Effectiveness of patient education for patients with osteoporosis: a systematic review.

In this systematic review, the effects of osteoporosis patient education were examined. All studies found an effect on physical function, but for the other themes, the results were inconclusive. The findings indicate a need for further research in this topic. INTRODUCTION: Osteoporosis is a chronic disease with serious consequences for the individual and major societal costs. With the aim of fracture prevention, many countries offer osteoporosis patient education. The objectives were to examine the effects and mediators of osteoporosis patient education and describe the characteristics of studies with and without an effect. Though, none of the included studies reported mediators, and therefore, we could not examine that. METHODS: Six databases were searched in October 2020. Two researchers independently conducted title and abstract screening as well as full-text review. Records were included if participants had osteoporosis, and the patient education was group-based, face-to-face, and addressed two or more aspects, e.g., diet, medication, and exercise. The Cochrane Collaboration tools were used for risk of bias assessment. Finally, data were extracted into a standardized form and presented narratively. RESULTS: In total, 2934 records were identified, and 13 studies met the inclusion criteria. All six studies examining the effects of patient education on physical function demonstrated improvements. In addition, one out of two RCT studies and one non-randomized study reported improved psychological wellbeing. Just one out of five RCT studies showed improvements regarding physical discomfort and disability. Effects on health-related quality of life, adherence and persistence, and knowledge of osteoporosis were inconclusive. CONCLUSION: There is limited evidence for the effectiveness of osteoporosis patient education. There is a need for high-quality randomized controlled trials, which should describe the characteristics of the interventions and examine the mechanisms of osteoporosis patient education. PROSPERO REGISTRATION NUMBER: CRD42020211930.

Use of antiosteoporotic medication in the Danish ROSE population-based screening study.

Use of antiosteoporotic medication in the population-based, risk-stratified osteoporosis strategy evaluation (ROSE) screening study, comparing the use of FRAX followed by DXA with usual care, was examined. Screening increased the overall use of medication. Being recommended treatment by the hospital and higher age increased the likelihood of starting medication, but, nevertheless, a large percentage opted not to start treatment. INTRODUCTION: The aim of the study was to examine the impact on medication prescription, adherence, and persistence of osteoporotic medicine in the randomized population-based ROSE screening study for osteoporosis. METHODS: The Danish ROSE study included a population-based random sample of women aged 65-81 years randomized to either a two-step screening program consisting of FRAX followed by DXA for high-risk participants or opportunistic screening for osteoporosis (usual care). This sub-study on the intention-to-treat population examined the impact of the screening program on antiosteoporotic medication redemption rates, adherence, and persistence using Danish registers. RESULTS: A total of 30,719 of 34,229 women were treatment-naïve. Significantly more participants in the screening group started on antiosteoporotic medication, but no differences in adherence and persistence rates were found. Higher age was associated with a higher likelihood of starting medication. A low Charlson comorbidity score (= 1) was associated with higher treatment initiation but lower adherence and persistence of antiosteoporotic treatment. A total of 31.7% of participants advised to initiate treatment did not follow the advice. CONCLUSIONS: Screening for osteoporosis using FRAX followed by DXA increased the overall use of antiosteoporotic medication in the screening group without differences in adherence and persistence rates. A large percentage of participants advised to initiate treatment did nevertheless fail to do so.

Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study.

There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION: Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS: The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS: A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION: The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.

Effectiveness of a two-step population-based osteoporosis screening program using FRAX: the randomized Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study.

