Kumar, B Siddhartha; Suneetha, P; Mohan, Alladi; Kumar, D Prabath; Sarma, K V S
2017-11-01
In patients with rheumatoid arthritis (RA), disease severity assessment is done using Disease Activity Score in 28 joints with ESR (DAS28). Computing DAS28 is time-consuming, requires laboratory testing and an online calculator. There is a need to validate rapid methods of disease severity assessment for routine daily use. This study was conducted to compare DAS28, Clinical Disease Activity Index (CDAI), Health Assessment Questionnaire Disability Index (HAQ-DI) and Routine Assessment of Patient Index Data with 3 measures (RAPID3) to assess the disease activity in patients with RA. We prospectively studied the utility of CDAI, HAQ-DI and RAPID3 scoring in 100 consecutive newly diagnosed, disease modifying antirheumatic drugs (DMARDs) naïve adult patients with RA seen during January 2013 and June 2014 at a tertiary care teaching hospital in south India. The mean age of the patients was 42.1±11.6 yr, there were 82 females. The median [interquartile range (IQR)] symptom duration was 6 (range 4-12) months. The median (IQR) DAS28, CDAI, HAQ-DI and RAPID3 scores at presentation were 7 (6-7), 36 (28-43), 2 (1-2) and 17 (13-19), respectively. A significant positive correlation was observed between DAS28 and CDAI (r=0.568; Pfair' agreement was observed in between DAS28 and CDAI (kappa-statistic=0.296). The agreement between DAS28 and HAQ-DI (kappa-statistic=0.007) and RAPID3 (kappa-statistic=0.072) was less robust. In adult patients with RA, in the setting where illiteracy is high, CDAI emerged as the preferred choice for rapid assessment of severity of disease at the time of initial presentation.
Kim, Hye-Lin; Kim, Dam; Jang, Eun Jin; Lee, Min-Young; Song, Hyun Jin; Park, Sun-Young; Cho, Soo-Kyung; Sung, Yoon-Kyoung; Choi, Chan-Bum; Won, Soyoung; Bang, So-Young; Cha, Hoon-Suk; Choe, Jung-Yoon; Chung, Won Tae; Hong, Seung-Jae; Jun, Jae-Bum; Kim, Jinseok; Kim, Seong-Kyu; Kim, Tae-Hwan; Kim, Tae-Jong; Koh, Eunmi; Lee, Hwajeong; Lee, Hye-Soon; Lee, Jisoo; Lee, Shin-Seok; Lee, Sung Won; Park, Sung-Hoon; Shim, Seung-Cheol; Yoo, Dae-Hyun; Yoon, Bo Young; Bae, Sang-Cheol; Lee, Eui-Kyung
2016-04-01
The aim of this study was to estimate the mapping model for EuroQol-5D (EQ-5D) utility values using the health assessment questionnaire disability index (HAQ-DI), pain visual analog scale (VAS), and disease activity score in 28 joints (DAS28) in a large, nationwide cohort of rheumatoid arthritis (RA) patients in Korea. The KORean Observational study Network for Arthritis (KORONA) registry data on 3557 patients with RA were used. Data were randomly divided into a modeling set (80 % of the data) and a validation set (20 % of the data). The ordinary least squares (OLS), Tobit, and two-part model methods were employed to construct a model to map to the EQ-5D index. Using a combination of HAQ-DI, pain VAS, and DAS28, four model versions were examined. To evaluate the predictive accuracy of the models, the root-mean-square error (RMSE) and mean absolute error (MAE) were calculated using the validation dataset. A model that included HAQ-DI, pain VAS, and DAS28 produced the highest adjusted R (2) as well as the lowest Akaike information criterion, RMSE, and MAE, regardless of the statistical methods used in modeling set. The mapping equation of the OLS method is given as EQ-5D = 0.95-0.21 × HAQ-DI-0.24 × pain VAS/100-0.01 × DAS28 (adjusted R (2) = 57.6 %, RMSE = 0.1654 and MAE = 0.1222). Also in the validation set, the RMSE and MAE were shown to be the smallest. The model with HAQ-DI, pain VAS, and DAS28 showed the best performance, and this mapping model enabled the estimation of an EQ-5D value for RA patients in whom utility values have not been measured.
Wylde, Vikki; Livesey, Christine; Learmonth, Ian D; Blom, Ashley W; Hewlett, Sarah
2010-06-01
Measuring facts about disability may not reflect their personal impact. An individualized values instrument has been used to weight difficulty in performing activities of daily living in rheumatoid arthritis, and calculate personal impact (Personal Impact Health Assessment Questionnaire; PI HAQ). This study aimed to evaluate the PI HAQ in osteoarthritis (OA). Study 1: 51 people with OA completed short and long versions of the value instrument at 0 and 1 week. Study 2: 116 people with OA completed the short value instrument, disability and psychological measures at 0 and 4 weeks. Study 1: The eight-category and 20-item value instruments correlated well (r = 0.85) and scores differed by just 2.7%. The eight-category instrument showed good internal consistency reliability (Cronbach's alpha = 0.85) and moderate one-week test-retest reliability (r = 0.68, Wilcoxon signed-rank test p = 0.16, intra-class correlation coefficient [ICC] 0.62). Study 2: Values for disability were not associated with disability severity or clinical status. After weighting disability by value, the resulting PI HAQ scores were significantly associated with dissatisfaction with disability, perceived increase in disability, poor clinical status and life dissatisfaction, and differed significantly between people with high and low clinical status (convergent and discriminant construct validity). There was moderate association with the disease repercussion profile disability subscale (r = 0.511; p personal impact of disability in people with OA, setting disability within a personal context. Further studies, including sensitivity to change, are required.
Comparison of measures of functional disability in patients with gout
ten Klooster, Peter M.; Oude Voshaar, Antonius H.; Taal, Erik; van de Laar, Mart A F J
2011-01-01
Objective. To compare the measurement properties of the HAQ disability index (HAQ-DI), HAQ-II and short form 36 physical functioning scale (PF-10) in patients with gout. Methods. A cross-sectional sample of 97 patients with gout completed all three measures. Reliability was assessed by examining the
Boyd, Tristan A; Bonner, A; Thorne, C; Boire, G; Hitchon, C; Haraoui, B P; Keystone, E C; Bykerk, V P; Pope, J E
2013-01-01
To investigate the relationship between function and disease activity in early inflammatory arthritis (EIA). Canadian Early Arthritis Cohort (CATCH) (n=1143) is a multi-site EIA cohort. Correlations between the Health Assessment Questionnaire Disability Index (HAQ) and DAS28 were done at every 3 months for the first year and then at 18 and 24 months. We also investigated the relationship between HAQ and DAS28 by age (<65 versus ≥65) and RF (positive vs negative). Mean HAQ and DAS28 scores were highest at the initial visit with HAQ decreasing over 24 months from a baseline of 0.94 to 0.40 and DAS28 scores decreasing from 4.54 to 2.29. All correlations between HAQ and DAS28 were significant at all time points (p<0.01). The correlations between HAQ and DAS28 were variable over time. The strongest correlation between HAQ and DAS28 occurred at initial visit (most DMARD naive) (n=1,143) and 18 months (r=0.57, n=321) and 24 months (r=0.59, n=214). The baseline correlation between HAQ and DAS28 was significantly different than correlations obtained at 3, 6, and 12 months (p=0.02, 0.01, and 0.01, respectively). Age did not change the association between HAQ and DAS28 {<65 years old (r=0.50, n=868) versus ≥65 (r=0.48, n=254), p=0.49}. The correlation between HAQ and DAS28 was stronger with RF+ patients (r=0.63, n=636) vs RF negative (r=0.47, n=477), p=0.0043. Over 2 years in EIA, HAQ and DAS both improved; correlations at time points were different over 2 years and RF status affected the correlations.
Pincus, Theodore; Swearingen, Christopher J
2009-11-01
The health assessment questionnaire (HAQ) is the questionnaire most widely used to assess and monitor patients with rheumatic diseases. The HAQ includes 20 activities grouped into 8 categories of 2 or 3 (and queries the use of "aids and devices" and "help from another person" to perform these activities), and visual analog scales (VAS) for pain and patient global estimate of status. Use of the HAQ in usual care over the years has led to several modifications to develop a multidimensional HAQ (MDHAQ). The MDHAQ includes 10 activities, one from each category of the HAQ plus 2 complex activities-walk 2 miles or 3 km-all on one side of a page for easy "eyeball" review by a clinician; pain, global and fatigue VAS with 21 circles rather than 10-cm lines for ease of scoring; recent medical history; review of systems; a query about exercise; and scoring templates for the 3 rheumatoid arthritis (RA) Core Data Set patient-reported measures-physical function, pain, and global estimate-for a routine assessment of patient index data (RAPID3) composite score. Both the HAQ and MDHAQ involve 2 sides of one sheet of paper, and are completed by patients in 5 to 10 minutes. The HAQ requires 42 seconds to score, compared with 5 to 10 seconds for RAPID3 on the MDHAQ.
Weaver, Arthur; Troum, Orrin; Hooper, Michele; Koenig, Andrew S; Chaudhari, Sandeep; Feng, Jingyuan; Wenkert, Deborah
2013-08-01
To determine whether disease activity and disability independently correlate with serious infection event (SIE) risk in a large rheumatoid arthritis (RA) cohort. The associations between SIE and Clinical Disease Activity Index (CDAI) and Health Assessment Questionnaire-Disability Index (HAQ-DI) in the Rheumatoid Arthritis Disease-Modifying Antirheumatic Drug Intervention and Utilization Study (RADIUS 1) cohort were evaluated using the Andersen-Gill model (a proportional HR model allowing > 1 event per patient). Of 4084 patients with 347 SIE, 271 patients experienced ≥ 1 SIE. A 5-unit CDAI increase and 0.4-unit HAQ-DI increase corresponded to an increase in SIE risk with and without covariate adjustments. A 5-unit CDAI increase corresponded with a 7.7% increased SIE risk (adjusted HR 1.077, 95% CI 1.044-1.112, p < 0.0001) and a 0.4-unit HAQ-DI increase with a 30.1% increased risk (adjusted HR 1.301, 95% CI 1.225-1.381, p < 0.0001). Categorical analysis showed that more severe RA activity (even after controlling for disability) and disability were associated with an increased SIE risk. Increased RA disease activity and disability were each associated with a significantly increased SIE risk in the RADIUS 1 cohort, which could not be completely accounted for by disability.
Pioneering the human development revolution: Analysing the trajectory of Mahbub ul Haq
D.R. Gasper (Des)
2011-01-01
textabstractMahbub ul Haq's work to coordinate, establish and propagate the human development approach offers an example of effective leadership in promoting more ethical socio-economic development. This article reviews Pioneering the Human Development Revolution-An Intellectual Biography of Mahbub
LENUS (Irish Health Repository)
Adams, Roisin
2012-02-01
BACKGROUND: The growth of economic analyses and in particular cost-utility analyses (CUA), which use the QALY as a measure of outcome, has heightened the interest in the methodologies used to calculate the QALY. The EQ-5D has produced quite different utility values from that of the SF-6D. This article seeks to understand these differences using a cohort of patients with inflammatory arthritis. OBJECTIVE: To examine the relationship between the disease-specific measure, Health Assessment Questionnaire (HAQ) disability index (DI) and the preference-based measures, SF-6D, EQ-5D and European League Against Arthritis (EULAR) Disease Activity Score (DAS) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS: Patients with RA and PsA (n = 504) attending a tertiary rheumatology referral centre completed the HAQ, SF-6D and the EQ-5D before starting biological therapy and again 12 months later. The SF-36 was converted into a utility using the preference-based SF-6D. Clinical outcomes such as the DAS, joint counts and laboratory measures were also recorded. We calculated single index utility scores from the preference-based instruments using UK population norms. We used regression analysis to derive a mapping function and calculated utility scores from the HAQDI and the DAS 28. RESULTS: The mean utility observed at baseline for RA was 0.43 for the EQ-5D and 0.54 for the SF-6D and for PsA was 0.49 for the EQ-5D and 0.57 for the SF-6D. The utility gain demonstrated by the EQ-5D was over twice that of the SF-6D. The EQ-5D scored 17% of the RA group as less than 0 (state defined as worse than death); 7% of this group remained less than 0 at follow-up. The distribution of the utility estimates was similar for both RA and PsA. CONCLUSIONS: Our findings draw attention to the impact of states worse than death on the overall distribution for the EQ-5D derived utilities and how these impact on its use in practice. EQ-5D-derived QALY changes are over twice
VizieR Online Data Catalog: QSO eHAQ0111+0641 spectra (Fynbo+, 2017)
Fynbo, J. P. U.; Krogager, J.-K.; Heintz, K. E.; Geier, S.; Moller, P.; Noterdaeme, P.; Christensen, L.; Ledoux, C.; Jakobsson, P.
2017-09-01
eHAQ0111+0641 was observed with the OSIRIS instrument at the Gran Telescopio Canarias (GTC) as part of a larger sample of candidate red quasars. We secured spectroscopy with OSIRIS and a range of grisms to better constrain the spectral energy distribution, metal lines, and hydrogen Lyα line. (2 data files).
Directory of Open Access Journals (Sweden)
Juan S Ruiz-Moreno
2018-01-01
Full Text Available The cyclic GMP-AMP synthase (cGAS-STING pathway is central for innate immune sensing of various bacterial, viral and protozoal infections. Recent studies identified the common HAQ and R232H alleles of TMEM173/STING, but the functional consequences of these variants for primary infections are unknown. Here we demonstrate that cGAS- and STING-deficient murine macrophages as well as human cells of individuals carrying HAQ TMEM173/STING were severely impaired in producing type I IFNs and pro-inflammatory cytokines in response to Legionella pneumophila, bacterial DNA or cyclic dinucleotides (CDNs. In contrast, R232H attenuated cytokine production only following stimulation with bacterial CDN, but not in response to L. pneumophila or DNA. In a mouse model of Legionnaires' disease, cGAS- and STING-deficient animals exhibited higher bacterial loads as compared to wild-type mice. Moreover, the haplotype frequency of HAQ TMEM173/STING, but not of R232H TMEM173/STING, was increased in two independent cohorts of human Legionnaires' disease patients as compared to healthy controls. Our study reveals that the cGAS-STING cascade contributes to antibacterial defense against L. pneumophila in mice and men, and provides important insight into how the common HAQ TMEM173/STING variant affects antimicrobial immune responses and susceptibility to infection.ClinicalTrials.gov DRKS00005274, German Clinical Trials Register.
Ruiz-Moreno, Juan S; Hamann, Lutz; Shah, Javeed A; Verbon, Annelies; Mockenhaupt, Frank P; Puzianowska-Kuznicka, Monika; Naujoks, Jan; Sander, Leif E; Witzenrath, Martin; Cambier, John C; Suttorp, Norbert; Schumann, Ralf R; Jin, Lei; Hawn, Thomas R; Opitz, Bastian
2018-01-01
The cyclic GMP-AMP synthase (cGAS)-STING pathway is central for innate immune sensing of various bacterial, viral and protozoal infections. Recent studies identified the common HAQ and R232H alleles of TMEM173/STING, but the functional consequences of these variants for primary infections are unknown. Here we demonstrate that cGAS- and STING-deficient murine macrophages as well as human cells of individuals carrying HAQ TMEM173/STING were severely impaired in producing type I IFNs and pro-inflammatory cytokines in response to Legionella pneumophila, bacterial DNA or cyclic dinucleotides (CDNs). In contrast, R232H attenuated cytokine production only following stimulation with bacterial CDN, but not in response to L. pneumophila or DNA. In a mouse model of Legionnaires' disease, cGAS- and STING-deficient animals exhibited higher bacterial loads as compared to wild-type mice. Moreover, the haplotype frequency of HAQ TMEM173/STING, but not of R232H TMEM173/STING, was increased in two independent cohorts of human Legionnaires' disease patients as compared to healthy controls. Our study reveals that the cGAS-STING cascade contributes to antibacterial defense against L. pneumophila in mice and men, and provides important insight into how the common HAQ TMEM173/STING variant affects antimicrobial immune responses and susceptibility to infection. ClinicalTrials.gov DRKS00005274, German Clinical Trials Register.
Hamann, Lutz; Verbon, Annelies; Mockenhaupt, Frank P.; Puzianowska-Kuznicka, Monika; Naujoks, Jan; Sander, Leif E.; Witzenrath, Martin; Schumann, Ralf R.; Hawn, Thomas R.
2018-01-01
The cyclic GMP-AMP synthase (cGAS)-STING pathway is central for innate immune sensing of various bacterial, viral and protozoal infections. Recent studies identified the common HAQ and R232H alleles of TMEM173/STING, but the functional consequences of these variants for primary infections are unknown. Here we demonstrate that cGAS- and STING-deficient murine macrophages as well as human cells of individuals carrying HAQ TMEM173/STING were severely impaired in producing type I IFNs and pro-inflammatory cytokines in response to Legionella pneumophila, bacterial DNA or cyclic dinucleotides (CDNs). In contrast, R232H attenuated cytokine production only following stimulation with bacterial CDN, but not in response to L. pneumophila or DNA. In a mouse model of Legionnaires’ disease, cGAS- and STING-deficient animals exhibited higher bacterial loads as compared to wild-type mice. Moreover, the haplotype frequency of HAQ TMEM173/STING, but not of R232H TMEM173/STING, was increased in two independent cohorts of human Legionnaires’ disease patients as compared to healthy controls. Our study reveals that the cGAS-STING cascade contributes to antibacterial defense against L. pneumophila in mice and men, and provides important insight into how the common HAQ TMEM173/STING variant affects antimicrobial immune responses and susceptibility to infection. Trial registration ClinicalTrials.gov DRKS00005274, German Clinical Trials Register PMID:29298342
Directory of Open Access Journals (Sweden)
M. Arif Rahman Hakim
2017-06-01
Full Text Available Strategi Guru Bahasa Inggris Dalam Mengajar Materi Speaking Terhadap Siswa Yang Berkarakteristik Introvert di Madrasah Aliyah (MA Ja-alHaq Bengkulu. Kemampuan sesorang dalam berkomunikasi sering dipengaruhi oleh karakteristik kepribadiannya. Berdasarkan penelitian para ahli, terdapat dua karakter utama dalam diri seseorang, yaitu ekstrovert dan introvert. Siswa yang berkarakter introvert memiliki kemampuan yang tidak sama dengan siswa ektrovert dalam berkomunikasi bahasa asing. Untuk mengatasi problem tersebut, guru Madrasah Aliyah (MA Ja-alHaq—sebagai objek penelitian ini—beberapa strategi agar kemampuan speaking siswa-siswinya meningkat. Penelitian ini bertujuan untuk memberikan deskripsi dari guru bahasa Inggris di Indonesia yang berpengalaman dalam pengajaran speaking terkait dengan tantangan dan strategi dalam proses belajar mengajar bagi siswa yang berkarakteristik introvert. Berdasarkan hasil penelitian, dapat disimpulkan bahwa para guru disarankan untuk menerapkan diskusi, main peran, story telling, dan wawancara. Di samping itu, guru juga harus mengetahui karakter dari peserta didiknya karena dengan mengetahui kepribadian peserta didik, para guru dapat memilih strategi pembelajaran yang tepat untuk diterapkan di kelas.
Personal impact of disability in osteoarthritis: patient, professional and public values.
Wylde, Vikki; Hewlett, Sarah; Learmonth, Ian D; Cavendish, Victoria J
2006-09-01
Osteoarthritis (OA) is a leading cause of disability. Numerous tools are available to assess this, but they fail to place a patient value upon disability. In rheumatoid arthritis, research has shown patients have different importance values for similar disabilities, and these individual values can be used to weight disability levels, creating a measure of personal impact. Firstly, to determine if the Health Assessment Questionnaire (HAQ) can be used as the basis for an importance value scale by assessing if it includes activities considered important by OA patients. Secondly, to determine if the weights used for the value scale should be based on population, healthcare professional or patient values. Twenty-five OA patients, 25 healthy controls and 25 healthcare professionals rated the importance of the items on the HAQ and shortened Modified HAQ (MHAQ). Prior to completing the HAQ, patients generated a list of activities that were important to them. The HAQ contained 69% of items that patients considered important. No items were consistently deemed unimportant by patients. There was low agreement within and between groups about the importance of the items on the HAQ and MHAQ. The HAQ is a suitable basis for a value scale for an OA disability impact score. Importance values for function differed for patients, healthcare professionals and the general population; therefore individual patient weightings need to be used. Further work is under way to validate a measure of the personal impact of disability in patients with lower limb OA. Copyright (c) 2006 John Wiley & Sons, Ltd.
Ruiz-Moreno, J.S. (Juan S.); Hamann, L. (Lutz); Shah, J.A. (Javeed A.); A. Verbon (Annelies); Mockenhaupt, F.P. (Frank P.); Puzianowska-Kuznicka, M. (Monika); Naujoks, J. (Jan); Sander, L.E. (Leif E.); Witzenrath, M. (Martin); Cambier, J.C. (John C.); Suttorp, N. (Norbert); Schumann, R.R. (Ralf R.); Jin, L. (Lei); T.R. Hawn; Opitz, B. (Bastian)
2018-01-01
textabstractThe cyclic GMP-AMP synthase (cGAS)-STING pathway is central for innate immune sensing of various bacterial, viral and protozoal infections. Recent studies identified the common HAQ and R232H alleles of TMEM173/STING, but the functional consequences of these variants for primary
Self-Reported Disability in Adults with Severe Obesity
Directory of Open Access Journals (Sweden)
I. Kyrou
2011-01-01
Full Text Available Self-reported disability in performing daily life activities was assessed in adults with severe obesity (BMI ≥ 35 kg/m2 using the Health Assessment Questionnaire (HAQ. 262 participants were recruited into three BMI groups: Group I: 35–39.99 kg/m2; Group II: 40–44.99 kg/m2; Group III: ≥45.0 kg/m2. Progressively increasing HAQ scores were documented with higher BMI; Group I HAQ score: 0.125 (median (range: 0–1.75; Group II HAQ score: 0.375 (0–2.5; Group III HAQ score: 0.75 (0–2.65 (Group III versus II P 0. The prevalence of this degree of disability increased with increasing BMI and age. It also correlated to type 2 diabetes, metabolic syndrome, and clinical depression, but not to gender. Our data suggest that severe obesity is associated with self-reported disability in performing common daily life activities, with increasing degree of disability as BMI increases over 35 kg/m2. Functional assessment is crucial in obesity management, and establishing the disability profiles of obese patients is integral to both meet the specific healthcare needs of individuals and develop evidence-based public health programs, interventions, and priorities.
Oude Voshaar, Antonius H.; ten Klooster, Peter M.; Glas, Cornelis A.W.; Vonkeman, Harald Erwin; Krishnan, Eswar; van de Laar, Mart A F J
2014-01-01
OBJECTIVE: To evaluate and compare the measurement precision and sensitivity to change of the Health Assessment Questionnaire disability index (HAQ DI), the Short Form 36 physical functioning scale (PF-10), and simulated Patient-Reported Outcomes Measurement Information System (PROMIS) physical
DEFF Research Database (Denmark)
Linde, Louise; Sørensen, Jan; Østergaard, Mikkel
2009-01-01
OBJECTIVE: The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome measure in rheumatoid arthritis (RA), whereas the SF-12v2 Health Survey (SF-12) was introduced recently. We investigated how the HAQ and SF-12 were associated with socio-demographic, lifestyle, and dise...... to differences in demographic, lifestyle, and disease- and treatment-related factors than the SF-12. The established clinical value and feasibility of the HAQ highlights its advantages over the SF-12 in describing health status in RA.......OBJECTIVE: The Health Assessment Questionnaire Disability Index (HAQ) is a widely used outcome measure in rheumatoid arthritis (RA), whereas the SF-12v2 Health Survey (SF-12) was introduced recently. We investigated how the HAQ and SF-12 were associated with socio-demographic, lifestyle......, and disease- and treatment-related factors in patients with RA. METHODS: In RA patients from 11 Danish centers, clinical and patient-reported data, including the HAQ and SF-12, were collected. Three multiple linear regression models were estimated, with the HAQ, SF-12 physical component score (PCS), and SF-12...
Hirano, Fumio; Yokoyama, Waka; Yamazaki, Hayato; Amano, Koichi; Kawakami, Atsushi; Hayashi, Taichi; Tamura, Naoto; Yasuda, Shinsuke; Dobashi, Hiroaki; Fujii, Takao; Ito, Satoshi; Kaneko, Yuko; Matsui, Toshihiro; Okuda, Yasuaki; Saito, Kazuyoshi; Suzuki, Fumihito; Yoshimi, Ryusuke; Sakai, Ryoko; Koike, Ryuji; Kohsaka, Hitoshi; Miyasaka, Nobuyuki; Harigai, Masayoshi
2017-09-01
To verify predictive validity of simplified disease activity index (SDAI) remission for subsequent functional and structural outcomes in real-world clinical settings under a treat-to-target strategy (T2T). In this multicenter, prospective cohort study, T2T was implemented in rheumatoid arthritis (RA) patients with moderate-to-high disease activity. SDAI or clinical disease activity index (CDAI) was assessed every 12 weeks, and treatment was adjusted to achieve clinical remission or low disease activity (LDA). Multivariate logistic regression models were used to examine the associations of SDAI remission (≤3.3) at week 24 with the health assessment questionnaire-disability index (HAQ-DI) ≤ 0.5 or with the delta van der Heijde-modified total Sharp score (ΔvdH-mTSS)
DEFF Research Database (Denmark)
Linde, L.; Sørensen, J.; Østergaard, Morten
2008-01-01
OBJECTIVE: To compare validity, reliability, and responsiveness of generic and disease specific health-related quality of life (HRQOL) instruments in rheumatoid arthritis (RA). METHODS: Two samples of patients completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), EuroQol (EQ)-5D...... and VAS pain were responsive to both improvement and deterioration. CONCLUSION: All instruments were valid measures for HRQOL in RA. The RAQoL and HAQ displayed the best reliability, while the SF-36 bodily pain scale and VAS pain were the most responsive. The choice of instrument should depend......, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. Validity (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated...
Social security work disability and its predictors in patients with fibromyalgia.
Wolfe, Frederick; Walitt, Brian T; Katz, Robert S; Häuser, Winfried
2014-09-01
To determine prevalence and incidence of US Social Security Disability and Supplemental Security Income (SSD) in patients with fibromyalgia and to investigate prediction of SSD. Over a mean of 4 years (range 1-13 years), we studied 2,321 patients with physician-diagnosed fibromyalgia (prevalent cases) and applied modified American College of Rheumatology (ACR) 2010 research criteria to identify criteria-positive patients. During the study, 34.8% (95% confidence interval [95% CI] 32.9-36.8%) of fibromyalgia patients received SSD. The annual incidence of SSD among patients not receiving SSD at study enrollment was 3.4% (95% CI 3.0-3.9%), and 25% were estimated to be work disabled at 9.0 years of followup. By comparison, the prevalence of SSD in rheumatoid arthritis (RA) patients with concomitant fibromyalgia was 55.6% (95% CI 54.3-57.0%) and was 42.4% in osteoarthritis (OA). By study conclusion, 31.4% of SSD awardees were no longer receiving SSD. In univariate models, incident SSD in patients with fibromyalgia was predicted by sociodemographic measures and by symptom burden; but the strongest predictor was functional status (Health Assessment Questionnaire disability index [HAQ DI]). In multivariable models, the HAQ DI and the Short Form 36-item health survey physical and mental component summary scores, but no other variables, predicted SSD. Fibromyalgia criteria-positive patients had more SSD, but the continuous scale, polysymptomatic distress index derived from the ACR criteria was a substantially better predictor of SSD than a criteria-positive diagnosis. The prevalence of SSD is high in fibromyalgia, but not higher than in RA and OA patients who satisfy fibromyalgia criteria. The best predictors of work disability are functional status variables. Copyright © 2014 by the American College of Rheumatology.
DEFF Research Database (Denmark)
Linde, Louise; Sørensen, Jan; Ostergaard, Mikkel
2008-01-01
.21-6.47). The longitudinal sample included 80% women, median age 60 years (22-82). Validity: all instruments discriminated between low, moderate, and high DAS28. Reliability: RAQoL and HAQ displayed good repeatability (ICC > 0.95) and internal consistency (Cronbach's alpha > 0.90). Responsiveness: SF-36 bodily pain scale......, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. Validity (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated...... questionnaires (at 2 weeks and 6 months) included questions about changes in health status since baseline. RESULTS: The cross-sectional sample included 77% women, median age 57 years (range 19-87), disease duration 6 years (0-58), with Disease Activity Score 28-joint count (DAS28) of 3.10 (1...
Pope, Janet E; Khanna, Dinesh; Norrie, Deborah; Ouimet, Janine M
2009-02-01
Patient-reported outcomes are used in clinical practice and trials. We studied a large clinical practice to determine the minimally important difference (MID) estimates for (1) the Health Assessment Questionnaire-Damage Index (HAQ-DI): improvement and worsening using patient global assessment anchor; and (2) pain using a patient-reported pain anchor. Patients with rheumatoid arthritis (RA; N = 225) had clinic visits at 2 timepoints within 1 year, completed the HAQ-DI and pain visual analog scale (VAS; 0-100 mm), and answered the question, "How would you describe your overall status/overall pain since the last visit?", as much worsened, somewhat worsened, the same, somewhat improved, or much improved. If rated as somewhat improved or worsened, they were defined as the minimally changed subgroups. Eighty-three percent were women, mean age 60 years, with disease duration 11.7 +/- 10.7 years. The baseline HAQ-DI was 0.97 +/- SD 0.76, and at followup 1.0 +/- 0.77 (mean change +0.03 +/- 0.40). The baseline pain VAS was 42.3 +/- 28.8, and at followup 38.5 +/- 27.9 (mean change -2.8 +/- 25.9). The mean (SD) HAQ-DI change score was -0.09 (0.42) for somewhat improved and 0.15 (0.33) for somewhat worsened. The HAQ-DI change for somewhat/much better was -0.20 +/- 0.52, and for somewhat/much worse +0.21 +/- 0.33. For pain, somewhat improved changed by -11.9 mm on the VAS, and somewhat worsened by 6.8 mm. Estimates for HAQ-DI and pain were larger than the for no-change group, 0.03 (0.32) and -3.2 (20.9). The MID for HAQ-DI in clinical practice is smaller than it is in trials. This may have implications for observational studies and clinical care.
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Barber, Ryan M; Fullman, Nancy; Sorensen, Reed J D
2017-01-01
and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ...... Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle...
DEFF Research Database (Denmark)
Wallman, Johan K; Eriksson, Jonas K; Nilsson, Jan-Åke
2016-01-01
between-patient associations) and by generalized estimating equations (GEE), using all observations to also account for within-patient associations of HAQ/DAS28/EQ-5D to costs. RESULTS: Regardless of the methodology (linear or GEE regression), HAQ was most closely related to both cost types, while work......OBJECTIVE: To compare how costs relate to disability, disease activity, and health-related quality of life (HRQOL) in rheumatoid arthritis (RA). METHODS: Antitumor necrosis factor (anti-TNF)-treated patients with RA in southern Sweden (n = 2341) were monitored 2005-2010. Health Assessment...... Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), and EQ-5D scores were linked to register-derived costs of antirheumatic drugs (excluding anti-TNF agents), patient care, and work loss from 30 days before to 30 days after each visit (n = 13,289). Associations of HAQ/DAS28/EQ-5D to healthcare...
Severe tophaceous gout and disability: changes in the past 15 years.
López López, Carlos Omar; Lugo, Everardo Fuentes; Alvarez-Hernández, Everardo; Peláez-Ballestas, Ingris; Burgos-Vargas, Rubén; Vázquez-Mellado, Janitzia
2017-01-01
Epidemiologic data from recent decades show a significant increase in the prevalence and incidence of gout worldwide, in addition to changes in its clinical expression. Our objective was to compare the frequency of the severity of gout and disability in two patient groups at our clinic during different periods. We included and compared data of two groups: group A (1995-2000), patients from previous report, and group B (2010-2014), the baseline data of current patients participating in a cohort (GRESGO). This evaluation included data of socioeconomic and educational levels, demographics, associated diseases, previous treatment, clinical and biochemical data, and disability evaluated using the Health Assessment Questionnaire (HAQ). We included data of 564 gout patients. Participants were 35.7 ± 12.7 years old at onset and had 12.0 ± 9.2-years disease duration at their first evaluation in our department. Group B patients were younger, had higher educational and socioeconomic levels, and had more severe disease. However, this group had less frequency of some associated diseases and significantly higher HAQ scores. With increased HAQ score, a higher number of acute flares and tender, limited-to-motion, and swollen joints were seen. The spectrum of gout has changed over the past decade. A higher percentage of our patients had a severe form of disease, were younger, had earlier disease onset, and had more disability reflected in higher HAQ scores. In our current patient group, the variable most associated with disability was limited-to-motion joints; however, the number of acute flares and tender and swollen joints was also higher in patients with greater disability.
Kwan, Yu Heng; Koh, Ee Tzun; Leong, Khai Pang; Wee, Hwee-Lin
2014-08-01
To investigate the association between helplessness, disability, and disease activity with health-related quality of life (HRQoL) in a multiethnic cohort of rheumatoid arthritis (RA) patients in Singapore. This cross-sectional study was conducted at Tan Tock Seng Hospital, Department of Rheumatology, Allergy and Immunology, from October 2010 to October 2011. All patients fulfilled the American College of Rheumatology 1987 criteria for RA. Socio-demographics, clinical, and patient-reported outcome (PRO) variables were collected. HRQoL outcomes were Short Form 36 (SF-36) physical and mental component summary (PCS and MCS) scores and Short Form 6 Dimensions (SF-6D) utilities. Stepwise multiple linear regression analyses were performed using HRQoL outcomes as dependent variables in separate models and with adjustment for helplessness (Rheumatology Attitudes Index, RAI), disability (Health Assessment Questionnaire, HAQ), and disease activity (Disease Activity in 28 joints) followed by socio-demographic, clinical, and PRO variables. Complete data were provided by 473 consenting subjects [mean (SD) age: 60.02 (11.04) years, 85 % female, 77 % Chinese]. After adjustment for all measured covariates, only RAI and HAQ scores remained significantly associated with SF-36 MCS (β: -0.9, p < 0.001; β: -7.0, p < 0.001) and SF-6D utilities (β: -0.005, p < 0.001; β: -0.081, p < 0.001), respectively, while only HAQ scores were significantly associated with SF-36 PCS (β: -7.7, p < 0.001). Interventions to address the sense of helplessness and to prevent or reduce disability could improve HRQoL of RA patients.
2017-07-15
National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This
Ebbevi, David; Essén, Anna; Forsberg, Helena Hvitfeldt
2017-05-12
The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. The study used secondary data analysis. Persons with RA participated in semi-structured interviews in previous research projects. Thirty-nine interviews were included based on data fit, and thematic analysis applied. The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.
Gwinnutt, James M; Sharp, Charlotte A; Symmons, Deborah P M; Lunt, Mark; Verstappen, Suzanne M M
2018-03-15
To assess baseline predictors of long-term functional disability in patients with inflammatory arthritis (IA). We conducted a systematic review of the literature from 1990 to 2017 using MEDLINE and EMBASE. Studies were included if (i) they were prospective observational studies, (ii) all patients had IA with symptom duration ≤2 years at baseline, (iii) follow-up was at least 5 years, and (iv) baseline predictors of HAQ score at long-term follow-up (i.e., ≥5 years following baseline) were assessed. Information on the included studies and estimates of the association between baseline variables and long-term HAQ scores were extracted from the full manuscripts. Of 1037 abstracts identified by the search strategy, 37 met the inclusion/exclusion criteria and were included in the review. Older age at baseline and female gender were reported to be associated with higher long-term HAQ scores in the majority of studies assessing these relationships, as were higher baseline HAQ and greater pain scores (total patients included in analyses reporting significant associations/total number of patients analysed: age 9.8k/10.7k (91.6%); gender 9.9k/11.3k (87.4%); HAQ 4.0k/4.0k (99.0%); pain 2.8k/2.9k (93.6%)). Tender joint count, erythrocyte sedimentation rate (ESR) and DAS28 were also reported to predict long-term HAQ score; other disease activity measures were less consistent (tender joints 2.1k/2.5k (84.5%); erythrocyte sedimentation rate 1.6k/2.2k (72.3%); DAS28 888/1.1k (79.2%); swollen joints 684/2.6k (26.6%); C-reactive protein 279/510 (54.7%)). Rheumatoid factor (RF) and erosions were not useful predictors (RF 546/4.6k (11.9%); erosions 191/2.7k (7.0%)), whereas the results for anti-citrullinated protein antibody positivity were equivocal (ACPA 2.0k/3.8k (52.9%)). Baseline age, gender, HAQ and pain scores are associated with long-term disability and knowledge of these may aid the assessment of prognosis. Copyright © 2018 The Authors. Published by Elsevier Inc. All
Camacho, Elizabeth M; Verstappen, Suzanne M M; Chipping, Jacqueline; Symmons, Deborah P M
2013-07-01
Cross-sectional studies have found that learned helplessness (LH) is associated with disease outcome in patients with RA. However, little is known about the longitudinal impact of LH. The aim of this study was to investigate whether LH is associated with future disease outcome (disability, pain and fatigue) and to investigate whether LH changes over time in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent. Patients included in this investigation had been recruited to the Norfolk Arthritis Register, a primary-care-based inception cohort. LH was measured at baseline as patients' total score on the Rheumatology Attitudes Index (RAI). A total of 443 patients completed the HAQ and visual analogue scales of pain and fatigue at baseline and after 2 years of follow-up. Greater feelings of LH at baseline were associated with higher HAQ scores at follow-up [difference in HAQ score per 1-point increase in RAI score (β-coefficient) 0.02; 95% CI 0.01, 0.04]. Greater baseline LH was also associated with more pain (β-coefficient 1.0; 95% CI 0.4, 1.5) and more fatigue (β-coefficient 1.0; 95% CI 0.2, 1.4) at follow-up. LH was highly changeable during follow-up, with 87% of patients showing any change and 50% improving. Baseline LH independently predicted disability, pain and fatigue at follow-up. Half of patients reported fewer feelings of helplessness after 2 years of follow-up, suggesting that LH may potentially be a modifiable risk factor for disease outcome in IP and a target for intervention.
Strand, Vibeke; Kremer, Joel M; Gruben, David; Krishnaswami, Sriram; Zwillich, Samuel H; Wallenstein, Gene V
2017-04-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We compared patient-reported outcomes (PROs) in patients with RA treated with tofacitinib or placebo in combination with conventional disease-modifying antirheumatic drugs (DMARDs). In a 12-month, phase III randomized controlled trial (ORAL Sync), patients (n = 795) with active RA and previous inadequate response to therapy with ≥1 conventional or biologic DMARD were randomized 4:4:1:1 to tofacitinib 5 mg twice daily (BID), tofacitinib 10 mg BID, placebo advanced to 5 mg BID, or placebo to 10 mg BID, in combination with stable background DMARD therapy. PROs included patient global assessment of arthritis (PtGA), patient assessment of arthritis pain (Pain), physical function (Health Assessment Questionnaire disability index [HAQ DI]), health-related quality of life (Short Form 36 health survey [SF-36]), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), and sleep (Medical Outcomes Study Sleep [MOS Sleep]). At month 3, statistically significant improvements from baseline versus placebo were reported in PtGA, Pain, HAQ DI, all 8 SF-36 domains, FACIT-F, and MOS Sleep with tofacitinib 10 mg BID, and in PtGA, Pain, HAQ DI, 7 SF-36 domains, FACIT-F, and MOS Sleep with tofacitinib 5 mg BID. Improvements were sustained to month 12. Significantly more tofacitinib-treated patients reported improvements of greater than or equal to the minimum clinically important differences at month 3 versus placebo in all PROs, except the SF-36 role-emotional domain (significant for tofacitinib 10 mg BID). Patients with active RA treated with tofacitinib combined with background conventional DMARD therapy reported sustained, significant, and clinically meaningful improvements in PROs versus placebo. © 2016, The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.
Strand, Vibeke; Kremer, Joel; Wallenstein, Gene; Kanik, Keith S; Connell, Carol; Gruben, David; Zwillich, Samuel H; Fleischmann, Roy
2015-11-04
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. In this 6-month, phase 3, randomized, placebo-controlled trial, 611 patients with inadequate response to disease-modifying anti-rheumatic drugs (DMARD-IR) were randomized 4:4:1:1 to receive: tofacitinib 5 mg BID or tofacitinib 10 mg BID for the duration of the study, or placebo for 3 months followed by tofacitinib 5 mg BID or tofacitinib 10 mg BID. Patient-reported outcomes (PROs) included: Patient Global Assessment of Disease Activity (PtGA); Patient Assessment of Pain (Pain); Health Assessment Questionnaire-Disability Index (HAQ-DI); Medical Outcomes Survey (MOS) Short Form-36 (SF-36); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and MOS Sleep Scale. Time-to-event data (PtGA and Pain) were collected using an interactive voice response system daily diary (baseline through day 14). At month 3, tofacitinib 5 and 10 mg BID demonstrated statistically significant improvements versus placebo in PtGA (both p tofacitinib treatment were rapid in onset and significant improvements were reported at week 2 for PtGA, Pain and HAQ-DI, and differentiation from baseline was seen as early as 3 days after treatment initiation for interactive voice response system (IVRS) PtGA and IVRS Pain. The numbers needed to treat for patients to report changes greater than or equal to the minimum clinically important difference in PtGA, Pain, HAQ-DI, SF-36 Physical Component Summary score and FACIT-F ranged between 4.0-6.1 (5 mg BID) and 3.2-5.0 (10 mg BID). Tofacitinib monotherapy in DMARD-IR patients resulted in statistically significant and clinically meaningful improvements in multiple PROs versus placebo at month 3, with sustained improvements over 6 months. Clinicaltrials.gov registration NCT00814307 , registered 22 December 2008.
Racial differences in health-related quality of life and functional ability in patients with gout.
Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P
2017-01-01
To compare the health-related quality of life (HRQOL) and the functional ability by race in patients with gout. In a 9-month prospective cohort multicentre study, patients with gout self-reported race, dichotomized as Caucasian or African American (others excluded). We calculated HRQOL/function scores adjusted for age, study site and college education for Short Form-36 (SF-36; generic HRQOL), Gout Impact Scale (GIS; disease-specific HRQOL) and HAQ-disability index (HAQ-DI; functional ability). Longitudinally adjusted scores were computed using multivariable mixed-effect regression models with a random patient effect and fixed sequential visit effect (3-monthly visits). Compared with Caucasians (n = 107), African Americans (n = 60) with gout were younger (61.1 vs 67.3 years) and had higher median baseline serum urate (9.0 vs 7.9 mg/dl) (P gout had worse HRQOL scores on three SF-36 domains, the mental component summary (MCS) and two of the five GIS scales than Caucasians [mean (se); P ⩽ 0.02 for all]: SF-36 mental health, 39.7 (1.1) vs 45.2 (0.9); SF-36 role emotional, 42.1 (4.2) vs 51.4 (4.2); SF-36 social functioning, 36.0 (1.1) vs 40.0 (0.9) (P = 0.04); SF-36 MCS, 43.2 (3.1) vs 50.0 (3.2); GIS unmet treatment need, 37.6 (1.6) vs 31.5 (1.4); and GIS concern during attacks, 53.3 (3.7) vs 47.4 (3.7). Differences between the respective HAQ-DI total scores were not statistically significant; 0.98 (0.1) vs 0.80 (1.0) (P = 0.11). Racial differences in SF-36 mental health, role emotional and MCS scales exceeded, and for HAQ-DI approached, the minimal clinically important difference thresholds. African Americans with gout have significantly worse HRQOL compared with Caucasians. Further research is necessary in the form of studies targeted at African Americans on how best to improve these outcomes. Published by Oxford University Press on behalf of the British Society for Rheumatology 2016. This work is written by US Government employees and is in the public domain in the
RAPID3 scores and hand outcome measurements in RA patients: a preliminary study.
Qorolli, Merita; Hundozi-Hysenaj, Hajrije; Rexhepi, Sylejman; Rehxepi, Blerta; Grazio, Simeon
2017-06-01
The Routine Assessment of Patient Index Data 3 (RAPID3) is a patient-reported disease activity measure used to assess physical function, pain, and global health in patients with rheumatoid arthritis (RA) without formal joint counts. Since hand involvement and its decreased function are hallmarks of RA, the aim of our study was to investigate the performance of RAPID3 scores with regard to hand function and to confirm previous findings that the RAPID3 score as a disease activity measure is strongly correlated with the DAS28 score. Sixty-eight consecutive patients with RA (85% female), aged 18-75 years, were included in the study and were recruited during their outpatient visit. Apart from demographic and clinical data, the obtained parameters of interest included RAPID3 scores and assessments of the function of the hand, namely, the signal of functional impairment (SOFI)-hand, grip strength, and pulp-to-palm distance, as well the Health Assessment Questionnaire- Disability Index (HAQ-DI) and DAS28 scores. Pearson's correlation coefficient, Student's t test and linear regression were used in the statistical analysis of the results. The significance was set to p < 0.05. A positive correlation was found between RAPID3 scores and HAQ-DI scores, SOFI-hand scores, and pulp-to-palm distance, and negative correlation was observed between RAPID3 scores and grip strength. The order regarding the strength of correlations between RAPID3 scores and other variables (from the strongest to the weakest) was as follows: HAQ-DI, grip strength, SOFI-hand and pulp-to-palm distance. The hand assessment variables had stronger correlations with RAPID3 scores than with DAS28 scores. Our preliminary study showed that RAPID3 scores were strongly correlated with measurements of the functional ability of the hand, demonstrating that RAPID3 can be used as a measure of disease activity in clinical practice and to characterize hand function. Further studies are needed to confirm this result.
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Martine H P Crins
Full Text Available The Patient-Reported Outcomes Measurement Information System (PROMIS is a universally applicable set of instruments, including item banks, short forms and computer adaptive tests (CATs, measuring patient-reported health across different patient populations. PROMIS CATs are highly efficient and the use in practice is considered feasible with little administration time, offering standardized and routine patient monitoring. Before an item bank can be used as CAT, the psychometric properties of the item bank have to be examined. Therefore, the objective was to assess the psychometric properties of the Dutch-Flemish PROMIS Physical Function item bank (DF-PROMIS-PF in Dutch patients receiving physical therapy.Cross-sectional study.805 patients >18 years, who received any kind of physical therapy in primary care in the past year, completed the full DF-PROMIS-PF (121 items.Unidimensionality was examined by Confirmatory Factor Analysis and local dependence and monotonicity were evaluated. A Graded Response Model was fitted. Construct validity was examined with correlations between DF-PROMIS-PF T-scores and scores on two legacy instruments (SF-36 Health Survey Physical Functioning scale [SF36-PF10] and the Health Assessment Questionnaire Disability-Index [HAQ-DI]. Reliability (standard errors of theta was assessed.The results for unidimensionality were mixed (scaled CFI = 0.924, TLI = 0.923, RMSEA = 0.045, 1th factor explained 61.5% of variance. Some local dependence was found (8.2% of item pairs. The item bank showed a broad coverage of the physical function construct (threshold-parameters range: -4.28-2.33 and good construct validity (correlation with SF36-PF10 = 0.84 and HAQ-DI = -0.85. Furthermore, the DF-PROMIS-PF showed greater reliability over a broader score-range than the SF36-PF10 and HAQ-DI.The psychometric properties of the DF-PROMIS-PF item bank are sufficient. The DF-PROMIS-PF can now be used as short forms or CAT to measure the level of
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Seyyedeh Maryam Rozatian
2010-03-01
Full Text Available Abstract Salaamaan and Absaal is a mysterious story that has been being passed around with several narratives and versions. Jaami has composed a poem based on one of these narratives by the Hanin-e Ibn-e Iss-haq, translated from Greek to Arabic in the third Hijri century ( 9th century A.D.. His interpretations of the story’s mystical secrets had occupied the minds of so many commentators such as “Khajeh Nassir-e Toosi”. Jaami, based on this philosophical interpretation by Khajeh Nassir, offered a rather mystical but short interpretation of the mysteries of this story at the end of his poem. In this article, we intend to provide a different analysis of the mysteries of this story based on the ancient frameworks discussed in Jung’s psychology. Karl Gustav Jung was the founder of the Psychoanalysis and archetypal criticism who combined his psychological perspectives with Hermetic, Gnostic, and the Indian notions. Since the original story is Greek, an Indian influence on the story is conceivable and the ancient frameworks of Jung in analyzing the mysteries will be very revealing .
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Gniadecki, R; Robertson, David; Molta, C T
2012-01-01
the impact of skin disease on QoL; the Health Assessment Questionnaire-Disability Index (HAQ-DI), an assessment of physical function; the Hospital Anxiety and Depression Scale (HADS), which screens for anxiety and depression symptoms; and individual questions on general health, disease activity, fatigue......Background Moderate/severe psoriasis combined with psoriatic arthritis (PsA) impairs health-related quality of life (QoL). Etanercept, a fully human tumour necrosis factor-a receptor fusion protein, is approved for treatment of both diseases. Objective To compare patient-reported health outcomes...... additional weeks. PROs included: the EuroQOL-5D (EQ-5D), which measures general health status and consists of the utility index measuring five dimensions of health, and a visual analogue scale (VAS) allowing patients to assess health status; the Dermatology Life Quality Index (DLQI), which measures...
Adaptation and Validation of the Foot Function Index-Revised Short Form into Polish
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Radosław Rutkowski
2017-01-01
Full Text Available Purpose. The aim of the present study was to adapt the Foot Function Index-Revised Short Form (FFI-RS questionnaire into Polish and verify its reliability and validity in a group of patients with rheumatoid arthritis (RA. Methods. The study included 211 patients suffering from RA. The FFI-RS questionnaire underwent standard linguistic adaptation and its psychometric parameters were investigated. The enrolled participants had been recruited for seven months as a convenient sample from the rheumatological hospital in Śrem (Poland. They represented different sociodemographic characteristics and were characterized as rural and city environments residents. Results. The mean age of the patients was 58.9±10.2 years. The majority of patients (85% were female. The average final FFI-RS score was 62.9±15.3. The internal consistency was achieved at a high level of 0.95 in Cronbach’s alpha test, with an interclass correlation coefficient ranging between 0.78 and 0.84. A strong correlation was observed between the FFI-RS and Health Assessment Questionnaire-Disability Index (HAQ-DI questionnaires. Conclusion. The Polish version of FFI-RS-PL indicator is an important tool for evaluating the functional condition of patients’ feet and can be applied in the diagnosis and treatment of Polish-speaking patients suffering from RA.
Adaptation and Validation of the Foot Function Index-Revised Short Form into Polish.
Rutkowski, Radosław; Gałczyńska-Rusin, Małgorzata; Gizińska, Małgorzata; Straburzyński-Lupa, Marcin; Zdanowska, Agata; Romanowski, Mateusz Wojciech; Romanowski, Wojciech; Budiman-Mak, Elly; Straburzyńska-Lupa, Anna
2017-01-01
The aim of the present study was to adapt the Foot Function Index-Revised Short Form (FFI-RS) questionnaire into Polish and verify its reliability and validity in a group of patients with rheumatoid arthritis (RA). The study included 211 patients suffering from RA. The FFI-RS questionnaire underwent standard linguistic adaptation and its psychometric parameters were investigated. The enrolled participants had been recruited for seven months as a convenient sample from the rheumatological hospital in Śrem (Poland). They represented different sociodemographic characteristics and were characterized as rural and city environments residents. The mean age of the patients was 58.9 ± 10.2 years. The majority of patients (85%) were female. The average final FFI-RS score was 62.9 ± 15.3. The internal consistency was achieved at a high level of 0.95 in Cronbach's alpha test, with an interclass correlation coefficient ranging between 0.78 and 0.84. A strong correlation was observed between the FFI-RS and Health Assessment Questionnaire-Disability Index (HAQ-DI) questionnaires. The Polish version of FFI-RS-PL indicator is an important tool for evaluating the functional condition of patients' feet and can be applied in the diagnosis and treatment of Polish-speaking patients suffering from RA.
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Laura Gonzalez-Lopez
2014-01-01
Full Text Available We evaluated the association between anti-cyclic citrullinated peptide antibodies (anti-CCP and anti-mutated citrullinated vimentin antibodies (anti-MCV with the presence of extra-articular (ExRA manifestations in 225 patients with rheumatoid arthritis (RA. Ninety-five patients had ExRA and 130 had no ExRA. There was no association of anti-CCP and anti-MCV levels with the presence of ExRA as total group (P=0.40 and P=0.91, resp.. Making an analysis of individual manifestations, rheumatoid nodules were associated with positivity for rheumatoid factor (RF; (P=0.01, anti-CCP (P=0.048, and anti-MCV (P=0.02. Instead, RF, anti-CCP, or anti-MCV were not associated with SS, chronic anemia, or peripheral neuropathy. Levels of anti-CCP correlated with the score of the Health Assessment Questionnaire-Disability Index (HAQ-Di (r=0.154, P=0.03, erythrocyte sedimentation rate (ESR; (r=0.155, P=0.03, and RF (P=0.254, P<0.001, whereas anti-MCV titres only correlated with RF (r=0.169, P=0.02. On adjusted analysis, ExRA was associated with longer age (P=0.015, longer disease duration (P=0.007, higher DAS-28 score (P=0.002, and higher HAQ-DI score (P=0.007, but serum levels of anti-CCP and anti-MCV were not associated. These findings show the need to strengthen the evaluation of the pathogenic mechanisms implied in each specific ExRA manifestation.
Guevara-Pacheco, Sergio Vicente; Feican-Alvarado, Astrid; Delgado-Pauta, Jorge; Lliguisaca-Segarra, Angelita; Pelaez-Ballestas, Ingris
2017-09-01
The aim of this study was to determine the prevalence of disability in patients with musculoskeletal pain and rheumatic diseases in Cuenca, Ecuador. We performed a cross-sectional analytical study with randomized sampling in 4877 subjects, from urban and rural areas. COPCORD (Community Oriented Program for Control of Rheumatic Diseases)-validated questionnaire was administered house-to-house to identify subjects with nontraumatic musculoskeletal pain and rheumatic diseases. The subjects were assessed by rheumatologists for diagnostic accuracy, and the Health Assessment Questionnaire Disability Index was administered to assess functional capacity. A logistic regression analysis was conducted to determine the association of rheumatic diseases with functional disability. Functional disability was found in 221 subjects (73.1% women), with mean age 62 (SD, 18.2) years, residing in rural areas (201 [66.5%]), with education of 6.9 (SD, 5.3) years, and of low income (77 [47.2%]). The value of HAQ-DI was a mean of 0.2 (0-2.9). The real prevalence of physical disability was 9.5%. Moderate and severe disability predominated in activities such as kneeling (4.9% and 3.3%), squatting (4.8% and 2.7%), and leaning to pick up objects (3.7% and 0.9%), respectively. Rheumatic diseases associated with physical disabilities were knee osteoarthritis (95 [31.4%]) and hand osteoarthritis (69 [22.8%]), mechanical low-back pain (43 [14.2%]), fibromyalgia (27 [9.5%]), and rheumatoid arthritis (11 [3.6%]; P Rheumatic diseases associated with disability were hand and knee osteoarthritis, back pain, fibromyalgia, and rheumatoid arthritis.
2014-01-01
Introduction The novel arthritis-specific Work Productivity Survey (WPS) was developed to estimate patient productivity limitations associated with arthritis within and outside the home, which is an unmet need in psoriatic arthritis (PsA). The WPS has been validated in rheumatoid arthritis. This report assesses the discriminant validity, responsiveness and reliability of the WPS in adult-onset PsA. Methods Psychometric properties were assessed using data from the RAPID-PsA trial (NCT01087788) investigating certolizumab pegol (CZP) efficacy and safety in PsA. WPS was completed at baseline and every 4 weeks until Week 24. Validity was evaluated at baseline via known-groups defined using first and third quartiles of patients’ Disease Activity Score 28 based on C-reactive protein (DAS28(CRP)), Health Assessment Questionnaire-Disability Index (HAQ-DI), Short Form-36 (SF-36) items and PsA Quality of Life (PsAQoL) scores. Responsiveness and reliability were assessed by comparing WPS mean changes at Week 12 in American College of Rheumatology 20% improvement criteria (ACR20) or HAQ-DI Minimal Clinically Important Difference (MCID) 0.3 responders versus non-responders, as well as using standardized response means (SRM). All comparisons were conducted on the observed cases in the Randomized Set, regardless of the randomization group, using a non-parametric bootstrap-t method. Results Compared with patients with a better health state, patients with a worse health state had on average 2 to 6 times more household work days lost, more days with reduced household productivity, more days missed of family/social/leisure activities, more days with outside help hired and a significantly higher interference of arthritis per month. Among employed patients, those with a worse health state had 2 to 4 times more workplace days lost, more days with patient workplace productivity reduced, and a significantly higher interference of arthritis on patient workplace productivity versus
Validation of Russian versions of questionnaires in patients with low back pain syndrome
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T. V. Chernyshova
2005-01-01
Full Text Available Objective. To assess psychometric characteristics of Russian versions Health Assessment Questionnaire (HAQ, WOMAC and the brief form of a questionnaire of pain Me Gill at patients with a low back pain (LBP. Material and methods. It is surveyed 100 patients with the chronic syndrome LBP caused by an osteochondrosis of a backbone. Mean age of patients has made 45,69 ± 7,61 years, from them women (77 % prevailed. Average duration of disease was 10,20 ± 6,01 years, and duration of an aggravation - 4,04 ± 1,75 months. Among surveyed patients with II radiological stage (R prevailed. The assessment constructive validity questionnaires HAQ, WOMAC and the brief form of a questionnaire of pain Me Gill was carried out by the multifactorial analysis with allocation of the main components, a method of "known groups" on the basis of construction of hypotheses, the correlation analysis with external criteria and separate clinical-tool parameters. Reliability of questionnaires was estimated with the help of coefficient internal constancy a Kronbach, sensitivity - definition of the answer to therapy on the clinical data and self-estimations of patients, to calculation of index Gyatt. Results. Simultaneously with improvement of a condition of patients the positive authentic by criterion Mann- Whitney (Z dynamics of parameters under questionnaires HAQ, WOMAC and the brief form of a questionnaire of pain Me Gill was marked. In group of patients with LBP where the answer from therapy was absent, changes of parameters of investigated questionnaires did not occur, that testified to sensitivity of questionnaires. Other methods have shown sufficient validity and reliability of questionnaires WOMAC, the brief form of a questionnaire of pain Me Gill, questionnaire HAQ, except for his scales "force of a brush ” and "reception peep" which were less actual for patients with LBP. High correlation communications of size FDI (Functional Disability Index on HAQ, scales
Mian, Aneela N; Ibrahim, Fowzia; Scott, Ian C; Bahadur, Sardar; Filkova, Maria; Pollard, Louise; Steer, Sophia; Kingsley, Gabrielle H; Scott, David L; Galloway, James
2016-01-27
Rheumatoid arthritis (RA) treatment paradigms have shifted over the last two decades. There has been increasing emphasis on combination disease modifying anti-rheumatic drug (DMARD) therapy, newer biologic therapies have become available and there is a greater focus on achieving remission. We have evaluated the impact of treatment changes on disease activity scores for 28 joints (DAS28) and disability measured by the health assessment questionnaire scores (HAQ). Four cross-sectional surveys between 1996 and 2014 in two adjacent secondary care rheumatology departments in London evaluated changes in drug therapy, DAS28 and its component parts and HAQ scores (in three surveys). Descriptive statistics used means and standard deviations (SD) or medians and interquartile ranges (IQR) to summarise changes. Spearman's correlations assessed relationships between assessments. 1324 patients were studied. Gender ratios, age and mean disease duration were similar across all cohorts. There were temporal increases in the use of any DMARDs (rising from 61% to 87% of patients from 1996-2014), combination DMARDs (1% to 41%) and biologic (0 to 32%). Mean DAS28 fell (5.2 to 3.7), active disease (DAS28 > 5.1) declined (50% to 18%) and DAS28 remission (DAS28 disability measured by HAQ. As a consequence the relationship between DAS28 and HAQ has become weaker over time. Although the reasons for this divergence between disease activity and disability are uncertain, focussing treatment entirely in suppressing synovitis may be insufficient.
Navarro-Compán, Victoria; Landewé, Robert; Provan, Sella A; Ødegård, Sigrid; Uhlig, Till; Kvien, Tore K; Keszei, András P; Ramiro, Sofia; van der Heijde, Désirée
2015-01-01
The aim of this study was to assess if any of the different types of radiographic damage [true joint space narrowing (JSN), (sub)luxation and erosions] are preferentially related to disability in patients with RA. Longitudinal data from 167 RA patients from the European Research on Incapacitating Diseases and Social Support study over 10 years were analysed to investigate the relationship between the three types of radiographic damage and disability [grip strength, HAQ and the dexterity scale in the Arthritis Impact Measurement Scales (AIMS)]. A longitudinal analysis including separate models per type of damage and joint group and combined models including all information was conducted. All types of damage were inversely related to grip strength in the analysis of separate models, but only true JSN independently remained statistically significant in the combined analysis [β = -0.087 (95% CI -0.151, -0.022)]. Neither JSN, (sub)luxation nor erosions were associated with HAQ score, while erosions were associated with AIMS dexterity only in the analysis of separate models. After stratifying for hand joint group, erosions at MCP joints [β = -0.288 (95% CI -0.556, -0.019)] and true JSN at the wrist [β = -0.132 (95% CI -0.234, -0.030)] were significantly related to grip strength. Erosions at the PIP [β = 0.017 (95% CI 0.005, 0.028)] and MCP joints [β = 0.114 (95% CI 0.010, 0.217)] was the only type of damage associated with HAQ and AIMS dexterity, respectively. All types of radiographically visible joint damage interfere with important aspects of physical functions. True JSN is most closely related to hand function. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Yukio Nakamura
2017-04-01
Full Text Available The aim of this 12-month retrospective study was to evaluate differences in the outcomes of denosumab alone or denosumab combined with vitamin D and calcium supplementation in patients having osteoporosis (OP with rheumatoid arthritis (RA. Patients were divided into the denosumab monotherapy group (denosumab group, 22 cases or denosumab plus vitamin D supplementation group (combination group, 21 cases. We measured serum bone alkaline phosphatase (BAP, N-terminal propeptide of type 1 collagen (P1NP, tartrate-resistant acid phosphatase (TRACP-5b, and urinary N-terminal telopeptide of type-I collagen (NTX at baseline, 1 week, and 1, 2, 4, 6, 8, and 12 months. We also assessed bone mineral density (BMD of the lumbar 1-4 vertebrae (L-BMD and bilateral total hips (H-BMD at baseline and 4, 8, and 12 months. Matrix metalloprotanase-3 (MMP-3, Disease Activity Score-28 C-reactive protein (DAS28-CRP, Simplified Disease Activity Index (SDAI, and Health Assessment Questionnaire-Disability Index (HAQ-DI were assessed before treatment and at 12 months to evaluate RA conditions. The study results showed that BAP, TRACP-5b, and NTX were significantly decreased, but tended to return to pre-treatment levels around 6 and 12 months in both groups. While L-BMD and H-BMD substantially increased in both groups, H-BMD had become significantly higher in the combination group at 12 months (p < 0.01 as compared with the denosumab group. There were no significant differences between the groups regarding MMP-3, DAS28-CRP, SDAI, or HAQ-DI. Compared with denosumab monotherapy, combination therapy of denosumab with vitamin D and calcium significantly increased H-BMD in patients having OP with RA.
Michaud, Kaleb; Strand, Vibeke; Shadick, Nancy A; Degtiar, Irina; Ford, Kerri; Michalopoulos, Steven N; Hornberger, John
2015-09-01
The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years. A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility. The effect of treatment changes on HAQ was derived from 5 tight-control and 13 treatment-switch trials. Baseline HAQ scores and the HAQ score relationship with medical costs and quality of life were derived from published National Data Bank for Rheumatic Diseases data. Use of the MBDA test is projected to improve HAQ scores by 0.09 units in year 1, declining to 0.02 units after 10 years. Over the 10 year time horizon, quality-adjusted life years increased by 0.08 years and costs decreased by US$457 (cost savings in disability-related medical costs, US$659; in productivity costs, US$2137). The most influential variable in the analysis was the effect of the MBDA test on clinician treatment recommendations and subsequent HAQ changes. The MBDA test aids in the assessment of disease activity in patients with RA by changing treatment decisions, improving the functional status of patients and cost savings. Further validation is ongoing and future longitudinal studies are warranted. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Mussen, Lauren; Boyd, Tristan; Bykerk, Vivian; de Leon, Faye; Li, Lihua; Boire, Gilles; Hitchon, Carol; Haraoui, Boulos; Thorne, J Carter; Pope, Janet
2013-02-01
We determined the prevalence of work disability in early rheumatoid arthritis (ERA) and undifferentiated early inflammatory arthritis (EIA) patients at first enrollment into the Canadian Early Arthritis Cohort (CATCH) who met the 2010 ACR criteria versus those not meeting criteria, to determine the impact of meeting new criteria on work disability status. Data at first visit into the cohort were analyzed. Descriptive statistics and logistic regression analyses were performed to investigate the association of other variables in our database with work disability. 1,487 patients were enrolled in the CATCH study, a multi-site observational, prospective cohort of patients with EIA. 934 patients were excluded (505 based on missing criteria for ACR 2010 classification, as anti-CCP was absent, and 429 were not working for other reasons). Of the 553 patients included, 71 % were female with mean disease duration of 6.4 months. 524 (94.8 %) were employed while 29 (5.2 %) reported work disability at first visit. There were no differences between those meeting 2010 ACR criteria versus those who did not. Baseline characteristics associated with work disability were male gender, age, education, income, HAQ, and positive RF status. The mean HAQ score in work disabled patients was 1.4 versus 0.9 in those who were working (p 50 years; p = 0.3), lower education (p = 0.3) or RF positivity (p = 0.6). We found rates of work disability to be low at entry into this EIA cohort compared to previous studies. There may be potential for intervention in ERA to prevent the development of work disability.
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Dmitriy Vladimirovich Goryachev
2010-01-01
The values of the utility index calculated by TTO failed to correlate with those of HAQ and EQ-5D. The disease duration was unrelated to the values of the utility index calculated by any of the methods used. The association of TTO index was found only for VAS-GH "thermometer". Conclusion. EQ-5D index and VAS-GH are the methods of choice in determining health utility for a clinicoeconomic analysis in patients with RA.
Hannibal, Niels; Domingo, Maria Rodrigo; Valentin, Jan B; Licht, Rasmus W
2017-11-01
No specific instrument has been developed for measuring alliance during music therapy. To evaluate the feasibility of using the Helping Alliance Questionnaire II (HAq-II) as a self-report measure for individuals receiving treatment for a psychiatric disorder. Specifically, we examined the percent of patients who filled out the questionnaire, and when completed, whether there were any missing items. We also examined internal consistency and associations between patient variables and HAq-II scores. Between October 2013 and April 2014, we invited 45 individuals with a psychiatric disorder, who were also receiving music therapy, to fill out the HAq-II. We also collected clinical data from each person's record. Thirty-one (69%) of the 45 invited patients filled out the HAq-II, and of those completed, only three had missing items. Of the 45 invited patients, thirty (67%) had a diagnosis of schizophrenia or other psychotic disorders, and 11 (24%) were diagnosed with other psychiatric disorders. In terms of diagnosis and other clinical variables, no statistically significant differences were found between the 31 patients who filled out the HAq-II and the 14 patients who did not return the questionnaire. The median HAq-II score was 5.11 (range 3.74-6.00), indicating a relatively high alliance. We did not find any statistically significant associations between the HAq-II scores and potential predictors of interest. The Cronbach's alpha was 0.85. Completion of the HAq-II was fairly high in this group of individuals with psychiatric diagnoses who were receiving music therapy. Internal consistency of the HAq-II was acceptable. Relatively high HAq-II scores suggest a high degree of therapeutic alliance, but the external validity of the HAq-II and the relationship between scores and therapy needs further evaluation. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
Fagnani, Francis; Pham, Thao; Claudepierre, Pascal; Berenbaum, Francis; De Chalus, Thibault; Saadoun, Carine; Joubert, Jean-Michel; Fautrel, Bruno
2016-08-01
To evaluate the cost-effectiveness of a Treat-to-Target strategy with certolizumab pegol in patients with rheumatoid arthritis in the context of a pay-for-performance agreement in which medication costs are refunded in case of discontinuation during the first 3 months of treatment. The Treat-to-Target strategy consisted of a systematic switch to second-line tumor necrosis factor (TNF)α inhibitor in case of an unmet ACR50 response at 3 months compared to current routine clinical practice. A reference cohort treated first-line with certolizumab pegol according to current practice without systematic switching was considered as the comparator. A decision-tree model was constructed to estimate clinical outcome (health assessment questionnaire-disability index or HAQ-DI score), time spent in ACR50 response (ACR 50), and direct costs of treatment over a 2-year period. HAQ scores were derived from American College of Rheumatology 50 (ACR50) responses. All TNFα inhibitors were assumed to have equivalent efficacy and tolerability. Costs were estimated at 2013 French retail prices (date of the pay-for-performance agreement). The mean duration of an ACR50 response was 1.23 years in the Treat-to-Target strategy certolizumab pegol cohort vs 0.98 years in the reference cohort, resulting in a mean gain in HAQ at 24 months of 0.117. The Treat-to-Target strategy with a mix of TNFα inhibitors as second-line therapy was more expensive than the reference strategy in absolute terms, but this difference was entirely offset by the pay-for-performance agreement. The Treat-to-Target strategy was, thus, cost-neutral over a 2-year period after the payback of CZP cost for patients not achieving the target at 3 months. In the context of a pay-for-performance agreement, the management of patients with rheumatoid arthritis using a Treat-to-Target strategy with certolizumab pegol in first line is dominant compared to standard use of this drug in the French setting in 2013.
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Diogo Homann
2011-08-01
Full Text Available Fibromyalgia can limit activities of daily living (ADLs performance and has a negative impact on the quality of life of these patients. The objective of this study was to evaluate the association between direct and indirect methods for the assessment of functional capacity and their relationship with some features of fibromyalgia. Thirty-eight women with a diagnosis of fibromyalgia participated in the study. Functional capacity was assessed by the Health Assessment Questionnaire (HAQ, distance in the six-minute walk test (6MWT, and handgrip strength (HGS. Pain was rated on a visual analog scale. The Fibromyalgia Impact Questionnaire (FIQ was applied to assess the impact on quality of life. Body mass index and waist circumference were also evaluated. Pearson’s correlation test was used for parametric data and Spearman’s correlation test for nonparametric data. Multiple regressions were also performed. Pain intensity was high in the patients (median: 9.5. The 6MWT distance was correlated with HAQ score (r=-0.55, p<0.01 and HGS (r=0.34, p<0.01. Pain was correlated with HGS (r=-0.41, p<0.01, HAQ score (r=0.62, p<0.01, and FIQ (r =0.66, p<0.01. Pain intensity explained 40% of the variation in HAQ scores. This variation increased to 60% after inclusion of 6MWT distance. In conclusion, pain seems to compromise HGS, ADLs and quality of life in women with fibromyalgia. The lower performance in the 6MWT might be explained by high body mass index. Taking into account pain, the HAQ seems to be an appropriate tool for the assessment of functional capacity in women with fibromyalgia.
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Diogo Homann
2011-06-01
Full Text Available Fibromyalgia can limit activities of daily living (ADLs performance and has a negative impact on the quality of life of these patients. The objective of this study was to evaluate the association between direct and indirect methods for the assessment of functional capacity and their relationship with some features of fibromyalgia. Thirty-eight women with a diagnosis of fibromyalgia participated in the study. Functional capacity was assessed by the Health Assessment Questionnaire (HAQ, distance in the six-minute walk test (6MWT, and handgrip strength (HGS. Pain was rated on a visual analog scale. The Fibromyalgia Impact Questionnaire (FIQ was applied to assess the impact on quality of life. Body mass index and waist circumference were also evaluated. Pearson’s correlation test was used for parametric data and Spearman’s correlation test for nonparametric data. Multiple regressions were also performed. Pain intensity was high in the patients (median: 9.5. The 6MWT distance was correlated with HAQ score (r=-0.55, p<0.01 and HGS (r=0.34, p<0.01. Pain was correlated with HGS (r=-0.41, p<0.01, HAQ score (r=0.62, p<0.01, and FIQ (r =0.66, p<0.01. Pain intensity explained 40% of the variation in HAQ scores. This variation increased to 60% after inclusion of 6MWT distance. In conclusion, pain seems to compromise HGS, ADLs and quality of life in women with fibromyalgia. The lower performance in the 6MWT might be explained by high body mass index. Taking into account pain, the HAQ seems to be an appropriate tool for the assessment of functional capacity in women with fibromyalgia.
Mohammad, Ausaf; Carey, John J; Storan, Eoin; Scarry, Margaret; Coughlan, Robert J; Lee, John M
2012-01-01
We determined the prevalence of fibromyalgia syndrome (FMS) in a cohort of subjects with chronic hepatitis C virus (HCV), and the relationship to subject demographics, viral characteristics, and quality of life. In a cross-sectional study of a cohort of HCV-infected individuals, all subjects underwent a standard assessment including history, clinical examination, and functional assessments for pain and disability. A total of 185 subjects met the inclusion criteria. Median age was 48.7 years, and 110 (59%) were women. A total of 106 (57%) of the subjects met criteria for the presence of FMS. Widespread pain and ≥11 tender points were present in all of the subjects with FMS, fatigue in 98 (92%), and depression in 60 (57%). Among those with FMS, mean pain score was 70±11.78 and 36% reported some functional impairment on (HAQ-DI>0), with 17% reporting moderate-to-severe functional impairment (HAQ-DI≥1.5). This study reveals a high prevalence of FMS (57%) among subjects with chronic HCV infection, one third of whom reported some degree of functional impairment. Recognition and management of this condition in such patients will help improve their quality of life.
Psychiatric symptoms of patients with primary mitochondrial DNA disorders
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Inczedy-Farkas Gabriella
2012-02-01
Full Text Available Abstract Background The aim of our study was to assess psychiatric symptoms in patients with genetically proven primary mutation of the mitochondrial DNA. Methods 19 adults with known mitochondrial mutation (MT have been assessed with the Stanford Health Assessment Questionnaire 20-item Disability Index (HAQ-DI, the Symptom Check List-90-Revised (SCL-90-R, the Beck Depression Inventory-Short Form (BDI-SF, the Hamilton Depression Rating Scale (HDRS and the clinical version of the Structured Clinical Interview for the the DSM-IV (SCID-I and SCID-II As control, 10 patients with hereditary sensorimotor neuropathy (HN, harboring the peripheral myelin protein-22 (PMP22 mutation were examined with the same tools. Results The two groups did not differ significantly in gender, age or education. Mean HAQ-DI score was 0.82 in the MT (range: 0-1.625 and 0.71 in the HN group (range: 0-1.625. Level of disability between the two groups did not differ significantly (p = 0.6076. MT patients scored significantly higher on the BDI-SF and HDRS than HN patients (12.85 versus 4.40, p = 0.031, and 15.62 vs 7.30, p = 0.043, respectively. The Global Severity Index (GSI of SCL-90-R also showed significant difference (1.44 vs 0.46, p = 0.013 as well as the subscales except for somatization. SCID-I interview yielded a variety of mood disorders in both groups. Eight MT patient (42% had past, 6 (31% had current, 5 (26% had both past and current psychiatric diagnosis, yielding a lifetime prevalence of 9/19 (47% in the MT group. In the HN group, 3 patients had both past and current diagnosis showing a lifetime prevalence of 3/10 (30% in this group. SCID-II detected personality disorder in 8 MT cases (42%, yielding 3 avoidant, 2 obsessive-compulsive and 3 personality disorder not otherwise specified (NOS diagnosis. No personality disorder was identified in the HN group. Conclusions Clinicians should be aware of the high prevalence of psychiatric symptoms in patients with
Li, Zhanguo; An, Yuan; Su, Houheng; Li, Xiangpei; Xu, Jianhua; Zheng, Yi; Li, Guiye; Kwok, Kenneth; Wang, Lisy; Wu, Qizhe
2018-02-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We assess the effect of tofacitinib + conventional synthetic disease-modifying anti rheumatic drugs (csDMARDs) on patient-reported outcomes in Chinese patients with RA and inadequate response to DMARDs. This analysis of data from the Phase 3 study ORAL Sync included Chinese patients randomized 4 : 4 : 1 : 1 to receive tofacitinib 5 mg twice daily, tofacitinib 10 mg twice daily, placebo→tofacitinib 5 mg twice daily, or placebo→tofacitinib 10 mg twice daily, with csDMARDs. Placebo non-responders switched to tofacitinib at 3 months; the remaining placebo patients switched at 6 months. Least squares mean changes from baseline were reported for Health Assessment Questionnaire-Disability Index (HAQ-DI), patient assessment of arthritis pain (Pain), patient global assessment of disease activity (PtGA), physician global assessment of disease activity (PGA), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scores, Short Form 36 (SF-36), and Work Limitations Questionnaire (WLQ), using a mixed-effects model for repeated measures. Overall, 216 patients were included (tofacitinib 5 mg twice daily, n = 86; tofacitinib 10 mg twice daily, n = 86; placebo→tofacitinib 5 mg twice daily, n = 22; placebo→tofacitinib 10 mg twice daily, n = 22). At month 3, tofacitinib elicited significant improvements in HAQ-DI, Pain, PtGA, PGA and SF-36 Physical Component Summary scores. Improvements were generally maintained through 12 months. Tofacitinib 5 and 10 mg twice daily + csDMARDs resulted in improvements in health-related quality of life, physical function and Pain through 12 months in Chinese patients with RA. © 2018 The Authors. International Journal of Rheumatic Diseases published by Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
Księżopolska-Orłowska, Krystyna; Pacholec, Anna; Jędryka-Góral, Anna; Bugajska, Joanna; Sadura-Sieklucka, Teresa; Kowalik, Katarzyna; Pawłowska-Cyprysiak, Karolina; Łastowiecka-Moras, Elżbieta
2016-01-01
Rehabilitation slows the progress of rheumatoid arthritis (RA) and prevents progression of disability. This study aimed to compare the impact of two rehabilitation programmes on pain, disease activity, locomotor function, global health and work ability forecast in RA patients. Sixty-four employed women aged 24-65 years participated in the study. All patients underwent individual and instrumental kinesiotherapy. Thirty-two patients underwent cryogenic chamber therapy and local cryotherapy as well as non-weight-bearing, instrumental and individual kinesiotherapy. The remaining 32 patients received traditional rehabilitation in the form of electromagnetic and instrumental therapy, individual and pool-based non-weight-bearing kinesiotherapy. Rehabilitation lasted 3 weeks. Patients were examined three times: prior to rehabilitation, after 3 weeks of therapy and 3 months after completion of rehabilitation. The following study instruments were used: to assess disease activity: DAS-28; functional impairment: HAQ-DI; pain severity: VAS; patients' overall well-being: a scale from 0 to 100 (Global Health Index); and patients' own prognosis of fitness for work: the 6th question from Work Ability Index (WAI). Statistical analysis of data was performed using the STATISTICA 8.0 package. Mixed-design two-way analysis of variance was used for hypothesis testing. All patients improved after rehabilitation. The group of patients those who underwent cryotherapy had improved DAS-28, HAQ-DI, VAS and global health scores immediately following the 3-week rehabilitation programme (p cryotherapy resulted in greater improvement in disease activity DAS-28 [F(2,105) = 5.700; p = 0.007; η(2) = 0.084] and HAQ-DI locomotor function scores [F(2,109) = 6.771; p = 0.003; η(2) = 0.098] compared to traditional rehabilitation. The impact of both forms of rehabilitation on patients' own prognosis of work ability in the next 2 years was not significant. Results of patients who underwent
Bisi, Melissa Cláudia; do Prado, Aline Defaveri; Piovesan, Deise Marcela; Bredemeier, Markus; da Silveira, Inês Guimarães; Mendonça, José Alexandre; Staub, Henrique Luiz
2017-04-01
Ultrasonography (US) is a useful tool for the evaluation of sinovial vascularization and proliferation in rheumatoid arthritis (RA). Accordingly, resistive index (RI) on spectral Doppler (sD) US provides a quantitative analysis of vascular inflammation, but its utility in the evaluation of RA activity has not been established. Our objective was to determine the association of RI with other US parameters of synovitis and with clinical disease activity in established RA. Patients with positive power Doppler (pD) were included in a prospective cross-sectional study. Disease activity and disability were evaluated using the Disease Activity Score in 28-joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Gray scale (GS) synovitis, pD, and sD analyses were performed by one of two examiners in wrists and the second and third metacarpophalangeal and proximal interphalangeal joints. The 10-joint GS and 10-joint pD scores and mean RI were then calculated. Weighted kappa (WK) values were employed to assess interobserver reability, and correlations were tested using the Spearman coefficient. Ninety-five RA patients (median duration of disease of 7 years and mean DAS28 of 4.32 ± 1.66) were included. WK values in real-time US were 0.77 for synovitis, 0.87 for pD, and 0.68 for RI. There were no significant correlations of RI with 10-joint GS, 10-joint pD, DAS28, joint counts, or HAQ (P > 0.10 for all tests). Patients in remission had a mean RI similar to those with high disease activity (0.62 ± 0.10, n = 15 versus 0.63 ± 0.13, n = 34, respectively). The addition of the RI score did not seem to improve US performance in patients with established RA.
