Osteoporosis is a common condition characterized by bone fragility and fractures. Hip fracture, leads to disability, morbidity, excess mortality and growing costs to health care systems. / Antiresorptive agents are used to treat osteoporosis and fractures; it is unknown if these agents are effective in preventing recurrent fractures in individuals who have sustained a hip fracture. / Using health services administrative databases, we ascertained the incidence of hip fractures and associated-mortality rates in the elderly population in Quebec, from 1996 to 2002 and, evaluated the effectiveness of antiresorptive agents for the prevention of recurrent hip fractures. / We identified 33,243 hip fractures. Age-adjusted annual rates of hip fractures decreased in women by 11% from 1996 to 2002 while they did not change in men. Overall one-year mortality rates were higher in men than in women (37% versus 24%), and remained stable over time. Patients exposed to antiresorptives had a 26% reduction in the rate of recurrent fractures (95% CI, 0.64--0.86) compared to patients who were not exposed to these agents. / Hip fractures remain a prevalent disease with serious complications. Further research is essential to confirm our results and, to clarify the association between increasing use of antiresorptive agents and the trend reversal in the incidence of hip fractures.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 295 pages. Includes vita. Includes bibliographical references.

Resumo: Produtos naturais têm sido estudados com relação ao controle químico da microbiota patogênica do biofilme bucal. O objetivo desse estudo foi esclarecer o efeito do extrato da folha de Psidium cattleianum no metabolismo de S. mutans, no biofilme formado in situ e na capacidade em inibir a desmineralização do esmalte. O extrato foi obtido por decocção das folhas em água deionizada. O efeito do extrato foi avaliado in vitro com relação à viabilidade, expressão protéica e produção de ácido de biofilmes de S. mutans. No estudo in situ, blocos de esmalte bovino foram fixados em dispositivos acrílicos palatinos de dez voluntários. A fase experimental consistiu de três etapas de 14 dias cada, separadas por intervalo de sete dias. Os voluntários gotejaram solução de sacarose 20% (8x/dia) e a solução de tratamento (água, extrato ou um enxaguatório comercial; 2x/dia). O biofilme dentário foi analisado quanto à acidogenicidade, quantidade microorganismos e presença de polissacarídeos álcali-solúveis. Nos blocos de esmalte, foram realizadas as análises de microdureza superficial e em secção longitudinal. O extrato foi capaz de afetar a viabilidade, a produção de ácidos e a síntese protéica do biofilme formado in vitro. No biofilme formado in situ, o extrato foi capaz de diminuir a queda do pH, o acúmulo de microorganismos, a formação de polissacarídeos extracelulares e a desmineralização do esmalte. Conclui-se que o extrato foi capaz de diminuir a expressão de proteínas envolvidas no metabolismo bacteriano, a patogenicidade do biofilme bucal e a desmineralização do esmalte in situ. / Abstract: Natural products have been studied with relation to chemical control of pathogenical microorganisms of dental biofilm. The aim of this study was to clarify the effect of Psidium cattleianum leaf extract on S. mutans metabolism, on in situ biofilms and on enamel demineralization. The extract was obtained by decoction in deionized water. The extract was studied in vitro with relation to viability, protein expression and acid production of S. mutans biofilms. On the in situ study, enamel bovine blocks were placed in palatal appliances of ten volunteers. The experimental phase consisted of three stages with a duration of 14 days each and a washout period of seven days. The volunteers dripped 20% sucrose (8x/day) and the treatment solution (water, extract or a marketed mouthwash - 2x/day) on the enamel blocks. The dental biofilm was analyzed regarding the amount of microorganisms and presence of alkalisoluble polysaccharides. On the enamel blocks, surface and cross-sectional microhardnessess were evaluated. The extract was able to affect the viability, acid production and protein synthesis of the in vitro biofilm. On the in situ biofilm, the extract was able to decrease pH drop, microorganism accumulation, extracellular polysaccharides formation and enamel demineralization. It can be concluded that the extract was able to reduce the expression of proteins involved on bacterial metabolism, the pathogenicity of dental biofilm and in situ enamel demineralization. / Orientador: Alberto Carlos Botazzo Delbem / Coorientador: Elerson Gaetti-Jardim Júnior / Banca: Marília Afonso Rabelo Buzalaf / Banca: Cínthia Pereira Machado Tabchoury / Banca: Cristina Antoniali Silva / Banca: Maria Aparecida de Andrade Moreira Machado / Doutor

