[Show abstract][Hide abstract] ABSTRACT: In America today, homelessness is coming under increasing pressure by federal, state, local, and faith-based providers of prevention and intervention services. American philanthropy makes a response to this pervasive problem possible through faith-based institutional and local efforts that facilitate the effectiveness of governmental programs designed to eliminate long-term homelessness by 2014. Faith-based providers of services are on the front line of efforts to wrap services around willing participants who build or rebuild effective social and instrumental resources. Most homelessness is temporary and even long-term homelessness often responds to supportive services delivered in a stable housing environment.
Family & community health 01/2009; 32(4):314-9. DOI:10.1097/FCH.0b013e3181b91f25 · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Hormonal contraceptives may adversely affect bone mineral density. However, racial differences and the reversibility of these changes are poorly understood. This study measured bone mineral density changes during hormonal contraceptive use and after discontinuation in a triethnic population.
Bone mineral density was measured every 6 months for up to 3 years in 703 white, African-American, and Hispanic women using oral contraceptives (OCPs), depot medroxyprogesterone acetate (DMPA), or nonhormonal contraceptives, and in 68 DMPA discontinuers for up to 2 additional years. Mixed-model regression analyses were used to estimate the percentage change in bone mineral density for each contraceptive method.
Over 3 years, DMPA and OCP users lost more bone mineral density than did nonhormonal contraceptive users (-3.7% and -0.5% compared with +1.9% at lumbar spine, and -5.2% and -1.3% compared with +0.6% at femoral neck, respectively). No differences were observed by race in bone mineral density changes that resulted from DMPA or OCP use. However, DMPA users aged 16-24 years lost more bone mineral density at the spine (4.2% compared with 3.2%, P=.006) and femoral neck (6.0% compared with 4.2%, P=.001) than those aged 25-33 years. After DMPA discontinuation, women who selected nonhormonal contraceptives gained bone mineral density (+4.9% at spine, +3.2% at femoral neck), whereas those who selected OCP recovered spinal (+2.3%) but not femoral neck bone mineral density (-0.7%).
Use of very-low-dose OCPs may result in a small amount of bone loss. Use of DMPA results in greater bone loss, but this is largely reversible at the spine. Use of very-low-dose OCPs after DMPA discontinuation may slow bone recovery.
Obstetrics and Gynecology 11/2008; 112(4):788-99. DOI:10.1097/AOG.0b013e3181875b78 · 5.18 Impact Factor
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