The Risk-stratified Osteoporosis Strategy Evaluation (ROSE) study investigated the effectiveness of a two-step screening program for osteoporosis in women. We found no overall reduction in fractures from systematic screening compared to the current case-finding strategy. The group of moderate- to high-risk women, who accepted the invitation to DXA, seemed to benefit from the program. INTRODUCTION: The purpose of the ROSE study was to investigate the effectiveness of a two-step population-based osteoporosis screening program using the Fracture Risk Assessment Tool (FRAX) derived from a self-administered questionnaire to select women for DXA scan. After the scanning, standard osteoporosis management according to Danish national guidelines was followed. METHODS: Participants were randomized to either screening or control group, and randomization was stratified according to age and area of residence. Inclusion took place from February 2010 to November 2011. Participants received a self-administered questionnaire, and women in the screening group with a FRAX score ≥ 15% (major osteoporotic fractures) were invited to a DXA scan. Primary outcome was incident clinical fractures. Intention-to-treat analysis and two per-protocol analyses were performed. RESULTS: A total of 3416 fractures were observed during a median follow-up of 5 years. No significant differences were found in the intention-to-treat analyses with 34,229 women included aged 65-80 years. The per-protocol analyses showed a risk reduction in the group that underwent DXA scanning compared to women in the control group with a FRAX ≥ 15%, in regard to major osteoporotic fractures, hip fractures, and all fractures. The risk reduction was most pronounced for hip fractures (adjusted SHR 0.741, p = 0.007). CONCLUSIONS: Compared to an office-based case-finding strategy, the two-step systematic screening strategy had no overall effect on fracture incidence. The two-step strategy seemed, however, to be beneficial in the group of women who were identified by FRAX as moderate- or high-risk patients and complied with DXA.

Non-participation in systematic screening for osteoporosis-the ROSE trial.

Population-based screening for osteoporosis is still controversial and has not been implemented. Non-participation in systematic screening was evaluated in 34,229 women age 65-81 years. Although participation rate was high, non-participation was associated with comorbidity, aging other risk factors for fractures, and markers of low social status, e.g., low income, pension, and living alone. A range of strategies is needed to increase participation, including development of targeted information and further research to better understand the barriers and enablers in screening for osteoporosis. INTRODUCTION: Participation is crucial to the success of a screening program. The objective of this study was to analyze non-participation in Risk-stratified Osteoporosis Strategy Evaluation, a two-step population-based screening program for osteoporosis. METHODS: Thirty-four thousand two hundred twenty-nine women aged 65 to 81 years were randomly selected from the background population and randomized to either a screening group (intervention) or a control group. All women received a self-administered questionnaire designed to allow calculation of future risk of fracture based on FRAX. In the intervention group, women with an estimated high risk of future fracture were invited to DXA scanning. Information on individual socioeconomic status and comorbidity was obtained from national registers. RESULTS: A completed questionnaire was returned by 20,905 (61%) women. Non-completion was associated with older age, living alone, lower education, lower income, and higher comorbidity. In the intervention group, ticking "not interested in DXA" in the questionnaire was associated with older age, living alone, and low self-perceived fracture risk. Women with previous fracture or history of parental hip fracture were more likely to accept screening by DXA. Dropping out when offered DXA, was associated with older age, current smoking, higher alcohol consumption, and physical impairment. CONCLUSIONS: Barriers to population-based screening for osteoporosis appear to be both psychosocial and physical in nature. Women who decline are older, have lower self-perceived fracture risk, and more often live alone compared to women who accept the program. Dropping out after primary acceptance is associated not only with aging and physical impairment but also with current smoking and alcohol consumption. Measures to increase program participation could include targeted information and reducing physical barriers for attending screening procedures.

Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008.

UNLABELLED: The study investigates an association between phalangeal bone mineral density (BMD) and self-reported passive smoking using data on 15,038 persons (aged 18-95 years), who underwent a BMD scan in the Danish KRAM study. BMD was significantly lower in persons exposed to long-term passive smoking in their home during adulthood. INTRODUCTION: Smoking is associated with decreased bone mineral density (BMD) and increased risk of osteoporotic fractures. This study aimed to investigate a possible association between BMD at the phalangeal bones and self-reported passive smoking. METHODS: The study included a cohort of 15,544 men and women aged 18-95 years, who underwent a BMD scan in the Danish KRAM study. BMD scans of the middle phalanges of the second, third and fourth digits of the non-dominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). Also, height, weight and body fat percentage were measured and 96.7% (n = 15,038) of the participants answered a self-reported questionnaire with information on passive smoking, other lifestyle factors, education, etc. The association between passive smoking and BMD was examined using multiple linear regression analysis. RESULTS: A total of 39.1% (n = 5,829) of the participants had been exposed to passive smoking in adulthood at home. BMD was significantly lower in subjects exposed to passive smoking, 0.343 vs. 0.331 g/cm(2); p < 0.01 (unadjusted) and 0.339 vs. 0.337 g/cm(2); p < 0.05 (adjusted for age, gender, height and weight, and smoking). Multiple linear regression analysis showed that exposure to passive smoking for more than 20 years in adulthood at home was significantly related to BMD when adjusted for potential confounders (men, ß = -4.4 × 10(-3); r = -0.05; p < 0.01 and women, ß = -2.3 × 10 (-3); r = -0.03; p < 0.05). This relationship was also seen in the group of never smokers (ß = -3.3 × 10(-3); r = -0.03; p = 0.01). CONCLUSION: Our study supports a potential negative effect of long-term passive smoking in adulthood at home on phalangeal BMD.

