Aims: The effect of the gut microbiota (GM) and its metabolite on bone health is termed the gut-bone axis. Multiple studies have elucidated the mechanisms but findings vary greatly. A systematic review was performed to analyze current animal models and explore the effect of GM on bone.Methods: Literature search was performed on PubMed and Embase databases. Information on the types and strains of animals, induction of osteoporosis, intervention strategies, determination of GM, assessment on bone mineral density (BMD) and bone quality, and key findings were extracted.Results: A total of 30 studies were included, of which six studies used rats and 24 studies used mice. Osteoporosis or bone loss was induced in 14 studies. Interventions included ten with probiotics, three with prebiotics, nine with antibiotics, two with short-chain fatty acid (SCFA), six with vitamins and proteins, two with traditional Chinese medicine (TCM), and one with neuropeptide Y1R antagonist. In general, probiotics, prebiotics, nutritional interventions, and TCM were found to reverse the GM dysbiosis and rescue bone loss.Conclusion: Despite the positive therapeutic effect of probiotics, prebiotics, and nutritional or pharmaceutical interventions on osteoporosis, there is still a critical knowledge gap regarding the role of GM in rescuing bone loss and its related pathways. Cite this article: Bone Joint Res 2021;10(1):51–59.

To analyze the effectiveness of exercise interventions on falls and fall-related fracture prevention among community-dwelling elderlies. Literature search was conducted in Pubmed and Embase. Keywords used for literature search were “fracture” AND “fall” AND “exercise”. Randomized controlled trials involving community-dwelling elderlies older than 60 years old with physical exercises as intervention were included. A systematic review and meta-analysis was performed. The primary outcomes were falls and fractures. Twelve studies were included and 4784 participants were involved with a mean age of 75.4. The most common exercise interventions were strength and balance exercises. The results of meta-analysis of 11 studies showed that exercise intervention had beneficial effect on fall prevention (RR = 0.71, 95% CI, 0.62–0.82; I2 = 24%, p < 0.0001). The effect was better when exercise intervention applied to women participants (RR = 0.64, 95% CI, 0.49–0.83; I2 = 28%, p = 0.00009) compared to men and women participants (RR = 0.75, 95% CI, 0.64–0.89; I2 = 24%, p = 0.001). The results of meta-analysis of seven studies showed that physical exercise had significant effect on fracture prevention (RR = 0.54, 95% CI, 0.35–0.83; I2 = 25%, p = 0.005). However, the effect was significant when exercise intervention applied to women participants only (RR = 0.37, 95% CI, 0.20–0.67; I2 = 0%, p = 0.001) but not significant when exercise intervention applied to both genders (RR = 0.80, 95% CI, 0.58–1.09; I2 = 0%, p = 0.15). Exercise interventions, especially the combination of strength and balance training, were effective in preventing falls. Resistance exercises and jumping exercises were effective for fracture prevention among community-dwelling older population. The effectiveness of exercise interventions on fracture prevention have more significant effect on women. Further studies are needed to test the effectiveness of exercise interventions in men. The use of effective exercises or biophysical interventions including vibration therapy can be incorporated into Fracture Liaison Services to prevent future fall and fracture.

In Hong Kong, social distancing has been adopted in order to minimise the spread of COVID-19. This study aims to examine the changes in physical health, mental health, and social well-being experienced by local residents who were homebound during the pandemic. An online questionnaire in both Chinese and English versions was completed by 590 eligible participants from 24 April to 13 May 2020. The questionnaire found that individuals aged 18 to 25 years spent more time resting and relaxing but experienced more physical strain. Working status was associated with social contact, with participants working full-time jobs scoring higher in “maintaining social communication via electronic means” and “avoiding social activities outside the home”. Additionally, approximately one third of the participants (29.7%) had moderate to severe depression, and participants aged 18 to 25 were found to have higher scores in PHQ-9. Changes in physical health and social contact were significantly associated with developing depressive symptoms. From the results, it is clear that the COVID-19 pandemic has the potential to exert a negative impact on the mental health status of individuals.

Physical and mental health wellness are always emphasising in the scope of community health by examining the people in that specific terrestrial area. As an important section of public health, community health education includes essential components which aiming to strengthen people’s sense of sub-health prevention awareness, prevent the spread of infectious diseases and adopt a healthy lifestyle. To achieve good community health and wellness, strategies have been developed by considering health from public health perspectives, and among all of the strategies, education plays a vital role in maintaining community health. For example, the establishment of Health fairs and advertising campaigns to expose the threats of risk factors like tobacco exposure, malnutrition and physical inactivity can raise awareness about the importance of choosing a healthy lifestyle. By exploring the strategies in different countries promoting for Community Health Education and Wellness Programmes, the factors and effectiveness for the various strategies can be examined whereas more evidence-based programmes can be implemented in the future. And a long-term impact of good community health and wellness can contribute to a sustainable health care system.

Schools present an unparalleled opportunity to promote children’s health and growth. With support by family, peer and community, sustainable development of healthy schools not only provide an environment that ensure students to reach a state of physical, psychological, spiritual and social wellbeing and foster their academic performance, but this also effectively prevent them from various non-communicable diseases in their adulthood by positively affecting their behaviours and lifestyle, leading to a dynamic and continuous process of economic, environment, social and health sustainability for the city. Structured and exceptional healthy school policies with provision of skills-based health services and education can effectively promote students’ overall health, nutrition and hygiene, ensure a safe and secure physical and positive psychological environment, as well as reveal justice and inclusion in learning environment. Together with adequate resources from district, local, regional and national levels, healthy school policies that are actively accepted and recommended by the community allow schools to demonstrate commitment to equity, human right and non-discrimination and act as a positive model in the society. This chapter explores current health-related practices in schools and colleges, reviews healthy school policies worldwide, provides recommendation for solving challenges in adopting healthy school policies and illustrates how healthy schools lead to a sustainable safe cities movement.

‘Prevention is better than cure.’ It is a truism which reminds us to think of how to prevent the disease by changing our health behaviour rather than treating the disease when it is deteriorating or in a late stage. The primary health care development takes a long way back to 1978 with the Alma-Ata Declaration. It aims to promote health equity globally and is one of the core concepts to enhance the population health. Undoubtedly, local groups like non-governmental organisations, educational institutions, support groups in districts, etc., are playing a key role in promoting health in the community. Meanwhile, the demand of public health service is increasing with an ageing population, and shortage of health care staff at all levels in the past 10 years. It has added a great burden to the public health care systems. Therefore, it is interesting to explore the reasons behind of the above situation and the question: how the local groups can shape the advocacy of population health in a better way? This chapter first explores the factors contributing population health and then provides two cases of the local group practice in primary health care system. The roles of the local groups playing in the community, their interconnection, the accessibility and availability of the resources are further discussed. To achieve health for all, it is recommended to provide different measures via a multidisciplinary approach to enhance health literacy for everyone in the community.