Role of bisphosphonates in the management of postmenopausal osteoporosis: an update on recent safety anxieties

Following their introduction in the 1990s, bisphosphonates have become the mainstay of treatment in the management of postmenopausal osteoporosis, and their use continues to rise. Commonly noted adverse effects in clinical practice include gastrointestinal side-effects, acute phase reactions (predominately seen with intravenous preparations) cutaneous reactions and more rarely, ocular side-effects. However, recent reports of potentially serious adverse effects of bisphosphonate therapy, including atypical subtrochanteric and femoral shaft fractures, atrial fibrillation, oesophageal carcinoma and osteonecrosis of the jaw, have prompted concerns regarding the long-term safety of this class of drugs. This review summarizes the benefits and potential adverse effects of bisphosphonates used in the treatment of postmenopausal osteoporosis. Although evidence of a definitive casual relationship between bisphosphonate therapy and serious adverse effects is lacking, concern remains particularly in relation to atypical subtrochanteric and femoral shaft fractures. This has important consequences in terms of determining optimum duration of therapy and how best to target therapy at those most at risk. Recently, attention has focused on individual fracture risk assessment in order to optimize the risk-benefit ratio of treatment for individual patients. A review of the role of hormone replacement therapy in younger women with significant risk of osteoporotic fractures may be timely in these circumstances.     

Gender and Psychotropics: Toward a Third Wave Framework

Correspondence to: Dr R. L. Farmer, School of Social Work, Virginia Commonwealth University, 1001 W. Franklin Street, Richmond, Virginia, 23284–2027 USA. E-mail rfarmer{at}atlas.vcu.edu Summary This paper highlights the fact that women are much more likelythan men to use psychotropic medications. It proposes the developmentof a new intellectual framework for understanding and respondingto the high use of psychotropic medications by women. The frameworkis developed using the conceptual space provided by Third Wavefeminisms and a Lacanian interpretation of the Hegelian dialectic.The Third Wave is seen as a viable lens for this endeavour sinceit tolerates contradictions and ambiguity and is radically opento difference and diversity. This new framework can incorporaterelevant aspects of the Discourse Model and the Medical Model.It is argued that the Third Wave framework, which includes apostmodern attitude, allows us to make use of both perspectives,since either model alone is inadequate to inform our understandingof why women are prescribed psychotropic medications so muchmore frequently than are men. The point is that each model byitself is inevitably inadequate. The answers have to be soughtfrom both models, even though these models conflict.     

Public Participation in the New NHS: No Closer to Citizen Control?

Over the last decade support for increasing public participation in decisions regarding the planning and delivery of health services has become a familiar feature of the policy agenda for the UK National Health Service. This paper reviews current Labour policy towards public participation and reports on the response of primary care groups (PCGs) to recent Labour directives to make patient and public involvement an integral part of the way they work, presenting the findings of a survey conducted in one English health region. The experience of these PCGs suggests that, despite the diverse backgrounds of board members, there is marked consensus between local and central decision makers as to their understanding of public participation. Whilst academic debates have tended to conceptualize participation in dualist terms as a form of consumerism or of citizenship, the survey data suggest that in the context of local implementation public participation is framed within a new public management perspective which values it as an aid to organizational learning. The findings of this study highlight obstacles to securing effective public participation, including a lack of substantive guidance regarding policy implementation that produces uncertainty amongst local decision makers as to how best to proceed. The inherent limitations of public participation within the new public management paradigm suggest that democratic renewal, one of the goals of the government's modernization agenda, is unlikely to be achieved.     

