المؤلفون: Alves, Kristin, Godwin, Christine L, Chen, Angela, Akellot, Daniella, Katz, Jeffrey N, Sabatini, Coleen S

المصدر: BMC Health Services Research. 18(1)

مصطلحات موضوعية: Health Services and Systems, Health Sciences, Clinical Research, Prevention, Health Services, 8.1 Organisation and delivery of services, Health and social care services research, Good Health and Well Being, Adult, Attitude of Health Personnel, Buttocks, Child, Delivery of Health Care, Female, Fibrosis, Health Personnel, Humans, Iatrogenic Disease, Injections, Intramuscular, Interviews as Topic, Male, Middle Aged, Motivation, Paralysis, Qualitative Research, Uganda, Gluteal fibrosis, Post-injection paralysis, Injection practices, Safe injection, Pediatric musculoskeletal health, Pediatric orthopaedics, Intramuscular injection, Library and Information Studies, Nursing, Public Health and Health Services, Health Policy & Services, Health services and systems, Public health

الوصف: BackgroundIatrogenic injection injury is a major cause of disability in Ugandan children. Two injuries thought to result from injection of medications into the gluteal region include post-injection paralysis (PIP) and gluteal fibrosis (GF). This study aimed to describe perceptions of local health care workers regarding risk factors, particularly injections, for development of GF and PIP. Specifically, we examine the role of injection practices in the development of these injuries by interviewing a diverse cohort of individuals working in the health sector.MethodsWe conducted a qualitative study in the Kumi and Wakiso Districts of Uganda in November 2017, utilizing 68 key informant interviews with individuals working in healthcare related fields. Interviews were structured utilizing a moderator guide focusing on injection practices, gluteal fibrosis and post-injection paralysis.ResultsWe identified six themes regarding perceptions of the cause of GF and PIP and organized these themes into a theoretical framework. There was a consensus among the individuals working in healthcare that inadequacies of the health care delivery system may lead to inappropriate intramuscular injection practices, which are presumed to contribute to the development of GF and PIP. Poor access to medications and qualified personnel has led to the proliferation of private clinics, which are often staffed by under-trained practitioners. Misaligned economic incentives and a lack of training may also motivate practitioners to administer frequent intramuscular injections, which cost more than oral medications. A lack of regulatory enforcement enables these practices to persist. However, due to limited community awareness, patients often perceive these practitioners as appropriately trained, and the patients frequently prefer injections over alternative treatment modalities.ConclusionThis qualitative study suggests that inappropriate intramuscular injections, may arise from problems in the health care delivery system. To prevent the disability of GF and PIP, it is important to not only address the intramuscular injections practices in Uganda, but also to examine upstream deficits in access, education, and policy enforcement.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3nq1t9sfTest

المؤلفون: Kraus, Virginia Byers, Collins, Jamie E, Hargrove, David, Losina, Elena, Nevitt, Michael, Katz, Jeffrey N, Wang, Susanne X, Sandell, Linda J, Hoffmann, Steven C, Hunter, David J

المصدر: Annals of the Rheumatic Diseases. 76(1)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Aging, Chronic Pain, Pain Research, Arthritis, Clinical Research, Musculoskeletal, Aged, Biomarkers, Case-Control Studies, Disease Progression, Female, Humans, Male, Middle Aged, Osteoarthritis, Knee, Pain Measurement, Predictive Value of Tests, Prognosis, ROC Curve, Radiography, Sensitivity and Specificity, Severity of Illness Index, OA Biomarkers Consortium, Disease Activity, Knee Osteoarthritis, Osteoarthritis, Immunology, Public Health and Health Services, Arthritis & Rheumatology, Clinical sciences

الوصف: ObjectiveTo investigate a targeted set of biochemical biomarkers as predictors of clinically relevant osteoarthritis (OA) progression.MethodsEighteen biomarkers were measured at baseline, 12 months (M) and 24 M in serum (s) and/or urine (u) of cases (n=194) from the OA initiative cohort with knee OA and radiographic and persistent pain worsening from 24 to 48 M and controls (n=406) not meeting both end point criteria. Primary analyses used multivariable regression models to evaluate the association between biomarkers (baseline and time-integrated concentrations (TICs) over 12 and 24 M, transposed to z values) and case status, adjusted for age, sex, body mass index, race, baseline radiographic joint space width, Kellgren-Lawrence grade, pain and pain medication use. For biomarkers with adjusted p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/18b9038bTest

