Health Professional- and Volunteer-partnered Self-management Support (COMBO-KEY) to Promote Self-efficacy and Self-management Behaviors in People with Stroke: A Randomized Controlled Trial.

BACKGROUND: Multiple systematic reviews have reported that self-management interventions are associated with positive impacts on self-efficacy and health-related quality of life (HRQoL) of people with stroke. PURPOSE: This article reports the effects of an enhanced stroke self-management program. METHODS: Eligible adults with stroke were recruited from community-based organizations and a support group for a two-arm, assessor-blinded randomized controlled trial. Participants in the control group received usual care, while those in the intervention group also received the 8-week self-management program, Coaching Ongoing Momentum Building On stroKe rEcovery journeY (COMBO-KEY), consisting of four individual home visits and five follow-up phone calls, delivered by healthcare professionals and trained volunteers. Assessments were conducted at baseline and after the intervention, for outcomes of self-efficacy, satisfaction with the performance of self-management behaviors, HRQoL, and community reintegration, which were analyzed using generalized estimating equations (GEEs). RESULTS: 134 Participants were recruited [mean age = 64.1 years, standard deviation (SD) = 12.7]. Over 80% of the participants had a first-ever stroke [mean years after first stroke: 4.2 (SD = 5.1)]. The GEE analysis revealed that the intervention group participants showed significantly greater improvements in self-efficacy, satisfaction with their performance of self-management behaviors, HRQoL, and community reintegration at 8-week follow-up with respect to their baseline levels. CONCLUSIONS: The COMBO-KEY program showed effective improvements in recovery outcomes of people with stroke. Future research should explore the inclusion of virtual/hybrid sessions, strategies to assess health conditions of people with stroke via online modes, and assessment of goal attainment and actual performance of self-management behaviors.

Self-management is the active involvement of a person in managing their overall needs for being able to live well with a chronic condition. Self-management interventions have shown to improve the recovery outcomes of people with stroke. We developed an 8-week long enhanced self-management program "COMBO-KEY" delivered by healthcare professionals and trained volunteers, consisting of individual home visits, follow-up phone calls, peer sharing videos, and enriched resources sharing through a website and a reference guide, aimed at promoting self-efficacy, and self-management behaviors of people with stroke. In this study, 134 adults with stroke were recruited and randomized to either receive the COMBO-KEY program or continue to receiving usual care only. Participants receiving the program showed greater improvements in self-efficacy and self-management behaviors with increased quality of life and reintegrating back to the community after eight weeks compared to the participants receiving usual care. The results highlighted the positive role of a health coaching approach, whereby healthcare professionals, and trained volunteers provide self-management support, to improve the recovery of people with stroke.

Unfolding and displaying the influencing factors of advance directives from the stakeholder's perspective: A concept mapping approach.

AIMS: To develop a culturally relevant conceptual map to discover perceptions of a statutory form of advance directive (AD) for Hong Kong Chinese. DESIGN: This was the first study on AD using a concept mapping approach with two phases. METHODS: The data collection of the two phases was conducted from February 2016-February 2017. In Phase I, 96 participants were recruited using purposive sampling. In Phase II, multi-dimensional scaling and hierarchical cluster analysis were used to create a concept map based on quantitative data. RESULTS: The map depicted six clusters of factors affecting the acceptance of AD, with their importance rating in decreasing order: Conditional factor, value system, process of AD, physical and illness factor, personal situation factor, and socio-cultural factor. CONCLUSION: The study adopted a comprehensive approach to unfolding the multi-faceted factors affecting the acceptance of ADs by stakeholders. Strategies targeting the clusters could be developed to facilitate the discussion and completion of AD.

Associations of pubertal stage and body mass index with cardiometabolic risk in Hong Kong Chinese children: A cross-sectional study.

