***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVE To estimate the utility ( preference for health ) associated with hip fracture and fear of falling among older women . DESIGN Quality of life survey with the time trade off technique . The technique derives an estimate of preference for health states by finding the point at which respondents show no preference between a longer but lower quality of life and a shorter time in full health . SETTING A r and omised trial of external hip protectors for older women at risk of hip fracture . PARTICIPANTS 194 women aged > /= 75 years enrolled in the r and omised controlled trial or who were eligible for the trial but refused completed a quality of life interview face to face . OUTCOME MEASURES Respondents were asked to rate their own health by using the Euroqol instrument and then rate three health states ( fear of falling , a " good " hip fracture , and a " bad " hip fracture ) by using time trade off technique . RESULTS On an interval scale between 0 ( death ) and 1 ( full health ) , a " bad " hip fracture ( which results in admission to a nursing home ) was valued at 0.05 ; a " good " hip fracture ( maintaining independent living in the community ) 0.31 , and fear of falling 0.67 . Of women surveyed , 80 % would rather be dead ( utility=0 ) than experience the loss of independence and quality of life that results from a bad hip fracture and subsequent admission to a nursing home . The differences in mean utility weights between the trial groups and the refusers were not significant . A test-retest study on 36 women found that the results were reliable with correlation coefficients within classes ranging from 0.61 to 0.88 . CONCLUSIONS Among older women who have exceeded average life expectancy , quality of life is profoundly threatened by falls and hip fractures . Older women place a very high marginal value on their health . Any loss of ability to live independently in the community has a considerable detrimental effect on their quality of life The Beaver Dam Health Outcomes Study ( BDHOS ) is an ongoing longitudinal cohort study of health status and health-related quality of life for a r and om sample of adults ( age range at interview was 45 to 89 years ; mean = 64.1 , SD = 10.8 ) in a community population . In a face-to-face interview lasting approximately an hour , each participant responds to several batteries of questions . Included are a history of chronic medical conditions , current medi cations , and past surgeries ; the SF-36 ( a general health-status question naire ) ; the Quality of Well-being index ; self-rated health status on a five-point scale from " excellent " to " poor " ; and evaluation of current health using the method of time tradeoffs . The authors present results from 1,356 interviews on these four principal measures , reporting mean scores by sex , by age , and for persons reporting being affected by various medical conditions . They believe data from the BDHOS will provide research ers and policy makers a reference col lection of vital statistics for health-related quality of life . Additionally , the data provide a way to compare results from studies that utilize different indices from among the four principal measures of the BDHOS . Key words : health status ; quality of life ( health-related ) ; population study ; cohort study . ( Med Decis Making 1993;13:89 - 102 The objective of this research was to determine the relative decrement in health-related quality of life , as measured by the health utilities index mark 3 ( HUI3 ) , in osteoporosis compared to other chronic medical conditions . The impact of chronic medical conditions other than osteoporosis on HUI3 measurements had been previously established in the 1996/1997 Canadian National Population Health Survey ( NPHS ) . The Canadian Multicentre Osteoporosis Study ( CaMos ) is a national population -based study in which regional participants were r and omly recruited , regardless of presence of osteoporosis . We analyzed data from participants aged ≥65 years who completed a baseline HUI3 question naire and provided information on their medical history ( n=3,750 ) . We determined the age- and gender-adjusted mean decrement in HUI3 for several chronic medical conditions , including osteoporosis . The mean changes in HUI3 adjusted for age and gender ( with 95 % confidence intervals ) were as follows : arthritis −0.10 ( −0.11 , −0.09 ) , chronic obstructive pulmonary disease ( COPD ) −0.07 ( −0.09 , -0.05 ) , diabetes mellitus −0.05 ( −0.08 , −0.03 ) , heart disease −0.06 ( -0.08 , −0.04 ) , hypertension −0.02 ( -0.03 , −0.01 ) , and osteoporosis −0.08 ( −0.11 , −0.06 ) , respectively ( model r2=0.17 ; P<0.0001 ) . These findings were comparable to those observed in the NPHS , with the exception of