Reasons and risk: factors underlying women's perceptions of susceptibility to osteoporosis

OBJECTIVES: To assess women's perceptions of risk for osteoporosis and to identify factors that shape those perceptions. METHODS: A community sample of 358 women (aged 40-86) rated their perceived risk of osteoporosis and provided detailed information about factors underlying their risk perceptions. Their open-ended responses were content analysed. RESULTS: On average, participants believed they were less likely to develop osteoporosis than other women their age. In all, 63% perceived their risk as lower than other women their age; only 16% as higher. In explaining their risk, women mentioned more risk-decreasing factors than risk-increasing factors. Women who rated their risk as low attributed their risk primarily to their own preventive behaviors (e.g. taking calcium, exercising), whereas women who rated their risk as high attributed their risk primarily to their family history. Risk-increasing and risk-decreasing personal actions, hereditary factors, and physiological factors accounted for 53% of the variance in perceived risk for osteoporosis. Only one-half and one-third of all women, however, mentioned calcium consumption and exercise, respectively, as protective factors employed to reduce osteoporosis risk. Women also held misconceptions about osteoporosis risk and protective factors. CONCLUSIONS: The current findings yield a detailed portrait of women's risk perceptions for osteoporosis. Increasing awareness of osteoporosis should be a priority for future osteoporosis prevention campaigns. Interventions should address misconceptions women may hold about their risk for the disease and promote specific behavioral strategies for osteoporosis prevention.     

A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs

Productivity costs can strongly impact cost-effectiveness outcomes. This study investigated the impact in the context of expensive hospital drugs. This study aimed to: (1) investigate the effect of productivity costs on cost-effectiveness outcomes, (2) determine whether economic evaluations of expensive drugs commonly include productivity costs related to paid and unpaid work, and (3) explore potential reasons for excluding productivity costs from the economic evaluation. We conducted a systematic literature review to identify economic evaluations of 33 expensive drugs. We analysed whether evaluations included productivity costs and whether inclusion or exclusion was related to the study population’s age, health and national health economic guidelines. The impact on cost-effectiveness outcomes was assessed in studies that included productivity costs. Of 249 identified economic evaluations of expensive drugs, 22 (9 %) included productivity costs related to paid work. One study included unpaid productivity. Mostly, productivity cost exclusion could not be explained by the study population’s age and health status, but national guidelines appeared influential. Productivity costs proved often highly influential. This study indicates that productivity costs in economic evaluations of expensive hospital drugs are commonly and inconsistently ignored in economic evaluations. This warrants caution in interpreting and comparing the results of these evaluations.     

The public health significance of low birth weight in the USA: With special reference to varying practices in providing special care to infants of low birth weight

In this discussion of the significance of low birth weight in the USA, the author presents data relating birth weight, ethnic grouping and duration of gestation to infant mortality rates, and concludes that measures designed to lower the infant mortality in one country or area cannot always be applied without change in another area. She challenges the notion that a birth weight of 2500 g or less necessarily implies a premature birth; it would hardly be valid, for instance, in areas where the median birth weights are below 3000 g. Moreover, the state of physiological development and efficiency of the infant is more important in determining its survival than its weight at birth.