Concurrent exposure of bottlenose dolphins (Tursiops truncatus) to multiple algal toxins in Sarasota Bay, Florida, USA

Sentinel species such as bottlenose dolphins (Tursiops truncatus) can be impacted by large-scale mortality events due to exposure to marine algal toxins. In the Sarasota Bay region (Gulf of Mexico, Florida, USA), the bottlenose dolphin population is frequently exposed to harmful algal blooms (HABs) of Karenia brevis and the neurotoxic brevetoxins (PbTx; BTX) produced by this dinoflagellate. Live dolphins sampled during capture-release health assessments performed in this region tested positive for two HAB toxins; brevetoxin and domoic acid (DA). Over a ten-year study period (2000–2009) we have determined that bottlenose dolphins are exposed to brevetoxin and/or DA on a nearly annual basis (i.e., DA: 2004, 2005, 2006, 2008, 2009; brevetoxin: 2000, 2004, 2005, 2008, 2009) with 36% of all animals testing positive for brevetoxin (n = 118) and 53% positive for DA (n = 83) with several individuals (14%) testing positive for both neurotoxins in at least one tissue/fluid. To date there have been no previously published reports of DA in southwestern Florida marine mammals, however the May 2008 health assessment coincided with a Pseudo-nitzschia pseudodelicatissima bloom that was the likely source of DA observed in seawater and live dolphin samples. Concurrently, both DA and brevetoxin were observed in common prey fish. Although no Pseudo-nitzschia bloom was identified the following year, DA was identified in seawater, fish, sediment, snails, and dolphins. DA concentrations in feces were positively correlated with hematologic parameters including an increase in total white blood cell (p = 0.001) and eosinophil (p<0.001) counts. Our findings demonstrate that dolphins within Sarasota Bay are commonly exposed to two algal toxins, and provide the impetus to further explore the potential long-term impacts on bottlenose dolphin health.

黄土高原丘陵沟壑区草地植物群落健康动态评价

植被恢复重建是遏制水土流失的有效措施之一,研究植被恢复重建过程、评价植物群落健康状况对加速植被建设具有重要的实践意义。本文根据黄土丘陵沟壑区的特点,建立了植物群落健康评价指标体系,对草地植被恢复重建过程中的不同阶段的植物群落的健康状况进行了评价。结果表明:植被群落活力变化过程呈抛物线型;群落组织力基本呈波动性变化;恢复力的变化则与活力变化过程相反,在群落活力达到最高水平时,群落的恢复力降至最低;土壤健康呈波动性上升的变化趋势。综合评价表明,植物群落健康水平随着演替过程的发展呈波动性且逐渐上升的变化过程。

额济纳天然绿洲景观格局、动态、演化机制及其健康评价

额济纳天然绿洲位于我国西北干旱内流区黑河流域下游，近年来，随着黑河中、上游地区下泄地表径流量的减少，额济纳天然绿洲面临的生态环境问题日益突出。本文以额济纳天然绿洲景观为研究对象，以景观生态学及生态系统健康学原理为基础，综合运用35技术，基于研究区1987年、1994年和2001年的景观格局、动态变化特征及其演化机制的研究，发展并构建了额济纳天然绿洲景观健康评价指标体系及评价标准，对研究区景观健康问题进行了深入探讨与评价，从而为保护地区景观健康、维持区域生态安全提供科学依据。主要研究结果：①研究区景观属于典型的"基质一廊道一斑块"景观结构特征，景观破碎化程度较高，具有较低的景观多样性和较为粗糙的景观质地特征。②近巧年来研究区水域面积急剧萎缩、绿洲面积明显缩减、荒漠化程度较为严重；景观斑块形状复杂性及景观异质性程度下降，景观质地变得越发粗糙，景观多样性及景观稳定性降低。③上游入境水量的锐减是研究区景观发生退化的根本原因，绿洲人类活动强度的增加、绿洲关键区域的超载和过牧及蒸发度的升高、湿润系数的下降均加剧了研究区景观退化的程度。④基于35项景观变化、生物物理、生态环境及社会经济指标构建了研究区景观健康评价指标体系，运用模糊综合评判方法得出研究区景观健康指数LHI为0.1972，位于健康评价级别中"濒危的"级别偏下的位置。说明近十多年来研究区的景观健康状况较早时期相比趋于恶化，其发展态势表现出严重的不可持续性。