osteoporosis , which had not been previously studied in this fashion . The decrement in HUI3 score seen in participants with osteoporosis was comparable to that observed in other chronic medical conditions , such as arthritis , COPD , diabetes mellitus or heart disease Background : Vertebral fractures are associated with back pain and disability ; however , relatively little is known about the impact of radiographic vertebral fractures on quality of life in population sample s. The aim of this study was to determine the impact of a recent radiographic vertebral fracture on health-related quality of life ( HRQoL ) . Methods : Men and women aged 50 years and over were recruited from population registers in 12 European centers . Subjects completed an interviewer-administered question naire and had lateral spine radiographs performed . Subjects in these centers were followed prospect ively and had repeat spinal radiographs performed a mean of 3.8 years later . Prevalent deformities were defined using established morphometric criteria , and incident vertebral fractures by both morphometric criteria and qualitative assessment . For each incident fracture case , three controls matched for age , gender , and center were selected : one with a prevalent deformity ( at baseline ) and two without prevalent deformities . All subjects were interviewed or completed a postal question naire instrument which included  Short Form 12 ( SF-12 ) , the  EQ-5D ( former EuroQol ) , and the  quality of life question naire of the International Osteoporosis Foundation ( QUALEFFO ) . The median time from the second spinal radiograph until the quality of life survey was 1.9 years . Comparison between cases and their matched controls was undertaken using the signed rank test . Results : 73 subjects with incident vertebral fracture ( cases ) , mean age 64.8 years ( of whom 23 had a baseline deformity ) , and 196 controls , mean age 63.9 years ( of whom 60 had a baseline deformity ) , were studied . There were strong correlations between the domain scores for each of the three instruments . There was no statistically significant difference in any of the domain scores between cases and those controls with a prevalent deformity . However , compared with the controls without a prevalent deformity the cases had significantly impaired quality of life as determined using the total QUALEFFO score ( 38.2 vs 33.7 ) , the physical component score of the SF-12 ( 39.9 vs 43.7 ) and the health status score of the EQ-5D ( 62.3 vs 69.9 ) . When the analysis was repeated after stratification of the cases by baseline deformity status ( i.e. , cases with and without a prevalent deformity at baseline ) , cases with a prevalent deformity had impaired quality of life compared with their matched controls , both with and without a prevalent deformity . In contrast there was no significant difference in quality of life among the cases without a prevalent deformity and either control group . Conclusion : In this population -based study a recent vertebral fracture was associated with impairment in quality of life , though this was mainly among those who had sustained a previous vertebral deformity BACKGROUND Recent r and omized , controlled trials performed at two years postoperatively have shown that a primary total hip replacement is superior to internal fixation for the treatment of a displaced femoral neck fracture in a relatively healthy , mentally competent , elderly patient . The primary aim of the present study was to evaluate the outcomes at four years . METHODS One hundred and two patients ( mean age , eighty years ) who had an acute displaced femoral neck fracture were r and omly allocated to be treated with total hip replacement or internal fixation . The inclusion criteria were an age of at least seventy years , absence of severe cognitive dysfunction , an independent living status , and the ability to walk independently . The main outcome measurements were hip complications , reoperations , hip function , and health-related quality of life . RESULTS The mortality rate was 25 % in both groups . At the forty-eight-month follow-up evaluation , the rate of hip complications was 4 % in the patients treated with total hip replacement and 42 % in those treated with internal fixation ( p < 0.001 ) and the reoperation rates were 4 % and 47 % , respectively ( p < 0.001 ) . The arthroplasty group had no additional hip complications or reoperations between the twenty-four and forty-eight-month follow-up visits . In the fixation group , the percentage of hip complications increased from 36 % to 42 % and the percentage of reoperations increased from 42 % to 47 % during the same period . The hip function was significantly better and the decline in health-related quality of life was less