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Biomedical subjects

D J Walker

Publications and source records attributed to D J Walker.

At least 73 records · Page 4Linked to original sources
PubMed1993

A questionnaire for patients' evaluations of their physicians' humanistic behaviors.

OBJECTIVES: To determine what behaviors patients perceive as reflecting a physician's humanistic qualities, to develop an instrument for patients to use to assess the humanistic behaviors of their own physicians, and to compare patient assessment of residents' humanistic behaviors with patient satisfaction and the assessment of attending physicians. DESIGN: Cross-sectional descriptive study, using patient interviews and questionnaires, and evaluations of residents by attending physicians. SETTING: Inpatient medical service in a tertiary care teaching hospital and in a primary care internal medicine clinic. PARTICIPANTS: Six medical interns and six medical residents, 119 medical patients in the hospital, and 111 patients in the internal medicine clinic. MEASUREMENTS AND MAIN RESULTS: The 25-item Physicians' Humanistic Behaviors Questionnaire (PHBQ) was developed from patients' statements about important humanistic behaviors. The mean PHBQ scores were 4.46 +/- 0.22 (mean +/- SD, on a scale of 1 to 5) in the clinic and 4.18 +/- 18 in the hospital (p = 0.003). The Spearman's rank correlations between the PHBQ and the Medical Interview Satisfaction Scale (MISS) were r = 0.8741 (p < 0.001) in the hospital and r = 0.8751 (p < 0.001) in the internal medicine clinic. The Spearman's rank correlation between the hospital PHBQ and the attending physician evaluations (for the six residents for whom the authors had complete data) was r = 0.5753 (p = 0.232). CONCLUSIONS: Patients can evaluate the humanistic behaviors of their physicians using the PHBQ. There is good correlation between the PHBQ and patient satisfaction, which supports the validity of the PHBQ. The relative lack of agreement between patients and attending physicians suggests different observations, criteria, or standards. The higher ratings from patients in the clinic compared with those from patients in the hospital suggest that residents' behaviors are different or that patients have different observations, criteria, or standards in the two settings. Therefore, a complete assessment of residents' humanistic behaviors may require sampling in both settings.

Clinical Competence↗
PubMed1993

Both inherited HLA-haplotypes are important in the predisposition to rheumatoid arthritis.

The distribution of the HLA-DR allele frequencies of 105 RA patients has been compared with the expected distribution under recessive and dominant modes of inheritance using control data from 2041 controls and the antigen genotype frequency among patients methodology. The observed distribution was compatible with a recessive mode of HLA-linked inheritance in RA, with a dominant mode rejected, whether HLA-DR4 was considered alone, or HLA-DR4 and HLA-DR1 were combined as if they were behaving as a single predisposing gene. Mean sibship concordance rates (MSCRs) were calculated for categories of proband HLA-DR genotypes. The highest MSCR was for HLA-DR4 homozygous probands, and the lowest for HLA-DR2 or 7/non-4 genotypes. These combined observations suggest that interactions between both inherited HLA-haplotypes are important in the predisposition to RA.

Alleles↗
PubMed1993

An evaluation of the Health Assessment Questionnaire in long-term longitudinal follow-up of disability in rheumatoid arthritis.

We have used the Health Assessment Questionnaire (HAQ) to follow changes in disability in an unselected group of 245 patients with RA. The HAQ has been widely used in cross-sectional studies of disability in RA, but little is known about the dynamics of the change in HAQ score with long term follow-up. If it is to prove useful as a measure of health outcome it must not only be able to accommodate a wide range of disability but also show adequate sensitivity to change in disability. We administered the HAQ to 245 RA inpatients and outpatients at the beginning and end of a 5-yr period to address this important question. The mean change in individual HAQ score in the 175 patients for whom complete data was available was +0.18 (SD 0.66) over 5 yr, i.e. 0.03 units per year. It is likely that the observed rate of change in HAQ score is an under-estimate of the true rate of progression of disability, as the scale failed to accommodate change in disability toward its upper limit. The inherent design of the HAQ creates several 'ceilings' in functional subcategories (such as lower limb function) which may be masked by the overall HAQ score. Longitudinal studies of disability using the HAQ as outcome measure should therefore be interpreted with caution, and close attention paid to the baseline HAQ score.

