various challenges to the sovereignty of their homelands explain whether diasporas involve with procedural or liberal aspects of democratization. Drawing evidence from the activities of the Ukrainian, Serbian, Albanian and Armenian diasporas after the end of communism, I argue that unless diasporas are linked to home countries that enjoy both international legal and domestic sovereignty, they will involve only with procedural aspects of democratization. Diasporas filter international pressure to democratize post-communist societies by utilizing democratic procedures to advance unresolved nationalist goals

Transforming the Fear of Death Through Near-Death Experiences and Experiential Psychedelics: A Transpersonal Hermeneutic Phenomenological Inquiry

This study examined the phenomenological experience of the transformation of the fear of death in the context of the mystical and transcendent nature of a near death experience (NDE) or while using psychedelics, specifically LSD or psilocybin. The study recruited and interviewed seven participants who had experienced a life-altering mystical NDE or transcendent psychedelic journey. The analysis of emergent themes was conducted using transpersonal and hermeneutic phenomenology research methods. The identified themes unfolded in three parts: the experience itself, illumination of the experience, and the gifts and lessons learned. A prominent theme involving transformation, especially as it relates to the fear of death, emerged from the findings. Thus, the findings of this study have important implications for psychotherapy, in particular how we treat death and dying. Further research into these exceptional experiences could be an opportunity to transform our collective pathology and fears around death

How do general practitioners experience providing care to refugees with mental health problems? A qualitative study from Denmark

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Challenges and priorities for pediatric critical care clinician-researchers in low- and middle-income countries

IntroductionThere is need for more data on critical care outcomes and interventions from low- and middle-income countries (LMIC). Global research collaborations could help improve health-care delivery for critically ill children in LMIC where child mortality rates remain high.Materials and methodsTo inform the role of collaborative research in health-care delivery for critically ill children in LMIC, an anonymous online survey of pediatric critical care (PCC) physicians from LMIC was conducted to assess priorities, major challenges, and potential solutions to PCC research. A convenience sample of 56 clinician-researchers taking care of critically ill children in LMIC was targeted. In addition, the survey was made available on a Latin American PCC website. Descriptive statistics were used for data analysis.ResultsThe majority of the 47 survey respondents worked at urban, public teaching hospitals in LMIC. Respondents stated their primary PCC research motivations were to improve clinical care and establish guidelines to standardize care. Top challenges to conducting research were lack of funding, high clinical workload, and limited research support staff. Respondent-proposed solutions to these challenges included increasing research funding options for LMIC, better access to mentors from high-income countries, research training and networks, and higher quality medical record documentation.ConclusionLMIC clinician-researchers must be better empowered and resourced to lead and influence the local and global health research agenda for critically ill children. Increased funding options, access to training and mentorship in research methodology, and improved data collection systems for LMIC PCC researchers were recognized as key needs for success

Conscious surgery: influence of the environment on patient anxiety

Aims: i) To investigate anxiety arising from the experience of the clinical environment during surgery under local/ regional anaesthesia and, ii) to uncover the specific aspects patients find anxiety provoking and possibly dissuade them from opting for such anaesthesia. Background: Operating theatres have historical been designed for safe, efficient surgery on the unconscious patient and not primarily designed for the care of the ‘awake’ patient. However, with the rise in day surgery, the quantity of surgery performed under local/ regional anaesthesia is increasing. Method: As part of a larger study investigating anxiety within modern elective day surgery, adult patients undergoing surgery and local/ regional anaesthesia (n=214) were provided with a questionnaire on the day of surgery for return by mail 24 - 48 hours following surgery. Findings: The experience of being awake, possibly feeling surgeon, seeing body cut open or surgery being more painful were anxiety provoking aspects. Utilising factor analysis ‘intra-operative apprehension’, ‘anaesthetic information provision and ‘health control’ were identified as central features. Moreover, when employing multiple regression, apprehension associated with the intra-operative experience and anaesthetic information provision were significantly associated with an increase in the overall level of anxiety. Conclusions: Although the surrounding clinical environment has previously been a cause of apprehension, the sensations associated with the physical act of surgery on the conscious self appear also to have a considerable influence. Focusing care upon managing patient intra-operative experience and providing anaesthetic information in advance may help limit anxiety and expel the apparent misapprehensions associated with conscious surgery

Workplace bullying a risk for permanent employees

Objective: We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. Methods: A cross-sectional population-based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self-report into four categories: permanent, casual, fixed-term and self-employed. Self-report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. Results: Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed-term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never-married workers. Conclusions: Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. Implications: A finer understanding of psycho-social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment

Exploring genetic factors involved in huntington disease age of onset. E2F2 as a new potential modifier gene

Age of onset (AO) of Huntington disease (HD) is mainly determined by the length of the CAG repeat expansion (CAGexp) in exon 1 of the HTT gene. Additional genetic variation has been suggested to contribute to AO, although the mechanism by which it could affect AO is presently unknown. The aim of this study is to explore the contribution of candidate genetic factors to HD AO in order to gain insight into the pathogenic mechanisms underlying this disorder. For that purpose, two AO definitions were used: the earliest age with unequivocal signs of HD (earliest AO or eAO), and the first motor symptoms age (motor AO or mAO). Multiple linear regression analyses were performed between genetic variation within 20 candidate genes and eAO or mAO, using DNA and clinical information of 253 HD patients from REGISTRY project. Gene expression analyses were carried out by RT-qPCR with an independent sample of 35 HD patients from Basque Country Hospitals. We found suggestive association signals between HD eAO and/or mAO and genetic variation within the E2F2, ATF7IP, GRIN2A, GRIN2B, LINC01559, HIP1 and GRIK2 genes. Among them, the most significant was the association between eAO and rs2742976, mapping to the promoter region of E2F2 transcription factor. Furthermore, rs2742976 T allele patient carriers exhibited significantly lower lymphocyte E2F2 gene expression, suggesting a possible implication of E2F2-dependent transcriptional activity in HD pathogenesis. Thus, E2F2 emerges as a new potential HD AO modifier factor

The responses of female and male cottonwood saplings to flooding

xiii, 117 leaves : ill. ; 29 cmCottonwoods are poplar trees that are adapted to riparian zones that are naturally occasionally flooded. Like all Salicaceae, cottonwoods are dioecious and prior studies have indicated that males are more drought-tolerant than females and found more often in poorer, drier sites. We investigated sex differentiation of cottonwoods in response to the opposite water-stress, flood, and predicted that the increased water-stress tolerance of males in drought would also apply to flood-stress. Twenty-one clones of male and female narrowleaf cottonwoods (Populus angustifolia) were grown in a greenhouse along with three female clones of the hybrid native lanceleaf cottonwood (P. x acuminata) for comparison. It was anticipated that the hybrids would show the fastest growth owing to the genetic contribution from the P. deltoides parent and its rapid intrinsic growth rate. Flood reduced heights and the numbers and sizes of leaves and roots, and consequently dry weights, abaxial stomatal conductance and leaf chlorophyll. Inundation increased carbon:nitrogen, but did not alter stomatal density, leaf water potential, or δ13C. The hybrid saplings were much larger than the narrowleaf saplings but their proportional growth reduction with flooding was greater than in the female P. angustifolia, suggesting higher flood-tolerance of the narrowleaf cottonwood. P. angustifolia sexes performed similarly under reference conditions but the males were proportionally more inhibited by flood, suggesting sex differentiation in flood-tolerance. This study indicates that riparian cottonwoods are reasonably flood-tolerant but slight differences exist between the sexes and to a greater extent, across taxa. While prior studies have indicated males are apparently more tolerant of drought, females are probably more flood-tolerant