University of York

About: University of York is a education organization based out in York, York, United Kingdom. It is known for research contribution in the topics: Population & Health care. The organization has 22089 authors who have published 56925 publications receiving 2458285 citations. The organization is also known as: York University & Ebor..

Conservation of Biodiversity in a Changing Climate

Abstract: *Center for Applied Biodiversity Science, Conservation International, Washington, D.C, 20037, U.S.A.†Climate Change Research Group, Ecology and Conservation, National Botanical Institute, Cape Town, South Africa‡The World Bank, Washington, D.C. 20433, U.S.A.§Botany Department, University of Cape Town, Cape Town, South Africa**Department of Biological Sciences, College of Science and Liberal Arts, Florida Institute of Technology, Melbourne,FL 32901–6975, U.S.A.††Environment Department, University of York, York, Y010 5DD, United Kingdom‡‡Adaptation and Impacts Research Group, Environment Canada at the Faculty of Environmental Studies, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada§§Department of Animal and Plant Sciences, University of Sheffield, Sheffield, S10 2TN, United Kingdom

Hormone Replacement Therapy and Prevention of Nonvertebral Fractures: A Meta-analysis of Randomized Trials

Abstract: ContextHormone replacement therapy (HRT) is widely considered to reduce fractures, but this belief is based on observational data; evidence from randomized trials is lacking.ObjectiveTo conduct a systematic review of all randomized trials of HRT that have reported or collected nonvertebral fracture data but that may not have focused on fracture prevention.Data SourcesThe MEDLINE, EMBASE, Science Citation Index, and Cochrane Controlled Trials Register databases were searched from 1997 through 2000 and a search was conducted of all recent systematic reviews to identify older studies. Authors were contacted to establish whether fracture data had been collected but not reported. Researchers in the field and pharmaceutical companies also were contacted to try to identify unpublished studies.Study SelectionTrials were included in which participants had been randomized to at least 12 months of therapy and data on nonvertebral fractures at any other site and due to any cause were available. Of 70 initially identified studies, 22 were included in the analysis.Data ExtractionBoth investigators extracted data independently and appraised trial quality according to the Jadad scale, which assesses the methods of randomization, concealment allocation, and reporting of withdrawals and dropouts. Disagreements were resolved by discussion.Data SynthesisThere was an overall 27% reduction in nonvertebral fractures in a pooled analysis (reduction favoring HRT in relative risk [RR], 0.73; 95% confidence interval [CI], 0.56-0.94; P = .02). This effect was greater among women randomized to HRT who had a mean age younger than 60 years (RR, 0.67; 95% CI, 0.46-0.98; P = .03). Among women with a mean age of 60 years or older, there was a reduced effect (RR, 0.88; 95% CI, 0.71-1.08; P = .22). For hip and wrist fractures alone, the effectiveness of HRT appeared more marked (RR, 0.60; 95% CI, 0.40-0.91; P = .02), particularly for women younger than 60 years (RR, 0.45; 95% CI, 0.26-0.79; P = .005).ConclusionsOur meta-analysis of randomized controlled trials of HRT noted a statistically significant reduction in nonvertebral fractures. However, this effect may be attenuated in older women.

Communicating with parents about vaccination: a framework for health professionals

Abstract: A critical factor shaping parental attitudes to vaccination is the parent’s interactions with health professionals. An effective interaction can address the concerns of vaccine supportive parents and motivate a hesitant parent towards vaccine acceptance. Poor communication can contribute to rejection of vaccinations or dissatisfaction with care. We sought to provide a framework for health professionals when communicating with parents about vaccination. Literature review to identify a spectrum of parent attitudes or ‘positions’ on childhood vaccination with estimates of the proportion of each group based on population studies. Development of a framework related to each parental position with determination of key indicators, goals and strategies based on communication science, motivational interviewing and valid consent principles. Five distinct parental groups were identified: the ‘unquestioning acceptor’ (30–40%), the ‘cautious acceptor’ (25–35%); the ‘hesitant’ (20–30%); the ‘late or selective vaccinator’ (2–27%); and the ‘refuser’ of all vaccines (<2%). The goals of the encounter with each group will vary, depending on the parents’ readiness to vaccinate. In all encounters, health professionals should build rapport, accept questions and concerns, and facilitate valid consent. For the hesitant, late or selective vaccinators, or refusers, strategies should include use of a guiding style and eliciting the parent’s own motivations to vaccinate while, avoiding excessive persuasion and adversarial debates. It may be necessary to book another appointment or offer attendance at a specialised adverse events clinic. Good information resources should also be used. Health professionals have a central role in maintaining public trust in vaccination, including addressing parents’ concerns. These recommendations are tailored to specific parental positions on vaccination and provide a structured approach to assist professionals. They advocate respectful interactions that aim to guide parents towards quality decisions.