Alien Registration- Wark, John H. (Presque Isle, Aroostook County)

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Design Considerations for a Virtual Community of Practice for Health Practitioners: A Learner Centred Design Approach

Online social networks are increasingly utilised by health practitioners, leading to development of virtual communities of practice where practitioners share knowledge and learn from other peers in the network. Yet, there is limited research on identifying design methods to retain participation in health virtual communities of practice based on the learning interaction imposed. Currently, research is focused more on health practitioners’ behaviour from using the virtual community and not the tool itself. In this study, we propose a conceptual model based on the Learner Centred Design approach to designing a health virtual community of practice to increase interaction leading to sustainment of the community. Expected outcomes of this study would validate the design considerations put forth and can be used as guidelines for future research as an evaluation metrics for current and future health VCoP projects

Vertebral Bone Mineral Measures and Psychological Wellbeing Among Individuals with Modic Changes

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Genetic Effects on Bone Loss in Peri- and Postmenopausal Women: A Longitudinal Twin Study

This longitudinal twin study was designed to assess the heritability of bone loss in peri- and postmenopausal women. A sample of 724 female twins was studied. Baseline and repeat BMD measurements were performed. Results of genetic model-fitting analysis indicated genetic effects on bone loss account for similar to 40% of the between-individual variation in bone loss at the lumbar spine, forearm, and whole body. Introduction: BMD and bone loss are important predictors of fracture risk. Although the heritability of peak BMD is well documented, it is not clear whether bone loss is also under genetic regulation. This study was designed to assess the heritability of bone loss in peri- and postmenopausal women. Materials and Methods: A sample of 724 female twins (177 monozygotic [MZ] and 185 dizygotic [DZ] pairs), 45-82 yr of age, was studied. Each individual had baseline BMD measurements at the lumbar spine, hip, forearm, and total body by DXA and at least one repeat measure, on average 4.9 yr later. Change in BMD (Delta BMD) was expressed as percent of gain or loss per year. Intraclass correlation coefficients for ABMD were calculated for MZ and DZ pairs. Genetic model-fitting analysis was conducted to partition the total variance of ABMD into three components: genetic (G), common environment (C), and specific environment, including measurement error (E). The index of heritability was estimated as the ratio of genetic variance over total variance. Results: The mean annual Delta BMD was -0.37 +/- 1.43% (SD) per year at the lumbar spine, -0.27 +/- 1.32% at the total hip, -0.77 +/- 1.66% at the total forearm, -0.36 +/- 56% at the femoral neck, and -0.16 +/- 0.81% at the whole body. Intraclass correlation coefficients were significantly higher in MZ than in DZ twins for all studied parameters, except at the hip sites. Results of genetic model-fitting analysis indicated that the indices of heritability for ABMD were 0.38, 0.49, and 0.44 for the lumbar spine, total forearm, and whole body, respectively. However, the genetic effect on ABMD at all hip sites was not significant. Conclusions: These data suggest that, although genetic effects on bone loss with aging are less pronounced than on peak bone mass, they still account for similar to 40% of the between-individual variation in bone loss for the lumbar spine, total forearm, and whole body in peri- and postmenopausal women. These findings are relevant for studies aimed at identification of genes that are involved in the regulation of bone loss

Chronic low back pain is associated with reduced vertebral bone mineral measures in community-dwelling adults

<p>Abstract</p> <p>Background</p> <p>Chronic low back pain (CLBP) experienced in middle-age may have important implications for vertebral bone health, although this issue has not been investigated as a primary aim previously. This study investigated the associations between CLBP and dual energy X-ray absorptiometry (DXA)-derived vertebral bone mineral measures acquired from postero-anterior and lateral-projections, among community-dwelling, middle-aged adults.</p> <p>Methods</p> <p>Twenty-nine adults with CLBP (11 male, 18 female) and 42 adults with no history of LBP in the preceding year (17 male, 25 female) were evaluated. Self-reported demographic and clinical data were collected via questionnaires. Areal bone mineral density (aBMD) was measured in the lumbar spine by DXA. Apparent volumetric (ap.v) BMD in the lumbar spine was also calculated. Multiple linear regression models were used to examine associations between study group (CLBP and control) and vertebral DXA variables by gender, adjusting for height, mass and age.</p> <p>Results</p> <p>There was no difference between groups by gender in anthropometrics or clinical characteristics. In the CLBP group, the mean (SD) duration of CLBP was 13.3 (10.4) years in males and 11.6 (9.9) years in females, with Oswestry Disability Index scores of 16.2 (8.7)% and 15.4 (9.1)%, respectively. Males with CLBP had significantly lower adjusted lateral-projection aBMD and lateral-projection ap.vBMD than controls at L3 with mean differences (standard error) of 0.09 (0.04) g/cm²(<it>p </it>= 0.03) and 0.02 (0.01) g/cm³(<it>p </it>= 0.04). These multivariate models accounted for 55% and 53% of the variance in lateral-projection L3 aBMD and lateral-projection L3 ap.vBMD.</p> <p>Conclusions</p> <p>CLBP in males is associated with some lumbar vertebral BMD measures, raising important questions about the mechanism and potential clinical impact of this association.</p

