Background A comprehensive assessment of the association of patients’ renal replacement therapy (RRT) modality on their participation in life activities (physical function, travel, recreation, freedom, work) is needed. Study Design Systematic review of peer-reviewed published studies. Setting & Population Adults undergoing RRT (hemodialysis, peritoneal dialysis, or transplantation). Selection Criteria for Studies We searched PubMed, Cochrane Library, and EMBASE from January 1980 through April 2012 for English-language articles that compared participation in life activities among patients receiving 1) hemodialysis compared with peritoneal dialysis, 2) hemodialysis compared with kidney transplantation, or 3) peritoneal dialysis compared with kidney transplantation. Predictor RRT modality. Outcomes Reported rates of physical function, travel, recreation, freedom, and work-related activities by RRT modality. Results A total of 46 studies (6 prospective cohort, 38 cross-sectional, and 2 pre-post transplantation) provided relevant comparisons of life participation activities among patients treated with hemodialysis, peritoneal dialysis, and kidney transplantation. Studies were conducted from 1985 to 2011 among diverse patient populations in 16 distinct locations. A majority of studies reported greater life participation rates among patients with kidney transplants compared to patients receiving either hemodialysis or peritoneal dialysis. In contrast, a majority of studies reported no differences in outcomes between patients receiving hemodialysis and patients receiving peritoneal dialysis. These results were consistent throughout the study period, across diverse populations, and among the subset of studies that performed appropriate adjustments for potential confounding factors. Limitations Many studies included in the review had significant design weaknesses. Conclusions Evidence suggests patients with kidney transplants may experience better rates of life participation compared to patients receiving dialysis, while patients receiving hemodialysis and patients receiving peritoneal dialysis may experience similar rates of life participation. Rigorously performed studies are needed to better inform patients about the association of RRT on these important patient reported outcomes.

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SummaryWe investigated reasons for non-treatment of osteoporosis and discontinuation of osteoporosis therapy. Barriers to treatment include patients’ preference for alternative treatments and a fear of possible side effects. Side effects are a common reason for treatment discontinuation, and they may be associated with a lack of willingness to restart treatment.Purpose/introductionOsteoporosis patients commonly cite treatment-related side effects, or the fear thereof, as a reason for discontinuing or not initiating anti-osteoporosis medications. The purpose of this study was to investigate, from the patient’s perspective, reasons for (i) non-treatment of osteoporosis and (ii) discontinuation of osteoporosis therapy.MethodsThis was an internet-based survey of postmenopausal women in the USA who self-reported having been diagnosed with osteoporosis. Respondents were recruited from consumer research panels and received nominal compensation.ResultsWithin the surveyed population (N = 1407), 581 patients were currently being treated, 503 had never been treated, and 323 had previously been treated. Among patients never treated for osteoporosis, the highest ranking reasons for non-treatment were the use of alternative treatments such as over-the-counter vitamins/supplements (57.5 % of respondents) and fear of side effects (43.9 %). Among previously treated patients, frequent reasons for discontinuation included the direction of the physician (41.2 % of respondents), concerns about long-term safety (30.3 %), and the experience of side effects (29.8 %). When asked about their willingness to restart their osteoporosis medication, previously treated patients who were not willing (N = 104) to restart had a higher frequency of experiencing side effects (44.2 versus 20.5 % of those willing; P < 0.001).ConclusionsFrom the osteoporosis patient’s perspective, barriers to prescription treatment include a preference for alternative, non-prescription treatments and a fear of possible side effects. Side effects are one of the most common reasons for discontinuing osteoporosis medications, and they appear to be associated with a lack of willingness to restart treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s11657-016-0272-5) contains supplementary material, which is available to authorized users.

We examined recalled measures of adolescent diet, physical activity, and body size in relation to adult breast density in 201 US Chinese immigrant women recruited 1/02-5/03 from Philadelphia region screening programs. Mammographic images were classified into one of four categories ranging from "entirely fatty" to "extremely dense." Questionnaires assessed diet and physical activity between ages 12-17, relative weight and height at age 10, and weight at age 18. To estimate odds ratios (ORs), we conducted logistic regression analyses using proportional odds models for polychotomous outcomes.Higher adult breast density was significantly associated with adolescent red meat intake (adjusted 3 rd vs. 1 st tertile OR=3.0, 95% confidence interval (CI) 1.5-6.4, trend p=0.003) but not with other adolescent factors. For the association of adult acculturation with breast density, adjustment for adolescent red meat intake attenuated the OR for the highest vs. lowest level of acculturation from 2.5 (95% CI 1.2-5.3) to 1.9 (95% CI 0.9-4.0).Greater adolescent red meat intake may have increased adult breast density and partly accounted for the strong association between acculturation and breast density in this sample of immigrant Chinese women. If confirmed by further study, dietary prevention efforts for breast cancer should be considered earlier in life.