基于遥感和GIS的巢湖流域生态系统健康评价

该文以巢湖流域为研究对象,以生态系统健康理论为基础,将流域生态系统的结构和功能结合起来,通过遥感和地理信息系统(GIS)技术获取生态环境变化信息,监测和评价小流域单元的健康状况,分析人类活动对生态系统结构和功能变化的影响,为巢湖流域的生态管理和政策制定提供指导.论文的主要内容包括:1、从生态系统研究的发展入手,对生态系统健康研究的发展、评价指标、度量、研究尺度、评价单元选择进行了概括,提出生态系统健康评价应以结构和功能评价为基础、把人类作为生态系统的一部分,对生态系统进行动态监测.2、以压力-状态-反映指标为概念框架,设计了巢湖流域生态系统健康评价指标体系;3、利用RS和GIS技术获取巢湖流域内各个小流域的生态系统数据,解决了小流域人口和社会经济数据获取难的问题;4、基于GIS技术,对流域生态系统健康评价状况进行定量评价,在此基础上,采用典型相关分析方法,分析了人类社会经济活动变化与生态系统健康状况变化的关系;分析了小流域NDVI多年月变化与生态系统健康状况的关系.

Program, abstracts and related documents.

The context: Soil biodiversity and sustainable agriculture; Abstracts - Theme 1: Monitoring and assessment: Bioindicators of soil health: assessment and monitoring for sustainable agriculture; Practical tools to measure soil health and their use by farmers; Biological soil quality from biomass to biodiversity - importance and resilience to management stress and disturbance; Integrated management of plant-parasitic nematodes in maize-bean cropping systems; Microbial quantitative and qualitative changes in soils under different crops and tillage management systems in Brazil; Diversity in the rhizobia associated with Phaseolus vulgaris L: in Ecuador and comparisons with Mexican bean rhizobia; Sistemas integrados ganadería-agricultura en Cuba; Soil macrofauna as bioindicator of soil quality; Biological functioning of cerrado soils; Hydrolysis of fluorescein diacetate as a soil quality indicator in different pasture systems; Soil management and soil macrofauna communities at Embrapa Soybean, Londrina, Brazil; Soil macrofauna in a 24 - year old no-tillage system in Paraná, Brazil; Invertebrate macrofauna of soils inpastures under different forms of management in the cerrado (Brazil); Soil tillage modifies the invertebrate soil macrofauna community; Soil macrofauna in various tillage and land use systems on an oxisols near Londrina, Paraná, Brazil; Interference of agricultural systems on soil macrofauna; Scarab beetle-grub holes in various tillage and crop management systems at Embrapa Soybean, Londrina, Brazil; Biological management of agroecosystems; Soil biota and nutrient dynamics through litterfall in agroforestry system in Rondônia, Amazônia, Brazil; Soil-C stocks and earthworm diversity of native and introduced pastures in Veracruz, Mexico; Theme 2 : Adaptive management: Some thoughts on the effects and implications of the transition from weedy multi-crop to wead-free mono-crop systems in Africa; Towards sustainable agriculture with no-tillage and crop rotation systems in South Brazil; Effect of termites on crusted soil rehabilitation in the Sahel; Management of macrofauna in traditional and conventional agroforestry systems from India with special reference to termites and earthworms; Adaptive management for redeveloping traditional agroecosystems; Conservation and sustainable use of soil biodiversity: learning with master nature!; Convergence of sciences: inclusive technology innovation processes for better integrated crop/vegetation, soil and biodiversity management; Potential for increasing soil biodiversity in agroecosystems; Biological nitrogen fixation and sustainability in the tropics; Theme 3: Research and innovation: Plant flavonoids and cluster roots as modifiers of soil biodiversity; The significance of biological diversity in agricultural soil for disease suppressiveness and nutrient retention; Linking above - and belowground biodiversity: a comparison of agricultural systems; Insect-pests in biologically managed oil and crops: the experience at ICRISAT; Sistemas agricolas micorrizados en Cuba; The effect of velvetbean (Mucuna pruriens) on the tropical earthworm Balanteodrilus pearsei: a management option for maize crops in the Mexican humid tropics; The potential of earthworms and organic matter quality in the rehabilitation of tropical soils; Research and innovation in biological management of soil ecosystems; Application of biodynamic methods in the Egyptian cotton sector; Theme 4: Capacity building and mainstreaming: Soil ecology and biodiversity: a quick scan of its importance for government policy in The Netherlands; Agrotechnological transfer of legume inoculants in Eastern and Southern Africa; Agricultura urbana en Cuba; Soil carbon sequestration for sustaining agricultural production and improving the environment; Conservation and sustainable management of below-ground biodiversity: the TSBF-BGBD network project; The tropical soil biology and fertility institute of CIAT (TSBF); South-South initiative for training and capacity building for the management of soil biology/biodiversity; Strategies to facilititate development and adoption of integrated resource management for sustainable production and productivity improvement; The challenge program on biological nitrogen fixation (CPBNF); Living soil training for farmers: improving knowledge and skills in soil nutrition management; Do we need an inter-governmental panel on land and soil (IPLS)? Protection and sustainable use of biodiversity of soils; Cases Studies -- Plant parasitic nematodes associated with common bean (Phaseolus vulgaris L.) and integrated management approaches; Agrotechnological transfer of legume inoculants in Eastern and Southern Africa; Restoring soil fertility and enhancing productivity in Indian tea plantations with earthworms and organic fertilizers; Managing termites and organic resources to improve soil productivity in the Sahel; Overview and case studies on biological nitrogen fixation: perspectives and limitations; Soil biodiversity and sustainable agriculture: an overview.

