Development and validation of a new clinical risk index for prediction of osteoporosis in Thai women.

The objective of this study was to develop and validate a new simple tool for identifying Thai women who are at high risk of having osteoporosis. A total of 322 women, aged > or = 45 years, were randomly divided into two cohorts: a development (n = 130) and a validation cohort (n = 192). Femoral neck and lumbar spine BMD were measured by LUNAR DPX-IQ densitometer. The prevalence of osteoporosis (defined by BMD T-scores < or = -2.5) was 33 per cent by either femoral neck or lumbar spine BMD. Khon Kaen Osteoporosis Study (KKOS), scoring based on age and weight was calculated and applied to the development cohort. Individuals with KKOS score < or = -1 were defined as "high risk"; otherwise a "low risk" was defined. In the validation cohort, the sensitivity and specificity of KKOS was 70 and 73 per cent, respectively. Furthermore, if the high risk individuals identified by KKOS are to be treated, and if the treatment reduces fracture incidence by 50 per cent and assuming that treatment cost is 10 bahts per day, then the cost to prevent one fracture is estimated to be 466,695 bahts per year. These data suggest that although age and body weight can be used to identify Thai women who are at high risk of having osteoporosis, its application to the general population requires further research to arrive at the optimal cost-benefit for the community.

Utilizaçäo hospitalar no Brasil e o efeito de medidas de contençäo do crescimento de hospitalizaçoës / Hospital utilization in Brazil and the effect of the measures to restrain the increase of hospitalizations

O propósito deste trabalho é o de analisar o crescimento e variaçäo das internaçöes hospitalares no Brasil, bem como discutir os efeitos de recentes medidas governamentais destinadas a conter o crescimento acelerado da utilizaçäo hospitalar no país. Uma destas medidas refere-se ao método de pagamento hospitalar (pagamento por procedimento ou caso), introduzido no final de 1983, que, ao que parece, contribuiu para aumentar e näo diminuir a taxa de internaçöes. Por outro lado, os dados mostram que, recentemente, tem havido maior utilizaçäo dos hospitais públicos, já que houve aumento do número de hospitalizaçöes nestes hopsitais. Os resultados mostram, também, que existe grande diferença na produçäo de serviços entre hospitais públicos e privados. Ao operarem maciçamente com internaçöes da especialidade de clínica médica, os hospitais privados podem estar tratando os casos mais simples, enquanto os hospitais públicos parecem cuidar dos casos mais complicados, dado o elevado percentual de internaçöes na especialidade de clínica cirúrgica