Osteoporosis in Postmenopausal Women

Abstract Background: Osteoporosis is a skeletal system disease that causes bone fragility due to low bone mineral density (BMD). BMD decreases with age and lack of estrogen production. Thus, post-menopausal women are prone to osteoporosis and have an elevated risk of bone fractures. Non-pharmaceutical interventions have the potential to increase BMD and lower osteoporosis patients\u27 risk for bone fractures. Objective: To compare published evidence on the effects of vitamin D, calcium supplements, and performing weight-bearing exercises in increasing BMD and lowering the risk for bone fractures among post-menopausal women. Methods: In accordance with PRISMA guidelines. we conducted a systematic search of Pubmed, Cochrane Library, and the National Center for Biotechnology Information for relevant published studies using the keywords post-menopausal women, osteoporosis, bone mineral density, calcium, and vitamin D supplements, and weight-bearing exercises. We included peer-reviewed studies that had post-menopausal women as their targeted population, published in English-language from 2012-2022, had vitamin D and calcium supplements, and/or weight-bearing exercise interventions, as their measurable outcomes as increased BMD and/or decreased fracture. Results: Fourteen articles were included in this review. Findings indicated weight-bearing exercises are effective in increasing BMD in post-menopausal women. There is inconclusive evidence on the effectiveness of calcium and vitamin D supplements increasing BMD in post-menopausal women. Conclusion: The findings revealed that weight-bearing exercises are effective for post-menopausal women to increase their BMD and lower their risk for bone fractures. However, evidence on the effects of calcium and vitamin D supplements on BMD is contested

Self‐Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141019/1/acr23262_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141019/2/acr23262.pd

Feasibility of a Randomized Controlled Trial of Self-Administered Acupressure for Symptom Management in Older Adults with Knee Osteoarthritis

Objectives: To assess the feasibility of a study to evaluate the efficacy of self-administered acupressure in pain and related symptom management for older people with symptomatic knee osteoarthritis. Feasibility with regard to (1) sample recruitment and retention, (2) treatment fidelity and adherence, and (3) tolerability and adverse events was examined. Methods: The study was a randomized controlled trial. Community-living older adults were recruited and randomly assigned to one of three groups: verum acupressure, sham acupressure, and usual care. Participants in the first two groups learned their respective acupressure protocol during their first center visit and from a set of materials. They were asked to practice the protocol at home once daily, 5 days a week, for 8 weeks. Participants attended three center visits and received weekly phone calls from a research assistant in an 8-week study period. Both quantitative and qualitative data collected from center visits and weekly phone calls were used to examine study feasibility. Results: A total of 150 participants (mean age, 73 years; 38% men) were enrolled; 83% completed all three center visits. Among those assigned to verum and sham acupressure groups, 94% passed a fidelity check at the second visit, more than 80% reported performing self-administered acupressure as instructed most of the time, and about 10% reported discomfort from performing the acupressure. Thirty adverse events were reported; most were related to pre-existing health conditions. Conclusions: It is feasible to conduct a study of self-administered acupressure for symptom management in community-living older adults with knee osteoarthritis, although sample recruitment may be challenging.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140088/1/acm.2015.0231.pd

Pharmacokinetic aspects of retinal drug delivery

Drug delivery to the posterior eye segment is an important challenge in ophthalmology, because many diseases affect the retina and choroid leading to impaired vision or blindness. Currently, intravitreal injections are the method of choice to administer drugs to the retina, but this approach is applicable only in selected cases (e.g. anti-VEGF antibodies and soluble receptors). There are two basic approaches that can be adopted to improve retinal drug delivery: prolonged and/or retina targeted delivery of intravitreal drugs and use of other routes of drug administration, such as periocular, suprachoroidal, sub-retinal, systemic, or topical. Properties of the administration route, drug and delivery system determine the efficacy and safety of these approaches. Pharmacokinetic and pharmacodynamic factors determine the required dosing rates and doses that are needed for drug action. In addition, tolerability factors limit the use of many materials in ocular drug delivery. This review article provides a critical discussion of retinal drug delivery, particularly from the pharmacokinetic point of view. This article does not include an extensive review of drug delivery technologies, because they have already been reviewed several times recently. Instead, we aim to provide a systematic and quantitative view on the pharmacokinetic factors in drug delivery to the posterior eye segment. This review is based on the literature and unpublished data from the authors' laboratory.Peer reviewe

Ambulation behaviors of people with Alzheimer's disease: Case studies of residents on three facilities along the homelike continuum.

