Association between a history of major osteoporotic fractures and subsequent hip fracture: a systematic review and meta-analysis.

PURPOSE: A history of fractures involving the distal radius, proximal humerus, spine, and hip may be associated with the incidence of subsequent hip fractures in older people. However, a comprehensive summary of this association using a rigorous methodology is lacking. Our objective was to systematically review the literature and examine the association between four major osteoporotic fractures and subsequent hip fractures in individuals aged ≥ 50 years. METHODS: We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov on February 15, 2023. The search included cohort or case-control studies investigating the association between these four types of osteoporotic fractures and subsequent hip fractures. We pooled the hazard ratios (HRs) with 95% confidence intervals (CI) using the random-effects model. We used the Quality In Prognosis Studies tool to assess the risk of bias in the included studies, and the grading of recommendations assessment, development, and evaluation approach to determine the certainty of evidence. RESULTS: The selection process identified 48 studies for qualitative synthesis and 23 studies (2,239,217 participants) for meta-analysis. The overall methodological quality had a low risk of bias in 65% of the included studies. The association between a history of major osteoporotic fractures and subsequent hip fracture varied, with a high certainty of evidence for a history of proximal humerus and hip fractures (HR 2.02, 95% CI 1.75-2.33 and 2.86, 95% CI 1.92-4.25, respectively), moderate certainty for distal radius fractures (HR 1.66, 95% CI 1.53-1.81), and low certainty for spine fractures (HR 1.53, 95% CI 1.38-1.69). CONCLUSIONS: In conclusion, a history of major osteoporotic fractures, particularly distal radius, proximal humerus, and hip fractures, is associated with subsequent hip fractures in older adults. Further research is needed to verify the association between a history of spine fracture and subsequent hip fractures. PROTOCOL REGISTRATION: Open Science Framework ( https://osf.io/7fjuc ).

Misleading presentations in functional food trials led by contract research organizations were frequently observed in Japan: meta-epidemiological study.

OBJECTIVES: The functional food market has experienced significant growth, leading to an uptick in clinical trials conducted by contract research organizations (CROs). Research focusing on CRO-managed trials and the communication of trial outcomes to the consumer market remains underexplored. This metaepidemiological study aims to evaluate the quality of randomized controlled trials (RCTs) facilitated by prominent CROs in Japan and to examine the quality of the representations used to convey their results to consumers. STUDY DESIGN AND SETTING: This study focused on the food trials that were registered in the University Hospital Medical Information Network Clinical Trial Registry or the International Clinical Trials Registry Platform by the top 5 CROs. Press releases of study results or advertisements of food products based on the study results were identified by conducting a Google search. The risk of bias in the RCT publications was independently assessed by 2 reviewers, who also evaluated the presence of "spin" in the abstracts and full texts. An assessment of "spin" in press releases/advertisements was undertaken. RESULTS: A total of 76 RCT registrations, 32 RCT publications, and 11 press releases/advertisements were included. Approximately 72% of the RCT publications exhibited a high risk of bias due to selective outcome reporting. "Spin" was present in the results of the abstract (72%), abstract conclusion (81%), full-text results (44%), and full-text conclusion (84%). "Spin" appeared in 73% of press releases/advertisements due to the selective outcome reporting. CONCLUSION: Functional food presentations in Japan frequently contained "spin." The Japanese government should more rigorously check whether food manufacturers report outcomes selectively.

Comparative efficacy, tolerability and acceptability of intravenous racemic ketamine with intranasal esketamine, aripiprazole and lithium as augmentative treatments for treatment-resistant unipolar depression: A systematic review and network meta-analysis.

BACKGROUND: Intravenous racemic ketamine is a promising treatment for treatment-resistant depression. However, its clinical utility compared with intranasal esketamine and the other well-studied conventional pharmacological interventions (i.e., aripiprazole and lithium) as augmentative treatments for treatment-resistant unipolar depression in adults remains unclear. Therefore, we aimed to compare the efficacy, tolerability and acceptability of intravenous racemic ketamine with intranasal esketamine, aripiprazole and lithium under such conditions. METHODS: The Cochrane Library, PubMed, CINHAL and ClinicalTrials.gov databases were systematically searched from their inception to 10 May 2023. Randomised controlled trials evaluating these drugs were included. A random-effects network meta-analysis was also performed. RESULTS: In the primary analysis, all four drugs were significantly more effective than placebo. In addition, intravenous racemic ketamine was significantly more effective and acceptable than intranasal esketamine and aripiprazole. Intravenous racemic ketamine was not significantly different from placebo in tolerability, whereas intranasal esketamine and aripiprazole were significantly less tolerable than placebo. Lithium did not differ significantly from intravenous racemic ketamine in efficacy, tolerability and acceptability. LIMITATIONS: The sample size of patients treated with intravenous racemic ketamine was small. CONCLUSIONS: Intravenous racemic ketamine may be a better augmentative treatment for treatment-resistant unipolar depression than intranasal esketamine and aripiprazole. Whether intravenous racemic ketamine or lithium is superior is unclear currently. A larger head-to-head trial of intravenous racemic ketamine versus conventional augmentative treatments for treatment-resistant unipolar depression is needed.

