Gestational vitamin D and offspring fracture risk: do associations persist into mid adolescence?

BACKGROUND: Previous studies report that maternal vitamin D exposure during pregnancy is associated with offspring later-life bone health. A study in the Vitamin D in Pregnancy (VIP) cohort reported sexually dimorphic effects of maternal 25-hydroxyvitamin-D (25(OH)D) and offspring fracture profiles at 10 years of age. We, therefore, aimed to determine associations between maternal 25(OH)D status and offspring fracture risk at 16 years of age in this cohort. METHODS: In total, 475 mother-child pairs were recruited to the VIP study in southeastern Australia. Maternal serum samples were obtained at recruitment (<16 weeks' gestation) and/or 28-32 weeks' gestation and analysed for 25(OH)D. Radiologically-confirmed incident fractures in children were ascertained from date of birth (2002-2004) until July 16, 2019. Cox proportional hazard models were used to determine associations between maternal 25(OH)D and childhood fracture risk, and final models included maternal age at recruitment, offspring sex, birth weight, gestation length and season of 25(OH)D sample. RESULTS: Data were available for 400 children (mean age 16.1 years). There were 122 (30.5%) children who sustained at least one fracture. Higher maternal 25(OH)D (per 10 nmol/L) in early gestation was associated with a decreased fracture risk in boys (HR 0.87; 95% CI: 0.77, 0.99); the pattern was reversed in girls (HR 1.10; 95% CI 1.00, 1.22). At late gestation, higher maternal 25(OH)D was associated with an increased fracture risk in girls (HR 1.14; 95% CI: 1.04, 1.24). CONCLUSIONS: While our findings must be interpreted within the constraints of our limitations, we report that the contradictory risk profiles observed at early childhood in this cohort remain in adolescence.

Probenecid Inhibits Influenza A(H5N1) and A(H7N9) Viruses In Vitro and in Mice.

Avian influenza (AI) viruses cause infection in birds and humans. Several H5N1 and H7N9 variants are highly pathogenic avian influenza (HPAI) viruses. H5N1 is a highly infectious bird virus infecting primarily poultry, but unlike other AIs, H5N1 also infects mammals and transmits to humans with a case fatality rate above 40%. Similarly, H7N9 can infect humans, with a case fatality rate of over 40%. Since 1996, there have been several HPAI outbreaks affecting humans, emphasizing the need for safe and effective antivirals. We show that probenecid potently inhibits H5N1 and H7N9 replication in prophylactically or therapeutically treated A549 cells and normal human broncho-epithelial (NHBE) cells, and H5N1 replication in VeroE6 cells and mice.

"I always felt like I wasn't supposed to be there". An international qualitative study of fathers' engagement in family healthcare during transition to fatherhood.

OBJECTIVE: Engagement of fathers in family health services confers benefits for the health and wellbeing of the whole family. The childbirth continuum is traditionally considered a feminine event, however, commensurate with the changing paradigm of gender equity in family healthcare worldwide, the role of fathers is in transformation. The aim of the study is to explore father's perceptions and experiences of healthcare engagement during pregnancy and early infant care. DESIGN: Qualitative free-text questions were embedded in a large multi-country, cross-sectional survey, to explored fathers' attendance, participation, and experience of health care during appointments with their pregnant partner and/or baby. SETTING AND PARTICIPANTS: Expectant and new fathers were recruited through Prolific®, an international paid online survey platform. FINDINGS: Qualitative responses (n=889) were provided by fathers from 28 countries, with experiences of a range of contexts and models of care; 46.8% of whose partners were pregnant and 53.2% had given birth since 2020. The findings suggest that although most fathers wanted to attend and participate in maternity and early parenting-related healthcare, multiple barriers were identified at the individual father, organisational context, and societal levels. Fathers reported negative social factors such as gender bias and restrictive gender norms as barriers to their healthcare engagement. In contrast, factors that enabled fathers to overcome barriers included the fathers' feelings of confidence in their partner's autonomy and decision-making skills, trusted professional relationships with clinicians, and clinicians with good interpersonal skills. KEY CONCLUSIONS: Multiple barriers restrict the participation of fathers in healthcare for childbearing and early parenting. Knowledge of these barriers can inform healthcare redesign to include more successful engagement strategies for fathers, to benefit fathers, mothers, and infants alike. IMPLICATIONS FOR PRACTICE: Health professionals consulting with the mother, father and infant triad are ideally placed to address the healthcare needs of both parents. Early engagement of fathers in family health care by use of inclusive interpersonal skills and the development of a trusted relationship has potential to improve paternal mental health, and may be associated with benefits for the health, wellbeing and safety of the whole family.

Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey.

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.

Yeast lacking the sterol C-5 desaturase Erg3 are tolerant to the anti-inflammatory triterpenoid saponin escin.

Escin is a mixture of over 30 glycosylated triterpenoid (saponin) structures, extracted from the dried fruit of horse chestnuts. Escin is currently used as an anti-inflammatory, and has potential applications in the treatment of arthritis and cancer. Engineered yeast would enable production of specific bioactive components of escin at industrial scale, however many saponins have been shown to be toxic to yeast. Here we report that a Saccharomyces cerevisiae strain specifically lacking the sterol C-5 desaturase gene ERG3, exhibits striking enhanced tolerance to escin treatment. Transcriptome analyses, as well as pre-mixing of escin with sterols, support the hypothesis that escin interacts directly with ergosterol, but not as strongly with the altered sterols present in erg3Δ. A diverse range of saponins are of commercial interest, and this research highlights the value of screening lipidome mutants to identify appropriate hosts for engineering the industrial production of saponins.

A cross-sectional health literacy profile of Australian regional adults using the Health Literacy Questionnaire©.

OBJECTIVE: Health literacy is the resources and abilities required to make and enact health decisions. This study aimed to describe the health literacy of a diverse cross-section of adults in regional Victoria. METHODS: Participants were recruited from two primary care clinics differing in socioeconomic scope and through non-clinical recruitment via the town's largest football club. Health Literacy Questionnaire© measured nine distinct scales, and comprehensive demographic data were also collected. Effect-sizes and regression were used for health literacy comparison between groups. RESULTS: In this sample of 351 adults, health literacy strengths were observed in Scale 1: 'Feeling understood and supported by healthcare providers' (mean 3.29/4 ±0.5) and Scale 9: 'Understanding health information well enough to know what to do' (mean 4.10/5 ±0.6). Challenging areas were Scale 5: 'Appraising health information' (mean 2.88/4 ±0.5) and Scale 7: 'Navigating the healthcare system' (mean 3.84/5 ±0.6). After adjustment, living alone predicted lower scores across most scales. CONCLUSIONS: This study showed greater health literacy barriers experienced by certain groups, particularly those who live alone and those who weren't clinically recruited. IMPLICATIONS FOR PUBLIC HEALTH: These findings have implications for further research into addressing health literacy barriers in marginalised individuals and non-clinical settings. Results from this study may inform interventions which address identified barriers.

Toxoplasma gondii F-Box Protein L2 Silences Feline-Restricted Genes Necessary for Sexual Commitment.

