Showing papers by "James F. Fries published in 1994"

The mortality of rheumatoid arthritis

Abstract: Objective. To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA). Methods. RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died. Results. The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use.

Measurement of health status in children with juvenile rheumatoid arthritis

Abstract: Objective. To develop and validate a self- or parent-administered instrument for measuring functional status in children with juvenile rheumatoid arthritis (JRA). Methods. We adapted the Stanford Health Assessment Questionnaire (HAQ) for use in children ages 1–19 years, by adding several new questions, such that for each functional area, there was at least 1 question relevant to children of all ages. The face validity of the instrument was evaluated by a group of 20 health professionals and parents of 22 healthy children. The questionnaire was then administered to parents of 72 JRA patients (mean age 9.1 years, onset type systemic in 16, polyarticular in 21, pauciarticular in 35). Results. The instrument showed excellent internal reliability (Cronbach's α = 0.94), with a mean inter-item correlation of 0.6. The convergent validity was demonstrated by strong correlations of the Disability Index (average of scores on all functional areas) with Steinbrocker functional class (Kendall's tau b = 0.77, P 8 years) was 0.84 (n = 29; P 0.9 by paired t-test; Spearman's correlation coefficient = 0.8, P < 0.002). Conclusion. The Childhood HAQ, which takes less than 10 minutes to complete, is a valid, reliable, and sensitive instrument for measuring functional status in children with JRA.

Running and the Development of Disability with Age

Abstract: Objective: To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age. Stud...

Criteria for rheumatic disease : different types and different functions

Abstract: Criteria sets formalize our approach to studying the etiology, course, and management of rheumatic diseases, and provide a conceptual base for measuring future improvements in clinical care. They focus our clinical objectives and improve our clinical research activities. They are dynamic, evolving, and will certainly undergo major changes. Understanding the purposes of specific criteria sets and the differences between different criteria categories is crucial for understanding the rheumatic disease literature and for the design and conduct of clinical and epidemiologic investigations.

Randomized controlled trial of cost reductions from a health education program: the California Public Employees' Retirement System (PERS) study.

Abstract: Purpose. This study evaluated the cost trend reduction from a health promotion program. Design. A randomized 12-month trial comparing claims data was conducted. Additional studies, utilizing quasi-experimental designs, analyzed changes in health habits and changes in costs estimated by self-report. Subjects. All active California Public Employees' Retirement System (PERS) employees (21,170), non-Medicare eligible retirees (8,316), and retirees with Medical Supplement coverage (25,416) administered by Blue Shield of California were included. Intervention. The program consisted of mailed health risk assessments at six- or 12-month intervals, with individualized reports and recommendation letters sent to participants emphasizing and encouraging change, self-management materials emphasizing self-care when appropriate, and quarterly newsletters. Passive participants received printed materials only. Measures. Health risks were based upon self-report; summary scores were computed by modified Framingham ...

Education, Gender, and the Compression of Morbidity:

Abstract: According to the Compression of Morbidity (CM) hypothesis, people who exercise, eat nutritiously, do not smoke, and maintain good weight, i.e., people who practice healthy habits, will be more like...

Arthritis and mortality in the epidemiological follow-up to the National Health and Nutrition Examination Survey I.

Abstract: Subsets were analyzed of respondents from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey I (NHANES I) who (1) answered a general arthritis question reflecting whether a doctor told the respondent that she or he had arthritis, (2) answered seven pain, swelling, and stiffness questions, and (3) had radiographs of knees and hips assessed for osteoarthritis at the time of the initial survey during the early 1970s. Data for the follow-up were collected between 1982 and 1984 and included 1,491 fatalities in the largest subsample analyzed here. The dependent variable was months of survival after the initial interview. No distinction was drawn between rheumatoid arthritis versus osteoarthritis. The NHANES I contained only limited information on rheumatoid arthritis versus osteoarthritis. Additional covariates included age, age squared, education, race, marital status, diastolic blood pressure, and body mass. After adjusting for age, no statistically significant associations emerged between answers to the general arthritis questions or any of the seven pain questions on the one hand, and mortality on the other. Similar statistically insignificant results were found when the association between radiographic diagnoses of osteoarthritis in the hips and months of survival was considered after adjusting for age. These statistically insignificant results persisted in repeated testing, which alternately included and excluded a number of covariates, and in separate subsamples of women, men, and persons older and younger than age 50. Some evidence was found, however, for a negative, statistically significant association between radiographic knee diagnoses of osteoarthritis and survival, especially among women, even after adjusting for covariates. These mixed results (1) do not discredit findings elsewhere suggesting that rheumatoid arthritis is associated with early death, since it is likely that the great majority of respondents answering in the affirmative to the general arthritis or seven pain questions in the NHANES I had osteoarthritis, and (2) suggest that future surveys should make greater attempts to distinguish between rheumatoid arthritis and osteoarthritis.

Patient Education and Health Promotion Can Be in Parkinson's Disease: A Randomized Controlled

Abstract: We performed a randomized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson’s disease. The health promotion program (PROPATH) was designed to improve health confidence, provide information and support, improve physical function through exercise, and work with the physician to optimize medical treatment and compliance. The intervention was delivered by mail, with disease assessment questionnaires completed by patient or caregiver at 0, 2, 4, and 6 months, with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians. Two hundred ninety patients completed the 6-month trial, 140 patients in the intervention group and 150 in a control group of patients who received only questionnaires. The intervention group had significantly increased exercise, decreased “time off” and percentage of time off, reduced side effects, and decreased summary Parkinson’s scores by approximately 10% (P >0.05). Twelve of 13 variables showed differences favoring the intervention group. The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise sharply for controls (P ~0.01). Levodopa dose rose for controls and slightly decreased for the intervention group. Doctor visits, hospital days, and sick days were reduced in the intervention group. The quality-of-life

Health care demand management.

Abstract: Health care costs, rising prohibitively, are related in part to the magnitude of the illness burden (need) and to the services requested (demand), which in turn are related in part to preventable illness and to inconsistent and unproductive requests for utilization. A broadened model of health promotion is suggested by the author, with the twin goals of health improvement and of cost reduction. The model includes health risk reduction goals and selected screening tests, but also includes cost-focused features. Eight such programs have recently been proven to reduce medical costs by 20%, potentially representing savings of $200 billion annually, but such programs are not yet widely disseminated.