Who Is Hispanic? Hispanic Identity among African Americans,Asian Americans,Others, and Whites*

Hispanics are now the largest minority group in the United States and their presence is likely to continue to expand. Little is known, however, about the correlates of Hispanic identity or the processes that are involved in its maintenance. We investigate these issues by ascertaining and then seeking to understand the various associations between reported racial identities and Hispanic ethnicity using data from the Current Population Surveys. Restricting the sample to individuals who are known to have demographic origins in Latin America, our results indicate that persons with African or Asian racial identifications are substantially less likely than whites or Others to also identify as Hispanic. Relative to the first generation, Hispanic identification declines and the racial differences increase in the second generation. The exceptions in this regard are Others for whom racial and Hispanic identifications are the most highly associated for both the first and second generations. These findings are interpreted as reflecting various social processes that are involved in the development and maintenance of racial and ethnic identities. Our results provide insight into the complex, social nature of Hispanic identification in modern America.     

Kin Expectations and Kin Support Among Rural Older Adults1

Abstract Relatively little attention has been given to the kin ties of rural older adults. To partially fill this gap in knowledge, kin selection theory was used as a conceptual framework to explore two questions on the extent rural older adults expect and receive assistance from the range of affinal and consanquineal kin and the factors that best explain the current level of support provided by each of the kin types in the family system. Analysis was based on interviews conducted in 1985–1986 with 368 rural older adults in the Piedmont region of North Carolina. Expectations of kin assistance were much higher than the actual level of support that was provided. Both expected and actual levels of assistance declined as the level of consanguineous kin and associated affinal ties decreased. The level of support provided by kin groups was mainly a function of geographic distance to kin and norms of obligation.     

Networking Through Loose and Strong Ties: An Australian Qualitative Study

Given the significant role attributed to community organizations by many social capital scholars, it is appropriate to investigate the dynamics of that process. In particular, Woolcock and Narayan (World Bank Res. Obs. 15(2): 225–249, 2000) have suggested that bridging and bonding are two different types of connections, whereby bridging is associated with loose ties across communities and bonding is associated with strong ties within a limited group. This qualitative study explores the loose and strong ties of 39 participants connected through community organizations in rural and urban New South Wales. The results suggest that loose and strong ties are not synonymous with bridging and bonding. In general loose and strong ties differ in degree rather than in kind and people prefer to bridge through their strong ties. The interesting exceptions were ties to professionals, which were highly trusted but defined as loose ties. It is suggested that a model for a high social capital society might be a chain of well-bonded groups each with strong links to some other groups.     

Volunteer and coordinator perspectives on managing women volunteers

Recent changes in Australia, such as the new public management and national competition policy, have affected the way that human services are provided and have complicated the role of volunteer coordinators. However, because volunteers are free to choose their level of contribution, it is the volunteers' perspective that is the ultimate yardstick against which their coordination is assessed. The aim of the research examined here was a deeper understanding of women volunteers' and their coordinators' views of their work. The research was conducted within a qualitative paradigm, employing individual and focus group interviews. The analysis identified eight areas of concern for volunteers around their management. The analysis of the coordinators' interviews revealed three coordination styles—horizontal, nurturing, and managerial—of which the managerial was most in conflict with the volunteers' perspective.     

Labor Force Participation and Socioeconomic Status*

This study examined the relationship between labor force participation by more than one family member and the socioeconomic status of the family, as measured by the Census SES score. The data were derived from a special tabulation of the 1960 Census five percent sample tape. In general, labor force participation by more than one family member was associated with higher SES scores in both white and Negro families. Multiple wage earners in white families were associated with “above the middle” level scores, whereas in Negro families multiple wage earners appear to contribute to barely or almost attaining middle level scores.     

Profiles of behavioral problems in children who witness domestic violence

Unlike previous investigations of shelter-based samples, our study examined whether profiles of adjustment problems occurred in a community-program-based sample of 175 school-aged children exposed to domestic violence. Cluster analysis revealed three stable profiles/clusters. The largest cluster (69%) consisted of children below clinical thresholds for any internalizing or externalizing problem. Children in the next largest cluster (18%) were characterized as having externalizing problems with or without internalizing problems. The smallest cluster (13%) consisted of children with internalizing problems only. Comparison across demographic and violence characteristics revealed that the profiles differed by child gender, mother's education, child's lifetime exposure to violence, and aspects of the event precipitating contact with the community program. Clinical and future research implications of study findings are discussed.