المؤلفون: Roemer, Frank W, Guermazi, Ali, Collins, Jamie E, Losina, Elena, Nevitt, Michael C, Lynch, John A, Katz, Jeffrey N, Kwoh, C Kent, Kraus, Virginia B, Hunter, David J

المصدر: BMC musculoskeletal disorders. 17(1)

مصطلحات موضوعية: Cartilage, Articular, Menisci, Tibial, Bone Marrow, Humans, Osteoarthritis, Knee, Synovitis, Disease Progression, Magnetic Resonance Imaging, Case-Control Studies, Aged, Middle Aged, Female, Male, Osteophyte, Biomarkers, MRI, Osteoarthritis, Progression, Scoring, Cartilage, Articular, Menisci, Tibial, Knee, Clinical Sciences, Orthopedics

الوصف: BackgroundTo describe the scoring methodology and MRI assessments used to evaluate the cross-sectional features observed in cases and controls, to define change over time for different MRI features, and to report the extent of changes over a 24-month period in the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium study nested within the larger Osteoarthritis Initiative (OAI) Study.MethodsWe conducted a nested case-control study. Cases (n = 406) were knees having both radiographic and pain progression. Controls (n = 194) were knee osteoarthritis subjects who did not meet the case definition. Groups were matched for Kellgren-Lawrence grade and body mass index. MRIs were acquired using 3 T MRI systems and assessed using the semi-quantitative MOAKS system. MRIs were read at baseline and 24 months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. We provide the definition and distribution of change in these biomarkers over time.ResultsSeventy-three percent of the cases had subregions with BML worsening (vs. 66 % in controls) (p = 0.102). Little change in osteophytes was seen over 24 months. Twenty-eight percent of cases and 10 % of controls had worsening in meniscal scores in at least one subregion (p

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3d57p99kTest

المؤلفون: Collins, Jamie E, Losina, Elena, Nevitt, Michael C, Roemer, Frank W, Guermazi, Ali, Lynch, John A, Katz, Jeffrey N, Kwoh, C Kent, Kraus, Virginia B, Hunter, David J

المصدر: Arthritis & Rheumatology. 68(10)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Arthritis, Pain Research, Osteoarthritis, Aging, Chronic Pain, Musculoskeletal, Aged, Arthralgia, Bone Marrow, Bone Marrow Diseases, Cartilage, Articular, Case-Control Studies, Disease Progression, Female, Humans, Knee Joint, Logistic Models, Magnetic Resonance Imaging, Male, Menisci, Tibial, Middle Aged, Multivariate Analysis, Organ Size, Osteoarthritis, Knee, Osteophyte, Radiography, Synovitis, Tibial Meniscus Injuries, Immunology, Public Health and Health Services, Arthritis & Rheumatology, Clinical sciences

الوصف: ObjectiveTo determine the association between changes in semiquantitative magnetic resonance imaging (MRI) biomarkers over 24 months and radiographic and pain progression over 48 months in knees with mild-to-moderate osteoarthritis (OA).MethodsWe undertook a nested case-control study as part of the Foundation for the National Institutes of Health Biomarkers Consortium Project. We used multivariable logistic regression models to examine the association between change over 24 months in semiquantitative MRI markers and radiographic and pain progression in knee OA. MRIs were read according to the MRI OA Knee Score system. We focused on changes in cartilage, osteophytes, meniscus, bone marrow lesions, Hoffa-synovitis, and effusion-synovitis.ResultsThe most parsimonious model included changes in cartilage thickness and surface area, effusion-synovitis, Hoffa-synovitis, and meniscal morphology (C statistic 0.740). Compared with no worsening, worsening in cartilage thickness in ≥3 subregions was associated with 2.8-fold (95% confidence interval [95% CI] 1.3-5.9) greater odds of being a case, and worsening in cartilage surface area in ≥3 subregions was associated with 2.4-fold (95% CI 1.3-4.4) greater odds of being a case. Worsening of meniscal morphology in any region was associated with 2.2-fold (95% CI 1.3-3.8) greater odds of being a case. Worsening effusion-synovitis and Hoffa-synovitis were also associated with a greater odds of being a case (odds ratios 2.7 and 2.0, respectively).ConclusionTwenty-four-month changes in cartilage thickness, cartilage surface area, effusion-synovitis, Hoffa-synovitis, and meniscal morphology were independently associated with OA progression, suggesting that these factors may serve as efficacy biomarkers in clinical trials of disease-modifying interventions for knee OA.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/14n7r761Test

