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J F Fries

Publications and source records attributed to J F Fries.

At least 55 records · Page 3Linked to original sources
PubMed1996

Risk factors for adult Still's disease.

OBJECTIVE: To assess risk factors for adult Still's disease (ASD). METHODS: A matched case-control study of 60 patients with ASD and 60 same sex siblings closest in age was conducted. Subjects were recruited from cohorts in Eastern Canada, Pittsburgh, and the Arthritis, Rheumatism, and Aging, Medical Information Systems (ARAMIS). A questionnaire was used to obtain data on demographic characteristics, education, income, occupation, exposure to toxic substances, stress, and medical history. RESULTS: 116 patients with ASD were identified, of which 104 participated. 86 identified same sex siblings, of which 60 replied. When compared to same sex siblings, ASD patients were similar with respect to education and occupation but had a trend to higher median income. There were no significant associations of ASD with smoking, alcohol consumption, individual toxic substances, vaccination, blood transfusion, minor or major surgery, pregnancy, or diet in the year preceding disease onset. There were no significant associations with tonsillectomy or adenoidectomy, appendectomy, asthma, hay fever, allergy shots, or pregnancy at any time preceding the onset of disease. There was a statistically nonsignificant increase in a history of exposure to coal dust [odds ratio (OR) 3.0; 95% confidence interval (CI) 0.30 to 28.84], in allergy preceding the onset of disease (OR 2.67; 95% CI 0.71 to 10.05), and in oral contraceptive use in the year preceding onset (OR 2.00; 95% CI 0.18 to 22.06). Stressful life events (OR 2.56; 95% CI 1.18 to 5.52) in the year preceding onset was significantly associated with increased risk for ASD. This positive association should be treated with caution unless confirmed by a separate study. CONCLUSION: This exploratory study of risk factors for ASD draws attention to stress as a potentially important risk factor, while likely excluding a considerable number of others.

Adult↗
PubMed1995

Potential and actual workdays lost among patients with HIV.

How many more potential and actual workdays are lost by HIV patients than persons without HIV? To answer this question, we assessed differences in the number of workdays among a panel of AIDS patients, patients who were HIV positive but did not yet have AIDS, and comparison patients. The patients included persons who were employed and unemployed. Information on 1,346 patients was gathered from January 1, 1990, to December 31, 1992, as part of the ongoing ATHOS (AIDS Time-Oriented Health Outcome Study) study. Data were collected every 3 months on AIDS and HIV-positive patients and every 6-12 months on the comparison patients. At the end of the study (December 31, 1992), 856 people were still enrolled. A total of 5,507 panel data points covering 3 years were available. Data were analyzed with a linear regression model. We found that patients with AIDS reported 29-32 and HIV-positive patients reported 9-13 more potential and actual workdays lost out of the previous 90 than the comparison patients, other variables being equal. All p values were < 0.005, and most were < 0.0001. We conclude that (a) while the AIDS patients showed substantially more workdays lost than the comparison group, the HIV-positive group showed only a modest number of more days lost than the comparison group and (b) that previous estimates exaggerated indirect morbidity costs.

Absenteeism↗
PubMed1995

Hours at work and employment status among HIV-infected patients.

