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Biomedical subjects

L F Callahan

Publications and source records attributed to L F Callahan.

At least 37 records · Page 2Linked to original sources
PubMed1996

Formal education and five-year mortality in rheumatoid arthritis: mediation by helplessness scale score.

OBJECTIVE: To analyze scores on a scale designed to measure helplessness, a cognitive variable, as a possible mediator of the association between formal education level and mortality over 5 years in patients with rheumatoid arthritis (RA). METHODS: A cohort of 1,416 patients with RA from 15 private practices in 6 states and Washington, DC was monitored for over 5 years. Demographic, socioeconomic, therapy, functional status, and psychological variables were analyzed as possible predictors of mortality in invariable and multivariable Cox Proportional Hazards models. RESULTS: In a 5-year followup, 1,384 patients were accounted for (97.3%), including 174 who died versus 111 expected (standardized mortality ratio = 1.54). Higher mortality was associated significantly with low formal education, high age, poor scores for activities of daily living (ADL) on a modified health assessment questionnaire (MHAQ), and poor scores on a helplessness scale (all P < 0.01) in univariable analyses. High age, few years of formal education, and poor MHAQ ADL scores were all significant independent predictors of mortality when analyzed simultaneously in a Cox Proportional Hazards model. When helplessness scale scores were included in a model, scores greater than 2.4 (on a scale of 1 to 4), higher age, male gender, and increased MHAQ ADL difficulty scores were all independently significantly predictive of 5-year mortality (P < 0.05), while years of education was no longer a significant predictor. CONCLUSION: Scores on a helplessness scale appear to mediate a component of the association between formal education level and 5-year mortality in these patients with RA. Health professionals and policy makers might consider interventions directed at modification of helplessness as adjunctive to standard interventions to improve outcomes in RA.

Adult↗
PubMed1995

The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups.

OBJECTIVE: To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States. METHODS: Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990-1992 National Health Interview Survey. RESULTS: The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to approximately 2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience approximately 1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions--more than 17 million in all--are limited in their activities. CONCLUSION: The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.

Activities of Daily Living↗
PubMed1995

The sense of coherence scale in patients with rheumatoid arthritis.

OBJECTIVE: To analyze Antonovsky's Sense of Coherence (SOC) Scale, in 828 patients with rheumatoid arthritis (RA) from 15 private rheumatology practices. This scale is designed to evaluate strengths within individuals that allow them to select appropriate strategies to deal with stressors; both the total 29-item (SOC-29) total scale and a 13-item (SOC-13) short form of the 29-item scale were analyzed. METHODS: Data were collected through mailed self-report questionnaires as a component of a long-term monitoring program. Internal consistency was evaluated according to Cronbach's alpha. Split-halves reliability was estimated according to the Spearman-Brown prophecy formula. Associations of the SOC-29 and the SOC-13 scale scores with demographic, clinical, and psychological variables were analyzed according to Pearson product moment correlations. RESULTS: Lower SOC-29 and SOC-13 scale scores were correlated significantly with higher scores for difficulty in performing activities of daily living (ADL), a visual analog pain scale score, global health status, and perceived learned helplessness. The levels of correlation for these variables suggest that each measure represents a construct that differs from the SOC. Lower scale scores were also correlated significantly with fewer years of formal education, adjusted for age, sex, and disease duration. CONCLUSIONS: The SOC-29 and SOC-13 scales are reliable and valid in patients with RA. The SOC scale explained in part variation in clinical status in patients with RA. The SOC-13 provides utility comparable to the SOC-29 in patients with RA.

Activities of Daily Living↗
PubMed1995

Mortality in the rheumatic diseases.

OBJECTIVE: To review mortality data in published studies of various rheumatic diseases. METHODS: A MEDLINE search of the literature on the rheumatic diseases, including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, scleroderma, polymyositis, and vasculitis. RESULTS: Mortality rates higher than expected have been reported in most rheumatic conditions, considerably higher for inflammatory rheumatic diseases. The mortality rates in patients with systemic lupus erythematosus, scleroderma, polymyositis, and vasculitis are often comparable to mortality rates seen in patients with neoplastic or cardiovascular diseases, although the causes of death often are not identified as the rheumatic disease. CONCLUSION: Mortality has been found to be predicted in most instances by more severe clinical status, and therefore death should not be considered as "unrelated" to the rheumatic disease. These observations may have important implications for clinical care and health policies regarding patients with rheumatic diseases.

Aged↗
PubMed1995

Systems for data analysis.

A system for data analysis is the end product of study planning, form design, data entry, data verification, and statistical analysis. This article reviews these steps and considers the fundamental choices in software for data entry and analysis. The appendix includes a listing of general and specialized software for data management and statistical analysis.

Data Interpretation, Statistical↗
PubMed1995

Quantitative analysis of hand radiographs in rheumatoid arthritis: time course of radiographic changes, relation to joint examination measures, and comparison of different scoring methods.

Quantitative studies of hand radiographs in patients with rheumatoid arthritis (RA) indicate that radiographic joint space narrowing and erosion are seen in more than 67% of patients within the 1st 2 years of disease, and progresses most rapidly during the 1st 5 years of disease, according to currently used scoring methods. Radiographic malalignment is rarely seen until after 5 years of disease. In cross sectional studies, correlations of radiographic scores with physical examination scores are minimally significant for joint tenderness, modestly significant for joint swelling, and highly significant for joint deformity and limited motion. In cross sectional studies, 3 quantitative methods, the Steinbrocker radiographic stage, modified Sharp method, and Larsen method, are highly significantly correlated and yield similar results in comparisons with other clinical measures.