المؤلفون: Losina, Elena, Paltiel, A David, Weinstein, Alexander M, Yelin, Edward, Hunter, David J, Chen, Stephanie P, Klara, Kristina, Suter, Lisa G, Solomon, Daniel H, Burbine, Sara A, Walensky, Rochelle P, Katz, Jeffrey N

المصدر: Arthritis Care & Research. 67(2)

مصطلحات موضوعية: Osteoarthritis, Chronic Pain, Health Services, Pain Research, Arthritis, Aging, Clinical Research, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Musculoskeletal, Good Health and Well Being, Adult, Aged, Arthroplasty, Replacement, Knee, Female, Health Care Costs, Health Services Needs and Demand, Humans, Male, Middle Aged, Models, Economic, Osteoarthritis, Knee, United States, Clinical Sciences, Public Health and Health Services, Psychology

الوصف: ObjectiveThe impact of increasing utilization of total knee arthroplasty (TKA) on lifetime costs in persons with knee osteoarthritis (OA) is understudied.MethodsWe used the Osteoarthritis Policy Model to estimate total lifetime costs and TKA utilization under a range of TKA eligibility criteria among US persons with symptomatic knee OA. Current TKA utilization was estimated from the Multicenter Osteoarthritis Study and calibrated to Health Care Cost and Utilization Project data. OA treatment efficacy and toxicity were drawn from published literature. Costs in 2013 dollars were derived from Medicare reimbursement schedules and Red Book Online. Time costs were derived from published literature and the US Bureau of Labor Statistics.ResultsEstimated average discounted (3% per year) lifetime costs for persons diagnosed with knee OA were $140,300. Direct medical costs were $129,600, with $12,400 (10%) attributable to knee OA over 28 years. OA patients spent a mean ± SD of 13 ± 10 years waiting for TKA after failing nonsurgical regimens. Under current TKA eligibility criteria, 54% of knee OA patients underwent TKA over their lifetimes. Estimated OA-related discounted lifetime direct medical costs ranged from $12,400 (54% TKA uptake) when TKA eligibility was limited to Kellgren/Lawrence grades 3 or 4 to $16,000 (70% TKA uptake) when eligibility was expanded to include symptomatic OA with a lesser degree of structural damage.ConclusionBecause of low efficacy of nonsurgical regimens, knee OA treatment-attributable costs are low, representing a small portion of all costs for OA patients. Expanding TKA eligibility increases OA-related costs substantially for the population, underscoring the need for more effective nonoperative therapies.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/49w7j4fmTest

المؤلفون: Solomon, Daniel H, Tonner, Chris, Lu, Bing, Kim, Seoyoung C, Ayanian, John Z, Brookhart, M Alan, Katz, Jeffrey N, Yelin, Ed

المصدر: Arthritis Care & Research. 66(8)

مصطلحات موضوعية: Arthritis, Autoimmune Disease, Clinical Research, Inflammatory and immune system, Adult, Age Factors, Antirheumatic Agents, Arthritis, Rheumatoid, Female, Hispanic or Latino, Humans, Male, Medication Adherence, Middle Aged, Socioeconomic Factors, Surveys and Questionnaires, Treatment Outcome, White People, Withholding Treatment, Clinical Sciences, Public Health and Health Services, Psychology

الوصف: ObjectiveDisease-modifying antirheumatic drugs (DMARDs) are the standard of care for rheumatoid arthritis (RA); however, studies have found that many patients do not receive them. We examined predictors of starting and stopping DMARDs among a longitudinal cohort of patients with RA.MethodsStudy participants came from a cohort of RA patients recruited from a random sample of rheumatologists' practices in Northern California. We examined patterns and predictors of stopping and starting nonbiologic and biologic DMARDs during 1982-2009 based on annual questionnaires. Stopping was defined as stopping all DMARDs and starting was defined as transitioning from no DMARDs to any DMARDs across 2 consecutive years.ResultsThe analysis of starting DMARDs included 471 subjects with 1,974 pairs of years with no DMARD use in the first of 2 consecutive years. From this population, subjects started DMARD use by year 2 in 313 (15.9%) of the pairs. The analysis of stopping DMARDs included 1,026 subjects with 7,595 pairs of years with DMARD use in the first of 2 consecutive years; in 423 pairs (5.6%), subjects stopped DMARD use by year 2. In models that adjusted for RA-related factors, sociodemographics, and comorbidities, significant predictors of starting DMARDs included younger age, Hispanic ethnicity, shorter disease duration, and the use of oral glucocorticoids. In separate adjusted models, predictors of stopping DMARDs included Hispanic ethnicity and low income, while younger age was associated with a reduced risk of stopping.ConclusionEfforts to improve DMARD use should focus on patient age, ethnicity, and income and RA-related factors.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/1qj887fmTest