Toxoplasma gondii is a foodborne pathogen that can cause severe and life-threatening infections in fetuses and immunocompromised patients. Felids are its only definitive hosts, and a wide range of animals, including humans, serve as intermediate hosts. When the transmissible bradyzoite stage is orally ingested by felids, they transform into merozoites that expand asexually, ultimately generating millions of gametes for the parasite sexual cycle. However, bradyzoites in intermediate hosts differentiate exclusively to disease-causing tachyzoites, which rapidly disseminate throughout the host. Though tachyzoites are well-studied, the molecular mechanisms governing transitioning between developmental stages are poorly understood. Each parasite stage can be distinguished by a characteristic transcriptional signature, with one signature being repressed during the other stages. Switching between stages requires substantial changes in the proteome, which is achieved in part by ubiquitination. F-box proteins mediate protein poly-ubiquitination by recruiting substrates to SKP1, Cullin-1, F-Box protein E3 ubiquitin ligase (SCF-E3) complexes. We have identified an F-box protein named Toxoplasma gondii F-Box Protein L2 (TgFBXL2), which localizes to distinct nuclear sites. TgFBXL2 is stably engaged in an SCF-E3 complex that is surprisingly also associated with a COP9 signalosome complex that negatively regulates SCF-E3 function. At the cellular level, TgFBXL2-depleted parasites are severely defective in centrosome replication and daughter cell development. Most remarkable, RNA seq data show that TgFBXL2 conditional depletion induces the expression of genes necessary for sexual commitment. We suggest that TgFBXL2 is a latent guardian of sexual stage development in Toxoplasma and poised to remove conflicting proteins in response to an unknown trigger of sexual development.

The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review.

In the context of an ageing population, the burden of disease and medicine use is also expected to increase. As such, medicine safety and preventing avoidable medicine-related harm are major public health concerns, requiring further research. Potentially suboptimal medicine regimens is an umbrella term that captures a range of indicators that may increase the risk of medicine-related harm, including polypharmacy, underprescribing and high-risk prescribing, such as prescribing potentially inappropriate medicines. This narrative review aims to provide a background and broad overview of the patterns and implications of potentially suboptimal medicine regimens among older adults. Original research published between 1990 and 2021 was searched for in MEDLINE, using key search terms including polypharmacy, inappropriate prescribing, potentially inappropriate medication lists, medication errors, drug interactions and drug prescriptions, along with manual checking of reference lists. The review summarizes the prevalence, risk factors and clinical outcomes of polypharmacy, underprescribing and potentially inappropriate medicines. A synthesis of the evidence regarding the longitudinal patterns of polypharmacy is also provided. With an overview of the existing literature, we highlight a number of key gaps in the literature. Directions for future research may include a longitudinal investigation into the risk factors and outcomes of extended polypharmacy, research focusing on the patterns and implications of underprescribing and studies that evaluate the applicability of tools measuring potentially inappropriate medicines to study settings. Plain Language Summary: A review on potentially inappropriate medicine regimens Medicine use in older age is common. Older adults with more than one chronic condition are likely to use multiple medicines to manage their health. However, there are times when taking multiple medicines may be unsafe and the number of medicines, or the combination of medicines used, may increase the risk of poor health outcomes. The term medicine regimens is used to describe all the medicines an individual takes. There are several ways to measure when a medicine regimen may be inappropriate and, therefore, potentially harmful. Much research has been published looking into potentially inappropriate medicine regimens. To bring together the current research, this review provides a background on the different measures of potentially inappropriate medicine regimens. It also summarizes how many people may experience potentially inappropriate medicine regimens, the impact it is having on their health and who may be at greater risk. In doing so, we found a number of gaps in the existing evidence, indicating that our understanding of potentially inappropriate medicine regimens is incomplete. This review highlights gaps in knowledge that can be addressed by future research. With an improved understanding of potentially inappropriate medicine regimens, we may be able to better identify those at greater risk to prevent or minimize the impact of poorer health outcomes related to unsafe medicine use.

Health literacy and cardiovascular disease prevention: a systematic scoping review protocol.