OBJECTIVE: To study differences in employment and work hours among three groups of HIV-infected and non-infected individuals. METHODS: Data on 1263 patients seen in five different sites in California were drawn from the AIDS Time-Oriented Health Outcome Study. Three groups of patients were examined: AIDS patients, HIV-positives without diagnosed AIDS, and HIV-negatives. The HIV-negative patients were used as a comparison group in comparing hours worked by all patients, whether they worked or not; the probability of working, regardless of the number of hours; and work hours only for those patients who worked. RESULTS: Adjustment for covariates in a 2-equation econometric model reduced the difference in employment rates between the AIDS patients and the other two groups, suggesting that characteristics other than AIDS status account, in part, for their low employment rates. After adjustment, we did not find any statistically significant differences in employment probabilities or work hours between the HIV-positive patients without diagnosed AIDS and the comparison group. However, AIDS patients reported approximately 14 work hours fewer (P < 0.0001) and lower probabilities of employment (P < 0.0001) than the HIV-negative comparison group among all patients with and without jobs. Moreover, among those with jobs, patients with AIDS reported approximately 3 work hours fewer per week (P = 0.0385). No statistically significant differences in work hours were found between HIV-positives without diagnosed AIDS and comparison patients. CONCLUSION: AIDS patients were less likely to be employed than either of the other groups, but crude, unadjusted unemployment rates exaggerate the effect of AIDS. For those employed, AIDS patients work only 3 h less per week than either of the other groups.

Adult↗
PubMed1995

ARAMIS and toxicity measurement. (Arthritis Rheumatism and Aging Medical Information System).

Side effects of medications make up an important part of adverse outcomes experienced by patients with rheumatic diseases. Quantitative measures to assess toxicity, however, have not been available, and this lack has limited estimates of the magnitude of effects and of differences in side effects among different drugs. This paper describes the development of the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) Toxicity Index and the issues arising in construction of such an index, and reviews early results in comparing toxicities of antirheumatic drugs. Findings have had major value in revising therapeutic strategies for rheumatic diseases, particularly rheumatoid arthritis, and have set the stage for development of toxicity-therapeutic ratios for different drugs.

Adverse Drug Reaction Reporting Systems↗
PubMed1994

Running and the development of disability with age.

OBJECTIVE: To determine, by longitudinal study, whether regular vigorous running activity is associated with accelerated, unchanged, or postponed development of disability with increasing age. STUDY DESIGN: 8-year prospective, longitudinal study with yearly assessments. PARTICIPANTS: 451 members of a runners' club and 330 community controls who were initially 50 to 72 years old (also characterized as "ever-runners" [n = 534] and "never-runners" [n = 247], respectively). MEASUREMENTS: The dependent variable was disability as assessed by the Health Assessment Questionnaire and separately validated in these participant cohorts. Covariates included age, sex, body mass index, comorbid conditions, education level, smoking history, alcohol intake, mean blood pressure, initial disability level, family history of arthritis, and radiologic evidence of osteoarthritis of the knee in a subsample. RESULTS: Initially, the runners were leaner, reported joint symptoms less frequently, took fewer medications, had fewer medical problems, and had fewer instances of and less severe disability, suggesting either that the average previous 12 years of running had improved health or that self-selection bias was present. After 8 years of longitudinal study, the differences in initial disability levels (0.026 compared with 0.079; P < 0.001) had steadily increased to 0.071 for runners compared with 0.242 for controls (P < 0.001). The difference was consistent for men and women. The rate of development of disability was several times lower in the runners' club members than in community controls; this difference persisted after adjusting for age, sex, body mass, baseline disability, smoking history, history of arthritis, or other comorbid conditions (slopes of progression of disability for the years 1984 to 1992, after adjusting for covariates: men in the runners' club, 0.004 [SE, 0.002]; community controls, 0.012 [SE, 0.002]; women in the runners' club, 0.009 [SE, 0.005]; community controls, 0.027 [SE, 0.004]; P < 0.002 for both sets of comparisons). In addition to differences in disability, there were significant differences in mortality between the runners' club members (1.49%) and community controls (7.09%) (P < 0.001). These differences remained significant after adjusting for age, sex, body mass, comorbid conditions, education level, smoking history, alcohol intake, and mean blood pressure (P < 0.002, conditional risk ratio for community controls compared with the runners, 4.27; 95% CI, 1.78 to 10.26). CONCLUSIONS: Older persons who engage in vigorous running and other aerobic activities have lower mortality and slower development of disability than do members of the general population. This association is probably related to increased aerobic activity, strength, fitness, and increased organ reserve rather than to an effect of postponed osteoarthritis development.