Petrol and ethanolic extracts of six asteraceous weeds were added to artificial diet and screened for inhibition of larval growth on variegated cutworm, Peridroma saucia (Hbn.). Petrol and ethanolic extracts of Artemisia tridentata and Chamomilla suaveolens and ethanolic extracts of Chrysothamnus nauseosus and Centaurea diffusa were highly inhibitory at five times the naturally occurring concentrations. The two C. suaveolens extracts and the ethanol extract of A. tridentata were active at the natural concentration (100%) and were further examined at 20, 40, 60, and 80% of this level. Inhibition of larval growth was directly related to concentration for each of the three extracts tested. EC₅₀'S (effective concentration to inhibit growth by 50% relative to controls) for the three extracts were 36-42% of the naturally occurring level in the plants. Nutritional indices were calculated for second instar P. saucia feeding on the active ethanolic A. tridentata extract and the petrol extract from C. suaveolens. The relative growth rate (RGR) of P. saucia larvae fed the ethanolic extract of A. tridentata in artificial diet was significantly lower than that in larvae fed diet with the petrol extract of C. suaveolens and larvae on control diet. Dietary utilization was significantly lower for larvae fed the A. tridentata extract. Results of a field trial indicated that a single treatment of A. tridentata extract at the equivalent of 0.2 g/ml could protect cabbage significantly better than the carrier solvent (30% aq ethanol) or distilled water as measured by a visual damage estimate. An insecticide standard, deltamethrin (17.9 µg/1 with 0.4% Superspred TM ), suppressed pest damage significantly better than the A. tridentata-extract treatment. A residual oviposition deterrency to Pieris rapae was found in the field results. Caged experiments in the laboratory confirmed the contact oviposition deterrency of the A. tridentata extract at 0.2 g/ml. Offspring of field-collected P. saucia larvae grew 2.5-fold heavier than larvae from the laboratory colony. However, diet with the A. tridentata extract inhibited both field-collected and laboratory reared saucia larvae equally when compared to their respective controls fed untreated diet. In summary, these results indicate the potential benefit of using specific unrefined plant extracts for growth inhibitors and oviposition deterrents against insect pests. The contribution of individual phytochemicals in the A. tridentata ethanolic extract to growth inhibition or oviposition deterrency is currently speculative. / Land and Food Systems, Faculty of / Graduate

The significance of this research lies in the fact that it makes a meaningful contribution to the development of comprehensive injury prevention programmes. The studies included in this thesis investigate technique-related intrinsic factors where injury is prevented at the expense of performance as well as intrinsic factors where there is potential for both injury prevention and performance to be simultaneously optimised. The cricket pace bowler is prone to injury due to the high load nature of the pace bowling action involving a complex sequence of forceful actions, consisting of practiced, particular movements. Various injury prevention programmes incorporating extrinsic factors have been studied and implemented previously, however the intrinsic factors associated with both injury and performance in pace bowlers have not yet been investigated sufficiently. In this thesis an overview of the literature includes the review of injuries sustained by pace bowlers, factors associated with injury and performance, and the kinematics of the pace bowling action. Premier league (amateur) cricket pace bowlers were recruited for this study. All pace bowlers were injury free at the start of the season. Details around past injuries as well as incidence of injuries were recorded throughout an eight month cricket season. Performance measures, namely ball release speed and accuracy, were measured during execution of the pace bowling action. Included in this thesis are six original papers. The first five papers investigated the association between intrinsic factors, injury and performance, while the sixth paper described abdominal muscle adaptations in the pace bowler. The first paper (Chapter 2) investigated bowlers’ ability to perform lumbo-pelvic movement control, static and dynamic balance tests at the start and at the end of a cricket season. Lumbo-pelvic movement control tests could not discriminate between bowlers who sustained an injury during the cricket season and bowlers who did not. However, performance in the single leg balance test (SLBT) (p=0.03) and the star excursion balance test (SEBT) (p=0.02) as measured at the start of the season, was better in bowlers who did not sustain an injury during the season. Paper 2 (Chapter 3) investigated lumbar proprioception (as measured by joint position sense) in the neutral