Discussion
Since the introduction of Osteoporosis prescreening methods, several studies have been organized for triaging postmenopausal women for referring to a Bone Mineral Density testing by DEXA, due to the fact that screening all women is not cost effective. All of these clinical stratification methods are intended to introduce a balance between the economical costs and the fact that anyone who might benefit from diagnosis should not be missed. Best validated tests are Osteoporosis Self Assessment Tool, based on an Asian study population (Koh, Sedrine et al. 2001), the Osteoporosis Risk Assessment Instrument from a population-based Canadian cohort (Cadarette SM 2000) and Simple Calculated Osteoporosis Risk Estimation from United States population. (Ben Sedrine, Devogelaer et al. 2001). However due to the varying performance of the original cut points proposed in these studies in different populations and lack of validation in different study groups, they have yet to be used internationally.
When SCORE was first developed and validated in 1998, based on femoral neck BMD of 2 or more SDs below the mean, it had a sensitivity of 89%, a specificity of 50%, ROC area of 0.81 using a score of 6 or more. (Lydick, Cook et al. 1998) ORAI, developed in 2000, yielded to a sensitivity of 95%, specificity of 41% using a score of 9 or greater.(Cadarette SM 2000) A sensitivity of 98% and a specificity of 29% were also reported for OST.(Koh, Sedrine et al. 2001) Many other models also exist, however they have reached the “good” quality rating, meaning that the Area Under Curve(AUC) has not been more than 0.6. (Nelson, Helfand et al. 2002, Lim, Hoeksema et al. 2009)
Further studies were conducted to evaluate the performance of these models. Re...
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...ld be done for evaluating and comparing this model with other international models. It should also be noted that the holdout method might not be efficient for estimation of internal validity. (Steyerberg, Harrell Jr et al. 2001)and might be weaker than other cross validation methods. Another limitation for this study is that we have not examined if the model is applicable in all rural and urban areas for family medicine centers. The model might be too complex for a nation-wide use. Attempts should be made to figure this model in an algorithm or a simple chart. The development of other statistical software and better methods might also provide a better decision tool for this purpose. One point is crucial however, that financial limits highlight the need of simple prescreening models for DXA testing which is the ultimate purpose in this study and many similar studies.
Osteoporosis comes from the latin word meaning “porous bone”. If you were to look closely at a bone you could see there are these small spaces on the bone which is good, now if you look at someone who suffers from osteoporosis you will see these spaces are much larger. As these spaces become larger it takes away from the strength and integrity of the bone making it grow weak and thin. Osteoporosis is most common in women over the age of 50 and gives them a higher risk of fractures and or breaks especially common in the hips. While we know osteoporosis comes from a number of things it can be broken down to age, the hormonal changes most commonly seen in menopause and a lower intake of Vitamin D and Calcium. Age is the unpreventable factor that doctors or you cannot change. Hormonal changes can be fixed with supplements or hormone therapy along with ones intake of Vitamin D and Calcium. Hormone therapy, estrogen alone or the combination of estrogen and progestin have been proven to prevent and aide in the treatment of osteoporosis in
The purpose of financial measurement in healthcare is to provide the community with the services it needs, at a clinically acceptable level of quality, at a publicly responsive level of amenity, at the least possible cost. This is done by providing healthcare finance managers with accounting and finance information to help accomplish the purpose of the organization (Nowicki, 2015). When making accounting decisions about budgeting and inventory control, an understanding of economics, statistics, and operations research is needed. Major Financial Measures
Osteopenia refers to having bone mineral density that is below normal levels but not low enough to be classified as osteoporosis. Bone Mineral Density (BMD) needs to be tested in woman over 60 to check for the early onset of osteoporosis. A BMD test is used to take these measurements and the most accurate test is called a DEXA procedure. According the WebMD Osteoporosis Health Center, Dual-energy X-ray absorptiometry (DEXA) tests measure the bones mineral density with X-ray beams
There are many different diseases that can affect our skeletal system and Osteoporosis is one of them. Osteoporosis lessens bone strength and bone density (amount of bone mineral in bone tissue), which will lead to fragile bones. It mainly affect the hips, ribs, spine, and wrists. Male or female, at any age, can get this but it is mostly occurs in older women (Team, 2016). Osteoporosis is very common, there are more than 3 million cases a year. There are many causes/risk factors, symptoms, and some treatment cases. About 54 million Americans have Osteoporosis and low bone mass (Foundation, 2016).
Papanicolas, I. & Smith, P. (2013). Health system performance comparison an agenda for policy, information and research. Maidenhead: Open University Press.