INTRODUCTION: Health literacy is 'The skills and resources of a person to access, understand and use information to make decisions, and take action on their own health and healthcare'. Literature investigating cardiovascular disease (CVD) prevention and health literacy often exist in silos, only exploring one element of prevention. This protocol aims to establish a scoping method of articles investigating health literacy and CVD preventive practices or knowledge in lay populations. METHODS AND ANALYSIS: A scoping review was deemed the most appropriate study design. The topic was conceptualised, with preliminary searching informing subsequent development of search strings. A search of the following databases will be conducted on 31 January 2022: MEDLINE, Global Health, PubMed, Embase, PsycINFO and CINAHL. Studies included will be published in English, of appropriate design, measuring health literacy and some aspect of primary CVD prevention in lay-populations. These criteria will be tested against 25 'pilot' articles from the results, undergoing necessary review before screening commences. A secondary author will screen 10% of abstracts, with a third subject-matter expert reviewing conflicts. ETHICS AND DISSEMINATION: This review will be disseminated through peer-reviewed scholarly networks, most likely including journal publication and conference presentation. ARTICLE SUMMARY: CVD is the leading cause of death around the world. This paper proposes an exploration of health literacy's relationship with CVD prevention as a whole, contrasting with the more segmented reviews currently published.

What Injured Workers With Complex Claims Look For in Online Communities: Netnographic Analysis.

BACKGROUND: Improved understanding of social constructs around injury may help insurance case managers to understand how best to support people after injury. OBJECTIVE: This study sought to explore what people who sustain work-related injuries may seek from online communities. The study highlights potential opportunities for improved engagement with insurance case management practice. METHODS: An observational netnographic analysis was undertaken on anonymous, publicly available messages posted on Australian message boards. All research data were drawn from anonymous, online communities. A person (author SM) with experience of making a claim through an Australian workers' compensation system and online engagement was involved in study conception, design, and analysis. Data were analyzed using NVivo12 in an iterative, multistage process including coding, journaling, and member checking. A total of 141 people were engaged in discussion across 47 threads housed on 4 Australian forums. RESULTS: In this qualitative study, themes emerged from the data, describing how injured workers use online communities to help make decisions, get support, and solve problems. The key motivators for action and engagement were seeking information, connection, or justice. Establishment of relationships was a key mediator of each of these parameters. CONCLUSIONS: Some work-related injuries may involve medical and medicolegal complexity as well as changed lifestyle and routine during convalescence and recovery. The mechanism used by some injured workers to seek information and problem solve suggests a capacity for self-management and self-care after work-related injury. Netnography provides information on a community that may not regularly engage with research because of the complexity of their situation and their vulnerability.

Utilization of social media communities for caregiver information support in stroke recovery: An analysis of content and interactions.

BACKGROUND: Caregivers often use the internet to access information related to stroke care to improve preparedness, thereby reducing uncertainty and enhancing the quality of care. METHOD: Social media communities used by caregivers of people affected by stroke were identified using popular keywords searched for using Google. Communities were filtered based on their ability to provide support to caregivers. Data from the included communities were extracted and analysed to determine the content and level of interaction. RESULTS: There was a significant rise in the use of social media by caregivers of people affected by stroke. The most popular social media communities were charitable and governmental organizations with the highest user interaction-this was for topics related to stroke prevention, signs and symptoms, and caregiver self-care delivered through video-based resources. CONCLUSION: Findings show the ability of social media to support stroke caregiver needs and practices that should be considered to increase their interaction and support.

Maternal vitamin D and offspring fracture risk: the Vitamin D in Pregnancy study.

