Biomedical subjects

Judith Fifield

Publications and source records attributed to Judith Fifield.

10 recordsLinked to original sources

PubMed2006

Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed.

This study examined the association between history of depression and day-to-day coping with rheumatoid arthritis (RA) pain. The sample was 188 RA-diagnosed participants, 73 of whom were identified by a structured clinical interview as having a history of major depression. None had current major depression. All participated in a 30-day prospective study in which they made end-of-day ratings of their arthritis pain, the strategies for how they coped with their pain, their appraisals of daily pain, and daily mood. Hierarchical linear models evaluated whether individuals with and without depression history differed in their average pain and the other daily measures; and separately, whether they differed in their within-person associations between pain and the daily measures (e.g., the day-to-day contingency between pain and mood). All analyses controlled for current mild depressive symptoms, neuroticism, and age. Previously depressed individuals were indistinguishable from their never depressed peers in their average pain and the other daily measures; however, the previously depressed exhibited significantly stronger associations between pain and several aspects of their daily emotional experience, suggesting more pain-contingent well-being. For individuals with a history of depression, increases in daily pain corresponded with more frequent efforts to cope with their pain by venting their emotions, significantly stronger impairments in mood, and, if they were also presently distressed, reduced perceptions of control over their pain, compared to the never depressed. Patterns suggest that formerly depressed individuals exhibit a hidden vulnerability in how they manage chronic pain. This vulnerability is best revealed by a daily process approach.

Adaptation, Psychological↗

PubMed2004

History of affective disorder and the experience of fatigue in rheumatoid arthritis.

OBJECTIVE: To evaluate how a prior affective disorder (major depression or generalized anxiety disorder) affects current fatigue among individuals with rheumatoid arthritis (RA). To determine whether that relationship is mediated by self-efficacy expectations. METHODS: Forty-eight RA patients with a prior affective disorder and 74 without a history of affective disorder completed a mailed questionnaire that included the Multidimensional Assessment of Fatigue and indicators of neuroticism and self efficacy. RESULTS: RA patients with a history of affective disorder reported higher levels of fatigue than those with no previous affective disturbance. Controlling for neuroticism and self efficacy, affective disorder history continued to predict current fatigue. Mediational analyses revealed both direct and indirect effects (via self efficacy) of history of affective disorder on the experience of fatigue in RA. CONCLUSION: History of affective disorder independently predicts higher levels of fatigue in RA patients, and self efficacy plays a mediating role in this relationship.

Aged↗

PubMed2004

From research to daily clinical practice: what are the challenges in "translation"?

BACKGROUND: Translating research findings into sustainable improvements in clinical and patient outcomes remains a substantial obstacle to improving the quality and safety of care. The Agency for Healthcare Research and Quality funded two initiatives to assess strategies for improvements--Translating Research into Practice (TRIP). The TRIP II initiative supported 13 quality improvement projects. SURVEYING THE TRIP II STUDIES: The principal investigators (PIs) of the 13 projects were surveyed regarding encountered barriers to implementation at 6 months and 18 months (when they were also asked about solutions). RESULTS: Seven of the 13 PIs responded to the survey at both times--6 and 18 months. For each project stage--Select a TRIP focus and develop intervention strategies (Stage 1), Conduct the intervention (Stage 2), and Measure the Impact (Stage 3)--barriers were described, and field-tested solutions were provided. For example, for Stage 2, if the target audience lacked buy-in and would not participate, solutions would be to get up-front buy-in from all staff, not just leaders; address root causes of problems; use opinion leaders and incentives; plan interventions ahead and provide make-up videos; and accept that targets vary in their readiness to change. DISCUSSION: The framework and examples provided should help overcome challenges in any work in which research findings are applied to clinical practice.

Evidence-Based Medicine↗

PubMed2004

Employment and quality of life outcomes among women with fibromyalgia compared to healthy controls.