BACKGROUND: Puberty is associated with a clustering of cardiometabolic risk factors (CMRFs) during adolescence that are manifested in later life. Although anthropometric variables such as body mass index (BMI) can predict cardiometabolic risk in children and adolescents, it is not clear whether there is an interaction between pubertal stage and BMI associated with cardiometabolic risk in this age group. This paper examines the association of pubertal stage and BMI with CMRFs in Hong Kong Chinese children. METHODS: A cross-sectional school-based study was conducted among 1985 (95.1%) students aged 6 to 18 years. Fasting lipid profile and plasma glucose, blood pressure, body weight, body height and waist circumference were measured. A self-reported pubertal stage questionnaire was used to assess pubertal stage of participants. Two cardiometabolic risk scores, alpha and beta, were constructed to quantify cardiometabolic risk. Cardiometabolic risk score alpha refers to the sum of z-scores of sex-specific, age-adjusted waist circumference, height-adjusted systolic and diastolic blood pressure, fasting plasma glucose, triglyceride and low-density lipoprotein cholesterol, and minus z-score of sex-specific age-adjusted high-density lipoprotein cholesterol. Cardiometabolic risk score beta includes all components of risk score alpha except waist circumference. RESULTS: The interaction of BMI z-score (ZBMI) and pubertal stage demonstrated a further increase in variance explained in both the cardiometabolic risk scores alpha and beta (0.5% and 0.8% respectively) in boys and (0.7% and 0.5% respectively) in girls. CONCLUSIONS: Pubertal stage has an interaction effect on the association of cardiometabolic risk by BMI in boys and may have a similar but lesser effect in girls.

Prevalence and correlates of unprotected anal intercourse among Hong Kong men who have sex with men traveling to Shenzhen, China.

In China, the HIV prevalence among men who have sex with men (MSM) has been increasing sharply. A total of 195 Hong Kong MSM having had sex with men in Shenzhen, a mainland China city separated from Hong Kong by a border, were recruited from some randomly selected gay venues in Shenzhen. Participants were face-to-face and anonymously interviewed. The results showed that in the last six months, respectively 62.1, 84.6, and 31.3 % of the participants from Hong Kong had had sex with commercial sex partners (CSP), non-regular partners (NRP) and regular partners (RP) in Shenzhen. The prevalence of unprotected anal intercourse (UAI) with these three types of sex partners was respectively 29.8, 27.9, and 78.7 %. Factors associated with UAI with any MSM in Shenzhen in the last six months included perceived chances of contracting HIV, perceived non-availability of condoms, giving money/gifts to Shenzhen MSM sex partners, and perception that MSM partners in Shenzhen would not always insist on condom use (multivariate OR = 2.9-13.90, p < 0.05), whilst factors of inverse associations included university education, having had sex with NRP but not with CSP and RP in Shenzhen and self-efficacy of insisting on condom use (multivariate OR = 0.04-0.22, p < 0.05). In sum, the prevalence of having multiple types of male sex partners and UAI was high. This was especially true when anal sex with RP was involved. Cross-border HIV prevention is greatly warranted. It should ensure condom availability and modify perceptions toward UAI.

Self-reported body weight and height: an assessment tool for identifying children with overweight/obesity status and cardiometabolic risk factors clustering.

Body mass index (BMI) is commonly used for assessing body fat. Self-reported body weight and height derived BMI (SRDBMI) is a simple, low cost and non-invasive assessment tool and it may be a useful self-reported assessment tool to monitor the prevalence of overweight/obesity in community settings and for epidemiological research. We assessed the agreement of BW and BH between assessor measured and child self-reported values and evaluated the diagnostic ability of SRDBMI to identify children with overweight/obesity status and cardiometabolic risk factors (CMRFs) clustering. A cross-sectional study was conducted in school settings using a cluster sampling method. A total of 1,614 children aged 6-18 years were included in the analysis. Children were given a questionnaire to complete at home prior to the anthropometric measurements and blood taking at the schools. There was almost perfect agreement on BW, BH and BMI between self-reported and measured values [intraclass correlation coefficients ranged from 0.93 (95% CI: 0.93-0.94) to 0.99 (95% CI: 0.98-0.99)]. About half of the children reported their BW and BH absolute values within 1 kg and 2 cm of measured values, respectively. The SRDBMI demonstrated good diagnostic ability for identifying children with overweight/obesity status (sensitivity, specificity, positive and negative predictive values ranged from 0.83 to 0.98) and CMRFs clustering (AUC-ROCs values of BMI between measured and self-reported values were close ranging from 0.85 to 0.89). Self-reported BW and BH demonstrated almost perfect agreement with measured values and could substantially identify children with overweight/obesity status and CMRFs clustering.

Effectiveness of Community Health Worker-Led Interventions in Enhancing Colorectal Cancer Screening Uptake in Racial and Ethnic Minority Populations: A Systematic Review and Meta-analysis.