lumbar spine position; as well as lumbar positions corresponding to those at front foot placement and ball release of the cricket pace bowling action in relation to previous injury and injury sustained during the cricket season under review. Lumbar reposition error in the sagittal plane (flexion-extension) was between 1.48˚ and 1.82˚ and in the frontal plane (left-right lateral flexion) it was between 0.81˚ and 0.88˚. Lumbar reposition error, as measured in two planes and in three different positions, was associated with self-reported general injuries, injuries sustained during the bowling action and especially, low back injury sustained in the past (p<0.05). From findings indicated in Papers 1, 2 and 3 (Chapters 2, 3 and 4) it can be postulated that if static balance, dynamic balance and lumbar proprioception can be improved in pace bowlers, their risk of lumbar injury may be reduced. Paper 3 and 4 (Chapter 4 and 5) investigated the relationship between kinematic angles as measured in the power phase of the pace bowling action and injury, as well as performance, respectively. In Paper 3 (Chapter 4) a difference was found between lumbar spine lateral flexion positioning (p=0.02) at the start compared to at the end of the season in injured pace bowlers. The range of flexion between front foot placement and ball release at L1 is much greater in the non-injured group than in the injured group as measured at the end of the season (p=0.03). Bowlers who did not sustain an injury during the season displayed a larger degree of absolute flexion at the start of the season than those who sustained an injury (p=0.02). Findings from Paper 4 (Chapter 5) are that the following absolute angles were positively correlated with higher ball release speeds at the start of the season: a more extended knee angle (p=0.037), a larger arm to thorax angle (p<0.0001), larger L1 (p=0.01), T10 (p<0.0001) and T7 (p<0.0001) segmental spinal lateral flexion and more global trunk left rotation (p=0.02). Paper 3 and 4 (Chapter 4 and 5) thus show that low back flexion and lateral flexion, and front knee kinematics, as found in the power phase of the pace bowling action, are associated with and may predict lower quarter injuries and performance outcomes in cricket pace bowlers. The fifth paper (Chapter 6) hypothesised that correlations between front knee angle, knee reposition error, as a measure of proprioception, and ball release speed should be present, however no such correlation could be established. The correlations between joint reposition error in 140˚ of knee extension (r=0.06), 160˚ of knee extension (r=0.30), front foot placement (r=0.22) and ball release (r=0.23) positions were not statistically significant (p>0.05). Furthermore, correlations between knee position error and reproduced knee angles were also not statistically significant (r=-0.35 to r=0.09; p>0.05). It was concluded that static knee joint position sense is not associated with dynamic knee angle during the bowling action, or with ball release speed and that dynamic mechanisms may contribute to knee angles and bowling speeds. The sixth study (Chapter 7) investigated and highlighted the possible muscle adaptations in absolute muscle thickness and activity as a consequence of the asymmetrical bowling action. The absolute thickness of the non-dominant obliquus abdominis internus (OI) was higher than that of the dominant OI at the start (p<0.0001) as well as at the end of the cricket season (p<0.0001). At the start of the season the percentage change during the abdominal drawing in manoeuvre, thus a measure of muscle activity, was higher for the non-dominant OI than for the dominant OI (p=0.02). Absolute thickness of the dominant obliquus abdominis externus (OE) at rest was significantly higher at the end of the season compared with at the start of the season (p<0.0001). During right side active straight leg raise, the activity of the left transversus abdominis (TA) was significantly higher than that of the right TA during left side active straight leg raise (p=0.03) when measured at the end of the season. These asymmetries in abdominal muscle thickness and activity may contribute to the predisposition to low back injury in cricket pace bowlers or may occur in an attempt to protect the pace bowler against injury. In conclusion, the high load nature of the pace bowling action allows for high ball release speeds to be attained but at the same time renders the pace bowler vulnerable to injury. Intrinsic factors found to be associated with both lower quarter injury and performance should be appropriately incorporated into injury prevention programmes in order to prevent the occurrence of injuries in the presence of the high load nature of the pace bowling action. Further research needs to be conducted on the effectiveness of these injury prevention programmes to prevent injury amongst pace bowlers.

