Osteoporosis Screening Disparities among Ethnic and Racial Minorities: A Systematic Review.

Background: Osteoporosis is a preventable disease that is simple and cost-effective to screen based on clinical practice guidelines, yet many patients go undiagnosed and untreated leading to increased burden of the disease. Specifically, racial and ethnic minorities have lower rates of dual energy absorptiometry (DXA) screening. Inadequate screening may lead to an increased risk of fracture, higher health care costs, and increased morbidity and mortality disproportionately experienced by racial-ethnic minority populations. Purpose: This systematic review assessed and summarized the racial and ethnic disparities that exist for osteoporosis screening by DXA. Methods: Using terms related to osteoporosis, racial and ethnic minorities, and DXA, an electronic search of databases was performed in SCOPUS, CINAHL, and PubMed. Articles were screened using predefined inclusion and exclusion criteria which dictated the final articles used in the review. Full text articles that were selected for inclusion underwent quality appraisal and data extraction. Once extracted, data from the articles were combined at an aggregate level. Results: The search identified 412 articles. After screening, a total of 16 studies were included in the final review. The overall quality of the studies included was high. Of the 16 articles reviewed, 14 identified significant disparities between racial minority and majority groups and determined that the eligible patients in racial minority groups were less likely to be referred to DXA screening. Conclusion: There is a significant disparity in osteoporosis screening among racial and ethnic minorities. Future efforts should focus on addressing these inconsistencies in screening and removing bias from the healthcare system. Additional research is required to determine the consequence of this discrepancy in screening and methods of equitizing osteoporosis care.

Cultural Influences on Dietary Self-Management of Type 2 Diabetes in East Asian Americans: A Mixed-Methods Systematic Review.

Purpose: Many East Asian Americans (EAAs) (populations originating from China, Korea, Japan, and Taiwan) with type 2 diabetes mellitus (T2DM) experience unique challenges in managing their disease, including language barriers and traditional cultural beliefs, particularly among first-generation immigrants.. The purpose of this mixed-methods systematic review was to examine cultural perspectives of EAAs that influence dietary self-management of T2DM and identify education interventions and their approaches to enhance EAAs' dietary self-management of diabetes. Methods: A mixed-methods systematic review was conducted to examine EAAs' perspectives from qualitative studies and to identify education interventions and their approaches from quantitative studies. A literature search was conducted using PubMed/MEDLINE, SCOPUS, CINAHL, and Web of Science from 1995 to 2018. Sixteen studies (10 qualitative and 6 quantitative) met criteria for analysis. Thematic synthesis of qualitative data was conducted using a line-by-line coding strategy. Extracted quantitative data were assessed for cultural approaches used in the interventions and diabetes-related outcomes. Results: In the qualitative studies, beliefs about food impacted EAAs' abilities to adopt appropriate dietary recommendations for diabetes management. Requiring a specialized diet disrupted social harmony and made EAAs feel burdensome to others. Having bilingual and bicultural resources eased the stress of making dietary modifications. The most commonly incorporated approaches in diabetes education interventions were bilingual education and culturally specific dietary recommendations. Social roles and harmony were not discussed. Significant reductions in hemoglobin A1c and increases in diabetes knowledge were reported post-intervention. Conclusions: Beliefs about food, beliefs about social roles, and access to culturally competent care play an important role in dietary self-management of T2DM among EAAs. Understanding the cultural influences on dietary self-management of T2DM and tailoring interventions to meet the needs of EAAs are essential in effort to address the growing epidemic and improve patient outcomes.

Twelve tips for developing and implementing curriculum in dedicated 'collaborative classrooms'.

Many health professional schools may be investing time and resources on dedicated educational spaces intended to promote collaborative learning. Alone, innovative physical space or technologies are not sufficient to ensure success in this. Lesson plans informed by collaborative praxis, individual motivation, faculty development, learner feedback, and team interactions also play a necessary and substantial role. We have used faculty observations, quantitative and qualitative student evaluation data, and the existing educational literature to provide twelve tips on leveraging curricular content, activity setup, physical space, learner behavior, and faculty facilitation to make the most of collaborative learning spaces.

Characteristics and residence of First Nations patients and their use of health care services in Saskatchewan, Canada: informing First Nations and Métis health services.