BACKGROUND: The colorectal cancer (CRC) screening uptake rate is substantially lower in ethnic minority populations than in the general population. Racial and ethnic minority individuals experience more barriers in obtaining a screening test for CRC when compared with the non-Hispanic White population. OBJECTIVE: To examine the effectiveness of community health worker-led interventions in improving the CRC screening uptake rate in racial and ethnic minority populations. METHODS: Five databases, EMBASE, CINAHL, MEDLINE, Scopus, and PubMed, were systematically searched, and reference lists of the identified articles were manually searched for relevant articles in May 2022. Only randomized controlled trials were included. RESULTS: A total of 10 randomized controlled trials conducted in the United States were included in this review. The findings of the meta-analysis showed that CRC screening uptake was enhanced in participants receiving community health worker-led interventions compared with those receiving no intervention (odds ratio, 2.25; 95% confidence interval, 1.48-3.44; P < .001). The subgroup analysis by diverse racial and ethnic groups and number of components (single vs multiple) of the community health worker-led interventions showed that multicomponent interventions were more effective in increasing the CRC uptake rate among all racial and ethnic groups regardless of their background. CONCLUSIONS: Multicomponent community health worker-led interventions can improve CRC screening uptake in racial and ethnic minority populations. IMPLICATIONS FOR PRACTICE: The findings of the present review show that multicomponent community health worker-led interventions are shown to be effective to improve the CRC screening uptake targeting other racial and ethnic minority groups in other countries.

Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: A pilot randomized controlled trial.

Beneficial effects of music intervention and progressive muscle relaxation alone on psychological issues were reported, however, studies evaluating their combined effects are limited. This study aimed to investigate the feasibility, acceptability and preliminary effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress, and quality of life among breast and gynaecological cancer patients receiving chemotherapy. METHODS: The study was carried out from March to May 2022 in an oncology hospital in Vietnam. A single-blinded randomized controlled trial was conducted among 24 women with breast and gynaecological cancer undergoing chemotherapy. The intervention group (n = 12) received a face-to-face training program about music listening and progressive muscle relaxation skills. They then performed the self-practice daily at home for three weeks. The control group (n = 12) received standard care, including health assessment, regular health advice and nutrition consultation. Ten participants in the intervention group were interviewed with open-ended questions to explore the acceptability of the intervention. Anxiety, depression and stress were measured using the Depression Anxiety Stress Scale, while The Functional Assessment of Cancer Therapy-General was used to evaluate the quality of life. The outcome measurements were collected at baseline (T0), post-intervention (3rd week, T1) and follow-up (6th week, T2). Appropriate descriptive statistics were used to depict the outcome measures across study time points. RESULTS: A total of 24 patients were eligible to join, and 20 of them completed the study. Greater reductions in anxiety, depression and stress were observed in the intervention group than in the control group at T1 and T2. Greater improvements on quality of life were found in the intervention group than control group at T1 and T2 with respect to T0. The content analysis supported the acceptable intervention of participants through two themes, perceived beneficial effects on psychological and physical health and willingness to keep practising in the future. CONCLUSIONS: Implementing music intervention combined with progressive muscle relaxation is feasible and had a trend in reducing anxiety, depression and stress levels. A larger scale randomized controlled trial is needed to confirm the effect of the intervention on outcomes. TRIAL REGISTRATION: This trial was registered on ClinicalTrials.gov with ID: NCT05262621.

Quality of life outcomes in chinese patients with implantable cardioverter defibrillators.

BACKGROUND: Patient-centered outcomes for Chinese implantable cardioverter defibrillator (ICD) patients have not been previously studied. This study examined health-related quality of life (HRQL) and its relation with ICD shock-related anxiety, ICD shock, patient acceptance of the ICD, and demographic and clinical characteristics among a sample of Chinese ICD patients. METHODS: Eighty-five ICD recipients completed the Chinese versions of the Short Form (SF-12) Health Survey, Florida Patient Acceptance Survey (FPAS), and Florida Shock Anxiety Scale (FSAS), and a demographic sheet during their follow-up visit. RESULTS: The mean scores of physical component summary and mental component summary (MCS) of ICD patients (41.7 and 46.6, respectively) were lower than the Hong Kong Chinese normative data. As expected, MCS was negatively correlated with shock anxiety (r =-0.38, P < 0.01) and positively correlated with patient acceptance (r = 0.50, P < 0.01). Shock anxiety was negatively correlated with patient acceptance of the ICD (r =-0.58, P < 0.01). Age was positively associated with FPAS (r = 0.55, P = 0.014) while negatively related with FSAS (r =-0.28, P = 0.003). The experience of ICD shock (yes/no) was not associated with any differences but shock frequency groups (no shocks, 1-2 shocks, and ≥3) and gender were significantly different on shock anxiety but not on general mental functioning. CONCLUSION: Higher ICD shock anxiety was associated with lower HRQL and lower ICD acceptance. Age, female, and clinical characteristics such as diabetes, coronary heart disease, and ICD shock experience can influence patient-centric outcomes of HRQL, FPAS, and FSAS. These results extend the evidence for increased clinical attention in Chinese patients to specific outcomes such as shock anxiety and its impact on HRQL.

