Determinants of osteoporosis prevention in low-income Mexican-American women

BACKGROUND: Prevention is the most cost-effective means of managing osteoporosis. However, little is known about osteoporosis-related preventive practices in Mexican-American women. We examined factors that might influence women's decision to start preventive measures for osteoporosis. METHODS: Information was gathered through a cross-sectional survey of low-income Mexican-American women who were seen at two clinics in southern Texas. RESULTS: Of the 270 participants, 37% reported calcium supplementation, and 41% reported regular weight-bearing exercise to prevent osteoporosis. Fifty (41%) of the postmenopausal women were currently using hormone replacement therapy. Only 15% of the premenopausal and 13% of the postmenopausal women recalled that their health care provider had counseled them about prevention. Multivariate analysis showed that public education, bone densitometry evaluation, knowledge of osteoporosis, and counseling were determinants of prevention. CONCLUSION: Although osteoporosis is a preventable condition, our findings suggest that the majority of Mexican-American women do not receive adequate preventive measures or counseling about osteoporosis. Furthermore, we found that their health care provider's counseling about osteoporosis was a major determinant of osteoporosis prevention in these women.     

The effectiveness of an osteoporosis prevention program among women in Taiwan

The purpose of this study was to develop an osteoporosis prevention program based on the Health Belief Model. This study found that the prevention program improved osteoporosis preventive behaviors among women in Taiwan. Health professionals could use this model to plan and evaluate their osteoporosis prevention programs.     

Exercise for the prevention of osteoporosis in postmenopausal women: an evidence-based guide to the optimal prescription

Background

Osteoporosis and related fragility fractures are a global public health problem in which pharmaceutical agents targeting bone mineral density (BMD) are the first line of treatment. However, pharmaceuticals have no effect on improving other key fracture risk factors, including low muscle strength, power and functional capacity, all of which are associated with an increased risk for falls and fracture, independent of BMD. Targeted exercise training is the only strategy that can simultaneously improve multiple skeletal and fall-related risk factors, but it must be appropriately prescribed and tailored to the desired outcome(s) and the specified target group.

Cost-effectiveness strategies to treat osteoporosis in elderly women

BACKGROUND: Comparing the cost-effectiveness of various antiosteoporotic drugs has not been defined. METHODS: We determined the cost-effectiveness of calcitonin, raloxifene, bisphosphates and PTH in a base-case cohort of women aged 65 or older with osteoporosis. After bone densitometry, women were stratified into groups of treatment or no treatment. Our outcome goal was a value of dollars 100,000 or less per quality-adjusted life years (QALY). A sensitivity analysis varied nonvertebral fracture reduction and compliance between the two most effective strategies to test various cost per QALY thresholds. RESULTS: Bisphosphonates displayed the most favorable incremental cost saving and prevented more fractures in our base-case analysis. In a sensitivity analysis, virtually all values of bisphosphonates were under dollars 100,000 per QALY and parathyroid hormone (PTH) was between dollars 100,000 and dollars 200,000 per QALY. CONCLUSIONS: Only bisphosphonates are cost-effective for fracture prevention in osteoporotic women aged 65 or older and this economic advantage is also maintained in subsets who have a lower relative risk of future fracture.     

Tailored biobehavioral interventions: a literature review and synthesis

This article presents a metasynthesis of the literature from 1996 through 2005 on randomized clinical or controlled trials comparing effects of tailored interventions to those of control conditions or other interventions. A search was conducted for publications written in English using the terms "patient-centered interventions," "tailored interventions," and "individualized interventions," using Ovid and Elton B. Stephens Company (EBSCO) Host databases. A total of 245 publications were located after deleting duplicates. An additional six studies were identified from two syntheses of intervention research. A total of 63 studies met the inclusion criteria, and 49 of these reported that tailored interventions were superior to control conditions for one or more of the main outcomes. The evidence strongly supports the efficacy of tailored behavioral interventions and provides beginning support for the efficacy of tailored psychosocial and biological interventions.     

