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R C Fiedler

Publications and source records attributed to R C Fiedler.

At least 37 records · Page 2Linked to original sources
PubMed1990

Functional assessment scales: a study of persons with multiple sclerosis.

The purpose of this study was to investigate disability in persons with multiple sclerosis (MS) by using combinations of functional assessment scales and subscales to predict (1) the burden of care measured in minutes of assistance provided per day by another person in the home, and (2) the subject's level of satisfaction with life in general. The Functional Independence Measure (FIM), Incapacity Status Scale, Environmental Status Scale, and the Barthel Index had high intercorrelations with each other. Although each was predictive of the MS subject's physical care needs, the FIM was the most useful. A change in total FIM score of one point was equivalent to an average of 3.38 minutes of help from another person per day. With the Brief Symptom Inventory and the Environmental Status Scale, the FIM contributed to predicting the patient's general satisfaction as well. We propose that burden of care and subjective satisfaction with life be the standards by which functional assessment instruments are compared to reflect, in pragmatic terms, the impact of disability on the lives of individuals and on the human and economic resources of the community.

Activities of Daily Living↗
PubMed1987

Mortality of a municipal-worker cohort: IV. Fire fighters.

Morbidity and mortality studies of fire fighters have produced varied and inconsistent findings regarding the potential chronic effects of fire fighting including respiratory disease, cardiovascular disease, and cancer. The mortality experience of 1,867 white male fire fighters who were employed for the City of Buffalo a minimum of five years with at least one year as a fire fighter was studied. Vital status was determined for 99% of the cohort, resulting in 470 observed deaths. The fire fighter cohort was characteristic of a healthy worker population. All-cause mortality was close to the expected standardized mortality ratio (SMR) = 95, and significantly lower than expected mortality was seen for all external causes (SMR = 67)--in particular, for suicide (SMR = 21) and respiratory diseases (SMR = 48). Significantly elevated SMRs were found for benign neoplasms (SMR = 417), cancer of the colon (SMR = 183), and cancer of the bladder (SMR = 286). Cause-specific mortality is presented by number of years employed, calendar year of death, year of hire, and latency. Cancer mortality was significantly higher in the long-term fire fighters, and risk of mortality from all malignant neoplasms tended to increase with increasing latency. Patterns in risk of mortality among fire fighters for cancers of the bladder, colon, and brain are intriguing. Additional follow-up of this cohort and initiation of cancer morbidity studies would be helpful in further clarifying the potential long-term effects of fire fighting on cancer risk.

Fires↗
PubMed1987

Sources of bias in retrospective cohort mortality studies: a note on treatment of subjects lost to follow-up.

The three important sources of bias in retrospective cohort mortality studies are: the healthy worker confounding bias, the lost to follow-up bias, and bias due to methods of follow-up that result in underascertainment of deaths. This paper presents how the treatment of the lost to follow-up impacts ultimately on the apparent forces of mortality in a cohort. The findings are discussed in the context of the other sources of bias. The treatment of subjects lost to follow-up as lost at the time of loss offers the best estimate of expected mortality and should be the preferred approach.

Age Factors↗
PubMed1986

Mortality of a municipal worker cohort: II. Females.

Women have become an increasingly important segment of the total work force, yet there are very few published occupational mortality studies of female workers. This paper reports the findings of a retrospective cohort mortality study of 1,371 full-time female municipal employees of the City of Buffalo, New York, who were employed at least 1 day between January 1, 1950, and October 1, 1979, and who worked a minimum of 5 years. Vital status was ascertained for 88% of the female cohort, resulting in the identification of 214 observed deaths. This predominantly white-collar, service-oriented female cohort demonstrated significantly lower mortality than that expected based on U.S. mortality rates for white females. This strong "healthy-worker effect" was consistent across the time period of the study, across cause-specific mortality especially for all malignant neoplasms and all diseases of the circulatory system, and across different workers groups. Findings are discussed in light of the methodological issues involved in occupational studies of female workers.

Adult↗
PubMed1986

Mortality of a municipal worker cohort: III. Police officers.

Very little is known about the long-term health risks associated with the high stress police officer occupation. We report here on a retrospective cohort of 2,376 ever-employed white male police officers employed between January 1950 and October 1979. Vital status was obtained for 96%, the officers accumulating a total of 39,462 person-years. Six-hundred sixty-one deaths were observed. Total mortality from all causes was comparable to that of the overall U.S. white male population (standardized mortality ratio [SMR] = 106). Significantly increased mortality was seen for all malignant neoplasms combined (SMR = 127), cancer of the esophagus (SMR = 286), and cancer of the colon (SMR = 180). Significantly lower than expected mortality was seen for infectious diseases (SMR = 26), respiratory diseases (SMR = 64), and accidents (SMR = 60). Internal cohort comparisons revealed that policeman exhibited significantly higher mortality from suicide compared to all other municipal employees (rate ratio = 2.9). Analysis of mortality by length of service as a police officer showed that those employed 10-19 years were at significantly increased risk of digestive cancers and cancers of the colon and lymphatic and hematopoietic tissues and decreased risk for all diseases of the circulatory system. Policeman employed more than 40 years had significantly elevated SMRs for all causes, all malignant neoplasms combined, digestive cancers, cancers of the bladder and lymphatic and hematopoietic tissues, and arteriosclerotic heart disease. Risk of mortality from arteriosclerotic heart disease tended to increase with increasing years employed. These findings are discussed in light of the police stress literature. The hypotheses generated in this study must be tested through study of the role of important confounders including reactions to stress on the job.