An embedded multiple case study design was used to examine the impact of physical environment on ambulation behavior for six cases with Alzheimer's disease within a real-life context. The descriptive observational approach aimed to identify and describe associations between ambulation behaviors and characteristics of the physical and social environment. Three settings (institutional, hotel-like, & home-like) were selected to demonstrate unique philosophical and environmental design issues across the continuum between institutional and homelike settings. Each case's level of impairment was described regarding: gait and balance testing, functional performance of activities of daily living, observed ambulation behaviors, and cognitive function. Ambulation behaviors (number of episodes, travel patterns, self-initiated activities, social contacts and negative consequences) were recorded on a palm held video camera over a 48 hour period. Ambulation episodes, time spent in each location, ambulation travel patterns, negative consequences of ambulation, and social contacts were recorded over a 48 hour period. Data were summarized using descriptive techniques. Home-Like Facility had the following positive outcomes: high number of episodes, more time spent ambulating, efficient travel, environmental ownership activities, and high number of social contacts. This was attributable to its: social model, small scale, visual access to multiple locations, familiar and engaging physical attributes, and individualized policies and procedures. The Hotel-Like Facility produced strikingly different outcomes than the other two facilities (i.e. low number of episodes, least time ambulating, inefficient travel, public activities, low number of social contacts). This was likely due to the large scale size, crowding and service style policies and procedures.Ph.D.Health and Environmental SciencesMental healthNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/129652/2/9542963.pd

Technology as a Tool for Social Justice

Co-presented by faculty and students at Bridgewater State University, this session considers the role of technology as a tool to advance social justice. The session will be structured among three themes: research related to technology as a tool of social justice, student experiences with online course assignments, and observations about student learning. Students will discuss their experiences with social work course assignments, including a semester blog related to community activism, an online activism day, a capstone project related to diversity and oppression, and an independent study connecting technology with craftivism (craft + activism). The session will conclude with observations and concrete tools to equip educators and to advance social justice work in online learning contexts

Person-Centered Primary Care Strategies For Assessment Of And Intervention For Aggressive Behaviors In Dementia

With an increase in the number of individuals affected by dementia, it is imperative for health care providers to be well versed in the most effective ways to manage neuropsychiatric symptoms, such as aggression. Aggression can be particularly hard to manage because it creates risk of harm for formal and informal caregivers, and options for medical intervention are complex and situation dependent. Although multiple guidelines for management of aggression in dementia are available in the literature, their scope is widespread and suggested treatments often vary, making decision making difficult to navigate for busy clinicians. Using a composite case as a model, the current article provides guidelines that take outpatient providers through the steps needed to provide effective treatment for aggression in individuals with dementia. Shifting the current focal point of health care for aggressive dementia patients toward a more person-centered approach will have a positive impact on patient care

“The Filter is Kind of Broken”: Family Caregivers' Attributions About Behavioral and Psychological Symptoms of Dementia

ObjectivesBehavioral and psychological symptoms of dementia (BPSD) are common, often challenging to manage, and may erode caregivers' well-being. Few studies have explored caregivers' perspectives of what causes these behaviors, but such attributions may be important-particularly if they negatively impact the care dyad. This study examined causal attributions about BPSD among individuals caring for a family member with dementia.DesignIn-depth qualitative data were obtained from family caregivers of older adults with dementia.SettingAs part of a larger study (NINR R01NR014200), four focus groups were conducted with caregivers by an experienced facilitator.ParticipantsA total of 26 family caregivers participated in the four focus groups.MeasurementsCaregivers reported their own attributions about the causes of their care recipient's BPSD. Sessions were audio-recorded. Data were transcribed, coded to determine relevant concepts, and reduced to identify major categories.ResultsFive categories were determined. Caregivers attributed BPSD to: 1) neurobiological disease factors; 2) physical symptoms or comorbid health conditions; 3) psychological reactions to dementia; 4) shifting social roles and relationships following dementia onset; and 5) environmental changes such as lack of routine and medical transitions (e.g., hospitalization). Despite this seemingly multifactorial attribution to BPSD etiology, a number of respondents also indicated that BPSD were at least partly within the care recipient's control.ConclusionsFamily caregivers attribute BPSD to a range of care recipient and environmental factors. Caregivers' own causal beliefs about BPSD may reflect unmet educational needs that should be considered in the development of targeted interventions to minimize caregiving stress

“I’ve learned to just go with the flow”: Family caregivers’ strategies for managing behavioral and psychological symptoms of dementia

BACKGROUND/OBJECTIVES:: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviors have implications for both care partners’ well-being. Yet the specific strategies that caregivers use in their daily management of BPSD are relatively unknown. This study used in-depth focus group data to examine family caregivers’ strategies for managing BPSD. DESIGN:: As part of a larger study (NINR R01NR014200), four focus groups were conducted with a total of 26 family caregivers of older adults with dementia. Caregivers were asked to describe the strategies they use to manage BPSD. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major categories. RESULTS:: Caregivers managed BPSD through: 1) modifying interactions within the care dyad (e.g., simplifying communication); 2) modifying the care environment (e.g., using written prompts); 3) activity engagement; 4) humor; 5) self-care; and 6) social support. CONCLUSION:: Family caregivers manage BPSD using strategies to minimize stress and address the needs of both care partners. Caregivers’ own accounts of these approaches reveal a window into their everyday management of difficult behaviors. The present findings generate key information for routine clinical care and targeted interventions to promote caregiver well-being