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      Exercise has a positive impact on bone mineral density in seropositive human immunodeficiency virus: do health professionals know?

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          Abstract

          Abstract Introduction: Despite the concomitant negative effects of human immunodeficiency virus on bone mineral density in HIV-infected persons, studies on knowledge of effect of exercise on this health parameter in HIV population among health professionals seem unavailable. This study therefore examined knowledge on effect of exercise on BMD in HIV-infected persons among health professionals. Material and methods: This cross-sectional survey employed researcher designed, experts - validated questionnaire to enroll 434 respondents. The reliability coefficient “r” of the questionnaire was 0.75 with 92% response rate. Descriptive and inferential statistics were used to summarize and analyze the data respectively. The alpha value was set at 0.05. Results: Age range and mean age in years of the respondents were 21–59 and 35.88 ± 9.09 respectively; age group of 30–39 years predominated (45.3%). Males were in preponderance (52.4%), and most (74.4%) were married; while majority (54.7%) were nurses. Substantial proportion (54.2%) had less than good knowledge on the subject examined in this study. Significant difference (p < 0.05; p = 0.015) in knowledge on effect of exercise on BMD in HIV population existed among the professions. Post hoc showed that knowledge of the physicians (p = 0.001) and laboratory scientists (p = 0.029) were significantly higher than that of the nurses. Physiotherapists' knowledge on this subject compared to that of other health professionals was statistically insignificant (p > 0.05). Conclusions: Knowledge on effect of exercise on BMD in HIV infected persons among health professionals was surprisingly below expectation, and therefore should be seen as a cause for concerned exercise scientists and public health experts.

          Translated abstract

          Resumen Introducción: A pesar de los efectos negativos concomitantes del virus de la inmunodeficiencia humana sobre la densidad mineral ósea en personas con VIH, los estudios sobre el conocimiento del efecto del ejercicio sobre este parámetro de salud en la población con VIH entre los profesionales de la salud parecen no estar disponibles. Por lo tanto, este estudio examinó el conocimiento sobre el efecto del ejercicio en la DMO en personas infectadas por el VIH entre los profesionales de la salud. Material y métodos: esta encuesta transversal empleó un cuestionario validado por expertos y diseñado por investigadores para inscribir a 434 encuestados. El coeficiente de confiabilidad “r” del cuestionario fue de 0,75 con una tasa de respuesta del 92%. Se utilizaron estadísticas descriptivas e inferenciales para resumir y analizar los datos respectivamente. El valor alfa se fijó en 0,05. Resultados: El rango de edad y la edad media en años de los encuestados fueron 21-59 y 35,88 ± 9,09 respectivamente; Predominó el grupo de edad de 30 a 39 años (45,3%). Predominaron los varones (52,4%) y la mayoría (74,4%) estaban casados; mientras que la mayoría (54,7%) eran enfermeras. Una proporción sustancial (54,2%) tenía menos que un buen conocimiento sobre el tema examinado en este estudio. Existió una diferencia significativa (p < 0,05; p = 0,015) en el conocimiento sobre el efecto del ejercicio en la DMO en la población con VIH entre las profesiones. Post hoc mostró que el conocimiento de los médicos (p = 0,001) y los científicos de laboratorio (p = 0,029) fue significativamente mayor que el de las enfermeras. El conocimiento de los fisioterapeutas sobre este tema en comparación con el de otros profesionales de la salud fue estadísticamente insignificante (p > 0,05). Conclusiones: El conocimiento sobre el efecto del ejercicio sobre la DMO en personas infectadas por el VIH entre los profesionales de la salud fue sorprendentemente inferior a las expectativas y, por lo tanto, debe verse como una causa para los científicos del ejercicio y los expertos en salud pública preocupados.

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          Exercise for preventing and treating osteoporosis in postmenopausal women.

          Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas mechanical loading through exercise increases bone mass. To examine the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women. During the update of this review we updated the original search strategy by searching up to December 2010 the following electronic databases: the Cochrane Musculoskeletal Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2010 Issue 12); MEDLINE; EMBASE; HealthSTAR; Sports Discus; CINAHL; PEDro; Web of Science; Controlled Clinical Trials; and AMED. We attempted to identify other studies by contacting experts, searching reference lists and searching trial registers. All randomised controlled trials (RCTs) that met our predetermined inclusion criteria. Pairs of members of the review team extracted the data and assessed trial quality using predetermined forms. For dichotomous outcomes (fractures), we calculated risk ratios (RRs) using a fixed-effect model. For continuous data, we calculated mean differences (MDs) of the percentage change from baseline. Where heterogeneity existed (determined by the I(2) statistic), we used a random-effects model. Forty-three RCTs (27 new in this update) with 4320 participants met the inclusion criteria. The most effective type of exercise intervention on bone mineral density (BMD) for the neck of femur appears to be non-weight bearing high force exercise such as progressive resistance strength training for the lower limbs (MD 1.03; 95% confidence interval (CI) 0.24 to 1.82). The most effective intervention for BMD at the spine was combination exercise programmes (MD 3.22; 95% CI 1.80 to 4.64) compared with control groups. Fractures and falls were reported as adverse events in some studies. There was no effect on numbers of fractures (odds ratio (OR) 0.61; 95% CI 0.23 to 1.64). Overall, the quality of the reporting of studies in the meta-analyses was low, in particular in the areas of sequence generation, allocation concealment, blinding and loss to follow-up. Our results suggest a relatively small statistically significant, but possibly important, effect of exercise on bone density compared with control groups. Exercise has the potential to be a safe and effective way to avert bone loss in postmenopausal women.
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            Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial.