Efficacy of telerehabilitation for patients after hip fracture surgery: A systematic review and meta-analysis.

INTRODUCTION: This study aimed to determine the efficacy of telerehabilitation for patients after hip fracture surgery through a systematic review and meta-analysis. METHODS: Eight electronic databases were searched in August 2022. The primary outcomes were mobility outcomes, activities of daily living (ADL) outcomes, and all adverse events, whereas the secondary outcomes were pain, health-related quality of life, and fall efficacy scale score. RESULTS: Seven randomized controlled trials were eligible for this study. The evidence regarding the effect of telerehabilitation on mobility outcomes (standardized mean difference (SMD): 0.05, 95% confidence interval (CI): -0.39 to 0.48) and all adverse events (risk ratio: 1.14, 95% CI: 0.62 to 2.21) was very uncertain. A clinically irrelevant but significant mean difference (MD) in ADL outcomes was found (MD: 4.82, 95% CI: 2.63 to 7.01). Telerehabilitation may result in a slight increase in fall efficacy scale score (SMD: 0.26, 95% CI: -0.02 to 0.54) and little to no difference in pain (MD: -1.0, 95% CI: -18.31 to 16.31). CONCLUSIONS: The efficacy of telerehabilitation for patients after hip fracture surgery was uncertain with respect to the mobility outcomes, all adverse events, and pain, with no clinically meaningful differences in ADL outcomes. Telerehabilitation may be necessary to be considered for patients after hip fracture surgery to improve their confidence in their ability to perform daily activities without falling. Therefore, medical staff may consider telerehabilitation for hip fractures.

Changes in neck pain and somatic symptoms before and after the adjustment of the pillow height.

[Purpose] The purpose of this study was to determine whether strict adjustment of the pillow height using the Set-up for Spinal Sleep method improves clinical outcomes like neck pain and somatic symptoms. [Participants and Methods] A total of 84 participants with chief complaints of stiff shoulders and neck pain were evaluated using the numerical rating scale and the Somatic Symptom Scale-8. Questionnaires were used to collect data at the baseline, after two weeks, and after three months of adjusting the pillow height. [Results] Forty-two participants (50%) achieved the minimal clinically important difference for neck pain with a decrease of three points or higher in the numerical rating scale. The baseline neck pain scores were significantly higher in the group that achieved the minimal clinically important difference. The three-month change in neck pain and the Somatic Symptom Scale-8 was significantly greater in participants who were satisfied with treatment. There was a significant positive association between improvement in the numerical rating scale score and improvement in the Somatic Symptom Scale-8 at three months. [Conclusion] Strict adjustment of the pillow height using the Set-up for the Spinal Sleep method significantly improved both physical neck pain and somatic symptoms related to psychological and social problems.

Can prior informed consent create virtuous cycle between biodiversity conservation and genetic resources utilization?

This study attempted to predict the effectiveness of prior informed consent (PIC) as a mechanism under the Nagoya Protocol (NP) through the case of Japan, a developed country with a wealth of genetic biodiversity. The NP to the Convention on Biological Diversity (CBD) aims at creating a virtuous cycle between biodiversity conservation and the utilization of genetic resources through fair and equitable benefit sharing. As PIC is a crucial component of the NP for promoting fair and equitable sharing, this study investigated whether introducing PIC creates a virtuous cycle. Considering the limitations of empirical data, this study adopted a policy Delphi comprising experts in an iterative group communication process that used consecutive questionnaires to reveal diverse issues as input for policymaking. We identified six related issues that were evaluated for the case of introduction and three for the case of no introduction of PIC. Their relative importance as a policy concern was measured through best-worst scaling to narrow down policy-relevant issues. This study revealed that contrary to the NP's intent, the overall contribution to the virtuous cycle is limited. In designing PIC mechanisms, policymakers must pay particular attention to bequest and research and development. This study identified three paths through which the negative impacts on research and development further negatively affect bequest, that is, slackening the identification of important genetic resources and ecosystems to conserve, disincentivizing biodiversity conservation for genetic resource use, and dampening ex-situ conservation efforts.

Does the Keele STarT Back Screening Tool Contribute to Effectiveness in Treatment and Cost and Loss of Follow-Up of the Mechanical Diagnosis and Therapy for Patients with Low Back Pain?