Lee, Min-Young; Park, Sun-Kyeong; Park, Sun-Young; Byun, Ji-Hye; Lee, Sang-Min; Ko, Su-Kyoung; Lee, Eui-Kyung
2015-08-01
This study evaluated the cost-effectiveness of introducing tofacitinib, an oral Janus kinase inhibitor, to the treatment of Korean patients with rheumatoid arthritis (RA) and an inadequate response to conventional disease-modifying antirheumatic drugs. In this cost-utility analysis model, patients transitioned through treatment sequences based on Korean guidelines for RA patients with inadequate response to conventional disease-modifying antirheumatic drugs. Lifetime health-related quality of life and costs were evaluated. Characteristics of the model cohort were based on those reported by the Oral Rheumatoid Arthritis phase 3 triaL (ORAL) Standard randomized Controlled trial of tofacitinib or adalimumab versus placebo. Efficacy was assessed using American College of Rheumatology response rates, converted to the changes in Health Assessment Questionnaire-Disability Index (HAQ-DI) scores, based on tofacitinib clinical trials data. Published clinical trial data on discontinuation rates of the indicated drugs were incorporated in the model. The HAQ-DI scores were mapped onto utility values to calculate outcomes in terms of quality-adjusted life-years (QALYs); HAQ-DI-to-utility (EuroQoL 5D) mapping was based on data from 5 tofacitinib clinical trials. Costs were analyzed from a societal perspective, with values expressed in 2013 Korean won (KRW). Cost-effectiveness is presented in terms of incremental cost-effectiveness ratios (ICERs). One-way sensitivity analyses were performed to assess the robustness of the model. First-line tofacitinib used before the standard of care (base-case analysis) increased both treatment costs and QALYs gained versus the standard-of-care treatment sequence, resulting in an ICER of KRW 13,228,910 per QALY. Tofacitinib also increased costs and QALYs gained when incorporated as a second-, third-, or fourth-line therapy. The inclusion of first-line tofacitinib increased the duration of active immunomodulatory therapy from 9.4 to 13.2 years
Camacho, E M; Verstappen, S M M; Symmons, D P M
2012-08-01
Independent investigations have shown that socioeconomic status (SES) and learned helplessness (LH) are associated with poor disease outcome in patients with rheumatoid arthritis (RA). Our aim was to investigate the cross-sectional relationship between SES, LH, and disease outcome in patients with recent-onset inflammatory polyarthritis (IP), the broader group of conditions of which RA is the major constituent. SES was measured using the Index of Multiple Deprivation 2007 for 553 patients consecutively recruited to the Norfolk Arthritis Register. Patients also completed the Rheumatology Attitudes Index, a measure of LH. SES and LH were investigated as predictors of disease outcome (functional disability [Health Assessment Questionnaire (HAQ)] and disease activity [Disease Activity Score in 28 joints]) in a regression analysis, adjusted for age, sex, and symptom duration. The role of LH in the relationship between SES and disease outcome was then investigated. Compared to patients of the highest SES, those of the lowest SES had a significantly worse outcome (median difference in HAQ score 0.42; 95% confidence interval [95% CI] 0.08, 0.75). Compared to patients with normal LH, patients with low LH had a significantly better outcome and patients with high LH had a significantly worse outcome (median difference in HAQ score 1.12; 95% CI 0.82, 1.41). There was a significant likelihood that LH mediated the association between SES and disease outcome (P = 0.04). LH is robustly associated with cross-sectional disease outcome in patients with IP, and appears to mediate the relationship between SES and disease outcome. As LH is potentially modifiable, these findings have potential clinical implications. Copyright © 2012 by the American College of Rheumatology.
Charles-Schoeman, Christina; van der Heijde, Désirée; Burmester, Gerd R; Nash, Peter; Zerbini, Cristiano A F; Connell, Carol A; Fan, Haiyun; Kwok, Kenneth; Bananis, Eustratios; Fleischmann, Roy
2018-02-01
Tofacitinib has been investigated for the treatment of rheumatoid arthritis (RA) in phase III studies in which concomitant glucocorticoids (GC) were allowed. We analyzed the effect of GC use on efficacy outcomes in patients with RA receiving tofacitinib and/or methotrexate (MTX) or conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in these studies. Our posthoc analysis included data from 6 phase III studies (NCT01039688; NCT00814307; NCT00847613; NCT00853385; NCT00856544; NCT00960440). MTX-naive patients or patients with inadequate response to csDMARD or biological DMARD received tofacitinib 5 or 10 mg twice daily alone or with csDMARD, with or without concomitant GC. Patients receiving GC (≤ 10 mg/day prednisone or equivalent) before enrollment maintained a stable dose throughout. Endpoints included the American College of Rheumatology (ACR) 20/50/70 response rates, rates of Clinical Disease Activity Index (CDAI)-defined low disease activity (LDA; CDAI ≤ 10) and remission (CDAI ≤ 2.8), and changes from baseline in CDAI, 28-joint count Disease Activity Score (DAS28-4)-erythrocyte sedimentation rate (ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain visual analog scale (VAS), and modified total Sharp score. Of 3200 tofacitinib-treated patients, 1258 (39.3%) received tofacitinib monotherapy and 1942 (60.7%) received tofacitinib plus csDMARD; 1767 (55.2%) received concomitant GC. ACR20/50/70 response rates, rates of CDAI LDA and remission, and improvements in CDAI, DAS28-4-ESR, HAQ-DI, and pain VAS with tofacitinib were generally similar with or without GC in monotherapy and combination therapy studies. GC use did not appear to affect radiographic progression in tofacitinib-treated MTX-naive patients. MTX plus GC appeared to inhibit radiographic progression to a numerically greater degree than MTX alone. Concomitant use of GC with tofacitinib did not appear to affect clinical or radiographic efficacy. MTX plus GC showed a
Nash, Peter; Ohson, Kamal; Walsh, Jessica; Delev, Nikolay; Nguyen, Dianne; Teng, Lichen; Gómez-Reino, Juan J; Aelion, Jacob A
2018-05-01
Evaluate apremilast efficacy across various psoriatic arthritis (PsA) manifestations beginning at week 2 in biological-naïve patients with PsA. Patients were randomised (1:1) to apremilast 30 mg twice daily or placebo. At week 16, patients whose swollen and tender joint counts had not improved by ≥10% were eligible for early escape. At week 24, all patients received apremilast through week 52. Among 219 randomised patients (apremilast: n=110; placebo: n=109), a significantly greater American College of Rheumatology 20 response at week 16 (primary outcome) was observed with apremilast versus placebo (38.2% (42/110) vs 20.2% (22/109); P=0.004); response rates at week 2 (first assessment) were 16.4% (18/110) versus 6.4% (7/109) (P=0.025). Improvements in other efficacy outcomes, including 28-joint count Disease Activity Score (DAS-28) using C reactive protein (CRP), swollen joint count, Health Assessment Questionnaire-Disability Index (HAQ-DI), enthesitis and morning stiffness severity, were observed with apremilast at week 2. At week 16, apremilast significantly reduced PsA disease activity versus placebo, with changes in DAS-28 (CRP) (P<0.0001), HAQ-DI (P=0.023) and Gladman Enthesitis Index (P=0.001). Improvements were maintained with continued treatment through week 52. Over 52 weeks, apremilast's safety profile was consistent with prior phase 3 studies in psoriasis and PsA. During weeks 0-24, the incidence of protocol-defined diarrhoea was 11.0% (apremilast) and 8.3% (placebo); serious adverse event rates were 2.8% (apremilast) and 4.6% (placebo). In biological-naïve patients with PsA, onset of effect with apremilast was observed at week 2 and continued through week 52. The safety profile was consistent with previous reports. NCT01925768; Results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Predictors of activity limitation in people with gout: a prospective study.
Stewart, Sarah; Rome, Keith; Eason, Alastair; House, Meaghan E; Horne, Anne; Doyle, Anthony J; Knight, Julie; Taylor, William J; Dalbeth, Nicola
2018-04-21
The objective of the study was to determine clinical factors associated with activity limitation and predictors of a change in activity limitation after 1 year in people with gout. Two hundred ninety-five participants with gout (disease duration limitation was assessed using the Health Assessment Questionnaire-II (HAQ-II). After 1 year, participants were invited to complete a further HAQ-II; follow-up questionnaires were available for 182 participants. Fully saturated and stepwise regression analyses were used to determine associations between baseline characteristics and HAQ-II at baseline and 1 year, and to determine predictors of worsening HAQ-II in those with normal baseline scores. Median (range) baseline HAQ-II was 0.20 (0-2.50) and 0.20 (0-2.80) after 1 year of follow-up. Pain score was the strongest independent predictor of baseline HAQ-II, followed by radiographic narrowing score, type 2 diabetes, swollen joint count, BMI, age and urate (model R 2 = 0.51, P limitation, and levels of activity limitation are, on average, stable over a 1-year period. Baseline pain scores are strongly associated with activity limitation and predict development of activity limitation in those with normal HAQ-II scores at baseline.
Moyano, Sebastián; Scolnik, Marina; Vergara, Facundo; García, María Victoria; Sabelli, Mirtha Rosa; Rosa, Javier Eduardo; Catoggio, Luis José; Soriano, Enrique Roberto
2018-03-19
The aims of this study were to compare learned helplessness (LH) and perceived self-efficacy (SE) in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) and to assess their correlation with functional disability, level of perceived pain, and fatigue. This multicenter, cross-sectional study included consecutive patients (aged ≥18 years) with RA, according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and FM, according to 2010 American College of Rheumatology criteria. Learned helplessness was measured by the Rheumatology Attitude Index, Spanish version; SE with the Arthritis Self-efficacy Scale, Spanish version; functional capacity with the Health Assessment Questionnaire (HAQ), Argentine version; depression with Center for Epidemiological Studies-Depression Scale 7-item version and perceived pain and fatigue by the visual analog scale. Disease activity was measured by the Clinical Disease Activity Index (CDAI) and disease impact with the Fibromyalgia Impact Questionnaire (FIQ). A total of 215 patients, 100 with FM and 115 with RA, were included. Mean age was 59 (SD, 14) years and 58 (SD, 13) years for FM and RA, patients respectively. Whereas LH and depression were significantly higher, SE was significantly lower in FM patients. We found a positive correlation between LH and HAQ, pain, depression, fatigue, FIQ, and CDAI in FM and RA patients. We observed a negative correlation between SE and HAQ, pain, depression, fatigue, FIQ (FM), and CDAI (RA) in both groups. Both LH and SE correlate significantly with functional capacity, perceived pain, disease activity, and disease impact in RA and FM patients. Learned helplessness was higher in patients with active disease or high disease impact, as opposed to those in remission or with low disease impact, and the reverse was true for SE. Patients with FM had significantly more LH, pain, fatigue, and depression and less SE compared with those with RA.
Mian, Aneela N; Ibrahim, Fowzia; Scott, David L; Galloway, James
2016-06-16
The overall benefit of intensive treatment strategies in rheumatoid arthritis (RA) remains uncertain. We explored how reductions in disability and improvements in quality of life scores are affected by alternative assessments of reductions in disease activity scores for 28 joints (DAS28) in two trials of intensive treatment strategies in active RA. One trial (CARDERA) studied 467 patients with early active RA receiving 24 months of methotrexate monotherapy or steroid and disease-modifying anti-rheumatic drug (DMARD) combinations. The other trial (TACIT) studied 205 patients with established active RA; they received 12 months of treatment with DMARD combinations or biologic agents. We compared changes in the health assessment questionnaire (HAQ) and Euroqol-5D (EQ5D) at trial endpoints in European League Against Rheumatism (EULAR) good and moderate EULAR responders in patients in whom complete endpoint data were available. In the CARDERA trial 98 patients (26 %) were good EULAR responders and 160 (32 %) were EULAR moderate responders; comparable data in TACIT were 66 (35 %) and 86 (46 %) patients. The magnitude of change in the HAQ and EQ5D was greater in both trials in EULAR good responders than in EULAR moderate responders. HAQ scores had a difference in of -0.49 (95 % CI -0.66, -0.32) in the CARDERA and -0.31 (95 % CI -0.47, -0.13) in the TACIT trial. With the EQ5D comparable differences were 0.12 (95 % CI 0.04, 0.19) and 0.15 (95 % CI 0.05, 0.25). Both exceeded minimum clinically important differences in HAQ and EQ5D scores. We conclude that achieving a good EULAR response with DMARDs and biologic agents in active RA results in substantially improved mean HAQ and EQ5D scores. Patients who achieve such responses should continue on treatment. However, continuing such treatment strategies is more challenging when only a moderate EULAR response is achieved. In these patients evidence of additional clinically important benefits in measures such as the HAQ
Putrik, Polina; Ramiro, Sofia; Lie, Elisabeth; Michaud, Kaleb; Kvamme, Maria K; Keszei, Andras P; Kvien, Tore K; Uhlig, Till; Boonen, Annelies
2018-03-01
To develop algorithms for calculating the Rheumatic Diseases Comorbidity Index (RDCI), Charlson-Deyo Index (CDI) and Functional Comorbidity Index (FCI) from the Medical Dictionary for Regulatory Activities (MedDRA), and to assess how these MedDRA-derived indices predict clinical outcomes, utility and health resource utilization (HRU). Two independent researchers linked the preferred terms of the MedDRA classification into the conditions included in the RDCI, the CDI and the FCI. Next, using data from the Norwegian Register-DMARD study (a register of patients with inflammatory joint diseases treated with DMARDs), the explanatory value of these indices was studied in models adjusted for age, gender and DAS28. Model fit statistics were compared in generalized estimating equation (prediction of outcome over time) models using as outcomes: modified HAQ, HAQ, physical and mental component summary of SF-36, SF6D and non-RA related HRU. Among 4126 patients with RA [72% female, mean (s.d.) age 56 (14) years], median (interquartile range) of RDCI at baseline was 0.0 (1.0) [range 0-6], CDI 0.0 (0.0) [0-7] and FCI 0.0 (1.0) [0-6]. All the comorbidity indices were associated with each outcome, and differences in their performance were moderate. The RDCI and FCI performed better on clinical outcomes: modified HAQ and HAQ, hospitalization, physical and mental component summary, and SF6D. Any non-RA related HRU was best predicted by RDCI followed by CDI. An algorithm is now available to compute three commonly used comorbidity indices from MedDRA classification. Indices performed comparably well in predicting a variety of outcomes, with the CDI performing slightly worse when predicting outcomes reflecting functioning and health. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Yasser El Miedany
2016-01-01
Full Text Available Objectives. To assess the validity, reliability, and responsiveness to change of a patient self-reported questionnaire combining the Widespread Pain Index and the Symptom Severity Score as well as construct outcome measures and comorbidities assessment in fibromyalgia patients. Methods. The PROMs-FM was conceptualized based on frameworks used by the WHO Quality of Life tool and the PROMIS. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction were achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. The questionnaire included the modified ACR criteria main items (Symptom Severity Score and Widespread Pain Index, in addition to assessment of functional disability, quality of life (QoL, review of the systems, and comorbidities. Every patient completed HAQ and EQ-5D questionnaires. Results. A total of 146 fibromyalgia patients completed the questionnaire. The PROMs-FM questionnaire was reliable as demonstrated by a high standardized alpha (0.886–0.982. Content construct assessment of the functional disability and QoL revealed significant correlation (p<0.01 with both HAQ and EQ-5D. Changes in functional disability and QoL showed significant (p<0.01 variation with diseases activity status in response to therapy. There was higher prevalence of autonomic symptoms, CVS risk, sexual dysfunction, and falling. Conclusions. The developed PROMs-FM questionnaire is a reliable and valid instrument for assessment of fibromyalgia patients. A phased treatment regimen depending on the severity of FMS as well as preferences and comorbidities of the patient is the best approach to tailored patient management.
Karagülle, Mine; Kardeş, Sinan; Karagülle, Oğuz; Dişçi, Rian; Avcı, Aslıhan; Durak, İlker; Karagülle, Müfit Zeki
2017-01-01
Oxidative stress has been shown to play a contributory role in the pathogenesis of rheumatoid arthritis (RA). Recent studies have provided evidence for antioxidant properties of spa therapy. The purpose of this study is to investigate whether spa therapy with saline balneotherapy has any influence on the oxidant/antioxidant status in patients with RA and to assess clinical effects of spa therapy. In this investigator-blind randomized controlled trial, we randomly assigned 50 patients in a 1:1 ratio to spa therapy plus standard drug treatment (spa group) or standard drug treatment alone (control group). Spa group followed a 2-week course of spa therapy regimen consisting of a total of 12 balneotherapy sessions in a thermal mineral water pool at 36-37 °C for 20 min every day except Sunday. All clinical and biochemical parameters were assessed at baseline and after spa therapy (2 weeks). The clinical parameters were pain intensity, patient global assessment, physician global assessment, Health Assessment Questionnaire disability index (HAQ-DI), Disease Activity Score for 28-joints based on erythrocyte sedimentation rate (DAS28-4[ESR]). Oxidative status parameters were malondialdehyde (MDA), nonenzymatic superoxide radical scavenger activity (NSSA), antioxidant potential (AOP), and superoxide dismutase (SOD). The NSSA levels were increased significantly in the spa group ( p = 0.003) but not in the control group ( p = 0.509); and there was a trend in favor of spa therapy for improvements in NSSA levels compared to control ( p = 0.091). Significant clinical improvement was found in the spa group compared to the control in terms of patient global assessment ( p = 0.011), physician global assessment ( p = 0.043), function (HAQ-DI) ( p = 0.037), disease activity (DAS28-4[ESR]) (0.044) and swollen joint count (0.009), and a trend toward improvement in pain scores (0.057). Spa therapy with saline balneotherapy exerts antioxidant effect in patients with RA as reflected by the
Advanced glycation end-products inhibition improves endothelial dysfunction in rheumatoid arthritis.
Syngle, Ashit; Vohra, Kanchan; Garg, Nidhi; Kaur, Ladbans; Chand, Prem
2012-02-01
Chronic inflammation in rheumatoid arthritis is associated with vascular endothelial dysfunction. The objective was to study the efficacy and safety of advanced glycation end products (AGEs) inhibitor (benfotiamine 50 mg + pyridoxamine 50 mg + methylcobalamin 500 μg, Vonder(®) (ACME Lifescience, Baddi, Himachal Pradesh, India)) on endothelial function in rheumatoid arthritis (RA). Twenty-four patients with established active RA with high disease activity (Disease Activity Score of 28 joints [DAS28 score] > 5.1) despite treatment with stable doses of conventional disease-modifying antirheumatic drugs were investigated. Inflammatory disease activity (DAS28 and Health Assessment Questionnaire-Disability Index [HAQ-DI] scores, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), markers of endothelial dysfunction, serum nitrite concentration and endothelium-dependent and -independent vasodilation of the brachial artery were measured before and after 12 weeks therapy with twice a day oral AGEs inhibitor. After treatment, flow-mediated vasodilation improved from 9.64 ± 0.65% to 15.82 ± 1.02% (P < 0.01), whereas there was no significant change in endothelium-independent vasodilation with nitroglycerin and baseline diameter; serum nitrite concentration significantly reduced from 5.6 ± 0.13 to 5.1 ± 0.14 μmol/L (P = 0.004), ESR from 63.00 ± 3.5 to 28.08 ± 1.5 mm in the first h (P < 0.01) and CRP levels from 16.7 ± 4.1 to 10.74 ± 2.9 mg/dL (P < 0.01). DAS28 and HAQ-DI scores were significantly reduced, from 5.9 ± 0.17 to 3.9 ± 0.17 (P < 0.01) and 4.6 ± 0.17 to 1.7 ± 0.22 (P < 0.01), respectively. Advanced glycation end products inhibitor improves endothelial dysfunction and inflammatory disease activity in RA. In RA, endothelial dysfunction is part of the disease process and is mediated by AGEs-induced inflammation. © 2011 The Authors. International Journal of Rheumatic Diseases © 2011 Asia Pacific League of Associations for Rheumatology and
Alfaro-Lara, Roberto; Espinosa-Ortega, Hector Fabricio; Arce-Salinas, César Alejandro
2017-08-31
To assess the efficacy and side effects of methotrexate and leflunomide in patients with rheumatoid arthritis (RA) as the first disease-modifying antirheumatic drug (DMARD). We performed a systematic review and meta-analysis of clinical studies that included patients who took methotrexate, leflunomide, placebo or another DMARD for RA treatment. A systematic review yielded 1971 articles from databases; once completely reviewed, 73 trials that completed inclusion criteria were selected. In structured workshops for discussion and assessment of each article, 6 could be meta-analyzed for the primary and secondary outcomes: achievement of American College of Rheumatology (ACR) 20 and its core set components; and change of serum C-reactive protein (CRP) levels, Health Assessment Questionnaire Disability Index (HAQ-Di), liver enzyme aspartate transaminase/alanine transaminase ratio, new gastrointestinal (GI) side effects and infections. A total of 1984 patients were included: 986 took leflunomide and 998 methotrexate. The probability of achieving ACR 20 had an odds ratio (OR) of 0.88 (95% confidence interval [CI] 0.74, 1.06) with a trend toward favoring methotrexate; reduction of the swollen joint count was greater for methotrexate: mean difference=0.82 (95%CI 0.24, 1.39); tender joint count, physician global assessment, HAQ-Di, and serum CRP levels revealed no significant difference between groups. Increased liver enzymes were more frequent in the leflunomide group, OR=0.38 (95%CI 0.27, 0.53), and new GI complaints were more common with methotrexate (OR=1.44; 95%CI 1.17, 1.79). There was no difference in the incidence of non-severe infections. Leflunomide used as the first DMARD in RA seemed to be as efficacious as methotrexate; only the reduction of swollen joint count was more marked for methotrexate. Leflunomide was linked to a greater increase in liver enzymes, but there were fewer GI complaints. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de
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Anna Kłak
2015-04-01
Full Text Available The aim of the study was to evaluate the current state of nutrition of patients with rheumatic diseases in the Polish population. Material and methods : An anonymous questionnaire study was carried out among the patients of the Institute of Rheumatology in Warsaw in the fourth quarter of 2012. Five hundred questionnaires were distributed, and 397 questionnaires were collected and accepted for further analysis (response rate = 79%. Results: Overweight or obesity was present in more than half (53% of the patients (overweight in 30.5% of respondents, obesity in 22.6%. Among obese subjects, 43% of men and 37% of women in the study think that their diet is correct. Sixty-eight percent of respondents declared that they do not follow any special diet and only 18% declared that they follow a diet with a reduced quantity of monosaccharides (no sweets. A milk-free diet was followed by 7% of respondents, a meat-free diet by 6%, and a fruit-and-vegetable diet by 5%. Dietary supplements were regularly used by 26.7% of respondents, whereas 33.8% did not use them at all. The average assessment of physical aptitude (Health Assessment Questionnaire – HAQ in the group of respondents was 0.71. No statistically significant differences were found between higher level of disability (e.g. HAQ ≥ 1 and the type of diet followed (p = 0.678 or body mass index (BMI value (p = 0.864 in relation to persons with the value of HAQ < 1. Conclusions : More than half of patients suffering from rheumatic diseases are overweight or obese, which corresponds to the body weight profile of the population of Poland. Most patients diagnosed with rheumatic diseases do not follow any special diet. In spite of the frequent use of dietary supplements, the patients do not consult a doctor or a dietician about it. The type of diet and BMI value do not differ according to the level of disability.
The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis
Rojas-Villarraga, Adriana; Bayona, Javier; Zuluaga, Natalia; Mejia, Santiago; Hincapie, Maria-Eugenia; Anaya, Juan-Manuel
2009-01-01
Background Alterations in the feet of patients with rheumatoid arthritis (RA) are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL) based on validated scales and its relationship to disease activity. Methods This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ) Disability Index and of the Disease Activity Score (DAS 28) were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs). Results Foot deformities were observed in 78 (82%) of the patients; hallux valgus (65%), medial longitudinal arch flattening (42%), claw toe (lesser toes) (39%), dorsiflexion restriction (tibiotalar) (34%), cock-up toe (lesser toes) (25%), and transverse arch flattening (25%) were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease), forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar) were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28–30.96; P = 0,02); hallux valgus, and dorsiflexion restriction (tibiotalar) were associated with disease activity. Conclusion Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice. PMID:19527518
Household income and earnings losses among 6,396 persons with rheumatoid arthritis.
Wolfe, Frederick; Michaud, Kaleb; Choi, Hyon K; Williams, Rhys
2005-10-01
Rheumatoid arthritis (RA) causes disability and reduced productivity. There are no large quantitative studies of earnings and productivity losses in patients with clinical RA, and no studies of household income losses. We describe methods for obtaining earnings and household income losses that are applicable to working as well as nonworking RA patients, and we perform such studies using these methods. We estimated cross-sectional expected annual earnings and household income losses in 6,649 persons with RA from Current Populations Survey (CPS) and O*NET (Occupational Information Network) data, and we estimated expected household income and earnings losses based on demographic characteristics after adjustment to Medical Outcomes Study Short-Form 36 (SF-36) population norms (internal method). Workplace productivity was measured by the Work Limitations Questionnaire (WLQ). 27.9% of patients aged Productivity losses were 6% based on work limitations identified by the WLQ. Household income loss (percentage loss) including transfer payments was USD 6,287 (11.8%) for all patients, USD 4,247 (6.9%) for employed patients, and USD 7,374 (14.8%) for nonworking patients. Among nonworking nondisabled patients aged status, education, age, ethnicity, and marital status. Income loss is predicted by the HAQ, HAQ-II, Modified HAQ, and SF-36.
Weber, Augusto; Werneck, Lineu; Paiva, Eduardo; Gans, Paulo
2015-02-01
Fibromyalgia (FM) is a disease that causes widespread pain and increased sensitivity to pain because of a dysfunction in the central nervous system. This study investigated the effect of music combined with vibration on acupuncture points for the treatment of FM. A total of 120 patients with FM were allocated randomly to four groups (30 patients each). One group listened to a sequence of Bach's compositions. The second group was subjected to vibratory stimuli on a combination of acupuncture points on the skin. The third group (complete) underwent both procedures in a simultaneous and synchronized manner, with inclusion of binaural beats. The fourth group (control) received no stimulation. The participants underwent the experimental procedure during five sessions performed on alternate days. They were assessed by the Fibromyalgia Impact Questionnaire (FIQ) and the Health Assessment Questionnaire (HAQ) before the first session and after the last session (20 days). All groups showed a significant improvement in FIQ and HAQ scores at the evaluation after the intervention. The complete group exhibited the best result on both the FIQ and HAQ (p<0.001), and the improvement in HAQ score was significant (p<0.004). The results suggest that the placebo effect in FM may be substantial. However, comparison between groups revealed that the complete group had the greatest reduction in both FIQ and HAQ, with a significant improvement in HAQ, suggesting that the combined use of music and vibration exerts a greater effect on FM symptoms.
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Erika Giannotti
2014-01-01
Full Text Available Objective. To propose a rehabilitation protocol able to produce immediate and long-term beneficial effects on level of disability and overall performance in ADLs. Materials and Methods. Forty-one FM patients were randomized to an exercise and educational-behavioral programme group (experimental group, EG = 21 or to a control group (CG = 20. Each subject was evaluated before, at the end (T1, and after 6 months (T6 from the conclusion of the rehabilitation treatment using the Fibromyalgia Impact Questionnaire (FIQ, the visual analogue scale (VAS, the Health Assessment Questionnaire (HAQ, the fatigue severity scale (FSS, the 6-minute walking test (6MWT, tender points count (TPC, and spinal active range of motion. The exercise protocol included 20 sessions consisting in self-awareness, stretching, strengthening, spine flexibility, and aerobic exercises, which patients were subsequently educated to perform at home. Results. The two groups were comparable at baseline. At T1, the EG showed a positive trend in FIQ, VAS, HAQ, and FSS scales and significant improvement in 6MWT and in most spinal active range of motion measurements (P between 0.001 and 0.04. The positive results were maintained at the follow-up. Conclusion. The proposed programme was well tolerated and produced immediate and medium-term beneficial effects improving function and strain endurance. This trial is registered with DRKS00005071 on DRKS.
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Gillian A Hawker
Full Text Available Because individuals with osteoarthritis (OA avoid physical activities that exacerbate symptoms, potentially increasing risk for cardiovascular disease (CVD and death, we assessed the relationship between OA disability and these outcomes.In a population cohort aged 55+ years with at least moderately severe symptomatic hip and/or knee OA, OA disability (Western Ontario McMaster Universities (WOMAC OA scores; Health Assessment Questionnaire (HAQ walking score; use of walking aids and other covariates were assessed by questionnaire. Survey data were linked to health administrative data to determine the relationship between baseline OA symptom severity to all-cause mortality and occurrence of a composite CVD outcome (acute myocardial infarction, coronary revascularization, heart failure, stroke or transient ischemic attack over a median follow-up of 13.2 and 9.2 years, respectively.Of 2156 participants, 1,236 (57.3% died and 822 (38.1% experienced a CVD outcome during follow-up. Higher (worse baseline WOMAC function scores and walking disability were independently associated with a higher all-cause mortality (adjusted hazard ratio, aHR, per 10-point increase in WOMAC function score 1.04, 95% confidence interval, CI 1.01-1.07, p = 0.004; aHR per unit increase in HAQ walking score 1.30, 95% CI 1.22-1.39, p<0.001; and aHR for those using versus not using a walking aid 1.51, 95% CI 1.34-1.70, p<0.001. In survival analysis, censoring on death, risk of our composite CVD outcome was also significantly and independently associated with greater baseline walking disability ((aHR for use of a walking aid = 1.27, 95% CI 1.10-1.47, p = 0.001; aHR per unit increase in HAQ walking score = 1.17, 95% CI 1.08-1.27, p<0.001.Among individuals with hip and/or knee OA, severity of OA disability was associated with a significant increase in all-cause mortality and serious CVD events after controlling for multiple confounders. Research is needed to elucidate modifiable
Fonseca, João Eurico; Cavaleiro, João; Teles, José; Sousa, Elsa; Andreozzi, Valeska L; Antunes, Marília; Amaral-Turkman, Maria A; Canhão, Helena; Mourão, Ana F; Lopes, Joana; Caetano-Lopes, Joana; Weinmann, Pamela; Sobral, Marta; Nero, Patrícia; Saavedra, Maria J; Malcata, Armando; Cruz, Margarida; Melo, Rui; Braña, Araceli; Miranda, Luis; Patto, José V; Barcelos, Anabela; da Silva, José Canas; Santos, Luís M; Figueiredo, Guilherme; Rodrigues, Mário; Jesus, Herberto; Quintal, Alberto; Carvalho, Teresa; da Silva, José A Pereira; Branco, Jaime; Queiroz, Mário Viana
2007-01-01
The objective of this study was to assess whether clinical measures of rheumatoid arthritis activity and severity were influenced by tumor necrosis factor-alpha (TNF-alpha) promoter genotype/haplotype markers. Each patient's disease activity was assessed by the disease activity score using 28 joint counts (DAS28) and functional capacity by the Health Assessment Questionnaire (HAQ) score. Systemic manifestations, radiological damage evaluated by the Sharp/van der Heijde (SvdH) score, disease-modifying anti-rheumatic drug use, joint surgeries, and work disability were also assessed. The promoter region of the TNF-alpha gene, between nucleotides -1,318 and +49, was sequenced using an automated platform. Five hundred fifty-four patients were evaluated and genotyped for 10 single-nucleotide polymorphism (SNP) markers, but 5 of these markers were excluded due to failure to fall within Hardy-Weinberg equilibrium or to monomorphism. Patients with more than 10 years of disease duration (DD) presented significant associations between the -857 SNP and systemic manifestations, as well as joint surgeries. Associations were also found between the -308 SNP and work disability in patients with more than 2 years of DD and radiological damage in patients with less than 10 years of DD. A borderline effect was found between the -238 SNP and HAQ score and radiological damage in patients with 2 to 10 years of DD. An association was also found between haplotypes and the SvdH score for those with more than 10 years of DD. An association was found between some TNF-alpha promoter SNPs and systemic manifestations, radiological progression, HAQ score, work disability, and joint surgeries, particularly in some classes of DD and between haplotypes and radiological progression for those with more than 10 years of DD.
Oliveira-Ramos, Filipa; Eusébio, Mónica; M Martins, Fernando; Mourão, Ana Filipa; Furtado, Carolina; Campanilho-Marques, Raquel; Cordeiro, Inês; Ferreira, Joana; Cerqueira, Marcos; Figueira, Ricardo; Brito, Iva; Canhão, Helena; Santos, Maria José; Melo-Gomes, José A; Fonseca, João Eurico
2016-01-01
To determine how adult juvenile idiopathic arthritis (JIA) patients fulfil classification criteria for adult rheumatic diseases, evaluate their outcomes and determine clinical predictors of inactive disease, functional status and damage. Patients with JIA registered on the Rheumatic Diseases Portuguese Register (Reuma.pt) older than 18 years and with more than 5 years of disease duration were included. Data regarding sociodemographic features, fulfilment of adult classification criteria, Health Assessment Questionnaire, Juvenile Arthritis Damage Index-articular (JADI-A) and Juvenile Arthritis Damage Index-extra-articular (JADI-E) damage index and disease activity were analysed. 426 patients were included. Most of patients with systemic JIA fulfilled criteria for Adult Still's disease. 95.6% of the patients with rheumatoid factor (RF)-positive polyarthritis and 57.1% of the patients with RF-negative polyarthritis matched criteria for rheumatoid arthritis (RA). 38.9% of the patients with extended oligoarthritis were classified as RA while 34.8% of the patients with persistent oligoarthritis were classified as spondyloarthritis. Patients with enthesitis-related arthritis fulfilled criteria for spondyloarthritis in 94.7%. Patients with psoriatic arthritis maintained this classification. Patients with inactive disease had lower disease duration, lower diagnosis delay and corticosteroids exposure. Longer disease duration was associated with higher HAQ, JADI-A and JADI-E. Higher JADI-A was also associated with biological treatment and retirement due to JIA disability and higher JADI-E with corticosteroids exposure. Younger age at disease onset was predictive of higher HAQ, JADI-A and JADI-E and decreased the chance of inactive disease. Most of the included patients fulfilled classification criteria for adult rheumatic diseases, maintain active disease and have functional impairment. Younger age at disease onset was predictive of higher disability and decreased the
The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis
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Rojas-Villarraga Adriana
2009-06-01
Full Text Available Abstract Background Alterations in the feet of patients with rheumatoid arthritis (RA are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL based on validated scales and its relationship to disease activity. Methods This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ Disability Index and of the Disease Activity Score (DAS 28 were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs. Results Foot deformities were observed in 78 (82% of the patients; hallux valgus (65%, medial longitudinal arch flattening (42%, claw toe (lesser toes (39%, dorsiflexion restriction (tibiotalar (34%, cock-up toe (lesser toes (25%, and transverse arch flattening (25% were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease, forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28–30.96; P = 0,02; hallux valgus, and dorsiflexion restriction (tibiotalar were associated with disease activity. Conclusion Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice.
Validation of an Italian version of the Fibromyalgia Impact Questionnaire (FIQ-I).
Sarzi-Puttini, P; Atzeni, F; Fiorini, T; Panni, B; Randisi, G; Turiel, M; Carrabba, M
2003-01-01
To validate a translated Italian version of the Fibromyalgia Impact Questionnaire (FIQ). The Italian version of the FIQ was administered to 50 patients affected by fibromyalgia (FM) (48 patients filled out the questionnaire again 10 days later) together with the Italian version of the Stanford Health Assessment Questionnaire (HAQ), the Medical Outcomes Survey Short Form-36 (SF-36), and a tender point count (TPC) obtained by summing the score (0-3) of each tender point tested by thumb palpation. All patients were asked about the severity of pain today (10 cm visual analog scale) and the duration of symptoms. Test-retest reliability was assessed using Spearman correlations. Internal consistency was evaluated with Cronbach's alpha of reliability. Construct validity of the FIQ was evaluated by correlations between the HAQ and subscales of the SF-36 as well as the TPC. The mean duration of symptoms was 6.5 years and the mean age of the participants was 57.4 years. Test-retest reliability was between 0.74 and 0.95 for physical functioning as well as for the total FIQ and other components. Internal consistency was 0.90 for the overall FIQ. Significant correlations were obtained between the FIQ items, the HAQ and the SF-36. The Italian FIQ is a reliable and valid instrument for detecting and measuring functional disability and health status in Italian patients with FM.
Kennedy, Norelee; Keogan, Fiona; Fitzpatrick, Martina; Cussen, Grainne; Wallace, Lorraine
2007-03-01
To describe the characteristics of patients with rheumatoid arthritis (RA) attending for physiotherapy management in Ireland. Managers of physiotherapy departments in the 53 hospitals in Ireland were invited to participate in a multi-centre observational study over a 6-month period. Data on patients with RA the day of presentation for physiotherapy management were recorded. These data related to patient demographic details, disease management, aids and appliances, splint and orthoses usage and occupational issues. The Health Assessment Questionnaire was also recorded for each patient. A total of 273 patients from eight physiotherapy departments participated in the survey (n = 199; 73% female). Mean age of the participants was 59.3 (SD 12.5) years with mean disease duration of 13.8 (SD 10.6) years. The majority of the patients were inpatients (n = 170, 62%). Sixty-eight per cent of patients had attended for previous physiotherapy treatment and 98% were under current rheumatologist care. Biologic therapies were prescribed to 11% of patients. Use of splint and foot orthoses was high with 133 patients (49%) wearing splints and 75 (31%) wearing foot orthoses. The majority of patients had moderate (n = 119, 44%) or severe (n = 94, 35%) disability as per Health Assessment Questionnaire (HAQ) score. Mean HAQ score was 1.5, with HAQ scores showing increasing disability with increasing age, disease duration and erythrocyte sedimentation rate (ESR) levels. Patients with RA attending for physiotherapy management present with varied profiles. This study provides valuable information on the characteristics of patients with RA attending for physiotherapy management which will contribute to physiotherapy service planning and delivery and will optimize patient care.
The relationship between vitamin D, vertebral deformity and quality of life in psoriatic arthritis.
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Bedriye Baskan
2016-10-01
Full Text Available Objective: The aim of this study is to investigate the relation between vitamin D levels, vertebral deformities, functional status, quality of life, acute phase reactants and enthesopathy in patients with psoriatic arthritis (PsA. Patients and Methods: Fifty-two patients with PsA and 52 controls were enrolled to the study. Routine blood tests and serums 25-(OHD3 were measured. The thoracic and lumbar vertebrae deformities identified in the radiographies were evaluated by a radiologist. Psoriatic Arthritis Quality of Life (PSAQoL was used for evaluating quality of life and disease activity parameters for PsA were assessed. In PsA patients, correlations was performed between the 25(OH-D3 levels and PGE (patient global assessment, PHGE (Physician global assessment, tender JC (joint count, HAQ-S (Health Assessment Questionnaire for the Spondyloarthropathies, PSAQoL, MASES (Maastricht Ankylosing Spondylitis Enthesitis Score and BASDAI(Bath Ankylosing Spondylitis Disease Activity Index values. Results: The results showed that 25(OH-D3 levels was not correlated with these values. (p>0.05 for r = -0.171, r = -0.167, r=-0.069, r=-0.236, r=-0.062, r= -0.058 and r = -0.106 respectively. It was determined that the PSAQoL score had a positive and statistically significant correlation with the DGD, swollen JC, CRP, HGD, tender JC, VAS-pain, HAQ-S, MASES and BASDAI values in PsA patients. (p>0.05 for r=0.291, r=0.324, r=0.346, r=0.312; and p=0.001 for r=0.472, r=0.380, r=0.565, r=0.696, r=0.359, r=0.633, respectively Statistical analyses demonstrated that PsA patients with vertebral deformities had higher numbers of tender joints, more prolonged periods of morning stiffness, higher DAS28-ESR (Disease Activity Score scores, and higher levels of vitamin D (p<0.05, p<0.05, p=0.05 and p<0.05, respectively. The multiple logistic regression analysis indicated that the only factor which had an effect on the development of vertebral deformities was the use of steroids
Better assessment of physical function: item improvement is neglected but essential.
Bruce, Bonnie; Fries, James F; Ambrosini, Debbie; Lingala, Bharathi; Gandek, Barbara; Rose, Matthias; Ware, John E
2009-01-01
Physical function is a key component of patient-reported outcome (PRO) assessment in rheumatology. Modern psychometric methods, such as Item Response Theory (IRT) and Computerized Adaptive Testing, can materially improve measurement precision at the item level. We present the qualitative and quantitative item-evaluation process for developing the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function item bank. The process was stepwise: we searched extensively to identify extant Physical Function items and then classified and selectively reduced the item pool. We evaluated retained items for content, clarity, relevance and comprehension, reading level, and translation ease by experts and patient surveys, focus groups, and cognitive interviews. We then assessed items by using classic test theory and IRT, used confirmatory factor analyses to estimate item parameters, and graded response modeling for parameter estimation. We retained the 20 Legacy (original) Health Assessment Questionnaire Disability Index (HAQ-DI) and the 10 SF-36's PF-10 items for comparison. Subjects were from rheumatoid arthritis, osteoarthritis, and healthy aging cohorts (n = 1,100) and a national Internet sample of 21,133 subjects. We identified 1,860 items. After qualitative and quantitative evaluation, 124 newly developed PROMIS items composed the PROMIS item bank, which included revised Legacy items with good fit that met IRT model assumptions. Results showed that the clearest and best-understood items were simple, in the present tense, and straightforward. Basic tasks (like dressing) were more relevant and important versus complex ones (like dancing). Revised HAQ-DI and PF-10 items with five response options had higher item-information content than did comparable original Legacy items with fewer response options. IRT analyses showed that the Physical Function domain satisfied general criteria for unidimensionality with one-, two-, three-, and four-factor models
DEFF Research Database (Denmark)
Jacobsen, Søren; Garred, Peter; Madsen, Hans Ole
2009-01-01
OBJECTIVE: To study the association between polymorphisms in the mannose-binding lectin gene (MBL2) and disease activity, physical disability, and joint erosions in patients with newly diagnosed rheumatoid arthritis (RA). METHODS: Patients with early RA (n=158) not previously treated with disease...... modifying antirheumatic drugs, participating in a treatment trial (CIMESTRA study) were examined at inclusion for MBL2 pooled structural genotypes (O/O, A/O, A/A), regulatory MBL2 promoter polymorphism in position -221 (XX, XY, YY), anti-cyclic citrullinated peptide 2 antibodies (anti-CCP2), disease...... activity by Disease Activity Score-28 (DAS28 score), physical disability by Health Assessment Questionnaire (HAQ) score, and erosive changes in hands and feet (Sharp-van der Heijde score). RESULTS: Eight patients were homozygous MBL2 defective (O/O), 101 belonged to an intermediate group, and 49 were MBL2...
Journal of Biosciences | Indian Academy of Sciences
Indian Academy of Sciences (India)
Home; Journals; Journal of Biosciences. Q M I Haq. Articles written in Journal of Biosciences. Volume 36 Issue 2 June 2011 pp 329-340 Articles. Mutagenesis in ORF AV2 affects viral replication in Mungbean yellow mosaic India virus · A Rouhibakhsh Q M I Haq V G Malathi · More Details Abstract Fulltext PDF. Mungbean ...
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Diogo Homann
2011-12-01
Full Text Available CONTEXTUALIZAÇÃO: A fibromialgia (FM parece limitar o desempenho físico, e a realização de atividades da vida diária (AVDs pode exacerbar a dor e o esforço percebido nesses pacientes. OBJETIVOS: Comparar o desempenho do teste de caminhada de 6 minutos (TC6 entre pacientes com FM e controles e verificar relações entre esse desempenho com o impacto na qualidade de vida, na realização de tarefas da vida diária e no nível de atividade física. MÉTODOS: Participaram do estudo 19 mulheres com FM e 20 mulheres saudáveis. Realizou-se o TC6 e, durante o teste, foram mensuradas a intensidade de dor e a percepção subjetiva de esforço (PSE. Foram aplicados o Fibromyalgia Impact Questionnaire (FIQ, Health Assessment Questionnaire (HAQ e o International Physical Activity Questionnaire (IPAQ. RESULTADOS: O grupo de mulheres com FM percorreu menor distância no TC6 (pacientes: 473,52±77,84 m versus controles: 541,75±85,62 m; p=0,02. Para o grupo de pacientes houve correlações entre a distância caminhada e o questionário FIQ (r=-0,46; p=0,05, o HAQ (r=-0,49; p=0,03 e o consumo de oxigênio (r=0,78; pBACKGROUND: Fibromyalgia has been association with physical performance limitations. Additionally, activities of daily living have been reported to be directly associated with the exacerbation of pain and perceived exertion in this patient population. OBJECTIVES: To compare the performance of a 6-minute walk (6MWT test in patients with fibromyalgia and controls and to evaluate the relationship between test performance and quality of life, limitations of activities of daily living and physical activity level. METHODS: The study included 19 women with fibromyalgia (FM and 20 healthy controls (CG. A 6MWT was conducted and pain intensity and perceived effort (PE were assessed during the test. In addition, Fibromyalgia Impact Questionnaire (FIQ, Health Assessment Questionnaire (HAQ and International Physical Activity Questionnaire (IPAQ were
Durán-Avelar, Ma de Jesús; Vibanco-Pérez, Norberto; Hernández-Pacheco, Raquel Rocío; Castro-Zambrano, América Del Carmen; Ortiz-Martínez, Liliana; Zambrano-Zaragoza, José Francisco
2016-12-01
Rheumatoid arthritis (RA) is a systemic autoimmune disease in whose etiology genetic factors are known to play an important role. Among the genes associated with RA, STAT4 could be an important factor in conducting helper T cells toward the pro-inflammatory Th1 and Th17 lineages. The aim of this study is to determine the association of the STAT4 polymorphism rs7574865 with RA, disease activity, and anti-cyclic citrullinated peptide (CCP) antibody levels in a Mexican population. Genotyping was carried out using the Taqman® system from Applied Biosystems in 140 patients with RA and 150 healthy subjects. Disease activity was evaluated by a rheumatologist using the DAS28 and Spanish-HAQ-DI instruments. Anti-CCP levels were determined by ELISA. Associations of the genotypes of rs7574865 with DAS28, HAQ, and anti-CCP antibody levels with RA were determined. Findings showed that the GT and TT genotypes and the T allele from rs7574865 were all associated as risk factors for RA, independently of their anti-CCP status. An association with moderate-to-high disease activity (DAS28 ≥ 3.2) was also found. Additionally, patients with the GT or TT genotypes showed lower HAQ values than those who carried the GG genotype. No differences in anti-CCP antibody levels or DAS28 and genotypes were found. This work supports the association of the STAT4 rs7574865 polymorphism with RA and disease activity, but not with anti-CCP antibody levels in a Mexican population.
Walker, Nancy; Michaud, Kaleb; Wolfe, Frederick
2005-06-01
To describe workplace limitations and the validity and reliability of the Work Limitations Questionnaire (WLQ) in persons with rheumatoid arthritis (RA). A total of 836 employed persons with RA reported clinical and work related measures and completed the WLQ, a 25 item questionnaire that assesses the impact of chronic health conditions on job performance and productivity. Limitations are categorized into 4 domains: physical demands (PDS), mental demands (MDS), time management demands (TMS), and output demands (ODS), which are then used to calculate the WLQ index. Of the 836 completed WLQ, about 10% (85) could not be scored, as more than half the items in each domain were not applicable to the patient's job. Demographic and clinical variables were associated with missing WLQ scores including older age (OR 1.7, 95% CI 1.3-2.1), male sex (OR 1.9, 95% CI 1.2-3.0), and Health Assessment Questionnaire (HAQ) scores (OR 1.4, 95% CI 1.0-2.0). Work limitations were present in all work domains: PDS (27.5%), MDS (15.7%), ODS (19.4%), and TMS (28.6%), resulting in a mean WLQ index of 5.9 (SD 5.6), which corresponds to a 4.9% decrease in productivity and a 5.1% increase in work hours to compensate for productivity loss. The WLQ index was inversely associated with Medical Outcomes Study Short Form 36 (SF-36) Mental Component Score (MCS; r = -0.60) and Physical Component Score (PCS; r = -0.49). Fatigue (0.5), pain (0.46), and HAQ (0.56) were also significantly associated with the WLQ index. Weaker associations were seen with days unable to perform (0.29), days activities cut down (0.38), and annual income (-0.10). The WLQ is a reliable tool for assessing work productivity. However, persons with RA tend to select jobs that they can do with their RA limitations, with the result that the WLQ does not detect functional limitations as well as the HAQ and SF-36. The WLQ provides special information that is not available using conventional measures of assessment, and can provide helpful
Validation of a Russian-language version of the Foot Functional Index (FFI questionnaire
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E. V. Orlova
2016-01-01
Full Text Available The Foot Functional Index (FFI questionnaire most completely reflects the functional status of patients with joint diseases of the feet.Objective: to study the psychometric properties of a Russian-language version of the FFI questionnaire.Patients and methods. The reliability, sensitivity, and validity of the Russian-language version of the FFI questionnaire were assessed in 55 patients with rheumatoid arthritis (RA. The investigators checked the reliability by assessing the internal consistency (calculating Cronbach's alpha and reproducibility by a test-retest analysis. The criterion validity was evaluated by correlation analysis using HAQ, RAPID3, and pain visual analogue scale (VAS scores. The sensitivity of FFI was studied by comparing its dynamics with RAPID3 changes during treatment.Results. Evaluating the internal consistency yielded a high Cronbach's alpha (0.78. The test-retest analysis demonstrated a significant correlation (0.83 between the results of primary and secondary testing. Assessing the criterion validity showed a high or near-high relationship to the scores of RAPID3 (0.78, HAQ (0.69, and pain VAS (0.76. The group of patients who were observed to have a decrease in disease activity according to RAPID3 from a high (16.2±4.1 to moderate (10.5±5.2 degree displayed a more marked reduction in FFI (ΔFFI = 20.5±2.3 than the group that did not exhibit significant changes in disease activity (ΔFFI = 6.9±3.4.Conclusion. FFI is a reliable, valid, and sensitive tool to evaluate the functional status of patients with foot diseases in RA.
Wallenstein, Gene V; Kanik, Keith S; Wilkinson, Bethanie; Cohen, Stanley; Cutolo, Maurizio; Fleischmann, Roy; Genovese, Mark C; Gomez Reino, Juan; Gruben, David; Kremer, Joel; Krishnaswami, Sriram; Lee, Eun Bong; Pascual-Ramos, Virginia; Strand, Vibeke; Zwillich, Samuel H
2016-01-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). Here we investigated the effects of tofacitinib on patient-reported outcomes (PRO) in patients with active RA. Two, 6-month, double-blind, placebo-controlled Phase 2b studies were performed. The combination study evaluated patients with inadequate response to methotrexate who received tofacitinib 1-15 mg twice daily (BID), 20 mg once daily or placebo, on background methotrexate. In the monotherapy study, patients with inadequate response to disease-modifying anti-rheumatic drugs received tofacitinib 1-15 mg BID, adalimumab 40 mg once every other week or placebo. PROs measured were: Patient's Assessment of Arthritis Pain (PAAP), Patient's Assessment of Disease Activity, HAQ-DI, FACIT-F and SF-36. In the combination study (n=507), significant improvements (ptofacitinib groups. In the monotherapy study (n=384), significant improvements in PAAP were observed at Week 12 for tofacitinib 5, 10 and 15 mg BID, and in HAQ-DI for tofacitinib 3, 5, 10 and 15 mg BID. Significant improvements versus placebo were seen at Week 2 in PAAP (both studies) and HAQ‑DI (monotherapy study) with tofacitinib, and were maintained throughout each study. In both studies, improvements in several domains of the SF-36 in the tofacitinib groups were observed at Weeks 12 and 24. In patients with active RA, tofacitinib, either in combination with methotrexate or as monotherapy, demonstrated rapid and sustained improvement in pain, physical functioning and health-related quality of life.
Schefte, David B; Hetland, Merete L
2010-01-01
The Danish DANBIO registry has developed open-source software for touch screens in the waiting room. The objective was to assess the validity of outcomes from self-explanatory patient questionnaires on touch screen in comparison with the traditional paper form in routine clinical care. Fifty-two AS patients and 59 RA patients completed Visual Analogue Scales (VASs) for pain, fatigue and global health, and Bath measures on Ankylosing Spondylitis Disease Activity Index (BASDAI) and Function Index (BASFI) (AS patients) or HAQs (RA patients) on touch screen and paper form in random order with a 1-h interval. Intra-class correlation coefficients (ICCs), 95% CIs and smallest detectable differences (SDDs) were calculated. ICC ranged from 0.922 to 0.988 (P health when compared with the traditional paper form. Implementation of touch screens in clinical practice is feasible and patients need no instruction.
Kruntorádová, Klára; Klimeš, Jiří; Šedová, Liliana; Štolfa, Jiří; Doležal, Tomáš; Petříková, Alena
2014-09-01
To determine and compare the impact of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis on work productivity, to calculate the productivity costs (PC), and to map out factors that influence (functional status and disease activity) work productivity. The Work Productivity and Activity Impairment questionnaire was used to evaluate productivity losses of patients with RA (n = 77), AS (n = 230), and psoriasis (n = 93). Demographic data, patient-reported outcomes (PROs) (Health Assessment Questionnaire [HAQ] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and clinical parameters (Disease Activity Score in 28 joints [DAS28], body surface area [BSA], and Psoriasis Area and Severity Index [PASI]) were collected. The correlations among PROs, clinical parameters, and overall productivity loss were examined, and multiple regression models were used to examine relationships among parameters and productivity loss. PC were calculated using the friction cost approach. Mean patient age and disease duration were 47.1 and 15.7 years, respectively. The mean HAQ and DAS28 in patients with RA were 1.22 and 5.6, respectively. The mean BASDAI score in patients with AS was 4.43. The mean BSA and PASI score in patients with psoriasis were 21.1% and 12.9, respectively. The percentage of patients with psoriatic arthritis (in those with psoriasis) was 24.7%. We did not find significant differences in Work Productivity and Activity Impairment domains among various diagnoses. Patients with AS, RA, and psoriasis reported overall work productivity losses of 40.9%, 42.9%, and 42.8%, respectively. Daily activity impairments were approximately 50.0%. Overall work productivity loss strongly correlated with PROs, whereas correlations with clinical parameters were weak. The HAQ and BASDAI were identified as major predictors of productivity impairment. The greatest loss in productivity was in those with psoriatic arthritis; however, it was not significant. In
Factors associated with sustained remission in patients with rheumatoid arthritis.
Martire, María Victoria; Marino Claverie, Lucila; Duarte, Vanesa; Secco, Anastasia; Mammani, Marta
2015-01-01
To find out the factors that are associated with sustained remission measured by DAS28 and boolean ACR EULAR 2011 criteria at the time of diagnosis of rheumatoid arthritis. Medical records of patients with rheumatoid arthritis in sustained remission according to DAS28 were reviewed. They were compared with patients who did not achieved values of DAS28<2.6 in any visit during the first 3 years after diagnosis. We also evaluated if patients achieved the boolean ACR/EULAR criteria. Variables analyzed: sex, age, smoking, comorbidities, rheumatoid factor, anti-CCP, ESR, CRP, erosions, HAQ, DAS28, extra-articular manifestations, time to initiation of treatment, involvement of large joints, number of tender joints, number of swollen joints, pharmacological treatment. Forty five patients that achieved sustained remission were compared with 44 controls. The variables present at diagnosis that significantly were associated with remission by DAS28 were: lower values of DAS28, HAQ, ESR, NTJ, NSJ, negative CRP, absence of erosions, male sex and absence of involvement of large joints. Only 24.71% achieved the boolean criteria. The variables associated with sustained remission by these criteria were: lower values of DAS28, HAQ, ESR, number of tender joints and number of swollen joints, negative CRP and absence of erosions. The factors associated with sustained remission were the lower baseline disease activity, the low degree of functional disability and lower joint involvement. We consider it important to recognize these factors to optimize treatment. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
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Angela Del Rosso
2013-01-01
Full Text Available Background. Anxious and depressive symptoms are frequent in Systemic Sclerosis (SSc. Our objective is to assess their prevalence and association with district and global disability and psychological variables. Methods. 119 SSc patients were assessed by Hospital Anxiety Depression Scale (HADS. Clinical depression and anxiety were defined for HADS score cutoff ≥8. Patients were assessed for psychological symptoms (RSES, COPE-NIV, hand (HAMIS, CHFDS, fist closure, and hand opening and face disability (MHISS, mouth opening, global disability, and fatigue (HAQ, FACIT. Results. Both depression and anxiety in SSc are 36%. Depressive patients with comorbid anxiety have higher HADS-D score than patients with depression only (. HADS-A and -D are positively correlated with global disability, hands and mouth disability, fatigue, self-esteem and avoidance coping strategy, and, only HADS-A, also with social support (. By multiple regression, HADS-D is independently associated with FACIT-F (, RSES (, and MHISS total score (, together explaining 50% of variance. HADS-A is independently associated with RSES (, COPE-NIV SA (, COPE-NIV SS (, FACIT-F (, and MHISS mouth opening (, explaining 41% of variance. Conclusions. In SSc depression and anxiety correlate to local and global disabilities and psychological characteristics. Depressive patients with comorbid anxiety have higher level of depressive symptoms.
Methotrexate in the treatment of peripheral arthritis in ulcerative colitis
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R. Scarpa
2011-06-01
Full Text Available Objective: To evaluate efficacy of methotrexate treatment in peripheral arthritis of ulcerative colitis. Methods: We studied 18 patients (10/8 M/F; mean age: 38.90 yrs; range: 21-65 yrs, with peripheral arthritis (14 with polyarticular, 4 with oligoarticular subset associate ulcerative colitis. Methotrexate 20 mg/week was administered in our patients, who were already receiving mesalazina for inflammatory bowel disease. At baseline, after 3 (T1, 6 (T2 and 12 months (T3 serological parameters (ESR and CRP, functional status (HAQ and disease activity (VAS, GH, Ritchie articular index were evaluated. Results: During the therapy a significant improvement was observed in disease activity, functional status and serological parameters since T1. ESR and CRP did not change at T2 and T3. Instead VAS, GH, Ritchie articular index and HAQ had a significant and gradual improvement from T1 to T3. Conclusion: Methotrexate treatment was efficacious in the treatment of peripheral arthritis associate ulcerative colitis. This drug induced improvement in disease activity, functional status and serological parameters after 3 months of therapy.
Work productivity in rheumatoid arthritis: relationship with clinical and radiological features.
Chaparro Del Moral, Rafael; Rillo, Oscar Luis; Casalla, Luciana; Morón, Carolina Bru; Citera, Gustavo; Cocco, José A Maldonado; Correa, María de Los Ángeles; Buschiazzo, Emilio; Tamborenea, Natalia; Mysler, Eduardo; Tate, Guillermo; Baños, Andrea; Herscovich, Natalia
2012-01-01
Objective. To assess the relationship between work productivity with disease activity, functional capacity, life quality and radiological damage in patients with rheumatoid arthritis (RA). Methods. The study included consecutive employed patients with RA (ACR'87), aged over 18. Demographic, disease-related, and work-related variables were determined. The reduction of work productivity was assessed by WPAI-RA. Results. 90 patients were evaluated, 71% women. Age average is 50 years old, DAS28 4, and RAQoL 12. Median SENS is 18 and HAQ-A 0.87. Mean absenteeism was of 14%, presenting an average of 6.30 work hours wasted weekly. The reduction in performance at work or assistance was of 38.4% and the waste of productivity was of 45%. Assistance correlated with DAS28 (r = 0.446; P productivity was noticed in higher levels of activity and functional disability. Patients with SENS > 18 showed lower work productivity than those with SENS work productivity were HAQ-A and RAQoL. Conclusion. RA patients with higher disease severity showed higher work productivity compromise.
Mian, Aneela N; Ibrahim, Fowzia; Scott, Ian C; Bahadur, Sardar; Filkova, Maria; Pollard, Louise; Steer, Sophia; Kingsley, Gabrielle H; Scott, David L; Galloway, James
2016-01-01
BACKGROUND: Rheumatoid arthritis (RA) treatment paradigms have shifted over the last two decades. There has been increasing emphasis on combination disease modifying anti-rheumatic drug (DMARD) therapy, newer biologic therapies have become available and there is a greater focus on achieving remission. We have evaluated the impact of treatment changes on disease activity scores for 28 joints (DAS28) and disability measured by the health assessment questionnaire scores (HAQ).METHODS: Four cross...
Mapping onto Eq-5 D for patients in poor health
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Brazier John E
2010-11-01
Full Text Available Abstract Background An increasing amount of studies report mapping algorithms which predict EQ-5 D utility values using disease specific non-preference-based measures. Yet many mapping algorithms have been found to systematically overpredict EQ-5 D utility values for patients in poor health. Currently there are no guidelines on how to deal with this problem. This paper is concerned with the question of why overestimation of EQ-5 D utility values occurs for patients in poor health, and explores possible solutions. Method Three existing datasets are used to estimate mapping algorithms and assess existing mapping algorithms from the literature mapping the cancer-specific EORTC-QLQ C-30 and the arthritis-specific Health Assessment Questionnaire (HAQ onto the EQ-5 D. Separate mapping algorithms are estimated for poor health states. Poor health states are defined using a cut-off point for QLQ-C30 and HAQ, which is determined using association with EQ-5 D values. Results All mapping algorithms suffer from overprediction of utility values for patients in poor health. The large decrement of reporting 'extreme problems' in the EQ-5 D tariff, few observations with the most severe level in any EQ-5 D dimension and many observations at the least severe level in any EQ-5 D dimension led to a bimodal distribution of EQ-5 D index values, which is related to the overprediction of utility values for patients in poor health. Separate algorithms are here proposed to predict utility values for patients in poor health, where these are selected using cut-off points for HAQ-DI (> 2.0 and QLQ C-30 ( Conclusion Mapping algorithms overpredict utility values for patients in poor health but are used in cost-effectiveness analyses nonetheless. Guidelines can be developed on when the use of a mapping algorithms is inappropriate, for instance through the identification of cut-off points. Cut-off points on a disease specific questionnaire can be identified through association
Development, linguistic and clinimetric validation of the WOMAC VA3.01 Bangla for Bangladesh Index.
Rabbani, M G; Haq, S A; Bellamy, N; Islam, M N; Choudhury, M R; Naheed, A; Ahmed, S; Shahin, A
2015-06-01
The aim of this study was to develop and to validate a Bengali version of the Western Ontario and McMaster Osteoarthritis (WOMAC) index in Bangladesh. The WOMAC was translated into the local language of Bangladesh (Bengali) and adapted in the local sociocultural context, following the standard guidelines by Beaton et al. Content validity of the preliminary Bengali version was assessed by using the index of content validity (ICV) and floor and ceiling effects. Patients were assessed at the Department of Rheumatology of Bangabandhu Sheikh Mujib Medical University and were diagnosed to have knee OA by American College of Rheumatology criteria and recruited according to the requirements of the validation study. Convergent and divergent validity were measured by comparing with Health Assessment Questionnaire (HAQ) and the Short Form-36 (SF-36), and internal consistency was assessed using Cronbach's alpha coefficient. The questionnaire was readministered to 40 patients within a week for assessing reliability by using intra-class correlation coefficient (ICC) and Spearman's rank correlation coefficient. In addition, factor analysis of Bengali WOMAC questionnaire was performed to examine the number of factors influencing a common set of items. A Bengali version was developed with changes in three items to suit local practices. The ICV of the content validity was 1 for all items. The Bengali WOMAC had similar construct validity when compared to the HAQ (ρ 0.74, n = 70) and SF-36 bodily pain and physical functioning. It had dissimilar construct validity to SF-36 mental health domain except WOMAC pain. Factor analysis revealed five factors with eigenvalues of more than 1.0. Cronbach's alpha and ICC exceeded 0.7 in all domains. In the test-retest reliability testing, Spearman's ρ for all items exceeded 0.4 (n = 40). This study has demonstrated that the Bengali version of WOMAC is a valid tool for assessing quality of life of patients with knee osteoarthritis in Bangladesh
Radominski, Sebastião Cezar; Cardiel, Mario Humberto; Citera, Gustavo; Goecke, Annelise; Jaller, Juan Jose; Lomonte, Andrea Barranjard Vannucci; Miranda, Pedro; Velez, Patricia; Xibillé, Daniel; Kwok, Kenneth; Rojo, Ricardo; García, Erika Gabriela
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We assessed tofacitinib efficacy and safety in the Latin American (LA) subpopulation of global Phase 3 and long-term extension (LTE) studies. Data from LA patients with RA and inadequate response to disease-modifying antirheumatic drugs (DMARDs) were pooled across five Phase 3 studies. Phase 3 patients received tofacitinib 5 or 10mg twice daily (BID), adalimumab or placebo; patients in the single LTE study received tofacitinib 5 or 10mg BID; treatments were administered alone or with conventional synthetic DMARDs. Efficacy was reported up to 12 months (Phase 3) and 36 months (LTE) by American College of Rheumatology (ACR) 20/50/70 response rates, Disease Activity Score (DAS)28-4(erythrocyte sedimentation rate [ESR]) and Health Assessment Questionnaire-Disability Index (HAQ-DI). Incidence rates (IRs; patients with event/100 patient-years) of adverse events (AEs) of special interest were reported. The Phase 3 studies randomized 496 LA patients; the LTE study enrolled 756 LA patients from Phase 2 and Phase 3. In the Phase 3 studies, patients who received tofacitinib 5 and 10mg BID showed improvements vs placebo at Month 3 in ACR20 (68.9% and 75.7% vs 35.6%), ACR50 (45.8% and 49.7% vs 20.7%) and ACR70 (17.5% and 23.1% vs 6.9%) responses, mean change from baseline in HAQ-DI (-0.6 and -0.8 vs -0.3) and DAS28-4(ESR) score (-2.3 and -2.4 vs -1.4). The improvements were sustained up to Month 36 in the LTE study. In the Phase 3 studies, IRs with tofacitinib 5 and 10mg BID and placebo were 7.99, 6.57 and 9.84, respectively, for SAEs, and 3.87, 5.28 and 3.26 for discontinuation due to AEs. IRs of AEs of special interest in tofacitinib-treated LA patients were similar to the global population. In Phase 3 and LTE studies in LA patients with RA, tofacitinib demonstrated efficacy up to 36 months with a manageable safety profile up to 60 months, consistent with the overall tofacitinib
Rheumatoid arthritis disease activity and vitamin D deficiency in an Asian resident population.
Quraishi, Mohammed K; Badsha, Humeira
2016-04-01
We aimed to assess the prevalence of vitamin D deficiency and its association with rheumatoid arthritis (RA) disease activity in a UAE population. Forty-five consecutive subjects were prospectively recruited during the early summer with their clinical examination and Health Assessment Questionnaire (HAQ) being recorded at a clinic appointment, along with their blood sample being taken for the 25-hydroxyvitamin D (25(OH)D) total test. Thirty-five (76%) patients claimed to be exposed to sunlight for Disease Activity Score (DAS28) or HAQ scores. A direct relationship was observed between HAQ scores and DAS28 scores (P culture. No association was observed between vitamin D and disease activity. However, the high prevalence of vitamin D deficiency may negatively impact on bone health of these patients in the future. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Avaliação do desempenho físico e funcional respiratório em obesos
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Kadma Karênina Damasceno Soares
Full Text Available INTRODUÇÃO: O desempenho físico tem se tornado importante objeto de estudo em obesos para a avaliação pré-operatória de cirurgia bariátrica. Contudo, ainda há escassez de estudos, especialmente, no que se refere aos testes de campo ou de capacidade funcional. OBJETIVO: comparar os resultados do Teste de Caminhada de seis Minutos (TC6' com os do Shuttle Walk Test (SWT em mulheres obesas, juntamente com as respostas do questionário HAQ-20. METODOLOGIA: avaliaram-se 13 mulheres, com idade média de 44 ± 11 anos e com Índice de Massa Corpórea (IMC 43 ± 5 kg/m², submetidas, aleatoriamente e de forma consecutiva, a TC6', SWT, espirometria, força muscular respiratória e questionário HAQ-20. RESULTADOS: Constatou-se que as distâncias apresentaram-se significativamente diferentes (TC6' = 489 ± 129 m e SWT = 244 ± 161 m, sendo que o score do HAQ-20 apresentou uma mediana de 1,125. Quando verificada a correlação do HAQ-20 com TC6' e o SWT, esta foi constatada apenas para o domínio vestir-se com os resultados do TC6. CONCLUSÃO: Com base nesses resultados, conclui-se que a distância percorrida no TC6' foi maior que no SWT, o que sugere melhor aplicabilidade do TC6' em obesos, sendo, nesse caso, possivelmente mais sensível na avaliação da capacidade funcional que o SWT. Os resultados do HAQ-20 foram pouco discriminadores, pois um domínio entre oito mostrou-se significativo quando correlacionado com as distâncias percorridas.
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Marcelo Cardoso de Souza
Full Text Available ABSTRACT Objective: The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients. Methods: Sixty patients with AS were randomized into the intervention group (IG or the control group (CG. Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM, BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale. Results: There was a statistical difference between groups for: strength (1 RM capacity in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p < 0.005; 6-minute walk test (p < 0.001; timed up and go test (p = 0.025 and Likert scale (p < 0.001, all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage. Conclusions: Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.
Oro-facial evaluation of women with rheumatoid arthritis.
Hoyuela, C P S; Furtado, R N V; Chiari, A; Natour, J
2015-05-01
Rheumatoid arthritis (RA) is an aggressive articular autoimmune disease that causes deformities and disability. The temporomandibular joint (TMJ) might be affected by this disease. Few controlled studies have evaluated bite force (BF) and oro-facial manifestations of this disease. To characterise oro-facial alterations in patients with RA, correlate these results with clinical and disease activity parameters and correlate BF with hand strength (HS). A cross-sectional study of 150 women was performed, (75 RA patients (RA group) and 75 healthy individuals (control group). The presence of articular sounds, pain on palpation of masseter, temporal and TMJ lateral pole, changes in occlusion, range of mandibular motion, measurement of BF in the incisor and molar regions and assessment of HS were evaluated. In relation to oro-facial evaluation there were statistical differences between the groups. There was correlation between BF and HS, in the RA group, this correlation was consistent in patients with natural teeth. Patients with RA had lower scores (P < 0·05) in the HAQ, DASH and OHIP-14 questionnaires than the control group. Inverse correlations were found between BF and HAQ, but not between BF and DAS-28, DASH and OHIP-14 questionnaires in the RA group. The women with RA presented more signs and symptoms in the oro-facial region and had a lower BF than the women in the control group. BF was inversely correlated with the overall function (evaluated by the HAQ) in the patients with RA, and there were correlations between BF and HS in the RA patients and in the control group. © 2014 John Wiley & Sons Ltd.
Lee, Yi Xuan; Kwan, Yu Heng; Png, Wan Yu; Lim, Ka Keat; Tan, Chuen Seng; Lui, Nai Lee; Chew, Eng Hui; Thumboo, Julian; Østbye, Truls; Fong, Warren
2017-10-01
To determine if obesity is associated with poorer patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA), we conducted a cross-sectional study using data of the PRESPOND registry from a tertiary referral center in Singapore between 2011 and 2015. Demographics, clinical, and PRO variables were collected. Patients were divided into three categories: normal (BMI < 23 kg/m 2 ), overweight (23 kg/m 2 ≤ BMI < 27.5 kg/m 2 ) and obese (BMI ≥ 27.5 kg/m 2 ), using Asian BMI classification. The dependent variables are Pain score, Bath Ankylosing Spondylitis Patient Global Score (BAS-G), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Health Assessment Questionnaire (HAQ), and Medical Outcomes Study Short Form 36 version 2 (SF-36). Multivariate regression analyses were performed with these dependent variables and obesity categories, adjusting for confounders. Among 194 patients with axSpA, 32% are overweight while 22% are obese. We found that obese patients had significant poorer pain (β: 11.87, 95%CI 2.13, 21.60) and BAS-G scores (β: 10.18, 95%CI 1.59, 18.76) when compared to normal BMI patients. However, obesity was not associated with BASDAI (β 0.50, 95%CI -0.22, 1.22), BASFI (β 0.08, 95%CI -0.66, 0.81), HAQ (β -0.07, 95%CI -0.21, 0.06), physical component summary (β -0.02, 95%CI -4.47, 4.44), and mental component summary (β -2.85, 95%CI -7.57, 1.88) of SF-36. Obesity was associated with pain score and BAS-G but not with BASDAI, BASFI, HAQ, and SF-36. Further study is needed to examine the causal relationship between obesity and poorer PROs.
Pulse radiolytic one-electron reduction of 2-hydroxy- and 2,6-dihydroxy-9,10-anthraquinones
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Pal, Haridas; Mukherjee, Tulsi; Mittal, J.P.
1994-01-01
The semiquinone free radicals produced by one-electron reduction of 2-hydroxy-9-10-anthraquinone (2HAQ) and 2,6-dihydroxy-9,10-anthraquinone (26DHAQ) in aqueous formate solution, water-isopropyl alcohol-acetone mixed solvent and isopropyl alcohol have been studied using the pulse radiolysis technique. The absorption characteristics, kinetic parameters of formation and decay, acid-base behaviour and redox characteristics of the semiquinones have been investigated and compared with the corresponding characteristics of a few intramolecularly hydro-bonded anthrasemiquinone derivatives. The non-hydrogen-bonded semiquinones show two pKsub(a) values (4.7 and 10.7 for 2HAQ and 5.4 and 8.7 for 26DHAQ, respectively) within the pH range 1-14, whereas other intramolecularly hydrogen-bonded semiquinones show only one pKsub(a). The one-electron reduction potential (E' 7 ) values for 2HAQ (-440 mV) and 26DHAQ (- 400 mV) are more negative than those of the intramolecularly hydrogen-bonded systems. (Author)
Czynniki ryzyka upadków i złamań kości u pacjentów chorych na reumatoidalne zapalenie stawów
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Krzysztof Tomaszewski
2010-04-01
Full Text Available Cel pracy: Ocena czynników ryzyka i częstości występowaniaupadków i złamań kości u chorych na reumatoidalne zapaleniestawów (RZS. Materiał i metody: Do badania kwalifikowano pacjentów chorychna RZS (spełniających kryteria ACR z 1984 r.. Dane na temat stanuzdrowia zebrano na podstawie ankiety zawierającej Kwestio -nariusz Oceny Stanu Zdrowia (HAQ, pytań dotyczących chorób,przyjmowanych leków, upadków i złamań kości w okresie ostatnich12 miesięcy. Wyniki: Przebadano 167 kobiet (89,8% i 19 mężczyzn (średni wiek± SD 58,5 ±13,8 roku. Średni czas trwania choroby wynosił14,4 ±10,7 roku. Średnia wartość HAQ 1,36 ±0,76. Z grupy 186 osóbupadek przydarzył się 80 badanym (43%. U 28 chorych (35%upadek zakończył się złamaniem bądź złamaniami obwodowymi.Liczba upadków dodatnio korelowała z wynikiem HAQ (r = 0,32;p < 0,05 oraz czasem trwania choroby (r = 0,31; p < 0,05.Głównymi czynnikami ryzyka upadków w badanej grupie byłyzawroty głowy [iloraz szans (OR = 2,68], stosowanie lekówhipotensyjnych (OR = 2,27 i przeciwdepresyjnych (OR = 2,56,deformacje stóp (OR = 3,14 oraz wysoki wskaźnik HAQ(OR = 2,08. Czas trwania RZS (OR = 1,05 i wiek (OR = 1,04 praktycznienie wpływały na ryzyko upadków. Głównymi czynnikamiryzyka złamań kości w badanej grupie były osteoporoza (t-score< –2,5 (OR = 4,70, stosowanie leków hipotensyjnych (OR = 4,98,deformacje stóp (OR = 4,82, zawroty głowy (OR = 3,30 orazwysoki wskaźnik HAQ (OR = 3,12. Wnioski: Upadki są poważnym problemem w przebiegu RZS.Głównymi czynnikami sprzyjającymi upadkom i złamaniomu chorych na RZS są deformacje stóp, zawroty głowy, zażywanieleków obniżających ciśnienie tętnicze oraz wysoka wartość HAQ.
Spa therapy for elderly: a retrospective study of 239 older patients with osteoarthritis
Karagülle, Mine; Kardeş, Sinan; Dişçi, Rian; Gürdal, Hatice; Karagülle, Müfit Zeki
2016-10-01
Very few studies tested the effectiveness of spa therapy in older patients with osteoarthritis. Therefore, we aimed to evaluate the short-term effects of spa therapy in patients aged 65 years and older with generalized, knee, hip, and cervical and lumbar spine osteoarthritis. In an observational retrospective study design at the Medical Ecology and Hydroclimatology Department of Istanbul Medical Faculty, we analyzed the records of 239 patients aged over 65 years with the diagnosis of all types of osteoarthritis who were prescribed a spa therapy course in some spa resorts in Turkey between 7 March 2002 and 31 December 2012. They travelled to a spa resort where they stayed at a thermal spa hotel and followed the usual therapy packages for 2 weeks. Patients were assessed by an experienced physician within a week before the spa journey and within a week after the completion of the spa therapy. Compared with baseline in whole sample, statistically significant improvements were observed in pain (visual analog scale, VAS), patient and physician global assessments (VAS), Health Assessment Questionnaire disability index (HAQ-DI), Lequesne algofunctional index (LAFI) for knee, Western Ontario and McMaster Universities index (WOMAC), Waddell disability index (WDI), and Neck Pain and Disability Scale (NPAD). According to Outcome Measures in Rheumatology—Osteoarthritis Research Society International (OMERACT-OARSI) Set of Responder Criteria, responder rate were 63.8 % (51/80) in generalized, 52 % (13/25) in knee, 50 % (2/4) in hip, 66.7 % (8/12) in lumbar, and 100 % (6/6) in cervical osteoarthritis subgroups. Spa therapy improved pain and physical functional status in older patients with osteoarthritis, especially generalized osteoarthritis and multiple joint osteoarthritis with involvement of knee. This improvement was clinically important in majority of the patients. To confirm the results of this preliminary study, there is a need of a randomized controlled clinical study
Ostojic, P; Bartolovic, D
2016-09-01
This study aims to estimate the impact of disease activity, obesity, functional disability, and depression on lipid status, glycoregulation, and risk for coronary heart disease (CHD) in patients with rheumatoid arthritis (RA). A total of 36 patients with RA (30 women and 6 men, mean age 54.9 years, mean disease duration 7.9 years) were included in this study. We estimated the impact of age, body mass index, disease activity [assessed by DAS28 index and C-reactive protein (CRP) value], functional ability (estimated using the HAQ disability index), and depression [assessed using the Beck Depression Inventory (BDI)] on glycoregulation, lipid status, and risk for CHD in our patients. Glycoregulation was assessed by measuring insulin resistance, insulin, and glucose in blood. Lipids tested in blood included total cholesterol, HDL and LDL cholesterol, and triglycerides (TG). The 10-year risk for CHD was estimated using the Framingham risk score. Of 36 patients, 11 (30.6 %) fulfilled the criteria for metabolic syndrome (MS). Ten of 11 patients (90.1 %) with MS have a 10-year risk for CHD greater than 10 % compared to only 3 of 25 patients (12 %) without MS (p = 0.0001). Patients with high disease activity had lower HDL values than patients with mild or moderate disease activity (1.4 vs. 1.7 mmol/l, p = 0.04). Significant correlations were observed between CRP level and insulinemia (ρ = 0.57, p = 0.003), as well as CRP level and the HOMA index (ρ = 0.59, p = 0.002). The body mass index (BMI) correlated significantly with total cholesterol (r = 0.46, p = 0.02), LDL (ρ = 0.41, p = 0.04), and TG (ρ = 0.65, p Obesity was found to be an independent risk factor for increased total cholesterol, LDL cholesterol, and TG. Depressed patients with RA tend to be overweight or obese and, therefore, have an unfavorable lipid profile.
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José Eduardo Martinez
2009-02-01
Full Text Available OBJETIVO: Estabelecer se há correlação entre o número de pontos dolorosos e a intensidade da percepção de aspectos centrais da síndrome (dor, fadiga, ansiedade, depressão e do seu impacto na capacidade funcional. MATERIAL E MÉTODOS: Avaliaram-se quarenta e um prontuários de pacientes que preenchem os Critérios de Classificação para Fibromialgia do Colégio Americano de Reumatologia, considerando as seguintes variáveis: percepção da intensidade de dor, fadiga, qualidade de vida global, depressão, ansiedade e contagem de pontos dolorosos. A avaliação da capacidade funcional foi realizada através do Questionário de Avaliação de Saúde simplificado (Health Assessment Questionnaire-HAQ. RESULTADOS: Observou-se correlação entre a contagem de pontos dolorosos e a intensidade da dor e a capacidade funcional. Não houve correlação com as notas atribuídas à fadiga (p = 0,358, ansiedade (p = 0,58, depressão (p = 0,50 e qualidade de vida (p = 0,538. A correlação entre o número de pontos dolorosos e a intensidade da dor foi mais forte que com o HAQ. CONCLUSÃO: Há correlação entre contagem dos pontos dolorosos e intensidade da dor e capacidade funcional. A correlação entre os pontos dolorosos e a intensidade da dor é mais importante do que com a capacidade funcional medida pelo HAQ. Não há correlação com as demais variáveis estudadas.OBJECTIVE: to study the correlation between the number of tender points and the intensity of the perception of key aspects of the fibromyalgia syndrome (pain, fatigue, anxiety, depression, and its impact in functional capacity. MATERIAL AND METHODS: forty-one records of patients who meet the Criteria for Classification of Fibromyalgia of the American College of Rheumatology were reviewed, focusing on the following variables: perception of the intensity of pain, fatigue, quality of sleep, depression, anxiety and the tender point count. The assessment of functional capacity was done by
The Stanford Health Assessment Questionnaire: Dimensions and Practical Applications
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Fries James F
2003-06-01
Full Text Available Abstract The ability to effectively measure health-related quality-of-life longitudinally is central to describing the impacts of disease, treatment, or other insults, including normal aging, upon the patient. Over the last two decades, assessment of patient health status has undergone a dramatic paradigm shift, evolving from a predominant reliance on biochemical and physical measurements, such as erythrocyte sedimentation rate, lipid profiles, or radiographs, to an emphasis upon health outcomes based on the patient's personal appreciation of their illness. The Health Assessment Questionnaire (HAQ, published in 1980, was among the first instruments based on generic, patient-centered dimensions. The HAQ was designed to represent a model of patient-oriented outcome assessment and has played a major role in many diverse areas such as prediction of successful aging, inversion of the therapeutic pyramid in rheumatoid arthritis (RA, quantification of NSAID gastropathy, development of risk factor models for osteoarthrosis, and examination of mortality risks in RA. Evidenced by its use over the past two decades in diverse settings, the HAQ has established itself as a valuable, effective, and sensitive tool for measurement of health status. It is available in more than 60 languages and is supported by a bibliography of more than 500 references. It has increased the credibility and use of validated self-report measurement techniques as a quantifiable set of hard data endpoints and has contributed to a new appreciation of outcome assessment. In this article, information regarding the HAQ's development, content, dissemination and reference sources for its uses, translations, and validations are provided.