            Tenofovir disoproxil fumarate (DF) is a once-daily nucleotide analogue reverse transcriptase inhibitor. To evaluate the efficacy and safety of tenofovir DF compared with stavudine in antiretroviral-naive patients. A prospective, randomized, double-blind study conducted at 81 centers in the United States, South America, and Europe from June 9, 2000, to January 30, 2004. A total of 753 patients infected with HIV who were antiretroviral naive were screened and 602 patients entered the study. Patients were randomized to receive either tenofovir DF (n = 299) or stavudine (n = 303), with placebo, in combination with lamivudine and efavirenz. Proportion of patients with HIV RNA levels of less than 400 copies/mL at week 48. In the primary intent-to-treat analysis in which patients with missing data or who added or switched antiretroviral medications before week 48 were considered as failures, the proportion of patients with HIV RNA of less than 400 copies/mL at week 48 was 239 (80%) of 299 in patients receiving tenofovir DF and 253 (84%) of 301 in patients receiving stavudine (95% confidence interval, -10.4% to 1.5%), exceeding the predefined -10% limit for equivalence. However, equivalence was demonstrated in the secondary analyses (HIV RNA <50 copies/mL) at week 48 and through 144 weeks. Virologic failure was associated most frequently with efavirenz and lamivudine resistance. Through 144 weeks, the K65R mutation emerged in 8 and 2 patients in the tenofovir DF and stavudine groups, respectively (P =.06). A more favorable mean change from baseline in fasting lipid profile was noted in the tenofovir DF group at week 144: for triglyceride levels (+1 mg/dL for tenofovir DF [n = 170] vs +134 mg/dL for stavudine [n = 162], P<.001), total cholesterol (+30 mg/dL [n = 170] vs +58 mg/dL [n = 162], P<.001), direct low-density lipoprotein cholesterol (+14 mg/dL [n = 169] vs +26 mg/dL [n = 161], P<.001), and high-density lipoprotein cholesterol (+9 mg/dL [n = 168] vs +6 mg/dL [n = 154], P =.003). Investigator-reported lipodystrophy was less common in the tenofovir DF group compared with the stavudine group (9 [3%] of 299 vs 58 [19%] of 301, P<.001). The number of bone fractures and the renal safety profile were similar between the 2 groups. Through 144 weeks, the combination of tenofovir DF, lamivudine, and efavirenz was highly effective and comparable with stavudine, lamivudine, and efavirenz in antiretroviral-naive patients. However, tenofovir DF appeared to be associated with better lipid profiles and less lipodystrophy.
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              Osteoporosis in children and adolescents.

              In recent years, the issue of low bone density in children and adolescents has attracted much attention. The classical definition of osteoporosis should be valid at any age, yet its practical applicability to children and adolescents remains a matter of debate and there is no consensus on a diagnosis based solely on the BMD value. The clinical relevance of uncomplicated low bone density in the young and its long-term consequences remain difficult to evaluate and there is only preliminary evidence that the BMD value is a predictor of fracture risk in growing subjects. Moreover, the interpretation of densitometric data in the young is difficult because the "normal" BMD values to be used for comparison are continuously changing with age, and in addition, depend on several variables, such as gender, body size, pubertal stage, skeletal maturation and ethnicity. Although Z-score values below -2 are generally considered a serious warning, most bone specialists make a diagnosis of osteoporosis in children and adolescents only in the presence of low BMD and at least one fragility fracture. The scope of this review is limited to presenting a picture of the available knowledge. The literature on fractures will be presented in detail, since fractures are one of the key elements in the debate. There are countless papers on fractures in childhood and adolescence, but very few of them attempt to identify fragility fractures, and still fewer develop the concept of osteoporosis in the young in relation to fractures. The different forms of primary and secondary osteoporosis, the more technical aspects of bone densitometry in pediatrics, and the delicate issue of treatment will be discussed only briefly.
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                Author and article information

                Journal
                ijm
                Iberoamerican Journal of Medicine
                Iberoam J Med
                Hospital San Pedro (Logroño, La Rioja, Spain )
                2695-5075
                2695-5075
                2023
                : 5
                : 2
                : 57-67
                Affiliations
                [5] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                [4] Maiduguri Borno orgnameUniversity of Maiduguri orgdiv1Department of Medical Rehabilitation (Physiotherapy) Nigeria
                [2] Maiduguri Borno orgnameUniversity of Maiduguri orgdiv1Department of Medical Rehabilitation (Physiotherapy) Nigeria
                [8] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                [11] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                [12] Awka orgnameNnamdi Azikiwe University orgdiv1Department of Psychology Nigeria
                [9] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                [1] Ishaka orgnameKampala International University, Western Campus orgdiv1Department of Physiotherapy Uganda
                [6] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                [7] Maiduguri Borno orgnameUniversity of Maiduguri orgdiv1Department of Medical Rehabilitation (Physiotherapy) Nigeria
                [3] Maiduguri Borno orgnameUniversity of Maiduguri orgdiv1Department of Medical Rehabilitation (Physiotherapy) Nigeria
                [10] Anambra State orgnameNnamdi Azikiwe University, Nnewi Campus orgdiv1Department of Medical Rehabilitation Nigeria
                Article
                S2695-50752023000200002 S2695-5075(23)00500200002
                10.53986/ibjm.2023.0010
                d498940a-bdc1-4c9a-8c4d-7e41b8bc1123

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 10 November 2022
                : 17 February 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 11
                Product

                SciELO Spain

                Categories
                Original Article

                Densidad mineral del hueso,Virus de immunodeficiencia humana,Machos,Fisioterapeutas,Bone mineral density,Human immunodeficiency virus,Males,Physiotherapists

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