Development of an explanatory model to explore cervical cancer screening behaviour among South Asian women: The influence of multilevel factors.

PURPOSE: To develop an explanatory model, built on an ecological basis, and examine the relational effects of multilevel factors on screening behaviour among South Asian immigrant women. METHODS: This is a cross-sectional, exploratory correlational study using path analysis. 776 South Asian immigrant women were recruited from community in Hong Kong. A self-administered survey with eight sections covering socio-demographics, recommendations received from others, previous screening experience, knowledge of the disease and screening, attitudes and perceptions, level of acculturation, cultural barriers to screening and perception of cancer fatalism was used to collect data. Path analysis was done to test the hypothesised model. FINDINGS: The final model obtained an acceptable model fit with x2/df = 2.52, RMSEA = 0.044, CFI = 0.95 and TLI = 0.93. A total of 15 factors, ranging from intra-personal to community level, were identified as being associated with South Asian immigrant women's cervical cancer screening behaviour. Three factors at the community level (language use, modesty and crisis orientation) had an inter-relationship with three intra-personal factors (perceived barriers to screening, cancer fatalism and perceived benefits of screening) and hence affected screening uptake. CONCLUSIONS: South Asian women's cervical cancer screening behaviour is affected by multi-level factors. Efforts should be made to change the current health-promoting strategies and attract more involvement from appropriate stakeholders, incorporating cultural and socio-environmental components in future interventions.

Comparative study of nasopharyngeal aspirate and nasal swab specimens for diagnosis of acute viral respiratory infection.

Paired nasopharyngeal aspirate (NPA) and nasal swab (NS) samples from 475 children hospitalized for acute respiratory infection were studied for the detection of influenza virus, parainfluenza virus, respiratory syncytial virus, and adenovirus by immunofluorescence test, viral culture, and multiplex PCR assay. The overall sensitivity of viral detection with NPA specimens was higher than that obtained with NS specimens.

Does hyperventilation improve operating condition during supratentorial craniotomy? A multicenter randomized crossover trial.

BACKGROUND: Hyperventilation has been an integral, but poorly validated part of neuroanesthetic practice. We conducted a two-period, crossover, randomized trial to evaluate surgeon-assessed brain bulk and measured intracranial pressure (ICP) in patients undergoing craniotomy for removal of supratentorial brain tumors during moderate hypocapnia or normocapnia. METHODS: Two-hundred and seventy-five adult patients with supratentorial brain tumors were randomized to one of two treatment sequences: hyperventilation (arterial carbon dioxide tension, PaCO2 = 25 +/- 2 mm Hg) followed by normoventilation (PaCO2 = 37 +/- 2 mm Hg) or normoventilation followed by hyperventilation. Ventilation and end-tidal CO2 tension were kept constant for 20 min. Patients were also randomly assigned to receive a propofol infusion or isoflurane anesthesia. At the end of each study period, subdural ICP was measured and the neurosurgeon, blinded to the treatment group, was asked to rate the brain bulk using a four-point scale. RESULTS: Using a generalized estimation equation model, we found that hyperventilation decreased the risk of increased brain bulk by 45%, P = 0.004, 95% confidence intervals 22% to 61%, and the number needed to treat was 8. The mean (+/-SD) ICP during hyperventilation, 12.3 +/- 8.1 mm Hg, was lower than that during normoventilation, 16.2 +/- 9.6 mm Hg, P < 0.001. Anesthetic regimen did not affect brain bulk assessment or ICP. CONCLUSIONS: In patients with supratentorial brain tumors, intraoperative hyperventilation improves surgeon-assessed brain bulk which was associated with a decrease in ICP.

Psychometric testing of the Chinese quality of recovery score.

