Association between health-related quality of life and clinical efficacy endpoints in rheumatoid arthritis patients after four weeks treatment with anti-inflammatory agents.

BACKGROUND: Improvement of health-related quality of life (QoL) is increasingly recognized as a maj or treatment goal for patients with rheumatoid arthritis (RA). There are several measures of general health status and of physical functioning for assessing treatment effects on QoL in patients with RA, however, the relationship between QoL outcomes and conventional clinical efficacy endpoints is not completely understood. OBJECTIVE: To describe the association between changes in QoL and changes in other efficacy measures, among patients with RA after four weeks of treatment with etoricoxib, naproxen or placebo, and to explore differences in the association of changes in efficacy and changes in QoL parameters across treatment groups. METHODS: The study used data from 1684 patients with RA enrolled in two identical clinical trials (one US and one multinational). Patients were randomized to placebo, etoricoxib 90 mg once daily, or naproxen 500 mg twice daily in a 2 : 2: 1 allocation ratio. Primary efficacy endpoints were tender joint count, swollen joint count, patient global assessment of disease activity (100 mm VAS), and investigator global assessment of disease activity (0 - 4 Likert scale). QoL assessments were based on the Health Assessment Questionnaire (HAQ) and the Medical Outcomes Survey Short Form 36 (SF-36). Mean differences between baseline and week four were calculated for each parameter studied. Linear regression analysis was performed to assess the association between changes in clinical efficacy and changes in QoL parameters, adjusted for covariates. RESULTS: The degree of association between changes in tender or swollen joint counts and changes in QoL variables was low, explaining less than 10% of the variability for most QoL variables, except bodily pain (SF-36). In contrast, changes in patient global assessment of disease activity explained 33% of the variability in the overall HAQ score, and in the physical component score (SF-36; adjusted regression models). Values for investigator global assessment of disease activity were below those for patient global assessment but above joint count measures. Results were similar between the etoricoxib, naproxen and placebo groups in the degree of association between changes in efficacy and QoL variables. CONCLUSION: Currently used efficacy endpoints are less than ideal predictors of change in QoL. There is no evidence from this study that the association between changes in CE endpoints and QoL was different across treatments. Our results highlight the need to assess both conventional efficacy measures and QoL in clinical trials of RA treatments.

Use of multiple providers for regular care and women's receipt of hormone replacement therapy counseling.

BACKGROUND: Prior research has explored women's lifetime receipt of HRT counseling and correlates of counseling, but has not explored receipt of counseling by current health care provider(s). The number and type(s) of provider(s) that women see for their regular care may be an important enabling factor in women's receipt of HRT counseling. OBJECTIVES: Whether there is an association between the number and specialties of physicians that women use for regular care and their receipt of HRT counseling by a current regular physician is explored. RESEARCH DESIGN: A self-administered mail survey was sent to 1,500 female members (ages 40-69) of a Connecticut IPA-model health plan. RESULTS: One thousand seven completed questionnaires were received (response rate = 69%). Twenty-eight percent of women reported seeing only a family practitioner or internist (no OB/GYN) for their regular care; 11% saw an OB/GYN only; and 59% saw both a family practitioner/internist and an OB/GYN. After adjustment for women's other predisposing and enabling characteristics, women who used both a family practitioner/internist and an OB/GYN were 3.1 times as likely (95% CI, 2.02, 4.66) as those seeing only a family practitioner/internist to have been counseled about HRT by a current provider, and those using only an OB/GYN were 2.5 times as likely (95% CI, 1.34, 4.61). CONCLUSIONS: The number and specialty of physician(s) that women use for their regular care is an important enabling factor in women's receipt of HRT counseling. Changes in the organization and delivery of women's primary care may help increase the receipt of female-specific clinical preventive services, particularly among women less likely to use an OB/GYN for regular care, such as low-income and older women.

Are women being counseled about estrogen replacement therapy?

The U.S. Preventive Services Task Force and several medical professional associations have published guidelines recommending that all women be counseled around the time of menopause about the benefits and risks of estrogen replacement therapy (ERT) so that they may make an informed decision about its use. Despite the proliferation of ERT counseling guidelines, little is known about whether these guidelines are being followed. There were 1,500 female members (aged 40 to 69) of a Northeastern U.S. Independent Practice Association--model Health Maintenance Organization who were surveyed, and 51 percent reported that a health care provider had talked with them about the benefits and risks of ERT. In multivariate analyses, a woman's demographic characteristics (age, race, income), stage of menopause, severity of menopausal symptoms, and body weight were the major correlates of receipt of ERT counseling. Women at greater risk for osteoporosis or heart disease were no more likely to be counseled, although those with diagnosed osteoporosis were. What appear to be selective ERT counseling practices will need to be modified if the goal of providing universal ERT counseling to midlife women is to be attained.

