University of Manitoba

About: University of Manitoba is a education organization based out in Winnipeg, Manitoba, Canada. It is known for research contribution in the topics: Population & Health care. The organization has 31888 authors who have published 66592 publications receiving 2095493 citations.

Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use.

Abstract: All therapies currently recommended for the management of osteoporosis act mainly to inhibit bone resorption and reduce bone remodeling. PTH and its analog, teriparatide [recombinant human PTH(1-34)], represent a new class of anabolic therapies for the treatment of severe osteoporosis, having the potential to improve skeletal microarchitecture. Significant reductions in both vertebral and appendicular fracture rates have been demonstrated in the phase III trial of teriparatide, involving elderly women with at least one prevalent vertebral fracture before the onset of therapy. However, there is as yet no evidence that the antifracture efficacy of PTH will be superior to the bisphosphonates, whereas cost-utility estimates suggest that teriparatide is significantly more expensive. Teriparatide should be considered as treatment for postmenopausal women and men with severe osteoporosis, as well as for patients with established glucocorticoid-induced osteoporosis who require long-term steroid treatment. Teriparatide should also be considered for the management of individuals at particularly high risk for fractures, including subjects who are younger than age 65 and who have particularly low bone mineral density measurements (T scores < or = 3.5). Teriparatide therapy is not recommended for more than 2 yr, based, in part, on the induction of osteosarcoma in a rat model of carcinogenicity. Total daily calcium intake from both supplements and dietary sources should be limited to 1500 mg together with adequate vitamin D intake (< or =1000 U/d). Monitoring of serum calcium may be safely limited to measurement after 1 month of treatment; mild hypercalcemia may be treated by withdrawing dietary calcium supplements, reducing the dosing frequency of PTH, or both. At present, concurrent therapy with antiresorptive therapy, particularly bisphosphonates, should be avoided, although sequential therapy with such agents may consolidate the beneficial effects upon the skeleton after PTH is discontinued.

“Incivility, social undermining, bullying…oh my!”: A call to reconcile constructs within workplace aggression research

Abstract: Research in the field of workplace aggression has rapidly developed in the last two decades, and with this growth has come an abundance of overlapping constructs that fall under the broad rubric of workplace aggression While researchers have conceptually distinguished these constructs, it is unclear whether this proliferation of constructs is adding appreciably to our knowledge, or whether it is constraining the questions we ask In this paper, I consider five example constructs (ie, abusive supervision, bullying, incivility, social undermining, and interpersonal conflict) and argue that the manner in which we have differentiated these (and other) aggression constructs does not add appreciably to our knowledge of workplace aggression I then provide supplementary meta-analytic evidence to show that there is not a predictable pattern of outcomes from these constructs, and propose a restructuring of the manner in which we conceptualize workplace aggression Copyright © 2010 John Wiley & Sons, Ltd

Laboratory medicine in Africa: a barrier to effective health care.

Abstract: Providing health care in sub-Saharan Africa is a complex problem. Recent reports call for more resources to assist in the prevention and treatment of infectious diseases that affect this population, but policy makers, clinicians, and the public frequently fail to understand that diagnosis is essential to the prevention and treatment of disease. Access to reliable diagnostic testing is severely limited in this region, and misdiagnosis commonly occurs. Understandably, allocation of resources to diagnostic laboratory testing has not been a priority for resource-limited health care systems, but unreliable and inaccurate laboratory diagnostic testing leads to unnecessary expenditures in a region already plagued by resource shortages, promotes the perception that laboratory testing is unhelpful, and compromises patient care. We explore the barriers to implementing consistent testing within this region and illustrate the need for a more comprehensive approach to the diagnosis of infectious diseases, with an emphasis on making laboratory testing a higher priority.

Desire for death in the terminally ill.

Abstract: Objective: Euthanasia and physician-assisted suicide have become prominent medical and social issues. This study investigated the prevalence of the desire for death in terminally ill patients, the stability of this desire over time, and its association with psychiatric disorders. Method: Two hundred terminally ill inpatients were given semistructured interviews that assessed their desire for death and evaluated theni for major and minor depressive episodes according to the Research Diagnostic Criteria. Each patient also completed a short form of the Beck Depression Inventory and provided ratings ofpain and socialsupport. When possible, patients who expressed a desire for death received a follow-up interview after a 2-week interval. Results: Although occasional wishes that death would come soon were common (reported by 44.5% of the patients), only I 7 (8.5%) of these individuals acknowledged a serious and pervasive desire to die. The desire for death was correlated with ratings of pain and low family support but most significantly with measures ofdepression. The prevalence ofdiagnosed depressive syndromes was 58.8% among patients with a desire to die and 7.7% among patients without such a desire. Follow-up interviews were conducted with six patients; in four cases, the desire to die had decreased during the 2-week interval. Conclusions: The desire for death in terminally ill patients is closely associated with clinical depression-a potentially treatable condition-and can also decrease over time. Informed debate about euthanasia should recognize the importance of psychiatric considerations, as well as the inherent transience of many patients ‘expressed desire to die. (AmJ Psychiatry 1995; 152:1185-1191)