History taking and clinical examination skills from a stoma nurse’s perspective

Comprehensive history-taking and clinical examination skills are examples of role development for a stoma care nurse specialist. Comprehensive history-taking is a thorough exploration of a patient's presenting complaint and the gathering of subjective information, while clinical examination is the gathering of objective information from a head-to-toe assessment or a focused assessment of a particular body system. This paper demonstrates the application of comprehensive history-taking and gastrointestinal clinical examination skills by the stoma care nurse in a clinical community setting, and explores their advantages and disadvantages in stoma care practice.

Determinants of mother-baby relationship evaluated during pregnancy

ABSTRACT Background Mental health promotion is supported by a strong body of knowledge and is a matter of public health with the potential of a large impact on society. Mental health promotion programs should be implemented as soon as possible in life, preferably starting during pregnancy. Programs should focus on malleable determinants, introducing strategies to reduce risk factors or their impact on mother and child, and also on strengthening protective factors to increase resilience. The ambition of early detecting risk situations requires the development and use of tools to assess risk, and the creation of a responsive network of services based in primary health care, especially maternal consultation during pregnancy and the first months of the born child. The number of risk factors and the way they interact and are buffered by protective factors are relevant for the final impact. Maternal-fetal attachment (MFA) is not yet a totally understood and well operationalized concept. Methodological problems limit the comparison of data as many studies used small size samples, had an exploratory character or used different selection criteria and different measures. There is still a lack of studies in high risk populations evaluating the consequences of a weak MFA. Instead, the available studies are not very conclusive, but suggest that social support, anxiety and depression, self-esteem and self-control and sense of coherence are correlated with MFA. MFA is also correlated with health practices during pregnancy, that influence pregnancy and baby outcomes. MFA seems a relevant concept for the future mother baby interaction, but more studies are needed to clarify the concept and its operationalization. Attachment is a strong scientific concept with multiple implications for future child development, personality and relationship with others. Secure attachment is considered an essential basis of good mental health, and promoting mother-baby interaction offers an excellent opportunity to intervention programmes targeted at enhancing mental health and well-being. Understanding the process of attachment and intervening to improve attachment requires a comprehension of more proximal factors, but also a broader approach that assesses the impact of more distal social conditions on attachment and how this social impact is mediated by family functioning and mother-baby interaction. Finally, it is essential to understand how this knowledge could be translated in effective mental health promoting interventions and measures that could reach large populations of pregnant mothers and families. Strengthening emotional availability (EA) seems to be a relevant approach to improve the mother-baby relationship. In this review we have offered evidence suggesting a range of determinants of mother-infant relationship, including age, marital relationship, social disadvantages, migration, parental psychiatric disorders and the situations of abuse or neglect. Based on this theoretical background we constructed a theoretical model that included proximal and distal factors, risk and protective factors, including variables related to the mother, the father, their social support and mother baby interaction from early pregnancy until six months after birth. We selected the Antenatal Psychosocial Health Assessment (ALPHA) for use as an instrument to detect psychosocial risk during pregnancy. Method Ninety two pregnant women were recruited from the Maternal Health Consultation in Primary Health Care (PHC) at Amadora. They had three moments of assessment: at T1 (until 12 weeks of pregnancy) they filed out a questionnaire that included socio-demographic data, ALPHA, Edinburgh post-natal Depression Scale (EDPS), General Health Questionnaire (GHQ) and Sense of Coherence (SOC); at T2 (after the 20th weeks of pregnancy) they answered EDPS, SOC and MFA Scale (MFAS), and finally at T3 (6 months after birth), they repeated EDPS and SOC, and their interaction with their babies was videotaped and later evaluated using EA Scales. A statistical analysis has been done using descriptive statistics, correlation analysis, univariate logistic regression and multiple linear regression. Results The study has increased our knowledge on this particular population living in a multicultural, suburb community. It allow us to identify specific groups with a higher level of psychosocial risk, such as single or divorced women, young couples, mothers with a low level of education and those who are depressed or have a low SOC. The hypothesis that psychosocial risk is directly correlated with MFAS and that MFA is directly correlated with EA was not confirmed, neither the correlation between prenatal psychosocial risk and mother-baby EA. The study identified depression as a relevant risk factor in pregnancy and its higher prevalence in single or divorced women, immigrants and in those who have a higher global psychosocial risk. Depressed women have a poor MFA, and a lower structuring capacity and a higher hostility to their babies. In average, depression seems to reduce among pregnant women in the second part of their pregnancy. The children of immigrant mothers show a lower level of responsiveness to their mothers what could be transmitted through depression, as immigrant mothers have a higher risk of depression in the beginning of pregnancy and six months after birth. Young mothers have a low MFA and are more intrusive. Women who have a higher level of education are more sensitive and their babies showed to be more responsive. Women who are or have been submitted to abuse were found to have a higher level of MFA but their babies are less responsive to them. The study highlights the relevance of SOC as a potential protective factor while it is strongly and negatively related with a wide range of risk factors and mental health outcomes especially depression before, during and after pregnancy. Conclusions ALPHA proved to be a valid, feasible and reliable instrument to Primary Health Care (PHC) that can be used as a total sum score. We could not prove the association between psychosocial risk factors and MFA, neither between MFA and EA, or between psychosocial risk and EA. Depression and SOC seems to have a clear and opposite relevance on this process. Pregnancy can be considered as a maturational process and an opportunity to change, where adaptation processes occur, buffering risk, decreasing depression and increasing SOC. Further research is necessary to better understand interactions between variables and also to clarify a better operationalization of MFA. We recommend the use of ALPHA, SOC and EDPS in early pregnancy as a way of identifying more vulnerable women that will require additional interventions and support in order to decrease risk. At political level we recommend the reinforcement of Immigrant integration and the increment of education in women. We recommend more focus in health care and public health in mental health condition and psychosocial risk of specific groups at high risk. In PHC special attention should be paid to pregnant women who are single or divorced, very young, low educated and to immigrant mothers. This study provides the basis for an intervention programme for this population, that aims to reduce broad spectrum risk factors and to promote Mental Health in women who become pregnant. Health and mental health policies should facilitate the implementation of the suggested measures.

