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Biomedical subjects

J J Anderson

Publications and source records attributed to J J Anderson.

At least 163 records · Page 9Linked to original sources
PubMed1989

Which traditional measures should be used in rheumatoid arthritis clinical trials?

It is standard practice to use multiple outcome measures in rheumatoid arthritis (RA) clinical trials. Because of this, multiple testing is usually done, and there is confusion in the interpretation of the results. It is not clear which measures are the most sensitive to detecting improvement and which provide independent information. To address these questions, we conducted an analysis of pooled raw data from 3 placebo-controlled RA trials: one of methotrexate, another of oral and injectable gold, and the third of low-dose and high-dose D-penicillamine. The results show that the joint tenderness count, erythrocyte sedimentation rate, grip strength, and physician assessment of disease activity perform best in RA clinical trials and cover the domain of change measured by traditional outcome measures. Other clinical measures may provide little additional useful information for a standard therapeutic trial of up to 6 months duration, and some measures, such as the proximal interphalangeal joint circumference, hemoglobin level, and 50-foot walking time, can be eliminated from such trials.

Administration, Oral↗
PubMed1989

Arthritis in nursing home residents. A validation of its prevalence and examination of its impact on institutionalization and functional status.

We studied nursing home residents to validate the method used in national surveys for estimating the prevalence of arthritis, and to examine the impact of arthritis on institutionalization and on the physical function of residents. Five homes were studied using a 3-phase approach. Directors of nursing in each home classified residents (n = 629) with respect to the presence of arthritis and senile dementia. The presence of osteoarthritis or rheumatoid arthritis and their impacts on a resident's initial placement were separately assessed by a physician through a chart review of a stratified subsample. The physician also rated a resident's likelihood of returning to community living. Finally, the functional impact of arthritis was assessed by a physical therapist. The nurses' estimate of the prevalence of arthritis in this population was 23.33%, while the physician estimate was 23.03%. These results are consistent with the 24.6% prevalence found in a 1977 national survey. Arthritis itself was a major cause of nursing home placement in 15% of all residents without dementia. Among those without dementia who also had arthritis, arthritis was a major cause of institutionalization in 31%. None of the residents without dementia showed substantial potential for reintegration into the community. Controlling for age, residents with arthritis had more pain, were more likely to require assistance in functional tasks, and were more likely to use a wheelchair daily than were their fellow residents. Nevertheless, our results suggest that arthritis, despite its impact on function, in and of itself is not a major cause of nursing home placement or ongoing institutionalization.

Activities of Daily Living↗
PubMed1989

Applicability of a health status model to osteoarthritis.

A five-component model of health status has been operationalized by the Arthritis Impact Measurement Scales (AIMS) to serve as a core for the health status assessment of individuals with rheumatoid arthritis (RA). These five components of health status are Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. To test the utility of this model, this study examines the stability and the applicability of the five-component model in a different rheumatic disease, osteoarthritis (OA). The model displays similar characteristics between OA and RA for Upper Extremity Function, Affect, and Social Interaction. Pain, however, appears to be more strongly associated with Physical Activity in the OA sample, suggesting that pain as a measured symptom of OA is closely related to ambulation, while pain as a symptom of RA may be more a manifestation of joint involvement and less dependent upon walking and climbing. This study presents the AIMS as a means of assessing five components of health status in either OA or RA.

Aged↗
PubMed1989

Familial resemblance of radial bone mass between premenopausal mothers and their college-age daughters.

The influences of heredity and environmental factors on radial bone mass were evaluated in 84 premenopausal mothers with their biological daughters (ages 18-22). Mid- and distal radial bone mineral content (BMC) and density (BMD) were assessed using single-photon absorptiometry. As a group, the daughters (mean age 18.6 years) had 5-10% less bone mass at both the distal and midradial sites than their mothers (mean age 44.2 years). Familial resemblance estimates showed significant relationships between mothers and daughters for mid- and distal BMC and BMD after considering the influence of body mass index (BMI). Daughters with a maternal family history of osteoporosis had 6-7% lower but nonsignificant values of mid- (P = 0.086) and distal BMC (P = 0.075) compared to values of women with a negative family history, whereas mothers with a positive family history had 3-4% lower (NS) values of distal and mid-BMC compared to those of mothers with a negative family history after adjustment for BMI. Multiple regression analyses showed BMI to be the most important determinant of the bone values of the mothers, and both BMI and dietary calcium intake were found to be significant for the daughters. The findings of this study suggest that hereditary contributions from the mothers play an overwhelmingly critical role in the accrual of bone mass by their daughters by ages 18-22, but that environmental influences on bone consolidation during the premenopausal decades may be more important in promoting optimal (peak) bone mass and thereby may help to delay the postmenopausal onset of osteoporotic fractures.

