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J F Fries

Publications and source records attributed to J F Fries.

At least 91 records · Page 5Linked to original sources
PubMed1993

Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study.

Successful improvement in health in our increasingly aged population will depend in substantial part on reduction of age specific disability levels. In turn, the epidemiologic model suggests that this requires identification of risk factors, development of intervention models, and testing of these models. We attempted to identify risk factors for physical disability among 4,428 50-77-year-olds using baseline data collected in the first National Health and Nutrition Examination Survey (NHANES I) (1971-1975) linked to disability data collected 10 years later in the NHANES I Epidemiologic Followup Study. Results of forward stepwise linear regression analysis showed that the major characteristics contributing to greater disability (explaining at least 1% of the variability in scores) were older age at baseline, less nonrecreational activity, arthritis history, less education, female sex, and greater body mass index at age 40. Other factors associated with greater disability included a history of asthma, cardiovascular disease, abnormal urine test, less recreational activity, higher sedimentation rate, rheumatic fever history, lower caloric intake, positive musculoskeletal findings, histories of polio and allergies, lower family income, elevated blood pressure, lower serum albumin, history of tuberculosis, glucose in the urine, and histories of hip or spine fracture, chronic pulmonary disease, and kidney disease.

Adult↗
PubMed1993

Quality of life and health service use among HIV-infected patients with chronic diarrhea.

Health-related quality of life and the utilization of health resources are important components of the evaluation of patient outcome in HIV infection because medical problems are often progressive and debilitating, and treatment is palliative. We evaluated quality-of-life measures and resource utilization of patients with AIDS and/or CD4 lymphocytes < 200 who had symptoms of chronic diarrhea and compared them with similar patients with AIDS and/or CD4 lymphocytes < 200 without diarrheal symptoms. Annual charges were 50% higher for patients with chronic diarrhea ($24,567 versus $14,471 for the comparison group, p < 0.01). Higher charges for the patients with diarrhea were a result of more physician visits and diagnostic testing. Quality-of-life scores were poor for all patients, but deterioration over the year in role functioning (social activity, daily living, energy, cognition) and general health was clearly evident (p < 0.01) for the patients with chronic diarrhea. These patients also suffered significant work loss and reported greater need for assistance in the home. These data suggest that HIV-infected patients with diarrhea experience marked decreases in quality of life and that care for patients with chronic diarrhea is costly. Relatively little attention has been paid to this debilitating syndrome, and current treatment options rarely provide permanent relief. Research and innovation in this area are needed; an estimated 25-50% of HIV-positive individuals suffer from this symptom complex.

Adult↗
PubMed1992

The health assessment questionnaire 1992: status and review.

Over 100 papers describing and utilizing the Stanford Health Assessment Questionnaire (HAQ) have been published since 1980. A brief overview of the HAQ is presented along with a guide to the accumulated literature. The topics covered include: studies using the disability, pain, economic, and drug side effect dimensions of the HAQ; reliability and validity studies; applications to various rheumatic diseases; language adaptations; modifications and derivative scales; studies correlating the HAQ with sociodemographic, health status, laboratory, and physical measures; and randomized controlled trials and observational studies using the HAQ. A few comments regarding future directions for research are also presented.

Arthritis↗
PubMed1992

Physical activity and fractures over the age of fifty years.

Our aim has been to determine the relationship between long term physical activity (running) and the number and type of fractures occurring in 906 subjects. Analysis focused on the fractures which occurred during the last 10 years of observation in 722 subjects over the age of 55 years (456 runners and 266 nonrunners). Male and female runners had more fractures than nonrunners, mainly in the lower extremity. Men with a high body mass had fewer total fractures and fewer arm fractures than those with a lower body mass. Men and women with a high calcium intake had fewer fractures from falls than those with a low calcium intake. Fewer fractures from falls occurred in women the longer they had been taking hormones.

Aged↗
PubMed1992

Changes in quality of life among persons with HIV infection.