The purpose of this study was to assess the effects of paid employment on health related quality of life among women with fibromyalgia compared to a group of women who were otherwise healthy. Participants were recruited from 118 rheumatology practices randomly sampled from the membership of the American College of Rheumatology. Three hundred and sixty-five patients were referred to the study and 287 completed a telephone interview. At the end of each interview, participants were asked to nominate 2 individuals to serve as control subjects. Because of lagging enrollment of control subjects, we initiated an additional method of asking control subjects to nominate controls. Of 381 control subjects nominated for the study, 286 or 75% completed the initial interview. As with patients, controls completed a computer assisted phone interview with a trained interviewer similar to that of the patient. The mean age of women with FMS was 47 years, most were married (59.6%), 87.8% were of white race and non-Hispanic ethnicity, 47.7% were employed, had an average of 14 years of education and household annual incomes generally exceeded $20,000, with 40.4% having incomes in excess of $50,000. There we no significant differences between women with FMS and those without FMS on these characteristics. Women with FMS had significantly worse physical and mental health related quality of life measured by SF-12 Physical (PCS) and Mental (MCS) Component Summary Scores; those who were not employed had significantly worse PCS scores but there were no differences by employment for MCS. Ordinal regression analysis adjusting for demographic characteristics showed that there were significant main effects for condition and employment on PCS in that those with FMS and those who were not employed had worse PCS scores. Initially, we also found an interaction effect between condition and employment in that the beneficial effects of employment was restricted to the FMS cases. However, when adjustments were made for the double nesting design, the interaction effect was no longer significant. For MCS, FMS cases had significantly worse health related quality of life, but there were no main effects for employment and no interactions were significant. Our results concur with findings in community studies that employed women report better quality of life than those not employed, but only for the physical dimension of quality of life. The findings regarding MCS are intriguing in that women with FMS are not very different from controls and that employment has little effect on the mental health component of quality of life.

Activities of Daily Living↗

PubMed2004

Rate of change in functional limitations for patients with rheumatoid arthritis: effects of sex, age, and duration of illness.

OBJECTIVE: To estimate the rate of change in functional limitations for patients with rheumatoid arthritis (RA) as a function of age, duration of illness, and sex. METHODS: Patients with RA (n = 700) aged 21-65 years in 1988 were interviewed yearly for 6 years in The National Rheumatoid Arthritis Study. Functional limitations scores based on a Rasch measurement model of 20 Health Assessment Questionnaire items were analyzed in mixed-effects models to estimate the rate of change in functional ability as a function of age, duration of illness, sex, and interactions. RESULTS: Models for both patient age and duration of illness significantly predicted limitations in functional ability for men and women. The model for age included a significant cubic effect; the model for duration of illness included a significant linear effect only. Sex was significant in both models and no interactions were significant in either model. The AIC index of fit, an indicator of the information value of the model, favored the model for duration of illness over the model for age. While both models showed higher levels of functional limitations in women than men, the rate of change for women was similar to men. CONCLUSION: Limitation in functional ability in RA progressed in a linear manner with duration of illness and progressed at the same rate for both men and women, but functional limitations were greater for women.

Activities of Daily Living↗

PubMed2003

A comparison of self-reports of distress and affective disorder diagnoses in rheumatoid arthritis: a receiver operator characteristic analysis.

OBJECTIVE: To compare 3 commonly used psychiatric symptom checklists (the Center for Epidemiological Studies Depression Scale [CES-D], the Positive and Negative Affect Schedule, and the Endler Multidimensional Anxiety Scales [EMAS]) to determine their sensitivity, specificity, and ability to discriminate between a disorder (Major Depression [MD], Generalized Anxiety Disorder [GAD]), and no disorder. To compare the checklists for their ability to discriminate between type of disorder (MD and GAD). To evaluate the discriminant ability of the subscales, particularly positive affect; whether the somatic items in the CES-D artificially inflate affective scores; and the optimal cut off score for the CES-D. METHODS: We compared the 3 scales to diagnostic criterion of MD, GAD, and comorbid disorder using receiver operator characteristic (ROC) and logistic regression analyses. The sample consisted of a national panel of 415 individuals with rheumatoid arthritis (RA). RESULTS: Each of the scales had high sensitivity and specificity (areas under the curve: CES-D = 0.92, negative affect = 0.88, positive affect and EMAS = 0.82). The CES-D, however, demonstrated better sensitivity and specificity than the positive affect and the EMAS, but not the negative affect scale. CONCLUSION: All 3 self-reports have high combined sensitivity and specificity as measures of affective disorders among RA patients.

Aged↗

PubMed2003

Do employment and family work affect the health status of women with fibromyalgia?