Psychopathology and emotional distress among older high-utilizing health maintenance organization patients.

BACKGROUND: Rates of psychopathology are often underestimated in primary care populations, especially older patient groups. High medical utilization is often a reflection of psychopathology and/or emotional distress. Increased awareness of primary care patients' emotional distress can help to improve well-being and reduce unnecessary high utilization of medical services. This study aimed to assess the degree of psychopathology present in a sample of older health maintenance organization (HMO) patients who utilized higher-than-average amounts of medical services. METHODS: Patients in a large HMO aged 55 years old and older who exceeded the mean number of inpatient and outpatient visits in the past year were recruited. Sixty-nine patients, mostly female (69%) and white (93%), volunteered. Patients were assessed with the Medical Outcomes Study SF-36 health survey and the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: Respondents made a mean of 41 visits in the previous year to medical providers, versus 24 visits per year for the average patient of this age in the HMO. Significant elevations on SCL-90-R global psychopathology, obsessive-compulsive, somatization, and depression scales were found. All patients met SCL-90-R criteria for psychiatric caseness. SF-36 health ratings were comparable with those of patients with chronic medical conditions assessed in other SF-36 samples. CONCLUSIONS: Older high-utilizing HMO patients show significantly more psychopathology and view their health status as poorer than that of other medical subpopulations; results suggest that care for these problems is rarely received.

Penicillium verrucosum in feed of ochratoxin A positive swine herds.

Ochratoxin A contamination of cereal feed grain was monitored during October 1989-September 1990 by analysis of blood samples from slaughter swine in Sweden. The detection of ochratoxin A in swine blood was used as a method to identify swine herds fed ochratoxin A contaminated feed. The contamination level of ochratoxin A in the blood of the positive herds was in the range 2-45 ng/ml with the mean concentration 5.2 ng/ml. Feed samples for mycological analysis were collected from both ochratoxin A positive herds (greater than or equal to ng/ml blood) and ochratoxin A negative herds (less than 2 ng/ml blood). From the ochratoxin A positive herds and the ochratoxin A negative herds 22 and 21 feed samples were collected, respectively. No quantitative differences in mould content, as determined by colony forming units, were observed between the two groups. However, there were differences in the mycoflora. The incidence of storage fungi (Penicillium and Aspergillus spp.) was significantly higher (p less than 0.05) in feed from ochratoxin A positive herds. Particularly, Penicillium verrucosum was found to be significantly more common (p less than 0.001). Altogether 274 isolates were screened for their ability to produce ochratoxin A. Ochratoxin A producers were found only within P. verrucosum; 38% of the 63 isolates produced detectable amounts of ochratoxin A. Ochratoxin A producing isolates of P. verrucosum were found in 60% of the feed samples collected from ochratoxin A positive swine herds and in one sample (5%) of the feed samples collected from the ochratoxin A negative herds.

Salmonella isolated from animals and feedstuffs in Sweden during 1983-1987.

This survey describes the frequency of Salmonella in animals and feedstuffs isolated in Sweden 1983-1987. Since 1949 National Veterinary Institute (NVI) has published such reports every fifth year. During the period of this report 760 outbreaks of Salmonella were reported in animals. This includes both domestic and wild animals. The corresponding figure for the previous period was 1266 outbreaks. 56 different serovariants were reported, 17 of these were new to Sweden. In cattle and swine there were a decrease of outbreaks. In poultry 86 outbreaks were reported, compared with 220 outbreaks during the previous five-year period. Swedish feed producing plants are checked both voluntary and compulsory, for the presence of Salmonella in raw materials, scrape and dust samples and compound feed. During 1983-1987 a total of 236 strains at Salmonella were isolated. This is the lowest incidence found during the last 15 years. All consignments of feedstuffs of animal origin intended for import to Sweden has to be examined for the presence of Salmonella. During 1983-1987 8.6% of the consignments were positive for Salmonella and were thus not allowed to be used in Sweden.

