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A Wasmus

Publications and source records attributed to A Wasmus.

8 recordsLinked to original sources
PubMed1992

[Population epidemiologic evaluation of the Hannover Mobile Rheumatoid Health Service].

The aim of the study was the evaluation of a potential selection process for patients with rheumatoid arthritis (RA) referred to the Mobile Service for Rheumatics in Hannover (MSRH). The MSRH is the only referral center for patients with inflammatory rheumatic diseases in Hannover. A comparison of the health status was made between 58 individuals with RA identified in a population study, and 103 RA patients from the MSRH. The following disease parameters were less favorable in the clinical group: duration of morning stiffness, functional capacity, number of swollen joints, rheumatoid factor, ESR, disease activity, and classical RA according to the Rome-criteria. Only 22% of the individuals with RA identified in the population study have been referred to the MSRH. These patients more frequently had definite or classical RA (statistically not significant: p = 0.17, p = 0.11, respectively). It was shown that the clinical group comprised more severe RA cases. Thus, data from such patients may not be generalized for the entire group of RA cases in the population.

Ambulatory Care Facilities↗
PubMed1989

Activity and severity of rheumatoid arthritis in Hannover/FRG and in one regional referral center.

Between November 1984 and July 1988 a total of 8044 randomly selected German residents of the city of Hannover/FRG, aged 25 to 74, have been screened for rheumatic complaints by means of a postal questionnaire. An average 87% of the probands contacted returned completed questionnaires. Respondents with a "positive" questionnaire, i.e. suggestive of the existence of an inflammatory joint disease were invited for a rheumatological examination at the Hannover Medical School. 72% participated. 45 of a total of 1291 participants were identified as suffering from active or inactive, mostly rheumatoid arthritis. This yields a minimum prevalence of 0.56% (+/- 0.19%). The true prevalence is estimated to be 0.91% (99%-confidence interval 0.64-1.18). In 1985 and 1986 103 German RA sufferers aged 25 to 74, all citizens of Hannover, were referred to our outpatient rheumatology clinic for a first consultation. A comparison between the two groups revealed a higher disease activity in terms of "objective" criteria (joint swellings, ESR, rheumatoid factor) in the group of the referred patients as opposed to RA suffers from the community. Both groups were comparable in respect to "subjective" symptoms (morning stiffness, joint pain, pain intensity), functional capacity and degree of erosive joint lesions. The rheumatological outpatient clinic at the Hannover Medical School, providing the only specialized service in the region, actually covers less than 20% of all RA sufferers within the municipal area of Hannover and less than 50% of those with a "classical" RA according to the ARA-criteria.

Adult↗
PubMed1989

Treatment profiles in different groups of RA-sufferers: description, analysis, evaluation.

(1) 50 to 80% of all rA-sufferers treated by rheumatologists have received second line therapy in contrast to 7 to 27% at the community level. (2) Disease duration and disease activity do not seem to affect the treatment regimens of primary and other physicians working in or around Hannover. The same holds true for social and demographic characteristics of the patients. (3) RA-sufferers are generally undertreated by community based doctors with regard to RiD-therapy and disease activity. Approximately 80% of patients with formal indication for the use of RiDs have not received these drugs, despite the fact that a rheumatological department with an outpatient clinic providing more than 3500 consultations per year has existed for more than 20 years at the Medizinische Hochschule Hannover. This outpatient clinic is utilized by more than 60% of all general practitioners as well as internal and orthopedic physicians working in the city of Hannover. We thus have to admit a rather low community effectiveness of our service. (4) A sensitivity of the formal evaluation-scheme of 0.70 and a specificity of 0.80 imply 30% false-negative and 20% false-positive assessments. In view of the larger number of false-negative judgements one must assume an even greater difference between treatment-reality and rheumatological concepts. (5) Sofar we cannot offer any safe explanation for the reasons underlying this unsatisfactory situation. The predictors we have investigated up to now have not proven to be selective. (6) Nevertheless, practical steps are urgently required, in order to be rheumatologically more effective at the community level--at least in Hannover/FRG.

Adult↗
PubMed1988

[Do patients with active chronic polyarthritis get "basic therapy"?].

The determination of the adequacy of an individual therapeutical regimen is part of the process evaluation of medical care. To evaluate the adequacy of individual antirheumatic therapy, we developed a five step procedure: 1. Assessment of the patient's health status; 2. assessment of his/her former and current therapy; 3. determination of the adequate antirheumatic therapy following an explicit norm; 4. formal comparison of current and adequate treatment; 5. clinical evaluation of possible differences between norm and reality. Due to methodological reasons we concentrated on the current treatment of rheumatoid arthritis (rA) patients with remission inducing drugs (RIDs; e.g. Chloroquine, Gold). The study analyzed the RID treatment of 75 rA-sufferers; 25 patients were referred to our outpatient department for the first time in late 1986; 25 patients were recruited from a social-medical study covering employed but actually disabled members of a major health insurance (AOK) in Hannover; 25 subjects were derived from an ongoing population study ("prevalence and care of rheumatoid arthritis in Hannover"). Only 9 out of 49 (18%) patients with an active disease, formally in need of treatment, were currently treated with RIDs. Thus 40 out of 49 (82%) seemed to be under an inadequate treatment. From the clinical point of view this formal judgement was assumed to be false positive in 5 and false negative in 15 cases. In relation to the clinical judgements we found for the formal procedure a sensitivity of 0.70 with a specificity of 0.80 and an overall agreement of 73% (kappa 0.44).

Adult↗
PubMed1988

[Physician consultation and use of drugs for rheumatic symptoms].

Between May 1986 and November 1987 we asked 4037 randomly sampled 25-74 year old german residents at Hannover (FRG) by a mailed questionnaire for back, neck and joint pain, for joint swelling and morning stiffness. Further we asked for the consultation of a physician during the past 12 months and for the use of drugs during the past 7 days because of rheumatoid complaints. 3426 members of the sample (85%) returned the questionnaire. 1828 (53%) reported at least one symptom "today" (= "the day you fill out this questionnaire"). The highest rate of persons suffering from complaints of the locomotor system was found among middle-aged women, with the maximum of 74% in the age group 50-54 years. For the illness behavior-physician consultation, use of drugs-the extent of complaints was of decisive importance. Sex was without, age of very low influence. The rate of those who reported the consultation of a physician and/or the use of drugs was increasing with the amount of positive answers to the questions on rheumatoid complaints. Nevertheless, of those who had answered in the affirmative all questions on complaints, 10% had denied the question on physician consultation. 41% had denied the question on the use of analgetic/antirheumatic drugs.

Adult↗
PubMedDate not supplied

[Epidemiology of the treatment of patients with chronic polyarthritis in Hannover].

Between 1984 and 1988 a community-based study of rheumatoid arthritis (RA) was undertaken in Hannover (Federal Republic of Germany) to determine patient characteristics and the patterns of antirheumatic treatment. Among 8044 randomly chosen German residents aged 25 to 74 years, we identified 45 persons suffering from RA; minimal prevalence 0.56% +/- 0.19%. Of these 45 RA-suffers only seven (16%) had consulted a rheumatologist (internist) "during the past 12 months". Only four (9%) persons were currently being treated with remission-inducing drugs (RIDs), e.g., chloroquine, gold. We could also ascertain low rates of physiotherapeutic treatment; "during the past 12 months" seven persons (16%) had received remedial gymnastics, one (2%) had received local application of cold. Our findings indicate that the treatment of RA in the population of Hannover is insufficient.

Adult↗