Identification of undiagnosed inflammatory arthritis in a community health fair screen.

OBJECTIVE: To identify individuals with undiagnosed inflammatory arthritis (IA) and rheumatoid arthritis (RA) in a community health fair screen, and to establish in a health fair setting the diagnostic accuracy of combinations of the Connective Tissue Disease Screening Questionnaire (CSQ) and autoantibody testing for IA. METHODS: Screening for IA/RA was performed at health fair sites using a combination of the CSQ, joint examination, rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibody testing. IA was defined as > or =1 swollen joint suggestive of synovitis on joint examination by a trained clinician. RESULTS: Six hundred one subjects were screened; 51.0% participated because of joint symptoms (pain, stiffness, or swelling). Eighty-four subjects (14.0%) had > or =1 swollen joint, designated as IA on joint examination. Of the 601 subjects screened, 9 (1.5%) had IA and met > or =4 of 7 American College of Rheumatology criteria for RA but had no prior diagnosis of RA, and 15 (2.5%) had IA and RF and/or anti-CCP positivity, suggesting early RA. The diagnostic accuracy of combinations of the CSQ and autoantibody testing for the identification of IA yielded maximal sensitivity, specificity, and positive and negative predictive values of 95.3%, 99.2%, 71.4%, and 97.7%, respectively. CONCLUSION: Health fair screening may be an effective approach for the identification of individuals with undiagnosed IA/RA. A combination of the CSQ and autoantibody testing alone has clinically useful diagnostic accuracy for the detection of IA. Decisions regarding which methodology to use for future health fair IA/RA screening will depend on goals of screening and funding.

Impact of a nurse telephone intervention among high-cardiovascular-risk, health fair participants.

BACKGROUND AND OBJECTIVES: Cardiovascular disease (CVD) is the leading cause of death in the United States, yet most individuals remain unaware of their risk. Current health fair models assess individual risk factors but miss the opportunity to assess, counsel, and follow-up with participants regarding global CVD risk. Objectives of this nurse telephone intervention were to (1) describe high-CVD-risk participants' healthcare-seeking behavior after the health fair and following a nurse telephone intervention and (2) describe CVD risk-reducing therapies provided to high-risk participants after the health fair and following a nurse telephone intervention. SUBJECTS AND METHODS: Five hundred twenty-nine of 4,489 health fair participants who completed an interactive Framingham risk assessment in 2006 were identified with high CVD risk. These participants received a nurse telephone intervention approximately 1 month after the health fair, during which the risk message was reinforced, principles of motivational interviewing were applied, and follow-up care was assessed. We evaluated the proportion of high-CVD-risk participants who obtained healthcare before and after intervention, and we compared the care received before and after intervention. RESULTS AND CONCLUSION: Among 447 contacted high-CVD-risk participants, 59% (n = 262) saw a healthcare provider, and 86% of those discussed CVD risk at their healthcare visit. A greater proportion of participants were started on a cardioprotective drug (41% vs 20%; P < .01), and more participants discussed "heart health" (96% vs 75%; P < .001) after receiving the nurse telephone intervention. Our findings suggest that a nurse intervention may improve individuals' CVD risk awareness as well as activate providers to implement CVD risk reduction strategies.