Vitamin D is important for bone health and strength. Previous studies report 25-hydroxyvitamin D (25(OH)D) exposure during pregnancy may impact offspring bone health later in life. In this study, maternal 25(OH)D at recruitment was associated with a lower fracture risk in boys and an increased fracture risk in girls at 28-32 weeks gestation. PURPOSE: Maternal 25-hydroxyvitamin D (25(OH)D) in pregnancy has been shown to be associated with offspring bone measures in some studies, but few have examined fracture risk. We aimed to determine associations between maternal vitamin D status and offspring fracture risk. METHODS: In total, 475 mother-child pairs participating in the Vitamin D in Pregnancy study in southeastern Australia were recruited. Maternal serum samples were taken at recruitment (< 16 weeks gestation) and/or 28-32 weeks gestation and analysed for 25(OH)D. Incident fractures in children were ascertained from date of birth (2002-2004) until December 31, 2012. Cox proportional hazard models included maternal age at recruitment, offspring sex, birth weight, gestation length and season of vitamin D sample. RESULTS: Complete follow-up data were available for 400 children (median age = 9.5 years). There were 68 (17.0%) children who sustained at least one fracture. Higher maternal 25(OH)D (per 10 nmol/L) in early gestation was weakly associated with a decreased fracture risk in boys (HR 0.82; 95% CI 0.68, 0.99; p = 0.048) but not girls (HR 1.10; 95% CI 0.98, 1.25; p = 0.11). At late gestation, higher maternal 25(OH)D was associated with increased fracture risk in girls (HR 1.11; 95% CI 1.01, 1.23; p = 0.038) but not boys (HR 0.94; 95% CI 0.80, 1.10; p = 0.42). No statistically significant relationships were detected in analyses investigating 25(OH)D as a categorical variable. CONCLUSION: There is some evidence that higher maternal 25(OH)D at recruitment was associated with lower fracture risk in boys, while higher maternal 25(OH)D at 28-32 weeks gestation was associated with an increased fracture risk in girls.

Gestational Folate and Offspring Bone Health; The Vitamin D in Pregnancy Study.

Maternal nutritional intake, such as folate and folic acid supplementation, during pregnancy may affect offspring bone health during childhood. We aimed to determine the associations between maternal dietary and supplementary folate intake and offspring bone health measures, including fracture risk. Data were obtained from 160 of 475 mother-child pairs who had returned for the 11-year follow up of the Vitamin D in Pregnancy Study, an observational cohort study. Incident fractures were ascertained from radiological records and dual X-ray absorptiometry was used to measure bone mineral density and content at 11 years of age. Maternal dietary folate intake during pregnancy was determined by Food Frequency Questionnaire and folate supplementation was determined through self-report. Both measures were undertaken at recruitment (before 16 weeks gestation) and at 28-32 weeks' gestation. Multivariable linear regression models and Cox regression models were used to examine associations. Results are presented as per 1000 µg folate for dietary measures. There were significant associations between maternal folate supplementation in early pregnancy (< 16 weeks gestation) and offspring spine bone mineral content (BMC) (ß = 1.53, 95% CI 0.21, 2.86), spine area (ß = 1.10, 95% CI 0.37, 1.82) and total body less head area (ß = 329.30, 95% CI 3.50, 55.20) at the 11-year follow-up. The association between spine BMC was attenuated after adjustment for bone size (ß = 0.13 95% CI - 0.85, 1.10). There was no association between maternal folate supplementation at 28-32 weeks' or maternal dietary intake at either time point with any offspring bone outcome. These data suggest that folate supplementation in early pregnancy may be associated with offspring bone size, but not other bone measures.

Gestational Vitamin D and Offspring Bone Measures: Is the Association Independent of Maternal Bone Quality?

Previously we have reported an association between maternal vitamin D and offspring bone as measured by dual-energy X-ray absorptiometry. It is plausible that shared genetics might confound associations between maternal vitamin D in pregnancy and offspring bone measures. We aimed to determine whether such associations are independent of maternal bone quality. Data for this analysis were derived from 168 mother-child pairs who returned at the 11-year follow-up of the vitamin D in pregnancy study. Gestational 25-hydroxyvitamin D [25(OH)D] was assessed by radioimmunoassay in early pregnancy at recruitment (before 16 weeks gestation) and later in pregnancy (28-32 weeks gestation). Bone quality was assessed for mothers and children at the calcaneus using quantitative ultrasound (Achilles InSight, GE). Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA) and Stiffness Index (SI) were the outcomes of interest. Maternal 25(OH)D in early pregnancy was associated with offspring SOS (ß 1.46 m/s 95% CI 0.12, 2.8). When separated by sex, there was no association between maternal 25(OH)D at recruitment and offspring SI (r = - 0.05, p = 0.68), SOS (r = 0.11, p = 0.34) or BUA (- 0.09, p = 0.43) in girls. In boys, maternal 25(OH)D at recruitment was associated with SI (r = 0.21, p = 0.048), and SOS (r = 0.24, p = 0.03) but not BUA (r = 0.10, p = 0.37). Adjustment for the offspring factors and respective maternal QUS parameter did not attenuate associations between maternal 25(OH)D in early pregnancy with offspring SOS, nor SI. There was no association with BUA. Furthermore, there was no association between maternal 25(OH)D in late pregnancy with any offspring QUS parameter. These prospective data support existing evidence of a positive relationship between maternal 25(OH)D levels during early pregnancy and measures of bone health of offspring in childhood, independent of maternal bone phenotype.