Sociodemographic and geographic patterns of firearm suicide in the United States, 1989-1993.

This study identified the sociodemographic and geographic patterns of using firearms to commit suicide in the United States. Data from the Mortality Detail Files (1989-1993) were analyzed using logistic regression. The adjusted odds of using firearms increased with age among men and decreased among women. Widowed men and married women had the highest odds of using firearms. The odds were highest among those without college education, in nonmetropolitan areas and in the East South Central and West South Central geographic divisions. The likelihood of using firearms to commit suicide varies significantly across sociodemographic and geographic subgroups of the US population and parallels patterns of gun ownership. The results of this study suggest that regional cultural factors play an important role in accounting for the differential rates in suicidal behavior involving firearms.

Firearm suicides and homicides in the United States: regional variations and patterns of gun ownership.

Among industrialized countries, the United States has the highest rates of firearm suicide and homicide, as well as the highest rate of gun ownership. The present study compares the differential impact of gun availability on firearm suicides and homicides in the U.S. Using data from the NCHS Mortality Detail Files (1989-1991), the 1990 U.S. census population estimates, and the General Social Surveys (1989-1991) for nine geographic divisions, we computed rates of firearm and non-firearm suicides and homicides as well as rates of gun ownership for four gender-race groups. We tested the strength of the associations between gun availability and firearm suicide and homicide rates by computing the Spearman correlation coefficients. To help elucidate the role of method substitution, we conducted similar analyses on non-firearm suicide and homicide. The results show that gun ownership has a stronger impact on firearm suicides than homicides. These findings held up after stratifying by gender and race. The study suggests that reducing the aggregate level of gun availability may decrease the risk of firearm-related deaths.

After unification: gender and subjective health status in East and West Germany.

Results of a random survey of 2574 adults in East and West Germany in 1992 show virtually no differences in subjective health status for the populations of East versus West Germany and only slight differences for men versus women. A closer analysis via multiple regression indicates, however, that contrary to previous results from other countries West German women have a better health status than men. Of the four gender groups analyzed separately East German men are the best off, while owing to a number of socio-economic status discrepancies, East German women report the worst health status. Surprisingly, West German men show a poorer subjective health status than East German men, although a number of factors like participation in sport, better income and younger age would predict otherwise. It is suggested that their health situation is negatively influenced not only by their work situation but also by outside private commitments not accounted for in this analysis. Also difficult to explain from the present data is the relatively good health status of East German men. Despite an insecure job and a difficult work situation they may experience unification in sociopolitical terms and their present social status as something positive. Overall, conditions in the system of West Germany show a tendency to favor women, while those in East Germany clearly favor men.

Firearm suicide among older women in the U.S.

Contrary to the common view that older women (65+) in the United States use suicide methods that have relatively low potential for death, firearms have become the most common suicide method in this group. The present study examines the association between demographic and geographic factors and the use of firearms vs other suicide methods. Data were derived from the National Center for Health Statistics (NCHS) Mortality Detail Files (1989-1991). Results from a logistic regression analysis indicate that among white women 65 and over who died by suicide in 1989-1991, the risk of using firearms varied significantly across demographic and geographic subcategories of the population. The following characteristics among women were significantly more likely to be associated with the use of firearms as a suicide method: ages 65-74, married, of lower educational attainment, in nonmetropolitan areas, and in the South. Research is needed to assess the effects of limiting firearms on the growing proportion of firearm-related suicides among older women.

Sociodemographic predictors of firearm suicide among older white males.

Compared to women, younger males, and other racial/ethnic groups in the United States, white males 65 and over have the highest suicide rates. Using the Mortality Detail Files (1989-1991), this study examined the sociodemographic factors associated with late life firearm (vs other methods) suicide among white males. White males aged 65-84 residing in nonmetropolitan areas who were married, divorced, or widowed and with less than a high school education were significantly more likely to have killed themselves with a firearm than with other methods. Policy initiatives and community interventions should incorporate knowledge of those demographic subgroups most at risk for firearm suicide.

[Age, health status and the utilization of general practitioners and specialists]. / Alter, Gesundheitsstatus und die Inanspruchnahme von Allgemein- und Fachärzten.

Data collected by mailed survey and a random sample of 2552 German adults, are analyzed via stepwise regression for the relationship between age and visits to GPs and Specialists. Contrary to common opinion and descriptive analysis the relationship is weak and non-linear. The total effect shows that contacts with GPs do not increase with age much an more. Analysis also shows that effects for both groups of physicians are not only biological but also cohort effects, the latter measured via education. Older people collectively have less education, show consequently 1. worse health and 2. more contacts with GPs than specialists. Results in light of debates about rationing and the cost saving behavior of older people have immediate importance for the policies of health care.