Does Education Setting Influence the Relationship between Substance use and Depression among Post Secondary Students

Background. This study examined whether experiences of and relationships between depressive symptoms and substance use differs for first year college and university students. Methods. A proportionate stratified random sample of 6,100 university students and a census sample of 7,300 college students were invited to anonymously complete the National College Health Assessment. The final sample included 444 young adult first year university (n = 298) and college (n = 146) students. Results. More college than university students used tobacco (26.7; 11.1%) and marijuana (26.7%; 20.8%). Similar proportions consumed alcohol (75.3%; 76.5%). Almost all students reported past-year depressive symptoms. Mean number of symptoms was 5.43. Tobacco, alcohol and marijuana use were each positively associated with depression after adjusting for age and gender. Educational setting moderated the relationship between depression and tobacco use, and depression and marijuana use, with the relationship being stronger for university students. Implications. University campus health professionals especially, need to assess depression among students using substances and vice versa. Differences between college and university students require further attention.

Evaluación de una herramienta educativa en conocimiento de donación y trasplante de órganos y tejidos en Colombia

El trasplante de órganos es considerado uno de los avances más significativos de la medicina moderna y es un procedimiento cada vez más exitoso en términos de supervivencia de los pacientes, siendo actualmente la mejor opción de tratamiento para los pacientes con innumerables patologías. El proceso de donación es insuficiente para cubrir las necesidades de trasplante de la población, por lo tanto, se hace necesario el desarrollo de nuevas estrategias para fortalecer la experiencia y efectividad de los programas existentes. La falta de conocimiento de los profesionales de la salud, su percepción y actitud hacia temas relacionados con el proceso de donación, pueden convertirlos en facilitadores o barreras para la identificación de potenciales donantes. Por esta razón, los recursos disponibles, las actitudes hacia la donación, la legislación y conocimiento de los procesos involucrados en la donación de tejidos y órganos son críticos. Dada la influencia de los profesionales de salud se definen los objetivos de este proyecto de tesis: determinar cuál es el conocimiento y las habilidades de los profesionales de la salud encargados de los trasplantes de órganos y de tejidos en la regional 1, evaluados mediante una herramienta educativa para contribuir a mejorar un programa eficiente de Donación de Órganos y tejidos y así mismo, fijar recomendaciones en aras de aumentar las tasas de donación, con especial énfasis en la actividad hospitalaria en el país. METODOLOGIA Se realizó un estudio basado en el análisis de la evaluación de conocimientos del proceso donación- trasplante de órganos y tejidos en el personal de salud participante en la herramienta educativa llamada “Curso taller primer respondiente del potencial donante de órganos y tejidos”. Este curso incluía un formato evaluativo que fue diligenciado de manera anónima por los participantes antes y después de recibir el contenido del curso. El estudio se desarrolló en personal de la Salud de IPS pertenecientes a la Regional I, de la Red Nacional de donación y trasplantes de órganos y tejidos. Con el fin de evidenciar si existen diferencias en el conocimiento de los participantes del curso antes y después de asistir al mismo, se utilizó la prueba de McNemar (p< 0.05). RESULTADOS Entre julio del 2011 y junio del 2012, se realizó el “Curso taller primer respondiente del potencial donante de órganos y tejidos” y se obtuvieron 303 encuestados incluidos médicos, enfermeras y auxiliares de enfermería. Al inicio del curso las respuestas acertadas con relación a legislación, selección del donante, muerte encefálica y mantenimiento del donante estuvieron alrededor del 50%. No fue posible detectar la profesión que pudiese generar riesgo en la detección del donante y los procesos asociados. Posterior al curso, el 72% de las preguntas se respondieron de manera correcta, lo que representa un incremento estadísticamente significativo. Este cambio evidenció significancia estadística al usar la prueba de McNemar y arrojar un valor de p=0.00. .DISCUSIÓN El personal de salud participante en el curso taller proveniente de unidades involucradas como generadoras de donantes muestra un déficit de conocimientos del proceso donación trasplantes lo que puede convertirlos en limitantes para dicho proceso

