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C Bombardier

Publications and source records attributed to C Bombardier.

161 records · Page 9Linked to original sources
PubMed1983

Methodologic issues in international rheumatologic clinical epidemiology.

Those who provide, plan, or pay for health services must decide which rheumatologic health services should be provided to whom to effectively and efficiently reduce the burden of disease and disability from arthritis. The achievement of this goal demands the generation of epidemiologic information based on the burden of illness reported in a suitable format that allows policymakers to use the data in making decisions about health care. We have developed an approach based upon an "iterative measurement loop" consisting of a cycle of 6 epidemiologic research and evaluation steps that can be used to contribute to health policy decisions for allocation of health services to reduce the burden of illness from arthritis.

Epidemiologic Methods↗
PubMed1983

Measuring disability: guidelines for rheumatology studies.

Mortality and disease prevalence studies do not reflect adequately the burden of disabilities in populations. Disability surveys are necessary for planning and evaluation. Choosing among the large number of available disability assessments can be difficult. We present 11 specific questions which can be used as guidelines in planning a rheumatological study of disability. These guidelines are derived from strict methodological criteria.

Activities of Daily Living↗
PubMed1981

Ethanol tolerance in the rat is learned.

Rats were trained to walk on a treadmill to avoid foot shock. The animals developed tolerance for ethanol if given subsequent practice while ethanol intoxicated. Rats given equivalent doses of ethanol after practice did not develop tolerance, nor did saline-treated controls. These results challenge the hypothesis that mere repeated doses of ethanol are sufficient to induce tolerance. It seems that tolerance does not develop unless the response used to measure tolerance is performed while the subject is intoxicated.

Animals↗
PubMed1977

Socioeconomic factors affecting the utilization of surgical operations.

Between 1963 and 1970 public programs were introduced to reduce inequalities in access to medical care. We examined differentials in surgical utilization among socioeconomic groups in 1970 as well as changes between 1963 and 1970. Multivariate analysis of National Health Interview Survey data indicated that large increases in surgical utilization occurred among disadvantaged groups: the aged, lower educated and nonwhites in urban areas. Some differential by race and residence remains, but is strongly related to income. Income had a large positive effect on surgical utilization, but this effect was less strong in 1970 than in 1963. Education had a negative effect on surgical utilization. Eleven surgical procedures were selected and scaled on indexes of "complexity," "urgency" and "necessity." These indexes do not vary among demographic groups that have significant differences in surgical utilization. However, lower-income groups utilized to a lesser extent procedures rated lowest on the necessity scale.

Adolescent↗
PubMedDate not supplied

Quality of life of patients on long-term total parenteral nutrition at home.

Quality of life and quality-adjusted survival were measured for a cohort of 73 patients maintained on long-term parenteral nutrition at home (HPN) for periods ranging from six months to 12 years. Quality-adjusted survival was also modeled (although not directly observed) for this cohort under alternative therapeutic strategies (e.g., parenteral nutrition in hospital as needed). Using three utility assessment techniques (category scaling, time-tradeoff, direct questioning of objectives), quality of life was measured through interviews with 37 patients. The quality of life of the patients interviewed was good (mean value 0.73 where 0 represents death and 1.0 represents perfect health); for those who had experienced a period of chronic malnutrition before HPN, quality of life had improved. For the entire cohort, the estimate of quality-adjusted survival was four times greater with HPN than with the alternative therapeutic strategies (p less than 0.001). In comparison with alternative strategies, HPN significantly improves the quality of life of patients unable to sustain themselves with oral alimentation. Quality of life (utility) techniques can be used to evaluate the effectiveness of interventions for patients with chronic diseases.

Acute Disease↗
PubMedDate not supplied

Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.

OBJECTIVE: Many existing upper extremity outcome measures have been designed for a specific anatomic site (e.g., shoulder) or a specific disease entity (e.g., carpal tunnel syndrome). The purpose of this paper is to examine whether questionnaire items taken from very specific measures are considered relevant only to that specific region or are applicable to the whole extremity. METHODS: Fifteen practicing clinicians categorized a sample of 132 items from existing questionnaires according to whether the items reflected disability specific to an anatomic site or were relevant to the whole extremity. RESULTS: Seventy-two percent of the items were categorized as relevant to the extremity as a whole, while only 21% of the items were categorized as specific to an anatomic site. CONCLUSION: Items in existing specific upper extremity questionnaires are also relevant to other regions and conditions. This finding is in agreement with kinesiologic and biomechanical theories that the upper extremity acts as a single functional unit. Questionnaires designed for the whole extremity could provide a more practical and still valid measure of upper extremity disability.

Activities of Daily Living↗
PubMedDate not supplied

Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity.

UNLABELLED: The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was developed to evaluate disability and symptoms in single or multiple disorders of the upper limb at one point or at many points in time. PURPOSE: The purpose of this study was to evaluate the reliability, validity, and responsiveness of the DASH in a group of diverse patients and to compare the results with those obtained with joint-specific measures. METHODS: Two hundred patients with either wrist/hand or shoulder problems were evaluated by use of questionnaires before treatment, and 172 (86%) were re-evaluated 12 weeks after treatment. Eighty-six patients also completed a test-retest questionnaire three to five days after the initial (baseline) evaluation. The questionnaire package included the DASH, the Brigham (carpal tunnel) questionnaire, the SPADI (Shoulder Pain and Disability Index), and other markers of pain and function. Correlations or t-tests between the DASH and the other measures were used to assess construct validity. Test-retest reliability was assessed using the intraclass correlation coefficient and other summary statistics. Responsiveness was described using standardized response means, receiver operating characteristics curves, and correlations between change in DASH score and change in scores of other measures. Standard response means were used to compare DASH responsiveness with that of the Brigham questionnaire and the SPADI in each region. RESULTS: The DASH was found to correlate with other measures (r > 0.69) and to discriminate well, for example, between patients who were working and those who were not (p<0.0001). Test-retest reliability (ICC = 0.96) exceeded guidelines. The responsiveness of the DASH (to self-rated or expected change) was comparable with or better than that of the joint-specific measures in the whole group and in each region. CONCLUSIONS: Evidence was provided of the validity, test-retest reliability, and responsiveness of the DASH. This study also demonstrated that the DASH had validity and responsiveness in both proximal and distal disorders, confirming its usefulness across the whole extremity.

Arm↗
PubMedDate not supplied

Histocompatibility studies in psoriasis vulgaris: family studies.

A significant correlation between certain histocompatibility antigens, psoriasis and psoriatic arthritis is well established. Familial studies of psoriatic patients have shown a familial aggregation of psoriasis and psoriatic arthritis. In the present investigation, we studied 2 families in which psoriasis and/or psoriatic arthritis were seen in several members of different generations. HLA typing and mixed lymphocyte culture studies were performed. The results provide further documentation of the complexity of the genetic influences in psoriatic arthritis and psoriasis.

Adolescent↗