المؤلفون: Yelin, Edward, Tonner, Chris, Kim, Seoyoung C, Katz, Jeffrey N, Ayanian, John Z, Brookhart, M Alan, Solomon, Daniel H

المصدر: Arthritis Care & Research. 66(7)

مصطلحات موضوعية: Aging, Clinical Research, Arthritis, Behavioral and Social Science, Autoimmune Disease, Inflammatory and immune system, Adult, Aged, Antirheumatic Agents, Arthritis, Rheumatoid, Biological Factors, Delivery of Health Care, Female, Humans, Longitudinal Studies, Male, Middle Aged, Socioeconomic Factors, Clinical Sciences, Public Health and Health Services, Psychology

الوصف: ObjectiveTo analyze the effect of sociodemographic, disease, and health system characteristics and contextual features about the community of residence on the subsequent initiation of treatment with biologic agents for rheumatoid arthritis (RA).MethodsWe analyzed data from the University of California, San Francisco Rheumatoid Arthritis Panel Study for the years 1999-2011. Principal data collection was by a structured annual phone survey. We estimated Kaplan-Meier curves of the time until initiation of biologic agents, stratified by age and income. We also used Cox regression to estimate the effect of individual-level sociodemographic and medical factors, contextual-level socioeconomic status measures, and density of health providers in the local community on the probability of initiating therapy with biologic agents for RA.ResultsIn total, 527 persons were included in the panel in 1999, and 229 persons (44%) had initiated therapy with biologic agents by 2011. In multivariable Cox regression models, age

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3wr1c681Test

المؤلفون: Roemer, Frank W, Guermazi, Ali, Collins, Jamie E, Losina, Elena, Nevitt, Michael C, Lynch, John A, Katz, Jeffrey N, Kwoh, C Kent, Kraus, Virginia B, Hunter, David J

مصطلحات موضوعية: Cartilage, Articular, Menisci, Tibial, Bone Marrow, Humans, Osteoarthritis, Knee, Synovitis, Disease Progression, Magnetic Resonance Imaging, Case-Control Studies, Aged, Middle Aged, Female, Male, Osteophyte, Biomarkers

الوصف: To describe the scoring methodology and MRI assessments used to evaluate the cross-sectional features observed in cases and controls, to define change over time for different MRI features, and to report the extent of changes over a 24-month period in the Foundation for National Institutes of Health Osteoarthritis Biomarkers Consortium study nested within the larger Osteoarthritis Initiative (OAI) Study.We conducted a nested case-control study. Cases (n = 406) were knees having both radiographic and pain progression. Controls (n = 194) were knee osteoarthritis subjects who did not meet the case definition. Groups were matched for Kellgren-Lawrence grade and body mass index. MRIs were acquired using 3 T MRI systems and assessed using the semi-quantitative MOAKS system. MRIs were read at baseline and 24 months for cartilage damage, bone marrow lesions (BML), osteophytes, meniscal damage and extrusion, and Hoffa- and effusion-synovitis. We provide the definition and distribution of change in these biomarkers over time.Seventy-three percent of the cases had subregions with BML worsening (vs. 66 % in controls) (p = 0.102). Little change in osteophytes was seen over 24 months. Twenty-eight percent of cases and 10 % of controls had worsening in meniscal scores in at least one subregion (p < 0.001). Seventy-three percent of cases and 53 % of controls had at least one area with worsening in cartilage surface area (p < 0.001). More cases experienced worsening in Hoffa- and effusion synovitis than controls (17 % vs. 6 % (p < 0.001); 41 % vs. 18 % (p < 0.001), respectively).A wide range of MRI-detected structural pathologies was present in the FNIH cohort. More severe changes, especially for BMLs, cartilage and meniscal damage, were detected primarily among the case group suggesting that early changes in multiple structural domains are associated with radiographic worsening and symptomatic progression.

وصف الملف: application/pdf

العلاقة: BMC musculoskeletal disorders; https://hdl.handle.net/10161/18052Test

الإتاحة: https://doi.org/10.1186/s12891-016-1310-6Test
https://hdl.handle.net/10161/18052Test

المؤلفون: Losina, Elena, Smith, Karen C., Paltiel, A. David, Collins, Jamie E., Suter, Lisa G., Hunter, David J., Katz, Jeffrey N., Messier, Stephen P.