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Evelien Bergrath
2017-01-01
Full Text Available Objective. To compare the efficacy and tolerability of tofacitinib, an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA, as monotherapy and combined with disease-modifying antirheumatic drugs (DMARDs versus biological DMARDs (bDMARDs and other novel DMARDs for second-line moderate-to-severe rheumatoid arthritis (RA patients by means of a systematic literature review (SLR and network meta-analysis (NMA. Methods. MEDLINE®, EMBASE®, and Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials (RCTs published between 1990 and March 2015. Efficacy data based on American College of Rheumatology (ACR response criteria, improvements in the Health Assessment Questionnaire Disability Index (HAQ-DI at 6 months, and discontinuation rates due to adverse events were analyzed by means of Bayesian NMAs. Results. 45 RCTs were identified, the majority of which demonstrated a low risk of bias. Tofacitinib 5 mg twice daily (BID and 10 mg BID monotherapy exhibited comparable efficacy and discontinuation rates due to adverse events versus other monotherapies. Tofacitinib 5 mg BID and 10 mg BID + DMARDs or methotrexate (MTX were mostly comparable to other combination therapies in terms of efficacy and discontinuation due to adverse events. Conclusion. In most cases, tofacitinib had similar efficacy and discontinuation rates due to adverse events compared to biologic DMARDs.
EVALUATION OF A DECRESE IN WORK PRODUCTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS
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Olga Yuryevna Vakulenko
2013-01-01
Full Text Available Objective. To study the association between the clinical manifestations and work ability in patients with rheumatoid arthritis (RA and to elaborate mathematical methods for predicting work productivity indicators according to the evaluation of the functional status of patients and disease activity.Material and Methods. A total of 185 RA patients were examined; 105 of them were employed. The mean age was 48.2±11.3 years; RA duration was 77.9±70.7 months; DAS28 4.68±1.53; visual analogue scale (VAS score was 40.6±22.2; HAQ was 1.3±0.7. The employed patients in the test group had a longer duration but weaker activity of RA according to DAS28 as compared to those in the control group (p<0.05. The WPAI indicators in the test and control groups, respectively, were as follows: presenteeism – 39.0±26.3 vs. 57.9±16.8%; total productivity decrease (TPD – 54.6±34.1 vs. 65.2±23.3%; daily activity (DA – 52.3±26.3 vs. 55.3±14.8%. The multiple regression method was used to create prognostic equations. A significant divergence of the distribution of absenteeism rates from the normal distribution prevented selection of regression equations.Results. HAQ, VAS pain, and DAS28 turned out to be optimal for selecting equations. The Spearman correlation coefficients with WPAI indicators were higher than 0.4 in all the cases. The following prognostic equations were obtained:Presenteeism (% = 0.66 + 11.31 • HAQ + 0.44 • VAS pain + 2.17 • DAS28 (R2 = 0.46, TPD (% = 8.53 + 3.90 • HAQ + 0.47 • VAS pain + 4.73 • DAS28 (R2 = 0.28, DA (% = 11.27 + 11.87 • HAQ + 0.36 • VAS pain + 1.96 • DAS28 (R2 = 0.44.Verification of the predicted WPAI values using the data of an additional group has demonstrated the coincidence of the predicted and actual values for presenteeism and TPD. However, the correlation coefficient between the predicted and actual presenteeism indicators was considerably higher (0.68 vs. 0.51. The predicated DA differed
Sampaio-Barros, Marília M; Takayama, Liliam; Sampaio-Barros, Percival D; Bonfá, Eloísa; Pereira, Rosa Maria R
2016-01-01
The aim of this study was to analyze the correlation of vitamin D levels with clinical parameters, bone mineral density (BMD), quality of life (QoL) and nailfold capillaroscopy (NC) in patients with diffuse systemic sclerosis (SSc). Thirty-eight female patients with diffuse SSc were analyzed regarding 25-hydroxyvitamin D (25OHD) serum levels. At inclusion, organ involvement, autoantibodies, modified Rodnan skin score (mRSS), Medsger Disease Severity Index (MDSI), body mass index (BMI), BMD, NC, Short-Form-36 Questionnaire (SF-36), and Health Assessment Questionnaire (HAQ), were performed through a standardized interview, physical examination and electronic chart review. Mean 25OHD serum level was 20.66±8.20ng/mL. Eleven percent of the patients had 25OHD levels ≤10ng/mL, 50% ≤20ng/mL and 87% ≤30ng/mL. Vitamin D serum levels were positively correlated with BMI (r=0.338, p=0.038), BMD-total femur (r=0.340, p=0.037), BMD-femoral neck (r=0.384, p=0.017), SF-36-Vitality (r=0.385, p=0.017), SF-36-Social Function (r=0.320, p=0.050), SF-36-Emotional Role (r=0.321, p=0.049) and SF-36-Mental Health (r=0.531, p=0.0006) and were negatively correlated with HAQ-Reach (r=-0.328, p=0.044) and HAQ-Grip Strength (r=-0.331, p=0.042). A negative correlation with NC-diffuse devascularization (p=0.029) and NC-avascular area (p=0.033) was also observed. The present study provides novel evidence demonstrating that low levels of 25OHD have a negative impact in diffuse SSc QoL and further studies are needed to define whether vitamin D supplementation can improve health related QoL in these patients. The additional observation of a correlation with severe NC alterations suggests a possible role of 25OHD in the underlying SSc vascular involvement. Copyright © 2016 Elsevier Editora Ltda. All rights reserved.
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Marília M. Sampaio-Barros
Full Text Available ABSTRACT Objective: The aim of this study was to analyze the correlation of vitamin D levels with clinical parameters, bone mineral density (BMD, quality of life (QoL and nailfold capillaroscopy (NC in patients with diffuse systemic sclerosis (SSc. Methods: Thirty-eight female patients with diffuse SSc were analyzed regarding 25-hydroxyvitamin D (25OHD serum levels. At inclusion, organ involvement, autoantibodies, modified Rodnan skin score (mRSS, Medsger Disease Severity Index (MDSI, body mass index (BMI, BMD, NC, Short-Form-36 Questionnaire (SF-36, and Health Assessment Questionnaire (HAQ, were performed through a standardized interview, physical examination and electronic chart review. Results: Mean 25OHD serum level was 20.66 ± 8.20 ng/mL. Eleven percent of the patients had 25OHD levels ≤10 ng/mL, 50% ≤20 ng/mL and 87% ≤30 ng/mL. Vitamin D serum levels were positively correlated with BMI (r = 0.338, p = 0.038, BMD-total femur (r = 0.340, p = 0.037, BMD-femoral neck (r = 0.384, p = 0.017, SF-36-Vitality (r = 0.385, p = 0.017, SF-36-Social Function (r = 0.320, p = 0.050, SF-36-Emotional Role (r = 0.321, p = 0.049 and SF-36-Mental Health (r = 0.531, p = 0.0006 and were negatively correlated with HAQ-Reach (r = −0.328, p = 0.044 and HAQ-Grip Strength (r = −0.331, p = 0.042. A negative correlation with NC-diffuse devascularization (p = 0.029 and NC-avascular area (p = 0.033 was also observed. Conclusion: The present study provides novel evidence demonstrating that low levels of 25OHD have a negative impact in diffuse SSc QoL and further studies are needed to define whether vitamin D supplementation can improve health related QoL in these patients. The additional observation of a correlation with severe NC alterations suggests a possible role of 25OHD in the underlying SSc vascular involvement.
Vergara, F; Rosa, J; Orozco, C; Bertiller, E; Gallardo, M A; Bravo, M; Catay, E; Collado, V; Gómez, G; Sabelli, M; García, M V; Rosemffet, M G; Citera, G; Schneeberger, E E; Catoggio, L J; Soriano, E R
2017-01-01
To evaluate the association between learned helplessness (LH) and self-efficacy (SE) with disease activity, functional capacity, and level of pain in patients with rheumatoid arthritis (RA) and to compare LH and SE between patients in remission and patients with active disease. This multicentre, cross-sectional study included consecutive patients (aged ≥ 18 years) with RA according to 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. LH was measured by the Rheumatology Attitude Index (RAI), Spanish version; SE with the Arthritis Self-efficacy Scale (ASES), Spanish version; functional capacity with the Health Assessment Questionnaire, Argentinian version (HAQ-A); and perceived pain by the visual analogue scale (VAS). Disease activity was measured by the Clinical Disease Activity Index (CDAI). A total of 115 patients (82% females) with a mean (± sd) age of 58 ± 13 years were included. We found a significantly positive correlation between LH and perceived pain (p < 0.001), HAQ-A score (p < 0.001), and CDAI (p < 0.001) and a significantly negative correlation between SE and perceived pain (p < 0.001), HAQ-A score (p < 0.001), and CDAI (p < 0.001). We found greater levels of SE and lower grades of LH in patients in remission compared to those with active disease (median 76 vs. 58; p < 0.001 and 6 vs. 11; p < 0.001, respectively). LH and SE correlated significantly with disease activity, functional capacity, and perceived pain. Levels of SE were higher in patients in remission compared to those with active disease as opposed to levels of LH, which were lower in patients in remission compared to those with active disease. These results show that cognitive factors are related to disease activity and their modifications may have importance in the management of RA.
VALIDATION OF THE RUSSIAN-LANGUAGE VERSION OF THE RAPID-3 QUESTIONNAIRE
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A S Starkova
2011-01-01
There were high correlations of RAPID-3 values with clinical parameters: the number of swollen joints (R=0.61 and tender joints (R = 0.46, combined DAS 28 indices (R=0.72, simple (R=0.60 and clinical (R=063 disease activity indices (SDAI and CDAI, inflammation activity index (IAI (R=0.62, health assessment questionnaire (HAQ (R=0.64, and quality of life questionnaire (EQ-5D scores (R=0.52. Conclusion. The RAPID-3 index is a reliable, sensitive, and valid tool to evaluate inflammation activity and functional status in patients with RA
Ruiz-Moreno, Juan Sebastian; Hamann, Lutz; Jin, Lei; Sander, Leif E; Puzianowska-Kuznicka, Monika; Cambier, John; Witzenrath, Martin; Schumann, Ralf R; Suttorp, Norbert; Opitz, Bastian
2018-03-01
Streptococcus pneumoniae is a frequent colonizer of the upper respiratory tract and a leading cause of bacterial pneumonia. The innate immune system senses pneumococcal cell wall components, toxin, and nucleic acids, which leads to production of inflammatory mediators to initiate and control antibacterial defense. Here, we show that the cGAS (cyclic GMP-AMP [cGAMP] synthase)-STING pathway mediates detection of pneumococcal DNA in mouse macrophages to primarily stimulate type I interferon (IFN) responses. Cells of human individuals carrying HAQ TMEM173 , which encodes a common hypomorphic variant of STING, were largely or partly defective in inducing type I IFNs and proinflammatory cytokines upon infection. Subsequent analyses, however, revealed that STING was dispensable for restricting S. pneumoniae during acute pneumonia in mice. Moreover, explorative analyses did not find differences in the allele frequency of HAQ TMEM173 in nonvaccinated pneumococcal pneumonia patients and healthy controls or an association of HAQ TMEM173 carriage with disease severity. Together, our results indicate that the cGAS/STING pathway senses S. pneumoniae but plays no major role in antipneumococcal immunity in mice and humans. Copyright © 2018 American Society for Microbiology.
Quality of life of patients with low back pain and pharmacoeconomic aspects of the treatment
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T V Chernyshova
2005-01-01
Full Text Available Objective. To define clinical efficacy of diclofenac and nise in pts with low back pain (LBP considering quality of life (QL and pharmacoeconomic aspects (PA Material and methods . 100 pts with chronic LBP due to vertebral osteochondrosis were included. Clinical examination was performed. QL was assessed with 4 questionnaires: Health Assessment Questionnaire (HAQ, WOMAC osteoarthritis index (Vfersion vas. 1, Osvestry Low Back Pain Disability Questionnaire and SF-36. 50 pts of the 1 group received diclofenac retard 100 mg twice a day during 10 days. Nise was administered to the 50 pts of the 2 group 100 mg twice a day. All pts received midocalm 450 mg/day. Results. The study showed high efficacy of nise in complex treatment of pts with chronic LBP considering its analgesic and anti-inflammatory properties, low adverse events frequency so as PA and QL improvement.
Fioravanti, Antonella; Tenti, Sara; Giannitti, Chiara; Fortunati, Nicola Angelo; Galeazzi, Mauro
2014-01-01
The aim of this study was to evaluate both the short-term and the long-term effectiveness of spa therapy in patients with primary hand osteoarthritis (OA). This was a prospective randomized, single blind controlled trial. Sixty outpatients with primary bilateral hand OA were included in the study and randomized to one of two groups. One group ( n = 30) was treated with 12 daily local mud packs and generalized thermal baths with a sulfate-calcium-magnesium-fluorides mineral water added to usual treatment. The control group ( n = 30) continued regular outpatient care routine (exercise, NSAIDs and/or analgesics). Each patient was examined at baseline, after 2 weeks, and after 3, 6, 9 and 12 months. Primary outcome measures were global spontaneous hand pain on a visual analogue scale (VAS) and the functional index for hand osteoarthritis (FIHOA) score; secondary outcomes were health assessment questionnaire (HAQ), duration of morning stiffness, medical outcomes study 36-item short form (SF-36) and symptomatic drugs consumption. Our results demonstrated that the efficacy of spa therapy was significant in all the assessed parameters, both at the end of therapy and after 3 months; the values of FIHOA, HAQ and drugs consumption continued to be significantly better after 6 months in comparison with baseline. There were no significant modifications of the parameters throughout the follow-up in the control group. Differences between the two groups were significant for all parameters at the 15th day and at 3 months follow-up; regarding FIHOA, HAQ, and symptomatic drugs consumption, the difference between the two groups persisted and was significant at 6month follow-up. Tolerability of spa therapy seemed to be good. In conclusion, our results confirm that the beneficial effects of spa therapy in patients with hand OA last over time.
Factors contributing to disability in rheumatoid arthritis patients: An Egyptian multicenter study.
Hammad, Marwa; Eissa, Mervat; Dawa, Ghada A
2018-04-30
Minimizing disability and enhancing physical function to its optimal levels is still a challenge in management of rheumatoid arthritis (RA). The aim is to identify factors leading to disability in RA. This is a cross-sectional Egyptian multicenter study carried out on 215 RA patients attending to our inpatient and outpatient rheumatology clinics during 4 months starting from April to July 2017 who agreed to participate in the study; 170 patients were from Cairo University hospitals and 45 from Zagazig University hospitals. We recorded a number of possible risk factors including demographic, clinical, serological and therapeutic factors. The assessment of patients' disability was done using Modified HAQ (MHAQ). A significant positive correlation was found between MHAQ and different markers of activity in addition to age and depression score (P<0.001). Illiteracy accounted for higher MHAQ scores (P=0.001). A higher MHAQ was found in patients with ischemic heart disease (P<0.05). Patients with erosions on X-rays had significantly higher MHAQ scores. Subluxations also accounted for higher MHAQ scores (P=0.000). Aging, illiteracy, disease activity, erosions, subluxations, depression and ischemic heart disease were all related to higher disability. Good control of disease activity which in turn reduces erosions and subluxations is mandatory. Screening for depression and proper use of anti-depressants is of great value. Proper screening and prophylaxis is recommended against ischemic heart disease by controlling modifiable risk factors like obesity, dyslipidaemia, hypertension, smoking and sedentary lifestyle. Copyright © 2018 Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. Publicado por Elsevier España, S.L.U. All rights reserved.
Harrold, Leslie R; John, Ani; Best, Jennie; Zlotnick, Steve; Karki, Chitra; Li, YouFu; Greenberg, Jeffrey D; Kremer, Joel M
2017-09-01
To evaluate the impact of rituximab on patient-reported outcomes (PROs) in a US-based observational cohort of patients with rheumatoid arthritis (RA). Patients with active RA, prior exposure to ≥1 tumor necrosis factor inhibitor (TNFi) and who newly initiated rituximab were identified. Changes in PROs were assessed 1 year after rituximab initiation. PRO measures included Clinical Disease Activity Index (CDAI); patient global disease activity, pain and fatigue (visual analog score; 0-100); morning stiffness (hours); modified Health Assessment Questionnaire (mHAQ; 0-3); and EuroQoL EQ-5D. Of the 667 patients who newly initiated rituximab, baseline PRO and clinical measures indicated that patients were substantially impacted by their RA disease and quality of life; 54% of patients had high disease activity. One year after rituximab initiation, 49.0, 47.1, 49.8, and 23.2% of patients reported clinically meaningful improvements in patient global, pain, fatigue, and mHAQ, respectively. Morning stiffness and EuroQol EQ-5D domains improved in 48 and 19-32% of patients, respectively. These real-world registry data demonstrated that patients with long-standing, refractory RA experienced improvements in PROs 1 year after initiating rituximab.
Kronisch, Caroline; McLernon, David J; Dale, James; Paterson, Caron; Ralston, Stuart H; Reid, David M; Tierney, Ann; Harvie, John; McKay, Neil; Wilson, Hilary E; Munro, Robin; Saunders, Sarah; Richmond, Ruth; Baxter, Derek; McMahon, Mike; Kumar, Vinod; McLaren, John; Siebert, Stefan; McInnes, Iain B; Porter, Duncan; Macfarlane, Gary J; Basu, Neil
2016-07-01
To identify baseline prognostic indicators of disability at 1 year within a contemporary early inflammatory arthritis inception cohort and then develop a clinically useful tool to support early patient education and decision-making. The Scottish Early Rheumatoid Arthritis (SERA) inception cohort is a multicenter, prospective study of patients with newly presenting RA or undifferentiated arthritis. SERA data were analyzed to determine baseline predictors of disability (defined as a Health Assessment Questionnaire [HAQ] score of ≥1) at 1 year. Clinical and psychosocial baseline exposures were entered into a forward stepwise logistic regression model. The model was externally validated using newly accrued SERA data and subsequently converted into a prediction tool. Of the 578 participants (64.5% female), 36.7% (n = 212) reported functional disability at 1 year. Functional disability was independently predicted by baseline disability (odds ratio [OR] 2.67 [95% confidence interval (95% CI) 1.98, 3.59]), depression (OR 2.52 [95% CI 1.18, 5.37]), anxiety (OR 2.37 [95% CI 1.33, 4.21]), being in paid employment with absenteeism during the last week (OR 1.19 [95% CI 0.63, 2.23]), not being in paid employment (OR 2.36 [95% CI 1.38, 4.03]), and being overweight (OR 1.61 [95% CI 1.04, 2.50]). External validation (using 113 newly acquired patients) evidenced good discriminative performance with a C statistic of 0.74, and the calibration slope showed no evidence of model overfit (P = 0.31). In the context of modern early inflammatory arthritis treatment paradigms, predictors of disability at 1 year appear to be dominated by psychosocial rather than more traditional clinical measures. This indicates the potential benefit of early access to nonpharmacologic interventions targeting key psychosocial factors, such as mental health and work disability. © 2016, American College of Rheumatology.
Boubouchairopoulou, Nadia; Flouri, Irini; Drosos, Alexandros A; Boki, Kyriaki; Settas, Loukas; Zisopoulos, Dimitrios; Skopouli, Fotini N; Papadopoulos, Ioannis; Iliopoulos, Alexios; Kyriopoulos, John; Boumpas, Dimitrios T; Athanasakis, Konstantinos; Sidiropoulos, Prodromos
2016-01-01
To assess in daily practice in patients with rheumatoid arthritis (RA) the effect of treatment with first tumour necrosis factor-α inhibitor (TNFi) in quality of life (Qol), disease activity and depict possible baseline predictors for gains in Qol. Patients followed prospectively by the Hellenic Registry of Biologic Therapies were analysed. Demographics were recorded at baseline, while RA-related characteristics at baseline and every 6 months. Paired t-tests were used to detect divergences between patient-reported (Health Assessment Questionnaire (HAQ), EuroQol (EQ-5D)) and clinical tools (Disease Activity Score-28 joints (DAS28)). Clinical versus self-reported outcomes were examined via cross-tabulation analysis. Multiple regression analysis was performed for identifying baseline predictors of improvements in QALYs. We analysed 255 patients (age (mean±SD) 57.1±13.0, disease duration 9.2±9.1 years, prior non-biologic disease-modifying anti-rheumatic drugs 2.3±1.2). Baseline EQ-5D, HAQ and DAS28 were 0.36 (0.28), 1.01 (0.72) and 5.9 (1.3), respectively, and were all significantly improved after 12 months (0.77 (0.35), 0.50 (0.66), 3.9 (1.5), respectively, p<0.05 for all). 90% of patients who improved from high to a lower DAS28 status (low-remission or moderate) had clinically important improvement in Qol (phi-coefficient=0.531,p<0.05). Independent predictors of gains in Qol were lower baseline HAQ, VAS global and younger age (adjusted R2=0.27). In daily practice TNFi improve both disease activity and Qol for the first 12 months of therapy. 90% of patients who improved from high to a lower DAS28 status had clinically important improvement in Qol. Younger patients starting with lower HAQ and VAS global are more likely to benefit.
Stevenson, Matt D; Wailoo, Allan J; Tosh, Jonathan C; Hernandez-Alava, Monica; Gibson, Laura A; Stevens, John W; Archer, Rachel J; Simpson, Emma L; Hock, Emma S; Young, Adam; Scott, David L
2017-07-01
To ascertain whether strategies of treatment with a biological disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English setting. Results are presented for those patients with moderate to severe rheumatoid arthritis (RA) and those with severe RA. An economic model to assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature review and network metaanalysis was undertaken to establish relative clinical effectiveness. The results were used to populate the model, together with estimates of Health Assessment Questionnaire (HAQ) score following European League Against Rheumatism response; annual costs, and utility, per HAQ band; trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients using nonbiologic therapy (NBT). Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness when only patients with the most severe prognoses taking NBT were provided with bDMARD treatment. The costs per quality-adjusted life-year (QALY) values were compared with reported thresholds from the UK National Institute for Health and Care Excellence of £20,000 to £30,000 (US$24,700 to US$37,000). In the primary analyses, the cost per QALY of a bDMARD strategy was £41,600 for patients with severe RA and £51,100 for those with moderate to severe RA. Under the supplementary analyses, the cost per QALY fell to £25,300 for those with severe RA and to £28,500 for those with moderate to severe RA. The cost-effectiveness of bDMARD in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.
Asbury, Elizabeth A; Chandrruangphen, Pornpat; Collins, Peter
2006-01-01
Exercise and physical activity provide a wide range of health benefits for postmenopausal women, although the impact of maintained exercise participation on psychological well-being is unclear. An exploration of continued exercise participation in psychological well-being after a moderate-intensity exercise program in previously inactive postmenopausal women was therefore undertaken. : Twenty-three healthy sedentary postmenopausal women (age 56 +/- 4 years) were randomly assigned to two groups. All participants completed the Short Form-36, Hospital Anxiety and Depression Scale (HADS), and Health Anxiety Questionnaire (HAQ) and then began a 6-week walking program at 50% heart rate reserve defined by (.-)V(O(2)) treadmill testing. Post-intervention, all participants underwent (.-)V(O(2)) treadmill testing and questionnaires. Group 1 was then instructed to continue exercising, whereas group 2 was instructed to desist for an additional 6-week period. On completion of the 6-week follow-up, participants completed a final set of questionnaires. Participants performed 97% of the prescribed 15-hour (900 minute) exercise program (875.1 +/- 177.4 minutes) in an average of 26 +/- 5 sessions. Total HAQ (P = 0.001), health worry (P = 0.001), fear of illness (P = 0.037), reassurance seeking behavior (P = 0.037), SF-36 well-being (P = 0.037), total HADS (P = 0.019), and HADS depression (P = 0.015) improved significantly following the exercise program. At follow-up, group 1 had lower HADS anxiety (P = 0.013), total HADS (P = 0.02), total HAQ (P = 0.03), and HAQ interference with life (P = 0.03) and significantly higher SF-36 energy (P = 0.01) than group 2. Healthy postmenopausal women gain significant psychological benefit from moderate-intensity exercise. However, exercise participation must continue to maintain improvements in psychological well-being and quality of life.
Iannuccelli, C; Sarzi-Puttini, P; Atzeni, F; Cazzola, M; di Franco, M; Guzzo, M P; Bazzichi, L; Cassisi, G A; Marsico, A; Stisi, S; Salaffi, F
2011-01-01
Fibromyalgia (FM) is a generalized chronic pain condition that is often accompanied by symptoms such as fatigue, sleep disturbances, psychological and cognitive alterations, headache, migraine, variable bowel habits, diffuse abdominal pain, and urinary frequency. Its key assessment domains include pain, fatigue, disturbed sleep, physical and emotional functioning, and patient global satisfaction and health-related quality of life (HRQL). A number of evaluation measures have been adapted from the fields of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, and others such as the Fibromyalgia Assessment Status (FAS) index and the Fibromyalgia Impact Questionnaire (FIQ) have been specifically developed. The aim of this study was to assess the impact of FM on HRQL by comparing the performance of the FAS index, the FIQ and the Health Assessment Questionnaire [HAQ] in 541 female and 31 male FM patients (mean age 50 years; mean disease duration 7.7 years) entered in the database of a web-based survey registry developed by the Italian Fibromyalgia Network (IFINET). Tests of convergent validity showed that the FAS index and FIQ significantly correlated with each other (rho=0.608, pFIQ in FM patients, and is simpler to administer and score. Both questionnaires may be useful when screening FM patients, with the choice of the most appropriate instrument depending on the setting.
Alciati, Alessandra; Caldirola, Daniela; Sarzi-Puttini, Piercarlo; Atzeni, Fabiola; Grassi, Massimiliano; Perna, Giampaolo
2016-01-01
To investigate the influence of panic disorder (PD) with/without agoraphobia on the clinical severity of fibromyalgia (FM). Eighty-one patients with FM, among those consecutively referring to a tertiary-care setting, were included in this cross-sectional study. Psychiatric diagnoses were made by the structured clinical interview in accordance with the 4th-TR version of the diagnostic and statistical manual of mental disorders. The clinical severity of FM was measured by means of the following self-administered scales: Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Status (FAS), Health Assessment Questionnaire (HAQ). A final sample of 66 females with FM with or without past PD was included in the analyses. The two groups did not significantly differ in age, years of education, length of illness or medication distribution. We did not find significant differences between the two groups in the FIQ and FAS scale scores, whereas subjects with FM and past PD showed significantly higher HAQ scale scores than those without past PD (p<.001). A history of PD in patients with FM increases the severity of functional impairment in performing a wide range of daily-life activities, as measured by the HAQ scale, with no effects on the severity of other clinical dimensions of FM. Potential underlying mechanisms and clinical implications will be discussed.
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Anna Sergeyevna Starkova
2013-01-01
Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory joint disease causing joint dysfunction; reduction of quality of life (QoL; loss of work ability, self-care ability, and executing daily routines in most patients 5–10 years after the disease onset.Objective. To study QoL and the functional status (FS of Russian RA patients receiving tocilizumab (TCZ.Material and Methods. The study involved 42 patients with verified RA diagnosis (moderate or high activity who had earlier undergone inefficient therapy with basic anti-inflammatory medications. The limitation of the FS of the RA patients was determined quantitatively using the Russian-language version of the HAQ questionnaire. QoL was evaluated using the EuroQol-5D (EQ-5D Quality of Life questionnaire prior to treatment and after 4, 8, 12, 16, 20, and 24 weeks.Results. TCZ therapy demonstrated a rapid improvement of the FS of RA patients with a 64% decrease in the HAQ index (ΔHAQ=1.12, which corresponded to a 50% improvement of the health status of patients according to the ACR criteria.The median value [25th; 75th percentile] of the EQ-5D index was 0.52 [-0.02; 0.52]; 27.7% patients assessed their QoL as “worse than death”. The index reliably increased by week 8 of therapy; there were no patients with the negative EQ-5D index by week 24. Depending on QoL, all the patients were subdivided into two groups. Group 1 (n=12 comprised the patients with the EQ-5D no higher than 0; in group 2 patients (n=30, it was higher than 0. The groups were comparable in terms of disease duration, age, disease activity indices, and the previous treatment. The low QoL index in all 12 patients in group 1 was attributed to the infeasibility of performing daily activities and the reliably higher pain level (75.0 [61.0; 86.0] and 66.0 [48.0; 71.0] in groups 1 and 2, respectively; p=0.02. Improved QoL and reduced pain level were observed in both groups as early as after the first TCZ infusion. By week 24
Mandel, David R; Eichas, Katy; Holmes, Judith
2010-01-12
Lactic acid-producing bacteria (LAB) probiotics demonstrate immunomodulating and anti-inflammatory effects and the ability to lessen the symptoms of arthritis in both animals and humans. This randomized, double-blind, placebo-controlled, parallel-design, clinical pilot trial was conducted to evaluate the effects of the LAB probiotic preparation, Bacillus coagulans GBI-30, 6086, on symptoms and measures of functional capacity in patients with rheumatoid arthritis (RA) in combination with pharmacological anti-arthritic medications. Forty-five adult men and women with symptoms of RA were randomly assigned to receive Bacillus coagulans GBI-30, 6086 or placebo once a day in a double-blind fashion for 60 days in addition to their standard anti-arthritic medications. Arthritis activity was evaluated by clinical examination, the American College of Rheumatology (ACR) criteria, the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI), and laboratory tests for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Subjects who received Bacillus coagulans GBI-30, 6086 experienced borderline statistically significant improvement in the Patient Pain Assessment score (P = .052) and statistically significant improvement in Pain Scale (P = .046) vs placebo. Compared with placebo, Bacillus coagulans GBI-30, 6086 treatment resulted in greater improvement in patient global assessment and self-assessed disability; reduction in CRP; as well as the ability to walk 2 miles, reach, and participate in daily activities. There were no treatment-related adverse events reported throughout this study. Results of this pilot study suggest that adjunctive treatment with Bacillus coagulans GBI-30, 6086 LAB probiotic appeared to be a safe and effective for patients suffering from RA. Because of the low study population size, larger trials are needed to verify these results. ACTRN12609000435280.
Bertin, Philippe; Fagnani, Francis; Duburcq, Anne; Woronoff, Anne-Sophie; Chauvin, Pierre; Cukierman, Gabrielle; Tropé-Chirol, Sonia; Joubert, Jean-Michel; Kobelt, Gisela
2016-01-01
To evaluate the impact of rheumatoid arthritis (RA) on career, productivity, and employability. A retrospective cross-sectional survey was conducted in 2012-2013 in France among patients with RA who were younger than 60 years of age and employed or unemployed. Patients were either recruited during a rheumatologist visit or among members of a nationwide patient-support organization (ANDAR). They completed a questionnaire on the functional impact of RA evaluated by the Health Assessment Questionnaire (HAQ) and on the impact of their disease on work ability. Of 488 surveyed patients, 364 (74.6%) were actively employed, 31 (6.4%) were job seekers, and 93 (19.1%) had left the workforce. In the employed group, mean age was 48.9 years; 82.1% of patients were women; mean RA duration was 11.6 years; and the HAQ score correlated strongly with various markers for decreased productivity including sick leaves, temporary or permanent work discontinuation, and having unwillingly downgraded from a full-time to a part-time work schedule or changed to a different job. Among job seekers, 54% had lost their previous job because of their RA. RA is associated with various forms of work disability, which are directly related to the severity of disease-related functional impairments. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Jaeger, Veronika K; Distler, Oliver; Maurer, Britta; Czirják, Laszlo; Lóránd, Veronika; Valentini, Gabriele; Vettori, Serena; Del Galdo, Francesco; Abignano, Giuseppina; Denton, Christopher; Nihtyanova, Svetlana; Allanore, Yannick; Avouac, Jerome; Riemekasten, Gabriele; Siegert, Elise; Huscher, Dörte; Matucci-Cerinic, Marco; Guiducci, Serena; Frerix, Marc; Tarner, Ingo H; Garay Toth, Beata; Fankhauser, Beat; Umbricht, Jörg; Zakharova, Anastasia; Mihai, Carina; Cozzi, Franco; Yavuz, Sule; Hunzelmann, Nicolas; Rednic, Simona; Vacca, Alessandra; Schmeiser, Tim; Riccieri, Valeria; García de la Peña Lefebvre, Paloma; Gabrielli, Armando; Krummel-Lorenz, Brigitte; Martinovic, Duska; Ancuta, Codrina; Smith, Vanessa; Müller-Ladner, Ulf; Walker, Ulrich A
2018-03-01
The multisystem manifestations of SSc can greatly impact patients' quality of life. The aim of this study was to identify factors associated with disability in SSc. SSc patients from the prospective DeSScipher cohort who had completed the scleroderma health assessment questionnaire (SHAQ), a disability score that combines the health assessment questionnaire and five visual analogue scales, were included in this analysis. The effect of factors possibly associated with disability was analysed with multiple linear regressions. The mean SHAQ and HAQ scores of the 944 patients included were 0.87 (s.d. = 0.66) and 0.92 (s.d. = 0.78); 59% of the patients were in the mild to moderate difficulty SHAQ category (0 ⩽ SHAQ disability category (1 ⩽ SHAQ disability category (2 ⩽ SHAQ ⩽ 3). The means of the visual analogue scales scores were in order of magnitude: overall disease severity (37 mm), RP (31 mm), pulmonary symptoms (24 mm), gastrointestinal symptoms (20 mm) and digital ulcers (19 mm). In multiple regression, the main factors associated with high SHAQ scores were the presence of dyspnoea [modified New York Heart Association (NYHA) class IV (regression coefficient B = 0.62), modified NYHA class III (B = 0.53) and modified NYHA class II (B = 0.21; all vs modified NYHA class I)], FM (B = 0.37), muscle weakness (B = 0.27), digital ulcers (B = 0.20) and gastrointestinal symptoms (oesophageal symptoms, B = 0.16; stomach symptoms, B = 0.15; intestinal symptoms, B = 0.15). SSc patients perceive dyspnoea, pain, digital ulcers, muscle weakness and gastrointestinal symptoms as the main factors driving their level of disability, unlike physicians who emphasize objective measures of disability. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Buoncompagni Antonella
2007-12-01
Full Text Available Abstract Objective To investigate concordance between physicians and parents in rating the degree of functional ability of children with juvenile idiopathic arthritis (JIA. Methods The attending physician and a parent were asked to rate independently the level of physical functioning of 155 patients with disease duration ≥ 5 years on a 6-point scale ranging from 1 = no disability (i.e. the child can do without difficulty all activities that children of his/her age can do to 6 = severe disability (i.e. all activities are difficult for the child. At study visit, measures of JIA activity and damage were assessed. Agreement was evaluated with weighted kappa (0.80 excellent agreement. Physician/parent evaluations were divided in 3 groups: 1 concordance; 2 parent over-rating = parent assessment over-rated relative to physician assessment; 3 physician over-rating = physician assessment over-rated relative to parent assessment. Factors affecting concordance/discordance were evaluated by means of Kruskal-Wallis or Chi-square/Fisher exact test. Results Concordance, parent over-rating and physician over-rating were observed in 107 (69%, 29 (18.7% and 19 (12.3% evaluations, respectively. Kappa value was 0.69. Parent over-rating was associated with greater intensity of pain (p = 0.01 and higher Childhood Health Assessment Questionnaire (C-HAQ score (p = 0.004, whereas physician over-rating was associated with more severe joint disease (p = 0.04 to Conclusion Physicians and parents revealed fair concordance in rating functional ability of children with JIA. Parent over-rating was associated with greater child's pain and worse C-HAQ score, whereas physician over-rating was associated with greater severity of joint inflammation and damage.
Juvenile idiopathic arthritis outcome and prognosis according to catamnesis evaluation
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O V Semenova
2005-01-01
Full Text Available Objective. To study outcome and prognosis in pts with juvenile idiopathic arthritis (JIA. Material and methods. 239 JIA pts with disease duration of 10 years and more were analyzed. 80 children and adolescents before 18 years old (66 girls and 14 boys were included in group 1. Arthritis clinical and laboratory activity, radiological stage and functional status according to Steinbroker and CHAQ questionnaire were assessed. 159 grown up pts (109 female and 50 male suffering from JIA from childhood were included in group 2. They were examined using Stanford Health Assessment Questionnaire (HAQ and a specially developed social status questionnaire. Results. Half pts of group 1 had recurrence of the disease during examination but activity in most cases did not exceed stage I or 2 (54% and 31% respectively. Joint destructive changes were revealed in 50% of pts. 80% of pts had radiological signs of secondary osteoarthritis. Amyloidosis was revealed in 2 from 27 pts with systemic type of JIA. 68% of pts had 1 or 2 functional class. 1/3 of pts did not have functional limitations (CHAQ=0. 13% of pts had maximal disability with CHAQ ranging from 2,1 to 3,0 (pts with polyarticular and systemic types of JIA. Most grown up pts (59% considered their health as good. Substantial part of them worked or learned. 10 pts did not worked because of the disease (1,5%. 61% of pts did not have functional limitations (HAQ=0. 32% of pts were disabled. Most of them had 3 or 2 disability degree and had possibility to work. Conclusion. Substantial part of pts with longstanding JIA have stabilization of the disease or remission. Recurrent course of the disease was characterized by decrease of activity. Most children and grown ups with longstanding disease have relatively benign functional outcome. Pts with polyarticular and systemic types of JIA require especial attention because they have maximal risk of joint destruction with severe disability.
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Teresa Paolucci
2016-01-01
Full Text Available Introduction/Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18–60 years old with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group, physical exercises group (PE-group, and control group (CG. The Fibromyalgia Impact Questionnaire (FIQ, Health Assessment Questionnaire (HAQ, and Fibromyalgia Assessment Scale (FAS were administered at baseline (T0, at the end of the treatment (T1 (after 10 rehabilitation sessions over a 5-week period, and at the 12-week follow-up (T2. Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.
Reliability and Validity of Athletes Disability Index Questionnaire.
Noormohammadpour, Pardis; Hosseini Khezri, Alireza; Farahbakhsh, Farzin; Mansournia, Mohammad Ali; Smuck, Matthew; Kordi, Ramin
2018-03-01
The purpose of this study was to evaluate validity and reliability of a new proposed questionnaire for assessment of functional disability in athletes with low back pain (LBP). Validity and reliability study. Elite athletes participating in different fields of sports. Participants were 165 male and female athletes (between 12 and 50 years old) with LBP. Athlete Disability Index (ADI) Questionnaire which is developed by the authors for assessing LBP-related disability in athletes, Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ). Self-reported responses were collected regarding LBP-related disability through ADI, ODI, and RDQ. The test-retest reliability was strong, and intraclass correlation value ranged between 0.74 and 0.94. The Cronbach alpha coefficient value of 0.91 (P visual analog scale was r = 0.626 (P disability levels were mild in the large majority of subjects (91.5% and 86.0%, respectively). Alternatively, disability assessments by the ADI did not cluster at the mild level and ranged more broadly from mild to very high. The ADI is a reliable and valid instrument for assessing disability in athletes with LBP. Compared with the available LBP disability questionnaires used in the general population, ADI can more precisely stratify the disability levels of athletes due to LBP.
Predictive value of European Scleroderma Group Activity Index in an early scleroderma cohort.
Nevskaya, Tatiana; Baron, Murray; Pope, Janet E
2017-07-01
To estimate the effect of disease activity, as measured by the European Scleroderma Research Group Activity Index (EScSG-AI), on the risk of subsequent organ damage in a large systemic sclerosis (SSc) cohort. Of 421 SSc patients from the Canadian Scleroderma Research Group database with disease duration of ⩽ 3 years, 197 who had no evidence of end-stage organ damage initially and available 3 year follow-up were included. Disease activity was assessed by the EScSG-AI with two variability measures: the adjusted mean EScSG-AI (the area under the curve of the EScSG-AI over the observation period) and persistently active disease/flare. Outcomes were based on the Medsger severity scale and included accrual of a new severity score (Δ ⩾ 1) overall and within organ systems or reaching a significant level of deterioration in health status. After adjustment for covariates, the adjusted mean EScSG-AI was the most consistent predictor of risk across the study outcomes over 3 years in dcSSc: disease progression defined as Δ ⩾ 1 in any major internal organ, significant decline in forced vital capacity and diffusing capacity of carbon monoxide, severity of visceral disease and HAQ Disability Index worsening. In multivariate analysis, progression of lung disease was predicted solely by adjusted mean EScSG-AI, while the severity of lung disease was predicted the adjusted mean EScSG-AI, older age, modified Rodnan skin score (mRSS) and initial severity. The EScSG-AI was associated with patient- and physician-assessed measures of health status and overpowered the mRSS in predicting disease outcomes. Disease activity burden quantified with the adjusted mean EScSG-AI predicted the risk of deterioration in health status and severe organ involvement in dcSSc. The EScSG-AI is more responsive when done repeatedly and averaged. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email
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Eichas Katy
2010-01-01
Full Text Available Abstract Background Lactic acid-producing bacteria (LAB probiotics demonstrate immunomodulating and anti-inflammatory effects and the ability to lessen the symptoms of arthritis in both animals and humans. This randomized, double-blind, placebo-controlled, parallel-design, clinical pilot trial was conducted to evaluate the effects of the LAB probiotic preparation, Bacillus coagulans GBI-30, 6086, on symptoms and measures of functional capacity in patients with rheumatoid arthritis (RA in combination with pharmacological anti-arthritic medications. Methods Forty-five adult men and women with symptoms of RA were randomly assigned to receive Bacillus coagulans GBI-30, 6086 or placebo once a day in a double-blind fashion for 60 days in addition to their standard anti-arthritic medications. Arthritis activity was evaluated by clinical examination, the American College of Rheumatology (ACR criteria, the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI, and laboratory tests for erythrocyte sedimentation rate (ESR and C-reactive protein (CRP. Results Subjects who received Bacillus coagulans GBI-30, 6086 experienced borderline statistically significant improvement in the Patient Pain Assessment score (P = .052 and statistically significant improvement in Pain Scale (P = .046 vs placebo. Compared with placebo, Bacillus coagulans GBI-30, 6086 treatment resulted in greater improvement in patient global assessment and self-assessed disability; reduction in CRP; as well as the ability to walk 2 miles, reach, and participate in daily activities. There were no treatment-related adverse events reported throughout this study. Conclusions Results of this pilot study suggest that adjunctive treatment with Bacillus coagulans GBI-30, 6086 LAB probiotic appeared to be a safe and effective for patients suffering from RA. Because of the low study population size, larger trials are needed to verify these results. Trial registration ACTRN12609000435280
2010-01-01
Background Lactic acid-producing bacteria (LAB) probiotics demonstrate immunomodulating and anti-inflammatory effects and the ability to lessen the symptoms of arthritis in both animals and humans. This randomized, double-blind, placebo-controlled, parallel-design, clinical pilot trial was conducted to evaluate the effects of the LAB probiotic preparation, Bacillus coagulans GBI-30, 6086, on symptoms and measures of functional capacity in patients with rheumatoid arthritis (RA) in combination with pharmacological anti-arthritic medications. Methods Forty-five adult men and women with symptoms of RA were randomly assigned to receive Bacillus coagulans GBI-30, 6086 or placebo once a day in a double-blind fashion for 60 days in addition to their standard anti-arthritic medications. Arthritis activity was evaluated by clinical examination, the American College of Rheumatology (ACR) criteria, the Stanford Health Assessment Questionnaire Disability Index (HAQ-DI), and laboratory tests for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results Subjects who received Bacillus coagulans GBI-30, 6086 experienced borderline statistically significant improvement in the Patient Pain Assessment score (P = .052) and statistically significant improvement in Pain Scale (P = .046) vs placebo. Compared with placebo, Bacillus coagulans GBI-30, 6086 treatment resulted in greater improvement in patient global assessment and self-assessed disability; reduction in CRP; as well as the ability to walk 2 miles, reach, and participate in daily activities. There were no treatment-related adverse events reported throughout this study. Conclusions Results of this pilot study suggest that adjunctive treatment with Bacillus coagulans GBI-30, 6086 LAB probiotic appeared to be a safe and effective for patients suffering from RA. Because of the low study population size, larger trials are needed to verify these results. Trial registration ACTRN12609000435280 PMID:20067641
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Imad Ghozlani
2018-04-01
Full Text Available Aim of the work: The aim of this study was to assess the influence of anti-cyclic citrullinated peptide (anti-CCP on disease activity, radiological severity, functional disability and bone loss in Moroccan women with rheumatoid arthritis (RA. Patients and methods: One hundred and thirty-six women with RA were recruited. Age, weight, height, disease duration and steroids cumulative dose were identified. Anti-CCP and Rheumatoid factor (RF were determined. Disease activity score (DAS28 was assessed and functional repercussion measured by the Health Assessment Questionnaire-disability index (HAQ-DI. Radiological status was assessed by the Sharp/van der Heijde (SvH erosion and narrowing score. Bone mineral density was determined by a Lunar Prodigy Vision Dual-energy X-ray absorptiometry and vertebral fracture assessment was classified using a combination of Genant semi-quantitative approach and morphometry. Results: Patients mean age was 49.6 ± 7.4 years and disease duration 7.7 ± 5 years. 109 (80.1% patients were anti-CCP positive. There was no significant difference in DAS28 between patients with and without anti-CCP. Nevertheless, weight, erythrocyte sedimentation rate (ESR, rheumatoid factor titer and positivity, SvH narrowing and erosion score and osteoporosis were significantly higher in patients with positive anti-CCP. Stepwise regression analysis showed that the presence of anti-CCP was independently associated with osteoporosis and SvH erosion score. Conclusions: Anti-CCP antibodies are strongly predictive for the development of osteoporosis and erosions in Moroccan RA patients. They not only have a valuable role in the disease prognosis prediction but also may be a relevant determinant of bone loss in RA. The presence of these antibodies warrants special attention. Keywords: Rheumatoid arthritis, Anti-cyclic citrullinated peptide, Disease activity, Joint damage, Bone loss
Gartner-Schmidt, Jackie L; Shembel, Adrianna C; Zullo, Thomas G; Rosen, Clark A
2014-11-01
To (1) develop and validate the Dyspnea Index (DI); (2) quantify severity of symptoms in upper airway dyspnea; and (3) validate the DI as an outcome measure. Survey development and validation. Three hundred sixty-nine participants were recruited for different phases of the study. Two hundred participants with chief complaints of dyspnea were given a 41-item questionnaire addressing common symptoms of dyspnea related to the upper airway. The questions were then reduced based on principal component analysis (PCA) and internal consistency resulting in a 10-item questionnaire. Cognitive interviews were conducted with 15 participants. Test-retest reliability and discriminant validity were measured from 51 participants. The DI was further validated by administering the index to 57 healthy controls (HC). Validation of the DI as a treatment outcome tool occurred with 46 participants' pre- and post-treatment scores. PCA revealed that only a single factor was being measured in both the original 41- and 10-item questionnaires. Additional cognitive interviewing suggested that no modification was needed to the DI. Test-retest reliability was r = 0.83. Discriminant validity was r = 0.62. The Mann-Whitney test demonstrated significant differences between healthy/symptomatic participants. Scores from the HC cohort resulted in a mean of 3.12 (SEM = 0.484; SD = 3.65) for the normative values. The DI is an effective and efficient instrument to quantify patients' symptoms of upper airway dyspnea. It is a statistically robust index, with significant reliability and validity, and can be dependably used as a treatment outcome measure. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
The Economic Situation in Contemporary Africa: Comment on ...
African Journals Online (AJOL)
2012-12-17
Dec 17, 2012 ... ul Haq's model, the lowest rankings [there are four rankings, namely: very ..... payments in 2005); sporadic resistance to European Union Economic. 7-Bond ..... Qn 7: Mr Devarajan, how would you respond to that view?
Development of the Global Disability Scale (Glo.Di.S: preliminary results
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Fountoulakis Konstantinos N
2012-05-01
Full Text Available Abstract Background The assessment of functioning and disability is an important part of the clinical evaluation, since it measures disease burden and reflects the effectiveness of therapeutic planning and interventions. The aim of the current study was to develop such a self-report instrument on the basis of a review of the literature, and compatible with the WHO approach. Material and methods The review of the literature led to the development of the Global Disability Scale (Glo.Di.S with 25 items assessing different aspects of disability. The study sample included 728 persons from vulnerable populations (homeless, jobless, very low income, single parent families etc.; (29.12% males and 70.88% females; aged 55.96 ± 15.22 years. The protocol included also the STAI and the CES-D. The statistical analysis included factor analysis item analysis and ANCOVA. Results The factor analysis revealed the presence of 4 factors explaining 71% of total variance (Everyday functioning, Social and interpersonal functioning, Severity and Mental disability. Chronbach’s alpha for the whole scale was 0.95 and for subscales were 0.74–0.94. Discussion The results of the current study suggest that the Glo.Di.S. has the potential to serve as a reliable and valid tool for assessing functioning and disability. Further research is needed to prove that it could be useful across countries, populations and diseases, and whether it provides data that are culturally meaningful and comparable. It can be used in surveys and in clinical research settings and it can generate information of use in evaluating health needs and the effectiveness of interventions to reduce disability and improve health.
DEFF Research Database (Denmark)
Moesgaard Iburg, Kim
2018-01-01
used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods...... and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used......·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America...
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D V Goryachev
2009-01-01
Full Text Available Lethality of pts with rheumatoid arthritis (RA exceeds mortality values in general population. Possibility of disease modifying anti-rheumatic drugs (DMARD influence on RA pts lethality has been widely discussed lately in scientific works. Objective. To determine possible lethality diminishment in Russian population of RA pts with one of biological drugs TNFα antagonist adalimumab. Material and methods. Model construction is based on the fact of lethality dependence on pt functional state assessed by HAQ. Model simulating progression of functional disability in pts with RA visiting medical institutions of Russia was made (RAISER study. 3 model variants for imitation of consecutive change of DMARDs including adalimumab were done. First consecution assessed DMARD change in the next chain: adalimumab-methotrexate-sulfasalazine-leflunomide-azathioprine-cyclosporine-palliative therapy. Second consecution: adalimumab administration after failure of first 3 DMARDs. Third consecution considered only change of synthetic DMARDs without adalimumab inclusion. Model imitated participation of 3000 pts in every consecution. Prognosis horizon was 12 years. Age of pts and initial HAQ distribution were get from results of epidemiological RAISER study. Calculation was done on the base of elevation of standardized lethality level (SLL in population of RA pts in average from 135% to 300%. SLL values from 80 to 320% were used depending on functional disability degree with converting to Russian values of age-specific lethality coefficient for 1999. Results. Lethality in treatment consecutions including adalimumab was significantly lower. To the end of 12th year in group not using adalimumab, using it at once and using it after 376 DMARDs respectively 65,1%, 71,6% and 71,1% of pts were still alive. Conclusion. Significant decrease of lethality with adalimumab inclusion in consecution of DMARD change during treatment of RA pts was demonstrated with imitation modeling
Pérez-Román, Diana I; Ortiz-Haro, Ana B; Ruiz-Medrano, Emmanuel; Contreras-Yáñez, Irazú; Pascual-Ramos, Virginia
2018-04-01
To describe disease activity and disability during the first year of follow-up, from rheumatoid arthritis (RA) patients who discontinue tofacitinib after they end participation in a clinical trial. From 2008 to 2016, 36 patients were enrolled in the "Long term follow-up study with tofacitinib (and methotrexate) for RA treatment". At the end of the study, tofacitinib was discontinued and patients were proposed to enter an observational study; 35 agree and had scheduled evaluations at baseline, at 15 and 30 days of follow-up, at month 2 and 3, and thereafter every 3 months. Disease activity was evaluated as per DAS28-ESR and disability as per HAQ. During follow-up, treatment was treat-to-target oriented, only conventional DMARDs were indicated. Descriptive statistics and nonparametric test were used. The study was approved by IRB. Patients were primarily females (N = 34), had median (Q25-75) age of 52 years (45-58), and had received tofacitinib for a median of 7.9 years (6.3-8.3). The proportion of patients with remission and low disease activity decreased from day 30 of follow-up and recovered after 270 days, meanwhile patients with high disease activity increased from 0% at baseline to 6.3% at 1 year. At study entry, 20 patients had remission/low disease activity; during follow-up, 85% deteriorated after (median) 30 days; among them, 23.5% recovered their baseline status after a median of 172.5 days. The HAQ showed a similar behavior, but 66.7% recovered. A substantial proportion of RA patients deteriorated outcomes early after tofacitinib cessation; some patients recovered baseline status with traditional DMARDS.
Progranulin Is Associated with Disease Activity in Patients with Rheumatoid Arthritis
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Lucie Andrés Cerezo
2015-01-01
Full Text Available Objective. Progranulin (PGRN is implicated in the pathogenesis of rheumatoid arthritis (RA. The aim of this study was to assess the relationship between PGRN and disease activity in RA. Methods. PGRN levels were evaluated in patients with RA (n=47 and OA (n=42 and healthy controls (n=41. Immunohistochemical analysis of PGRN in synovial tissues was performed. The association between PGRN and C-reactive protein (CRP, disease activity score (DAS28-CRP, and health assessment questionnaire (HAQ was studied. Results. Circulating PGRN was elevated in patients with RA and OA compared to healthy controls (227.1±100.2 and 221.5±102.5 versus 128.1±34.7 ng/mL; P<0.001. Synovial fluid levels of PGRN were higher in patients with RA compared to OA (384.5±275.3 versus 241.4±165.2 ng/mL; P=0.002. PGRN expression was significantly upregulated in the synovial tissue of RA patients particularly in the inflammatory infiltrates. Serum PGRN levels correlated with DAS28 (r=0.327, P=0.049 and HAQ score (r=0.323, P=0.032, while synovial fluid PGRN correlated only with HAQ (r=0.310, P=0.043 in patients with RA. PGRN levels were not associated with CRP or autoantibodies. Conclusions. This study demonstrates increased PGRN expression at local sites of inflammation and association between PGRN levels, disease activity, and functional impairment in patients with RA.
DEFF Research Database (Denmark)
Frydenlund Michelsen, Charlotte; Khademi, Seyed Mohammad Hossein; Johansen, Helle Krogh
2016-01-01
The effect of polymicrobial interactions on pathogen physiology and how it can act either to limit pathogen colonization or to potentiate pathogen expansion and virulence are not well understood. Pseudomonas aeruginosa and Staphylococcus aureus are opportunistic pathogens commonly found together......1 and DK2-P2M24-2003, which comprised several virulence factors and signaling 4-hydroxy-2-alkylquinoline (HAQ) molecules. Strikingly, a further modulation of the HAQ profile was observed in DK2-P2M24-2003 during interaction with S. aureus, resulting in an area with thickened colony morphology...... host-adapted strain, DK2-P2M24-2003, and S. aureus. In this study, characterization by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) imaging mass spectrometry (IMS) and mass spectral (MS) molecular networking revealed a significant metabolic divergence between P. aeruginosa PAO...
Huber, Adam M; Feldman, Brian M; Rennebohm, Robert M; Hicks, Jeanne E; Lindsley, Carol B; Perez, Maria D; Zemel, Lawrence S; Wallace, Carol A; Ballinger, Susan H; Passo, Murray H; Reed, Ann M; Summers, Ronald M; White, Patience H; Katona, Ildy M; Miller, Frederick W; Lachenbruch, Peter A; Rider, Lisa G
2004-05-01
To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in children with juvenile idiopathic inflammatory myopathy (juvenile IIM), and to obtain preliminary data on the clinical significance of CMAS scores. One hundred eight children with juvenile IIM were evaluated on 2 occasions, 7-9 months apart, using various measures of physical function, strength, and disease activity. Interrater reliability, construct validity, and responsiveness of the CMAS were examined. The minimum clinically important difference (MID) and CMAS scores corresponding to various degrees of physical disability were estimated. The intraclass correlation coefficient for 26 patients assessed by 2 examiners was 0.89, indicating very good interrater reliability. The CMAS score correlated highly with the Childhood Health Assessment Questionnaire (C-HAQ) score and with findings on manual muscle testing (MMT) (r(s) = -0.73 and 0.73, respectively) and moderately with physician-assessed global disease activity and skin activity, parent-assessed global disease severity, and muscle magnetic resonance imaging (r(s) = -0.44 to -0.61), thereby demonstrating good construct validity. The standardized response mean was 0.81 (95% confidence interval 0.53, 1.09) in patients with at least 0.8 cm improvement on a 10-cm visual analog scale for physician-assessed global disease activity, indicating strong responsiveness. In bivariate regression models predicting physician-assessed global disease activity, MMT remained significant in models containing the CMAS (P = 0.03) while the C-HAQ did not (P = 0.4). Estimates of the MID ranged from 1.5 to 3.0 points on a 0-52-point scale. CMAS scores corresponding to no, mild, mild-to-moderate, and moderate physical disability, respectively, were 48, 45, 39, and 30. The CMAS exhibits good reliability, construct validity, and responsiveness, and is therefore a valid instrument for the assessment of physical function, muscle strength, and
The Danish Neck Disability Index
DEFF Research Database (Denmark)
Lauridsen, Henrik Hein; O'Neill, Lotte; Kongsted, Alice
2017-01-01
Objective: To (1) translate and culturally adapt and (2) determine the clinimetric properties of the Danish 8-item Neck Disability Index (NDI-8) in primary sector patients (PSPs) and secondary sector patients (SSPs). Methods: Analyses included 326 patients with neck pain. Validity and reliability...
Maddali Bongi, Susanna; Paoletti, Gianluca; Calà, Michael; Del Rosso, Angela; El Aoufy, Khadija; Mikhaylova, Svetlana
2016-08-01
Fibromyalgia Syndrome (FMS) is characterized by musculoskeletal pain, muscle tenderness leading to disability, impaired quality of life (QoL), fatigue and it is accompanied by sleep disorders and psychological distress. Mind body therapies (MBT), such as Tai Ji Quan (TJQ), use different techniques to facilitate the ability of the mind to influence disease characteristics and symptoms. Some studies showed that TJQ, in patients with rheumatic diseases, particularly FMS, improved QoL, disability and psychological distress. To evaluate the efficacy of TJQ on disability, QoL, fatigue, sleep and psychological distress in an Italian cohort of FMS patients. We enrolled 44 FMS patients: 22 patients (Experimental Group) participated to a course of Tai Ji Quan style of (2/week for 16 weeks); 22 patients (Control Group) participated to an educational course about FMS (2/week for 16 weeks). At baseline (T0) and at the end of treatment (T1), patients were assessed for disability [Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ)], Quality of Life [Short-Form 36 (SF36)], fatigue [Functional Assessment of Chronic Illness-Fatigue (FACIT-F)], pain [Widespread Pain Index (WPI)], tenderness [Tender Points (TP)], Sleep Quality [Pittsburgh Sleep Quality Index (PSQI)] and mood disorders [Hospital Anxiety and Depression Scale (HADS)]. At T1 versus T0, patients of the Experimental Group showed a significant improvement in FIQ, FACIT, SF36 (Summary Physical Index, Physical activity, physical role, bodily pain, general health, vitality, emotional role limitations), in WPI, TP, PSQI (total, sleep duration, and sleep disturbance) and HADS (total score and anxiety subscale), while Patients in the Control Group did not improve in any parameter. In FMS patients TJQ, if performed by an expert physiotherapist, should be regarded as an effective rehabilitation method. Copyright © 2016 Elsevier Ltd. All rights reserved.
Ankle tenosynovitis in rheumatoid arthritis: clinical and ultrasonographic evaluation
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Ana Luiza Naves Pereira
2016-11-01
Full Text Available Objective: To investigate ankle tenosynovitis in rheumatoid arthritis patients, regarding its presence, the kind of tendon involved and the concordance between clinical and ultrasound findings. Methods: Twenty patients with rheumatoid arthritis and pain or swollen ankle joint were evaluated. Tendon involvement was evaluated with ultrasound imaging. The Health Assessment Questionnaire (HAQ was performed for disability evaluation. Age, sex, disease duration, and vocational activity levels were also obtained. The statistical analysis included Fisher’s exact test. The significance level was 0.05. Results: Tenosynovitis was found in 13 of 20 (65.0% patients in 19 joints, in which 6 were bilaterally (46.1% and unilateral in 7 (53.8%. Tibialis posterior tenosynovitis was seen in nine (45.0% patients, Achilles tenosynovitis in seven (35.0%, tibialis anterior tenosynovitis in three (15.0%, and peroneal tenosynovitis in three (15.0% patients. We found concordance between symptomatic ankle and ultrasonographic findings in 92.3% of the patients with tenosynovitis. Association between severe HAQ with tendon involvement was not found (p>0.05. Disease duration was not associated with tenosynovitis. Patients were predominantly older, female, with mean age around 50.8 years. The long disease duration of patients presented a mean of 11.4 years and, most of them, with no vocational activity (65.0%. Conclusions: The results indicate that ankle tenosynovitis is very common in rheumatoid arthritis patients, both unilateral and bilateral. Tibialis posterior was the most common tendon involvement found. Finally, we found concordance between the clinical and ultrasound findings in almost all rheumatoid arthritis patients with ankle tenosynovitis.
Sensitivity analysis in multiple imputation in effectiveness studies of psychotherapy.
Crameri, Aureliano; von Wyl, Agnes; Koemeda, Margit; Schulthess, Peter; Tschuschke, Volker
2015-01-01
The importance of preventing and treating incomplete data in effectiveness studies is nowadays emphasized. However, most of the publications focus on randomized clinical trials (RCT). One flexible technique for statistical inference with missing data is multiple imputation (MI). Since methods such as MI rely on the assumption of missing data being at random (MAR), a sensitivity analysis for testing the robustness against departures from this assumption is required. In this paper we present a sensitivity analysis technique based on posterior predictive checking, which takes into consideration the concept of clinical significance used in the evaluation of intra-individual changes. We demonstrate the possibilities this technique can offer with the example of irregular longitudinal data collected with the Outcome Questionnaire-45 (OQ-45) and the Helping Alliance Questionnaire (HAQ) in a sample of 260 outpatients. The sensitivity analysis can be used to (1) quantify the degree of bias introduced by missing not at random data (MNAR) in a worst reasonable case scenario, (2) compare the performance of different analysis methods for dealing with missing data, or (3) detect the influence of possible violations to the model assumptions (e.g., lack of normality). Moreover, our analysis showed that ratings from the patient's and therapist's version of the HAQ could significantly improve the predictive value of the routine outcome monitoring based on the OQ-45. Since analysis dropouts always occur, repeated measurements with the OQ-45 and the HAQ analyzed with MI are useful to improve the accuracy of outcome estimates in quality assurance assessments and non-randomized effectiveness studies in the field of outpatient psychotherapy.
African Journal of Biotechnology - Vol 11, No 10 (2012)
African Journals Online (AJOL)
Foliar application of calcium chloride and borax affects the fruit skin strength and cracking incidence in litchi (Litchi chinensis Sonn.) cultivars · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. I Haq, A Rab, 2445-2453 ...
Degenerative lumbar spinal stenosis: correlation with Oswestry Disability Index and MR imaging.
Sirvanci, Mustafa; Bhatia, Mona; Ganiyusufoglu, Kursat Ali; Duran, Cihan; Tezer, Mehmet; Ozturk, Cagatay; Aydogan, Mehmet; Hamzaoglu, Azmi
2008-05-01
Because neither the degree of constriction of the spinal canal considered to be symptomatic for lumbar spinal stenosis nor the relationship between the clinical appearance and the degree of a radiologically verified constriction is clear, a correlation of patient's disability level and radiographic constriction of the lumbar spinal canal is of interest. The aim of this study was to establish a relationship between the degree of radiologically established anatomical stenosis and the severity of self-assessed Oswestry Disability Index in patients undergoing surgery for degenerative lumbar spinal stenosis. Sixty-three consecutive patients with degenerative lumbar spinal stenosis who were scheduled for elective surgery were enrolled in the study. All patients underwent preoperative magnetic resonance imaging and completed a self-assessment Oswestry Disability Index questionnaire. Quantitative image evaluation for lumbar spinal stenosis included the dural sac cross-sectional area, and qualitative evaluation of the lateral recess and foraminal stenosis were also performed. Every patient subsequently answered the national translation of the Oswestry Disability Index questionnaire and the percentage disability was calculated. Statistical analysis of the data was performed to seek a relationship between radiological stenosis and percentage disability recorded by the Oswestry Disability Index. Upon radiological assessment, 27 of the 63 patients evaluated had severe and 33 patients had moderate central dural sac stenosis; 11 had grade 3 and 27 had grade 2 nerve root compromise in the lateral recess; 22 had grade 3 and 37 had grade 2 foraminal stenosis. On the basis of the percentage disability score, of the 63 patients, 10 patients demonstrated mild disability, 13 patients moderate disability, 25 patients severe disability, 12 patients were crippled and three patients were bedridden. Radiologically, eight patients with severe central stenosis and nine patients with moderate
D.R. Gasper (Des)
2011-01-01
markdownabstract__Abstract__ The human development approach emerged in the late 1980s in response to the negative effects of structural adjustment programmes applied to countries in the South. Led originally by two South Asian scholars, Mahbub ul Haq and Amartya Sen, in cooperation with a large
Zhou, Yin; Zhu, Jun; Li, Lian-Bo; He, Tian-Feng; Chen, Xiao-Yi; Zheng, Yong-Yao; Chen, Yun-Fei
2016-10-25
To compare the effects between electroacupuncture (EA) plus western medicine and simple western medicine in improving clinical symptoms and local joint function of rheumatoid arthritis (RA) patients with yin deficiency of Liver and Kidney. A total of 68 RA patients of yin deficiency of Liver and Kidney were equally randomized into EA+medication group and medication group ( n =34 in each group). Both groups were given once-a-week methotrexate (7.5 mg/time) and once-a-day leflunomide (10 mg/time), while EA+medication group was additionally treated by EA at bilateral Ganshu (BL 18), Shenshu (BL 23), Xuanzhong (GB 39), Zusanli (ST 36), Taichong (LR 3), Hegu (LI 4) 3 times/week. The treatment lasted for 12 weeks. The visual analogue scale (VAS, for assessing rest pain), swollen joint count (SJC), tender joint count (TJC), patient's global assessment (PGA), physician's global assessment (PhGA), traditional Chinese medicine (TCM) symptom scoring, 28 joints activity index (disease activity score, DAS 28), American College of Rheumatology 20 (ACR 20, i.e. 20% of clinical improving rate), and health assessment questionnaire (HAQ) were assessed and erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) levels were examined for comparison. Statistical differences were observed in before-after-treatment comparisons in both groups in reducing rest pain, SJC, TJC, serum CRP content, PGA and PhGA, HAQ scoring and DAS 28 ( P yin deficiency of Liver and Kidney.
Alemao, Evo; Joo, Seongjung; Kawabata, Hugh; Al, Maiwenn J; Allison, Paul D; Rutten-van Mölken, Maureen P M H; Frits, Michelle L; Iannaccone, Christine K; Shadick, Nancy A; Weinblatt, Michael E
2016-03-01
To evaluate associations between achieving guideline-recommended targets of disease activity, defined by the Disease Activity Score in 28 joints using C-reactive protein level (DAS28-CRP) Clinical Disease Activity Index (CDAI) ≤2.8, and other health outcomes in a longitudinal observational study. Other defined thresholds included low disease activity (LDA), moderate (MDA), or severe disease activity (SDA). To control for intraclass correlation and estimate effects of independent variables on outcomes of the modified Health Assessment Questionnaire (M-HAQ), the EuroQol 5-domain (EQ-5D; a quality-of-life measure), hospitalization, and durable medical equipment (DME) use, we employed mixed models for continuous outcomes and generalized estimating equations for binary outcomes. Among 1,297 subjects, achievement (versus nonachievement) of recommended disease targets was associated with enhanced physical functioning and lower health resource utilization. After controlling for baseline covariates, achievement of disease targets (versus LDA) was associated with significantly enhanced physical functioning based on SDAI ≤3.3 (ΔM-HAQ -0.047; P = 0.0100) and CDAI ≤2.8 (-0.073; P = 0.0003) but not DAS28-CRP measures was associated with enhanced physical functioning and health-related quality of life. Some health outcomes were similar in subjects attaining guideline targets versus LDA. Achieving LDA is a worthy clinical objective in some patients. © 2016 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of the American College of Rheumatology.
Grotle, M; Brox, J I; Vøllestad, N K
2003-09-01
To evaluate reliability and construct validity of the Norwegian versions of the Roland Morris Disability Questionnaire and the modified Oswestry Disability Index. Translation of two functional status questionnaires and a cross-sectional study of measurement properties. The questionnaires were translated and back-translated following the Guillemin criteria. The Norwegian versions were tested for 55 patients with acute low back pain and 50 patients with chronic low back pain. Test-retest with a 2-day interval was performed in a subsample of 28 patients from the chronic sample. Reliability was assessed by repeatability according to Bland and Altman, intraclass coefficient and coefficient of variation. Internal consistency was assessed by Cronbach's alpha. Concurrent construct validity was assessed with correlations between the questionnaires and the SF-36, Disability Rating Index and pain intensity. Repeatability of the Roland Morris Disability Questionnaire was 4 points, coefficient of variation 15% and intraclass correlation coefficient 0.89, and of the modified Oswestry Disability Index 11, 12% and 0.88, respectively. Internal consistency was 0.94 for both questionnaires. The questionnaires correlated highly with the physical functioning scale of SF-36, moderately with pain, and low with mental scales of the SF-36. The reliability and construct validity of the Norwegian versions of the Roland Morris Disability Questionnaire and the modified Oswestry Disability Index are acceptable for assessing functional status of Norwegian-speaking patients with low back pain.
Sokka, Tuulikki; Kautiainen, Hannu; Pincus, Theodore; Verstappen, Suzanne M M; Aggarwal, Amita; Alten, Rieke; Andersone, Daina; Badsha, Humeira; Baecklund, Eva; Belmonte, Miguel; Craig-Müller, Jürgen; da Mota, Licia Maria Henrique; Dimic, Alexander; Fathi, Nihal A; Ferraccioli, Gianfranco; Fukuda, Wataru; Géher, Pál; Gogus, Feride; Hajjaj-Hassouni, Najia; Hamoud, Hisham; Haugeberg, Glenn; Henrohn, Dan; Horslev-Petersen, Kim; Ionescu, Ruxandra; Karateew, Dmitry; Kuuse, Reet; Laurindo, Ieda Maria Magalhaes; Lazovskis, Juris; Luukkainen, Reijo; Mofti, Ayman; Murphy, Eithne; Nakajima, Ayako; Oyoo, Omondi; Pandya, Sapan C; Pohl, Christof; Predeteanu, Denisa; Rexhepi, Mjellma; Rexhepi, Sylejman; Sharma, Banwari; Shono, Eisuke; Sibilia, Jean; Sierakowski, Stanislaw; Skopouli, Fotini N; Stropuviene, Sigita; Toloza, Sergio; Valter, Ivo; Woolf, Anthony; Yamanaka, Hisashi
2010-01-01
all subgroups was Health Assessment Questionnaire (HAQ) functional disability score. Work disability rates remain high among people with RA during this millennium. In low-GDP countries, people remain working with high levels of disability and disease activity. Cultural and economic differences between societies affect work disability as an outcome measure for RA.
Sadhana | Indian Academy of Sciences
Indian Academy of Sciences (India)
Home; Journals; Sadhana. Hossein Mohammadhosseini. Articles written in Sadhana. Volume 40 Issue 6 September 2015 pp 1989-1999. Influence of palm oil fuel ash on fresh and mechanical properties of self-compacting concrete · Hossein Mohammadhosseini A S M Abdul Awal Abdul Haq Ehsan · More Details Abstract ...
Broensted Acids and Bases: They are not Substances but Molecules ...
African Journals Online (AJOL)
For chemistry education we are discussing mainly two concepts of acids and bases: theories of Arrhenius and Broensted. For the first theory, dissociation into ions is generally discussed: acidic solutions contain H+(aq) ions, alkaline solutions contain OH-(aq) ions. This theory therefore deals with substances, which are ...
Effect of N fertilizer and foliar-applied Fe fertilizer at various ...
African Journals Online (AJOL)
DrSohrabi
2012-05-17
May 17, 2012 ... yield component and chemical composition of soybean. (Glycine ... fertilizer are the main source of meeting the nitrogen (N) ... influence grain yield and protein concentration (Haq and .... The data were analyzed using the Statistical Analysis System ... application and interaction of Fe and N fertilizers had no.
Rainfall and temperature scenarios for Bangladesh for the middle of ...
Indian Academy of Sciences (India)
mean surface air temperature projection for Bangladesh is experimentally obtained for 2050 and 2060. This work discloses that simulated ... seasonal and annual rainfall, and mean surface air temperature in Bangladesh. The projected change ... already being felt in South Asia and will continue to intensify (Haq et al 1998; ...
Toward Ultrasonic Tunable Ultra-Damping Metamaterials
2014-03-06
using this approach. Fabrication of the silicon monoliths: The polyHIPE approach was first developed during the 80s in the Unilever laboratories...Science 342, 323 (2013) [20] T. Brunet et al., Physical Review Letters 111, 264301 (2013) [21] Barby, D.; Haq. Z., European Patent 0 060 138 ( Unilever
Spiegel, Matthew A; Lafage, Renaud; Lafage, Virginie; Ryan, Devon; Marascalchi, Bryan; Trimba, Yuriy; Ames, Christopher; Harris, Bradley; Tanzi, Elizabeth; Oren, Jonathan; Vira, Shaleen; Errico, Thomas; Schwab, Frank; Protopsaltis, Themistocles S
2016-01-01
Retrospective. This study assessed the feasibility of combining Oswestry and Neck Disability Index (ODI and NDI) into 1 shorter "Total Disability Index" (TDI) from which reconstructed scores could be computed. ODI and NDI are not pure assessments of disability related to back and neck, respectively. Because of similarities/redundancies of questions, ODI scores may be elevated in neck-pain patients and the converse is true for NDI in back-pain patients. Spine patients completed ODI and NDI, and complaints were recorded as back pain (BP), neck pain (NP), or both (BNP). Questionnaire scores were compared across cohorts via descriptives and Spearman (ρ) correlations. In exploring the feasibility of merging ODI/NDI, TDI was constructed from 9 ODI and 5 NDI items. Extracting questions from TDI, reconstructed 9-item rODI and 10-item rNDI indices were formed and compared with true ODI/NDI. There were a total of 1207 patients: 741 BP, 134 NP, and 268 BNP. Mean ODI was 37 ± 21 and mean NDI was 32 ± 21. Patients with concurrent BP and NP had significantly more disability. Seventy-eight patients of 134 (58%) patients with NP only had at least "moderate disability" by ODI and 297 of 741 (40%) patients with back pain only, had at least "moderate disability" by NDI. ODI versus NDI correlation was ρ = 0.755; ODI versus reconstructed rODI correlated at ρ = 0.985, and NDI versus reconstructed rNDI correlated at ρ = 0.967 (P disability in 1 region affects scores on both surveys. This study constructed a 14-item TDI that represents every domain of ODI/NDI with exception of ODI "Sex Life." From this TDI, reconstructed scores correlated near perfectly with true scores. TDI provides a more global assessment of spinal disability and is a questionnaire that reduces the time burden to patients. The TDI allows for simultaneous assessment of back, neck, and global spinal disability.
Trends, prospects and deprivation index of disability in India: Evidences from census 2001 and 2011.
Awasthi, Ashish; Pandey, C M; Dubey, Manisha; Rastogi, Sanjay
2017-04-01
Since the dawn of civilization, disabilities have existed in various dimensions of human life. World Health Organization (WHO) defines disability as an umbrella term, covering impairments, activity limitations, and participation restrictions. Globally, approximately 1 billion people have some form of disability, and approximately 20% have significant functioning impairments. This study aims to estimate the level, trends and prospects of disability in 640 districts of India. Data for the present study has been taken from Census of India, 2001 and 2011. A Disability Index was calculated at the district level, and state level indexing was done using the Disability Deprivation Index. The population for the year 2021 was projected using the exponential growth rate method. The Disability Deprivation Index was calculated using child labor, adult unemployment, illiteracy, and the ratio of beggars in the disabled population. The study reveals that the proportion of the disabled population in India was 2.10% in 2001, which increased to 2.21% in 2011. According to the Disability Deprivation Index, Maharashtra was the best-performing state in 2011. There were 4.90 million new cases of disability in India during 2001-11, out of which 1.52 million cases belonged to non-congenital disability. There is a rise in the disabled population in India, which needs special attention. The working status of the disabled is gloomy. The majority of the disabled people are non-working and need adequate rehabilitation measures that would facilitate employment. Copyright © 2016 Elsevier Inc. All rights reserved.
The Muslim Brotherhood in America: Orthodox and Active
2012-05-17
Mohammed’s martial activity. “Part I: The genealogy of Muhammad; traditions from the pre- Islamic era; Muhammad’s childhood and early manhood,” has 105...of extremism was cultivated and encouraged under the military dictatorships of Gen. Mohammad Zia ul-Haq from 1977 to 1988 and Gen. Pervez Musharraf
PLATELET AGGREGATION AND ANTI-INFLAMMATORY EFFECTS OF GARDEN PEA, DESI CHICKPEA AND KABULI CHICKPEA
Czech Academy of Sciences Publication Activity Database
ZIA-UL-HAQ, M.; ALI KHAN, B.; Landa, Přemysl; Kutil, Zsófia; AHMED, S.; QAYUM, M.; Ahmad, S.
2012-01-01
Roč. 69, č. 4 (2012), s. 707-711 ISSN 0001-6837 Institutional research plan: CEZ:AV0Z50380511 Keywords : platelet aggregation * Garden pea * Desi chickpea Subject RIV: EF - Botanics Impact factor: 0.665, year: 2012 http://home.ueb.cas.cz/publikace/2012_Haq_ACTA_POLONIAE_PHARMACEUTICA_707.pdf
Vieira, Maria-Cecilia; Zwillich, Samuel H; Jansen, Jeroen P; Smiechowski, Brielan; Spurden, Dean; Wallenstein, Gene V
2016-12-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This analysis compared the efficacy and safety of tofacitinib with biologic disease-modifying antirheumatic drugs in patients with RA and a prior inadequate response (IR) to tumor necrosis factor inhibitors (TNFi). A systematic literature review identified 5 randomized placebo-controlled trials that evaluated tofacitinib or biologic disease-modifying antirheumatic drugs (bDMARDs) against placebo in patient populations with RA with a prior IR to TNFi. The definition of TNFi-IR varied across studies, and included patients with an IR or who had failed treatment with TNFi for any reason. A network meta-analysis was conducted comparing study data with regard to American College of Rheumatology response rates and Health Assessment Questionnaire-Disability Index improvement at weeks 12 and 24, rates of treatment withdrawal due to all causes; adverse events (AEs) and lack of efficacy; and rates of AEs, serious AEs, and serious infections. The 5 trials included a total of 2136 patients. Tofacitinib 5 mg twice daily combined with methotrexate was found to have relative risk estimates of American College of Rheumatology responses and change from baseline in Health Assessment Questionnaire-Disability Index score comparable with abatacept, golimumab, rituximab, and tocilizumab combined with conventional synthetic disease-modifying antirheumatic drugs. Withdrawal rates from trials due to all causes and AEs were comparable between treatments, and tofacitinib had a lower rate of withdrawals due to lack of efficacy. Rates of AEs and HAQ-DI were comparable between tofacitinib, other active treatments, and placebo. No serious infections were reported with tofacitinib during the placebo-controlled period (up to week 12) in this study population; rates of serious infection with other active treatments were generally low and similar to placebo. During a 24-week period, tofacitinib had efficacy
Mader, Reuven; Novofastovski, Irina; Rosner, Ehud; Adawi, Muhammad; Herer, Paula; Buskila, Dan
2010-09-01
To investigate the degree of nonarticular tenderness and functional status in patients with diffuse idiopathic skeletal hyperostosis (DISH). We assessed these variables' correlation with their clinical, radiographic, and constitutional measurements and with metabolic syndrome (MS). Eighty-seven patients with DISH were compared with 65 controls without DISH. Examination of nonarticular tenderness was performed by thumb palpation. Tenderness was scored for the 18 fibromyalgia tender points (TP), and 4 control points. Nonarticular tenderness was expressed by the number of TP and by the total tenderness score (TTS). The Short Health Assessment Questionnaire (HAQ II) was administered to all participants. Clinical and laboratory data were collected from all patients. Patients were classified as having MS by both the National Cholesterol Education Program and World Health Organization definitions. There was a statistically significant difference in TTS between controls and patients with DISH. The mean tenderness of many individual TP was significantly higher in the DISH group compared with the control group. TP counts, TTS, and body mass index (BMI) positively correlated with the HAQ II. There was a linear trend in intensity of T-spine bony bridges (BB) and the total number of TP as well as many individual TP. Patients with DISH were more likely to be affected by MS. No correlation was found between TP count, TTS, and MS. Patients with DISH have a lower pain threshold than patients who do not have DISH. TP count and TTS correlate with the functional status, BMI, waist circumference, and high-grade BB. No correlation was observed between pain threshold and MS.
Brodin, Nina; Lohela-Karlsson, Malin; Swärdh, Emma; Opava, Christina H
2015-01-01
To describe cost-effectiveness of the Physical Activity in Rheumatoid Arthritis (PARA) study intervention. Costs were collected and estimated retrospectively. Cost-effectiveness was calculated based on the intervention cost per patient with respect to change in health status (EuroQol global visual analog scale--EQ-VAS and EuroQol--EQ-5D) and activity limitation (Health assessment questionnaire - HAQ) using cost-effectiveness- and cost-minimization analyses. Total cost of the one-year intervention program was estimated to be €67 317 or €716 per participant. Estimated difference in total societal cost between the intervention (IG) and control (CG) was €580 per participant. Incremental cost-effectiveness ratio (ICER) for one point (1/100) of improvement in EQ-VAS was estimated to be €116. By offering the intervention to more affected participants in the IG compared to less affected participants, 15.5 extra points of improvement in EQ-VAS and 0.13 points of improvement on HAQ were gained at the same cost. "Ordinary physiotherapy" was most cost-effective with regard to EQ-5D. The intervention resulted in improved effect in health status for the IG with a cost of €116 per extra point in VAS. The intervention was cost-effective if targeted towards a subgroup of more affected patients when evaluating the effect using VAS and HAQ. The physical activity coaching intervention resulted in an improved effect on VAS for the intervention group, to a higher cost. In order to maximize cost-effectiveness, this type of physical activity coaching intervention should be targeted towards patients largely affected by their RA. The intervention is cost-effective from the patients' point of view, but not from that of the general population.