Adult↗
PubMed1993

Rheumatoid arthritis, HLA identity, and age at menarche.

OBJECTIVE: To determine whether women with rheumatoid arthritis (RA) had differences in obstetric and gynaecological histories when compared with sisters without RA (controls) METHODS: Ninety eight RA discordant sister pairs, 36 of whom were identical for histocompatibility locus antigen (HLA-A, HLA-B, and HLA-Cw) types, were asked to recall their age of menarche, duration of use of contraceptive pill, pregnancy history, and age of menopause. RESULTS: The 98 siblings with RA had an older mean age of menarche (13.90 (95% confidence interval (95% CI) 13.56 to 14.24) years) than their sisters (13.49 (95% CI 13.22 to 13.76) years; mean difference within pairs 0.41, 95% CI 0.09 to 0.73 years, paired t test t = 2.54, p = 0.013). When the pairs were divided into identical HLA and non-identical HLA groups, the first showed no significant difference (mean difference 0.17 (95% CI -0.40 to 0.73) years), whereas the second did (mean difference 0.55 (95% CI 0.16 to 0.94) years, t = 2.80, p = 0.007). A multiple regression analysis to predict differences in menarche in the non-identical HLA sibling pairs failed to show any demographic or reproductive confounding variables. In 19 RA concordant sibling pairs, the seven HLA identical pairs had similar ages of menarche, whereas the 12 non-identical HLA pairs had interpair differences that narrowly missed significance (p = 0.054). All other obstetric and gynaecological variables were not significantly different within the pairs. CONCLUSIONS: The interpretations of these results are that either delayed menarche may predispose to or act as a marker of RA, or HLA linked genes are important in determining the age of menarche irrespective of disease state. This study fails to support a significant role for other obstetric and gynaecological variables in RA.

Adult↗
PubMed1993

Linkage of rheumatoid arthritis with HLA.

OBJECTIVE: To determine whether HLA exerts a variable influence on the predisposition of siblings of probands with clinically mild and severe rheumatoid arthritis (RA). METHOD: Calculation of crude and adjusted odds ratios for concordance rates in sibships sharing two, one and no HLA haplotypes with a proband with clinically mild and severe RA, and HLA haplotype sharing in multiply affected sibships in the same clinical groups. RESULTS: Compared with a reference value of 1.0 in siblings sharing no HLA haplotypes with a proband with mild RA, siblings sharing two HLA haplotypes with a severely affected proband had a sibship concordance rate odds ratio of 9.7 (95% confidence interval 2.5 to 38.2). When adjusted for age, sex, and disease duration, the odds ratio was 7.6 (1.8 to 32.4). No other sibships showed concordance rates which were significantly higher than the reference group. HLA haplotype sharing in multiply affected sibships in which the proband had severe RA deviated significantly from random (two, one, and no HLA haplotypes shared: 53.3, 40, and 6.7%, respectively; expected 25, 50, and 25%), whereas in sibships of probands with mild RA they did not (14.6, 70.8, and 14.6%). CONCLUSIONS: In the predisposition of siblings to RA, sharing HLA haplotypes with a proband is only important if the proband has severe RA. Mild RA is not genetically linked to the HLA region.

Adult↗
PubMed1992

Rheumatoid arthritis in thyroid disease positive and negative same-sexed sibships.

A total of 249 rheumatoid arthritis (RA) same-sexed sibships were clinically documented, HLA-typed and had auto-antibody screens performed. Sibships with a history of thyroid disease (TD) or significant thyroid antibodies were categorized as 'thyroid' sibships and the rest 'non-thyroid'. TD was more common in the female RA sibships than controls, particularly in the RA probands. The presence of thyroid microsomal antibody, but not thyroglobulin antibody, was significantly higher in all members of the female sibships, and in the probands and non-RA siblings of the male sibships. Comparing the thyroid and non-thyroid sibships, there was no significant difference in the distribution of HLA haplotypes in RA-RA sibling pairs, and HLA-DR status, clinical or immunological characteristics of the probands. These data do not support the concept that predisposition to RA in thyroid sibships might be non-DR4 or non-HLA linked.

Arthritis, Rheumatoid↗
PubMed1992

Anti-Proteus antibodies in rheumatoid arthritis same-sexed sibships.