Análisis de la producción escrita en revistas internacionales especializadas en terapia ocupacional (American Journal of Occupational Therapy – Canadian Journal of Occupational Therapy) sobre el concepto de desempeño ocupacional en el periodo comprendido entre 1996 – 2006

En todas las etapas de la vida, las personas se encuentran influenciadas por el ambiente, el cual es un facilitador o inhibidor para el desarrollo de sus actividades, permitiéndole elegir qué ocupaciones desea desempeñar de acuerdo a sus intereses y habilidades. Es por ello que el presente trabajo sustenta el objeto de estudio por medio de la revisión, análisis y reflexión de textos especializados en terapia ocupacional en el periodo comprendido entre 1996 – 2006, en las revistas Canadiense y Americana de Terapia Ocupacional, encontradas en la Biblioteca Ciencias de la Salud de la Universidad del Rosario.

salud financiera y riesgo en los estados financieros de la empresa avianca del sector aeronautico

La globalización y la competitividad como realidad de las empresas, implica que los gerentes preparen a sus empresas de la mejor manera para sobrevivir en este mundo tan inestable y cambiante. El primer paso consta de investigar y medir como se encuentra la empresa en cada uno de sus componentes, tales como recurso humano, mercadeo, logística, operación y por último y más importante las finanzas. El conocimiento de salud financiera y de los riesgos asociados a la actividad de las empresas, les permitirá a los gerentes tomar las decisiones correctas para ser rentables y perdurables en el mundo de los negocios inmerso en la globalización y competitividad. Esta apreciación es pertinente en Avianca S.A. esto teniendo en cuenta su progreso y evolución desde su primer vuelo el 5 de diciembre de 1919 comercial, hasta hoy cuando cotiza en la bolsa de Nueva York. Se realizó un análisis de tipo descriptivo, acompañado de la aplicación de ratios y nomenclaturas, dando lugar a establecer la salud financiera y los riesgos, no solo de Avianca sino también del sector aeronáutico. Como resultado se obtuvo que el sector aeronáutico sea financieramente saludable en el corto plazo, pero en el largo plazo su salud financiera se ve comprometida por los riegos asociados al sector y a la actividad desarrollada.

Sjuksköterskors uppfattning om munvård och munhälsobedömning hos äldre boende på särskilt boende : En intervjustudie

Syfte: Syftet med denna studie var att beskriva uppfattningen hos sjuksköterskor med tjänst på särskilda boenden gällande deras arbete med tillämpningen av munhälsobedömningar och deras uppfattning om hur munvård utförs. Metod: Studien genomfördes med kvalitativ deskriptiv design. Data samlades in hjälp av intervjuer med sjuksköterskor (n= 6).  Intervjuerna analyserades med hjälp av innehållsanalys och fyra olika teman identifierades: Sjuksköterskors uppfattning om munvård, sjuksköterskors uppfattning om munhälsobedömning, sjuksköterskors uppfattning om munvår och munhälsobedömning i samband med palliativ vård samt sjuksköterskor uppfattning om samarbete med folktandvården. Resultat: Resultatet visade sjuksköterskorna uppfattade att munhälsobedömningar sällan utförs av sjuksköterskorna. Dock ansåg de att munhälsobedömning och munvård utförs regelbundet av såväl sjuksköterskor samt omvårdnadspersonal när vårdtagarna befinner sig i livets slutskede. De eftersöker instruktioner och utbildning av munhälsobedömning enligt ROAG innan detta införs i verksamheten. Munhälsobedömning har utförts av folktandvården en gång om året och de har även kommit till boendena om det finns problem med någon vårdtagares munhälsa. Folktandvården är ansvarig för att skriva vårdtagarnas munvårdskort som är ett stöd för vårdpersonalen vid utförande av daglig munvård. Resultatet har även visat att daglig munvård utförs av undersköterskor och vårdbiträden. Slutsats: Resultatet visar att munhälsobedömning utförs bristfälligt av sjuksköterskor i den kommunala äldreomsorgen. Vidare anser de tillfrågade sjuksköterskorna att utbildning i munhälsobedömningsinstrumentet ROAG är nödvändig innan införandet.