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

Individuals with glucocorticoid-induced osteoporosis experience vertebral fractures at an increased rate and at higher vertebral areal bone mineral density (aBMD) than individuals with primary osteoporosis. Standard posteroanterior- (PA-) projection dual energy X-ray absorptiometry (DXA) lacks the diagnostic sensitivity required for reliable estimation of vertebral fracture risk in individuals. Assessment of subregional vertebral aBMD using lateral-projection DXA may improve the predictive value of DXA parameters for fracture. One hundred and four individuals were recruited and grouped for this study: primary osteoporosis with no history of vertebral fracture (n = 43), glucocorticoid-induced bone loss (n = 13), and healthy controls (n = 48). Standard PA-projection and supine-lateral scans were performed, and lateral scans were analysed according to an established protocol to measure aBMD within 6 subregions. Main effects for subregion and group were assessed and observed, by ANCOVA. Ratios were calculated between subregions and compared between groups, to overcome the potentially confounding influence of variability in subregional geometry. Significantly lower values were observed in the glucocorticoid group for the ratios of (i) anterior subregion: whole vertebral body and (ii) posterior: whole vertebral body when compared to the primary osteoporosis and control groups (P < 0.0 5). Lower anterior subregional aBMD in individuals on glucocorticoid therapy may help to explain the increased vertebral fracture risk in this patient group

Health Practitioner Perceptions of using a Health Virtual Community of Practice for their Continuing Professional Development

Health practitioner (HP) use of online social networks for learning and knowledge sharing has increased in the past decade, leading to the evolution of virtual communities of practice (VCoP). However, there is limited research on VCoP use for HPs’ continuing professional development (CPD) as a legitimate means of learning and sharing knowledge with their peers from a tools perspective. This paper continues our previous work about design and role considerations to explore HPs’ perceptions of using a VCoP for CPD purposes and reports qualitative study findings from two focus groups conducted with 12 HPs in each group. Our findings suggest that our design and role considerations are important when designing a sustainable Health VCoP for CPD. We identify a new design construct (Patient Information Anonymisation) that extends our conceptual model, and make theoretical and practical contributions that extend the Health VCoP literature

Influenza Vaccine Effectiveness against Hospitalisation with Confirmed Influenza in the 2010-11 Seasons: A Test-negative Observational Study

Immunisation programs are designed to reduce serious morbidity and mortality from influenza, but most evidence supporting the effectiveness of this intervention has focused on disease in the community or in primary care settings. We aimed to examine the effectiveness of influenza vaccination against hospitalisation with confirmed influenza. We compared influenza vaccination status in patients hospitalised with PCR-confirmed influenza with patients hospitalised with influenza-negative respiratory infections in an Australian sentinel surveillance system. Vaccine effectiveness was estimated from the odds ratio of vaccination in cases and controls. We performed both simple multivariate regression and a stratified analysis based on propensity score of vaccination. Vaccination status was ascertained in 333 of 598 patients with confirmed influenza and 785 of 1384 test-negative patients. Overall estimated crude vaccine effectiveness was 57% (41%, 68%). After adjusting for age, chronic comorbidities and pregnancy status, the estimated vaccine effectiveness was 37% (95% CI: 12%, 55%). In an analysis accounting for a propensity score for vaccination, the estimated vaccine effectiveness was 48.3% (95% CI: 30.0, 61.8%). Influenza vaccination was moderately protective against hospitalisation with influenza in the 2010 and 2011 seasons

Utilization of prehospital emergency medical services in Saudi Arabia: An urban versus rural comparison

Background: There is limited research outside the USA, Europe, or Australia on the capacity, efficiency, and development of prehospital emergency medicine services (EMS) between urban and rural areas. This study aimed to examine the usage of prehospital EMS across rural and urban areas in Riyadh region in the Kingdom of Saudi Arabia.Methods: A random sample of 800 (400 urban and 400 rural) emergency patient records from the Saudi Red Crescent Authority EMS was collected. The following variables were analyzed: patient demographics, clinical characteristics, length of hospital stay, and length of intensive care unit (ICU) stay.Results: A skewed distribution was noted with respect to sex, i.e., 559 men versus 241 women. Rural patients were younger (42.75 vs. 39.72 years) and had significantly longer hospital (15 days versus 9 days) and ICU (5 days versus 2 days) stays than urban patients following transportation. All injury types were comparable, except for head injury, which was higher in the rural group than in the urban group. Advanced treatment and trauma transport were more often used in rural areas than in urban areas.Conclusions: In this study, rural EMS users were more likely to experience trauma-related incidents that necessitate EMS transportation, while medical reasons were more common among urban EMS users. Moreover, men used EMS at much higher rates than women and were more likely to be transported to the hospital following a call-out