Sarah M. Hosking

Effect of sport-tinted contact lenses for contrast enhancement on retinal straylight measurements

Purpose:  To investigate the effect of two tinted contact lenses (CL) designed for outdoor sports activity on the psychometric determination of retinal straylight using the compensation comparison method.

DNA methylation and the social gradient of osteoporotic fracture: A conceptual model

INTRODUCTION Although there is a documented social gradient for osteoporosis, the underlying mechanism(s) for that gradient remain unknown. We propose a conceptual model based upon the allostatic load theory, to suggest how DNA methylation (DNAm) might underpin the social gradient in osteoporosis and fracture. We hypothesise that social disadvantage is associated with priming of inflammatory pathways mediated by epigenetic modification that leads to an enhanced state of inflammatory reactivity and oxidative stress, and thus places socially disadvantaged individuals at greater risk of osteoporotic fracture. METHODS/RESULTS Based on a review of the literature, we present a conceptual model in which social disadvantage increases stress throughout the lifespan, and engenders a proinflammatory epigenetic signature, leading to a heightened inflammatory state that increases risk for osteoporotic fracture in disadvantaged groups that are chronically stressed. CONCLUSIONS Our model proposes that, in addition to the direct biological effects exerted on bone by factors such as physical activity and nutrition, the recognised socially patterned risk factors for osteoporosis also act via epigenetic-mediated dysregulation of inflammation. DNAm is a dynamic modulator of gene expression with considerable relevance to the field of osteoporosis. Elucidating the extent to which this epigenetic mechanism transduces the psycho-social environment to increase the risk of osteoporotic fracture may yield novel entry points for intervention that can be used to reduce individual and population-wide risks for osteoporotic fracture. Specifically, an epigenetic evidence-base may strengthen the importance of lifestyle modification and stress reduction programs, and help to reduce health inequities across social groups. MINI ABSTRACT Our conceptual model proposes how DNA methylation might underpin the social gradient in osteoporotic fracture. We suggest that social disadvantage is associated with priming of inflammatory signalling pathways, which is mediated by epigenetic modifications, leading to a chronically heightened inflammatory state that places disadvantaged individuals at greater risk of osteoporosis.

Recommendations for dietary calcium intake and bone health: the role of health literacy

Osteoporosis is a skeletal disease that involves micro-architectural deterioration of the bone matrix and depletion of bone mineral. Inadequate dietary calcium, especially in a vitamin D deficient environment, may predispose an individual to osteoporosis. Given that recommendations for daily intake (RDI) of dietary calcium differ between countries, and according to life-stages, understanding RDIs and how to achieve them is likely to be a complex process for many individuals. Health literacy, or the ability of individuals to gain access to, understand and use health-related information, will influence the capacity of individuals to meet RDIs. Furthermore, the lowest health literacy is observed in the same groups identified as having an increased risk of osteoporosis; older individuals, and those that are socially disadvantaged. It is imperative to consider the specific health literacy needs of at-risk populations when promoting recommendations for dietary calcium intake.

Comparison of fracture rates between indigenous and non-indigenous populations: a systematic review protocol

Introduction Over recent years, there has been concerted effort to ‘close the gap’ in the disproportionately reduced life expectancy and increased morbidity experienced by indigenous compared to non-indigenous persons. Specific to musculoskeletal health, some data suggest that indigenous peoples have a higher risk of sustaining a fracture compared to non-indigenous peoples. This creates an imperative to identify factors that could explain differences in fracture rates. This protocol presents our aim to conduct a systematic review, first, to determine whether differences in fracture rates exist for indigenous versus non-indigenous persons and, second, to identify any risk factors that might explain these differences. Methods and analysis We will conduct a systematic search of PubMed, OVID, MEDLINE, CINAHL and EMBASE to identify articles that compare all-cause fracture rates at any skeletal site between indigenous and non-indigenous persons of any age. Eligibility of studies will be determined by 2 independent reviewers. Studies will be assessed for methodological quality using a previously published process. We will conduct a meta-analysis and use established statistical methods to identify and control for heterogeneity where appropriate. Should heterogeneity prevents numerical syntheses, we will undertake a best-evidence analysis to determine the level of evidence for differences in fracture between indigenous and non-indigenous persons. Ethics and dissemination This systematic review will use published data; thus, ethical permissions are not required. In addition to peer-reviewed publication, findings will be presented at (inter)national conferences, disseminated electronically and in print, and will be made available to key country-specific decision-makers with authority for indigenous health.

Knowledge change regarding osteoporosis prevention: translating recommended guidelines into user-friendly messages within a community forum

BackgroundOsteoporosis is a skeletal disorder characterised by low bone mineral density and increased fracture risk. Nationally the total costs of this chronic disease are currently estimated at

The Role of Health Literacy in the Treatment of Osteoporosis.