Adult↗
PubMed1985

Mortality of a municipal worker cohort: I. Males.

A retrospective cohort mortality study was conducted on 11,499 full-time municipal employees of the City of Buffalo, New York, who were employed at least one day between January 1, 1950 and October 1, 1979 and worked a minimum of five years. This paper outlines the method of the study and presents the all cause and cause-specific mortality for the male cohort of 10,128. Statistically significant deficits in mortality are seen for infectious diseases, diseases of the circulatory system, diseases of the respiratory system, and all external causes. Statistically significant increased mortality is seen for both malignant and benign neoplasms. All cause mortality was significantly lower than expected for professional, manager, and clerical workers. White-collar workers exhibit a decreased risk of mortality from all diseases of the circulatory system, all diseases of the respiratory system, and all external causes of death. No statistically significant increased or decreased risk of mortality from specific cancer sites is seen for white-collar workers. Blue-collar workers show statistically significant deficits in mortality from infectious diseases, all diseases of the circulatory system, all respiratory diseases, and all external causes. Blue-collar workers exhibit statistically significant increases for benign and malignant neoplasms and in particular, malignant neoplasms of the esophagus, large intestine, and rectum. The meaning of these findings will be clarified through analyses of specific worker groups.

Adult↗
PubMed1985

Mortality of workers in an automobile engine and parts manufacturing complex.

A proportionate mortality ratio (PMR) study was conducted using data on workers from three local unions representing an integrated automobile factory composed of forge, foundry, and engine (machine and assembly) plants. Ninety four percent of the death certificates were obtained for all active and non-active workers who died during the period 1 January 1970 to 31 December 1979 and were vested in union and company benefit programmes. Observed numbers of deaths were compared with expected numbers based on two standards, the proportionate mortality among men in the United States 1970-9 and among men in Erie County 1975. There was close agreement between the number of observed and expected deaths by either standard of comparison among white auto workers in the forge and foundry plants. Valid analyses of cause specific mortality among non-whites could be conducted for the foundry plant only. Although there was raised PMR for deaths due to diseases of the circulatory system using the Erie County standard, none of the other cause specific PMRs was significant. Although based on small numbers, the risk of cancer of the lung was significantly high in non-whites under age 50 in the foundry (PMR = 2.6; p less than 0.05). The cause specific PMRs for whites in the engine plant were statistically significant for malignant neoplasms (1.2) and all external causes (0.62) based on the US white male standard. Analysis of cancer specific mortality among white men in the machining/assembly plant showed significant excesses for cancer of the digestive system (PMR=1.5), particularly of the liver (PMR=2.6) and pancreas (PMR=1.9); cancers of the respiratory system (PMR=1.4 using the Erie County standard); and cancer of the urinary bladder (PMR=2.3). Workers employed for more than 20 years showed statistically increased mortality ratios for cancers of the digestive system (1.9), particularly cancer of the pancreas (2.3) and cancer of the rectum (2.8). Individuals whose employment began during or before 1950 exhibited increased PMRs for cancers of the digestive organs (1.8), particularly of the pancreas (2.5) and of the bladder (3.4). Workers whose employment began after 1950, on the other hand, exhibited raised PMRs for cancers of the respiratory system (1.5) and of the kidney (3.2). Since the foundry and forge plants did not start production until 1955, mortality associated with those work settings may be greater in the future.

Adult↗
PubMedDate not supplied

Functional gain and length of stay for major rehabilitation impairment categories. Patterns revealed by function related groups.