OBJECTIVE: To assess health status differences of women with fibromyalgia syndrome (FM) who are employed and not employed, and to evaluate whether employment and family work influence the health status of women with FM as it does for women in community studies. METHODS: Participants were 287 women recruited from 118 randomly selected rheumatology practices. They completed telephone interviews that collected data on demographic characteristics, health status, symptoms, family work, and social support. One hundred thirty-seven were employed and 150 were not employed. Formal statistical analysis, including estimation and testing, focused on the relationship between employment and 4 health status measures: Modified Health Assessment Questionnaire (MHAQ), visual analog scale (VAS) for pain on the interview day, number of painful areas, and VAS for fatigue on the interview day. The relationship between employment and these measures was evaluated using analysis of variance, chi-square, linear regression, and ordinal logistic regression. RESULTS: The majority of participants reported high levels of symptoms and poor health status. In the bivariate analyses, employed women reported significantly less pain, less fatigue, and better functional status than those who were not employed. In the multivariate analyses, employment remained a significant factor in explaining number of painful areas, functional status (MHAQ), and fatigue, with employed women reporting better health status than those not employed. Employment was not associated with pain on the day of the interview when other factors were considered in the analysis. The psychological demands of family work were consistently related to all dependent measures of health status, as those with greater psychological demands reported worse health status. CONCLUSION: As in community studies, employed women with FM report better health status than women who are not employed. The demands of family work exert a serious and significant effect on every dimension of health status and should be the focus of greater clinical attention. Further followup will assess whether employment has a protective effect for women with FM as in community studies or whether women with less severe FM tend to remain in the workforce.

Activities of Daily Living↗

PubMed2002

Stratifying medical and pharmaceutical administrative claims as a method to identify pediatric asthma patients in a Medicaid managed care organization.

Claims data are a problematic indicator of underlying clinical diagnosis. They are attractive because of their affordability, a criterion especially salient in resource-shy environments such as the Medicaid Managed Care Organization. This study tested the validity of administrative medical and pharmaceutical claims stratified by treatment modality to identify true pediatric asthma patients. Primary and secondary data were used. Secondary data consisted of 1997 medical and pharmaceutical claims. Primary data consisted of chart data collected through expert chart review. We stratified claims by treatment modality hypothesized to better identify true asthma patients. Claim patterns were analyzed for support of expectations. Expert chart review determined true asthma status on study sample. We found that claims are patterned in accordance with hypotheses about stratification groups. The combined use of both medical and pharmaceutical claims was more effective in identifying asthmatics than the use of either set of claims by itself. The Medicaid Managed Care Organization can begin to identify its asthma population using the stratification meth.

Asthma↗

PubMed2002

Rehabilitation therapy self-efficacy and functional recovery after hip fracture.

Little is known about the role of psychological factors in the functional recovery process of hip fracture patients. This study employed a prospective cohort design to test the hypothesis that hospitalized hip fracture patients with greater reported self-efficacy for conducting rehabilitation therapy would have a greater likelihood of recovering to a pre-fracture level of locomotion function six months after the fracture. This hypothesis was tested controlling for pre-fracture level of function and depressive symptoms reported during hospitalization for surgical repair. An original measure of rehabilitation therapy self-efficacy was evaluated prior to hypothesis testing. Study patients were recruited from two hospitals, interviewed during hospitalization and followed up six months later. Patients included in hypothesis test analyses (n = 24) were mostly women (82%) with a mean age of 79 years. Results showed that patients with higher self-efficacy scores had a greater likelihood of locomotion recovery, controlling for pre-fracture locomotion function level (adjusted odds ratio (AOR) = 1.21; 95% confidence interval (CI) = 1.00-1.45; P= 0.05). This positive association between rehabilitation therapy self-efficacy and likelihood of locomotion recovery persisted after adding depressive symptoms (the Center for Epidemiological Studies-depression (CES-D) score) to this logistic regression model (AOR for self-efficacy = 1.18; 95% CI = 0.99-1.42; P= 0.07). It is concluded that rehabilitation therapy self-efficacy is a potentially important psychological factor in helping hip fracture patients recover locomotion functioning.

Activities of Daily Living↗

PubMed1987

Downward comparison and coping with serious medical problems.

Correlates of selective comparisons by mothers of high-risk infants and individuals with rheumatoid arthritis showed that mothers were especially likely to make downward comparisons. Arthritis patients making downward comparisons were rated by their health care providers as more positively adjusted, independent of actual severity of illness. Implications for support providers are discussed.

Adaptation, Psychological↗