Ochratoxin A in swine blood used for evaluation of cereal handling procedures.

In a survey during the years 1985, 1986 and 1987 the quality of Swedish feeding grain was followed by the analysis of ochratoxin A in blood collected from swine at slaughter. The swine herds sampled were selected on feed handling procedures used. From information about the feed used, risk parameters for ochratoxin A contamination were identified. The results showed annual variation in the content of ochratoxin A in the grain and that ochratoxin A increased during storage of grain, particularly in the harvest of 1985. Drying of the grain with forced ambient air was found to be inferior to the use of heated forced air. It was also noticed that more than 9% of the grain was contaminated with ochratoxin A regardless of handling. The pronounced difference between the samples studied was seen mainly as a function of geographical origin, with the island of Gotland having a much higher frequency of positive samples than the rest of Sweden. No correlation between ochratoxin A in swine feed and post mortem signs of infectious diseases in the swine herds was found.

Intraoperative auditory brain stem response monitoring during ultrasonic aspiration of posterior fossa tumors.

The use of an ultrasonic aspirator may decrease the morbidity associated with the surgical removal of intracranial tumors by reducing the duration of surgery. In this study we monitored the auditory brain stem response (ABR) during ultrasonic surgical aspiration of 20 posterior fossa tumors. Twelve subjects had a transient decrement in the ABR during use of the ultrasonic aspirator; one had a temporary sensorineural hearing loss contralateral to the side of the surgery. Monitoring of the ABR during use of the ultrasonic aspirator in the posterior fossa helped minimize the risk of injury to normal structures. Changes in latency, amplitude, and interpeak interval of the ABR waves alert the surgeon to the need to adjust the aspirator settings or the conditions in the operative field before continuing to use the tool.

Salmonella isolated from animals and feed stuffs in Sweden during 1978-1982.

Regulations concerning the control of Salmonella in animals are more strict in Sweden than in most other countries, though a certain liberalization took place in 1982. The main purpose of these regulations is to prevent transmission of Salmonella infections from animals to man. Veterinarians and laboratories are obliged to report all Salmonella cases to the veterinary authorities. The cases are recorded by the Swedish Board of Agriculture. During the period of this report, 1978-1982, 1266 outbreaks of Salmonella in animals were recorded in Sweden. Isolated strains belonged to 78 different serotypes. The most frequent serotypes were S. typhi-murium (38.5% of the recorded cases) and S. dublin (37%). S. dublin was isolated mainly from cattle, while S. typhi-murium was isolated from a wide range of animal species. Next in frequency are some serotypes isolated mainly from chicken, at rates around 2%: S. livingstone, S. liverpool, and S. agona. Of the 78 isolated serotypes, 25 were never isolated before from animals in Sweden. There were 687 outbreaks of Salmonella recorded in cattle. Predominant serotypes are S. dublin (67% of the outbreaks in cattle) and S. typhi-murium (28%). The outbreaks of S. dublin, like earlier in the sixties and seventies, occurred mainly in south-eastern Sweden. The recorded occurrence of Salmonella in swine continued to decrease. During this period only 37 outbreaks were diagnosed. Of these more than half were caused by S. typhi-murium. S. choleraesuis was isolated from 6 cases only.(ABSTRACT TRUNCATED AT 250 WORDS)

Ochratoxin A in blood of slaughter pigs.

The global ochratoxin A contamination of Swedish feed cereals was studied by analysis of pig blood samples from 122 different herds. The samples were collected at seven Swedish slaughterhouses. The ochratoxin A analysis showed 21% of the samples to contain greater than or equal to 2 ng ochratoxin A per ml. Samples from Visby showed a significantly higher frequency of contamination compared with the rest of the country.

The effect of feeding diets containing avoparcin and monensin on the occurrence of Salmonella in caecum and liver in experimentally infected chickens.

In two experiments (Experiments A and B) chickens experimentally infected with S. infantis at 7 days of age and fed diets containing both avoparcin (10 ppm) and monensin (90 ppm) showed a higher frequency of Salmonella-positive livers and higher caecal counts of Salmonella 1 and 2 weeks after challenge than similarly infected chickens fed only avoparcin (10 ppm). The results may indicate a synergistic action between the two drugs on the ability of chickens to withstand Salmonella infections.