Aging↗
PubMed1994

Criteria for rheumatic disease. Different types and different functions. The American College of Rheumatology Diagnostic and Therapeutic Criteria Committee.

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

Forecasting↗
PubMed1994

The mortality of rheumatoid arthritis.

OBJECTIVE: To determine the risk and causes of death and to quantify mortality predictors in patients with rheumatoid arthritis (RA). METHODS: RA patients (n = 3,501) from 4 centers (Saskatoon n = 905, Wichita n = 1,405, Stanford n = 886, and Santa Clara n = 305) were followed for up to 35 years; 922 patients died. RESULTS: The overall standardized mortality ratio (SMR) was 2.26 (Saskatoon 2.24, Wichita 1.98, Stanford 3.08, Santa Clara 2.18) and increased with time. Mortality was strikingly increased for specific causes: infection, lymphoproliferative malignancy, gastroenterologic, and RA. In addition, as an effect of the SMR of 2.26, the expected number of deaths was increased nonspecifically across all causes (except cancer), with a large excess of deaths attributable to cardiovascular and cerebrovascular diseases. Independent predictors of mortality included age, education, male sex, function, rheumatoid factor, nodules, erythrocyte sedimentation rate, joint count, and prednisone use. CONCLUSION: Mortality rates are increased at least 2-fold in RA, and are linked to clinical severity.

Arthritis, Rheumatoid↗
PubMed1994

Measurement of health status in children with juvenile rheumatoid arthritis.

OBJECTIVE: To develop and validate a self- or parent-administered instrument for measuring functional status in children with juvenile rheumatoid arthritis (JRA). METHODS: We adapted the Stanford Health Assessment Questionnaire (HAQ) for use in children ages 1-19 years, by adding several new questions, such that for each functional area, there was at least 1 question relevant to children of all ages. The face validity of the instrument was evaluated by a group of 20 health professionals and parents of 22 healthy children. The questionnaire was then administered to parents of 72 JRA patients (mean age 9.1 years, onset type systemic in 16, polyarticular in 21, pauciarticular in 35). RESULTS: The instrument showed excellent internal reliability (Cronbach's alpha = 0.94), with a mean inter-item correlation of 0.6. The convergent validity was demonstrated by strong correlations of the Disability Index (average of scores on all functional areas) with Steinbrocker functional class (Kendall's tau b = 0.77, P < 0.0001), number of involved joints (Kendall's tau b = 0.67, P < 0.0001), and morning stiffness (Kendall's tau b = 0.54, P < 0.0001). Spearman's correlation coefficient between Disability Index scores from questionnaires administered to parents and those from questionnaires administered to older children (> 8 years) was 0.84 (n = 29; P < 0.001), showing that parents can accurately report for their children. The test-retest reliability, studied at a 2-week interval, revealed virtually identical Disability Index scores measured on the 2 occasions (0.96 versus 0.96; P > 0.9 by paired t-test; Spearman's correlation coefficient = 0.8, P < 0.002). CONCLUSION: The Childhood HAQ, which takes less than 10 minutes to complete, is a valid, reliable, and sensitive instrument for measuring functional status in children with JRA.

Arthritis, Juvenile↗
PubMed1994

Patient education and health promotion can be effective in Parkinson's disease: a randomized controlled trial. PROPATH Advisory Board.

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

Activities of Daily Living↗
PubMed1994

Correlations between education and arthritis in the 1971-1975 NHANES I.

