Effect of Lifestyle Modification Intervention Programme on Bone Mineral Density among Postmenopausal Women with Osteoporosis.

Objectives: Osteoporosis is one of the major public health problems worldwide among postmenopausal osteoporotic women. Lifestyle modification interventions along with pharmacotherapy help to revert bone loss and prevent complications. Methods: A randomised controlled trial was conducted at Kasturba Hospital, Manipal from January 2019 to December 2021 among postmenopausal women with osteoporosis. The postmenopausal women who attended the osteoporosis clinic and were within the age group of 45-65 years, could speak and understand English or Kannada and whose bone mineral density (BMD) score was between -1 and -3 were included in the study. The total sample size of the study was 120 with 60 in each of the experimental and control groups. After obtaining informed consent, a stratified block randomisation method was used to allocate the participants to intervention and control groups. The BMD was monitored by the portable ultrasound densitometer by a technician at the outpatient departments. The baseline information was collected by a structured demographic questionnaire. Intervention group participants received a lifestyle modification intervention program (LMIP) whereas the control group received standard regular care from the physician. Follow-up was done at three and six months. Results: The results revealed that the increase in the BMD median score among the experimental group was from -2.2 (-2.5- -1.8) to -1.5 (-1.8- -0.65) whereas in the control group, it was from -2.3 (-2.6- -1.9) to -2.0 (-2.4- -1.5). The results of the Mann Whitey U test showed a statistical significance between the intervention and control groups in the post-test after six months (U = 505.5; P <0.05). Wilcoxon signed rank test showed a significant change in both the intervention and control groups from pre-test to post-test I (3 months) and post-test II (6 months; P <0.001). Conclusion: The lifestyle modification intervention was found to be effective in improving the bone health status of postmenopausal women. Hence it is very important to integrate it into regular therapy.

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews.

BACKGROUND: To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS: Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION: Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.

Impact of COVID-19 on Mental Health Among Healthcare Workers in India: A Mixed-methods Systematic Review.

Healthcare workers (HCWs) experienced significant mental health challenges during the COVID-19 pandemic. This review aimed to comprehensively assess the impact of the COVID-19 pandemic on the mental health of HCWs in India. We conducted a mixed-methods systematic review, which adopts a results-based convergent approach that incorporates quantitative and qualitative data. A comprehensive literature search was conducted in relevant databases: PubMed-Medline, CINAHL, Web of Science, and ProQuest. All available full-text studies in the English language that assessed the mental health outcomes (anxiety, stress, and depression) of HCWs during the pandemic and published until 28 February 2022 were included. A total of 31 studies were included in this review (27 quantitative studies, three qualitative studies, and one mixed-method study). The pooled prevalence of depression, anxiety, and stress among HCWs in India was 32.96%, 29.49%, and 33.47%, respectively. Integration of quantitative and qualitative findings using social determinants of health framework resulted in various contributing factors and coping strategies. There is a need for a supportive work environment, mental health support, and mental health policies for HCWs in India.

Burden of Osteopenia and Osteoporosis Among Postmenopausal Women in India: A Systematic Review and Meta-Analysis.

Aim: Postmenopausal osteoporosis is a major public health problem around the world. The objective of this systematic review is to determine the prevalence of osteoporosis in postmenopausal women in India. Materials and Methods: This review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified relevant studies through a search of literature published from 2010 to January 2021 in the databases PubMed, Web of Science, ProQuest, CINHAL, and PEDro databases. We searched for cross-sectional studies involving India that were published in English. Results: There was a total of 1631 hits in the initial search and out of which 60 studies were selected for full-text review. Twelve studies were selected for qualitative analysis. Excluded studies were 48 with reasons: 20 studies had included other diseases such as knee arthritis, celiac diseases, diabetes mellitus, and kidney diseases. Eleven studies included premenopausal women, young adults, and men. Ten studies outcomes were different, and seven studies were excluded as they have done retrospective analysis and were commentaries. The pooled prevalence of osteoporosis at the lumbar spine region was 29%, the hip region was 6% and the femoral neck region was 29% whereas the pooled prevalence of osteopenia at the lumbar spine region was 37%, the hip was 6%, and femoral neck region was 37%. Conclusion: This systematic review found that postmenopausal women are at significant risk of developing low bone mineral density, and the prevalence of osteoporosis and osteopenia was high in the lumbar area.

Effect of exercise on bone mineral density and quality of life among postmenopausal women with osteoporosis without fracture: A systematic review.

BACKGROUND: Osteoporosis is a progressive disease commonly seen in postmenopausal women which is characterized by decreased bone mass. This is becoming an important public health issue in India. This review aimed to evaluate the effect of exercise on quality of life and bone health status among postmenopausal osteoporotic women. METHODS: We searched the following databases: Pubmed-Medline, Proquest, CINAHL, Scopus, Cochrane Central and PEDro. The review included randomized controlled trials that examined the use of exercise aimed at improving bone mineral density and quality of life in postmenopausal osteoporotic women without a history of fracture. Risk of bias was assessed by the Cochrane Risk of Bias tool. RESULTS: This review suggests exercise is effective in improving the bone mineral density and quality of life of postmenopausal women with osteoporosis. The exercise interventions included in the studies were heterogeneous and included: Tai Chi, high intensity aerobic exercises, Modified Eight Section Brocade exercises, progressive slow loading low impact exercises, pilates and closed kinetic exercises. Four studies had a small sample size and in three studies, interventions were for a shorter duration. Meta-analysis could not be performed as the studies were not homogenous. CONCLUSION: There is a need to conduct more experimental trials with robust research methods so that a high risk of bias can be avoided. The available evidence supports the positive effects of exercises on postmenopausal osteoporosis.