PADI4 Haplotypes in Association with RA Mexican Patients, a New Prospect for Antigen Modulation
Directory of Open Access Journals (Sweden)
Maria Guadalupe Zavala-Cerna
2013-01-01
Full Text Available Peptidyl arginine deiminase IV (PAD 4 is the responsible enzyme for a posttranslational modification called citrullination, originating the antigenic determinant recognized by anti-cyclic citrullinated peptide antibodies (ACPA. Four SNPs (single nucleotide polymorphisms have been described in PADI4 gene to form a susceptibility haplotype for rheumatoid arthritis (RA; nevertheless, results in association studies appear contradictory in different populations. The aim of the study was to analyze if the presence of three SNPs in PADI4 gene susceptibility haplotype (GTG is associated with ACPA positivity in patients with RA. This was a cross-sectional study that included 86 RA patients and 98 healthy controls. Polymorphisms PADI4_89, PADI4_90, and PADI4_92 in the PADI4 gene were genotyped. The susceptibility haplotype (GTG was more frequent in RA patients; interestingly, we found a new haplotype associated with RA with a higher frequency (GTC. There were no associations between polymorphisms and high scores in Spanish HAQ-DI and DAS-28, but we did find an association between RARBIS index and PADI4_89, PADI4_90 polymorphisms. We could not confirm an association between susceptibility haplotype presence and ACPA positivity. Further evidence about proteomic expression of this gene will determine its participation in antigenic generation and autoimmunity.
Work Productivity in Rheumatoid Arthritis: Relationship with Clinical and Radiological Features
Directory of Open Access Journals (Sweden)
Rafael Chaparro del Moral
2012-01-01
Full Text Available Objective. To assess the relationship between work productivity with disease activity, functional capacity, life quality and radiological damage in patients with rheumatoid arthritis (RA. Methods. The study included consecutive employed patients with RA (ACR'87, aged over 18. Demographic, disease-related, and work-related variables were determined. The reduction of work productivity was assessed by WPAI-RA. Results. 90 patients were evaluated, 71% women. Age average is 50 years old, DAS28 4, and RAQoL 12. Median SENS is 18 and HAQ-A 0.87. Mean absenteeism was of 14%, presenting an average of 6.30 work hours wasted weekly. The reduction in performance at work or assistance was of 38.4% and the waste of productivity was of 45%. Assistance correlated with DAS28 (r = 0.446; P 18 showed lower work productivity than those with SENS < 18 (50 versus 34; P=0.04. In multiple regression analysis, variables associated with reduction of total work productivity were HAQ-A and RAQoL. Conclusion. RA patients with higher disease severity showed higher work productivity compromise.
Quintana, Rosana; Silvestre, Adriana M R; Goñi, Mario; García, Vanina; Mathern, Nora; Jorfen, Marisa; Miljevic, Julio; Dhair, Daniel; Laithe, Matias; Conti, Silvana; Midauar, Fadua; Martin, Maria Celeste; Barrios, Maria Cecilia; Nieto, Romina; Prigione, Cristina; Sanabria, Alvaro; Gervasoni, Viviana; Grabbe, Emilio; Gontero, Romina; Peláez-Ballestas, Ingris; Pons-Estel, Bernardo A
2016-07-01
This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases among the indigenous Qom (Toba) population in the city of Rosario, Santa Fe, Argentina. An analytical cross-sectional study using methodology of the Community Oriented Program for the Control of Rheumatic Diseases (COPCORD) was performed. Subjects ≥18 years of age were interviewed by advanced students of medicine and nursing, bilingual translator-facilitators, and coordinators. Individuals with musculoskeletal pain (positive cases) were evaluated sequentially for 7 days by internists and rheumatologists for diagnosis and treatment. The study included 1656 individuals (77 % of the census population). Of these, 1020 (61.5 %) were female, with mean age of 35.3 (SD 13.9) years, and 1028 (62.0 %) were bilingual. The public health care system covers 87.1 % of the population. Musculoskeletal pain in the previous 7 days and/or at some time during their life was present in 890 subjects (53.7 %). Of those with pain in the last 7 days, 302 (64.1 %) subjects had an Health Assessment Questionnaire Disability Index (HAQ-DI) score ≥0.8. The most frequent pain sites were lumbar spine (19.3 %), knees (13.0 %), and hands (12.0 %). The prevalence of rheumatic diseases was as follows: mechanical back pain (20.1 %), rheumatic regional pain syndrome (2.9 %), osteoarthritis (4.0 %) rheumatoid arthritis (2.4 %), inflammatory back pain (0.2 %), systemic sclerosis (0.1 %), Sjögren syndrome (0.1 %), fibromyalgia (0.1 %), mixed connective tissue disease (0.06 %), and systemic lupus erythematosus (0.06 %). The prevalence of musculoskeletal disorders was 53.7 % and rheumatic diseases 29.6 %. Rheumatoid arthritis prevalence was 2.4 % using COPCORD methodology, one of the highest reported at present.
Standardizzazione isogravitá di un case-mix ospedaliero mediante Charlson index
Directory of Open Access Journals (Sweden)
G. Messina
2003-05-01
Full Text Available
Introduzione: la comorbidità è un importante fattore confondente negli studi epidemiologici valutativi dell’assistenza ospedaliera. Diversi strumenti di risk adjustment misurano la complessità della malattia, consentendo di correlarla al consumo di risorse assistenziali, agli esiti, nonchè di confrontare studi eseguiti in tempi e realtà diversi.
Obiettivi: - Standardizzare per complessità casistica la mortalità dei pazienti assistiti da un grande ospedale; - Identificare le variabili in grado di migliorare la capacità predittiva di mortalità intraospedaliera (IM. Materiali e
Metodi: sono state analizzate 40.801 schede di dimissione prodotte dal Policlinico Senese nel 2001. Sono stati studiati i tassi di IM specifici per Charlson Index Score (CSI: quest’ultimo considera 19 categorie di patologia e si basa sull’ ICD-IX-CM. Le variabili studiate mediante analisi bivariate e regressione logistica, sono state: CSI (codificato in 5 livelli 0, 1, 2, 3, 4, lunghezza del ricovero (LR, sesso ed età. Risultati: CSI è risultato associato con IM (p‹0.001. Sesso, età e LR sono risultati associati sia con CSI (p‹0.001 che IM (p‹0.001. Confrontando i 4 livelli di CSI con quello di riferimento (0, le seguenti Odds Ratio (OR di IM sono state trovate: Livello 1 verso livello 0 OR: 6.79 (p‹0.001, Livello 2 verso livello 0 OR: 15.8 (p‹0.001, Livello 3 verso livello 0 OR: 9.36 (p‹0.001, Livello 4 verso livello 0 OR: 7.4 (p‹0.001. La variabile sesso non è risultata aver un effetto confondente tra CSI e IM al contrario delle variabili LR ed età.
Conclusioni: il CSI aiuta a valutare (predire il rischio di mortalità intraospedaliera, sebbene in modo non lineare. Abbiamo sempre rilevato valori più alti di mortalità confrontando i livelli 1, 2, 3, e 4 con quello di riferimento (0. In particolare il valore più alto lo ha raggiunto il secondo livello
Grando, Luciana Rosa; Horn, Roberta; Cunha, Vivian Trein; Cestari, Tania Ferreira
2016-04-01
The Cardiff Acne Disability Index was originally developed in English for measuring quality of life of acne patients. Considering the psychosocial impact of this disease, it is important to have instruments culturally and linguistically validated for use in Brazilian adolescents. To translate the Cardiff Acne Disability Index into Brazilian Portuguese, culturally adapt it, and verify its reliability and validity in adolescent patients with acne. In the first step, the Cardiff Acne Disability Index was translated and validated linguistically to Brazilian Portuguese in accordance with international guidelines published. In the second step, the validation of the Cardiff Acne Disability Index into Brazilian Portuguese instrument was performed, when patients aged from 12 to 20 years with acne were selected. The participants were interviewed to collect demographic data, submitted to the classification of acne by the Global Acne Grading System and invited to respond the Cardiff Acne Disability Index into Brazilian Portuguese version and DLQI (>16 years) or CDLQI (≤16 years). The internal consistency of Cardiff Acne Disability Index into Brazilian Portuguese was assessed by Cronbach's alpha coefficient and concurrent validity was measured by the Spearman correlation coefficient and Student 's t-test for paired samples. The study included 100 adolescents. The Cardiff Acne Disability Index into Brazilian Portuguese version showed good reliability and internal consistency (Cronbach's alpha = 0.73). The concurrent validity of the scale was supported by a strong and significant correlation with CDLQI / DLQI instruments (rs=0.802;pPortuguese version is a reliable, valid and valuable tool to measure the impact of acne on quality of life in adolescent patients.
DEFF Research Database (Denmark)
Khan, Nasim Ahmed; Spencer, Horace Jack; Nikiphorou, Elena
2017-01-01
Objective: To assess intercentre variability in the ACR core set measures, DAS28 based on three variables (DAS28v3) and Routine Assessment of Patient Index Data 3 in a multinational study. Methods: Seven thousand and twenty-three patients were recruited (84 centres; 30 countries) using a standard...... built to adjust for the remaining ACR core set measure (for each ACR core set measure or each composite index), socio-demographics and medical characteristics. ANOVA and analysis of covariance models yielded similar results, and ANOVA tables were used to present variance attributable to recruiting...... centre. Results: The proportion of variances attributable to recruiting centre was lower for patient reported outcomes (PROs: pain, HAQ, patient global) compared with objective measures (joint counts, ESR, physician global) in all models. In the full model, variance in PROs attributable to recruiting...
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Dirven Linda
2012-07-01
Full Text Available Abstract Objective To determine the prevalence of vertebral fractures (VFs after 5 years of disease activity score (DAS-steered treatment in patients with early rheumatoid arthritis (RA and to investigate the association of VFs with disease activity, functional ability and bone mineral density (BMD over time. Methods Five-year radiographs of the spine of 275 patients in the BeSt study, a randomized trial comparing four treatment strategies, were used. Treatment was DAS-steered (DAS ≤ 2.4. A height reduction >20% in one vertebra was defined a vertebral fracture. With linear mixed models, DAS and Health Assessment Questionnaire (HAQ scores over 5 years were compared for patients with and without VFs. With generalized estimating equations the association between BMD and VFs was determined. Results VFs were observed in 41/275 patients (15%. No difference in prevalence was found when stratified for gender, prednisone use and menopausal status. Disease activity over time was higher in patients with VFs, mean difference 0.20 (95% CI: 0.05-0.36, and also HAQ scores were higher, independent of disease activity, with a mean difference of 0.12 (95% CI: 0.02-0.2. Age was associated with VFs (OR 1.06, 95% CI: 1.02-1.09, mean BMD in spine and hip over time were not (OR 95% CI, 0.99: 0.78-1.25 and 0.94: 0.65-1.36, respectively. Conclusion After 5 years of DAS-steered treatment, 15% of these RA patients had VFs. Higher age was associated with the presence of VFs, mean BMD in hip and spine were not. Patients with VFs have greater functional disability over time and a higher disease activity, suggesting that VFs may be prevented by optimal disease activity suppression.
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Muquith Mohammed A
2012-08-01
Full Text Available Abstract Background Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM. The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ into Bengali (B-FIQ and to test its validity and reliability in Bangladeshi patients with FM. Methods The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ, selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA patients also completed the B-FIQ. Results For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (α = 0.73 and the total scale (α = 0.83. With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86 and individual items (r = 0.73-0.86, except anxiety (r = 0.27 and morning tiredness (r = 0.64. Conclusion This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.
Muquith, Mohammed A; Islam, Md Nazrul; Haq, Syed A; Ten Klooster, Peter M; Rasker, Johannes J; Yunus, Muhammad B
2012-08-27
Currently, no validated instruments are available to measure the health status of Bangladeshi patients with fibromyalgia (FM). The aims of this study were to cross-culturally adapt the modified Fibromyalgia Impact Questionnaire (FIQ) into Bengali (B-FIQ) and to test its validity and reliability in Bangladeshi patients with FM. The FIQ was translated following cross-cultural adaptation guidelines and pretested in 30 female patients with FM. Next, the adapted B-FIQ was physician-administered to 102 consecutive female FM patients together with the Health Assessment Questionnaire (HAQ), selected subscales of the SF-36, and visual analog scales for current clinical symptoms. A tender point count (TPC) was performed by an experienced rheumatologist. Forty randomly selected patients completed the B-FIQ again after 7 days. Two control groups of 50 healthy people and 50 rheumatoid arthritis (RA) patients also completed the B-FIQ. For the final B-FIQ, five physical function sub-items were replaced with culturally appropriate equivalents. Internal consistency was adequate for both the 11-item physical function subscale (α = 0.73) and the total scale (α = 0.83). With exception of the physical function subscale, expected correlations were generally observed between the B-FIQ items and selected subscales of the SF-36, HAQ, clinical symptoms, and TPC. The B-FIQ was able to discriminate between FM patients and healthy controls and between FM patients and RA patients. Test-retest reliability was adequate for the physical function subscale (r = 0.86) and individual items (r = 0.73-0.86), except anxiety (r = 0.27) and morning tiredness (r = 0.64). This study supports the reliability and validity of the B-FIQ as a measure of functional disability and health status in Bangladeshi women with FM.
Amendola, Fernanda; Alvarenga, Márcia Regina Martins; Latorre, Maria do Rosário Dias de Oliveira; Oliveira, Maria Amélia de Campos
2014-02-01
This exploratory, descriptive, cross-sectional, and quantitative study aimed to develop and validate an index of family vulnerability to disability and dependence (FVI-DD). This study was adapted from the Family Development Index, with the addition of social and health indicators of disability and dependence. The instrument was applied to 248 families in the city of Sao Paulo, followed by exploratory factor analysis. Factor validation was performed using the concurrent and discriminant validity of the Lawton scale and Katz Index. The descriptive level adopted for the study was p DD was validated using both the Lawton scale and Katz Index. We conclude that FVI-DD can accurately and reliably assess family vulnerability to disability and dependence.
The Responsiveness and Interpretability of the Shoulder Pain and Disability Index
Thoomes-de Graaf, Marloes; Scholten-Peeters, Wendy; Duijn, Edwin; Karel, Yasmaine; de Vet, Henrica C W; Koes, Bart; Verhagen, Arianne
2017-01-01
Study Design Clinical measurement study; prospective cohort design. Background Shoulder pain is a common disorder and treatment is most often focused on a reduction of pain and functional disabilities. Several reviews have encouraged the use of the Shoulder Pain and Disability Index (SPADI) to
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E. S. Zhugrova
2008-01-01
Full Text Available Abstract. Rheumatoid arthritis (RA is a chronic autoimmune systemic disease with predominantly destructive lesions of peripheral joints, with prevalence of 0.6 to 1.6% in general population. An important pathogenetic role in this disease is now attributed to imbalance between pro- and antiinflammatory cytokines. Clinical introduction of biological preparations, such as Infliximab (monoclonal antibodies to TNFα within last years have changed therapeutic approach to treatment of rheumatic diseases. The aim of our research was to evaluate dynamics of pro- and antiinflammatory cytokine profile in the patients with rheumatoid arthritis (RА during combined therapy with Infliximab and Methotrexate (MT. The study included 30 patients (27 females, 3 males, mean age of 52.5±2.0 years who received combined therapy with МТ and Infliximab (Inx. Inx was initially injected at a single dose of 3 mg/kg intravenously, followed by administration 2 and 6 weeks later, and then repeated every 8 weeks. Regular examination of the patients included clinical and laboratory studies (ESR, levels of IL-6, IL-8, TNFα, IL-4, IL-10, GSM-CSF, IFNγ. Levels of antibodies against Infliximab in the groups of RА patients were determined before treatment and 22 weeks later. Efficiency of the therapy was estimated according to DAS28 3V Index and to HAQ Questionnaire.Upon decreased activity of disease, as assessed by DAS28, and improvement of HAQ parameters, a marked decrease in proinflammatory cytokine levels (IL-6, IL-8, TNFα was detected, that confirming a pathogenetic significance of cytokine in RА patients. In patients with marked clinical effect (group I, an initially normal contents of TNFα was found in blood serum, and this group showed better response to Infliximab therapy, than groups II and III (resp., moderate and absent response with initially high contents of TNFα and other cytokines, that was proven by correlations with ACR criteria and HAQ functional index
Konijn, N P C; van Tuyl, L H D; Bultink, I E M; Lems, W F; Earthman, C P; van Bokhorst-de van der Schueren, M A E
2014-01-01
To examine differences between the assessment of body composition by body mass index (BMI) and bioelectrical impedance analysis (BIA) in patients with rheumatoid arthritis (RA). The body composition of RA patients was assessed during their visit to the outpatient department of a Dutch academic hospital using BMI, fat-free mass index (FFMI), and fat mass index (FMI). FFMI and FMI were determined by single-frequency BIA. Sixty-five consecutive RA patients (83% women, mean age 58 years, median disease duration 7 years) with moderately active disease [mean Disease Activity Score using 28 joint counts (DAS28) = 3.40; mean Rheumatoid Arthritis Disease Activity Index (RADAI) score = 3.49] and moderate disability [mean Health Assessment Questionnaire (HAQ) score = 0.87] were included. Based on BMI, 2% of our study population were underweight, 45% had a healthy body composition, and 54% were overweight or obese. Based on BIA, 18% of the patients showed a low FFMI and 74% had a high or very high FMI. Low FFMI was found in 44% of the women with a normal BMI, and high FMI was found in 40% of the women and 75% of the men with a normal BMI. A high frequency of unfavourable body composition, predominantly reduced FFMI and elevated FMI, was found in a cohort of RA patients with moderately active disease, turning BMI into an unreliable method for assessment of body composition in RA. BIA, however, might be the preferred method to assess FFMI and FMI in RA patients in clinical practice, as it is easy to use and relatively inexpensive.
Rasch scaling of the Oswestry Disability Index and the Roland-Morris Disability Questionnaire
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Lauridsen, Henrik Hein; Hartvigsen, Jan
Questionnaire (RMQ) and the Oswestry Disability Index (ODI), however, only few studies have tested these questionnaires using Rasch analysis. This study used Rasch scaling to test the construct validity of the Danish versions of the RMQ (23-item Patrick version) and the ODI (version 2.1a) in a heterogeneous...... on an ordinal scale into interval scaling in addition to optimising the fit of instrument items to the target population. In low back pain research the two most commonly used and well-validated questionnaires to assess functional status in patients with low back pain are the Roland-Morris Disability...
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Caballero, Carlo Vinicio; Rozenboim, Jonathan; Afanador, Ernesto; Venegas, Carla; Rocha, Felix; Carpio, Marjorie; Alonso, Luz.
2005-01-01
There are few studies that have demonstrated the usefulness of prognostic factors in patients with RA using only variables commonly recorded in the clinical records at the beginning of the disease. The aim of our study was to elaborate a simple questionnaire (PPS: Poor Prognosis Score) to evaluate risk factors at the beginning of the illness classifying it in a mild, moderate or severe. We want to know if this simple questionnaire correlates with known variables of worst outcome such as incapacity, mortality, utilization of health services and surgery. Prognostic factors that have shown an association with the worse outcome of RA in different studies were revised. According to literature and published relative risks (RR) of associations, these can be classified as mild (RR 2.0 and 3.0). In accordance with the levels of association, scores were given to the risk factors being 1 for those prognostic factors with mild association, 2 for those with moderate association, and 3 for those strongly associated with a poor prognosis. The PPS was created with the scores assigned. We excluded from the questionnaire variables not use ID a routine practice in our country such as HLA or although available of high cost for our country as the anti-citrulline antibodies. The chosen variables for the questionnaire were: Mild association: (1 point) age, sex, menopause, smoking, incomplete high school, low socioeconomic status, and depression. Moderate association: (2 points) ESR more than 40, C- Reactive protein 6 mg/dl, knee, elbows and, hands inflammation, and duration of RA more than 6 months without a DMARd treatment. Strong association: (3 points) Rheumatoid factor, presence of hand X- ray hand joints more than 20 joints affected at the beginning of disease, HAQ more than 1, and presence of extraarticular manifestations. Patients were classified in mild RA if the score were less than 10 points, moderate RA between 11 and 20 points and severe RA if the score was more than 20
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Loppenthin, K.; Esbensen, B. A.; Østergaard, M.
2015-01-01
. An inverse univariate association was found between moderate to vigorous physical activity, and fatigue (MFI mental, MFI activity, MFI physical and MFI general), sleep, diabetes, depression, pain, patient global assessment, HAQ and disease activity. The multivariate prediction model demonstrated that fatigue......The aim of this study was to examine physical activity behavior in patients with rheumatoid arthritis and to identify potential correlates of regular physical activity including fatigue, sleep, pain, physical function and disease activity. A total of 443 patients were recruited from a rheumatology...... outpatient clinic and included in this cross-sectional study. Physical activity was assessed by a four-class questionnaire, in addition to the Physical Activity Scale. Other instruments included the Multidimensional Fatigue Inventory (MFI), the Pittsburgh Sleep Quality Index and the Health Assessment...
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B Siddhartha Kumar
2017-01-01
Interpretation & conclusions: In adult patients with RA, in the setting where illiteracy is high, CDAI emerged as the preferred choice for rapid assessment of severity of disease at the time of initial presentation.
PROXIMAL DISABILITY AND SPINAL DEFORMITY INDEX IN PATIENTS WITH PROXIMAL FEMUR FRACTURES
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Sylvio Mistro Neto
2015-12-01
Full Text Available Objective : To evaluate the quality of life related to the spine in patients with proximal femoral fractures. Methods : Study conducted in a tertiary public hospital in patients with proximal femoral fractures caused by low-energy trauma, through the Oswestry Disability Index questionnaire to asses complaints related to the spine at the time of life prior to the femoral fracture. The thoracic and lumbar spine of patients were also evaluated applying the radiographic index described by Gennant (Spinal Deformity Index, which assesses the number and severity of fractures. Results : Seventeen subjects completed the study. All had some degree of vertebral fracture. Patients were classified in the categories of severe and very severe disability in the questionnaire about quality of life. It was found that the higher SDI, the better the quality of life. Conclusion : There is a strong association of disability related to the spine in patients with proximal femoral fracture, and this complaint must be systematically evaluated in patients with appendicular fracture.
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Mihaela Chicu
2016-12-01
Full Text Available Staging in rheumatoid arthritis (RA and evaluating the effectiveness of drug treatment involves the determination of radiological scores (for narrowing and erosions, this being the most specific changes and most commonly found in RA.Matherials and methods: Our study was condacted over a period of 12 months in Medical Rehabilitation Clinic of „Sf. Spiridon” Iasi Hospital, on a group of 40 women patients with RA in various stages of evolution. X-ray examination was done on hands and feet at the beginning and the end of the study period. There were computed radiographic Sharp scores for narrowing and erosions and the total score. Erosions were examined for 16 joints in each hand. For narrowing five joints were evaluated. For accuracy, radiological examination was done on mammography film. Rezults:After calculating Sharp scores - Van der Heide version - I compared them with the levels of clinical (HAQ, NAT, NAD, DAS28, bone densitometry and laboratory (ESR, CRP, rheumatoid factor, IL-1β parameters.Conclusions: The values of radiological scores for narrowing and erosions are directly correlate with DAS28, HAQ, rheumatoid factors levels and IgG values, and indirectly correlated with IL-1β levels.
Efficacy of extremely low-frequency magnetic field in fibromyalgia pain: A pilot study.
Paolucci, Teresa; Piccinini, Giulia; Iosa, Marco; Piermattei, Cristina; de Angelis, Simona; Grasso, Maria Rosaria; Zangrando, Federico; Saraceni, Vincenzo Maria
2016-01-01
The purpose of this pilot study was to determine the efficacy of an extremely low-frequency magnetic field (ELF-MF) in decreasing chronic pain in fibromyalgia (FM) patients. Thirty-seven females were recruited and randomized into two groups: one group was first exposed to systemic ELF-MF therapy (100 microtesla, 1 to 80 Hz) and then to sham therapy, and the other group received the opposite sequence of intervention. Pain, FM-related symptoms, and the ability to perform daily tasks were measured using the Visual Analog Scale, Fibromyalgia Impact Questionnaire (FIQ), Fibromyalgia Assessment Scale (FAS), and Health Assessment Questionnaire (HAQ) at baseline, end of first treatment cycle, beginning of second treatment cycle (after 1 mo washout), end of second treatment cycle, and end of 1 mo follow-up. ELF-MF treatment significantly reduced pain, which increased on cessation of therapy but remained significantly lower than baseline levels. Short-term benefits were also observed in FIQ, FAS, and HAQ scores, with less significant effects seen in the medium term. ELF-MF therapy can be recommended as part of a multimodal approach for mitigating pain in FM subjects and improving the efficacy of drug therapy or physiotherapy.
Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis.
Adly, Afnan Sedky; Adly, Aya Sedky; Adly, Mahmoud Sedky; Serry, Zahra M H
2017-07-01
The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm 2 , power 100 mW, power density 100 mW/cm 2 , energy dosage 4 J, energy density 4 J/cm 2 , irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p rheumatoid arthritis.
Wada, Tomoki; Yasunaga, Hideo; Yamana, Hayato; Matsui, Hiroki; Fushimi, Kiyohide; Morimura, Naoto
2018-03-01
There was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding. This retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort. The derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794-0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855-0.857). Severe physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma. Copyright © 2018 Elsevier Ltd. All rights reserved.
Sugihara, Takahiko; Ishizaki, Tatsuro; Hosoya, Tadashi; Iga, Shoko; Yokoyama, Waka; Hirano, Fumio; Miyasaka, Nobuyuki; Harigai, Masayoshi
2015-05-01
The aim of this study was to evaluate structural damage and physical disability in patients with elderly-onset RA (EORA) who were treated in clinical practice with a therapeutic strategy targeting low disease activity (LDA). Data from 151 MTX-naive patients (mean age 74.9 years) with EORA from a prospective, monocentric registry were analysed. Treatment was adjusted every 3 months targeting LDA [28-joint DAS using ESR (DAS28-ESR) target strategy was observed in 83.4% of the 151 patients at week 24 and in 75.5% at week 52. At week 52, 67.6% of the patients were receiving a nbDMARD alone, 31.0% a TNFi with or without MTX and 1.4% tocilizumab. At week 52, structural remission (ΔmTSS/yr ≤0.5) was achieved in 49.7% of the patients, functional remission (HAQ-DI ≤0.5) in 63.4% and LDA in 51.0%. Clinical responses at weeks 12 and 24 were significant independent predictors of CRRP. Cumulative disease activity during the first 12 weeks predicted CRRP with a C-statistic of 0.888. Achieving structural remission, functional remission and LDA in clinical practice in EORA patients are realistic goals. Our results indicate significant benefits for a therapeutic strategy targeting LDA for EORA patients in clinical practice. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Association between intervertebral disc degeneration and the Oswestry Disability Index.
Middendorp, Marcus; Vogl, Thomas J; Kollias, Konstantinos; Kafchitsas, Konstantinos; Khan, M Fawad; Maataoui, Adel
2017-01-01
Low back pain and lumbar intervertebral disc degeneration (IDD) are common findings. Valid data on correlation between clinical pain scores and grades of IDD are not available. To investigate the correlation of intervertebral disc degeneration (IDD) at lumbar levels L4/5 and L5/S1 and the Oswestry Disability Index (ODI). The lumbar discs L4/5 and L5/S1 of 591 patients were evaluated according to the 5-point (Grade I to Grade V) grading system as published by Pfirrmann et al. Functional status was assessed using the Oswestry Disability Index. Spearman's coefficient of rank correlation was used for statistical analysis (p disability (ODI score between 21 and 40%). There was a weak, but statistically significant positive correlation between IDD and ODI for both evaluated lumbar levels. Increased lumbar IDD in MRI goes along with an increased ODI. Thus, MRI is a strong indicator of a patient's clinical appearance. However, low back pain cannot be explained by imaging alone. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.
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Marwa Niazy
2017-10-01
Full Text Available Aim of the work: To assess the urological disorders in rheumatoid arthritis (RA patients, analyse the risk factors and to find their relation to disease activity and functional status. Patients and methods: 291 RA patients (253 females and 38 males; F:M 6.7:1 and 242 matched controls were included. Urological disorders in the form of urinary tract infections (UTI, urolithiasis and acute urine retention (AUR were assessed, risk factors were analysed. Disease activity score (DAS-28 and modified health assessment questionnaire (mHAQ were calculated. Results: RA patients had more frequent urological disorders (38.14% than controls (20.66%, more UTI (p < 0.001 and this difference persisted in females (p < 0.001. Urolithiasis tended to be more frequent in RA patients (p = 0.3; the difference was significant between the female patients and controls (p = 0.04. Urinary stones were comparable between the male patients and controls (p = 0.2. RA patients had more AUR (4.8% than the controls (2.1% (p = 0.07. Asthmatic patients particularly the females had more UTI (p = 0.001 and p < 0.001 respectively. UTIs were observed with higher steroid doses (p = 0.04 and urolithiasis were noticed more in hypertensive female patients (p = 0.03. Patients with higher DAS-28 and mHAQ developed more urological comorbidities (p0.49 and p = 0.82 respectively. UTI and urolithiasis were detected in patients with higher DAS 28 (p = 0.1 and p = 0.4 respectively. Conclusion: RA patients were found to have more urological disorders. Bronchial asthma, hypertension and higher steroid doses may increase risk for urinary comorbidities in RA. Patients with higher DAS28 and mHAQ had more urological comorbidities, however without statistically significant difference.
Hewlett, Sarah; Kirwan, John; Bode, Christina; Cramp, Fiona; Carmona, Loreto; Dures, Emma; Englbrecht, Matthias; Fransen, Jaap; Greenwood, Rosemary; Hagel, Sofia; van de Laar, Maart; Molto, Anna; Nicklin, Joanna; Petersson, Ingemar F; Redondo, Marta; Schett, Georg; Gossec, Laure
2018-02-01
To evaluate the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ), the revised Bristol Rheumatoid Arthritis Numerical Rating Scales (BRAF-NRS V2) and the Rheumatoid Arthritis Impact of Disease (RAID) scale in six countries. We surveyed RA patients in France, Germany, The Netherlands, Spain, Sweden and the UK, including the HAQ, 36-item Short Form Health Survey (SF-36) and potential revisions of the BRAF-NRS coping and Spanish RAID coping items. Factor structure and internal consistency were examined by factor analysis and Cronbach's α and construct validity by Spearman's correlation. A total of 1276 patients participated (76% female, 25% with a disease duration <5 years, median HAQ 1.0). The original BRAF-MDQ four-factor structure and RAID single-factor structure were confirmed in every country with ⩾66% of variation in items explained by each factor and all item factor loadings of 0.71-0.98. Internal consistency for the BRAF-MDQ total and subscales was a Cronbach's α of 0.75-0.96 and for RAID, 0.93-0.96. Fatigue construct validity was shown for the BRAF-MDQ and BRAF-NRS severity and effect scales, correlated internally with SF-36 vitality and with RAID fatigue (r = 0.63-0.93). Broader construct validity for the BRAFs and RAID was shown by correlation with each other, HAQ and SF-36 domains (r = 0.46-0.82), with similar patterns in individual countries. The revised BRAF-NRS V2 Coping item had stronger validity than the original in all analyses. The revised Spanish RAID coping item performed as well as the original. Across six European countries, the BRAF-MDQ identifies the same four aspects of fatigue, and along with the RAID, shows strong factor structure and internal consistency and moderate-good construct validity. The revised BRAF-NRS V2 shows improved construct validity and replaces the original. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Naranjo, Antonio; Cáceres, Laura; Hernández-Beriaín, José Ángel; Francisco, Félix; Ojeda, Soledad; Talaverano, Sigrid; Nóvoa-Medina, Javier; Martín, José Adán; Delgado, Esmeralda; Trujillo, Elisa; Álvarez, Fátima; Magdalena, Laura; Rodríguez-Lozano, Carlos
2016-01-01
To analyze compliance with t2t clinical practice guidelines. Cross-sectional observational study in consecutive patients with rheumatoid arthritis (RA) in 5 hospitals in the Canary Islands. Patients filled out activity scales, HAQ and answered the question of whether the doctor had explained the treatment target. The rheumatologist also collected: visits in the past year, use of activity indices and HAQ, DAS28 of current visit and date of the next visit. The percentage of compliance to indicators based on the t2t recommendations (R) 1, 3, 5-7 and 10 was analyzed. A total of 343 patients were recruited, 77% female, mean age 57, RA duration of 10 years. Median visits in the last year were 3 and mean time between last and current visit was 5.6 months. A total of 93% of the patients were treated with DMARDs and 44% were in remission by DAS (R1). In the previous visit, documented joint count was present in 85%, a HAQ in 19%, patient VAS in 41%, and a DAS28 in 35% of the patients (R6). The next visit was scheduled at an average of 4.3 months (R5). In 64% of patients with DAS28> 3.2 a visit between one and 3 months was scheduled (R5). A total of 96% of patients said they had been informed of the treatment target (R10). Variability between centers existed but was moderate. The only factor determining the performance of a DAS28 in the last visit was the patient's center of origin. The Canary Island centers studied achieved high levels of remission and low activity in their patients. The performance of composite indices and follow-up frequency recommended by the t2t are met, although there is room for improvement. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Rosa-Gonçalves, Diana; Bernardes, Miguel; Costa, Lúcia
2017-04-08
To analyze the Health related Quality of Life (HRQoL) and physical function in rheumatoid arthritis (RA) patients and compare it with the general population. We also intended to analyze about disease activity influence in HRQoL and functional capacity, as well as determine potential determinants for these outcomes. A cross-sectional study was conducted in RA patients from a university hospital of Portugal. We obtained Short Form 36, EuroQoL 5D, health assessment questionnaire, visual analog scale for pain and patient's assessment of disease activity. Comparisons between SF-36 and EQ-5D values with our population reference values were conducted using the Mann-Whitney test. Data were compared in different levels of disease activity, using Kruskal Wallis test and Fisher's exact test. A multiple regression analysis was conducted to identify the potential determinants of outcomes. RA sample showed significantly lower values than the portuguese general population on physical summary measure of SF-36 (median=32 vs. 50, p<0.001) and EQ-5D (median=0.620 vs. 0.758 respectively; p<0.001). Lower disease activity levels had better PROs and this was true even when compared patients achieving remission with those in low disease activity. The HAQ (r 2 =67%), VAS-P (r 2 =62%) and VAS-DA (r 2 =58%) were the variables that strongly related to SF-36. Considering HAQ, the strongest relation was found with VAS-P, VAS-DA and age (r 2 =60%, 61% and 33%, respectively). Multiple regression analysis identified HAQ, VAS-P and educational status as determinants of the HRQoL; age, female gender, employment, VAS-P and VAS-DA as determinants of physical function. Impairment of HRQoL in RA patients is enormous. We found significant differences between different levels of disease activity, showing higher HRQoL and functional capacity at lower disease activity levels. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights
Psychometric properties of the Oswestry Disability Index.
Saltychev, Mikhail; Mattie, Ryan; McCormick, Zachary; Bärlund, Esa; Laimi, Katri
2017-09-01
The aim of this study was to investigate the psychometric properties of the Oswestry Disability Index (ODI) in a large cross-sectional cohort of individuals with chronic low back pain by defining its internal consistency, construct structure and validity, and its ability to differentiate between different degrees of functional limitation. A total of 837 consecutive outpatient patients with low back pain were studied. The internal consistency of ODI was assessed by Cronbach's α, construct structure by exploratory factor analysis, construct validity by confirmatory factor analysis, and discrimination was determined by item response theory analysis. The ODI showed good internal consistency (α=0.85). Explanatory factor analysis showed that ODI is a unidimensional test measuring functional level and nothing else. The confirmatory factor analysis showed that the standardized regression weights of all ODI items were relatively high, varying from 0.5 to 0.7. The item response theory analysis suggested that eight out of 10 ODI items have a close to perfect ability to measure functional limitations in accordance with the actual severity of disability experienced by the respondents. Discrimination of all the items was high to perfect (1.08-2.01). The test characteristic and test information curves showed that the discriminative ability of the ODI is superior at higher levels of disability. The present data showed that the ODI is an internally consistent, unidimensional scale with overall excellent construct validity and ability to discriminate the severity of functional disability. The analysis suggests that the ODI may better distinguish between the relative degrees of function at above-average disability levels.
Gheita, Tamer A; Sayed, Safaa; Gheita, Heba A; Kenawy, Sanaa A
2016-03-01
To assess vitamin D levels in rheumatoid arthritis (RA) patients and to find their relation to clinical parameters, fibromyalgia syndrome (FMS), quality of life (QoL) and disease activity. The study included 63 RA patients and 62 controls. Clinical examination and laboratory investigations were performed. For patients, the Disease Activity Score (DAS-28), QoL index, Health Assessment Questionnaire II (HAQ II) and Modified Larsen score were calculated. 25-OH-vitamin D was measured in patients and controls. The patients' mean age was 41.59 ± 9.69 years and disease duration 5.89 ± 3.67 years. The level of vitamin D in RA patients was significantly lower (23.11 ± 12.71 ng/mL) than that in the controls (32.59 ± 13.06 ng/mL) (P = 0.005) being deficient in 50.8%, insufficient in 23.8% and normal in 25.4%. The RA patients with FMS (n = 33) had significantly lower levels of vitamin D (19.08 ± 10.59 ng/mL) than those without (27.55 ± 13.51 ng/mL) (P = 0.008). The difference was significant on comparing those receiving hydroxychloroquine (17.39 ± 7.84 ng/mL) to those not (31.85 ± 13.85 ng/mL) (P < 0.001). Vitamin D significantly correlated with QoL index (r = 0.58, P < 0.001) and negatively with HAQ II (r = -0.36, P = 0.004) and BMI (r = -0.39, P = 0.001). Special attention is required regarding vitamin D levels in RA patients with FMS and decreased QoL. Vitamin D should be corrected and supplementation considered among the RA management armamentarium. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Ambriz Murillo, Yesenia; Menor Almagro, Raul; Campos-González, Israel David; Cardiel, Mario H
2015-01-01
Chronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (Prenal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. The HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact diseases and therefore should receive more attention. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.
Directory of Open Access Journals (Sweden)
Geraldo Magela Salomé
2009-01-01
Full Text Available OBJETIVO: Avaliar a capacidade funcional de pessoas com diabetes mellitus e pé ulcerado. MÉTODOS: Estudo analítico, transversal e comparativo, realizado em hospital público do município de São Paulo, sendo os dados coletados no período de 2 de junho a 30 julho de 2008. Foram selecionados para compor o Grupo de Estudo, 20 pacientes com diabetes mellitus e pé ulcerado; para o Grupo Controle 20 pessoas com diagnóstico médico de diabetes mellitus, sem úlcera no pé. O instrumento utilizado foi Health Assessment Questionnaire-20. RESULTADOS: O grupo estudo diferiu do grupo controle, quanto ao escores HAQ-20, bem como em relação aos componentes 1,2,3,5,6,7 e 8. Também apresentaram diferença estatística significante (POBJETIVO: Evaluar la capacidad funcional de personas con diabetes mellitus y pié ulcerado. MÉTODOS: Se trata de un estudio analítico, transversal y comparativo, realizado en un hospital público del municipio de Sao Paulo, cuyos datos fueron recolectados en el período del 2 de junio al 30 julio del 2008. Fueron seleccionados para componer el Grupo de Estudio, 20 pacientes con diabetes mellitus y pié ulcerado; para el Grupo Control 20 personas con diagnóstico médico de diabetes mellitus, sin úlcera en el pié. El instrumento utilizado fue el Health Assessment Questionnaire-20. RESULTADOS: El grupo de estudio difirió del grupo control, en cuanto a los escores HAQ-20, así como en relación a los componentes 1,2,3,5,6,7 y 8. También presentaron diferencia estadísticamente significativa (POBJECTIVE: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. METHODS: A cross sectional descriptive comparative study was conducted in a public hospital in the district of São Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The
Association between facet joint osteoarthritis and the Oswestry Disability Index.
Maataoui, Adel; Vogl, Thomas J; Middendorp, Marcus; Kafchitsas, Konstantinos; Khan, M Fawad
2014-11-28
To investigate the correlation of facet joint osteoarthritis (FJOA) at lumbar levels L4/L5 and L5/S1 and the Oswestry Disability Index (ODI). The study involved lumbar MRIs of 591 patients with a mean age of 47.3 years. The MRIs of the lumbar spine were performed on a 1.5 Tesla scanner (Magnetom(®) Avanto, Siemens AG, Erlangen, Germany) using a dedicated receive only spine coil. After initial blinding, each dataset was evaluated by 2 board certified radiologist with more than 5 years experience in musculoskeletal imaging. In total 2364 facet joints were graded. Degenerative changes of the facet joints were evaluated according to the 4-point scale as proposed by Weishaupt et al Functional status was assessed using the ODI. The index is scored from 0 to 100 and interpreted as follows: 0%-20%, minimal disability; 20%-40%, moderate disability; 40%-60%, severe disability; 60%-80%, crippled; 80%-100%, patients are bedbound. Spearman's coefficient of rank correlation was used for statistical analysis, with significance set at P disability had a minimum of 0% and a maximum of 91.11% with an arithmetic mean of 32.77% ± 17.02%. The majority of patients (48.39%) had moderate functional disability (21%-40%). There was no significant correlation between FJOA and ODI on both sides of lumbar level L4/5 and on the left side of lumbar level L5/S1. A weak positive correlation was evaluated between ODI and FJOA on the right side of lumbar level L5/S1. The missing correlation of FJOA and ODI confirms our clinical experience that imaging alone is an insufficient approach explaining low back pain. Clinical correlation is imperative for an adequate diagnostic advance in patients with low back pain.
Jackson, Judy; Fiddler, Maggie; Kapur, Navneet; Wells, Adrian; Tomenson, Barbara; Creed, Francis
2006-04-01
In consecutive new outpatients, we aimed to assess whether somatization and health anxiety predicted health care use and quality of life 6 months later in all patients or in those without demonstrable abnormalities. On the first clinic visit, participants completed the Illness Perception Questionnaire (IPQ), the Health Anxiety Questionnaire (HAQ), and the Hospital Anxiety and Depression Scale (HADS). Outcome was assessed as: (a) the number of medical consultations over the subsequent 6 months, extracted from medical records, and (b) Short-Form Health Survey 36 (SF36) physical component score 6 months after index clinic visit. A total of 295 patients were recruited (77% response rate), and medical consultation data were available for 275. The number of bodily symptoms was associated with both outcomes in linear fashion (Psomatization and hypochondriasis.
Cardiff acne disability index in Sarawak, Malaysia.
Yap, Felix Boon-Bin
2012-05-01
Acne is considered a cosmetic nuisance in Malaysia since no insurance coverage is provided for its treatment. Its psychological impact is unknown. The aim of this study is to determine the impact of acne on quality of life and its relationship with severity. A cross-sectional study using the Cardiff acne disability index (CADI) and Global Acne Grading System for acne severity grading was done in three government-run dermatology clinics in Sarawak, Malaysia. The study cohort of 200 patients had a mean CADI score of 5.1. Most of the patients (59.5%) had mild CADI impairment, with the domain of feelings most affected. Patients with a family income 0.05). The correlation between CADI and mild acne severity was low (Pearson correlation coefficient=0.35; pSarawak was moderate and must be addressed. It should be viewed as a psychologically disabling disease requiring optimal management and resource allocation.
Lochhead, Lois E; MacMillan, Peter D
2013-01-01
The Oswestry disability index (ODI) is the most widely used measure of perceived disability for low back conditions. It has been adopted without adaptation in functional capacity evaluation (FCE). Rigorous testing of the ODI with modern psychometric methods, in this setting, is warranted. To determine the psychometric properties of the ODI in FCE: unidimensionality; differential item functioning; item coverage and to identify poorly functioning items, allowing for improvement of these items and recalibration of the scale. Rasch analysis, specifically Masters' partial credit model, was conducted on data. 133 work-disabled individuals presenting for FCE in northern British Columbia, Canada. All items had one poorly functioning option. Items were rescaled from six categories to five, improving the psychometric properties of the ODI as a unidimensional (disability due to back pain) scale. Item difficulty range is sufficient for a population with mild to severe disability. Although two of the ten ODI items functioned marginally unsatisfactorily in the unrevised state, the 5-option revised ODI appears superior. Use in clinical settings across a broad spectrum of disability levels could help establish its psychometric properties. Health professionals should be aware that the ODI may perform differently depending on client population.
Mease, Philip J; Karki, Chitra; Palmer, Jacqueline B; Etzel, Carol J; Kavanaugh, Arthur; Ritchlin, Christopher T; Malley, Wendi; Herrera, Vivian; Tran, Melody; Greenberg, Jeffrey D
2017-08-01
Psoriatic arthritis (PsA) is commonly comorbid with psoriasis; the extent of skin lesions is a major contributor to psoriatic disease severity/burden. We evaluated whether extent of skin involvement with psoriasis [body surface area (BSA) > 3% vs ≤ 3%] affects overall clinical and patient-reported outcomes (PRO) in patients with PsA. Using the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and PRO at registry enrollment were assessed for patients with PsA aged ≥ 18 years with BSA > 3% versus ≤ 3%. Regression models were used to evaluate associations of BSA level with outcome [modified minimal disease activity (MDA), Health Assessment Questionnaire (HAQ) score, patient-reported pain and fatigue, and the Work Productivity and Activity Impairment questionnaire score]. Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologics, disease-modifying antirheumatic drug, and prednisone use. This analysis included 1240 patients with PsA with known BSA level (n = 451, BSA > 3%; n = 789, BSA ≤ 3%). After adjusting for potential confounding variables, patients with BSA > 3% versus ≤ 3% had greater patient-reported pain and fatigue and higher HAQ scores (p = 2.33 × 10 -8 , p = 0.002, and p = 1.21 × 10 -7 , respectively), were 1.7× more likely not to be in modified MDA (95% CI 1.21-2.41, p = 0.002), and were 2.1× more likely to have overall work impairment (1.37-3.21, p = 0.0001). These Corrona Registry data show that substantial skin involvement (BSA > 3%) is associated with greater PsA disease burden, underscoring the importance of assessing and effectively managing psoriasis in patients with PsA because this may be a contributing factor in PsA severity.
Directory of Open Access Journals (Sweden)
Kotenko К.V.
2013-12-01
Full Text Available Objective: the comparative research of phytocomplex phonophoresis rehabilitation efficiency of patients with knee joint osteoarthrosis. Material and Methods, the study included 100 patients with knee joint osteoarthrosis; the effectiveness evaluation was made in terms of American Rheumatologic Association (ARA, the data of visual-analogue scale (VAS and goniometry, indexes WOMAC, Lekena and the index of activity SIA, criteria of life quality questionnaire HAQ. Results. The complex use of phyto- and ultrasonic therapy in conjunction with an medicamentous treatment of patients have a more pronounced positive effect on pain (by 26-28%, function of the knee joint (by 22-26% and the quality of life (by 24% compared to treatment with medicamentous only treatment or combined using ultrasonic and medicamentous therapy. Conclusion. The new method of phytocomplex phonophoresis leads to the expressed regress of clinical symptomatology at patients with knee joint osteoarthrosis, improves locomotor function of knee joints and quality of life.
Tofacitinib for Psoriatic Arthritis in Patients with an Inadequate Response to TNF Inhibitors.
Gladman, Dafna; Rigby, William; Azevedo, Valderilio F; Behrens, Frank; Blanco, Ricardo; Kaszuba, Andrzej; Kudlacz, Elizabeth; Wang, Cunshan; Menon, Sujatha; Hendrikx, Thijs; Kanik, Keith S
2017-10-19
Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who had previously had an inadequate response to tumor necrosis factor (TNF) inhibitors. In this 6-month randomized, placebo-controlled, double-blind, phase 3 trial, we randomly assigned 395 patients, in a 2:2:1:1 ratio, to four regimens: 5 mg of tofacitinib administered orally twice daily (132 patients); 10 mg of tofacitinib twice daily (132 patients); placebo, with a switch to 5 mg of tofacitinib twice daily at 3 months (66 patients); or placebo, with a switch to 10 mg of tofacitinib twice daily at 3 months (65 patients). Data from the patients who received placebo during the first 3 months of the trial were pooled. The primary end points were the percentage of patients who had at least 20% improvement according to the criteria of the American College of Rheumatology (ACR20 response) and the change from baseline score on the Health Assessment Questionnaire-Disability Index (HAQ-DI; scores range from 0 to 3, with higher scores indicating greater disability) at the month 3 analysis. At 3 months, the rates of ACR20 response were 50% with the 5-mg dose of tofacitinib and 47% with the 10-mg dose, as compared with 24% with placebo (Ptofacitinib continuously and in 6% who received the 10-mg dose continuously. Over the course of 6 months, there were four serious infections, three herpes zoster infections, one myocardial infarction, and one ischemic stroke among the patients who received tofacitinib continuously. Elevations of aspartate and alanine aminotransferase concentrations of three or more times the upper limit of the normal range occurred in more patients who received tofacitinib continuously than in patients who received placebo followed by tofacitinib. In this trial involving patients with active psoriatic arthritis who had had an inadequate response to TNF inhibitors, tofacitinib
Multilingual evaluation of voice disability index using pitch rate
Directory of Open Access Journals (Sweden)
Shuji Shinohara
2017-06-01
Full Text Available We propose the use of the pitch rate of free-form speech recorded by smartphones as an index of voice disability. This research compares the effectiveness of pitch rate, jitter, shimmer, and harmonic-to-noise ratio (HNR as indices of voice disability in English, German, and Japanese. Normally, the evaluation of these indices is performed using long-vowel sounds; however, this study included the recitation of a set passage, which is more similar to free-form speech. The results showed that for English, the jitter, shimmer, and HNR were very effective indices for long-vowel sounds, but the shimmer and HNR for read speech were considerably worse. Although the effectiveness of jitter as an index was maintained for read speech, the pitch rate was better in distinguishing between healthy individuals and patients with illnesses affecting their voice. The read speech results in German, Japanese, and English were similar, and the pitch rate showed the greatest efficiency for identification. Nevertheless, compared to English, the identification efficiency for the other two languages was lower.
Disability Insurance Benefits and Labor Supply
Jonathan Gruber
2000-01-01
Disability Insurance (DI) is a public program that provides income support to persons unable to continue work due to disability. The difficulty of defining disability, however, has raised the possibility that this program may be subsidizing the early retirement of workers who are not truly disabled. A critical input for assessing the optimal size of the DI program is therefore the elasticity of labor force participation with respect to benefits generosity. Unfortunately, this parameter has be...
[Validating the Oswestry Disability Index in patients with low back pain in Sichuan].
Tan, Ke; Zheng, Min; Yang, Bang-xiang; Ernest, Volinn; Liu, Hui; He, Jing; Jiang, Min; Li, Xiao-song
2009-05-01
To test the reliability and validity of the Oswestry Disability Index (ODI) in patients with low back pain in China. Eighty six patients (female 51, male 35, average age 39.5 +/- 10.1) with chronic low back pain were assessed with the ODI. The assessment was repeated 48 hours after the first test. The Cronbach' Alpha coefficient for the ODI was 0.891. The intraclass correlation coefficient (ICC) for the repeated tests was 0.854 (95% CI = 0.775-0.905). The exploratory factor analysis extracted two factors, which accounted for 61.91% of the total variance. Significant correlations were found between the ODI and the 6 domains of the SF-36. The Chinese version of Oswestry Disability Index has satisfactory reliability and validity. It can be used as an instrument for assessing chronic low back pain-related disability.
Efficacy study of multimedia rheumatoid arthritis patient education program.
Unk, Julie A; Brasington, Richard
2014-07-01
The research goal of improving patient adherence was assessed in this randomized controlled trial of the outcomes of a 15-min multimedia educational program when compared to educational literature for rheumatoid arthritis (RA) patients. One hundred eight RA patients from a Midwestern rheumatology outpatient clinic completed the self-reported Medication Adherence Questionnaire (MAQ), the Brief Illness Perception Questionnaire (BIPQ), and Health Assessment Questionnaire (HAQ) at baseline and 1 month after education. A paired samples t-test was use for data analyses to determine if there was a significant difference in the change between the groups at preintervention and 1-month postintervention. There were no significant differences in the scores between the two groups from pretest to posttest. Results from this study showed that medication adherence, illness perception, and disability were not improved by use of multimedia or the literature within 1 month. Findings from this research study showed that a short multimedia educational program is as effective as printed materials to educate patients with RA about their disease and treatment. However, neither multimedia nor literature affects medication adherence, illness perception, or disability as self-reported by patients with RA. ©2013 American Association of Nurse Practitioners.
Cultural adaptation and validation of the "Fibromyalgia Impact Questionnaire"--Portuguese version
Rosado, Maria da Lapa; Pereira, José Pascoalinho; da Fonseca, João Pedro; Branco, Jaime
2006-01-01
The aim of this study was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Portuguese (Portugal) and to evaluate its reliability and validity by use with Portuguese--speaking patients with Fibromyalgia. After translating the FIQ into Portuguese we administered it to 68 patients with Fibromyalgia together with an informed consent, a Portuguese version of the Health Assessment Questionnaire (HAQ) and a formulary with the socio-demographic characteristics and duration of the complai...
Colucci, G; Pellicciotta, A; Buono, S; Di Nuovo, S F
1998-10-01
The aims of the present research were to assess the level of self-concern in people with intellectual disability using the Rorschach Egocentricity Index, to correlate the Index with other Rorschach and IQ variables, and to study the effect of associated psychological pathology. The Rorschach Inkblot Test and the Wechsler Intelligence Scale were administered to a group of 75 subjects with intellectual disability, aged between 18 and 38 years, who were divided into subgroups according to their additional diagnosis (i.e. personality disorders, psychosis and depression). A fourth subgroup was composed of people with intellectual disability but without other pathologies. The Egocentricity Index was very low in the subjects with intellectual disability and differences were a result of the effects of additional psychological pathologies. The meaning of the measurement of egocentricity in people with intellectual disability is discussed.
Esteba-Castillo, S; Pena-Casanova, J; Garcia-Alba, J; Castellanos, M A; Torrents-Rodas, D; Rodriguez, E; Deus-Yela, J; Caixas, A; Novell-Alsina, R
2017-05-16
Neuropsychological assessment in individuals with intellectual disability is of utmost importance in order to determine the cognitive deficits underlying brain dysfunction and limiting intellectual functioning and adaptive behavior. However, no neuropsychological batteries in Spanish language have been created and validated for this population. To adapt the 'programa integrado de exploracion neuropsicologica-test Barcelona' and to validate the new version, the Barcelona Test for Intellectual Disability (TB-DI). To create normative data for its clinical use. The original test was modified based on data from a pilot sample of 65 individuals with intellectual disability. In order to study the psychometric properties of the TB-DI, it was administered to a sample of 170 individuals with intellectual disability and to a group of 60 individuals without it. The relevant variables for stratification of normative data were determined by means of regression models. The TB-DI was finally composed by 67 subtests grouped in eight cognitive domains and it showed good psychometric properties. Normative data were created for five groups taking into account intellectual disability level, age and acquired curricular competence. These data were organized in percentiles in a way that allows the creation of cognitive profiles in the clinical and experimental fields. The TB-DI constitutes a tool of high applicability in the population with intellectual disability. It shows adequate validity and reliability, and it has good psychometric properties. The cognitive profiles obtained by the TB-DI will provide valuable information for the treatment of adult adults with mild and moderate intellectual disability.
Directory of Open Access Journals (Sweden)
A. NICCOLI
2013-12-01
Full Text Available In questo lavoro vengono esaminati gli effetti a lungo termine di piena indicizzazione dei salari ai prezzi in un sistema economico . In particolare , l'autore dimostra che la piena indicizzazione dei salari , mentre amplifica i fenomeni inflazionistici , non influenza il livello o tasso di crescita dei salari reali .Viene proposto un meccanismo alternativo con effetti inflazionistici molto più piccoli ..In this paper the long-term effects of full wage indexation to prices in an economic system are examined. In particular, the author shows that full wage indexation, while amplifying the inflationary phenomena, does not affect the level or growth rate of real wages. An alternative mechanism with much smaller inflationary effects is then proposed.JEL: E31
Hoving, Jan Lucas; O'Leary, Elizabeth F.; Niere, Ken R.; Green, Sally; Buchbinder, Rachelle
2003-01-01
The Neck Disability Index (NDI) and Northwick Park Neck Pain Questionnaire (NPQ) were developed to measure self-perceived disability from neck pain, including that which may arise from whiplash injury. However, there is little data specifically concerning their validity for whiplash-associated
Armour, Brian S; Courtney-Long, Elizabeth; Campbell, Vincent A; Wethington, Holly R
2012-01-01
Obesity is associated with adverse health outcomes in people with and without disabilities; however, little is known about disability prevalence among people who are obese. The purpose of this study was to determine the prevalence and type of disability among obese adults in the United States. We analyzed pooled data from sample adult modules of the 2003-2009 National Health Interview Survey (NHIS) to obtain national prevalence estimates of disability, disability type, and obesity by using 30 questions that screened for activity limitations, vision and hearing impairment, and cognitive, movement, and emotional difficulties. We stratified disability prevalence by category of body mass index (BMI, measured as kg/m(2)): underweight, less than 18.5; normal weight, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or higher. Among the 25.3% of adult men and 24.6% of women in our pooled sample who were obese, 35.2% and 46.9%, respectively, reported a disability. In contrast, 26.7% of men and 26.8% women of normal weight reported a disability. Disability was much higher among obese women than among obese men (46.9% vs 35.2%, P < .001). Movement difficulties were the most common disabilities among obese men and women, affecting 25.3% of men and 37.9% of women. This research contributes to the literature on obesity by including disability as a demographic in characterizing people by body mass index. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs.
Wang, Qiong; Wang, Yi-Ru; Jia, Qing-Yun; Liu, Li; Xu, Chong-Qing; Wang, Xiao-Yun; Yao, Min; Cui, Xue-Jun; Shi, Qi; Wang, Yong-Jun; Liang, Qian-Qian
2018-03-20
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by swelling and painful joints, eventually leading to joint destruction. There is still a lack of effective therapy to treat RA. The Juanbi pill is a Chinese medicine that has been widely used to treat active RA in China for hundreds of years, relieving pain and protecting the affected joints from malformation. However, there is no solid evidence to show the effect of the Juanbi pill on the management of active RA. We will conduct a multicenter, randomized, double-blind, placebo-controlled clinical trial to determine whether the traditional Chinese medicine Juanbi pill could relieve joint pain in RA and protect the joints. A total of 120 patients with active RA will be enrolled and treated with the Juanbi pill or a placebo for 3 months. The primary outcome measures are as follows: rate of in the American College of Rheumatology (ACR)50, change in the 28-joint Disease Activity Score (DAS28) from baseline at beginning of therapy to 3 months, and a change in the van der Heijde modified Sharp score measured from baseline to 12 months. The secondary outcome measures are as follows: rate of change in ACR20, ACR70, Health Assessment Questionnaire-Disability Index (HAQ-DI), and change in score in the Patient Assessment of Arthritis Pain, Patient Global Assessment of Arthritis, and the Athens Insomnia Scale (AIS) from baseline to 2-week, 1-month, 2-month, 3-month, 6-month, and 12-month follow up. In addition, the rate of change (score) in the ACR50 and DAS28 from the baseline to 2-week, 1-month, 2-month, 6-month, and 12-month follow up are also the secondary outcome measures. Although the Juanbi pill has been used in China for many years to treat RA, there is a lack of consensus about its effectiveness. This trial will provide convincing evidence about the effect of Juanbi pill on active RA. ClinicalTrials.gov, NCT02885597 . Registered on 30 August 2016.
Oswestry Disability Index scoring made easy.
Mehra, A; Baker, D; Disney, S; Pynsent, P B
2008-09-01
Low back pain effects up to 80% of the population at some time during their active life. Questionnaires are available to help measure pain and disability. The Oswestry Disability Index (ODI) is the most commonly used outcome measure for low back pain. The aim of this study was to see if training in completing the ODI forms improved the scoring accuracy. The last 100 ODI forms completed in a hospital's spinal clinic were reviewed retrospectively and errors in the scoring were identified. Staff members involved in scoring the questionnaire were made aware of the errors and the correct method of scoring explained. A chart was created with all possible scores to aid the staff with scoring. A prospective audit on 50 questionnaires was subsequently performed. The retrospective study showed that 33 of the 100 forms had been incorrectly scored. All questionnaires where one or more sections were not completed by the patient were incorrectly scored. A scoring chart was developed and staff training was implemented. This reduced the error rate to 14% in the prospective audit. Clinicians applying outcome measures should read the appropriate literature to ensure they understand the scoring system. Staff must then be given adequate training in the application of the questionnaires.
Gabel, Charles Philip; Cuesta-Vargas, Antonio I; Osborne, Jason W; Burkett, Brendan; Melloh, Markus
2014-08-01
The Neck Disability Index frequently is used to measure outcomes of the neck. The statistical rigor of the Neck Disability Index has been assessed with conflicting outcomes. To date, Confirmatory Factor Analysis of the Neck Disability Index has not been reported for a suitably large population study. Because the Neck Disability Index is not a condition-specific measure of neck function, initial Confirmatory Factor Analysis should consider problematic neck patients as a homogenous group. We sought to analyze the factor structure of the Neck Disability Index through Confirmatory Factor Analysis in a symptomatic, homogeneous, neck population, with respect to pooled populations and gender subgroups. This was a secondary analysis of pooled data. A total of 1,278 symptomatic neck patients (67.5% female, median age 41 years), 803 nonspecific and 475 with whiplash-associated disorder. The Neck Disability Index was used to measure outcomes. We analyzed pooled baseline data from six independent studies of patients with neck problems who completed Neck Disability Index questionnaires at baseline. The Confirmatory Factor Analysis was considered in three scenarios: the full sample and separate sexes. Models were compared empirically for best fit. Two-factor models have good psychometric properties across both the pooled and sex subgroups. However, according to these analyses, the one-factor solution is preferable from both a statistical perspective and parsimony. The two-factor model was close to significant for the male subgroup (pfactor structure when analyzed by Confirmatory Factor Analysis in a pooled, homogenous sample of neck problem patients. However, a two-factor model did approach significance for male subjects where questions separated into constructs of mental and physical function. Further investigations in different conditions, subgroup and sex-specific populations are warranted. Copyright © 2014 Elsevier Inc. All rights reserved.
Scheper, Mark; Rombaut, Lies; de Vries, Janneke; De Wandele, Inge; van der Esch, Martin; Visser, Bart; Malfait, Franciska; Calders, Patrick; Engelbert, Raoul
2017-07-01
The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients. Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders. Muscle strength was associated with 30CRT (r = 0.67, p = <0.001), 6MWT (r = 0.58, p = <0.001) and HAQ (r = 0.63, p= <0.001). Proprioception was associated with 30CRT (r = 0.55, p < 0.001), 6MWT (r = 0.40, p = <0.05) and HAQ (r = 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association. Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. Implications for rehabilitation Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most
Directory of Open Access Journals (Sweden)
Stojanović Sonja
2009-01-01
Full Text Available Introduction It has been well known that balneophysical therapy has a therapeutic effect on clinical and biological parameters of disease activity in the patients with rheumatoid arthritis (RA. Objective. To determine the influence of balneophysical therapy on functional capacity, activity and quality of life of the patients with RA primarily treated with some of disease modifying antirheumatic drugs. Methods. The study enrolled 73 patients with RA treated with some of disease modifying antirheumatic drugs (Methotrexate in 85% of patients. During hospitalization at the Clinical Rheumatologic Department of the Institute 'Niska Banja', the patients were treated, beside the medicamentous therapy, by hydrotherapy (oligomineral, homeothermic, low radioactive water, mineral peloid therapy, electrotherapy and kinesiotherapy. Before and after balneotherapy, the patients filled in the Health Assessment Questionnaire (HAQ and the Quality of Life Rheumatoid Arthritis (QOL-RA scale. The Disease Activity Score (DAS 28 was used to measure the disease activity before and after balneotherapy. A possible value of HAQ was from 0 to 3, and QOL-RA from 0 to 10. Results. The mean value of the duration of balneophysical therapy was 14.7±4.8 days. We found significant improvement of functional capacity in the patients with RA. The average HAQ score before balneotherapy was 1.07±0.61, and 0.86±0.55 after balneotherapy, which was statistically significantly lower (p<0.05. DAS 28 after balneotherapy was also statistically significantly lower than DAS 28 before balneotherapy: the mean value of DAS 28 before therapy was 6.30±0.81 and after therapy 5.48±0.75 (p<0.001. The quality of life significantly improved after balneophysical therapy: the mean value of QOL-RA scale before therapy was 5.38±1.62 and after therapy 7.35±1.81 (p<0.05. Conclusion. Balneophysical therapy, when properly dosed, is an effective, adjuvant therapy in the patients with RA of mild disease
Extensive Validation of the Pain Disability Index in 3 Groups of Patients With Musculoskeletal Pain
Soer, Remko; Koke, Albere J. A.; Vroomen, C.A.J.; Stegeman, Patrick; Smeets, Rob J. E. M.; Coppes, Maarten H.; Reneman, Michiel F.
2013-01-01
Study Design. A cross-sectional study design was performed. Objective. To validate the pain disability index (PDI) extensively in 3 groups of patients with musculoskeletal pain. Summary of Background Data. The PDI is a widely used and studied instrument for disability related to various pain
Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index.
Miekisiak, Grzegorz; Kollataj, Marta; Dobrogowski, Jan; Kloc, Wojciech; Libionka, Witold; Banach, Mariusz; Latka, Dariusz; Sobolewski, Tomasz; Sulewski, Adam; Nowakowski, Andrzej; Kiwic, Grzegorz; Pala, Adam; Potaczek, Tomasz; Gierlotka, Maciej
2013-02-15
Validation of a translated, culturally adapted questionnaire. To translate and culturally adapt a Polish version of the Oswestry Disability Index (ODI) and to validate its use in Polish patients. The ODI is among the most popular questionnaires used to evaluate back pain-related disability. To our knowledge no validated Polish version of the index was available at the time our study was initiated. The questionnaire was translated and culturally adapted by 2 independent translators and approved by expert committee. Final version was included in the booklet consisting in addition of a previously validated Roland-Morris disability questionnaire, VAS for low back and leg and 3 Likert scale questions (pain medications, pain frequency, disability). It was tested on 169 patients with chronic low back pain, 164 (97%) of them were enrolled, and 84 of 164 (53%) returned the completed retest booklet within 2 to 14 days after the baseline test. There were no differences between the 2 groups in demographic and clinical parameters. Test-retest reliability, internal consistency, and construct validity were investigated. The mean ODI (standard deviation [SD]) was 48.45 (18.94); minimum 2, maximum 94. The Cronbach α for baseline questionnaires (n = 164) was 0.90. Concurrent validity, measured by comparing ODI responses with the results of the Roland-Morris disability questionnaire score was very good (r = 0.607, P disability in Polish-speaking patients with lower back pain.
Park, Sang-Won; Shin, Ye-Sle; Kim, Hye-Jin; Lee, Jin-Ho; Shin, Joon-Shik; Ha, In-Hyuk
2014-10-01
The admission due to low back pain (LBP) became prevalent cause of international economic losses. Since LBP patients with disability are often subject to inpatient care, it is important to determine the appropriate time of discharge. The purpose of this study is to set the cut-off value of appropriate Oswestry Disability Index (ODI) at the time of discharge. Of 1,394 LBP patients admitted in hospital specialized in spinal disease, 774 eligible patients with disability were included in this study. And several clinical variables including numerical rating score, ODI, satisfaction level were observed during the hospital stay. We considered satisfaction level as an important factor for discharge, categorized patients into satisfied group and dissatisfied group. Through the statistical analysis, appropriate factor for determining dischargeable patients satisfied with their current condition and its cut-off value of ODI were found. And proper predictors for the cut-off value were extracted statistically and logically from a pool of several clinical indexes. The ODI at the time of discharge was most accurate in determining dischargeable patients. The cut-off value of ODI was 30. Predictors were ODI questions 4 and 6. We set the cut-off value of dischargeable ODI for LBP inpatient with disability and found its predictor.
Validation of a Korean version of the Fibromyalgia Impact Questionnaire.
Kim, Yun-A; Lee, Shin-Seok; Park, Kyeongsoo
2002-01-01
The aim of this study was to translate the Fibromyalgia Impact Questionnaire (FIQ) into Korean and to evaluate its reliability and validity for use with Korean-speaking patients with fibromyalgia (FM). After translating the FIQ into Korean, we administered it to 55 patients with FM (28 patients filled out the questionnaire again 7 days later) together with a Korean version of the Health Assessment Questionnaire (HAQ) and the Symptom Checklist-90-Revision (SCL-90-R). The tender-point count (TP...
Directory of Open Access Journals (Sweden)
Kotenko К.V.
2013-12-01
Full Text Available Aim: to study the effect features of combined use of pelotherapy and phytocomplex on main clinical symptoms regress and quality of life in patients with knee joint osteoarthrosis. Material and Methods. The study included 96 patients with knee joint osteoarthrosis; the effectiveness evaluation was estimated in terms of American Rheumatologic Association (ARA, the data of visual-analogue scale (VAS, goniometry and laser Doppler flowmetry, indexes WOMAC, Lekena and the index of activity SIA, criteria of life quality questionnaire HAQ. Results. The complex use of pelotherapy and phytocomplex in conjunction with a drug treatment of patients have a more pronounced positive effect on pain (by 35-36%, function of the knee joint (by 26-28%, microcirculation (1.5-2 times and the quality of life (by 22-25% compared to treatment with only drug treatment or combined using of ultrasound and drug therapy. Conclusion. The new method of combined use of pelotherapy and phytocomplex leads to the evident regress of clinical symptomatology at patients with knee joint osteoarthrosis, improves locomotor function, microcirculation of knee joints and quality of life.
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Lely Fera Triani
2014-03-01
Indeks harga saham gabungan merupakan cerminan dari kegiatan pasar modal secara umum. Pergerakan indeks harga saham gabungan yang meningkat menunjukkan kondisi pasar modal sedang bullish, sebaliknya jika menurun menunjukkan kondisi pasar modal sedang bearish. Kejadian tersebut dipengaruhi oleh beberapa faktor makroekonomi, seperti: volume perdagangan saham, nilai tukar, dan Suku Bunga Indonesia. Tujuan dalam penelitian ini adalah untuk menganalisis: pengaruh faktor makro ekonomi melalui volume perdagngan saham, nilai tukar, dan suku bunga Indonesia terhadap Indeks harga saham gabungan di Jakarta Islamic Index. Sampel dari penelitian ini adalah: volume perdagangan saham, nilai tukar, suku bunga Indonesia, dan Indeks harga saham gabungan di Jakarta Islamic Index dengan menggunakan data harian selama tahun 2011, sehingga data pada observasi (n = 247. Ada pengaruh faktor ekonomi makro yang diwakili oleh volume transaksi, dan tingkat suku bunga terhadap indeks harga saham gabungan. Variabelnilai tukar tidak berpengaruh secara signifikan terhadap indeks harga saham gabungan. Hasil perhitungan yang diperoleh nilai F = 27,416; menjadi jelas bahwa perubahan dalam volume transaksi, nilai tukar, dan nilai suku bunga berpengaruh signifikan secara bersama-sama Indeks Harga Saham Gabungan.
Reliability and validity study of the Gujarati version of the Oswestry Disability Index 2.1a.
Shah, Sweni; Balaganapathy, M
2017-09-22
Among all musculoskeletal disorders back pain is the most common reason for functional limitation in working age. It is due to low back pain (LBP) that the ODI has become one of the principal outcome measures for evaluation of disability and has been widely used in research as well as in clinical practice. So far, validated Gujarati version of the ODI 2.1a has not been reported. To accomplish the translation and validation of the Oswestry Disability Index (ODI) version 2.1a into the Gujarati language. Cross-sectional study. The validation of the ODI-Gujarati was tested in 120 patients diagnosed with non-specific LBP, who were receiving physiotherapy at a clinic in Gujarat, India. Data was collected at on initial visit and after 48 hours. During both visits, patients completed the Oswestry Disability Index-Gujarati (ODI-G), Roland-Morris Disability Questionnaire-Gujarati (RMDQ-G), and Visual Analogue Scale-Pain (VAS-P). Internal consistency was measured by Cronbach's alpha. The Gujarati version indicated high internal consistency (α= 0.96). Test-retest reliability was measured by intra-class correlation coefficient and it revealed very high correlation (ICC = 0.92). Construct validity was confirmed by strong correlation with RMDQ-G (r= 0.76), and concurrent validity indicated moderate correlation with VAS-P (r= 0.50). Factor analysis explained that the ODI was loaded on 1 factor. The Oswestry disability index version 2.1a was successfully translated into Gujarati language, showing excellent psychometric properties. Therefore, it can be used in evaluating the disability amongst Gujarati population with LBP for both clinical and research purposes.
Goeree, Ron; Chiva-Razavi, Sima; Gunda, Praveen; Graham, Christopher N; Miles, LaStella; Nikoglou, Efthalia; Jugl, Steffen M; Gladman, Dafna D
2018-02-01
The study evaluates the cost-effectiveness of secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin (IL)-17A, vs currently licensed biologic treatments in patients with active psoriatic arthritis (PsA) from a Canadian healthcare system perspective. A decision analytic semi-Markov model evaluated the cost-effectiveness of secukinumab 150 mg and 300 mg compared to subcutaneous biologics adalimumab, certolizumab pegol, etanercept, golimumab, and ustekinumab, and intravenous biologics infliximab and infliximab biosimilar in biologic-naive and biologic-experienced patients over a lifetime horizon. The response to treatments was evaluated after 12 weeks by PsA Response Criteria (PsARC) response rates. Non-responders or patients discontinuing initial-line of biologic treatment were allowed to switch to subsequent-line biologics. Model input parameters (Psoriasis Area Severity Index [PASI], Health Assessment Questionnaire [HAQ], withdrawal rates, costs, and resource use) were collected from clinical trials, published literature, and other Canadian sources. Benefits were expressed as quality-adjusted life years (QALYs). An annual discount rate of 5% was applied to costs and benefits. The robustness of the study findings were evaluated via sensitivity analyses. Biologic-naive patients treated with secukinumab achieved the highest number of QALYs (8.54) at the lowest cost (CAD 925,387) over a lifetime horizon vs all comparators. Secukinumab dominated all treatments, except for infliximab and its biosimilar, which achieved minimally more QALYs (8.58). However, infliximab and its biosimilar incurred more costs than secukinumab (infliximab: CAD 1,015,437; infliximab biosimilar: CAD 941,004), resulting in higher cost-effectiveness estimates relative to secukinumab. In the biologic-experienced population, secukinumab dominated all treatments as it generated more QALYs (8.89) at lower costs (CAD 954,692). Deterministic sensitivity analyses
Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators.
Jansen, Jeroen P; Incerti, Devin; Mutebi, Alex; Peneva, Desi; MacEwan, Joanna P; Stolshek, Bradley; Kaur, Primal; Gharaibeh, Mahdi; Strand, Vibeke
2017-07-01
To determine the cost-effectiveness of treatment sequences of biologic disease-modifying anti-rheumatic drugs or Janus kinase/STAT pathway inhibitors (collectively referred to as bDMARDs) vs conventional DMARDs (cDMARDs) from the US societal perspective for treatment of patients with moderately to severely active rheumatoid arthritis (RA) with inadequate responses to cDMARDs. An individual patient simulation model was developed that assesses the impact of treatments on disease based on clinical trial data and real-world evidence. Treatment strategies included sequences starting with etanercept, adalimumab, certolizumab, or abatacept. Each of these treatment strategies was compared with cDMARDs. Incremental cost, incremental quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each treatment sequence relative to cDMARDs. The cost-effectiveness of each strategy was determined using a US willingness-to-pay (WTP) threshold of $150,000/QALY. For the base-case scenario, bDMARD treatment sequences were associated with greater treatment benefit (i.e. more QALYs), lower lost productivity costs, and greater treatment-related costs than cDMARDs. The expected ICERs for bDMARD sequences ranged from ∼$126,000 to $140,000 per QALY gained, which is below the US-specific WTP. Alternative scenarios examining the effects of homogeneous patients, dose increases, increased costs of hospitalization for severely physically impaired patients, and a lower baseline Health Assessment Questionnaire (HAQ) Disability Index score resulted in similar ICERs. bDMARD treatment sequences are cost-effective from a US societal perspective.
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Mazzocchi, F.; Castorina, M.; De Mei, M. [ENEA, Centro Ricerche Casaccia, Rome (Italy). Dipt. Ambiente
1998-07-01
In the present work the study of indexing tools to evaluate environmental quality from biological data has been performed using a certain number of floristic and vegetational indices near Macchia Grande of Ponte Galeria (Rome, Italy). The indices have been applied on the basis of the data coming from a phyto sociological study of the area. Multivariate statistics methodologies have been utilized to obtain a synthetic evaluation of the indices. [Italian] Nel presente lavoro e' stato effettuato uno studio di alcuni strumenti di indicizzazione definiti sulla base di dati bioligici per la stima della qualita' ambientale, utilizzando una serie di indici floristici e vegetazionali dell'area di Macchia Grande di Ponte Galeria (Roma). Sono state analizzate le proprieta' espresse dagli indici come singole entita' ed in particolare le principali tendenze di variazione rispetto alla variazione di qualita' delle unita' ambientali e della loro integrabilita' reciproca. Sono state inoltre utilizzate le metodologie dell'analisi multivariata.
Digital Repository Service at National Institute of Oceanography (India)
Madhupratap, M.; Nair, S.R.S.; Haridas, P.; Padmavati, G.
.U. Haq and J.D. Milliman, (Eds.), Marine Geology and Oceanography ofArabian Sea and Coastal Pakistan. New York: Reinhold, pp. 339-350. PAFFENHOFER, G-A.; WESTER, B.T. and NICHO· LAS, W.O., 1984. Zooplankton abundance in rela- Journal of Coastal Research... Ocean. Proceedings of the Indian Academy of Sciences, 94, 129-137. SMITH, S.L., 1982. The northwest Indian Ocean dur ing the monsoons of 1979: distribution, abundance and feeding of zooplankton. Deep-Sea Research, 29, 1331-1353. SMITH, S.L.; BOYQ, C...
Kang, Jeong-Il; Jeong, Dae-Keun; Choi, Hyun
2016-06-01
[Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilization exercise group as the control group. [Results] There were significant differences in the activities of the rectus abdominis, transverse abdominis, external oblique abdominal, and erector spinae muscles as well as in the Oswestry Disability Index within the experimental group. There were meaningful differences in the activities of the rectus abdominis, external oblique abdominal, and erector spinae muscles and in the Oswestry Disability Index within the control group. In addition, there was a meaningful intergroup difference in transverse abdominis muscle activity alone and in the Oswestry Disability Index. [Conclusion] The breathing exercise effectively increased muscle activity by training gross and fine motor muscles in the trunk. Moreover, it was verified as a very important element for strengthening body stability because it both released and prevented low back pain.
Disability in subacute whiplash patients: usefulness of the neck disability index.
Nieto, Rubén; Miró, Jordi; Huguet, Anna
2008-08-15
Cross-sectional study. To analyze the psychometric properties of the neck disability index (NDI), with a special emphasis in its factor structure, and its usefulness, in a sample of patients suffering from a subacute whiplash problem. A valid and reliable instrument to assess pain-related disability would be of great help to clinicians and researchers interested in whiplash associated disorders. First, to better understand the impact of whiplash on the patient's life, and his or her progress over time. Second, to formulate comprehensive treatment plans, and evaluate the results from therapeutic actions. Finally, to follow-up patients' changes and improvement. The NDI could be an appropriate instrument for these purposes. A convenience sample of 150 subacute whiplash patients participated. They were requested to complete the Catalan version of the NDI, and report about their pain intensity, pain interference and depression. RESULTS.: An exploratory factor analysis showed that the NDI can be viewed as a 2-factor instrument. The items and the instrument's total score were normally distributed. Internal consistency was also appropriate both for the total score (Cronbach's alpha: 0.87) and the 2 subscales (0.7 for the pain and interference with cognitive functioning scale, and 0.83 for the physical functioning scale). Total NDI and subscales scores significantly correlated with pain intensity, pain interference, and depression. The NDI showed excellent psychometric properties in a sample of subacute whiplash patients. Additional research is needed to replicate the NDIs factor structure.
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Jones, A; Shepard, S [UT MD Anderson Cancer Center, Houston, TX (United States); Dave, J [Thomas Jefferson University, Philadelphia, PA (United States); Fisher, R [The Cleveland Clinic, Cleveland, OH (United States); Hulme, K [The Cleveland Clinic, Beachwood, OH (United States); Rill, L [University Florida, Jacksonville Beach, FL (United States); Zamora, D [University of Washington, Seattle, WA (United States); Woodward, A [The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Brady, S [St. Jude Children’s Research Hospital, Memphis, TN (United States); MacDougall, R [Children’s Hospital, Boston, MA (United States); Goldman, L [Hartford Hospital, Hartford, CT (United States); Lang, S; Peck, D [Henry Ford Health System, Detroit, MI (United States); Apgar, B [AGFA HealthCare, Greenville, SC (United States); Uzenoff, R [FUJIFILM Medical Systems U.S.A., Inc., Weston, CT (United States); Willis, C [University of Texas MD Anderson Cancer Center, Bellaire, TX (United States)
2016-06-15
Purpose: To characterize the distribution of the deviation index (DI) in digital radiography practices across the United States. Methods: DI data was obtained from 10 collaborating institutions in the United States between 2012 and 2015. Each institution complied with the requirements of the Institutional Review Board at their site. DI data from radiographs of the body parts chest, abdomen, pelvis and extremity were analyzed for anteroposterior, posteroanterior, lateral, and decubitus views. The DI data was analyzed both in aggregate and stratified by exposure control method, image receptor technology, patient age, and participating site for each body part and view. The number of exposures with DI falling within previously published control limits for DI and descriptive statistics were calculated. Results: DI data from 505,930 radiographic exposures was analyzed. The number of exposures with DI falling within published control limits for DI varied from 10 to 20% for adult patients and 10 to 23% for pediatric patients for different body parts and views. Mean DI values averaged over other parameters for radiographs of the abdomen, chest, pelvis, and extremities ranged from 0.3 to 1.0, −0.6 to 0.5, 0.8, and −0.9 to 0.5 for the different adult views and ranged from −1.6 to −0.1, −0.3 to 0.5, −0.1, −0.2 to 1.4 for the different pediatric views, respectively (DI data was solicited only for anteroposterior view of pelvis). Standard deviation values of DI from individual sites ranged from 1.3 to 3.6 and 1.3 to 3.0 for the different adult and pediatric views, respectively. Also of interest was that target exposure indicators varied by up to a factor of 6 between sites for certain body parts and views. Conclusion: Previously published DI control limits do not reflect the state of clinical practice in digital radiography. Mean DI and target exposure indicators are targets for quality improvement efforts in radiography.