المصدر: Arthritis Care Res (Hoboken)

مصطلحات موضوعية: Male, Comparative Effectiveness Research, Time Factors, Cost-Benefit Analysis, Health Care Costs, Middle Aged, Osteoarthritis, Knee, Article, Models, Economic, Treatment Outcome, Weight Loss, Quality of Life, Humans, Computer Simulation, Female, Healthy Lifestyle, Obesity, Quality-Adjusted Life Years, Exercise, Monte Carlo Method, Risk Reduction Behavior, health care economics and organizations, Aged, Caloric Restriction

الوصف: The Intensive Diet and Exercise for Arthritis (IDEA) trial showed that an intensive diet and exercise (D+E) program led to a mean 10.6-kg weight reduction and 51% pain reduction in patients with knee osteoarthritis (OA). The aim of the current study was to investigate the cost-effectiveness of adding this D+E program to treatment in overweight and obese (body mass index27 kg/mWe used the Osteoarthritis Policy Model to estimate quality-adjusted life-years (QALYs) and lifetime costs for overweight and obese patients with knee OA, with and without the D+E program. We evaluated cost-effectiveness with the incremental cost-effectiveness ratio (ICER), a ratio of the differences in lifetime cost and QALYs between treatment strategies. We considered 3 cost-effectiveness thresholds: $50,000/QALY, $100,000/QALY, and $200,000/QALY. Analyses were conducted from health care sector and societal perspectives and used a lifetime horizon. Costs and QALYs were discounted at 3% per year. D+E characteristics were derived from the IDEA trial. Deterministic and probabilistic sensitivity analyses (PSAs) were used to evaluate parameter uncertainty and the effect of extending the duration of the D+E program.In the base case, D+E led to 0.054 QALYs gained per person and cost $1,845 from the health care sector perspective and $1,624 from the societal perspective. This resulted in ICERs of $34,100/QALY and $30,000/QALY. In the health care sector perspective PSA, D+E had 58% and 100% likelihoods of being cost-effective with thresholds of $50,000/QALY and $100,000/QALY, respectively.Adding D+E to usual care for overweight and obese patients with knee OA is cost-effective and should be implemented in clinical practice.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::4b0a19eb2b3a7d665e361762ea743f75Test
https://europepmc.org/articles/PMC6349519Test/

المؤلفون: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Jarraya, Mohamed, Guermazi, Ali, Mandl, Lisa A., Martin, Scott D., Wright, John, Losina, Elena, Katz, Jeffrey N.

مصطلحات موضوعية: Cartilage, Articular, Male, Synovitis, Knee Joint, Middle Aged, Osteoarthritis, Knee, Magnetic Resonance Imaging, Article, Tibial Meniscus Injuries, Disease Progression, Humans, Female, Physical Therapy Modalities, Aged, Meniscectomy

الوصف: Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion-synovitis and changes in effusion-synovitis with changes in cartilage damage in a cohort with OA and meniscal tear.We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery versus physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion-synovitis and cartilage damage on magnetic resonance imaging, and dichotomized effusion-synovitis as none/small (minimal) and medium/large (extensive). We assessed the association of baseline effusion-synovitis and changes in effusion-synovitis with changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for patient demographic characteristics, treatment, and baseline cartilage damage.We analyzed 221 participants. Over 18 months, effusion-synovitis was persistently minimal in 45.3% and persistently extensive in 21.3% of the patients. The remaining 33.5% of the patients had minimal synovitis on one occasion and extensive synovitis on the other. In adjusted analyses, patients with extensive effusion-synovitis at baseline had a relative risk (RR) of progression of cartilage damage depth of 1.7 (95% confidence interval [95% CI] 1.0-2.7). Compared to those with persistently minimal effusion-synovitis, those with persistently extensive effusion-synovitis had a significantly increased risk of progression of cartilage damage depth (RR 2.0 [95% CI 1.1-3.4]).Our findings indicate that the presence of extensive effusion-synovitis is associated with subsequent progression of cartilage damage over 18 months. The persistence of extensive effusion-synovitis over time is associated with the greatest risk of concurrent cartilage damage progression.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid________::a342f6043d4b011147f6fb5e1a66ff5eTest
https://europepmc.org/articles/PMC6310094Test/