BACKGROUND: We evaluated a Chinese translation of the quality of recovery (QoR) score for measuring health status in patients after surgery and anesthesia. METHODS: The Chinese QoR score was developed by a panel of linguistic experts using a series of forward and backward translations. We then compared the psychometric performance of the Chinese QoR score with the original English version in bilingual Chinese patients undergoing a variety of surgeries. Using a crossover design, 210 patients were randomly assigned to complete both versions of the QoR score, 1 h apart, in the morning after surgery according to one of the two sequences: Chinese followed by the English QoR score or the reverse order. Test-retest and interrater reliabilities were calculated by comparing scores administered 6-8 h later and those completed by the patients and duty nurses, respectively. RESULTS: Patient responses to the Chinese QoR score agreed well with the English version (weighted kappa statistic, kappaw=0.92). Both QoR scores correlated with patient satisfaction scores (Chinese version, rho=0.82; English version, rho=0.79) confirming convergent validity. There was also significant negative correlation between the QoR scores and female gender, duration of hospital stay, or magnitude of surgery (discriminant construct validity). We found the Chinese QoR score has good internal consistency (Cronbach's rho=0.91), interobserver (kappaw=0.77), and test-retest reliability (kappaw=0.83). These values were similar to those of the original English version (Cronbach's rho=0.89, interobserver kappaw=0.84, test-retest reliability kappaw=0.88). CONCLUSION: The Chinese QoR score is conceptually, semantically, and operationally equivalent to the English version. Both scales provide valid, reliable, and responsive assessment of the QoR after surgery and anesthesia.

The additive interactions between ondansetron and droperidol for preventing postoperative nausea and vomiting.

Prophylactic ondansetron or droperidol reduces the incidence of postoperative nausea and vomiting (PONV). Previous studies showed that the combination of these two drugs produced better antiemetic effect than either drug alone. We present a nonparametric method to determine the pharmacologic interaction between ondansetron and droperidol and compared the observed response of the drug combination with that predicted from additivity. This is calculated as the product of the individual drug response, normalized to that of the controls. Five minutes before induction of anesthesia, 400 patients scheduled for laparoscopic gynecologic surgery were randomly assigned to receive 1) saline IV; 2) ondansetron 4 mg IV; 3) droperidol 1.25 mg IV; or 4) a combination of droperiodol 1.25 mg and ondansetron 4 mg IV. A standardized anesthetic technique and postoperative analgesic regimen were used. Patients were reviewed regularly for 48 h. Changes in the heart rate adjusted QT (QTc) interval were measured from electrocardiograms recorded before and 5 min after study drug administration. In a subgroup of 160 patients, QTc intervals were measured again at 2-3 h after surgery. During the first 48 h after the surgery, the proportion of patients experiencing PONV was 68% (95% CI 58-77) in the control group. A single dose of ondansetron or droperidol decreased the incidence of PONV to 30% (95% CI 21-40) and 28% (95% CI 20-38), respectively. The predicted incidence of PONV after drug combination, 11.8% (7.1-11.9), was similar to that observed, 12.1% (6.4-20.2), P = 0.94. The corresponding predicted and observed treatment responses in the combination group were 88.2% and 87.9%, respectively. There was a modest and transient increase in QTc interval after administration of ondansetron, droperidol, or their combination. The changes were however similar among groups. We conclude that the interaction between ondansetron and droperiodol was additive. Both drugs acted independently of each other through their specific mechanisms of action. The incidence of QTc prolongation did not increase with the drug combination.

Oscillometric 24-h ambulatory blood pressure reference values in Hong Kong Chinese children and adolescents.

OBJECTIVES: We aimed to establish community-based normal reference values of 24-h ambulatory blood pressure monitoring (ABPM) for Chinese children and adolescents. Furthermore, we investigated how excluding overweight children affects BP percentiles and compared them with German references. METHODS: In this territory-wide cross-sectional prospective cohort study, 1445 Hong Kong Chinese children and adolescents aged 8-17 years with body height between 119 and 185 cm were recruited. Their ABPM assessment was performed using validated arm oscillometric recorders (A&D TM-2430) and complied with American Heart Association's recommendations. The reference tables were constructed using the LMS method to normalize skewed distribution of ABP data to sex and age or height. RESULTS: The ambulatory BP was higher among boys and the difference between boys and girls progressively widened with age. An increasing trend in daytime and night-time SBP and DBP with age and height was observed in both sexes. The age-specific and sex-specific 95th percentiles from nonoverweight children (n=1147; 79%) were lower than the whole cohort by up to 2.5 and 1 mmHg for SBP and DBP, respectively. In comparison, our overall and nonoverweight reference standards were generally higher than corresponding German references. CONCLUSION: The study provides ambulatory BP standards for Chinese children, with sex-related age-specific and height-specific percentiles. Further longitudinal studies are required for investigating its clinical utility in Chinese.