International Nuclear Information System (INIS)
Jones, A; Shepard, S; Dave, J; Fisher, R; Hulme, K; Rill, L; Zamora, D; Woodward, A; Brady, S; MacDougall, R; Goldman, L; Lang, S; Peck, D; Apgar, B; Uzenoff, R; Willis, C
2016-01-01
Purpose: To characterize the distribution of the deviation index (DI) in digital radiography practices across the United States. Methods: DI data was obtained from 10 collaborating institutions in the United States between 2012 and 2015. Each institution complied with the requirements of the Institutional Review Board at their site. DI data from radiographs of the body parts chest, abdomen, pelvis and extremity were analyzed for anteroposterior, posteroanterior, lateral, and decubitus views. The DI data was analyzed both in aggregate and stratified by exposure control method, image receptor technology, patient age, and participating site for each body part and view. The number of exposures with DI falling within previously published control limits for DI and descriptive statistics were calculated. Results: DI data from 505,930 radiographic exposures was analyzed. The number of exposures with DI falling within published control limits for DI varied from 10 to 20% for adult patients and 10 to 23% for pediatric patients for different body parts and views. Mean DI values averaged over other parameters for radiographs of the abdomen, chest, pelvis, and extremities ranged from 0.3 to 1.0, −0.6 to 0.5, 0.8, and −0.9 to 0.5 for the different adult views and ranged from −1.6 to −0.1, −0.3 to 0.5, −0.1, −0.2 to 1.4 for the different pediatric views, respectively (DI data was solicited only for anteroposterior view of pelvis). Standard deviation values of DI from individual sites ranged from 1.3 to 3.6 and 1.3 to 3.0 for the different adult and pediatric views, respectively. Also of interest was that target exposure indicators varied by up to a factor of 6 between sites for certain body parts and views. Conclusion: Previously published DI control limits do not reflect the state of clinical practice in digital radiography. Mean DI and target exposure indicators are targets for quality improvement efforts in radiography.
Young, Ian A; Dunning, James; Butts, Raymond; Cleland, Joshua A; Fernández-de-Las-Peñas, César
2018-01-01
Background Self-reported disability and pain intensity are commonly used outcomes in patients with cervicogenic headaches. However, there is a paucity of psychometric evidence to support the use of these self-report outcomes for individuals treated with cervicogenic headaches. Therefore, it is unknown if these measures are reliable, responsive, or result in meaningful clinically important changes in this patient population. Methods A secondary analysis of a randomized clinical trial (n = 110) examining the effects of spinal manipulative therapy with and without exercise in patients with cervicogenic headaches. Reliability, construct validity, responsiveness and thresholds for minimal detectable change and clinically important difference values were calculated for the Neck Disability Index and Numeric Pain Rating Scale. Results The Neck Disability Index exhibited excellent reliability (ICC = 0.92; [95 % CI: 0.46-0.97]), while the Numeric Pain Rating Scale exhibited moderate reliability (ICC = 0.72; [95 % CI: 0.08-0.90]) in the short term. Both instruments also exhibited adequate responsiveness (area under the curve; range = 0.78-0.93) and construct validity ( p numeric pain rating scale and a 5.5-point reduction on the neck disability index after 4 weeks of intervention to be considered clinically meaningful.
Directory of Open Access Journals (Sweden)
Yesim Garip
2016-10-01
Full Text Available Aims: The aim of our study was to investigate the comorbidities in Turkish RA patients and evaluate the impact of comorbidities on health-related quality of life (HRQoL in terms of disease activity, functional and radiological status, severity of pain, and social and emotional functioning. Methods: In a cross-sectional setting, a total of 160 RA patients who were admitted to our outpatient clinic between December 2013 and February 2014 were consecutively enrolled in the study. Comorbidities were recorded. Disease activity was measured by using Disease Activity Score-28 (DAS28. Stanford Health Assessment Questionnaire (HAQ was used for determining functional status, Nottingham Health Profile (NHP for HRQoL, and modified Sharp Score for radiological damage. Major results: Comorbidities were reported in 107 patients (66.88 %. The most common was peptic ulcer (31.25%. This was followed by osteoporosis (21.25%, dyslipidemia (15.63%, depression (15%, hypertension (13.75%, diabetes mellitus (13.13%, thyroid disorders (%8.13, lung diseases (%6.88, cardiovascular diseases (6.25%, and cancers [(1 breast cancer, 1 malign melanoma, 3 lung carcinoma, 3.13%], respectively. Patients with comorbidities scored significantly higher in DAS28, HAQ, pain, energy and physical mobility subgroups of NHP (p0.05. Conclusions: Comorbid conditions of RA are common and associated with more active and severe disease and functional impairment. Comorbidities should be detected and treated earlier to reduce its negative impact on outcome in RA.
The use of continuous data versus binary data in MTC models: a case study in rheumatoid arthritis.
Schmitz, Susanne; Adams, Roisin; Walsh, Cathal
2012-11-06
Estimates of relative efficacy between alternative treatments are crucial for decision making in health care. When sufficient head to head evidence is not available Bayesian mixed treatment comparison models provide a powerful methodology to obtain such estimates. While models can be fit to a broad range of efficacy measures, this paper illustrates the advantages of using continuous outcome measures compared to binary outcome measures. Using a case study in rheumatoid arthritis a Bayesian mixed treatment comparison model is fit to estimate the relative efficacy of five anti-TNF agents currently licensed in Europe. The model is fit for the continuous HAQ improvement outcome measure and a binary version thereof as well as for the binary ACR response measure and the underlying continuous effect. Results are compared regarding their power to detect differences between treatments. Sixteen randomized controlled trials were included for the analysis. For both analyses, based on the HAQ improvement as well as based on the ACR response, differences between treatments detected by the binary outcome measures are subsets of the differences detected by the underlying continuous effects. The information lost when transforming continuous data into a binary response measure translates into a loss of power to detect differences between treatments in mixed treatment comparison models. Binary outcome measures are therefore less sensitive to change than continuous measures. Furthermore the choice of cut-off point to construct the binary measure also impacts the relative efficacy estimates.
The use of continuous data versus binary data in MTC models: A case study in rheumatoid arthritis
Directory of Open Access Journals (Sweden)
Schmitz Susanne
2012-11-01
Full Text Available Abstract Background Estimates of relative efficacy between alternative treatments are crucial for decision making in health care. When sufficient head to head evidence is not available Bayesian mixed treatment comparison models provide a powerful methodology to obtain such estimates. While models can be fit to a broad range of efficacy measures, this paper illustrates the advantages of using continuous outcome measures compared to binary outcome measures. Methods Using a case study in rheumatoid arthritis a Bayesian mixed treatment comparison model is fit to estimate the relative efficacy of five anti-TNF agents currently licensed in Europe. The model is fit for the continuous HAQ improvement outcome measure and a binary version thereof as well as for the binary ACR response measure and the underlying continuous effect. Results are compared regarding their power to detect differences between treatments. Results Sixteen randomized controlled trials were included for the analysis. For both analyses, based on the HAQ improvement as well as based on the ACR response, differences between treatments detected by the binary outcome measures are subsets of the differences detected by the underlying continuous effects. Conclusions The information lost when transforming continuous data into a binary response measure translates into a loss of power to detect differences between treatments in mixed treatment comparison models. Binary outcome measures are therefore less sensitive to change than continuous measures. Furthermore the choice of cut-off point to construct the binary measure also impacts the relative efficacy estimates.
Rehabilitation of patients with rheumatoid arthritis treated in stationary spa treatment
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Amila Jaganjac
2015-04-01
Full Text Available Introduction: Rheumatic diseases are nonsurgical diseases of the locomotor system and connective tissue. Rheumatoid arthritis (RA is a systemic inflammatory disease of connective tissue of unknown cause, with progressive chronic or subacute course. The aim of the research is to determine whether stationary spa treatment leads to improvement of the functional status in patients with rheumatoid arthritis. Methods: We included 35 patients with diagnosis of rheumatoid arthritis, referred for treatment at the spa " Ilidža " Gradačac from February to April 2014. Patients not adhering to treatment protocols were excluded. We used Visual analogue pain scale (VAS, HAQ questionnaire and assessment of the clinical condition before and after the treatment based on the scores 1-5.Results: There were 32 female and 3 male patients. The average age was 62.28±8.31 years. Based on the HAQ, 12 patients had no difficulties, 9 of them perform activities with little difficulties, 10 with many difficulties, and 4 patients cannot perform certain activities. Before treatment VAS was 6.63±2.36, and after treatment the 2.51±2.27. Ratings of clinical condition before treatment was 2.38±0.74, and after the treatment 3.64±0.98. The most frequently used therapies were kinesitherapy, magnetotherapy and interferential electricity. Conclusions: Stationary treatment at the spa „Ilidža“ Gradačac leads to an improvement of the functional status in patients with rheumatoid arthritis.
Validation of an adapted arabic version of fibromyalgia syndrome impact questionnaire.
El-Naby, Mai Abd; Hefny, Mohamed Ahmed; Fahim, Ayman Ekram; Awadalla, Magdy Ahmed
2013-10-01
Fibromyalgia (FM) is the most common chronic pain syndrome encountered in medical practice, affecting females more than males, and the estimated prevalence of FM in Egypt is 1.3 %. The aim was to translate and adapt the Fibromyalgia Impact Questionnaire (FIQ) into Arabic and assess reliability and validity. The Arabic version of Fibromyalgia Impact Questionnaire (FIQ-A) was adapted following the forward/backward translation approach. Fifty-one female patients with FM were studied to assess psychometric properties of the FIQ-A. Reliability was analyzed by the correlation coefficient between test and retest. Internal consistency was checked by the Cronbach's alpha coefficient. Construct validity was assessed comparing FIQ-A with Health Assessment Questionnaire (HAQ), Health Assessment Questionnaire of Fibromyalgia (FHAQ), The Medical Outcome Survey Short-Form-36 (SF-36), and the Total Visual Analog Scale (TVAS) for FM symptom, and feasibility was assessed by the time taken in completing the FIQ-A and the proportion of patients completed the questionnaire. Patients studied were 33.2 ± 9.8 years old. Translation was concordant. Adaptation affected 4 sub-items of physical function. Test-retest correlation coefficient was 0.89 for total FIQ-A and Cronbach's alpha was 0.76. Excellent to good statistically significant correlations (p FIQ-A items and HAQ, FHAQ, and SF-36. The FIQ-A is a reliable, valid for measuring health status and physical function in Arabic-speaking FM patients.
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Seidel Wojciech
2016-09-01
Full Text Available Introduction. When evaluating the swimming technique of people with disabilities, a particularly important factor, besides physiological aspects, is the efficiency of the effort expended. This suggests that assessing and monitoring the effectiveness of swimming should be a regular part of training for swimmers with disabilities. Therefore, it seems important to distinguish how changes occur in the parameters that determine the effectiveness of swimming. This is especially true of anaerobic lactic exercise as the lactic acid concentration in the blood increases significantly. The aim of this study was to evaluate the usefulness of calculating velocity and the stroke index in the swimming training of people with disabilities, along with the progressive fatigue of a high-intensity interval training workout. Material and methods. The sample comprised 12 elite competitors with a disability. The experiment consisted in swimming sequential distances of 48 m, 50 m, 52 m, and 54 m at maximum intensity. Competitors performed four sets of four repetitions with a 75-second interval between repetitions and 15 minutes of active resting between sets. All sets were recorded using five digital cameras with a frequency of 50 frames per second. The recorded material was analysed with the use of motion analysis software, and the stroke index was calculated. Results. There was found to be no significant change in the average swimming velocity during each set and corresponding repetition, which means that the participants were able to tolerate the training intensity. Also, the stroke index did not change to a statistically significant degree in either of the subsequent sets or the subsequent repetitions (p < 0.05. Conclusions. We conclude that analysing the value of the swimming stroke index for people with disabilities can be a diagnostic method for assessing the effectiveness of high-intensity interval training.
Validation in the cross-cultural adaptation of the Korean version of the Oswestry Disability Index.
Jeon, Chang-Hoon; Kim, Dong-Jae; Kim, Se-Kang; Kim, Dong-Jun; Lee, Hwan-Mo; Park, Heui-Jeon
2006-12-01
Disability questionnaires are used for clinical assessment, outcome measurement, and research methodology. Any disability measurement must be adapted culturally for comparability of data, when the patients, who are measured, use different languages. This study aimed to conduct cross-cultural adaptation in translating the original (English) version of the Oswestry Disability Index (ODI) into Korean, and then to assess the reliability of the Korean versions of the Oswestry Disability Index (KODI). We used methodology to obtain semantic, idiomatic, experimental, and conceptual equivalences for the process of cross-cultural adaptation. The KODI were tested in 116 patients with chronic low back pain. The internal consistency and reliability for the KODI reached 0.9168 (Cronbach's alpha). The test-retest reliability was assessed with 32 patients (who were not included in the assessment of Cronbach's alpha) over a time interval of 4 days. Test-retest correlation reliability was 0.9332. The entire process and the results of this study were reported to the developer (Dr. Fairbank JC), who appraised the KODI. There is little evidence of differential item functioning in KODI. The results suggest that the KODI is internally consistent and reliable. Therefore, the KODI can be recommended as a low back pain assessment tool in Korea.
Health-Related Quality of Life
DEFF Research Database (Denmark)
Linde, Louise; Sørensen, Jan; Ostergaard, Mikkel
2008-01-01
OBJECTIVE: To compare validity, reliability, and responsiveness of generic and disease specific health-related quality of life (HRQOL) instruments in rheumatoid arthritis (RA). METHODS: Two samples of patients completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36), EuroQol (EQ)-5D......, 15D, Rheumatoid Arthritis Quality of Life Scale (RAQoL), Health Assessment Questionnaire (HAQ), and visual analog scales (VAS) for pain, fatigue, and global RA. Validity (convergent, discriminant, and known-groups) was evaluated in a cross-section of 200 patients. Reliability was evaluated...
A case report and brief literature review of Klippel-Trénaunay syndrome
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Choudhary MG
2012-05-01
Full Text Available Madan Gopal Choudhary, Zia Ul Haq, Ram Narayan Sehra, Chandra Kumar ChaharDepartment of Paediatrics, Sardar Patel Medical College and P.B.M Hospital, Rajasthan, IndiaAbstract: Klippel-Trénaunay syndrome is a rare disorder characterized by the triad of vascular malformations, venous varicosities, and bone and soft-tissue hypertrophy. We present a case of Klippel-Trénaunay syndrome with limb hypertrophy, port-wine stains, angiokeratoma, and venous varicosities in the limbs.Keywords: Klippel-Trénaunay syndrome, sporadic, venous varicosities, port-wine stain, angiokeratoma
Reliability and validity of the Yoruba version of the Oswestry disability index.
Aiyegbusi, Ayoola Ibifubara; Akodu, Ashiyat Kehinde; Agbede, Eniolorunda Olajide
2017-01-01
Low back pain (LBP) is a major cause of disability, and the Oswestry Disability Index (ODI) is a validated assessment tool for evaluating disability in LBP patients. Cross-cultural adaptation of the ODI is important because not all populations are proficient in English. The Yoruba language is an indigenous language spoken by 40 million people in the Western part of Nigeria and some countries in West Africa and Latin America. Currently, no validated Yoruba version of ODI is available. The aim of the study was to translate, culturally adapt and validate the ODI in Yoruba language for participants with LBP. The ODI was translated into Yoruba, and this translated version was analysed in terms of semantics and linguistics. Then, the Yoruba version was translated back into English and both versions administered to 160 participants with LBP. The internal consistency using Cronbach's alpha coefficient, criterion validity and test-retest reliability were assessed using Spearman's rank correlation with significance set at Pdisability in LBP patients.
The Neck Disability Index-Russian Language Version (NDI-RU): A Study of Validity and Reliability.
Bakhtadze, Maxim A; Vernon, Howard; Zakharova, Olga B; Kuzminov, Kirill O; Bolotov, Dmitry A
2015-07-15
Cross-cultural adaptation and psychometric testing. To perform a validated Russian translation and then to evaluate the validity and reliability of the Russian language version of the Neck Disability Index (NDI-RU). Neck pain is highly prevalent and can greatly affect daily activity. The Neck Disability Index (NDI) is the most frequently used scale for self-rating of disability due to neck pain. Its translated versions are applied in many countries. However, the Russian language version of the NDI has not been developed yet. Cross-cultural adaptation of the NDI-RU was performed according to established guidelines. Then, the NDI-RU was evaluated for content validity, concurrent criterion validity, internal consistency, test-retest reliability, factor structure, and minimum detectable change. Two hundred thirty-two patients took part in the study in total: 109 in validity (39.5 ± 10 yr), 123 in reliability (38.4 ± 11 yr; 80 in the test-retest phase). A culturally valid translation was achieved. NDI-RU total scores were distributed normally. Floor/ceiling effects were absent. Good values of Cronbach α were obtained for each item (from 0.80 to 0.84) and for the total NDI-RU (0.83). A 2-factor solution was found for the NDI-RU. The average interitem correlation coefficient was 0.53. Intraclass correlation coefficients for test-retest reliability coefficients ranged from 0.65 to 0.92 for different items and 0.91 for the total NDI-RU. Moderate correlation (Spearman rs = 0.62; P Russian language version of the Neck Disability Index resulted in a valid, reliable instrument that can be used both in clinical practice and scientific investigations. 1.
Papuga, Mark O; Mesfin, Addisu; Molinari, Robert; Rubery, Paul T
2016-07-15
A prospective and retrospective cross-sectional cohort analysis. The aim of this study was to show that Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT) assessments for physical function and pain interference can be efficiently collected in a standard office visit and to evaluate these scores with scores from previously validated Oswestry Disability Index (ODI) and Neck Disability Index (NDI) providing evidence of convergent validity for use in patients with spine pathology. Spinal surgery outcomes are highly variable, and substantial debate continues regarding the role and value of spine surgery. The routine collection of patient-based outcomes instruments in spine surgery patients may inform this debate. Traditionally, the inefficiency associated with collecting standard validated instruments has been a barrier to routine use in outpatient clinics. We utilized several CAT instruments available through PROMIS and correlated these with the results obtained using "gold standard" legacy outcomes measurement instruments. All measurements were collected at a routine clinical visit. The ODI and the NDI assessments were used as "gold standard" comparisons for patient-reported outcomes. PROMIS CAT instruments required 4.5 ± 1.8 questions and took 35 ± 16 seconds to complete, compared with ODI/NDI requiring 10 questions and taking 188 ± 85 seconds when administered electronically. Linear regression analysis of retrospective scores involving a primary back complaint revealed moderate to strong correlations between ODI and PROMIS physical function with r values ranging from 0.5846 to 0.8907 depending on the specific assessment and patient subsets examined. Routine collection of physical function outcome measures in clinical practice offers the ability to inform and improve patient care. We have shown that several PROMIS CAT instruments can be efficiently administered during routine clinical visits. The
D.R. Gasper (Des)
2008-01-01
markdownabstractAbstract: Much of Amartya Sen’s work has been directly policy-related, but his methodology of policy analysis has not been explained in detail. Action-related social science involves value-imbued procedures that guide the numerous unavoidable choices. This theme was explored
Bos, Isaac; Wynia, Klaske; Drost, Gea; Almansa, Josué; Kuks, Joannes
2017-01-01
OBJECTIVE: To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease
The Cross-Cultural Validity of the Learning Disability Index: A Reanalysis of Mishra's Data.
Inglis, James; Lawson, J. S.
1985-01-01
Investigated nature of a learning disability index (LDI) for the objective assessment of verbal-nonverbal patterns of intellectual deficit on the Wechsler Intelligence Scale for Children-Revised using Factor II score coefficients derived from an unrotated principal components analysis of normative data, and average scaled scores. The…
Singh, Jasvinder A; Hossain, Alomgir; Tanjong Ghogomu, Elizabeth; Mudano, Amy S; Maxwell, Lara J; Buchbinder, Rachelle; Lopez-Olivo, Maria Angeles; Suarez-Almazor, Maria E; Tugwell, Peter; Wells, George A
2017-03-10
Biologic disease-modifying anti-rheumatic drugs (DMARDs: referred to as biologics) are effective in treating rheumatoid arthritis (RA), however there are few head-to-head comparison studies. Our systematic review, standard meta-analysis and network meta-analysis (NMA) updates the 2009 Cochrane overview, 'Biologics for rheumatoid arthritis (RA)' and adds new data. This review is focused on biologic or tofacitinib therapy in people with RA who had previously been treated unsuccessfully with biologics. To compare the benefits and harms of biologics (abatacept, adalimumab, anakinra, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, tocilizumab) and small molecule tofacitinib versus comparator (placebo or methotrexate (MTX)/other DMARDs) in people with RA, previously unsuccessfully treated with biologics. On 22 June 2015 we searched for randomized controlled trials (RCTs) in CENTRAL, MEDLINE, and Embase; and trials registries (WHO trials register, Clinicaltrials.gov). We carried out article selection, data extraction, and risk of bias and GRADE assessments in duplicate. We calculated direct estimates with 95% confidence intervals (CI) using standard meta-analysis. We used a Bayesian mixed treatment comparison (MTC) approach for NMA estimates with 95% credible intervals (CrI). We converted odds ratios (OR) to risk ratios (RR) for ease of understanding. We have also presented results in absolute measures as risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB). Outcomes measured included four benefits (ACR50, function measured by Health Assessment Questionnaire (HAQ) score, remission defined as DAS tofacitinib (399 participants). The majority of the trials (10/12) lasted less than 12 months.We judged 33% of the studies at low risk of bias for allocation sequence generation, allocation concealment and blinding, 25% had low risk of bias for attrition, 92% were at unclear risk for selective reporting; and 92% had low risk
Karagülle, Mine; Kardeş, Sinan; Karagülle, Müfit Zeki
2017-11-01
The objective of this study is to determine the use and efficacy of spa therapy in patients with a wide spectrum of rheumatic and musculoskeletal diseases under real-life clinical practice circumstances. In this retrospective observational study at the Medical Ecology and Hydroclimatology Department of Istanbul Faculty of Medicine, the records of all adult patients with rheumatic and musculoskeletal diseases who were prescribed a spa therapy in various health resorts in Turkey between 2002 and 2012 were analyzed. Patients sojourned to and stayed at a health resort and followed a usual 2-week course of spa therapy. The patients were examined within a week before and after the spa therapy at the department by the physicians and outcome measures were pain intensity (visual analog scale, VAS), patient's general evaluation (VAS), physician's general evaluation (VAS), Health Assessment Questionnaire (HAQ), Lequesne's Functional Index (LFI), Western Ontario and McMaster Universities Index (WOMAC), Waddell Index (WI), Neck Pain and Disability Scale (NPDS), Shoulder Disability Questionnaire (SDQ), Fibromyalgia Impact Questionnaire (FIQ), and Beck's Depression Inventory (BDI). In total, 819 patients were included in the analysis. The diagnoses were 536 osteoarthritis; 115 fibromyalgia; 50 lumbar disc herniation; 34 cervical disc herniation; 23 nonspecific low back pain; 22 ankylosing spondylitis; 16 rheumatoid arthritis; 9 rotator cuff tendinitis; and 14 other conditions/diseases including scoliosis, stenosing flexor tenosynovitis, congenital hip dislocation in adult, Behçet's disease, de Quervain tendinopathy, psoriatic arthritis, osteoporosis, fracture rehabilitation, and diffuse idiopathic skeletal hyperostosis. Statistically significant decrease in pain scores was found in all patients except hip osteoarthritis ( p = 0.063) and rheumatoid arthritis ( p = 0.134) subgroups; and statistically significant improvement in function in all patients except hip osteoarthritis ( p
Dawson, Anna P; Steele, Emily J; Hodges, Paul W; Stewart, Simon
2010-05-01
Disability due to back pain in nurses results in reduced productivity, work absenteeism and attrition from the nursing workforce internationally. Consistent use of outcome measures is needed in intervention studies to enable meta-analyses that determine efficacy of back pain preventive programs. This study investigated the psychometric and measurement properties of the Oswestry Disability Index (ODI) in nursing students to determine its suitability for assessing back pain related disability in intervention studies. Bachelor of Nursing students were recruited. Test-retest reliability and the ability of the ODI to discriminate between individuals with serious and non-serious back pain were investigated. The measurement error of the ODI was examined with the minimal detectable change at the 90% confidence level (MDC(90)). Student nurses (n=214) had a low mean ODI score of 8.8+/-7.4%. Participants with serious back pain recorded higher scores than the rest of the cohort (pdisability in this population. Data from this and previous studies demonstrate that the measurement properties of the ODI are inappropriate for studying back pain related disability in nurses. The ODI is not recommended for back pain intervention studies in the nursing population and an alternative tool that is sensitive to lower levels of disability must be determined. Copyright 2009 Elsevier Ltd. All rights reserved.
Sex life and the Oswestry Disability Index.
Costa, Michelle; Marshman, Laurence A G
2015-06-01
Despite the option to not answer, there is widespread anecdotal belief that the Oswestry Disability Index (ODI) Section 8 (ODI-8/sex life) is answered inaccurately (ie, in relation to psychosocial factors, not pain) or that it repels ODI participation. Oswestry Disability Index versions have therefore been created that omit ODI-8; however, no evidence base justifies this. Interestingly, one recent study reported an ODI-8 response rate (RR) of 97%. The aims of this study were to measure RR to sex life questions in patients with chronic low back pain (CLBP) and to validate that ODI-8 is answered appropriately and represents a specific measure of CLBP-mediated sexual inactivity. Original. Eighty-eight patients. The outcome measures used in this study were the ODI, the Sexual Quality of Life Scale-version 2 (SQOL-2), the Short Form-12 version 2 (mental and physical), the Depression Anxiety and Stress Scale, the Coping Strategies Questionnaire, the Short-Form McGill Pain Questionnaire-version 2, the Opioid Risk Tool, and the Fear-Avoidance Beliefs Questionnaire (work and physical). Chronic low back pain patients older than 18 years attending a multicultural Western spinal clinic were prospectively offered the aforementioned questionnaires. Sex life disability questions--pain dependent (ODI-8) and pain independent (SQOL-2)--appeared first and fifth in every sequence. Results were obtained in 65 patients (male 29, female 36). Despite expected response attrition with battery progression (RRs for the first and eighth questionnaires were 100% and 64.61%, respectively), RRs for ODI-8 (52.31%) and SQOL-2 (52.31%) were equal and significantly lower than others (p<.001). Nonresponders to ODI-8 (60.57±13.3 years) and SQOL-2 (59.68±13.34 years) were significantly older than responders (ODI-8: 47.82±12.17 years, p<.001; SQOL-2: 48.27±12.76 years, p=.001). Among ODI-8 or SQOL-2 responders, ODI-8 and SQOL-2 were not correlated (r=-0.340, p=.104). Although ODI-8 significantly
Saltychev, Mikhail; Mattie, Ryan; McCormick, Zachary; Laimi, Katri
2017-05-13
The Neck Disability Index (NDI) is commonly used for clinical and research assessment for chronic neck pain, yet the original version of this tool has not undergone significant validity testing, and in particular, there has been minimal assessment using Item Response Theory. The goal of the present study was to investigate the psychometric properties of the original version of the NDI in a large sample of individuals with chronic neck pain by defining its internal consistency, construct structure and validity, and its ability to discriminate between different degrees of functional limitation. This is a cross-sectional cohort study of 585 consecutive patients with chronic neck pain seen in a university hospital rehabilitation clinic. Internal consistency was evaluated using Cronbach's alpha, construct structure was evaluated by exploratory factor analysis, and discrimination ability was determined by Item Response Theory. The NDI demonstrated good internal consistency assessed by Cronbach's alpha (0.87). The exploratory factor analysis identified only one factor with eigenvalue considered significant (cutoff 1.0). When analyzed by Item Response Theory, eight out of 10 items demonstrated almost ideal difficulty parameter estimates. In addition, eight out of 10 items showed high to perfect estimates of discrimination ability (overall range 0.8 to 2.9). Amongst patients with chronic neck pain, the NDI was found to have good internal consistency, have unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability. Implications for Rehabilitation The Neck Disability Index has good internal consistency, unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability. The Neck Disability Index is recommended for use when selecting patients for rehabilitation, setting rehabilitation goals, and measuring the outcome of intervention.
Correlations between IL6 and the main clinical and biological parameters in rheumatoid arthritis
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Mihaela Chicu
2016-09-01
Full Text Available Introduction: Cytokines are a family of complex peptide with hormone-like activity. They are soluble proteins without enzymatic activity and serves as the main intracellular mediators. Many cytokines achieves its effects by binding to special receptors membrane, and their adjustment is via soluble receptors. Cytokines are characterized by pleiotropism, overlapping and mutual adjustment. Proinflammatory cytokine involved in major rheumatoid arthritis are TNF, IL1α, IL1β, IL8.The biological effects of IL6 overlap in large part over those of TNF. If TNF is involved in induction of apoptosis or programmed cell death, IL6 is specifically associated with angiogenic factors activation and the occurrence of neovascularity to the synovium; favors articular cartilage degradation by increasing the release of MMP, decreasing PG, recruit osteoclasts, apoptosis of osteoblasts, release of degradative enzymes and the inflammatory mediators - iNOS, COX2 - TNF, IL6, IL8.Material and methods: Based on these data we proposed and realized – for the first time in Romania – the measurement of IL6 levels and the correlation with values of DAS28 score, HAQ, ESR, CRP, Hb and the immunological parameters too. The study was conducted on a group of 80 sick diagnosed with RA in various stages of evolution, under treatment with disease-modifying medication , type Methotrexate, Arava.Conclusions: Levels of IL-6 correlate a direct manner with those of acute phase reactants ,ESR, CRP and indirect values of Hb, IgG; the clinical parameters (number of tender and swollen joints, DAS28, HAQ are not influenced by values IL6.
Huang, Wei-Lieh; Chen, Tzu-Ting; Chen, I-Ming; Chang, Li-Ren; Lin, Yu-Hsuan; Liao, Shih-Cheng; Gau, Susan Shur-Fen
2016-05-15
Whether personality features affect the development of somatoform disorders and their psychopathologies is an important issue. Aim of this study was to resolve this issue by comparing indicators of psychopathology and personality features in subjects with somatoform disorders and healthy controls. This study recruited 148 subjects with somatoform disorders and 146 healthy controls. The severity of psychopathology was measured with the Patient Health Questionnaire-15 (PHQ-15), Health Anxiety Questionnaire (HAQ), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). The Tridimensional Personality Questionnaire (TPQ) was used to assess personality features. Demographic data, psychopathology indicators, and TPQ scores were compared between groups. Correlation and multivariate linear regression analysis were used to identify the personality dimensions or demographic variables associated with psychopathology. The somatoform group had lower novelty seeking (NS) and reward dependence (RD) and higher harm avoidance (HA) and severity of psychopathologies. Multiple regression analysis revealed that fatigability, persistence, gender, and education level were predictive of PHQ-15; HA, educational level, persistence, and dependence were predictive of HAQ; HA, persistence, education level, and NS were predictive of BDII-II; and fatigability, education level, persistence, and anticipatory worry were predictive of BAI. The development of somatoform disorders was associated with fatigability, age, residence location, education level, and attachment. The limitations include heterogeneity of the diagnosis, the high proportion of undifferentiated somatoform disorder, and the cross-sectional study design. HA/fatigability, persistence, and education level are associated with each type of psychopathology. Fatigability is a powerful predictor of somatoform disorder development. Copyright © 2016. Published by Elsevier B.V.
The Effectiveness of Aquatic Exercises in the Treatment of Rheumatoid Arthritis
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Tuncay Çakır
2014-04-01
Full Text Available Objective: Rheumatoid Arthritis (RA is a chronic destructive inflammatory disorder. This study is aimed to investigate the effects of balneotherapy and aquatherapy in the treatment of RA patients. Materials and Methods: A total of 59 patients who fulfilled the American College of Rheumatology diagnostic criteria for RA were included this study. Patients were randomly assigned into three groups. Group 1 (n=20 received balneotherapy, group 2 (n=20 received an aquatic exercise program and group 3 (n=19 was accepted as control group. These programs were applied five times a week, over three weeks (15 sessions. Patients were evaluated for clinical and laboratory parameters. Clinical parameters included pain,duration of morning stiffness, number of swollen and tender joints, disease activity score (DAS28, Modified health assessment questionnaire (mHAQ, physician’s and patient’s global assessment and hand grip strength. Laboratory evaluation included erythrocyte sedimentation rate(ESR and C-reactive protein (CRP. The assessment parameters were measured before, at the end of and after 3 months of the therapy. Results: The mean age of the patients was 54±10.7 (25-75 years and the mean disease duration was 122.3±98.1 (1-424 months. In aquatic exercise group we observed an improvement in DAS28 scores (p0.05. Conclusion: This study shows that aquatic exercise program is beneficial in the management of DAS28, pain, HAQ parameters and should be taken in to consideration in planning exercise therapy for RA patients. (Turkish Journal of Osteoporosis 2014;20: 10-5
Rodrigo, Luis; Blanco, Ignacio; Bobes, Julio; de Serres, Frederick J
2013-11-09
Celiac disease (CD) is an autoimmune disorder, characterized by the presence of gastrointestinal and multisystem symptoms, which occasionally mimic those of Irritable Bowel Syndrome (IBS) and Fibromyalgia Syndrome (FMS). To assess the effectiveness of a Gluten-Free Diet (GFD) in seven adult female screening-detected CD subjects, categorized as severe IBS and FMS patients. All subjects showed villous atrophy in duodenal biopsies, were HLA-DQ2/DQ8-positive, and fulfilled the Rome III and ACR 1990 criteria respectively for IBS and FMS classification. GFD effectiveness was assessed at baseline and after 1 year, examining the score changes in the Tender Points (TPs) test, Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), Short Form Health Survey (SF-36), Visual Analogue Scales (VAS) for gastrointestinal complaints, pain and tiredness, drug prescriptions and tissue-Trans-Glutaminase (tTG) serum levels. At baseline, all patients had poor Quality of Life and VAS scores, a high number of TPs and drug prescriptions, and increased tTG levels. After 1 year of GFD, all outcome measures significantly improved, with a decrease of 51-60% in TPs, FIQ, HAQ, and VAS scales, and in the number of prescribed drugs, accompanied by an increase of 48-60% in SF-36 Physical and Mental Component Summary scores, and a decrease of tTG to normal values. Results of this pilot study show that the adherence to a GFD by CD-related IBS/FMS patients can simultaneously improve CD and IBS/FMS symptoms, and indicate the merit of further research on a larger cohort.
Strand, Vibeke; van Vollenhoven, Ronald F; Lee, Eun Bong; Fleischmann, Roy; Zwillich, Samuel H; Gruben, David; Koncz, Tamas; Wilkinson, Bethanie; Wallenstein, Gene
2016-06-01
To evaluate effects of tofacitinib or adalimumab on patient-reported outcomes (PROs) in patients with moderate to severe RA and inadequate responses to MTX. In this 12-month, phase 3, randomized controlled trial (ORAL Standard), patients (n = 717) receiving background MTX were randomized to tofacitinib 5 or 10 mg twice daily (BID), adalimumab 40 mg once every 2 weeks or placebo. PROs included HAQ-Disability Index, Patient Global Assessment of Arthritis, Patient Assessment of Arthritis Pain, health-related quality of life (Short Form-36 [SF-36]), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue) and sleep (Medical Outcomes Study-Sleep). At month 3, tofacitinib 10 mg BID treatment resulted in significant changes from baseline vs placebo across all PROs, sustained to month 12, with the highest number of patients reporting improvements ⩾minimum clinically important differences vs placebo (P tofacitinib 5 mg BID and adalimumab were similar and statistically significant vs placebo across most PROs, excluding SF-36 Mental Component Score and Social Functioning, Role Emotional, and Mental Health domains, with significantly more patients reporting improvements ⩾minimum clinically important differences. Numbers Needed to Treat were lowest for tofacitinib 10 mg BID and similar between tofacitinib 5 mg BID and adalimumab. Patients with moderate to severe RA and inadequate responses to MTX reported improvements across a broad range of PROs with tofacitinib 5 and 10 mg BID and adalimumab that were significantly superior to placebo. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Rheumatology.
Psychometric properties and clinical usefulness of the Oswestry Disability Index.
Vianin, Michael
2008-12-01
Outcome measures with good reliability, validity, responsiveness, and low burden of administration are clinically useful. The Oswestry Disability Index (ODI) is one of the most commonly used outcome measures for individuals with low back pain. Psychometric properties of the ODI will determine the questionnaire's suitability as a useful clinical tool. A literature search of relevant databases on psychometric evaluation of the ODI was performed. The search was done using the key words disability evaluation, and low back pain, and questionnaires, and reproducibility of results, and the term Oswestry. Inclusion criterion was direct reference regarding psychometric property, interpretability, and burden being included in the abstract. Eight articles met the inclusion criterion. The ODI shows good construct validity; internal consistency is rated as acceptable; test-retest reliability and responsiveness have been shown to be high; and burden of administration is low. The ODI is a valid, reliable, and responsive condition-specific assessment tool that is suited for use in clinical practice. It is easy to administer and score, objectifies clients' complaints, and monitors effects of therapy.
The normative score and the cut-off value of the Oswestry Disability Index (ODI).
Tonosu, Juichi; Takeshita, Katsushi; Hara, Nobuhiro; Matsudaira, Ko; Kato, So; Masuda, Kazuhiro; Chikuda, Hirotaka
2012-08-01
The Oswestry Disability Index (ODI) is one of the most common scoring systems used for patients with low back pain (LBP). Although the normative score of the ODI was reported to be 10.19 in a review article, no study has calculated the normative score after adjusting the value based on the age distribution. In addition, none of the previous studies has estimated the cut-off value which separates LBP with disability from LBP without disability. The purpose of this study was to estimate the normative score by adjusting the data for age distribution in Japan, and to determine the cut-off value which separates LBP with disability from LBP without disability. We conducted an internet survey on LBP using the Japanese version of the ODQ. A total of 1,200 respondents, composed of 100 males and 100 females in each age group (from the 20s to 70s), participated in this study. We also asked them to provide information about their backgrounds. We estimated the normative score after correcting for the age distribution of Japan. We also estimated the ODI of those with or without disability, the factors associated with the ODI, and the cut-off value which separates LBP with disability from LBP without disability. The participants' backgrounds were similar to the national survey. The normative score of the ODI was estimated at 8.73. The ODI of the LBP with disability group was 22.07. Those with sciatica and obese subjects showed higher ODI than those without. The optimal cut-off value was estimated to be 12. We defined the normative score and the cut-off value of the ODI.
Magic informationally complete POVMs with permutations
Planat, Michel; Gedik, Zafer
2017-09-01
Eigenstates of permutation gates are either stabilizer states (for gates in the Pauli group) or magic states, thus allowing universal quantum computation (Planat, Rukhsan-Ul-Haq 2017 Adv. Math. Phys. 2017, 5287862 (doi:10.1155/2017/5287862)). We show in this paper that a subset of such magic states, when acting on the generalized Pauli group, define (asymmetric) informationally complete POVMs. Such informationally complete POVMs, investigated in dimensions 2-12, exhibit simple finite geometries in their projector products and, for dimensions 4 and 8 and 9, relate to two-qubit, three-qubit and two-qutrit contextuality.
DEFF Research Database (Denmark)
Kuettel, D; Primdahl, J; Christensen, R
2018-01-01
Heijde method. Major outcomes were change from baseline in Total Sharp Score (ΔTSS) and functional impairment, expressed by the Health Assessment Questionnaire (ΔHAQ). Their association with flare phenotype was analysed by logistic regression. RESULTS: The study included 268 RA patients (70% female; 73......% immunoglobulin M rheumatoid factor positive), with a median age (interquartile range) of 63 (55-70) years, and 7 (4-13) years' disease duration. Flares were recalled as NF (n = 77), TF (n = 141), and PJC (n = 50). ΔTSS > 0 was observed in 35%, 37%, and 46%, respectively (p = 0.42), but statistically...
DEFF Research Database (Denmark)
Sode, Jacob
2014-01-01
and interferon-gamma pathways were assessed in 538 anti-TNF naive Danish RA patients. Prospectively collected clinical data including functional status (HAQ), patient global score, smoking status, tender and swollen joint counts, treatments, rheumatoid factor (RF) status and C-reative protein (CRP) were obtained...... for seropositive RA in CARD8 (rs2043211), IL18 (rs187238) and TLR1 (rs4833095) (data not shown) but due to low power these results are preliminary. Conclusion: Our results confirm association between a TLR5 locus and EULAR response to anti-TNF treatment. Previous studies suggest that this polymorphism...
Gota, Carmen E; Kaouk, Sahar; Wilke, William S
2015-09-01
The aim of this study was to determine the frequency of increasing body mass index (BMI) in fibromyalgia (FM) and to understand the impact of increasing BMI on FM. Patients with FM were divided into 3 BMI classifications: normal weight, overweight, and obese. We then sought relationships of increasing BMI to core process FM variables and symptoms and disability, as well as medical comorbidities and demographic, socioeconomic, psychiatric, and treatment data. Of 224 patients, 0.4% were underweight; 25.9%, normal weight; 29.9%, overweight; 43.8%, obese. We found no differences within groups with regard to age, gender, demographics, FM symptoms, FM impact questionnaire scores, and meeting the American College of Rheumatology 1990 criteria and FM survey criteria. Patients with FM who are obese, compared with normal-weight patients, have higher depression scores measured by Patient Health Questionnaire 9 (13.2 [6.6] vs 10.5 [6], P = 0.03), report increased disability by Health Assessment Questionnaire Disability Index scores (1.3 [0.6] vs 0.9 [0.6], P BMI with the Health Assessment Questionnaire Disability Index (not FM impact questionnaire) and depression. We confirm that the prevalence of overweight and obesity is high in FM and believe that physicians treating FM should be aware of our bivariate linear correlations and discuss weight loss with their FM patients. Even if increasing BMI is not intrinsic to FM, it contributes to poor mood and functional outcome and should be a treatment goal.
Pasha, Ibrahim Farooq; Qureshi, Muhammad Asad; Farooq, Maheen; Talha, Muhammed; Ahmed, Naveed; Ismail, Junaid
2015-11-01
To assess the outcome of surgical treatment in spondylolisthesis of lumbosacral region using Oswestry disability Index. The quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi from 2006 to 2013 and comprised surgically treated patients with spondylolisthesis. The patients with degenerative and isthmic types with follow-up of at least two years were included. A performa was designed for each patient and records were kept in a custom-built database. Oswestry disability index was used as the assessment tool and assessment was done pre-operatively, at 1, 3 and 6 months and then at 1 year and 2 years. There were 96 patients with mean pre-op Oswestry disability index score of 81.06% (range 42.22-100, SD ±11.99). L5-S1 was affected in 44 (45.83%) patients, L4-L5 in 30 (31.25%), L4-5-S1 in 7 (7.29%) and multi or high level was found in the rest of the cases. One level was involved in 77 (80.2%), 2 in 11 (11.45%), 3 in 7 (7.29%) and 4 in 1 (1.04%). The slip grade as per Meyerding grades was 1 in 31 (32.29%), II in 39 (40.62%), III in 19 (19.79%), IV in 5 (5.2%) and 2 (2.08%) had spondyloptosis. Mean follow-up was 42 months (range 24-63). Mean Oswestry disability score at 1 month was 38.51% (range 11- 62.22%, SD ±11.75); at 6 months 10.02% (range 0-40%, SD ±6.99); at 1 year 4.62% (range 0-24%, SD ±5.36) and at 2 years 4.21% (range 0-15%, SD ±4.2). Surgical treatment of spondylolisthesis gives excellent long-term result in most patients.
Yamanaka, Hisashi; Tanaka, Yoshiya; Takeuchi, Tsutomu; Sugiyama, Naonobu; Yuasa, Hirotoshi; Toyoizumi, Shigeyuki; Morishima, Yosuke; Hirose, Tomohiro; Zwillich, Samuel
2016-01-28
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. Here, tofacitinib safety and efficacy data from a long-term extension study in Japanese patients are presented. Study A3921041 was a multi-centre, open-label, long-term extension study that included Japanese patients who had participated in a prior Phase 2 or Phase 3 study of tofacitinib as monotherapy or with background methotrexate. Patients received tofacitinib 5 mg twice daily (BID) or tofacitinib 10 mg BID. Dose adjustment of tofacitinib during treatment period, and concomitant usage of disease-modifying antirheumatic drugs including methotrexate after week 12 were permitted. Primary endpoints were adverse events, laboratory parameters and vital signs. Secondary efficacy endpoints included American College of Rheumatology (ACR)20/50/70 response rates, Disease Activity Score (DAS)28-4(erythrocyte sedimentation rate (ESR))tofacitinib-treated patients, the incidence rate (patients with events per 100 patient-years) was 10.7 for serious adverse events, 3.3 for serious infections, 7.4 for herpes zoster (serious and non-serious) and 1.2 for malignancies (excluding non-melanoma skin cancer). Mean changes from baseline (start of the index study) in laboratory parameters were consistent with those seen in previously reported studies of tofacitinib. ACR20/50/70 response rates, DAS-defined remission rates and HAQ-DI scores were sustained through to study completion. Tofacitinib (with or without background methotrexate) demonstrated a stable safety profile and sustained efficacy in Japanese patients with active rheumatoid arthritis. The risk of herpes zoster appears to be higher in Japanese patients treated with tofacitinib than in the global population. Clinicaltrials.gov NCT00661661 . Registered 7 February 2008.
The predictors of foot ulceration in patients with rheumatoid arthritis.
Firth, Jill; Waxman, Robin; Law, Graham; Nelson, E Andrea; Helliwell, Philip; Siddle, Heidi; Otter, Simon; Butters, Violet; Baker, Lesley; Hryniw, Rosemary; Bradley, Sarah; Loughrey, Lorraine; Alcacer-Pitarch, Begonya; Davies, Samantha; Tranter, Jennifer
2014-05-01
This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration
Bethge, Matthias; Gutenbrunner, Christoph; Neuderth, Silke
2013-11-01
To determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation. Cohort study with 3-month follow-up. Seven inpatient rehabilitation centers. Patients (N=294; 168 women; mean age, 49.9y) with chronic back pain. The WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation. Application for disability pension, as assessed by a postal questionnaire 3 months after discharge. Receiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62-.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6-68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5-16.8) higher odds of unemployment, and 6 times (95% CI, 2.4-15.2) higher odds of long-term sick leave at follow-up. The WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Evaluation of responsiveness of Oswestry low back pain disability index.
Changulani, Manish; Shaju, Anthony
2009-05-01
To assess the response of Oswestry disability index (ODI) among patients undergoing caudal epidural steroid injections for lumbosacral radicular pain. A total number of 107 consecutive patients were analysed. ODI was obtained at preassessment and then at 6 weeks post-injection. At follow-up, patients were asked to rate their condition on an ordinal scale as compared to pre-injection based on their response to five questions (much better, better, same, worse, much worse). As a measure of responsiveness, the effect size and standardized response mean (SRM) was calculated. The mean age of the cohort was 58 years. The mean duration of symptoms was 11 months. The mean Pre-injection ODI for 107 patients was 49(95% CI 46-52). The mean post-injection ODI at 6 weeks was 32(95% CI 28-35). The mean change in ODI was 16.9(95% CI 14-19). The mean change in ODI for much better or much worse group was 21.98(95% CI 18-25). The mean change in ODI for better or worse group was 15(95% CI 10-19) (P = 0.01). The mean change in ODI for same group was -0.6(95% CI -10 to 11). The effect size for the whole group was 1.05. The responsiveness as measured by SRM for the whole group was 0.84. This study shows that ODI can detect small changes in disability over time in patients undergoing caudal epidural injections for lumbosacral radicular pain. It can also differentiate between small and large changes in the level of disability.
Liu, Siqi; Oh, Heesoo; Chambers, David William; Xu, Tianmin; Baumrind, Sheldon
2018-04-06
Determine optimal weightings of Peer Assessment Rating (PAR) index and Discrepancy Index (DI) for malocclusion severity assessment in Chinese orthodontic patients. Sixty-nine Chinese orthodontists assessed a full set of pre-treatment records from a stratified random sample of 120 subjects gathered from six university orthodontic centres. Using professional judgment as the outcome variable, multiple regression analyses were performed to derive customized weighting systems for the PAR index and DI, for all subjects and each Angle classification subgroup. Professional judgment was consistent, with an Intraclass Correlation Coefficient (ICC) of 0.995. The PAR index or DI can be reliably measured, with ICC = 0.959 and 0.990, respectively. The predictive accuracy of PAR index was greatly improved by the Chinese weighting process (from r = 0.431 to r = 0.788) with almost equal distribution in each Angle classification subgroup. The Chinese-weighted DI showed a higher predictive accuracy, at P = 0.01, compared with the PAR index (r = 0.851 versus r = 0.788). A better performance was found in the Class II group (r = 0.890) when compared to Class I (r = 0.736) and III (r = 0.785) groups. The Chinese-weighted PAR index and DI were capable of predicting 62 per cent and 73 per cent of total variance in the professional judgment of malocclusion severity in Chinese patients. Differential prediction across Angle classifications merits attention since different weighting formulas were found.
Fleischmann, R; Mease, P J; Schwartzman, S; Hwang, L-J; Soma, K; Connell, C A; Takiya, L; Bananis, E
2017-01-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). This post hoc analysis investigated the effect of methotrexate (MTX) dose on the efficacy of tofacitinib in patients with RA. ORAL Scan (NCT00847613) was a 2-year, randomized, Phase 3 trial evaluating tofacitinib in MTX-inadequate responder (IR) patients with RA. Patients received tofacitinib 5 or 10 mg twice daily (BID), or placebo, with low (≤12.5 mg/week), moderate (>12.5 to tofacitinib 5 mg BID (N = 321), tofacitinib 10 mg BID (N = 316), or placebo (N = 160); 242, 333, and 222 patients received low, moderate, and high MTX doses, respectively. At months 3 and 6, ACR20/50/70 response rates were greater for both tofacitinib doses vs placebo across all MTX doses. At month 3, mean changes from baseline in CDAI and HAQ-DI were significantly greater for both tofacitinib doses vs placebo, irrespective of MTX category; improvements were maintained at month 6. Both tofacitinib doses demonstrated improvements in DAS28-4(ESR), and less structural progression vs placebo, across MTX doses at month 6. Tofacitinib plus MTX showed greater clinical and radiographic efficacy than placebo in MTX-IR patients with RA, regardless of MTX dose.
D.R. Gasper (Des)
2007-01-01
textabstractLeadership is a matter that social scientists often are ambivalent about, but is important in knife-edge' situations and when people choose direction within wide-open possibilities. "Good leaders" need contexts that stimulate and discipline them, good "followers"/ collaborators, and
Directory of Open Access Journals (Sweden)
Oonagh Wilson
2017-10-01
Full Text Available Abstract Background Foot symptoms in rheumatoid arthritis (RA derive from a combination of inflammation, altered foot mechanics, deformity and secondary skin lesions. Guidelines recommend regular review of patients’ feet, but the extent to which the general population of RA patients report foot symptoms and access foot care has not been established. The aims of this study were to determine the prevalence, impact and care of foot problems in all patients with RA in one geographical area and identify factors associated with accessing foot care. Methods Cross-sectional survey of a random sample of patients with RA, who resided within a single community-based National Health Service (NHS podiatry service. The questionnaire collected demographic data (age, gender, local deprivation score, clinical data (disease duration, arthritis medications, disability (Health Assessment Questionnaire (HAQ, current foot problems, foot care accessed (podiatry, orthotics and/or orthopaedics and care received, measures of impact (Foot Impact Scale and ability to work. Results Of 1003 total eligible patients in the target population, 739 were posted survey packs. Of these 413 (56% replied. Responders and non-responders had similar age (63.5 yr. vs.61.5 yr, gender (74.1%F vs. 75.2%F, and highest deprivation category (13.3% vs.15.9%. Of the responders 92.1% reported current foot problems: articular 73.8%, cutaneous lesions 65.4%, structural 57.6%, extra-articular 42.6%. Responders’ median (IQR disease duration 10 (5–20 years, HAQ 1.5 (0.75–2.0, FISIF 10 (6–14 and FISAP 16 (7–23 and 37.8% reported impacts on work. While 69.5% had accessed foot care there were differences in the route of access (by gender and whether independent or NHS provision and were older (64.9 yr. vs 60.4 yr. p = 0.001, had longer disease duration (12 yr. vs 7 yr. p < 0.001 and had a greater proportion of females (72.2% vs 61.7% p = 0.04 than those who had not accessed
Quantitative nailfold video capillaroscopy in patients with idiopathic inflammatory myopathy.
Mercer, Louise K; Moore, Tonia L; Chinoy, Hector; Murray, Andrea K; Vail, Andy; Cooper, Robert G; Herrick, Ariane L
2010-09-01
To quantify nailfold capillary density and dimensions in patients with idiopathic inflammatory myopathy (IIM) and compare them with those in healthy controls; to look for associations with microvascular disease in IIM; and to determine whether nailfold capillary density and dimensions change over time. Nailfold video microscopy (x300 magnification) was performed on 24 patients with IIM and 35 healthy controls. Capillary density and dimensions (total width and apical width) were quantified. Patients were clinically assessed and disease activity recorded using the Myositis Disease Activity Assessment Tool. Disease severity and physical function were assessed using the myositis damage index and Stanford HAQ, respectively. Findings were analysed using linear and logistic regression, adjusted for age and sex. In a subgroup of 16 patients with IIM and 27 controls, the process was repeated 6-12 months later and the results were analysed using Student's t-test. Capillary density was lower and dimensions were higher in patients with IIM compared with healthy controls (P nailfold capillaroscopy, suggesting that nailfold capillaroscopy may be useful as an outcome measure of microvascular disease in studies of IIM.
Liu, S; Oh, H; Chambers, D W; Baumrind, S; Xu, T
2017-08-01
To assess the validity of the American Board of Orthodontics Discrepancy Index (ABO-DI) and Peer Assessment Rating (PAR) Index in evaluating malocclusion severity in Chinese orthodontic patients. A stratified random sample of 120 orthodontic patients based on Angle classification was collected from six university orthodontic centres. Sixty-nine orthodontists rated malocclusion severity on a five-point scale by assessing a full set of pre-treatment records for each case and listed reasons for their decision. Their judgement was then compared with ABO-DI and PAR scores determined by three calibrated examiners. Excellent interexaminer reliability of clinician judgement, ABO-DI and PAR index was demonstrated by the Intraclass Correlation Coefficient (rho= 0.995, 0.990 and 0.964, respectively). Both the ABO-DI and US-PAR index showed good correlation with clinician judgement (r=.700 and r=.707, respectively). There was variability among the different Angle classifications: the ABO-DI showed the highest correlation with clinician judgement in Class II patients (r=.780), whereas the US-PAR index showed the highest correlation with clinician judgement in Class III patients (r=.710). Both indices demonstrated the lowest correlations with clinician judgement in Class I patients. With strong interexaminer agreement, the panel consensus was used for validating the ABO-DI and US-PAR index for malocclusion severity. Overall, the ABO-DI and US-PAR index were reliable for measuring malocclusion severity with significantly variable weightings for different Angle classifications. Further modification of the indices for different Angle classification may be indicated. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Aithala, Janardhana P
2015-06-09
In Indian patients, in view of language plurality and illiteracy, self-reporting of English version of Oswestry Disability Index (ODI) is not practical. Our study aim was to find out to what extent self-reporting of ODI was possible and in cases where self-reporting was not possible, to see validity and reliability of a translator-assisted ODI score. Fifty patients with low backache and who could not use the English version were assessed with ODI with the use of two translators at a gap of 3 h in a test and retest manner. Patients were also asked to report the most important disabling activity in their day-to-day life. A total of 58 questionnaires were filled during the study period out of which eight patients (14%) self-reported English version; while 50 patients needed a translator. The Cronbach's alpha between two translators for the ODI scores of 50 patients was 0.866, but aggregate of difference between two scores for each ODI component shows high difference between two translators for question nos. 3, 9, and 10. Cronbach's alpha was best when item no. 3 was deleted (0.875, translator 1; 0.777, translator 2). Thirty-seven people did not answer the question related to sexual activity. Agreement between two values was assessed using Kendall's tau and was found good (0.585, Spearman's coefficient 0.741). Kendall's tau values correlating total ODI score and individual components show that all the items move together, but correlation was poor for question no. 3 (P value 0.16 for translator 2). Translator-assisted ODI is a good outcome assessment tool in backache assessment in places where validated local language versions are not available, but in Indian patients, inclusion of question nos. 3 and 8 related to weight lifting and sexual function needs to be reviewed.
Why are there different versions of the Oswestry Disability Index?
Fairbank, Jeremy C T
2014-01-01
This article updates readers on the current state of the Oswestry Disability Index (ODI) and the impact of unvalidated versions. The ODI is now licensed to the Mapi Research Trust in order to preserve a standard version in English and in validated translations. A proposed threshold of "normality" is potentially helpful as an outcome for both audit and research. There is an application of the sex section as a quality measure in Germany. The ODI is an important international shared resource for clinicians and investigators and should not be abused. Its current status will not be enhanced by further modification. It is now registered with the International Consortium for Health Outcomes Measurement as a standard outcome measure.
Tofacitinib or Adalimumab versus Placebo for Psoriatic Arthritis.
Mease, Philip; Hall, Stephen; FitzGerald, Oliver; van der Heijde, Désirée; Merola, Joseph F; Avila-Zapata, Francisco; Cieślak, Dorota; Graham, Daniela; Wang, Cunshan; Menon, Sujatha; Hendrikx, Thijs; Kanik, Keith S
2017-10-19
Tofacitinib is an oral Janus kinase inhibitor that is under investigation for the treatment of psoriatic arthritis. We evaluated tofacitinib in patients with active psoriatic arthritis who previously had an inadequate response to conventional synthetic disease-modifying antirheumatic drugs (DMARDs). In this 12-month, double-blind, active-controlled and placebo-controlled, phase 3 trial, we randomly assigned patients in a 2:2:2:1:1 ratio to receive one of the following regimens: tofacitinib at a 5-mg dose taken orally twice daily (107 patients), tofacitinib at a 10-mg dose taken orally twice daily (104), adalimumab at a 40-mg dose administered subcutaneously once every 2 weeks (106), placebo with a blinded switch to the 5-mg tofacitinib dose at 3 months (52), or placebo with a blinded switch to the 10-mg tofacitinib dose at 3 months (53). Placebo groups were pooled for analyses up to month 3. Primary end points were the proportion of patients who had an American College of Rheumatology 20 (ACR20) response (≥20% improvement from baseline in the number of tender and swollen joints and at least three of five other important domains) at month 3 and the change from baseline in the Health Assessment Questionnaire-Disability Index (HAQ-DI) score (scores range from 0 to 3, with higher scores indicating greater disability) at month 3. ACR20 response rates at month 3 were 50% in the 5-mg tofacitinib group and 61% in the 10-mg tofacitinib group, as compared with 33% in the placebo group (P=0.01 for the comparison of the 5-mg dose with placebo; Ptofacitinib group and -0.40 in the 10-mg tofacitinib group, as compared with -0.18 in the placebo group (P=0.006 for the comparison of the 5-mg dose with placebo; Ptofacitinib group, 71% in the 10-mg tofacitinib group, 72% in the adalimumab group, 69% in the placebo group that switched to the 5-mg tofacitinib dose, and 64% in the placebo group that switched to the 10-mg tofacitinib dose. There were four cases of cancer, three serious
Dislipidemia en pacientes con artritis reumatoide atendidos en un hospital general
Directory of Open Access Journals (Sweden)
Jose Galindo
2011-04-01
Full Text Available Objetivo: Determinar la frecuencia de dislipidemia en pacientes con artritis reumatoide (AR atendidos en un hospital general. Material y métodos: Estudio observacional, descriptivo y transversal. Se incluyeron 44 pacientes a quienes se les determinó perfil lipídico sérico. Los resultados se clasificaron según el reporte modificado en el 2004 del tercer panel de tratamiento del adulto (ATP III. Además, se determinó el índice de masa corporal (IMC, la puntuación para la actividad de la enfermedad (DAS-28 y la limitación funcional medida con el cuestionario de evaluación de salud - versión peruana (HAQ-P. Resultados: La frecuencia de dislipidemia en pacientes con AR fue 75%. El 54,5% tuvo un IMC fuera de los límites normales. En el DAS-28, la mayoría de pacientes se encontraron con actividad severa de la enfermedad. Sin embargo, hubo más pacientes con dislipidemia en el grupo con moderada actividad. En la escala de HAQ-P, la mitad tuvo incapacidad funcional moderada a severa y mayor número de sujetos con dislipidemia. El 69,7% de los pacientes con alteraciones en el perfil lipídico presentó dislipidemia mixta. Conclusiones: La dislipidemia en los pacientes con AR del estudio se presentó con una alta frecuencia y con diversas formas de alteración en el perfil lipídico sin un patrón uniforme. Por lo tanto, el tratamiento de la dislipidemia sería individualizado en cada paciente para prevenir eventos cardiovasculares.(Rev Med Hered 2011;22:47-53.
Bansback, Nick; Zhang, Wei; Walsh, David; Kiely, Patrick; Williams, Richard; Guh, Daphne; Anis, Aslam; Young, Adam
2012-02-01
To understand the impact of the early years of RA on all aspects of work productivity, and determine how this is related to clinical markers. Previous research on work productivity has examined predominantly early retirement and absenteeism. The impact of reduced work performance (presenteeism) and activity impairment is less well understood in early RA populations. Working patients enrolled in an RA inception cohort were recruited into a nested study. A questionnaire incorporating the Work Productivity and Activity Impairment (WPAI) instrument was administered with a number of clinical outcomes, including the Multidimensional Health Assessment Questionnaire (MD-HAQ) and scales for pain, fatigue and patient assessment of disease patient global assessment (PtGA). Analysis included 150 RA patients, with the mean age at onset being 48 years (s.d. 10 years) and disease duration from symptom onset being 49 months. Patients had relatively mild disease: MD-HAQ (0.6), pain (3.6), PtGA (3.6) and fatigue (4.6). Of the 92% patients working for pay, 19% reported missing work (absenteeism) in the past week due to their health, accounting for 46% of their working time. Even while at work, ∼25% of actual hours was lost due to poor health, while outside work 33% of patients' regular daily activities were prevented. In multivariate analyses, disease severity was associated with the presence of absenteeism, presenteeism and activity impairment. Patients able to self-schedule their work had lower presenteeism and activity impairment. Productivity loss is common in patients in the first years of RA who are in paid work and was associated with work characteristics and adverse clinical outcomes.
Hassett, Afton L; Li, Tracy; Buyske, Steven; Savage, Shantal V; Gignac, Monique A M
2008-05-01
To consider the feasibility of assessing multiple facets of independence in rheumatoid arthritis (RA) using a measure developed from existing items and examining its face validity, construct validity and responsiveness to change. The ATTAIN (Abatacept Trial in Treatment of Anti-tumor necrosis factor [TNF] Inadequate responders) database was used. Patients with RA were randomized 2:1, abatacept (n = 258) and placebo (n = 133). A multi-faceted scale to measure physical and psychosocial independence was constructed using items from the Health Assessment Questionnaire (HAQ) and Short Form 36 Health Survey (SF-36). Questions assessing activity limitations and need for outside caregiver help were also examined. Interviews with 20 RA patients assessed face validity. Item Response Theory analysis yielded two traits - 'Psychosocial Independence', derived from the number of days with activity limitations plus the Role Emotional, Social Functioning and Role Physical subscale items from the SF-36; and 'Physical Independence', derived from 15 HAQ items assessing need for help from another. The two traits showed no significant differential item functioning for age or gender and demonstrated good face validity. Changes over 169 days on Psychosocial Independence were greater (mean 0.46 units, 95% confidence interval [CI]: 0.17-0.75) for the abatacept group than for placebo (p = 0.002). Changes in Physical Independence were greater (mean 0.59 units, 95% CI: 0.35-0.82) for the abatacept group than for placebo (p anti-TNF therapy. However, we caution against an interpretation that these data suggest that abatacept improves independence because the component parts of this assessment came from instruments used in the ATTAIN trial where data had been previously analyzed.
[The social vulnerability index regarding Medellín's disabled population].
Cardona-Arango, Doris; Agudelo-Martínez, Alejandra; Restrepo-Molina, Lucas; Segura-Cardona, Angela M
2014-01-01
Constructing a social vulnerability index (SVI) for Medellín's disabled population during 2008 aimed at determining areas which were reducing opportunities for this population to use their tangible and intangible assets, thus impairing their quality of life. This descriptive cross-sectional study drew on a source of secondary information regarding people having some kind of limitation recorded in the Quality of Life Survey, 2008. Physical, human and social variables were grouped when constructing the SVI; the models were run in principal component analysis to determine their degree of vulnerability, defined by the number of negative factors identified (high category=4 or 5, medium=2 or 3 and low=1 or none). Such classification led to identifying non-causal relationships with demographic variables through Mann-Whitney, Chi-square and Kruskal-Wallis tests (5.0 % statistical significance level); multinomial logistic regression was used for calculating adjusted measures for epidemiological measurement, such as opportunity ratios and confidence intervals. A degree of medium vulnerability predominated in disabled people living in Medellín (60.3 %) followed by low vulnerability (28.7 %) and high vulnerability populations (11.0 %). The proposed ISV classified the city's communes according to high, medium or low vulnerability, supported by the use of statistical and spatial location techniques.
Pereira, Éverton Luís; Barbosa, Livia
2016-10-01
This article derives from a study conducted on the validation of the Brazilian Functionality Index (IF-BrA) applied to the granting of retirement benefits to disabled persons. The retirement of persons with disabilities is regulated by Complementary Law 142 of May 8, 2013. The aim is to discuss how the individuals involved in application of the instrument perceive the concept of disability and the possible implications for ensuring the right to retirement. Eleven agencies of the National Social Security Institute (INSS) were visited and 16 physicians, 16 social workers and 40 persons with disabilities were interviewed. The evaluation and assessment process was also observed. The results indicate that there are conceptual tensions between the perspective on disability of the professionals and the IF-BrA concepts. Social workers and physicians are challenged in their technical specialties in the application of the instrument. Persons with disabilities do not always consider themselves to be disabled in their daily lives. Disability is either presented as a political description of the body in accordance with the social model of disability, or it is described as a specific difficulty justifying the right to seek retirement.
Systematic review and meta-analysis
DEFF Research Database (Denmark)
Lo, B; Prosberg, M V; Gluud, L L
2018-01-01
BACKGROUND: The Inflammatory Bowel Disease Disability Index (IBD-DI) has recently been developed for patients with Crohn's disease (CD) and ulcerative colitis (UC). AIM: To assess the severity of disability and associated factors using the IBD-DI, and review the validity of the IBD-DI as a tool. ...... review and meta-analysis found a significant association between disease activity, treatment received and disability; although significant heterogeneity was found. The IBD-DI is reliable and valid, but further studies are needed to measure its interpretability....
A study comparing MRI with clinical examinations on wrists with rheumatoid arthritis
International Nuclear Information System (INIS)
Wang Jun; Niu Jinliang; Xie Weina; Song Zhizhen; Zheng Jie; Ma Qiang
2004-01-01
Objective: To study the appearances of rheumatoid arthritis (RA) on MRI, and compare MRI with clinical examinations on wrists with RA. Methods: Fifty patients, fulfilled 1987 American Rheumatism Association (ARA) revised criteria, and 10 age-matched healthy controls entered the study. T 1 -weighted spin echo, short time inversion recovery (STIR) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were performed in the coronal planes. MRl, plain wrist radiographs, clinical date, including swollen joint, patient global assessment (AIMS), and laboratory examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score. Results: In 50 patients, all had pannus on MRI of wrists, 38 patients had enhanced signal intensity for pannus, 21 patients had bone marrow edema, 37 patients had joint effusion, and 37 patients had bone erosions. There were significant difference in the ESR, HAQ, AIMS as well as swollen joint count between patients with bone marrow edema and patients without bone marrow edema (P 2 =5.06, P=0.025; χ 2 =5.59, P=0.018). Number of patients with MRI erosion of wrists was associated with the number of patients without MRI bone marrow edema of wrists (χ 2 =5.11, P=0.024). Conclusion: MRI can find the appearances of wrists with RA. Comparing MRI with clinical examinations on wrists with RA, authors can assess and evaluate the role of MRI on RA
Kim, Beom-Ryong; Lee, Hye-Jin
2017-08-01
The purpose of this study was to evaluate the effect of abdominal muscle strengthening training (AMST) using proprioceptive neuromuscular facilitation (PNF) on pulmonary function, pain, and functional disability index in chronic low back pain (CLBP) patients. Thirty CLBP patients were randomly assigned to the traditional physical therapy (control) group (n=15) and PNF-AMST group (n=15). Forced expiratory volume at 1 second (FEV 1 ) was measured to measure changes in pulmonary function. To measure the degree of pain, a visual analog scale (VAS) was used. The Oswestry Disability Index (ODI) was used to assess the disability level due to low back pain. A paired t -test was performed to compare differences within the groups before and after intervention. An independent t -test was performed to compare differences between the test and control groups. The level of significance was set at α=0.05. Within-group changes in FEV 1 were significantly different in the experimental group ( P disability index inpatients with CLBP. We expect it to be useful as one of the programs for CLBP patients in the future.
Directory of Open Access Journals (Sweden)
Thorlund K
2012-12-01
Full Text Available Kristian Thorlund,1 Eric Druyts,2 J Antonio Aviña-Zubieta,3,4 Edward J Mills1,21Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; 2Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; 3Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; 4Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, CanadaObjective: To evaluate the comparative effectiveness of available tumor necrosis factor-a inhibitors (anti-TNFs for the management of psoriatic arthritis (PsA in patients with an inadequate response to disease-modifying antirheumatic drugs (DMARDs.Methods: We used an exhaustive search strategy covering randomized clinical trials, systematic reviews and health technology assessments (HTA published on anti-TNFs for PsA. We performed indirect comparisons of the available anti-TNFs (adalimumab, etanercept, golimumab, and infliximab measuring relative risks (RR for the psoriatic arthritis response criteria (PsARC, mean differences (MDs for improvements from baseline for the Health Assessment Questionnaire (HAQ by PsARC responders and non-responders, and MD for the improvements from baseline for the psoriasis area and severity index (PASI. When the reporting of data on intervention group response rates and improvements were incomplete, we used straightforward conversions based on the available data.Results: We retrieved data from 20 publications representing seven trials, as well as two HTAs. All anti-TNFs were significantly better than control, but the indirect comparison did not reveal any statistically significant difference between the anti-TNFs. For PsARC response, golimumab yielded the highest RR and etanercept the second highest; adalimumab and infliximab both yielded notably smaller RRs. For HAQ improvement, etanercept and infliximab yielded the largest MD among PsARC responders
Congressional Statistics: Disability Insurance for December 2014
Social Security Administration — While Social Security is best known for providing retirement benefits, the program also provides Disability Insurance (DI) protection to workers and their families...
Family vulnerability index to disability and dependence (FVI-DD), by social and health conditions.
Amendola, Fernanda; Alvarenga, Márcia Regina Martins; Latorre, Maria do Rosário Dias de Oliveira; Oliveira, Maria Amélia de Campos
2017-06-01
The Family Vulnerability Index to Disability and Dependence (FVI-DD) aims to summarize the dimensions of vulnerability to disability and dependence using family data monitored by Family Health Strategy (ESF) teams. This study aims to analyze the FVI-DD according to the social and health vulnerability, to validate and extract a cutoff point for each dimension. The FVI-DD was built with a sample of 248 families living in a region of São Paulo. The dimension related to health conditions was validated with good internal consistency, with respect to the Katz Index and the Lawton Scale, whereas the dimension related to social conditions was only validated in relation to Lawton Scale. Thus, a vulnerable family was defined as one with 15 or more points in the Total FVI-DD, and a vulnerable family in health conditions that with a score of 6 or more points in that dimension. Therefore, it is possible to classify families as not vulnerable, vulnerable in the social aspects, vulnerable in the health aspects and the more vulnerable family (social and health) using social indicators of empowerment and wear and health indicators related not only to the biological sphere, but also in the access to health services, health self-assessment and existing vulnerable groups.
Sohn, Y. K.; Rhee, C. W.; Shon, H.
2001-09-01
-level fluctuations. We suggest that the four alternations of conglomerates (lowstand systems) and hemipelagic mudstones (condensed intervals) resulted most probably from the 3rd-order glacioeustatic cycles during the middle Miocene. This finding implies that the signatures of global sea-level fluctuations can be deciphered from a tectonically active sedimentary basin if the timing of regional tectonic development is well constrained, and the global sea-level chart of Haq et al. ( Haq, B.W., Hardenbol, J., Vail, P.R., 1987, Chronology of fluctuating sea levels since the Triassic. Science 235, 1156-1167; Haq, B.U., Hardenbol, J., Vail, P.R., 1988. Mesozoic and Cenozoic chronostratigraphy and eustatic cycles. In: Wilgus, C.K., Hastings, B.S., Posamentier, H., Van Wagoner, J., Ross, C.A., Kendall, C.G.S.C. (Eds.), Sea-Level Changes: an Integrated Approach: Soc. Econ. Paleont. Mineral. Spec. Publ. 42, pp. 71-108) may serve as a guide to basinfill interpretation even in tectonically active sedimentary basins.
The tumor necrosis factor-α inhibitor golimumab in the treatment of rheumatoid arthritis
Directory of Open Access Journals (Sweden)
Natalia Vladimirovna Chichasova
2014-01-01
Full Text Available The tumor necrosis factor-α (TNF-α golimumab (GLM, that is a fully human monoclonal anti-body, was registered in Russia in 2012 to treat rheumatic diseases, such as rheumatoid arthritis (RA, ankylosing spondylitis, and psoriatic arthritis. Its distinguishing characteristics are a high affinity for TNF-α and easiness-to-use: the drug as a 0.5-ml solution is injected subcutaneously once monthly. The registration of the medication was followed by the implementation of a massive program of clinical trials. The randomized placebo-controlled GO-FORWARD, GO-BEFORE, and GO-AFTER studies have indicated that GLM is effective in patients with RA from different subgroups and has a favorable safety profile as compared to that of the entire class of biological agents. According to the data of these studies, GLM had a positive effect on the functional status and quality of life in patients with RA: there was a significantly greater decrease in HAQ scores in both the early and long open treatment phases (to 5 years and in fatigability than in the control group (p=0.032, physical and mental health improvements, as shown by the SF-36 questionnaire, and a significant reduction in disability.
Hatipoglu, Hasan; Canbaz Kabay, Sibel; Gungor Hatipoglu, Mujgan; Ozden, Hilmi
2016-01-01
The aim of this study was to evaluate the association between different disability states in patients with multiple sclerosis (MS) as determined by the expanded disability status scale (EDSS) and dental-periodontal measures. Eighty patients with MS (64 females and 16 males) were included in this study. Data on MS types, attack frequency, disease duration, EDSS scores and orofacial complaints prior to an MS attack were obtained from medical records. The plaque index (PI), probing depth (PD), clinical attachment level (CAL), gingival index (GI), decayed-missing-filled teeth (DMFT) index and number of present teeth were measured during one dental examination for each subject. The MS patients were divided into the following 2 groups based on their EDSS scores: low physical disability (L-DS) and high physical disability (H-DS). Differences in dental parameters between groups of low and high disability were investigated. p disability in MS patients. In addition, some maxillofacial-oral complaints prior to an MS attack were observed. © 2015 S. Karger AG, Basel.
Psychometric properties of the Hebrew version of the Oswestry Disability Index.
Gamus, Dorit; Glasser, Saralee; Langner, Elisheva; Beth-Hakimian, Aliza; Caspi, Israel; Carmel, Narin; Siev-Ner, Itzhak; Amir, Hagai; Ziv, A; Papa, M; Lerner-Geva, Liat
2016-06-17
Low back pain (LBP) is one of the most common health complaints, with lifetime prevalence rates as high as 84%. The Oswestry Disability Index (ODI) is often the measure of choice for LBP in both research and clinical settings and, as such, has been translated into 29 languages and dialects. Currently, however, there is no validated version of Hebrew-translated ODI (ODI-H). To examine the psychometric properties of the ODI-H. Cross-culturally appropriate translation into Hebrew was conducted. A convenience sample of 115 participants (Case Group) with LBP and 68 without LBP (Control Group) completed the ODI-H, SF-36 Health Survey, and two Visual Analog Scales (VAS). Internal consistency was α = 0.94 and test-retest reliability for 18 participants repeating the ODI-H was 0.97. No floor or ceiling effects were noted for Cases, although there was a floor effect for the Control Group. Scores were significantly different for the two groups, indicating discriminant validity. Concurrent validity was reflected by significant correlations with SF-36 scores, particularly the Physical Functioning and Bodily Pain subscales (-0.83 and -0.79, respectively) and with the VAS (0.84 and 0.79). The ODI-H is a valid and reliable measure of low back pain-related disability for the Hebrew-speaking public.
Characteristics of patients with rheumatoid arthritis in Qatar: a cross-sectional study.
Lutf, Abdo; Poil, Abdul R; Hammoudeh, Mohammed
2014-01-01
To describe the clinical characteristics, serologic, radiological and clinical disease activity, and modality of therapy in patients with rheumatoid arthritis (RA) at tertiary outpatient care in Qatar. The study design was cross-sectional where 100 consecutive cases who met 1987 American College of Rheumatology criteria for diagnosis of RA were enrolled in this study. Demographic data (sex, nationality and age) numbers of swollen and tender joints, X-rays and current medications were collected during outpatients visits to Hamad General Hospital. Disease Activity Score of 28 joints (DAS28) and Health Assessment Questionnaires (HAQ) scores were calculated. All patients with RA who were seen as rheumatology outpatients were invited to participate in the study. One hundred patients were seen and examined during their follow-up at the outpatient clinic; data were collected and analyzed. Females represented 67% of all patients, 6% had more than six swollen joints, 9% had more than six tender joints. DAS28 and erythrocyte sedimentation rate (DAS28) calculation revealed 49% of patients were in remission (DAS28 3.2.Mean HAQ score was 1.02. Rheumatoid factor (RF) was positive in 63%, while anti-cyclic citrullinated protein antibody (anti-CCP) was positive in 71%, and 49% were positive for both. Radiography of hands and feet during the previous year was done in 65% of patients: 11% of them had erosions. Sixty-six percent were on one synthetic disease-modifying anti-rheumatic drug (DMARD) and 27% where on more than one synthetic DMARD and 7% where on no DMRD. Glucocorticoids were used in 51% and 29% were on biologics. Sixty-four percent of rheumatoid arthritis patients in Qatar were in remission or had low disease activity while the remaining 36% had active disease and among these patients 29% were on biologics. © 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.
Directory of Open Access Journals (Sweden)
Freke Wink
Full Text Available OBJECTIVE: The Psoriatic Arthritis Quality of Life (PsAQoL questionnaire is a disease- specific instrument developed to measure quality of life (QoL in patients with psoriatic arthritis (PsA. The aim of this study was to translate the measure into Dutch and to determine its psychometric properties. METHOD: Translation of the original English PsAQoL into Dutch was performed by bilingual and lay panel. Ten field-test interviews with PsA patients were performed to assess face and content validity. In total, 211 PsA patients were included in a test-retest postal survey to investigate the reliability and construct validity of the Dutch adaptation of the PsAQoL. The PsAQoL, Health Assessment Questionnaire (HAQ and Skindex-17 were administered on two different occasions approximately two weeks apart. RESULTS: The Dutch version of the PsAQoL was found to be relevant, understandable and easy to complete in only a few minutes. It correlated as expected with the HAQ (Spearman's ρ = 0.72 and the 2 subscales of the Skindex-17 (ρ = 0.40 for the psychosocial and ρ = 0.46 for the symptom scale. Furthermore, the measure had good internal consistency (Cronbach's α = 0.92 and test-retest reliability (ρ = 0.89. The PsAQoL was able to define groups of patients based on self-reported general health status, self-reported severity of PsA and flare of arthritis. Duration of PsA did not influence PsAQoL scores. CONCLUSIONS: The Dutch version of the PsAQoL is a valid and reliable questionnaire suitable for use in clinical or research settings to asses PsA-specific QoL.
Mas, A J; Carmona, L; Valverde, M; Ribas, B
2008-01-01
To estimate the prevalence of fibromyalgia (FM) and to compare some descriptive epidemiological and quality of life data between persons with and without FM criteria in a representative sample of the general Spanish population. Cross sectional study of 2,192 Spaniards aged 20 or above, selected by cluster sampling. Subjects were invited to a structured interview carried out by trained rheumatologists to ascertain various musculoskeletal disorders. The visit included screening and examination, validated instruments for measuring function (HAQ) and quality of life (SF-12) and questions about socio-demographic characteristics and musculoskeletal, mental, and other general symptoms. FM was suspected in subjects with widespread pain for more than three months. FM was defined by theAmerican College of Rheumatology classification criteria. All estimates are adjusted to sampling scheme. The prevalence of FM in Spain is 2.4% (95% CI: 1.5-3.2). FM is significantly more frequent in women (4.2%) than in men (0.2%), with an OR for women of 22.5 (95%CI: 7.2- 69.9), mainly in the 40-49 years age interval. It is more frequent in rural (4.1%) than in urban settings (1.7%), with an OR for rural settings of 2.5 (95%CI: 1.03-5.9). FM is associated with a low educational level, to a low social class, and to self-reported depression. The scores in the HAQ and in the SF-12 were significantly lower in FM subjects, despite adjustment by covariates. FM has a high prevalence in the general population. FM is associated to female gender, comorbidities, age between 40 and 59 years, and a rural setting. Persons fulfilling FM criteria show impaired functioning and quality of life.