Using theory to plan appropriate interventions: cancer prevention for older Hispanic and non-Hispanic white women

Research on cancer prevention among Hispanics and non-Hispanic whites (Anglos) has focused on identifying differential barriers they encounter Although the information has been helpful in adapting traditional interventions for Hispanic clients, changes have not generally been theory-based This research explores the applicability of value-expectancy theory, which holds that the likelihood of taking action is a function of the perceived value of the goal and the expectancy of achieving it, with 26 Anglo and 24 Hispanic women Value was operationalized as perceived effectiveness, and expectancy as perceived difficulty of adopting 11 specific recommended behaviours Likelihood of adopting or maintaining the behaviour in the coming year was the dependent variable Subjects used a direct ratio scaling method, magnitude estimation, to give estimates of the variables Substantial variation in likelihood was explained in both groups (adjusted R2 = 0 49 for Anglos and 0 53 for Hispanics), but only difficulty was significant for both Anglo and Hispanic groups The relationship between difficulty and likelihood was curvilinear, with likelihood decreasing rapidly as difficulty increased slightly Results suggest the theory can be used to develop interventions for both groups and that these should focus on decreasing the individual's perceived difficulty of adopting and maintaining cancer prevention activities     

运动疗法对防治更年期妇女骨质疏松症的临床研究

目的探讨运动疗法对更年期妇女骨质疏松症的防治作用。方法将更年期妇女120人随机分为康复组与对照组各60人,康复组给予有氧运动、补钙、饮食调节等综合康复治疗,对照组给予补钙及饮食调节,疗程2年,观察两组治疗前后腰椎骨密度的变化。结果康复组治疗后腰椎骨密度比治疗前稍增高,但无统计学意义(P＞0.05),但康复组腰椎骨密度比对照组显著增高(P＜0.05)。对照组腰椎骨密度比治疗前明显降低(P＜0.05)。结论运动疗法能有效地防治更年期妇女骨质疏松症。     

阿仑膦酸钠肠溶片预防和治疗绝经后妇女骨质疏松症的相关研究

目的 比较绝经后妇女(观察组)和正常育龄期妇女(对照组)的骨代谢相关指标,及瘦素、白细胞介素6(IL-6)的水平变化,探索骨质疏松症发病可能的相关因素;观察口服阿仑膦酸钠肠溶片在预防和治疗骨质疏松症方面的有效性和安全性.方法 对照组25例不加任何处理.观察组42例受试者给予以口服钙尔奇D600 mg/d以及阿仑膦酸钠肠溶片70 mg,每周1次,连续服用6个月.分别测定观察组和对照组骨密度指标及瘦素、IL-6水平,以及观察组服药前、服药6个月末和停药1年后腰椎2～4(L2～4)、左侧股骨颈、Ward三角区、股骨粗隆的骨密度,以及血碱性磷酸酶(ALP),血清骨钙素(BGP),抗酒石酸酸性磷酸酶(TRAP),肝、肾功能,血清钙(Ca)、磷(P)等生化指标,综合评价口服阿仑磷酸钠肠溶片的临床疗效、安全性和耐受性.结果与对照组比较,观察组L2～4及左股骨颈、股骨粗隆和Ward三角区的骨密度显著减少(P＜0.01);观察组血清IL-6水平高于对照组,(69.22±7.01)μg/L vs (11.37±4.86)μg/L( P＜0.01).应用阿仑膦酸钠肠溶片治疗6个月末,观察组L2～4以及左股骨颈、股骨粗隆和Ward三角区的骨密度与治疗前比较显著增加,治疗前、治疗后和停药1年L2～4(0.83±0.08)g/m3、(0.88±0.08) g/m3和(0.87±0.07)g/m3(p＜0.05);股骨颈(0.68±0.11)g/m3、(0.72±0.07)g/m3和(0.73±0.06)g/m3( P＜0.05);骨股粗隆(0.61±0.09)g/m3、(0.71±0.09) g/m3和(0.69±0.08)g/m3(P ＜0.01);Ward三角区(0.48±0.13)g/m3、(0.57±0.11)g/m3和(0.55±0.13)g/m3(P＜0.01).ALP、BGP、TRAP水平较治疗前显著降低(P＜0.05或＜0.01).结论 观察组骨质疏松症的发生与绝经后骨代谢加快相关,与体脂含量及瘦素水平无明显相关.口服阿仑膦酸钠肠溶片可显著增加绝经后骨质疏松妇女的骨密度,降低骨转化指标,且无明显不良反应.     

Using osteoporosis management to reduce fractures in elderly women

Once regarded as an inevitable part of aging, osteoporosis and fracture risk are now recognized as preventable and treatable. Detecting fracture risk and preventing fractures are key intervention strategies. Comprehensive evaluation and treatment of individuals at risk include making the correct diagnosis, identifying correctable factors that can contribute to low bone mass and increased fracture risk, and treating at-risk patients with pharmacologic and nonpharmacologic therapies. Patients must employ sound nutrition practices and reduce the potential for injuries sustained in falls through exercise and environmental safeguards.     