Health-related quality of life (QOL) is an important component of the evaluation of patient outcome in HIV infection where disease is progressive and debilitating. This paper compares patient-reported QOL obtained from questionnaires which cover functional ability, social functioning, cognition, mental health, disability days, disease symptoms, and overall health in the previous 3 months. These scales have been validated on HIV populations. We compared changes in health status over 12 months for 669 patients with varying HIV disease severity: 134 asymptomatic, 416 symptomatic (previously termed ARC), and 119 AIDS. Groups were evaluated at baseline for demographic and health status differences (i.e., age, CD4+). Declines in health status and psychosocial status were found over the year for all persons. Individuals with symptomatic disease or AIDS had significant declines of 10-20% (p < 0.001) in all aspects of role functioning (social, daily activities, energy, and global health) and increased disease symptoms, but no significant declines in cognition or mental health. Persons with AIDS had greater declines than those with symptomatic disease. AIDS and symptomatic patients also reported significantly fewer hours at work and more disability days than asymptomatic patients. The impact that HIV disease has on the health status of non-AIDS symptomatic patients is especially striking.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Osteophytosis of the knee: association with changes in weight-bearing exercise.

Osteoarthritis has been held to result from wear and tear. We addressed this hypothesis by analysis of anteroposterior radiographs of the knees of 51 subjects with mean age of 60 years who regularly practiced weight-bearing exercise. Radiographs were assessed for longitudinal changes in spur formation over a two-year period. The results showed a negative association between changes in weight-bearing exercise and changes in the rate of spur development in both males and females. The findings suggest that increasing repetitive impulse loading in the form of regular painless weight-bearing activity does not promote osteophytosis (or perhaps degenerative disease) in knee joints.

Aged↗
PubMed1992

The chronic disease data bank model: a conceptual framework for the computer-based medical record.

The principles underlying the chronic disease data bank model are straight-forward: (1) the purpose of medical care is to improve patient outcomes; (2) patient outcomes in contemporary developed societies are overwhelmingly linked to chronic illnesses and degenerative processes and will become increasingly so; (3) such outcomes have multiple determinants including the psychological and social, as well as the biologic; (4) outcome antecedents (risk factors) may precede clinical illness by years or decades; and (5) these complex characteristics require for their study (a) computer aid and (b) longitudinal data. The chronic disease data bank provides an important resource, available to many investigators, for examination of the complex set of clinical and policy questions arising with long-term illness and addressing the questions of lifetime health. The chronic disease data bank consecutively enrolls eligible subjects, follows them for life, and amasses time-oriented, multidisciplinary data including clinical findings, medical history, demographics, treatments, resource utilization and disease outcomes, and assessing both the quality of life and its duration. Analyses are longitudinal and time-series in type, examining changes in trends and tempo of the disease, and are focused upon long-term outcomes. Outcomes are regularly and carefully assessed, and include the outcome dimensions of death, disability, discomfort, iatrogenic toxicity, and dollar cost. Specific studies address the description of the disease from biologic, demographic, economic, and social viewpoints, identify the factors associated with good and bad outcomes, and assess the effects of treatment, both good and ill. The clinical and policy goals are focused upon delaying transitions from more benign disease states to more serious ones, thus improving both longevity and the quality of life. The time is appropriate to consider generalization of the chronic disease data bank model to the usual clinical care situation, with large rewards in improvement of the quality of care. The traditional medical record lacks systematic documentation of end results and of important covariates related to health risks. As such, it cannot readily be used to assess the ultimate quality of care and to establish a feedback loop to change behaviors and thereby improve outcomes. It is weak where the chronic disease data bank is strong. The technology is transferable.

Chronic Disease↗
PubMed1992

Strategies for reduction of morbidity.

The future health of our increasingly senior populations depend upon the interrelationship between two critical points: the onset time of the first major disease, infirmity, or disability and the time of death. Reduction of morbidity requires compressing the average period between these points and reducing the average level of morbidity during this period. The goal of compression of morbidity currently is being achieved in some areas. Life expectancy increases in the United States above age 65 y have plateaued, with further increases becoming ever more difficult. Some major chronic diseases, such as atherosclerosis and lung cancer, now occur later in life. Work disability prevalence has begun to decline. Intergenerational comparisons demonstrate improved health at specific ages. Randomized-controlled trials of primary prevention have failed to decrease total mortality in risk subjects while markedly decreasing the morbidity experienced by the same subjects. Compression has been documented for higher socioeconomic class subpopulations. These observations have major implications for health policy and mandate initiatives directed at prevention of disability and infirmity.