Directory of Open Access Journals (Sweden)
Giselle Helena de Paula Rodrigues
2015-06-01
Full Text Available Background: The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists. Objective: Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life. Methods: This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State. Results: The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old. 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68. 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014, obesity (p < 0.001, lack of physical activity (p = 0.016, osteoarthritis (p < 0.001, cognitive impairment (p < 0.001, and major depression (p < 0.001. Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36. Conclusion: Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.
Development of a Danish Language Version of the Manchester Foot Pain and Disability Index
DEFF Research Database (Denmark)
Pedersen, Christian K; Danneskiold-Samsøe, Bente; Garrow, Adam P
2013-01-01
Scale (VAS). Reproducibility was assessed using the intraclass correlation coefficient (ICC) and 95% limits of agreement (Bland-Altman plot). Construct validity was evaluated with Pearson's Rho, using a priori hypothesized correlations with SF-36 subscales and VASmean. Results. The MFPDI-DK showed very......Introduction. The Manchester Foot Pain and Disability Index (MFPDI) is a 19-item questionnaire for the assessment of disability caused by foot pain. The aim was to develop a Danish language version of the MFPDI (MFPDI-DK) and evaluate its reproducibility and construct validity. Methods. A Danish...... good reliability with an ICC of 0.92 (0.88-0.95). The 95% limits of agreement ranged from -6.03 to 6.03 points. Construct validity was supported by moderate to very strong correlations with the SF-36 physical subscales and VASmean. Conclusion. The MFPDI-DK appears to be a valid and reproducible...
Koriakin, Taylor A; McCurdy, Mark D; Papazoglou, Aimilia; Pritchard, Alison E; Zabel, T Andrew; Mahone, E Mark; Jacobson, Lisa A
2013-09-01
We examined the implications of using the Full Scale IQ (FSIQ) versus the General Abilities Index (GAI) for determination of intellectual disability using the Wechsler Intelligence Scales for Children, fourth edition (WISC-IV). Children referred for neuropsychological assessment (543 males, 290 females; mean age 10y 5mo, SD 2y 9mo, range 6-16y) were administered the WISC-IV and the Adaptive Behavior Assessment System, second edition (ABAS-II). GAI and FSIQ were highly correlated; however, fewer children were identified as having intellectual disability using GAI (n=159) than when using FSIQ (n=196). Although the 44 children classified as having intellectual disability based upon FSIQ (but not GAI) had significantly higher adaptive functioning scores than those meeting intellectual disability criteria based upon both FSIQ and GAI, mean adaptive scores still fell within the impaired range. FSIQ and GAI were comparable in predicting impairments in adaptive functioning. Using GAI rather than FSIQ in intellectual disability diagnostic decision-making resulted in fewer individuals being diagnosed with intellectual disability; however, the mean GAI of the disqualified individuals was at the upper end of criteria for intellectual impairment (standard score 75), and these individuals remained adaptively impaired. As GAI and FSIQ were similarly predictive of overall adaptive functioning, the use of GAI for intellectual disability diagnostic decision-making may be of limited value. © 2013 Mac Keith Press.
Effectiveness of early adalimumab therapy in psoriatic arthritis patients from Reuma.pt - EARLY PsA.
Santos, Helena; Eusébio, Mónica; Borges, Joana; Gonçalves, Diana; Ávila-Ribeiro, Pedro; Faria, Daniela Santos; Lopes, Carina; Rovisco, João; Águeda, Ana; Nero, Patrícia; Valente, Paula; Cravo, Ana Rita; Santos, Maria José
2017-01-01
Objective To compare outcomes in psoriatic arthritis (PsA) patients initiating adalimumab (ADA), with short- and long-term disease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids. Methods Analyses included adult PsA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) between June 2008-June 2016 who received ADA for ≥3 months. Psoriatic Arthritis Response Criteria (PsARC) response, tender and swollen joint count, inflammatory parameters, patient (PtGA) and physician global assessment (PhGA), Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire Disability Index (HAQ-DI) were compared between patients with PsA) and those with ≥5 years of disease duration (late PsA). Time to achieving PsARC response was estimated using the Kaplan-Meier method. Results Of 135 PsA patients treated with ADA, 126 had information on disease duration (earlyPsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs 62.2% late PsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs 75.9% late PsA; P=0.044). Early PsA patients achieved significantly less painful joints (2.7 vs 6.7, p=0.006), lower mean C-reactive protein (0.5 mg/dL vs 1.3 mg/dL; P=0.011), and PhGA (18.3 vs 28.1; P=0.020) at 3 months. In the long term, early PsA patients also had fewer swollen joints (0.3 vs 1.7; P=0.030) and lower PhGA (6.3 vs 21.9; PPsA, respectively. Early PsA patients obtained PsARC response more rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concomitant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs 60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC response over 2 years of follow-up. Persistence on ADA was similar in both groups. Conclusion Early PsA patients had a greater chance of improvement after ADA therapy and better functional outcome, and
Valorizzazione e qualificazione di prodotti della pesca ed acquacoltura
Olivieri, Vincenzo
2010-01-01
La ricerca ha valutato parametri sensoriali, fisici, chimici e microbiologici di orata (Sparus aurata) durante la conservazione in MAP. Campioni di pesce, ottenuti da 2 allevamenti off-shore situati rispettivamente nel Tirreno Settentrionale e nel Tirreno meridionale, sono stati analizzati dopo 1, 5, 7, 12, 15 e 19 giorni di stoccaggio. La valutazione sensoriale è stata effettuata utilizzando il Quality Index Method (QIM). Le analisi di tipo fisico, chimico e microbiologico sono state esegu...
The Oswestry Disability Index (version 2.1a): validation of a Dutch language version.
van Hooff, Miranda L; Spruit, Maarten; Fairbank, Jeremy C T; van Limbeek, Jacques; Jacobs, Wilco C H
2015-01-15
A cross-sectional study on baseline data. To translate the Oswestry Disability Index (ODI) version 2.1a into the Dutch language and to validate its use in a cohort of patients with chronic low back pain in secondary spine care. Patient-reported outcome measures (PROMs) are commonly accepted to evaluate the outcome of spine interventions. Functional status is an important outcome in spine research. The ODI is a recommended condition-specific patient-reported outcome measure used to evaluate functional status in patients with back pain. As yet, no formal translated Dutch version exists. The ODI was translated according to established guidelines. The final version was built into the electronic web-based system in addition with the Roland Morris Disability Questionnaire, the numeric rating scale for pain severity, 36-Item Short Form Health Survey Questionnaire for quality of life, and the hospital anxiety and depression scale. Baseline data were used of 244 patients with chronic low back pain who participated in a combined physical and psychological program. Floor and ceiling effects, internal consistency, and the construct validity were evaluated using quality criteria. The mean ODI (standard deviation) was 39.6 (12.3); minimum 6, maximum 70. Most of the participants (88%) were moderately to severely disabled. Factor analysis determined a 1-factor structure (36% explained variance) and the homogeneity of ODI items is shown (Cronbach α = 0.79). The construct validity is supported as all (6:6) the a priori hypotheses were confirmed. Moreover, the ODI and Roland Morris Disability Questionnaire, showed a strong significant correlation (r = 0.68, P disability among Dutch patients with chronic low back pain. This translated condition-specific patient-reported outcome measure version is recommended for use in future back pain research and to evaluate outcome of back care in the Netherlands.
Gison, Annalisa; Rizza, Federica; Bonassi, Stefano; Donati, Valentina; Giaquinto, Salvatore
2015-01-01
This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson's disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson's Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO di not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances.
Membrilla-Mesa, Miguel David; Cuesta-Vargas, Antonio Ignacio; Pozuelo-Calvo, Rocio; Tejero-Fernández, Victor; Martín-Martín, Lydia; Arroyo-Morales, Manuel
2015-12-21
The Shoulder Pain Disability Index (SPADI) is a recently published but widely used outcome measure. This study included 136 patients with shoulder disorders. SPADI was first translated and back-translated and then subjected to psychometric validation. Participants completed the Spanish versions of the SPADI, general health (SF-12), the Simple Shoulder Test (SST), Disability of Arm, Shoulder, and Hand (DASH) questionnaires and a pain intensity visual analog scale (VAS). The factors explained 62.8 % of the variance, with an internal consistency of α = 0.916 and 0.860, respectively. The confirmatory factor analysis showed a Comparative Fit Index of 0.82 and a Normed Fit Index of 0.80. The Root Mean Square Error of Aproximation was 0.12. The x (2) test for the 2-factor model was significant (x (2) = 185.41, df = 62, p validity analysis, strong positive correlations were observed between Spanish Version of the SPADI and DASH (pain: r = 0.80; p Spanish Version of the SPADI and VAS (pain: r = 0.67; p Spanish Version of the SPADI and SST-Sp (pain: r = -0.71; p Spanish Version of the SPADI was only weakly correlated with physical and mental components of SF-12 (both r = 0.40; p Spanish version of SPADI demonstrated satisfactory psychometric properties in a patient sample in the hospital setting.
Vegan diet alleviates fibromyalgia symptoms.
Kaartinen, K; Lammi, K; Hypen, M; Nenonen, M; Hanninen, O; Rauma, A L
2000-01-01
The effect of a strict, low-salt, uncooked vegan diet rich in lactobacteria on symptoms in 18 fibromyalgia patients during and after a 3-month intervention period in an open, non-randomized controlled study was evaluated. As control 15 patients continued their omnivorous diet. The groups did not differ significantly from each other in the beginning of the study in any other parameters except in pain and urine sodium. The results revealed significant improvements in Visual analogue scale of pain (VAS) (p=0.005), joint stiffness (p=0.001), quality of sleep (p=0.0001), Health assessment questionnaire (HAQ) (p=0.031), General health questionnaire (GHQ) (p=0.021), and a rheumatologist's own questionnaire (p=0.038). The majority of patients were overweight to some extent at the beginning of the study and shifting to a vegan food caused a significant reduction in body mass index (BMI) (p=0.0001). Total serum cholesterol showed a statistically significant lowering (p=0.003). Urine sodium dropped to 1/3 of the beginning values (p=0.0001) indicating good diet compliance. It can be concluded that vegan diet had beneficial effects on fibromyalgia symptoms at least in the short run.
Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings?
Pereira, Daniele Freitas; Gutierrez, Marwin; de Buosi, Ana Leticia Pirozzi; Ferreira, Fernando Bernardes Maia Diniz; Draghessi, Antonella; Grassi, Walter; Natour, Jamil; Furtado, Rita Nely Vilar
2015-11-01
The study is addressed to determine if there is a correlation between intra-articular power Doppler (PD) and pain symptoms in patients with rheumatoid arthritis (RA). A cross-sectional study of patients with established RA was rolled out. Seventy-two patients with chronic swelling at metacarpophalangeal (MCP) joints were consecutively enrolled in the study and divided into two groups (painful and painless). In the painful group, the inclusion criteria were pain in the visual analog scale (VAS), from 0 to 10 cm, of at least 4 cm and 0 in the painless group. All two to five MCP joints, bilaterally, were scanned by ultrasound (US) searching for intra-articular PD presence. Any value of p painful group had longer morning stiffness, worse 28-joint disease activity score (DAS 28), and health assessment questionnaire (HAQ) indexes. There were no association between pain and gray scale (GS) synovitis, odds ratio (OR) = 0.9 (0.6-1.2), p = 0.485; and pain and intra-articular PD, OR = 0.8 (0.6-1.2), p = 0.244. Intra-articular PD was not correlated with pain symptom in this study.
Is the Oswestry Disability Index a valid measure of response to sacroiliac joint treatment?
Copay, Anne G; Cher, Daniel J
2016-02-01
Disease-specific measures of the impact of sacroiliac (SI) joint pain on back/pelvis function are not available. The Oswestry Disability Index (ODI) is a validated functional measure for lower back pain, but its responsiveness to SI joint treatment has yet to be established. We sought to assess the validity of ODI to capture disability caused by SI joint pain and the minimum clinically important difference (MCID) after SI joint treatment. Patients (n = 155) participating in a prospective clinical trial of minimally invasive SI joint fusion underwent baseline and follow-up assessments using ODI, visual analog scale (VAS) pain assessment, Short Form 36 (SF-36), EuroQoL-5D, and questions (at follow-up only) regarding satisfaction with the SI joint fusion and whether the patient would have the fusion surgery again. All outcomes were compared from baseline to 12 months postsurgery. The health transition item of the SF-36 and the satisfaction scale were used as external anchors to calculate MCID. MCID was estimated for ODI using four calculation methods: (1) minimum detectable change, (2) average ODI change of patients' subsets, (3) change difference between patients' subsets, and (4) receiver operating characteristic (ROC) curve. After SI fusion, patients improved significantly (p disability caused by SI pain. We estimated the MCID for ODI to be 13-15 points, which falls within the range of that previously reported for lumbar back pain and indicates that an improvement in disability should be at least 15 % to be beyond random variation.
Kirchhoff, Anne C; Parsons, Helen M; Kuhlthau, Karen A; Leisenring, Wendy; Donelan, Karen; Warner, Echo L; Armstrong, Gregory T; Robison, Leslie L; Oeffinger, Kevin C; Park, Elyse R
2015-06-01
Supplemental security income (SSI) and social security disability insurance (DI) are federal programs that provide disability benefits. We report on SSI/DI enrollment in a random sample of adult, long-term survivors of childhood cancer (n = 698) vs a comparison group without cancer (n = 210) from the Childhood Cancer Survivor Study who completed a health insurance survey. A total of 13.5% and 10.0% of survivors had ever been enrolled on SSI or DI, respectively, compared with 2.6% and 5.4% of the comparison group. Cranial radiation doses of 25 Gy or more were associated with a higher risk of current SSI (relative risk [RR] = 3.93, 95% confidence interval [CI] = 2.05 to 7.56) and DI (RR = 3.65, 95% CI = 1.65 to 8.06) enrollment. Survivors with severe/life-threatening conditions were more often enrolled on SSI (RR = 3.77, 95% CI = 2.04 to 6.96) and DI (RR = 2.73, 95% CI = 1.45 to 5.14) compared with those with mild/moderate or no health conditions. Further research is needed on disability-related financial challenges after childhood cancer. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
Validation of a Russian Language Oswestry Disability Index Questionnaire.
Yu, Elizabeth M; Nosova, Emily V; Falkenstein, Yuri; Prasad, Priya; Leasure, Jeremi M; Kondrashov, Dimitriy G
2016-11-01
Study Design Retrospective reliability and validity study. Objective To validate a recently translated Russian language version of the Oswestry Disability Index (R-ODI) using standardized methods detailed from previous validations in other languages. Methods We included all subjects who were seen in our spine surgery clinic, over the age of 18, and fluent in the Russian language. R-ODI was translated by six bilingual people and combined into a consensus version. R-ODI and visual analog scale (VAS) questionnaires for leg and back pain were distributed to subjects during both their initial and follow-up visits. Test validity, stability, and internal consistency were measured using standardized psychometric methods. Results Ninety-seven subjects participated in the study. No change in the meaning of the questions on R-ODI was noted with translation from English to Russian. There was a significant positive correlation between R-ODI and VAS scores for both the leg and back during both the initial and follow-up visits ( p Russian-speaking population in the United States.
Puolakka, K; Kautiainen, H; Pekurinen, M; Möttönen, T; Hannonen, P; Korpela, M; Hakala, M; Arkela-Kautiainen, M; Luukkainen, R; Leirisalo-Repo, M
2006-07-01
To explore the monetary value of rheumatoid arthritis related loss of productivity in patients with early active disease. In a prospective cohort substudy of the FIN-RACo Trial, 162 patients with recent onset rheumatoid arthritis, aged 18 to 65 years and available to the workforce, were followed up for five years. Loss of work productivity in euros 2002 was estimated by data on absence for sickness and on income (human capital approach) from official databases. Treatment responses were evaluated by area under the curve (AUC) of the ACR-N measure and by increase in number of erosions in radiographs of hands and feet. The health assessment questionnaire (HAQ) at six months was linked to the International Classification of Functioning, Disability and Health (ICF). In all, 120 (75%) patients, women more often (82%) than men (61%) (p=0.002), lost work days. The mean lost productivity per patient-year was euro7217 (95% confidence interval (CI), 5561 to 9148): for women, euro6477 (4858 to 8536) and for men, euro8443 (5389 to 12,898). There was an inverse correlation with improvement: euro1101 (323 to 2156) and euro14 952 (10,662 to 19,852) for the highest and lowest quartiles of AUC of ARC-N, respectively. Lost productivity was associated with increase in the number of erosions and with disability in "changing and maintaining body position" subcategory of the ICF. Despite remission targeted treatment with disease modifying antirheumatic drugs, early rheumatoid arthritis results in substantial loss of productivity. A good improvement in the disease reduces the loss markedly.
[Cross-cultural validation of the Oswestry disability index in French].
Vogler, D; Paillex, R; Norberg, M; de Goumoëns, P; Cabri, J
2008-06-01
The aim of this study was to interpret and validate a French version of the Oswestry disability index (ODI), using a cross-cultural validation method. The validity and reliability of the questionnaire was assessed in order to ensure the psychometric characteristics. The cross-cultural validation was carried out according to Beaton's methodology. The study was conducted with 41 patients suffering from low back pain. The correlation between the ODI and the Roland-Morris disability questionnaire (RMDQ), the medical outcome survey short form-36 (MOS SF-36) and a pain visual analogical scale (VAS) was assessed. The validity of the Oswestry questionnaire was studied using the Cronbach Alpha coefficient calculation: 0.87 (n=36). The significant correlation between the ODI and RMDQ was 0.8 (P<0.001, n=41) and 0.71 (P<0.001, n=36) for the pain VAS. The correlation between the ODI and certain subscales (physical functioning 0.7 (P<0.001, n=41), physical role 0.49 et bodily pain 0.73 (P<0.001, n=41)) of the MOS SF-36 were equally significant. The reproducibility of the ODI was calculated using the Wilcoxon matched pairs test: there was no significant difference for eight out of ten sections or for the final score. This French translation of the ODI should be considered as valid and reliable. It should be used for any future clinical studies carried out using French language patients. Complimentary studies must be completed in order to assess its sensitivity to change in the event of any modifications in the patients functional capacity.
Directory of Open Access Journals (Sweden)
Rubén A. Bronberg
2011-02-01
Full Text Available Los pacientes con discapacidad intelectual (DI pueden presentar un riesgo elevado de padecer alteraciones nutricionales. Nuestro objetivo fue determinar la prevalencia de malnutrición en pacientes institucionalizados con DI, en la Colonia Nacional Montes de Oca, provincia de Buenos Aires, Argentina. Se realizó valoración antropométrica transversal mediante peso (kg y talla (cm en 614 individuos (352 varones y 262 mujeres. Se determinó IMC y la prevalencia de bajo peso, sobrepeso y obesidad por sexo y tipo de DI: leve, moderada y grave. Independientemente del sexo, las prevalencias de bajo peso, sobrepeso y obesidad fueron del 2.9%, 30% y 27.7% respectivamente. Sin considerar el grupo de DI, en mujeres se observó mayor prevalencia de obesidad (41.2% y en varones de sobrepeso (34.7%. Teniendo en cuenta el grado de DI e independientemente del sexo se observó mayor prevalencia de bajo peso en DI grave y de sobrepeso y obesidad en DI leve. Ninguno de los pacientes con DI leve presentó bajo peso. Teniendo en cuenta el sexo y el grupo de DI las mayores prevalencias de bajo peso y sobrepeso se hallaron en varones con DI leve, (7% y 38.4% respectivamente y de obesidad en mujeres con DI moderada (44%. Los resultados obtenidos indicarían la importancia del control del ingreso calórico y gasto energético de adultos con DI, prestando especial atención a las condiciones de vida y a los desordenes alimentarios en relación al grado de DI y a sus múltiples discapacidades asociadas.As patients with intellectual and developmental disability (ID may be more exposed to unfavorable factors, they are at higher risk of suffering nutritional alterations. Our objective was to determine prevalence of malnutrition in institutionalized patients with ID. An evaluation of the nutritional status through determination of transversal anthropometric parameters of weight (kg and height (cm was made on 614 individuals (352 men and 262 women institutionalized at
Energy Technology Data Exchange (ETDEWEB)
Macchi, E. [Milan Politecnico, Milan (Italy)
1999-09-01
The recent decree on liberalization of the Italian electric market assigns to the authority for electric energy and natural gas the task of defining under which conditions a combined heat and power plant (CHP) obtains a significant primary energy saving when compared to separate productions. The present paper outlines and discusses the proposal made by a working group of CTI (Italian thermo-technical committee). The most significant features of the proposal are the following: i the use of IRE (Energy saving index), based upon net, annual energy production, certified by independent institutions; ii the adoption of an automatic procedure of yearly updating the reference performance related to conventional power generation, accounting for technology evolution; iii the assumption of a lower limit for the thermal/fuel energy ratio and iv correction procedures in case of usage of non-conventional fuels (municipal wastes, process gases, etc.) [Italian] Il recente decreto sulla liberalizzazione del mercato elettrico prevede che l'autorita per l'energie elettrica e il gas definisca le condizioni per cui un impianto di produzione combinata di energia elettrica e calore garantisce un significativo risparmio di energia rispetto alle produzioni separate. Nella presente nota viene descritta e commentata una proposta operativa avanzata da un gruppo di lavoro del Comitato Termotecnico Italiano (CTI). Elementi caratterizzanti la proposta sono: i) il riferimento all'indice IRE (indice di Risparmio di Energia primaria), valutato su prestazioni annue nette, a consuntivo e certificate da Enti indipendenti, ii) l'introduzione di un meccanismo automatico di revisione annuale di parametri di confronto relativi alla generazione separata che tenga conto dell'evoluzione tecnologica, iii) l'introduzione di un limite inferiore al rapporto fra la generazione di energia termica utile e l'energia introdotta con il combustibile e iv l'inserimento di
Energy Technology Data Exchange (ETDEWEB)
Cagnetti, P.; Grandoni, G.; Mammarella, M.C.; Pellegrini, A.; Racalbuto, S.; Boccadoro, M.; Fedele, P. [ENEA, Centro Ricerche Casaccia, Rome (Italy). Dipt. Ambiente
1999-07-01
The present work has been done during the preparatory events of the National Conference on Energy and Environment (CNEA), studying the diffusive properties of the lower layers of the atmosphere, in order to find out a set of air quality indicators for urban areas. The data of 180 meteorological stations of the Italian Air Force Meteorological Service cover the whole Italian territory and are easily available; for this reason, this study, is based on those data. By analysing the available data, the variability range of the considered parameters was investigated and then an attempt was done to combine those parameters in order to describe, with a general index related to each site, the higher or lower attitude to diffuse pollutants released in the atmosphere. After that, the sites have been classified by their capacity of dispersion in atmosphere, making use of the meteo-diffusivity index described above, and pointing out the importance of meteorology in the study of the air quality of urban sites. [Italian] Questo lavoro e' stato svolto durante gli eventi preparatori della Conferenza Nazionale Energia Ambiente (CNEA), con lo scopo di individuare un set di indicatori della qualita' dell'aria in aree urbane, sulla base di studi e ricerche sui parametri meteodiffusivi dei bassi strati dell'atmosfera. Sono stati presi in considerazione, perche' subito fruibili e a diffusione nazionale, i dati provenienti dalle 180 stazioni meteorologiche dell'Areonautica Militare. Dopo un'analisi di tali dati al fine di individuare l'intervallo di variabilita' dei parametri meteorologici presi in considerazione, e' stata proposta una combinazione di tali parametri in grado di descrivere, sotto forma di un indice generale ed in relazione a tutti i siti considerati, la maggiore o minore tendenza alla diffusione degli inquinanti immessi in atmosfera. Sulla base di tale definizione di un indice di meteodiffusivita', sono stati
DEFF Research Database (Denmark)
Jespersen, Annette Bennedsgaard; Gustafsson, Malin Eleonora Av Kák
2018-01-01
PURPOSE: The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient's walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe...
Mousavi, Sayed Javad; Parnianpour, Mohamad; Mehdian, Hossein; Montazeri, Ali; Mobini, Bahram
2006-06-15
Cross-cultural translation and psychometric testing were performed. To cross-culturally translate the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RDQ), and Quebec Back Pain Disability Scale (QDS) into Persian, and then investigate the psychometric properties of the Persian versions produced. To the authors' knowledge, there is no validated instrument to measure functional status in Persian-speaking patients with low back pain (LBP) in Iran. To our knowledge, the widely used back-specific measures, the ODI, RDQ, and QDS, have not been translated and validated for Persian-speaking patients with LBP. The translation and cross-cultural adaptation of the original questionnaires were performed in accordance with published guidelines. A total of 100 patients with chronic LBP were asked to complete a questionnaire booklet (the Persian versions of the ODI, RDQ, QDS, Short Form Health Survey (SF-36), and visual analog scale measure of pain). There were 31 randomly select patients with chronic LBP asked to complete the second questionnaire booklet 24 hours later. The Cronbach-alpha for the ODI, RDQ, and QDS was 0.75, 0.83, and 0.92, respectively. The ODI, RDQ, and QDS showed excellent test-retest reliability (intraclass correlation coefficient = 0.91, 0.86, and 0.86, respectively) (P < 0.01). The correlation among the ODI, RDQ, QDS and physical functioning scales of the SF-36 was -0.66, -0.62, and -0.69, respectively (P < 0.001). The correlation among the ODI, RDQ, and QDS and visual analog scale was 0.54, 0.36, and 0.46, respectively (P < 0.001). The Persian versions of the ODI, RDQ, and QDS are reliable and valid instruments to measure functional status in Persian-speaking patients with LBP. They are simple and fast scales, and the use of them can be recommended in a clinical setting and future outcome studies in Iran.
Back to Work: Employment Effects of Tighter Disability Insurance Eligibility in the Netherlands
S. Garcia Mandico (Silvia); M.P. García-Gómez (Pilar); A.C. Gielen (Anne); O.A. O'Donnell (Owen)
2016-01-01
markdownabstractThe trends in the composition of the disability insurance (DI) program show the strong increase in the incidence of mental disorders in its rolls over the past decade. In fact, the OECD reports that the share of individuals with mental health conditions represents one third of all DI
Prasarn, Mark L; Kostantinos, Vasalos; Coyne, Ellen; Wright, John; Rechtine, Glenn R
2015-01-01
We sought to analyze whether the amount of paraspinal fatty degeneration correlates with a patient's physical fitness, and to determine if these findings on lumbar magnetic resonance imaging (MRI) scans can help predict functional outcomes. A retrospective review was performed on 172 patients. Inclusion criteria involved being seen by a spine surgeon for low back pain, having aerobic index (AI), body mass index (BMI), Oswestry disability index (ODI), and body fat percentage measured recently, and having had a recent lumbar MRI scan. The percentage of fatty muscle degeneration was graded by three reviewers using T2-weighted axial images at L3 and L5 using a newly proposed system that was validated independently. The system is graded as follows: Grade 1: 0-24%, Grade 2: 25-49%, Grade 3: 50-74%, and Grade 4: 75-100%. An independent t-test was used for comparisons. The average AI was 34.87, and the cohort was divided into two groups: above-average AI (89 patients) and below-average AI (83 patients). For all paraspinal fat measurements and body fat percentage, the difference between the above- and below-average AI groups was statistically significant (P < 0.05), with the least amount of paraspinal fatty degeneration and body fat in the greater AI group. Weight alone and BMI were not found to be significantly different between those with above-average AI when compared to those with below-average AI (P = 0.491 and P = 0.122, respectively). There was a trend for lower ODI scores in the above-average AI group (41.9 vs 46.1), but this did not reach statistical significance between the two groups (P = 0.075). For all patients it was shown that there was significantly less paraspinal fat at the L3 level as compared to L5 (P < 0.001). We were able to show that patients with a higher AI have lower body fat percentages and lower amounts of fatty degeneration in their lumbar paraspinal musculature. The amount of paraspinal fatty degeneration, therefore, correlates with physical
Measuring participation in patients with chronic back pain-the 5-Item Pain Disability Index.
McKillop, Ashley B; Carroll, Linda J; Dick, Bruce D; Battié, Michele C
2018-02-01
Of the three broad outcome domains of body functions and structures, activities, and participation (eg, engaging in valued social roles) outlined in the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF), it has been argued that participation is the most important to individuals, particularly those with chronic health problems. Yet, participation is not commonly measured in back pain research. The aim of this study was to investigate the construct validity of a modified 5-Item Pain Disability Index (PDI) score as a measure of participation in people with chronic back pain. A validation study was conducted using cross-sectional data. Participants with chronic back pain were recruited from a multidisciplinary pain center in Alberta, Canada. The outcome measure of interest is the 5-Item PDI. Each study participant was given a questionnaire package containing measures of participation, resilience, anxiety and depression, pain intensity, and pain-related disability, in addition to the PDI. The first five items of the PDI deal with social roles involving family responsibilities, recreation, social activities with friends, work, and sexual behavior, and comprised the 5-Item PDI seeking to measure participation. The last two items of the PDI deal with self-care and life support functions and were excluded. Construct validity of the 5-Item PDI as a measure of participation was examined using Pearson correlations or point-biserial correlations to test each hypothesized association. Participants were 70 people with chronic back pain and a mean age of 48.1 years. Forty-four (62.9%) were women. As hypothesized, the 5-Item PDI was associated with all measures of participation, including the Participation Assessment with Recombined Tools-Objective (r=-0.61), Late-Life Function and Disability Instrument: Disability Component (frequency: r=-0.66; limitation: r=-0.65), Work and Social Adjustment Scale (r=0.85), a global
Valasek, Tamás; Varga, Peter Paul; Szövérfi, Zsolt; Kümin, Michelle; Fairbank, Jeremy; Lazary, Aron
2013-05-01
Patient-reported outcome measurements (PROMs) are widely used in spine care. The development of reliable and valid National versions of spine-related disability questionnaires is strongly recommended from both the clinical and scientific points-of-view. The aims of this study were to adapt and validate the Oswestry Disability Index (ODI) and the Quebec back pain disability scale (QDS) for use with the Hungarian language. After translating and culturally adapting the ODI and QDS, 133 patients with lumbar degenerative spinal disorder filled in the questionnaire booklet twice within 2 weeks. Subjects completed the Hungarian versions of the two PROMs as well as the WHOQoL-BREF validated as a general life quality questionnaire and Visual Analogue Scale of pain. Internal consistency, reliability and construct validity of the questionnaires were determined, as were the standard error of measurement (SEM) and minimal detectable change (MDC) scores. The Hungarian ODI consisted of one factor that showed good internal consistency (Cronbach-α 0.890). The QDS showed a four-factor structure with Cronbach-α values between 0.788 and 0.917. No significant floor or ceiling effects were observed. The test-retest analysis showed excellent reliability of the Hungarian ODI and QDS. The intraclass correlation coefficients (ICC) were 0.927 and 0.923, respectively. SEM values of 4.8 and 5.2 resulted in a MDC of 13 and 14 points in the Hungarian ODI and QDS, respectively. The correlation coefficient (r) between pain and ODI was 0.680 (p 0.4, p disability measured by the Hungarian ODI and QDS was significantly higher in the surgical subgroup than in non-surgically treated patients (p < 0.001). Translation and cultural adaptation of the ODI and QDS were successful. Hungarian versions of the ODI and QDS proved to be reliable, valid PROMs confirming that they can be used in future clinical and scientific work with Hungarian-speaking spine patients.
Extensive validation of the pain disability index in 3 groups of patients with musculoskeletal pain.
Soer, Remko; Köke, Albère J A; Vroomen, Patrick C A J; Stegeman, Patrick; Smeets, Rob J E M; Coppes, Maarten H; Reneman, Michiel F
2013-04-20
A cross-sectional study design was performed. To validate the pain disability index (PDI) extensively in 3 groups of patients with musculoskeletal pain. The PDI is a widely used and studied instrument for disability related to various pain syndromes, although there is conflicting evidence concerning factor structure, test-retest reliability, and missing items. Additionally, an official translation of the Dutch language version has never been performed. For reliability, internal consistency, factor structure, test-retest reliability and measurement error were calculated. Validity was tested with hypothesized correlations with pain intensity, kinesiophobia, Rand-36 subscales, Depression, Roland-Morris Disability Questionnaire, Quality of Life, and Work Status. Structural validity was tested with independent backward translation and approval from the original authors. One hundred seventy-eight patients with acute back pain, 425 patients with chronic low back pain and 365 with widespread pain were included. Internal consistency of the PDI was good. One factor was identified with factor analyses. Test-retest reliability was good for the PDI (intraclass correlation coefficient, 0.76). Standard error of measurement was 6.5 points and smallest detectable change was 17.9 points. Little correlations between the PDI were observed with kinesiophobia and depression, fair correlations with pain intensity, work status, and vitality and moderate correlations with the Rand-36 subscales and the Roland-Morris Disability Questionnaire. The PDI-Dutch language version is internally consistent as a 1-factor structure, and test-retest reliable. Missing items seem high in sexual and professional items. Using the PDI as a 2-factor questionnaire has no additional value and is unreliable.
Directory of Open Access Journals (Sweden)
Risda Muli
2016-03-01
Full Text Available Pencemaran tanah yang diakibatkan oleh penambangan minyak bumi berpengaruh terhadap lingkungan, vegetasi, dan kelimpahan arthropoda. Oleh karena itu, perlu dilakukan penelitian dampak pencemaran minyak bumi di tanah terhadap komunitas Arthropoda. Penelitian dilakukan untuk mengetahui perbedaan struktur komunitas arhtropoda tanah di sekitar lokasi eksplorasi minyak bumi. Kelembapan, pH, suhu tanah, dan kadar TPH tanah diukur dan dianalisis untuk mengetahui pengaruhnya terhadap indeks keanekaragaman, dominansi, dan kemerataan arthropoda. Penelitian dilakukan di sumur minyak bumi Desa Mangunjaya Kecamatan Babat Toman pada tanggal 19-24 Februari 2015. Arthropoda dikoleksi menggunakan pit fall traps dan corong barlese-tullgren, pengambilan sampel dilakukan di 96 titik. Identifikasi arthropoda dilakukan di Laboratorium Entomologi Jurusan Hama Penyakit Tanaman Fakultas Pertanian. Analisis kadar TPH tanah menggunakan metode Gravimetri dilakukan di Laboratorium Kimia Fakultas MIPA Universitas Sriwijaya. Hasil penelitian menunjukkan rata-rata TPH dan pH tanah di lokasi eksplorasi minyak bumi yang dilakukan oleh Pertamina EP Asset 1 Field Ramba lebih rendah daripada eksplorasi oleh masyarakat. Kelembaban dan suhu tanah di lokasi eksplorasi oleh Pertamina EP Asset 1 Field Ramba lebih tinggi daripada di lokasi eksplorasi masyarakat. Kadar TPH, pH, kelembaban, dan suhu tanah tidak berpengaruh terhadap indeks keanekaragaman, dominansi, dan kemerataan arhtropoda. Rata-rata indeks keanekaragaman arthropoda tergolong rendah dengan nilai indeks kurang dari 1. Soil contamination caused by the extraction of petroleum affects the environment, vegetation, and abundance of arthropods. Therefore, it is necessary to study the impact of oil pollution on the ground against arthropod community. The research has conducted to determine the differences of terrestrial arthropod around petroleum exploration. Moisture, pH, temperature, and soil TPH (Total Petroleum Hydrocarbon
DEFF Research Database (Denmark)
Thomsen, T; Aadahl, Mette; Beyer, Nina Ann-Marie
2016-01-01
for daily leisure time sitting > 4 h. The 16-week intervention included 1) three individual motivational counselling sessions and 2) individual text message reminders aimed at reducing daily sitting time. The control group was encouraged to maintain their usual lifestyles. Outcomes were assessed at baseline...... and screened before 20 met eligibility criteria and consented; reasons for declining study participation were mostly flares, lack of time and co-morbidities. One patient from the control group dropped out before end of intervention (due to a RA flare). Intervention participants completed all counselling...... tailored, theory-based behavioural intervention targeting reduction in daily sitting time in patients with RA. METHODS: A randomised, controlled trial with two parallel groups. RA patients >18 years of age and Health Assessment Questionnaire (HAQ) score
[Treatment of rheumatoid arthritis in 2005: prompt, agressive and customized].
Guerne, P-A; Stingelin-Guerne, S
2005-03-09
Treatment of rheumatoid arthritis in 2005: prompt, aggressive and customized Rheumatoid arthritis can be extremely serious (joint destruction, functional loss, decrease in life expectancy). Fortunately, our therapeutic means have recently progressed enormously (better appreciation of efficacy and ways to use DMARDs combinations and new molecules such as leflunomide and anti-TNFs, understanding of the importance of early adequate and intensive treatments when necessary). Huge progresses have also been performed with regards to evaluation and follow-up strategies (disease activity score--DAS, health assessment questionnaire--HAQ), which allows us to adapt the treatment much better. The goal now can and must be quick and total remission of the disease in all patients thus avoiding as much as possible irreversible joint damages with accompanying morbidities.
Bivariate copula in fitting rainfall data
Yee, Kong Ching; Suhaila, Jamaludin; Yusof, Fadhilah; Mean, Foo Hui
2014-07-01
The usage of copula to determine the joint distribution between two variables is widely used in various areas. The joint distribution of rainfall characteristic obtained using the copula model is more ideal than the standard bivariate modelling where copula is belief to have overcome some limitation. Six copula models will be applied to obtain the most suitable bivariate distribution between two rain gauge stations. The copula models are Ali-Mikhail-Haq (AMH), Clayton, Frank, Galambos, Gumbel-Hoogaurd (GH) and Plackett. The rainfall data used in the study is selected from rain gauge stations which are located in the southern part of Peninsular Malaysia, during the period from 1980 to 2011. The goodness-of-fit test in this study is based on the Akaike information criterion (AIC).
Roelen, C.A.M.; Rhenen, van W.; Groothoff, J.W.; Klink, van der J.J.L.; Twisk, W.R.; Heymans, M.W.
2014-01-01
Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP.
Effects of electrical stimulation in early Bells palsy on facial disability index scores
Directory of Open Access Journals (Sweden)
P. Alakram
2011-01-01
Full Text Available Recovery following facial nerve palsy is variable. Physiotherapists try to restore function in patients with Bell’s palsy. The choice of treatment modality depends on the stage of the condition. Although limited evidence exists for the use of electrical stimulation in the acute stage of Bell’s palsy, some physiotherapists in South Africa have been applying this modality. This study examined the effects of electrical stimulation on functional recovery from Bell’s palsy using the Facial Disability Index, a tool that documents recovery from the patients’ perspective. A two group pre-test post-test experimental design comprising of 16 patients with Bell’s Palsy of less than 30 days duration was utilized. Patients with a clinical diagnosis of Bell’s Palsy were systematically allocated to the control and experimental groups. Patients (n=16 were pre-tested and post-tested using the Facial Disability Index. Both groups were treated with heat, massage, exercises and given a home program. The experimental group also received electrical stimulation. The FDI of the control group improved between 17, 8% and 95, 4% with a mean of 52, 8%. The improvement in the experimental group ranged between 14, 8% and 126% with a mean of 49, 8%. Certain clinical residuals persisted in a mild form in both groups on discharge from the study. The effects of electrical stimulation as used in this study during the acute phase of Bell’s palsy, quantified as the FDI was clinically but not statistically significant. A larger sample size, longer stimulation time or both should be investigated.
Karaarslan, Fatih; Ozkuk, Kagan; Seringec Karabulut, Serap; Bekpinar, Seldag; Karagulle, Mufit Zeki; Erdogan, Nergis
2018-05-01
The study aims to investigate the effect of spa treatment on vascular endothelium and clinical symptoms of generalized osteoarthritis. Forty generalized osteoarthritis (GOA) patients referred to a government spa hospital, and 40 GOA patients followed on university hospital locomotor system disease ambulatory clinics were included as study and control groups, respectively. Study group received spa treatment including thermal water baths, physical therapy modalities, and exercises. Control group was followed with home exercises for 15 days. Plasma ADMA, L-arginine, L-arginine/ADMA ratio, routine blood analyses, 6-min walking test, including fingertip O2 saturation, systolic/diastolic blood pressure, and pulse rate, were measured at the beginning and at the end of treatment. Groups were evaluated with VAS pain, patient, and physician global assessment; HAQ; and WOMAC at the beginning, at the end, and after 1 month of treatment. In study group, L-arginine and L-arginine/ADMA ratio showed statistically significant increase after treatment. Plasma ADMA levels did not change. There is no significant difference in intergroup comparison. Study group displayed statistically significant improvements in all clinical parameters. The study showed that spa treatment does not cause any harm to the vascular endothelium through ADMA. Significant increase in plasma L-arginine and L-arginine/ADMA ratio suggests that balneotherapy may play a preventive role on cardiovascular diseases. Balneotherapy provides meaningful improvements on clinical parameters of GOA.
Karaarslan, Fatih; Ozkuk, Kagan; Seringec Karabulut, Serap; Bekpinar, Seldag; Karagulle, Mufit Zeki; Erdogan, Nergis
2017-12-01
The study aims to investigate the effect of spa treatment on vascular endothelium and clinical symptoms of generalized osteoarthritis. Forty generalized osteoarthritis (GOA) patients referred to a government spa hospital, and 40 GOA patients followed on university hospital locomotor system disease ambulatory clinics were included as study and control groups, respectively. Study group received spa treatment including thermal water baths, physical therapy modalities, and exercises. Control group was followed with home exercises for 15 days. Plasma ADMA, L-arginine, L-arginine/ADMA ratio, routine blood analyses, 6-min walking test, including fingertip O2 saturation, systolic/diastolic blood pressure, and pulse rate, were measured at the beginning and at the end of treatment. Groups were evaluated with VAS pain, patient, and physician global assessment; HAQ; and WOMAC at the beginning, at the end, and after 1 month of treatment. In study group, L-arginine and L-arginine/ADMA ratio showed statistically significant increase after treatment. Plasma ADMA levels did not change. There is no significant difference in intergroup comparison. Study group displayed statistically significant improvements in all clinical parameters. The study showed that spa treatment does not cause any harm to the vascular endothelium through ADMA. Significant increase in plasma L-arginine and L-arginine/ADMA ratio suggests that balneotherapy may play a preventive role on cardiovascular diseases. Balneotherapy provides meaningful improvements on clinical parameters of GOA.
PENAMPILAN REPRODUKSI SAPI POTONG DI KABUPATEN BOJONEGORO
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Moh Nur Ihsan
2012-04-01
Full Text Available abstrak Suatu penelitian untuk mengevaluasi penampilan reproduksi yang diukur berdasarkan indeks fertilitas pada sapi potong telah dilaksanakan di Kabupaten Bojonegoro. Dalam penelitian ini digunakan sampel pemilik sapi yang diambil secara acak dari 11 kelompok peternak yang terdapat di wilayah kerja inseminator di Kecamatan Tambakrejo, Kabupaten Bojonegoro. Variabel yang diukur meliputi Days open (DO, Service per Conception (S/C, Calving Interval (CI, Conception Rate (CR dan indeks fertilitas (IF. Hasil penetlitian menunjukkan bahwa IF sapi Peranakan Ongole, Limosin dan Simental masing-masing pada paritas 2 dan 3 adalah 47.5 dan 50.6. Disimpulkan bahwa indeks fertilitas masing-masing bangsa sapi maupun paritas tidak menunjukkan perbedaan. Kata kunci: indeks fertilitas, paritas dan sapi potong REPRODUCTIVE PERFORMANCE OF BEEF CATTLE IN BOJONEGORO REGENCY ABSTRACT The research for evaluation reproductive performance measured by fertility index of beef cattle has carried out at Bojonegoro regency. The materials used in this study is to beef cattle (Ongole, Limousin and Simental filial, used the gathering of secondary data from 11 farmer group in Tambakrejo district, Bojonegoro regency. The observed variables are Service per conception (S / C, Days open (DO, Calving interval (CI, Conception rate (CR and Fertility index. The experiment showed that fertility index for Ongole, Limosin and Simental filial in second and thirh parity is 47.5 and 50.6 respectively. It was concluded that there was not difference of fertility index between Ongole, Limousin and Simental filial on 2nd and 3th parity. Key words : Fertility index, parity and beef cattle
Scott, David L; Ibrahim, Fowzia; Farewell, Vern; O'Keeffe, Aidan G; Ma, Margaret; Walker, David; Heslin, Margaret; Patel, Anita; Kingsley, Gabrielle
2014-10-01
Rheumatoid arthritis (RA) is initially treated with methotrexate and other disease-modifying antirheumatic drugs (DMARDs). Active RA patients who fail such treatments can receive tumour necrosis factor inhibitors (TNFis), which are effective but expensive. We assessed whether or not combination DMARDs (cDMARDs) give equivalent clinical benefits at lower costs in RA patients eligible for TNFis. An open-label, 12-month, pragmatic, randomised, multicentre, two-arm trial [Tumour necrosis factor inhibitors Against Combination Intensive Therapy (TACIT)] compared these treatment strategies. We then systematically reviewed all comparable published trials. The TACIT trial involved 24 English rheumatology clinics. Active RA patients eligible for TNFis. The TACIT trial compared cDMARDs with TNFis plus methotrexate or another DMARD; 6-month non-responders received (a) TNFis if in the cDMARD group; and (b) a second TNFi if in the TNFi group. The Heath Assessment Questionnaire (HAQ) was the primary outcome measure. The European Quality of Life-5 Dimensions (EQ-5D), joint damage, Disease Activity Score for 28 Joints (DAS28), withdrawals and adverse effects were secondary outcome measures. Economic evaluation linked costs, HAQ changes and quality-adjusted life-years (QALYs). In total, 432 patients were screened; 104 started on cDMARDs and 101 started on TNFis. The initial demographic and disease assessments were similar between the groups. In total, 16 patients were lost to follow-up (nine in the cDMARD group, seven in the TNFi group) and 42 discontinued their intervention but were followed up (23 in the cDMARD group and 19 in the TNFi group). Intention-to-treat analysis with multiple imputation methods used for missing data showed greater 12-month HAQ score reductions with initial cDMARDs than with initial TNFis [adjusted linear regression coefficient 0.15, 95% confidence interval (CI) -0.003 to 0.31; p = 0.046]. Increases in 12-month EQ-5D scores were greater with initial c
Roelen, C.A.M.; van Rhenen, W.; Groothoff, J.W.; van der Klink, J.J.L.; Twisk, J.W.R.; Heymans, M.W.
2014-01-01
Objectives Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP. Methods This
Roelen, Corne A. M.; van Rhenen, Willem; Groothoff, Johan W.; van der Klink, Jac J. L.; Twisk, Jos W. R.; Heymans, Martijn W.
Objectives Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP. Methods This
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Roberto D’Andrea
2010-04-01
Full Text Available In base all’esperienza maturata in anni di sperimentazione sull’analisi delle caratteristiche meccaniche dei materiali mediante indagine termografica, nel presente lavoro è proposta una procedura per il controllo di qualità di componenti meccanici in linea di produzione, che è già stata argomento di brevetto. Lo sviluppo di questo lavoro si colloca nell’ambito del progetto FIRB Smart Reflex “Sistemi di produzione intelligenti, flessibili e riconfigurabili”. L’attività svolta dal DIIM riguarda il controllo avanzato dell’affidabilità di componenti meccanici per l’industria automobilistica. Viene proposta, quindi, la realizzazione di una cella di controllo in linea di produzione capace di valutare la presenza di eventuali componenti difettosi attraverso l’analisi termica degli stessi, sollecitati secondo un modello predefinito. L’attività, svolta in questa prima fase in laboratorio, è facilmente trasferibile in linea di produzione, considerando la possibilità di realizzare celle di prova in ambiente controllato, con condizioni praticamente identiche a quelle di laboratorio, eliminando gli effetti di disturbo che possono influenzare la risposta dell’indagine termografica in ambiente non strutturato.
Kaoulla, Patricia; Frescos, Nicoletta; Menz, Hylton B
2008-01-01
Abstract Background The Manchester Foot Pain and Disability Index (MFPDI) is a 19 item questionnaire used to assess the severity and impact of foot pain. The aim of this study was to develop a Greek-language version of the MFPDI and to assess the instrument's psychometric properties. Methods The MFPDI was translated into Greek by three bilingual content experts and two bilingual language experts, and then back-translated into English to assess for equivalence. The final Greek version was admi...
Graphic Organizers for Secondary Students with Learning Disabilities
Singleton, Sabrina M.; Filce, Hollie Gabler
2015-01-01
Research suggests students with learning disabilities often have trouble connecting new and prior knowledge, distinguishing essential and nonessential information, and applying comprehension strategies (DiCecco & Gleason, 2002; Vaughn & Edmonds, 2006). Graphic organizers have been suggested as tools educators can use to facilitate critical…
SITUASI VEKTOR DEMAM BERDARAH SAAT KEJADIAN LUAR BIASA (KLB DI KECAMATAN PASARREBO, JAKARTA TIMUR
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M. Hasyimi
2012-10-01
Full Text Available Kejadian luar biasa (KLB penyakit Demam berdarah dengue (DBD sering terjadi sejak dilaporkan tahun 1968. Pemberantasannya dengan penemuan penderita, pengobatan dan pengendalian vektor. Karena obat dan vaksin belum ditemukan maka sampai saat ini pemberantasan dan pencegahannya masih mengandalkan pada pengendalian vektor. Tujuan dari penelitian vektor ini adalah untuk mendapatkan informasi tentang habitat perkembangbiakan, kepadatan larva dan nyamuk penular DBD pada waktu terjadi KLB serta tipe virus yang dikandung vektornya. Penelitian dilakukan di Kecamatan Pasar Rebo, Jakarta Timur selama tiga bulan yaitu Juni sampai dengan Agustus 2003. Penelitian entomologi dilakukan merujuk kepada alamat penderita rawat inap yang bertempat tinggal di Kecamatan Pasar Rebo. Diagnosa penderita dilakukan dengan uji Hemagglutination inhibition (HI terhadap 24 akut konvalesen sera penderita yang diambil dari Rumah Sakit Pasar Rebo. Basil penelitian menunjukkan bahwa index larva sebagai berikut House index (HI 22,6%; Container index (Cl 11,4% dan Breuteau index (Bl 30,3. Kontainer yang positif larva yang berada di dalam rumah 12, 7% dari 387 kontainer. Sementara yang berada di luar rumah 3,1% dari 65 kontainer. Angka bebas jentik (ABJ di daerah KLB kurang dari 95%. Hasil uji HI sera penderita menunjukkan 70,8% dari pasangan sera yang diperiksa, terinfeksi oleh virus dengue.
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Edina Tanovic
2014-09-01
Full Text Available Introduction: Multiple sclerosis (MS is a chronic, autoimmune and progressive multifocal demyelinating disease of the central nervous system. The aim of this study was to evaluate rehabilitation of patients with multiple sclerosis using BI (Barthel index and EDDS (Expanded Disability Status Scale.Methods: A clinical observational study was made at the clinic for physical medicine and rehabilitation in Sarajevo. We analyzed 49 patients with MS in relation of gender, age and level of disability at admission and discharge, patient disability were estimated using EDDS scale. The ability of patients in their activities of daily living were also analyzed according to the BI at admission and discharge.Results: Of the total number of patients (n=49 there were 15 men and 34 women. The average age of female patient was 42.38±13.48 and male patient 46.06±9.56. EDDS values were significantly different at the beginning and at the end of the therapy (p=0.001 as was the value of BI (p=0.001.Conclusion: MS patients, after the rehabilitation in hospital conditions show significant recovery and a reduced level of disability; they show higher independence in activities but rehabilitation demands individual approach and adjustment with what patients are currently capable of achieving.
Vincent, Joshua Israel; Macdermid, Joy Christine; Grewal, Ruby; Sekar, Vincent Prabhakaran; Balachandran, Dinesh
2014-01-01
Prospective longitudinal validation study. To translate and cross-culturally adapt the Oswestry Disability Index (ODI) to the Tamil language (ODI-T), and to evaluate its reliability and construct validity. ODI is widely used as a disease specific questionnaire in back pain patients to evaluate pain and disability. A thorough literature search revealed that the Tamil version of the ODI has not been previously published. The ODI was translated and cross-culturally adapted to the Tamil language according to established guidelines. 30 subjects (16 women and 14 men) with a mean age of 42.7 years (S.D. 13.6; Range 22 - 69) with low back pain were recruited to assess the psychometric properties of the ODI-T Questionnaire. Patients completed the ODI-T, Roland-Morris disability questionnaire (RMDQ), VAS-pain and VAS-disability at baseline and 24-72 hours from the baseline visit. The ODI-T displayed a high degree of internal consistency, with a Cronbach's alpha of 0.92. The test-retest reliability was high (n=30) with an ICC of 0.92 (95% CI, 0.84 to 0.96) and a mean re-test difference of 2.6 points lower on re-test. The ODI-T scores exhibited a strong correlation with the RMDQ scores (r = 0.82) pTamil version of the ODI Questionnaire is a valid and reliable tool that can be used to measure subjective outcomes of pain and disability in Tamil speaking patients with low back pain.
Lawson, J. S.; Inglis, James
1984-01-01
A learning disability index (LDI) for the assessment of intellectual deficits on the Wechsler Intelligence Scale for Children-Revised (WISC-R) is described. The Factor II score coefficients derived from an unrotated principal components analysis of the WISC-R normative data, in combination with the individual's scaled scores, are used for this…
Lee, Chin-Pang; Fu, Tsai-Sheng; Liu, Chia-Yih; Hung, Ching-I
2017-10-03
Disputes exist regarding the psychometric properties of the Oswestry Disability Index (ODI). The present study was to examine the reliability, validity, and dimensionality of a Chinese version of the ODI version 2.1 in a sample of 225 adult orthopedic outpatients with chronic low back pain [mean age (SD): 40.7 (11.4) years]. We conducted reliability analysis, exploratory bifactor analysis, confirmatory factor analysis, and Mokken scale analysis of the ODI. To validate the ODI, we used the Short-Form 36 questionnaire (SF-36) and visual analog scale (VAS). The reliability, and discriminant and construct validities of the ODI was good. The fit statistics of the unidimensional model of the ODI were inadequate. The ODI was a weak Mokken scale (H s = 0.31). The ODI was a reliable and valid scale suitable for measurement of disability in patients with low back pain. But the ODI seemed to be multidimensional that was against the use of the raw score of the ODI as a measurement of disability.
Alijani, Babak; Emamhadi, Mohamahreza; Behzadnia, Hamid; Aramnia, Ali; Chabok, Shahrokh Yousefzadeh; Ramtinfar, Sara; Leili, Ehsan Kazemnejad; Golmohamadi, Shabnam
2015-01-01
The purpose of this study was to evaluate the disability in patients with spondylolisthesis who assigned either to posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) and to compare it between two groups. In a prospective observational study, 102 surgical candidates with low-grade degenerative and isthmic spondylolisthesis enrolled from 2012 to 2014, and randomly assigned into two groups: PLF and PLIF. Evaluation of disability has been done by a questionnaire using Oswestry Disability Index (ODI). The questionnaire was completed by all patients before the surgery, the day after surgery, after 6 months and after 1-year. There were no statistically significant differences in terms of age and sex distribution and pre-operation ODI between groups (P > 0.05). Comparison of the mean ODI scores of two groups over the whole study period showed no significant statistical difference (P = 0.074). ODIs also showed no significant differences between two groups the day after surgery, 6(th) months and 1-year after surgery (P = 0.385, P = 0.093, P = 0.122 and P = 433) respectively. Analyzing the course of ODI over the study period, showed a significant descending pattern for either of groups (P disability of patients with spondylolisthesis, and none of the fusion techniques were related to a better outcome in terms of disability.
Efficacy and safety of tofacitinib in older and younger patients with rheumatoid arthritis.
Curtis, Jeffrey R; Schulze-Koops, Hendrik; Takiya, Liza; Mebus, Charles A; Terry, Ketti K; Biswas, Pinaki; Jones, Thomas V
2017-01-01
Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We evaluated the efficacy and safety of tofacitinib 5 or 10 mg twice daily (BID), in patients with moderate to severe RA, aged ≥65 and tofacitinib, or placebo (Phase 3 only), with/without conventional synthetic DMARDs (mainly methotrexate). Clinical efficacy outcomes from Phase 3 studies were evaluated at Month 3. Safety evaluations using pooled Phase 3 data (Month 12) and pooled LTE data (Month 24) compared exposure-adjusted incidence rates (IRs; with 95% confidence intervals [CIs]), in older versus younger patients. In Phase 3 and LTE studies, 15.3% (475/3111) and 16.1% (661/4102) of patients, respectively, were aged ≥65 years. Consequently, exposure to tofacitinib was lower in older versus younger patients in Phase 3 (259.2 vs. 1554.9 patient years [pt-yrs]) and LTE (962.1 vs. 5071.7 pt-yrs) studies. Probability ratios for ACR responses and HAQ-DI improvement from baseline ≥0.22 (Month 3) favoured tofacitinib and were similar in older and younger patients, with overlapping CIs. IRs for SAEs and discontinuations due to AEs were generally numerically higher in older versus younger patients, irrespective of treatment. Older patients receiving tofacitinib 5 or 10 mg BID had a similar probability of ACR20 or ACR50 response and, due to comorbidities, a numerically higher risk of SAEs and discontinuations due to AEs compared with younger patients.
Self-Esteem and Self-Motivational Needs of Disabled and Non-Disabled: A Comparative Analysis
Bunmi Omolayo
2009-01-01
The study was designed to compare the self-esteem and self motivational needs of disabled and non-disabled. One hundred and eightysix disabled and non-disabled selected from the South-Western States of Nigeria participated in the study. Two instruments namely Index of Self Esteem (ISE) and Manifest Need Questionnaire (MNQ) were used to generate data for the study while collected data was analyzed with t-test for independent groups and regressions analysis. Testing four hypotheses, result show...
Koç, Meltem; Bayar, Banu; Bayar, Kılıçhan
2017-10-03
A comparison study of Back Pain Functional Scale (BPFS) with Roland Morris Questionnaire (RMQ), Oswestry Disability Index (ODI) and Short Form 36-Health Survey (SF-36). The aim of this study is to investigate the correlation of BPFS with RMQ, ODI and SF-36. The primary goal in the treatment of patients with low back pain is to improve the patients' levels of activities and participation. Many questionnaires focusing on function have been developed in patients with low back pain. BPFS is one of these questionnaires. No studies have investigated the correlation of BPFS with ODI and SF-36. This study was conducted with 120 patients receiving outpatient and inpatient treatment in physiotherapy and rehabilitation units of a state hospital. BPFS, RMQ, ODI, SF-36 questionnaires were used to assess the disability in low back pain. Spearman and Pearson Correlation were used to compare the data obtained in the study. There was a good correlation among the five functional outcome measures (correlation r = -0.693 for BPFS/RMQ, r = -0.794 for BPFS/ODI, r = 0.697 for BPFS/SF-36 Physical function and r = 0.540 for BPFS/SF-36 Pain). BPFS demonstrated good correlation with RMQ, ODI, SF-36 physical function and SF-36 pain. 2.
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Juul, Tina; Søgaard, Karen; Davis, Aileen M.
2016-01-01
Objective:To assess reliability, construct validity, responsiveness, and interpretability for Neck OutcOme Score (NOOS), Neck Disability Index (NDI), and Short Form–36 (SF-36) in neck pain patients. Study Design and Setting: Internal consistency was assessed by Cronbach alpha. Test-retest reliabi...
Predictors of Oswestry Disability Index worsening after lumbar fusion.
Gum, Jeffrey L; Carreon, Leah Y; Stimac, Jeffrey D; Glassman, Steven D
2013-04-01
The authors identified patients with an increase in their Oswestry Disability Index (ODI) score after lumbar spine fusion to evaluate whether this is a plausible definition of deterioration and to determine whether any common patient characteristics exist.A total of 1054 patients who underwent lumbar spinal fusion and had 2-year follow-up data, including the Short Form 36, the ODI, and numeric rating scales for back and leg pain, were identified. Patients with worsening ODI were compared with the remaining cohort. Twenty-eight patients had an absolute increase (worse) in ODI at 1 year postoperatively. Participants with worsening ODI scores included 13 men and 15 women with an average age of 43.3 years; 15 (54%) were smokers. Common medical comorbidities included obesity and hypertension. Complications occurred in 5 (18%) patients and included wound infection, dural tear, and nerve root injury. Pseudarthrosis was common (n=8; 28%). Twenty-one patients required an additional intervention, including epidural injections, fusion revision, and cervical spine surgery.It is important to have a clear definition of deterioration to better provide informed consent or choice of treatment. Only 28 (2.6%) patients were identified as having an increase in ODI score at 2-year follow-up. Copyright 2013, SLACK Incorporated.
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Shinta Shinta
2013-05-01
Full Text Available Abstrak Demam berdarah dengue (DBD adalah salah satu masalah kesehatan di Indonesia. Untuk saat ini, belum ada obat atau vaksin untuk mencegah DBD. Oleh karena itu pencegahan dan pengendalian vektor menjadi sangat penting. Indikator yang digunakan untuk melakukan surveilans dalam pengawasan kepadatan populasi Ae. aegypti dan memprediksi risiko penularan adalah pupa indeks. Pupa indeks digunakan untuk mengukur HPI, CPI, pupa/orang, pupa/rumah, dan pupa/ kontainer. Tujuan penelitian ini adalah untuk mengetahui habitat reproduksi terbesar, kepadatan penduduk dan persentase pupa di lima kecamatan di DKI Jakarta yaitu Johar Baru (Jakarta Pusat, Tanjung Priok (Jakarta Utara, Kramat Jati (Jakarta Timur, Kebun Jeruk (Jakarta Barat, dan Cilandak (Jakarta Selatan. Metode yang digunakan adalah deskriptif dengan teknik stratified random sampling. Hasil penelitian menunjukkan habitat pupa Ae. Aegypti, yaitu kontainer air (bak mandi, bak WC, drum, tempayan, bak wudhu, dan bak tandu, wadah air tidak permanen (barang bekas, bekas sumur, vas/pot bunga, kolam/akuarium, tempat minum unggas, tatakan dispenser, wastafel dan bath tube, habitat alami (potongan bambu dan pelepah daun. Nilai rata-rata indeks pupa di lima wilayah penelitian adalah CPI = 8,45%; HPI = 23,98%; pupa/orang = 0,65; pupa/rumah = 3,58; dan pupa/kontainer = 0,96. Ada konsistensi nomor indeks di semua wilayah penelitian; Jika indeks HPI tinggi, indeks pupa lainnya akan tinggi juga. Kata kunci: Aedes aegypti, pupa indeks, DBD Abstract Dengue fever is one of the most concerning health problems in Indonesia. For this time, there are merely no known medicines or vaccines to prevent this disease from manifesting. Rigorous studies are still conducted intensively. Hence, vector prevention and control efforts become very important. Indicator used here to conduct surveillance, measure Ae.aegypti population density and predict transmission risk was pupa index. Pupa index was used to measure HPI, CPI
Michaud, Kaleb; Berglind, Niklas; Franzén, Stefan; Frisell, Thomas; Garwood, Christopher; Greenberg, Jeffrey D; Ho, Meilien; Holmqvist, Marie; Horne, Laura; Inoue, Eisuke; Nyberg, Fredrik; Pappas, Dimitrios A; Reed, George; Symmons, Deborah; Tanaka, Eiichi; Tran, Trung N; Verstappen, Suzanne M M; Wesby-van Swaay, Eveline; Yamanaka, Hisashi; Askling, Johan
2016-10-01
We implemented a novel method for providing contextual adverse event rates for a randomised controlled trial (RCT) programme through coordinated analyses of five RA registries, focusing here on cardiovascular disease (CVD) and mortality. Each participating registry (Consortium of Rheumatology Researchers of North America (CORRONA) (USA), Swedish Rheumatology Quality of Care Register (SRR) (Sweden), Norfolk Arthritis Register (NOAR) (UK), CORRONA International (East Europe, Latin America, India) and Institute of Rheumatology, Rheumatoid Arthritis (IORRA) (Japan)) defined a main cohort from January 2000 onwards. To address comparability and potential bias, we harmonised event definitions and defined several subcohorts for sensitivity analyses based on disease activity, treatment, calendar time, duration of follow-up and RCT exclusions. Rates were standardised for age, sex and, in one sensitivity analysis, also HAQ. The combined registry cohorts included 57 251 patients with RA (234 089 person-years)-24.5% men, mean (SD) baseline age 58.2 (13.8) and RA duration 8.2 (11.7) years. Standardised registry mortality rates (per 100 person-years) varied from 0.42 (CORRONA) to 0.80 (NOAR), with 0.60 for RCT patients. Myocardial infarction and major adverse cardiovascular events (MACE) rates ranged from 0.09 and 0.31 (IORRA) to 0.39 and 0.77 (SRR), with RCT rates intermediate (0.18 and 0.42), respectively. Additional subcohort analyses showed small and mostly consistent changes across registries, retaining reasonable consistency in rates across the Western registries. Additional standardisation for HAQ returned higher mortality and MACE registry rates. This coordinated approach to contextualising RA RCT safety data demonstrated reasonable differences and consistency in rates for mortality and CVD across registries, and comparable RCT rates, and may serve as a model method to supplement clinical trial analyses for drug development programmes. Published by the BMJ Publishing
Perfil lipídico em pacientes adultos com artrite idiopática juvenil
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Thelma Larocca Skare
2013-08-01
Full Text Available O processo inflamatório articular de uma criança com artrite idiopática juvenil (AIJ pode persistir na vida adulta. A inflamação tem sido ligada a distorções do perfil lipídico e à aterogênese acelerada. Neste trabalho, estudou-se o perfil lipídico de indivíduos adultos com AIJ, comparando-o ao de pessoas saudáveis. Foram recrutados 54 adultos com AIJ (57,3% poliarticular, 37% oligoarticular, 1,9% do subtipo entesítica e 3,7% do subtipo sistêmica e 54 indivíduos saudáveis para comparação de perfil lipídico. Nos adultos AIJ, coletaram-se dados sobre sexo, idade e idade de início da doença, presença de fator reumatoide (FR e fator antinuclear (FAN, HAQ (Health Assessment Questionnaire e tempo de doença. Observou-se que hipercolesterolemia, aumento de LDL e diminuição de HDL foram mais comuns em pacientes com AIJ do que nos controles (com P = 0,016; P < 0,0001 e P = 0,0008, respectivamente. Alterações no colesterol total (CT e no LDL foram mais comuns em indivíduos com início de doença mais tardio (P = 0,0017 para CT e P = 0,023 para LDL. Em todo o grupo de pacientes com AIJ nenhuma outra variável pode ser ligada à dislipidemia tal como presença de FR, FAN, duração de doença e HAQ (P = ns. Concluiu-se que pacientes adultos com AIJ apresentam um perfil lipídico com aumento de CT e de LDL, e diminuição de HDL em relação aos controles. Nenhuma característica clínica pode ser ligada a essa alteração, exceto idade de início da doença.
Detert, Jacqueline; Bastian, Hans; Listing, Joachim; Weiß, Anja; Wassenberg, Siegfried; Liebhaber, Anke; Rockwitz, Karin; Alten, Rieke; Krüger, Klaus; Rau, Rolf; Simon, Christina; Gremmelsbacher, Eva; Braun, Tanja; Marsmann, Bettina; Höhne-Zimmer, Vera; Egerer, Karl; Buttgereit, Frank; Burmester, Gerd-R
2013-06-01
To investigate the long-term effects of induction therapy with adalimumab (ADA) plus methotrexate (MTX) in comparison with placebo (PBO) plus MTX in DMARD-naïve patients with active early rheumatoid arthritis (RA). Patients with active early RA (disease duration of ≤12 months) were randomly assigned to receive 40 mg ADA subcutaneously every other week (eow) plus MTX 15 mg/week subcutaneously or PBO plus MTX subcutaneously at 15 mg/week over 24 weeks. Thereafter, all patients received MTX monotherapy up to week 48. The primary outcome was the Disease Activity Score 28 (DAS28) at week 48. Secondary outcomes included proportions of patients in remission (DAS28Health Assessment Questionnaire (HAQ) score and radiographic progression. 87 patients were assigned to ADA/MTX and 85 patients to PBO/MTX. At baseline, DAS28 was 6.2±0.8 in the ADA/MTX and 6.3±0.9 in the PBO/MTX groups. At week 24, treatment with ADA/MTX compared with PBO/MTX resulted in a greater reduction in DAS28 (3.0±1.2 vs 3.6±1.4; p=0.009) and other secondary outcomes such as DAS28 remission rate (47.9% vs 29.5%; p=0.021) and HAQ (0.49±0.6 vs 0.72±0.6; p=0.0014). At week 48, the difference in clinical outcomes between groups was not statistically significant (DAS28: 3.2±1.4 vs 3.4±1.6; p=0.41). Radiographic progression at week 48 was significantly greater in patients administered PBO/MTX (Sharp/van der Heijde score: ADA/MTX 2.6 vs PBO/MTX 6.4; p=0.03, Ratingen score: 1.7 vs 4.2; p=0.01). A greater reduction in radiographic progression after initial combination therapy with ADA and MTX was seen at week 48, even after discontinuation of ADA treatment at week 24. This sustained effect was not found at the primary endpoint (DAS28 reduction).
Low, Andrea Hsiu Ling; Xin, Xiaohui; Law, Weng Giap; Teng, Gim Gee; Santosa, Amelia; Lim, Anita; Chan, Grace; Ng, Swee Cheng; Thumboo, Julian
2017-07-01
The aim of this study was to (1) translate the Gastrointestinal Tract Instrument (GIT) 2.0 from English to Chinese and (2) validate both versions in a multi-ethnic systemic sclerosis cohort in Singapore (SCORE). The English GIT2.0 was translated to Chinese using a standard forward-backward translation approach. Psychometric evaluation of the GIT2.0 included internal consistency reliability (using Cronbach's alpha), test-retest reliability (using intra-class correlation coefficient (ICC)), scale level factor analysis, and construct validity (using Spearman correlation) against the modified Scleroderma Health Assessment Questionnaire (S-HAQ) and the SF-36 v2. Most of the patients were females (88.6%) and Chinese (78.2%), with mean (SD) age of 51.0 (13.0) years and median disease duration of 4.5 years. We administered English (n = 146) and Chinese (n = 74) GIT2.0. The mean (SD) total GIT score was 0.29 (0.37). There was good internal consistency (Cronbach's alpha >0.70 for all subscales) and good test-retest reliability for the scale and all subscales (ICC 0.71-0.92) except for "diarrhoea" (ICC = 0.54). Our hypothesised a priori construct validity was supported by moderate correlations between the total GIT score and S-HAQ GI subscale (r = 0.446), and the social functioning subscale and SF36v2 role-social domain (r = 0.337), and weak-to-moderate correlation between the emotional subscale and SF-36v2 role-emotional (r = 0.295) and mental health (r = 0.298) domains and mental component summary (r = 0.356). Exploratory factor analysis of the seven subscales yielded a two-factor solution explaining 69.63% of the total variance. This study provides evidence for the reliability and validity of the English and Chinese GIT2.0 to be used in Singapore for research and routine practice.
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Horacio Daniel García
2015-06-01
Full Text Available RESUMEN: Para indagar la percepción del paciente de la relación terapéutica y las valoraciones acerca del terapeuta que podrían ser facilitadoras, se diseñó un estudio recurriendo a una muestra no probabilística compuesta por 108 pacientes (M = 31.90, DE = 11.54, residentes en San Luis, Argentina. Se utilizó el Helping Alliance Questionnaire - HAq-II (Luborsky et al., 1996 y un cuestionario construido ad hoc. En los resultados se observa, en general, una adecuada relación terapéutica y una alta valoración en los terapeutas de aspectos como calidez, seriedad, comprensión, confianza, respeto, interés y compromiso. Las terapeutas mujeres obtuvieron puntuaciones mayores en calidez y seriedad, clima de confianza, compromiso de trabajo, entre otros. Los pacientes sin conocimiento de los diferentes enfoques de psicoterapia tienden a valorar más positivamente aspectos vinculares de la relación terapéutica; en tanto quienes tienen conocimiento poseen expectativas más altas respecto a los resultados que pretenden alcanzar. ABSTRACT: To investigate the patient’s perception of the therapeutic relationship and assessments about the therapist which could be facilitating, we designed a study using a non-probabilistic sample composed by 108 patients (M = 31.90, SD = 11.54, residents in San Luis, Argentina. The Helping Alliance Questionnaire - HAq-II was used (Luborsky et al., 1996 and a questionnaire built ad hoc, too. In general, the results show an appropriate therapeutic relationship and a high rating of therapist aspects such as warmth, seriousness, understanding, trust, respect, interest and commitment. Women therapists obtained higher scores in warmth and seriousness, trust, commitment to work, among others. Patients without knowledge of the different psychotherapy approaches tend to assess more positively relational aspects of the therapeutic relationship; meanwhile those who have knowledge have higher expectations about the results
Joshi, Veena D; Raiturker, Pradyumna P Pai; Kulkarni, Aditi A
2013-05-15
A total of 200 patients with low back pain (LBP) completed an English and Marathi Oswestry Disability Index (ODI) questionnaires (100 each), visual analogue scale, and Roland-Morris Disability Questionnaire. To validate the English and Marathi versions of ODI (version 2.1a). Patient-orientated assessment methods are important in the evaluation of treatment outcome. The ODI is one of the condition-specific questionnaires recommended for the use of patients with LBP. An adaptation of the ODI (version 2.1a) for Marathi language was carried out according to established guidelines. Average age of patients who answered the English ODI was 42 ± 15, whereas that of Marathi-speaking patients was 52 ± 15 years. About 40% were males. The Cronbach α reliability score was 0.877 for English and 0.943 for Marathi. Forty-seven and 53 of these patients were retested with English and Marathi ODI within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient (ICC) for the test-retest reliability of the questionnaire was 0.877 and 0.943 for English and Marathi respectively. The ODI scores correlated with visual analogue scale pain intensity (r = 0.67, P Disability Questionnaire score (r = 0.71, P Disability Questionnaire scores (r = 0.503, P Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as the English version. It should represent a valuable tool for use in future patient-orientated outcome studies for population with LBP in India.
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Mancini, Marcello; Liuzzi, Raffaele [CNR, Napoli (Italy). Istituto di biostrutture e bioimmagini; Daniele, Stefania; Raffio, Teresa; Salvatore, Marco [Napoli Univ., Napoli (Italy). Dipartimento di diagnostica per immagini; Sabbatini, Massimo; Cianciaruso, Bruno [Napoli Univ., Napoli (Italy). Istituto di nefrologia medica; Ferrara, Liberato Aldo [Napoli Univ., Napoli (Italy). Dipartimento di medicina clinica e sperimentale
2005-04-01
Purpose: Aim of the presents study was to evaluate the repeatability and reproducibility of the Doppler Resistive Index (R.I.) and the Ultrasound renal volume measurement in renal transplants. Materials and methods: Twenty -six consecutive patients (18 men, 8 women) mean age of 42,8{+-}12,4 years (M{+-}SD)(range 22-65 years) were studied twice by each of two trained sonographers using a color Doppler ultrasound scanner. Twelve of them had a normal allograft function (defined as stable serum creatinine levels {<=}123,76 {mu}mol/L), whilst the remaining 14 had decreased allograft function (serum creatinine 132.6-265.2 {mu}mol/L). Results were given as mean of 6 measurements performed at upper, middle and lower pole of the kidney. Intra- and interobserver variability was assessed by the repeatability coefficient and coefficient of variation (CV). Results: Regarding Resistive Index measurement, repeatability coefficient was between 0.04 and 0.06 and the coefficient of variation was <5%. The analysis of the Student's test did not show any significant difference between the measurements (t=0.15; p=0.87 n.s.). A good reproducibility was also detected in US measurements of renal length and volume. Conclusions: These results suggest that Color Doppler Resistive Index measurements of renal allograft and Ultrasound renal volume measurements are repeatable and reproducible. [Italian] Scopo: Valutare la ripetibilit� e la riproducibilit� delle misurazioni ecografiche dell'Indice di Resistenza (I.R.) e del volume del rene trapiantato. Materiale e metodi: Ventisei pazienti (18 uomini, 8 donne) con et� media di 42,8{+-}12,4 anni (M{+-}SD)(range 22-65 anni) sono stati studiati consecutivamente due volte con eco-color-Doppler da due ecografisti esperti. Dodici pazienti avevano funzione renale normale (livello serico di creatina stabilmente {<=}123,76 {mu}mol/L, i rimanenti 14 avevano una lieve e stabile disfunzione del rene trapiantato (creatina serica 132.6-265.2 {mu
Saberi, Hooshang; Isfahani, Arash Vatankhahan
2008-01-01
To evaluate the surgical outcome in terms of functional and subjective recovery, patients who needed discectomies at L1-L2, L2-L3 and L3-L4 levels were compared with an age and sex-matched group of patients who required L4-L5 and L5-S1 discectomies. We prospectively enrolled 50 consecutive patients, referred to our center, who had L1-L2, L2-L3 and L3-L4 herniations and required surgical intervention. Likewise, a comparative group of 50 consecutive patients with herniations at L4-L5 and L5-S1 were selected. All 100 patients were treated and followed for a 1 year period. Physical examination findings as well as Oswestry Disability Questionnaire before surgery were recorded. After 1 year, patients were requested to fill the same questionnaire. Significant decline in the Oswestry Disability Index (ODI) scores was considered to be a measure of functional improvement and recovery. The mean age of patients with upper lumbar disc herniation (L1-L2, L2-L3, L3-L4) was 45.7 years and patients with lower lumbar disc herniation (L4-L5, L5-S1) had a mean age of 41.2 years. There was no statistically significant difference in age between the two groups. The preoperative Oswestry Disability (ODI) Index score had a statistically significant impact on ODI score improvement after surgery in both lower and upper lumbar disc groups. All 100 patients with either lower or upper lumbar disc herniation had statistically significant ODI change after surgical intervention (P disability (ODI of 21-40%) did not show significant improvement, while patients with ODI greater than 40% had significant reduction (P = 0.018). Surprisingly, as many as 25% of the former had even an increase in ODI scores after surgery. Gender was also a conspicuous factor in determining the surgical outcome of patients with upper lumbar disc herniation, and male patients had more reduction in ODI score than female patients (P = 0.007). Since the functional recovery in patients with herniated lumbar disc, especially
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d. Diana
1965-06-01
Full Text Available Si descrive una tecnica elio permette di misurare ilnumero di atomi di Uranio di una soluzione, con un errore non superioreal 10%.Il sistema consiste in un tubo di Geiger (Philips 18503 sistemato inun contenitore di vetro nel quale viene diluita una certa quantità di peso dinitrato di Uranile, misurato con una precisione migliore dell'1%. Al variaredella diluizione si registra il numero di particelle che il Geiger conta, e quindisi riporta in grafico. Da questi per diverse quantità di sale sciolto si determinala retta di taratura.
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Stefano Vinaccia
2004-01-01
Full Text Available El objetivo de este estudio descriptivo transversal fue estudiar las relaciones entre variables sociodemográficas, incapacidad funcional, dolor y desesperanza aprendida en pacientes con artritis reumatoide. Se utilizó una muestra de 124 pacientes (110 mujeres y 14 hombres diagnosticados con artritis reumatoide según los criterios del American College of Rheumatology. Como instrumento de medida de la discapacidad funcional se utilizó el Activities of Daily Living (HAQ-ADL, para evaluar el dolor se aplicó el Pain Severity Scale MOS y para la desesperanza aprendida el Arthritis Helplessness Index (AHÍ. Los resultados indicaron que los factores sociodemográficos son mejores predictores de desesperanza que el dolor y la incapacidad funcional, hecho que presenta evidentes discrepancias con investigaciones que plantean lo contrario, es decir una fuerte relación entre incapacidad funcional, dolor y desesperanza. Probablemente estas diferencias dependan de factores culturales que diferencian claramente la sociedad norteamericana de la colombiana con respecto al rol, la forma de atención y al cuidado de los enfermos crónicos. Esto nos permite entender más coherentemente una enfermedad crónica multifactorial, como es la artritis reumatoide, mediante un modelo bio-psico-social-ambiental y cultural.
Dahmen, Rutger; Buijsmann, Saskia; Siemonsma, Petra C; Boers, Maarten; Lankhorst, Gustaaf J; Roorda, Leo D
2014-06-01
An estimated 55-90% of patients with rheumatoid arthritis have foot problems. Therapeutic footwear is frequently prescribed as part of usual care, but data on its use and effect is incomplete. This study aimed to investigate the use and effects of therapeutic footwear. Patients with rheumatoid arthritis receiving custom-made therapeutic footwear for the first time formed an inception cohort. Patients reported their therapeutic footwear use on 3 consecutive days in activity diaries 14 and 20 weeks after delivery of the footwear. The Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) was used as the primary outcome of lower-extremity-related pain and activity limitations, and the Health Assessment Questionnaire (HAQ) as a secondary outcome measure of activity limitations, both at baseline and 26 weeks after therapeutic footwear delivery. The cohort comprised 114 rheumatoid arthritis patients (median disease duration 10 years). Mean (standard deviation) therapeutic footwear use was 54 (25)% of the time patients were out of bed. The median (interquartile range) WOMAC score improved from 41 (27-59) to 31 (16-45) (p footwear was used with moderate intensity by most rheumatoid arthritis patients and was associated with a substantial decrease in pain and activity limitations. Therapeutic footwear is a relevant treatment option for patients with rheumatoid arthritis and foot problems.
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Fitzcharles Mary-Ann
2012-09-01
Full Text Available Abstract Background Fibromyalgia (FM is a pain condition with associated symptoms contributing to distress. The Fibromyalgia Survey Diagnostic Criteria and Severity Scale (FSDC is a patient-administered questionnaire assessing diagnosis and symptom severity. Locations of body pain measured by the Widespread Pain Index (WPI, and the Symptom Severity scale (SS measuring fatigue, unrefreshing sleep, cognitive and somatic complaints provide a score (0–31, measuring a composite of polysymptomatic distress. The reliability and validity of the translated French version of the FSDC was evaluated. Methods The French FSDC was administered twice to 73 FM patients, and was correlated with measures of symptom status including: Fibromyalgia Impact Questionnaire (FIQ, Health Assessment Questionnaire (HAQ, McGill Pain Questionnaire (MPQ, and a visual analogue scale (VAS for global severity and pain. Test-retest reliability, internal consistency, and construct validity were evaluated. Results Test-retest reliability was between .600 and .888 for the 25 single items of the FSDC, and .912 for the total FSDC, with all correlations significant (p Conclusions The French FSDC is a valid instrument in French FM patients with reliability and construct validity. It is easily completed, simple to score, and has the potential to become the standard for measurement of polysymptomatic distress in FM.