围绝经期妇女骨质疏松预防知识、自我效能和健康行为的调查分析

目的 分析围绝经期妇女骨质疏松(Osteoporosis,OP)预防知识、自我效能和相关健康行为水平及其相关因素.方法 采用修订汉化的OP知识问卷(OKT)、OP自我效能量表(OSES)和自设的OP相关健康行为问卷对198名围绝经期妇女进行调查.结果 OKT的不及格率为75.2%,绝经与否、职业、文化程度、年龄是影响OKT得分的主要因素(P<0.05);OP相关健康行为方面较差,没有日常饮用牛奶的习惯,从不或偶尔考虑食物钙质含量的人数分别占总人数的57.1%和73.2%;OP相关健康行为得分与OSES评分、OSES评分与OKT评分呈正相关.结论 围绝经期妇女骨质疏松预防知识、自我效能和相关健康行为有待提高.     

Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review

Title.  Hygiene interventions for prevention of cytomegalovirus infection among childbearing women: systematic review.
Aim.  This paper is a report of a systematic review to examine the effectiveness of preventive interventions to reduce congenital cytomegalovirus transmission and infection among women of childbearing age.
Background.  Congenital cytomegalovirus has been identified as the leading infectious cause of damage to the growing fetus in developed countries, including Down syndrome, fetal alcohol syndrome and spina bifida. Despite the prevalence and consequences of this infection, it has a low profile and pregnant mothers are often unaware of the risks and protective behaviours related to its transmission. Women with children in daycare and nurses working with children are particularly at risk of acquiring the virus.
Data sources.  A computerized literature search for articles up to 1 December 2007 was performed using MEDLINE (from 1950); EMBASE (from 1980) and CINAHL (from 1982).
Review methods.  Both authors independently reviewed studies that met inclusion criteria and assigned a quality rating determined by the number of validity criteria met. Differences were discussed until consensus was reached.
Findings.  Differences in hygiene behaviour changes were most statistically significant for pregnant, seronegative women. Although the methodological quality of the three included studies was not strong, seroconversion rates consistently decreased as cytomegalovirus education and support increased.
Conclusion.  Nurses can act as preventive agents for cytomegalovirus infection through education about hygiene precautions during antenatal care and through preventive measures in the workplace. The review findings suggest educational interventions in hygiene practices have the potential to be a feasible, large-scale, primary prevention strategy.     

Postmenopausal osteoporosis in obese women

AIM: assessment of frequency of obesity and comorbidities in women with postmenopausal osteoporosis (OP). METHODS: cross-sectional study included 243 postmenopausal symptomatic women with OP diagnosed by dual energy lumbar spine absorptiometry. RESULTS: normal body mass was found in 74 women (30.5%), 105 persons (43.2%) had overweight and 64 patients (26.3%) were obese. Obese OP patients had significantly higherfrequency of arterial hypertension, chronic heart failure, osteoarthritis and glucose metabolism disorders than those with normal body mass. Obese persons also had more severe menopausal symptoms than women with normal body mass. There was no difference in non-traumatic fractures between obese, overweight and slim patients. Thus, postmenopausal OP in obese women was associated with numerous comorbidities and more severe menopausal symptoms.     

Advances in the prevention of osteoporosis

Recent advances in the techniques for measuring bone mass and the advent of hormone replacement therapy have markedly improved the outlook for patients with osteoporosis. The ability to predict which women are at high risk will enable preventive measures to be taken.     

Using the benchmarking process to enhance pressure ulcer prevention

Pressure ulcers are a recognized source of increased debilitation that continually impact on patients' quality of life and the NHS economy. While it remains arguable that all pressure ulcers can be prevented, it could be suggested that with closer monitoring of care provision by the healthcare professionals delivering that care, not only will quality of care be enhanced but a reduction in pressure ulcer incidence is a further potential outcome. The Department of Health prioritised pressure ulcer prevention within Essence of Care and the introduction of clinical benchmarking across a number of care settings demonstrates that care provision relating to pressure ulcer prevention can be enhanced through this process. Clinical benchmarking is an on-going process and should remain an integral component to every day nursing practice in order to sustain this positive phenomenon of change.