Adolescent↗
PubMed1989

Lifetime calcium intake and physical activity habits: independent and combined effects on the radial bone of healthy premenopausal Caucasian women.

Lifetime calcium intake and lifetime physical activity (PA) habits of 181 healthy premenopausal Caucasian women (aged 20-50) were studied. Nondominant arm was measured by single-photon absorptiometry at the distal (Dis) or 5-mm site and the midshaft (Mid) or two-thirds site of the radius. Values of bone mineral content (BMC), bone width (BW), and bone mineral density (BMD) were obtained. An intermediate or high lifetime Ca (greater than 500 mg/d) was significantly associated with a greater DisBMC (p = 0.0031), DisBMD (p = 0.0031), MidBMC (p = 0.0015), and MidBMD (p = 0.0015) when adjusted for PA. Similarly, with Ca adjusted for, a high lifetime PA (greater than or equal to 45 min of moderate to strenuous activity four times a week) was significantly associated with greater DisBMC (p = 0.0032), DisBMD (p = 0.0022), MidBMC (p = 0.0012), MidBW (p = 0.0173), and MidBMD (p = 0.0546). These findings suggest important roles for both adequate Ca intake and PA habits in enhancing peak adult skeletal mass and a trade-off between these two variables, when each was intermediate or higher.

Adult↗
PubMed1989

Ethnic and genetic differences in bone mass: a review with a hereditary vs environmental perspective.

Based on a review of the literature, ethnic and genetic factors are significant determinants of bone mass, along with such environmental factors as diet and exercise. Differences in bone density between blacks and whites remain even after adjustment for body mass. Black-white differences in bone mass appear to be related to ethnicity because blacks have not only greater skeletal calcium content, but also greater total body potassium and muscle mass. Genetic studies of twins and parent-offspring pairs reflect strong constitutional associations of both bone mineral content and bone density at commonly measured skeletal sites. At least for females, bone mass accumulation by age 20 y is highly associated with maternal bone mass; up to menopause it is enhanced by child-bearing and lactation; beyond menopause environmental factors seem to dominate. Dietary calcium and physical activity are significant in the control of bone mass. These findings are important for osteoporosis and fractures, especially in elderly people.

Aging↗
PubMed1989

Effect sizes for interpreting changes in health status.

Health status measures are being used with increasing frequency in clinical research. Up to now the emphasis has been on the reliability and validity of these measures. Less attention has been given to the sensitivity of these measures for detecting clinical change. As health status measures are applied more frequently in the clinical setting, we need a useful way to estimate and communicate whether particular changes in health status are clinically relevant. This report considers effect sizes as a useful way to interpret changes in health status. Effect sizes are defined as the mean change found in a variable divided by the standard deviation of that variable. Effect sizes are used to translate "the before and after changes" in a "one group" situation into a standard unit of measurement that will provide a clearer understanding of health status results. The utility of effect sizes is demonstrated from four different perspectives using three health status data sets derived from arthritis populations administered the Arthritis Impact Measurement Scales (AIMS). The first perspective shows how general and instrument-specific benchmarks can be developed and how they can be used to translate the meaning of clinical change. The second perspective shows how effect sizes can be used to compare traditional clinical measures with health status measures in a standard clinical drug trial. The third application demonstrates the use of effect sizes when comparing two drugs tested in separate drug trials and shows how they can facilitate this type of comparison. Finally, our health status results show how effect sizes can supplement standard statistical testing to give a more complete and clinically relevant picture of health status change. We conclude that effect sizes are an important tool that will facilitate the use and interpretation of health status measures in clinical research in arthritis and other chronic diseases.