The reduction of intentional exposure to ultraviolet (UV) radiation is an important area of skin cancer prevention. Hillhouse et al. (Cancer 113:3257-3266, 2008) have developed an appearance-focused intervention with evidence of efficacy in lowering indoor tanning UV exposure in young women. In the current study, a subgroup approach was used to determine moderators of intervention efficacy. Undergraduate females in two regions of the United States (n = 362) were randomized into an intervention or control condition. Latent profile analysis was used to identify subgroups of indoor tanners based on patterns of indoor tanning motives. Intervention efficacy was examined within each subgroup. We found evidence for 4 subgroups of tanners: knowledgeable-appearance tanners, low-knowledge tanners, low-knowledge, relaxation tanners, and knowledgeable, low-appearance and lowrelaxation tanners. The intervention significantly reduced indoor tanning for the low-knowledge subgroup (34% of the sample). The utility of the subgroup approach in developing targeted behavioral skin cancer interventions is discussed.

Background World Health Organization reports that there are no exact statistics of how many older adults worldwide suffer from malnutrition, but available data suggest that about 15–60 percent of older adults cared for in hospitals, nursing homes and home-care programmes are suffering from malnutrition. It is important that the registered nurse is aware of different interventions and how they can be implemented in order to improve the nutritional status of the older adult. Aim The aim of this study was to examine nursing interventions used to treat and prevent malnutrition in older adults at hospitals and nursing homes. Method The study design was a literature review with 15 scientific articles included. The data collection was done in the databases PubMed and CINAHL. The result articles were a mix of both qualitative- and quantitative studies. Intergraded data analysis was used to compile the 15 articles. Results The interventions had an overall positive effect on the nutritional status of the older adults. Oral nutritional supplements were the most common intervention. Both environmental and social factors had effect on the mealtime experience. The older adult was not often involved in the nutritional care and the evaluation of the outcome of the interventions was scarce. The teamwork between health professionals, relatives and the older adult was inadequate. Conclusions Malnutrition in older adults is a prevalent problem and is often de-prioritized in nursing care. The most common intervention used was oral nutritional supplements but there are other interventions that also provide positive results and provide more individual care and are often disregarded by the RN’s. The older adults’ involvement in the nutritional care can be increased and improved as well as involvement of relatives. The importance of treating and preventing malnutrition is a topic that could be emphasized more within the geriatric care. / Bakgrund Världshälsoorganisationen rapporterar att det inte finns någon exakt statistik över hur många äldre personer över hela världen som lider av undernäring, men tillgängliga data tyder på att cirka 15–60 procent av de äldre personer som vårdas på sjukhus, särskilt boende och inom hemsjukvården lider av undernäring. Det är viktigt att den legitimerade sjuksköterskan är medveten om olika omvårdnadsåtgärder och hur de kan genomföras för att förbättra den äldre personens näringsstatus. Syfte Syftet med denna studie var att undersöka tillämpade omvårdnadsåtgärder för att förebygga och behandla undernäring hos äldre personer på sjukhus och särskilt boende. Metod Studiedesignen var en litteraturöversikt med 15 vetenskapliga artiklar inkluderade. Datainsamlingen gjordes i databaserna PubMed och CINAHL. Resultatartiklarna var en blandning av både kvalitativa och kvantitativa artiklar. En integrerad analys utfördes för att sammanställa de 15 artiklarna. Resultat Omvårdnadsåtgärderna hade en övergripande positiv effekt på de äldre personernas näringsstatus. Näringsdrycker var den vanligaste åtgärden. Både miljömässiga och sociala faktorer påverkade matupplevelsen. Den äldre personen var sällan involverad i sin nutritionsvård och utvärdering av omvårdnadsåtgärderna var sällsynt. Samarbetet mellan vårdpersonal, anhöriga och den äldre personen var otillräckligt. Slutsats Undernäring hos äldre personer är ett vanligt förekommande problem som ofta bortprioriteras inom vården. Den vanligaste åtgärden var insättande av näringsdryck men det finns andra åtgärder som ger goda resultat och är mer individanpassade som ofta förbises av sjuksköterskan. Den äldre personens medverkan i sin vård gällande nutrition kan ökas och förbättras, såväl som medverkan av anhöriga. Vikten av att behandla och förebygga undernäring är ett ämne som skulle kunna betonas mer inom geriatrisk vård.

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