Data from the National Health and Nutrition Examination Survey I, 1971-1975 (NHANES I) were used to analyze associations among highest education level and arthritis. The dependent variables indicated whether the respondent had ever been diagnosed with any form of arthritis by a physician (10,678 women and 7243 men) or whether physician X-ray readings suggested arthritis of the knee (3491 women and 3119 men). These variables did not distinguish between osteo- and rheumatoid arthritis. It is likely that the great majority of the sample reporting or diagnosed with arthritis had osteoarthritis. There were strong univariate correlations between answers to the general arthritis question and the knee question on the one hand and gender, age, body mass, schooling, income and employment on the other. Respondents' education level was found to be strongly and negatively associated with self-reported arthritis in the larger samples both before and after controls were entered for employment, income and potential biological risk factors. The association between self-reported arthritis or arthritis of the knees and education was weaker for men, but not for women after employment and income were accounted for. When body mass was accounted for, the association between self-reported arthritis or arthritis of the knees and education was weaker among women but not men. Long-run preventive strategies to combat osteoarthritis ought to consider investments in education.

Adult↗
PubMed1994

Predictors of physical disability after age 50. Six-year longitudinal study in a runners club and a university population.

Predictors of disability were studied over 6 years among 50- to 80-year-old members of a runners club (N = 407) and a university population (N = 299). Data have been collected annually since 1984 on sociodemographic characteristics, health habits, medical history, medication use, family history, psychological parameters, and physical disability as measured by the Health Assessment Questionnaire. Members of the runners club, compared to university participants, had better overall health and less disability at baseline (0.03 versus 0.08) and at 6-year follow-up (0.04 versus 0.24). Predictors of greater subsequent disability among university participants were greater baseline disability, greater medication use, greater number of pack-years of cigarette smoking, older age, being unmarried, higher blood pressure, history of arthritis, and less physical activity compared to one's peers. In addition, changes in characteristics during follow-up that were independently associated with greater disability were development of joint pain, arthritis, or bone fracture and increased body mass index. Predictors of greater disability in the runners group included greater baseline disability, being a nonrunner at baseline, greater dietary salt intake, more years of running at baseline, and greater frequency of physician visits for running injuries. Greater disability in this group also was associated with increases in medication use, declining alcohol consumption, and development of joint pain over 6 years. Results of this study suggest that physical disability is linked to a constellation of characteristics, health habits, medical history, comorbidities, and marital status. While self-selection bias cannot be ruled out entirely, these data are consistent with the hypothesis that those who engage in high levels of physical activity beyond middle age will continue to maintain better functional abilities.

Aged↗
PubMed1994

Education, gender, and the compression of morbidity.

According to the Compression of Morbidity (CM) hypothesis, people who exercise, eat nutritiously, do not smoke, and maintain good weight, i.e., people who practice healthy habits, will be more likely to live free of disabling diseases and injuries up until the last few months or years of life. The Increasing Misery (IM) hypothesis, on the other hand, holds that preventive health measures will extend life expectancy but will also increase the number of infirm years. The CM theory implies that curves of morbidity or disability with age should become increasingly "rectangular" for groups who practice healthy habits in the broadest sense. The IM theory does not. This Rectangularization hypothesis is examined with cross-sectional data measuring disability from the Epidemiological Follow-up to the National Health and Nutrition Examination Survey, I (NHEFS), using years of schooling as the independent variable proxy representing favored health status, and examining interactions with age. A modified version of the Disability Index (DI) from the Stanford Health Assessment Questionnaire (HAQ) is used to measure disability. In some analyses, deceased subjects were assigned the worst disability score. Four subsamples of women and men, fifty years old and over, alive and deceased in 1982-84, were analyzed. Female, and especially male, subsamples which included the deceased provided evidence for the CM hypothesis. Results for the subsamples of those remaining alive in 1982-84 were ambiguous. However, lifetime (over age 50) cumulative disability was 21 to 60 percent less for the more educated than the less educated, depending upon whether deceased were included or excluded. If higher education level is an appropriate surrogate for the effect of good health practices, then extending such practices will result in less, rather than more, lifetime disability.

Activities of Daily Living↗
PubMed1994

Health care demand management.

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

Awards and Prizes↗
PubMed1994

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

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

Adolescent↗