Activities of Daily Living↗
PubMed1989

Impaired vision and hip fracture. The Framingham Study.

Falls affect a large proportion of the elderly and can result in a variety of injuries, including hip fractures. Several studies have suggested that visual impairment contributes to falls, but studies have not used standardized definitions of visual impairment and have not examined injurious falls or fractures. We looked at the risk of hip fracture associated with visual impairment in those members of the Framingham Study Cohort who took part in the Framingham Eye Study in 1973-75. Of 2,633 subjects followed for 10 years after the eye exam, 110 sustained hip fractures. The fracture rates in those with moderately impaired (20/30 to 20/80) vision (8.5%) and poor (20/100 or worse) vision (11.3%) were higher than in those with good (20/25 or better) vision (3.0%). After adjustment for age, sex, weight, alcohol consumption, and (in women) estrogen use, the relative risk of fracture in those with moderate impairment was 1.54 (95% CI = 0.95-2.49), while for those with poor vision, the relative risk was 2.17 (95% CI = 1.24-3.80). Of note, those with moderately impaired vision in one eye and good vision in the other had a higher risk of fracture (relative risk = 1.94) than those with a similar degree of binocular impairment (relative risk = 1.11). Poor vision in one or both eyes was linked to an elevated fracture risk. This suggests that good stereoscopic vision may be necessary to prevent falls. The risk of fracture with poor and moderately impaired vision combined was increased in women (relative risk = 1.96, 95% CI = 1.23-3.11) but not in men (relative risk = 0.79, 95% CI = 0.23-2.72).(ABSTRACT TRUNCATED AT 250 WORDS)

Accidental Falls↗
PubMed1989

Sensitivity of a health status measure to short-term clinical changes in arthritis.

To assess the sensitivity of the Arthritis Impact Measurement Scales (AIMS), we analyzed data from 3 clinical trials. One trial involving 255 patients with rheumatoid arthritis (RA) was a 12-week, randomized controlled trail of diclofenac, naproxen, and aspirin. Two trials were open-label studies of 24 weeks duration that included 165 RA and 355 osteoarthritis (OA) patients, all of whom were treated with diclofenac. In addition to the AIMS, tender joint count, morning stiffness, and erythrocyte sedimentation rate were used as outcome measures in the trials. The AIMS results showed substantial improvements in Physical Function, Psychological Status, and Pain, as well as in overall Arthritis Impact. These improvements were detected by the time of the initial outcome assessment at 4 weeks or 8 weeks, and were detected in patients with either OA or RA. These AIMS results closely parallel improvements shown by traditional clinical measures, and demonstrate that the AIMS health status measure is sensitive to improvements in OA as well as in RA. The AIMS also detects responses produced by therapy with nonsteroidal antiinflammatory drugs (NSAIDs), and these improvements can be demonstrated in as short a treatment time as 4 weeks. These findings confirm the utility of the AIMS for assessing outcome in rheumatic disease studies, and they have implications for the design of future clinical trials of NSAIDs.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1989

The prevalence of chondrocalcinosis in the elderly and its association with knee osteoarthritis: the Framingham Study.

Chondrocalcinosis and osteoarthritis (OA) both increase in prevalence with age, yet previous studies assessing their association have often been too small to adjust for age and have had biased selection of subjects. We assessed the prevalence of chondrocalcinosis and its link with OA in the Framingham Knee Osteoarthritis Study, a large population based study of the elderly. After controlling for age, we found a modestly increased rate of radiographic OA in those with chondrocalcinosis (relative risk = 1.52 (95% CI 1.22, 1.90). There was a similar link between chondrocalcinosis and severe radiographic OA (relative risk = 1.52). Chondrocalcinosis was positively associated with both symptomatic and asymptomatic radiographic OA. The proportion of radiographic OA potentially attributable to chondrocalcinosis was only 4.4%. Our results confirm that chondrocalcinosis is significantly associated with OA after controlling for age, but they also suggest that chondrocalcinosis and OA increase independently with age.