This study evaluates the relationship of functional severity to patterns of functional gain and length of stay (LOS) for patients discharged from medical rehabilitation. It further compares differences in patterns between summed and Rasch transformed subscales of the Functional Independence Measure (FIM). Two different schemes of the FIM-Function Related Groups (FIM-FRGs) are used to define groups of patients who present with similar degrees of functional severity. The first scheme was developed using summed admission motor and cognitive FIM subscores (FIM-FRGs). The second scheme was developed by transforming these same motor and cognitive FIM subscores into logits (Logit FIM-FRGs), thus making FIM scores more equal-interval. The study included 32,494 patients who were discharged from 123 facilities that submitted data to the Uniform Data System for Medical Rehabilitation (UDSMR) and involved the separate evaluation of 18 different rehabilitation impairment categories. Motor FIM gain was calculated for each FRG in both schemes as the patient's discharge motor FIM score minus the admission motor FIM score. There were four patterns of motor FIM gain and two patterns of LOS across rehabilitation impairment. The most common pattern in both schemes was linear trend, for which median gains and LOS were highest for patients in the most disabled FRGs and lowest for patients in the least disabled FRGs. Gain patterns differed across impairment and across the two schemes. The motor FIM gain distributions provide clinicians with a range of typical functional outcomes for patients admitted to medical rehabilitation. This descriptive approach provides clinicians and administrators with a simple way to compare the motor FIM gain and LOS patterns of patients teated in local facilities with broad-based norms. This sample includes about one-quarter of rehabilitation facilities nationwide, thus representing population standards for facilities participating in the UDSMR. Suggestions are made on how to use these norms most appropriately for both facility and patient comparison.

Activities of Daily Living↗
PubMedDate not supplied

A brief outpatient functional assessment measure: validity using Rasch measures.

The Medical Rehabilitation Follow Along (MRFA(TM)) is a brief outpatient functional assessment measure that was developed using Rasch analysis. The MRFA currently has musculoskeletal, neurologic, multiple sclerosis, cardiac, and pulmonary forms. Using Rasch scoring and selected scales, the 31-item musculoskeletal form of the MRFA was compared with and contrasted to a measure of general health status, the Medical Outcomes Trust SF-36. Content, construct, and criterion validity were addressed using scale scores before and after outpatient rehabilitation, as well as therapist ratings of improvement. The results supported the validity of inferences made from the MRFA scales using Rasch measures for persons with musculoskeletal problems. Rasch and raw scoring provided similar results with respect to the validity of the MRFA scales. Implications for the use of Rasch and raw scoring approaches with the MRFA are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Predicting follow-up functional outcomes in outpatient rehabilitation.

Functional outcomes at an average of six months after outpatient rehabilitation were investigated in a pilot study with a sample of 42 patients receiving physical therapy for low back, neck, and other musculoskeletal problems. Logistic regression analyses were used to study variables related to the achievement of a predetermined level of physical functioning or to whether improvement occurred from initial to follow-up assessment. Scales used in the analyses were obtained from two measures of functioning, the Medical Outcomes Trust Short Form 36 (SF-36) and the Medical Rehabilitation Follow Along (MRFA instrument). Demographic and program characteristic variables obtained from clinic records were also included in the analyses. The independent variables entered into two groups of regression equations included age, gender, presenting problem, workers' compensation coverage, functioning at initial assessment, number of visits, length of program, and intensity of program. For the SF-36, the General Health scale and presenting problem predicted above or below a level greater than one standard deviation less than the mean on the Physical Functioning scale at follow-up. The combination of the Role Physical and Role Emotional scales predicted follow-up level on the Physical Component Summary (PCS) scale. The interaction of age and intensity of treatment was predictive for both the Physical Functioning and PCS scales. For predicting improvement or no improvement using the SF-36 scales, General Health and the interaction between age and intensity were predictive of change on the Physical Functioning scale, whereas age and the interaction between age and number of visits were predictive of change on the PCS scale. For the MRFA instrument, the interaction between age and the intensity of treatment was predictive for both a predetermined level of physical functioning and amount of improvement in physical functioning at follow-up. An intensity rating of pain and a measure of affective distress at initial assessment both improved the identification of patients at risk for not reaching a given level of functioning, whereas treatment intensity improved the identification of those patients at risk for not showing improvement at follow-up. Length of time between the end of outpatient therapy and follow-up assessment was generally not related to follow-up physical functioning. Interpretation and implications of these findings, as well as applications of this analytic approach to outcomes assessment, are discussed.

Activities of Daily Living↗
PubMedDate not supplied

The Interest Checklist: a factor analysis.

OBJECTIVE: The purpose of this study was to determine whether the 80 items on the Interest Checklist empirically cluster into the five categories of interests described by Matsutsuyu, the developer of the tool. METHOD: The Interest Checklist was administered to 367 subjects classified in three subgroups: students, working adults, and retired elderly persons. An 80-item correlation matrix was formed from the responses to the Interest Checklist for each subgroup and then used in a factor analysis model to identify the underlying structure or domains of interest. RESULTS: Results indicated that the Social Recreation theoretical category was empirically independent for all three subgroups; the Physical Sports and Cultural/Educational theoretical categories were empirically independent for only the college students and working adults; and the Manual Skills theoretical category was empirically independent for only the working adults. CONCLUSION: Although therapists should continue to be cautious in their interpretation of patients' Interest Checklist scores, the tool is useful for identifying patients' interests in order to choose meaningful activities for therapy.

Activities of Daily Living↗