PERTUMBUHAN EKONOMI DAN KETIMPANGAN PENDAPATAN ANTAR KABUPATEN DI KALIMANTAN TIMUR
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TUTIK YULIANI
2015-03-01
Full Text Available Penelitian ini bertujuan untuk mengetahui ketimpangan pembangunan dan pendapatan antar Kabupaten di Kalimantan Timur serta membuktikan apakah Hipotesis U terbalik berlaku di Propinsi Kalimantan Timur. Untuk mengetahui seberapa besar ketimpangan pendapatan digunakan Indeks Williamson dan Indeks Entropi Theil,.Berdasarkan indeks Wiliamson menunjukkan bahwa selama tahun 2010 sampai dengan 2012 terdapat ketimpangan pembanguan antar kabupaten di Kalimantan Timur sebesar 0.69 di tahun 2010 menjadi 0.72 di tahun 2012. Sedangkan dari hitungan Entropi Theil menunjukkan bahwa rata-rata selama tahun 2010 sampai dengan 2012 terdapat ketimpangan pendapatan sebesar 17.45. Setelah dilakukan analisis Kuznets menunjukkan bahwa di Kalimantan Timur selama tahun 2010 sampai dengan 2012 berlaku hukum Kuznets.This study aims to find out the development and income inequality inter regency in East Kalimantan and prove whether the inverted U hypothesis applied in the East Kalimantan. To find out how much income inequality, the writer used Williamson and Theil's Entropy Index. Based on Williamson index, it indicates that there is income inequality inter regency in East Kalimantan during 2010 to 2012, at 0.69 in 2010 to 0.72 in 2012. Whereas Entropy Theil calculation shows that on average during 2010 to 2012, there was income inequality by 17.45. Meanwhile, Kuznets analysis shows that Kuznets law applied in East Kalimantan during 2010 to 2012.
Vincent, Joshua Israel; MacDermid, Joy Christine; Grewal, Ruby; Sekar, Vincent Prabhakaran; Balachandran, Dinesh
2014-01-01
Study Design: Prospective longitudinal validation study Objective: To translate and cross-culturally adapt the Oswestry Disability Index (ODI) to the Tamil language (ODI-T), and to evaluate its reliability and construct validity. Summary of Background Data: ODI is widely used as a disease specific questionnaire in back pain patients to evaluate pain and disability. A thorough literature search revealed that the Tamil version of the ODI has not been previously published. Methods: The ODI was translated and cross-culturally adapted to the Tamil language according to established guidelines. 30 subjects (16 women and 14 men) with a mean age of 42.7 years (S.D. 13.6; Range 22 - 69) with low back pain were recruited to assess the psychometric properties of the ODI-T Questionnaire. Patients completed the ODI-T, Roland-Morris disability questionnaire (RMDQ), VAS-pain and VAS-disability at baseline and 24-72 hours from the baseline visit. Results: The ODI-T displayed a high degree of internal consistency, with a Cronbach's alpha of 0.92. The test-retest reliability was high (n=30) with an ICC of 0.92 (95% CI, 0.84 to 0.96) and a mean re-test difference of 2.6 points lower on re-test. The ODI-T scores exhibited a strong correlation with the RMDQ scores (r = 0.82) pdisability in Tamil speaking patients with low back pain. PMID:24563681
Human Development in Romania: A Comparative Approach to Identifying Shortcomings
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Robert STEFAN
2017-12-01
Full Text Available Following the research carried out by the economist Mahbub ul Haq, derived from the studies of Amartya Sen on human capabilities, in 1990, the United Nations Development Programme (UNDP published its first Human Development Report. It introduced the notion that development of a country is not merely equal to economic growth, but has the ultimate purpose of enriching human life by expanding people’s choices. Thus, Human Development seeks to reveal the fundamental role of human life: that of reaching its full potential. Even after 28 years since the fall of communism, the political environment in Romania continues to be unsopportive of proper development. This study seeks to identify the shortcomings of the primary dimensions of Human Development in Romania and hopefully make a firm and rhetorical call to action.
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Sørensen, Jan; Primdahl, J; Horn, Hc
2014-01-01
per quality-adjusted life year (QALY) threshold, shared care and nurse care were cost-effective with more than 90% probability. Nurse care was cost-effective in comparison with shared care with 75% probability. Conclusions: Shared care and nurse care seem to cost less but provide broadly similar......Objectives: To compare the cost-effectiveness of three types of follow-up for outpatients with stable low-activity rheumatoid arthritis (RA). Method: In total, 287 patients were randomized to either planned rheumatologist consultations, shared care without planned consultations, or planned nurse...... consultations. Effectiveness measures included disease activity (Disease Activity Score based on 28 joint counts and C-reactive protein, DAS28-CRP), functional status (Health Assessment Questionnaire, HAQ), and health-related quality of life (EuroQol EQ-5D). Cost measures included activities in outpatient...
Storie di genere, storie di partito
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Elisa Bellè
2012-04-01
Full Text Available Lo studio delle narrazioni di genere all'interno di questo tipo di organizzazione desta inoltre un particolare interesse anche in ragione della sottorappresentazione delle donne nella sfera della politica. Si tratta di un deficit democratico che coinvolge i sistemi politici moderni nel loro complesso, ma che interessa l'Italia con una particolare gravità ed evidenza. La questione della sottorappresentazione politica delle donne è stata sinora affrontata prevalentemente in termini tecnico-legali (politiche di pari opportunità ed azione positiva, o di teoria politica (la dicotomia pubblico-maschile e privato-femminile come fondamento del contratto sessuale della politica. Mancano invece contributi che guardino ai partiti come organizzazioni largamente responsabili dei processi di selezione e promozione delle carriere politiche, dunque come luoghi di quotidiana produzione di pratiche e culture di genere, più o meno egualitarie o, viceversa, discriminatorie. Sulla base di tale vuoto di ricerca e riflessione, il presente articolo si propone di mettere in luce le pratiche e le culture di genere che emergono dai racconti di uomini e donne all'interno di due organizzazioni partitiche, una di destra e una di sinistra, situate nel contesto territoriale della provincia di Trento. La ricerca è stata condotta attraverso lo strumento dell'intervista semi-strutturata, coinvolgendo quattro donne e quattro uomini, divisi per coppie di età (un uomo ed una donna giovani ed un uomo ed una donna da lungo presenti nel partito, accostabili per quanto concerne ruolo e posizione nelle organizzazioni partitiche considerate. L'attenzione analitica si è concentrata sulla costruzione del genere di uomini e donne intervistati/e, intesa sia come dimensione ed esperienza individuale (le storie di genere dei/lle singoli/e, sia come dimensione organizzativa più ampia (le storie di genere delle organizzazioni, narrate dalle diverse voci. Un'ulteriore dimensione analitica
Oliveira, C. S.; Ferreira, M. A.
2015-12-01
Apart from the loss of lives, injuries and homeless resulting from an earthquake, not only the economy and physical landscape are altered, but also the lives of citizens and their places of work are dramatically altered. If critical services and functions are disrupted for more than a reasonable time period, consequences can be severe. All communities are at risk and face potential disaster, if unprepared. The Disruption Index (DI) is a tool that allows the representation of a complex, multidimensional, situation in a concise and easier way, providing institutions and communities with a way to identify the global earthquake impact in a geographical area, the elements at risk, and the means to reduce it. Understanding how the loss and cascading effects across a number of areas might be correlated during a single earthquake is critical to evaluate risk. The application of this tool, prior-to a catastrophe, assumes a huge importance for earthquake risk professionals and planners to understand their impacts and to start building earthquake resilient cities. Post-to an event, this tool provides an assessment of its extent and impact considering the propagation effects, developed in a Geographic Information System (GIS) environment. The DI was already tested, calibrated after several earthquakes and applied in Portugal, Italy, Spain and Iceland. The next step in this research is to implement this tool directly into web portals or websites as well as PAGER or GDACS platforms to: - Rapidly assess an earthquake impact in a region following significant events. Nowadays the institutions used the shake maps; it's an important tool but cannot reflect the impact on livelihoods and the cascade effects. The DI maps can be used by state and local organizations, both public and private, for post-earthquake response and recovery, public and scientific information.
The effect of protein and glycemic index on children's body composition
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Papadaki, Angeliki; Linardakis, Manolis; Larsen, Thomas Meinert
2010-01-01
To investigate the effect of protein and glycemic index (GI) on body composition among European children in the randomized, 6-month dietary intervention DiOGenes (diet, obesity, and genes) family-based study.......To investigate the effect of protein and glycemic index (GI) on body composition among European children in the randomized, 6-month dietary intervention DiOGenes (diet, obesity, and genes) family-based study....
Denis, Isabelle; Fortin, Luc
2012-04-01
Cross-cultural translation and psychometric testing. To translate, culturally adapt, and validate the Oswestry Disability Index (ODI) version 2.0 for the French-Canadian population. Many authors have recommended the administration of standardized instruments, rather than the creation of new scales, and advocate the adaptation of validated questionnaires in other languages. The application of these scales in different countries and by cultural groups necessitates cross-cultural adaptation. Many scales evaluate the functional incapacity resulting from low back pain. The ODI is among the most commonly used for this purpose. The French-Canadian ODI (ODI-FC) was developed by cross-cultural adaptation following internationally recommended methodology: forward translation, back translation, expert committee revision, and clinical evaluation of the prefinal version. Psychometric testing was performed on 72 patients with chronic low back pain. The subjects were recruited from a physiatry department in a university hospital and from a private practice physiatry clinic. They came from the Montreal area. The psychometric testing included internal consistency (Cronbach α), test-retest reliability (intraclass correlation coefficient) with a time interval set at 48 hours, and construct validity, comparing the ODI-FC with the Roland-Morris Disability Questionnaire and the Quebec Back Pain Disability Scale (Pearson correlation coefficient). In 44.4% of the subjects, the average duration of low-back pain varied between 1 and 5 years. Average score for the ODI-FC was 29.2. Good internal consistency was found (Cronbach α = 0.88). Reliability was excellent, with intraclass correlation coefficient = 0.92 (95% confidence interval, 0.87-0.95). Construct validity results revealed excellent correlations between the ODI and the Quebec Back Pain Disability Scale (r = 0.90) and between the ODI and the Roland-Morris Disability Questionnaire (r = 0.84). Cross-cultural translation and
Kang, Jeong-Il; Jeong, Dae-Keun; Choi, Hyun
2016-01-01
[Purpose] This study investigated the effect of exhalation exercises on trunk muscle activity and Oswestry Disability Index by inducing trunk muscle activity through increasing intra-abdominal pressure and activating muscles, contributing to spinal stability. [Subjects and Methods] This intervention program included 20 male patients with chronic low back pain. A total of 10 subjects each were randomly assigned to an exhalation exercise group as the experimental group and a spinal stabilizatio...
Mueller, Ruediger B; Gengenbacher, Michael; Richter, Symi; Dudler, Jean; Möller, Burkhard; von Kempis, Johannes
2016-04-14
Vacation can present a major problem to patients with rheumatoid arthritis (RA) treated with weekly subcutaneous biologics, including subcutaneous (SC) abatacept. Therefore, the replacement of four SC doses of abatacept by a single dose of intravenous (IV) abatacept may present an acceptable alternative to cover a 4-week interval needed for vacations. In the study presented, we analyzed the efficacy and safety of this intervention followed by a switch back to SC abatacept after 4 weeks. This open-label, prospective, single-arm, 24-week trial recruited patients with established RA in low disease activity (LDA) or in remission on treatment with SC abatacept for at least 3 months to receive a single dose of IV abatacept (baseline) followed by a break of 4 weeks and then continuation of weekly SC abatacept from day 28 on. Disease-modifying anti-rheumatic drug (DMARD)-inadequate or biologic-inadequate responders (or both) were included. The baseline characteristics of the 49 patients (per protocol) were typical for a cohort of RA patients with established disease (mean disease duration of 8.31 years) in LDA under treatment with synthetic DMARDs and a biologic. Two patients (one flare and one patient decision) dropped out of the study. The proportions of patients with disease activity score in 28 joints (DAS-28) of not more than 3.2 at day 28 were 93.9 % (95 % confidence interval (CI) 83.5-97.9) and 93.6 % (95 % CI 82.8-97.8) at the end of the study (day 168). The average DAS-28 values were 1.74 (standard deviation (SD) ± 0.72) at baseline, 2.03 (SD ± 1.03) at day 28, and 1.96 (SD ± 0.92) at the end of the study (day 168). Pre-exposure to IV abatacept and having failed methotrexate or anti-tumor necrosis factor (anti-TNF) did not influence the average DAS-28 or the proportion of patients maintaining LDA over time. The average health assessment questionnaire disability index (HAQ-DI) was stable throughout the study. Adverse events (AEs) occurred in
Flores, Margaret M.; Nelson, Cynthia; Hinton, Vanessa; Franklin, Toni M.; Strozier, Shaunita D.; Terry, LaTonya; Franklin, Susan
2013-01-01
There is limited research demonstrating Direct Instruction (DI) as an effective reading comprehension intervention for students with autism spectrum disorders (ASD) and developmental disabilities (DD). Previous research has shown that DI, when portions of the program were implemented, resulted in increased skills (Flores & Ganz, 2007; Flores…
Goni, Vijay G; Hampannavar, Aravind; Gopinathan, Nirmal Raj; Singh, Paramjeet; Sudesh, Pebam; Logithasan, Rajesh Kumar; Sharma, Anurag; Bk, Shashidhar; Sament, Radheshyam
2014-02-01
Cross-sectional study. The aim of the study was to determine relationship between the degrees of radiologically demonstrated anatomical lumbar canal stenosis using magnetic resonance imaging (MRI) and its correlation with the patient's disability level, using the Oswestry Disability Index (ODI). The relationship between the imaging studies and clinical symptoms has been uncertain in patients suffering from symptomatic lumbar canal stenosis. There is a limited number of studies which correlates the degree of stenosis with simple reproducible scoring methods. Fifty patients were selected from 350 patients who fulfilled the inclusion criteria. The patients answered the national-language translated form of ODI. The ratio of disability was interpreted, and the patients were grouped accordingly. They were subjected to MRI; and the anteroposterior diameters of the lumbar intervertebral disc spaces and the thecal sac cross sectional area were measured. Comparison was performed between the subdivisions of the degree of lumbar canal stenosis, based on the following: anteroposterior diameter (three groups: normal, relative stenosis and absolute stenosis); subdivisions of the degree of central canal stenosis, based on the thecal sac cross-sectional area, measured on axial views (three groups: normal, moderately stenotic and severely stenotic); and the ODI outcome, which was also presented in 20 percentiles. No significant correlation was established between the radiologically depicted anatomical lumbar stenosis and the Oswestry Disability scores. Magnetic resonance imaging alone should not be considered in isolation when assessing and treating patients diagnosed with lumbar canal stenosis.
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A. Zucchi
2003-05-01
Full Text Available
Introduzione: la complessità interpretativa dei dati relativi ad alcuni fenomeni sanitari a livello territoriale impone la necessità di uno strumento semplice di lettura “epidemiologica”; tale lettura si fonda sull’utilizzo di una serie di “indicatori”, fondamenta di un processo dinamico di monitoraggio temporale e spaziale in grado di descrivere sinteticamente fenomeni di per sé complessi, al fine di fornire al decisore un supporto sintetico ma scientificamente solido.
Obiettivi: istituzione di un sistema di monitoraggio sanitario community-based; definizione di indicatori sanitari comparabili tramite un esame critico dei dati esistenti; sviluppo di metodologie per la raccolta e la validazione dei dati; supporto alla creazione di un sistema efficace e affidabile di trasferimento e scambio dei dati e degli indicatori stessi con uso spinto della tecnologia telematica; elaborazione di metodi e di strumenti necessari alla produzione di analisi e relazioni.
Materiali e metodi: gli indicatori analizzati fanno riferimento
all’elenco definito dal decreto ministeriale n. 27 del 12 dicembre 2001 “sistema di garanzie per il monitoraggio dell’assistenza sanitaria”. A questo elenco ne sono stati aggiunti altri, per un totale di 127, divisi in grandi capitoli tematici: assistenza sanitaria, assistenza distrettuale, assistenza ospedaliera, indicatori stato di salute, consumo di risorse sanitarie (cui è stato dato particolare enfasi, indicatori di domanda/accessibilità. Per definire infine un
profilo di sintesi di questi grandi capitoli e delle relative
eterogeneità territoriali si è successivamente applicata la tecnica statistica dello “z-score”.
Risultati: le differenze emerse a livello distrettuale hanno permesso di disegnare una ‘mappa’ degli indicatori sanitari in provincia di Bergamo.
Conclusioni:i risultati di
Gabel, Charles P.; Cuesta-Vargas, Antonio I.; Barr, Sebastian; Winkeljohn Black, Stephanie; Osborne, Jason W.; Melloh, Markus
2016-01-01
Purpose The neck disability index (NDI) as a 10-item patient reported outcome (PRO) measure is the most commonly used whiplash associated disorders (WAD) assessment tool. However, statistical rigor and factor structure are not definitive. To date, confirmatory factor analysis (CFA) has not examined whether the factor structure generalizes across different groups (e.g., WAD versus non-WAD). This study aimed to determine the psychometric properties of the NDI in these population groups.
International Nuclear Information System (INIS)
Pasha, I.F.; Qureshi, M.A.; Farooq, M.
2014-01-01
Background/Aims: Oswestry Disability index is an established tool for assessment of Spinal Disability. It has been translated into many languages and but not to Urdu. The aim of this prospective observational study was translation, application and validation of Urdu version of the Oswestry Disability Index (Urdu ODI) for our specific cultural background. Methods: Urdu version of ODI was developed and applied for outcome assessment in 50 patients, suffering from lumbar prolapsed inter vertebral discs and treated with caudal epidural steroid injection. All patients having mechanical low backache with radiculopathy and single level disc prolapse at L-4-5 or L5- S 1 on Magnetic Resonance Imaging (MRI) were included in the study. Single Steroid Injection with local anesthetic was injected into sacral caudal epidural space through sacral hiatus. A Performa was made for each patient and records were kept in a custom built Microsoft access database. Outcome was assessed using Urdu ODI and validation by comparing with Numeric rating Scale 0-10 at each visit. Results: Fifty patients received caudal epidural injections, 23 (46%) were male and 27 (54%) were female. The mean age was 34 years, with the range being 21-55. Low mechanical backache with right sided radiculopathy was in 29 (58%) and left sided in 21 (42%) patients. The commonest involved disc was L4-S in 28 (56%) and L5-S1 in 22 (44%) patients Pain was assessed with Numeric Rating Scale (NRS) of ten points. This was mean 7.35, range 9-6 at presentation and mean improvement was 4.15 with range 5-3 at fist week, 3.80 with range 5-2 at first month and 3.05 with range 4-1 after six months. Functional disability assessment was done using Urdu ODI. The mean Urdu ODI at the time of presentation was 66.23% with range 81%-48%. The mean functional status was found to be 38.64% with range 26%-45% at the end of the first week, 43.65% with range 31%-48% after one month and 44.85% with range 28%-48% after six months. So there was
Evaluation of Helkimo anamnestic and dysfunction index in identical twins
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Kučević Esad H.
2016-01-01
Full Text Available Introduction: In 1974 Marti Helkimo designed special questionnaires which were used for entering adequate contemporary data collected by medical history, analyzing the functions of the orofacial system and analyzing occlusion. Data were evaluated numerically with 0, 1 or 5, depending on the severity of the relevant findings and severity of clinical signs or symptoms of dysfunction. Objective: The aim of the research was to establish and evaluate specially designed Helkimos anamnestic and dysfunction index in monozygotic twins. Materials and Methods: A longitudinal prospective study was carried out on a randomized sample of 30 pairs of twins, 20 to 40 years old, and of both sexes. Dedicated design of the questionnaire made it possible to calculate the Helkimos anamnestic index (Ai, based on subjective feeling and positive or negative answers of subjects about the state of their masticatory apparatus. The clinical dysfunction index (Di represents objective functional analysis of structural and functional disorders of the orofacial complex, because it monitors multiple parameters. Kinematics of the lower jaw, conditions and limited function of the temporomandibular joints, the presence or absence of painful sensations during mandible movements during palpation of the joints and masticatory muscles, and the overall quantification of the incidence of craniomandibular dysfunction were all monitored and evaluated. The study was conducted in accordance with the local and international laws and ethical standards. Results: Medical records of 47 (78.3% twins did not present the signs and symptoms of craniomandibular dysfunction, i.e., Ai = 0. Twelve respondents were aware of the existence of mild signs of craniomandibular disorders (CMD. Acute and expressed craniomandibular disorder was identified in one of the twins Ai II 1 (1.7%. By evaluating and analyzing the results obtained using Helkimo analysis, positive dysfunction index (Di> 0, or certain signs
Sexual Health of Polish Athletes with Disabilities
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Ryszard Plinta
2015-06-01
Full Text Available The purpose of this study was to determine sexual functioning of Polish athletes with disabilities (including paralympians. The study encompassed 218 people with physical disabilities, aged between 18 and 45 (149 men and 69 women. The entire research population was divided into three groups: Polish paralympians (n = 45, athletes with disabilities (n = 126 and non-athletes with disabilities (n = 47. The quality of sexual life of Polish paralympians was measured by using the Polish version of Female Sexual Function Index and International Index of Erectile Function. Clinically significant erectile dysfunctions were most often diagnosed in non-athletes (83.33% with 50% result of severe erectile dysfunctions, followed by athletes and paralympians with comparable results of 56.98% and 54.17% respectively (p = 0.00388. Statistically significant clinical sexual dysfunctions concerned lubrication, orgasm as well as pain domains, and prevailed among female non-athletes (68.42%, 68.42% and 57.89%. Practising sports at the highest level has a favourable effect on the sexuality of men and women with physical disabilities. Men with physical disabilities manifest more sexual disorders than women, an aspect which should be considered by health-care professionals working with people with disabilities.
Chen, He; Du, Wei; Li, Ning; Chen, Gong; Zheng, Xiaoying
2013-06-01
Traffic crashes have become the fifth leading cause of burden of diseases and injuries in China. More importantly, it may further aggravate the degree of health inequality among Chinese population, which is still under-investigated. Based on a nationally representative data, we calculated the concentration index (CI) to measure the socioeconomic inequality in traffic-related disability (TRD), and decomposed CI into potential sources of the inequality. Results show that more than 1.5 million Chinese adults were disabled by traffic crashes and the adults with financial disadvantage bear disproportionately heavier burden of TRD. Besides, strategies of reducing income inequality and protecting the safety of poor road users, are of great importance. Residence appears to counteract the socioeconomic inequality in TRD, however, it does not necessarily come to an optimistic conclusion. In addition to the worrying income gap between rural and urban areas, other possible mechanisms, e.g. the low level of post-crash medical resources in rural area, need further studies. China is one of the developing countries undergoing fast motorization and our findings could provide other countries in similar context with some insights about how to maintain socioeconomic equality in road safety. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Paola Marinò
2015-12-01
Full Text Available L’articolo affronta il tema del finanziamento degli interventi di restauro e riuso delle grandi architetture del ‘900, in un momento storico in cui le risorse finanziarie pubbliche sono sempre più scarse e difficili da reperire. La ricerca affronta la possibilità di ricorrere al crowdfunding attraverso il caso studio del progetto di “Torino Esposizioni”, un’architettura del ‘900, parzialmente utilizzata, in stato di degrado, nonostante sia riconosciuta dalla critica internazionale come un’opera di eccezionale valore. A partire dal Master Plan, messo a punto dal Politecnico di Torino in collaborazione con la Città di Torino, è stata simulata l’applicabilità del crowdfunding attraverso un’indagine che valuta la disponibilità a contribuire da parte dei potenziali fruitori del complesso di “Torino Esposizioni” e, quindi, a comprendere l’interesse dei cittadini nei confronti del valore storico del complesso di “Torino Esposizioni” e del progetto di riuso che dovrebbe valorizzarlo. Gli esiti della ricerca, nell’evidenziare un’inattesa scarsa disponibilità a contribuire al finanziamento collettivo del progetto, hanno messo in evidenza, non solo la scarsa conoscenza del crowdfunding come strumento di finanziamento, ma anche la scarsa consapevolezza del valore storico architettonico del patrimonio moderno della città di Torino, di cui “Torino Esposizioni” rappresenta un esempio eccezionale, seppur non l’unico.
Definition of dose intensity (DI), average relative DI and effective DI
International Nuclear Information System (INIS)
Alberto, P.
1995-01-01
The cytotoxic activity of cancer chemotherapy is related to the dose and to the amount of drug delivered per time unit. the significance of time in the effectiveness of a treatment program is frequently overlooked. The term of dose intensity (DI) is used to define the drug dose delivered per time unit and is expressed as mg/m 2 per week. A delay in the sequence of treatment cycles decreases the DI in the DI in the same proportion as a reduction of dose. Average relative DI corresponds to the mean DI of combined agents and is expressed as a fraction of a similar combination selected as a standard. Di is useful to compare the dose actually received with the prescribed dose. The relation of DI with tumor response or survival has not been fully demonstrated. A threshold DI level for therapeutic activity is evident. Above this threshold, a linear relationship of DI and effectiveness is not obvious, particularly regarding high-dose chemotherapy. The term of DI is more useful in its principle than in the significance of its calculated value. (authors). 19 refs., 3 tabs., 3 figs
Reti di città, mobilità e ambiente: il Preliminare di PTCP di Avellino
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Carmela Gargiulo
2010-02-01
Full Text Available L’articolo propone la lettura dei contenuti del Preliminare del PTCP di Avellino, un piano per molti aspetti innovativo, soprattutto per aver coniugato pianificazione di area vasta di tipo tradizionale e logica “strategica”. In particolare, l’articolo descrive idee guida, contenuti e strategie del piano orientate, prevalentemente, a stimolare lo sviluppo sostenibile di un’area in ritardo di sviluppo come la provincia irpina, attraverso la salvaguardia e valorizzazione delle risorse naturali e storico-culturali, la costruzione di reti di medie e piccole città e reti di mobilità alle diverse scale, da quella urbana a quella internazionale, e interventi sul sistema della mobilità. Nel 2004, ormai più di cinque anni fa, è stato adottato, a maggioranza assoluta (solo due gli astenuti, il Preliminare di Piano Territoriale di Coordinamento della Provincia di Avellino, dopo un lavoro di oltre due anni che ha visto impegnati gli uffici provinciali con due dipartimenti universitari. Il lavoro, che va ben oltre il significato e la valenza di un preliminare e che coniuga due pratiche di piano diverse (quella tradizionale e quella strategica ruota attorno a tre idee di fondo, tra loro strettamente interrelate, che costituiscono i criteri guida che finora ha inteso seguire la provincia di Avellino nell’attività di governo delle trasformazioni. Tali idee, quindi, costituiscono le fondamenta su cui è stato costruito il Preliminare e sono la griglia di specificazione delle strategie e degli obiettivi di piano. Esse sono alla base delle scelte elaborate per lo sviluppo compatibile del territorio, e sono riferibili alle azioni operative di trasformazione del territorio che gli Enti locali, cui è demandato tale compito, nel prossimo futuro dovranno affrontare. Le tre idee forza del Preliminare, descritte nel seguito, sono riferibili ai sistemi di risorse principali della provincia di Avellino, oggetto di una indagine analitico
DEFF Research Database (Denmark)
Einarsson, Jon Thorkell; Geborek, Pierre; Saxne, Tore
2016-01-01
of the strongest predictors of longterm outcomes. The purpose of this study was to investigate the physical function over a long time in patients with RA who achieved sustained remission (SR) compared with that of patients occasionally achieving remission [non-sustained remission (NSR)]. METHODS: Patients with RA...... treated with antitumor necrosis factor and included in the South Swedish Arthritis Treatment Group register were eligible for this study. We identified patients with a Disease Activity Score at 28 joints (DAS28) achieved...... SR, i.e., remission during consecutive visits for at least 6 months. The course of functional status was assessed using the HAQ at each visit. RESULTS: Of the 2416 patients, 1177 (48.7%) reached DAS28 remission at some point. SR was achieved by 382 (15.8%) for the DAS28 and 186 (7.7%) for the SDAI...
Quality of sleep, physical activity and fatigue in patients with rheumatoid arthritis
DEFF Research Database (Denmark)
Løppenthin, Katrine; Esbensen, Bente Appel; Jennum, Poul Jørgen
2012-01-01
a rheumatology outpatient clinic were recruited consecutively to participate in an observational cross-sectional study. The self-administered questionnaire covered the Health Assessment Questionnaire (HAQ), Visual Analogue Scale (VAS) for pain and fatigue, Physical Activity Scale (PAS), Multidimensional Fatigue...... to Physical Activity (PA) and fatigue. Understanding PA, fatigue and the impact on sleep disturbances could illuminate ways to promote sufficient sleep in RA patients. Thus, the aim of this study was to examine the association between sleep disturbance, PA, and fatigue. Methods A total of 500 RA patients from...... of 58 years), and 80% were women. The mean disease duration was 14 years and mean DAS score was 2.7. The prevalence of poor sleep quality was 61 %. Higher level of general fatigue, mental fatigue, physical fatigue, reduced activity and reduced motivation was reported in patients with poor sleep quality...
Sheahan, Peter J; Nelson-Wong, Erika J; Fischer, Steven L
2015-01-01
The Oswestry Disability Index (ODI) is a self-report-based outcome measure used to quantify the extent of disability related to low back pain (LBP), a substantial contributor to workplace absenteeism. The ODI tool has been adapted for use by patients in several non-English speaking nations. It is unclear, however, if these adapted versions of the ODI are as credible as the original ODI developed for English-speaking nations. The objective of this study was to conduct a review of the literature to identify culturally adapted versions of the ODI and to report on the adaptation process, construct validity, test-retest reliability and internal consistency of these ODIs. Following a pragmatic review process, data were extracted from each study with regard to these four outcomes. While most studies applied adaptation processes in accordance with best-practice guidelines, there were some deviations. However, all studies reported high-quality psychometric properties: group mean construct validity was 0.734 ± 0.094 (indicated via a correlation coefficient), test-retest reliability was 0.937 ± 0.032 (indicated via an intraclass correlation coefficient) and internal consistency was 0.876 ± 0.047 (indicated via Cronbach's alpha). Researchers can be confident when using any of these culturally adapted ODIs, or when comparing and contrasting results between cultures where these versions were employed. Implications for Rehabilitation Low back pain is the second leading cause of disability in the world, behind only cancer. The Oswestry Disability Index (ODI) has been developed as a self-report outcome measure of low back pain for administration to patients. An understanding of the various cross-cultural adaptations of the ODI is important for more concerted multi-national research efforts. This review examines 16 cross-cultural adaptations of the ODI and should inform the work of health care and rehabilitation professionals.
Le collezioni di Mammiferi del Museo Civico di Zoologia di Roma: una sintesi storica
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Gloria Svampa
2003-10-01
Full Text Available Il Museo Civico di Zoologia di Roma è sorto nel 1932 all?interno del Giardino Zoologico dell?allora Governatorato di Roma, di cui ha condiviso la direzione tecnica ed amministrativa sino al 1998. Il nucleo centrale delle collezioni è costituito dal materiale di proprietà universitaria, di quello che fu il Museo di Zoologia della Regia Università, a sua volta diretto discendente delle collezioni del Museo di Zoologia ed Anatomia Comparata del Pontificio Archiginnasio Romano. La quasi totalità degli esemplari tassidermizzati risale al periodo in cui l?Istituto di Zoologia fu diretto da Antonio Carruccio (1883-1914. Dal 1932, la collezione teriologica si è andata arricchendo, in particolare di materiale osteologico, soprattutto con acquisizioni provenienti dal Giardino Zoologico e da rare spedizioni scientifiche, come quella organizzata dal CNR nell?Alto Rio Negro del 1962-3, guidata da Ettore Biocca. Anche a causa del fatto che per molti anni il Museo è stato privo di curatori, mancano importanti collezioni teriologiche da studio, fatta eccezione per quella cetologica. In molti casi, singoli esemplari potenzialmente di grande valore scientifico, mancano di dati esatti sulla località di cattura. Nell?ambito di un programma di ricatalogazione della collezione recentemente intrapreso, particolare attenzione è stata posta all?acquisizione di tutti i dati legati alla storia dei singoli esemplari, rintracciabili attraverso i resoconti di viaggio dei singoli esploratori. Nel periodo universitario, infatti, il Museo della nuova capitale d?Italia fu oggetto di grande attenzione da parte di privati ed enti, a partire dai Savoia, che donarono le loro collezioni o il materiale raccolto durante le spedizioni effettuate. Il lavoro di revisione in corso sta mettendo in luce una serie di esemplari meritevoli di ulteriori, dettagliate ricerche. È probabile che molto del materiale del Museo, pervenuto a Roma attraverso donazioni della famiglia reale
Oswestry Disability Index: a psychometric analysis with 1,610 patients.
Brodke, Darrel S; Goz, Vadim; Lawrence, Brandon D; Spiker, W Ryan; Neese, Ashley; Hung, Man
2017-03-01
One-fourth of the adult US population has or will experience back pain and has undergone one of a myriad of treatments. Understanding the outcomes of these many treatments from pharmacologic to surgical, from manipulation to modality, allows for a better understanding and value-driven decision making. Patient-reported outcome measures are the current standard and include general and disease-specific measures. The Oswestry Disability Index (ODI) is the most commonly used disease-specific patient-reported outcome tool to measure functional disability related to back pain. Few studies have evaluated its psychometric properties in a large patient sample using a modern tool such as the Rasch analysis model. This study aims to identify the benefits and deficiencies of the ODI as an outcome tool for assessing patients with back pain. This study aimed to investigate the psychometric properties, performance, and applicability of the ODI in patients with back pain who visited a university-based outpatient clinic. This study used a secondary analysis-assessment of diagnostic tool on consecutive patients. The sample comprised 1,610 patients visiting an academic spine center. The ODI was the outcome measure. Detailed Rasch analysis of the ODI was performed. Standard descriptive statistics were also assessed. The ODI performed well overall. It demonstrated suboptimal unidimensionality (ie, unexplained variance after accounting for the first dimension) of 8.3%. Person reliability was good, at 0.85, and item reliability was excellent, at 1.00. The overall item fit for the ODI was good with an outfit mean square of 1.02. The ODI had a floor effect of 29.9% and ceiling effect of 3.9%. The raw score to measure correlation of the ODI was excellent, at 0.944. The ODI performed relatively well overall, with some problematic findings. It had good person and item reliability, although it did not demonstrate strong evidence of unidimensionality. The ODI has moderately poor coverage, with a
Clinical value of MRI on wrists with arthritis
International Nuclear Information System (INIS)
Ma Qiang; Ma Daqing; He Wen; Le Erhu; Ma Xinfa; Wang Jun; Zuo Zhaoyong
2006-01-01
Objective: To study the appearances of various kinds of arthritis on MRI, and to assess and evaluate the role of MRI on diagnosing various kinds of arthritis. Methods: One hundred and fifty-one patients with medical history of wrist pain entered the study. T 1 -weighted spin echo, STIR (short time inversion recovery) of both wrists, gadolinium contrast material-enhanced sequences of dominant wrists were examined in the coronal planes. MRl, plain wrist radiographs, clinical data including swollen joint and patient global assessment (AIMS), and laboratory, examinations including ESR, RF, APF, and AKA were obtained at the same time. Functional disability was assessed using the Health Assessment Questionnaire Disability Score (HAQ). According to 1987 American Rheumatism Association (ARA) revised criteria, in 151 patients, 80 patients were diagnosed as rheumatoid arthritis, 29 patients as undifferentiated spondyloarthropathy, 20 patients as seronegative spondyloarthropathy, and 22 as other kinds of connective tissue diseases. Results: All 80 patients diagnosed with rheumatoid arthritis had bilateral pannus. Among 29 patients diagnosed with undifferentiated spondyloanthropathy, 3 cases had bilateral pannus, 24 had lateral pannus. Among 20 patients diagnosed with seronegative spondyloanthropathy, 4 cases had bilateral pannus, 15 had lateral pannus. Among 22 patients diagnosed with other kinds of connective tissue disease, 21 had lateral pannus. Bilateral pannus on bilateral wrists occured in 87 patients. There were not significant difference in the unilateral pannus among patients with various arthritis (χ 2 =6.157; P>0.05). But there were significant difference in the bilateral pannus among patients with various arthritis (χ 2 =126.882, P 2 =94.192, P 2 =70.354, P 2 =96.174, P<0.001). Conclusion: MRI can show the pathologic changes of wrists with various kinds of arthritis. MRI plays an important role in the differential diagnosis of various kinds of arthritis
Keanekaragaman Jenis Kupu-Kupu Superfamili Papilionoidae di Banyuwindu, Limbangan Kendal
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Ratna Oqtafiana
2013-03-01
Full Text Available Kupu-kupu turut memberi andil dalam mempertahankan keseimbangan ekosistem dan memperkaya keanekaragaman hayati. Tujuan dari penelitian ini adalah untuk mengetahui keanekaragaman jenis kupu-kupu superfamili Papilionoidae di Dukuh Banyuwindu Desa Limbangan Kecamatan Limbangan Kabupaten Kendal khususnya di habitat hutan sekunder, permukiman, Daerah Aliran Sungai (DAS dan persawahan.Populasi dalam penelitian ini adalah semua jenis kupu-kupu superfamili Papilionoidae yang ada di Banyuwindu, Limbangan Kendal. Sampel penelitian ini adalah jenis kupu-kupu superfamili Papilionoidae yang teramati di Banyuwindu Limbangan Kendal khususnya di habitat hutan sekunder, permukiman, DAS dan persawahan. Penelitian dilakukan dengan metode Indeks Point Abudance (IPA atau metode titik hitung.Hasil penelitian ditemukan sebanyak 62 jenis kupu-kupu superfamili Papilionoidae yang terdiri dari 737 individu yang tergolong kedalam empat famili yaitu Papilionidae, Pieridae, Lycaenidae dan Nymphalidae. Hasil analisis indeks keanekaragaman jenis berkisar antara 2,74-3,09, indeks kemerataan jenis berkisar antara 0,86-0,87 dan memiliki dominansi berkisar antara 0,07-0,09. Indeks keanekaragaman jenis dan indeks kemerataan jenis tertinggi tercatat pada habitat permukiman yaitu 3,09 dan 0,87 dan memiliki dominansi 0,07 sedangkan terendah tercatat pada habitat persawahan yaitu 2,74 dan 0,86 dan memiliki dominansi 0,07.Butterfly also contribute in maintaining the ecological balance and enrich biodiversity. The aim of this research was to determine the diversity of butterflies’ superfamily Papilionoidae in Banyuwindu Hamlet Limbangan Sub district Kendal Regency, especially in the secondary forest habitat, settlements, river flow area (RFA and rice field. The population in this research were all kinds of butterflies’ Papilionoidae superfamily in Banyuwindu, Limbangan Kendal. The sample was kind of butterfly superfamily Papilionoidae that observed in Banyuwindu Limbangan Kendal
Relationship Between Work Productivity and Clinical Characteristics in Rheumatoid Arthritis.
Salazar-Mejía, Carlos Eduardo; Galarza-Delgado, Dionicio Ángel; Colunga-Pedraza, Iris Jazmín; Azpiri-López, José Ramón; Wah-Suárez, Martín; Wimer-Castillo, Blanca Otilia; Salazar-Sepúlveda, Laura Leticia
2018-03-01
This study assesses the relationship between the ability to perform productive activities and the clinical characteristics of RA, such as disease activity, quality of life, functional capacity, workload, pharmacotherapy, and comorbidities. A cross-sectional, observational and descriptive study was conducted. Patients aged 18-75years with a diagnosis of RA according to ACR/EULAR 2010 criteria who attended regularly to the Rheumatology service in the period between January and March 2017 were included. The questionnaires, WPAI-AR, HAQ-DI and RAQoL, were applied. RA disease activity was measured by DAS28-PCR. Correlations were made between the clinical data obtained and work productivity and activity impairment measured by WPAI-AR. Two hundred four patients with a diagnosis of RA were included, of whom 92.6% were women. Mean age was 54.46±9.3years. Regarding the percentage of impairment of daily life activities, we found a significant difference between employed and unemployed patients (P≤.002). A positive correlation was found between RA activity measured by DAS28-PCR, quality of life, and functional ability with the percentages of absenteeism, presenteeism, overall productivity loss, and impairment of daily life activities. A correlation between RA disease activity, functional capacity, quality of life, and working impairment was found. The strongest association was established with the degree of functional capacity. Copyright © 2018 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Analisis Penerapan E-Government di Kabupaten Sragen
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Yan Andriariza AS
2013-09-01
Full Text Available ABSTRAK Kabupaten Sragen merupakan salah satu pemerintah kabupaten yang menerapkan e-government dengan baik, dan merupakan kabupaten yang menjadi percontohan dalam suksesnya penerapan e-government. Karenanya perlu untuk dilakukan analisis penerapan e-government di Kabupaten Sragen, sebagai contoh bagi daerah lain dalam membangun e-government di daerah tersebut. Analisa yang dilakukan antara lain melihat seberapa jauh penerapan G2C, G2B dan G2G di Pemerintah Kabupaten Sragen. Selain itu juga dilakukan analisa menggunakan The UN Web Measure Index, dan analisa terakhir melakukan analisa deskriptif untuk 5 faktor kesuksesan penerapan e-government, yaitu Hukum dan Peraturan, Struktur Organisasi, Proses Bisnis, Teknologi Informasi dan Visi, Objektif dan Strategi. Dari hasil analisis diperoleh kesimpulan bahwa Kabupaten Sragen telah menerapkan G2B dan G2G, serta berada pada tahap awal penerapan G2C, selain itu Kabupaten Sragen juga telah mencapai pemerintahan yang online, tanpa kertas dan transparan. Implementasi e-government di kabupaten Sragen tersebut dapat dikatakan sukses karena telah memenuhi beberapa faktor dalam mencapai kesuksesan implementasi e-government, yaitu hukum dan peraturan, struktur organisasi, teknologi informasi dan visi, objektif dan strategi. Bila dilihat berdasarkan UN Web Measured Index, Kabupaten Sragen telah mencapai tahap 4. Saran yang dapat diberikan melalui penelitian ini adalah untuk unit kerja yang menangani TIK di Kabupaten Sragen akan lebih baik bila dipegang oleh unit kerja setingkat eselon 2 dan perlunya SOP dan peraturan tambahan terkait TIK di Kabupaten Sragen. ABSTRACT Sragen is one of the districts that implement well e-government, and being a model for the successful implementation of e-government. It is necessary to do the analysis of the application of e-government in Sragen, as an example for other regions in developing e-government in the area. Analysis was carried out to see how far the application of G2C
Shin, Young Jun; Kim, Won Hyo; Kim, Seong Gil
2017-08-01
This study investigated the correlation between the neck disability index (NDI) and visual analogue scale (VAS), which are indicators of neck pain, shoulder joint range of motion (ROM), and muscle strength in women with a slight forward head posture. This study was carried out on 42 female college students attending Uiduk University in Gyeongju, Korea. The neck pain and disability index for each subject was measured using VAS and NDI, respectively. Two physiotherapists measured the shoulder joint ROM and muscle strengths of the subjects using a goniometer and a dynamometer, respectively. External rotation, internal rotation, and abduction of the shoulder joint were measured for each subject. A significant negative correlation between neck pain and shoulder joint ROM in external rotation and the muscle strength of the shoulder joint in abduction was found in the subjects. In addition, a significant positive correlation was observed between ROM in external rotation and muscle strength in abduction. This study showed a significant negative correlation between neck pain and ROM in external rotation as well as between neck pain and the muscle strength in abduction.
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Andréa Diniz Lopes
2009-02-01
Full Text Available OBJECTIVE: The purpose of the present study was to compare self-report and interview administration methods using the Western Ontario Rotator Cuff Index (WORC and Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH in patients with rotator cuff disorders. METHODS: Thirty male and female patients over 18 years of age with rotator cuff disorders (tendinopathy or rotator cuff tear and Brazilian Portuguese as their primary language were recruited for assessment via administration of the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire. A randomization method was used to determine whether the questionnaires would be self-reported (n=15 or administered by an interviewer (n=15. Pearson correlation coefficients were used to evaluate the correlation between the Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire in each group. The t-test was used to determine whether the difference in mean questionnaire scores and administration time was statistically significant. For statistical analysis, the level of significance was set at 5%. RESULTS: The mean subject age was 55.07 years, ranging from 27 to 74 years. Most patients had a diagnosis of tendinopathy (n=21. With regard to level of schooling, the majority (n=26 of subjects had completed a college degree or higher. The mean questionnaire scores and administration times did not significantly differ between the two groups (p>0.05. There were statistically significant correlations (p<0.05 between Western Ontario Rotator Cuff Index and and Disabilities of the Arm, Shoulder and Hand Questionnaire, and strong correlations were found between the questionnaires in both groups. CONCLUSION: There are no differences between the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire administration methods with regard to administration time or correlations between the
Reliability and validity study of the Finnish version 2.0 of the oswestry disability index.
Pekkanen, Liisa; Kautiainen, Hannu; Ylinen, Jari; Salo, Petri; Häkkinen, Arja
2011-02-15
Prospective clinical validation study. The aims of this study were to translate into Finnish and culturally adapt and study the psycho-metric properties of the Oswestry Disability Index (ODI) version 2.0. The ODI is one of the most commonly reported back-specific disability questionnaires. It is widely used both in clinical work and in medical studies. To date, no validated Finnish version of the ODI version 2.0 has been reported. The ODI version 2.0 was translated into the Finnish language. A total of 115 patients with back pain, referred by the primary care physician to the outpatient clinic of the department of physical medicine and rehabilitation, were recruited for this study. The patients answered a questionnaire package that included the Finnish ODI 2.0, Back Pain Questionnaire for Visual Analogue Assessment (Million-VAS), Visual Analogue Scales of back and leg pain (VASback, VASleg), the Depressions Scale, and a question on their subjectively perceived health. The package was administered twice; 2 weeks before and at the arrival to the clinic. Reproducibility of the ODI was 0.90 (95% confidence interval [CI] = 0.85-0.94) and the internal consistency was 0.86 (95% CI = 0.81-0.90). Factor analysis showed that the ODI was loaded on 2 factors, which explained 51% of the total variance. In testing convergent validity ODI correlated with Million-VAS, r = 0.75 (95% CI = 0.64-0.84); VASback, r = 0.48 (95% CI = 0.32-0.62); and VAS leg, r = 0.41 (95% CI = 0.23-0.57). The Finnish ODI version 2.0 proved to be a valid and reliable instrument that showed psychometric properties comparable with the original English version. Therefore, it can be used in assessing the disability among Finnish-speaking patients with back pain for both clinical and scientific purposes.
Wealth Inequality and Mental Disability Among the Chinese Population: A Population Based Study
Wang, Zhenjie; Du, Wei; Pang, Lihua; Zhang, Lei; Chen, Gong; Zheng, Xiaoying
2015-01-01
In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend wealth index category had a significant, inverse association with mental disability when all severities of mental disability were taken into consideration. This study’s results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability. PMID:26492258
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Inge Kirchberger
Full Text Available Home-based secondary prevention programs led by nurses have been proposed to facilitate patients' adjustment to acute myocardial infarction (AMI. The objective of this study was to conduct secondary analyses of the three-year follow-up of a nurse-based case management for elderly patients discharged from hospital after an AMI.In a single-centre randomized two-armed parallel group trial of hospitalized patients with AMI ≥65 years, patients hospitalized between September 2008 and May 2010 in the Hospital of Augsburg, Germany, were randomly assigned to case management or usual care. The case-management intervention consisted of a nurse-based follow-up for three years including home visits and telephone calls. Study endpoints were time to first unplanned readmission or death, clinical parameters, functional status, depressive symptoms and malnutrition risk. Persons who assessed three-year outcomes and validated readmission data were blinded. The intention-to-treat approach was applied to the statistical analyses which included Cox Proportional Hazards models.Three hundred forty patients were allocated to receive case-management (n = 168 or usual care (n = 172. During three years, in the intervention group there were 80 first unplanned readmissions and 6 deaths, while the control group had 111first unplanned readmissions and 3 deaths. The intervention did not significantly affect time to first unplanned readmission or death (Hazard Ratio 0.89, 95% confidence interval (CI 0.67-1.19; p = 0.439, blood pressure, cholesterol level, instrumental activities of daily life (IADL (only for men, and depressive symptoms. However, patients in the intervention group had a significantly better functional status, as assessed by the HAQ Disability Index, IADL (only for women, and hand grip strength, and better SCREEN-II malnutrition risk scores than patients in the control group.A nurse-based management among elderly patients with AMI did not significantly affect
Mannion, A F; Junge, A; Fairbank, J C T; Dvorak, J; Grob, D
2006-01-01
Patient-orientated assessment methods are of paramount importance in the evaluation of treatment outcome. The Oswestry Disability Index (ODI) is one of the condition-specific questionnaires recommended for use with back pain patients. To date, no German version has been published in the peer-reviewed literature. A cross-cultural adaptation of the ODI for the German language was carried out, according to established guidelines. One hundred patients with chronic low-back pain (35 conservative, 65 surgical) completed a questionnaire booklet containing the newly translated ODI, along with a 0-10 pain visual analogue scale (VAS), the Roland Morris Disability Questionnaire, and Likert scales for disability, medication intake and pain frequency [to assess ODI's construct (convergent) validity]. Thirty-nine of these patients completed a second questionnaire within 2 weeks (to assess test-retest reliability). The intraclass correlation coefficient for the test-retest reliability of the questionnaire was 0.96. In test-retest, 74% of the individual questions were answered identically, and 21% just one grade higher or lower. The standard error of measurement (SEM) was 3.4, giving a "minimum detectable change" (MDC(95%)) for the ODI of approximately 9 points, i.e. the minimum change in an individual's score required to be considered "real change" (with 95% confidence) over and above measurement error. The ODI scores correlated with VAS pain intensity (r = 0.78, P disability, medication use and pain frequency (in each case P Oswestry questionnaire is reliable and valid, and shows psychometric characteristics as good as, if not better than, the original English version. It should represent a valuable tool for use in future patient-orientated outcome studies in German-speaking lands.
Visual functions and disability in diabetic retinopathy patients.
Shrestha, Gauri Shankar; Kaiti, Raju
2014-01-01
This study was undertaken to find correlations between visual functions and visual disabilities in patients with diabetic retinopathy. A cross-sectional study was carried out among 38 visually impaired diabetic retinopathy subjects at the Low Vision Clinic of B.P. Koirala Lions Centre for Ophthalmic Studies, Kathmandu. The subjects underwent assessment of distance and near visual acuity, objective and subjective refraction, contrast sensitivity, color vision, and central and peripheral visual fields. The visual disabilities of each subject in their daily lives were evaluated using a standard questionnaire. Multiple regression analysis between visual functions and visual disabilities index was assessed. The majority of subjects (42.1%) were of the age group 60-70 years. Best corrected visual acuity was found to be 0.73±0.2 in the better eye and 0.93±0.27 in the worse eye, which was significantly different at p=0.002. Visual disability scores were significantly higher for legibility of letters (1.2±0.3) and sentences (1.4±0.4), and least for clothing (0.7±0.3). Visual disability index for legibility of letters and sentences was significantly correlated with near visual acuity and peripheral visual field. Contrast sensitivity was also significantly correlated with the visual disability index, and total scores. Impairment of near visual acuity, contrast sensitivity, and peripheral visual field correlated significantly with different types of visual disability. Hence, these clinical tests should be an integral part of the visual assessment of diabetic eyes. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.
The efficacy of peloid therapy in management of hand osteoarthritis: a pilot study
Kasapoğlu Aksoy, Meliha; Altan, Lale; Eröksüz, Rıza; Metin Ökmen, Burcu
2017-12-01
Hand osteoarthritis (OA) is associated with pain, reduced grip strength, loss of range of motion (ROM), and joint stiffness, leading to impaired hand function and difficulty in performance of daily living activities. Mud bath therapy has been reported to play a primary role in the prevention and management of OA. Thus, we planned to conduct a study aimed at investigating the effects of peloid therapy on pain, functional state, grip strength, and the quality of life and performing a comparative analysis of the outcomes of peloid therapy. In this randomized, controlled, single-blind, pilot study, patients ( n = 33) underwent peloid therapy over 2 weeks, 5 sessions a week, for a total of 10 sessions and home exercise program in group 1. Patients in group 2 (control, n = 30) received only the same home exercise program as in group 1. Patients were evaluated just before, and 2 and 6 weeks after the start of the study with Visual Analogue Scale (VAS), Australian/Canadian Hand Osteoarthritis Index (AUSCAN), Health Assessment Questionnaire (HAQ), hand grip strength (HGS), and pinch strength (PS). Statistically significant improvements were observed in all parameters assessed at week 2 and week 6 in the group 1 ( p management of symptomatic osteoarthritis of the hand and may provide effective pain control and improvements in the hand functions, quality of life, and grip strength.
Development of a Chinese version of the Oswestry Disability Index version 2.1.
Lue, Yi-Jing; Hsieh, Ching-Lin; Huang, Mao-Hsiung; Lin, Gau-Tyan; Lu, Yen-Mou
2008-10-01
Cross-cultural adaptation and cross-sectional psychometric testing in a convenience sample of patients with low back pain. To translate and culturally adapt the Oswestry Disability Index version 2.1 (ODI 2.1) into a Mandarin Chinese version and to assess its reliability and validity. The Chinese ODI 2.1 has not been developed and validated. The ODI 2.1 was translated and culturally adapted to the Chinese version. The validity of the translated Chinese version was assessed by examining the relationship between the ODI and other well-known measures. Test-retest reliability was examined in 52 of these patients, who completed a second questionnaire within 1 week. Internal consistency of the ODI 2.1 was excellent with Cronbach's alpha = 0.903. The intraclass correlation coefficient of test-retest reliability was 0.89. The minimal detectable change was 12.8. The convergent validity of the Chinese ODI is supported by its high correlation with other physical functional status measures (Roland Morris Disability Questionnaire and SF-36 physical functioning subscale, r = 0.76 and -0.75, respectively), and moderate correlation with other measures (Visual Analogue Scale, r = 0.68) and certain SF-36 subscales (role-physical, bodily pain, and social functioning, r range: -0.49 to -0.57). As expected, the ODI was least correlated with nonfunctional measures (SF-36 mental subscale and role-emotional subscale, r = -0.25 and -0.33, respectively). The results of this study indicate that the Chinese version of the ODI 2.1 is a reliable and valid instrument for the measurement of functional status in patients with low back pain.
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Muhammad Arifudin
2016-01-01
Full Text Available AbstrakDemam berdarah dengue merupakan salah satu masalah kesehatan masyarakat yang masih ditemukan di Indonesia. Penyakit ini disebabkan oleh virus Dengue yang ditularkan melalui gigitan nyamuk Aedes. Kelurahan Kuranji merupakan kelurahan dengan kasus demam berdarah dengue terbanyak di Kota Padang. Tujuan penelitian ini adalah menentukan density figure (kepadatan larva nyamuk Aedes di Kelurahan Kuranji Padang. Penelitian dilaksanakan di Kelurahan Kuranji pada bulan April 2014. Desain penelitian adalah survei deskriptif dengan jumlah sampel 50 buah rumah yang diambil dengan cara multistage sampling. Hasil penelitian menunjukkan bahwa aedes aegypti ditemukan lebih banyak dibandingkan aedes albopictus, yaitu 97,74%. house index yaitu 52,50%, container index yaitu 34,72%, breteau index yaitu 66,50% dan density figure yaitu 7. Hasil penelitian ini menunjukkan bahwa aedes aegypti lebih banyak ditemukan di dalam rumah dan aedes albopictus hanya ditemukan di luar rumah. Bak mandi dari semen merupakan kontainer yang paling banyak ditemukan larva Aedes dibandingkan jenis kontainer lain.Kata kunci: dengue, aedes, density figure AbstractDengue haemorraghic fever is one of important public health problem in Indonesia. This disease is caused by the dengue virus which is transmitted by Aedes bytes. Kuranji is the most prevalent dengue haemorraghic fever in Padang.The objective of this study was to determine density figure in Kuranji district. This research had been held in Kuranji district in April 2014. The design was descriptive survey research method. The number of sampel was 50 that was taken by multi stage sampling method. The result showed that aedes aegypti found more than aedes albopictus, about 97.74%. house index 52.50%, container index 34.72%, breteau index 66.50% and density figure 7. The research showed that Aedes aegypti is mostly found at house and aedes albopictus only found outdoor. The bath tank which are made from cement is the
Applicazione delle linee guida nazionali nell'attivitá di notifica di casi di legionellosi
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E. Corsano
2003-05-01
Full Text Available
Obiettivi: é noto che effettuare diagnosi di Legionellosi risulta difficile a causa della sovrapposizione della sintomatologia con altre forme di polmonite. Questo spiega, in parte, perché i casi di Legionellosi siano sottostimati. I metodi diagnostici disponibili, sebbene richiedano tempi relativamente lunghi, sono necessari per l’esatta stima di prevalenza della Legionellosi e per gli eventuali interventi preventivi.
Metodi: nell’Azienda Ospedaliera “G. Panico” di Tricase, seguendo i criteri delle Linee Guida della Legionellosi (G.U. 5 maggio 2000 n. 103 durante la degenza dei pazienti che presentavano segni clinici ed obiettivi di polmonite sono state eseguite indagini radiologiche (Rx Torace, TAC, esami di laboratorio (espettorato, sangue, urina ed avviata terapia antibiotica (macrolidi e cefalosporine di III generazione. L’antigene urinario e le IgG anti-Legionella (metodo IFA, sono stati determinati in collaborazione con il Laboratorio di riferimento Regionale.
Risultati: nel periodo ottobre 2001 gennaio 2003 sono stati notificati nel nostro ospedale 11 casi di Legionellosi accertati da indagini clinico-strumentali e di laboratorio: tutti i casi avevano titoli anticorpali abbastanza elevati, confermati poi da un secondo controllo a distanza di tempo. Solo due hanno presentato una positività per l’antigene urinario. All’atto della dimissione, per il 63.6% dei casi è stato documentato un miglioramento delle condizioni clinico-laboratoristico-strumentali, nel 18.2% si è avuta una effettiva guarigione. La letalità è stata pari al 18.2%. In tutti casi si è provveduto alla sorveglianza ambientale.
Considerazioni: i nostri dati evidenziano che i casi di Legionellosi registrati sono stati tutti di tipo comunitario. Una corretta applicazione delle Linee Guida nel sistema di notifica permette l’avvio dell’attività di prevenzione oltre
Tareque, Md Ismail; Hoque, Nazrul; Islam, Towfiqua Mahfuza; Kawahara, Kazuo; Sugawa, Makiko
2013-12-01
Life expectancy has increased considerably throughout the world. In Bangladesh, life expectancy has increased from about 53 years in 1975 to 69 years in 2010. However, it is unknown whether the increase in life expectancy is simultaneously accompanied by an increase in disability-free life expectancy (DFLE). The purpose of the study described in this article was to explore the relationship between life expectancy and DFLE in the Rajshahi District of Bangladesh by examining the relationships between the Active Aging Index (AAI) and DFLE. The study fi ndings suggest that urban, more-educated, elderly males are more active in all aspects of life and have longer DFLE. Females are found to outlive males but are more likely to live a greater part of their remaining life with disability. Positive correlations between the AAI and DFLE suggest that older adults could enjoy more DFLE by involving themselves in active aging activities.
The EuroMyositis registry: an international collaborative tool to facilitate myositis research.
Lilleker, James B; Vencovsky, Jiri; Wang, Guochun; Wedderburn, Lucy R; Diederichsen, Louise Pyndt; Schmidt, Jens; Oakley, Paula; Benveniste, Olivier; Danieli, Maria Giovanna; Danko, Katalin; Thuy, Nguyen Thi Phuong; Vazquez-Del Mercado, Monica; Andersson, Helena; De Paepe, Boel; deBleecker, Jan L; Maurer, Britta; McCann, Liza J; Pipitone, Nicolo; McHugh, Neil; Betteridge, Zoe E; New, Paul; Cooper, Robert G; Ollier, William E; Lamb, Janine A; Krogh, Niels Steen; Lundberg, Ingrid E; Chinoy, Hector
2018-01-01
The EuroMyositis Registry facilitates collaboration across the idiopathic inflammatory myopathy (IIM) research community. This inaugural report examines pooled Registry data. Cross-sectional analysis of IIM cases from 11 countries was performed. Associations between clinical subtypes, extramuscular involvement, environmental exposures and medications were investigated. Of 3067 IIM cases, 69% were female. The most common IIM subtype was dermatomyositis (DM) (31%). Smoking was more frequent in connective tissue disease overlap cases (45%, OR 1.44, 95% CI 1.09 to 1.90, p=0.012). Smoking was associated with interstitial lung disease (ILD) (OR 1.32, 95% CI 1.06 to 1.65, p=0.013), dysphagia (OR 1.43, 95% CI 1.16 to 1.77, p=0.001), malignancy ever (OR 1.78, 95% CI 1.36 to 2.33, p<0.001) and cardiac involvement (OR 2.40, 95% CI 1.60 to 3.60, p<0.001).Dysphagia occurred in 39% and cardiac involvement in 9%; either occurrence was associated with higher Health Assessment Questionnaire (HAQ) scores (adjusted OR 1.79, 95% CI 1.43 to 2.23, p<0.001). HAQ scores were also higher in inclusion body myositis cases (adjusted OR 3.85, 95% CI 2.52 to 5.90, p<0.001). Malignancy (ever) occurred in 13%, most commonly in DM (20%, OR 2.06, 95% CI 1.65 to 2.57, p<0.001).ILD occurred in 30%, most frequently in antisynthetase syndrome (71%, OR 10.7, 95% CI 8.6 to 13.4, p<0.001). Rash characteristics differed between adult-onset and juvenile-onset DM cases ('V' sign: 56% DM vs 16% juvenile-DM, OR 0.16, 95% CI 0.07 to 0.36, p<0.001). Glucocorticoids were used in 98% of cases, methotrexate in 71% and azathioprine in 51%. This large multicentre cohort demonstrates the importance of extramuscular involvement in patients with IIM, its association with smoking and its influence on disease severity. Our findings emphasise that IIM is a multisystem inflammatory disease and will help inform prognosis and clinical management of patients. © Article author(s) (or their employer(s) unless otherwise stated
Turner, Deborah E; Helliwell, Philip S; Woodburn, James
2007-11-06
Whilst evidence exists to support the use of single treatments such as orthoses and footwear, the effectiveness of podiatry-led care as a complex intervention for patients with rheumatoid arthritis (RA) related foot problems is unknown. The aim of this study was to undertake an exploratory randomised controlled parallel arm clinical trial (RheumAFooT) to inform the design and implementation of a definitive trial and to understand the potential benefits of this care. Patients with a definite diagnosis of RA, stable drug management 3 months prior to entry, and a current history of foot problems (pain, deformity, stiffness, skin or nail lesions, or footwear problems) were recruited from a hospital outpatient rheumatology clinic and randomised to receive 12 months of podiatry treatment or no care. The primary outcome was change in foot health status using the impairment/footwear (LFISIF) and activity limitation/participation restriction (LFISAP) subscales of the Leeds Foot Impact Scale. Disease Activity Score (DAS), Health Assessment Questionnaire (HAQ) score and walking speed (m/s) were also recorded. Of the 80 patients identified, 64 patients were eligible to participate in the pilot and 34 were recruited. 16 patients were randomised to receive podiatry led foot care and 18 received no care. Against a backdrop of stable disease (DAS and HAQ scores), there was a statistically significant between group difference in the change in foot health status for foot impairment (LFISIF) but not activity/participation (LFISAP) or function (walking speed) over 12 months. In the podiatry arm, 1 patient declined treatment following randomisation (did not want additional hospital visits) and 3 self-withdrew (lost to follow-up). Patients received an average of 3 consultations for assessment and treatment comprising routine care for skin and nail lesions (n = 3), foot orthoses (n = 9), footwear referral to the orthotist (n = 5), and ultrasound guided intra-articular steroid injection
Vacinação em pacientes da Coorte Brasília de artrite reumatoide inicial
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Luciana Feitosa Muniz
2014-10-01
Full Text Available Introdução: Os pacientes com diagnóstico de artrite reumatoide (AR apresentam risco aumentado de infecções. A vacinação é uma medida preventiva recomendada. Não há estudos avaliando a prática da vacinação nos pacientes com AR inicial. Objetivos: Avaliar a frequência de vacinação e a orientação (feita pelo médico sobre vacinas entre os pacientes com diagnóstico de AR inicial. Métodos: Estudo transversal incluindo pacientes da coorte Brasília de AR inicial. Foram analisados dados demográficos, índice de atividade da doença (Disease Activity Score 28 - DAS28, incapacidade funcional (Health Assessment Questionnaire - HAQ, dados sobre tratamento e vacinação após o diagnóstico da AR. Resultados: Foram avaliados 68 pacientes, sendo 94,1% mulheres, com idade média de 50,7 ± 13,2 anos. O DAS28 foi de 3,65 ± 1,64, e o HAQ de 0,70. A maioria dos pacientes (63% possuía cartão vacinal. Apenas cinco pacientes (7,3% foram orientados pelo médico sobre uso das vacinas. Os pacientes foram vacinados para tríplice viral (8,8%, tétano (44%, febre amarela (44%, hepatite B (22%, gripe (42%, influenza H1N1 (61,76%, pneumonia (1,4%, meningite (1,4% e varicela (1,4%. Todos os pacientes vacinados com vírus vivo atenuado estavam em uso de imunossupressores e receberam as vacinas de forma inadvertida, sem orientação médica. Não houve associação entre o uso de nenhuma vacina e atividade da doença, incapacidade funcional, anos de escolaridade, hábitos de vida, comorbidades. Conclusão: Os pacientes foram pouco orientados pelo médico com relação ao uso das vacinas, com elevada frequência de vacinação inadvertida com componente vivo atenuado, enquanto a imunização com vírus mortos ficou aquém do recomendado.
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Dong WJ
2013-01-01
Full Text Available Wenjie Dong,1 Jing Luo,2 Hongxuan He,2 Long Jiang11Beijing National Laboratory for Molecular Science, Institute of Chemistry, Chinese Academy of Sciences, Beijing, People's Republic of China; 2National Research Center for Wildlife Born Diseases, Key Laboratory of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, People's Republic of ChinaAbstract: In this study, we immobilized polydiacetylene vesicles (PDAVs onto the surface of polystyrene microspheres (1 µm in diameter by using both electrical charge and conjugated forces to form a reinforced composite structure. These reinforced complexes could be easily washed, separated by centrifugation, and resuspended by gentle agitation. After passing through a narrow 200 µm-diameter channel, the composite structures maintained their original shape, demonstrating their resilience and potential for use in microfluidic technologies. The number of PDAVs in the composite structure could be mediated by changing the extent of layer deposition, which affected the sensitivity of detection. It showed that PDAVs did not change their blue color after addition of detecting probes such as anti-H5N1, which was of great importance in the fabrication and modification of stable color-changeable biosensors based on PDAVs. By conjugating anti-H5N1 antibodies to the PS@PDAV via N-hydroxysuccinimide and 1-ethyl-3-(3-dimethylaminopropyl carbodiimide chemistry, a stable blue complex, anti-H5N1 microsphere (PS@PDAV-anti-H5N1 was formed. A target antigen of H5N1 (HAQ [H5N1 strain A/environment/Qinghai/1/2008{H5N1} in clade 0] was detected by PS@PDAV-anti-H5N1. At an optimal PDAV deposition level of three layers, the limit of detection was determined to be approximately 30 ng/mL of HAQ by using optical spectrum measurement and visual inspection, meeting the needs of fast and simple color-changeable detection. However, a much lower limitation of detection (1 ng/mL was able to be
Titanium di-oxide films using a less hygroscopic colloidal precursor
Energy Technology Data Exchange (ETDEWEB)
Vandana,, E-mail: vandana1@nplindia.org; Batra, Neha; Kumar, Praveen; Sharma, Pooja; Singh, P.K., E-mail: pksingh@nplindia.org
2014-04-01
We report the study of titanium dioxide films (TiO{sub 2}) using titanium di-isopropoxyl di-2ethyl hexanoate Ti(OC{sub 3}H{sub 7}){sub 2} (C{sub 7}H{sub 15}COO){sub 2} colloidal precursor. This compound is less hygroscopic in nature and easy to use with processes like spin or dip coating. Thin films of TiO{sub 2} are made on silicon substrates and their structural and optical properties are studied. The effect of Ti content in the precursor, sintering temperature and its duration on film thickness and refractive index are investigated. Refractive index shows an increasing trend with the rise in the sintering temperature but remains unchanged with the time. The film thickness decreases with both sintering temperature and time and increases with Ti content in the precursor. Reflectivity measurements show marked reduction in the reflection losses compared to bare silicon surface wherein the film thickness is altered by spin speed. XRD results show anatase phase in the samples sintered at lower temperature (<680 °C), however, a mix of anatase, brookite and rutile phases is seen above this temperature. In the samples sintered above 1100 °C, rutile phase is dominant. These results are supported by the X-ray photoelectron spectroscopy. Atomic force microscopy reveals larger grain size at higher sintering temperature. The titanium dioxide films of desirable thickness and refractive index could be used as an antireflection coating on solar cells. - Highlights: • TiO{sub 2} films are made using titanium di-isopropoxyl di-2ethyl hexanoate precursor. • Effect of Ti content in the precursor, sintering temperature and time is studied. • Refractive index (μ) increases with sintering temperature but is independent of time. • Films of desired thickness and μ could be used as an antireflection coating. • XRD results show that rutile phase dominates in samples sintered above 1100 °C.
Wealth Inequality and Mental Disability Among the Chinese Population: A Population Based Study.
Wang, Zhenjie; Du, Wei; Pang, Lihua; Zhang, Lei; Chen, Gong; Zheng, Xiaoying
2015-10-19
In the study described herein, we investigated and explored the association between wealth inequality and the risk of mental disability in the Chinese population. We used nationally represented, population-based data from the second China National Sample Survey on Disability, conducted in 2006. A total of 1,724,398 study subjects between the ages of 15 and 64, including 10,095 subjects with mental disability only, were used for the analysis. Wealth status was estimated by a wealth index that was derived from a principal component analysis of 10 household assets and four other variables related to wealth. Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for mental disability for each category, with the lowest quintile category as the referent. Confounding variables under consideration were age, gender, residence area, marital status, ethnicity, education, current employment status, household size, house type, homeownership and living arrangement. The distribution of various types and severities of mental disability differed significantly by wealth index category in the present population. Wealth index category had a positive association with mild mental disability (p for trend disability (p for trend disability when all severities of mental disability were taken into consideration. This study's results suggest that wealth is a significant factor in the distribution of mental disability and it might have different influences on various types and severities of mental disability.
Elementi di interfaccia per l’analisi di strutture murarie
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Jessica Toti
2009-04-01
Full Text Available Il presente articolo riguarda la modellazione del comportamento meccanico di elementi in muratura intesi come sistemi eterogenei composti da malta, blocchi ed interfacce di connessione. La strategiacomputazionale che viene adottata consiste nel modellare separatamente i blocchi, i letti di malta ed le interfacce responsabili di fenomeni di decoesione malta-blocco; a tale scopo, si propone uno speciale modello di interfaccia che combina il danneggiamento con l’attrito. Si sviluppa una procedura numerica, basata sull’algoritmo backward di Eulero, per risolvere il problema evolutivo; per il passo temporale si utilizza invece la tecnica predictor-corrector a controllo di spostamenti. Si effettuano alcune applicazioni numeriche con lo scopodi verificare la capacità del modello e dell’algoritmo proposto nel riprodurre la risposta non lineare della muratura dovuta a fenomeni di degrado localizzati. Infine, si conduce lo studio della modellazione di un arco murario, confrontando i risultati numerici con quelli sperimentali; si dimostra la abilità del modello proposto nel simulare il comportamento globale della struttura ad arco in termini di carico ultimo e di meccanismo di collasso.
Hosseinpoor, Ahmad R; Stewart Williams, Jennifer A; Gautam, Jeny; Posarac, Aleksandra; Officer, Alana; Verdes, Emese; Kostanjsek, Nenad; Chatterji, Somnath
2013-07-01
We compared national prevalence and wealth-related inequality in disability across a large number of countries from all income groups. Data on 218,737 respondents participating in the World Health Survey 2002-2004 were analyzed. A composite disability score (0-100) identified respondents who experienced significant disability in physical, mental, and social functioning irrespective of their underlying health condition. Disabled persons had disability composite scores above 40. Wealth was evaluated using an index of economic status in households based on ownership of selected assets. Socioeconomic inequalities were measured using the slope index of inequality and the relative index of inequality. Median age-standardized disability prevalence was higher in the low- and lower middle-income countries. In all the study countries, disability was more prevalent in the poorest than in the richest wealth quintiles. Pro-rich inequality was statistically significant in 43 of 49 countries, with disability prevalence higher among populations with lower wealth. Median relative inequality was higher in the high- and upper middle-income countries. Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.
1985-06-01
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DEFF Research Database (Denmark)
Greisen, S R; Rasmussen, T K; Stengaard-Pedersen, K
2014-01-01
OBJECTIVES: Programmed death-1 (PD-1) is an immunoregulatory molecule functioning by down-regulating immune responses. PD-1 is present on follicular helper T cells (TFH) and is important in the formation of plasma cells. PD-1 exists in a bioactive soluble form (sPD-1) and is thought to be implica......OBJECTIVES: Programmed death-1 (PD-1) is an immunoregulatory molecule functioning by down-regulating immune responses. PD-1 is present on follicular helper T cells (TFH) and is important in the formation of plasma cells. PD-1 exists in a bioactive soluble form (sPD-1) and is thought...... Questionnaire (HAQ) score, immunoglobulin M rheumatoid factor (IgM-RF), anti-cyclic citrullinated peptide (anti-CCP) antibodies, C-reactive protein (CRP), interleukin-21 (IL-21), and total Sharp score (TSS). We also measured sPD-1 in plasma from healthy volunteers (HV) (n = 20) and in plasma and synovial fluid...
The crop water stress index (CWSI) for drip irrigated cotton in a semi ...
African Journals Online (AJOL)
The crop water stress index (CWSI) for drip irrigated cotton in a semi-arid region of Turkey. ... Four irrigation treatments designated as full (I100) with no water stress and slight (DI70), moderate (DI50) and strong water ... from 32 Countries:.
Lezioni di meccanica razionale con elementi di statica grafica
Sbrana, Francesco
1950-01-01
Elementi di calcolo vettoriale ; riduzione di un sistema qualunque di vettori applicati ; trattazione analitica dei sistemi di vettori applicati ; uso dei poligni funicolari per la composizione di più vettori applicati complanari ; vettori variabili ; cinematica del punto ; studio del moto di un punto in un piano in coordinate polari ; cinematica de sistemi rigidi ; moto di un sistema rigido con un punto fisso (moto rigido sferico) ; moto relativo ; sistemi di punti in general, vincoli ; concetti e postulati fondamentali della meccanica ; unità mecchaniche, omogeneità, modelli ; equilibrio di un punto e di un sistema di punti materiali ; statica dei solidi indeformabili (sistemi rigidi) ; sistemi deformabili, travature reticolari ; equilibrio dei poligoni funicolari e delle curve funicolari ; nozioni sull'attrito ; integrazione grafica ; baricentri ; momenti d'inerzia ; calcolo grafico dei momenti statici e dei momenti d'inerzia dei sistemi piani ; dinamica del punto libero ; dinamica del punto vincolato ;...
Development of a new index of balance in adults with intellectual and developmental disabilities.
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Antonio Cuesta-Vargas
Full Text Available PURPOSES: The first objective was to propose a new model representing the balance level of adults with intellectual and developmental disabilities (IDD using Principal Components Analysis (PCA; and the second objective was to use the results from the PCA recorded by regression method to construct and validate summative scales of the standardized values of the index, which may be useful to facilitate a balance assessment in adults with IDD. METHODS: A total of 801 individuals with IDD (509 males mean 33.1 ± 8.5 years old, were recruited from Special Olympic Games in Spain 2009 to 2012. The participants performed the following tests: the timed-stand test, the single leg stance test with open and closed eyes, the Functional Reach Test, the Expanded Timed-Get-up-and-Go Test. Data was analyzed using principal components analysis (PCA with Oblimin rotation and Kaiser normalization. We examined the construct validity of our proposed two-factor model underlying balance for adults with IDD. The scores from PCA were recorded by regression method and were standardized. RESULTS: The Component Plot and Rotated Space indicated that a two-factor solution (Dynamic and Static Balance components was optimal. The PCA with direct Oblimin rotation revealed a satisfactory percentage of total variance explained by the two factors: 51.6 and 21.4%, respectively. The median score standardized for component dynamic and static of the balance index for adults with IDD is shown how references values. CONCLUSIONS: Our study may lead to improvements in the understanding and assessment of balance in adults with IDD. First, it confirms that a two-factor model may underlie the balance construct, and second, it provides an index that may be useful for identifying the balance level for adults with IDD.
BIAGIONI, ANGELO
2011-01-01
Il presente lavoro di ricerca è stato articolato intorno a temi attinenti l’ingegneria biomedica, riguardando, in particolare, lo studio del comportamento di agenti di contrasto in campi ultracustici per tecniche di ecografia diagnostica. Nell’ambito di tale settore scientifico, un ruolo di fondamentale importanza è svolto dalla diagnostica medica per immagini e in particolare dalle tecniche ecografiche. Queste ultime rappresentano un ottimo compromesso tra la pericolosità per l’organismo e l...
Rupp, Kalman
2012-01-01
Various factors outside the control of decision makers may affect the rate at which disability applications are allowed or denied during the initial step of eligibility determination in the Social Security Disability Insurance (DI) and Supplemental Security Income (SSI) programs. In this article, using individual-level data on applications, I estimate the role of three important factors--the demographic characteristics of applicants, the diagnostic mix of applicants, and the local unemployment rate--in affecting the probability of an initial allowance and state allowance rates. I use a random sample of initial determinations from 1993 through 2008 and a fixed-effects multiple regression framework. The empirical results show that the demographic and diagnostic characteristics of applicants and the local unemployment rate substantially affect the initial allowance rate. An increase in the local unemployment rate tends to be associated with a decrease in the initial allowance rate. This negative relationship holds for adult DI and SSI applicants and for SSI childhood applicants.
Programmazione del Network di 'Virologia Ambientale': Stato di avanzamento
Carlesi, Carlo
2004-01-01
Presentazione 'Power Point' dell'intervento all'incontro di lavoro 'VIRAMB II incontro del Network di Virologia Ambientale', presso l'Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana. Nell'intervento si presenta lo stato di avanzamento dei lavori riguardo la realizzazione dell'infrastruttura telematica del 'Network di Virologia Ambientale' promosso dal 'Dipartimento di Patologia Sperimentale, Biotecnologie Mediche, Infettivologia ed Epidemiologia' dell'Universit? di Pisa.
Afma, Vera Methalina
2016-01-01
Operator packing di PT. XYZ selalu melakukan kegiatan mengangkat dan menurunkan barang seberat 3 kg dan dilakukan 16 kali selama satu hari. Hal ini akan menimbulkan rasa lelah pada operator packing. Di PT. XYZ ada 3 orang operator packing yang melakukan aktivitas yang sama. Penulis tertarik untuk mengetahui dan menganalisa beban kerja operator packing di PT. XYZ dengan pendekatan NASA-TLX. Dari hasil penelitian disimpulkan, beban kerja masing-masing operator packing di PT. XYZ menggunakan me...
D'Alonges, Sara
2013-01-01
Il contesto globale del comparto agro-alimentare richiede ad oggi una ricerca continua per assicurare qualità e sicurezza degli alimenti. La produzione moderna di alimenti richiede elevato grado di standardizzazione, particolarmente la produzione gli alimenti fermentati che include un processo biotecnologico in cui la componente biotica gioca un ruolo fondamentale Di qui la necessità disporre di un’ampia gamma di microrganismi atti alla conduzione del processo fermentativo in modo da im...
Stress indotto dalla guida di autoveicoli: studio di parametri psicofisiologici
Directory of Open Access Journals (Sweden)
R. Vivoli
2003-05-01
Full Text Available
La guida di un autoveicolo, specie in condizioni di intenso traffico o di cattive condizioni meteoclimatiche, è considerata uno dei principali fattori stressanti della vita odierna. Durante la guida si possono infatti osservare significative risposte simpatoadrenergiche e cardiovascolari con la comparsa anche di episodi coronarici. Tali risposte presentano un’ampia variabilità interindividuale in quanto sono influenzate da vari fattori (stile di vita, personalità etc..
In questa rassegna, vengono presentati i principali risultati degli studi da noi condotti sulle risposte psicofisiologiche indotte dalla guida di diversi tipi di autoveicoli. In conducenti di autobus urbani è stato registrato un sensibile aumento del tasso urinario di adrenalina durante il turno lavorativo rispetto alla stessa fascia oraria di un giorno di riposo. Tale risposta adrenergica era esaltata dall’abitudine tabagica e dall’assunzione di caffè e bevande alcoliche. In soggetti che alla guida di camion coprono lunghe distanze, i più elevati tassi urinari di catecolamine e i più alti livelli di frequenza cardiaca sono stati registrati quando la guida era particolarmente stressante per la presenza di nebbia o di intenso traffico. In soggetti che partecipano, a livello amatoriale, a manifestazioni agonistiche di velocità su pista, abbiamo osservato che durante la gara, rispetto al periodo pre-gara, l’escrezione urinaria di catecolamine aumenta in misura molto rilevante. Analogamente a quanto osservato in autisti di camion, l’attivazione del sistema adrenergico è risultata direttamente associata ai livelli di ansietà. Dall’elettrocardiogramma dinamico è emerso che durante la gara la frequenza cardiaca raggiunge un valore medio di 163.5±7.4 battiti/min. (range: 146,180 battiti/min..