2.754 billion annually. Effective public health messages providing clear recommendations are vital in supporting prevention efforts. This research aimed to investigate knowledge change associated with the translation of preventive guidelines into accessible messages for the community.FindingsWe delivered a community-based information session that translated recommended guidelines for osteoporosis prevention into lay terms; items focused on dietary calcium, vitamin D, physical activity, alcohol, smoking and general osteoporosis-related knowledge. We developed a 10-item questionnaire reflecting these key points (score range 0–10) and investigated knowledge change associated with the session. Pre- and post-test questionnaires were completed by 47 participants (51% female), aged 21–94 years. Relatively high pre-test scores were observed for questions regarding sedentary activity and calcium intake. The lowest pre-test scores were observed for the item concerning whether swimming and cycling strengthened bones, and the highest possible score post-test was achieved for three of the items: calcium-rich food as a protective factor, and excessive alcohol and smoking as risk factors. The overall increase in knowledge change was a mean score of +2.08 (95%CI 1.58–2.42).ConclusionsAn increase in knowledge regarding osteoporosis prevention was demonstrated over the short-term. Our findings suggest that the guidelines concerning dietary calcium are generally well understood; however, the asymptomatic nature of osteoporosis and the types of physical activity that assist with bone strength are less well understood.

Poor quality of life in Australian men: cross-sectional associations with obesity, mobility, lifestyle and psychiatric symptoms

SM Hosking, R Buchbinder, JA Pasco, LJ Williams, and SL Brennan-Olsen School of Medicine, Deakin University, Geelong, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Australia Melbourne Medical School–Western Campus, University of Melbourne, St Albans, Australia Australian Institute for Musculoskeletal Science, University of Melbourne, St Albans, Australia Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

OBJECTIVES Despite their public health importance, little is known about associations between modifiable lifestyles, quality of life (QOL), and psychiatric symptoms in men. We investigated relationships between QOL, obesity, mobility and lifestyle in Australian men, including whether associations were mediated by anxiety and depression. STUDY DESIGN A cross-sectional study of 893 men (aged 24-92 yrs) participating in the Geelong Osteoporosis Study: an age-stratified, population-based sample of men randomly recruited from the Barwon Statistical Division (BSD), in south-eastern Australia. MAIN OUTCOME MEASURES Using a validated tool, QOL was measured in the domains of physical health, psychological health, social relationships and the environment. Anxiety and depression were ascertained using the Hospital Anxiety and Depressive Scale. Models were adjusted for age, clinical measures of obesity and mobility, and self-reported lifestyles, with adjustment made for anxiety and depression. RESULTS Associations were observed between low mobility and lower psychological-related QOL (OR 0.70, 95%CI 0.53-0.93), and for smoking and low mobility with lower environment-related QOL (OR 0.48, 95%CI 0.27-0.84; OR 0.67, 95%CI 0.50-0.90, respectively). Age, anxiety and depression were independently associated with QOL in each domain. CONCLUSIONS Independent of age, anxiety and depression, smoking and low mobility showed particularly strong effects on the likelihood of men reporting a lower satisfaction with their QOL. This information will inform the design of effective and equitable health policies, the allocation of resources toward unmet needs, and the development of strategic health-related plans.

Health literacy and uptake of anti-fracture medications in a population-based sample of Australian women

Background Compared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences. Methods On 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries. Results Our search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture. Conclusions The observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

Vitamin D during pregnancy and offspring body composition: a prospective cohort study: Maternal vitamin D and child body composition

Abstract This study investigated associations between health literacy and use of anti‐fracture medications in women with osteoporosis. Data were collected for women participating in the population‐based Geelong Osteoporosis Study in Australia. Health literacy was ascertained using the Health Literacy Questionnaire (HLQ) and bone mineral density by dual x‐ray absorptiometry. Self‐reported current medications were classified using MIMS codes, with the category ‘Agent affecting calcium and bone metabolism’ indicating osteoporosis treatment. Analysis of Variance (p‐value <0.1 indicating a trend) and Cohens d effect sizes (ES [95%CI]) (categorised; Small >0.2‐<0.5, Moderate >0.5–0.8, Large >0.8) were calculated for differences in HLQ scale scores between participants who did vs. did not self‐report medication use. Among 620 women, 134 (21.6%) had osteoporosis, 14 (10.5%) of whom self‐reported current anti‐fracture medication use. Small/moderate ES indicated women taking medication had lower HLQ scores in scales ‘Navigating the healthcare system’, ‘Ability to find health information’ and ‘Understand health information’ (ES 0.36 [0.25–0.79], 0.41 [0.29–0.87] and 0.64 [0.54–1.03], respectively). A trend was observed (p = 0.09) for ‘Understand health information’ scale scores and utilisation of medication. These data suggest women with less confidence in their ability to find and understand health information may follow healthcare provider recommendations and utilise anti‐fracture medications more readily.