Aged↗
PubMed1988

Obesity and knee osteoarthritis. The Framingham Study.

STUDY OBJECTIVE: To determine whether obesity preceded knee osteoarthritis and was thus a possible cause. DESIGN: Cohort study with weight and other important variables measured in 1948 to 1951 (mean age of subjects, 37 years) and knee arthritis evaluated in 1983 to 1985 (mean age of subjects, 73 years). SETTING: Population-based participants; a subset (n = 1420) of the Framingham Heart Study cohort. METHODS: For those subjects in the Framingham Study having knee radiographs taken as part of the 18th biennial examination (1983 to 1985), we examined Metropolitan Relative Weight, a measure of weight adjusted for height at the onset of the study (1948 to 1951). Relative risks were computed as the cumulative incidence rate of radiographic knee osteoarthritis in the heaviest weight groups at examination 1 divided by the cumulative rate in the lightest 60% weight groups at examination 1. Relative risks were adjusted for age, physical activity level, and uric acid level. RESULTS: In 1983 to 1985, 468 subjects (33%) had radiographic knee osteoarthritis. For men, the risk of knee osteoarthritis was increased in those in the heaviest quintile of weight at examination 1 compared with those in the lightest three quintiles (age-adjusted relative risk, 1.51; 95% confidence interval [CI], 1.14 to 1.98); risk was not increased for those in the second heaviest quintile (relative risk, 1.0). The association between weight and knee osteoarthritis was stronger in women than in men; for women in the most overweight quintile at examination 1, relative risk was 2.07 (95% CI, 1.67 to 2.55), and for those in the second heaviest group, relative risk was 1.44 (95% CI, 1.11 to 1.86). This link between obesity and subsequent osteoarthritis persisted after controlling for serum uric acid level and physical activity level, and was strongest for persons with severest radiographic disease. Obesity at examination 1 was associated with the risk of developing both symptomatic and asymptomatic osteoarthritis. CONCLUSIONS: These results and other corroborative cross-sectional data show that obesity or as yet unknown factors associated with obesity cause knee osteoarthritis.

Activities of Daily Living↗
PubMed1988

A model of health status for rheumatoid arthritis. A factor analysis of the Arthritis Impact Measurement Scales.

Health status is a key aspect of quality of life that may be addressed and affected by health care. The measurement of this construct requires the identification of unique and relevant components of health status that can be operationally defined by specific scales or scale groupings. We explored the components of health status that are operationalized by the Arthritis Impact Measurement Scales (AIMS). Prior testing has shown that the AIMS measures delineate at least 3 components of health status: Physical Function, Psychological Status, and Pain. This 3-component model, however, can be theoretically and empirically restrictive. Using AIMS responses from a rheumatoid arthritis (RA) patient population, our investigation, through factor analyses, identifies 5 components of health status in this chronic disease: Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. It is proposed that these intuitively reasonable and measurable components constitute the core of the health status construct for individuals with RA. These 5 components could also prove central to the assessment of health status in other rheumatic diseases. Future studies of health status in RA should include tested measures to assess these 5 components.

Arthritis, Rheumatoid↗
PubMed1988

Dietary factors in bone health of elderly lactoovovegetarian and omnivorous women.

The relationships between dietary factors and radial bone indices of omnivorous (n = 287) and lactoovovegetarian (n = 88) postmenopausal women were investigated. Bone mineral content (BMC) and bone density (BD) were determined at mid and distal radius sites using a Norland single-beam bone densitometer. A quantitative food frequency questionnaire assessed usual current and long-term intakes. Multiple regression analyses showed that 1) vegetarianism was a positive contributor (p less than 0.05) to Mid BMC, 2) protein was a positive contributor (p less than 0.02) to Mid and Distal BMC, 3) phosphorus was a negative contributor (p less than 0.10) to Mid and Distal BMC and Mid BD, and 4) current calcium was not a significant contributor to any of the bone indices after age, body mass index, energy, protein, P, and vegetarianism were accounted for in the models. Estimations of long-term Ca intake and other nutrients are necessary if relationships between diet and bone are to be identified at any age period using cross-sectional epidemiological methods.

Aged↗
PubMed1988

Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work.