Age Factors↗
PubMed1992

Health status instruments and physical examination techniques in clinical measurement methodologies.

Chronic rheumatic diseases can severely compromise a patient's functional ability. These limitations are often better appreciated through a patient's self-report and a physician examination than through laboratory and radiographic assessments. Researchers are adapting the established health status questionnaires for non-English-speaking patients and for other rheumatic conditions besides rheumatoid arthritis. Rather than tailoring existing instruments for other diseases, some clinician investigators are developing entirely new disease-specific self-assessment questionnaires. Physicians are also addressing the subjectivity of their physical examination techniques. They are devising consistent and sensitive parameters that can be combined with health status questionnaires to monitor disease activity, gauge therapeutics, predict health services utilization, and predict work disability.

Disability Evaluation↗
PubMed1992

Predictors of disability in a longitudinal sample of patients with rheumatoid arthritis.

Information from the Health Assessment Questionnaire (HAQ) is used to identify which variables measured in 1981 successfully predict the severity of disease in 1989 and the eight year change in severity of disease in a sample of 330 residents of Santa Clara County, California, USA. This study is exploratory and no previous hypotheses are made. Using univariate correlations and stepwise linear regressions, initial values of a number of variables are found to be useful predictors including, in order: the HAQ disability index, pain scale, global health status, tender joints, few work hours, age, female sex, never married, widowhood, and occupation as operative (e.g. dry wall installers, assemblers). Data suggest that deterioration over eight years is least rapid for those with severe disease in 1981. A mathematical identity suggests that analyses of the changes in severity versus analyses of 1989 severity are identical, provided that the 1981 disability index is entered as a covariate. The initial level of the disability index of the HAQ is by far the strongest predictive variable and provides a clinically important gauge for the likelihood of future impairment.

Arthritis, Rheumatoid↗
PubMed1992

Gender and race differences in the correlation between body mass and education in the 1971-1975 NHANES I.

STUDY OBJECTIVE: Differences in the correlation between body mass index and education across four gender and race groups were investigated while simultaneously accounting for occupation, income, marital status, and age. DESIGN: The study used analysis of covariance techniques to calculate average body mass and confidence intervals within education categories while simultaneously adjusting for the covariates: age, square of age, family income, marital status, and occupation. SETTING: Data were drawn from the US National Health and Nutrition Examination Survey (NHANES I), 1971-1975. NHANES I is a national probability sample designed to gather information on the non-institutionalised US civilians, ages 1-74 years. SUBJECTS: Samples of 8211 white women, 1673 black women, 6188 white men, and 1023 black men were drawn from the NHANES I, 1971-1975. MAIN RESULTS: Data in the female samples indicate a strictly inverse relation between body mass and years of schooling among white women and an inverted "U" association among black women, achieving a maximum around 8 to 11 years of schooling. In the male samples data indicate inverted "U" relations among both black and white men, reaching maxima between 12 and 15 years of schooling. The sides of the "U" curve are much steeper for black than for white men. CONCLUSIONS: The four gender/race categories display four different body mass index and education associations. These four associations are only slightly altered by simultaneously adjusting for two additional measures of socioeconomic status: occupation and income.

Age Factors↗
PubMed1992

Improvement in intergenerational health.

Differences in health status between subjects, their parents, and their children were analyzed in 2206 subjects who had attended the University of Pennsylvania during the 1939 to 1940 school year. Subjects compared their overall health status at the average age of 70 with that of their same-sex parent at the same age and with that of their same-sex child at the approximate average age of 45, providing reasons for reported differences. Thus, health status in family members of the same sex at the same age in 1988 was compared with that in approximately 1963. Subject health was strikingly improved compared with that of their parents a generation earlier, with 58% reporting their health to be better or much better, and only 9% reporting it to be worse or much worse (P less than .001). The major reasons for the difference were decreased prevalence of chronic conditions and healthier life-styles. The same results were observed in a community-based population of 317 subjects and, even more strikingly, in a group of 422 aging long-distance runners. These observations suggest substantial improvement in senior health status over the past quarter century in selected populations, and they contrast with equivocal changes that have been noted with traditional serial survey techniques.

Age Factors↗
PubMed1992

Disability in occupations in a national sample.