The composite score is objective and calculated through a weighted formula designed to provide an equal contribution from each item while the severity rating is subjective and indicates the need for additional treatment in specific areas (Haraguchi et al., 2009). The SR ranges from 0 to 9 points and the CS ranges from 0 to 1 with anything higher than the normal 9 SR or 1 CS indicating greater problem severities (Haraguchi et al., 2009). Although some problems still exist, the ASI has been reported to have nearly achieved both reliability and validity (Haraguchi et al.,
Osteoporosis is a condition, which advances with age, resulting in fragile, weak bones due to a decrease in bone mass. Externally osteoporotic bone is shaped like normal bone, however it’s internal appearance differs. Internally the bone becomes porous due to a loss in essential minerals, including phosphate and calcium. The minerals are loss more quickly than they can be replaced and in turn cause the bones to become less dense and weak. The bones become prone to fracture, due to their weakness. Therefore the awareness of the disease tends to occur after a fracture has been sustained. The bones most commonly affected are the ribs, wrist, pelvis and the vertebrae.
Osteoporosis is a condition, in which bones are weak from deterioration, loss of bone mass, and quality-bone strength. Osteoporosis usually triggers postmenopausal women (women who have not had their period for a whole year), or older men and women. Some risks both older men and women endure when experiencing Osteoporosis are decrease of calcium and bone fractures. These symptoms or effects can all be caused by weight loss, smoking, age, ethnicity, genetics, medications, bone structure, and certain diseases that can later on contribute to Osteoporosis, such as rheumatoid arthritis. Osteoporosis may be prevented by going to drug therapy to stop alcoholism and smoking, a sufficient amount of calcium intake, and exercising; such as jogging, walking,
In consequence, this will limit poor adults finding the proper treatment since many doctors do not accept Medicaid patients. High rates of uninsured populations were associated with lower primary care capacity (Ku et al., 2011). Thus, expanding insurance coverage can support more primary care practices in rural areas and can help equal the gap in primary care positions. The impact of not expanding affects APRN practice by limiting them to practice in areas where they are needed the most. This not only affects APRNs from practicing without a physician supervision but also limit those that need coverage for basic preventive measures to reduce non-paying visits to the emergency room. Ensuring access to care will be contingent upon the ability to attain progress from insurance coverage and primary
West, S. L., & O'Neal, K. K. (2004). Project D.A.R.E. outcome effectiveness revisited. American Journal of Public Health. doi:10.2105/AJPH.94.6.1027
Willis, E, Reynolds, L & Keleher, H 2012, Understanding the australian health care system, Mosby Elesvier, Chatswood, NSW.
Osteoporosis is one of the main types of bone diseases that is more commonly developed in the adult years of men and women, but can also affect younger aged people too. This disease contributes to “…decrease bone mass, increased skeletal fragility, and an increased risk of fractures…” (Caple & Schub. 2014). Bones are constantly being replaced by new bone hence it is living tissue. Osteoporosis eventually occurs when new bone has failed to be developed. In Canada, “1.5 million Canadians 40 years of age or older (10%) reported having been diagnosed with osteoporosis, of which, women were 4 times more likely to report having osteoporosis than men” (“What is the impact,” 2010). Women are at greater risk then men because the hormone changes in women can affect the bone density. Estrogen is essential for bone density but after menopause the levels fall resulting in bone loss. On the other hand, the cause for men is still unknown. However, testosterone: the male hormone helps to keep bones healthy. Even though men still produce the male hormone at an old age, there is still a risk of osteoporosis because the levels have dropped. Occasionally bone loss occurs without any cause, and later realizing that it is a silent theif when you ultimately develop symptoms (“Osteoporosis – Review,” 2014). In most instances osteoporosis is preventable, even though it is not reversible and harmful disease.
The state is responsible for the overall regulatory, supervisory and fiscal functions as well as for quality monitoring and planning of the distribution of medical specialties at the hospital level (Schäfer et al., 2010). The 5 regions are responsible for hospitals and for self-employed health care professionals, whereas the municipalities are responsible for disease prevention and health promotion rel...
For decades, individuals living in rural areas have been considered medically underserved. Access to healthcare is a problem that has been increasing for individuals in rural America due to aging populations, declining economies, rural hospital closures, rising healthcare costs, healthcare provider shortages and difficulties attracting and retaining healthcare personnel and physicians (Bauer, 2002). This population experience more health disparities than t...
Osteoporosis is a disease in which the bones become so weak and brittle that even a cough can cause enough stress on the bone that it will cause the bone to facture. The most commonly broken bones are the hip, wrist, and the spine. Although it affects men and women of all races, post-menopausal Caucasian and Asian women are more commonly affected than those of other ethnicities and sexes. In fact, thirty percent of all post-menopausal women in the US and Europe will be diagnosed with Osteoporosis and at least 40 percent of those will suffer from a fracture in their lifetime.