The authors used data from the United States first national Health and Nutrition Examination Survey of 1971-1975 (HANES I) to explore the cross-sectional associations between radiographic osteoarthritis of the knee and a variety of putative risk factors. A total of 5,193 black and white study participants aged 35-74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were available for analysis. After controlling for confounders, the authors found significant associations of knee osteoarthritis with overweight, race, and occupation, all of which have been suggested by smaller cross-sectional studies. They then focused specifically on those factors. For overweight, they found a strong association between current obesity and osteoarthritis of the knee, with a dose-response effect not previously assessed. This association was also seen for self-reported minimum adult weight, a proxy for long-term obesity, and was present in persons with asymptomatic osteoarthritis of the knee. These findings strongly suggest that obesity is causative. HANES I was the first study in which racial differences in osteoarthritis of the knee could be assessed within the same country. The black women who were studied had an increased risk of disease (odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.39-3.23) after controlling for age and weight, although the black men did not. Finally, the authors used the US Department of Labor Dictionary of Occupational Titles to obtain characterizations of the physical demands and knee-bending stress associated with occupations and to study the relation between physical demands of jobs and osteoarthritis of the knee. They found for persons aged 55-64 years an association between knee-bending demands and osteoarthritis of the knee (men, OR = 2.45, 95% CI = 1.21-4.97; women, OR = 3.49, 95% CI = 1.22-10.52). Since such occupational physical demands are common, the authors conclude that they may be associated with a substantial proportion of osteoarthritis of the knee.

Adult↗
PubMed1988

Alcohol consumption and hip fractures: the Framingham Study.

Alcoholics often sustain hip and other fractures. However, a detailed examination of the association between alcohol consumption and hip fractures has not been undertaken. Specifically, the effects of moderate alcohol intake, of alcohol consumption in the elderly, and of changes in consumption have not been studied. Using a retrospective cohort design, the authors evaluated this association in the population-based Framingham Heart Study cohort, a group studied over 35 years and queried repeatedly about their alcohol consumption. In 117,224 person-years of observation, 217 hip fractures occurred. Heavy current alcohol consumption (defined as seven or more ounces (207 ml or more) per week) was associated with a modestly increased risk of hip fracture for women (relative risk (RR) = 1.54) and for men (RR = 1.26) after adjustment for age. In a logistic regression analysis controlling for age, sex, weight, and smoking, current alcohol consumption was associated with a significant (p = 0.01) increase in risk of fracture. The relative risks at different ages were not uniform. For those aged less than 65 years, moderate (2-6 ounces (59.14-177.4 ml) per week) and heavy (seven or more ounces (207 ml or more) per week) were associated with a substantial and significant increased risk, but there was only a marginal and nonsignificant increase in risk in those aged 65 years or more. Examination of the effect of changing alcohol consumption over time indicated that among present heavy alcohol users, past light alcohol consumption reduced the risk (p = 0.03) of fracture, whereas in those with present light consumption, past heavy intake had little effect on fracture risk (p = nonsignificant). In conclusion, alcohol consumption, especially if long-term and heavy, increases the risk of hip fracture.

Accidental Falls↗
PubMed1988

The purification of four respiratory syncytial virus proteins and their evaluation as protective agents against experimental infection in BALB/c mice.

The fusion (F) glycoprotein, large glyco- (G) protein, phospho- (P) protein and 22K protein of respiratory syncytial (RS) virus A2 strain were purified by a combination of immunoaffinity adsorption and preparative SDS-PAGE. All four proteins elicited serum antibody in mice after repeated inoculation in adjuvant, although the magnitude of the response as measured by ELISA varied from mouse to mouse. The F protein generated neutralizing antibodies in only 50% of the mice determined to be seropositive by ELISA. The G protein also induced neutralizing antibodies but in this instance neutralization tests and ELISA titres were more closely correlated. No neutralizing activity was detected in mice immunized with the P or 22K proteins although all produced antibody detectable by ELISA. Mice immunized with either the F or the G protein were found to be protected against subsequent RS virus challenge, whether they had developed neutralizing antibody or not. Mice inoculated with the P or 22K proteins were not protected.

Animals↗