OBJECTIVES: We sought to develop lists of jobs whose members reported high and low levels of functional disability. METHODS: Samples of women (n = 6096) and men (n = 3653) were drawn from the National Health and Nutrition Examination Survey I Epidemiological Follow-up. Disability was measured with a modified Stanford Health Assessment Questionnaire. We analyzed women and men separately, and we calculated average disability indices within longest-held occupations while adjusting for age, age-squared, married spouse present, and education. We minimized attrition bias with an econometric technique. RESULTS: From highest to lowest association with disability, the female broad occupations ranking was as follows: farming, no occupation, laborers, service, technicians, operatives, crafts workers, transportation operators, professionals, sales workers, administrative support, and managers. The male broad occupations ranking was as follows: no occupation, farming, operatives, crafts workers, service, technicians, manager, administrative support, sales, and professionals. The highest levels of disability for women and men occurred among nonconstruction laborers, farm workers, twisting machine operators, servants, machinery maintenance workers, mining machine operators, and bus drivers. CONCLUSIONS: Our results suggest that, in understanding levels of functional disability, occupational safety and health play a larger role than is generally assumed.

Persons with Disabilities↗
PubMed1992

Assessing and understanding patient risk.

Nonsteroidal anti-inflammatory drug (NSAID) gastropathy is the most frequent and one of the most severe drug side effects in the United States. NSAID-associated gastropathy has been estimated to account for at least 7600 deaths and 76000 hospitalizations each year in the United States alone. Hospitalizations in rheumatoid arthritis patients occurred in 1.6% of patients; for patients with osteoarthritis the incidence appears to be substantially lower. This is based on a consecutive series of 3000 patients with rheumatoid arthritis who were followed prospectively for an average of five years by ARAMIS, the Arthritis, Rheumatism and Aging Medical Information System. Multivariate analyses assessing risk factors for serious gastrointestinal (GI) events were performed on 1694 rheumatoid arthritis patients taking NSAIDs. The most important risk factors of higher age, use of prednisone, previous NSAID GI side effects, prior GI hospitalization, functional disability (based on the American Rheumatism Association classification), and NSAID dose are variables in an algorithm which estimates the risk of a serious GI event occurring in the next 12 months. Knowledge of risk factors and their interrelationships provides a tool for identifying patients at high risk and guides therapeutic decisions.

Aging↗
PubMed1992

Severity of disability and duration of disease in rheumatoid arthritis.

A longitudinal sample of patients with rheumatoid arthritis (RA) from Santa Clara County, CA was analyzed. Severity was measured with the Disability Index from the Health Assessment Questionnaire (HAQ). First, 6 cohorts were created of women and men with 0 to 10, > 10 to 20, and > 20 years of duration of illness in 1981. Experiences of the 6 cohorts were studied from 1981 to 1989. For both sexes, and both samples which alternately included and excluded the deceased, persons with > 20 years of duration experienced faster deterioration than those with < 20 years. Second, multiple regression models were estimated which treated the Disability Index as the dependent variable. In the regression models, the Disability Index worsened more quickly for women than men, for persons with few rather than many years of education, and for older than younger persons. Regression models which excluded an intercept term suggested a unique "S" shaped curve that described the Disability Index and duration relation.

Adult↗
PubMed1992

Impact of running on lumbar bone density: a 5-year longitudinal study.

Our study was designed to examine associations of longterm physical impact (running) with changes in lumbar bone mineralization. Study subjects were a volunteer sample of 14 members of a running club now aged 55 to 77 years and 14 matched controls undergoing computerized scans of the first lumbar vertebra both at baseline and after 5 years. Separate analyses included data from 23 runners available over the entire 5-year period. A decrease in bone mineral density (BMD) over time was statistically significant in both runners and controls. Among runners bone loss was most pronounced in those decreasing their running habits substantially. At the 5-year mark, runners maintained greater BMD. A highly significant correlation was found between change in lumbar BMD and average time spent running (min/week) over the 5-year period. Furthermore, changes in BMD were positively correlated with changes in run min/week. We conclude that regular running appears to reduce age related bone loss both in women and men over 50 years of age. However, substantial decreases in physical weight bearing activity are associated with important bone loss in the lumbar spine.

Aged↗