Arthritis, Rheumatoid↗
PubMed1994

Prediction of long-term mortality in patients with rheumatoid arthritis according to simple questionnaire and joint count measures.

OBJECTIVE: To describe mortality over 15 years in a cohort of patients with rheumatoid arthritis, according to a simple questionnaire and joint count. DESIGN: A cohort study with 15 years of follow-up. SETTING: University hospital outpatient clinic. PATIENTS: A cohort of 75 patients with rheumatoid arthritis. MEASUREMENTS: Quantitative baseline measures: demographic, articular (joint counts), clinical, questionnaire, and physical measures, including modified questionnaire and joint count measures with substantially fewer items. RESULTS: Although few deaths were seen in the first 3 years after baseline, the standard mortality ratio over 15 years was 1.62, similar to findings in other series. Significant predictors of mortality included age, formal education level, joint count, activities-of-daily-living questionnaire scores, disease adjustment scores, morning stiffness, comorbid cardiovascular disease, grip strength, modified walking time, and button test. Five-year survival in patients with the poorest status according to these quantitative measures was 40% to 60%, comparable to expected survival at that time of patients with three-vessel coronary artery disease or with stage 4 Hodgkin disease. Simplified measures, including a count using only 28 joints and a questionnaire using only 8 activities of daily living, were similar to the more elaborate traditional measures for predicting mortality. CONCLUSION: Higher mortality rates in patients with rheumatoid arthritis are predicted by more severe clinical disease, as in other chronic diseases. Severe rheumatoid arthritis may be identified using quantitative functional status questionnaires and joint counts, which can be ascertained in about 10 to 15 minutes in any clinical setting.

Activities of Daily Living↗
PubMed1993

Depression scales in rheumatoid arthritis: criterion contamination in interpretation of patient responses.

Self-report depression scales include items concerning somatic symptoms, such as fatigue, pain, and inability to work, which may be symptoms of depression in individuals who do not have a chronic disease. However, in patients with somatic diseases such as rheumatoid arthritis, these symptoms may reflect disease rather than depression. Interpretation of responses to these items in patients with chronic disease as indicating depression is known as "criterion contamination". Criterion contamination has been described in responses of patients with rheumatoid arthritis on many widely-used depression scales, including the Minnesota Multiphasic Personality Inventory (MMPI), the Beck Depression Inventory, and the Center for Epidemiologic Studies Depression Index (CES-D). Evidence for criterion contamination in responses of patients with rheumatoid arthritis on these depression scales is summarized in this essay.

Arthritis, Rheumatoid↗
PubMed1993

Variability in individual responses of 532 patients with rheumatoid arthritis to first-line and second-line drugs.

Variability in individual responses to drugs used to treat rheumatoid arthritis was studied in 532 patients under care in seven U.S. rheumatology private practices. Among 15 nonsteroidal anti-inflammatory drugs (NSAIDs), estimated continuation of 1,775 courses was 48% at 12 months and 20% at 60 months. Acetylated salicylates, other than plain aspirin, were continued significantly longer than other NSAIDs. Among second-line drugs, estimated continuation of 50% of courses was 10 months for oral gold, 20 months for hydroxychloroquine, 21 months for penicillamine, 25 months for parenteral gold, 27 months for azathioprine, and more than 60 months for methotrexate and prednisone, the only drugs continued by more than 50% of patients 60 months after initiation.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

A brief measure of helplessness in rheumatic disease: the helplessness subscale of the Rheumatology Attitudes Index.

A short 5-item unifactorial form of the Rheumatology Attitudes Index was demonstrated to constitute an acceptable scale of helplessness for research or for clinical screening purposes. These items are the exact counterparts of the Arthritis Helplessness Index items that were identified as constituting a helplessness factor. These brief measures appear to be superior to their longer counterparts because they are conceptually less ambiguous and more convenient.

Attitude to Health↗
PubMed1993

What is the natural history of rheumatoid arthritis?

Analyses of the natural history of RA, recognizing that all patients receive therapies, indicate the following: 1. Classification criteria for RA identify individuals with (at least) three different types of pathogenetic processes and long-term outcomes; most patients seen in clinical settings have progressive disease. 2. Results of therapies documented to be efficacious in clinical trials are not applicable to the long-term course of RA, in part due to patient selection and the short-time frame of observation in clinical trials; most therapies for RA are not effective in most patients over long periods. 3. Over periods of 10 years or longer, most patients with RA experience radiographic progression and severe functional declines, and work disability is seen in 60% of patients after 10 years of disease. 4. Mortality rates are increased in patients with RA, although RA is generally not listed on death certificates. 5. Individual patients with RA who are at risk for early mortality may be identified through clinical markers, including many involved joints, comorbid cardiovascular disease, and poor functional status according to questionnaires and physical measures. 6. Patient behaviors and lifestyles identified through formal educational level as a marker appear of great importance in the prevalence, morbidity, and mortality of RA.

Arthritis, Rheumatoid↗