A pilot randomized study to assess immunogenicity, reactogenicity, safety and tolerability of two human papillomavirus vaccines administered intramuscularly and intradermally to females aged 18-26 years.

Intradermal administration of human papillomavirus (HPV) vaccines could be dose-sparing and cost-saving. This pilot randomized study assessed Cervarix(®) and Gardasil(®) administered either intramuscularly or intradermally, in different doses (full-dose or reduced to 20%) by different methods (needle and syringe or PharmaJet needle-free jet injection device). Following an initial reactogenicity study of 10 male subjects, sexually naïve women aged 18-26 years were randomized to the eight study groups to receive vaccine at 0, 2 and 6 months. 42 female subjects were enrolled and complete data were available for 40 subjects. Intradermal administration of either vaccine raised no safety concerns but was more reactogenic than intramuscular administration, although still tolerable. All subjects demonstrated a seroconversion (titre≥1:320) by Day 95. Further evaluation of intradermal HPV vaccination and its potential for cost reduction in resource poor settings is warranted.

Associations of sleep duration with obesity and serum lipid profile in children and adolescents.

INTRODUCTION: The association between sleep duration, obesity, and serum lipid profile in the youth population is under-explored. OBJECTIVE: To evaluate the association between sleep duration, obesity and serum lipid profile in the youth population. METHODS: We conducted a cross-sectional population-based study with students recruited from primary and secondary schools in Hong Kong. Anthropometric measurements, fasting lipid profiles and validated questionnaires on sleep duration were performed. A subgroup (n=138) was randomly selected for both questionnaires and actigraphy to assess the agreement between subjective and objective measurements of sleep duration. RESULTS: We studied 2053 healthy children and adolescents aged 6-20 years. Their mean ages were 13.0±3.3 (boys) and 13.6±3.3 (girls) years. The average sleep duration during schooldays, weekends, and long holidays was 8.0±1.1, 9.6±1.2, and 9.8±1.2h in boys and 7.7±1.1, 9.9±1.2, and 10.1±1.2h in girls, respectively. Using logistic regression, age, and pubertal stage were associated with obesity in secondary school students, whereas male gender and short sleep duration were associated with obesity in primary school children. In secondary school children, those with long sleep duration, as compared to those with short sleep duration, were significantly associated with reduced risk to have high TC and LDL-C levels after adjustment for age, gender, BMI, and pubertal stage. There was no significant association between sleep duration and lipid levels in primary school children. CONCLUSION: Reduced sleep duration was associated with obesity and atherogenic dyslipidemia in young school children in Hong Kong.

Compromised bone marrow perfusion in osteoporosis.

A link between bone blood flow and osteoporosis may exist. Outside of the spine, the proximal femur is the most common site of osteoporotic fracture and is also an area prone to avascular necrosis and fracture nonunion. This study of the proximal femur investigates the relationship between BMD, bone marrow fat content, bone perfusion, and muscle perfusion. One hundred twenty healthy female subjects (mean age, 74 yr; age range, 67-89 yr) underwent DXA examination of the hip, proton MR spectroscopy, and dynamic contrast-enhanced MR imaging of the right proximal femur, acetabulum, and adductor thigh muscle. In all bone areas examined (femoral head, femoral neck, femoral shaft, acetabulum), perfusion indices (maximum enhancement, enhancement slope) were significantly reduced in subjects with osteoporosis compared with subjects with osteopenia or normal BMD. Adductor muscle perfusion was not affected by change in BMD. As marrow perfusion decreased in the proximal femur, marrow fat increased (r = 0.827). This increase in fat content seemed to account for the decrease in marrow perfusion more than a reduction in BMD. For normal BMD subjects, perfusion parameters in the femoral head were one third of those in the femoral neck or shaft and one fifth of those in the acetabulum. Perfusion throughout the proximal femur is reduced in osteoporotic subjects compared with osteopenic and normal subjects. This reduction in perfusion only affects bone and not those tissues outside of bone with the same blood supply. As bone perfusion decreased, there was a corresponding increase in marrow fat.