published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

The primary purpose of this research study was to cross-validate the risk factors in the Osteoporosis Risk Assessment by Composite Linear Estimate [ORACLE] as a screening tool in a population of healthy U.S. women at various menopausal stages. The secondary purpose of this study was to evaluate the potential use of physical activity history and relevant osteoporosis risk factors to effectively determine current bone status for a mixed menopausal population. Third, the purpose of this study was to compare Omnisense quantitative ultrasound [QUS] and dual-energy x-ray absorptiometry [DXA] diagnostic values of osteopenia/osteoporosis based upon T- and Z-scores. Methods: Fifty-six female subjects (46.1 ± 6.3 years) in pre-, peri-, and post-menopausal stages who volunteered to participate in this study. Subjects completed an osteoporosis risk factor and physical activity history questionnaire. Subjects underwent laboratory testing comprised of distal radius quantitative ultrasound scan, dual hip and spine DXA scans, and a one week physical activity assessment. Results: Logistic regression analysis was utilized to examine the ability of the ORACLE to predict low BMD at the femoral neck and lumbar spine. There were no significant relationships between the group of ORACLE variables and BMD status at either the femoral neck or lumbar spine. In addition, none of the individual variables (age, BMI, use of HRT therapy, previous fracture, speed of sound [SOS]) were found to be significant predictors of low BMD at the femoral neck or lumbar spine. Notably, SOS measures from the Omnisense QUS were not found to have a strong positive predictive ability, with sensitivity values between 0-20% and specificity values between 81-86% at the femoral neck and lumbar spine. When the cohort was divided into normal and overweight/obese groups, sensitivity and specificity of QUS measures was not improved in the normal BMI group compared to the overweight/obese group. The use of physical activity variables to predict low BMD revealed some relationships trending toward significance, supporting previous research. Linear regression analyses revealed that the individual accelerometry variable of moderate-vigorous non-bout activity counts at the lumbar spine approached significance as a predictor of low BMD (p = 0.081). A significant correlation (r = 0.31, p < 0.05) between steps/day and subjective measures of current weight-bearing activity support the validity of the physical activity recall method for current physical activity. Conclusions: This study found that the ORACLE risk factors were not a valid osteoporosis screening tool in a mixed menopausal population of U.S. women. Secondarily, subjective and objective physical activity measures were non-significant predictors of current low BMD, but greater levels of moderate to vigorous non-bout activity counts trend towards being a significant predictor of higher BMD at the lumbar spine. Finally, results showed that Omnisense QUS measures were not found to be significantly related to DXA measures. Key Words: bone mineral density, dual-energy x-ray absorptiometry, osteoporosis, physical activity, quantitative ultrasound. / School of Physical Education, Sport, and Exercise Science

Thesis (Psy. D.)--Indiana University of Pennsylvania. / Includes bibliographical references.

Thesis (Ph.D.)--Australian National University, 2003.

Project (M.P.P.) - Simon Fraser University, 2006. / Theses (Master of Public Policy Program) / Simon Fraser University.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 235-250). Available also in a digital version from Dissertation Abstracts.

Thesis (M.P.H.)--University of Michigan, 1946.

Thesis (Ph.D.)--Duquesne University, 2009. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 161-178) and index.

Childhood trauma greatly impacts the lives of patients and their future health outcomes. Since the discovery of the utility of the Adverse Childhood Experiences (ACEs) screening tool in the 1990s, many providers have attempted to screen and intervene on these past experiences of trauma with mixed results. ACEs have an outsized impact on adult health. There is considerable literature documenting the changing state of screening for ACEs in adult populations, and the compelling rationales for doing so. There are also a number of interventions available currently, but providers face challenges to use them. Ethical considerations and issues with the current state of screening for ACEs exist, due to some of these challenges and differential availability of interventions between populations. Here, I use the principles of urban bioethics to explain the ethical obligation of screening for ACEs despite these challenges and to dispute previous discussions on this topic. This article will show that there are general strategies that providers can take to implement ACEs screening in an ethical manner and specifically discusses trauma-informed care’s utility to help achieve these strategies. Through this discussion, I hope to encourage providers to reconsider ACEs screening and give them strategies to do so. / Urban Bioethics