Associations of physical activity with body weight and fat in men and women

OBJECTIVE: Increasing physical activity is strongly advocated as a key public health strategy for weight gain prevention. We investigated associations of leisure-time physical activity (LTPA) and occupational/domestic physical activity with body mass index (BMI) and a skinfold-derived index of body fat (sum of six skinfolds), among normal-weight and overweight men and women.

DESIGN: Analyses of cross-sectional self-report and measured anthropometric data.

SUBJECTS: A total of 1302 men and women, aged 18-78 y, who were part of a randomly selected sample and who agreed to participate in a physical health assessment.

MEASUREMENTS: Self-report measures of physical activity, measured height and weight, and a skinfold-derived index of body fatness.

RESULTS: Higher levels of LTPA were positively associated with the likelihood of being in the normal BMI and lower body fat range for women, but few or no associations were found for men. No associations were found between measures of occupational/domestic activity and BMI or body fat for men or women.

CONCLUSION: By using a skinfold sum as a more direct measure of adiposity, this study extends and confirms the previous research that has shown an association between BMI and LTPA. Our results suggest gender differences in the relationship of leisure-time physical activity with body fatness. These findings, in conjunction with a better understanding of the causes of such differences, will have important public health implications for the development and targeting of weight gain prevention strategies.

Peripheral quantitative computed tomography in children and adolescents : the 2007 ISCD pediatric official positions

Peripheral quantitative computed tomography (pQCT) has mainly been used as a research tool in children. To evaluate the clinical utility of pQCT and formulate recommendations for its use in children, the International Society
of Clinical Densitometry (ISCD) convened a task force to review the literature and propose areas of consensus and future research. The types of pQCT technology available, the clinical application of pQCT for bone health assessment in children, the important elements to be included in a pQCT report, and quality control monitoring techniques were evaluated. The review revealed a lack of standardization of pQCT techniques, and a paucity of data regarding differences between pQCT manufacturers, models and software versions and their impact in pediatric assessment. Measurement sites varied across studies. Adequate reference data, a critical element for interpretation of pQCT results, were entirely lacking, although some comparative data on healthy children were available. The elements of the
pQCT clinical report and quality control procedures are similar to those recommended for dual-energy X-ray absorptiometry. Future research is needed to establish evidence-based criteria for the selection of the measurement site, scan acquisition and analysis parameters, and outcome measures. Reference data that sufficiently characterize the normal range of variability in the population also need to be established.

A pilot program of physical activity promotion among clients receiving home and community care

Three Victorian local governments cooperated in a pilot study of physical activity promotion as part of home and community care (HACC) service delivery. Thirty-one people receiving HACC volunteered to participate, including completing the Transtheoretical Stages of Change Exercise Questionnaire and the short-form Stanford Health Assessment Questionnaire (HAQ) just before and at 3 months and 6 months after starting regular self-selected physical activity. Twenty-one participants returned questionnaires at 3 months, and 17 participants returned questionnaires at 6 months. Data were analysed using paired t tests and effect sizes were calculated as mean differences. At 3 months, mean improvements were identified on 6 of the 8 HAQDI (disability index) subscales, and in the overall HAQ-DI score. Improvement in dressing and grooming was preserved at 6 months. At either 3 or 6 months, improvements in dressing and grooming, reach, hygiene, and daily activities, and overall HAQ-DI score exceeded the minimum clinically important difference. No improvements were statistically significant, as is likely in a pilot study with a small sample, however, these results suggest that even very small increases in physical activity may afford clinically meaningful improvements in some areas of physical function required for independent living.