A conceptual and disease model framework for osteoporotic kyphosis

This paper presents a multi-method research project to develop a conceptual framework for measuring outcomes in studies of osteoporotic kyphosis. The research involved literature research and qualitative interviews among clinicians who treat patients with kyphosis and among patients with the condition.

INTRODUCTION

Kyphosis due to at least one vertebral compression fracture is prevalent among osteoporotic patients, resulting in well-documented symptoms and impact on functioning and well-being. A three-part study led to development of a conceptual measurement framework for comprehensive assessment of symptoms, impact, and treatment benefit for kyphosis.

METHODS

A literature-based disease model (DM) was developed and tested with physicians (n = 10) and patients (n = 10), and FDA guidelines were used to develop a final disease model and a conceptual framework.

RESULTS

The DM included signs, symptoms, causes/triggers, exacerbations, and functional status associated with kyphosis. The DM was largely confirmed, but physicians and patients added several concepts related to impact on functioning, and some concepts were not confirmed and removed from the DM.

CONCLUSIONS

This study confirms the need for more comprehensive assessment of health outcomes in kyphosis, as most current studies omit key concepts.

Preventing type 2 diabetes after gestational diabetes: women's experiences and implications for diabetes prevention interventions

AIMS

To explore factors influencing post-natal health behaviours following the experience of gestational diabetes, and to elicit women's views about the feasibility of lifestyle intervention to prevent diabetes during the first 2 years after childbirth.

METHODS

Qualitative study using semi-structured interviews with women who had gestational diabetes. In phase 1 (31 women), interviews explored the experience of gestational diabetes, ideas about future risk of diabetes and factors influencing post-natal health-related behaviours. Statements were developed summarizing women's views of lifestyle change to prevent diabetes. In phase 2 (14 women), interviews explored how the passage of time had contributed to changes in health behaviour, and the statements were used to develop views about diabetes interventions.

RESULTS

Women were aware of their risk of developing diabetes, but did not always act on such knowledge. Pregnancy motivated behaviour changes to benefit the unborn child, but after delivery these changes were often not maintained. Tiredness, maternal attachment and childcare demands were prominent barriers in the early post-natal months. Later, work, family and child development became more significant barriers. Many women became more receptive to healthy eating messages around the time of weaning. Women were positive about long-term support for self-management to reduce their diabetes risk.

CONCLUSIONS

There is potential to reduce the risk of Type 2 diabetes post-natally among women with gestational diabetes. Interventions need to be developed that take into account contextual factors and competing demands, are flexible and respond to women's individual circumstances. Randomized trials of such interventions are warranted.

Mortality due to SUDEP and status epilepticus

Mortality in patients with epilepsy (PWE) is increased compared to the general population. For this reason the National Programme of Epilepsy Care, which was established under the Health Service Executive's National Director for Clinical Strategy and Programmes, identified a reduction in mortality from epilepsy as a key quality metric to monitor the success of the programme. The increased mortality is greatest in the first years after diagnosis where it is predominantly related to the underlying cause but there remains a persistent elevation in mortality rates especially amongst those with longstanding epilepsy. This group of patients is more likely to die from epilepsy, predominantly sudden unexpected death in epilepsy (SUDEP) or status epilepticus (SE). This paper identifies a number of studies on mortality in epilepsy from SE and SUDEP and uses this data to generate an estimate for annual mortality from SUDEP and SE in Ireland. These estimates indicate that mortality in patients with epilepsy due to SUDEP and SE account for between 48 and 162 deaths per year in Ireland and sources of mortality information currently available possibly underestimate the numbers involved especially if deaths due to non-convulsive status are included.