One hundred and forty-two RA patients and 121 of their healthy same-sexed siblings were tested for antibodies (Abs) to Proteus mirabilis and Escherichia coli by indirect immunofluorescence. Eighty-five individuals had active RA (CRP greater than 10 mg/l) and 57 inactive RA. The anti-Proteus Ab titre in the active RA group was significantly higher than in the inactive RA and non-RA group (P less than 0.0001 in both cases). Anti-Proteus Abs were significantly elevated in 30 individuals with active RA compared with their healthy HLA-identical same-sexed siblings (P less than 0.001). In 42 HLA-DR4 positive and 15 HLA-DR4 negative active RA patients, the Ab titre was non-significantly higher in the former group. Anti-E. coli Abs were not significantly elevated in any of the groups. Longitudinal data on 36 RA patients demonstrated a significant positive correlation between changes in CRP and changes in anti-Proteus antibody titres (r = 0.52, P less than 0.001). These observations require an explanation.

Antibodies, Bacterial↗
PubMed1992

Specificity of the proteus antibody response in rheumatoid arthritis.

Antibodies to proteus were determined by indirect immunofluorescence in 146 serum samples from patients with rheumatoid arthritis (RA). An autoantibody screen was performed in the same samples and in 52 of these antibody titres to the viruses influenza A, adenovirus, rubella, and parvovirus were determined. There was no significant correlation between proteus antibodies and any of the other antibodies tested. Dividing the samples into those from patients with active (C reactive protein > 10 mg/l) and inactive RA showed that the only antibodies to be significantly increased in active RA were the proteus antibodies. These observations suggest that the proteus antibody response in RA is specific.

Acute Disease↗
PubMed1992

P blood group phenotype, proteus antibody titres, and rheumatoid arthritis.

The interrelationships between P blood group phenotype, proteus antibodies and rheumatoid arthritis (RA) were investigated in 140 patients with RA and 114 of their siblings who did not have RA. In the group with RA P2 subjects had significantly higher titres of proteus antibodies than P1 patients. This was not observed in the group without RA, or for antibodies to Escherichia coli. Although C reactive protein was the best predictor of proteus antibodies in the group with RA, the P blood group had an independent and significant influence. These observations suggest a testable model in which asymptomatic carriage of proteus in the urinary tract may lead to antibody production, which in turn may be important in the pathogenesis of RA.

Acute Disease↗
PubMed1992

Contribution of inherited factors to rheumatoid arthritis.

A total of 231 sibships of the same sex (186 female, 45 male), in which the proband had classical or definite rheumatoid arthritis (RA) have been selected from rheumatology clinics. Each sibship member was questioned about symptomatic joints, which were then examined. Hospital records, radiographs, and rheumatoid factor measurements allowed each sibling to be classified as having classical, definite, probable, or no RA. Each sibling was typed for HLA-A and B and was classified as sharing two, one, or zero HLA haplotypes with the proband. Concordance rates for classical and definite RA were three times greater in sibships of women than of men (9.3 v 3.0%). Concordance rates in HLA identical sibships were twice those in hemi- and non-identical sibships (15.5, 7.1, and 5.2%, respectively). Probable RA was more common in male and HLA hemi- and non-identical sibships. These results suggest that female sex and the two inherited HLA haplotypes are important for the presence and expression of RA. Although environmental factors may be shared more in twins than siblings, a concordance rate of 20.5% in seropositive HLA identical sibships of the same sex compared with 30% in monozygotic twins suggests that sex and HLA type account for about two thirds of the inherited risk of RA.

Arthritis, Rheumatoid↗
PubMed1992

Influence of the severity of rheumatoid arthritis on sex differences in health assessment questionnaire scores.

In a study of 284 consecutive patients with rheumatoid arthritis attending hospital clinics a previous observation that female patients score higher on the Stanford Health Assessment Questionnaire (HAQ) than men was confirmed. A clinical disease severity score and the spread/severity index also showed that women had more severe disease. Although scores in some categories of the HAQ were higher in women, they were not disproportionately so, providing no evidence that domestic categories of the HAQ are biased against women. A multiple regression analysis showed that the spread/severity index score was the best predictor of HAQ scores, with sex making no significant contribution. The severity of the disease adequately explained the higher HAQ scores in female patients with rheumatoid arthritis.

Arthritis, Rheumatoid↗