pronounced in the arthroplasty group than it was in the fixation group at the four , twelve , and twenty-four-month follow-up evaluations . Ninety-seven percent of the patients in the arthroplasty group and 57 % of the patients in the fixation group who were available for follow-up at forty-eight months had no hip complications ( p < 0.001 ) . CONCLUSIONS Compared with internal fixation , primary total hip replacement provides a better outcome for mentally competent elderly patients with a displaced femoral neck fracture . The complication and reoperation rates were significantly lower and hip function and health-related quality of life were at least as good at four years after the surgery BACKGROUND Previous studies have indicated that patients with a hip fracture who have impaired cognitive function have an increased risk for complications , poor long-term outcome , and an increased mortality rate . An assessment of cognitive function is often lacking in nursing and medical records . We investigated whether an assessment of cognitive function obtained with use of a vali date d instrument would be a useful patient management adjunct . METHODS We studied 213 patients with a hip fracture who had a mean age of eighty-four years and were entered in a prospect i ve trial with a follow-up evaluation at four and twelve months . On admission to the orthopaedic ward , the patients were evaluated with use of the Short Portable Mental Status Question naire to assess their cognitive function .  The outcome for patients with severe cognitive dysfunction , i.e. , those with a score of <3 on the question naire , was compared with the outcome for patients with higher scores . The main outcome measurements were the Charnley hip score , activities of daily living status , health-related quality of life , and mortality . RESULTS A Short Portable Mental Status Question naire score of <3 and male gender were associated with an increased mortality rate during the first twelve months . Moreover , patients with a score of <3 had a significantly worse outcome with regard to the ability to walk and to perform the activities of daily living , with 36 % of these patients confined to a wheelchair and almost 39 % totally dependent with regard to daily living functions at the time of the final follow-up ( p < 0.001 ) . CONCLUSIONS The systematic use of the Short Portable Mental Status Question naire upon admission to the orthopaedic ward identifies patients with a hip fracture who have severe cognitive dysfunction and effectively predicts their outcome with regard to the ability to walk , ability to perform the activities of daily living , and mortality , and it can be recommended for use in the care of elderly patients with a hip fracture Health-related quality of life ( HRQOL ; “ QOL ” hereafter ) was evaluated in Japanese osteoporotic patients using three question naires ; the SF-36 ( MOS 36-Item Short-Form Health Survey ; generic , profile-type ) , the EQ-5D ( Euro Qol-5 Dimensions ; generic , preference-based ) , and the JOQOL ( Japanese Osteoporosis Quality of Life 1999 ; disease-targeted ) . The eight subscales and two summary scores of the SF-36 were impaired in these patients even after correction for age and sex . The scores on the EQ-5D and JOQOL correlated well with the subscales of the SF-36 that represent the physical aspects of physical function and bodily pain , which suggests that physical aspects are important determinants of overall QOL status in osteoporotic patients . Although the QOL scores did not correlate with bone mineral density , they were markedly influenced by the presence of vertebral fractures . In particular , the presence of two or more vertebral fractures greatly decreased the QOL scores . We then evaluated the QOL scores before and after treatment . The patients were either given calcium supplementation alone or calcium plus once-weekly elcatonin ( Elcitonin , Asahi Kasei Pharma , Tokyo , Japan ) injection . Elcatonin treatment markedly improved diverse aspects of the QOL , whereas calcium alone did not . The current data suggest that osteoporosis , especially in the presence of vertebral fracture , is associated with compromised QOL , and therapeutic intervention for osteoporosis should be evaluated in terms of QOL , as well as in terms of increases in bone mineral density and fracture prevention This prospect i ve observational data collection study assessed the cost and quality of life related to hip , vertebral and wrist fracture 1 year after the fracture , based on a patient sample consisting of 635 male and female patients surv 
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Conclusion The paper provides a set of multipliers representing the loss in HSUVs for use as a “ reference case ” in cost-effectiveness models