BACKGROUND: Mechanical diagnosis and therapy (MDT) and the stratified approach using the Keele STarT Back Screening Tool (SBST) are examples of stratified low back pain (LBP) management. We investigated whether the medium-high risk in SBST can contribute to the time and sessions until discharge from MDT (Question 1) and to the loss of follow-up before identifying a promising management strategy (Question 2). METHODS: A retrospective chart study was conducted. Multiple regression modeling was constructed using 10 independent variables, including whether the SBST was medium-high risk or not for Question 1, and the 9/10 independent variables for Question 2. RESULTS: The data of 89 participants for Question 1 and 166 participants for Question 2 were analyzed. SBST was not a primary contributing factor for Question 1 (R2 = 0.17-0.19). The model for Question 2 included SBST as a primary contributing factor and the shortest distance from the patient address to the hospital as a secondary contributing factor (93.4% correct classification). CONCLUSION: SBST status was not a primary contributing factor for time and sessions until discharge from MDT, but was a critical factor for the loss of MDT follow-up before identifying a promising management strategy.

Long-term evolution of preferences for conservation projects in the Seto Inland Sea, Japan: a comprehensive analytic framework.

BACKGROUND: The long-term evolution of preferences for nature is crucial to conservation projects, given their targeted long-term horizons. Neglecting to account for this evolution could lead to undesirable human-nature relationships. This study compares the willingness to pay (WTP) for three coastal conservation projects in the Seto Inland Sea, Japan, at two distant time points (1998 and 2015), and tests for temporal transferability. It also compares protest responses that are often overlooked in WTP practices, regardless of their utility for conservation projects. METHODS: Given the lack of a unanimous protocol for protest response analyses and their use in estimating WTP, we propose a comprehensive analytic framework that integrates the two. RESULTS: We show that, while preferences for coastal ecosystem services were overall stable and temporarily transferable, the preferences for certain aspects of conservation projects considerably changed. DISCUSSION: This suggests the need to reconsider the projects' scheme, not the ecosystem services themselves, along with the clarification of beneficiaries and those responsible for past destruction. We conclude by suggesting further studies with a focus on regions experiencing significant social-ecological changes, such as developing countries, by exploiting the rich asset of existing valuations. This could contribute to the database for more temporal-sensitive ecosystem service valuations utilized for benefit transfers.

Best-worst scaling survey of preferences regarding the adverse effects of tobacco use in China.

We use best-worst scaling to assess two types of concern levels of the adverse consequences of smoking in China. While the smoking cessation policy has worked well in Taiwan, more than 1 million people in mainland China are estimated to die every year from tobacco use. This study compares the preferences of Chinese individuals in the two jurisdictions (mainland versus Taiwan) and explores the possibility of information-based interventions. The relative importance of 13 adverse effects was assessed by conducting a web-based survey on a sample of 480 Chinese participants. The 13 items consist of various adverse effects of tobacco use: from long-term health risk, such as lung cancer and cardiovascular diseases, to reduction of physical capacity and sexual dysfunction, and disturbance to non-smokers. The resulting data suggest possible strategies to curb smoking. Subgroup analysis, focusing on gender, smoking status, and nicotine dependence, was also conducted. Lung cancer, cardiovascular diseases, and chronic obstructive pulmonary disease, in this order, rank highest for both types of respondents. On the other hand, high expenditures (13th) and weight gain after cessation (12th) are the lowest ranked for both. Measuring individual best-worst scores reveals substantial heterogeneity among respondents and that information-based intervention can help curb smoking.

Economic valuation of the Seto Inland Sea by using an Internet CV survey.

We estimate the economic value of the natural environment damaged in the Seto Inland Sea after the introduction of the Law on Temporary Measures for the Environmental Conservation of the Seto Inland Sea (Setouchi Law) and the value of the natural environment that survived, using a Contingent Valuation (CV) survey on an Internet web site. The CV survey contains three plans. Plan 1 is to restore 4 ha of reclaimed land. By estimating the Willingness To Pay (WTP) for plan 1, we can appraise the value of the natural environment that was damaged as a result of the original reclamation. Plan 2 is to transplant Zostera (eel-grass) into an area of 10 ha offshore. Plan 3 is to preserve the shore area, a natural habitat for rare animal species, under the National Trust Program. From the WTP for plans 2 and 3, we can estimate the value of the shore area and the areas a little farther offshore. The value of the natural environment damaged in the Seto Inland Sea as a result of reclaiming projects after the introduction of the Setouchi Law and the value of the existing natural environment of the Seto Inland Sea from the WTP for the plans were estimated to about 172 trillion yen (1.46 trillion dollars) and about 424 trillion yen (3.60 trillion dollars), respectively. The results indicate that in the 25 years since the introduction of the Setouchi Law, we have degraded every year about 6.88 trillion yen (58.5 billion dollars) worth of the natural environment by reclaiming. Some seaweed farms and natural shore areas, natural habitats to rare marine life-forms like the horseshoe crab and the fiddler crab have survived, but their value amounts to about 80% of Japan's GDP.