The Vitamin D in Pregnancy Study: a prospective prebirth cohort in southern Australia.

PURPOSE: The Vitamin D in Pregnancy Study is a long-term ongoing cohort study. It was conceived to explore relationships between maternal vitamin D status in pregnancy and offspring growth and development, and has since diversified to include a wide range of physical and mental health exposures and outcomes. PARTICIPANTS: Recruitment was from the University Hospital Geelong (Barwon Health) antenatal clinic, Geelong, Victoria, Australia, between 2002 and 2004. 475 women were initially recruited, which resulted in 400 eligible mother-child pairs at birth. FINDINGS TO DATE: The cohort has been followed up twice in pregnancy, at birth, and 1 year, 6 years and 11 years post birth. The study has reported an association between vitamin D in pregnancy and musculoskeletal health and body composition in the children. FUTURE PLANS: Subject to funding, there will be a prospective young adult follow-up. This profile aims to foster both cross-national and international collaborations with both existing and future data collection.

Correction to: Osteoporosis medication use among Australian women over two decades.

The original version of this article, published 06 May 2020, unfortunately contained a mistake.

The association between a fracture risk tool and frailty: Geelong Osteoporosis Study.

BACKGROUND: Frailty is characterised by age-related declines in physical, psychological and social functioning. Features of frailty overlap with risk factors for fragility fractures. The aim of this study was to investigate the association between the fracture risk assessment tool (FRAX®) and frailty. METHODS: In cross-sectional analysis, frailty status was determined for participants aged 60-90 yr at 15-year follow-up of the Geelong Osteoporosis Study, using a modified Fried frailty phenotype. Using the FRAX on-line tool, scores for hip and major osteoporotic fracture (MOF) were calculated with and without bone mineral density (BMD). Using the area under Receiver Operating Characteristic (AUROC) curves, and FRAX scores calculated at the baseline visit for these participants, we investigated the association of FRAX and frailty 15 years later. RESULTS: Forty-seven of 303 women (15.5%) and 41 of 282 men (14.5%) were frail at the 15-year visit. There was a gradient of increasing median FRAX scores from robust to frail. For example, for women, median MOF-FRAX without BMD increased from 5.9 for the robust to 7.5 for the pre-frail and 14.0 for the frail (p < 0.001). In secondary analyses, an association was observed between FRAX and frailty over 15 years, with the highest AUROC for women being 0.72 for MOF-FRAX with BMD, and for men, 0.76 hip-FRAX without BMD. CONCLUSION: An association was observed between FRAX and frailty where frail men and women had higher FRAX-scores compared to the other groups. Preliminary data suggest that FRAX, with or without BMD, may be useful in enhancing the information on frailty. Further research using larger datasets will be required to explore this.

Root Cause Analysis to Identify Medication and Non-Medication Strategies to Prevent Infection-Related Hospitalizations from Australian Residential Aged Care Services.

Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infection, and models of care that facilitate timely access to medical services. The RCA and clinical panel findings provide a roadmap to assist targeting services to prevent infection and limit unnecessary hospital transfers from RACS.

Osteoporosis medication use among Australian women over two decades.

