Biomedical subjects
Carlos A Agudelo
Publications and source records attributed to Carlos A Agudelo.
Use of laboratory studies in rheumatologic diseases.
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Is it gout? Tap the joint!
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Prediction of pain behavior and functional status of rheumatoid arthritis patients using medical status and psychological variables.
This study examined the extent to which the psychological variables of depression, anxiety, and helplessness predicted the pain behavior and functional status of 64 rheumatoid arthritis (RA) patients beyond what could be predicted on the basis of demographic and medical status variables. Pain behavior was evaluated using a standardized observation method, and functional status was assessed using a modified Health Assessment Questionnaire (MHAQ) and rheumatologists' ratings. Regression analyses revealed that a modified rheumatoid activity index and/or disease duration were significant predictors of levels of guarding, rigidity, and total pain behavior. The psychological variables examined did not predict independently RA pain behavior. The rheumatoid activity index explained a significant proportion of the variance in functional status ratings and MHAQ daily function scores. Age, disease duration and depression also were independent predictors of functional status ratings. Thus, depression had a significant relationship with physician ratings of functional status but not with patient self-reports of disability. Psychological factors not examined in this study that might influence RA pain behavior and self-reports of functional status are discussed.
Development of an observation method for assessing pain behavior in rheumatoid arthritis patients.
Four studies examined the reliability and validity of a behavioral observation method for the assessment of pain associated with rheumatoid arthritis (RA). The major purpose of experiment 1 was to evaluate the interobserver reliability of the observation method. Two observers recorded the frequencies of pain behaviors displayed by 20 RA patients. Each of 3 types of reliability estimates indicated that the pain behavior could be reliably observed. The purpose of experiment 2 was to examine the concurrent validity of the observation system by correlating 53 patients' self-reports of pain with the frequencies of their pain behaviors. Significant and positive correlations were found between patients' total pain behavior and 3 self-report measures of pain and functional disability. Furthermore, unlike the self-reports of pain, total pain behavior was only minimally related to self-report of depression. Experiment 3 was performed in order to assess the observation method's construct validity. Naive observers viewed video recordings of 25 RA patients and made global estimates of patients' pain severity and unpleasantness. Highly significant and positive correlations were found between these global estimates and total pain behavior. In experiment 4, the pain behaviors of 11 RA patients were recorded prior to and immediately following cognitive-behavioral treatment for the reduction of RA pain. There was a significant decrease in total pain behavior from pretreatment to posttreatment. The data indicate that the observation method provides a reliable, valid, and relatively objective measure of RA patient pain behavior. Future validation studies of the observation method are discussed.
[Use of health services and epidemiological profiles as parameters for adjusting the Compulsory Health Plan in Colombia].
OBJECTIVE: To evaluate the use of health services and the epidemiological profiles as parameters for adjusting the contents of the Compulsory Health Plan--POS. METHODS: An evaluative study of the contents of the Compulsory Health Plan--POS was performed regarding the use of health services and the regional epidemiological profiles, within the framework of the current problems of the General System of Health Social Security. The 1994 Survey on Equity of the Fiscal Expenditure, the 1997 National Survey on Quality of Life, and the 2000 National Household Survey estimated the use of services. The epidemiological profiles were obtained from the 2000 mortality data of the National Administrative Statistics Department--DANE. RESULTS: Affiliation to the health system has only reached 56% of the total population. However, health expenditure has increased constantly between 1993 and 2000, from 7.2% to nearly 10% of the GNP. Greater use of health services was found among the elderly population, and people with greater levels of spending. Women, particularly those residing in urban areas and on the higher quintile of spending, are the people who most use the health services. The people who use health services the least are men in urban areas in the lower quintile of spending. CONCLUSIONS: Organizing the Compulsory Health Plan with a modular structure makes it possible to adjust it according to the parameters of the use of health services and epidemiological profiles, in such a way that it contributes to the opportunity and pertinence of services, as well as to increase the affiliation to the system.