RATIONALE: In Canada, Aboriginal people, particularly First Nations experience significant health disparities and a lower health status compared with the non-Aboriginal population. AIMS AND OBJECTIVES: The purpose of this study was to examine the demographic and clinical characteristics of First Nations patients admitted to hospitals in Saskatchewan, and the acute care services used by First Nations compared with non-First Nations, specifically hospital length of stay. Primary residence of patients was also mapped to determine geographic patterns that would inform health service provision. METHODS: A retrospective medical chart audit was carried out to collect data on patient demographics and clinical characteristics of 203 First Nations and 200 non-First Nations patients admitted to two urban hospitals in Saskatchewan from 2012 to 2014. RESULTS: The most common reason for admission of First Nations and non-First Nations patients was infection (24.6%) and cardiology conditions (19.5%), respectively. There was no significant difference in mean length of stay for First Nations (10.44 days) compared with non-First Nations (10.57 days). After adjusting for age, mean length of stay for First Nations was nearly 3 days longer than non-First Nations. First Nations patients' residence was from across the broad geography of Saskatchewan, with 45% living in rural communities or on reserve. CONCLUSIONS: The outcomes of this study are clinically meaningful and support the need for research, in collaboration with Aboriginal patients and families, to further examine and improve the care experience in order to decrease health disparities for Aboriginal patients in Canada.

Development and implementation of the Saskatchewan Leadership Program: Leading for healthcare transformation.

The Saskatchewan Leadership Program (SLP) was developed based on the LEADS framework and aligned with Lean management to build leadership renewal and sustainability conducive to transformational change in the Saskatchewan health system. This article describes the development, implementation, and evaluation of the SLP, including experiences and lessons learned.

Bone mineral density screening and its accordance with Canadian clinical practice guidelines from 2000-2013: an unchanging landscape in Saskatchewan, Canada.

UNLABELLED: We examined the clinical characteristics of patients who underwent initial dual energy X-ray absorptiometry (DXA) testing at a primary care facility from 2000 to 2013, and whether these factors changed over time in accordance with Canadian clinical practice guidelines. The burden of osteoporosis remains high and largely unchanged and clinical practice guidelines are not being followed, overall. PURPOSE: This study examined the clinical risk factors, therapeutic health behaviors, and bone mineral density (BMD) status of patients who underwent initial DXA testing at a primary care facility in Saskatchewan, Canada, and whether these factors changed over time from 2000 to 2013 in accordance with Canadian clinical practice guidelines. METHODS: We conducted a retrospective cross-sectional medical chart audit of 800 patients 50 years of age and older who underwent their first DXA test to assess BMD status. Data was extracted from 2000 to 2013 and further stratified into four periods (2000-2001, 2002-2006, 2007-2009, and 2010-2013; n = 200 each period) based on the years when practice guidelines were implemented. Extracted data included BMD outcomes, clinical risk factor indicators for DXA testing, and recommendations for therapeutic health behaviors outlined in the clinical practice guidelines. RESULTS: There were no differences in BMD status across the four time stratas (p = 0.430). Overall, most clinical risk factors had little change over time. The number of males screened significantly increased over time (p < 0.05), and osteoporosis drug therapy use decreased from 2000-2001 to 2010-2013 (p < 0.001). Increasing age, body mass <60 kg, and history of adult fracture were significant independent predictors of osteoporosis diagnosis. CONCLUSIONS: The burden of osteoporosis remains high and largely unchanged in Saskatchewan, Canada. These results serve to inform strategies to enhance health-care provider awareness and compliance with practice guidelines, as well as improve screening rates and patient health behaviors.

Discriminatory Performance of the Calcaneal Quantitative Ultrasound and Osteoporosis Self-Assessment Tool to Select Older Women for Dual-Energy X-ray Absorptiometry.

The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff <65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice.

Using problem-based case studies to learn about knowledge translation interventions: an inside perspective.

Knowledge translation (KT) interventions can facilitate the successful implementation of best practices by engaging and actively involving various stakeholders in the change process. However, for novices, the design of KT interventions can be overwhelming. In this article, we describe our experience as participants in a problem-based case study on planning a KT intervention and reflect on the use of problem-based learning (PBL) to develop knowledge and skills relevant to the KT process. Participants were six fellows and two faculty members attending the 2009 Canadian Institutes of Health Research KT Summer Institute. Participants received a case study asking them to develop a KT intervention with the goal of implementing a stroke response protocol for hospital inpatients. The group was given 5 hours spread over 2 days to complete the learning task. As the members of the small group reflected on their experience with the case study, 4 themes emerged: (1) balancing engaging stakeholders with moving forward; (2) exploring the research gaps and role of the Knowledge-to-Action Framework; (3) investigating methodological approaches for KT research; and (4) experiencing a supportive training environment. Participation in the problem-based case study allowed participants to expand their individual understanding of KT, while fostering the learning experiences of other group members. In a supportive learning environment, participants were able to identify influential stakeholders for the stroke response protocol implementation, discuss potential barriers by stakeholder group, and consider effective KT interventions. Future training initiatives focusing on strengthening KT capacity and knowledge should consider using small-group problem-based case study to facilitate learning.

A systematic review of osteoporosis health beliefs in adult men and women.

