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Treatment thresholds and minimal clinically important effect sizes of antiosteoporotic medication
(2022)
Background
Patient decisions to take preventative treatments for osteoporosis depend on their perceptions of fracture risk, medication effect sizes (ES) of benefits and harms. However, physicians and lay persons may have differing perceptions of risks and medication efficacy. Both tend to overestimate medication benefits. This study surveyed at what risk physicians would prescribe and lay persons would be willing to take bisphosphonates, the minimum ES both groups do demand and the physicians estimates of the actual benefit of bisphosphonates.
Design
Cross-sectional online questionnaire survey.
Methods
Respondents were confronted with a case vignette with an osteoporotic patient (10-year femoral fracture risk: 32%). They were asked at what threshold of 10-year-risk of femoral neck fracture they would prescribe or take a drug. They were asked for the minimum ES (absolute risk reduction, ARR) they demand from bisphosphonates to prescribe or take them. Physicians were asked to provide their estimate of the actual ARR of bisphosphonates.
Results
114 physicians and 140 lay persons answered (convenience sample/snowball distribution). The 10-year-risk threshold of lay persons (Mdnlay = 60%) willing to take medication was twice as high as the physicians’ threshold (Mdnphy = 30%) to prescribe it (p < .001). The median minimum ARR physicians demanded for bisphosphonates prescription was 17%, whereas lay persons demanded 22% (p < .001). Physicians estimated the actual ARR of bisphosphonates to be 12%. This estimated effect size was below their own minimum threshold for prescription.
Conclusions
Lay persons tolerate a higher fracture risk and demand a larger benefit of antiosteoporotic medication for fracture prevention than physicians. Physicians demand higher minimum benefits than their own estimates which in turn are above the benefit evidence suggests. Physicians should be more familiar with ES of antiosteoporotic drugs concerning patient outcomes and actively advise lay persons before preventive treatment decisions are taken.
The Work of Fr. Raymond Flanagan, OCSO, Author of Historical Novels, Devotional Books, and Pamphlets
(2021)
Father Mary Raymond Flanagan (1903–1990), a monk of Gethsemani Abbey, was the widely- read author of dozens of books and pamphlets particularly popular in the 1940s, 1950s, and early 1960s. Numbering in the dozens, his publications were characterized by a hard-hitting, vigorous Catholic piety that accentuated American family values, fidelity to Catholic traditions, the beauty of religious vocations, anti-Communism, and the athletic asceticism he associated with the first Cistercians. His works lost their appeal to a wide audience during the cultural shift of the late 1960s and later, but several of his writings have been reissued in recent years.
This essay includes a short biography and a bibliography of Flanagan's books and pamphlets.
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Post-migrant societies in Europe are characterized by political, cultural, religious, and social changes. Where people meet under the conditions of migration and globalization, new places and spaces of negotiating are arising. They are formed by provocative questions, dynamic reorientation, and social transformation, in particular regarding religious affiliations, contexts and experiences. This article will consider challenges and the resources of religion in terms of coping with ambiguity and building up post-migrant community relations. In this context, the concept of the ‘contact zone’ as a post-migrant place or space provides an insight to social spaces where cultures and religions meet, clash and grapple with each other, often in emotionally charged contexts of highly asymmetrical relations of power, like displacement and their aftermaths. These contact zones offer a place of discussing power, oppression, and religious diversities, but also find innovative perspectives for post-migrant identities. With reference to this, three case studies based on experiences of refugees in Europe with contact zones in refugee centers, schools and educational institutions allow for an understanding of the significance of places, the feeling of rootlessness and the findings of new places of religious identity, of ‘embodied’ habitation and participation. Finally, this article emphasizes the meaning of public speech in post-migrant societies from a Christian perspective.
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