Despite the burden of osteoporosis and treatment availability, a treatment gap remains. Women in a population-based study were followed with respect to use of anti-fracture medication over two decades. Use increased over time but remained suboptimal, with less than 20% of those at high risk of fracture receiving treatment. PURPOSE: We examined trends in osteoporosis-related medication use over time using data from the Geelong Osteoporosis Study, an ongoing, population-based study. METHODS: Self-reported medication use data were available for 822 women (50-90 years) at time-1 (1993-1997), 575 women at time-2 (2004-2008), and 527 women at time-3 (2011-2014) participating in a longitudinal study. Prevalence of any osteoporosis-related medication use (pooled anti-fracture (bisphosphonates, raloxifene, denosumab, or strontium); hormone therapy; and supplements (calcium and/or vitamin D)) was calculated using bootstrapping methods for the whole group and those at risk of fracture, identified using FRAX Aus® (probability of major osteoporotic fracture ≥ 20% and/or ≥ 3% hip fracture) and BMD (osteoporosis indicated by a T-score of less than - 2.5 at either the femoral neck or spine). Time trend (age groups 50-59, 60-69, 70-79, 80+ years) and time-point effects were evaluated using mixed effects logistic models. RESULTS: The use of any osteoporosis-related medication increased over three time points (time-1, 25.9% (95% CI 23.1, 28.8); time-2, 32.5% (28.7, 36.3); time-3, 35.9% (31.9, 39.8)), driven by the use of supplements (time-1, 12.9% (95% CI 10.6, 15.1); time-2, 22.1% (18.8, 25.4); time-3, 30.9% (26.9, 35.5)) and anti-fracture medication (time-1, 0.9% (0.4, 1.6); time-2, 5.0% (3.3, 6.8); time-3, 4.4% (2.7, 6.3)). Women at high risk of fracture were identified by BMD (time-1, n = 231 (28.1%); time-2, n = 92 (16.0%); time-3, n = 51 (9.7%)) and FRAX criteria (time-1, n = 272 (33.1%); time-2, n = 105 (18.3%); time-3, n = 100 (19.0%)). The use of anti-fracture medication was low among these groups (BMD criteria: time-1, 1.7% (0.4, 3.7); time-2, 16.3% (8.7, 24.3); time-3, 15.7% (7.1, 26.1); FRAX criteria: time-1, 1.1% (0.0, 2.3); time-2, 18.1% (11.5, 25.5); time-3, 13.0% (6.5, 19.8)). CONCLUSION: Use of anti-fracture medication among women at risk of fracture remained low over time. Investment into systems approaches to correct the treatment gap is warranted.

The Association Between Muscle Mass and Strength in Relation to Bone Measures in a Paediatric Population: Sex-Specific Effects.

Post-puberty, bone mass displays clear sex-specific patterns. However, research has suggested that a sexual dimorphism in bone mass is evident in younger children and is likely attributable to differences in lean mass. Thus, we aimed to determine whether the association with both overall muscle mass and/or muscle strength was different between the sexes in a paediatric population. Participants were recruited as part of the Vitamin D in Pregnancy Study, Australia. There were 209/402 (52.3%) children at the 11-year follow-up, and 172 had complete data. Children were assessed for bone mineral content (BMC), bone mineral density (BMD) and lean mass by DXA (Lunar). Handgrip strength (kg) was measured using a dynamometer (JAMAR). Linear regression models were adjusted for height, weight, age and pubertal stage. In adjusted models, including both muscle strength and lean mass, the observed association differed between boys and girls. At the spine in boys, BMC and BMD were associated with muscle strength (ß 0.34 [95%CI 0.09-0.59] and 0.008 [95%CI 0.003-0.014]; respectively) but not total muscle mass. However, muscle mass was associated with BMC and BMD at the total body (less head). In girls, spine BMC and BMD were associated with total lean mass (ß 0.95 [95%CI 0.61-1.3] and ß 0.01 [95%CI 0.005-0.02], respectively), with a similar pattern of association with total body (less head) measures. Muscle mass and strength appear to have sexually dimorphic effects on bone mass in school-aged children. These findings should be replicated in longitudinal studies.