Un significativo peggioramento della percezione visiva stereoscopica, con potenziale ricaduta negativa sulla performance dei guidatori, è stato osservato in
Advocacy Disabled in Publishing Newspapers Media in Malaysia
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Hazzlan Sama
2017-07-01
Full Text Available This article discusses the role of news media in communicating information about Disabled news to the public. The focus of the discussion centered issue and advocacy role of the news media conducted to understand the issues of persons with disabilities. Studies conducted using the method of analysis to systematically review the library of selected journals that conduct media exposure of persons with disabilities at the global level and so focused towards media conference in Malaysia. In this research, the data was obtained through databases ERIC, google scholar, Journal of Education, Journal of Social Sciences and Journal of Communication. A total of 30 articles were based on keywords such as disabled people, newspapers, news exposure to people with disabilities. However, researchers have obtained 13 articles that met after being filtered. The results obtained showed that the press releases are also still not open and not to report the news on disabilities. This is because there is a stigma that prevents acceptance of disabilities such as discrimination and negative attitudes towards them. Outlook negative stereotypes of people with disabilities who are strangers, the great ones, defects often appear in the media. Even now there is increasing advocacy for press media publishing news on this special group but the content or dissemination of information about them is still less show. Artikel ini membincangkan peranan media akhbar dalam menyampaikan maklumat berita tentang Orang Kurang Upaya kepada masyarakat. Fokus perbincangan ditumpukan isu dan peranan advokasi media akhbar dijalankan untuk memahami isu orang kurang upaya. Kajian yang dijalankan menggunakan kaedah analisis perpustakaan secara sistematik review terhadap jurnal-jurnal terpilih yang menjalankan kajian paparan media ke atas orang kurang upaya di peringkat global dan seterusnya difokus ke arah media akhbar di Malaysia. Dalam penyelidikan ini, data-data diperolehi melalui pengkalan
[Disability attributable to excess weight in Spain].
Martín-Ramiro, José Javier; Alvarez-Martín, Elena; Gil-Prieto, Ruth
2014-08-19
To estimate the disability attributable to higher than optimal body mass index in the Spanish population in 2006. Excess body weight prevalence data were obtained from the 2006 National Health Survey (NHS), while the prevalence of associated morbidities was extracted from the 2006 NHS and from a national hospital data base. Population attributable fractions were applied and disability attributable was expressed as years life with disability (YLD). In 2006, in the Spanish population aged 35-79 years, 791.650 YLD were lost due to higher than optimal body mass index (46.7% in males and 53.3% in females). Overweight (body mass index 25-29.9) accounted for 45.7% of total YLD. Males YLD were higher than females under 60. The 35-39 quinquennial group showed a difference for males of 16.6% while in the 74-79 group the difference was 23.8% for women. Osteoarthritis and chronic back pain accounted for 60% of YLD while hypertensive disease and type 2 diabetes mellitus were responsible of 37%. Excess body weight is a health risk related to the development of various diseases with an important associated disability burden and social and economical cost. YLD analysis is a useful monitor tool for disease control interventions. Copyright © 2013 Elsevier España, S.L. All rights reserved.
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Kiranjit Kaur
2016-03-01
Full Text Available Latar Belakang: LBP merupakan gangguan muskuloskeletal yang banyak dikeluhkan oleh petani. Kegiatan yang dilakukan petani umumnya memerlukan posisi tubuh yang statis dan repetitif yang meningkatkan prevalensi keluhan LBP. Selain posisi kerja yang salah, umur, jenis kelamin, lama kerja, masa kerja, posisi kerja, riwayat merokok dan trauma juga merupakan faktor untuk terjadi LBP. Petani di wilayah cakupan kerja UPT payangan berjumlah sebanyak 4.883. Dilihat dari tingginya jumlah petani di wilayah tersebut angka kejadian LBP diperkirakan tinggi. Namun kenyataannya, dari 43.597 total kunjungan pasien ke balai pengobatan tahun 2014, angka kejadian LBP hanya 111. Tujuan Penelitian: Mengetahui prevalensi keluhan LBP pada petani di wilayah kerja UPT Kesmas Payangan tahun 2015. Metode Penelitian: Penelitianmenggunakan desain studi deskriptif cross-sectional untuk mengetahui prevalensi keluhan LBPpada petani yang tinggal dan bekerja di wilayah kerja UPT Kesmas Payangan.Populasi dari penelitian ini adalah semua petani yang berada di wilayah kerja UPT Kesmas Payangan. Pengumpulan data dilakukan dengan wawancara terstruktur menggunakan kuesioner lalu dilakukan analisis secara univariat dan bivariat. Hasil:Sebanyak 68,6% (48 orang responden mengeluh LBP. Perempuan (71%lebih banyak mengalami LBP dibandingkan dengan laki-laki (66,7%. Kelompok usia dengan keluhan >45 tahun paling banyak mengalami LBP (73,3%. Sebanyak 63,6% petani yang memiliki waktu kerja kurang dari 5 jam dan sebanyak 70,6% petani yang bekerja lebih dari 5 jam mengalami LBP. Sebanyak 60% petani yang bekerja kurang dari 10 tahun mengalami LBP dan sebanyak 69,2% petani yang bekerja lebih dari 10 tahun mengalami LBP. Sebanyak 72,7% petani yang merokok mengalami LBP dan sebanyak 64,9% petani yang tidak merokok mengalami LBP. Keluhan LBP terbanyak dikeluhkan oleh petani yang sering melakukan posisi kerja membungkuk (68,6%. Sebanyak 93,75% petani yang tidak memiliki riwayat jatuh mengalami LBP
Health, Disability Insurance and Retirement in Denmark
DEFF Research Database (Denmark)
Bingley, Paul; Datta Gupta, Nabanita; Jørgensen, Michael
2014-01-01
There are large differences in labor force participation rates by health status. We examine to what extent these differences are determined by the provisions of Disability Insurance and other pension programs. Using administrative data for Denmark we find that those in worse health and with less...... schooling are more likely to receive DI. The gradient of DI participation across health quintiles is almost twice as steep as for schooling - moving from having no high school diploma to college completion. Using an option value model that accounts for different pathways to retirement, applied to a period...... spanning a major pension reform, we find that pension program incentives in general are important determinants of retirement age. Individuals in poor health and with low schooling are significantly more responsive to economic incentives than those who are in better health and with more schooling. Similar...
Directory of Open Access Journals (Sweden)
Matteo Camprini
2013-10-01
Full Text Available Il mercato delle costruzioni in Italia soffre problemi di maturità da molto tempo. Dagli anni ’90, infatti, per superare i fatti di tangentopoli venne riformata la legislazione dei lavori pubblici per giungere a livelli di competizione maggiori e più simili a quelli esistenti in Europa. In questo contesto le imprese che per la loro struttura culturale, organizzativa e produttiva mostravano maggiore sensibilità a tali aspetti avviarono processi di formazione e riorganizzazione introducendo specifiche procedure mirate alla gestione completa dei progetti trasformandosi così da imprese di sola produzione a imprese operanti per progetti.La presente memoria vuole descrivere il sistema di gestione attuato, le modifiche ed i miglioramenti che si sono susseguiti nel tempo, la sua struttura organizzativa e gli strumenti di lavoro messi a disposizione.A conclusione verrà illustrata l’applicazione al caso concreto della costruzione del nuovo impianto di trattamento e recupero di rifiuti urbani.
Design e valutazione di una esperienza di mobile learning
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Marco Arrigo
2008-01-01
Full Text Available Analisi dello sviluppo scientifico e tecnologico nel campo di mobile learning, con particolare riferimento ai problemi di progettazione e valutazione nelle esperienze. Vengono analizzate le caratteristiche di metodologia didattica innovativa insieme a delle proposte per strumenti operativi concreti che consentano di progettare interventi didattici di mobile learning.
Nishant; Chhabra, Harvinder Singh; Kapoor, Kulwant Singh
2014-10-01
Prospective cohort study along with questionnaire. To measure the correlation of the visual analogue score (VAS), with (Oswestry disability Index [ODI], version 2.1a) in English, and modified ODI (English and Hindi version). To validate translated version of the modified ODI in English version to Hindi. Conflicting evidence in literature regarding the ability for existing ODI score to accurately measure the pain associated disability. One hundred and three patients conservatively treated for low back pain were enrolled in the study. The Pearson correlation coefficient for VAS and ODI along with the Cronbach α and test-retest reliability for Hindi version using the intraclass correlation coefficient was recorded. The new proposed translated Hindi version of ODI was carried out with established guidelines. The mean age in English and Hindi version of ODI was 53.5 years and 58.5 years, respectively. The gender ration was 21:24 in the English version and 35:23 in the Hindi version. The mean follow-up in English and Hindi version of ODI was 3.4 months and 50.27 months, respectively. The Cronbach coefficient α=0.7541 for English ODI and 0.9913 for Hindi ODI was recorded for the both modified versions. The new modified ODI is time saving and accurate, and it avoids the need to measure other scores and has stronger correlation with VAS score compared to the previous scores. We recommend this version for both English and Hindi speaking population as an assessment tool to measure the disability related to pain.
Directory of Open Access Journals (Sweden)
Nilzio Antonio da Silva
2001-03-01
patients aged between 40 and 80 years old were randomly allocated in a single-blind fashion to one of two treatment groups, which consisted in a 30-day treatment with nimesulide (tablets or celecoxib (capsules, 100 mg twice a day of either one. After the baseline period, there were three visits with a 10-day interval between each. At each visit, the severity of pain (at rest, movement and night, morning stiffness, the degree of functional impairment (HAQ, functional classification (ACR-1991 and severity index for knee osteoarthritis were evaluated. For those with osteoarthritis of the knee or hip, the time that was necessary to walk fifteen meters was measured. The efficacy and tolerability were assessed separately by physicians and patients at all visits except during the baseline visit. All adverse events were reported throughout the whole study period. There was a significant and similar decrease in the averages of the pain scale at movement and rest for both groups at all visits. The nocturnal pain decreased throughout the treatment for the celecoxib group and at the third visit for the nimesulide group. At the end of the study period these averages were statistically similar (p = 0,152. The mean duration of morning stiffness decreased significantly in the nimesulide group throughout the whole study, and began only from the third visit on for the celecoxib group, becoming statistically similar at the end (p = 0,993. The mean time to walk the fifteen meters decreased significantly for the nimesulide group only at visit 4 (p < 0,001*, and all the means from the second visit on were lower than those for the celecoxib group. There was a significant decrease in the means of functional impairment (HAQ scale for the nimesulide group during the whole study period, while in the celecoxib group this decrease appeared on visit 4, where the means became similar (p = 0,517. The severity index of The Lesquesne & Samson's (1991 for osteoarthritis of the knee for the nimesulide group
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Trovò, Francesco
2010-12-01
Full Text Available In order to interpret the links between Venice and Byzantium, it is firstly described how earliest houses in Venice were decorated by using sculptures coming from trading places. It is described the use of disassembled elements and the replacement of others, such as cornices, windows’ elements, coats of arms, among others. These were used firstly as a revival (Neo-Byzantine, 15th century, and later as reflection of the Venetian society «prudence», related to its behaviours and traditions. This prudence is mainly shown in the Renaissance. Besides this, other aspects such as the type of building and the façades, which are the main transformed surface, are analysed with the aim of researching periodical and characteristic dynamics, mainly in those façades showing stylistic renewal and new elements. Some external façades have maintained specific and easy observable characteristics, so they can be associated to a determined stylistic and morphological period. Other façades are stratified, as it is shown by the presence of elements (windows, cornices, … of different building phases. After tracing the main stratifying processes in about 40 study-cases, thanks to a macroscopic analysis, some ways of new composition elements and different stratified units are described. According to this, it is clear that the main principle is the searching for symmetry. Finally, some ways of intervention on the façades are described, highlighting some significant cases.[it] Nella prima parte dell’articolo viene descritto il modo di adornare le prime case veneziane con sculture importate dai luoghi del commercio, come ricostruzione del legame fra Venezia e Bisanzio. Si descrive l’uso di disaggregare e riposizionare vari elementi, come cornici, elementi di finestre, stemmi, prima come un iniziale revival, sia esso neobizantino o riferito al XV secolo, poi come manifestazione di «prudenza» della società veneziana, legata ai costumi, alle tradizioni. La
I ministri di culto delle confessioni religiose di minoranza: problematiche attuali
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Matteo Carnì
2015-06-01
SOMMARIO: 1. I ministri di culto nell’ordinamento giuridico italiano - 2. I ministri di culto delle confessioni religiose dotate di intesa - 2.1. (segue L’individuazione dei ministri di culto - 2.2. (segue L’assistenza spirituale nelle strutture segreganti - 2.3.(segue Il matrimonio celebrato dai ministri di culto - 2.4 (segue Problematiche attinenti ai ministri di culto buddhisti – 3. I ministri di culto delle confessioni prive di intesa - 3.1. (segue In attesa della legge di approvazione: i ministri di culto della Congregazione cristiana dei Testimoni di Geova - 3.2. (segue Islam e ministri di culto - 4. Osservazioni conclusive.
Disability predictors in chronic low back pain after aquatic exercise.
Baena-Beato, Pedro Ángel; Delgado-Fernández, Manuel; Artero, Enrique G; Robles-Fuentes, Alejandro; Gatto-Cardia, María Claudia; Arroyo-Morales, Manuel
2014-07-01
The physical and psychological factors associated with reduction of disability after aquatic exercise are not well understood. Sixty participants (30 men and 30 women; age, 50.60 [9.69] yrs; body mass index, 27.21 [5.20] kg/m²) with chronic low back pain were prospectively recruited. The 8-wk aquatic therapy program was carried out in an indoor pool sized 25 × 6 m, with 140-cm water depth and 30°C (1°C) of water temperature, where patients exercised for 2-5 days a week. Each aquatic exercise session lasted 55-60 mins (10 mins of warm-up, 20-25 mins of aerobic exercise, 15-20 mins of resistance exercise, and 10 mins of cooldown). Demographic information, disability (Oswestry Disability Index), back pain (visual analog scale), quality-of-life (Short Form 36), abdominal muscular endurance (curl-up), handgrip strength, trunk flexion and hamstring length (sit and reach), resting heart rate, and body mass index were outcomes variables. Significant correlations between change in disability and visual analog scale (at rest, flexion, and extension), curl-up and handgrip (r ranged between -0.353 and 0.582, all Ps pain and abdominal muscular endurance were significant predictors of change in disability after therapy.
Parenting disability, parenting stress and child behaviour in early inflammatory arthritis.
Zelkowitz, P; Looper, K J; Mustafa, S S; Purden, M; Baron, M
2013-03-01
Our study examines the association between the disease characteristics of inflammatory arthritis and patients' self-perception of mental health, parenting disability, parenting stress and child behaviour in early inflammatory arthritis (EIA). Patients in the early phase (more than 6 weeks, less than 18 months) of inflammatory arthritis were recruited from a larger EIA registry that recorded sociodemographic data and measures of pain, physical functioning and disease activity. Patient-perceived parenting disability, parenting stress, depression and children's behaviour problems were assessed using the Parenting Disability Index, Parenting Stress Index, Center for Epidemiologic Studies--Depression Mood Scale and Child Behavior Checklist, respectively. Pain, physical dysfunction, number of tender joints and physician global assessment of disease activity were associated with parenting disability. Self-report measures of parenting disability were associated with those of depression and parenting stress. Parenting stress was associated with children internalizing and externalizing behaviour problems while parenting disability was associated with children externalizing behaviour problems. This study suggests a possible reciprocal relationship among physical aspects of disease activity, parenting disability and parent and child distress in EIA.
Il Servizio Intercultura dell’Istituto di Terapia Familiare di Firenze
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Giancarlo Francini
2013-12-01
Full Text Available Nel corso del presente articolo vengono descritte le premesse epistemologiche e le metodologie adottate dagli operatori del Servizio Intercultura dell’Istituto di Terapia Familiare di Firenze (ITFF nel lavoro con la popolazione migrante ed elencati gli interventi fatti nel territorio. Il Servizio Intercultura dell’ITFF si è interrogato in questi anni sul valore della cultura come porta d’ingresso nel rapporto con il migrante; nel chiedere loro di narrare aspetti della loro cultura condividiamo aspetti della nostra cultura. L’incontro con il malinteso, che come dice Jankelevitch «(… è un quasi niente» (Jankelevitch, 1987, p. 233, perché se fosse stato qualcosa di più ce ne saremmo accorti e se fosse qualcosa di meno non sarebbe significativo, ci permette di aprirci a un rapporto che cambia entrambi, operatore e migrante, nella relazione. È nella relazione e attraverso il racconto dell’evento migrazione e del ciclo di vita che si costruisce e si cerca un linguaggio comune per la descrizione e l’espressione del disagio. Il lavoro con i migranti deve fare i conti con le difficoltà legate all’impiego, alla casa, al permesso di soggiorno e non ultimo alla brevità di alcuni incontri, perché per alcuni la nostra città è solo una tappa di un percorso che continua alla ricerca di una sistemazione migliore. Nel territorio di Firenze sono stati messi a punto una serie di servizi: oltre alla clinica e a uno sportello di consulenza, ci si dedica alla formazione degli operatori che lavorano con i migranti. Esempi di queste attività sono: un progetto di peer tutoring in alcune scuole superiori, uno di formazione per le assistenti sociali al fine di proporre un protocollo più efficace di presa in carico dei migranti, una serie di focus group con dipendenti Asl all’interno del progetto “Mamma segreta” della regione Toscana; inoltre, la collaborazione con le associazioni presenti sul territorio ha permesso un contatto
Studio di prevalenza delle polmoniti in un'Azienda opsedaliera di Bologna
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E. Leoni
2003-05-01
Full Text Available
Obiettivi: nell’ambito di un progetto di sorveglianza attiva dei casi di polmonite da legionella, è stata studiata la prevalenza di tutti i casi di polmonite ricoverati in un ospedale di Bologna, allo scopo di definirne la distribuzione per origine (comunitaria o nosocomiale, eziologia, caratteristiche individuali e di confrontarle con le polmoniti da legionella.
Metodi: per ogni caso con diagnosi clinica e/o radiologica di polmonite è stato compilato un questionario, raccogliendo le informazioni dalle cartelle cliniche. Tutti i casi di polmonite non specificata sono stati inoltre sottoposti al test per la ricerca dell’antigene di legionella nelle urine.
Development and psychometrics of the five item daily index in a psychiatric sample.
Dyer, Kale; Hooke, Geoff; Page, Andrew C
2014-01-01
Effective treatment of affective disorders requires the ability to reliably monitor patient progress and outcome. The current study aimed to establish the Daily Index-5 (DI-5) as a psychometrically sound and clinically valid measure of treatment response in psychiatric care for use as a companion measure with the WHO Wellbeing Index (WHO-5; Bech et al., 1996. Psychother. Psychosom. 65, 183-190.). Eight hundred and ninety four consecutive inpatients and day-patients at a psychiatric facility completed the DI-5, WHO-5, SF-36 (Ware et al., 1993. SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Centre, Boston, MA.) and DASS-21 (Lovibond and Lovibond, 1995b. Manual for the Depression Anxiety Stress Scales. Psychology Foundation, Sydney, Australia.; Ware et al., 1993. SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Centre, Boston, MA.) routinely during treatment. The DI-5 was shown to be a measure with high reliability and validity. In addition criteria for clinically significant recovery are presented with an example implementation of a Clinical Significance Monitoring system. Finally, the latent structure of the DI-5 is established as a uni-dimensional index of affective disorder. The results may be generalized to samples with primary diagnoses of depressive and/or anxiety disorders though assessment of the DI-5 as a measure of treatment response is warranted in patients with other primary diagnoses. The current study indicates that the DI-5 is a quick to administer and interpret, reliable and valid measure for assessing patient outcome that is appropriate for use in monitoring patient change. © 2013 Published by Elsevier B.V.
Energy Technology Data Exchange (ETDEWEB)
Ronsivalle, C [ENEA, Centro Ricerche Frascati, Rome (Italy). Unita tecnico scientifica Tecnologie Fisiche Avanzate; Casali, F [Bologna Univ., Bologna (Italy), Dipartimento di fisica; Colavita, E [Calabria Univ., Arcavacata (Italy). Diparimento di fisica; Lamanna, E [Magna Graecia Univ., Germaneto (Italy). Dipartimento di medicina sperimentale e clinica
2005-07-15
In the last years there has been an increasing interest on IORT (Intraoperative Radiation Therapy), also because of the development of dedicated accelerators. This technique represents a very effective oncological treatment consisting in delivering a single high dose on a tumour bed soon after surgery resection. In the following we present the proposal of development of a last generation IORT system based on the use of a linear accelerator with variable energy in the range 3-15 MeV, operating in C band (5712 MHz). Respect to the accelerator used in the commercial IORT systems operating at a typical frequency of 2998 MHz (S band) limited to a maximum energy of 12 MeV, the use of a higher RF frequency allows an increase of the maximum energy. This extends the use of the IORT technique to a wider field of tumors and an improvement of the system in terms of compactness and weight reduction. In addition the machine will be provided with a devoted absolute dosimetry system that will strongly simplify the procedures of dosimetric characterization. We intend to develop the system by a collaboration between ENEA, some Universities (Bologna, Catanzaro and Cosenza) and the national industry. [Italian] Negli ultimi anni si e sviluppato un sempre maggior interesse intorno alla Radioterapia IntraOperatoria (IORT), una particolare tecnica radioterapica che permette di irradiare la zona interessata da un tumore durante un intervento chirurgico utilizzando un fascio di elettroni prodotto da un acceleratore. La diffusione di questa metodica e stata favorita dalla presenza sul mercato di acceleratori installabili direttamente in sala operatoria. Come conseguenza di questa disponibilita sono emerse sia nuove esigenze legate alle particolari applicazioni cliniche, sia richieste di facilita di utilizzo e perfomances sempre piu sofisticate. Viene qui presentata una proposta di sviluppo di un sistema IORT di ultima generazione basato sull'utilizzo di un acceleratore lineare con energia
Energy Technology Data Exchange (ETDEWEB)
Ronsivalle, C. [ENEA, Centro Ricerche Frascati, Rome (Italy). Unita tecnico scientifica Tecnologie Fisiche Avanzate; Casali, F. [Bologna Univ., Bologna (Italy), Dipartimento di fisica; Colavita, E. [Calabria Univ., Arcavacata (Italy). Diparimento di fisica; Lamanna, E. [Magna Graecia Univ., Germaneto (Italy). Dipartimento di medicina sperimentale e clinica
2005-07-15
In the last years there has been an increasing interest on IORT (Intraoperative Radiation Therapy), also because of the development of dedicated accelerators. This technique represents a very effective oncological treatment consisting in delivering a single high dose on a tumour bed soon after surgery resection. In the following we present the proposal of development of a last generation IORT system based on the use of a linear accelerator with variable energy in the range 3-15 MeV, operating in C band (5712 MHz). Respect to the accelerator used in the commercial IORT systems operating at a typical frequency of 2998 MHz (S band) limited to a maximum energy of 12 MeV, the use of a higher RF frequency allows an increase of the maximum energy. This extends the use of the IORT technique to a wider field of tumors and an improvement of the system in terms of compactness and weight reduction. In addition the machine will be provided with a devoted absolute dosimetry system that will strongly simplify the procedures of dosimetric characterization. We intend to develop the system by a collaboration between ENEA, some Universities (Bologna, Catanzaro and Cosenza) and the national industry. [Italian] Negli ultimi anni si e sviluppato un sempre maggior interesse intorno alla Radioterapia IntraOperatoria (IORT), una particolare tecnica radioterapica che permette di irradiare la zona interessata da un tumore durante un intervento chirurgico utilizzando un fascio di elettroni prodotto da un acceleratore. La diffusione di questa metodica e stata favorita dalla presenza sul mercato di acceleratori installabili direttamente in sala operatoria. Come conseguenza di questa disponibilita sono emerse sia nuove esigenze legate alle particolari applicazioni cliniche, sia richieste di facilita di utilizzo e perfomances sempre piu sofisticate. Viene qui presentata una proposta di sviluppo di un sistema IORT di ultima generazione basato sull'utilizzo di un acceleratore lineare con
KETERAMPILAN SOSIAL SISWA BERKEBUTUHAN KHUSUS DI SEKOLAH DASAR INKLUSI
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Rina Diahwati
2016-08-01
Full Text Available Based on preliminary study, obtained some facts related to the social skills of students with special needs in inclusion elementary school. The problems include how the fifth grade students with special needs in inclusion elementary school tend to be less able to respond to others, show less acceptable behaviors by others, and have less adaptive behavior. The purpose of this study is to describe the social skills of students with special needs in inclusion elementary school. In general, research result shows that social skills of students with special needs is varied. Students with autism tend to have low social skills. Students with ADHD (Attention Deficit Hyperactivity Disorder is likely to have some aspects of low social skills. Students with intellectual disability tend to have moderate social skills. Berdasarkan studi pendahuluan diperoleh beberapa fakta terkait keterampilan sosial siswa berkebutuhan khusus di sekolah dasar inklusi. Permasalahan tersebut di antaranya siswa berkebutuhan khusus kelas V di SDN inklusi cenderung kurang mampu merespon orang lain, cenderung memiliki perilaku yang kurang dapat diterima oleh orang lain, dan cenderung memiliki perilaku yang kurang adaptif. Tujuan penelitian ini untuk mendeskripsikan secara mendalam tentang keterampilan sosial siswa berkebutuhan khusus di sekolah dasar inklusi. Hasil penelitian ini secara umum yaitu keterampilan sosial siswa berkebutuhan khusus berbeda-beda. Siswa autis cenderung memiliki keterampilan sosial yang rendah. Siswa ADHD (Attention Deficit Hyperactivity Disorder cenderung memiliki beberapa aspek keterampilan sosial yang rendah. Siswa tunagrahita cenderung memiliki keterampilan sosial yang sedang.
Il concetto di Natura nella filosofia di Denis Diderot
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Francesco Consiglio
2014-03-01
Full Text Available L’immagine della Natura che emerge dalla lettura delle opere di Diderot, è quella di una sorta di organismo in cui tutto risulta legato da una rete di forze inquadrate in un ordine omogeneo e dinamico. Le leggi di quest’ordine sono riscontrabili in tutti gli eventi naturali ed ogni fenomeno non è mai frutto del caso, ma ordinato deterministicamente. Allo spinozismo di quest’ordine geometrico si coniuga un atomismo di matrice epicurea, speci camente nella versione lucreziana del De Rerum Natura: gli atomi che costituiscono la materia si combinano da sempre e all’in nito in un continuo divenire di forme normate da leggi intrinseche, e gli individui nascono dal cozzare e dall’ammassarsi di questi atomi. Non esiste uno stadio culmine di questa “evoluzione”, piuttosto esistono in nite varianti, nel tempo e nello spazio, di un unico modello prototipico che, secondo Diderot, evolve in una specie o in un'altra in maniera totalmente a- nalistica, sebbene assolutamente determinis- tica. La regolarità dell’ordine (per no nell’apparente caos di un turbine di pol- vere e il continuo farsi e rifarsi delle forme si connettono al principio di conti- nuità della natura: la natura non fa salti, tutto è connesso come in una ragnatela e la materia continua muta la sua disposizione in grumi di atomi che, secondo il principio dell’epigenesi, giungono a formare gli individui. Le opere in cui Diderot elabora in maniera più organica e precisa la sua concezione della natura sono particolarmente due: L’interpretazione della natura (1753 e Il sogno di d’Alembert (1769. In mezzo a queste stanno gli scritti sui Sa- lons, tra i quali è particolarmente saliente, per il discorso sulla natura, quello del 1767, in cui, con la Promenade Vernet, molti di questi temi vengono a rontati o ripresi nel pittoricismo della narrazione, attraverso limpide metafore. Natura e arte, in Diderot, sono strettamente connesse. La seconda imita la prima, ma non tenta
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Directory of Open Access Journals (Sweden)
Elena Cartotto
2008-07-01
La lettura viene condotta sulla base di categorie concettuali di carattere psicoanalitico, in quanto tali categorie trovano la propria origine, prima ancora che nel pensiero, nella più concreta e profonda esperienza umana. Ed è proprio il collocarsi all'interno di questa viva esperienza umana che consente di cogliere in modo più diretto la dimensione antropologica che pare emergere dagli scrittori monastici di questo periodo.
La logistica nei processi di trasformazione dell’area orientale di Napoli
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Adriana Galderisi
2010-07-01
Full Text Available Stoccaggio e trasporto merci hanno assunto, già da alcuni anni, un ruolo rilevante nell’area orientale di Napoli, con impatti significativi sulla qualità urbana ed ambientale dell’area. In quest’area, anche grazie alla sua vicinanza ai principali nodi della mobilità (porto, aeroporto, stazione ferroviaria e alla significativa presenza di aree produttive dismesse o in dismissione, trovano oggi spazio numerose attività di stoccaggio e spedizione merci, in molti casi localizzate all’interno di ex aree industriali, in assenza di una reale ottica “sistemica”. Pertanto, a partire da una breve disamina dell’evoluzione dell’area orientale e di quanto previsto dagli strumenti urbanistici vigenti per la sua trasformazione, il contributo focalizza l’attenzione sul ruolo attuale dslle attività di stoccaggio e trasporto merci nell’area. Quindi, sulla base di alcune recenti esperienze di italiane e in riferimento ad ipotesi già avanzate per l’organizzazione di una piattaforma logistica nell’area orientale di Napoli -quale strumento per ottimizzare le necessità di stoccaggio e trasporto merci riducendone le esternalità negative- valuta la compatibilità di tali scelte con le prospettive di evoluzione/trasformazione dell’area e il potenziale ruolo che l’area potrebbe svolgere in una prospettiva di ri-organizzazione del trasporto merci in ambito urbano.
Evaluation of central and peripheral corneal thicknesses in patients with rheumatoid arthritis
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Alime Gunes
2015-08-01
Full Text Available ABSTRACTPurpose:To evaluate central corneal thickness (CCT and peripheral corneal thickness (PCT in patients with rheumatoid arthritis (RA and to assess the relationships among the corneal parameters, dry eye disease, and clinical variables of RA.Methods:A total of 58 RA patients and 58 control subjects participated in this study. A detailed ophthalmological examination was performed on each subject. Dry eye evaluation was performed using Schirmer’s test, tear break-up time (TBUT, corneal fluorescein staining, and Ocular Surface Disease Index (OSDI. Corneal thickness at the apex point, the center of the pupil, the thinnest point, and PCT (3 mm from the apex to the superior, inferior, nasal, and temporal locations were evaluated using Scheimpflug imaging (Pentacam®. Additionally, the relative peripheral index (RPI was calculated by dividing the PCT by the CCT. The disease severity and quality of life were evaluated with DAS28 and HAQ, respectively. The laboratory evaluation comprised ESR and CRP.Results:The mean corneal thicknesses at the apex point, the center of the pupil, the thinnest point, and the superior, inferior, nasal, and temporal points were significantly thinner in RA patients than controls. Schirmer’s test scores and TBUT were significantly lower, and corneal staining and OSDI scores were significantly higher in RA patients. There were no significant correlations between the corneal parameters and the clinical variables of RA or dry eye tests.Conclusion:The CCT and PCT were thinner in RA patients compared to those in control subjects. However, there were no significant correlations between the corneal parameters and the clinical variables of RA or dry eye tests.
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M. Bondi
2003-05-01
Full Text Available Le amebe a vita libera sono state oggetto di diversi studi negli ultimi anni, non solo per le loro potenzialità patogene nei confronti dell’uomo, ma anche per l’importante ruolo che svolgono in natura, dove agiscono come predatori in grado di controllare le popolazioni batteriche. Alcuni degli organismi fagocitati però possono evitare la lisi fagosomiale e mantenere la loro condizione vitale a livello intracellulare, divenendo endosimbionti. Le amebe fungono così da riserva per questi batteri, proteggendoli da difficili condizioni extracellulari e provvedendo ad un ambiente consono alla loro replicazione. Tale tipo di interazione è particolarmente studiata in Legionella pneumophila, dal momento che l’ampia diffusione di questo germe, nonché la sua virulenza, pare siano fortemente influenzate dalla capacità di parassitare protozoi appartenenti ai generi Acanthamoeba, Naegleria e Balamuthia. Al fine di ottenere maggiori informazioni sui fattori favorenti o inibenti lo sviluppo di questi protozoi, è stato studiato il comportamento di un ceppo di Acanthamoeba polyphaga coltivato, in solido e in liquido, in associazione con L. pneumophila ed altri batteri ad habitat acquatico (Pseudomonas, Aeromonas, Achromobacter, Burkholderia. Su tappeti di cellule batteriche allestiti in Non Nutrient Agar (NNA, A.polyphaga si è mostrata in grado di moltiplicarsi utilizzando come nutrimento tutti i ceppi testati, nonostante alcuni, come Burkholderia cepacia SSV6 e Achromobacter xylox SS28, risultino più idonei al suo sviluppo. In piastre a pozzetti addizionate di acqua condottata autoclavata, il protozoo ha mostrato una buona capacità di sopravvivenza, non risultando inoltre influenzato dalla presenza di legionella o dei batteri acquatici testati. Dal momento che, fra i batteri descritti come capaci di vita intra-amebica, sono inclusi patogeni quali Chlamydia, Legionella, Listeria e Rickettsiae, risulta necessario riconsiderare la rilevanza clinica
Donne e Uomini con disabilità. Studi di genere, disability studies e nuovi intrecci contemporanei
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Elena Malaguti
2011-06-01
Full Text Available Disabled men and women in modern society: a few explored issue in Italy. It is an actual challenge that require to scientific community to rethink the existing theories on the basis of new paradigms such as empowerment, resilience, advocacy and citizenship. This approach may become an ideal setting to suggest new perspectives on the status of women and men with disabilities if it consider at the light of the rights and gender studies. This article aims to define suggestion on the relationship between gender studies and disability studies through selected study cases, particularly for the women.
McNearney, Terry A; Hunnicutt, Sonya E; Fischbach, Michael; Friedman, Alan W; Aguilar, Martha; Ahn, Chul W; Reveille, John D; Lisse, Jeffrey R; Baethge, Bruce A; Goel, Niti; Mayes, Maureen D
2009-12-01
To measure self-reported physical and mental functioning and associated clinical features at study entry in 3 ethnic groups with systemic sclerosis (SSc). Sixty Hispanic, 39 African American, and 104 Caucasian patients with recent-onset SSc ( fatigue scores > IBQ > clinical variables (hypertension, skin score, and percentage predicted DLCO). Scleroderma-HAQ scores had ethnic-specific associations with IBQ > AHI scores > most clinical and laboratory variables. Decreased mental component summary (MCS) scores associated with AHI > ISEL. Ethnic-specific immunogenetic variables HLA-DQB1*0202 (Caucasian) and HLA-DRB 1*11 (African American), and HLA-DQA1*0501 (Hispanic) also associated with MCS. Antinuclear autoantibodies, anti-topoisomerase I, and RNA polymerases I and III also demonstrated associations with functioning in African American and Hispanic groups. Clinical, psychosocial, and immunogenetic variables had ethnic-specific associations with perceived physical and mental functioning. Consideration of ethnic-specific psychological and behavioral support in designing more personalized, relevant therapeutic interventions for the patient may improve therapeutic efficacy in SSc.
MELACAK ALGORITMA HISAB AWAL BULAN QAMARIYAH DALAM KITAB NURUL ANWAR
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Ahmad Fauzan
2015-01-01
Full Text Available This research examines the Risalah al-Falak Nurul Anwar min Muntaha al-Aqwal fi Ma’rifah Hisab al-Sinin wa al-Hilal wa al-Khusuf ala Haqīqī bi al-Tahqīq bi Rasd al-Jadid, the work of KH. Nur Ahmad, SS, using content analysis. The results are: First, the book calculations algorithm in terms of determining the beginning of the month Qamariyah fall under hisab Haqiqi bi al-Tahqīq. While Spherical Trigonometry is the basis for its theory and calculation. Second, in the making process, the book used Badī’ah al-Mitsāl and al-Khulāsah al-Wāfiah as reference. This literature research also found that the trend of the data is taken from the book of Badī’ah al-Mitsāl, while the calculation is taken from the book of al-Khulāsah al-Wāfiah, by adapting the rules of modern astronomy.
DEFF Research Database (Denmark)
Højgaard, Pil; Glintborg, Bente; Hetland, Merete Lund
2015-01-01
study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, logistic and Cox regression analyses by smoking status (current/previous/never smoker) were calculated for treatment adherence, ACR20/50/70-responses and EULAR-good-response. Additional stratified analyses were performed according...... to gender and TNFi-subtype (adalimumab/etanercept/infliximab). RESULTS: Among 1388 PsA patients included in the study, 1148 (83%) had known smoking status (33% current, 41% never and 26% previous smokers). Median follow-up time was 1.22 years (IQR 0.44-2.96). At baseline, current smokers had lower Body Mass...... Assessment Questionnaire (HAQ) score (1.1 (0.7 to 1.5)/1.0 (0.5 to 1.5)) than never smokers (all psmokers had shorter treatment adherence than never smokers (1.56 years (0.97 to 2.15)/2.43 years (1.88 to 2.97), (median (95% CI)), log rank p=0.02) and poorer 6 months' EULAR-good-response rates...
Noda, Wataru; Okada, Ryo; Tani, Iori; Ohnishi, Masafumi; Naoto, Mochizuki; Nakajima, Syunji; Tsujii, Masatsugu
2013-06-01
The present study examines the relationship among inattentive, and hyperactive-impulsive behavior, aggression, and depression in elementary school and junior high school students. The participants were 3,885 children and their teachers and caregivers. Children's inattentive and hyperactive-impulsive behavior was rated by their teachers and caregivers (ADHD-RS). Children rated aggression (HAQ-C) and depression (DSRS-C) themselves. Inattentive and hyperactive-impulsive behavior rated by teachers and caregivers were positively related to aggression and depression. Inattention predicted higher levels of aggression and depression. Inattentive and hyperactive-impulsive behavior as rated by teachers was more highly related to depression than those behaviors as rated by caregivers. The relationships among inattentive, and hyperactive-impulsive behavior, aggression, and depression were almost the same for both elementary school and junior high school students. This study suggests the importance of assessing inattentive and hyperactive-impulsive behavior from multiple views to examine the relationship between inattentive and hyperactive-impulsive behavior and mental health problems.
Pengawasan Islam dalam Operasional Lembaga Keuangan Syariah
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Neneng Nurhasanah
2013-06-01
Full Text Available State has a role and responsibility in managing and monitoring the implementation principles of Shariah in society. In addition, each individual is required to participate in society as well as overseeing the form of “da’wa fil haq wa shabr” and “amr ma’ruf nahi munkar” with based on the general principles of Islamic law, namely: the principle of tawhid, ‘adalah (justice, amr ma’ruf nahi munkar, al-huriyyah wa al-mas’uliyyah (responsible freedom, al-musawah (equality, al-Ta’awun (the principle of mutual help and tasa’muh (tolerance Shariah Supervisory Board (DPS which is charged with overseeing the financial institutions practice of Shari’ah (LKS to conform with the principles of Shari’ah, its implementation has not been optimized to prevent the occurrence of irregularities, so requires strengthening the regulatory aspects of the worksheet other than banks and aspects of quality of human resources in the banking Shariah Supervisory Board.
Fazio, Michelangelo
2008-01-01
L’introduzione delle lauree triennali ha in molti casi costretto i docenti a ridurre drasticamente il numero di ore di insegnamento e quindi l’estensione dei programmi dei corsi di Fisica. In questo volumetto l'autore si è proposto di esporre sinteticamente ma con il massimo rigore possibile il corso di Fisica Generale I evitando le dimostrazioni delle leggi fisiche, ma dando la priorità alle applicazioni di tali leggi e allo svolgimento di esercizi che in genere viene trascurato in molti corsi. Ha cercato pertanto di presentare i fenomeni fisici sottolineando, dove possibile, la loro presenza nella vita quotidiana e le loro più semplici e immediate applicazioni, consentendo in tal modo agli studenti di vedere la Fisica non più come una interminabile serie di formule ma come un nuovo modo di interpretare e di capire i fenomeni naturali inanimati (del resto non dobbiamo dimenticare che il termine greco da cui deriva il suo nome è fisis, fisis, ovvero natura). Il contenuto è completo, comprendendo anc...
Correlation between subtalar varus angle and disability in patients with patellofemoral arthritis
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Patel Birenkumar Jagdishbhai
2009-11-01
Full Text Available Aim: To find the correlation between subtalar varus angle & disability in patients with patellofemoral arthritis. Methods: A total of 30 subjects aged (48.86±5.74 referred to the department of physiotherapy, with patellofemoral arthritis and fulfilling the criteria of inclusion were recruited for the study, sampling method being convenient sampling. Disability score was measured of each patient by WOMAC index (Western Ontario and McMaster Universities Index of Osteoarthritis disability questionnaire and subtalar varus angle was measured in non weight bearing position in prone lying. Results: Pearson’s correlation coefficient test showed a highly significant (p=0.000 positive correlation (r=0.821 between disability scores and subtalar varus angle. Conclusion: There is a highly significant relation between disabilities due to patellofemoral pain in patellofemoral arthritis patients and sub talar varus angle
Ma, Chao; Wu, Shaoling; Xiao, Lingjun; Xue, Yunlian
2011-03-01
The Oswestry Disability Index (ODI) is one of the most widely used questionnaires that assess disability in patients with low back pain (LBP). Responsiveness is both an important psychometric property of an instrument and a key issue for clinicians when choosing suitable outcome measures. The objective of this study was to examine the responsiveness of the Chinese version of the ODI (ODI-Chinese) for subjects with chronic LBP following a physical therapy program. In total, 76 patients with chronic LBP completed the ODI-Chinese, a visual analog scale (VAS) of pain, and the Chinese version of Short Form-36 (SF-36) before and after treatment. All patients also completed a global perception of change Likert scale in condition after the program. The scale was collapsed to produce a dichotomous variable outcome, improved or non-improved. The responsiveness of the instruments was determined using the standardized response means (SRM) and receiver operating characteristics (ROC). After treatment, 56 patients considered themselves to be improved. The SRM of the ODI-Chinese was -1.2 in the improved group and -0.4 in the non-improved group. The area of the ROC curve for the ODI-Chinese was 0.77 (95% CI 0.66-0.89). Therefore, the Chinese version of the ODI is both responsive and appropriate for use in chronic LBP patients after conservative therapy.
La necropoli neolitica a domus de janas di S. Pietro di Sorres in Comune di Borutta - Sassari
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Pier Paolo Soro
2009-05-01
Full Text Available La necropoli di Sorres si trova nel territorio del Comune di Borutta in provincia di Sassari. E’ ubicata lungo il versante SE del colle di Sorres, sul quale sorge imponente la chiesa in stile romanico di San Pietro di Sorres (XI-XII sec. sede dell’antica diocesi medievale. La necropoli è composta attualmente da cinque tombe a grotticella artificiale del tipo a domus de janas, scavate nella roccia calcara durante il neolitico recente ed in uso per tutto l’eneolitico. Si presume che fosse l’area sepolcrale dell’insediamento in grotta di Ulàri, una cavità carsica di notevoli dimensioni il cui ingresso si apre lungo il versante Nord del colle; la grotta ha restituito testimonianze archeologiche che vanno dal neolitico media fino al medioevo. La necropoli di Sorres, sebbene sia stata rimaneggiata nella forma degli ambienti ipogei e nella destinazione d’uso, costituisce una delle principali testimonianze del capillare tessuto insediativo del territorio del nord Sardegna.
Studio di prototipo di calorimetro per neutroni per l'esperimento ALICE
Arnaldi, R; Cicalò, C; Cortese, P; De Falco, A; Dellacasa, G; De Marco, N; Gallio, M; Macciotta, P; Masoni, A; Musso, A; Oppedisano, C; Piccotti, A; Puddu, G; Scomparin, E; Siddi, S; Serci, E; Soave, C; Usai, G L; Vercellin, Ermanno
1999-01-01
ALICE e uno dei quattro esperimenti previsti ad LHC, al CERN, il cui scopo e lo studio delle osservabili che danno informazioni rilevanti sulla formazione del quark gluon plasma, che potrebbe essere prodotto in collisioni centrali Pb-Pb, di energia nel centro di massa di 5.5 A TeV.Il parametro di impatto di tali collisioni verra determinato grazie ad un insieme di calorimetri per protoni e neutroni che misureranno l'energia portata in avanti dai nucleoni non interagenti(spettatori).E' stato costruito un prototipo di calometro per neutroni, formato da piani di fibre di quarzo, posti a 45 gradi rispetto all'asse del fascio e inframmezzati da piani di materiale passivo denso(tungsteno). La luce Cerenkov prodotta nelle fibre dallo sciame sviluppato nel materiale passivo,viene raccolta da guide ottiche in aria.Verranno presentati i rilustati di un test previsto al CERN SPS per il luglio 1999.
Rimozione Urbana: La Necessità di una Nuova Direzione di Attività di Pubblica Amministrazione
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Eneida Criscuolo Gabriel Bueno Silva
2015-12-01
Full Text Available Questo lavoro si propone di discutere la legitimità delle decisioni amministrative nel democratico Stato di diritto; il discorso e la democrazia sono correlati nel mondo contemporaneo, mostrando la necessità di discussione pubblica in attività amministrativa, in tale contesto, con il passare dell'atto amministrativo, la razionalità degli decisioni amministrativa dovrebbe essere dimostrata attraverso del processo amministrativo come mezzo di discussione in una prospettiva democratica. Pacifico che il discorso è un mezzo attraverso il quale la democrazia può avvenire, ma devono osservare qui: senza partecipazione sociale, senza coscienza politica, il discorso porta a una democrazia apparente. Questo articolo discute la relazione tra democrazia, discorso e attività amministrativa in processi di rimozione urbana, indagando gli aspette che riguardano, a fini de equilibrio nel rapporto tra stato e cittadino. Questo lavoro ha origine de una ricerca de 2232 documenti, utilizzando la tecnica di analisi di contenuto.
Disability and Fatigue Can Be Objectively Measured in Multiple Sclerosis.
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Caterina Motta
Full Text Available The available clinical outcome measures of disability in multiple sclerosis are not adequately responsive or sensitive.To investigate the feasibility of inertial sensor-based gait analysis in multiple sclerosis.A cross-sectional study of 80 multiple sclerosis patients and 50 healthy controls was performed. Lower-limb kinematics was evaluated by using a commercially available magnetic inertial measurement unit system. Mean and standard deviation of range of motion (mROM, sROM for each joint of lower limbs were calculated in one minute walking test. A motor performance index (E defined as the sum of sROMs was proposed.We established two novel observer-independent measures of disability. Hip mROM was extremely sensitive in measuring lower limb motor impairment, being correlated with muscle strength and also altered in patients without clinically detectable disability. On the other hand, E index discriminated patients according to disability, being altered only in patients with moderate and severe disability, regardless of walking speed. It was strongly correlated with fatigue and patient-perceived health status.Inertial sensor-based gait analysis is feasible and can detect clinical and subclinical disability in multiple sclerosis.
Peste equina: descrizione di focolai di malattia in Namibia
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Massimo Scacchia
2009-06-01
Full Text Available La peste equina è una malattia virale degli equidi trasmessa da vettori. Scopo di questo lavoro è di riferire su casi di malattia verificatisi in Namibia nel corso degli anni 2006-2008, osservati dal personale dell'Istituto Zooprofilattico Sperimentale dell'Abruzzo e del Molise “G. Caporale” e del Central Veterinary Laboratory di Windhoek, Namibia e confermati dagli esami di laboratorio. Il lavoro è stato possibile anche grazie alla fattiva collaborazione stabilitasi con i veterinari pubblici, privati e allevatori Namibiani.
L'ISOLA DI ARTURO DI ELSA MORANTE
African Journals Online (AJOL)
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Vi è una curiosa atmosfera di attesa negli anni '50, ed è questa temperie morale che Elsa Morante rappresenta e interpreta nell'Isola di Arturo. Nel romanzo la Morante ci dà veramente un ritratto intero di quegli anni, nel senso che dal testo sorge una attitudine complessa, contenente in sè la percezione del tempo in corso, ...
Ghosh, Subrata; Louis, Edouard; Beaugerie, Laurent; Bossuyt, Peter; Bouguen, Guillaume; Bourreille, Arnaud; Ferrante, Marc; Franchimont, Denis; Frost, Karen; Hebuterne, Xavier; Marshall, John K; OʼShea, Ciara; Rosenfeld, Greg; Williams, Chadwick; Peyrin-Biroulet, Laurent
2017-03-01
The Inflammatory bowel disease (IBD) Disability Index is a validated tool that evaluates functional status; however, it is used mainly in the clinical trial setting. We describe the use of an iterative Delphi consensus process to develop the IBD Disk-a shortened, self-administered adaption of the validated IBD Disability Index-to give immediate visual representation of patient-reported IBD-related disability. In the preparatory phase, the IBD CONNECT group (30 health care professionals) ranked IBD Disability Index items in the perceived order of importance. The Steering Committee then selected 10 items from the IBD Disability Index to take forward for inclusion in the IBD Disk. In the consensus phase, the items were refined and agreed by the IBD Disk Working Group (14 gastroenterologists) using an online iterative Delphi consensus process. Members could also suggest new element(s) or recommend changes to included elements. The final items for the IBD Disk were agreed in February 2016. After 4 rounds of voting, the following 10 items were agreed for inclusion in the IBD Disk: abdominal pain, body image, education and work, emotions, energy, interpersonal interactions, joint pain, regulating defecation, sexual functions, and sleep. All elements, except sexual functions, were included in the validated IBD Disability Index. The IBD Disk has the potential to be a valuable tool for use at a clinical visit. It can facilitate assessment of inflammatory bowel disease-related disability relevant to both patients and physicians, discussion on specific disability-related issues, and tracking changes in disease burden over time.
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Valentina Fulginiti
2014-05-01
Full Text Available Being an extreme case of fictitious representation of linguistic otherness, pseudo-translation challenges the idea of a fatal and exclusive link between language and national ethos, a fundamental notion in the Nineteenth-century linguistic and literary culture. The present article compares two emblematic cases of pseudo-translation in post-Unification Italian culture: Luigi Capuana’s hoax Un poeta danese (published in 1882 and the earliest short stories published by Salvatore di Giacomo in 1878, mistakenly considered a plagiarizing translation from an uncredited German original. Their use of pseudo-translation is marked by opposite goals of parody and stylistic imitation; however, both authors challenge the fundamental assumption underlying the notion of «ethnicity of language». Pseudo-translation thus becomes a space of linguistic elaboration, complementary to the author’s direct involvement in translating major European works into Italian (such as Ibsen’s masterpiece A House of Dolls, which Capuana translated in 1891, and Edmond de Goncourt’s novel Sœur Philomèle, which Di Giacomo translated in 1892. Translation thus provides a free space for authors to experiment with new expressive solutions and challenge commonplaces about language and identity: such reflection on the limits of language and nations represent a direct contribution to the linguistic unification of Italy. Caso estremo di rappresentazione fittizia del- l’alterità linguistica, la pseudo-traduzione chiama in causa l’idea del legame unico e “fatale” fra lingua e nazione – concetto fondamentale nella cultura linguistica del XIX secolo. L’articolo mette a confronto due casi emblematici di pseudo-traduzione nella cultura meridionale post-unitaria: la beffa letteraria di Luigi Capuana Un poeta danese (1882 e le ‘tedescherie’ di Salvatore di Giacomo, gruppo di novelle pubblicate nel 1878 che molti considerarono (a torto un plagio da ignoto autore tedesco
Effects of rheumatoid arthritis on household chores and leisure-time activities.
Leino, Mauri; Tuominen, Sini; Pirilä, Laura; Tuominen, Risto
2015-11-01
The aim of the study was to determine household chores and leisure-time activities most affected by rheumatoid arthritis (RA) and to evaluate the perceived impact on performing these activities. Also, our aim was to estimate the required and received assistance for household chores. In an interview study via telephone, 124 patients with moderate-to-severe RA, visiting a tertiary-level dermatological clinic, listed spontaneously without predefined list the household chores and leisure-time activities that they considered were particularly affected by the RA. Ability to perform household chores and leisure-time activities were asked. The need for outside assistance with household chores and help received were also determined. Rheumatoid arthritis affected wide range of everyday household activities, with tasks related to cleaning of the house mentioned most often. Eleven of the categories out of 16 were similar to those included in the HAQ index. The majority of the patients (84.6 %) reported disadvantage in performing household chores because of RA. More than half of the patients (55.7 %) received assistance with household chores, women significantly more often than men (69.0 vs. 26.3 %, p Leisure-time activities listed by respondents as affected by RA were mostly related to sport. The majority of patients (77.2 %) had either reduced or completely given up at least one leisure-time activity. When estimating the total burden of the disease, the impact on both household chores and leisure-time activities should be taken into account.
Quality of Life, Disability, and Body Mass Index Are Related in Obese Patients
Sirtori, Anna; Brunani, Amelia; Liuzzi, Antonio; Pasqualinotto, Lucia; Villa, Valentina; Leonardi, Matilde; Raggi, Alberto
2011-01-01
The aim of this study is to analyze the relationship between health-related quality of life (QoL), disability, and degree of obesity. Adult obese patients (BMI greater than 30) were consecutively enrolled in this cross-sectional observational study. The WHO Disability Assessment Schedule (WHO-DAS II) and the short version of the impact of weight…
Gijon-Nogueron, Gabriel; Ndosi, Mwidimi; Luque-Suarez, Alejandro; Alcacer-Pitarch, Begonya; Munuera, Pedro Vicente; Garrow, Adam; Redmond, Anthony C
2014-03-01
The Manchester Foot Pain and Disability Index (MFPDI) is a self-assessment 19-item questionnaire developed in the UK to measure foot pain and disability. This study aimed at conducting cross-cultural adaptation and validation of the MFPDI for use in Spain. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes measures were followed in the MFPDI adaptation into Spanish. The cross-cultural validation involved Rasch analysis of pooled data sets from Spain and the UK. Spanish data set comprised 338 patients, five used in the adaptation phase and 333 in the cross-cultural validation phase, mean age (SD) = 55.2 (16.7) and 248 (74.5 %) were female. A UK data set (n = 682) added in the cross-cultural validation phase; mean age (SD) = 51.6 (15.2 %) and 416 (61.0 %) were female. A preliminary analysis of the 17-item MFPDI revealed significant local dependency of items causing significant deviation from the Rasch model. Grouping all items into testlets and re-analysing the MFPDI as a 3-testlet scale resulted in an adequate fit to the Rasch model, χ (2) (df) = 15.945 (12), p = 0.194, excellent reliability and unidimensionality. Lack of cross-cultural invariance was evident on the functional and personal appearance testlets. Splitting the affected testlets discounted the cross-cultural bias and satisfied requirements of the Rasch model. Subsequently, the MFPDI was calibrated into interval-level scales, fully adjusted to allow parametric analyses and cross-cultural data comparisons when required. Rasch analysis has confirmed that the MFPDI is a robust 3-subscale measure of foot pain, function and appearance in both its English and Spanish versions.
Park, Seong-Doo; Yu, Seong-Hun
2013-04-01
The purpose of this study was to effects of abdominal draw-in maneuver and core exercise with 4 weeks using the musculoskeletal ultrasonography on muscle thickness and disability in subjects with low back pain. Twenty patients with nonspecific back pain (abdominal draw-in maneuver group: n= 10, core exercise group: n= 10) were recruited in the study. Both group received exercise intervention 3 times a week for 4weeks. The test were based on muscle thickness (transversus abdominis; Tra, internal oblique; IO and external oblique; EO), disability (Oswestry disability index; ODI) measured immediately before and after intervention. The data was measured by SPSS program 12.0 version and analyzed by Paired t-test and Independent t-test. The following results were obtained. The thickness of IO, EO for both group significantly improved except for muscle thickness of Tra. The ODI were significant difference for both groups. As the results of this study, we suggest that it may be effective method to apply to increase for the thickness of Tra, EO using abdominal draw-in maneuver and thickness of IO using core exercise.
Profili di salute soggettivi e oggettivi: una combinazione vincente
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C. Quercioli
2003-05-01
Full Text Available
Introduzione: nella valutazione prospettica dell’impegno assistenziale richiesto o retrospettiva del risultato di salute ottenuto, entrambi collegabili a meccanismi retributivi, diventa sempre più importante usare sintetici descrittori di severità/complessità/outcome. In quest’ottica abbiamo studiato con strumenti oggettivi (Charlson Index Score-CSI e soggettivi (SF36 lo stato di salute di pazienti non ospedalizzati. Obiettivo: confrontare e correlare i livelli di salute registrati con i due strumenti.
Materiali e Metodi: il CSI è un indice che considera numero e severità delle copatologie. Il questionario SF36 studia lo stato di salute percepito attraverso 8 domini. Sono stati studiati 137 pazienti di un Medico di Medicina Generale, che ha fornito età, sesso, livello di istruzione e stato civile dei pazienti. È stato creato un modello di regressione in cui il punteggio del CSI costituiva la variabile dipendente e le quattro scale dell’SF36 che sono risultate correlate con il CSI le variabili indipendenti. Risultati: è stata identificata correlazione tra i punteggi del CSI e le scale Salute Generale (SG (Coefficiente di Spearman 0,38 p‹0,001, Attività Fisica (AF (C.S. 0,35 p‹0,001, Ruolo Fisico (RF (C.S. 0,37 p‹0,001, Ruolo Emotivo (RE (C.S. 0,25 p=0,003. Aggiustando il CSI e le suddette 4 scale dell’SF 36 per “sesso”, “livello di istruzione” e “stato civile”, si è trovato che: (i “stato civile” influenza l’associazione tra RF e CSI (crude O.R. 1,71, p‹0,001; O.R. coniugati 1,47 p= 0,025; O.R. non coniugati 3,05 p‹ 0,001 e SG e CSI (crude O.R. 1,76 p‹0,001; O.R. stato civile 1,61 p=0,006; (ii “livello di istruzione” influenza l’associazione tra AF e CSI (crude O.R. 1,88 p‹0,001; O.R. livello di istruzione 1,76 p=0,001 e SG e CSI (crude O.R. 1,76 p‹0,001; O.R. elevata istruzione 1,22 p=0,33; O.R. scarsa istruzione 2,69 p‹0,001.
Il loricato acefalo di Rusellae (Roselle, GR: una proposta di identificazione
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Eleonora Romanò
2013-07-01
Full Text Available Lo studio è incentrato sul tentativo di comprendere la scena presente sulla lorica di una statua acefala di probabile fine età claudia rinvenuta nell'area archeologica di Rusellae (Roselle, GR all'interno di un edificio connesso al culto imperiale. La decorazione analizzata è composta da diversi elementi: un trofeo di armi ed un'aquila in posizione pressocchè centrale, ai loro lati si dispongono figure umane interpretabili come barbari e per le quali si propone l'identificazione con il britanno Caratacus accompagnato dai suoi familiari mentre rivolge una supplica di liberazione al Senato ed all'imperatore Claudio, secondo l'episodio riportato negli Annales di Tacito (12.33-40.
International Nuclear Information System (INIS)
Djamali, Essmaiil; Cobble, James W.
2009-01-01
Standard state thermodynamic properties for fully ionized aqueous perrhenic acid at temperature in the range of (298.15 to 598.15) K and at p sat were determined by high dilution solution calorimetry (10 -4 m). A comparison of the standard state thermodynamic properties for fully ionized aqueous perrhenic acid, HReO 4 (aq), and sodium perrhenate, NaReO 4 (aq), establishes for the first time the quantitative values for the differences between H + (aq) and Na + (aq) from temperature of (298.15 to 598.15) K. Perrhenic acid is believed to be the first strong acid to be thermodynamically well characterized under standard state conditions to date from measurements down to 10 -4 m. The value of the Debye-Hueckel limiting slope for enthalpies of dilution at temperature of 596.30 K of 122 ± 6 kJ . mol -3/2 . kg 1/2 , obtained from the integral heats of solution measurement at various concentrations, is in good agreement with theoretical value in literature, 121 kJ . mol -3/2 . kg 1/2 . This agreement verifies that HReO 4 (aq) obeys the simple limiting law for strong electrolytes. Many thermodynamic properties of soluble sodium electrolytes can now be converted to the corresponding acid form.
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Merete Amann Gainotti
2012-12-01
Full Text Available Negli anni 1921-1923 a Mosca, sulla scia delle profonde trasformazioni politiche e sociali innescate dalla Rivoluzione di ottobre si colloca un esperimento educativo originale, promosso da Vera Schmidt, una pedagogista formata alle idee psicoanalitiche, che si proponeva di cercare nuove vie educative per la prima infanzia sulla base delle recenti conquiste e conoscenze fornite dalla teoria psicoanalitica di S. Freud. Obiettivo di questo contributo è di fornire un breve excursus storico relativo alla diffusione della psicoanalisi in Unione sovietica e alla fondazione dell'asilo sperimentale di Mosca, di ricordare le figure delle due studiose Vera Schmidt e Sabina Spielrein che hanno animato l'iniziativa, il cui lavoro scientifico è rimasto in ombra rispetto a quello dei loro più famosi colleghi S. Freud e di C.G. Jung; infine si intende rendere conto dei principi educativi che esse cercarono di mettere in pratica nell'asilo sperimentale di Mosca.
Disability prevalence among healthy weight, overweight, and obese adults.
Armour, Brian S; Courtney-Long, Elizabeth A; Campbell, Vincent A; Wethington, Holly R
2013-04-01
Obesity is associated with adverse health outcomes in people with and without disabilities. However, little is known about disability prevalence among people who are obese. The purpose of this study is to determine the prevalence and type of disability among adults who are obese. Pooled data from the 2003-2009 National Health Interview Survey (NHIS) were analyzed to obtain national prevalence estimates of disability, disability type and obesity. The disability prevalence was stratified by body mass index (BMI): healthy weight (BMI 18.5-reported a disability. In contrast, 26.7% of those with a healthy weight and 28.5% of those who were overweight reported a disability. The most common disabilities among respondents with obesity were movement difficulty (32.5%) and work limitation (16.6%). This research contributes to the literature on obesity by including disability as a demographic in assessing the burden of obesity. Because of the high prevalence of disability among those who are obese, public health programs should consider the needs of those with disabilities when designing obesity prevention and treatment programs. Copyright © 2013 The Obesity Society.
Integrazione rigorosa di dati provenienti da fonti di acquisizione differenti
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Leandro Bornaz
2011-04-01
Full Text Available La geomatica mette oggi a disposizione di esperti di diverse discipline un’ampia gamma di strumenti e tecniche che vengono utilizzate estensivamente come sostegno per l’acquisizione, la contestualizzazione e la georeferenziazione di informazioni molto diversificate come ad esempio dati georadar, geosismici, interferometrici, provenienti da strumenti di misura spesso utilizzati in diversi ambiti e con sistemi di riferimento differenti, talvolta non direttamente compatibili tra loro. Questa problematica, spesso trascurata utilizzando un approccio di tipo classico, è stata affrontata e risolta in modo rigoroso dagli autori permettendo così l’integrazione corretta di dati di differente natura e provenienza.Integration of data acquired from different sourcesGeomatics today offers to experts from different disciplines a wide range of tools and techniques, which are used extensively as technical support for the acquisition, context and geo-refer-encing data coming from different investigations: geo radar, interpherometry, geophysics analysis. Each technology gener-ally provide data with different reference systems, often not di-rectly compatible each other. This problem, often overlooked by using a classical approach, has been resolved in a rigorous way by the authors thus allowing proper integration of data of different nature.
Chiavetta, Cristian
2013-01-01
La dissertazione ha riguardato l’analisi di sostenibilità di un sistema agronomico per la produzione di olio vegetale a fini energetici in terreni resi marginali dall’infestazione di nematodi. Il processo indagato ha previsto il sovescio di una coltura con proprietà biofumiganti (brassicacea) coltivata in precessione alla specie oleosa (soia e tabacco) al fine di contrastare il proliferare dell’infestazione nel terreno. Tale sistema agronomico è stato confrontato attraverso una analisi di cic...
Managing missing scores on the Roland Morris Disability Questionnaire
DEFF Research Database (Denmark)
Lauridsen, Henrik Hein
Background and purpose: It is likely that the most common method for calculating a Roland Morris Disability Index (RMDQ) sum score is to simply ignore any unanswered questions. In contrast, the raw sum score on the Oswestry Disability Index (ODI) is converted to a 0-100 scale, with the advantage...... of unanswered RMDQ questions was measured in a research and a routine care setting. The accuracy of the RMDQ proportional recalculation method was measured using 311 fully completed RMDQ and matching ODI questionnaire sets. Raw sum scores were calculated, and questions systematically dropped. At each stage, sum...
Kaoulla, Patricia; Frescos, Nicoletta; Menz, Hylton B
2008-06-01
The Manchester Foot Pain and Disability Index (MFPDI) is a 19 item questionnaire used to assess the severity and impact of foot pain. The aim of this study was to develop a Greek-language version of the MFPDI and to assess the instrument's psychometric properties. The MFPDI was translated into Greek by three bilingual content experts and two bilingual language experts, and then back-translated into English to assess for equivalence. The final Greek version was administered, along with a questionnaire consisting medical history and the Medical Outcomes Study Short Form 36 (SF-36), to 104 Greek-speaking, community-dwelling people (64 female, 40 male), aged between 64 and 90 years (mean 73.00, SD 5.26) with disabling foot pain. The Greek translation of the MFPDI was found to have high internal consistency (Cronbach's alpha= 0.89, and item-total correlation coefficients from 0.33 to 0.72). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern with appearance and activity restriction, which explained 60.8% of the variance, with 38.9% of the variance explained by the first construct (functional limitation). Six items demonstrated different factor loadings to the original English version. The Greek-language version of the MFPDI appears to be a valid tool in assessing foot pain in Greek-speaking older people. The total MFPDI scores are comparable between the Greek and English version, however due to differences in the factor loadings of some items, between-language comparisons of MFPDI should be undertaken with some caution.
Diversitas Kelelawar (Chiroptera Penghuni Gua, Studi Gua Ngerong di Kawasan Karst Tuban Jawa Timur
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Tatag Bagus Putra Prakarsa
2013-12-01
Full Text Available Penelitian ini bertujuan untuk mengetahui diversitas kelelawar penghuni gua di gua Ngerong. Penelitian ini merupakan penelitian Nature Snapshop Experiment (NSE. Penelitian ini dilaksanakan pada bulan November - Desember 2011 di gua Ngerong, Desa Rengel, Kecamatan Rengel, Kabupaten Tuban, Jawa Timur. Penangkapan dilakukan dengan metode tangkap langsung. Penangkapan dilakukan dengan menggunakan misnet dan handnet. Kelelawar diidentifikasi berdasarkan pengukuran morfometri dan ciri morfologi mengacu kunci identifikasi Suyanto, 2001 dan Payne et al., 2000. Seluruh data dianalisis secara deskriptif. Di gua Ngerong terdapat 9 spesies dari 4 famili atau 60% dari total spesies kelelawar penghuni gua di kawasan karst Tuban. Enam spesies anggota Subordo Microchiroptera yang merupakan insectivor dan 3 spesies anggota Subordo Megachiroptera yang merupakan frugivor dan nictivor. Keanekaragaman di gua Ngerong tergolong tinggi dengan nilai Simpson's Diversity Index sebesar 0,76. Tingginya diversitas kelelawar penghuni gua Ngerong berbanding lurus dengan panjang lorong gua Ngerong. gua Ngerong merupakan gua terpanjang di kawasan karst Tuban, dengan panjang lorong mencapai 1800m.kata kunci: Kelelawar (Chiroptera, Diversitas, Gua Ngerong, Biospeleologi, Karst
Sviluppo e valutazione di test diagnostici per la sierodiagnosi di brucellosi suina
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Tiziana Di Febo
2012-06-01
Full Text Available Sono stati sviluppati una ELISA competitiva (c-ELISA, una ELISA indiretta (i-ELISA e un test immunologico DELFIA (Dissociation-Enhanced Lanthanide Fluorescence Immunoassay per la ricerca di anticorpi verso Brucella suis in sieri di maiale e cinghiale. I tre test prevedono l’utilizzo di un anticorpo monoclonale (MAb 4B5A verso l’LPS di Brucella (c-ELISA e DELFIA e di un anticorpo monoclonale (MAb 10C2G5 verso le IgG suine (i-ELISA. La specificità (Sp e la sensibilità (Se dei tre test sono le seguenti: per la c-ELISA Se e Sp = 100% con un valore di cut-off pari al 61.0% (B/B0%; per la i-ELISA Sp = 99.1% e Se = 100% con un valore di cut-off di 21.7% (PP%; per il DELFIA Sp = 91.0% e Se = 75% ponendo il valore di cut-off al 37.0% (B/B0%. Inoltre sono state valutate le performance, nei confronti di sieri suini, di un test FPA (Fluorescence Polarization Assay commerciale sviluppato per la ricerca di anticorpi anti-Brucella in sieri bovini; la specificità e la sensibilità ottenute sono entrambe del 100% al valore di cut-off di 99.5 (mP. Questi risultati suggeriscono che la combinazione di c-ELISA, i-ELISA e FPA può essere utilizzata per migliorare la diagnosi di brucellosi suina.
Analisi dell'efficacia di un programma di prevenzione secondaria del carcinoma orale
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S. Iannazzo
2003-05-01
Full Text Available
In Italia i carcinomi del cavo orale (KCO sono diagnosticati
prevalentemente al II-IV stadio TNM con conseguenti basse sopravvivenza a 5 anni e qualità della vita. Una maggior frequenza di diagnosi allo stadio I porterebbe a migliorare ampiamente i valori medi dei suddetti parametri.
Scopo del presente lavoro è stato valutare l’efficacia di un programma di prevenzione secondaria del KCO in termini di aumento di diagnosi allo stadio I e di vite salvate.
Abbiamo stimato la prevalenza di casi istopatologicamente
accertati (livello C3 di leucoplachia, principale lesione precancerosa del KCO, nella ASL/RMA come prodotto tra la prevalenza stimata di leucoplachia diagnosticata clinicamente (livello C2 (2989,2Ĩ13077,7 e la proporzione, scelta arbitrariamente, di C3 tra i C2 (0,50.
Tenendo presente che nel campione studiato nella ASL/RMA la proporzione di KCO allo stadio I tra i C3 era 0,03, abbiamo stimato il numero di KCO.
Abbiamo stimato quanti KCO verrebbero diagnosticati allo stadio I se venisse attuato un programma di prevenzione secondaria, considerando diversi livelli di compliance, e sulla base di una sopravvivenza media a 5 anni, in Italia, del 53% per tutti gli stadi e del 79% per i KCO allo stadio I, abbiamo calcolato il numero di vite salvate. I valori sono stati espressi come IC95.
Le prevalenze di leucoplachia C3 e KCO sono risultate,
rispettivamente, 1494,6Ĩ6538,8 e 44,8Ĩ196,2. Con compliance del 10%, 40% e 75% verrebbero diagnosticati, rispettivamente, 4,5Ĩ19,6, 17,9Ĩ78,5 e 33,6Ĩ147,2 casi di KCO e le vite salvate sarebbero 1,1Ĩ5,1, 4,6Ĩ20,4 e 8,7Ĩ38,3 rispettivamente.
In termini di vite salvate i dati evidenziano la necessita di attuare programmi di screening del KCO, anche nell' eventualità di uno scarso coinvolgimento della popolazione a rischio.
Pianificazione urbana e comportamenti di viaggio: più di una relazione
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Elisabetta Vitale Brovarone
2010-04-01
Full Text Available L’influenza dei caratteri urbani sulla domanda di mobilità è un tema ampiamente dibattuto e studiato. Al di là delle assunzioni teoriche a riguardo, molti studiosi hanno tentato di individuare empiricamente nessi attestanti questo fenomeno. Gran parte della letteratura scientifica sul tema può essere ricondotta al dibattito sulla città compatta e sullo sprawl. Due principali obiettivi contraddistinguono questo dibattito: la comprensione delle complesse dinamiche che legano la domanda di mobilità ai caratteri urbani e l’individuazione di configurazioni sostenibili degli usi del suolo. Il fenomeno è dunque studiato al fine dello sviluppo di strategie fondate sull’integrazione tra i trasporti e gli usi del suolo, finalizzate a limitare l’uso dell’auto e ad ottenere una distribuzione modale degli spostamenti più equilibrata. Buona parte della ricerca scientifica, specialmente nell’ultimo decennio, è dunque focalizzata sull’identificazione di nessi causali tra gli usi del suolo e i trasporti, per supportare, o in alcuni casi mettere in discussione, esperienze e politiche integrate. Nonostante la quantità e varietà di studi dedicati al tema, il fenomeno è ancora lungi dall’essere compreso e dimostrato empiricamente. Il dibattito in proposito è ampio e l’impressione è che con l’aumentare degli studi in proposito e del livello di approfondimento delle analisi diminuisca la sensazione di chiarezza. Attraverso un’analisi della letteratura, l’articolo mette in evidenza i principali problemi emergenti dal dibattito. Senza negare l’importanza del riconoscimento di nessi causali tra i caratteri degli insediamenti e la domanda di mobilità, opinione di chi scrive è che l’individuazione di questi nessi non debba necessariamente costituire una condizione imprescindibile per la definizione e l’adozione di un approccio integrato.
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Alessandro Castagnoli
2011-12-01
Full Text Available Un’ampia area dismessa nel centro della città storica, è stata considerata l’opportunità strategica per valorizzare e rigenerare anche interi brani di tessuto urbano circostante con l’obiettivo di riammagliare gli sfrangiamenti materiali e immateriali nel complesso rapporto fra passato, presente e futuro.Questo caso di studio ha consentito di approfondire un approccio meta progettuale più generale, puntando sulla ricerca di una metodologia appropriata rispetto alla progettazione dello spazio architettonico in quanto tale, con l’obiettivo di sviluppare ragionamenti di compatibilità nell’ambito della vasta tematica del riuso urbano ed edilizio.
Monticone, Marco; Baiardi, Paola; Vanti, Carla; Ferrari, Silvano; Pillastrini, Paolo; Mugnai, Raffaele; Foti, Calogero
2012-01-01
An ability to assess longitudinal changes in health status is crucial for the outcome measures used in treatment efficacy trials. The aim of this study was to verify the responsiveness of the Italian versions of the Oswestry Disability Index (ODI) and the Roland Morris Disability Questionnaire (RMDQ) in subjects with subacute or chronic low back pain (LBP). At the beginning and end of an 8 week rehabilitation programme, 179 patients completed a booklet containing the ODI, the RMDQ, a 0-10 numerical rating scale (NRS), and the 36-item Short-Form Health Survey (SF-36). A global perception of change scale was also completed at the end of the programme, and collapsed to produce a dichotomous outcome (i.e. improved vs. not improved). Responsiveness was assessed by means of distribution methods [minimum detectable change (MDC); effect size (ES); standardised response mean (SRM)] and anchor-based methods (ROC curves). The MDC for the ODI and RMDQ was, respectively, 13.67 and 4.87; the ES was 0.53 and 0.68; and the SRM was 0.80 and 0.81. ROC analysis revealed an area under the curve of 0.71 for the ODI and 0.64 for the RMDQ, thus indicating discriminating capacity; the best cut-off point for the dichotomous outcome was 9.5 for the ODI (sensitivity 76% and specificity 63%) and 2.5 for the RMDQ (sensitivity 62% and specificity 55%). These estimates were comparable between the subacute and chronic subjects. Both the ODI and the RMDQ moderately correlated with the SF-36 and NRS (Spearman's and Pearson's correlation coefficients of >0.30). The Italian ODI and RMDQ proved to be sensitive in detecting clinical changes after conservative treatment for subacute and chronic LBP. Our findings are consistent with those published in the literature, thus allowing cross-cultural comparisons and stimulating cross-national studies.
Caldirola, Piero
Richiami di meccanica analitica ; richiami di termodinamica ; richiami di elettromagnetismo ; appunti sulla teoria della relatività ; la non validità delle teorie classiche nel mondo microscopico ; la meccanica atomica di Bohr e Sommerfeld ; I fondamenti della meccanica quantistica ; applicazioni nell'equazione di Schroedinger ; meccanica quantistica dei sistemi l'atomo di idrogeno ; particella in un campo elettrico e magnetico ; il calcolo delle perturbazioni nella teoria quantistica ; teoria dell'emissione e dell'assorbimento della luce ; sistemi di particelle identiche ; il legame chimico omopolare nella molecola di idrogeno ; la teoria di Dirac.
Nina, Vinicius José da Silva; Jatene, Fabio B.; Sevdalis, Nick; Mejía, Omar Asdrúbal Vilca; Brandão, Carlos Manuel de Almeida; Monteiro, Rosangela; Caneo, Luiz Fernando; Scudeller, Paula Gobi; Mendes, Augusto Dimitry; Mendes, Vinícius Giuliano; Romano, Bellkiss Wilma
2017-01-01
Introduction Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study. PMID:29267606
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Vinicius José da Silva Nina
Full Text Available Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1 translation of the questionnaire into Portuguese; (2 back translation into English; (3 panel of experts to draft the preliminary version; and (4 pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.
Le tentazioni di un genere : sul fantastico nella narrativa di Tabucchi
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Patrizia Farinelli
2007-12-01
Full Text Available Nella rielaborazione di Tabucchi del genere fantastico, l'evento strano e inspiegabile non crea una sovrapposizione di due realtà inconciliabili, semmai richiama l'attenzione su una realtà già in partenza permeata di illogico e quindi inafferrabile. Anche l'esitazione del protagonista di fronte a tale evento appare ridotta e di conseguenza limitata la sua ricerca di spiegazioni razionali. La quete del personaggio tabucchiano non si indirizza ali' evento strano e inspiegabile, ma piuttosto al passato ìrrisolto che questo fa riaffiorare. In questo senso i criteri indicati da Todorov come basilari per i riconoscimento del genere non tengono più pienamente. Indubbio è tuttavia che, pur in presenza delle trasformazioni indicate, diverse strategie narrative del fantastico continuano ad essere utilizzate da Tabucchi per costruire una dimensione multipla, sia a livello di storia che di discorso. Proprio perché la scrittura postmodema fa delll' ambiguità momento centrale di riflessione, non può non essere tentata (e sedotta dal fantastico.
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Maria Astone
2015-01-01
Full Text Available L’adozione del minore da parte di una persona singola torna all’attenzione della giurisprudenza che, ancora una volta, viene investita della questione relativa al riconoscimento ed efficacia di una sentenza straniera di adozione con effetti legittimanti. Tribunale per i minorenni Bologna 17 aprile 2013 si è trovato ad affrontare il caso di un genitore single, non coniugato, cittadino italiano, che, avendo ottenuto negli Stati Uniti d’America, una sentenza di adozione di minore, ne ha chiesto il riconoscimento. Due i problemi sottoposti al Tribunale: il primo, relativo alla competenza territoriale del giudice adito, positivamente risolto ai sensi degli articoli 40 e 41 della legge n. 218 del 1995 ; il secondo, invece, più complesso, legato agli effetti che il riconoscimento della sentenza avrebbe avuto in Italia. In particolare, per il giudice di merito si è trattato di stabilire se il provvedimento straniero di adozione potesse produrre anche in Italia gli effetti legittimanti dell’adozione ordinaria dei minori, già prodottisi negli Stati Uniti d’America.
The burden and undertreatment of fragility fractures among senior women.
Rodrigues, Ana M; Eusébio, Mónica; Santos, Maria José; Gouveia, Nélia; Tavares, Viviana; Coelho, Pedro S; Mendes, Jorge M; Branco, Jaime C; Canhão, Helena
2018-03-07
Using a large population database, we showed that fragility fractures were highly prevalent in senior women and were associated with significant physical disability. However, treatment rates were low because osteoporosis treatment was not prescribed or not agreed to by the majority of women with prevalent fragility fractures. The purpose of the study is to estimate prevalence of fragility fractures (FF), risk factors, and treatment rates in senior women and to assess impact of FF on physical function and quality of life. Women aged 65 years and older from the EpiReumaPt study (2011-2013) were evaluated. Rheumatologists collected data regarding FF, clinical risk factors for fractures, and osteoporosis (OP) treatment. Health-related quality of life (EQ5D) and physical function (HAQ) were analyzed. Peripheral dual-energy X-ray absorptiometry was performed. FF was defined as any self-reported low-impact fracture that occurred after 40 years of age. Prevalence estimates of FF were calculated. Among 3877 subjects evaluated in EpiReumaPt, 884 were senior women. The estimated prevalence of FF was 20.7%. Lower leg was the most frequent fracture site reported (37.8%) followed by wrist (18.6%). Only 7.1% of the senior women reporting a prevalent FF were under treatment for OP, and 13.9% never had treatment. OP treatment was not prescribed in 47.7% of FF women, and 23.4% refused treatment. Age (OR = 2.46, 95% CI 1.11-5.47), obesity (OR = 2.05, 95% CI 1.14-3.70), and low wrist BMD (OR = 2.29; 95% CI 1.20, 4.35; p = 0.012) were positively associated with prevalent FF. A significantly higher proportion of women in the lowest quintile of wrist bone mineral density reported FF (OR = 2.29, 95% CI 1.20-4.35). FF were associated with greater physical disability (β = 0.33, 95% CI 0.13-0.51) independent of other comorbidities. FF was frequently reported among senior women as an important cause of physical disability. However, the prevalence of OP treatment was
Sbrana, Francesco
1951-01-01
Calcolo integrale delle funzioni di una variabile ; serie di funzioni di una variabile reale o complessa ; proprietà notevoli delle curve piane e sghembe ; ancora sulla intregazione delle funzioni di una variabile ; derivate e differenziali delle funzioni di più variabili ; integrali curvilinei, e di campo ; equazioni differenziali ordinarie ; cenni sulle equazioni alle derivate parziali ; cenni sulle serie di funzioni ortogonali.
Prospettive della reazione di idroformilazione nella sintesi di composti biologicamente attivi
Marchetti, Mauro
2000-01-01
Il nostro gruppo sta conducendo uno studio su complessi di rodio con una nuova classe di leganti idrosolubili di origine proteica, tali complessi impiegati nell’idroformilazione bifasica in solvente acquoso di diversi substrati hanno fornito buoni risultati.