Osteoporosis is major public health concern affecting millions of older adults worldwide. A systematic review was carried out to identify the most common osteoporosis health beliefs in adult men and women from descriptive and intervention studies. The Osteoporosis Health Belief Scale (OHBS) and Osteoporosis Self-efficacy Scale (OSES) evaluate osteoporosis health beliefs, including perceived susceptibility and seriousness, benefits, barriers, and self-efficacy of calcium and exercise, and health motivation, and their relationship to preventive health behaviours. A comprehensive search of studies that included OHBS and OSES subscale scores as outcomes was performed. Fifty full-text articles for citations were reviewed based on inclusion criteria. Twenty-two articles met the inclusion criteria. Greater perceived seriousness, benefits, self-efficacy, health motivation, and fewer barriers were the most common health-belief subscales in men and women. Few studies were interventions (n = 6) and addressed osteoporosis health beliefs in men (n = 8). Taking health beliefs into consideration when planning and conducting education interventions may be useful in both research and practice for osteoporosis prevention and management; however, more research in this area is needed.

Can dietary fructans lower serum glucose?

BACKGROUND: Convincing evidence indicates that the consumption of inulin-type fructans, inulin, and oligofructose has beneficial effects on blood glucose changes in animal models, although data in humans have been considered equivocal. As such, a systematic review of available literature on humans was conducted to evaluate the effectiveness of dietary inulin-type fructans on serum glucose. METHODS: Thirteen eligible randomized controlled trials (RCT), published from 1984 to 2009, were identified using a comprehensive search strategy involving the PubMed, Medline, and Cochrane Library databases. Exclusion criteria, such as the absence of a control group, lack of information on the quantity of inulin-type fructans used, and lack of glucose values at outcome, were established. RESULTS: Upon review, only four of the 13 trials (31%) showed a decrease in serum glucose concentration and only one of these was statistically significant. The remaining nine trials showed no significant changes in serum glucose concentration. CONCLUSION: Based on the present systematic review, it does not appear that inulin-type fructans have a significant lowering effect on serum glucose in humans. More RCT are needed to determine whether inulin-type fructans, inulin, and oligofructose have beneficial effects on blood glucose in humans.

Identifying women with low bone mass: a systematic review of screening tools.

Several osteoporosis risk-factor screening tools have been developed to identify women at increased risk of low bone mineral density, who would most benefit from dual x-ray absorptiometry (DXA) screening. The purpose of this systematic review was to assess the effectiveness of these screening tools in determining postmenopausal Caucasian women at risk of developing osteoporosis. Appropriate databases and sources of primary studies were identified. A systematic review of the literature using a comprehensive search strategy was employed, and all citations were stored. Exclusion criteria were established, and critical quality was assessed. Study characteristics were tabulated and comparisons made. Upon reviewing the evidence, 6 screening tools (Simple Calculated Osteoporosis Risk Estimation, the Osteoporosis Risk Assessment Instrument, the Osteoporosis Self-Assessment Tool [OST], the body weight criterion, the Osteoporosis Index of Risk, and Age, Body Size, No Estrogen) were identified. Studies show that these screening tools are useful in identifying postmenopausal Caucasian women in need of DXA screening and possible intervention for osteoporosis. For clinical and community practice, the OST is the simplest approach to determine individuals at risk of osteoporosis and in need of DXA screening. There is still a need for further development and validation of screening tools in both men and ethnicities other than Caucasian.

Predictors of change in calcium intake in postmenopausal women after osteoporosis screening.

Osteoporosis is a serious public health concern. Understanding the extent to which a bone density assessment affects change in dietary intake in postmenopausal women is needed. This study investigated whether results of bone density screening tests resulted in reported initiation or change in either dietary and/or supplemental calcium intake. Between 1997 and 2000, dual-energy X-ray absorptiometry (DXA) screening was conducted on 1468 postmenopausal women as part of an ancillary study of the Women's Health Initiative Observational Study in Buffalo, New York. One year after bone density testing, a questionnaire was sent to determine change in lifestyle behaviors and dietary intake. Participants included in this analysis were 923 Caucasian women who had not had a prior bone density screening test, reported no prior diagnosis of osteoporosis and were not taking medication (other than hormone therapy) for osteoporosis. Of these, according to WHO T-score criteria, 36% had osteoporosis, 48% had osteopenia, and 17% had normal bone density. Factors associated (P < 0.05) with increase in calcium intake in crude analyses included: BMI, follow-up consultation with a health care provider, and osteopenia or osteoporosis compared with normal T-score level. In multivariate adjusted analyses, both osteopenia [OR = 2.37, 95% CI (1.45-3.89); P = 0.001] and osteoporosis [OR = 3.86, 95% CI (2.30-6.46); P = <0.001] found on DXA were strong independent predictors of women's decision to start or increase calcium intake. This study provided evidence that the results of osteoporosis DXA screening influence postmenopausal women's decisions to increase calcium intake.